Difference between revisions of "Parathyroid glands"

From patholines.org
Jump to navigation Jump to search
 
(8 intermediate revisions by the same user not shown)
Line 6: Line 6:
 
===Intraoperative consultation===
 
===Intraoperative consultation===
 
Necessary components are:
 
Necessary components are:
*'''Weight''' of the parathyroid gland or fragment thereof. It generally does ''not'' need to include a subjective description such as "enlarged".<ref group=notes name=weight>The average weight of each parathyroid gland is about 30&nbsp;mg in men and 35&nbsp;mg in women.<sup>A</sup> 90% of normal parathyroid glands weight less than 100g, and 96% less than 160g.<sup>B</sup><br>A. {{cite journal|last=Johnson|first=S J|title=Best Practice No 183: Examination of parathyroid gland specimens|journal=Journal of Clinical Pathology|date=1 April 2005|volume=58|issue=4|pages=338–342|doi=10.1136/jcp.2002.002550|pmid=15790694|pmc=1770637}}<br>B. {{cite journal|last1=Yao|first1=Kathy|last2=Singer|first2=Frederick R.|last3=Roth|first3=Sanford I.|last4=Sassoon|first4=Aaron|last5=Ye|first5=Cynthia|last6=Giuliano|first6=Armando E.|title=Weight of Normal Parathyroid Glands in Patients with Parathyroid Adenomas|journal=The Journal of Clinical Endocrinology & Metabolism|volume=89|issue=7|year=2004|pages=3208–3213|issn=0021-972X|doi=10.1210/jc.2003-031184}}
+
*'''Weight''' of the parathyroid gland or fragment thereof. Generally, there should ''not'' be any subjective description of "enlarged" or similar.<ref group=note name=weight>The average weight of each parathyroid gland is about 30&nbsp;mg in men and 35&nbsp;mg in women,<sup>A</sup> but with a great variability: 90% of normal parathyroid glands weight less than 100g, and 96% less than 160g.<sup>B</sup> Thus, by weight alone, a pathologists generally can't tell whether a parathyroid is enlarged, or whether it is of its normal weight, such as being one of the 4% that are normally over 160g.<br>- A. {{cite journal|last=Johnson|first=S J|title=Best Practice No 183: Examination of parathyroid gland specimens|journal=Journal of Clinical Pathology|date=1 April 2005|volume=58|issue=4|pages=338–342|doi=10.1136/jcp.2002.002550|pmid=15790694|pmc=1770637}}<br>- B. {{cite journal|last1=Yao|first1=Kathy|last2=Singer|first2=Frederick R.|last3=Roth|first3=Sanford I.|last4=Sassoon|first4=Aaron|last5=Ye|first5=Cynthia|last6=Giuliano|first6=Armando E.|title=Weight of Normal Parathyroid Glands in Patients with Parathyroid Adenomas|journal=The Journal of Clinical Endocrinology & Metabolism|volume=89|issue=7|year=2004|pages=3208–3213|issn=0021-972X|doi=10.1210/jc.2003-031184}}
 
</ref>
 
</ref>
*'''Presence of parathyroid tissue''' upon frozen section.
+
*'''Presence of parathyroid tissue''' upon frozen section. In particular, exclude sampling from the [[thyroid]]. It is not necessary to specify any particular parathyroid pathology on intraoperative consultation (which in case of hyperparathyroidism relies on imaging and intraoperative parathyroid hormone levels rather than the histopathology)<ref name="pmid30090736">{{cite journal| author=Naik AH, Wani MA, Wani KA, Laway BA, Malik AA, Shah ZA| title=Intraoperative Parathyroid Hormone Monitoring in Guiding Adequate Parathyroidectomy. | journal=Indian J Endocrinol Metab | year= 2018 | volume= 22 | issue= 3 | pages= 410-416 | pmid=30090736 | doi=10.4103/ijem.IJEM_678_17 | pmc=6063190 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30090736  }}</ref>.
  
 
===Autopsy===
 
===Autopsy===
Line 17: Line 17:
 
*'''Parathyroid hyperplasia''': Typically involves all 4 glands with diffuse enlargement.<ref name=MurroLin2020>{{cite web|url=https://www.pathologyoutlines.com/topic/parathyroidpthadenoma.html|title=Thyroid & parathyroid - Parathyroid nonmalignant - Parathyroid adenoma|author=Diana Murro Lin|website=Pathology Outlines}} Topic Completed: 27 October 2020. Minor changes: 2 June 2021.</ref>
 
*'''Parathyroid hyperplasia''': Typically involves all 4 glands with diffuse enlargement.<ref name=MurroLin2020>{{cite web|url=https://www.pathologyoutlines.com/topic/parathyroidpthadenoma.html|title=Thyroid & parathyroid - Parathyroid nonmalignant - Parathyroid adenoma|author=Diana Murro Lin|website=Pathology Outlines}} Topic Completed: 27 October 2020. Minor changes: 2 June 2021.</ref>
 
*Parathyroid '''adenoma''': Typically nodular growth with compressed rim of normal tissue.<ref name=MurroLin2020/>
 
*Parathyroid '''adenoma''': Typically nodular growth with compressed rim of normal tissue.<ref name=MurroLin2020/>
Either is indicated by a decreased amount of intra-gland adipose tissue, and increased weight. A weight of 35-160 mg is above average but not enough for a diagnosis in the absence of other findings.<ref group=notes name=weight/>
+
Either is indicated by a decreased amount of intra-gland adipose tissue, and increased weight. A weight of 35-160 mg is above average but not in itself "enlarged" in the absence of other findings.<ref group=note name=weight/>
  
 
<gallery mode=packed heights=220>
 
<gallery mode=packed heights=220>
 
File:1814 The Parathyroid Glands.jpg|Location and histology of the parathyroid glands
 
File:1814 The Parathyroid Glands.jpg|Location and histology of the parathyroid glands
 
File:Histopathology of parathyroid chief cell hyperplasia.jpg|Parathyroid '''chief cell hyperplasia''': An increase in the parenchymal cell mass,as a result of the proliferation of chief cells, oncocytes, and transitional oncocytes in multiple parathyroid glands.<ref>{{cite journal|last1=Piciucchi|first1=Sara|last2=Barone|first2=Domenico|last3=Gavelli|first3=Giampaolo|last4=Dubini|first4=Alessandra|last5=Oboldi|first5=Devil|last6=Matteuci|first6=Federica|title=Primary Hyperparathyroidism: Imaging to Pathology|journal=Journal of Clinical Imaging Science|volume=2|year=2012|pages=59|issn=2156-7514|doi=10.4103/2156-7514.102053}}<br>- This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</ref>
 
File:Histopathology of parathyroid chief cell hyperplasia.jpg|Parathyroid '''chief cell hyperplasia''': An increase in the parenchymal cell mass,as a result of the proliferation of chief cells, oncocytes, and transitional oncocytes in multiple parathyroid glands.<ref>{{cite journal|last1=Piciucchi|first1=Sara|last2=Barone|first2=Domenico|last3=Gavelli|first3=Giampaolo|last4=Dubini|first4=Alessandra|last5=Oboldi|first5=Devil|last6=Matteuci|first6=Federica|title=Primary Hyperparathyroidism: Imaging to Pathology|journal=Journal of Clinical Imaging Science|volume=2|year=2012|pages=59|issn=2156-7514|doi=10.4103/2156-7514.102053}}<br>- This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</ref>
File:Parathyroid Adenoma 2 (4702993415).jpg|Parathyroid '''adenoma'''
 
 
File:Histopathology of parathyroid adenoma.jpg|thumb|Parathyroid '''adenoma''', with chief cells and eosinophilic follicles
 
File:Histopathology of parathyroid adenoma.jpg|thumb|Parathyroid '''adenoma''', with chief cells and eosinophilic follicles
 
File:Parathyroid Adenoma, FNA (5691039847).jpg|Parathyroid '''adenoma''', fine needle aspiration
 
File:Parathyroid Adenoma, FNA (5691039847).jpg|Parathyroid '''adenoma''', fine needle aspiration
Line 29: Line 28:
  
 
===Microscopy report===
 
===Microscopy report===
Whenever possible, make a single report for multiple fragments from the same location. Example:
+
Example for an '''intraoperative consultation''':
 +
{|class=wikitable
 +
| A. Left inferior parathyroid, excision:<br>24 mg of parathyroid tissue.
 +
 
 +
C. Right superior parathyroid, excision:<br>14 mg of parathyroid tissue.
 +
|}
 +
 
 +
Whenever possible, make a single report for multiple fragments from the same location. Example of '''final report''', including additional fragments from the same locations:
 
{|class=wikitable
 
{|class=wikitable
 
| A,B. Left inferior parathyroid gland, excision:<br>Hypercellular parathyroid gland (121 mg aggregate weight), consistent with parathyroid hyperplasia.
 
| A,B. Left inferior parathyroid gland, excision:<br>Hypercellular parathyroid gland (121 mg aggregate weight), consistent with parathyroid hyperplasia.
Line 44: Line 50:
 
| Sections show <<1, 2, 3, 4>> parathyroid glands with no focal changes or signs of hyperplasia.
 
| Sections show <<1, 2, 3, 4>> parathyroid glands with no focal changes or signs of hyperplasia.
 
|}
 
|}
 
+
<noinclude>
 
==See also==
 
==See also==
 
*[[Thyroid]]
 
*[[Thyroid]]
 
{{Bottom}}
 
{{Bottom}}
 +
</noinclude>

Latest revision as of 12:19, 12 September 2022

Author: Mikael Häggström [note 1]

Presentations

Intraoperative consultation

Necessary components are:

  • Weight of the parathyroid gland or fragment thereof. Generally, there should not be any subjective description of "enlarged" or similar.[note 2]
  • Presence of parathyroid tissue upon frozen section. In particular, exclude sampling from the thyroid. It is not necessary to specify any particular parathyroid pathology on intraoperative consultation (which in case of hyperparathyroidism relies on imaging and intraoperative parathyroid hormone levels rather than the histopathology)[1].

Autopsy

Optionally for a comprehensive autopsy, or where there is suspicion of parathyroid pathology, an effort is made to find the parathyroid glands, and inspect them for general or focal hyper-/neoplasia.

Microscopic evaluation

The main conditions to look for and distinguish are:

  • Parathyroid hyperplasia: Typically involves all 4 glands with diffuse enlargement.[2]
  • Parathyroid adenoma: Typically nodular growth with compressed rim of normal tissue.[2]

Either is indicated by a decreased amount of intra-gland adipose tissue, and increased weight. A weight of 35-160 mg is above average but not in itself "enlarged" in the absence of other findings.[note 2]

Microscopy report

Example for an intraoperative consultation:

A. Left inferior parathyroid, excision:
24 mg of parathyroid tissue.

C. Right superior parathyroid, excision:
14 mg of parathyroid tissue.

Whenever possible, make a single report for multiple fragments from the same location. Example of final report, including additional fragments from the same locations:

A,B. Left inferior parathyroid gland, excision:
Hypercellular parathyroid gland (121 mg aggregate weight), consistent with parathyroid hyperplasia.

C,D. Right superior parathyroid gland, excision:
Parathyroid gland (94 mg aggregate weight) without significant histopathologic changes.

E. Left superior parathyroid gland, excision:
Hypercellular parathyroid gland (142 mg aggregate weight), consistent with parathyroid hyperplasia.

F. Right inferior parathyroid gland, excision:
Hypercellular parathyroid gland (85 mg aggregate weight), consistent with parathyroid hyperplasia.

Normal example in autopsy:

Sections show <<1, 2, 3, 4>> parathyroid glands with no focal changes or signs of hyperplasia.

See also

Notes

  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.
  2. 2.0 2.1 The average weight of each parathyroid gland is about 30 mg in men and 35 mg in women,A but with a great variability: 90% of normal parathyroid glands weight less than 100g, and 96% less than 160g.B Thus, by weight alone, a pathologists generally can't tell whether a parathyroid is enlarged, or whether it is of its normal weight, such as being one of the 4% that are normally over 160g.
    - A. Johnson, S J (1 April 2005). "Best Practice No 183: Examination of parathyroid gland specimens ". Journal of Clinical Pathology 58 (4): 338–342. doi:10.1136/jcp.2002.002550. PMID 15790694. 
    - B. Yao, Kathy; Singer, Frederick R.; Roth, Sanford I.; Sassoon, Aaron; Ye, Cynthia; Giuliano, Armando E. (2004). "Weight of Normal Parathyroid Glands in Patients with Parathyroid Adenomas ". The Journal of Clinical Endocrinology & Metabolism 89 (7): 3208–3213. doi:10.1210/jc.2003-031184. ISSN 0021-972X. 

Main page

References

  1. Naik AH, Wani MA, Wani KA, Laway BA, Malik AA, Shah ZA (2018). "Intraoperative Parathyroid Hormone Monitoring in Guiding Adequate Parathyroidectomy. ". Indian J Endocrinol Metab 22 (3): 410-416. doi:10.4103/ijem.IJEM_678_17. PMID 30090736. PMC: 6063190. Archived from the original. . 
  2. 2.0 2.1 Diana Murro Lin. Thyroid & parathyroid - Parathyroid nonmalignant - Parathyroid adenoma. Pathology Outlines. Topic Completed: 27 October 2020. Minor changes: 2 June 2021.
  3. Piciucchi, Sara; Barone, Domenico; Gavelli, Giampaolo; Dubini, Alessandra; Oboldi, Devil; Matteuci, Federica (2012). "Primary Hyperparathyroidism: Imaging to Pathology ". Journal of Clinical Imaging Science 2: 59. doi:10.4103/2156-7514.102053. ISSN 2156-7514. 
    - This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Image sources