Necessary components are:
- Weight of the parathyroid gland or fragment thereof. Generally, there should not be any subjective description of "enlarged" or similar.[notes 1]
- Presence of parathyroid tissue upon frozen section.
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.
The main conditions to look for and distinguish are:
- Parathyroid hyperplasia: Typically involves all 4 glands with diffuse enlargement.
- Parathyroid adenoma: Typically nodular growth with compressed rim of normal tissue.
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.[notes 1]
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.
Example for an intraoperative consultation:
|A. Left inferior parathyroid, excision:|
24 mg of parathyroid tissue.
C. Right superior parathyroid, excision:
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:
E. Left superior parathyroid gland, excision:
F. Right inferior parathyroid gland, excision:
Normal example in autopsy:
|Sections show <<1, 2, 3, 4>> parathyroid glands with no focal changes or signs of hyperplasia.|
- 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.
- Diana Murro Lin. Thyroid & parathyroid - Parathyroid nonmalignant - Parathyroid adenoma. Pathology Outlines. Topic Completed: 27 October 2020. Minor changes: 2 June 2021.
- 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.
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