Parathyroid glands

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Author: Mikael Häggström [notes 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.[notes 2]
  • Presence of parathyroid tissue upon frozen section.

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.[1]
  • Parathyroid adenoma: Typically nodular growth with compressed rim of normal tissue.[1]

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.[notes 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. 1.0 1.1 Diana Murro Lin. Thyroid & parathyroid - Parathyroid nonmalignant - Parathyroid adenoma. Pathology Outlines. Topic Completed: 27 October 2020. Minor changes: 2 June 2021.
  2. 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.