Parathyroid adenoma
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Parathyroid adenoma is a common benign pathology of the parathyroid gland.
General
- Clinical diagnosis.
- One parathyroid is big... the others are small.
- May be associated with MEN 1 and MEN 2A.
MEN 1:
- Parathyroid adenoma.
- Pancreatic neuroendocrine tumour.
- Pituitary adenoma.
MEN 2A:
- Parathyroid adenoma.
- Medullary thyroid carcinoma.
- Pheochromocytoma.
Subtypes
Histologic subtyping:[1]
- Chief cell parathyroid adenoma.
- Common.
- Oxyphil parathyroid adenoma.
- Uncommon.[2]
- Mixed.
Microscopic
Features - general:
- Proliferation of parathyroid cells (chief cells, oxyphils or both) lacking adipose tissue.
- Classically have a rim of normal parathyroid gland around it[3] with adipose tissue.
Note:
- Generally, it is impossible to discern between parathyroid adenomas and parathyroid hyperplasias by histology alone.[3]
- One requires information of the size of the other glands to make the diagnosis.
DDx:
- Parathyroid hyperplasia - differentiated by clinical history.
- Parathyroid carcinoma - destructive invasion of surrounding tissue or far away mets, increased proliferative activity.
Chief cell parathyroid adenoma
Features:[4]
- Chief cells - key feature:
- Small central nucleus.
- Round with stippled chromatin - important.
- Moderate cytoplasm.
- Small central nucleus.
- +/-Scattered oxyphil cells:
- Large cells.
- Abundant cytoplasm.
- Architecture:
- Nests.
- Circular formations - often around capillaries (perivascular pseudorosettes).
Images
Parathyroid adenoma - low mag. (WC/Nephron)
Parathyroid adenoma - high mag. (WC/Nephron)
Oxyphil parathyroid adenoma
Features:[4]
- Oxyphil cells:
- Large cells.
- Abundant cytoplasm.
DDx:
- Hürthle cell adenoma of the thyroid gland.
Image:
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Note:
- One should not say "negative for malignancy".
Parathyroid Gland, Excision: - Chief cell parathyroid adenoma.
Parathyroid Gland, Excision: - Chief cell parathyroid adenoma with adjacent normal parathyroid tissue.
Parathyroid Gland (Submitted as "Right Superior Parathyroid Adenoma"), Excision: - Parathyroid adenoma with adjacent normal parathyroid tissue.
Block letters
PARATHRYOID GLAND, EXCISION: - CHIEF CELL PARATHYROID ADENOMA.
Micro
The section shows an adenoma consisting predominantly of chief cells. A rim of normal parathyroid is seen adjacent to the adenoma. A small amount of unremarkable adipose tissue is present.
See also
References
- ↑ Moran, CA.; Suster, S. (Nov 2005). "Primary parathyroid tumors of the mediastinum: a clinicopathologic and immunohistochemical study of 17 cases.". Am J Clin Pathol 124 (5): 749-54. doi:10.1309/WJEL-N05L-9A06-9DU0. PMID 16203274.
- ↑ Fleischer, J.; Becker, C.; Hamele-Bena, D.; Breen, TL.; Silverberg, SJ. (Dec 2004). "Oxyphil parathyroid adenoma: a malignant presentation of a benign disease.". J Clin Endocrinol Metab 89 (12): 5948-51. doi:10.1210/jc.2004-1597. PMID 15579742.
- ↑ 3.0 3.1 Taxy, J.; Husain, A; Montag, A. (2009). Biopsy Interpretation: The Frozen Section (1st ed.). Lippincott Williams & Wilkins. pp. 191. ISBN 978-0781767798.
- ↑ 4.0 4.1 Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; Aster, Jon (2009). Robbins and Cotran pathologic basis of disease (8th ed.). Elsevier Saunders. pp. 1127. ISBN 978-1416031215.
- ↑ URL: http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/enfrm.html. Accessed on: 6 December 2010.