Difference between revisions of "Parathyroid adenoma"

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(rm 'diagnosis' category; now only the subtypes 'chief cell' and 'oxyphil')
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#redirect [[Parathyroid_glands#Parathyroid_adenoma]]
'''Parathyroid adenoma''' is a common benign pathology of the [[parathyroid gland]].
 
==General==
*One parathyroid is big... the others are small.
*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:<ref name=pmid16203274>{{Cite journal  | last1 = Moran | first1 = CA. | last2 = Suster | first2 = S. | title = Primary parathyroid tumors of the mediastinum: a clinicopathologic and immunohistochemical study of 17 cases. | journal = Am J Clin Pathol | volume = 124 | issue = 5 | pages = 749-54 | month = Nov | year = 2005 | doi = 10.1309/WJEL-N05L-9A06-9DU0 | PMID = 16203274 }}</ref>
#Chief cell parathyroid adenoma.
#*Common.
#Oxyphil parathyroid adenoma.
#*Uncommon.<ref name=pmid15579742>{{Cite journal  | last1 = Fleischer | first1 = J. | last2 = Becker | first2 = C. | last3 = Hamele-Bena | first3 = D. | last4 = Breen | first4 = TL. | last5 = Silverberg | first5 = SJ. | title = Oxyphil parathyroid adenoma: a malignant presentation of a benign disease. | journal = J Clin Endocrinol Metab | volume = 89 | issue = 12 | pages = 5948-51 | month = Dec | year = 2004 | doi = 10.1210/jc.2004-1597 | PMID = 15579742 }}</ref>
#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<ref name=Ref_BITFS191>{{Ref BITFS|191}}</ref> with adipose tissue.
 
Note:
*Generally, it is impossible to discern between [[parathyroid adenoma]]s and [[parathyroid hyperplasia]]s by histology alone.<ref name=Ref_BITFS191>{{Ref BITFS|191}}</ref>
**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:<ref name=Ref_PBoD8_1127>{{Ref PBoD8|1127}}</ref>
*Chief cells - '''key feature''':
**Small central nucleus.
***Round with stippled chromatin - '''important'''.
**Moderate cytoplasm.
*+/-Scattered oxyphil cells:
**Large cells.
**Abundant cytoplasm.
*Architecture:
**Nests.
**Circular formations - often around capillaries (perivascular pseudo[[rosette]]s).
 
====Images====
<gallery>
Image:Parathyroid_adenoma_low_mag.jpg |Parathyroid adenoma - low mag. (WC/Nephron)
Image:Parathyroid_adenoma_high_mag.jpg |Parathyroid adenoma - high mag. (WC/Nephron)
</gallery>
 
===Oxyphil parathyroid adenoma===
Features:<ref name=Ref_PBoD8_1127>{{Ref PBoD8|1127}}</ref>
*Oxyphil cells:
**Large cells.
**Abundant cytoplasm.
 
DDx:
*[[Hürthle cell adenoma]] of the [[thyroid gland]].
 
Image:
*[http://library.med.utah.edu/WebPath/jpeg4/ENDO091.jpg Parathyroid adenoma (med.utah.edu)].<ref>URL: [http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/enfrm.html http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/enfrm.html]. Accessed on: 6 December 2010.</ref>
 
==Sign out==
Note:
*One should not say "negative for malignancy".
 
<pre>
Parathyroid Gland, Excision:
- Chief cell parathyroid adenoma.
</pre>
 
<pre>
Parathyroid Gland, Excision:
- Chief cell parathyroid adenoma with adjacent normal parathyroid tissue.
</pre>
 
<pre>
Parathyroid Gland (Submitted as "Right Superior Parathyroid Adenoma"), Excision:
- Parathyroid adenoma with adjacent normal parathyroid tissue.
</pre>
 
====Block letters====
<pre>
PARATHRYOID GLAND, EXCISION:
- CHIEF CELL PARATHYROID ADENOMA.
</pre>
 
===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==
*[[Parathyroid glands]].
 
==References==
{{Reflist|1}}
 
[[Category:Diagnosis]]

Revision as of 16:52, 10 September 2015

Parathyroid adenoma is a common benign pathology of the parathyroid gland.

General

  • One parathyroid is big... the others are small.
  • Associated with MEN 1 and MEN 2A.

MEN 1:

MEN 2A:

Subtypes

Histologic subtyping:[1]

  1. Chief cell parathyroid adenoma.
    • Common.
  2. Oxyphil parathyroid adenoma.
  3. 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:

DDx:

Chief cell parathyroid adenoma

Features:[4]

  • Chief cells - key feature:
    • Small central nucleus.
      • Round with stippled chromatin - important.
    • Moderate cytoplasm.
  • +/-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:

Image:

Sign out

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

  1. ↑ 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.
  2. ↑ 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. ↑ 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. ↑ 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.
  5. ↑ URL: http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/enfrm.html. Accessed on: 6 December 2010.
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