Difference between revisions of "Parathyroid adenoma"

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{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Parathyroid adenoma intermed mag.jpg
| Width      =
| Caption    = Chief cell parathyroid adenoma (left of image) and unremarkable parathyroid gland (right of image). [[H&E stain]]. (WC)
| Synonyms  =
| Micro      =
| Subtypes  =
| LMDDx      = [[parathyroid hyperplasia]], [[parathyroid carcinoma]], [[lymph node]], [[thyroid gland]]
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[parathyroid gland]] ([[head and neck pathology|neck]]/[[mediastinum]])
| Assdx      =
| Syndromes  = [[MEN 1|multiple endocrine neoplasia 1]], [[MEN 2A|multiple endocrine neoplasia 2A]]
| Clinicalhx =
| Signs      =
| Symptoms  =
| Prevalence =
| Bloodwork  = increased parathyroid hormone, serum calcium increased
| Rads      =
| Endoscopy  =
| Prognosis  = benign
| Other      =
| ClinDDx    = nodule (lymph node, other tumours), hyperparathyroidism ([[parathyroid hyperplasia]], [[parathyroid carcinoma]]), DDx of [[hypercalcemia]]
| Tx        = removal
}}
'''Parathyroid adenoma''' is a common benign pathology of the [[parathyroid gland]].
'''Parathyroid adenoma''' is a common benign pathology of the [[parathyroid gland]].


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*[[Clinical diagnosis]].
*[[Clinical diagnosis]].
*Most common cause of [[primary hyperparathyroidism]].<ref name=Ref_PBoD8_1127>{{Ref PBoD8|1127}}</ref>
*Most common cause of [[primary hyperparathyroidism]].<ref name=Ref_PBoD8_1127>{{Ref PBoD8|1127}}</ref>
*One parathyroid is big... the others are small.
*May be associated with [[MEN 1]] and [[MEN 2A]].
*May be associated with [[MEN 1]] and [[MEN 2A]].


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#*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>
#*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.
#Mixed.
==Gross==
*One parathyroid is big... the others are small.


==Microscopic==
==Microscopic==

Revision as of 03:19, 11 September 2015

Parathyroid adenoma
Diagnosis in short

Chief cell parathyroid adenoma (left of image) and unremarkable parathyroid gland (right of image). H&E stain. (WC)
LM DDx parathyroid hyperplasia, parathyroid carcinoma, lymph node, thyroid gland
Site parathyroid gland (neck/mediastinum)

Syndromes multiple endocrine neoplasia 1, multiple endocrine neoplasia 2A

Blood work increased parathyroid hormone, serum calcium increased
Prognosis benign
Clin. DDx nodule (lymph node, other tumours), hyperparathyroidism (parathyroid hyperplasia, parathyroid carcinoma), DDx of hypercalcemia
Treatment removal

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

General

MEN 1:

MEN 2A:

Subtypes

Histologic subtyping:[2]

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

Gross

  • One parathyroid is big... the others are small.

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[4] with adipose tissue.

Note:

DDx:

Chief cell parathyroid adenoma

Features:[1]

  • 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

Oxyphil parathyroid adenoma

Features:[1]

  • 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. 1.0 1.1 1.2 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.
  2. 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.
  3. 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.
  4. 4.0 4.1 Taxy, J.; Husain, A; Montag, A. (2009). Biopsy Interpretation: The Frozen Section (1st ed.). Lippincott Williams & Wilkins. pp. 191. ISBN 978-0781767798.
  5. URL: http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/enfrm.html. Accessed on: 6 December 2010.