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Parathyroid adenoma (view source)
Revision as of 16:52, 10 September 2015
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# | '''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]] | |||