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Human Pathology May 2022Intraoperative consultation for assessment of parathyroid tissue is a controversial area of endocrine pathology. This assessment often follows historical institutional... (Review)
Review
Intraoperative consultation for assessment of parathyroid tissue is a controversial area of endocrine pathology. This assessment often follows historical institutional and individual surgical practitioner practices rather than documented utility data and adjuvant intraoperative testing data, including intraoperative parathyroid hormone level testing by clinical pathologists and the use of Oil Red O vital stain on frozen tissue sections by anatomic pathologists, as a means of conferring etiology of parathyroid disease. The American Association of Endocrine Surgeons (AAES), in 2016, proposed guidelines for the management of primary hyperparathyroidism, including recommendations for intraoperative consultation, recommending against the use of intraoperative frozen section to determine parathyroid functional status but in support for its use for parathyroid identification. In this series, we review a one-year, retrospective cohort of consecutive parathyroid surgeries at Massachusetts General Hospital, including over 200 cases meeting inclusion criteria for which primary hyperparathyroidism was the indication for surgery, discussing outcomes, compliance with AAES guidelines, and overall utility of intraoperative consultation and adjuvant testing.
Topics: Humans; Hyperparathyroidism, Primary; Parathyroid Glands; Parathyroid Hormone; Parathyroidectomy; Retrospective Studies
PubMed: 35196527
DOI: 10.1016/j.humpath.2022.02.012 -
Endocrinology Dec 2023
Topics: Humans; Calcium; Vitamin D; Cyclin D1; Parathyroid Glands; Parathyroid Hormone; Vitamin D Deficiency; Carcinogenesis
PubMed: 38104244
DOI: 10.1210/endocr/bqad189 -
International Journal of Molecular... May 2022Parathyroid tumors are very prevalent conditions among endocrine tumors, being the second most common behind thyroid tumors. Secondary hyperplasia can occur beyond... (Review)
Review
Parathyroid tumors are very prevalent conditions among endocrine tumors, being the second most common behind thyroid tumors. Secondary hyperplasia can occur beyond benign and malignant neoplasia in parathyroid glands. Adenomas are the leading cause of hyperparathyroidism, while carcinomas represent less than 1% of the cases. Tumor suppressor gene mutations such as and were demonstrated to be involved in tumor development in both familiar and sporadic types; however, the epigenetic features of the parathyroid tumors are still a little-explored subject. We present a review of epigenetic mechanisms related to parathyroid tumors, emphasizing advances in histone modification and its perspective of becoming a promising area in parathyroid tumor research.
Topics: Epigenesis, Genetic; Epigenomics; Histone Code; Humans; Hyperparathyroidism; Parathyroid Neoplasms
PubMed: 35628190
DOI: 10.3390/ijms23105378 -
Surgical Pathology Clinics Mar 2023Parathyroid disease typically presents with parathyroid hyperfunction as result of neoplasia or a consequence of non-neoplastic systemic disease. Given the parathyroid... (Review)
Review
Parathyroid disease typically presents with parathyroid hyperfunction as result of neoplasia or a consequence of non-neoplastic systemic disease. Given the parathyroid gland is a hormonally active organ with broad physiologic implications and serologically accessible markers for monitoring, the diagnosis of parathyroid disease is predominantly a clinical pathologic correlation. We provide the current pathological correlates of parathyroid disease and discuss preoperative, intraoperative, and postoperative pathology consultative practice for optimal patient care.
Topics: Humans; Parathyroid Glands; Parathyroid Neoplasms; Parathyroid Hormone; Parathyroidectomy; Monitoring, Intraoperative
PubMed: 36739169
DOI: 10.1016/j.path.2022.10.001 -
Endokrynologia Polska 2022Parathyroid carcinoma is a rare condition and accounts for < 1% of cases of sporadic primary hyperparathyroidism. It accounts for 0.005% of all cancers. Often the...
INTRODUCTION
Parathyroid carcinoma is a rare condition and accounts for < 1% of cases of sporadic primary hyperparathyroidism. It accounts for 0.005% of all cancers. Often the differentiation between adenoma and carcinoma is challenging and requires multidisciplinary cooperation. Complete surgical resection is the treatment of choice. We present a retrospective analysis of 29 patients who were surgically treated for parathyroid cancer.
MATERIAL AND METHODS
Between the years 1983 and 2018, 71 (7.0%) patients were treated for suspicion of parathyroid cancer among a group of 1019 operated for primary hyperparathyroidism.
RESULTS
We confirmed the diagnosis of parathyroid cancer in 29 (2.8%) patients, 12 men and 17 women, aged 27 to 77 years, mean 55.1 years. That constituted 43.9% of the 71 patients with initial suspicion of cancer diagnosis. All operated patients were under long-term observation.
CONCLUSIONS
A diagnosis of parathyroid carcinoma should always be considered during surgery in patients diagnosed with primary hyperparathyroidism, especially in patients with severe hypercalcaemia, significantly enlarged neck circumference, and concomitant diseases of the renal and skeletal system. Parathyroid carcinoma is rarely definitively diagnosed preoperatively or even intraoperatively, and the final diagnosis can be made exclusively after operation. The optimal treatment is a complete surgical resection at a reference centre - specialized in parathyroid surgery - to improve outcomes and provide the best chance of recovery.
Topics: Adenoma; Adult; Aged; Female; Humans; Hyperparathyroidism; Male; Middle Aged; Parathyroid Neoplasms; Parathyroidectomy; Retrospective Studies
PubMed: 35156702
DOI: 10.5603/EP.a2022.0003 -
Materia Socio-medica 2023The most comon patohistological finding in primary hyperparathyroidism is adenoma of the parathyroid gland, followed by hyperplasia and the rarest is carcinoma. However,...
BACKGROUND
The most comon patohistological finding in primary hyperparathyroidism is adenoma of the parathyroid gland, followed by hyperplasia and the rarest is carcinoma. However, hyperplasia of the parathyroid glands (PTG) is most commonly found in secondary and tertiary hyperparathyroidism.
OBJECTIVE
To determine the relationship between the localization of the parathyroid glands and pathological diagnosis, as well as the prevalence of individual pathological diagnosis after surgery in patients with hyperparathyroidism.
METHODS
Analysis of retrospective-prospective database of 79 patiens who underwent parathyreoidectomy for hyperparathyroidism in the 7-year study period. Diagnostic methods were used to identify enlarged parathyroid glands as well as to determine their localization: ultrasound examination, scintigraphy and operative finding. Standard hematoxylin eosin staining was used for pathohistological diagnosis. A correlation analysis between parathyroid gland localization and pathohistological diagnosis was performed.
RESULTS
The median age of the patients were 51 age (range 20-73) and 67,1% of the patients were female. In the total number of surgically removed parathyroid glands (182), the most common pathohistological diagnosis was hyperplasia. Parathyroid adenoma was found in 21 cases. Other diagnoses (thyroid nodule / tissue, lymph node, thymus, cancer) were found in 11 cases, while a normal finding was found in 12 glands. Pathohistological diagnosis of hyperplasia and adenoma were more common in the lower parathyroid glands. Using the chi-square test, no association was found between pathohistological diagnosis and localization of enlarged parathyroid glands.
CONCLUSION
The most common pathohistological diagnosis in hyperparathyroidism was hyperplasia and was most commonly found in the inferior parathyroid glands. Adenoma as pathohistological diagnosis is also most commonly found in the lower parathyroid glands, but without statistical significance.
PubMed: 37701350
DOI: 10.5455/msm.2023.35.130-134 -
Minerva Endocrinology Jun 2022Hyperparathyroidism is caused by parathyroid adenoma, hyperplasia or carcinoma. Parathyroid adenomas are the most common cause of parathyroid disease (85-88%) while...
BACKGROUND
Hyperparathyroidism is caused by parathyroid adenoma, hyperplasia or carcinoma. Parathyroid adenomas are the most common cause of parathyroid disease (85-88%) while atypical parathyroid adenomas and carcinomas are the least frequently seen parathyroid neoplasms which cause diagnostic difficulty. This series aims to identifiy lesions of parathyroidectomy specimens in our center and draw attention to borderline cases in between parathyroid adenoma and carcinoma.
METHODS
The study included 638 parathyroidectomy materials diagnosed in our center between the years 2005 and 2016 and examined retrospectively, and all were included in the study.
RESULTS
In all the 638 parathyroidectomy cases evaluated, 427 were diagnosed with adenoma, 117 with hyperplasia, 54 with normal parathyroid tissue, 32 with parathyroid neoplasm with uncertain malignant potential, 7 with parathyroid carcinoma and 1 with normal thyroid tissue.
CONCLUSIONS
Parathyroid neoplasm with uncertain malignant potential defines cases with suspicious histopathological features of carcinoma but doesn't meet the criteria for parathyroid carcinoma. In our series, these cases are identified as atypical parathyroid adenoma. We present clinical and morphological features of our parathyroidectomy cases in an 11-year period and aim to raise concern about borderline cases in between adenoma and carcinoma. We think that such tumors, similar to the thyroid neoplasm classification, should be defined as parathyroid neoplasms with uncertain malignant potential and should be followed closely.
Topics: Adenoma; Carcinoma; Humans; Hyperplasia; Parathyroid Neoplasms; Parathyroidectomy; Retrospective Studies
PubMed: 33103869
DOI: 10.23736/S2724-6507.20.03171-5 -
European Journal of Case Reports in... 2020Pheochromocytoma, papillary thyroid carcinoma and hyperparathyroidism have rarely been reported together. Whether this association is coincidental or results from an...
UNLABELLED
Pheochromocytoma, papillary thyroid carcinoma and hyperparathyroidism have rarely been reported together. Whether this association is coincidental or results from an unknown genetic predisposition is difficult to ascertain. We present the case of a patient who was diagnosed with pheochromocytoma, bilateral papillary thyroid carcinoma and parathyroid hyperplasia with primary hyperparathyroidism. A genetic mutation was hypothesized as the connection between these lesions. Previously described mutations were explored.
LEARNING POINTS
Parathyroid hyperplasia, primary hyperparathyroidism and papillary thyroid carcinoma individually are common conditions, but association with each other, although possibly incidental, should trigger genetic testing.Further research is needed to reliably explain the relationship between primary hyperparathyroidism and non-medullary thyroid cancer.
PubMed: 33194854
DOI: 10.12890/2020_001818 -
Journal of the College of Physicians... Apr 2021To determine the success rate of minimally invasive parathyroidectomies (MIPs) with preoperative scintigraphy and ultrasonography, and to assess whether these imaging... (Observational Study)
Observational Study
OBJECTIVE
To determine the success rate of minimally invasive parathyroidectomies (MIPs) with preoperative scintigraphy and ultrasonography, and to assess whether these imaging modalities are sufficient.
STUDY DESIGN
Observational study.
PLACE AND DURATION OF STUDY
Department of General Surgery, University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey between March 2017 and December 2019.
METHODOLOGY
Medical records of 61 patients, who underwent MIP to treat primary hyperparathyroidism, were examined. Age, gender, and pre- and postoperative calcium, parathormone, and phosphorus levels were obtained from patient records. For all patients, the parathyroid (PT) glands were localised, using ultrasonography and Tc-99m methoxyisobutylisonitrile (MIBI) scintigraphy.
RESULTS
The average patient age was 56.89 ± 13.47 years. Of the patients, 83.6% (n = 51) were females. Localisation of the PT glands with preoperative scintigraphy had an accuracy rate of 100%. However, ultrasonographic localisation was unsuccessful in five patients. Adenomas were noted in 44 patients (72.1%), hyperplasia in 15 patients (24.6%), and neoplasia in two patients (3.3%). Serum parathormone and calcium levels were measured 24 hours after surgery, and were found to be significantly reduced compared to the corresponding preoperative levels (p <0.001). Hypocalcaemia developed in four patients (6.6%), two (3.3%) of which were symptomatic. After three months, persistent hyperparathyroidism developed in five patients (8.2%).
CONCLUSION
Parathyroid scintigraphy has been demonstrated to be the gold standard for the preoperative localisation of PT glands. In the absence of scintigraphy, ultrasound guidance is the next useful technique for PT gland localisation. Key Words: Minimal invasive parathyroidectomy, Parathyroid scintigraphy, Ultrasonography, Parathormone.
Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Parathyroid Glands; Parathyroidectomy; Radiopharmaceuticals; Technetium Tc 99m Sestamibi; Turkey; Ultrasonography
PubMed: 33866731
DOI: 10.29271/jcpsp.2021.04.440