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    Parathyroid

    Background

    Parathyroid glands may be resected as treatment for primary tumours (adenomas or less commonly adenocarcinomas)1 or where adjacent thyroid tumours impinge on the glands.

    Parathyroid glands are not routinely totally removed due to the impact of hypoparathyroidism that would result. Where possible, subtotal parathyroidectomy is undertaken to limit resection to three glands plus part of the fourth.2 If necessary, parathyroid is autotransplanted into the patient, sometimes into the forearm, after subtotal parathyroidectomy or thyroidectomy. However, supernumerary or ectopic glands can occur anywhere between the upper pole of the thyroid and the mediastinum so other tissues may be received with parathyroid glands.2,3

    Parathyroidectomy may be required to treat hyperparathyroidism; in which case, hyperplasia needs to be distinguished from malignancy of the gland.

    Parathyroid adenomas can be single or multiple tumours located in one or more glands.4 The size can vary from “microadenomas” (<0.1g) to larger tumours seen in association with significant bone disease.5

    Parathyroid carcinomas are aggressive with frequent recurrence and poor outcome. The diagnosis needs to be clearly distinguished from adenomas with degenerative and atypical adenomas in the examination of parathyroid glands.1,6-8

    Intraoperative consultation with frozen section is often performed to confirm that parathyroid tissue has been resected.

    Record the patient identifying information and any clinical information supplied together with the specimen description as designated on the container. See overview page for more detail on identification principles.

    • No
      • Non-routine fixation (not formalin), describe.
    • Yes
      • Special studies required, describe.
      • Ensure samples are taken prior to fixation.
    • Not performed
    • Performed, describe type and result
      • Frozen section
      • Imprints
      • Other, describe
    See general information for more detail on specimen handling procedures.

    Inspect the specimen and dictate a macroscopic description.


    External Inspection

    Orientate and identify the anatomical features of the specimen.

    Record additional orientation or designation provided by operating clinician:

    • Absent
    • Present
      • Method of designation (e.g. suture, incision)
      • Featured denoted

    Photograph the intact specimen if required.

    Describe the following features of the specimen:

    Procedure

    Describe as stated by the clinician.

    • Parathyroidectomy
    • Ectopic or supernumerary location
    • En bloc resection
      • Right
      • Left
      • Other
    • Other, describe

    Anatomical components (more than one may apply) and specimen dimensions (mm)

    Describe and measure the anatomical components present.

    • Total specimen in three dimensions
    • Parathyroid, each gland in three dimensions
      • Left upper
      • Left lower
      • Right upper
      • Right lower
    • Other, describe see relevant tissue protocol

    Specimen weight (g)

    • Total specimen
    • Parathyroid gland (remove as much of the adjacent fat as possible)
    • Other tissues

    The normal weight of a parathyroid gland is between 0.025 and 0.040 g. The weight varies with age and sex.

    Evidence of previous biopsy or surgery (if present)

    • Needle track
    • Scar
    • Sutures

    Surface

    • Unremarkable
    • Adhesions
    • Fibrotic
    • Purulent
    • Nodular

    Specimen integrity

    • Intact
    • Disrupted

    Dissection

    In glands < 5mm in maximum dimension, no dissection is required.

    Larger glands should be bisected.


    Internal Inspection

    Describe the internal or cut surface appearance including the following items:

    Tumour

    • Absent
    • Present
      • No
      • Yes, number; if more than one tumour, designate and describe each tumour separately

    Tumour size

    • Max. dimension in mm

    Tumour description

    • Colour
    • Consistency
    • Haemorrhage
    • Necrosis
    • Calcification

    Tumour capsule intact

    • Yes
    • No
    • Cannot assess

    Distance of tumour to margins (mm)

    • Distance of tumour to nearest excision margin

    Non-lesional tissue appearance

    • Colour
    • Consistency

    Retrieved from resection specimen

    • Describe site(s)
    • Number retrieved

    Separately submitted

    • For each specimen container, record specimen number and designation
    • Collective size of tissue in three dimensions (mm)
    • Number of lymph nodes submitted
    • Maximum diameter of each (mm)

    Note any photographs taken, diagrams recorded, ink or marks used for identification.


    Processing

    • Glands <5mm in maximum dimension, submit whole
    • Glands >5mmin maximum dimension, bisect (or serially section at 3-4mm intervals) and submit all tissue for processing

    Submit representative sections of:

    • Tumour demonstrating relationship with margins
    • Other structures

    Submit all lymph nodes received.

    An illustrated block key similar to the one provided may be useful.

    Block allocation key

    Cassette id Site No. of pieces
    A-B Parathyroid gland  
     

    Acknowledgements

    Prof Alfred Lam for his contribution in reviewing and editing this protocol.


    References

    1. Johnson SJ. Changing clinicopathological practice in parathyroid disease. Histopathology 2010;56(7):835-851.
    2. Johnson SJ, Sheffield EA and McNicol AM. Best practice no 183. Examination of parathyroid gland specimens. J Clin Pathol 2005;58(4):338-342.
    3. Osamura RY and Hunt JL. Current practices in performing frozen sections for thyroid and parathyroid pathology. Virchows Arch 2008;453(5):433-440.
    4. Wheeler MH. Primary hyperparathyroidism: a surgical perspective. Ann R Coll Surg Engl 1998;80(5):305-312.
    5. DeLellis RA Parathyroid tumors and related disorders. Mod Pathol 2011;24 Suppl 2:S78-93.
    6. Stojadinovic A, Hoos A, Nissan A, Dudas ME, Cordon-Cardo C, Shaha AR, Brennan MF, Singh B and Ghossein RA (2003). Parathyroid neoplasms: clinical, histopathological, and tissue microarray-based molecular analysis. Hum Pathol 2003;34(1):54-64.
    7. DeLellis RA. Tumours of the Parathyroid Gland. Armed Forces Institute of Pathology, Washington DC, 1993.
    8. Schantz A and Castleman B. Parathyroid carcinoma. A study of 70 cases. Cancer 1973;31(3):600-605.
    9. Johnson SJ and Stephenson TJ. Dataset for parathyroid cancer histopathology reports, The Royal College of Pathologists, London, 2010.
    10. Lester SC. Manual of Surgical Pathology, Saunders Elsevier, Philadelphia, 2010.
    11. Milne D, Johnson SJ, Stephenson T and Poller D. Tissue pathways for endocrine pathology, The Royal College of Pathologists, London, 2012.

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      Parathyroid 1

      Parathyroid

      Parathyroid 2

      Parathyroid bisected

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      21-Mar-2019
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