Reviewer: Monika Roychowdhury, M.D. (see Reviewers page)
Revised: 17 February 2013, last major update January 2013
Copyright: (c) 2003-2013, PathologyOutlines.com, Inc.
● Communication with surgeon important
● Weigh, measure and freeze largest gland
● Algorithm: presumed adenoma if rim of normal tissue, diffuse chief cell growth, no fat, bizarre nuclei; if these criteria not met, examine at least one more gland
● Oil Red O fat stain may be helpful if little fat in suspect gland and abundant fat in normal appearing gland (Am J Surg Pathol 1981;5:381, Hum Pathol 1985;16:1255)
● Density gradient measurements: denser tissue sinks in 25% mannitol solution, implies more parenchymal cells / abnormal glands
● Parathyroid tissue usually lacks birefringent calcium oxalate crystals detectable by polarized light microscopy that are present in thyroid tissue (Am J Surg Pathol 2002;26:813)
● Fewer thyroid frozen sections are now performed (Virchows Arch 2008;453:433)
Thyroid with a pattern resembling parathyroid neoplasm (DD)
● In touch preparations, parathyroid tissue appears as clusters of cells vs. discohesive lymphocytes and histiocytes in lymph nodes mistaken as parathyroid gland
(Am J Surg Pathol 2000;24:158)
● Parathyroid: moderately cellular, small uniform cells in isolation/small groups with round/oval nuclei, salt and pepper chromatin, occasional naked nuclei, delicate vacuoles in cytoplasm and in background (Arch Pathol Lab Med 2003;127:64)
● Cytology plus frozen section is more accurate than either alone (Am J Clin Pathol 2002;118:895)
● Rapid intraoperative parathyroid hormone assay of needle aspirates is an accurate method of distinguishing parathyroid from nonparathyroid tissues during FNA as well as parathyroidectomy (Am J Otolaryngol 2011;32:574, World J Surg 2010;34:538)
● Coexisting parathyroid and nodular thyroid disease
● Intrathyroidal parathyroid glands with conspicuous follicle formations or abundant oncocytic cells mimics thyroid tissue
● Solitary thyroid nodules with fatty stroma: see Am J Surg Pathol 1998;22:538
● Thyroid tissue with parathyroid pattern: see Mod Pathol 2000;13:210
End of Parathyroid gland > Neoplasms > Frozen section
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