Parathyroid gland
Frozen section

Topic Completed: 1 January 2013

Minor changes: 26 October 2020

Copyright: 2003-2021,, Inc.

PubMed Search: Frozen section[TI] parathyroid

Monika Roychowdhury, M.D.
Page views in 2020: 866
Page views in 2021 to date: 38
Cite this page: Roychowdhury M. Frozen section. website. Accessed January 18th, 2021.
Definition / general
  • 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)
Cytology description
  • 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)
Differential diagnosis
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