A Retrospective Review of Parathyroidectomy Specimen Pathology: A Diagnostic Accuracy Study
Christina M Kovacs, Vania Nose. University of Miami, Miami, FL; Jackson Memorial Hospital, Miami, FL
Background: Parathyroidectomy is most often performed to treat hyperparathyroidism. Hyperparathyroidism can either be primary, secondary or tertiary depending on etiology. Certain histologic patterns are suggestive of etiology and even inherited endocrine syndromes. The pathology of the parathyroid gland can be largely divided into three categories: normal, hyperplastic and neoplastic. These categories can be further subdivided. The hyperplasias can be categorized as diffuse, nodular, primary and secondary. The neoplastic category includes parathyroid adenoma, atypical adenoma and parathyroid carcinoma. We reviewed parathyroidectomy cases to determine if there was a difference between the diagnoses made by general surgical pathologists versus a sub-specialized endocrine pathologist.
Design: We reviewed 169 parathyroidectomy specimens received between 1999 and 2009 from patients with secondary or tertiary hyperparathyroidism. These cases were originally diagnosed by general surgical pathologists and were subsequently reviewed by an endocrine pathologist. We evaluated the differences between the diagnoses made by both types of pathologist.
Results: The differences between the type and number of each diagnoses made by a general pathologist versus an endocrine pathologist are summarized in [table 1]. Of note, four cases (2%) were considered to be atypical adenomas when reviewed by an endocrine pathologist, which had been previously diagnosed as either parathyroid tissue or hypercellular parathyroid tissue. There was no diagnosis of atypical adenoma made by the general surgical pathology group. Sixty-five cases (38%) were re-classified as neoplastic upon review by an endocrine pathologist.
|Diagnosis||No. of Diagnoses made by General Surgical Pathologist||No. of Diagnoses Made by Endocrine Pathologist|
|Parathyroid Tissue||36 (21%)||0 (0%)|
|Normocellular||9 (5%)||7 (4%)|
|Hypercellular||28 (17%)||9 (5%)|
|Hyperplasia||75 (44%)||56 (33%)|
|Nodular Hyperplasia||14 (8%)||25 (15%)|
|Adenoma||5 (3%)||14 (8%)|
|Adenoma Arising in Hyperplasia||2 (1%)||54 (32%)|
|Atypical Adenoma||0 (0%)||4 (2%)|