Inflammatory diseases of the parathyroid gland

Department of Endocrine Surgery, King's College Hospital NHS Foundation Trust and King's Health Partners, London, UK.
Histopathology (Impact Factor: 3.45). 11/2011; 59(5):897-908. DOI: 10.1111/j.1365-2559.2011.04001.x
Source: PubMed


Inflammatory disorders of the parathyroid gland are very rare as compared with those of other endocrine organs. The aim of this study was to provide the first systematic review of this condition.
A 42-year-old patient underwent surgery for recurrent secondary hyperparathyroidism. Histology showed hyperplastic parathyroiditis defined by a mixed inflammatory infiltrate with active germinal centres. Molecular markers revealed significant upregulation of CD68 in an ischaemic background (hypoxia-inducible factor 1 upregulation) with mitochondrial reaction (malate dehydrogenase 2 upregulation) and hyperparathyroidism (carbonic anhydrase 4 upregulation). Our case demonstrates true intraparathyroid inflammation with terminal B-cell differentiation. We searched PubMed, ISI Thompson and Google Scholar up to January 2011, using the terms 'parathyroiditis', 'inflammation of parathyroid gland', 'lymphocytic infiltrate', 'tuberculosis of the parathyroid', 'sarcoidosis', and 'graulomatous inflammation'. Three autopsy series, 27 articles and 96 case reports with inflammatory parathyroid disorders were identified. Autopsy series showed lymphocytic infiltrates in up to 16% of all cases. The entire material reported lymphocytic infiltrates (n=69), parathyroiditis with germinal centres (n=15), sarcoidosis (n=6), tuberculosis (n=4), and other granulomatous diseases (n=2).
Distinct inflammatory and granulomatous processes in the parathyroid gland are rare. Scanty lymphocytic infiltrates are common, and occur in generalized inflammatory conditions or venous congestion. We note the surprising absence of an association between histological proof of parathyroiditis and hypoparathyroidism.


Available from: Salvador J Diaz-Cano
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abnormalities of the parathyroid glands are the commonest cause of hypercalcaemia and the histopathologist has an important role in classifying the underlying pathological condition. Diagnostic assessment includes confirmation that the tissue removed is parathyroid versus, most commonly, lymph nodes or thyroid, possibly requiring intra-operative assessment, and in hyperparathyroidism, establishing whether excised parathyroid glands represent hyperplasia or neoplasia. The commonest neoplastic diagnosis is of an adenoma, usually single, and ‘atypical adenoma’ and carcinoma are much less common. It is important to distinguish the worrisome histopathological features of atypical adenoma, which if precisely defined has an excellent prognosis, from the frankly malignant features of parathyroid carcinoma. Parathyromatosis, presenting most frequently after previous parathyroid surgery, must be distinguished from dissemination from a carcinoma. Less common lesions include parathyroid cysts, parathyroiditis and rare metastases to the parathyroid glands. The molecular and genetic events underlying parathyroid disease are complex, heterogeneous, overlapping and poorly understood. Newer antibodies, including parafibromin and PGP9.5, have been proposed to be useful in separating adenoma from carcinoma but overlapping patterns occur and clinicopathological assessment remains the yardstick of diagnosis.
    Diagnostic Histopathology 06/2012; 18(6):221–233. DOI:10.1016/j.mpdhp.2012.03.006
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Head and neck arterio-venous malformations (AVM) are not frequent lesions and no thyroid cases have been reported to date; as hypervascular nodular lesions, they can be misdiagnosed as malignant. Findings: We present two patients with palpable thyroid nodules with suspicions of malignancy based on the hypervascular imaging findings. Histologically, these lesions were well-defined adenomatous nodules with multiple interconnected blood vessels of variable size, many of them dilated and arranged predominantly at the periphery of the lesions. These findings characterize thyroid AVM in the background of adenomatous nodules. Age-matched euthyroid benign non-infiltrative follicular lesions without vascular component, adenomatous hyperplastic nodules (37) and follicular adenomas (21), during the same period (2 years) were retrieved to evaluate vascular markers. Compared with the non-nodular tissues and controls, the hyperplastic nodules with vascular malformation displayed significant mRNA overexpression for VEGF-A, PDGF-A, PDGF-B, and eNOS. Conclusions: Vascular lesions of thyroid gland are rare and they can present as palpable nodules revealing well-defined edges, zonal blood vessel distribution and up-regulation of VEGF-related pathway and eNOS. These findings can help identify the true nature of these lesions.
    Histology and histopathology 05/2013; DOI:10.6084/m9.figshare.707349 · 2.10 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Inflammatory lesions, particularly granulomas, involving adenoma of the parathyroid gland are rare. Ectopic thymic tissue is commonly associated with the thyroid and/or parathyroid gland due to their close embryonic relationship. We report a rare case of coexisting adenoma and granuloma of the parathyroid gland with adjacent ectopic thymic tissue.
    Case Reports 06/2014; 2014. DOI:10.1136/bcr-2014-205527
Show more