Atypical presentations of parathyroid gland pathology: A pictorial review

Kowa, Xin-Ying; Richards, Paula J.; Waterhouse, Mona; Parvanta, Laila; Adams, Ashok

doi:10.1016/j.ejro.2019.10.001

Cited by 8 publications

(3 citation statements)

References 28 publications

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“…During the development of the embryo, the parathyroid glands migrate and separate outward from the third and fourth pharyngeal sacs. However, due to the impact of a variety of factors, ectopic migration (to the sublingual area, lower neck, and even the mediastinum) may occur (6,7), especially for the lower parathyroid glands.…”

Section: Discussionmentioning

confidence: 99%

Safety and effectiveness of reoperation for persistent or recurrent drug refractory secondary hyperparathyroidism

Zhu¹,

Cheng²,

Zhu³

et al. 2020

Gland Surg

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Background: Drug-refractory secondary hyperparathyroidism (SHPT) is the most common complication in patients with chronic renal failure (CRF). Although surgery is the most effective and safe method for drug-refractory SHPT, the condition may persist or recur after the primary surgery, and reoperation is often required in these patients. The purpose of our current study was to evaluate the safety and effectiveness of reoperation for drug-refractory SHPT. Methods:The clinical data of 15 patients requiring reoperation after a surgery for drug-refractory SHPT in our hospital from 2010 to 2019 were retrospectively analyzed. Changes in biochemical markers including intact parathyroid hormone (iPTH), blood calcium (Ca), blood phosphorus (P), alkaline phosphatase (ALP), and blood calcium phosphorus product (Ca*P) were compared before and after the surgery, and the effectiveness and complications of the reoperation were summarized. Results:The reoperation was successful in all the 15 patients after a single attempt. Routine pathological examinations identified a total of 25 parathyroid glands, of which 10 were in the neck in situ, 5 were ectopic in the neck, and 10 were in the forearm. The ectopic parathyroid glands were located inside the thyroid gland (n=1), anterior superior mediastinum (n=1), or thymus (n=3). Surgical treatment significantly improved clinical symptoms such as skin pruritus and bone pain. Blood iPTH, Ca, P, ALP, and Ca*P were significantly reduced (P<0.05 or P<0.01) after surgery. Hypothyroidism occurred in 1 patient; 4 patients undergoing orthotopic neck surgery developed transient hoarseness, which were alleviated within 6 months; no severe complications such as bleeding or death were noted. No recurrence occurred during the 6-month follow-up.Conclusions: Reoperation is safe and effective for drug-refractory SHPT. Preoperative imaging should be performed to achieve accurate positioning, and the recurrent laryngeal nerve should be closely monitored during surgery. The purpose of the reoperation is to remove all possible parathyroid tissues to avoid recurrence.

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Section: Discussionmentioning

confidence: 99%

Safety and effectiveness of reoperation for persistent or recurrent drug refractory secondary hyperparathyroidism

Zhu¹,

Cheng²,

Zhu³

et al. 2020

Gland Surg

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“…The literature regarding less avidly enhancing parathyroid lesions is scarce. Lipid‐rich adenomas, cystic degeneration, hemorrhage, and fibrosis within the parathyroid adenomas are associated with a lower degree of arterial enhancement and lower washout on 4DCT 21,22 . Notably, multiple areas of hemorrhage were identified on the histopathology of parathyroid adenoma in our patient, which can be speculated to explain the lower attenuation on 2DCT.…”

Section: Discussionmentioning

confidence: 61%

“…Lipid-rich adenomas, cystic degeneration, hemorrhage, and fibrosis within the parathyroid adenomas are associated with a lower degree of arterial enhancement and lower washout on 4DCT. 21,22 Notably, multiple areas of hemorrhage were identified on the histopathology of parathyroid adenoma in our patient, which can be speculated to explain the lower attenuation on 2DCT. The lesion in our patient was ascertained to be parathyroid adenoma based on its characteristic location, lower attenuation in the noncontrast phase that differentiated it from thyroid, and relatively higher wash-in in the arterial phase that differentiated it from a lymph node.…”

Section: Discussionmentioning

confidence: 65%

Percentage arterial enhancement on 2D CT in the diagnosis of primary hyperparathyroidism: A prospective validation study and potential pitfalls

et al. 2022

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Background: Parathyroid lesions are identified by subjective enhancement and washout patterns on computed tomography (CT). We have previously proposed "percentage arterial enhancement" (PAE) as an objective index and now aim to validate its performance prospectively.Methods: Dual-phase CT was performed in 40 consecutive primary hyperparathyroidism patients. PAE was calculated as [{arterial phase Hounsfield unit (HU)-unenhanced phase HU}/unenhanced phase HU] Â 100. PAE > 128.9% was considered parathyroid.Results: PAE had 94.2% sensitivity, 100% positive predictive value (PPV) in lateralization, and sensitivity and PPV of 93.9% in quadrant localization of singlegland disease. PAE failed to identify two lesions: an intrathyroidal parathyroid carcinoma in the background of multinodular goiter and another lower enhancing cystic parathyroid adenoma. PAE had 60% sensitivity, and 100% PPV to identify multigland disease. The mean effective dose was 2.74 mSV.Conclusions: PAE is a specific CT index for parathyroid lesions with less radiation exposure. Areas of caution include intrathyroidal and cystic lesions.

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Atypical Sonographic Appearances of Enlarged Parathyroids

Singhal

2023

Atlas of Sonography of Parathyroid

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Atypical presentations of parathyroid gland pathology: A pictorial review

Cited by 8 publications

References 28 publications

Safety and effectiveness of reoperation for persistent or recurrent drug refractory secondary hyperparathyroidism

Safety and effectiveness of reoperation for persistent or recurrent drug refractory secondary hyperparathyroidism

Percentage arterial enhancement on 2D CT in the diagnosis of primary hyperparathyroidism: A prospective validation study and potential pitfalls

Atypical Sonographic Appearances of Enlarged Parathyroids

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