Box 1 Figure 1 The embryological pathway of parathyroid migration, showing possible locations for lower parathyroid glands. negative with thyroglobulin, TTF1, PAX-8, CEA, tyrosine Privacy, Help They may occur as sporadic or as a part of hereditary syndromes. Despite frozen-section diagnos … Two of these adenomas were virtually indistinguishable visually from the normal glands. One of the following features is necessary for definitive malignancy diagnosis of parathyroid lesion: Estimated 5 year and 10 year overall survival rates are 78 - 85% and 49 - 70%, respectively (, Younger patients usually associated with familial syndromes, < 1% of cases of primary hyperparathyroidism (, Different sites of neck in which parathyroid gland can be seen such as retro-esophageal space, mediastinum, thymus and thyroid gland (, Several patients are reported associated with familial isolated hyperparathyroidism, multiple endocrine neoplasia types 1 and 2 (, Rare sporadic cases have been reported following radiation exposure and in patients with long standing secondary hyperparathyroidism (, Bone disease (osteitis fibrosa cystica, osteoporosis, fractures), Renal disease (nephrolithiasis, nephrocalcinosis), Neurocognitive symptoms (fatigue, weight loss, weakness, anxiety, depression, polyuria, polydipsia). follicular carcinoma . Parathyroid adenoma is a common benign pathology of the parathyroid gland . Abdulla S(1), Shamil E(2), Wilsher M(3), Jacob A(2). Drag here to reorder. They occur more commonly in females, with a female-to-male ratio of 3:1 to 4:1.15, 17, 26, 27 Among them are USG, CT, MRI and technetium 99m scan. Neurofibromatosis type 1 (NF1) is an autosomal dominant systemic disease that may be associated with hyperparathyroidism. So based on lab tests alone one can’t reliably distinguish between an adenoma or hyperplasia. The other three remaining parathyroid glands are normal. Immunohistochemistry. Patients present with primary hyperparathyroidism: elevated serum calcium levels and elevated serum parathyroid hormonelevels. From 80% to 85% of primary hyperparathyroidism is caused by parathyroid adenoma, followed by primary parathyroid hyperplasia (15%) and parathyroid carcinoma (5%). (2)Department of ENT Surgery, University Hospital Lewisham, London, UK. Epub 2014 Jul 9. adenoma, ‘atypical adenoma’ or carcinoma. Surgical Pathology Criteria is focused on the presentation of useful diagnostic, grading and staging criteria in an accessible format. hydroxylase. Author information: (1)School of Medical Education, King's College London, London, UK. National Library of Medicine Benign tumor that shows evidence of follicular differentiation but lacks evidence of capsular and vascular invasion and lacks papillary carcinoma nuclear features Atypical adenoma : pleomorphism, cellularity, mitotic figures or necrosis but without capsular or vascular invasion; typically considered to have benign behavior but may be precursor of anaplastic carcinoma ( … Biopsies are not included. The 4 submitted parathyroid glands (left superior and inferior, and right superior and inferior) weighed 0.27, 0.31, 0.44, and 0.34 g, respectively. Parathyroid carcinoma is an aggressive disease with a propensity for multiple recurrences. Bethesda, MD 20894, Copyright Parathyroid carcinoma, atypical parathyroid adenoma, and para-thyromatosis can be differentiated relatively easily from typical parathyroid ade-nomas, but distinguishing them from each other is more difficult. Acute hyperparathyroid crisis: ectopic submandibular parathyroid gland the culprit. Among them are USG, CT, MRI and technetium 99m scan. Pathology recheck was performed in four tu-mors and resulted in revision to the final diagnosis in two (i.e., atypical basa l cell adenoma or adeno-carcinoma rather than typi cal basal cell adenoma). The associations of some parathyroid disorders with specific genetic syndromes are also reviewed. Abundant blood flow signals on CDFI (c). A single parathyroid adenoma (PA) accounts for the overwhelming majority of cases of primary hyperparathyroidism (PHPT); 80% to 85% of cases. 2016, Saponaro et al. nodular hyperplasia. 2014-03-11 00:00:00 Parathyroid tumors can be divided in adenomas and carcinomas, usually detected by hypercalcemia. This site needs JavaScript to work properly. follicular carcinoma. depression, psychosis, delirium, coma, ataxia. BACKGROUND. Neoplasia (MEN-1) and hyperparathyroidism jaw-tumor syndrome can lead to above mentioned disease, if left untreated.11 Primary hyperparathyroidism results from parathyroid adenoma in the majority of cases (80 - 85%), followed by hyperplasia (10 - 15%), multiple adenomas (4%), atypical adenomas and parathyroid carcinomas in rare cases (< 1%).12 Y1 - 2018/4/7. C Identify parathyroid cysts, benign implants and rare metastases. A 50-year-old female presented to the … The dataset has been developed for the pathology reporting of parathyroid resection specimens when the diagnosis is atypical parathyroid neoplasm (atypical parathyroid adenoma or carcinoma. Gross pathology 4.1. Treatment. Ddx. DDx. We report a case of parathyroid adenoma in a young man, who complained of a pressure in the left neck region. nodule (lymph node, other tumours), hyperparathyroidism ( parathyroid hyperplasia, parathyroid carcinoma ), DDx of hypercalcemia. Menon P, Dayal D, Rao SG, Bhattacharya A, Narasimha Rao KL. invasion, metastasis) for carcinoma. Parathyroid adenomas versus four-gland hyperplasia as the cause of primary hyperparathyroidism in patients with prolonged lithium therapy World J Surg . Complete nuclear parafibromin loss is detected, which correlates with HRPT2 (CDC73) mutation Benign parathyroid neoplasm composed of chief cells, oncocytes or transitional oncocytes or an admixture of these cell types, Usually asymptomatic, no palpable mass and grossly smaller than parathyroid carcinoma, Serum calcium level elevated but often not as high as carcinoma, Scattered mitosis could be seen but high mitotic rate rare and usually lacks atypical mitosis, Lack of definitive diagnostic features of parathyroid carcinoma (invasion or metastases), Rare type of adenoma which exhibits some of the features of parathyroid carcinoma such as cytological atypia, mitotic activity, fibrous bands, adherence to adjacent structures, trabecular growth pattern, tumor cells within the capsule, Ancillary immunohistochemical markers could be used for differential diagnosis of parathyroid adenoma and carcinoma (, Well differentiated thyroid malignancy arising from follicular epithelial cells, Papillary or follicular growth pattern, may have colloid, typical nuclear features for papillary carcinoma, lacks well defined cytoplasmic membrane, Follicular cell neoplasm that shows limited evidence of follicular differentiation, Solid, trabecular or insular growth pattern and lacks well defined cytoplasmic membrane, Malignant neuroendocrine tumor derived from C cells of thyroid, Also lacks colloid and is positive for neuroendocrine markers and, Nonepithelial tumor originating from neural crest derived paraganglion cells, Also positive for neuroendocrine markers and, Clinical history, radiological and laboratory findings are important, Usually positive for neuroendocrine markers and. T1 - Immunohistochemistry in Diagnostic Parathyroid Pathology. Atypical parathyroid adenoma is a rare clinical entity. Immunohistochemical staining with Ki-67 shows approximately 3-4% positivity, supporting the diagnosis of atypical parathyroid adenoma. Comparison of technetium-99m-MIBI, technetium-99m-tetrofosmin, ultrasound and MRI for localization of abnormal parathyroid glands. [99m Tc-sestamibi in the diagnosis of the location of hyperparathyroidism]. (The third adenoma was found only after fixation and permanent sections.) There are 12 mitoses Parathyroid carcinomas (PC) are rare and "devastating" causes of hyperparathyroidism (HP), frequently discovered fortuitously,with not always doubtless pathological confirmation, and dissociate post-therapeutic outcomes and prognosis even after well-performed surgery. Parathyroid Adenoma. The spectrum of typical and atypical imaging appearances is presented with potential pitfalls encountered in our practice in a tertiary centre. 30100 Telegraph Road, Suite 408, Bingham Farms, Michigan 48025 (USA). Atypical parathyroid adenoma Parathyroid lesions clinically manifest themselves in the form of primary hyperparathyroidism most of the times. Sarcoma, lymphoma and metastasis are not covered in this dataset. Parathyroid glands are located in the neck, on the thyroid gland. (WC/Nephron) Endocrine atypia refers to nuclear atypia seen in normal and benign endocrine organs and is relatively common. This website is intended for pathologists and laboratory personnel but not for patients. © Copyright PathologyOutlines.com, Inc. Click, Parathyroid carcinoma[TI] free full text[sb] pathology, Lloyd RV, Osamura RY, Klöppel G, Rosai J: WHO Classification of Tumours of Endocrine Organs, Fourth Edition, 2017, Endocrinol Metab Clin North Am 2017;46:405, Mete O, Asa SL: Endocrine Pathology, First Edition, 2016, Nose V: Diagnostic Pathology Endocrine, Second Edition, 2018, Malignant neoplasm originating from parathyroid parenchymal cells, 90% of patients present with excess parathyroid hormone (PTH). On describing parathyroid gland pathology in our … 2 Department of Pathology, University of Califor-nia at San Francisco, San Francisco, California. Pathophysiology / etiology CTNNB1 and APC gene mutations can account for up to 89% of cases (Genes Chromosomes Cancer 2010;49:560) May be driven by a combination of genetic mutations, high estrogen states and antecedent trauma which leads to activation of the canonical Wnt / β catenin pathway Table 2 Anatomical pathology findings in the overall population Total population n =117 Single gland disease 110 (94.0) Typical adenoma 100 (85.5) Atypical parathyroid adenoma 10 (8.5) MGD 7 (6.0) Double typical adenoma 7 (6.0) Parathyroid hyperplasia 0 (0.0) Parathyroid carcinoma 0 (0.0) Size of parathyroid gland (mm)a 24±14 Weight of parathyroid gland (mg) 33±42. Atypical parathyroid adenomas represent a group of intermediate form of parathyroid neoplasms of uncertain malignant potential which show some atypical histological features that represent a challenge for the differential diagnosis with parathyroid carcinomas. Parathyroid neoplasms that show some histologically worrisome features but do not fulfill the more robust criteria of invasion or metastasis are classified as atypical parathyroid neoplasm (atypical parathyroid adenoma)/parathyroid neoplasm of uncertain malignant potential. Cancer. • Atypical parathyroid neoplasm (atypical parathyroid adenoma)/ neoplasm of uncertain malignant potential (UMP)* • Parathyroid carcinoma *Note: Defined as tumours that are histologically or clinically worrisome but do not fulfil the more robust criteria (i.e. Parathyroid adenoma below the inferior pole of the right lobe of thyroid. 4.2. (3)Department of Pathology, University Hospital Lewisham, London, UK. Stains. Non-secreting atypical parathyroid adenoma Poppe, K.; Pipeleers-Marichal, M.; Flamen, P.; Bossuyt, A.; Lamote, J.; Vanhaelst, L.; Velkeniers, B. Atypical presentation of oncocytic parathyroid adenoma masquerading as metastatic carcinoma. In one tumor, the recheck was due to marked de … ‘parathyroid atypical adenoma’ or ‘equivocal parathyroid adenoma’ or ‘parathyroid equivocal adenoma’ and yielded 144, 181, 70 and 56 articles, respectively, after a filtration for the use of English language in the text. Adenoma/diagnosis; Adenoma/pathology* Aged; … The final pathology report revealed cystic parathyroid tissue favoring parathyroid adenoma with focal atypia (Figure 4). Would you like email updates of new search results? no or incomplete capsule. Background: Atypical parathyroid adenoma is a rare entity that share some pathology features of parathyroid carcinoma such as fibrosis. Pathology. One of the most difficult diagnostic aspects faced by the pathologist in evaluating parathyroid is distinguishing between parathyroid adenoma, particularly atypical adenoma, and parathyroid carcinoma. Many diagnostic methods have to be used to establish the point of the abnormal locality of the parathyroid gland adenoma. 2 Department of Pathology, University of Califor-nia at San Francisco, San Francisco, California. 4.3. has papillary carcinoma nuclear features. In the postoperative period, serum calcium and intact parathyroid hormone levels were decreased as levels of 7 mg/dL and 42.6 pg/mL, respectively. We reported on the young woman … An atypical parathyroid adenoma, with some histopathological features of parathyroid carcinoma, may be found in some of the cases, although it may not fulfill all the criteria for this diagnosis. Summary. The lesion was histopathologically consistent with atypical parathyroid adenoma. increased mitotic rate (>1/10hpf) - uncommon. Please enable it to take advantage of the complete set of features! As nuclear atypia is considered a benign finding in endocrine organs, malignant diagnoses can be challenging or near impossible to render in these organs. Although rare, they pose considerable diagnostic dilemma to the pathologist. A single parathyroid adenoma (PA) accounts for the overwhelming majority of cases of primary hyperparathyroidism (PHPT); 80% to 85% of cases. Case 1. invasion, metastasis) for carcinoma Generally includes tumors that have 2 or more concerning features, such as fibrous bands, mitotic figures, necrosis, trabecular growth or adherence to surrounding tissues … The commonest neoplastic diagnosis is of an adenoma, usually single, and ‘atypical adenoma’ and carcinoma are much less common. does not compress surrounding thyroid tissue. Parathyroid tumors can be divided in adenomas and carcinomas, usually detected by hypercalcemia. Atypical parathyroid adenoma is a tumor that has characteristics both of typical adenoma and parathyroid carcinoma. Patients with parathyroid carcinoma may also have concomitant disease in other parathyroid glands, including adenoma, hyperplasia, or a second parathyroid carcinoma (1,2,8-10). They may occur as sporadic or as a part of hereditary syndromes. The … Most people have four pea-sized, oval-shaped parathyroid glands. 2003 Apr;27(4):486-8. doi: 10.1007/s00268-002-6824-4. capsular invasion. Tumor cells characterized by Recurrence portends poor outcome. Endocrine atypia in the thyroid. parathyroid adenoma. One of the following microscopic features is necessary for definitive malignancy diagnosis of parathyroid lesion: PTH levels usually > 3 times the upper limit of normal (, 3rd / 2nd generation PTH assay ratio usually > 1 (, Albumin corrected calcium levels > 3 mmol/L (85% of patients) (, Rare “nonfunctioning” parathyroid carcinomas have also been reported (, Infiltration or calcification on neck ultrasound (, Suspicion of metastatic disease on sestamibi or CT scan (, The following microscopic features have been reported with aggressive growth in some parathyroid tumors (, Older age at time of diagnosis, larger tumor size and male gender are negative prognostic factors (, Estimated 5 year and 10 year overall survival rates are 78 - 85% and 49 - 70% respectively (, 25 year old man with hyperparathyroidism symptoms and parafibromin deficient parathyroid carcinoma due to a rare germline, 59 year old man with calcitonin and calcitonin gene related peptide expressing parathyroid carcinoma (, 60 year old woman with intrathyroidal parathyroid carcinoma (, 61 year old man with multiple endocrine neoplasm type 1 syndrome (, 63 year old man with atypical thyroid nodule and symptomatic hypercalcemia (, 67 year old man with nonfunctioning parathyroid carcinoma (, En bloc resection with ipsilateral hemithyroidectomy and central lymphadenectomy (, Benefits of adjuvant therapy (chemotherapy and radiotherapy) unclear (, Typically large, variably encapsulated, poorly circumscribed mass (, Mean diameter of 3.4 cm and weight of 19.2 g (, Cut section usually firm, pinkish-tan and lobular appearance (, Variable, sometimes indistinguishable from parathyroid adenoma (, The distinction between parathyroid adenoma and carcinoma is often difficult to make on frozen section if the tumor does not show grossly evident invasion into adjacent structures, Uniform cells or mild to moderate nuclear atypia, Mostly composed of chief cells; however, oxyphil cells and transitional cells can also be seen, Increased mitotic activity (> 5/50 HPF) and atypical mitosis may be seen, One of the following features is necessary for definitive malignancy diagnosis of parathyroid lesion, Cellular, composed of cohesive sheets, ribbon-like cords, Nuclei are uniform or show mild to moderate atypia, Cytoplasm is moderately abundant and granular, Distinction between parathyroid carcinoma and adenoma is extremely difficult to make on cytology; nuclear pleomorphism, prominent macronucleoli, enlarged uniform hyperchromatic nuclei, mitotic figures favor carcinoma (. Childhood parathyroid adenoma: a rare but important cause of nephrolithiasis. Clin. We report a case of parathyroid adenoma in a young man, who complained of a pressure in the left neck region. The most common place of the ectopia is the thymus. A parathyroid adenoma is a benign tumor that develops inside a parathyroid gland and continually grows. We reported an atypical parathyroid adenoma accompanied by severe hypercalcemia and hyperparathyroidism. Download Citation | Pathology of the Parathyroid Glands | The parathyroid glands act as primary regulator of calcium homeostasis through secretion of parathyroid hormone. Careers. The most common place of the ectopia is the thymus. No dataset is utilized for parathyroid hyperplasia or parathyroid adenoma of usual type. Pleomorphic adenoma may show various architectural and cytologic features that resemble other salivary tumors. encapsulated follicular variant of papillary carcinoma. It is characterized by capsular, vascular, and soft-tissue invasion. increased mitotic rate (>1/10 hpf) - uncommon. Both parathyroid adenoma and hyperplasia can present with elevations of calcium & PTH, they can also present as normocalcemic HPT or normohormonal HPT. 15 This is often accompanied by renal and bone involvement. No dataset is utilized for parathyroid hyperplasia or parathyroid adenoma of usual type. Note: Adenomas likely need to show more than just one abnormal feature to be designated as 'atypical', with some suggesting 2+ to qualify for a diagnosis. Parathyroid hyperplasia is an abnormal proliferation of the parathyroid glands and a relatively common cause of hyperparathyroidism that … Atypical parathyroid adenomas represent a group of intermediate form of parathyroid neoplasms of uncertain malignant potential which show some atypical histological features that represent a challenge for the differential diagnosis with parathyroid carcinomas. Parathyroid lesions clinically manifest themselves in the form of primary hyperparathyroidism most of the times. The atypical location of the adenoma of the parathyroid gland occurs not frequently. Physical … Lesions associated with this metabolic disorder, including adenoma, atypical adenoma, carcinoma, and hyperplasia, are discussed. FOIA PTH is a great stain to determine the parathyroid nature of … follicular adenoma pathology pathology in outline format with mouse over histology previews. Atypical parathyroid adenoma Rare type of adenoma which exhibits some of the features of parathyroid carcinoma such as cytological atypia, mitotic activity, fibrous bands, adherence to adjacent structures, trabecular growth pattern, tumor cells within the capsule carcinoma, oxyphilic type. Morphological and Atypical parathyroid adenomas represent a group of intermediate form of parathyroid neoplasms of uncertain malignant potential which show some atypical histological features that represent a challenge for the differential diagnosis with parathyroid carcinomas. They may occur as sporadic or as a part of hereditary syndromes. Lymphatic and vascular invasion are also seen. No remarkable gross features were apparent. Here we report a patient with the unusual coexistence of parathyroid carcinoma, parathyroid adenoma, and papillary thyroid carcinoma. They are usually oval or bean-shaped, but larger adenomas can be multilobulated. A clinicopathologic and DNA flow cytometric study was performed on seven patients (three males, four females) with atypical adenoma of the thyroid gland, using formalin‐fixed paraffin‐embedded tissues. Although Ca (9.7 mg/dl), phosphorus (3.3 mg/dl) and intact-PTH (49 pg/ml) were normal, imaging … They occur more commonly in females, with a female-to-male ratio of 3:1 to 4:1.15, 17, 26, 27 Atypical parathyroid adenoma with diffuse fibrosis. This results in multisystem effects including osteoporosis, renal calculi, constipation, peptic ulcers, mental changes, fatigue, and depression. Although rare, they pose considerable diagnostic dilemma to the pathologist. However, we cannot answer medical or research questions or give advice. J Pediatr Endocrinol Metab. Comment: There is a cellular malignant tumor with thyroid gland and The nodule was negative on planar images and Tc-99m MIBI SPECT/CT (d, e). BACKGROUND. Adrenal gland - see pheochromocytoma. Case 2 . N2 - Pathologists are usually readily able to diagnose parathyroid tissues and diseases, particularly when they have knowledge of the clinical information, laboratory findings, and radiographic imaging studies. AU - Mete, Ozgur. Atypical histologic features are commonly found in children, making adrenal cortical adenomas difficult to distinguish from adrenal cortical carcinoma Laboratory Battery of endocrine tests usually within normal limits, although a minority may have subclinical hormone production with slight abnormalities These laboratory results were consistent with 3. surgical removal of all parathyroid glands & re-implantation of half of one parathyroid in the forearm. (WC/Nephron) Endocrine atypia refers to nuclear atypia seen in normal and benign endocrine organs and is relatively common. Figure 1: gross pathology Figure 1: gross pathology. calcitonin+. The diagnosis is reached by excluding with strict methods the presence of malignancy criteria. Little is known about the clinical behavior of atypical parathyroid adenomas. PTH, GATA3, chromogranin-A and synaptophysin while they are Clipboard, Search History, and several other advanced features are temporarily unavailable. immunohistochemical features strongly support parathyroid Case 3. This review focuses on the pathology of parathyroid in hyperparathyroidism. Result: 27 year old female presented … Immunohistochemically the tumor cells show strong expression of Adrenal gland - see pheochromocytoma. per 50 high powered fields, some of which show atypical features. Although rare, they pose considerable diagnostic dilemma to … uniform cytology; variants. 2021 Jan;103(1):e7-e9. eosinophilic cytoplasm, nuclear enlargement with distinctive Accessibility Hurthle cell adenoma; atypical adenoma; toxic adenoma. One of the most difficult diagnostic aspects faced by the pathologist in evaluating parathyroid is distinguishing between parathyroid adenoma, particularly atypical adenoma, and parathyroid carcinoma. Parathyroid specific markers: PTH, PTH related peptide, Complete nuclear or nucleolar loss of parafibromin has shown strong association with, Additional molecular alterations (nonspecific) also found, Parathyroid carcinoma, oxyphilic type (see comment). Parathyroid lesions clinically manifest themselves in the form of primary hyperparathyroidism most of the times. Tumors of the Parathyroid Gland. However, the appearance of parathyroid gland enlargement and pathology can be varied and the radiologist should be aware of the spectrum of atypical presentations highlighted in this paper. excised parathyroid glands represent hyperplasia or neoplasia. doi: 10.1308/rcsann.2020.0183. Many markers have and continue to be evaluated for diagnostic utility, and are even beginning to be studied for prognostic utility. Multiple atypical adenomas are even less frequent. 2018). Parathyroid carcinoma typically presents with a palpable neck mass, as well as a more profound hypercalcaemia (>3.5 mmol/L or >14 mg/dL) and primary hyperparathyroidism (3–15 times the normal upper limit) compared with benign disease. nodular hyperplasia. The vast majority (up to 87% 2) ... Adenoma of parathyroid glands; ADVERTISEMENT: Supporters see fewer/no ads. Pathology showed a mixed picture consistent with possible atypical adenoma versus parathyroid carcinoma. METHODS. Parathyroid adenoma constitutes one of the important causes of the same. These lesions lack unequivocal invasion . Atypical parathyroid adenoma compared to typical adenoma … As nuclear atypia is considered a benign finding in endocrine organs, malignant diagnoses can be challenging or near impossible to render in these organs. Background: Primary hyperparathyroidism occurs as a result of isolated parathyroid adenoma in 80% to 85% of all cases. Prevention and treatment information (HHS). The same mass was surgically excised and histopathological features are discussed in this report. Clark CM(1), Payne SJ, Warrick JI, Goldenberg D. Author information: (1)Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA. Molecular markers, Ki-67 and p27, may distinguish parathyroid carcinoma from adenoma. The atypical location of the adenoma of the parathyroid gland occurs not frequently. and also familial and sporadic parathyroid carcinoma. Severe hypercalcemia due to cystic atypical parathyroid adenoma is rare entity. 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. 2016 Jul 1;29(7):853-6. doi: 10.1515/jpem-2015-0369. 2014 Dec 1;120(23):3602-16. doi: 10.1002/cncr.28891. We welcome suggestions or questions about using the website. A very rare condition, detection of atypical adenomas in four of the parathyroid glands by dual phase Tc-99m MIBI SPECT, is presented in this case. Atypical parathyroid neoplasm is defined as a tumor that is histologically or clinically worrisome but does not fulfill the more robust criteria (i.e. Ishibashi M, Nishida H, Hiromatsu Y, Kojima K, Tabuchi E, Hayabuchi N. Ann R Coll Surg Engl. Many diagnostic methods have to be used to establish the point of the abnormal locality of the parathyroid gland adenoma. Cases and figures. In the past 11 years we have operated on three patients with "tiny" parathyroid adenomas (less than 60 mg). 8600 Rockville Pike Atypical adenoma: contains borderline features concerning for (but not diagnostic of) malignancy (Surg Pathol Clin 2019;12:1007) Dense fibrous bands with hemosiderin Prominent nuclear atypia with spindled nuclei Notable mitotic activity Adherence to adjacent tissue Necrosis Solid or trabecular growth
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