Pitfalls in the interpretation of parathyroid pathology

Abstract

This article briefly describes the pathology of the parathyroid gland seen commonly in routine practice and the application of recent WHO terminologies in practice. The commonest clinical presentation is hypercalcaemia due to hyperparathyroidism. Diagnosis of parathyroid lesions requires the integration of clinical, biochemical, surgical and histopathological features. MDT discussion and optimized clinical information support the pathological features. Often, histological specimens require a detailed workup including processing the entire gland, further levels and sectioning, and ancillary testing. The new WHO guidance provides a detailed genetic and molecular correlate for the histological features. Genetic and molecular pathogenetic mechanisms are described introducing new nomenclature replacing some traditional terminology. This article is not a replacement for various guidance available, it tries to resolve some routine histological conundrums. The readership is therefore encouraged to access further reading material from the WHO guidance, ICCR guidance and RCPath guidance.