Parathyroid

The Pathology of Hyperparathyroidism
Published:October 06, 2014DOI:https://doi.org/10.1016/j.path.2014.08.004

      Abstract

      This review focuses on the pathologic entities associated with hyperparathyroidism in humans. A discussion of the lesions, their embryology, and pathologic features is included. Immunohistology, cytopathology, and a brief overview of molecular aspects of the lesion are included.

      Keywords

      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Surgical Pathology Clinics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Westra W.H.
        • Pritchett D.D.
        • Udelsman R.
        Intraoperative confirmation of parathyroid tissue during parathyroid exploration: a retrospective evaluation of the frozen section.
        Am J Surg Pathol. 1998; 22: 538-544
        • Baloch Z.W.
        • LiVolsi V.A.
        Intraoperative assessment of thyroid and parathyroid lesions.
        Semin Diagn Pathol. 2002; 19: 219-226
        • Baloch Z.W.
        • LiVolsi V.A.
        Pathology of the parathyroid glands in hyperparathyroidism.
        Semin Diagn Pathol. 2013; 30: 165-177
        • Morris L.F.
        • Zanocco K.
        • Ituarte P.H.
        • et al.
        The value of intraoperative parathyroid hormone monitoring in localized primary hyperparathyroidism: a cost analysis.
        Ann Surg Oncol. 2010; 17: 679-685
        • Roth S.I.
        • Faquin W.C.
        The pathologist's intraoperative role during parathyroid surgery.
        Arch Pathol Lab Med. 2003; 127: 15
        • Alwaheeb S.
        • Rambaldini G.
        • Boerner S.
        • et al.
        Worrisome histologic alterations following fine-needle aspiration of the parathyroid.
        J Clin Pathol. 2006; 59: 1094-1096
        • Carpenter J.M.
        • Michaelson P.G.
        • Lidner T.K.
        • et al.
        Parathyromatosis.
        Ear Nose Throat J. 2007; 86: 21
        • Akerstrom G.
        • Rudberg C.
        • Grimelius L.
        • et al.
        Histologic parathyroid abnormalities in an autopsy series.
        Hum Pathol. 1986; 17: 520-527
        • Roth S.I.
        • Gallagher M.J.
        The rapid identification of “normal” parathyroid glands by the presence of intracellular fat.
        Am J Pathol. 1976; 84: 521-528
        • Wang C.A.
        • Rieder S.V.
        A density test for the intraoperative differentiation of parathyroid hyperplasia from neoplasia.
        Ann Surg. 1978; 187: 63-67
        • Miccoli P.
        • Bendinelli C.
        • Berti P.
        • et al.
        Video-assisted versus conventional parathyroidectomy in primary hyperparathyroidism: a prospective randomized study.
        Surgery. 1999; 126 ([discussion: 1121–2]): 1117-1121
        • Greene A.B.
        • Butler R.S.
        • McIntyre S.
        • et al.
        National trends in parathyroid surgery from 1998 to 2008: a decade of change.
        J Am Coll Surg. 2009; 209: 332-343
        • Monchik J.M.
        • Barellini L.
        • Langer P.
        • et al.
        Minimally invasive parathyroid surgery in 103 patients with local/regional anesthesia, without exclusion criteria.
        Surgery. 2002; 131: 502-508
        • Udelsman R.
        Primary hyperparathyroidism.
        Curr Treat Options Oncol. 2001; 2: 365-372
        • Irvin 3rd, G.L.
        • Deriso 3rd, G.T.
        A new, practical intraoperative parathyroid hormone assay.
        Am J Surg. 1994; 168: 466-468
        • Grimelius L.
        • Akerstrom G.
        • Johansson H.
        • et al.
        Anatomy and histopathology of human parathyroid glands.
        Pathol Annu. 1981; 16: 1-24
        • Hunt P.S.
        • Poole M.
        • Reeve T.S.
        A reappraisal of the surgical anatomy of the thyroid and parathyroid glands.
        Br J Surg. 1968; 55: 63-66
        • Butterworth P.C.
        • Nicholson M.L.
        Surgical anatomy of the parathyroid glands in secondary hyperparathyroidism.
        J R Coll Surg Edinb. 1998; 43: 271-273
        • Thompson N.W.
        • Eckhauser F.E.
        • Harness J.K.
        The anatomy of primary hyperparathyroidism.
        Surgery. 1982; 92: 814-821
        • Lengele B.
        • Hamoir M.
        Anatomy and embryology of the parathyroid glands.
        Acta Otorhinolaryngol Belg. 2001; 55: 89-93
        • Reddick R.L.
        • Costa J.C.
        • Marx S.J.
        Parathyroid hyperplasia and parathyromatosis.
        Lancet. 1977; 1: 549
        • Akerstrom G.
        • Malmaeus J.
        • Grimelius L.
        • et al.
        Histological changes in parathyroid glands in subclinical and clinical renal disease. An autopsy investigation.
        Scand J Urol Nephrol. 1984; 18: 75-84
        • Dufour D.R.
        • Wilkerson S.Y.
        The normal parathyroid revisited: percentage of stromal fat.
        Hum Pathol. 1982; 13: 717-721
        • Dekker A.
        • Dunsford H.A.
        • Geyer S.J.
        The normal parathyroid gland at autopsy: the significance of stromal fat in adult patients.
        J Pathol. 1979; 128: 127-132
        • Dufour D.R.
        • Durkowski C.
        Sudan IV stain. Its limitations in evaluating parathyroid functional status.
        Arch Pathol Lab Med. 1982; 106: 224-227
        • Kebebew E.
        • Hwang J.
        • Reiff E.
        • et al.
        Predictors of single-gland vs multigland parathyroid disease in primary hyperparathyroidism: a simple and accurate scoring model.
        Arch Surg. 2006; 141 ([discussion: 782]): 777-782
        • Awad S.S.
        • Miskulin J.
        • Thompson N.
        Parathyroid adenomas versus four-gland hyperplasia as the cause of primary hyperparathyroidism in patients with prolonged lithium therapy.
        World J Surg. 2003; 27: 486-488
        • Yeh M.W.
        • Barraclough B.M.
        • Sidhu S.B.
        • et al.
        Two hundred consecutive parathyroid ultrasound studies by a single clinician: the impact of experience.
        Endocr Pract. 2006; 12: 257-263
        • Graff-Baker A.
        • Roman S.A.
        • Boffa D.
        • et al.
        Diagnosis of ectopic middle mediastinal parathyroid adenoma using endoscopic ultrasonography-guided fine-needle aspiration with real-time rapid parathyroid hormone assay.
        J Am Coll Surg. 2009; 209: e1-e4
        • Ogus M.
        • Mayir B.
        • Dinckan A.
        Mediastinal, cystic and functional parathyroid adenoma in patients with double parathyroid adenomas: a case report.
        Acta Chir Belg. 2006; 106: 736-738
        • Pitsilos S.A.
        • Weber R.
        • Baloch Z.
        • et al.
        Ectopic parathyroid adenoma initially suspected to be a thyroid lesion.
        Arch Pathol Lab Med. 2002; 126: 1541-1542
        • Salem C.
        • Massiani M.A.
        • Bazot M.
        • et al.
        Retrotracheal cystic mass in the mediastinum.
        Rev Pneumol Clin. 2002; 58 ([in French]): 226-231
        • Tublin M.E.
        • Yim J.H.
        • Carty S.E.
        Recurrent hyperparathyroidism secondary to parathyromatosis: clinical and imaging findings.
        J Ultrasound Med. 2007; 26: 847-851
        • Baloch Z.W.
        • Fraker D.
        • LiVolsi V.A.
        Parathyromatosis as cause of recurrent secondary hyperparathyroidism: a cytologic diagnosis.
        Diagn Cytopathol. 2001; 25: 403-405
        • Ljungberg T.
        • Ungerstedt U.
        Evidence that the different properties of haloperidol and clozapine are not explained by differences in anticholinergic potency.
        Psychopharmacology. 1979; 60: 303-307
        • Bondeson A.G.
        • Bondeson L.
        • Ljungberg O.
        • et al.
        Fat staining in parathyroid disease–diagnostic value and impact on surgical strategy: clinicopathologic analysis of 191 cases.
        Hum Pathol. 1985; 16: 1255-1263
        • Kasdon E.J.
        • Rosen S.
        • Cohen R.B.
        • et al.
        Surgical pathology of hyperparathyroidism. Usefulness of fat stain and problems in interpretation.
        Am J Surg Pathol. 1981; 5: 381-384
        • Cinti S.
        • Sbarbati A.
        Ultrastructure of human parathyroid cells in health and disease.
        Microsc Res Tech. 1995; 32: 164-179
      1. DeLellis R.A. Tumors of parathyroid gland. Armed Forces Institute of Pathology, Washington, DC1993
        • Livolsi V.A.
        • Feind C.R.
        Incidental medullary thyroid carcinoma in sporadic hyperparathyroidism. An expansion of the concept of C-cell hyperplasia.
        Am J Clin Pathol. 1979; 71: 595-599
        • Arnold A.
        • Shattuck T.M.
        • Mallya S.M.
        • et al.
        Molecular pathogenesis of primary hyperparathyroidism.
        J Bone Miner Res. 2002; 17: N30-N36
        • Bakker B.
        • van der Eerden B.C.
        • Koppenaal D.W.
        • et al.
        Effect of x-irradiation on growth and the expression of parathyroid hormone-related peptide and Indian hedgehog in the tibial growth plate of the rat.
        Horm Res. 2003; 59: 35-41
        • Boehm B.O.
        • Rosinger S.
        • Belyi D.
        • et al.
        The parathyroid as a target for radiation damage.
        N Engl J Med. 2011; 365: 676-678
        • Hendy G.N.
        Molecular mechanisms of primary hyperparathyroidism.
        Rev Endocr Metab Disord. 2000; 1: 297-305
      2. Castleman B. Roth S.I. Tumors of the parathyroid glands. Armed Forces Institute of Pathology, Washington, DC1978
        • Marcocci C.
        • Cetani F.
        Clinical practice. Primary hyperparathyroidism.
        N Engl J Med. 2011; 365: 2389-2397
        • Woolner L.B.
        • Keating Jr., F.R.
        • Black B.M.
        Tumors and hyperplasia of the parathyroid glands; a review of the pathological findings in 140 cases of primary hyperparathyroidism.
        Cancer. 1952; 5: 1069-1088
        • Gooding G.A.
        • Duh Q.Y.
        Primary hyperparathyroidism: functioning hemorrhagic parathyroid cyst.
        J Clin Ultrasound. 1997; 25: 82-84
        • Prinz R.A.
        • Lonchyna V.
        • Carnaille B.
        • et al.
        Thoracoscopic excision of enlarged mediastinal parathyroid glands.
        Surgery. 1994; 116 ([discussion: 1004–5]): 999-1004
        • Bedetti C.D.
        • Dekker A.
        • Watson C.G.
        Functioning oxyphil cell adenoma of the parathyroid gland: a clinicopathologic study of ten patients with hyperparathyroidism.
        Hum Pathol. 1984; 15: 1121-1126
        • Schantz A.
        • Castleman B.
        Parathyroid carcinoma. A study of 70 cases.
        Cancer. 1973; 31: 600-605
        • Snover D.C.
        • Foucar K.
        Mitotic activity in benign parathyroid disease.
        Am J Clin Pathol. 1981; 75: 345-347
        • Sanjuan X.
        • Bryant B.R.
        • Sobel M.E.
        • et al.
        Clonality analysis of benign parathyroid lesions by human androgen receptor (HUMARA) gene assay.
        Endocr Pathol. 1998; 9: 293-300
        • Tokumoto M.
        • Tsuruya K.
        • Fukuda K.
        • et al.
        Reduced p21, p27 and vitamin D receptor in the nodular hyperplasia in patients with advanced secondary hyperparathyroidism.
        Kidney Int. 2002; 62: 1196-1207
        • Alo P.L.
        • Visca P.
        • Mazzaferro S.
        • et al.
        Immunohistochemical study of fatty acid synthase, Ki67, proliferating cell nuclear antigen, and p53 expression in hyperplastic parathyroids.
        Ann Diagn Pathol. 1999; 3: 287-293
        • Lloyd R.V.
        • Carney J.A.
        • Ferreiro J.A.
        • et al.
        Immunohistochemical analysis of the cell cycle-associated antigens Ki-67 and retinoblastoma protein in parathyroid carcinomas and adenomas.
        Endocr Pathol. 1995; 6: 279-287
        • Varma D.
        • Nigam S.
        • Singhal N.
        • et al.
        A report of two cases of Hashimoto's thyroiditis and synchronous parathyroid adenoma.
        Indian J Pathol Microbiol. 2006; 49: 635-636
        • Ebrahimi H.
        • Edhouse P.
        • Lundgren C.I.
        • et al.
        Does autoimmune thyroid disease affect parathyroid autotransplantation and survival?.
        ANZ J Surg. 2009; 79: 383-385
        • Auger M.
        • Charbonneau M.
        • Huttner I.
        Unsuspected intrathyroidal parathyroid adenoma: mimic of lymphocytic thyroiditis in fine-needle aspiration specimens-a case report.
        Diagn Cytopathol. 1999; 21: 276-279
        • Gittes R.F.
        Experimental autoimmune thyroiditis in transplanted isologous tissue and attempts to produce parathyroid lesions.
        Clin Exp Immunol. 1966; 1: 297-306
        • Tezelman S.
        • Shen W.
        • Shaver J.K.
        • et al.
        Double parathyroid adenomas. Clinical and biochemical characteristics before and after parathyroidectomy.
        Ann Surg. 1993; 218 ([discussion: 307–9]): 300-307
        • Harness J.K.
        • Ramsburg S.R.
        • Nishiyama R.H.
        • et al.
        Multiple adenomas of the parathyroids: do they exist?.
        Arch Surg. 1979; 114: 468-474
        • Mitchell J.
        • Milas M.
        • Barbosa G.
        • et al.
        Avoidable reoperations for thyroid and parathyroid surgery: effect of hospital volume.
        Surgery. 2008; 144 ([discussion: 906–7]): 899-906
        • Sharma J.
        • Milas M.
        • Berber E.
        • et al.
        Value of intraoperative parathyroid hormone monitoring.
        Ann Surg Oncol. 2008; 15: 493-498
        • DeLellis R.A.
        • Lloyd R.D.
        • Heitz P.U.
        • et al.
        WHO: pathology and genetics.
        in: Kleihues P. Sobin L.E. Tumours of endocrine organs. IARC Press, Lyon (France)2004: 493-498
        • Stojadinovic A.
        • Hoos A.
        • Nissan A.
        • et al.
        Parathyroid neoplasms: clinical, histopathological, and tissue microarray-based molecular analysis.
        Hum Pathol. 2003; 34: 54-64
        • Fernandez-Ranvier G.G.
        • Khanafshar E.
        • Jensen K.
        • et al.
        Parathyroid carcinoma, atypical parathyroid adenoma, or parathyromatosis?.
        Cancer. 2007; 110: 255-264
        • Agrawal R.
        • Agarwal A.
        • Kar D.K.
        • et al.
        Parathyroid carcinoma.
        J Assoc Physicians India. 2001; 49: 990-993
        • Bell W.C.
        Surgical pathology of the parathyroid glands.
        Adv Exp Med Biol. 2005; 563: 1-9
        • Beus K.S.
        • Stack Jr., B.C.
        Parathyroid carcinoma.
        Otolaryngol Clin North Am. 2004; 37: 845-854
        • Bornstein-Quevedo L.
        • Gamboa-Dominguez A.
        • Angeles-Angeles A.
        • et al.
        Histologic diagnosis of primary hyperparathyroidism: a concordance analysis between three pathologists.
        Endocr Pathol. 2001; 12: 49-54
        • Busaidy N.L.
        • Jimenez C.
        • Habra M.A.
        • et al.
        Parathyroid carcinoma: a 22-year experience.
        Head Neck. 2004; 26: 716-726
        • Owen R.P.
        • Silver C.E.
        • Pellitteri P.K.
        • et al.
        Parathyroid carcinoma: a review.
        Head Neck. 2011; 33: 429-436
        • Fang S.H.
        • Lal G.
        Parathyroid cancer.
        Endocr Pract. 2011; 17: 36-43
        • Erickson L.A.
        • Jin L.
        • Papotti M.
        • et al.
        Oxyphil parathyroid carcinomas: a clinicopathologic and immunohistochemical study of 10 cases.
        Am J Surg Pathol. 2002; 26: 344-349
        • Abdelgadir Adam M.
        • Untch B.R.
        • Olson Jr., J.A.
        Parathyroid carcinoma: current understanding and new insights into gene expression and intraoperative parathyroid hormone kinetics.
        Oncologist. 2010; 15: 61-72
        • Botea V.
        • Edelson G.W.
        • Munasinghe R.L.
        Hyperparathyroidism, hypercalcemia, and calcified brain metastatic lesions in a patient with small cell carcinoma demonstrating positive immunostain for parathyroid hormone.
        Endocr Pract. 2003; 9: 40-44
        • Carlson D.
        Parathyroid pathology: hyperparathyroidism and parathyroid tumors.
        Arch Pathol Lab Med. 2010; 134: 1639-1644
        • Carpten J.D.
        • Robbins C.M.
        • Villablanca A.
        • et al.
        HRPT2, encoding parafibromin, is mutated in hyperparathyroidism-jaw tumor syndrome.
        Nat Genet. 2002; 32: 676-680
        • Bradley K.J.
        • Cavaco B.M.
        • Bowl M.R.
        • et al.
        Parafibromin mutations in hereditary hyperparathyroidism syndromes and parathyroid tumours.
        Clin Endocrinol. 2006; 64: 299-306
        • Gill A.J.
        • Clarkson A.
        • Gimm O.
        • et al.
        Loss of nuclear expression of parafibromin distinguishes parathyroid carcinomas and hyperparathyroidism-jaw tumor (HPT-JT) syndrome-related adenomas from sporadic parathyroid adenomas and hyperplasias.
        Am J Surg Pathol. 2006; 30: 1140-1149
        • Tan M.H.
        • Morrison C.
        • Wang P.
        • et al.
        Loss of parafibromin immunoreactivity is a distinguishing feature of parathyroid carcinoma.
        Clin Cancer Res. 2004; 10: 6629-6637
        • Rozenblatt-Rosen O.
        • Hughes C.M.
        • Nannepaga S.J.
        • et al.
        The parafibromin tumor suppressor protein is part of a human Paf1 complex.
        Mol Cell Biol. 2005; 25: 612-620
        • Farber L.J.
        • Kort E.J.
        • Wang P.
        • et al.
        The tumor suppressor parafibromin is required for posttranscriptional processing of histone mRNA.
        Mol Carcinog. 2010; 49: 215-223
        • Wang O.
        • Wang C.
        • Nie M.
        • et al.
        Novel HRPT2/CDC73 gene mutations and loss of expression of parafibromin in Chinese patients with clinically sporadic parathyroid carcinomas.
        PLoS One. 2012; 7: e45567
        • DeLellis R.A.
        • Mazzaglia P.
        • Mangray S.
        Primary hyperparathyroidism: a current perspective.
        Arch Pathol Lab Med. 2008; 132: 1251-1262
        • DeLellis R.A.
        The neuroendocrine system and its tumors: an overview.
        Am J Clin Pathol. 2001; 115: S5-S16
        • Karges W.
        • Jostarndt K.
        • Maier S.
        • et al.
        Multiple endocrine neoplasia type 1 (MEN1) gene mutations in a subset of patients with sporadic and familial primary hyperparathyroidism target the coding sequence but spare the promoter region.
        J Endocrinol. 2000; 166: 1-9
        • Dwarakanathan A.A.
        • Zwart S.
        • Oathus R.C.
        Isolated familial hyperparathyroidism with a novel mutation of the MEN1 gene.
        Endocr Pract. 2000; 6: 268-270
        • Chaitin B.A.
        • Goldman R.L.
        Mitotic activity in benign parathyroid disease.
        Am J Clin Pathol. 1981; 76: 363-364
        • Agarwal G.
        • Barraclough B.H.
        • Reeve T.S.
        • et al.
        Minimally invasive parathyroidectomy using the ‘focused' lateral approach. II. Surgical technique.
        ANZ J Surg. 2002; 72: 147-151
        • Alveryd A.
        Parathyroid glands in thyroid surgery. I. Anatomy of parathyroid glands. II. Postoperative hypoparathyroidism–identification and autotransplantation of parathyroid glands.
        Acta Chir Scand. 1968; 389: 1-120
        • Calo P.G.
        • Pisano G.
        • Loi G.
        • et al.
        Surgery for primary hyperparathyroidism in patients with preoperatively negative sestamibi scan and discordant imaging studies: the usefulness of intraoperative parathyroid hormone monitoring.
        Clin Med Insights Endocrinol Diabetes. 2013; 6: 63-67
        • Tominaga Y.
        • Grimelius L.
        • Johansson H.
        • et al.
        Histological and clinical features of non-familial primary parathyroid hyperplasia.
        Pathol Res Pract. 1992; 188: 115-122
        • Absher K.J.
        • Truong L.D.
        • Khurana K.K.
        • et al.
        Parathyroid cytology: avoiding diagnostic pitfalls.
        Head Neck. 2002; 24: 157-164
        • Sheldon H.
        On the water-clear cell in the human parathyroid gland.
        J Ultrastruct Res. 1964; 10: 377-383
        • Stout Jr., L.C.
        Water-clear-cell hyperplasia mimicking parathyroid adenoma.
        Hum Pathol. 1985; 16: 1075-1076
        • Malmaeus J.
        • Grimelius L.
        • Johansson H.
        • et al.
        Parathyroid pathology in hyperparathyroidism secondary to chronic renal failure.
        Scand J Urol Nephrol. 1984; 18: 157-166
        • Jimeno J.
        • Perez M.
        • Pereira J.A.
        • et al.
        Surgical treatment of recurrent secondary hyperparathyroidism.
        Cir Esp. 2005; 78 ([in Spanish]): 34-38
        • Silver J.
        • Kilav R.
        • Naveh-Many T.
        Mechanisms of secondary hyperparathyroidism.
        Am J Phys. 2002; 283: F367-F376
        • Goodman W.G.
        Calcimimetic agents and secondary hyperparathyroidism: treatment and prevention.
        Nephrol Dial Transplant. 2002; 17: 204-207
        • Falvo L.
        • Catania A.
        • Sorrenti S.
        • et al.
        Relapsing secondary hyperparathyroidism due to multiple nodular formations after total parathyroidectomy with autograft.
        Am Surg. 2003; 69: 998-1002
        • Eid W.
        • Wheeler T.M.
        • Sharma M.D.
        Recurrent hypercalcemia due to ectopic production of parathyroid hormone-related protein and intact parathyroid hormone in a single patient with multiple malignancies.
        Endocr Pract. 2004; 10: 125-128
        • Yamasaki K.
        Pathology of renal secondary hyperparathyroidism in mice.
        Jikken Dobutsu. 1986; 35: 93-96
        • Dorenbeck U.
        • Leingartner T.
        • Bretschneider T.
        • et al.
        Tentorial and dural calcification with tertiary hyperparathyroidism: a rare entity in chronic renal failure.
        Eur Radiol. 2002; 12: S11-S13
        • Rivkees S.A.
        • el-Hajj-Fuleihan G.
        • Brown E.M.
        • et al.
        Tertiary hyperparathyroidism during high phosphate therapy of familial hypophosphatemic rickets.
        J Clin Endocrinol Metab. 1992; 75: 1514-1518
        • Sharma J.
        • Bajpai A.
        • Kabra M.
        • et al.
        Hypocalcemia clinical, biochemical, radiological profile and follow-up in a tertiary hospital in India.
        Indian Pediatr. 2002; 39: 276-282
        • Jarnagin W.R.
        • Clark O.H.
        Mediastinal parathyroid cyst causing persistent hyperparathyroidism: case report and review of the literature.
        Surgery. 1998; 123: 709-711
        • Fortson J.K.
        • Patel V.G.
        • Henderson V.J.
        Parathyroid cysts: a case report and review of the literature.
        Laryngoscope. 2001; 111: 1726-1728
        • Ippolito G.
        • Palazzo F.F.
        • Sebag F.
        • et al.
        A single-institution 25-year review of true parathyroid cysts.
        Langenbecks Arch Surg. 2006; 391: 13-18
        • Mallette L.E.
        • Malini S.
        • Rappaport M.P.
        • et al.
        Familial cystic parathyroid adenomatosis.
        Ann Intern Med. 1987; 107: 54-60
        • Villablanca A.
        • Farnebo F.
        • Teh B.T.
        • et al.
        Genetic and clinical characterization of sporadic cystic parathyroid tumours.
        Clin Endocrinol. 2002; 56: 261-269
        • Palmer J.A.
        • Brown W.A.
        • Kerr W.H.
        • et al.
        The surgical aspects of hyperparathyroidism.
        Arch Surg. 1975; 110: 1004-1007
        • Fitko R.
        • Roth S.I.
        • Hines J.R.
        • et al.
        Parathyromatosis in hyperparathyroidism.
        Hum Pathol. 1990; 21: 234-237
        • Lee P.C.
        • Mateo R.B.
        • Clarke M.R.
        • et al.
        Parathyromatosis: a cause for recurrent hyperparathyroidism.
        Endocr Pract. 2001; 7: 189-192
        • Lentsch E.J.
        • Withrow K.P.
        • Ackermann D.
        • et al.
        Parathyromatosis and recurrent hyperparathyroidism.
        Arch Otolaryngol Head Neck Surg. 2003; 129: 894-896
        • Bisceglia M.
        • Spagnolo D.
        • Galliani C.
        • et al.
        Tumoral, quasitumoral and pseudotumoral lesions of the superficial and somatic soft tissue: new entities and new variants of old entities recorded during the last 25 years. Part XII: appendix.
        Pathologica. 2006; 98: 239-298
        • Weiland L.H.
        • Garrison R.C.
        • ReMine W.H.
        • et al.
        Lipoadenoma of the parathyroid gland.
        Am J Surg Pathol. 1978; 2: 3-7
        • Turner W.J.
        • Baergen R.N.
        • Pellitteri P.K.
        • et al.
        Parathyroid lipoadenoma: case report and review of the literature.
        Otolaryngol Head Neck Surg. 1996; 114: 313-316
        • Ogrin C.
        A rare case of double parathyroid lipoadenoma with hyperparathyroidism.
        Am J Med Sci. 2013; 346: 432-434
        • Johnson N.
        • Serpell J.W.
        • Johnson W.R.
        • et al.
        Parathyroid lipoadenoma.
        ANZ J Surg. 2013; ([Epub ahead of print])
        • Drickman A.
        Metastatic carcinoma involving the parathyroid glands. Report of two cases and a short review of the literature.
        Arch Surg. 1961; 82: 576-578
        • Fulciniti F.
        • Pezzullo L.
        • Chiofalo M.G.
        • et al.
        Metastatic breast carcinoma to parathyroid adenoma on fine needle cytology sample: report of a case.
        Diagn Cytopathol. 2011; 39: 681-685
        • Gattuso P.
        • Khan N.A.
        • Jablokow V.R.
        • et al.
        Neoplasms metastatic to parathyroid glands.
        South Med J. 1988; 81: 1467
        • Lee H.E.
        • Kim D.H.
        • Cho Y.H.
        • et al.
        Tumor-to-tumor metastasis: hepatocellular carcinoma metastatic to parathyroid adenoma.
        Pathol Int. 2011; 61: 593-597
        • Margolis C.I.
        • Goldenberg V.E.
        Breast carcinoma metastatic to parathyroid adenoma.
        N Y State J Med. 1969; 69: 702-703
        • Venkatraman L.
        • Kalangutkar A.
        • Russell C.F.
        Primary hyperparathyroidism and metastatic carcinoma within parathyroid gland.
        J Clin Pathol. 2007; 60: 1058-1060
        • Liu F.
        • Gnepp D.R.
        • Pisharodi L.R.
        Fine needle aspiration of parathyroid lesions.
        Acta Cytol. 2004; 48: 133-136
        • Tseleni-Balafouta S.
        • Gakiopoulou H.
        • Kavantzas N.
        • et al.
        Parathyroid proliferations: a source of diagnostic pitfalls in FNA of thyroid.
        Cancer. 2007; 111: 130-136
        • Tseng F.Y.
        • Hsiao Y.L.
        • Chang T.C.
        Ultrasound-guided fine needle aspiration cytology of parathyroid lesions. A review of 72 cases.
        Acta Cytol. 2002; 46: 1029-1036
        • Abati A.
        • Skarulis M.C.
        • Shawker T.
        • et al.
        Ultrasound-guided fine-needle aspiration of parathyroid lesions: a morphological and immunocytochemical approach.
        Hum Pathol. 1995; 26: 338-343
        • Grimelius L.
        • Johansson H.
        Pathology of parathyroid tumors.
        Semin Surg Oncol. 1997; 13: 142-154
        • Portel-Gomes G.M.
        • Grimelius L.
        • Johansson H.
        • et al.
        Chromogranin A in human neuroendocrine tumors: an immunohistochemical study with region-specific antibodies.
        Am J Surg Pathol. 2001; 25: 1261-1267
        • Khan A.
        • Tischler A.S.
        • Patwardhan N.A.
        • et al.
        Calcitonin immunoreactivity in neoplastic and hyperplastic parathyroid glands: an immunohistochemical study.
        Endocr Pathol. 2003; 14: 249-255
        • McGregor D.K.
        • Khurana K.K.
        • Cao C.
        • et al.
        Diagnosing primary and metastatic renal cell carcinoma: the use of the monoclonal antibody ‘Renal Cell Carcinoma Marker’.
        Am J Surg Pathol. 2001; 25: 1485-1492
        • Feng C.C.
        • Ding G.X.
        • Song N.H.
        • et al.
        Paraneoplastic hormones: parathyroid hormone-related protein (PTHrP) and erythropoietin (EPO) are related to vascular endothelial growth factor (VEGF) expression in clear cell renal cell carcinoma.
        Tumour Biol. 2013; 34: 3471-3476
        • Porzionato A.
        • Macchi V.
        • Barzon L.
        • et al.
        Immunohistochemical assessment of parafibromin in mouse and human tissues.
        J Anat. 2006; 209: 817-827
        • Cetani F.
        • Ambrogini E.
        • Viacava P.
        • et al.
        Should parafibromin staining replace HRTP2 gene analysis as an additional tool for histologic diagnosis of parathyroid carcinoma?.
        Eur J Endocrinol. 2007; 156: 547-554
        • Juhlin C.C.
        • Villablanca A.
        • Sandelin K.
        • et al.
        Parafibromin immunoreactivity: its use as an additional diagnostic marker for parathyroid tumor classification.
        Endocr Relat Cancer. 2007; 14: 501-512
        • Ozcan A.
        • Shen S.S.
        • Hamilton C.
        • et al.
        PAX 8 expression in non-neoplastic tissues, primary tumors, and metastatic tumors: a comprehensive immunohistochemical study.
        Mod Pathol. 2011; 24: 751-764
        • Canavese G.
        • Azzoni C.
        • Pizzi S.
        • et al.
        p27: a potential main inhibitor of cell proliferation in digestive endocrine tumors but not a marker of benign behavior.
        Hum Pathol. 2001; 32: 1094-1101
        • Perez-Martinez F.C.
        • Alonso V.
        • Sarasa J.L.
        • et al.
        Immunohistochemical analysis of low-grade and high-grade prostate carcinoma: relative changes of parathyroid hormone-related protein and its parathyroid hormone 1 receptor, osteoprotegerin and receptor activator of nuclear factor-kB ligand.
        J Clin Pathol. 2007; 60: 290-294
        • Tominaga Y.
        • Tsuzuki T.
        • Uchida K.
        • et al.
        Expression of PRAD1/cyclin D1, retinoblastoma gene products, and Ki67 in parathyroid hyperplasia caused by chronic renal failure versus primary adenoma.
        Kidney Int. 1999; 55: 1375-1383
        • Shattuck T.M.
        • Valimaki S.
        • Obara T.
        • et al.
        Somatic and germ-line mutations of the HRPT2 gene in sporadic parathyroid carcinoma.
        N Engl J Med. 2003; 349: 1722-1729
        • Cetani F.
        • Pardi E.
        • Borsari S.
        • et al.
        Genetic analyses of the HRPT2 gene in primary hyperparathyroidism: germline and somatic mutations in familial and sporadic parathyroid tumors.
        J Clin Endocrinol Metab. 2004; 89: 5583-5591
        • Krebs L.J.
        • Shattuck T.M.
        • Arnold A.
        HRPT2 mutational analysis of typical sporadic parathyroid adenomas.
        J Clin Endocrinol Metab. 2005; 90: 5015-5017
        • Niramitmahapanya S.
        • Sunthornthepvarakul T.
        • Deerochanawong C.
        • et al.
        Sensitivity of HRPT2 mutation screening to detect parathyroid carcinoma and atypical parathyroid adenoma of Thai patients.
        J Med Assoc Thai. 2011; 94: S17-S22
        • Cryns V.L.
        • Thor A.
        • Xu H.J.
        • et al.
        Loss of the retinoblastoma tumor-suppressor gene in parathyroid carcinoma.
        N Engl J Med. 1994; 330: 757-761
        • Pearce S.H.
        • Trump D.
        • Wooding C.
        • et al.
        Loss of heterozygosity studies at the retinoblastoma and breast cancer susceptibility (BRCA2) loci in pituitary, parathyroid, pancreatic and carcinoid tumours.
        Clin Endocrinol. 1996; 45: 195-200
        • Hendy G.N.
        • D'Souza-Li L.
        • Yang B.
        • et al.
        Mutations of the calcium-sensing receptor (CASR) in familial hypocalciuric hypercalcemia, neonatal severe hyperparathyroidism, and autosomal dominant hypocalcemia.
        Hum Mutat. 2000; 16: 281-296
        • D'Souza-Li L.
        • Canaff L.
        • Janicic N.
        • et al.
        An acceptor splice site mutation in the calcium-sensing receptor (CASR) gene in familial hypocalciuric hypercalcemia and neonatal severe hyperparathyroidism.
        Hum Mutat. 2001; 18: 411-421
        • Chen R.A.
        • Goodman W.G.
        Role of the calcium-sensing receptor in parathyroid gland physiology.
        Am J Phys. 2004; 286: F1005-F1011
        • Skelly B.J.
        • Franklin R.J.
        Mutations in genes causing human familial isolated hyperparathyroidism do not account for hyperparathyroidism in Keeshond dogs.
        Vet J. 2007; 174: 652-654
        • Juhlin C.C.
        • Nilsson I.L.
        • Johansson K.
        • et al.
        Parafibromin and APC as screening markers for malignant potential in atypical parathyroid adenomas.
        Endocr Pathol. 2010; 21: 166-177
        • Svedlund J.
        • Auren M.
        • Sundstrom M.
        • et al.
        Aberrant WNT/beta-catenin signaling in parathyroid carcinoma.
        Mol Cancer. 2010; 9: 294
        • Arnold A.
        • Kim H.G.
        • Gaz R.D.
        • et al.
        Molecular cloning and chromosomal mapping of DNA rearranged with the parathyroid hormone gene in a parathyroid adenoma.
        Clin Investig. 1989; 83: 2034-2040
        • Arnold A.
        • Staunton C.E.
        • Kim H.G.
        • et al.
        Monoclonality and abnormal parathyroid hormone genes in parathyroid adenomas.
        N Engl J Med. 1988; 318: 658-662
        • Cetani F.
        • Pardi E.
        • Giovannetti A.
        • et al.
        Genetic analysis of the MEN1 gene and HPRT2 locus in two Italian kindreds with familial isolated hyperparathyroidism.
        Clin Endocrinol. 2002; 56: 457-464
        • Westin G.
        • Bjorklund P.
        • Akerstrom G.
        Molecular genetics of parathyroid disease.
        World J Surg. 2009; 33: 2224-2233
        • Sharretts J.M.
        • Simonds W.F.
        Clinical and molecular genetics of parathyroid neoplasms.
        Best Pract Res Clin Endocrinol Metab. 2010; 24: 491-502
        • Chandrasekharappa S.C.
        • Guru S.C.
        • Manickam P.
        • et al.
        Positional cloning of the gene for multiple endocrine neoplasia-type 1.
        Science. 1997; 276: 404-407
        • Lemmens I.
        • Van de Ven W.J.
        • Kas K.
        • et al.
        Identification of the multiple endocrine neoplasia type 1 (MEN1) gene. The European Consortium on MEN1.
        Hum Mol Genet. 1997; 6: 1177-1183
        • Carrasco C.A.
        • Gonzalez A.A.
        • Carvajal C.A.
        • et al.
        Novel intronic mutation of MEN1 gene causing familial isolated primary hyperparathyroidism.
        J Clin Endocrinol Metab. 2004; 89: 4124-4129
        • Cetani F.
        • Pardi E.
        • Ambrogini E.
        • et al.
        Genetic analyses in familial isolated hyperparathyroidism: implication for clinical assessment and surgical management.
        Clin Endocrinol. 2006; 64: 146-152
        • Farnebo F.
        • Teh B.T.
        • Dotzenrath C.
        • et al.
        Differential loss of heterozygosity in familial, sporadic, and uremic hyperparathyroidism.
        Hum Genet. 1997; 99: 342-349
        • Honda M.
        • Tsukada T.
        • Tanaka H.
        • et al.
        A novel mutation of the MEN1 gene in a Japanese kindred with familial isolated primary hyperparathyroidism.
        Eur J Endocrinol. 2000; 142: 138-143
        • Howell V.M.
        • Cardinal J.W.
        • Richardson A.L.
        • et al.
        Rapid mutation screening for HRPT2 and MEN1 mutations associated with familial and sporadic primary hyperparathyroidism.
        J Mol Diagn. 2006; 8: 559-566
        • Carling T.
        • Correa P.
        • Hessman O.
        • et al.
        Parathyroid MEN1 gene mutations in relation to clinical characteristics of nonfamilial primary hyperparathyroidism.
        J Clin Endocrinol Metab. 1998; 83: 2960-2963