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Parathyroid cytology: avoiding diagnostic pitfalls.
Kimberly J Absher1, Luan D Truong, Kamal K Khurana
1Department of Pathology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA. iramzy@bcm.tmc.edu
Head & Neck
|March 14, 2002
Summary
Interpreting parathyroid fine-needle aspirates (FNA) is challenging due to rarity and limited literature. This study identifies key cytologic criteria to differentiate parathyroid lesions from thyroid aspirates, aiding diagnosis.
Area of Science:
- Cytopathology
- Endocrine Pathology
- Surgical Pathology
Background:
- Interpretation of parathyroid fine-needle aspirates (FNA) is difficult due to specimen rarity and limited literature.
- Systematic review of parathyroid FNAs sought to establish additional diagnostic criteria.
Purpose of the Study:
- To delineate diagnostic criteria for parathyroid fine-needle aspirates (FNA).
- To differentiate parathyroid FNAs from thyroid aspirates based on cytomorphologic features.
Main Methods:
- Systematic review of 12 parathyroid lesions (adenomas, hyperplastic, atypical, cysts) from January 1990 to June 1998.
- Cytologic review of Papanicolaou and Diff Quik-stained smears.
- Comparison with thyroid FNAs to establish differential diagnostic criteria.
Main Results:
- Parathyroid cysts yielded acellular, water-clear fluid with elevated parathyroid hormone (PTH).
- Seven other aspirates showed cellular smears with varied architectural patterns (3D groups, sheets, papillary fragments, microfollicles).
- Key findings included nuclear overlapping and molding, uncommon in thyroid aspirates, and mild to moderate anisokaryosis.
Conclusions:
- Parathyroid FNAs can be confused with thyroid aspirates due to overlapping cytomorphologic features.
- A combination of cytologic parameters, not a single feature, suggests a parathyroid lesion.
- Aspirates of parathyroid cysts are characterized by acellular, water-clear fluid and elevated PTH levels.