Changing clinicopathological practice in parathyroid disease

Parathyroid glands are received for histological examination during treatment of hyperparathyroidism. There are a small number of likely diagnoses available to the histopathologist, but distinction between these can be difficult due to overlap of morphological features. Recent developments in surgical approaches and preoperative imaging techniques have led to increased use of focused surgical approaches after preoperative localization of any abnormal parathyroid glands, thereby reducing the number of glands received for histological examination. Pathologists need to be aware of these clinical developments and the possible impact on their diagnostic practice. The pathogenesis of hyperparathyroidism is also reviewed, as is the rare but important diagnosis of parathyroid carcinoma.