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Parathyroid Lipoadenoma: a Clinicopathological Diagnosis and Possible Trap for the Unaware Pathologist

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Abstract

The authors present clinicopathological features of parathyroid lipoadenoma in a 48-year-old woman who presented with symptomatic primary hyperparathyroidism manifesting with pathological fractures and osteoporosis. Preoperative sestamibi scan failed to localize the source of her disease. Exploratory surgery identified an enlarged parathyroid gland with abundant fat tissue. The significant drop of intraoperative serum parathyroid hormone after the removal of this gland and postoperative biochemical cure justified the presence of a single gland disease presenting as parathyroid lipoadenoma. From an educational perspective, the presented case emphasizes why the historical approach to parathyroid proliferations by assessing alone the ratio of parenchymal cells to adipocytes is not a reliable method in the diagnostic evaluation of parathyroid disease. While the accurate size and weight of a parathyroid gland are defining parameters of an abnormal gland, intraoperative and postoperative biochemical workup distinguishes uniglandular disease (adenoma) from multiglandular disease (hyperplasia). The authors also provide a brief review of the previously published cases of parathyroid lipoadenomas to highlight their clinicopathological characteristics of relevance to surgical pathologists.

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Authors and Affiliations

  1. Department of Pathology, University Health Network, M5G 2C4, Toronto, ON, Canada

    Martin D. Hyrcza, Pınar Sargın & Ozgur Mete

  2. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada

    Martin D. Hyrcza & Ozgur Mete

  3. Endocrine Oncology Site Group, The Princess Margaret Cancer Centre, Toronto, Canada

    Ozgur Mete

Authors
  1. Martin D. Hyrcza
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  2. Pınar Sargın
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  3. Ozgur Mete
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Correspondence to Ozgur Mete.

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This case report does not contain any research studies with human participants or animals performed by any of the authors. Therefore, for this type of manuscript, formal consent is not required.

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The authors declare that they have no competing interests.

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Hyrcza, M.D., Sargın, P. & Mete, O. Parathyroid Lipoadenoma: a Clinicopathological Diagnosis and Possible Trap for the Unaware Pathologist. Endocr Pathol 27, 34–41 (2016). https://doi.org/10.1007/s12022-015-9404-5

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