Solid Cell Nests Within a Parathyroid Gland—Report of an Exceptional Case

The ultimobranchial body (UBB) denotes the cellular mass originating from the fourth branchial pouch, which migrates from the neural crest and infolds within the middle and upper poles of the thyroid lobes, thereby establishing the presence of calcitonin-secreting parafollicular C cells. In various numbers, UBB remnants (entitled “solid cell nests”, or SCNs) are found in thyroid glands examined histologically. However, despite the close embryological relation between the UBB and the superior parathyroid glands, intraparathyroidal SCNs have to our knowledge not been previously reported. Here, we describe a patient presenting with a papillary thyroid carcinoma with central and lateral lymph node metastases. Upon postoperative analysis, an unintentionally removed parathyroid gland was observed adjacent to the superior aspect of the right thyroid lobe. Within a 0.6?×?0.5-mm area of the parathyroid gland, solid nests composed of epithelial cells with oval and slightly elongated nuclei were seen. The cells were positive for p40, p63, and GATA3, but negative for PTH. The final diagnosis was a SCN entrapped within the parathyroid gland. Empirically, we have not previously observed SCNs within the parathyroid glands. To our knowledge, our finding thus constitutes a very unusual histological manifestation, and could indicate an underlying aberrancy during embryogenesis given the close anatomical relationship between the UBB and the superior parathyroid glands.     

Location, number and morphology of parathyroid glands: results from a large anatomical series

Surgical management of parathyroid gland disease may sometimes be difficult, due mainly to the surgeon's failure to successfully detect parathyroids in unusual locations. The records of 942 cadavers (574 men and 368 women) who underwent autopsy in the Department of Forensic Medicine in Athens during the period 1988-2009 were reviewed. In total, 3,796 parathyroid glands were resected and histologically verified. Parathyroid glands varied in number. In 47 cases (5 %), one supernumerary (fifth) parathyroid was found, while in 19 cases (2 %) three parathyroid glands found. Superior glands were larger than inferior ones. However, there was no significant difference between the genders with respect to gland size. In 324 (8.5 %) out of 3,796, the glands were detected in an ectopic location: 7 (0.2 %) in the thyroid parenchyma, 79 (2 %) in different sites in the neck and 238 (6.3 %) in the mediastinum, 152 (4.1 %) of which were found in the upper and 86 (2.2 %) in the lower mediastinum. Significant anatomical variations of normal parathyroid glands may exist regarding number and location-knowledge that is essential for their successful identification and surgical management.     

Variations in the anatomy of the thyroid gland: clinical implications of a cadaver study

Surgical removal of the thyroid gland is associated with risk of damage to the parathyroid glands, external branch of superior laryngeal nerves, inferior laryngeal nerves, and haematoma due to vascular damage and the chance of residual thyroid tissue being left in case of cancer and Graves’ disease. The present study was designed to report the prevalence of anatomical variations and developmental anomalies of the thyroid gland that will hopefully help to minimise the aforementioned complications related to thyroid surgery. A total of 52 male and 18 female properly embalmed cadavers were dissected. The thyroid gland was examined for the presence of the pyramidal lobe, levator glandulae thyroideae and partial or complete absence of isthmus. Length, greatest transverse and anteroposterior extent of both the right and left lobe of the gland was recorded. A pyramidal lobe was present in 43.9% male and 22.2% female cadavers and was more prevalent on the left side of the median plane. Levator glandulae thyroideae was present in 34.6% male and 27.8% female cadavers. Isthmus was absent in 9.6% male and 5.6% female cadavers. The average length, greatest transverse and anteroposterior extent of right lobe was 4.43, 2.54 and 1.69 cm, respectively, whereas for the left lobe it was 4.21, 2.63 and 1.7 cm, respectively. The nature of the specimens studied, and the region where the study is carried out, affect the different goitre zones, age, sex, and race of population studied, all of which can contribute to the anatomical variations of the thyroid gland found in different reports by various authors.     

Morphological study of parafollicular cells and the parathyroid gland in the house shrew (Suncus murinus).

A morphological study of parafollicular cells in the thyroid gland and parathyroid gland of the house shrew (Suncus murinus) was made. The results indicated that (1) there were two pairs of parathyroid glands which were located in the upper part of the house shrew thyroid gland, (2) the volumes of the house shrew parathyroid glands ranged from 0.014 to 0.079 mm3, (3) the number of parafollicular cells along the follicles was largest in the upper part of the thyroid lobe, while no parafollicular cells were present in the isthmus, and (4) there were about 20 parafollicular cells per 100 follicular cells and 1.519 parafollicular cells per follicle. The number of parafollicular cells per 100 follicular cells was thus about 5 times larger than that in rats and the number of parafollicular cells per follicle about 2.5 times larger than that in rats.     

甲状腺假被膜的形态特点及临床意义

目的　研究甲状腺假被膜的解剖学形态特点,探讨其临床意义。 方法 在95例单侧甲状腺叶切除术中,观察甲状腺假被膜的解剖学形态,甲状腺假被膜与真被膜、甲状腺血管、甲状旁腺和喉返神经的关系。 结果 在甲状腺下静脉、中静脉和上血管附着于腺体的部位,甲状腺假被膜呈“系膜”样结构附着在腺体上,切除腺叶后观察“系膜”呈“C”型的延续平面,甲状腺下静脉、中静脉和上血管分别自系膜缘穿出,喉返神经、甲状腺下动脉、甲状旁腺位于“系膜”的“C”型圈内。 结论 对甲状腺假被膜的解剖新认识,有助于术者安全的完成甲状腺手术,特别是被膜解剖技术的应用。     

甲状腺周围筋膜及筋膜间隙的应用解剖学观察

目的　从临床应用解剖角度重新认识甲状腺周围筋膜及筋膜间隙的解剖特点,为甲状腺癌中央区清扫术的手术范围、入路层面等提供可以借鉴的解剖依据。  方法　5具10侧标本,对甲状腺周围筋膜和筋膜间隙进行观察;10例甲状腺癌患者进行手术解剖验证观察。  结果　气管前筋膜分为前后两层,两层之间是脂肪淋巴组织及甲状腺下静脉等;气管前间隙是气管前筋膜后层与气管之间的无血管的间隙。气管旁脂肪组织与气管前脂肪组织相延续,甲状腺血管、淋巴系统走行其中。气管旁、气管前脂肪淋巴组织前后均有一层筋膜覆盖,前后筋膜在外侧与血管鞘相融合,并开口于甲状腺血管根部,内侧与甲状腺相连,其结构与功能均类似肠系膜。气管旁脂肪组织在前方与甲状腺之间存在一间隙,后方与椎前筋膜之间存在一间隙。  结论　甲状腺有系膜且呈“U”分布于气管前及气管旁。甲状腺系膜切除能达到彻底清扫中央区淋巴组织的目的。甲状腺系膜与脏器之间的筋膜间隙是进行手术操作的外科平面。     

甲状腺手术中甲状旁腺显露及功能保护的临床研究

目的 探讨甲状腺手术中甲状旁腺显露及功能保护的临床研究。方法 回顾分析2018年1月~2019年1月在天津第三中心医院行甲状腺切除术的54例患者临床资料,术中充分显露甲状旁腺,并保护显露的甲状旁腺和相关血供,观察术后甲状旁腺的功能状态。结果 54例患者术中50例患者甲状旁腺及血管充分显露,4例未清晰显露,未显露率为7.41%;术后15例发生低钙血症,发生率为27.77%。5例发生甲状旁腺功能降低,发生率为9.25%。治疗15 d后均恢复正常,未出现永久低钙血症。结论甲状旁腺位置与血供联系紧密,甲状腺切除术中应仔细解剖,并做好原位功能保护,可以有效避免术后甲状腺功能异常的发生,确保良好的手术效果,具有临床应用的重要价值。     

Thyroidectomy and parathyroidectomy in progeny encumbered with an insufficiency of these glands in the ancestors

Summary Thyroid and parathyroid glands were studied in 134 fetuses and neonates born of thyroparathyroidectomized rats.Parathyroid and thyroid glands in such progeny were subject to destructive and dystrophic changes indicating their functional exhaustion and premature waste. In 50–60% of the progeny presenting an aggravated history of a two-fold surgical intervention in the ancestry, microscopy demonstrated the presence of hyperemia and enlargement of the parathyroid glands. Histological examination showed a marked atrophy of the parathyroid gland parenchyma and its replacement by paretically dilated vessels.(Presented by Active Member N. N. Zhukov-Verezhnikov AMN SSSR) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 57, No. 5, pp. 86–89, May, 1964     

Pathomorphological and immunohistochemical analysis of autoimmune processes in the thyroid gland

The morphology and function of TG were studied in residents of an East Kazakhstan region with unfavorable ecology. One-third of the population developed autoimmune processes in this organ. The morphogenesis and regeneratory processes in the thyroid gland against the background cellular infiltration were studied. Irrespective of the morphogenesis stage, the autoimmune processes in the thyroid gland were paralleled by dysregulatory disorders in the follicular epithelium which in many cases acquired immunohistochemical characteristics of the main cells of the parathyroid glands. Structural reorganization was paralleled by changes in the cell composition of the stroma, focal hyperplasia of oncocytes and C-cells, and enhanced angiogenesis. __________ Translated from Byulleten’ Eksperimental’noi Biologii i Meditsiny, Vol. 143, No. 6, pp. 704–708, June, 2007     

The intrathyroidal hyperfunctioning parathyroid gland

Six cases of primary hyperparathyroidism due to hyperfunctioning intrathyroidal parathyroid glands are reported. In five cases, hyperparathyroidism was due to an intrathyroidal parathyroid adenoma; in the sixth case, hyperparathyroidism resulted from an intrathyroidal parathyroid carcinoma. All five patients with adenoma were female with ages ranging from 40 to 70 yr. The patient with carcinoma was a 55-yr-old male. In all five patients with intrathyroidal parathyroid adenoma, thyroidectomy was performed when an abnormal parathyroid gland could not be located in the neck during surgery for hyperparathyroidism. The patient with intrathyroidal parathyroid carcinoma presented with hypercalcemia and a palpable right thyroid mass. The differential diagnosis of intrathyroidal parathyroid adenoma includes thyroid follicular adenoma. In some cases, the possibility of medullary carcinoma of thyroid might also be considered. Immunocytochemical staining for parathormone (PTH), thyroglobulin, and calcitonin is valuable in establishing the correct diagnosis.     

The effect of thyroid-and parathyroidectomy on the development of the first,second and third generations

Summary The effect produced by thyroparathyroidectomy on the development of the progeny in three generations of rats was studied.Thyroparathyroidectomy in mothers caused anomalies of fetal development, incompatible with life, or gave use to premature function of the thyroid gland. During the first days after birth in young rats born of operated mothers there was hypertrophy and congestion of the thyroid and parathyroid glands (2–2 1/2 fold enlargement as compared with control).Morpho-histological examination of the thyroid gland pointed to an increased function. An augmented function of the thyroid and parathyroid glands occurring in the progeny of the first generation was retained in the second and third generations.Insufficiency of the endocrine system of ancestors induced constitutional disturbances in the progency in the form of gigantism, dwarfism and sterility. Developmental defects were manifested by changes in the skeleton and disturbances of the skin and fur.Presented by Active Member N. N. Zhukov-Verezhnikov AMN SSSR Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 57, No. 4, pp. 101–105, April, 1964     

Langerhans cell histiocytosis involving the thyroid and parathyroid glands.

Langerhans cell histiocytosis (LCH) is a rare illness, and the disease afflicting the thyroid gland is very uncommon, even in the presence of multisystem involvement. In this report, we document histologically, for the first time, concurrent involvement of the thyroid and parathyroid glands by LCH. A young Chinese woman with a history of diabetes insipidus and hypogonadism underwent a total thyroidectomy for enlarged thyroid gland secondary to LCH causing airway obstruction. Microscopic examination of the excised specimen disclosed CD1a- and S-100-positive LCH cells involving the thyroid and parathyroid glands. In a patient with LCH affecting the thyroid gland, parathyroid gland disease should be suspected when the serum calcium levels are depressed in association with an inappropriate serum parathyroid hormone level, such as a normal parathyroid hormone level in this case.     

Ectopic intrathyroidal thymus accompanied by intrathyroidal parathyroid as a cause of a solitary thyroid nodule in adult

Ectopic intrathyroidal thymic tissue can form a mass lesion within the thyroid gland and has rarely been reported in children. We report a case of intrathyroidal thymus accompanied by an intrathyroidal parathyroid gland in a 29-year-old woman who visited our hospital due to right neck mass diagnosed as metastatic papillary carcinoma by aspiration cytology in an outside hospital. She had a history of right thyroidectomy due to papillary thyroid carcinoma three years ago. Ultrasonographic examination of the left thyroid gland showed a well-defined hyperechoic nodule, which did not show change in size compared with the previous study. She underwent complete thyroidectomy with right neck dissection. Grossly, the left thyroid had a well demarcated pale yellow nodule measuring 0.9 cm in diameter. On microscopic examination, the nodule was composed of mature fat tissue, ectopic thymic tissue with Hassall’s corpuscles, and an intrathyroidal parathyroid gland. This is an exceedingly rare case of ectopic intrathyroidal thymus with intrathyroidal parathyroid gland, in an adult.     

Fine-needle biopsy of parathyroid adenomas

Summary High-resolution real-time sonography was performed in 15 cases of clinically and chemically suspected primary hyperparathyroidism and in 20 patients with different thyroid nodules. The suspected enlarged parathyroid glands and the thyroid nodules were percutaneously punctured under sonographic control. Concentrations of parathy-roid hormone, human thyroglobulin, and human calcitonin were measured in the aspirate, and immunocytology was performed. The mean concentration of the aspirated parathyroid hormone in the parathyroid glands was 4,013.6 pmol/1±4,519 (SD) as compared with 14.9 pmol/1±8.7 in the thyroid nodules. Thyroglobulin was present in the aspirated fluid of parathyroid adenomas located behind the thyroid (mean±SD, 398.1 ng/ml±317). In comparison, the aspirated thyroglobulin from the thyroid nodules averaged 9,689.7 ng/ml ±3,732. Immunocytology for parathyroid hormone was positive in 14 of the 15 biopsied specimens. Of 15 patients who were scanned for suspected hyperparathyroidism, six had concomitant thyroid nodules.It is concluded that the measurement of high concentrations of parathyroid hormone in the aspirate from a cervical mass, with sonographic control of needle position and/or positive immunocytology provides absolute localization of parathyroid tissue.Abbreviations (FITC) Fluorescein-isothiocyanate - (hCT) human calcitonin - (PBS) phosphate buffered saline - (PTH) parathyroid hormone - (SD) standard deviation - (TG) human thyroglobulin     

Parathyroids and ultimobranchial bodies in monotremes

Only scant information is available in the scientific literature on the parathyroids and ultimobranchial bodies in the primitive mammals, the echidna (Tachyglossus aculeatus) and platypus (Ornithorhynchus anatinus). The major aim of this paper is to describe the morphology of the monotreme parathyroid gland and to compare it with parathyroids in mammals and reptiles. The gross anatomy and light microscopic structure of the ultimobranchial body, thymus, and thyroid are also given. Animals were dissected and routine light and electron microscopic techniques used to examine the microscopic morphology. The locations of parathyroid hormone, calcitonin and calcitonin gene‐related peptide in tissue sections were identified by immunostaining. Monotremes have one pair of parathyroid glands located in the thorax and they are often associated with thymic tissue but never with the thyroid which is also present in the mediastinum. Ultimobranchial bodies are ventrolateral to the commencement of the trachea. Thymic lobules with Hassall's corpuscles are scattered in the fibrofatty tissue of the mediastinum and the ventral surface of the pericardium. Histologically, principal cells, water‐clear cells, and non‐secretory cells were identified in the parathyroid glands. Principal cells showed polarity and had microlamellar projections that formed intercellular canaliculi. Non‐secretory cells had features similar to those of thymic epithelial reticular cells. Immunostaining of parathyroid hormone showed a diffuse distribution in parathyroid principal cells and none in ultimobranchial bodies. Identification of the ultimobranchial bodies was confirmed by immunostaining. The monotreme parathyroid gland, ultimobranchial bodies and thyroid show reptilian as well as mammalian features. Anat Rec 254:269–280, 1999. © 1999 Wiley‐Liss, Inc.     

Near-infrared autofluorescence for the detection of parathyroid glands

A major challenge in endocrine surgery is the intraoperative detection of parathyroid glands during both thyroidectomies and parathyroidectomies. Current localization techniques such as ultrasound and sestamibi scan are mostly preoperative and rely on an abnormal parathyroid for its detection. In this paper, we present near-infrared (NIR) autofluorescence as a nonintrusive, real-time, automated in vivo method for the detection of the parathyroid gland. A pilot in vivo study was conducted to assess the ability of NIR fluorescence to identify parathyroid glands during thyroid and parathyroidectomies. Fluorescence measurements at 785 nm excitation were obtained intra-operatively from the different tissues exposed in the neck region in 21 patients undergoing endocrine surgery. The fluorescence intensity of the parathyroid gland was found to be consistently greater than that of the thyroid and all other tissues in the neck of all patients. In particular, parathyroid fluorescence was two to eleven times higher than that of the thyroid tissues with peak fluorescence occurring at 820 to 830 nm. These results indicate that NIR fluorescence has the potential to be an excellent optical tool to locate parathyroid tissue during surgery.     

Thyroid dimensions of Korean adults on routine neck computed tomography and its relationship to age, sex, and body size

The purpose of this study was to establish a “normal” range of dimensions of the thyroid gland on routine neck computed tomography in the Korean population and to investigate the possible influence of some physiological factors on the thyroid dimension. Neck computed tomography scans of 100 adults (57 males, 43 females; mean age=55.2 years) were reviewed retrospectively to measure the size of the thyroid gland and to evaluate its relationship to the trachea and cervical vertebra. For right and left lobes, the mean width was 15.7±2.6 mm and 15.2±3.1 mm, the mean thickness was 20.9±3.4 mm and 18.9±3.4 mm, the mean length was 61.8±8.6 mm and 58.5±8.3 mm, the mean estimated volume of each lobe was 8.8±3.1 cm³ and 7.6±3.0 cm³, respectively. The mean volume of total thyroid glands (including isthmus) was 17.5±6.6 cm³. There was no significant difference between the total study group and the normal thyroid function group. The dimensions of the right lobe were significantly larger that those of the left. There was no significant difference between males and females. In multiple regression analysis, it was likely that the influence of body weight on the thyroid dimension was most pronounced. Our study presents initial data for assessing the thyroid gland on neck computed tomography scans in Koreans, and thereby provides suitable limit values of normal thyroid glands.     

环甲间隙在腔镜甲状腺手术中的重要意义

目的　探讨环甲间隙在颈部无瘢痕腔镜甲状腺手术（scarless in the neck endoscopic thyroidectomy,SET）中对保护喉上神经外支（external branch of superior laryngeal nerve,EBSLN）、喉返神经（recurrent laryngeal nerve,RLN）、甲状旁腺（parathyroid gland,PT）及处理甲状腺上极的重要意义。 方法　回顾分析本院2014年4月至2018年7月腔镜甲状腺手术128例,包括单侧或双侧切除、次全切除或部分切除等。在处理甲状腺上极时均采用环甲间隙入路,结合甲状腺下极及外侧操作完成甲状腺叶部分或腺叶全部切除术。 结果　全部SET在分离进入环甲间隙后处理甲状腺上极血管,其中59.3%（76例）显露EBSLN。在甲状腺下极区域首先显露RLN者82.8%（106例）,其余17.2%在经环甲间隙入路处理甲状腺上极血管后显露RLN入喉点。术中显露UPT位于近环甲关节处者83%（106例）,位于甲状腺上极背面者17%（22例）。84例随访至今,术后暂时性声音嘶哑并单侧喉返神经麻痹2例,无声音低钝及饮水呛咳者,无永久性低钙者。 结论　环甲间隙在SET中对于安全切断甲状腺上极血管和有效保护EBSLN、RLN及上甲状旁腺具有重要意义,因此结合甲状腺峡部、下极及外侧操作可以形成腔镜甲状腺的程式化手术步骤,提升了该术式的安全性,有利于该术式的推广。     

甲状旁腺囊肿的临床病理特征分析

目的 探讨甲状旁腺囊肿（PCs）的临床和病理特征。方法 回顾性研究。纳入陕西省人民医院2012年11月—2021年11月病理检查确诊PCs的患者15例。其中,男8例、女7例,年龄31~65岁（中位年龄45岁）。患者均行PCs切除治疗。总结患者的临床特征、影像学特点及病理学特征。结果 15例患者中有14例为自查或体检时发现颈部包块,1例以咳嗽为首发症状,患者均无其他临床表现。所有患者术前血钙、血磷均在正常范围,甲状旁腺素、甲状腺功能检查均正常。12例在甲状腺左叶或右叶下极,3例在甲状腺腺体内,2例位于胸骨后方纵隔内,1例位于右侧Ⅵ区淋巴结区。超声结果显示颈部见囊性液暗区,边界清;CT示平扫颈部见类圆形薄壁低密度影,增强扫描无强化。病理检查大体标本示,PCs长径1~7（4.33±1.47）cm,囊内多含无色清亮液体;镜下示纤维囊壁内见挤压呈巢状及条索状的甲状旁腺组织,其主要由主细胞及嗜酸性细胞构成;免疫组织化学染色示甲状旁腺组织均嗜铬素A阳性表达,甲状腺球蛋白、甲状腺转录因子、突触素均阴性表达。结论 PCs临床少见,解剖位置多变,又缺乏特异的临床及影像学特征,术前诊断较为困难。明确诊断主要依靠病理检查,囊壁内典型甲状旁腺组织是其主要病理特征,可利用免疫组织化学鉴别诊断。     

Follicular carcinoma arising in ectopic thyroid tissue: Case report with fine-needle aspiration findings

A 32-yr-old woman was found to have a 1 × 2 cm mass in the soft tissue of the neck 1 cm lateral to the left lobe of the thyroid gland. A fine-needle aspiration biopsy showed a follicular neoplasm. The excised mass showed a follicular carcinoma arising in lateral ectopic thyroid tissue. Subsequent excision of the thyroid gland and pathological examination showed no primary carcinoma in the gland. This report illustrates a case of primary follicular carcinoma arising in a lateral ectopic thyroid tissue in the neck. Diagn. Cytopathol. 16:39–41, 1997. © 1997 Wiley-Liss, Inc.