Head & Neck Case Review 2020-03

Head & Neck Case Review

March, 2020


The patient is a 57 year-old male with a history of recurrent nephrolithiasis for 20 years. Serum biochemistry revealed: PTH 11.5 pmol/L (reference range, 2.0 – 9.3 pmol/L) and calcium 2.62 (reference range 2.20 – 2.60 mmol/L). A diagnosis of primary hyperparathyroidism was made. Pre-operative localizing studies were not helpful in determining location of a parathyroid lesion. Bilateral neck exploration was undertaken with planned parathyroidectomy.

Intraoperative findings included: three normal-appearing parathyroid glands (which were biopsied) and a single markedly enlarged left superior parathyroid gland (which was easily resected without adhesions). Intraoperative post-resection serum biochemistry revealed: PTH 3.4 pmol/L.

Surgical pathology received biopsies of the three grossly “normal-appearing” parathyroid glands which showed normocellular parathyroid tissue on histology (not pictured). The excised parathyroid weighed 4.27 g (fresh) and measured 3.1 cm in greatest dimension (pictured).


Virtual H&E slide


Q1. Compared to a conventional parathyroid adenoma, the entity in this case

  • A. is associated with an increased risk of vascular invasion.
  • B. occurs secondary to renal failure/changes in renal function.
  • C. frequently shows an increased mitotic index.
  • D. is comparable in terms of prognosis.
  • E. does not result in hyperparathyroidism.

Q2. The amount of adipose tissue is directly proportional to the body mass index of this patient.

  • A. True
  • B. False



Stephen M. Smith, MD
Assistant Professor, Division of Anatomic Pathology
Department of Laboratory Medicine & Pathobiology
The University of Toronto/University Health Network