Head and Neck: Parathyroid

  • Elwira Bakuła-ZalewskaEmail author


FNAC is of limited value in the preoperative assessment of patients with hyperparathyroidism. Majority FNA of parathyroid lesions is unintended, as intrathyroidal parathyroid adenomas and parathyroid cysts are often mistaken for thyroid lesions. Many investigators have stressed the difficulty in discerning thyroid from parathyroid in FNA smears. However, ultra sound (US)-guided FNA of the parathyroid is helpful in patients with persistent hypercalcemia after failed surgery when the neck anatomy is distorted and in patients with atypical or intrathyroidal parathyroid gland location. US-guided FNA may be also useful to localize parathyroid lesions in recurrent disease and to distinguish abnormal parathyroid glands from lymph nodes.


Parathyroid FNA Cytology Parathyroid hyperplasia Parathyroid adenoma Cyst Parathormone 


  1. 1.
    Erbil Y, Salmaslioglu A, Kabul E, Issever H, Tunaci M, Adalet I, et al. Use of preoperative parathyroid fine-needle aspiration and parathormone assay in the primary hyperparathyroidism with concomitant thyroid nodules. Am J Surg. 2007;193(6):665–71.CrossRefGoogle Scholar
  2. 2.
    Abraham D, Sharma PK, Bentz J, Gault PM, Neumayer L, McClain DA. Utility of ultrasound-guided fine-needle aspiration of parathyroid adenomas for localization before minimally invasive parathyroidectomy. Endocr Pract. 2007;13(4):333–7.CrossRefGoogle Scholar
  3. 3.
    Shi C, Guan H, Qi W, Ji J, Wu J, Yan F, et al. Intrathyroidal parathyroid adenoma: diagnostic pitfalls on fine-needle aspiration: two case reports and literature review. Diagn Cytopathol. 2016;44(11):921–5.CrossRefGoogle Scholar
  4. 4.
    Paker I, Yilmazer D, Yandakci K, Arikok AT, Alper M. Intrathyroidal oncocytic parathyroid adenoma: a diagnostic pitfall on fine-needle aspiration. Diagn Cytopathol. 2010;38(11):833–6.CrossRefGoogle Scholar
  5. 5.
    Domingo RP, Ogden LL, Been LC, Kennedy GC, Traweek ST. Identification of parathyroid tissue in thyroid fine-needle aspiration: a combined approach using cytology, immunohistochemical, and molecular methods. Diagn Cytopathol. 2017;45(6):526–32.CrossRefGoogle Scholar
  6. 6.
    Vaidya A, Gouri M, Sudha HM, Mysorekar V, Balekudura A. Ectopic parathyroid adenoma presenting as a mediastinal mass. J Clin Diagn Res JCDR. 2017;11(5):ED40–ED2.PubMedGoogle Scholar
  7. 7.
    Vu DH, Erickson RA. Endoscopic ultrasound-guided fine-needle aspiration with aspirate assay to diagnose suspected mediastinal parathyroid adenomas. Endocr Pract. 2010;16(3):437–40.CrossRefGoogle Scholar
  8. 8.
    Noussios G, Anagnostis P, Natsis K. Ectopic parathyroid glands and their anatomical, clinical and surgical implications. Exp Clin Endocrinol Diabetes. 2012;120(10):604–10.CrossRefGoogle Scholar
  9. 9.
    Graff-Baker A, Roman SA, Boffa D, Aslanian H, Sosa JA. Diagnosis of ectopic middle mediastinal parathyroid adenoma using endoscopic ultrasonography-guided fine-needle aspiration with real-time rapid parathyroid hormone assay. J Am Coll Surg. 2009;209(3):e1–4.CrossRefGoogle Scholar
  10. 10.
    Balakrishnan M, George SA, Rajab SH, Francis IM, Kapila K. Cytological challenges in the diagnosis of intrathyroidal parathyroid carcinoma: a case report and review of literature. Diagn Cytopathol. 2018;46(1):47–52.CrossRefGoogle Scholar
  11. 11.
    Cho M, Oweity T, Brandler TC, Fried K, Levine P. Distinguishing parathyroid and thyroid lesions on ultrasound-guided fine-needle aspiration: a correlation of clinical data, ancillary studies, and molecular analysis. Cancer Cytopathol. 2017;125(9):674–82.CrossRefGoogle Scholar
  12. 12.
    Lieu D. Cytopathologist-performed ultrasound-guided fine-needle aspiration of parathyroid lesions. Diagn Cytopathol. 2010;38(5):327–32.PubMedGoogle Scholar
  13. 13.
    Abati A, Skarulis MC, Shawker T, Solomon D. Ultrasound-guided fine-needle aspiration of parathyroid lesions: a morphological and immunocytochemical approach. Hum Pathol. 1995;26(3):338–43.CrossRefGoogle Scholar
  14. 14.
    Wuertz FG, Kresnik E, Malle P, Hyden M, Lind P, Rogatsch H, et al. Fine-needle aspiration with immunohistochemistry using a modified scrape cell block technique for the diagnosis of thyroid and parathyroid nodules. Acta Cytol. 2016;60(2):118–30.CrossRefGoogle Scholar
  15. 15.
    Trimboli P, D’Aurizio F, Tozzoli R, Giovanella L. Measurement of thyroglobulin, calcitonin, and PTH in FNA washout fluids. Clin Chem Lab Med. 2017;55(7):914–25.CrossRefGoogle Scholar
  16. 16.
    Ozderya A, Temizkan S, Cetin K, Ozugur S, Gul AE, Aydin K. The results of parathyroid hormone assay in parathyroid aspirates in pre-operative localization of parathyroid adenomas for focused parathyroidectomy in patients with negative or suspicious technetium-99m-sestamibi scans. Endocr Pract. 2017;23(9):1101–6.CrossRefGoogle Scholar
  17. 17.
    Fustar Preradovic L, Danic D, Dzodic R. Small nonfunctional parathyroid cysts: single institution experience. Endocr J. 2017;64(2):151–6.CrossRefGoogle Scholar
  18. 18.
    Abdelghani R, Noureldine S, Abbas A, Moroz K, Kandil E. The diagnostic value of parathyroid hormone washout after fine-needle aspiration of suspicious cervical lesions in patients with hyperparathyroidism. Laryngoscope. 2013;123(5):1310–3.CrossRefGoogle Scholar
  19. 19.
    Bancos I, Grant CS, Nadeem S, Stan MN, Reading CC, Sebo TJ, et al. Risks and benefits of parathyroid fine-needle aspiration with parathyroid hormone washout. Endocr Pract. 2012;18(4):441–9.CrossRefGoogle Scholar
  20. 20.
    Owens CL, Rekhtman N, Sokoll L, Ali SZ. Parathyroid hormone assay in fine-needle aspirate is useful in differentiating inadvertently sampled parathyroid tissue from thyroid lesions. Diagn Cytopathol. 2008;36(4):227–31.CrossRefGoogle Scholar
  21. 21.
    Halbauer M, Crepinko I, Tomc Brzac H, Simonovic I. Fine needle aspiration cytology in the preoperative diagnosis of ultrasonically enlarged parathyroid glands. Acta Cytol. 1991;35(6):728–35.PubMedGoogle Scholar
  22. 22.
    Mincione GP, Borrelli D, Cicchi P, Ipponi PL, Fiorini A. Fine needle aspiration cytology of parathyroid adenoma. A review of seven cases. Acta Cytol. 1986;30(1):65–9.PubMedGoogle Scholar
  23. 23.
    Tseng FY, Hsiao YL, Chang TC. Ultrasound-guided fine needle aspiration cytology of parathyroid lesions. A review of 72 cases. Acta Cytol. 2002;46(6):1029–36.CrossRefGoogle Scholar
  24. 24.
    Liu F, Gnepp DR, Pisharodi LR. Fine needle aspiration of parathyroid lesions. Acta Cytol. 2004;48(2):133–6.CrossRefGoogle Scholar
  25. 25.
    Odronic SI, Reynolds JP, Chute DJ. Cytologic features of parathyroid fine-needle aspiration on ThinPrep preparations. Cancer Cytopathol. 2014;122(9):678–84.CrossRefGoogle Scholar
  26. 26.
    Dimashkieh H, Krishnamurthy S. Ultrasound guided fine needle aspiration biopsy of parathyroid gland and lesions. CytoJournal. 2006;3:6.CrossRefGoogle Scholar
  27. 27.
    Agarwal C, Kaushal M. Parathyroid lesions: difficult diagnosis on cytology. Diagn Cytopathol. 2016;44(8):704–9.CrossRefGoogle Scholar
  28. 28.
    Absher KJ, Truong LD, Khurana KK, Ramzy I. Parathyroid cytology: avoiding diagnostic pitfalls. Head Neck. 2002;24(2):157–64.CrossRefGoogle Scholar
  29. 29.
    Giorgadze T, Stratton B, Baloch ZW, Livolsi VA. Oncocytic parathyroid adenoma: problem in cytological diagnosis. Diagn Cytopathol. 2004;31(4):276–80.CrossRefGoogle Scholar
  30. 30.
    Papanicolau-Sengos A, Brumund K, Lin G, Hasteh F. Cytologic findings of a clear cell parathyroid lesion. Diagn Cytopathol. 2013;41(8):725–8.CrossRefGoogle Scholar
  31. 31.
    Park GS, Lee SH, Jung SL, Jung CK. Liquid-based cytology in the fine needle aspiration of parathyroid lesions: a comparison study with the conventional smear, ThinPrep, and SurePath. Int J Clin Exp Pathol. 2015;8(10):12160–8.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Agarwal AM, Bentz JS, Hungerford R, Abraham D. Parathyroid fine-needle aspiration cytology in the evaluation of parathyroid adenoma: cytologic findings from 53 patients. Diagn Cytopathol. 2009;37(6):407–10.CrossRefGoogle Scholar
  33. 33.
    Kumari N, Mishra D, Pradhan R, Agarwal A, Krishnani N. Utility of fine-needle aspiration cytology in the identification of parathyroid lesions. J Cytol Indian Acad Cytologists. 2016;33(1):17–21.CrossRefGoogle Scholar
  34. 34.
    Sung S, Saqi A, Margolskee EM, Crapanzano JP. Cytomorphologic features distinguishing Bethesda category IV thyroid lesions from parathyroid. CytoJournal. 2017;14:10.CrossRefGoogle Scholar
  35. 35.
    Wong YP, Sharifah NA, Tan GC, Gill AJ, Ali SZ. Intrathyroidal oxyphilic parathyroid carcinoma: a potential diagnostic caveat in cytology? Diagn Cytopathol. 2016;44(8):688–92.CrossRefGoogle Scholar
  36. 36.
    Rossi ED, Revelli L, Giustozzi E, Straccia P, Stigliano E, Lombardi CP, et al. Large non-functioning parathyroid cysts: our institutional experience of a rare entity and a possible pitfall in thyroid cytology. Cytopathology. 2015;26(2):114–21.CrossRefGoogle Scholar
  37. 37.
    Kaplanoglu V, Kaplanoglu H, Ciliz DS, Duran S. A rare cystic lesion of the neck: parathyroid cyst. BMJ Case Rep. 2013;2013.Google Scholar
  38. 38.
    Ogo A, Komori K, Nishida K, Hiramatsu S, Sakai Y, Matoba Y, et al. Fluid aspiration identified the primary cyst among multiple cervical cysts in a case of hyperparathyroidism. J Endocrinol Investig. 2010;33(5):360–1.CrossRefGoogle Scholar
  39. 39.
    Shifrin A, LiVolsi V, Shifrin-Douglas S, Zheng M, Erler B, Matulewicz T, et al. Primary and metastatic parathyroid malignancies: a rare or underdiagnosed condition? J Clin Endocrinol Metab. 2015;100(3):E478–81.CrossRefGoogle Scholar
  40. 40.
    Fulciniti F, Pezzullo L, Chiofalo MG, Butera D, Losito NS, Tommaselli AP, et al. Metastatic breast carcinoma to parathyroid adenoma on fine needle cytology sample: report of a case. Diagn Cytopathol. 2011;39(9):681–5.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of PathologyThe Maria Sklodowska-Curie Memorial Cancer Centre and Institute of OncologyWarsawPoland

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