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March 26, 1982

Evaluation of Parathyroid Gland Lesions

JAMA. 1982;247(12):1694. doi:10.1001/jama.1982.03320370012007

To the Editor.—  The recent article by Carnevale et al (1981;246:1332) emphasizes the difficulty in histopathological diagnosis of parathyroid gland lesions, since their illustrations are clearly not what they are claimed to be. Neither Fig 1 nor 3 is compatible with parathyroid adenoma; instead, they represent nodular (Fig 1) and diffuse (Fig 3) chief-cell hyperplasia. Although it may be difficult in some cases to differentiate hyperplasia from adenoma, the glands in the illustrations have an intimate admixture of chief cells and fat cells and lack a dominant, encapsulated nodule. These features are present in cases of hyperplasia but are not seen in cases of adenoma. In addition, the gland in Fig 2 shows a distinct nodular pattern in the upper half and near the lower border, a finding seen in hyperplastic glands.As the article clearly emphasizes, visualization of all four glands at surgery is of critical importance in determining