Dr Dufour's letter underscores the difficulties that endocrine pathologists and surgeons face when they attempt to establish a clear differentiation between hyperplasia and adenoma of the parathyroid glands. It is necessary to recognize that parathyroid adenomas, like their counterparts in the adrenal, pituitary, and thyroid glands, develop from a background of cellular hyperplasia that can then progress to nodular hyperplasia, to adenoma formation, and, on rare occasions, to frank carcinomatous dedifferentiation.1,2 Given this sequence of events, it follows that there will be instances where combinations of hyperplasia, nodular hyperplasia, single adenoma, or "double adenomas" coexist in the same patient and, at times, within the same parathyroid gland.Unfortunately, controversy over the classification of parathyroid histopathology has not resolved the endocrine surgeon's dilemma at the time of surgery. Only then can the extent of the disease, including the number of glands involved, and whether a particular gland is
Payolan E, Lawrence AM. Evaluation of Parathyroid Gland Lesions-Reply. JAMA. 1982;247(12):1694–1695. doi:10.1001/jama.1982.03320370012008
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