- Juhlin 与 Gill 的 Modern Pathology 综述：日常甲状旁腺腺瘤多数靠形态即可，但一旦出现不典型特征、需与甲状旁腺癌鉴别时，过度诊断与漏诊风险陡升。
- 病理的角色不只是「腺瘤 vs 癌」，还包括识别分子异常、提示遗传性综合征的形态/免疫表型线索，有时是启动胚系检测的第一站。
- 实用框架：腺瘤与正常腺体区分、不典型甲状旁腺肿瘤与癌的边界、IHC/分子整合、遗传性线索。本站仅摘要；原文 Unpaywall 标 hybrid OA（CC BY），出版社页对本站 Cloudflare 拦截未采全文。
收录范围：PubMed 英文摘要及中文翻译（abstract-only）。Unpaywall 标注原文为 hybrid 开放获取（CC BY），但 ScienceDirect 与 modernpathology.org 对本站出口返回 Cloudflare 验证页（curl 与 Chrome/CDP 均未通过），未采集全文、图表；全文待后续补采。
摘要
原发性甲状旁腺功能亢进症日常所见的甲状旁腺肿瘤，多数可依据常规组织形态学直接分类，无需大量生物标志物工作。这种相对简单的印象，使人对甲状旁腺肿瘤病理评估产生「大体不难」的错觉。然而，当病变出现超出常规腺瘤预期的不典型特征——尤其是鉴别诊断包含甲状旁腺癌（极罕见但可致命）时，局面迅速改变。在此类困难病例中，内分泌病理医生需承担重要责任：将易被误读、过度诠释的不典型所见，与真正具有恶性潜能或复发风险升高的病变区分开来。除分类外，病理还在识别甲状旁腺癌中具有诊断或治疗意义的分子异常，以及提示遗传性综合征的形态学或免疫表型线索方面居核心地位。有时病理医生可能是最先提出胚系疾病怀疑并启动进一步遗传学检查的人。本综述聚焦原发性甲状旁腺功能亢进症中的主要组织病理挑战，着重讨论：如何将普通腺瘤与正常腺体区分；如何识别不典型甲状旁腺肿瘤与甲状旁腺癌并避免过度诊断；如何将免疫组化与分子发现整合进诊断实践；以及如何识别提示遗传性疾病的特征。旨在提供一套实用框架，支持对甲状旁腺肿瘤更准确、可重复且具临床相关性的病理评估。
- Juhlin & Gill review in Modern Pathology: most parathyroid adenomas are straightforward on morphology, but atypical features and the carcinoma differential sharply raise over-/under-diagnosis risk.
- Pathology’s role extends beyond adenoma vs carcinoma to molecular findings and morphologic/immunophenotypic clues to hereditary syndromes — sometimes the first prompt for germline testing.
- Practical framing: adenoma vs normal gland, atypical parathyroid tumor vs carcinoma, IHC/molecular integration, hereditary clues. Abstract-only here; Unpaywall lists hybrid OA (CC BY) but publisher pages Cloudflare-blocked this exit.
Scope: PubMed abstract only. Unpaywall lists hybrid open access (CC BY), but ScienceDirect and modernpathology.org returned a Cloudflare challenge to this site (curl and Chrome/CDP), so full text, figures and tables were not collected.
Abstract
Parathyroid neoplasms encountered in routine practice are most often diagnostically straightforward and can usually be classified on the basis of conventional histomorphology without the need for extensive biomarker work-up. This relative simplicity has contributed to the perception that pathologic assessment of parathyroid tumors is largely uncomplicated. Yet this view rapidly changes when a lesion exhibits atypical features beyond those expected in a conventional adenoma, particularly when the differential diagnosis includes parathyroid carcinoma, an exceptionally rare but potentially fatal malignancy. In these difficult cases, the endocrine pathologist carries substantial responsibility in separating misleading and overinterpreted atypical findings from lesions that truly harbor malignant potential or an increased risk of recurrence. Beyond classification, pathology also has a central role in identifying molecular abnormalities of diagnostic or therapeutic relevance in parathyroid carcinoma, as well as recognizing morphologic or immunophenotypic clues that may point to an underlying hereditary syndrome. In some cases, the pathologist may be the first to raise suspicion of a germline disorder and thereby initiate further genetic investigation. This review provides a focused analysis of the major histopathologic challenges in primary hyperparathyroidism. Particular emphasis is placed on distinguishing ordinary adenoma from normal glands, identifying atypical parathyroid tumors and parathyroid carcinoma while avoiding overdiagnosis, integrating immunohistochemical and molecular findings into diagnostic practice, and identifying features suggestive of hereditary disease. Our aim is to provide a practical framework that supports more accurate, reproducible, and clinically relevant pathologic assessment of parathyroid tumors.