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<p>The differentiation between atypical parathyroid tumors and parathyroid carcinoma remains a&#xa0;significant clinical, diagnostic, and histopathological challenge. The transition from the term “atypical adenoma” to “atypical parathyroid tumor” reflects more than a&#xa0;simple change in terminology; it represents a&#xa0;conceptually important shift driven by biological and clinical insights. In conventional pathological usage, the term “adenoma” implies a&#xa0;benign epithelial neoplasm—an assumption that has proven inappropriate for this group of lesions. Indeed, a&#xa0;proportion of tumors formerly classified as atypical adenomas have shown recurrence, molecular alterations, or morphological features that place them closer to parathyroid carcinoma than to typical adenomas.</p><p>By introducing the designation “atypical parathyroid tumor,” the World Health Organization (WHO) acknowledges this diagnostic uncertainty and establishes a&#xa0;distinct intermediate category characterized by the absence of definitive invasion but an uncertain malignant potential. This revised terminology also facilitates clearer clinical communication, as it inherently suggests the need for closer surveillance and careful interdisciplinary evaluation.</p><p>In addition, this reclassification mirrors advances in molecular pathology, particularly insights into <i>CDC73</i>/parafibromin alterations and parafibromin-deficient neoplasms, as well as a&#xa0;growing understanding of associated hereditary syndromes. As a&#xa0;result, the traditional binary distinction between adenoma and carcinoma is increasingly considered inadequate.</p><p>From a&#xa0;diagnostic perspective, distinguishing atypical parathyroid tumors from parathyroid carcinoma remains one of the most demanding tasks in endocrine pathology. The decisive criterion is the presence of unequivocal invasive growth or metastatic disease, rather than isolated atypical histological features. However, preoperative assessment is often inconclusive, and considerable overlap exists in both histological and immunohistochemical findings. Therefore, a&#xa0;reliable diagnosis requires an integrated approach that incorporates clinical presentation, surgical findings, pathological evaluation, and longitudinal follow-up.</p>

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Atypischer Nebenschilddrüsentumor versus Nebenschilddrüsenkarzinom – Herausforderungen in Diagnostik, Therapie und Prognose

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月12日

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  • Christina Lenschow,
  • Nicolas Schlegel

摘要

The differentiation between atypical parathyroid tumors and parathyroid carcinoma remains a significant clinical, diagnostic, and histopathological challenge. The transition from the term “atypical adenoma” to “atypical parathyroid tumor” reflects more than a simple change in terminology; it represents a conceptually important shift driven by biological and clinical insights. In conventional pathological usage, the term “adenoma” implies a benign epithelial neoplasm—an assumption that has proven inappropriate for this group of lesions. Indeed, a proportion of tumors formerly classified as atypical adenomas have shown recurrence, molecular alterations, or morphological features that place them closer to parathyroid carcinoma than to typical adenomas.

By introducing the designation “atypical parathyroid tumor,” the World Health Organization (WHO) acknowledges this diagnostic uncertainty and establishes a distinct intermediate category characterized by the absence of definitive invasion but an uncertain malignant potential. This revised terminology also facilitates clearer clinical communication, as it inherently suggests the need for closer surveillance and careful interdisciplinary evaluation.

In addition, this reclassification mirrors advances in molecular pathology, particularly insights into CDC73/parafibromin alterations and parafibromin-deficient neoplasms, as well as a growing understanding of associated hereditary syndromes. As a result, the traditional binary distinction between adenoma and carcinoma is increasingly considered inadequate.

From a diagnostic perspective, distinguishing atypical parathyroid tumors from parathyroid carcinoma remains one of the most demanding tasks in endocrine pathology. The decisive criterion is the presence of unequivocal invasive growth or metastatic disease, rather than isolated atypical histological features. However, preoperative assessment is often inconclusive, and considerable overlap exists in both histological and immunohistochemical findings. Therefore, a reliable diagnosis requires an integrated approach that incorporates clinical presentation, surgical findings, pathological evaluation, and longitudinal follow-up.