Bibliographic record
Abstract
The diagnosis of a non-metastatic parathyroid carcinoma requires the demonstration of invasive growth that defines malignancy. These include angioinvasion or vascular invasion (i.e., tumor penetrating the vessel wall and associated with thrombus or intravascular tumor cells intermixed with thrombus), lymphatic invasion, perineural (intraneural) invasion, and/or direct invasion into adjacent anatomical structures. However, the distinction of a pT1 disease (8th edition of UICC TNM staging system) which represents a localized disease (tumor confined to the parathyroid gland or showing minimal extra-parathyroidal soft tissue invasion without direct invasion into adjacent structures) often requires meticulous microscopic examination that couples multiple levels and biomarker studies. Although the diagnostic criteria of malignancy are clearly defined, the identification of harbingers of invasive growth and distinguishing them from their mimics can pose diagnostic challenges. Several artifacts and manipulations can simulate malignancy. For example, a prior biopsy, PTH washout, ethanol injection, or any form of surgical manipulation may result in fibrosis, crush (mechanical) artifacts, or tissue distortion, which can obscure histological details and mimic invasion. Peliosis-the presence of extravasated erythrocytes without an endothelial lining-may simulate vascular invasion. Other common mimics include mechanically displaced intravascular tumor cells unassociated with thrombus, which can occur at the time of specimen handling. Extension of the tumor into the adjacent irregular connective tissue or pseudo-capsule can be mistaken for invasive growth. Similarly, an intrathyroidal location of the parathyroid gland adds another layer of complexity. In such cases, the boundary between the parathyroid tissue and surrounding thyroid parenchyma may not be clearly discernible, making it difficult to determine whether there is genuine invasive growth into thyroid (pT2 disease, 8th edition of UICC TNM system) or simply anatomical proximity. In addition, parathyromatosis and contour irregularities associated with long-standing secondary or tertiary hyperparathyroidism are other challenging manifestations. Atypical parathyroid tumors (WHO 2022) should also be clearly delineated using appropriate criteria. In summary, pathologists must be aware of the potential pitfalls that may lead to overdiagnosis of parathyroid carcinoma. A consolidated diagnostic workup, which combines multiple levels and biomarkers, is necessary to ensure diagnostic accuracy in all parathyroid tumors. This review provides practical insights on these diagnostic difficulties, illustrating common artifacts and mimics. We also discuss the relevant clinical, histological, immunohistochemical, and molecular features associated with parathyroid carcinoma, with the goal of enhancing diagnostic accuracy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.020 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.005 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.005 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".