The role of hyperplasia in multiple parathyroid adenomas

Larian, Babak; Alavi, Sassan; Roesler, John; Namazie, Ali; Blackwell, Keith E.; Calcaterra, Thomas C.; Wang, Marilene B.

doi:10.1002/1097-0347(200102)23:2<134::aid-hed1008>3.0.co;2-j

Cited by 19 publications

(10 citation statements)

References 19 publications

(22 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Similar to our study, various other studies have found no proliferated cells in normal or suppressed parathyroid tissue (19,24). In another study, the highest PCNA LI was observed in adenoma and nodular areas of hyperplasia (25).…”

Section: Discussionsupporting

confidence: 92%

See 1 more Smart Citation

Comparison of Proliferative Activity in Parathyroid Glands in Primary and Secondary Hyperparahyroidism

Demıralay¹

2011

Acta Endo (Buc)

View full text Add to dashboard Cite

Objective.Parathyroid gland hyperplasia is diffuse or nodular in secondary hyperparathyroidism (sHPT) in patients with renal failure. Whether the nodular growth starts from the beginning or is the transformation of a diffusely-growing gland into nodular hyperplasia in parallel with increases in the severity of the disease is unknown. The disease might be unresponsive to medical treatment when nodular hyperplasia develops. This study aims to differentiate the characteristics of the parathyroid glands with and without nodular hyperplasia in sHPT, and to investigate if there is any similarity between the nodular hyperplastic glands of sHPT and the parathyroid adenomas of primary hyperparathyroidism.Materials and Methods. Hyperplasia types (nodular or diffuse) and parathyroid cell types, and the expression of proliferating cell nuclear antigen (PCNA) and Ki-67 in parathyroid tissue were investigated histopathologically and immunohistochemically in 94 parathyroid glands of 42 patients with hyperparathyroidism. Results andDiscussion. 63 glands showed nodular hyperplasia and 16 diffuse hyperplasia in sHPT. Chief cells predominated across the whole series. Vacuolated chief cells most frequently accompanied chief cells in both nodular hyperplasia (28.6%) and adenomas (53%). The median ratio of PCNA LI (labelling index) was 30/10³ (min: 4-max: 720) cells in nodular hyperplasia, 16/10³ (min: 2-max: 180) cells in diffuse hyperplasia and 30/10³ (min: 10-max: 707) cells in adenomas (p>0.05). The highest PCNA LI according to all the cell types in the series was in chief cell and vacuolated chief cell combinations (53/10³, p=0.04). These findings suggest that parathyroid adenoma and nodular hyperplasia have histopathologically-and i m m u n o h i s t o c h e m i c a l l y -s i m i l a r characteristics suggesting that both have aggressive cell proliferation.

show abstract

Section: Discussionsupporting

confidence: 92%

“…Clonal analyses have indicated that parathyroid adenomas are monoclonal (19)(20)(21). It is thought that each nodule observed in nodular hyperplasia cases consists of a single type cell with potential for aggressive proliferation, similar to parathyroid adenoma (9).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Proliferative Activity in Parathyroid Glands in Primary and Secondary Hyperparahyroidism

Demıralay¹

2011

Acta Endo (Buc)

View full text Add to dashboard Cite

show abstract

“…Current evidence regarding the histopathogenesis of parathyroid adenoma and hyperplasia is unclear. Although most adenomas are monoclonal proliferations, suggesting a neoplastic origin, histopathologic evidence indicates the evolution to a monoclonal adenoma from polyclonal hyperplasia and vice versa (44)(45)(46). Therefore, parathyroid adenoma and hyperplasia could be the same disease entity, representing opposite ends of the spectrum of phenotypic expression.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of parathyroid imaging: comparison of planar scintigraphy, spect, spect/ct and c-11 methionine pet for the detection of parathyroid adenomas and glandular hyperplasia

Öksüz

Dittmann²,

Wicke³

et al. 2010

Diagn Interv Radiol

View full text Add to dashboard Cite

Sporadic primary hyperparathyroidism is the most common cause of hypercalcemia in the outpatient population, with a prevalence of one per 500 women and one per 2000 men over 40 years of age. Both increased cell proliferative activity and a decreased sensitivity of cells to secretory inhibition by calcium occur in hyperparathyroidism (1). The diagnosis of hyperparathyroidism is usually made by the demonstration of an inappropriately elevated parathyroid hormone level compared to the simultaneously measured serum calcium level (2). In 80% to 85% of patients, primary hyperparathyroidism is caused by one or more parathyroid adenomas, and in 15% to 20% of cases, it is the result of parathyroid hyperplasia. A rare cause of primary hyperparathyroidism, accounting for less than 1% of all cases, is parathyroid carcinoma. Persistent hyperparathyroidism occurs in 5% to 10% of all patients who undergo surgery for primary hyperparathyroidism, with a continuation of the pre-operative hypercalcemia in the immediate post-operative period. Hyperparathyroidism that presents after a period of more than six months of normocalcemia following surgery is called "recurrent hyperparathyroidism" and is commonly due to continuing growth of the remaining parathyroid glands (3). Secondary hyperparathyroidism is a compensatory hypertrophy of all parathyroid glands due to hypocalcemia, as occurs in renal failure or with vitamin D deficiency (4), whereas tertiary hyperparathyroidism describes the development of autonomous function of parathyroid tissue after longstanding secondary hyperparathyroidism (5-8).In most cases (80%-85%), parathyroid adenomas are found adjacent to the thyroid gland, which is the normal location for these adenomas. However, in up to 20% of cases, they are ectopically placed, e.g., in the anterosuperior, posterosuperior, or very rarely in the mid-lower mediastinum. Occasionally, parathyroid adenomas may be found within, or lateral to, the carotid sheath. Rarely, the lower parathyroid glands fail to migrate, remaining in the high neck anterior to the carotid bifurcation. Finally, 1.4% to 3.2% of all parathyroid adenomas are intrathyroidal, i.e., embedded completely within the thyroid gland (9).Among the several imaging procedures that have been developed for the detection and localization of parathyroid adenomas, dual-phase scintigraphy with Tc-99m sestamibi combined with ultrasonography is considered the imaging method of choice for pre-operatively localizing parathyroid adenomas. The overall accuracy of dual-phase scintigraphy combined with ultrasonography has been found to be superior to that of other scintigraphic or radiological techniques (10, 11). Studies comparing planar imaging and single photon emission computed tomography (SPECT) have shown significantly increased sensitivity for Tc-99m sestamibi SPECT, thus supporting its routine use prior to surgery (12-14). HEAD AND NECK IMAGING PURPOSETo compare the accuracy of planar scintigraphy, single photon emission computed tomography (SPECT), SPECT-CT, and positron...

show abstract

“…Immunohistochemical PCNA staining of adenomas, secondary hyperthyroidism cases and normal parathyroid tissue cells in studies showed PCNA LI to be highest in adenomas (7,11). It was highest in vacuolated chief cells and lowest (2,11).…”

Section: Methodsmentioning

confidence: 98%

“…Clonal analyses have shown that parathyroid adenomas are monoclonal (2,8,9). All adenomas were determined to be monoclonal and normal parathyroid tissue to be polyclonal with the phosphoglycerate kinase gene in studies of Larian et al (2).…”

Section: Five Cell Types Have Been Identified In Normal Parathyroid Tmentioning

confidence: 99%

Morphological evaluation of parathyroid adenomas and immunohistochemical analysis of pcna and ki-67 proliferation markers

Demıralay

Altaca²,

Demirhan³

2011

TJPATH

View full text Add to dashboard Cite

Objective: Parathyroid adenomas are the most common cause of primary hyperparathyroidism. Biological studies have shown that parathyroid adenomas are monoclonal proliferations. Up to date, five cell types have been identified in normal parathyroid tissues; chief cells, vacuolated chief cells, dark chief cells, oxyphil cells and transitional oxyphil cells. Most parathyroid adenomas are predominantly composed of chief cells.In this study, we aimed to indicate the relationship between the predominant cell type in parathyroid adenomas and proliferating cell nuclear antigen, Ki-67 antigen, and serum parathormone levels and the gland weight. Material and Method:15 cases who had a diagnosis of parathyroid adenomas were included in the study. Histopathologically, the predominant cell type was determined in all the cases. Paraffin blocks were immunohistochemically stained with proliferating cell nuclear antigen and Ki-67. Results:The average parathormone level of the cases was 239.52 ± 36.61 pg/ml before surgery. Mean gland weight was 1.69 ± 0.49 g. Two of the cases showed atypical adenoma characteristics. The predominant cell type was vacuolated chief cell. Immunohistochemical investigation showed that the mean average Ki-67 index value was 4.26 ± 0.86%. The mean proliferating cell nuclear antigen index was 93.20± 45.72/10³. There was a meaningful relationship between gland weights and serum parathormone levels. There was no meaningful relationship between predominant cell types and serum parathormone levels, proliferating cell nuclear antigen index, and Ki-67 index. The chief cell was identified as the predominant cell type. Conclusion Bulgular:Hastaların tümü kadın olup ortalama yaş 58 ± 13,36 olarak saptandı. Operasyon öncesi ortalama parathormon düzeyleri 239,52 ± 36,61 pg/ml idi. Bez ağırlıkları ortalama 1,69 ± 0,49 gr idi. Olgulardan biri lipoadenomdu. İki tanesi atipik adenom özellikleri göstermekteydi. Olgulardan 8 tanesinde baskın hücre tipi "berrak esas hücre", 6 tanesinde "esas hücre", 1 tanesinde ise "oksifil hücre" idi. İmmünohistokimyasal incelemelerde Ki-67 indeksi ortalama değeri % 4,26 ± 0,86 olarak saptandı. Prolifere hücre nükleer antijeni indeksi ortalama 93,20 ± 45,72/10³ olarak belirlendi. Bez ağırlıklarının serum parathormon düzeyleri üzerine anlamlı etkisi olduğu saptandı. Baskın olan hücre tiplerinin serum parathormon düzeyleri, Prolifere hücre nükleer antijeni indeksi, Ki-67 indeksi üzerine anlamlı etkisi olmadığı tespit edildi. Sonuç olarak çalışmamızda olguların çoğunda baskın hücre tipi esas hücre olarak saptanmıştır.

show abstract

The role of hyperplasia in multiple parathyroid adenomas

Cited by 19 publications

References 19 publications

Comparison of Proliferative Activity in Parathyroid Glands in Primary and Secondary Hyperparahyroidism

Comparison of Proliferative Activity in Parathyroid Glands in Primary and Secondary Hyperparahyroidism

Accuracy of parathyroid imaging: comparison of planar scintigraphy, spect, spect/ct and c-11 methionine pet for the detection of parathyroid adenomas and glandular hyperplasia

Morphological evaluation of parathyroid adenomas and immunohistochemical analysis of pcna and ki-67 proliferation markers

Contact Info

Product

Resources

About