Transplantathyperparathyreoidismus ?Tumor�hnliches Wachstum und autonome Funktion menschlicher Autotransplantate von hyperplastischen Epithelk�rperchen

Abstract

The results of clinical and morphologic studies performed in 41 patients with chronic, renal failure and secondary hyperparathyroidism, who had total parathyroidectomy and autotransplantation of parathyroid tissue into the forearm muscle are presented. In five cases, 7--33 months after autotransplantation we found transplantation tumors developing in the forearm. Explanted grafts showed invasive growth of parathyroid tissue in the adjacent structures, into the musculature and blood vessels. The increased incidence of mitosis otherwise seen as evidence of malignant neoplasia of parathyroid tumors, indicated atypical focal proliferation of the transplanted tissue. This is justification for not performing transplantations any more in the treatment of renal osteodystrophy.

Fulminant Calcinosis in Two Patients after Kidney Transplantation

“…In addition, vascular calcifications usually do not regress even if some improvement is seen, whereas nonvascular calcinosis -as in our case -often regresses nearly com pletely after PTX [2, 6, 20], Our first patient developed recurrence of hyperpara thyroidism after total PTX with autotransplant. Com plete removal of the autotransplant from the left forearm was not possible although invasive growth of parathy roid tissue in the neighbouring structures as reported by others [21][22][23] was histologically not seen. Similar to the patients in the recent studies of Korzets [21] and Ellis [23], parathyroid tissue was implanted in several frag ments into small pockets of the brachioradialis muscle and was retained in place with fibrin adhesive.…”

Ultrastructure of parathyroid autografts in chronic renal failure including the occurrence of concentric membranous bodies and intermediate filaments

“…In no previous reports of the ultrastructure of parathyroid autografts in renal patients has reference been made to the presence of concentric membranous bodies, confronting cisternae, intracellular filaments or the cell 'nesting' phenomenon (Wells et al 1975, 1977, Burnett, Thompson & Barbour 1977, Talwalker et al 1979, Klempa et al 1982,1984. Cell 'nesting' was most marked in the donor glands and in the hyperplastic autograft tissues (Ellis 1988) especially in case 8 in which there was recurrent rapid growth of the graft tissue.…”