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Histopathological Differentiation of Parathyroid Adenoma and Hyperplasia

Year 2019, , 291 - 301, 31.12.2019
https://doi.org/10.24938/kutfd.541510

Abstract

Objective: The histopathological findings are not always sufficient for
differentiating parathyroid adenoma and parathyroid hyperplasia. The
differentiation is important due to treatment modalities. In this study, we
investigated the histopathological
differentiation of parathyroid adenoma and
p
arathyroid hiperplasia.

Material and Methods: Sixty parathyroid adenoma, 35 parathyroid hiperplasia
and 20 normal parathyroid gland cases were included to the study. Eighteen main
histological parameters with 27 sub-histological parameters were investigated
among these groups.

Results: In the histopathological examination, a statistically significant entity of normal
parathyroid tissue was seen in 71.6%of parathyroid adenomas but was not present
in any of the parathyroid hiperplasia cases. A
remarkable (+++)
capsule thickening was observed in 28.3%of parathyroid adenomas,
whereas none of parathyroid hiperplasia revealed such
thickening. The presences of (+), (++), (+++) fat cells were seen in 93.3%, 6.7%and
none of the paratiroid adenomas and were seen 51.4%, 42.8%and 8.6%of
parathyroid hiperplasia cases respectively. Nest formation was observed in 8.3%of
parathyroid adenomas, 22.8%of parathyroid hiperplasia cases.
Lymphocyte infiltration was observed in 26.7%of parathyroid adenomas
and 8.6%of parathyroid hiperplasias. No significant difference was observed
between parathyroid adenoma and parathyroid hiperplasia in terms of fibrous
band, cyst formation, cell line patterns except nest formation, necrosis,
degeneration, bleeding, presence of colloid-like material, cell type,
inflammation except lymhocyte infiltration, nuclear form, nuclear chromatin
structure, presence of intranuclear inclusion.

Conclusion: It was determined that normal parathyroid tissue in the
rim, remarkable (+++) capsule thickening, small amount of fat cell (+),
lymhocyte infiltration were seen much more frequently in parathyroid adenoma
than in parathyroid hyperplasia and the difference was found statistically
significant. The presences of nest formation, (+) capsule thickening and
remarkable fat cell (++ and +++) were found to be significantly higher in
parathyroid hiperplasia than in parathyroid adenomas.

References

  • 1. Arnold A, Staunton CE, Kim HG, Gaz RD, Kronenberg HM. Monoclonality and abnormal parathyroid hormone genes in parathyroid adenomas. N Engl J Med. 1988;318(11):658-62.
  • 2. Noguchi S, Motomura K, Inaji H, Imaoka S, Koyama H. Clonal analysis of parathyroid adenomas by means of the polymerase chain reaction. Cancer Lett. 1994(1-3);78:93-7.
  • 3. Kvasnicka T, Wang W, Johansson H, Sandelin K, Grimelius L. Apoptosis and growth factors in parathyroid adenomas. Hormone and Metabolism Research.1997;29(11):544-8.
  • 4. Lumachi F, Basso SM. Pathophysiology and treatment of nonfamilial hyperparathyroidism. Recent Pat CNS Drug Discov. 2014;9(3):164-72.
  • 5. Berger AC, Libutti SK, Bartlett DL, Skarulis MG, Marx SJ, Spiegel AM. Heterogenous gland size in sporadic multiple gland parathyroid hyperplasia. J Am Coll Surg.1999;188(4):382-9.
  • 6. DeLellis RA. Parathyroid tumours and related disorders. Mod Pathol. 2011;24(Suppl 2):S78-93.
  • 7. Akerstrom G, Malmaeus J, Bergstrom S. Surgical anatomy of human parathyroid glands. Surgery. 1984;95(1):14-21.
  • 8. Torre NG, Buley I, Wass JAH, Jackson DG, Turner HE. Angiogenesis and lymphangiogenesis in parathyroid proliferative lesions. J Clin Endocrinol Metab. 2004;89(6):2890-6.
  • 9. LiVolsi VA, Montone K, Sack M. Pathology of thyroid disease. In: Sternberg SS, ed. Diagnostic Surgical Pathology. 4th ed. Philadelphia. Lippincott, Williams & Wilkins, 1999:529-571.
  • 10. Dufour DR, Wilkerson SY. Factors related to parathyroid weight in normal persons. Arch Pathol Lab Med. 1983;107(4):167-72.
  • 11. Roth SI, Capen CC. Ultrastructural and functional correlations of the parathyroid gland. Int Rev Exp Pathol. 1974;13:161-221.
  • 12. Deker A, Dunsford HA, Geyer SJ. The normal parathyroid gland at autopsy: the significance of stromal fat in adult patients. J Pathol. 1979;128(3):127-32.
  • 13. Akerstrom G, Grimelius L, Johasnsson H, Pertoft H, Lundquist H. Estimation of parathyroid parenchymal cell mass by density gradients. Am J Pathol. 1980;99(3):685-94.
  • 14. Obara T, Fujimoto Y, Hirayama A. Flow cytometric DNA analysis of parathyroid tumors with special reference to its diagnostic and prognostic value in parathyroid carcinoma. Cancer. 1990;65(8):1789-93.
  • 15. Harlow S, Roth SI, Bauer K. Flow cytometric DNA analysis of normal and pathologic parathyroid glands. Mod Pathol. 1991;4(3):310-5.
  • 16. August DA, Flynn SD, Jones MA. Parathyroid carcinoma: The relationship of nuclear DNA content to clinical Outcome. Surgery. 1993;113(3):290-6.
  • 17. Heath HWI, Hodgson SF, Kennedy MA. Primary hyperparathyroidism: Incidence, morbidity and potential ecnomic impact in a community. N Engl J M. 1980;302(4):189-93. 18. Verdonk CA, Edis AJ. Parathyroid “double adenomas”: fact or fiction? Surgery. 1981;90(3);523-6. 19. Tezelman S, Shen W, Shaver JK. Double parathyroid adenomas. Clinical and biochemical characteristics before and after parathyroidectomy. Ann Surg. 1993;218(3):300-7.
  • 20. Tezelman S, Shen W, Siperstein AE, Duch QY, Clark OH. Persistent or recurrent hyperparathyroidism in patients with double adenomas. Surgery. 1995;118(6):1115-22.
  • 21. Castleman B, Schantz A, Roth SI. Parathyroid hyperplasia in primary hyperparathyroidism: A review of 85 cases. Cancer. 1976;38(4):1668-75.
  • 22. Attie, JN, Bock, G, Auguste, LJ. Multiple parathyroid adenomas: report of thirty-three cases. Surgery. 1990;108(6):1014-9.
  • 23. Clark OH. Surgical treatment of primary hyperparathyroidism. Adv Endocrinol Metab. 1995;6(5):1-9.
  • 24. DeLellis R. Tumors of the parathyroid glands. In: Atlas of Tumor Pathology. 3th ed. Washington DC. Armed Force Institute of Pathology, 1993:20-45.
  • 25. Veress B, Nordenstrom J. Lymhocytic infiltration and destruction of parathyroid adenomas. A possible tumor specific autoimmunne reaction in two cases of primary hyperparathyroidism. Histopathology. 1994;25(4):373-8.
  • 26. Ünal N, Öz Atalay F, Saraydaroğlu Ö, Şen F, Kırdak T, Ertürk E. Paratiroid adenomu tanısında Ki67 ve p53 ekspresyonunun rolü. Uludağ Üniv Tıp Fak Derg. 2016;42(2-3):83-7.
  • 27. Karak KA, Sarkar C, Chumber S, Tandon N. MIB-1 prolifertive index in parathyroid adenoma and hyperplasia. Indian J Med Res.1997;105(5):235-8.
  • 28. Stojadinovic A, Hoos A, Nisan A, Dudas EM, Cordon-Carlo C, Shaha RA et al. Parathyroid neoplasms: clinical, histopathological, and tissue microarray-based molecular analysis. Hum Pathol. 2003;34(1):54-64.
  • 29. Abbona GC, Papotti M, Gasparri G, Bussolati G. Proliferative activity in parathyroid tumors as detected by Ki-67 immunohistostaining. Hum Pathol. 1995;26(2):135-8.
  • 30. Snover DC, Foukar K. Mitotic activity in benign parathyroid disease. Am J Clin Pathol. 1981;75(3):345-7.

PARATİROİD ADENOMU VE HİPERPLAZİSİNİN HİSTOPATOLOJİK AYRIMI

Year 2019, , 291 - 301, 31.12.2019
https://doi.org/10.24938/kutfd.541510

Abstract

Amaç: Paratiroid
adenomu
ve paratiroid
hiperplazisinin ayrımında kullanılan histopatolojik bulgular, bu iki patolojiyi
ayırmada her zaman yeterli olamamaktadır. Paratiroid adenomu
ve paratiroid hiperplazilerinin
birbirinden ayrımı tedavi farklılıkları nedeni ile önemlidir. Bu çalışmada,
paratiroid adenomu
ve paratiroid hiperplazisinin
histopatolojik ayrımı araştırıldı.

Gereç ve Yöntemler: Çalışma grubu, 60 paratiroid adenomu, 35 paratiroid
hiperplazisi ve 20 normal paratiroid bezi olgusundan meydana gelmekte olup bu
gruplar arasında 18 ana histolojik parametre ile 27 alt histolojik parametre
araştırıldı.

Bulgular: Histopatolojik
incelemede, kenarda normal paratiroid bezi varlığı, paratiroid adenomlarının %71.6’sında
görülürken, paratiroid hiperplazilerinin hiçbirinde gözlenmedi. Belirgin (+++)
kapsül kalınlığı, paratiroid adenomlarının %28.3’ünde izlenirken, paratiroid
hiperplazilerinin hiçbirinde yoktu. Paratiroid hiperplazilerinin %48.6’sında ve
paratiroid adenomlarının %10’unda (+) kapsül kalınlığı izlendi. Orta derece ve
belirgin yağ hücresi varlığı (++ ve +++) paratiroid adenomu vakalarının toplam %6.6’sında,
paratiroid hiperplazisi vakalarının %48.6’sında görüldü. Paratiroid
adenomlarında (+) yağ hücresi varlığı %93.3 iken, paratiroid hiperplazilerinde %51.4
oranında, (++) yağ hücresi varlığı paratiroid adenomlarında %6.7, paratiroid
hiperplazilerinde %42.8 oranında, (+++) yağ hücresi varlığı paratiroid
adenomlarında izlenmez iken paratiroid hiperplazilerinde %8.6 olguda
izlenmiştir. Dizilim paternlerinden nest formasyonu paratiroid adenomlarının %8.3’ünde,
paratiroid hiperplazilerinin %22.8’inde mevcuttu. Lenfosit infiltrasyonu
paratiroid adenomlarının %26.7’sinde mevcut iken paratiroid hiperplazilerinin %8.6’sında
izlendi. Fibröz bant varlığı, kist formasyonu, nest formasyonu hariç dizilim
paternleri, nekroz, dejenerasyon, kanama, kolloid benzeri materyal, hücre tipi,
lenfosit infiltrasyonu hariç inflamasyon, nükleer pleomorfizm, nükleer şekil,
nükleer kromatin, intranükleer inklüzyon, ve mitoz bakımından paratiroid
adenomu ve paratiroid hiperplazisi arasında anlamlı farklılık gözlenmedi.

Sonuç: Paratiroid adenomu ile paratiroid
hiperplazisinin ayrımında kenarda normal paratiroid bezi varlığı, belirgin
kapsül kalınlığı (+++), az miktarda yağ hücresi oranı (+) ve lenfosit
infiltrasyonu paratiroid adenomu lehine anlamlı bulundu. Nest formasyonu,
paratiroid hiperplazilerinde paratiroid adenomlarına göre anlamlı olarak daha
yüksek izlendi.

References

  • 1. Arnold A, Staunton CE, Kim HG, Gaz RD, Kronenberg HM. Monoclonality and abnormal parathyroid hormone genes in parathyroid adenomas. N Engl J Med. 1988;318(11):658-62.
  • 2. Noguchi S, Motomura K, Inaji H, Imaoka S, Koyama H. Clonal analysis of parathyroid adenomas by means of the polymerase chain reaction. Cancer Lett. 1994(1-3);78:93-7.
  • 3. Kvasnicka T, Wang W, Johansson H, Sandelin K, Grimelius L. Apoptosis and growth factors in parathyroid adenomas. Hormone and Metabolism Research.1997;29(11):544-8.
  • 4. Lumachi F, Basso SM. Pathophysiology and treatment of nonfamilial hyperparathyroidism. Recent Pat CNS Drug Discov. 2014;9(3):164-72.
  • 5. Berger AC, Libutti SK, Bartlett DL, Skarulis MG, Marx SJ, Spiegel AM. Heterogenous gland size in sporadic multiple gland parathyroid hyperplasia. J Am Coll Surg.1999;188(4):382-9.
  • 6. DeLellis RA. Parathyroid tumours and related disorders. Mod Pathol. 2011;24(Suppl 2):S78-93.
  • 7. Akerstrom G, Malmaeus J, Bergstrom S. Surgical anatomy of human parathyroid glands. Surgery. 1984;95(1):14-21.
  • 8. Torre NG, Buley I, Wass JAH, Jackson DG, Turner HE. Angiogenesis and lymphangiogenesis in parathyroid proliferative lesions. J Clin Endocrinol Metab. 2004;89(6):2890-6.
  • 9. LiVolsi VA, Montone K, Sack M. Pathology of thyroid disease. In: Sternberg SS, ed. Diagnostic Surgical Pathology. 4th ed. Philadelphia. Lippincott, Williams & Wilkins, 1999:529-571.
  • 10. Dufour DR, Wilkerson SY. Factors related to parathyroid weight in normal persons. Arch Pathol Lab Med. 1983;107(4):167-72.
  • 11. Roth SI, Capen CC. Ultrastructural and functional correlations of the parathyroid gland. Int Rev Exp Pathol. 1974;13:161-221.
  • 12. Deker A, Dunsford HA, Geyer SJ. The normal parathyroid gland at autopsy: the significance of stromal fat in adult patients. J Pathol. 1979;128(3):127-32.
  • 13. Akerstrom G, Grimelius L, Johasnsson H, Pertoft H, Lundquist H. Estimation of parathyroid parenchymal cell mass by density gradients. Am J Pathol. 1980;99(3):685-94.
  • 14. Obara T, Fujimoto Y, Hirayama A. Flow cytometric DNA analysis of parathyroid tumors with special reference to its diagnostic and prognostic value in parathyroid carcinoma. Cancer. 1990;65(8):1789-93.
  • 15. Harlow S, Roth SI, Bauer K. Flow cytometric DNA analysis of normal and pathologic parathyroid glands. Mod Pathol. 1991;4(3):310-5.
  • 16. August DA, Flynn SD, Jones MA. Parathyroid carcinoma: The relationship of nuclear DNA content to clinical Outcome. Surgery. 1993;113(3):290-6.
  • 17. Heath HWI, Hodgson SF, Kennedy MA. Primary hyperparathyroidism: Incidence, morbidity and potential ecnomic impact in a community. N Engl J M. 1980;302(4):189-93. 18. Verdonk CA, Edis AJ. Parathyroid “double adenomas”: fact or fiction? Surgery. 1981;90(3);523-6. 19. Tezelman S, Shen W, Shaver JK. Double parathyroid adenomas. Clinical and biochemical characteristics before and after parathyroidectomy. Ann Surg. 1993;218(3):300-7.
  • 20. Tezelman S, Shen W, Siperstein AE, Duch QY, Clark OH. Persistent or recurrent hyperparathyroidism in patients with double adenomas. Surgery. 1995;118(6):1115-22.
  • 21. Castleman B, Schantz A, Roth SI. Parathyroid hyperplasia in primary hyperparathyroidism: A review of 85 cases. Cancer. 1976;38(4):1668-75.
  • 22. Attie, JN, Bock, G, Auguste, LJ. Multiple parathyroid adenomas: report of thirty-three cases. Surgery. 1990;108(6):1014-9.
  • 23. Clark OH. Surgical treatment of primary hyperparathyroidism. Adv Endocrinol Metab. 1995;6(5):1-9.
  • 24. DeLellis R. Tumors of the parathyroid glands. In: Atlas of Tumor Pathology. 3th ed. Washington DC. Armed Force Institute of Pathology, 1993:20-45.
  • 25. Veress B, Nordenstrom J. Lymhocytic infiltration and destruction of parathyroid adenomas. A possible tumor specific autoimmunne reaction in two cases of primary hyperparathyroidism. Histopathology. 1994;25(4):373-8.
  • 26. Ünal N, Öz Atalay F, Saraydaroğlu Ö, Şen F, Kırdak T, Ertürk E. Paratiroid adenomu tanısında Ki67 ve p53 ekspresyonunun rolü. Uludağ Üniv Tıp Fak Derg. 2016;42(2-3):83-7.
  • 27. Karak KA, Sarkar C, Chumber S, Tandon N. MIB-1 prolifertive index in parathyroid adenoma and hyperplasia. Indian J Med Res.1997;105(5):235-8.
  • 28. Stojadinovic A, Hoos A, Nisan A, Dudas EM, Cordon-Carlo C, Shaha RA et al. Parathyroid neoplasms: clinical, histopathological, and tissue microarray-based molecular analysis. Hum Pathol. 2003;34(1):54-64.
  • 29. Abbona GC, Papotti M, Gasparri G, Bussolati G. Proliferative activity in parathyroid tumors as detected by Ki-67 immunohistostaining. Hum Pathol. 1995;26(2):135-8.
  • 30. Snover DC, Foukar K. Mitotic activity in benign parathyroid disease. Am J Clin Pathol. 1981;75(3):345-7.
There are 28 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section ART
Authors

İbrahim İbiloğlu This is me 0000-0002-8407-2583

Mustafa Kösem 0000-0002-2347-0940

İsmail Yıldız This is me 0000-0001-5505-838X

Publication Date December 31, 2019
Submission Date March 18, 2019
Published in Issue Year 2019

Cite

APA İbiloğlu, İ., Kösem, M., & Yıldız, İ. (2019). PARATİROİD ADENOMU VE HİPERPLAZİSİNİN HİSTOPATOLOJİK AYRIMI. The Journal of Kırıkkale University Faculty of Medicine, 21(3), 291-301. https://doi.org/10.24938/kutfd.541510
AMA İbiloğlu İ, Kösem M, Yıldız İ. PARATİROİD ADENOMU VE HİPERPLAZİSİNİN HİSTOPATOLOJİK AYRIMI. Kırıkkale Üni Tıp Derg. December 2019;21(3):291-301. doi:10.24938/kutfd.541510
Chicago İbiloğlu, İbrahim, Mustafa Kösem, and İsmail Yıldız. “PARATİROİD ADENOMU VE HİPERPLAZİSİNİN HİSTOPATOLOJİK AYRIMI”. The Journal of Kırıkkale University Faculty of Medicine 21, no. 3 (December 2019): 291-301. https://doi.org/10.24938/kutfd.541510.
EndNote İbiloğlu İ, Kösem M, Yıldız İ (December 1, 2019) PARATİROİD ADENOMU VE HİPERPLAZİSİNİN HİSTOPATOLOJİK AYRIMI. The Journal of Kırıkkale University Faculty of Medicine 21 3 291–301.
IEEE İ. İbiloğlu, M. Kösem, and İ. Yıldız, “PARATİROİD ADENOMU VE HİPERPLAZİSİNİN HİSTOPATOLOJİK AYRIMI”, Kırıkkale Üni Tıp Derg, vol. 21, no. 3, pp. 291–301, 2019, doi: 10.24938/kutfd.541510.
ISNAD İbiloğlu, İbrahim et al. “PARATİROİD ADENOMU VE HİPERPLAZİSİNİN HİSTOPATOLOJİK AYRIMI”. The Journal of Kırıkkale University Faculty of Medicine 21/3 (December 2019), 291-301. https://doi.org/10.24938/kutfd.541510.
JAMA İbiloğlu İ, Kösem M, Yıldız İ. PARATİROİD ADENOMU VE HİPERPLAZİSİNİN HİSTOPATOLOJİK AYRIMI. Kırıkkale Üni Tıp Derg. 2019;21:291–301.
MLA İbiloğlu, İbrahim et al. “PARATİROİD ADENOMU VE HİPERPLAZİSİNİN HİSTOPATOLOJİK AYRIMI”. The Journal of Kırıkkale University Faculty of Medicine, vol. 21, no. 3, 2019, pp. 291-0, doi:10.24938/kutfd.541510.
Vancouver İbiloğlu İ, Kösem M, Yıldız İ. PARATİROİD ADENOMU VE HİPERPLAZİSİNİN HİSTOPATOLOJİK AYRIMI. Kırıkkale Üni Tıp Derg. 2019;21(3):291-30.

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