Histopathological Differentiation of Parathyroid Adenoma and Hyperplasia

Yıl 2019, Cilt: 21 Sayı: 3, 291 - 301, 31.12.2019

İbrahim İbiloğlu Mustafa Kösem İsmail Yıldız

https://doi.org/10.24938/kutfd.541510

Öz

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
parathyroid 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.

Anahtar Kelimeler

Parathyroid adenoma, parathyroid hyperplasia, histopathology

PARATİROİD ADENOMU VE HİPERPLAZİSİNİN HİSTOPATOLOJİK AYRIMI

Öz

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.

Anahtar Kelimeler

Paratiroid adenomu, paratiroid hiperplazisi, histopatoloji

Kaynakça

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