Light Microscopical Immunohistochemical Study on Parathyroid Adenoma in Primary Hyperparathyroidism

Abstract

Fifteen adenomatous parathyroid glands obtained from 15 patients with primary hyperparathyroidism were examined both pathologically and immuno-histochemically and connected with the clinical data for each patient. Four consecutive sections of the largest section surface of each resected adenomatous parathyroid gland were utilized for 4 kinds of stains, that is, hematoxylineosin, Grimelius and the immunohistochemical stains for parathyroid hormone (PTH) and chromogranin A. The results were as follows: (1) The large adenomatous parathyroid glands showed strong reactions to PTH as well as chromogranin A and Grimelius. On the other hand, the parathyroid adenoma obtained from a 9-year-old boy with hypercalcemic crisis showed almost no stain-positive cells for both PTH and chromogranin A. It is assumed that the former phenomenon reflects a substantial storage of secretory granules, while the latter reflects exhaustion of these granules. (2) The normal parathyroid cells in the neoplastic parathyroid glands generally showed stronger reactions to PTH and chromogranin A than neoplastic parathyroid cells. This suggests that normal cells in the neoplastic parathyroid glands may have their release of PTH rather than its synthesis suppressed, and also might support the hypothesis of some authors that chromogranin A or SP-I might contribute to stabilization of PTH or the secretory vesicle.

Successful Detection and Removal of a Functional Parathyroid Adenoma in a Pony Using Technetium Tc 99m Sestamibi Scintigraphy

“…Given the clear clinical evidence that the mass removed was the source of the excessive PTH, and the histopathologic appearance consistent with neuroendocrine tissue, the diagnosis of a parathyroid adenoma was made despite the lack of PTH reactivity on immunohistochemistry. Although parathyroid adenomas in dogs that have been stained for PTH have been highly positive with either diffuse cytoplasmic or perinuclear staining,10 in people, some parathyroid adenomas do not stain for PTH 11, 12. This is attributed to such a high rate of release of the hormone that an insufficient amount is stored in the cells to take up stain 11.…”

“…Although parathyroid adenomas in dogs that have been stained for PTH have been highly positive with either diffuse cytoplasmic or perinuclear staining,10 in people, some parathyroid adenomas do not stain for PTH 11, 12. This is attributed to such a high rate of release of the hormone that an insufficient amount is stored in the cells to take up stain 11. Alternatively, because normal equine parathyroid tissue was not available as a positive control, the lack of staining could have been a failure of the testing method.…”

“…11,12 This is attributed to such a high rate of release of the hormone that an insufficient amount is stored in the cells to take up stain. 11 Alternatively, because normal equine parathyroid tissue was not available as a positive control, the lack of staining could have been a failure of the testing method. CgA can undergo atypical processing in neoplastic tissue, which is thought to account for the lack of staining in certain neuroendocrine neoplasms.…”