Parathyroid hyperplasia in primary hyperparathyroidism.A review of 85 cases

Abstract

Parathyroid hyperplasia of all four glands was found to be the cause of primary hyperparathyroidism in 85 of 557 cases seen at the Massachusetts General Hospital between 1930 and 1973. There were 66 cases of chief cell hyperplasia and 19 cases of clear cell hyperplasia that were grossly, microscopically, and ultrastructurally distinct. Although the clinical findings overlap, there are several differences in the signs and symptoms between these two forms of hyperplasia. Both types are treated by subtotal removal of all the parathyroid tissue. Removal of insufficient tissue has left residual hyperparathyroidism in 45% of those with chief cell hyperplasia and 11% of those with clear cell hyperplasia after what was thought to be definitive surgery. Postoperative hypoparathyroidism was found in 15% of the patients with chief cell hyperplasia and in none with clear cell hyperplasia. These findings further suggest that removal of three and one-half glands in the more than 86% of patients with one gland involvement (adenoma or carcinoma) as the cause of primary hyperparathyroidism is unwarranted.

A quick intraoperative parathyroid hormone assay in the surgical management of patients with primary hyperparathyroidism: a study of 206 consecutive cases

“…approach (11 -13), or even minimally invasive (14), video-assisted parathyroid surgery (10,15), the potential benefits of these procedures being the decreased risk of postoperative hypocalcemia, nerve injury and shorter operating time (16 -18). The main limitation of these latter procedures is the possibility of a multiglandular disease in up to 15 -20% of cases of sporadic PHPT, a condition that cannot often be identified preoperatively (5,6).…”

“…Moreover in some circumstances it is difficult to distinguish normal from abnormal glands either at the operating table or by frozen section. Indeed in most cases the pathologist can only indicate if the biopsied lump is a parathyroid, but not whether it is normal or abnormal (5,6).…”

The role of hyperplasia in multiple parathyroid adenomas

“…Most patients with pHPT (80%-85%) have a single adenoma, whereas only 15% to 20% have multigland involvement. [2][3][4][5][6][7][8] Our appreciation of clinical manifestationsCorrespondence to: B. Larian …”

Molecular Diagnosis in Head and Neck: What a Surgical Pathologist Must Know

“…There are some histopathologic features which are associated with malignancy, though they are certainly not pathognomonic for carcinoma. Worrisome features include the presence of increased or atypical mitoses, broad bands of fibrosis, trabecular growth pattern, invasion of adjacent tissue, and perineural or angiolymphatic invasion [29]. These features usually correlate with malignancy, though these histologic features are not always present in every case of parathyroid carcinoma [25,30,31].…”