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Morphology of the parathyroid glands. A study of 146 samples and
review of the literature.
An
Otorrinolaringol Ibero Am. 2007;34(2):135-42.
Parathyroid
hyperfunction condition has a very diverse and unspecific symptoms and
signs. We have performed an anatomopathologic study of 146 parathyroid
gland from patients diagnosed from hyperparathyroidism. About a 72.6%
of the patients presented a parathyroid adenoma while in the rest
27.4% it was observed principal cells hyperplasia. Up to now we have
not registered any cases of parathyroid carcinoma after
anatomopathological exam of the removed gland. The mayority of the
adenomas (85%) were found on the lower parathyroids and its size
varied between 6 mm and 5 cm. In one case an double adenoma was
diagnosed and in another two cases the adenoma was located in the
superior mediastine.
Combined parathyroid
adenoma and an occult papillary carcinoma.Saudi
Med J. 2004 Nov;25(11):1707-10.
Although the
pathological association of thyroid and parathyroid disease is common,
the association of both parathyroid adenoma and thyroid cancer is
rare. We report here a case of a 45-year-old Saudi woman who was
diagnosed to have primary hyperparathyroidism due to a single
parathyroid adenoma as confirmed biochemically and radiologically. At
operation, the adenoma was found to be an intrathyroid and therefore a
thyroid lobectomy was performed. Histology of the excised lobe
revealed in addition to the intrathyroid parathyroid adenoma a
concurrent occult thyroid papillary carcinoma. This interesting
association is discussed based on a literature review.
Parathyroid adenoma,
hyperplasia, and carcinoma: localization, technical details of primary
neck exploration, and treatment of hypercalcemic crisis.
Surg Oncol Clin N Am. 1998 Oct;7(4):721-48
The pathologic
characteristics and clinical presentation of patients with primary
hyperparathyroidism are discussed including the treatment of
hypercalcemic crisis. Surgical issues, including the use of localizing
studies, and the surgical treatment of primary hyperparathyroidism are
reviewed.
Double parathyroid
adenomas. Clinical and biochemical characteristics before and after
parathyroidectomy.
Ann Surg. 1993
Sep;218(3):300-7.
OBJECTIVE: There
is considerable debate about whether double parathyroid adenomas are a
discrete entity or represent hyperplasia with parathyroid glands of
varying sizes. This distinction is important because it impacts on the
extent of parathyroid resection and the success of the parathyroid
operation. SUMMARY BACKGROUND DATA: Double parathyroid adenomas have
been reported to occur in 1.7% to 9% of patients with primary
hyperparathyroidism (HPT). It is important for surgeons to
differentiate between double adenoma and hyperplasia with glands of
varying sizes using gross examination during the initial procedure
because microscopic findings of a small biopsy specimen at
frozen-section examination may not be diagnostic. METHODS: From 1982
to 1992, 416 unselected patients (309 women and 107 men) with primary
HPT without familial HPT or multiple endocrine neoplasia (MEN) were
treated by one surgeon at the University of California at San
Francisco. Double adenoma occurred in 49 patients, solitary adenoma in
309 patients, and hyperplasia in 58 patients. The authors analyzed the
clinical manifestations, the preoperative and postoperative serum
levels of calcium, phosphate, and parathyroid hormone (PTH), and the
success rate and outcome after parathyroidectomy and compared their
results in 49 patients with double adenomas to the results for
patients with solitary adenomas or hyperplasia. RESULTS: Ten of the
patients with double adenomas (20.4%) were referred for persistent HPT
after removal of one abnormal parathyroid gland. The ages of the
patients with double adenoma, single adenoma, and hyperplasia were 61
+/- 14, 56 +/- 15, and 58 +/- 7 years, respectively. Fatigue, muscle
weakness, and bone pain were common in patients with double adenomas,
whereas nephrolithiasis occurred more frequently in patients with
solitary adenoma (p = 0.0001). Serum calcium and PTH levels (per cent
of upper limit of normal) fell from 11.5 +/- 1.2 mg/dL and 487% to 9.5
+/- 0.8 mg/dL and 61% for patients with double adenomas; from 11.9 +/-
0.9 mg/dL and 378% to 9.3 +/- 1.4 mg/dL and 101% for patients with
single adenoma; and from 10.9 +/- 0.5 mg/dL and 418% to 9.1 +/- 0.7
mg/dL and 94% for patients with hyperplasia, respectively. There was
no recurrence in the patients with double adenomas with a mean
follow-up time of 5.8 years. CONCLUSIONS: Double adenomas are a
discrete entity and occur more often in older patients. Patients with
double adenomas can be successfully treated by removal of the two
abnormal glands.
Surgery for parathyroid adenoma and hyperplasia: relationship of
histology to outcome.
Head Neck. 1993
Jan-Feb;15(1):24-8.
Recent
histopathologic evidence challenges the teaching that enlargement of a
solitary parathyroid gland is invariably caused by an adenoma, whereas
multiple gland enlargement results from hyperplasia. We have
re-examined the parathyroid tissue obtained from 152 consecutive
patients undergoing surgery for primary hyperparathyroidism and
compared it with their clinical outcome. Our approach was to excise
enlarged glands and biopsy the remainder. In 124 patients (82%) at
least three glands were biopsied or removed. The ratio of adenoma to
hyperplasia was reversed by our histologic re-examination; adenomas
were found in only 27 patients (25 single, two double), whereas
hyperplasia was found in 117 patients (one gland, 87 patients; two
glands, 16 patients; three glands, five patients; four glands, nine
patients). Normal tissue only was reported in eight patients. During a
2-year follow-up, five patients (3%) developed hypocalcemia and none
developed recurrent hypercalcemia. Our results indicate that a full
neck exploration with removal of all enlarged glands is more important
than the histologic diagnosis in planning a successful surgical
strategy for primary hyperparathyroidism.
Multiple parathyroid adenomas: report of thirty-three cases.
Surgery 1990 Dec;108(6):1014-9.
An increasing
number of patients with primary hyperparathyroidism are found to have
two or three enlarged parathyroid glands. Of 865 patients successfully
operated on by one surgeon (J.N.A.), multiple enlarged parathyroid
glands (adenomas) were found and resected in 33 cases (3.8%), with
resulting normocalcemia lasting from 1 to 22 years (mean 5.8).
Twenty-nine patients had two adenomas and four had three adenomas. In
28 patients the multiple adenomas were synchronous. Twenty-five
patients underwent removal of all of the enlarged parathyroid glands
in one operation; in three patients one adenoma was removed,
reoperation for persistent hypercalcemia was performed, and a second
adenoma was resected with cure. In five patients one adenoma was
removed, normocalcemia ensued for 3 to 18 years, and a second (metachronous)
adenoma occurred and was resected successfully. Although 10 of 70
enlarged parathyroid glands removed were labeled hyperplasia, cure in
all but one of our patients by selective resection of only enlarged
parathyroid glands emphasizes the unreliability of histologic criteria
in differentiating between parathyroid adenoma and hyperplasia. Based
on this study, we support the existence of multiple adenomas and
advocate removal of only macroscopically enlarged parathyroid glands
in patients with primary hyperparathyroidism.
Surgical considerations in hyperparathyroidism: reappraisal of the
need for multigland biopsy.
Am J Surg. 1976 Sep;132(3):338-40.
Sixty-seven
cases of neck exploration for suspected hyperparathyroidism were
reviewed. Thirty-nine patients underwent removal of an adenoma with
biopsy of one or more other parathyroid glands. In another group, nine
patients underwent removal of the adenoma only. Both groups have had
no recurrences of hyperparathyroidism in follow-up periods of two
months to twelve years. The data presented indicate that removal of a
parathyroid adenoma alone, without biopsy of other tissue, represents
satisfactory treatment. Experience with hyperplastic glands is also
reviewed. Subtotal parathyroidectomy was effective treatment in all
patients, but a 30 per cent incidence of hypocalcemia was noted after
this operation.
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