Difference between revisions of "Parathyroid hyperplasia"

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'''Parathyroid hyperplasia''' is a common cause of [[hyperparathyroidism]] that is often associated with [[chronic renal failure]].<ref name=pmid23267748>{{Cite journal  | last1 = Jamal | first1 = SA. | last2 = Miller | first2 = PD. | title = Secondary and tertiary hyperparathyroidism. | journal = J Clin Densitom | volume = 16 | issue = 1 | pages = 64-8 | month =  | year =  | doi = 10.1016/j.jocd.2012.11.012 | PMID = 23267748 }}</ref>
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Parathyroid hyperplasia -- intermed mag.jpg
| Width      =
| Caption    = Parathyroid hyperplasia. [[H&E stain]].
| Synonyms  =
| Micro      = hypercellular - usu. chief cell predominant, decreased adipose tissue, +/-"water-clear" cells (cells with abundant granular/foamy cytoplasm, mild nuclear pleomorphism)
| Subtypes  =
| LMDDx      = [[parathyroid adenoma]], [[parathyroid carcinoma]]
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      = all parathyroid glands are enlarged
| Grossing  =
| Staging    =
| Site      = [[parathyroid gland]]
| Assdx      = [[chronic renal failure]]
| Syndromes  = [[MEN 1]], [[MEN 2A]]
| Clinicalhx =
| Signs      =
| Symptoms  =
| Prevalence = uncommon
| Bloodwork  = elevated PTH, +/-elevated calcium
| Rads      =
| Endoscopy  =
| Prognosis  =
| Other      =
| ClinDDx    = parathyroid adenoma
| Tx        = surgical removal of all parathyroid glands & re-implantation of half of one parathyroid in the forearm
}}
'''Parathyroid hyperplasia''' is an abnormal proliferation of the [[parathyroid gland]]s and a relatively common cause of [[hyperparathyroidism]] that is typically associated with [[chronic renal failure]].<ref name=pmid23267748>{{Cite journal  | last1 = Jamal | first1 = SA. | last2 = Miller | first2 = PD. | title = Secondary and tertiary hyperparathyroidism. | journal = J Clin Densitom | volume = 16 | issue = 1 | pages = 64-8 | month =  | year =  | doi = 10.1016/j.jocd.2012.11.012 | PMID = 23267748 }}</ref>


==General==
==General==
*Common cause of [[hyperparathyroidism]].
*Common cause of [[hyperparathyroidism]].  
*Usually associated with [[chronic renal failure]].
*Usually associated with [[chronic renal failure]].
*May be syndromic - chief cell hyperplasia - associated with [[MEN 1]], [[MEN 2A]].<ref>URL: [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970475-2 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970475-2]. Accessed on: 29 July 2010.</ref>
*May be syndromic - chief cell hyperplasia - associated with [[MEN 1]], [[MEN 2A]].<ref>URL: [http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970475-2 http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970475-2]. Accessed on: 29 July 2010.</ref> ‡
 
Treatment:
*Surgical removal of all parathyroid glands & re-implantation of half of one parathyroid in the forearm.
 
Note: <br>
‡ MEN 1 and MEN 2A are often described as causing parathyroid hyperplasia; more correctly, it is thought these are actually multiple parathyroid adenomas.<ref name=pmid15490065>{{cite journal |authors=Doherty GM, Lairmore TC, DeBenedetti MK |title=Multiple endocrine neoplasia type 1 parathyroid adenoma development over time |journal=World J Surg |volume=28 |issue=11 |pages=1139–42 |date=November 2004 |pmid=15490065 |doi=10.1007/s00268-004-7560-8 |url=}}</ref>


==Gross==
==Gross==
*Classically all parathyroid glands are involved; however, some may be spared making it difficult to differentiate this from parathyroid adenoma.<ref name=Ref_PBoD8_1128>{{Ref PBoD8|1128}}</ref>
*Parathyroid gland enlargement - classically all parathyroid glands are involved; however, some may be spared making it difficult to differentiate this from parathyroid adenoma.<ref name=Ref_PBoD8_1128>{{Ref PBoD8|1128}}</ref>


==Microscopic==
==Microscopic==
Features:<ref name=Ref_PBoD8_1128>{{Ref PBoD8|1128}}</ref>
Features:
*Classically have abundant adipose tissue.
*Hyperplastic/hypercellular appearance:
*+/-Water-clear cells ("water-clear cell hyperplasia").
**Decreased adipose tissue.<ref name=pmid8090603>{{Cite journal  | last1 = Yong | first1 = JL. | last2 = Vrga | first2 = L. | last3 = Warren | first3 = BA. | title = A study of parathyroid hyperplasia in chronic renal failure. | journal = Pathology | volume = 26 | issue = 2 | pages = 99-109 | month = Apr | year = 1994 | doi =  | PMID = 8090603 }}</ref>
**Increased parenchymal cells.  
***Chief cells - usually predominant.<ref name=pmid8090603/>
***"Water-clear" cells:
****Abundant foamy or granular cytoplasm.<ref name=pmid7487410/>
****Mild [[nuclear pleomorphism]].
****May not be present or apparent.
***Other parenchymal cells include: oxyphil cells and transitional oxyphil cells.


Note:
Note:
*Generally, it is impossible to discern between [[parathyroid adenoma]]s and [[parathyroid hyperplasia]]s by histology alone.<ref name=Ref_BITFS191>{{Ref BITFS|191}}</ref>
*Generally, it is impossible to discern between [[parathyroid adenoma]]s and parathyroid hyperplasias by histology alone.<ref name=Ref_BITFS191>{{Ref BITFS|191}}</ref>
**One requires information of the size of the other glands to make the diagnosis.
**One requires information of the size of the other glands to make the diagnosis.
*Water-clear cells may be seen in an adenoma.<ref name=pmid7487410>{{Cite journal  | last1 = Grenko | first1 = RT. | last2 = Anderson | first2 = KM. | last3 = Kauffman | first3 = G. | last4 = Abt | first4 = AB. | title = Water-clear cell adenoma of the parathyroid. A case report with immunohistochemistry and electron microscopy. | journal = Arch Pathol Lab Med | volume = 119 | issue = 11 | pages = 1072-4 | month = Nov | year = 1995 | doi =  | PMID = 7487410 }}</ref>


DDx:
DDx:
*[[Parathyroid adenoma]] - classically have a rim of normal parathyroid gland around it.
*[[Parathyroid adenoma]] - classically have a rim of normal parathyroid gland around it.
*[[Parathyroid carcinoma]] - has invasive tissue destruction or far away metastases.
===Images===
<gallery>
Image: Parathyroid hyperplasia -- very low mag.jpg | PA - very low mag. (WC)
Image: Parathyroid hyperplasia -- low mag.jpg | PA - low mag. (WC)
Image: Parathyroid hyperplasia -- intermed mag.jpg | PA - intermed. mag. (WC)
Image: Parathyroid hyperplasia -- high mag.jpg | PA - high mag. (WC)
</gallery>
====www====
*[https://www.flickr.com/photos/jian-hua_qiao_md/13138532173 Water clear cells in hyperplasia (flicker.com)].


==Sign out==
==Sign out==
===Clinical history is suggestive===
<pre>
<pre>
A. Right Superior Parathyroid, Excision:
A. Right Superior Parathyroid, Excision:

Latest revision as of 21:53, 6 April 2022

Parathyroid hyperplasia
Diagnosis in short

Parathyroid hyperplasia. H&E stain.
LM hypercellular - usu. chief cell predominant, decreased adipose tissue, +/-"water-clear" cells (cells with abundant granular/foamy cytoplasm, mild nuclear pleomorphism)
LM DDx parathyroid adenoma, parathyroid carcinoma
Gross all parathyroid glands are enlarged
Site parathyroid gland
Associated Dx chronic renal failure
Syndromes MEN 1, MEN 2A
Prevalence uncommon
Blood work elevated PTH, +/-elevated calcium
Clin. DDx parathyroid adenoma
Treatment surgical removal of all parathyroid glands & re-implantation of half of one parathyroid in the forearm

Parathyroid hyperplasia is an abnormal proliferation of the parathyroid glands and a relatively common cause of hyperparathyroidism that is typically associated with chronic renal failure.[1]

General

Treatment:

  • Surgical removal of all parathyroid glands & re-implantation of half of one parathyroid in the forearm.

Note:
‡ MEN 1 and MEN 2A are often described as causing parathyroid hyperplasia; more correctly, it is thought these are actually multiple parathyroid adenomas.[3]

Gross

  • Parathyroid gland enlargement - classically all parathyroid glands are involved; however, some may be spared making it difficult to differentiate this from parathyroid adenoma.[4]

Microscopic

Features:

  • Hyperplastic/hypercellular appearance:
    • Decreased adipose tissue.[5]
    • Increased parenchymal cells.
      • Chief cells - usually predominant.[5]
      • "Water-clear" cells:
      • Other parenchymal cells include: oxyphil cells and transitional oxyphil cells.

Note:

  • Generally, it is impossible to discern between parathyroid adenomas and parathyroid hyperplasias by histology alone.[7]
    • One requires information of the size of the other glands to make the diagnosis.
  • Water-clear cells may be seen in an adenoma.[6]

DDx:

Images

  • PA - very low mag. (WC)

  • PA - low mag. (WC)

  • PA - intermed. mag. (WC)

  • PA - high mag. (WC)

www

Sign out

Clinical history is suggestive

A. Right Superior Parathyroid, Excision:
- Parathyroid tissue compatible with hyperplasia.

B. Right Inferior Parathyroid, Excision:
- Parathyroid tissue compatible with hyperplasia.

C. Portion of Left Inferior Parathyroid, Excision:
- Parathyroid tissue compatible with hyperplasia.

D. Left Superior Parathyroid, Excision:
- Parathyroid tissue compatible with hyperplasia.

See also

References

  1. ↑ Jamal, SA.; Miller, PD.. "Secondary and tertiary hyperparathyroidism.". J Clin Densitom 16 (1): 64-8. doi:10.1016/j.jocd.2012.11.012. PMID 23267748.
  2. ↑ URL: http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970475-2. Accessed on: 29 July 2010.
  3. ↑ Doherty GM, Lairmore TC, DeBenedetti MK (November 2004). "Multiple endocrine neoplasia type 1 parathyroid adenoma development over time". World J Surg 28 (11): 1139–42. doi:10.1007/s00268-004-7560-8. PMID 15490065.
  4. ↑ Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; Aster, Jon (2009). Robbins and Cotran pathologic basis of disease (8th ed.). Elsevier Saunders. pp. 1128. ISBN 978-1416031215.
  5. ↑ 5.0 5.1 Yong, JL.; Vrga, L.; Warren, BA. (Apr 1994). "A study of parathyroid hyperplasia in chronic renal failure.". Pathology 26 (2): 99-109. PMID 8090603.
  6. ↑ 6.0 6.1 Grenko, RT.; Anderson, KM.; Kauffman, G.; Abt, AB. (Nov 1995). "Water-clear cell adenoma of the parathyroid. A case report with immunohistochemistry and electron microscopy.". Arch Pathol Lab Med 119 (11): 1072-4. PMID 7487410.
  7. ↑ Taxy, J.; Husain, A; Montag, A. (2009). Biopsy Interpretation: The Frozen Section (1st ed.). Lippincott Williams & Wilkins. pp. 191. ISBN 978-0781767798.
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