Parathyroid hyperplasia in primary hyperparathyroidism.A review of 85 cases
1976; Wiley; Volume: 38; Issue: 4 Linguagem: Inglês
10.1002/1097-0142(197610)38
ISSN1097-0142
AutoresBenjamin Castleman, Arthur Schantz, Sanford I. Roth,
Tópico(s)Soft tissue tumor case studies
ResumoCancerVolume 38, Issue 4 p. 1668-1675 ArticleFree Access Parathyroid hyperplasia in primary hyperparathyroidism. A review of 85 cases Benjamin Castleman MD, Benjamin Castleman MD Department of Pathology, Harvard Medical School and the James Homer Wright Pathology Laboratories of the Massachusetts General Hospital Shattuck Professor of Pathology Emeritus, Harvard Medical School and Former Chief, Department of Pathology, Massachusetts General Hospital.Search for more papers by this authorArthur Schantz MD, Arthur Schantz MD Department of Pathology, Harvard Medical School and the James Homer Wright Pathology Laboratories of the Massachusetts General Hospital Formerly, Resident in Pathology, Massachusetts General Hospital.Search for more papers by this authorSanford I. Roth MD, Corresponding Author Sanford I. Roth MD Department of Pathology, Harvard Medical School and the James Homer Wright Pathology Laboratories of the Massachusetts General Hospital Formerly, Associate Professor of Pathology, Harvard Medical School, Associate Pathologist, Massachusetts General Hospital. Professor and Chairman, Department of Pathology, University of Arkansas College of Medicine, Little Rock, Arkansas.Department of Pathology, University of Arkansas, College of Medicine, Little Rock, AR 72201===Search for more papers by this author Benjamin Castleman MD, Benjamin Castleman MD Department of Pathology, Harvard Medical School and the James Homer Wright Pathology Laboratories of the Massachusetts General Hospital Shattuck Professor of Pathology Emeritus, Harvard Medical School and Former Chief, Department of Pathology, Massachusetts General Hospital.Search for more papers by this authorArthur Schantz MD, Arthur Schantz MD Department of Pathology, Harvard Medical School and the James Homer Wright Pathology Laboratories of the Massachusetts General Hospital Formerly, Resident in Pathology, Massachusetts General Hospital.Search for more papers by this authorSanford I. Roth MD, Corresponding Author Sanford I. Roth MD Department of Pathology, Harvard Medical School and the James Homer Wright Pathology Laboratories of the Massachusetts General Hospital Formerly, Associate Professor of Pathology, Harvard Medical School, Associate Pathologist, Massachusetts General Hospital. Professor and Chairman, Department of Pathology, University of Arkansas College of Medicine, Little Rock, Arkansas.Department of Pathology, University of Arkansas, College of Medicine, Little Rock, AR 72201===Search for more papers by this author First published: October 1976 https://doi.org/10.1002/1097-0142(197610)38:4 3.0.CO;2-XCitations: 79 AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Abstract Parathyroid hy perplasia 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 of 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. References 1 Albright, F., Bloomberg, E., Castleman, B., and Churchill, E. B.: Hyperparathyroidism due to diffuse hyperplasia of all parathyroid glands rather than an adenoma of one. Clinical studies on three such cases. Arch. Intern. Med. 54: 315– 329, 1934. 2 Bartsch, G.: Elektronemikroskopische Untersuchungen von Epithelkörperchen bei primären Hyperparathyreoidismus. Verh. Dtsch. Ges Pathol. 54: 682– 683, 1970. 3 Black, W. C., III: Correlative light and electron microscopy in primary hyperparathyroidism. Arch. Path. 88: 225– 241, 1969. 4 Black, W. C. and Haff, R. C.: The surgical pathology of parathyroid chief cell hyperplasia. Am. J. Clin. Path. 53: 565– 579, 1970. 5 Black, W. C. III, and Utley, J. R.: The differential diagnosis of parathyroid adenoma and chief cell hyperplasia. Am. J. Clin. Path. 49: 761– 775, 1968. 6 Case Records of the Massachusetts General Hospital: Case 29–1963. N. Engl. J. Med. 268: 943– 953, 1963. 7 Castleman, B., and Cope, O.: Primary parathyroid hypertrophy and hyperplasia. A review of 11 cases at the Massachusetts General Hospital. Bull. Hosp. Joint Dis. 12: 368– 378, 1951. 8 Cope, O. Hyperparathyroidism—The significance of generalized hyperplasia—Report of the seventh case. Clinics 1: 1168– 1178, 1943. 9 Cope, O.: Hyperparathyroidism—Diagnosis and management. Am. J. Surg. 99: 394– 403, 1960. 10 Cope, O., Keynes, W. M., Roth, S. I., and Castleman, B.: Primary chief cell hyperplasia of the parathyroid glands—A new entity in the surgery of hyperparathyroidism. Ann. Surg. 148: 375– 388, 1958. 11 Faccini, J. M.: The ultrastructure of parathyroid glands removed from patients with primary hyperparathyroidism. A report of 40 cases, including four carcinomas. J. Pathol. 102: 189– 199, 1970. 12 Glenn, F.: Surgical treatment of hyperparathyroidism. Ann. Surg. 149: 305– 320, 1959. 13 Haff, R. C.: Trends in current management of primary hyperparathyroidism. Surgery 75: 715– 719, 1974. 14 Holzmann, K., and Lange, R.: Zur Zytologie der Glandula parathyreoidea des Menschen—weitere Untersuchungen and Epithelkörperadenomen. Z. Zellforsch. 58: 759– 789, 1963. 15 Munger, B. L., and Roth, S. I.: The cytology of the normal parathyroid glands of man and Virginia deer. A light and electron microscopic study with morphologic evidence of secretory activity. J. Cell. Biol. 16: 379– 400, 1963. 16 Paloyan, E., Paloyan, D., and Pickleman, J. R.: Hyperparathyroidism today. Surg. Clin. North Am. 53: 211– 220, 1973. 17 Purnell, D. C., Scholz, D. A., Smith, L. H., et al.: Treatment of primary hyperparathyroidism. Am. J. Med. 56: 800– 809, 1974. 18 Purnell, D. C., Smith, L. H., Scholz, D. A., Elvebeck, L. R., and Arnaud, C. D.: Primary hyperparathyroidism—A prospective study. Am. J. Med. 50: 670– 677, 1971. 19 Romanus, R., Heimann, P., Nilsson, O., and Hansson, G.: Surgical treatment of hyperparathyroidism. Prog. Surg. 12: 22– 76, 1973. 20 Roth, S. I.: Pathology of the parathyroids in hyperparathyroidism. Discussion of recent advances in the anatomy and pathology of the parathyroid glands. Arch. Pathol. 73: 495– 510, 1962. 21 Roth, S. I.: The ultrastructure of primary water-clear cell hyperplasia of the parathyroid glands. Am. J. Pathol. 61: 233– 248, 1970. 22 Roth, S. I.: Recent advances in parathyroid gland pathology. Am. J. Med. 50: 612– 622, 1971. 23 Roth, S. I., and Gallagher, M. J.: Rapid identification of normal parathyroid glands by presence of intracellular fat. Am. J. Pathol., in press. 24 Roth, S. I., and Munger, B. L.: The cytology of the adenomatosis, atrophic and hyperplastic parathyroid glands of man. A light and electron microscopic study. Virchows Arch. (Pathol. Anal.) 335: 389– 410, 1962. 25 Roth, S. I., Wang, C.-A., and Potts, J. T., Jr.: The team approach to primary hyperparathyroidism. Hum. Pathol. 6: 645– 648, 1975. 26 Sheldon, H.: On the water-clear cell in the human parathyroid gland. J. Ultrastruct. Res. 10: 377– 383, 1964. 27 Wang, C. A.: Surgery of the parathyroid glands. In Advances in Surgery, vol. 5, C. E. Welch and J. D. Hardy, Eds. Chicago, Yearbook Medical Publishers 1971; pp. 109– 127. Citing Literature Volume38, Issue4October 1976Pages 1668-1675 ReferencesRelatedInformation
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