Parathyroid hyperplasia

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Parathyroid hyperplasia
Diagnosis in short

Parathyroid hyperplasia. H&E stain.
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

Gross

  • Classically all parathyroid glands are involved; however, some may be spared making it difficult to differentiate this from parathyroid adenoma.[3]

Microscopic

Features:[3]

  • Classically have abundant adipose tissue.
  • +/-"Water-clear" cells:[4]

Note:

DDx:

Images

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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. 3.0 3.1 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.
  4. 4.0 4.1 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.
  5. Taxy, J.; Husain, A; Montag, A. (2009). Biopsy Interpretation: The Frozen Section (1st ed.). Lippincott Williams & Wilkins. pp. 191. ISBN 978-0781767798.