Parathyroid hyperplasia

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

Common cause of hyperparathyroidism.
Usually associated with chronic renal failure.
May be syndromic - chief cell hyperplasia - associated with MEN 1, MEN 2A.^[2] ‡

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:
    - Abundant foamy or granular cytoplasm.^[6]
    - Mild nuclear pleomorphism.
    - May not be present or apparent.
  - 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:

Parathyroid adenoma - classically have a rim of normal parathyroid gland around it.
Parathyroid carcinoma - has invasive tissue destruction or far away metastases.

Images

PA - very low mag. (WC)
PA - low mag. (WC)
PA - intermed. mag. (WC)
PA - high mag. (WC)

www

Water clear cells in hyperplasia (flicker.com).

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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.

References

↑ 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.
↑ URL: http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675%2806%2970475-2. Accessed on: 29 July 2010.
↑ 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.
↑ 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.
↑ ^5.0 ^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.
↑ ^6.0 ^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.
↑ Taxy, J.; Husain, A; Montag, A. (2009). Biopsy Interpretation: The Frozen Section (1st ed.). Lippincott Williams & Wilkins. pp. 191. ISBN 978-0781767798.

[pmid23267748-1] 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.

[pmid15490065-3] 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.

[Ref_PBoD8_1128-4] 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.

[pmid8090603-5] 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.

[pmid7487410-6] 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.

[Ref_BITFS191-7] 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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Parathyroid hyperplasia

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