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. 1984 Apr;115(1):70–83.

The parathyroid adenoma. A histopathologic definition with a study of 172 cases of primary hyperparathyroidism.

L Ghandur-Mnaymneh, N Kimura
PMCID: PMC1900356  PMID: 6711681

Abstract

There is unanimous agreement that parathyroid adenoma lacks precise histopathologic definition. Likewise, it is generally accepted that hyperplasia may involve the parathyroid glands unequally, causing tumorous enlargement of a single parathyroid gland. On the basis of observations of the histologic features of the normal parathyroid gland and on the accepted definition of an adenoma, and based on the concept of unequal or "focal" hyperplasia, histopathologic criteria for the recognition of adenoma and its differentiation from hyperplasia were formulated. Study of 172 cases of primary hyperparathyroidism with the use of these criteria showed that adenomas accounted for only 5.8% of cases of primary hyperparathyroidism and that hyperplasia with single gland enlargement accounted for 75.1%. The literature and data supporting the view that solitary masses of the parathyroid glands more often represent hyperplasia than adenoma are cited.

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Selected References

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  1. Akerström G., Grimelius L., Johansson H., Pertoft H., Lundqvist H. Estimation of the parathyroid parenchymal cell mass by density gradients. Am J Pathol. 1980 Jun;99(3):685–694. [PMC free article] [PubMed] [Google Scholar]
  2. Akerström G., Grimelius L., Johansson H., Pertoft H., Lundqvist J. Parenchymal cell mass determination in parathyroid glands and its application in a material of hyperparathyroidism. World J Surg. 1981 Jul;5(4):555–563. doi: 10.1007/BF01655010. [DOI] [PubMed] [Google Scholar]
  3. BLACK B. K., ACKERMAN L. V. Tumors of the parathyroid; a review of twenty-three cases. Cancer. 1950 May;3(3):415–444. doi: 10.1002/1097-0142(1950)3:3<415::aid-cncr2820030304>3.0.co;2-#. [DOI] [PubMed] [Google Scholar]
  4. Ballinger W. F., Haff R. C. Hyperparathyroidism: increased freuency of diagnosis. South Med J. 1970 May;63(5):571–575. [PubMed] [Google Scholar]
  5. Baylin S. B., Gann D. S., Hsu S. H. Clonal origin of inherited medullary thyroid carcinoma and pheochromocytoma. Science. 1976 Jul 23;193(4250):321–323. doi: 10.1126/science.935869. [DOI] [PubMed] [Google Scholar]
  6. Bengtsson A., Grimelius L., Johansson H., Pontén J. Nuclear DNA-content of parathyroid cells in adenomas, hyperplastic and normal glands. Acta Pathol Microbiol Scand A. 1977 Jul;85(4):455–460. doi: 10.1111/j.1699-0463.1977.tb03876.x. [DOI] [PubMed] [Google Scholar]
  7. Black W. C., 3rd Correlative light and electron microscopy in primary hyperparathyroidism. Arch Pathol. 1969 Sep;88(3):225–241. [PubMed] [Google Scholar]
  8. Black W. C., 3rd, Utley J. R. The differential diagnosis of parathyroid adenoma and chief cell hyperplasia. Am J Clin Pathol. 1968 Jun;49(6):761–775. doi: 10.1093/ajcp/49.6.761. [DOI] [PubMed] [Google Scholar]
  9. Black W. C., Haff R. C. The surgical pathology of parathyroid chief cell hyperplasia. Am J Clin Pathol. 1970 May;53(5):565–579. doi: 10.1093/ajcp/53.5.565. [DOI] [PubMed] [Google Scholar]
  10. Block M. A., Greenawald K., Horn R. C., Jr, Frame B. Involvement of multiple parathyroids in hyperparathyroidism. Surgical aspects. Am J Surg. 1967 Oct;114(4):530–537. doi: 10.1016/0002-9610(67)90012-8. [DOI] [PubMed] [Google Scholar]
  11. COPE O., KEYNES W. M., ROTH S. I., CASTLEMAN B. Primary chief-cell hyperplasia of the parathyroid glands: a new entity in the surgery of hyperparathyroidism. Ann Surg. 1958 Sep;148(3):375–388. doi: 10.1097/00000658-195809000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. CUTLER R. E., REISS E., ACKERMAN L. V. FAMILIAL HYPERPARATHYROIDISM. A KINDRED INVOLVING ELEVEN CASES, WITH A DISCUSSION OF PRIMARY CHIEF-CELL HYPERPLASIA. N Engl J Med. 1964 Apr 23;270:859–865. doi: 10.1056/NEJM196404232701701. [DOI] [PubMed] [Google Scholar]
  13. Castleman B., Mallory T. B. The Pathology of the Parathyroid Gland in Hyperparathyroidism: A Study of 25 Cases. Am J Pathol. 1935 Jan;11(1):1–72.17. [PMC free article] [PubMed] [Google Scholar]
  14. Castleman B., Schantz A., Roth S. Parathyroid hyperplasia in primary hyperparathyroidism: a review of 85 cases. Cancer. 1976 Oct;38(4):1668–1675. doi: 10.1002/1097-0142(197610)38:4<1668::aid-cncr2820380438>3.0.co;2-x. [DOI] [PubMed] [Google Scholar]
  15. Clark O. H., Way L. W., Hunt T. K. Recurrent hyperparathyroidism. Ann Surg. 1976 Oct;184(4):391–402. doi: 10.1097/00000658-197610000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Coffey R. J., Lee T. C., Canary J. J. The surgical treatment of primary hyperparathyroidism: a 20 year experience. Ann Surg. 1977 May;185(5):518–523. doi: 10.1097/00000658-197705000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Dekker A., Watson C. G., Barnes E. L., Jr The pathologic assessment of primary hyperparathyroidism and its impact on therapy. A prospective evaluation of 50 cases with oil-red-O stain. Ann Surg. 1979 Nov;190(5):671–675. doi: 10.1097/00000658-197911000-00020. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Dufour D. R., Durkowski C. Sudan IV stain. Its limitations in evaluating parathyroid functional status. Arch Pathol Lab Med. 1982 May;106(5):224–227. [PubMed] [Google Scholar]
  19. Esselstyn C. B., Jr, Levin H. S., Eversman J. J., Schumacher O. P., Skillern P. G. Reappraisal of parathyroid pathology in hyperparathyroidism. Surg Clin North Am. 1974 Apr;54(2):443–447. doi: 10.1016/s0039-6109(16)40290-2. [DOI] [PubMed] [Google Scholar]
  20. Fialkow P. J., Jackson C. E., Block M. A., Greenawald K. A. Multicellular origin of parathyroid "adenomas". N Engl J Med. 1977 Sep 29;297(13):696–698. doi: 10.1056/NEJM197709292971304. [DOI] [PubMed] [Google Scholar]
  21. Fialkow P. J., Martin G. M., Klein G., Clifford P., Singh S. Evidence for a clonal origin of head and neck tumors. Int J Cancer. 1972 Jan 15;9(1):133–142. doi: 10.1002/ijc.2910090116. [DOI] [PubMed] [Google Scholar]
  22. Grimelius L., Akerström G., Johansson H., Bergström R. Anatomy and histopathology of human parathyroid glands. Pathol Annu. 1981;16(Pt 2):1–24. [PubMed] [Google Scholar]
  23. HELLSTROM J., IVEMARK B. I. Primary hyperparathyroidism. Clinical and structural findings in 138 cases. Acta Chir Scand Suppl. 1962;Suppl 294:1–113. [PubMed] [Google Scholar]
  24. Haff R. C., Armstrong R. G. Trends in the current management of primary hyperparathyroidism. Surgery. 1974 May;75(5):715–719. [PubMed] [Google Scholar]
  25. Haff R. C., Ballinger W. F. Causes of recurrent hypercalcemia after parathyroidectomy for primary hyperparathyroidism. Ann Surg. 1971 Jun;173(6):884–891. doi: 10.1097/00000658-197106010-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Harness J. K., Ramsburg S. R., Nishiyama R. H., Thompson N. W. Multiple adenomas of the parathyroids: do they exist? Arch Surg. 1979 Apr;114(4):468–474. doi: 10.1001/archsurg.1979.01370280122018. [DOI] [PubMed] [Google Scholar]
  27. Hoehn J. G., Beahrs O. H., Woolner L. B. Unusual surgical lesions of the parathyroid gland. Am J Surg. 1969 Nov;118(5):770–778. doi: 10.1016/0002-9610(69)90227-x. [DOI] [PubMed] [Google Scholar]
  28. Irvin G. L., 3rd, Bagwell C. B. Identification of histologically undetectable parathyroid hyperplasia by flow cytometry. Am J Surg. 1979 Oct;138(4):567–571. doi: 10.1016/0002-9610(79)90420-3. [DOI] [PubMed] [Google Scholar]
  29. Kasdon E. J., Rosen S., Cohen R. B., Silen W. Surgical pathology of hyperparathyroidism. Usefulness of fat stain and problems in interpretation. Am J Surg Pathol. 1981 Jun;5(4):381–384. [PubMed] [Google Scholar]
  30. Kay S. The abnormal parathyroid. Hum Pathol. 1976 Mar;7(2):127–138. doi: 10.1016/s0046-8177(76)80015-9. [DOI] [PubMed] [Google Scholar]
  31. King D. T., Hirose F. M. Chief cell intracytoplasmic fat used to evaluate parathyroid disease by frozen section. Arch Pathol Lab Med. 1979 Nov;103(12):609–612. [PubMed] [Google Scholar]
  32. Lawrence D. A. A histological comparison of adenomatous and hyperplastic parathyroid glands. J Clin Pathol. 1978 Jul;31(7):626–632. doi: 10.1136/jcp.31.7.626. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Ljungberg O., Tibblin S. Peroperative fat staining of frozen sections in primary hyperparathyroidism. Am J Pathol. 1979 Jun;95(3):633–641. [PMC free article] [PubMed] [Google Scholar]
  34. Nilsson O. Studies on the ultrastructure of the human parathyroid glands in various pathological conditions. Acta Pathol Microbiol Scand Suppl. 1977;(263):1–88. [PubMed] [Google Scholar]
  35. Palmer J. A., Brown W. A., Kerr W. H., Rosen I. B., Watters N. A. The surgical aspects of hyperparathyroidism. Arch Surg. 1975 Aug;110(8):1004–1007. doi: 10.1001/archsurg.1975.01360140148028. [DOI] [PubMed] [Google Scholar]
  36. Paloyan E., Paloyan D., Pickleman J. R. Hyperparathyroidism today. Surg Clin North Am. 1973 Feb;53(1):211–220. doi: 10.1016/s0039-6109(16)39947-9. [DOI] [PubMed] [Google Scholar]
  37. Purnell D. C., Scholz D. A., Beahrs O. H. Hyperparathyroidism due to single gland enlargement: prospective postoperative study. Arch Surg. 1977 Apr;112(4):369–372. doi: 10.1001/archsurg.1977.01370040021003. [DOI] [PubMed] [Google Scholar]
  38. RIDDICK F. A., Jr, REISS E. Hyperparathyroidism. Analysis of recent experiences, clinical spectrum, and diagnostic tests. Ann Intern Med. 1962 Feb;56:183–197. doi: 10.7326/0003-4819-56-2-183. [DOI] [PubMed] [Google Scholar]
  39. ROTH S. I., MUNGER B. L. The cytology of the adenomatous, atrophic, and hyperplastic parathyroid glands of man. A light- and electron-microscopic study. Virchows Arch Pathol Anat Physiol Klin Med. 1962;335:389–410. doi: 10.1007/BF00957031. [DOI] [PubMed] [Google Scholar]
  40. Reiss E., Canterbury J. M. Application of radioimmunoassay to differentiation of adenoma and hyperplasia and to preoperative localization of hyperfunctioning parathyroid glands. N Engl J Med. 1969 Jun 19;280(25):1381–1385. doi: 10.1056/NEJM196906192802504. [DOI] [PubMed] [Google Scholar]
  41. Roth S. I., Capen C. C. Ultrastructural and functional correlations of the parathyroid gland. Int Rev Exp Pathol. 1974;13(0):161–221. [PubMed] [Google Scholar]
  42. Roth S. I., Gallagher M. J. The rapid identification of "normal" parathyroid glands by the presence of intracellular fat. Am J Pathol. 1976 Sep;84(3):521–528. [PMC free article] [PubMed] [Google Scholar]
  43. Roth S. I. Recent advances in parathyroid gland pathology. Am J Med. 1971 May;50(5):612–622. doi: 10.1016/0002-9343(71)90116-1. [DOI] [PubMed] [Google Scholar]
  44. Sicard G. A. Parathyroid hyperplasia versus adenoma--clinical or histologic diagnosis. Surgery. 1981 Jul;90(1):125–126. [PubMed] [Google Scholar]
  45. Utley J. R., Black W. C. Hyperparathyroidism. A clinicopathologic evaluation. Am J Surg. 1967 Nov;114(5):788–795. doi: 10.1016/0002-9610(67)90149-3. [DOI] [PubMed] [Google Scholar]
  46. WOOLNER L. B., KEATING F. R., Jr, BLACK B. M. Tumors and hyperplasia of the parathyroid glands; a review of the pathological findings in 140 cases of primary hyperparathyroidism. Cancer. 1952 Nov;5(6):1069–1088. doi: 10.1002/1097-0142(195211)5:6<1069::aid-cncr2820050603>3.0.co;2-r. [DOI] [PubMed] [Google Scholar]
  47. Wang C. A., Rieder S. V. A density test for the intraoperative differentiation of parathyroid hyperplasia from neoplasia. Ann Surg. 1978 Jan;187(1):63–67. doi: 10.1097/00000658-197801000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Woltering E. A., Emmott R. C., Javadpour N., Marx S. J., Brennan M. F. ABO(H) cell surface antigens in parathyroid adenoma and hyperplasia. Surgery. 1981 Jul;90(1):1–9. [PubMed] [Google Scholar]

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