Chief cell and clear cell parathyroid adenoma do not influence clinical and biochemical expression of the sporadic primary hyperparathyroidism (original) (raw)
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A Rare Case of Primary Hyperparathyroidism with Clear Cell Adenoma
Endocrine Journal, 2004
We report a 52-year-old woman who was noted to have elevated alkaline phosphatase (ALP), hypercalcemia (Ca: 11.7 mg/dL), and intact parathyroid hormone (intact PTH: 643.1 pg/mL), and then referred to our hospital with suspected hyperparathyroidism. Ultrasound examination of the neck and magnetic resonance imaging showed a mass region in the posterior aspect of the left lobe of the thyroid, and Tl-Tc subtraction scintigraphy showed Tl uptake at the same location. Based on laboratory and imaging studies, she was diagnosed with primary hyperparathyroidism. The excised parathyroid was a large mass measuring 6.8 × 2.8 × 1.9 cm in diameter and weighing 15.4 g. It was soft, covered with a thin capsule, did not infiltrate the thyroid parenchyma, and showed no evidence of malignant process. Histopathological examination showed that it was clear cell adenoma. There was no evidence of metastasis from the parathyroid tumor in other organs. The post-operative course was excellent, and serum PTH, Ca, and ALP levels returned to normal. Among parathyroid tumors, large adenomas are commonly considered to be more likely malignant, but in this case it was benign despite measuring more than 6 cm in diameter. The histopathological type of the adenoma was clear cell adenoma, a very rare type. We report a clear cell adenoma of the parathyroid gland, which has not been described previously in Japan.
Functional evidence for two types of parathyroid adenoma
Clinical Endocrinology, 1998
OBJECTIVE The carboxyterminal parathyroid hormone (C-PTH)/intact (I-) PTH ratio is in¯uenced by serum calcium concentrations in man, increasing to a maximum value in hypercalcaemia and decreasing to a minimum value in hypocalcaemia. We decided to use this ratio to screen for parathyroid tumour with a normal sensitivity to calcium, symptomatic mainly through a mass effect. DESIGN AND SUBJECTS Nineteen patients with hypercalcaemia and elevated or inappropriate PTH, were studied in the basal state and during CaCl 2 and Na 2 EDTA infusion and compared with 26 normal individuals. They all had one parathyroid adenoma removed surgically, and two remained hypercalcaemic. RESULTS In the basal state, the patients were hypercalcaemic (ionized calcium 1´44 6 0´12 vs. 1´23 6 0´03 mmol/l, P < 0´001) and had elevated PTH levels (I-PTH: 10´8 6 8´0 vs. 2´3 6 0´6 pmol/l, P < 0´001; C-PTH: 31´6 6 38´9 vs. 5´25 6 1´11 pmol/l, P < 0´001) when compared with normals. Their mean C-PTH/I-PTH ratio was similar to normals (2´7 6 1´3 vs. 2´4 6 0´6, NS) but, when individual values were considered, three patients had elevated values at 4´9, 5´3 and 5´8 (normal 1´2±3´6). The regression line between basal C-and I-PTH revealed a signi®cantly higher slope in these patients (P < 0´0001). The 16 patients with a normal basal C-PTH/I-PTH ratio had, as a group, an increased set point of I-or C-PTH stimulation by calcium and increased values of stimulated and non-suppressible I-and C-PTH, but these abnormalities were not all present in the smaller tumours (#200 mg). Only three tumours in that group were larger than 1000 mg.
Cytologic findings of a clear cell parathyroid lesion
Diagnostic Cytopathology, 2013
On fine-needle aspiration (FNA) biopsy, clear cell parathyroid lesions can be misdiagnosed as thyroid neoplasms, salivary gland neoplasms, paraganglioma, or even metastatic renal cell carcinoma. We report the clinicopathological, cytologic, and histologic findings of a clear cell parathyroid tumor in a 64-year-old HIV-positive patient. A computed tomography (CT) scan with contrast showed a heterogeneous and enhancing mass at the inferolateral aspect of the left thyroid lobe. FNA showed a cellular smear with many single and loosely clustered tumor cells with finely granular and vacuolated light-purple cytoplasm and central nuclei. Occasional microfollicular structures were noted. No colloid was seen. This FNA was misdiagnosed as a follicular neoplasm of the thyroid. Sections of the excised mass showed large polyhedral cells with well-defined cell membranes and clear cytoplasm with a small amount of eosinophilic granular material. These clear cells were positive for pancytokeratin and PTH immunohistochemical stains. These results favored a diagnosis of parathyroid Water Clear Cell Adenoma. This brief report highlights the cytologic findings of clear cell parathyroid lesions and their potential diagnostic pitfalls. Diagn. Cytopathol. 2011;00:000-000. ' 2011 Wiley Periodicals, Inc.
Parathyroid Adenoma without Hyperparathyroidism
Japanese Journal of Clinical Oncology, 2004
A 45-year-old female patient was admitted to our hospital presenting with a right anterior cervical tumor that was elastic, hard, painless and 3.5 × 3.5 cm in size. Laboratory data including serum calcium level, thyroid and parathyroid hormonal functions revealed no abnormalities. Further examination, consisting of computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography (US) and radioisotope (RI)-imaging demonstrated that it was a solid tumor located behind the right thyroid lobe. The tumor, whose origin was unclear, was successfully removed with right thyroid lobectomy. Macroscopically, it appeared as reddish solid tumor consisting of small cystic lesions storing chocolate-colored mucous. Immunohistology confirmed that there was proliferation of chief cells with positive parathyroid hormone (PTH) staining. Thus the tumor was diagnosed as parathyroid adenoma despite a lack of clinical evidence for hyperparathyroidism. The reason for the lack of clinical features of hyperparathyroidism in this adenoma still remains unclear, however, there might be inactivation of hormone excretion, possibly due to insufficiency of blood supply. This was a very rare case of parathyroid adenoma exhibiting no clinical evidence of hyperparathyroidism.
THE PARATHYROID ADENOMAS CLINICAL AND THERAPEUTIC STUDY
The purpose of our study was the evaluation of epidemiological profile, the diagnosis, the therapeutic management and post-operative complications for patients suffering from parathyroid adenomas. This work is based on a retrspective study. Its purpose is to discuss the results found of 26 patients operated for parathyroid adenoma at the department of visceral surgery at the Ibn Rochd University hospital of Casablanca, during a period of 07 years, from January 2010 to December 2016, based on the data collected from the clinical files of the patients. The average age of our patients was 53 with a female predominance. The circumstances of discovery for disease were various: like the etiological assessment of a bone tumor and the fortuitous discovery at the time of a cervical surgery. The clinical signs of hypocalcemia were found among 61,54% of patients (asthenia, vomiting, polyuriapolydipsia syndrome, headache, and weight loss), while bone signs were found in 19,23% of patient and renal events were found in 7,69% of patient either. The value of blood-calcium among our patients was between 94 and 176mg /l with an average of 121,81 mg /l. All of our patients presented high levels of parathormone with an average to 115,06 pg/ml and extremes with 94 and 2897 pg/ml. The ultrasound revealed the parathyoid adenoma in 84,62% cases while i twas not decisive in 15,38% cases. On the other hand, the scintigraphy was decisive for all the patients having benefited from this examination. All our patients benefited from a parathyroidectomy of pathological gland. Extemporaneous examination revealed an appearance of parathyroid adenoma in 65.38% of cases, and parathyroid hyperplasia in 34.62% of cases. Nevertheless, conventional pathological examination revealed a parathyroid adenoma in all of our patients. Two of our patients developed a transitory hypocalcemia. The evolution was marked by a normalization of the bloos-calcium of all our patients.
Hyperparathyroidism due to clear cell hyperplasia
The American Journal of Medicine, 1973
Serial determinations of serum ionized calcium (Ca++), serum total calcium (Ca), parathyroid hormone (PTH) and calcitonin levels were made in a patient with hyperparathyroidism due to clear cell hyperplasia. Although serum Ca declined to normal levels prior to parathyroidectomy, serum Ca++ and PTH levels remained elevated until after operation. This suggests that the calcium ion electrode may prove valuable in the diagnosis and management of patients with hyperparathyroidism, especially when they are normocalcemic. The excised parathyroid glands yielded very low PTH concentrations upon extraction, implying that in this form of hyperparathyroidism PTH secretion is excessive whereas storage is markedly reduced. CT levels were normal in both serum and excised glands. This finding is of interest in relation to the patient's associated generalized neurofibromatosis and serves further to distinguish the present syndrome from that characterized by mucosal neuromas, hyperparathyroidism and medullary carcinoma of the thyroid.
Synchronous water-clear cell double parathyroid adenomas a hitherto uncharacterized entity?
Archives of pathology & laboratory medicine, 2001
Water-clear cell hyperplasia is a rare but well-documented cause of primary hyperparathyroidism. Parathyroid adenomas of the water-clear cell type are exceptionally rare, and only 2 cases have been reported. We describe a patient with synchronous water-clear cell double parathyroid adenomas, an entity that has not previously been reported. In our case, the enlarged superior parathyroid glands were completely replaced by water-clear cells, with only a minute rim of extracapsular, histologically unremarkable parathyroid tissue. The inferior parathyroid glands were grossly unremarkable, and incisional biopsy specimens were histologically normal (no foci of water-clear cells were identified). The findings in this case are most consistent with the diagnosis of double adenomas of the water-clear cell type. We acknowledge that despite molecular proof of monoclonality of the 2 lesions, it is not possible to entirely exclude the possibility that this unusual case could be due to asymmetric h...
Annals of The Royal College of Surgeons of England, 2013
Water clear cell hyperplasia (WCCH) and water clear cell adenomas (WCCA) of the parathyroid glands are rare causes of primary hyperparathyroidism. We report in this series one case of WCCH and two cases of WCCA representing 0.3% of patients with primary hyperparathyroidism presenting to our institution. Increased parathyroid cellular water content was responsible for relatively larger parathyroid gland sizes. However, this was not associated with higher biochemical markers or more severe clinical presentations. Histological distinction between WCCH and WCCA is difficult but important since patients with WCCH who have had a parathyroidectomy via a unilateral neck exploration may carry an increased risk of future disease recurrence.