Affiliation:
1. Irkutsk Scientific Centre of Surgery and Traumatology
2. Irkutsk Regional Pathoanatomical Bureau
Abstract
Background. There are no specific morphological signs for sporadic multiglandular disease (MGD) in primary hyperparathyroidism (PHPT). The aim of the study. To study the structure of the morphological substrate of primary, secondary and tertiary hyperparathyroidism and to assess the effectiveness of morphological criteria in the diagnosis of sporadic multiglandular disease in primary hyperparathyroidism. Methods. The study included 69 patients; 18 patients with PHPT and sporadic multiglandular disease (npreparation = 31) formed the main group, 51 patients (npreparations = 104) – the comparison group. The comparison group was divided into 3 subgroups: 1) patients with PHPT and solitary parathyroid gland (PTG) lesions – 26 patients (npreparations = 26); 2) patients with secondary hyperparathyroidism (SHPT) – 15 patients (npreparations = 48); 3) patients with tertiary hyperparathyroidism (TGPT) – 10 patients (npreparations = 30). Results. The morphological structure of the comparison groups is homogeneous: group 1 is represented by parathyroid adenoma (26 (100 %)), groups 2 and 3 – by hyperplasia (48 (100 %) and 30 (100 %), respectively). Most of the PTG specimens of the main group are represented by hyperplasia (25 (80 %)), and in 1/5 cases – by adenomas (6 (19.4 %)). Sporadic multiglandular disease in PHPT was characterized by a predominant frequency of detecting the absence of a capsule and a rim of unchanged tissue, as well as the presence of adipocytes (pχ2 < 0.01). Components of the PTG morphological structure make it possible to identify changes specific to the sporadic multiglandular disease in PHPT, with a diagnostic efficiency of 76.5–90.3 %. Conclusion. Sporadic multiglandular disease in any clinical variant of hyperparathyroidism is characterized by a high prevalence of hyperplasia – 80 % in PHPT and 100 % in SHPT and TGPT. The following morphological criteria for sporadic multiglandular disease in PHPT have been established: the presence of adipocytes in the PTG parenchyma (diagnostic efficiency (DE) – 90 %)); absence of a capsule (DE = 78 %) and a rim of unchanged gland tissue (DE = 76 %).
Subject
General Immunology and Microbiology,General Biochemistry, Genetics and Molecular Biology
Reference14 articles.
1. Mokrysheva NG, Eremkina AK, Mirnaya SS, Krupinova JA, Voronkova IA, Kim IV, et al. The clinical practice guidelines for primary hyperparathyroidism, short version. Problems of Endocrinology. 2021; 67(4): 94-124. (In Russ.). doi: 10.14341/probl12801
2. Bilezikian JP, Bandeira L, Khan A, Cusano NE. Hyperparathyroidism. Lancet. 2018; 391(10116): 168-178. doi: 10.1016/S0140-6736(17)31430-7
3. Barczyński M, Bränström R, Dionigi G, Mihai R. Sporadic multiple parathyroid gland disease – A consensus report of the European Society of Endocrine Surgeons (ESES). Langenbeck’s Arch Surg. 2015; 400: 887-905. doi: 10.1007/s00423-015-1348-1
4. Golokhvastov NN. Criteria for morphological diagnosis of adenoma and hyperplasia of the parathyroid glands in primary hyperparathyroidism. Saint Petersburg; 1995. (In Russ.).
5. Kazantseva IA, Kalinin AP, Bogatyrev OP. Principles of clinical and morphological examination of the parathyroid glands in hyperparathyroidism. Informational letter. Moscow; 1997: 3-15. (In Russ.).