Abstract
Parathyroid lipoadenomas (PLAs) are rare tumors, and case descriptions are limited, < 80 to date. As a consequence, scarce information regarding the etiology of these enigmatic lesions is available. We searched our departmental pathology database for PLAs diagnosed between 1992 and 2020, reexamined the histology of each case, and recorded clinical parameters from the patients’ medical charts. As the diagnostic criteria of this lesion vary over this time period, we defined PLA as an enlarged parathyroid gland with > 50% fat on histologic examination with preoperative evidence of primary hyperparathyroidism (PHPT). A total of 8 bona fide PLA cases and 2 equivocal PLAs (close to 50% fat) were included. As approximately 4000 conventional parathyroid adenomas were diagnosed at our department during the same time interval, the prevalence of PLA was 0.20%. PLA patients were predominately female (63%) and presented with classical PHPT-related symptoms. Majority of cases were successfully located preoperatively and had an average tumor weight of 445 mg. Histologically, all PLAs consisted of > 50% mature adipose tissue, except a single case with brown fat. Of note, PLA patients exhibited a body mass index in line with PHPT patients in general, but a relatively high, near-significant prevalence of arterial hypertension was observed when compared to tumors with less fat (P = 0.0584). Future studies on this finding might be warranted. To summarize, we present one of the largest institutional PLA case series to date, and conclude that PLAs are rare, sporadic tumors mirroring many clinical aspects of conventional adenomas—with a potential coupling to hypertension worthy of follow-up studies.
Highlights
In primary hyperparathyroidism (PHPT), the proper identification of a hyperfunctioning parathyroid gland is oftenElectronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, SwedenDepartment of Oncology-Pathology, Karolinska Institutet, BioClinicum J6:20, 171 64, Solna, Stockholm, SwedenDepartment of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, SwedenDepartment of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, SwedenDepartment of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital, Stockholm, Sweden a concerted series of investigations using biochemical, radiological, surgical, and histological approaches
We used a definition in which parathyroid lipoadenoma was denoted as an enlarged parathyroid gland demonstrating a definite increase in parathyroid acinar tissue and > 50% fat on histologic examination excised from a patient exhibiting primary hyperparathyroidism
After exclusion of erroneous Systematized Nomenclature of Medicine (SNOMED) coding (n = 2) and cases with a suspicion of Parathyroid lipoadenomas (PLAs) due to only small areas of the tumor with a generous stromal fat component (n = 4, well below the 50% adipose tissue cutoff suggested in our PLA definition described earlier), a total of 21 assumed PLAs from 19 patients were chosen for further scrutinizing
Summary
Information regarding intraoperative PTH measurements and/or postoperative biochemistry may constitute useful information, but the picture is complicated by the frequent occurrence of multiglandular disease in PHPT
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
