Morphological criteria for sporadic multiple parathyroid gland disease

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 %).