Cases Of Parathyroid Adenoma Research Articles

Severe hypercalcemia secondary to parathyroid adenoma: Series of four consecutive cases at a tertiary care hospital in Qatar.

In most cases of parathyroid adenoma (PA), it is not palpable and physical examination shows no remarkable findings. Hence diagnosis requires an index of suspicion. The current paper describes four cases of severe hypercalcemia secondary to PA. Case 1 - 29 years old Sudanese female with history of nausea/vomiting, fatigue, loss of appetite and bone aches. She had large palpable left lower neck swelling, and high calcium and PTH. Ultrasound (US) neck and SPECT/CT scan after sestamibi injection showed left inferior PA. Case 2-73 years old Sudanese male referred with history of abdominal pain and flatulence. He had severely high calcium, elevated parathormone (PTH), and high 24-hour urine calcium. US and SPECT/CT showed a left inferior PA. Case 3-54 years old Bangladeshi male, referred with history of renal colic/urolithiasis. Laboratory results showed severely high calcium and PTH levels. US and SPECT/CT scan showed right inferior PA. Case 4-35 years old Tunisian female, 12 weeks pregnant, referred with recurrent nausea and vomiting of increasing frequency from the second week of pregnancy. Laboratory tests revealed severe hypercalcemia and high PTH. US showed two parathyroid lesions. The patients were admitted as emergency cases and investigations diagnosed severe hypercalcemia secondary to PA. All patients underwent neck exploration and PA excision. Histology confirmed PA. The four cases were swiftly assessed and treated before progressing into the more serious hypercalcemic crisis which can lead to grave consequences, particularly in the case of the pregnant female. All patients recovered with no complications and were clinically well with normal calcium level on follow up. Severe hypercalcemia must be swiftly and thoroughly assessed to prevent the more serious hypercalcemic crisis. Clinicians need to be suspicious of parathyroid adenoma as a probable cause. Severe hypercalcemia is often accompanied with vomiting, and in pregnant females, this could be mistaken for hyperemesis gravidarum. Excision of the parathyroid adenoma treats the condition and follow up of serum calcium and PTH confirms the favorable outcome of surgery.

S3276 A Rare Case of Non-Small Cell Lung Cancer Causing False Positive Hepatitis B Surface Antigen

Introduction: Hepatitis B surface antigen (HBsAg) is a protein on the surface of HBV which can be a distinctive serological marker of acute or chronic hepatitis B infection. We present a case of 74-year-old male with a false positive HBsAg test. Case Description/Methods: A 74-year-old African American male with medical comorbidities of stage IV non-small cell lung cancer (NSCLC) and HTN presented to the hospital for an acute kidney injury with proteinuria. Hepatitis B virus (HBV) panel was obtained and revealed positive HBsAg. HBsAg was previously negative two years prior. Patient had multiple risk factors for hepatitis B infection including prior use of IV cocaine and multiple sexual partners. The patient denied any recent vaccinations. Liver function tests were normal. Physical examination did not reveal chronic liver disease manifestations. HBs Antibody (HBsAb) was positive with a quantitative value of 0.53. Hepatitis B core immunoglobulin M (HBc IgM), HBcAb total, HBeAg, HBeAb were all negative with undetectable serum HBV DNA. The HBsAg was not confirmed as a true positive after repeat testing with an antibody neutralizing procedure involving a human antibody to HbsAg. Discussion: Accurate interpretation of laboratory tests is imperative in diagnosing hepatitis B. There was high suspicion that patient had false positive HBsAg. The patient’s serological profile did not fit acute or chronic hepatitis B. The patient had no evidence of acute hepatitis B with negative HBc IgM, HBV DNA and no evidence of chronic hepatitis B with HBcAb total being negative. Furthermore, a positive HBsAb is not seen in acute and chronic hepatitis B. Transient HBsAg has been seen in patients for up to 2 weeks after HBV vaccination, however, our patient had not been vaccinated recently. The most common cause is the presence of heterophile antibodies. These naturally occurring human antibodies can bind to a variety of chemical structures including animal antibodies seen in immunochemistry assays. They can be neutralized by specific inactivating binders. Other viral infections such as Epstein-Barr Virus (EBV), transfusions, or systemic disease can cause false positives. A likely suspect was the patient’s NSCLC causing a paraneoplastic syndrome which would be the first instance of such in the literature. There have been cases of parathyroid adenoma and basal cell carcinoma causing false positivity. Patients with false-positive HBsAg need further workup to prevent misdiagnosis and potentially harmful management.

Left parathyroid adenoma with features of brown tumor, incidental finding: a case report

Primary hyperparathyroidism (PHPT) occurs in a setting of excessive parathyroid hormone (PTH) secretion with an autonomous parathyroid gland which resulting in hypercalcemia. Cases of parathyroid adenoma are rare, PTH is a chief regulator of calcium homeostasis in the human body. PHPT could be caused by solitary adenomas, hyperplasia, multiple adenomas and carcinomas. A 35-year-old female who came in with complaints of left hip pain past 1 month which aggravated since 1 week, with previous medical history of hyperthyroidism. Laboratory and biochemical findings suggested features of PHPT. She underwent left parathyroid excision with subtotal thyroidectomy. Histopathology analysis revealed features of parathyroid adenoma with eosinophilic to clear cytoplasm, few foci with oxyphilic nodules. Patient showed significant fall in PTH levels after tumor excision and is being discharged 5th day after surgery. PHPT occurs at any age, but it is most commonly seen in people over the age of 50 years and postmenopausal women. The current presentation of PHPT shifts from the classical symptomatic form to the asymptomatic form. parathyroidectomy is still the treatment of choice for both symptomatic and asymptomatic forms. Parathyroid adenoma has an excellent prognosis with surgical treatment.

RARE AND DEMANDING: PARATHYROID ADENOMA LOCALIZATION, SURGERY AND OUTCOME.

Objectives: To assess the methods of preoperative parathyroid adenoma localization and to compare it with operative findings. Patients and methods: Between June 2017 and June 2019, we had operated 8 cases of parathyroid adenomas. Three patients were males and 5 patients were females. Age ranged from 26 year old to 72 year old with average of 42 year old. Seven cases were sporadic while one case was part of MEN2a. All patients had ultrasonography for preoperative localization, all had CT scan and 4 patients had Sestamibi scan. In all patients, intraoperative measurements of parathyroid hormone was done before and 10 minutes after surgical excision. Results: Ultrasonography was successful in localizing only one case with certainty. CT scan located the adenoma in another 2 patients. In 4 patients who performed Sestamibi scan, the adenomas were located precisely in all of them including one case of ectopic parathyroid adenoma behind the sternum. In one patient, all the modalities failed in localization which was achieved easily intraoperatively. Single adenoma was found in 6 patients and two adenomas in two patients. The adenomas were located in the neck in 7 patients and in the anterior mediastinum in one patient .Surgical removal was done through neck incision in 7 cases while midline sternotomy in one case. All the patients had resolution of symptoms within the follow up period. Conclusion: Sestamibi scan is the best investigation in preoperative localization of parathyroid adenoma. Ultrasonography and CT scan can aid in the diagnosis with less sensitivity. Intraoperative localization is possible even in cases of negative investigations.

Correlations between parathyroid hormone level, adenoma size, and serum calcium level in patients with primary hyperparathyroidism

Aim: The main goal of this study is to determine the association of preoperative parathyroid hormone (PTH) levels with parathyroid gland adenoma sizes and serum calcium levels in patients with primary hyperparathyroidism caused by single-gland adenoma. Methods: We included all patients with single parathyroid gland adenoma who were admitted to and underwent parathyroidectomy at Security Forces Hospital in Riyadh during a period of 10 years from January 1, 2000 to October 30, 2011. PTH level and serum corrected calcium were recorded 1 day before surgery. Adenoma size was recorded from pathology reports for all patients. Results: In 35 cases of parathyroid adenoma including 12 males (34.3%) and 23 females (65.7%) with an average age of 48.94 years (±13.52), the average PTH level 1 day preoperatively was 769.94 pg/mL (±793.27), the average largest dimension (LD) of parathyroid adenoma was 2.18 cm (±1.38), and the average calcium level 1 day preoperatively was 2.71 mmol/L (±0.3). The mean PTH level in males was 1098.5 pg/mL compared to 598.5 pg/mL in females (P = 0.068), mean LD of parathyroid adenoma in males was 2.34 cm versus 2.09 cm in females (P = 0.72), and mean calcium level in males was 2.70 mmol/L compared to 2.72 mmol/L in females (P = 0.46). A positive correlation was found between PTH level and adenoma size, with a correlation coefficient of 0.29 (P = 0.095). The correlation between PTH level and calcium level was negative, with a correlation coefficient of −0.033 (P = 0.85). Negative correlation was also found between adenoma size and calcium level, with a correlation coefficient of −0.033 (P = 0.85). Conclusion: Based on the findings of this study, preoperative PTH level or serum calcium level cannot be used to predict adenoma size. Further prospective studies with larger sample sizes are recommended.

Water Clear Parathyroid Adenoma: A report of 2 cases

Hyperparathyroidism occurs mainly due to parathyroid hyperplasia, adenoma and rarely carcinoma. Most of the adenomas are composed of chief cells. Water clear cell adenoma are a rare phenomenon. We are sharing two cases of parathyroid adenomas composed entirely of water clear cells and requires high degree to suspicion to identify them as they have low endocrinological activity. DOI: 10.21276/APALM.1074

Expression and clinical significance of CD147 in parathyroid carcinoma

To study the expression and clinical significance of CD147 in the patients of parathyroid carcinoma. Fourteen cases of parathyroid carcinoma encountered during the period from 2012 to 2015 were enrolled. Thirty three cases of parathyroid adenoma encountered during the same period were enrolled. The expression of CD147 in parathyroid carcinoma and parathyroid adenoma was studied by means of immunohistochemistry (EnVision method). CD147 positive color was brown and yellow, and positive position was located mainly in the cytomembrane, and a small amount of cytoplasm was appeared. Among 14 cases of parathyroid carcinoma, 11 cases of CD147 positive score was 3+ , 3 cases of CD147 positive score was 2+ ; Among 33 cases of parathyroid adenoma , 8 cases of CD147 positive score was 2+ , 15 cases of it was 1+ , 10 cases of it was negative. CD147 was highly expressed in parathyroid carcinoma tissues, and the expression of CD147 was significantly different from the expression of parathyroid adenoma(P<0.05). CD147 immunohistochemical staining can help to diagnose parathyroid carcinoma.

Parathyroid adenomas: A case series and clinicopathological study from a tertiary care center in South India

Background: The incidence of primary hyperparathyroidism (PHP) in India is 2.5/1000 individuals. The major cause for PHP is parathyroid adenoma. To arrive at the correct diagnosis, clinical setting, biochemical and radiological investigations, the status of other glands assessed intraoperatively and finally histopathologic confirmation is essential. Materials and Methods: We carried out a retrospective analysis of the last 5 years of operated cases of parathyroid adenomas. Diagnosis was based on histological confirmation. In all the cases clinical data, details of biochemical, radiological, and other investigations including histopathological findings were recorded. Results: There were four operated patients of parathyroid adenoma at our center in the last 5 years. Out of four operated cases of parathyroid adenomas, three were symptomatic and one case was detected incidentally. The symptoms were varied and included skeletal, renal, neuromuscular, and neuropsychiatric manifestations. Two of the patients had diabetes mellitus at the time of presentation. They showed improvement in glycemic control after surgery. Histopathologically, all the parathyroid adenomas were of clear cell type without any evidence of capsular or vascular invasion to suggest the possibility of malignancy. Conclusion: Majority of our patients were females who showed symptomatic improvement after surgery. Histopathologically, all the cases were parathyroid adenomas and in one case of papillary carcinoma of thyroid, the parathyroid adenoma was incidentally detected.

Clinicopathologic features of parathyroid carcinoma: a study of 11 cases with review of literature

To study the clinicopathologic characteristics of parathyroid carcinoma (PTC). Eleven cases of PTC encountered during the period from 1994 to 2012 were enrolled into the study. Forty cases of parathyroid adenoma (PA) were also retrieved for comparison. The clinical manifestations, laboratory results and pathologic features were analyzed, with literature review. The main clinical manifestations of PTC included neck mass (11/11), hypercalcemia (11/11) and hyperparathyroidism (11/11). Most patients also had osteoporosis (10/11). In contrast, PA often manifested as hypercalcemia (40/40) and hyperparathyroidism (40/40). Histologic examination of PTC showed that the tumor cells contained clear to eosinophilic cytoplasm and separated by dense bands of fibrosis. The tumor mass was surrounded by thick fibrous capsule. Foci of capsular invasion and vascular permeation were identified at the tumor periphery in all cases. Cellular atypia was not conspicuous but mitotic figures and coagulative necrosis were easily identified. On the other hand, PA were composed of tumor cells with clear to eosinophilic cytoplasm, forming glands, trabeculae or nests. Most of them (35/40) had intact fibrous capsule. Mitotic figures were rarely encountered and tumor necrosis was absent. Immunohistochemical study showed that the tumor cells in PTC were positive for CK19 (11/11), chromogranin A (9/11), synaptophysin (7/11) and parathyroid hormone (11/11). They were negative for thyroglobulin, TTF-1 and calcitonin. The Ki-67 index was less than 10% (range = 2% to 9%). In contrast, the tumor cells in PA were positive (40/40) for CK19, chromogranin A, synaptophysin and parathyroid hormone. They were negative for thyroglobulin, TTF-1 and calcitonin. The Ki-67 index was less than 3%. Follow up-data were available in 9 cases of PTC (duration of follow up = 11 months to 224 months) and 7 of the patients were still alive. Follow up of all PA cases showed no evidence of recurrence. PTC is a rare malignant endocrine tumor presenting as neck mass. Histologic features suggestive of malignant behavior include presence of coagulative tumor necrosis and capsular/vascular invasion. It needs to be distinguished from other entities such as parathyroid adenoma, papillary thyroid carcinoma and medullary thyroid carcinoma.

Diagnosis and surgical treatment of parathyroid neoplasms

To explore the clinical features, diagnosis and surgical treatment of parathyroid neoplasms. From January 2003 to December 2011, a total of 51 patients were recruited. Their clinical data, presentations, examinations and surgical approaches were analyzed retrospectively. Among them, there were parathyroid adenoma (n = 32), parathyroid cysts (n = 18) and parathyroid carcinoma (n = 1). The sensitivity and positive rate of neck ultrasonography and (99)Tc(m)-methoxyisobutylisonitrile (MIBI) were 84.3% and 93.5%, 91.7% and 100.0% respectively. The high levels of serum calcium and parathyroid hormone (PTH) in 32 cases of parathyroid adenoma and 1 case of parathyroid carcinoma returned to normal after operation. The levels of serum calcium and PTH remained normal in 18 cases of parathyroid cysts. The clinical manifestations of parathyroid adenoma were complex. The serum levels of calcium and PTH and neck ultrasonography are preferred screening tools for parathyroid neoplasms.(99)Tc(m)-MIBI is suitable for tumor localization.Surgery is effective and safe for parathyroid neoplasm.Real time intraoperative monitoring of PTH is of great importance.

Cystic Parathyroid Adenomas on Dynamic CT

We have encountered 2 cases of parathyroid adenomas that are atypical because of their large size, cystic character, and faint enhancement compared with the typical solid parathyroid adenomas. Specifically, the enhancement pattern of a typical parathyroid adenoma in a multiphasic scan demonstrates rapid arterial enhancement and rapid washout on delayed imaging, whereas, comparatively, the 2 cystic parathyroid adenomas we encountered demonstrated less arterial phase enhancement and little washout on venous and delayed-phase imaging.

Parathyroid Adenomas Seen in the Clinical Follow-Up of Patients With Differentiated Thyroid Carcinoma

The coexistence of nonmedullary thyroid carcinoma and parathyroid adenoma is an uncommon clinical entity. In most of the previously published studies, thyroid carcinomas are diagnosed incidentally during or after the treatment of parathyroid disease, mostly in the pathology specimens. Here, we report 2 cases of parathyroid adenoma who presented years after the treatment of differentiated thyroid carcinoma. Neither of the patients had symptoms of hypercalcemia and hyperparathyroidism, and parathyroid adenomas were diagnosed on routine physical examination of the neck and on routine monitoring of serum calcium levels.

Apport de la scintigraphie parathyroïdienne au 99mTc-MIBI en double phase dans l’exploration des hyperparathyroïdies. À propos de 20 cas

Introduction 99mTc-sestamibi parathyroid scintigraphy is a means of functional imaging allowing the exploration of hyperparathyroidism. The aim of our study is to demonstrate the utility of double-phase 99mTc-sestamibi scintigraphy in the exploration of the secreting abnormal parathyroid gland. Materials and methods We report, through this work, the observation of 20 patients followed for a biologically ascertained hyperparathyroidism and explored, for the majority of them, by ultrasonography and/or computed tomography. All our patients benefited from a double-phase 99mTc-sestamibi scintigraphy. Results On the 20 studied cases, the sex-ratio was equal to 1, two patients exhibited three high uptake foci at the 99mTc-sestamibi scintigraphy, six exhibited two foci, twelve exhibited one parathyroid focus. In our series, 80% of patients exhibited secondary hyperparathyroidism and 20% exhibited a primary hyperparathyroidism. The pathologic exam revealed four cases of parathyroid adenoma and 16 parathyroid cases of hyperplasia. Discussion The double-phase 99mTc-sestamibi scintigraphy contributes to the orientation and the improvement of the surgical attitude of the hyperparathyroidism, insofar as it could affirm the multiplicity of some adenomas, the diffuse form of some hyperplasias, and especially ectopic localization of the abnormal parathyroid gland.

Loss of parafibromin expression in a subset of parathyroid adenomas

Inactivation of the hyperparathyroidism-jaw tumour syndrome (HPT- JT) gene, HRPT2, was recently established as a genetic mechanism in the development of parathyroid tumours. Its encoded protein parafibromin has tumour-suppressor properties that play an important role in tumour development in the parathyroids, jaws and kidneys. Inactivating HRPT2 mutations are common in HPT- JT and parathyroid carcinomas, and have been described in a few cases of parathyroid adenomas with cystic features. In this study, 46 cases of cystic parathyroid adenomas previously investigated for HRPT2 mutations were characterized with regard to MEN1 gene mutations, cyclin D1 expression and parafibromin expression. In normal tissues and cell lines, parafibromin was ubiquitously expressed. Furthermore, parafibromin was detected as a dominating nuclear and a weaker cytoplasmic signal in transfected cell lines. In the three parathyroid tumours with inactivating HRPT2 mutations parafibromin expression was not detectable, and in one of two cases with aberrantly sized parafibromin the protein was delocalized. Both high and low cyclin D1 levels were found among HRPT2-mutated and -unmutated tumours, suggesting that these events are not mutually exclusive in parathyroid tumour development. The presented data suggest that in the majority of benign parathyroid tumours the expression of parafibromin remains unaltered, while the loss of parafibromin expression is strongly indicative of gene inactivation through mutation of the HRPT2 gene.

Dose-response relationship for parathyroid adenoma after exposure to ionizing radiation in infancy.

Several authors have suggested that there is an excess risk of hyperparathyroidism, adenomas or hyperplasia after exposure to ionizing radiation. There is still, however, some uncertainty about this association, because these diseases are often asymptomatic and escape clinical detection if not specially searched for. This study is based on a pooled Swedish cohort of 27,925 persons with skin hemangiomas. The majority received radiation treatment in infancy between 1920 and 1965 in Stockholm and Gothenburg. The mean age at treatment was 6 months and the median thyroid dose was 0.20 Gy (range 0-28.5 Gy). Record linkage with the Swedish Cancer Register for the period 1958-1997 gave 43 cases of parathyroid adenoma in the cohort. Analyses of excess relative risk (ERR) models were performed using Poisson regression methods. Clinical records were scrutinized to determine if the childhood radiation exposure was known (biased cases) at the time of diagnosis. Seven of the cases of parathyroid adenoma were classified as biased cases. The standardized incidence ratio (SIR) was 2.10 (95% confidence interval 1.52-2.82) when all cases were included and 1.76 (95% CI 1.23-2.43) with the biased cases excluded. A linear dose-response model with stratification for sex fitted the data best. The ERR per gray was 3.84 (95% CI 1.56-8.99) with all cases and 1.56 (95% CI 0.36-4.45) with the biased cases excluded. There was a significant difference in the ERR per gray between the two subcohorts, probably because of different diagnostic activity in the regions. Our findings confirm that there is a dose-response relationship for radiation-induced parathyroid adenomas.

Immunohistochemistry of cyclin D1 and β-catenin, and mutational analysis of exon 3 of β-catenin gene in parathyroid adenomas

Parathyroid adenomas are benign uniglandular tumors and are the most common cause of primary hyperparathyroidism. Several genetic changes in parathyroid tumors, including inactivation of tumor suppressor genes, activation of oncogenes and loss of heterozygosity at several chromosomal loci, have been reported. In this study, we analyzed the status of cyclin D1 and beta-catenin in 24 cases of parathyroid adenoma. Immunohistochemistry of cyclin D1 showed positive staining in 9 (37.5%) of the 24 parathyroid adenomas. The status of beta-catenin, which has recently been identified as a regulator of cyclin D1 transcription, was examined by direct sequencing of exon 3 of the beta-catenin gene and immunohistochemistry of beta-catenin protein, but neither mutation nor accumulation of beta-catenin was detected in any of the cases. These results indicate that cyclin D1 is frequently accumulated in parathyroid adenomas, independently of dysfunction in the Wnt signaling pathway.

Incidental parathyroid adenomas with normocalcemia discovered during thyroid operations: report of three cases.

We report three cases of parathyroid adenoma incidentally discovered during a total thyroidectomy. No patients showed any clinical or chemical features that led us to suspect a hyperparathyroidism condition before operation, but a macroscopically enlarged parathyroid was discovered during the dissection and it was removed in all three cases. All patients had a single adenoma confirmed by a histological analysis. Calcemia decreased after operation in every case but only one patient needed temporary adjunctive therapy. No permanent hypoparathyroidism or recurrent hyperparathyroidism was observed. We recommend that any enlarged parathyroid discovered during neck surgery should thus be removed in order to avoid the risks of future surgical procedures due to successive bouts of clinical hyperparathyroidism.

Mutation analysis of glial cell line-derived neurotrophic factor, a ligand for an RET/coreceptor complex, in multiple endocrine neoplasia type 2 and sporadic neuroendocrine tumors.

Causative germline missense mutations in the RET proto-oncogene have been associated with over 92% of families with the inherited cancer syndrome multiple endocrine neoplasia type 2 (MEN 2). MEN 2A is characterized primarily by medullary thyroid carcinoma (MTC) and pheochromocytoma, both tumors of neural crest origin. Parathyroid hyperplasia or adenoma is also seen in MEN 2A, but rarely in MEN 2B, which has additional stigmata, including a marfanoid habitus, mucosal neuromas, and ganglioneuromatosis of the gastrointestinal tract. In familial MTC, MTC is the only lesion present. Somatic RET mutations have also been identified in a subset of sporadic MTCs, pheochromocytomas, and rarely, small cell lung cancer, but not in sporadic parathyroid hyperplasias/adenomas or other neuroendocrine tumors. Glial cell line-derived neurotrophic factor (GDNF) and its receptor molecule GDNFR-alpha, have recently been identified as members of the RET ligand binding complex. Therefore, the genes encoding both GDNF and GDNFR-alpha are excellent candidates for a role in the pathogenesis of those MEN 2 families and sporadic neuroendocrine tumors without RET mutations. No mutations were found in the coding region of GDNF in DNA samples from 9 RET mutation negative MEN 2 individuals (comprising 6 distinct families), 12 sporadic MTCs, 17 sporadic cases of parathyroid adenoma, and 10 small cell lung cancer cell lines. Therefore, we find no evidence that mutation within the coding regions of GDNF plays a role in the genesis of MEN 2 and sporadic neuroendocrine tumors.

PREOPERATIVE DIAGNOSIS OF LOCALIZATION OF ABNORMAL PARATHYROID GLANDS WITH MAGNETIC RESORNANT TOMOGRAPHY

The preoperative diagnosis of localization and number of pathological parathyroid glands in very important for surgions. In this paper we describe the diagnostic results of MRI comparing to those of CT, Ultrasonogram and T1-Tc subtraction scintigram.The materials were 65 parathyroid glands of 19 cases (3 cases of parathyroid adenoma and 16 cases of hyperplasia following chronic renal failure) operated on at the department from May 1989 to December 1990.Diagnostic sensitivity rate of MRI, CT, T1-Tc and Ultrasonogram were 43.1 (%), 50.8, 52.3 and 55.4, respectively. On the otherhand false negative rates were 0 (%), 2.9, 5.56 and 18.2, respectively. It is concluded that, MRI can not provide excellent results for localizing diagnosis of the pathological parathyroid and general diagnosis based on various imaging methods is recommended.

Chromogranin A and B in parathyroid tissue of cases of primary hyperparathyroidism: an immunohistochemical study

Routinely processed parathyroid tissues from 26 cases with primary hyperparathyroidism (19 adenomas, 7 multiglandular hyperplasia) and 8 normal human parathyroid glands were investigated with antibodies against chromogranin A and B and parathyroid hormone (PTH). Normal parathyroids were immunohistochemically positive for PTH and chromogranin A but negative for chromogranin B. Hyperplastic glands showed a focal staining for PTH and chromogranin A without correlation of the staining pattern on serial sections. Adenomas were either uniformly positive for both PTH and chromogranin A or showed a staining pattern similar to that seen in hyperplastic glands. Focal chromogranin B positivity (less than 10% of cells) was found in 3 cases (1 hyperplastic gland and 2 cases of parathyroid adenoma with an immunohistochemical staining pattern similar to hyperplastic glands). Our immunohistochemical results may support previously published findings that most parathyroid adenomas are monoclonal neoplasms whereas hyperplastic glands are of polyclonal origin.