Background: Parathyroid tissue abnormalities in MEN I are currently classified as hyperplasia because multiple glands are usually involved. However, in the majority of cases individual glands from a patient are not simultaneously affected to the same extent resulting in size and structure heterogeneity. This phenomenon deserves further investigation considering its obvious implications in diagnosis and management of MEN I-associated hyperparathyroidism (HPT). Methods: We reviewed the histologic features of 45 parathyroid glands from 13 MEN I patients (5 males and 8 females, mean age 37 yrs) who underwent surgery between 1990 and 1994. Results: The pattern most commonly encountered in the single enlarged gland was nodular hyperplasia (28/33, 85%). A single adenoma-like nodule was present in 3 of these glands; diffuse hyperplasia was found in 5. Microscopic features suggesting early hyperplasia were observed in 7 nearly normal sized glands. No abnormalities were found in 5 glands (11%). Two patients had 2 morphologically normal glands out of 4. Conclusions: These findings emphasize that: 1) the spectrum of parathyroid hyperplasia in MEN I is wider than previously believed, and cannot be predicted in the single patient; 2) histologic confirmation of all presumed parathyroid glands is strongly needed; 3) total parathyroidectomy with autograft of the parathyroid tissue showing no or minor abnormalities is the treatment of choice of MEN I-associated HPT.
Histologic features of parathyroid hyperplasia in multiple endocrine neoplasia type I (MEN I). Diagnostic and surgical implications
Amorosi A.;
1994-01-01
Abstract
Background: Parathyroid tissue abnormalities in MEN I are currently classified as hyperplasia because multiple glands are usually involved. However, in the majority of cases individual glands from a patient are not simultaneously affected to the same extent resulting in size and structure heterogeneity. This phenomenon deserves further investigation considering its obvious implications in diagnosis and management of MEN I-associated hyperparathyroidism (HPT). Methods: We reviewed the histologic features of 45 parathyroid glands from 13 MEN I patients (5 males and 8 females, mean age 37 yrs) who underwent surgery between 1990 and 1994. Results: The pattern most commonly encountered in the single enlarged gland was nodular hyperplasia (28/33, 85%). A single adenoma-like nodule was present in 3 of these glands; diffuse hyperplasia was found in 5. Microscopic features suggesting early hyperplasia were observed in 7 nearly normal sized glands. No abnormalities were found in 5 glands (11%). Two patients had 2 morphologically normal glands out of 4. Conclusions: These findings emphasize that: 1) the spectrum of parathyroid hyperplasia in MEN I is wider than previously believed, and cannot be predicted in the single patient; 2) histologic confirmation of all presumed parathyroid glands is strongly needed; 3) total parathyroidectomy with autograft of the parathyroid tissue showing no or minor abnormalities is the treatment of choice of MEN I-associated HPT.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
