原発性上皮小体機能亢充進症における上皮小体の組織像と電顕像について

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When performing a parathyroidectomy for primary hyperparathyroidism surgery is the therapy of choice for histological variations such as adenoma, hyperplasia, and carcinoma. Surgical procedures for adenoma, hyperplasia, and carcinoma vary as the histological diagnosis indicates. Since the histological evaluation of parathyroid pathology is so difficult we feel that the evaluation procedure should be done by the surgical table at the time of surgery. A clinicopathologic study of 36 patients operated on at the 1st Dept. of Surgery, Nagoya University was undertaken. 24 of the patients were thought to have single adenomas. Eleven patients had multiple parathyroid enlargements, and of these two were thought to have multiple adenomas. Adenomas and hyperplasias occurred concurrently in two cases. Of the seven cases thought to be hyperplasia, three had near normal glandular histology. It appears from this histological study that there are transitional forms in some para-thyroid lesions. It is supposed that once the normal parathyroid gland has developed hyperplasia it can in turn lead to adenoma. Electron microscopic investigation was also made of the parathyroid glands. Parathyroid tissue was obtained from 22 patients who had undergone parathyroid or thyroid surgery. 13 had single adenomas, two had multiple adenomas, two had mixtures of adenomas and hyperplasias, two had hyperplasias, and three had normal glands. In the normal parathyroid glands mentioned above, abundant glycogen granules were frequently seen, and the lipid bodies were compactly collected in the cytoplasm. The rough surfaced endoplasmic reticulum was small in number and sparse. The Golgi complex was insignificant. A few secretory granules were randomly seen throughout the cytoplasm. In the hyperfunctioning glands, lipid bodies of the collected type were hardly seen, but a few lipid bodies of a solitary type were scattered in the cytoplasm. Glycogen granules decreased in amount in most cases. The Golgi complex and secretory granules tended to increase. Especially observed was the remarkable increase in the size and number of the rough surfaced endoplasmic reticulum. Their shape altered to a rounded concentric structure. In several cases of parathyroid adnoma, there was evidence that the rough surefaced endoplasmic reticulum transmuted to annulate lamellae. It was proved that these annulate lamellae originated from the rough surfaced endoplasmic reticulum. Annulate lamellae were found in small adenomas and were not found in large adenomas and hyperplasias. One of these cases showed normal glands microscopically but under the electron microscope hyperfunction became apparent. The case was diagnosed as hyperplasia from ultrastructural findings. In conclusion; In cases of enlargement of even two parathyroid glands, a three and one-half gland parathyroidectomy should be performed. We feel that this should be done because in cases such as these other glands are mostly hyperplastic. Electron microscopic investigation of the parathyroid glands is helpful to differentiate hyperplasia from normal glands.
一般社団法人日本内分泌学会の論文

原発性上皮小体機能亢充進症における上皮小体の組織像と電顕像について

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