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Objective:To evaluate the feasibility of indocyanine green fluorescence imaging technology applied in thyroid surgery to identify parathyroid gland.Methods:From Oct 2021 to May 2022, data of 42 patients undergoing thyroidectomy via gasless unilateral axillary approach in Zhejiang Provincial Hospital of Traditional Chinese Medicine were retrospectively analyzed. Cases using intraoperative fluorescence imaging technology(42 cases) were compared with conventional laparocopic approach.Results:The number of parathyroid glands dissected in the study group 1.57±0.61 was higher than that in the control group 0.56± 0.59 ( t=-5.472, P<0.05). The PTH value of the study group was (2.88±1.23)pmol/L on the first day after operation, which was higher than that of the control group (2.16±0.10)pmol/L ( t=-1.844, P<0.05). The blood parathyroid hormone value on the third day(3.22±1.31)pmol/L was higher than that of the control group (2.55±0.81) pmol/L ( t=-2.041, P<0.05). There were 2 cases of hypoparathyroidism in the study group, less than 5 cases in the control group, but there was no significant difference between the two groups( χ2=0.942, P>0.05). There was 1 case of hypocalcemia in the study group and 3 cases in the control group ( χ2=0.731, P>0.05). Conclusion:Using indocyanine green fluorescence imaging technology to identify parathyroid gland is feasible, simple, fast, safe and effective.
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Objective:To observe the application of near-infrared autofluorescence imaging (NIRAF) technology combined with carbon nanoparticle (CNP) negative imaging in identification of parathyroid gland (PG) during thyroid carcinoma surgery.Methods:80 patients with thyroid cancer who underwent total thyroidectomy + central lymph node dissection performed by the same experienced physician team at the 960th Hospital of the PLA from Jan. to Mar. 2022 were prospectively included. Before operation, they were divided into two groups using random number table method before surgery: control group (40 cases) using CNP negative imaging, and experimental group (40 cases) using CNP negative imaging combined with NIRAF technique for intraoperative identification of PG. The gold standard for the identification of parathyroid glands was to compare the amount of intraoperative discovery retention misresection and transplantation of PG and the number of postoperative parathyroid hormone (PTH) and the number of complications in the two groups by immune colloidal gold technique. SPSS 25.0 software was used for statistical analysis.Results:All patients in the two groups were successfully operated and followed up. 137 149 PG were found and confirmed in the control group and the observation group, 108 132 PG were retained in situ and 29 17 PG were transplanted, the differences were statistically significant (all P <0.05) ; The number of A1 PG was 103 and 109, respectively. Among them, 84 102 were retained in situ and 19 7 were transplanted, the difference was statistically significant ( P <0.05) . There was no significant difference in the amount of A2 type PG and B type PG between the two groups ( P >0.05) . No A3 type PG was found in the two groups, and a total of 3 A3 types of PG were confirmed in postoperative pathological reports. There were no significant differences in misresection in the control group and the observation group, 5 and 2 PG were mistakenly cut, respectively (all P >0.05) . The PTH 1 day after surgery was 17.7 (5.6,30.4) pg/mL in the control group and 21.7 (12.8,38.3) pg/mL in the observation group, the difference was statistically significant ( P<0.05) . There were no significant differences in the levels of serum calcium and serum phosphorus 1 day after operation and PTH 1 month after surgery between the two groups (all P > 0.05) . Conclusion:Compared with CNP alone, combined with NIRAF technique can quickly and effectively identify PG, and PG can be better protected in situ and postoperative hypoparathyroidism can be reduced.
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Objective:To investigate the feasibility and clinical significance of near-infrared fluorescence positive imaging combined with intraoperative rapid parathyroid hormone (PTH) determination in identification and function protection of the parathyroid gland during thyroidectomy.Methods:According to the inclusion and exclusion criteria, patients in the Affiliated Lihuili Hospital of Ningbo University, who needed bilateral thyroidecto-my and central lymph node dissection due to suspected bilateral thyroid cancer from Mar. 2020 to Oct. 2020 were selected for a prospective clinical study. They were randomly divided into the study group (near-infrared fluorescence positive imaging combined with intraoperative rapid PTH determination) and the control group (intraoperative experience identification) . The number of parathyroid glands found during operation, PTH before and after the operation, blood calcium, blood phosphorus, the presence of parathyroid tissues in routine pathological section examinations, and postoperative symptoms were collected. SPSS 25.0 statistical software was used for analysis, the measurement data were expressed by mean±standard deviation ( ± s) , t test was used for comparison between groups, and χ2 test was used for counting date. Results:In the study group of 33 cases, 135 suspicious parathyroid glands were exhibited during operation, with an average of (4.09±0.52) ; Hand and foot numbness occurred in 1 case (3.03%) ; On the 1st after the operation, PTH was (23.68±9.48) ng/L. In the control group of 31 cases, 109 parathyroid glands were identified by naked eyes, with an average of (3.52±0.63) ; Hand and foot numbness occurred in 6 cases (19.35%) ; On the 1st after the operation, PTH was (17.93±11.58) ng/L. The differences were statistically significant ( P<0.05) . But no statistical significance was found in operation duration (79.45±30.18) min, postoperative hospitalization days (5.85±2.27) days, PTH (27.10±9.80, 33.08±10.21) ng/L, blood calcium (2.11±0.10,2.25±0.09) mmol/L, and blood phosphorus (1.20±0.20,1.15±0.12) mmol/L on the 3rd day and the 6th month after the operation. Conclusion:Near-infrared fluorescence positive imaging combined with intraoperative rapid PTH determination can improve the recognition rate of the parathyroid gland and reduce postoperative complications, which is a safe, effective and rapid method for intraoperative parathyroid gland recognition.
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With the increasing incidence of thyroid cancer, more and more thyroid operations are being performed.The relationship between parathyroid gland and thyroid gland is closed and complex, and parathyroid gland’s location is changeable and its blood supply is fragile.Hypoparathyroidism caused by the damage of parathyroid gland has become one of the common postoperative complications.The causes of injury or dysfunction of parathyroid gland are various, which are not only related to anatomical factors, including the variation in morphology, colour, quantity, location and blood supply, but also related to the operation skills of the surgeon or the use of energy devices, while the destruction of blood supply and tissue thermal damage are the main reasons.Therefore, expert mastery on the anatomical location of parathyroid gland and distribution of blood supply of parathyroid gland, careful anatomy during the operation to prevent accidental removal of parathyroid gland, rational use of energy devices to prevent mechanical damage of parathyroid gland and blood supply and thermal damage, is conducive to improving protection of parathyroid function and can reduce the occurrence of postoperative hypoparathyroidism.
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Objective:To investigate the effect of fine anatomy combined with exposure of recurrent laryngeal nerve in cricothyroid space in differentiated thyroid cancer surgery.Methods:Sixty patients with differentiated thyroid cancer who received treatment in Ningbo Hospital of Traditional Chinese Medicine from January 2017 to April 2020 were included in this study. They were randomly assigned to receive either fine anatomy combined with exposure of recurrent laryngeal nerve in cricothyroid space (observation group, n = 30) or routine surgery + inferior thyroid artery exposure of recurrent laryngeal nerve (control group, n = 30). Operative time, the volume of intraoperative blood loss, and the number of lymph node dissected were compared between the two groups. Parathyroid hormone (PTH) and blood calcium (Ca 2+) concentrations in the two groups were determined. The adverse reactions such as recurrent laryngeal nerve and parathyroid injury were observed in each group. Results:Operative time, the volume of intraoperative blood loss, and the number of lymph node dissected in the observation group were (71.28 ± 10.08) minutes, (16.69 ± 4.65) mL, and (4.78 ± 1.26), respectively, which were significantly different from those in the control group [(69.27 ± 11.89) minutes, (17.14 ± 4.52) mL, (4.76 ± 1.22), t = 0.706, 0.380, 0.062, all P > 0.05]. Before surgery, there were no significant differences in PTH and Ca 2+ concentrations between the two groups [PTH: (50.24 ± 11.21) g/L vs. (50.21 ± 11.19) g/L; Ca 2+: (2.18 ± 0.08) mmol/L vs. (2.17 ± 0.09) mmol/L, t = 0.010, 0.454, both P > 0.05]. After surgery, PTH and Ca 2+ concentrations in the observation group were significantly higher than those in the control group [PTH: [(31.44 ± 6.09) g/L vs. (16.57 ± 2.35) g/L; Ca 2+: (2.07 ± 0.10) mmol/L vs. (1.23 ± 0.12) mmol/L, t = 12.477, 29.454, both P < 0.01]. Total incidence of adverse reactions in the observation group was significantly lower than that in the control group [10.00% (3/30) vs. 46.67% (14/30), χ2 = 9.931, P < 0.01). Conclusion:Application of fine anatomy combined with exposure of recurrent laryngeal nerve in cricothyroid space in differentiated thyroid cancer surgery is highly effective in the clinic. Accurate identification of recurrent laryngeal nerve in cricothyroid space is helpful to preserve the parathyroid gland and blood supply in situ, leads to a small range of changes in PTH and Ca 2+ concentrations, reduces postoperative complications, so as to protect the recurrent laryngeal nerve and parathyroid gland and thereby promote postoperative recovery.
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Introduction: Terminal branches of inferior thyroid artery (ITA) supplies thyroid and parathyroids. Recurrentlaryngeal nerve (RLN) is related to ITA at lower pole of thyroid and RLN may lie either posterior, anterior orintermingled with terminal branches of ITA. RLN is a vulnerable structure that gets damaged during thyroidsurgeries.Aim: Present study aims to determine variation in relationship between ITA and RLN, entering pattern of ITA intothyroid and number of terminal branches of ITA in Sri Lankan population.Materials and methods: A total of 312 sides (Male:204, Female:108) of thyroid together with intact neurovascularstructures were selected for study of relationship, entrance pattern and number of terminal branches of ITA. TheRLN may lie either posterior (Type A) or anterior (Type B) to ITA or its branches. Sometimes RLN may interminglewith terminal branches of ITA (Type C).Results: A total sample of 65.2% in male (M) and 60.9% in female (F) were Type A, samples of 10.35%(M) and22.22%(F) were Type B and 24.5%(M) and 17.59%(F) were type C. Type A was more predominant in left side of bothgenders and in the right side there are 50% of chances for Type A in both genders. Comparatively Type B was morein female and Type C was more in male. A total of 63.7%(M) and 69.44%(F) ITA entered into middle 1/3rd, 36.27%(M)and 30.55%(F) into lower 1/3rd of the thyroid lobe and entering pattern was more or less similar in both genders.ITA commonly entered thyroid just above junction of middle and lower third of thyroid lobe. ITA divided into twobranches in 52.45%9(M) and 56.48%(F), three in 44.6%(M) and 41.66%(F) and four in 2.94%(M) and 1.85%(F) ofstudied samples.Conclusions: Knowledge of anatomical variation of ITA and RLN is mandatory to avoid injury to RLN in thyroidsurgeries. Understanding the entrance pattern and terminal branches of ITA are essential for thyroid andparathyroid surgeries
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Hypoparathyroidism is an important complication of thyroidectomy. Identification of the parathyroid glands during thyroid-ectomy may be the first step for preserving these organs and preventing the loss of their function. Generally, surgeons can confirm parathyroid tissues based on frozen biopsy during thyroid surgery; however, this method can lead to vascular damage as a result of cut-ting part of the parathyroid glands and is associated with additional cost and waiting time. To identify the parathyroid gland more con-veniently, quickly, and accurately during thyroid surgery, some novel techniques have been developed. In this article, current studies that describe intraoperative rapid in situ identification of the parathyroid glands are reviewed.
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Objective To explore the anatomical features and the dissection technique of thyrothymic ligament (TTL),and to explore the clinical significance of protecting the inferior parathyroid gland (IPTG) with this structure.Methods Patients who received the initial thyroid surgery in the Department of Thyroid Surgery of the First Affiliated Hospital with Nanjing Medical University from May.2017 to Dec.2017 were prospectively analyzed.We dissected TTL,identified and located the IPTG,described the structural features of TTL,and investigated the position relationship of TTL and IPTG to evaluate the possibility and value of protecting IPTG in situ.Results About 121 patients underwent the dissection,totally 194 sides dissected that included 96 left sides and 98 right sides.TTL was found in 143 sides (73.7％),78 left sides (81.3％) and 65 right sides (66.3％).Nearly 70.6％ IPTG can be proactively identify and located by the TTL during the operation.TTL was a kind of adipose connective tissue that was wide at the bottom and narrow at the top,accompanying with the inferior thyroid vein,from the thymus to the thyroid.76.2％ TTL were attached to the lower pole and the lower 1/3 dorsal of thyroid,containing fat and vessels.33.5％ IPTGs were located in the area surrounding around the ends of the TTL.25.3％ IPTGs were located in the TTL.4.6％ IPTGs were located in the thymus and 7.2％ IPTGs surrounding around the TTL.The incidence rate of post-operation hypoparathyroidism was 14.9％.Conclusions TTL commonly exists and has significant relationship with IPTG.TTL connects thymus and IPTG,which would be considered a complex (thymus-thyrothymic ligament-IPTG complex,TLIC).The meticulous TTL dissection technique will help proactively identify,locate and protect IPTG during operation,and reduce the incidence rate of post-operation hypoparathyroidism.
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Objective To explore the value and method of using carbon nanoparticles in endoscopic treatment of papillary thyroid microcarcinoma.Method 74 cases were randomly divided into two groups,34 cases in experimental group which were injected with carbon nanoparticles,and 40 cases in the control group without any injection.All cases were analyzed in terms of the tumor size,the number of lymph nodes and parathyroid gland injury.Results All patients underwent the operation smoothly.The postoperative pathological specimens result showed there was no statistical difference of carcinoma size between the two groups.The number of lymph nodes dissected was 177 in the control group and 220 in the experimental group (the rate of lymph node black staining rate was 89％).In the experimental group,the average number of lymph node detected in each patient was 6.47±2.13,more than 4.42±1.91 in the control group.The number of parathyroid glands found in the experimental group was 3 and 11 in the control group,and the difference had no statistical significance.Postoperative temporary laryngeal recurrent nerve injury occurred to 2 cases in each group,and no statistical difference was found.Conclusion Using carbon nanoparticles in endoscopic treatment of papillary thyroid microcarcinoma can increase the detection rate of lymph node,and to some extent,reduce the parathyroid injury.It has a certain clinical significance,However,care should be taken to avoid contamination of the mirror field of view.
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Objective: To investigate the anatomical characteristics of the parathyroid lymphatic system and the mechanism of the"negative development"of the carbon nanoparticles for parathyroid gland in thyroidectomy.Methods:This retrospective study used parathyroid tissue samples from patients that were obtained from archival records in the pathology department,including 45 cases of normal parathyroid gland tissues that were accidentally resected in thyroidectomy,10 cases of parathyroid adenomas,and 7 cases of parathyroid carcinoma.Ten cases of normal thyroid tissues were selected as positive control.Immunohistochemistry was performed using the antibodies specific for lymphatic endothelium,such as D2-40 and LYVE-1,and antibodies specific for vascular endothelial cell such as CD31 and CD34,to distinguish them from each other.Results:A total of 62 parathyroid glands samples were stained with vas-cular markers CD31,CD34 and lymphatic markers D2-40,LYVE-1 respectively(partial samples were stained unsuccessfully).Vascular vessels in the CD31 staining group were detected in 50 of 58 examined glands and the positive rate was 86.2%.In the CD34 staining group,positive rate was 100%(60/60).The positive cells were found in the central,periphery and vascular hilum of the glands.Howev-er,lymph vessels in the D2-40 staining group were detected from 17 out of 59 examined glands,with the positive rate of 28.8%;In the LYVE-1 staining group,positive rate was 39.6%(23/58).The positive cells were found in the membrane or vascular hilum,less frequent or undetectable in the central portion.Conclusions:Most of the parathyroid glands of adults might lack a lymphatic network.Only a few adult parathyroid glands had minority lymph vessels,and these lymphatics generally localized at the membrane area or in the vas-cular hilum, which could be one of the main and anatomical mechanisms resulting in drainage failure or obstruction of carbon nanoparticles and thus in parathyroid"negative development."
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Hyperparathyroidism is an important complication of thyroid surgery.Identification is the premise of intraoperative pretection.At present,identification of the parathyroid gland relies on personal experience of surgeons.Amplifying display of endoscope or surgical magnifying glass,the use of dyeing agent such as methylene blue,nanocarbon,5-ALA or BB5-G1,the use of radionuclide imaging and contact endoscope,and biopsy like intraoperative frozen pathological examination and FNA are all important trials.This article is going to make a review of the methods.
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Surgery is the major treatment option for malignant tumors and some benign neoplasms of the thyroid, most of which are differentiated thyroid carcinoma. Despite the progresses that have been made in surgical techniques, iatrogenic injuries of the parathy-roid and laryngeal nerves, including superior and recurrent laryngeal nerves, could not be completely avoided in the surgical manage-ment of thyroid tumors. In this review, the causes of intraoperative injuries of parathyroid and laryngeal nerves are systematically ana-lyzed with respect to types and extents of surgical operations, changes in topical anatomy, and secondary thyroid surgeries. The princi-ples and strategies for protecting and restoring injuries of the parathyroid and laryngeal nerves are also elucidated for the effective prevention and adequate treatment of these major complications in the thyroid surgery.
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objective To determine a proper fiducial photography distance setting for ideal amptitied endoscopic imaging of parathyroid gland by high definition endoscopy system.Methods 30 patients were operated with MIVAT mode (modified Miccoli's approach) for treatment of thyroid carcinoma from Apr.2013 to Mar.2014.High definition imaging was established by Image 1 Endoscopy System(Karl Storz Co.) to observe parathyroid gland and related fine anatomical structures during surgery.5 fiducial photography distances (1.0/1.5/2.0/2.5/3.0 cm) were separately tested during surgery.Maximally amplified parathyroid gland images of each setting were obtained by the approaching-amplifying photographic method,and then the size of the real parathyroid glands as well as their screen images were measured and recorded to calculate the magnification.A proper fiducial photography distance setting was determined postoperatively by comparison of the magnification times,as well as clarity,stability of the imaging and surgical maneuverability.Results ①90 parathyroid glands were successfully observed and measured.②At the longest fiducial photography distance (3.0 cm),the parathyroid gland could be stably magnified by 14.26±3.06(long trail)/12.62±2.88 (wide trail)times,but their contour and color not clear.③At the intermediate distance (2.5 cm),the parathyroid gland could be magnified by 16.74±3.15 (long trail)/14.81± 3.47(wide trail)times with the graphics stable,and the color and contour more clear,but the vascular pedicle and the tiny vessels under the capsule still blurred.④At the shortest distance (1.0 cm),the parathyroid gland could be magnified by 27.72±6.45 (long trail)/26.33±7.22(wide trail)times,not only the color and contour,but also the vascular pedicle and the tiny vessels under the capsule of the gland became further clearer,unfortunately the graphics was shimmy and unstable.Conclusions ①2.5 cm can be a proper fiducial photography distance for searching,identifying and preserving parathyroid gland in MIVAT,while 1.0 cm can be a special fiducial photography distance for further confirming parathyroid gland when necessary.② Current high definition endoscopy system can be applied to identify the parathyroid gland if fiducial photography distance was properly set and approachingamplifying photographic method was used.Along with the magnification of the imaging,the features of the parathyroid gland may become clearer,including its yellow-brown color and oval contour,as well as the detail structures such as the tiny vessels under the capsule and the vascular pedicle.
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Objective Recently a lot of studies have shown carbon nanoparticles can protect parathyroid, however, there is no application in outpatient thyroid operation. The article was to investigate the influence of carbon nanoparticles suspension ( CNS) in?jection on the operation and prognosis of outpatient thyroid microcarcinoma(TMC) surgery. Methods Retrospective analysis was conducted on the clinical data of 65 patients who underwent outpatient TMC surgery from January to June in 2015 in our hospital. The patients were divided into 2 groups:33 patients in trial group were injected with CNS, and the other 32 patients in control group under?went conventional surgery. Comparison was made in operation information, pathologic data, postoperative complications, postoperative hospital stay as well as C?reactive protein(CRP) and blood calcium of the first day after operation between the two groups. Results The average number of VI region lymph nodes in trial group(8.21±2.08)was significantly higher than that of control group(P=0.004). Removal of 5 parathyroid glands for mistake was detected in control group, but no removal of parathyroid gland was detected in trial group, showing significant difference (P=0.028). 3 patients in control group had numbness in skin, while none in trial group. The hospital stay of trial group was lowered significantly in comparison to that of control group([31.09±6.62] vs [35.75±7.37], P=0.009). The average C?reactive protein ( CRP ) of the first day after operation in trial group was much lower that of control group([7.17±5.20] vs [9.87±5.60] mg/L, P=0.048). The average blood calcium of the first day in trial group was much higher than that of control group ([2.07±0.17] vs [1.98±0.20] mmol/L, P=0.036). Conclusion Outpatient TMC surgery injected with carbon nanoparticles sus?pension can protect parathyroid gland function, reduce surgical stress and accelerate recovery.
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BACKGROUND AND OBJECTIVES: The inferior parathyroid glands receive their blood supply from the inferior thyroid artery. The anatomic relationship of this artery and the recurrent laryngeal nerve can assume three different patterns. To maintain the vascular supply of the inferior parathyroid glands during central neck dissection, we considered the anatomic relationship of these structures in our surgical approach. MATERIALS AND METHODS: Fibrofatty tissue in the central neck compartment was removed by dissection proceeding along the recurrent laryngeal nerve. During the dissection, care was taken not to injure the vascular supply of the inferior parathyroid gland. RESULTS: For an inferior parathyroid gland that receives its blood supply from the posterolateral vascular pedicle, preservation is achieved by performing the dissection along the recurrence laryngeal nerve on the gland's medial side. In patients in whom the inferior thyroid artery travels deep to the right recurrent laryngeal nerve, such that the right parathyroid gland receives its blood supply from the posteromedial vascular pedicle, central neck dissection should be performed carefully along the lateral side of the gland to preserve the pedicle. CONCLUSION: Preservation of inferior parathyroid gland function requires a detailed understanding of the anatomic relationship between the inferior thyroid artery and recurrent laryngeal nerve. The direction of the dissection along the nerve should be adjusted according to its anatomic relationship to the inferior thyroid artery.
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Humans , Arteries , Hypoparathyroidism , Laryngeal Nerves , Neck , Neck Dissection , Parathyroid Glands , Recurrence , Recurrent Laryngeal Nerve , Thyroid GlandABSTRACT
Objective To discuss the protective effect of carbon nanoparticles lymphatic tracer on parathyroid glands in the operation of thyroid carcinoma. Methods Retrospectively analyzed the clinical data of 65 thyroid carcinoma patients from January 2014 to October 2014, and they were divided into 2 groups according to whether injected with carbon nanoparticles. The experimental group (30 cases) were injected with carbon nanoparticles in thyroidglands before major procedure, while the control group (35 cases) were not injected. In the experimental group, there were 22 cases accepted total thyroidectomy of the affected side gland + isthmus thyroidectomy + subtotal thyroidectomy of the offside gland, and 8 cases of total thyroidectomy. In the control group, there were 25 cases accepted total thyroidectomy of the affected side gland + isthmus thyroidectomy + subtotal thyroidectomy of the offside gland,and 10 cases of total thyroidectomy. And all the 65 cases ac-cepted centrallymph nodes dissection. Results After carbon nanoparticles injection, central lymph nodes became black while parathyroid glands did not become black. The experimental group showed (2. 6 ± 0. 8) parathyroids each patient, and no parathyroid was cut by mis-take;the control group showed (1. 9 ± 0. 7) parathyroids each patient, and 3 parathyroids were cut by mistake. and the difference between the two groups was statistical meaningful (P<0. 05). There was no permanent hypoparathyroidism in the two groups. There was 1 cases of temporary hypoparathyroidism occured in the experimental group, and 3 cases occured in the control group, and there was no statistical sig-nificance difference between the two groups. Conclusion Carbon nanoparticles is benefit to the identification of parathyroid in surgery, and it can reduce the incidence of inadvertent parathyroidectomy, but it cann’ t reduce the incidence of hypoparathyroidism after procedure.
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Hoxa3-Pax1/Pax9-Eya1-Six1/4 regulatory pathway seems to be operating during forming the bilateral parathyroid/thymus common primordial in early embryonic development.The specification of the parathyroid domain in the parathyroid/thymus primordial is regulated through a Shh-Tbx1-Gcm2 pathway.Gcm2 also may play roles in later steps of parathyroid development,including CaSR and PTH gene expression.MafB and Gcm2 interact with each other and synergistically activate PTH transcription.Genetic basis and the etiology of some hypoparathyroid disorders in man are involved defects in transcription factors that include GCMB,GATA3,Tbxl,SOX3 and GNA11.This marker expression in thymus and parathyroid primordium includes HoxA3,Pax1,Eya1,and Six1;and expression of parathyroid cell-like cells includes Gcm2,CaSR,and PTH.These expressions may serve as markers of stem cell differentiation into parathyroid cell-like cells.
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Objective: To enhance the understanding of the diagnosis and treatment of intrathyroidal parathyroid tumor by retrospective review of the medical records of three patinets with intrathyroidal parathyroid tumor. Methods: A retrospective analysis of medical records was conducted for three patients with intrathyroidal parathyroid tumor in Tianjin Medical University Cancer Institute and Hospital between January 2011 and June 2013, and the review of the related literatures was performed. Results: All of the three patients with intrathyroidal parathyroid tumor were females, aged 37 to 56 years; of the three patients, two had parathyroid adenoma, one had parathyroid carcinoma. All patinets did not have hyperparathyroidism. Conclusion: Intrathyroidal parathyroid tumor is very rare. The error in diagnosis is common in clinical practice. Accuracy in positioning and qualitative diagnosis is essential to achieve success in treatment. Copyright © 2014 by TUMOR.
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Objective To understand the histological characteristics of the major endocrine organs of tree shrew , and provide a normal histological atlas of endocrine organs of tree shrew .Methods Ten artificially fed healthy tree shrews were killed and dissected after anesthesia .The thyroid, parathyroid, adrenal and pituitary glands were observed by gross inspection and samples were taken for routine histological examination with HE staining .Results ( 1 ) The thyroid gland was pale yellow, located on both sides of the 2-4 tracheal rings.The thyroid gland was plate-shaped, its surface was covered with a thin fibrous capsule . The thyroid parenchyma was divided into several lobules by stretched capsule membrane .Follicular and parafollicular cells were distributed in the lobules , and red colloid was present in follicular cavity.(2) Each side had one parathyroid , located on the cranial or the outer surface of the middle part of the thyroid gland, and was slightly covered by thyroid .The gland was round or oval , and its parenchyma was made up of the principal cells and eosinophil cells , and acinar structure appeared in the parenchyma .( 3 ) The adrenal glands were oval , yellow color, located in the renal hili , and linked to the kidneys .They were surrounded by a thin capsule .The parenchyma was divided into cortex and medulla .The cortex was divided into zona glomerulosa , zona fasciculata and zona reticularis from outside to inside.The zona glomerulosa was the thickest layer and the zona fasciculata was the thinnest .The medulla cells formed clumps or mesh, with central vein in the central part .(4) The pituitary gland was located in the sella turcica , with no recessus hypophysis .The pituitary gland was composed of the adenohypophysis and neurohypophysis .Its surface was covered with a connective tissue capsule .The pituitary gland was divided into distal part , middle part and pars tuberalis . neurohypophysis was made up of neural and pars infundibularis .Conclusions The histological atlas of endocrine organs in the tree shrew is established , which is close to that of the primate animals in the morphology , and provide histological evidence for the study of tree shrew endocrine organs and disorders , as well as the animal model of human diseases .
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Aims: The aim of this study was to isolate and extensively characterize parathyroid gland stem cells (PT-SCs) from secondary hyperparathyroidism cases. For this purpose, proliferation capacity, phenotypic properties, differentiation characteristics and gene expression profiles were analyzed and compared with mesenchymal stem cells from bone marrow (BM-MSCs) of the human. Methods: Stem cells isolated from PT and BM were analyzed by flow cytometry, RT-PCR, Real Time-PCR, and immunocytochemistry. Both cell lines were directionally differentiated towards adipogenic, osteogenic and neurogenic cell lineages. Results: The isolated hPT-SCs share similar characteristics of hBM-MSCs by immunophenotypic, histological and molecular analyses. Both cells were shown to differentiate successfully into adipogenic and osteogenic cell lines. Embryonic stem cell markers Pou5F1, Zpf42, FoxD3, Sox2 and Nanog were also expressed beside 5 fold higher telomerase activity in hPT-SCs that could indicate the regenerative ability of the human parathyroid gland. The osteogenic cell markers were expressed by hPT-SCs, which transformed efficiently into osteogenic cell lines, both at the level of genes (BMP2, BMP4, BGLAP, Coll11a1, Runx2, Sparc) and of proteins (BMP2, BMP4, Osteocalcin, Osteonectin, Osteopontin). Higher alkaline phosphatase (ALP) activity indicating osteogenic differentiation was determined in hPT-SCs from secondary hyperparathyroidism patients. Conclusion: PT-SCs might responsible for the calcified parathyroid glands and other ectopic calcifications including the vascular ones, observed in the secondary hyperparathyroidism cases, beside parathyroid hormone-dependent hypercalcemia leading diffusion of calcium phosphate precipitation in tissues.