ABSTRACT
Nucleolar organizer region proteins, which can be stained and visualized by an argyrophil technique (AgNORs), are markers of cell activities, such as DNA transcription and proliferation, and they are useful for differential diagnosis between benign and malignant tumors. We counted both AgNOR numbers in 25 parathyroid lesions (three carcinomas, 11 adenomas, 10 hyperplasias, and one hyperplasia with carcinoma) to determine if the AgNOR number could be useful as a diagnostic aid in parathyroid neoplasms and hyperplasias, because it is often difficult to histopathologically distinguish among these lesions. The AgNOR numbers were significantly higher in carcinomas (3.18 +/- 0.05) than in adenomas (1.67 +/- 0.30, P < .001) or hyperplasias (1.85 +/- 0.16, P < .001), but there was no significant difference between adenomas and hyperplasias. These results suggest that AgNORs may be useful as an adjunct to discriminating carcinomas from adenomas or hyperplasias in the parathyroid gland.
Subject(s)
Adenoma/metabolism , Hyperplasia/metabolism , Nucleolus Organizer Region/metabolism , Parathyroid Diseases/metabolism , Parathyroid Neoplasms/metabolism , Adenoma/pathology , Coloring Agents , Diagnosis, Differential , Humans , Hyperplasia/pathology , Parathyroid Diseases/pathology , Parathyroid Neoplasms/pathology , Retrospective Studies , SilverABSTRACT
Extopic parathyroid glands and rudimentary glands which are not detected during initial parathyroidectomy may develop hyperplasia in the future, causing recurrence of hyperthyroidism. We have devised an improved surgical strategy to prevent the recurrence of hyperparathyroidism. The strategy is to dissect all central lymph nodes and fatty tissue according to the procedure of the dissection of thyroid cancer. The upper level of the dissection area is the upper edge of the thyroid cartilage and the lateral level of the dissection includes the lateral edge of the bilateral carotid sheath. Bilateral transcervical thymectomy is always included in this strategy. Upon confirming that more than 4 glands have been removed by intraoperative stamp cytology, total parathyroidectomy is terminated and 80 mg of glands is autotransplanted to the muscle of one forearm. We have performed this operation on 30 patients since 1987. More than 4 glands could be extirpated in every case, and supernumerary glands were detected in 6 cases (7 glands in 1 case and 5 glands in 4 cases). We have had no operative side effects in this series of 30 patients, and we have not experienced any persistent or recurrent hyperparathyroidism after any of these operations.
