Abstract
The histological pattern and the cell proliferative activity (as detected by Ki-67 immunostaining) of a series of 50 parathyroid hyperplasias (PTHs) secondary to renal failure were studied to assess their value in predicting recurrence of hyperparathyroidism (HPT). On account of their clinical evolution, these cases were divided into two groups: recurrent HPT (23 cases) and nonrecurrent HPT (27 cases). A nodular growth pattern (as opposed to diffuse) was the prevalent one and was observed in 20 (74%) cases of nonrecurrent HPT and in 22 (95.6%) cases of recurrent HPT, a statistically significant difference (p<0.05). The Ki-67 proliferative fraction was 1.9% in recurrent HPT cases, as compared with 0.81% in nonrecurrent HPT, a difference which was statistically significant (p=0.001). We conclude that a nodular pattern of growth and an elevated Ki-67 proliferative fraction (>1.5%) in PTH are both associated with a higher risk of recurrence (4.30) of HPT.
Similar content being viewed by others
References
Tominaga Y, Tanaka Y, Sato K, Numano M, Uchida K, Falkmer U, Grimelius L, Johansson, Takagi H. Recurrent renal hyperparathyroidism and DNA analysis of autografted parathyroid tissue. World J Surg 16:595–603, 1992
Korzets Z, Magen H, Kraus L, Bernheim J. Total parathyroidectomy with autotransplantation in hemodialysed patients with secondary hyperparathyroidism—should it be abandoned? Nephrol Dial Transplant 2:341–346, 1987.
Tagaky H, Tominaga Y, Uchida K, Yamada N, Kawai M, Kano T. Subtotal versus total parathyroidectomy with forearm autograft for secondary hyperparathyroidism in chronic renal failure. Ann Surg 200: 18–23, 1984.
Klempa I, Röttger P, Schneider M, Frei U, Koch KM. Transplantathyperparathyroidismus-Tumorahnliches wachstum und autonome, function menschlicher autotransplantate von hyperplastichen epithelkorperchen. Langenbecks Arch Chir 356:191–204, 1982.
Black WC, Slatopolsky E, Elkan I, Hoffsten P. Parathyroid morphology in suppressible and nonsuppressible renal hyperparathyroidism. Lab Invest 23:497–509, 1976.
Hasleton PS, Ali HH. The parathyroid in chronic renal failure—a light and electron microscopical study. J Pathol 132:307–323, 1980.
Niederle B, Horandner H, Roka R, Wolosczuk W, Waldhor I. Parathyreoidektomie und Autotransplantation beim renalen Hyperparatireoidismus. Funktionelle in vitro Untersuchungen zur Gewebeauswahl. Langenbecks Arch Chir 373:337–344, 1988.
Niederle B, Horandner H, Roka R, Woloszczuk W. Parathyreoidektomie und Autotransplantation beim renalen Hyperparatireoidismus. Morphologische und funktionelle untersuchung bei transplantatabhangigem rezidiv. Chirurghia 60:671–667, 1989.
Ellis HA. Fate of long-term parathyroid autografts in patients with chronic renal failure treated by parathyroidectomy: a histopathological study of autografts, parathyroid glands and bone. Histopathology 13:289–309, 1988.
Tanaka Y, Seo H, Tominaga Y, Funahashi H, Matsui N, Takagi H. Factors related to the recurrent hyperfunction of autografts after total parathyroidectomy in patients with severe secondary hyperparathyroidism. Surg Today 23:220–227, 1993.
Niederle B, Hörandner H, Roka R, Woloszczuk W. Morphologic and functional studies to prevent graft-dependent recurrence in renal osteodystrophy. Surgery 106:1043–1048, 1989.
Hörandner H, Niederle B, Krich K, Woloszczuk W, Roka R, Hlaushofer K. Clinical significance of mitotic index for recurrent hyperparathyroidism. Acta Endocrinol 117(Suppl. 287):65, 1988.
Niederle B, Roka R, Hörandner H. Rezidivierender renaler Hyperparathyreoidismus: reoperationen am Autotransplantat. Wien Klin Wochenschr 100:369–372, 1988.
Abbona GC, Papotti M, Gasparri G, Bussolati G. Proliferative activity in parathyroid tumors as detected by Ki-67 immunostaining. Hum Pathol 26:135–138, 1995.
Hsu SM, Paine L, Fanger H. Use of the avidin-biotin-peroxidase complex (ABC) in immunoperoxidase techniques: a comparison between ABC and unlabeled antibody (PAP) procedures. J Histochem Cytochem 29:577–580, 1981.
Loda M, Lipman J, Cukor B, Bur M, Kwan P, DeLellis R. Nodular foci in parathyroid adenomas and hyperplasias: an immunohistochemical analysis of proliferative activity. Hum Pathol 25:1050–1056, 1994.
Gerdes G, Becker MH, Kei G, Cattoretti G. Immunohistological detection of tumor growth fraction (Ki-67 antigen) in formalin-fixed and routinely processed tissues. J Pathol 168:85–87, 1992.
Cattoretti G, Becker MHG, Key G, Duchrow M, Schlüter C, Gallet J, Gerdes J. Monoclonal antibodies against recombinant parts of the Ki-67 antigen (MIB-1 and MIB-3) detect proliferating cells in microwave-processed formalin-fixed paraffin sections. J Pathol 168:357–363, 1992.
Niederle E, Horandner H, Roka R, Woloszczuk W. Parathyreoidektomie und Autotransplantation beim renalen Hyperparathyreoidismus. Morphologische Untersuchungen zur Gewebeauswahl. Langenbecks Arch Chir 373:325–336, 1988.
Wallfelt CH, Larsson R, Gylfe E, Ljunghall S, Rastad J, Åkerström G. Secretory disturbance in hyperplastic parathyroid nodules of uremic hyperparathyroidism: implication for parathyroid autotransplantation. World J Surg 12:431–438, 1988.
Åkerström G, Malmaeus J, Grimelius I, Ljunghall S, Bergström R. Histological changes in parathyroids glands in subclinical and clinical renal disease. Scand J Nephrol 18:75–84, 1984.
Roth Sl, Marshall RB. Pathology and ultrastructure of the human parathyroid glands in chronic renal failure. Arch Intern Med 124:397, 1969.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Abbona, G., Papotti, M., Gasparri, G. et al. Recurrence in parathyroid hyperplasias owing to secondary hyperparathyroidism is predicted by morphological patterns and proliferative activity values. Endocr Pathol 7, 55–61 (1996). https://doi.org/10.1007/BF02739915
Issue Date:
DOI: https://doi.org/10.1007/BF02739915