İbrahim İBİLİOĞLU, Mustafa KÖSEM, İsmail YILDIZ

PARATİROİD ADENOMU VE HİPERPLAZİSİNİN HİSTOPATOLOJİK AYRIMI

Amaç: Paratiroid adenomu ve paratiroid hiperplazisinin ayrımında kullanılan histopatolojik bulgular, bu iki patolojiyi ayırmada her zaman yeterli olamamaktadır. Paratiroid adenomu ve paratiroid hiperplazilerinin birbirinden ayrımı tedavi farklılıkları nedeni ile önemlidir. Bu çalışmada, paratiroid adenomu ve paratiroid hiperplazisinin histopatolojik ayrımı araştırıldı.Gereç ve Yöntemler: Çalışma grubu, 60 paratiroid adenomu, 35 paratiroid hiperplazisi ve 20 normal paratiroid bezi olgusundan meydana gelmekte olup bu gruplar arasında 18 ana histolojik parametre ile 27 alt histolojik parametre araştırıldı. Bulgular: Histopatolojik incelemede, kenarda normal paratiroid bezi varlığı, paratiroid adenomlarının %71.6’sında görülürken, paratiroid hiperplazilerinin hiçbirinde gözlenmedi. Belirgin (+++) kapsül kalınlığı, paratiroid adenomlarının %28.3’ünde izlenirken, paratiroid hiperplazilerinin hiçbirinde yoktu. Paratiroid hiperplazilerinin %48.6’sında ve paratiroid adenomlarının %10’unda (+) kapsül kalınlığı izlendi. Orta derece ve belirgin yağ hücresi varlığı (++ ve +++) paratiroid adenomu vakalarının toplam %6.6’sında, paratiroid hiperplazisi vakalarının %48.6’sında görüldü. Paratiroid adenomlarında (+) yağ hücresi varlığı %93.3 iken, paratiroid hiperplazilerinde %51.4 oranında, (++) yağ hücresi varlığı paratiroid adenomlarında %6.7, paratiroid hiperplazilerinde %42.8 oranında, (+++) yağ hücresi varlığı paratiroid adenomlarında izlenmez iken paratiroid hiperplazilerinde %8.6 olguda izlenmiştir. Dizilim paternlerinden nest formasyonu paratiroid adenomlarının %8.3’ünde, paratiroid hiperplazilerinin %22.8’inde mevcuttu. Lenfosit infiltrasyonu paratiroid adenomlarının %26.7’sinde mevcut iken paratiroid hiperplazilerinin %8.6’sında izlendi. Fibröz bant varlığı, kist formasyonu, nest formasyonu hariç dizilim paternleri, nekroz, dejenerasyon, kanama, kolloid benzeri materyal, hücre tipi, lenfosit infiltrasyonu hariç inflamasyon, nükleer pleomorfizm, nükleer şekil, nükleer kromatin, intranükleer inklüzyon, ve mitoz bakımından paratiroid adenomu ve paratiroid hiperplazisi arasında anlamlı farklılık gözlenmedi.Sonuç: Paratiroid adenomu ile paratiroid hiperplazisinin ayrımında kenarda normal paratiroid bezi varlığı, belirgin kapsül kalınlığı (+++), az miktarda yağ hücresi oranı (+) ve lenfosit infiltrasyonu paratiroid adenomu lehine anlamlı bulundu. Nest formasyonu, paratiroid hiperplazilerinde paratiroid adenomlarına göre anlamlı olarak daha yüksek izlendi.

Anahtar Kelimeler:

Paratiroid adenomu, paratiroid hiperplazisi, histopatoloji

Histopathological Differentiation of Parathyroid Adenoma and Hyperplasia

Objective: The histopathological findings are not always sufficient for differentiating parathyroid adenoma and parathyroid hyperplasia. The differentiation is important due to treatment modalities. In this study, we investigated the histopathological differentiation of parathyroid adenoma and parathyroid hiperplasia.Material and Methods: Sixty parathyroid adenoma, 35 parathyroid hiperplasia and 20 normal parathyroid gland cases were included to the study. Eighteen main histological parameters with 27 sub-histological parameters were investigated among these groups.Results: In the histopathological examination, a statistically significant entity of normal parathyroid tissue was seen in 71.6%of parathyroid adenomas but was not present in any of the parathyroid hiperplasia cases. A remarkable (+++) capsule thickening was observed in 28.3%of parathyroid adenomas, whereas none of parathyroid hiperplasia revealed such thickening. The presences of (+), (++), (+++) fat cells were seen in 93.3%, 6.7%and none of the paratiroid adenomas and were seen 51.4%, 42.8%and 8.6%of parathyroid hiperplasia cases respectively. Nest formation was observed in 8.3%of parathyroid adenomas, 22.8%of parathyroid hiperplasia cases. Lymphocyte infiltration was observed in 26.7%of parathyroid adenomas and 8.6%of parathyroid hiperplasias. No significant difference was observed between parathyroid adenoma and parathyroid hiperplasia in terms of fibrous band, cyst formation, cell line patterns except nest formation, necrosis, degeneration, bleeding, presence of colloid-like material, cell type, inflammation except lymhocyte infiltration, nuclear form, nuclear chromatin structure, presence of intranuclear inclusion.Conclusion: It was determined that normal parathyroid tissue in the rim, remarkable (+++) capsule thickening, small amount of fat cell (+), lymhocyte infiltration were seen much more frequently in parathyroid adenoma than in parathyroid hyperplasia and the difference was found statistically significant. The presences of nest formation, (+) capsule thickening and remarkable fat cell (++ and +++) were found to be significantly higher in parathyroid hiperplasia than in parathyroid adenomas.

Keywords:

Parathyroid adenoma, parathyroid hyperplasia, histopathology,

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