Parathyroid gland - Primary chief cell hyperplasia

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Parathyroid gland

Hyperparathyroidism

Primary chief cell hyperplasia

Reviewer: Monika Roychowdhury, M.D. (see Reviewers page)
Revised: 16 February 2013, last major update January 2013
Copyright: (c) 2003-2013, PathologyOutlines.com, Inc.

General
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● Parathyromatosis: microscopic foci of hyperplastic parathyroid tissue in neck associated with chief cell hyperplasia and prior surgery (Hum Pathol 1990;21:234)

Case reports
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● Bilateral primary chief cell hyperplasia associated with loss of APC gene (Am J Surg Pathol 2002;26:103)

Treatment
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● Excise 3 of 4 glands
● Some surgeons remove all parathyroid tissue
● Can use frozen section, touch prep or intraoperative PTH assay to confirm removal

Gross description
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● Classically, all glands enlarged (up to 10g) vs. pseudoadenomatous (one gland enlarged) vs. occult (all glands normal size but histologically hyperplastic)

Micro description
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● Sheets of chief cells, minimal fat, rare oxyphils
● Usually no rim of normal tissue

Molecular / cytogenetics description
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● Increased production of PTH; associated with MEN 1, 2A/2 in 30% of cases (not MEN 2B/3)
● 50% have allelic loss on #11 (where MEN 1 gene is located)

End of Parathyroid gland > Hyperparathyroidism > Primary chief cell hyperplasia

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