parathyroid gland histopathology m-2 p.e. wakely, jr., m.d. department of pathology wexner medical...
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Parathyroid Gland Histopathology M-2
P.E. Wakely, Jr., M.D.Department of Pathology
Wexner Medical Center
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Parathyroid Gland - Objectives
Describe
• the embryology & histology of the parathyroid glands.
Define
• the etiology and clinical features of hyper- and hypo-parathyroidism.
Recognize
• the distinction between parathyroid hyperplasia and parathyroid adenoma.
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Parathyroid Glands
Derived from pharyngeal pouches
Inferior glands from 3rd pouch
Superior glands from 4th pouch
Typically 4 glands – 2 on each side
Cell Types: • Chief cells: pale or clear
cytoplasm• Oxyphil cells:
eosinophilic cytoplasm• 30-40 mg. each
Two major diseases: • hyper- and hypo- PTH
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Ivar Sandström, MD1852-1889
26 y/o medical student Uppsala Hospital Discoverer of
parathyroid glands Suicide, age 37 yrs.
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Normal parathyroid
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Primary HyperParathyroidism
serum PTH level
Mobilized Ca++ serum Ca++, serum P
Etiology: adenoma – 80%• hyperplasia – 15-20%• carcinoma – <1 %
Clinical Manifestations• F:M = 4:1; 50-75 yrs. • renal calculi / weakness/fatigue / osteoporosis / bone resorption
[osteitis fibrosa cystica]• mental status change, seizures
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Fig. 10-44. Parathyroid hyperplasia. All four glands are enlarged, albeit not to the same extent.
Parathyroid hyperplasia
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Capt C. Martell
1926 the first parathyroidectomy performed in the USA.
Over several yrs. had 6 operations in neck for hyperparathyroidism
7th operation: found tumor in mediastinum.
Cured hyperPTH
Died 6 weeks later from hypocalcemic-induced hypoparathyroidism.
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PTH Adenoma
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Parathyroid adenoma
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PTH Adenoma
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PTH Adenoma, Oxyphilic Type
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PTH Adenoma
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PTH Adenoma, Clear Cell Type
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h13
85-90%
5-15%
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HypoParathyroidism
serum Ca++
Etiology• inadvertent surgical removal, congenital absence,
idiopathic atrophy
Clinical manifestations• tetany [neuromuscular irritability numbness
laryngospasm, seizures] • mental status changes, • cardiac conduction disturbances: prolongation QT
interval
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