Focal proliferation in reactive hyperplastic parathyreoid tissue in end stage renal failure-implication for autotransplantation after total parathyroidectomy
H. Horandner et al., Focal proliferation in reactive hyperplastic parathyreoid tissue in end stage renal failure-implication for autotransplantation after total parathyroidectomy, WIEN KLIN W, 112(8), 2000, pp. 353-357
Total parathyroidectomy with simultaneous autotransplantation may be associ
ated with recurrence of graft-dependent hyperfunction due to excessive prol
iferation. We performed macroscopic tissue selection with a stereomicroscop
e prior to autotransplantation, which resulted in very low recurrence rates
. As this technique greatly depends on experience, we investigated the poss
ibility of additionally using proliferation staining (PCNA, MIB-1) for the
detection of dysfunctional tissue. Selected tissue from 26 patients was inv
estigated. Serial sections of freshly removed parathyroid tissue were corre
lated with their macroscopic appearance, HE and immunohistochemically stain
ed paraffin sections, and with semithin Epon sections. The asymptotic growt
h mode of clonal proliferating regions was reflected by highest staining in
tensity (1-5%) in small to medium sized foci (diffuse, up to 3 mm in diamet
er) and very low staining in large areas (diffuse or nodular, 5-15 mm in di
ameter, from 0.03 to 0.003% positive cells).
Thus, very large dysfunctional regions with (almost) no proliferation could
not be detected by this method. However, they were very evident on macrosc
opic investigation.
In conclusion, multiple fulminant recurrence after parathyroidectomy can be
prevented by selecting tissue after proliferation staining. This may allow
a delayed autotransplantation after total parathyoidectomy for those surge
ons lacking experience in macroscopic tissue classification.