Hello
Can we differentiate between adenoma and hyperplasia in a patient with long standing renal failure on dialysis?
For example, in a renal failure patient on dialysis with secondary hyperparathyroidism..one gland was bigger at 3x4cm ,and the other 3 glands are 1.5x1cm each. How do we differentiate histologically whether that bigger gland is an adenoma rather than glandular hyperplasia?
Any immunostaining?
Thank you
These resources may be helpful for you.
https://www.pathologyoutlines.com/topic/parathyroidpthhyper.html
https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC1145364&blobtype=pdf
Article P53 as a marker of differentiation between hyperplastic and ...
Article Expression of p53, Ki-67 and Bcl-2 in parathyroid adenoma an...
1. Adenoma happened in one gland . High parathyroid level usually makes other parathyroid gland atrophic!
2. During surgery excision of adenoma leads to normalisation / sudden drop of parathyroid hormone. This dont happen if its is hyperplasia; as remaining 3 parathyroid will continue to secret hormone! Usually surgeon will get parathyroid hormone immediate post op/ in theatre to confirm that the excision of adenoma was adequate!
Tarant Patel: This is not true in case of long term renal failure with 2nd hyperparathyroidism
Tarang Patel Thank you for the reply. I was asking about a situation where a possible adenoma developed in a patient with secondary hyperparathyroidism. During total parathyroidectomy , a gland seemed to be way bigger than the rests.
Honigman Isabelle thank you for the comment. Can we differentiate those two? thank you
There often is a difference of size between the glands in 2nd hyperparathyroidism, it s the colour change that makes a difference. To my knowledge, it doesn't lead to any change apart that you have to spare first a small piece of gland (size of one normal gland), then remove the other glands (when you re sure about the vitality).
Not sure this helps you, sorry
Sorry! I got carried away! Thanks for clarifying. In secondary hyperparathyroidism, if surgery is indicated, half of parathyroid is preserved or implanted in sternomastoid muscle. Of course, de novo primary parathyroid adenoma can happen! I am sure histopathologist has a clear answer.
In secondary hyperparathyroidism due to parathyroid gland hyperplasia due to renal failure, and if the calcium is not is very high and the patient is a surgical risk,, you can use calcimimetic drugs. This is very important because parathyroid surgery must be done in highly experienced centers. We have to remember that these patients may need frequent dialysis and drugs, which makes treatment more expensive. The problem is that calcimimetic drugs are also expensive.
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