Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Hyogo, Japan.
Department of Surgery, Kuma Hospital, Kobe, Hyogo, Japan.
Pathol Int. 2021 Jun;71(6):400-405. doi: 10.1111/pin.13091. Epub 2021 Mar 19.
This study aimed to clarify the histological alterations following fine-needle aspiration for parathyroid adenoma and discuss the occurrence of diagnostic problems. Among the 392 patients with parathyroid adenoma who underwent resection, fine-needle aspiration was performed for 21 (5.1%) parathyroid adenoma nodules. Histological findings that were significantly more frequent in cases that underwent fine-needle aspiration were considered histological alterations following fine-needle aspiration for parathyroid adenoma, including the following six findings: thick fibrous capsule (71.4%), multilayered fibrous capsules (14.3%), capsular pseudo-invasion (42.9%), fibrous bands (57.1%), hemosiderin deposition (14.3%), and tumor implantation (14.3%). Eighteen parathyroid adenoma nodules (85.7%) exhibited one or more of the six findings. Tumor cells and adipocytes entrapped within the thick fibrous capsule were occasionally observed. The fibrous bands were frequently connected to the thick fibrous capsule. The number of passes, duration between fine-needle aspiration and resection, tumor size, and purpose of fine-needle aspiration were not related to the incidence of histological findings. Because of the histological alterations following fine-needle aspiration for parathyroid adenoma that can be easily mistaken for signs of atypical adenoma or parathyroid carcinoma, we recommend that the six findings be excluded from pathological findings indicating atypical adenoma or parathyroid carcinoma in patients with preoperative fine-needle aspiration.
本研究旨在阐明甲状旁腺腺瘤细针抽吸后的组织学改变，并讨论诊断问题的发生。在 392 例接受甲状旁腺腺瘤切除术的患者中，有 21 例（5.1%）甲状旁腺腺瘤结节进行了细针抽吸。细针抽吸组中更常见的组织学发现被认为是甲状旁腺腺瘤细针抽吸后的组织学改变，包括以下 6 种发现：厚纤维囊（71.4%）、多层纤维囊（14.3%）、囊假性浸润（42.9%）、纤维带（57.1%）、含铁血黄素沉积（14.3%）和肿瘤种植（14.3%）。18 个甲状旁腺腺瘤结节（85.7%）表现出 1 种或多种 6 种发现。偶尔可以观察到被厚纤维囊包裹的肿瘤细胞和脂肪细胞。纤维带经常与厚纤维囊相连。细针抽吸的次数、细针抽吸与切除之间的时间间隔、肿瘤大小和细针抽吸的目的与组织学发现的发生率无关。由于甲状旁腺腺瘤细针抽吸后的组织学改变容易被误诊为非典型腺瘤或甲状旁腺癌的征象，我们建议在术前细针抽吸的患者中，将这 6 种发现从提示非典型腺瘤或甲状旁腺癌的病理发现中排除。
