Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Pathology. 2021 Dec;53(7):852-859. doi: 10.1016/j.pathol.2021.02.011. Epub 2021 May 14.
Parathyroid lesions exhibiting a water clear cell morphology are exceedingly rare manifestations in primary hyperparathyroidism (PHPT), and the phenomenon has been reported both for uniglandular (water clear cell adenoma; WCCA) and multiglandular disease (water clear cell hyperplasia; WCCH). In all, only 24 previous descriptions of WCCA exist in the literature. Herein, we present seven cases with water clear cell morphology (6 WCCAs and 1 case of WCCH) in an institutional series of approximately 4000 parathyroid lesions spanning 29 years in a tertiary centre setting. Major histological attributes and clinical parameters associated with this morphological subtype were reviewed, and a literature search was conducted. WCCA and WCHH exhibited an institutional prevalence of 0.15% and 0.025%, respectively. All cases displayed histological hallmarks of water clear cell morphology, with cells exhibiting abundant cytoplasm filled with vacuoles. Atypical findings or unequivocal evidence of invasive behaviour were not observed. The gender distribution was 6:1 (F:M), patients were generally symptomatic with mild hypercalcaemia, and the median age at surgery was 53 years (range 38-78). The preoperative localisation was inconclusive in four of seven, and neck exploration of all four glands was undertaken in five cases. The excised WCCAs exhibited an average weight of 1215 mg, markedly higher than conventional adenomas, and all patients were cured of PHPT following parathyroidectomy. Interestingly, previous reports mirror our observations that these lesions often are large, in relation to their sizes biochemically fairly indolent, and indecisively localised using scintigraphy, providing correlations of possible clinical value when pre-operatively assessing these rare lesions.
甲状旁腺病变表现为水样透明细胞形态在原发性甲状旁腺功能亢进症 (PHPT) 中极为罕见，该现象在单腺（水样透明细胞腺瘤；WCCA）和多腺疾病（水样透明细胞增生；WCCH）中均有报道。文献中总共只有 24 例之前描述的 WCCA 存在。在此，我们在一个三级中心环境中，对 29 年间大约 4000 例甲状旁腺病变的机构系列中存在水样透明细胞形态的 7 例病例（6 例 WCCA 和 1 例 WCCH）进行了介绍。对这种形态学亚型的主要组织学特征和临床参数进行了回顾，并进行了文献检索。WCCA 和 WCCH 在机构中的患病率分别为 0.15%和 0.025%。所有病例均显示水样透明细胞形态的组织学特征，细胞具有丰富的细胞质，充满空泡。未观察到非典型表现或明确的侵袭性行为证据。性别分布为 6:1（F:M），患者通常有症状，伴有轻度高钙血症，手术时的中位年龄为 53 岁（范围 38-78 岁）。术前定位在 7 例中的 4 例中不明确，在 5 例中对所有 4 个腺体进行了颈部探查。切除的 WCCA 平均重量为 1215 毫克，明显高于常规腺瘤，所有患者在甲状旁腺切除术后均治愈 PHPT。有趣的是，以前的报告反映了我们的观察结果，即这些病变通常很大，与其大小相比，其生化活性相当惰性，并且使用闪烁扫描术难以明确定位，为术前评估这些罕见病变提供了可能具有临床价值的相关性。
