Abati A, Skarulis M C, Shawker T, Solomon D
Diagnostic Radiology Department, National Institutes of Health/National Cancer Institute, Bethesda, MD 20892.
Hum Pathol. 1995 Mar;26(3):338-43. doi: 10.1016/0046-8177(95)90068-3.
Ultrasound-guided (US) fine-needle aspiration (FNA) can successfully localize abnormal parathyroid tissue (PT) preoperatively in hyperparathyroid patients. Samples from 12 patients with primary hyperparathyroidism evaluated using this technique since 1990 at the National Institutes of Health form the basis of this report. Eleven patients had undergone previous parathyroid surgery that failed to correct their hyperparathyroidism. Cytological evaluation and C-terminal (midmolecule) parathyroid hormone radioimmunoassay (PTH RIA) were performed on all samples. When sufficient material was available, immunocytochemical stains for chromogranin and thyroglobulin were performed. All cytological diagnoses were made with-out knowledge of the PTH RIA results. Using a combined approach of cytology and immunocytochemistry, six of 12 of the samples (50%) were diagnosed as PT. Follow-up on these six patients was confirmatory. Four of 12 samples (33%) were identified as thyroid; one of these patients had a PT adenoma identified in another location (the remaining three patients await further localization studies). Two of 12 samples (17%) could not be diagnosed because of insufficient cellularity; in both patients PT lesions were found in other locations. Morphological features of PT in FNA include the presence of cellular tissue fragments with epithelial cells arranged perivascularly around capillary cores, an overall organoid or trabecular architecture, and frequent microacini. Parathyroid tissue cells have round, fairly uniform nuclei measuring 6 to 8 microns. Clusters of larger oxyphil cells may show considerable anisonucleosis. The absence of features of thyroid tissue such as hemosiderin-laden macrophages, abundant colloid, and paravacuolar granules is significant. However, in cases of intrathyroidal PT, admixed thyroid material included in the aspiration tract may be present immunocytochemical stains for chromogranin, which is present in parathyroid tissue but not thyroid follicular cells, were positive in six of six samples interpreted as PT by cytology. No thyroglobulin staining was observed in any of the four of six PT samples for which material was available. C-terminal (midmolecule) PTH RIA correlated with cytological diagnoses in 100% of samples. Parathyroid hormone levels ranged from 1,300 to 262,000 pg/mL (normal blood level, 50 to 340 pg/mL) in the six samples diagnosed as PT by cytology. Parathyroid hormone RIA levels in the six non-PT samples were below normal blood values. The combined approach of cytology and immunocytochemistry provides high diagnostic accuracy in the interpretation of US-guided FNA for preoperative localization of parathyroid tissue.
超声引导下（US）细针穿刺抽吸活检（FNA）能够在术前成功定位甲状旁腺功能亢进患者的异常甲状旁腺组织（PT）。自1990年以来，美国国立卫生研究院使用该技术对12例原发性甲状旁腺功能亢进患者进行了评估，本报告以此为基础。11例患者曾接受过甲状旁腺手术，但未能纠正其甲状旁腺功能亢进。对所有样本进行了细胞学评估和C端（中分子）甲状旁腺激素放射免疫分析（PTH RIA）。当有足够的材料时，进行嗜铬粒蛋白和甲状腺球蛋白的免疫细胞化学染色。所有细胞学诊断均在不知道PTH RIA结果的情况下做出。采用细胞学和免疫细胞化学相结合的方法，12个样本中有6个（50%）被诊断为PT。对这6例患者的随访得到了证实。12个样本中有4个（33%）被鉴定为甲状腺；其中1例患者在其他部位发现了甲状旁腺腺瘤（其余3例患者等待进一步的定位研究）。12个样本中有2个（17%）因细胞数量不足而无法诊断；这2例患者在其他部位均发现了PT病变。FNA中PT的形态学特征包括存在细胞组织碎片，上皮细胞围绕毛细血管核心呈血管周围排列，整体呈类器官或小梁结构，且常有微腺泡。甲状旁腺组织细胞有圆形、相当均匀的细胞核，直径为6至8微米。较大的嗜酸性细胞簇可能显示出明显的核大小不一。缺乏甲状腺组织的特征，如含铁血黄素巨噬细胞、丰富的胶质和空泡旁颗粒，具有重要意义。然而，在甲状腺内PT的病例中，穿刺道内可能存在混合的甲状腺物质。嗜铬粒蛋白存在于甲状旁腺组织而非甲状腺滤泡细胞中，6个经细胞学解释为PT的样本中，免疫细胞化学染色均为阳性。6个PT样本中有4个有可用材料，均未观察到甲状腺球蛋白染色。C端（中分子）PTH RIA与100%的样本细胞学诊断相关。在6个经细胞学诊断为PT的样本中，甲状旁腺激素水平为1300至262000 pg/mL（正常血水平为50至340 pg/mL）。6个非PT样本中的甲状旁腺激素RIA水平低于正常血值。细胞学和免疫细胞化学相结合的方法在解释US引导下FNA用于甲状旁腺组织术前定位时具有很高的诊断准确性。
