Cinti S, Sbarbati A
Institute of Normal Human Morphology, University of Ancona, Italy.
Microsc Res Tech. 1995 Oct 1;32(2):164-79. doi: 10.1002/jemt.1070320210.
Parathyroid glands (n = 271) removed from 130 patients were examined by light and electron microscopy. A standardized method of tissue processing was employed and morphometry was performed. The aim of the paper is to provide a description of the human parathyroid chief cell ultrastructure in health and disease, with quantitative evaluation of structures involved in secretion of parathyroid hormone in a large case series, and to discuss their role in current diagnostic histopathology. The patients were euparathyroid (n = 10), or affected by primary (n = 97), secondary (n = 8), or tertiary (n = 15) hyperparathyroidism. In normal glands, solid parenchyma was composed of chief cells, large clear cells, transitional-oxyphil cells, and oxyphil cells. Chief cell hyperplasia, pseudo-adenomatous hyperplasia, adenoma, water-clear cell hyperplasia, and carcinoma were the most usual forms of parathyroid disease responsible for primary hyperparathyroidism. In chief cell hyperplasia, all the parathyroid glands were enlarged and the chief cells were in an active state of hormone secretion, with a large Golgi complex, abundant rough endoplasmic reticulum (RER), small lipid droplets, and tortuous plasma membrane. In pseudo-adenomatous hyperplasia, one gland was enlarged and the others displayed a normal size; however, electron microscopic examination and morphometric analysis showed that all the glands had active cells. Adenomas displayed a pattern similar to those of pseudo-adenomatous hyperplasia, with one gland enlarged and the others of normal size. However, ultrastructural examination and morphometry showed that the normal-size glands were hypo-active. Water-clear cell hyperplasia showed cells filled with cytoplasmic vacuoles. In these cells, structures with intermediate features between secretory granules and vacuoles were visible. Nucleo-cytoplasmic atypias were frequently visible in parathyroid carcinoma cells. In secondary and tertiary hyperplasia, active chief cells were regularly mixed with oxyphil or transitional-oxyphil cells. The tertiary hyperplasia was characterized by RER-associated structures that were not found in the normal or other pathological conditions. These results demonstrate that electron microscopy and morphometry represent useful tools in parathyroid histopathology.
对从130例患者身上切除的271个甲状旁腺进行了光镜和电镜检查。采用了标准化的组织处理方法并进行了形态计量学分析。本文旨在描述健康和疾病状态下人类甲状旁腺主细胞的超微结构，对大量病例系列中参与甲状旁腺激素分泌的结构进行定量评估，并讨论它们在当前诊断组织病理学中的作用。患者分为甲状旁腺功能正常者（n = 10），以及患有原发性（n = 97）、继发性（n = 8）或三发性（n = 15）甲状旁腺功能亢进症者。在正常腺体中，实性实质由主细胞、大透明细胞、过渡性嗜酸性细胞和嗜酸性细胞组成。主细胞增生、假腺瘤样增生、腺瘤、水样透明细胞增生和癌是导致原发性甲状旁腺功能亢进症的最常见甲状旁腺疾病形式。在主细胞增生中，所有甲状旁腺均增大，主细胞处于激素分泌活跃状态，具有大的高尔基体、丰富的粗面内质网（RER）、小脂滴和曲折的质膜。在假腺瘤样增生中，一个腺体增大，其他腺体大小正常；然而，电镜检查和形态计量学分析表明所有腺体均有活跃细胞。腺瘤表现出与假腺瘤样增生相似的模式，一个腺体增大，其他腺体大小正常。然而，超微结构检查和形态计量学表明大小正常的腺体活性较低。水样透明细胞增生表现为细胞充满细胞质空泡。在这些细胞中，可见具有分泌颗粒和空泡之间中间特征的结构。甲状旁腺癌细胞中经常可见核质异型性。在继发性和三发性增生中，活跃的主细胞经常与嗜酸性或过渡性嗜酸性细胞混合。三发性增生的特征是存在与RER相关的结构，而在正常或其他病理状态下未发现这些结构。这些结果表明，电镜检查和形态计量学是甲状旁腺组织病理学中有用的工具。
