2. repaso de histología normal de pt
• Glándula: parduza-amarillenta de 25-
50mg c/una.
• IHQ: cromogranina A, glicógeno,
citoqueratina, PTH.
Compuesta primariamente por
c. principales y grasa dentro de
una cápsula fibrosa que la
divide en lóbulos.
•Ce. principales / Chief cells
•Ce. oxifílicas / Oxyphil cells
•Water clear cell
4. otras variantes de adenoma de pt
Adenoma típico.
Adenoma onocítico.
Adenoma water-clear.
Lipoadenoma.
Adenoma atípico.
Dx diferenciales:
Hiperplasia de células principales.
Adenoma vs. Carcinoma
Paratiroides vs. lesiones tiroideas.
7. reflexiones finales
Causa infrecuente de hiperparatiroidismo primario.
Puede ser pasada por alto por cirujanos y patólogos.
Bx por congelación.
Importancia de medición de PTH intraoperatoria.
8. Bibliografía Consultada
1. Yoon V, Treat K, Maalouf NM. Ectopic atypical parathyroid
lipoadenoma: a rare cause of severe primary
hyperparathyroidism. J Bone Miner Metab. 2013 Sep;31(5):595-
600.
2. Mohammad Hossein Sanei, Azar Naimi, and Seyed Abbas Tabatabaei.
Ectopic lipoadenoma of parathyroid. J Res Med Sci. Oct
2012; 17(10): 983–984.
3. Sheikh S.S. · Massloom H.S. Lipoadenoma: Is It Arising from
Thyroid or Parathyroid? A Diagnostic Dilemma. ORL
2002;64:448–450.
4. Lee AY, Wang BY, Heller KS. Importance of intraoperative
parathyroid hormone measurement in the diagnosis of
parathyroid lipoadenoma. Head Neck. 2011 Jun;33(6):917-9.
5. Rastogi A, Jain M, Agarawal T, Mishra AK, Gupta S, Agarwal A.
Parathyroid lipoadenoma: case report and review of
the literature. Indian J Pathol Microbiol. 2006 Jul;49(3):404-6.
Notas del editor
● May have a pseudofollicle pattern resembling thyroid follicles (pink material is PAS positive)
Chief cells:
● 6-8 microns, polygonal, central round nuclei, contain granules of parathyroid hormone (PTH)
● Basic cell type, other cell types are due to differences in physiologic activity
● 80% of chief cells have intracellular fat
● Chief cell is most sensitive to changes in ionized calcium
Oxyphil cells:
● Slightly larger than chief cell (12 microns), acidophilic cytoplasm due to mitochondria
● No secretory granules
● First appear at puberty as single cells, then pairs, then nodules at age 40
Water clear cell:
● Abundant optically clear cytoplasm and sharply defined cell membranes
● Chief cells with excessive cytoplasmic glycogen
● Glandular elements associated with large areas of mature adipose tissue; usually functional; rarely associated with myxomatous stroma, metaplastic bone (Am J Surg Pathol 1978;2:3, Arch Pathol Lab Med 1977;101:28)
adenoma-general adenoma-atypical adenoma-chief cell adenoma-oxyphil adenoma-water clear cell carcinoma lipoadenoma lipothymoadenoma other neoplastic spread from other tumors frozen section