[The cytomorphologic characteristics of parathyroid gland under various forms of hyperparathyroidism]

The study was organized to establish criteria of cytological diagnostic of pathology of parathyroid glands under various forms of hyperparathyroidism. The ultrasound examination of pathology of parathyroid glands was applied to 74 patients with hyperparathyroidism aged 24-66 years (20 males and 54 females). The examination was applied to 11 patients with primary hyperparathyroidism (bone visceral form), 51 patients with secondary hyperparathyroidism of severe course and 12 patients with tertiary hyperparathyroidism (post-transplantation). The 109 samples of expanded parathyroid glands were visualized and subjected to fine-needle aspiration biopsy. The cytologic material was colored with azure-eosin according Pappenheim method and analyzed using light microscopy technique. The cytological material was informative in 105 (96%) findings. The elements of tissue of parathyroid glands were detected in 99 (90.8%) samples. The main cytomorphologic indications of adenoma of parathyroid gland were follicle-like and papillary structures of main parathyrocites detected in all patients with primary hyperparathyroidism; main parathyrocites at various stages of secretory cycle - in 64% of patients and macrophages - in 50% of patients. The characteristic cytomorphologic indications of hyperplasia of parathyroid gland turned out to be situated in groups, papillary and branching structures with expressed intercellular contacts, main dark parathyrocytes detected in 88% of patients with secondary hyperparathyroidism, parathyrocytes at various stages of secretory cycle (53% of patients) and small basophilic granules of secretion of parathyrocites in cytoplasm and/or extracellular space (31% of patients). The distinctive cytological indications of tissue of parathyroid gland under tertiary hyperparathyroidism included prevalence of main light parathyrocites situated in small clusters and groups with ill-defined intercellular contacts and presence of large basophilic secretory granules in cytoplasm of parathyrocites, extracellular space and colloid-like substance (92% of patients). The comparative analysis detected similar cytological indications in tissue of parathyroid gland and strictly definite criteria characteristic for primary, secondary and tertiary hyperparathyroidism. The relationship between structural functional condition of tissue of parathyroid gland and development of either form of hyperparathyroidism is discussed. The cytomorphologic characteristics of tissue of parathyroid gland under primary, secondary and tertiary hyperparathyroidism can be included in algorithm of pre-surgery diagnostic.