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C-cell hyperplasia. An ultrastructural analysis

R A DeLellis, G Nunnemacher, H J Wolfe

    Laboratory Investigation; a Journal of Technical Methods and Pathology
    |March 1, 1977
    PubMed
    Summary
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    Calcitonin testing aids in identifying individuals at high risk for medullary thyroid carcinoma. Ultrastructural studies reveal distinct C-cell types in C-cell hyperplasia, correlating with functional variations.

    Area of Science:

    • Endocrinology
    • Surgical Pathology
    • Oncology

    Background:

    • The C-cell, originating from the ultimobranchial bodies, is the sole source of calcitonin, a hormone that lowers serum calcium levels.
    • Medullary thyroid carcinoma (MTC) is a malignant neoplasm arising from C-cells, and early detection is crucial for patient outcomes.
    • Calcitonin levels, stimulated by calcium and pentagastrin, serve as a biomarker for identifying at-risk individuals and diagnosing MTC.

    Purpose of the Study:

    • To investigate the spectrum of C-cell proliferative abnormalities, from C-cell hyperplasia (CCH) to invasive MTC.
    • To correlate light microscopic and immunohistochemical findings with ultrastructural characteristics of C-cells.
    • To identify distinct C-cell types within CCH and explore their potential functional variations.

    Main Methods:

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    • Correlative light microscopy and immunohistochemistry were employed to study C-cell lesions.
    • Ultrastructural analysis using electron microscopy was performed on normal and hyperplastic C-cells.
    • C-cell populations were characterized based on secretory granule size, number, and cellular morphology.

    Main Results:

    • A spectrum of C-cell abnormalities, including C-cell hyperplasia and invasive MTC, was identified.
    • Ultrastructural examination revealed that C-cells are intrafollicular, situated between the follicular basal lamina and luminal colloid.
    • Two distinct C-cell types were observed in CCH: Type I cells, abundant in secretory granules (280 nm), predominated in diffuse CCH and appeared to be in a storage phase; Type II cells, with fewer, smaller granules (130 nm), were found in nodular CCH and showed signs of active secretion.

    Conclusions:

    • C-cell hyperplasia exhibits a range of morphological changes, including nodular formations that may arise from follicular replacement.
    • The ultrastructural differences between Type I and Type II C-cells suggest distinct functional states related to calcitonin synthesis and secretion.
    • These findings contribute to understanding the pathogenesis of C-cell neoplasms and may aid in risk stratification for medullary thyroid carcinoma.