Peroperative fat staining of frozen sections in primary hyperparathyroidism

Roth and Gallaher recently described a fat staining method for rapid peroperative differentiation between parathyroid adenoma and chief cell hyperplasia. They used Sudan IV in a solution of ethanol and acetone. This solution, however, was found to cause a considerable dissolution of small lipid droplets from the tissue; in our hands sections stained with this technique were diffcult to interpret. To diminish the loss of fat from the tissue, we have used a modification of Lillie's supersaturated ispropanol method with oil red O. This method gave a deeper staining and increased the difference between hyperfunctioning and unnivolved parathyroid tissue with respect to the amount of stainable lipid in the chief cells. It was found to be a valuable supplement, adding a functional dimension to the structural interpretation of the tissue, and it facilitated the peroperative distinction between ademona and hyperplasia. The pattern of lipid distribution within the glands from patients with nodular hyperplasia suggests that the compact nodules of such glands are autonomously hyperfunctioning, whereas the intervening parts of the parenchyma are more or less responsive to the serum calcium level.