RU2524422C1 - Diagnostic technique for hyperparathyroidism - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: ultrasound-assisted fine-needle aspiration of palpable abnormalities of parathyroid glands is followed by producing a preparation to be examined with light microscopy. If observing principal parathyrocyte accumulations with manifested intercellular structures, as well as secretory granules in the primary parathyrocyte cytoplasm, hyperparathyroidism is diagnosed.

EFFECT: more reliable topical diagnosis of the pathologically changed parathyroid glands by an accurate morphological diagnosis in examining a patient that enables verifying the pathological process in the tissue and assessing a secretory activity of parathyrocytes.

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Description

The invention relates to medicine, namely to endocrinology, biology, and can be used to diagnose hyperfunction of the parathyroid glands - hyperparathyroidism (HPT).

Hyperparathyroidism (primary and secondary) refers to a common endocrine pathology, the morphological substrate of which is polyclonal and / or monoclonal hyperplasia of one or more parathyroid glands. Topical diagnosis of pathologically altered parathyroid glands presents serious difficulties. To clarify the localization of pathologically altered parathyroid glands, modern instrumental technologies are used, such as ultrasound, computed tomography, magnetic resonance imaging, as well as a number of invasive techniques.

There is a method of preoperative topical diagnosis of hyperparathyroidism (SN Pamputis et al. “Verification of pathologically altered parathyroid glands by determining the level of parathyroid hormone in aspiration material.” J. Modern aspects of surgical endocrinology. Materials of the II Ukrainian-Russian Symposium September 29 - October 1 2011, pp. 327-332).

In this method, under the control of ultrasound, a fine-needle aspiration puncture biopsy of a formation suspicious of a pathologically altered parathyroid gland is performed. The resulting aspiration material is washed off the needle and the level of parathyroid hormone is determined in it.

This method is time-consuming, due to the duration of the sample, as well as the subsequent mathematical processing of the results of the study. Expensive, as it requires the repeated determination of parathyroid hormone in each patient. All this limits its widespread use in clinical practice.

Closest to the proposed is a method for the diagnosis of hyperparathyroidism, including obtaining material from the parathyroid glands, creating the drug and conducting microscopic studies (Pat. RF No. 2395229, class AB 5/00, 2010).

This method consists in the fact that four glass plates are placed symmetrically in the area of the projection of the parathyroid glands locally, in the area above the upper and lower poles of the thyroid gland, onto which a 1% solution of aspartic amino acid is previously applied as a track. The plates are held for several minutes in the projection zone of the parathyroid glands, dried, then examined in polarized light with a quartz compensator. In the presence of aggregation crystals from radial-ray spherulites in the preparations, hyperparathyroidism is diagnosed.

The disadvantage of this method is the low diagnostic accuracy due to the lack of reliability of the material obtained from the parathyroid glands, as well as the preparation prepared from it, used for research.

So, for example, the tissue material of the parathyroid glands is obtained not directly from the area of the pathologically altered parathyroid gland, but from the proposed area of the projection of the thyroid gland using glass plates superimposed on this area. In addition, in the preparation of the drug, a reagent is used - an aspartic amino acid, which can change activity.

The low accuracy of the diagnosis is also evidenced by the fact that the description of the morphological features of this invention does not indicate quantitative or qualitative characteristics (features) that distinguish the material of patients with hyperparathyroidism from the material of patients with normal parathyroid function.

The method used expensive equipment (the study of the samples is carried out under a microscope in polarized light with a quartz compensator).

In accordance with this, the task was set to create a simple minimally invasive method that provides accurate morphological diagnosis during the examination of the patient (before treatment, in the preoperative period), by obtaining reliable material with a fine needle aspiration biopsy under the control of an ultrasound examination, preparation of a cytological preparation and research it using light microscopy. The cytological research method increases the reliability of the topical diagnosis of pathologically altered parathyroid glands, allows you to verify the hyperplastic process in the tissue of the parathyroid glands, and makes it possible to evaluate the secretory activity of parathyrocytes.

This task is achieved by the fact that in a method for diagnosing hyperparathyroidism, including obtaining material from the parathyroid glands, creating a drug and conducting microscopic studies, it is proposed to obtain material using a fine-needle aspiration biopsy of nodular formations of the parathyroid glands under ultrasound control, and to study the prepared preparation using light microscopy and upon detection in the preparations of clusters of major parathyrocytes with pronounced intercellular contacts, as well as secretory cells anul in the cytoplasm of the main parathyrocytes, diagnose hyperparathyroidism.

Figure 1 shows a fragment of the cytogram, which shows the accumulation of the main parathyrocytes with pronounced intercellular contacts, as well as the presence of secretory granules in the cytoplasm. Azur-eosin. About. 40 × (Example 1).

Figure 2 shows a fragment of the cytogram, which shows a large accumulation of major parathyrocytes with pronounced intercellular contacts, as well as the presence of secretory granules in the cytoplasm. Azur-eosin. About. 40 × (Example 2).

Figure 3 shows a fragment of the cytogram, which shows a large accumulation of major parathyrocytes with pronounced intercellular contacts, as well as the presence of secretory granules in the cytoplasm. Azur-eosin. About. 40 × (Example 3).

The method is as follows. A fine-needle aspiration biopsy of nodules in the thyroid projection is performed under the supervision of an ultrasound scan (ultrasound) on a Phillips device using a linear 7-12 MHz sensor. The aspiration material is applied in a thin layer to fat-free glass slides, dried in air and stained with the Pappenheim method. The study of drugs is carried out using light microscopy at a magnification of × 100, × 400.

The main cytological signs of hyperparathyroidism are the presence in the material of the main cells of the thyroid tissue. These are epithelial glandular cells, the so-called main paratyrocytes. They are small polygonal mononuclear cells with a diameter of 5-8 microns. The nucleus is located centrally, the cytoplasm is weakly basophilic. In cytological preparations for hyperparathyroidism, the main paratyrocytes are located, as a rule, in bulk clusters or groups, tightly adjacent to each other, while intercellular contacts are expressed (Figure 2, 3). An essential cytological sign of hyperparathyroidism is the presence of secretory granules in the cytoplasm of the main cells (Figure 1).

Clinical examples.

Example 1. B. K. 22 years old. Diagnosis: Primary hyperparathyroidism. The concentration of parathyroid hormone in the blood serum is 169 pg / ml.

With ultrasound of the anterior surface of the neck, the thyroid gland with clear, even contours is not enlarged, with a heterogeneous structure. In the projection of the lower third of the left lobe, a hypoechoic nodular formation 10 × 6 mm in size is defined (left lower parathyroid gland?).

Conclusion: nodular formation of the left thyroid lobe.

A fine needle aspiration biopsy of the nodule was performed. When a cytological study in the material detected accumulations of parathyrocytes with the presence of secretory granules in the cytoplasm (Figure 1).

Parathyroidectomy performed.

Histological conclusion: diffuse-nodular hyperplasia of mainly the main cells of the parathyroid tissue with stromal fibrosis.

Example 2. B-th T. 32 years. Diagnosis: Chronic kidney disease of the fifth stage (hemodialysis). Secondary hyperparathyroidism.

Performed scintigraphy of the parathyroid glands on the apparatus "Gamma camera Elscint" (activity 450 MBq, dose 4.05 mSv).

Conclusion: there is no data on adenoma of the parathyroid glands, “cold” nodes of both lobes of the thyroid gland.

With ultrasound of the anterior surface of the neck, the thyroid gland with clear, even contours is not enlarged, with a heterogeneous structure. In the projection of the lower pole of the left lobe, a hypoechoic formation is defined with clear even contours, 17 × 10 mm in size (left lower parathyroid gland).

A fine needle aspiration biopsy of the nodule was performed. When cytological examination in the material detected clusters of major parathyrocytes with pronounced intercellular contacts, as well as secretory granules in the cytoplasm (Figure 2).

Parathyroidectomy performed.

Histological conclusion: hyperplasia of mainly the main cells of the parathyroid tissue, stomal fat is absent.

Example 3. B. G. 39 years. Diagnosis: Chronic kidney disease of the fifth stage (hemodialysis). Condition after cadaveric kidney transplantation. Tertiary hyperparathyroidism.

With ultrasound of the anterior surface of the neck, the thyroid gland with clear, even contours is not enlarged, with a heterogeneous structure. In the projection of the lower pole of the right lobe, a hypoechoic formation of 16 × 10 mm in size (the right lower parathyroid gland) is determined, in the thickness of the left lobe, a nodular formation of 6 × 4 mm in size (expanded follicle).

A fine needle aspiration biopsy of the nodule was performed. During the cytological examination of the material obtained from the nodular formation in the projection of the lower pole of the right lobe of the thyroid gland, clusters of major parathyrocytes with pronounced intercellular contacts, as well as the presence of secretory granules in the cytoplasm were detected (Figure 3). Cytological examination of aspiration material from a nodule in the left lobe of the thyroid gland revealed a colloid.

The operation was performed - removal of nodular formation in the projection of the lower pole of the right lobe of the thyroid gland.

The use of a simple, minimally invasive method with high diagnostic accuracy will find wide application in outpatient practice.

Claims (1)

A method for the diagnosis of hyperparathyroidism, including obtaining material from the parathyroid glands, creating a drug and conducting microscopic studies, characterized in that the material is obtained using a fine-needle aspiration biopsy of nodular formations of the parathyroid glands under ultrasound control, and the study of the prepared preparation is carried out using light microscopy, and upon detection in preparations of accumulations of major parathyrocytes with pronounced intercellular contacts, as well as secretory granules in cytoplasm, the main x paratyrocytes diagnosed with hyperparathyroidism.

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