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4th Exam Parathyroid Pathology Flashcards

1
Q

Inferior parathyroid glands arise from:

A

3rd pharyngeal pouch

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2
Q

Superior parathyroid glands arise from:

A

4th pouch

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3
Q

all 4 glands are most commonly found here:

A

on posterior thyroid surface

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4
Q

Where are migration variants more common?

A

inferior parathyroid glands

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5
Q

Superior variants:

A

Retropharyngeal, Retrolaryngeal, Retroesophageal, Mediastinum

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6
Q

Inferior variants:

A

Mediastinum, Aortopulmonary window, Jugularcarotid axis, Trachoesophageal groove

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7
Q

normal range in mg per gland:

A

< 60 mg per gland, usually 2040mg

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8
Q

3 cell types of parathyroid:

A

chief cells, clear cells, oxyphil cells

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9
Q

Chief cells:

A

Principal cells, Fried egg, Synthesize PTH

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10
Q

Clear cells:

A

Larger than chief cells, more cytoplasm, secrete PTH

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11
Q

Oxiphil cells:

A

appear after puberty, inc w age, function not clear

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12
Q

What happens when inc Ca2+ is sensed in the parathyroid?

A

PTH released, effects on bone and kidney

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13
Q

parathyroid is responsible for homeostasis of:

A

serum Ca2+ phosphorus

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14
Q

Dec serum Ca2+ effects via parathyroid:

A

stimulates PTH to inc serum Ca2+, negative feedback loop to dec PTH

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15
Q

Parathyroid Hormone is aka:

A

Parathormone

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16
Q

PTH antagonist:

A

calcitonin

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17
Q

Calcitonin is secreted by:

A

thyroid parafollicular cells, aka C cells

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18
Q

How does PTH increases serum Ca2+?

A

Bone: stimulates osteoclasts via RNAK, Kidney: activates vit D which inc GI uptake of Ca, which inhibit phosphate resporption

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19
Q

Increased serum Ca:

A

feedback inhibition PTH secretion

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20
Q

Increased Vitamin D:

A

feedback inhibition PTH synthesis

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21
Q

These affect (PTH levels)? renal phosphate resorption:

A

PTH decreases renal phosphorus resorption, Vitamin D increases renal phosphorus resorption

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22
Q

Secreted by osteocytes in response to hyperphosphatemia:

A

FGF-23

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23
Q

Function of FGF-23:

A

Increases phosphaturia (phosphate loss in urine) and inhibits 1-a hydroxylase, decreasing Vit D

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24
Q

Case: 62, woman, fatigue, dec energy, weakness, sleeping less, depressed, no hx of cancer or smoking, mild inc BP, no breast or LN masses, no fecal occult blood, Ca+ 11.5 mg/dl, BUN & creatinine normal, “Two-site” assay for PTH: increased (C-terminal, amino terminal), generalized dec bone density, radionuclide sestamibi scan – uptake w “hot spot”, lower L neck, Surgery – L inferior parathyroid gland enlarged, others normal

A

Hyperparathyroidism, parathyroid adenoma

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25
Causes of hypercalcemia:
Malignancy, lithium, estrogens, progesterone, Vit D overload, Sarcoidosis, hyperparathyroidism, Alkali syndrome (Ca2+ carbonate supplements, alkaline antacids, sodium bicarbonate), Paget’s disease of Bone
26
Primary Hyperparathyroidism:
Parathyroid Adenoma
27
Who are more effected by Parathyroid Adenoma, men or women?
women, 3:1
28
Parathyroid Adenoma:
50-60yo, 80-85%: adenoma, 15-20%: hyperplasia (2+ glands enlarged)
29
2 preop tests for Parathyroid Adenoma:
PTH assay and sestamibi scan
30
Sestamibi scan:
@15 min: see all 4 glands, washes out at 2 hours, @2 hours: uptake persists in (metabolically active parathyroid cells of) hyperplasia
31
Intraop test for Parathyroid Adenoma:
PTH assay
32
Adenoma is easily confused w:
hyperplasia
33
How to distinguish between adenoma and primary hyperparathyroidism:
If a section goes thru hilum, might see normal parathyroid tissue, different from the lesion
34
Parathyroid adenoma is histology nonspecific, except if taken here:
exactly at hilum
35
TF? There is an inc in intraglandular fat w parathyroid adenoma.
F. dec
36
TF? Capsule compressing adjacent tissue causes adenoma.
does not make an adenoma
37
Are atypical cells predictive of malignancy?
No
38
Parathyroid Adenoma is what type of adenoma?
Clear cell adenoma
39
Primary hyperparathyroidism cancers, most to least prevalence:
adenoma, hyperplasia, carcinoma
40
Dec chief cell receptors Ca2+ ion sensing:
Primary hyperplasia
41
of glands enlarged in parathyroid hyperplasia:
2+
42
Most common gastrinoma:
Pancreatic islet cell tumors
43
Most common prolactinoma:
Pituitary adenoma
44
MEN I PPP is aka:
Wermer’s Syndrome
45
MEN I PPP:
part of group of disorders, the Multiple Endocrine Neoplasias, affect endocrine system thru development of neoplastic lesions in pituitary, parathyroid gland and pancreas, loss of MEN 1 suppressor gene, Chr 11q11-13, Parathyroid hyperplasia, pancreatic islet cell tumors (most common gastrinoma), pituitary adenomas (most common prolactinoma), adrenal adenomas less common
46
MEN II PPT:
Parathyroid hyperplasia, Pheochromocytoma, Thyroid medullary carcinoma
47
Secondary Hyperparathyroidism:
Usually chronic renal failure, Inadequate production of active Vit D, red GI absorption of Ca2+, renal retention of phosphate, inc serum phosphate depresses serum Ca2+, compensatory increased PTH, parathyroid hyperplasia, Serum Ca++ usually low normal or low, bone lesions, Histo: fibrosis, hemorrhage, hypertrabecular pattern
48
Tertiary Hyperparathyroidism:
Occurs in setting of longstanding secondary hyperplasia, autonomous hyperplasia develops, monoclonal population in one focus, hypercalcemia, Rx: surgery to remove 3+ glands
49
Least common primary hyperparathyroidism:
Parathyroid Carcinoma
50
Parathyroid Carcinoma:
30-60yo, palpable mass, PTH > 3x normal, profound symptomatic hypercalcemia, may be assoc w prior neck irradiation or hyperparathyroid jaw tumor syndrome, autosomal dominant, mutation HRPT2, central benign fibro-osseus tumors
51
Diagnostic criteria for parathyroid carcinoma:
Invasion into surrounding organs, lymphatic or vascular invasion, cytologic pleomorphism and mitotic activity may not be predictive
52
Hyperparathyroidism is assoc w (pneumonic):
Stones, Bones, Moans, Groans
53
Stone issues related to hyperparathyroidism:
Kidney stones
54
Bone issues related to hyperparathyroidism:
Osteoporosis, fractures, brown tumors
55
Moans related to hyperparathyroidism:
Depression
56
Groans issues related to hyperparathyroidism
GI tract problems
57
Case: 30yo, painful mass in lower L jaw, lethargic, began months ago w slight swelling, inc along w lethargy, swelling - firm to touch, Xray: multilocular radiolucency, incisal biopsy done, histo path showed chronic inflammatory cells w many multi-nucleated giant cells, hemorrhagic areas and hemosiderin, serum Ca2+: 14 mg/dl, PTH: 890 pg/ml
Mandibular tumor?
58
Mandibular Tumor:
Bone production (membranous, immature bone), not a giant cell tumor, but a giant cell process, brown tumor, loss of lamina dura, root resorption of teeth, complication of hyperparathyroidism
59
Bone Tumor:
Circumscribed lytic lesion, hemorrhage, increased vascularity, hemosiderin: brown, inc osteoclastic activity, macs, reparative fibrous tissue, sometimes cystic
60
Dental Consequences of Hyperparathyroidism
Bone disease, brown tumor, dec bone density, weak teeth, soft tissue calcifications, loss of lamina dura, widening of PDL, resorption of tooth roots
61
Generalized hyperparathyroidism:
Hands: subperiosteal bone resorption, very advanced stage… doesn’t progress this far today due to Ca2+ testing
62
Paget’s Disease of Bone:
Disordered bone remodeling, cotton wool appearance, disorganized thickening
63
Tumor Induced Rickets:
Osteogenic osteomalacia (softening of bone), FGF-23 induced phosphaturia, FGF-23 can be secreted by a variety of bone and soft tissue tumors, widespread bony lytic lesions, serum PTH, Ca, P normal, inc P and Ca in urine
64
Hypercalcemia in cancer:
Paraneoplastic syndrome, squamous ca (lung, esophagus), renal cell ca, serum PTH is low, often secrete PTHrP (related protein), shares 1st 13 AA of PTH, binds to PTH receptors, bone mets, osteoclast activating factors secreted by tumor

Pathology (23 decks)

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