Citološko predoperacijsko razlikovanje promjena u paratireoidnim žlijezdama [Cytologic preoperative differentiation of parathyroid lesions]

Fuštar-Preradović, Ljubica (2016) Citološko predoperacijsko razlikovanje promjena u paratireoidnim žlijezdama [Cytologic preoperative differentiation of parathyroid lesions]. PhD thesis, Sveučilište u Zagrebu.

PDF Download (1MB)

Abstract

Introduction. Minimally invasive surgery is the method of choice in the management of hyperparathyroidism caused by parathyroid adenoma, whereas in case of parathyroid hyperplasia radical operative procedure is necessary to prevent disease relapse. Material and methods. Sixty-seven parathyroid cytologic smears, preoperatively obtained by ultrasound-guided aspiration biopsy were analyzed. Fifty parathyroid cell nuclei per smear were analyzed including morphometric analysis and analysis of the nucleolar organizer region (AgNOR) properties using SFORM software (Vamstec). Preoperative ultrasonography, aspiration cytology, Grimelius' and AgNOR cytochemistry, and morphometry findings were compared with histopathology findings. Mann-Whitney U-test was employed to determine differences in the measured parameters. Correlations of parameters were determined by Spearman's correlation coefficient Rho (r). Hypothesis. The aim of the study was to investigate morphological and cytochemical parameters differentiating parathyroid adenoma from parathyroid hyperplasia in cytologic smears in preoperative work-up of patients with hyperparathyroidism. Results. Grimelius' cytochemistry can differentiate parathyroid cells and thyroid cells, but not parathyroid adenoma cells from parathyroid hyperplasia cells. Morphometric analysis showed statistically significantly higher values of nuclear size, area, circumference, minimal radius, convexity and width in parathyroid hyperplasia as compared with adenoma. Higher values of standard deviation were recorded in parathyroid hyperplasia versus parathyroid adenoma. When extrapolated to cell morphology, greater nuclear heterogeneity and size diversity was found in hyperplasia as compared with � 83 adenoma. The nuclear form factor and nuclear elongation factor were almost equal in both groups, pointing to the uniformity of nuclear shape in both groups. Comparison of the AgNOR number with the parameters of nuclear size and shape did not yield significant correlation. Morphometric measurement revealed a significantly greater AgNOR area and heterogeneity in hyperplasia as compared with adenoma. Comparison of AgNOR area and nuclear size parameters yielded significant correlation. The cells with greater AgNOR area showed higher values of the nuclear size parameters in hyperplasia than in adenoma. The overall area of all AgNORs did not correlate with the nuclear shape parameters. AgNOR classification according to their proliferation activity into individual AgNORs, AgNOR clusters and annular AgNORs was found to be irrelevant in differentiating parathyroid adenoma from parathyroid hyperplasia. Conclusion. Study results pointed to the justifiable utilization of cytodiagnosis, along with morphological, cytochemical and morphometric methods, in preoperative identification of parathyroid gland tumors. Particular nuclear and AgNOR morphometric parameters can influence patient selection as candidates for minimally invasive or radical surgery.

Abstract in Croatian

Minimalna invazivna kirurgija je metoda izbora u lijecenju hiperparatireoidizma (HPT) uzrokovanog adenomom DŽ, dok je kod hiperplazije DŽ neophodan radikalni zahvat zbog sprjecavanja razvoja recidiva koji zahtijevaju reoperacije. Svrha ovog rada je istražiti morfološke i citokemijske pokazatelje za diferenciranje adenoma od hiperplazije DŽ, u citološkim preparatima, u svrhu preoperacijske obrade bolesnika s HPT. Analizirano je 67 razmaza punktata DŽ, dobivenih preoperacijski punkcijom pod kontrolom ultrazvuka. Analiza je obuhvatila morfometrijsku analizu i analizu osobina regija jezgrine organizacije (AgNOR) u 50 jezgara stanica DŽ u svakom razmazu, na osobnom racunalu „SFORM“ tvrtke VAMSTEC, Zagreb. Nalazi ultrazvuka, citološke punkcije, citokemijskih pretraga po Grimelius-u, AgNOR-a i morfometrijskih mjerenja uspore�eni su s patohistološkim nalazima. Za utvr�ivanje razlika u mjerenim parametrima korišten je Mann-Whitney U-test, a njihova povezanost utvr�ena je Spearmanov-im koeficijentom korelacije Rho (r). Citokemijskom metodom po Grimelius-u mogu se razlikovati stanice DŽ, od stanica štitne žlijezde, ali se ne mogu razlikovati stanice adenoma DŽ od stanica hiperplazije DŽ. Morfometrijskim mjerenjem parametri koji se odnose na velicinu jezgre, površina, opseg, minimalni radijus, zakrivljenost i širina jezgre, pokazuju vece vrijednosti u hiperplaziji DŽ, nego u adenomu, uz statisticki znacajnu razliku. Standardna devijacija pokazuje više vrijednosti u hiperplaziji nego u adenomu. Primijenjeno na morfologiju stanica u hiperplaziji se nalaze stanice s vecim jezgrama i jace izraženom nejednolikosti u velicini jezgara nego adenomu. Cimbenici oblika: cimbenik pravilnosti jezgre i cimbenik izduženosti jezgre su podjednaki u obje skupine što upucuje na jednolikost u obliku jezgara u obje skupine. Usporedbom broja AgNOR-a s parametrima koji se odnose na velicinu i oblik jezgre, nije � 81 na�ena znacajna povezanost. Morfometrijskim mjerenjem utvr�ena je znacajno veca površina i nejednolikost AgNOR-a u hiperplaziji nego u adenomu, a usporedbom s parametrima koji se odnose na velicinu jezgre, na�ena je znacajna povezanost. U hiperplaziji stanice s vecom površinom AgNOR-a imaju i vece vrijednosti parametara koji se odnose na velicinu jezgre nego u adenomu. Ukupna površina svih AgNOR-a nije povezana s cimbenicima oblika. Podjela AgNOR-a na pojedinacne, nakupine i prstenaste, obzirom na njihovu proliferacijsku aktivnost, nema znacaja u razlikovanju adenoma od hiperplazije DŽ. Rezultati istraživanja upucuju na opravdanost primjene citološke dijagnostike, uz primjenu morfoloških, citokemijskih i morfometrijskih metoda, u preoperacijskoj identifikaciji tumora DŽ, te da pojedini morfometrijski pokazatelji jezgre i AgNOR-a mogu utjecati na izbor bolesnika koji bi bili kandidati za minimalni invazivni ili radikalni kirurški zahvat.

Actions (login required)

View Item

Downloads