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World Journal of Surgery

, Volume 22, Issue 10, pp 1098–1103 | Cite as

Surgical Significance of Supernumerary Parathyroid Glands in Renal Hyperparathyroidism

  • Masahiro Numano
  • Yoshihiro Tominaga
  • Kazuharu Uchida
  • Akira Orihara
  • Yuji Tanaka
  • Hiroshi Takagi

Abstract. In secondary hyperparathyroidism (2HPT) fundamentally all parathyroid glands, including supernumerary glands, become hyperplastic, and stimulation of parathyroid glands continues after parathyroidectomy (PTx). Therefore supernumerary glands have special significance during surgery for 2HPT, whether persistent or recurrent HPT. In the present study 570 patients underwent initial total PTx with a forearm autograft. The frequency, type, location, histopathology, and clinical significance of the supernumerary glands were evaluated. At the initial operation 90 supernumerary glands were removed from 82 of 570 patients (14.4%); 12 patients (2.1%) required extirpation of supernumerary glands for persistent/recurrent HPT. Altogether 104 supernumerary glands were identified at operation in 94 of the 570 patients (16.5%). Among these 104 glands, 25 (24.0%) were of the rudimentary, or split, type and 79 (76.0%) of the proper type. Supernumerary glands were most frequently identified in the thymic tongue (53/104, 51.0%); 32 (60.4%) of these 53 glands were identified only microscopically. In 6 of the 570 cases (1.1%), reoperation was required for persistent HPT due to supernumerary glands located in the mediastinum, and 6 patients underwent neck reexploration for recurrence. Histopathologically, 61 of 104 (58.7%) supernumerary glands, including 36 glands recognized only microscopically, showed diffuse hyperplasia, and 43 (41.3%) displayed nodular hyperplasia. Residual small supernumerary glands with diffuse hyperplasia have the potential to be transformed to nodular hyperplasia during long-term hemodialysis. Therefore all parathyroid glands including supernumerary glands should, if possible, be removed at the initial operation. Routine removal of the thymic tongue and careful examination of the regions surrounding the lower poles of the thyroid, especially on the left side, are important steps in the surgical treatment.

Keywords

Hyperparathyroidism Parathyroid Gland Initial Operation Lower Pole Careful Examination 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Société Internationale de Chirugie 1998

Authors and Affiliations

  • Masahiro Numano
    • 1
  • Yoshihiro Tominaga
    • 2
  • Kazuharu Uchida
    • 2
  • Akira Orihara
    • 1
  • Yuji Tanaka
    • 3
  • Hiroshi Takagi
    • 3
  1. 1.Department of Transplant Surgery, Kakegawa City General Hospital, 721 Sugitani Kakegawa, Shizuoka 436, JapanJP
  2. 2.Department of Transplant Surgery, Nagoya Second Red Cross Hospital, 2-9 Myoken-cho Showa-ku, Nagoya 466, JapanJP
  3. 3.Department of Surgery II, Nagoya University School of Medicine, 65 Tsurumai-cho Showa-ku, Nagoya 466, JapanJP

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