Surgery Today

, Volume 44, Issue 4, pp 773–777 | Cite as

Water-clear cell adenoma associated with primary hyperparathyroidism: report of a case

  • Keigo Murakami
  • Michio Watanabe
  • Noriaki Nakashima
  • Keisei Fujimori
  • Kazuyuki Ishida
  • Noriaki Ohuchi
  • Hironobu Sasano
Case Report

Abstract

We report a case of water-clear cell adenoma associated with primary hyperparathyroidism. A 59-year-old woman with a history of renal stones and bone fracture was referred for investigation of hypercalcemia and an elevated serum parathyroid hormone level. Skeletal X-rays showed osteopenia and ultrasound showed enlarged tumors in both sides of the inferior thyroid region. Computed tomography demonstrated a tumor in the posterior aspect of the left thyroid lobe but no lesion in the right aspect of the neck. Grossly, we found a 500 mg left lower parathyroid gland (PTG) and a 100 mg right lower PTG. Histologically, the left lower PTG comprised mainly water-clear cells (WCCs) containing numerous vacuoles. Chief cells were dispersed among the WCCs, but the right lower PTG showed normal parathyroid tissue. Several investigators have speculated that WCCs are derived from chief cells, and we diagnosed WCC adenoma. Following this case report, we review the relevant literature.

Keywords

Water-clear cell Adenoma Primary hyperparathyroidism 

References

  1. 1.
    Kovacs K, Horvath E, Ozawa Y, Yamada S, Matushita H. Large clear cell adenoma of the parathyroid in a patient with MEN-1 syndrome. Ultrastructural study of the tumour exhibiting unusual RER formations. Acta Biol Hung. 1994;45:275–84.PubMedGoogle Scholar
  2. 2.
    Grenko RT, Anderson KM, Kauffman G, Abt AB. Water-clear cell adenoma of the parathyroid. A case report with immunohistochemistry and electron microscopy. Arch Pathol Lab Med. 1995;119:1072–4.PubMedGoogle Scholar
  3. 3.
    Begueret H, Belleannee G, Dubrez J, Trouette H, Parrens M, Velly JF, et al. Clear cell adenoma of the parathyroid gland: a rare and misleading lesion. Ann Pathol. 1999;19:316–9.PubMedGoogle Scholar
  4. 4.
    Dundar E, Grenko RT, Akalin A, Karahuseyinoglu E, Bildirici K. Intrathyroidal water-clear cell parathyroid adenoma: a case report. Hum Pathol. 2001;32:889–92.PubMedCrossRefGoogle Scholar
  5. 5.
    Kuhel WI, Gonzales D, Hoda SA, Pan L, Chiu A, Giri D, et al. Synchronous water-clear cell double parathyroid adenomas a hitherto uncharacterized entity? Arch Pathol Lab Med. 2001;125:256–9.PubMedGoogle Scholar
  6. 6.
    Kanda K, Okada Y, Tanikawa T, Morita E, Tsurudome Y, Konishi T, et al. A rare case of primary hyperparathyroidism with clear cell adenoma. Endocr J. 2004;51:207–12.PubMedCrossRefGoogle Scholar
  7. 7.
    Prasad KK, Agarwal G, Krishnani N. Water-clear cell adenoma of the parathyroid gland: a rare entity. Indian J Pathol Microbiol. 2004;47:39–40.PubMedGoogle Scholar
  8. 8.
    Kodama H, Iihara M, Okamoto T, Obara T. Water-clear cell parathyroid adenoma causing primary hyperparathyroidism in a patient with neurofibromatosis type 1: report of a case. Surg Today. 2007;37:884–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Liang Y, Mojica W, Chen F. Water-clear cell adenoma of parathyroid gland: a case report and literature review. N Am J Med Sci. 2010;3:194–8.CrossRefGoogle Scholar
  10. 10.
    Roth SI. The ultrastructure of primary water-clear cell hyperplasia of the parathyroid glands. Am J Pathol. 1970;61:233–48.PubMedCentralPubMedGoogle Scholar
  11. 11.
    Emura S, Shoumura S, Isono H. Ultrastructure of the water-clear cell in the rabbit parathyroid gland. Arch Histol Cytol. 1992;55:159–66.PubMedCrossRefGoogle Scholar
  12. 12.
    Baloch ZW, LiVolsi VA. Double adenoma of the parathyroid gland: does the entity exist? Arch Pathol Lab Med. 2001;125:178–9.PubMedGoogle Scholar
  13. 13.
    Albright F, Bloomberg E, Castleman B. Hyperparathyroidism due to diffuse hyperplasia of all parathyroid glands rather than adenoma of one. Arch Intern Med. 1934;54(3):315–29.Google Scholar
  14. 14.
    Hoefler H, Denk H, Lackinger E, Helleis G, Polak JM, Heitz PU. Immunocytochemical demonstration of intermediate filament cytoskeleton proteins in human endocrine tissues and (neuro-) endocrine tumours. Virchows Arch A Pathol Anat Histopathol. 1986;409:609–26.PubMedCrossRefGoogle Scholar
  15. 15.
    Miettinen M, Clark R, Lehto VP, Virtanen I, Damjanov I. Intermediate-filament proteins in parathyroid glands and parathyroid adenomas. Arch Pathol Lab Med. 1985;109:986–9.PubMedGoogle Scholar
  16. 16.
    Chen H, Emura S, Shoumura S. Ultrastructure of the water-clear cell in the parathyroid gland of SAMP6 mice. Tissue Cell. 2006;38:187–92.PubMedCrossRefGoogle Scholar
  17. 17.
    Dawkins RL, Tashjian AH Jr, Castleman B, Moore EW. Hyperparathyroidism due to clear cell hyperplasia. Serial determinations of serum ionized calcium, parathyroid hormone and calcitonin. Am J Med. 1973;54:119–26.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Japan 2013

Authors and Affiliations

  • Keigo Murakami
    • 1
  • Michio Watanabe
    • 2
  • Noriaki Nakashima
    • 2
  • Keisei Fujimori
    • 2
  • Kazuyuki Ishida
    • 3
  • Noriaki Ohuchi
    • 2
  • Hironobu Sasano
    • 3
  1. 1.Division of Transplantation, Reconstruction and Endoscopic SurgeryTohoku University HospitalSendaiJapan
  2. 2.Division of Surgical OncologyTohoku University HospitalSendaiJapan
  3. 3.Division of PathologyTohoku University HospitalSendaiJapan

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