Primary Chief Cell Hyperplasia of the Parathyroid Glands

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Abstract
Clinical and histological findings in 6 patients with primary hyper-parathyroidism resulting from chief cell hyperplasia are described. Three of the patients were sisters; in all 3 the histological appearances were similar, the main features being great variability in the composition of the gland from lobule to lobule and a virtual absence of fat. In the non-familial cases the glands were much more homogeneous and contained an abundance of fat. Histological criteria for the differentiation of primary chief cell hyperplasia from adenoma and secondary hyperplasia are proposed. There was a marked tendency towards recurrence of primary hyperparathyroidism even after nearly all the parathyroid tissue had been removed; 2 patients had total parathyroid-ectomies. In chief cell hyperplasia, all parathyroid tissue is affected, but it should be emphasized that the glands are not necessarily enlarged; 3 patients in this series had 2 or 3 glands of normal size (in 1 patient previously normal-sized glands were found to be enlarged at re-exploration of the neck 2 1/2 years later). Consequently when only 1 or 2 glands are found to be enlarged at operation, the surgeon cannot distinguish between adenoma and chief cell hyperplasia. Rapid frozen sections are usually not helpful and the diagnosis may not be established until paraffin sections are examined. One re-exploration of the neck may therefore be inevitable.

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