| Abstract | 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
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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. |
| Abstract (english) | 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
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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. |
