caa a22 4500 477035124 CHVBK 20180405111303.0 cr unu---uuuuu 170330e19960701xx s 000 0 eng 10.1007/s002689900113 doi (NATIONALLICENCE)springer-10.1007/s002689900113 Clonal Analysis of Nodular Parathyroid Hyperplasia in Renal Hyperparathyroidism [Elektronische Daten] [Yoshihiro Tominaga, Setsuko Kohara, Yasushi Namii, Takaharu Nagasaka, Toshihito Haba, Kazuharu Uchida, Masahiro Numano, Yuji Tanaka, Hiroshi Takagi] Abstract. Although it is well known that chronic renal failure induces parathyroid hyperplasia, the pathogenesis and development of this parathyroid lesion in this disease are poorly understood. Histopathologically, there is progression from diffuse to nodular hyperplasia, and each nodule consists of a single cell type with aggressive proliferative potential. Pathophysiologic and clinical investigations have suggested that neoplastic tumors may emerge from nodular hyperplasia. In this study the clonality of parathyroid tissue in nodular and diffuse hyperplasia in renal hyperparathyroidism was analyzed by a method based on restriction fragment length polymorphism of the X chromosome-linked phosphoglycerokinase gene and on random inactivation of the gene by methylation. DNA of peripheral lymphocytes was screened in 43 women undergoing parathyroidectomy for advanced renal hyperparathyroidism, and 10 of these patients appeared to be heterozygous. Fourteen specimens from these patients were available for clonal analysis. The analysis showed that all four specimens of diffuse hyperplasia were polyclonal, whereas all seven specimens from nodules in nodular hyperplasia and all three samples representing parathyroid tissue removed from forearm because of graft-dependent recurrence were revealed to be monoclonal. It is likely that the clonal origin of each nodule is independent. These results suggest that in renal hyperparathyroidism parathyroid glands initially grow diffusely and polyclonally, and then the cells in the nodules are later transformed monoclonally and proliferate aggressively. From the present study it can be concluded that nodular hyperplasia represents monoclonal parathyroid neoplasia, which might explain why patients with nodular hyperplasia in renal hyperparathyroidism are refractory to medical treatment, requiring parathyroidectomy. To prevent recurrences, nodular hyperplastic tissue should not be left at surgery.: 1996 by the Société Internationale de Chir, ugie Tominaga Yoshihiro Department of Transplant Surgery, Nagoya 2nd Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya 466, Japan, JP aut Kohara Setsuko Department of Transplant Surgery, Nagoya 2nd Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya 466, Japan, JP aut Namii Yasushi Department of Transplant Surgery, Nagoya 2nd Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya 466, Japan, JP aut Nagasaka Takaharu Department of Transplant Surgery, Nagoya 2nd Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya 466, Japan, JP aut Haba Toshihito Department of Transplant Surgery, Nagoya 2nd Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya 466, Japan, JP aut Uchida Kazuharu Department of Transplant Surgery, Nagoya 2nd Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya 466, Japan, JP aut Numano Masahiro Department of Transplant Surgery, Kakegawa General Hospital, Shizuoka, Japan, JP aut Tanaka Yuji Department of Surgery II, Nagoya University School of Medicine, Nagoya, Japan, JP aut Takagi Hiroshi Department of Surgery II, Nagoya University School of Medicine, Nagoya, Japan, JP aut https://doi.org/10.1007/s002689900113 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s002689900113 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Tominaga Yoshihiro Department of Transplant Surgery, Nagoya 2nd Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya 466, Japan, JP aut NATIONALLICENCE 700 1- Kohara Setsuko Department of Transplant Surgery, Nagoya 2nd Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya 466, Japan, JP aut NATIONALLICENCE 700 1- Namii Yasushi Department of Transplant Surgery, Nagoya 2nd Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya 466, Japan, JP aut NATIONALLICENCE 700 1- Nagasaka Takaharu Department of Transplant Surgery, Nagoya 2nd Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya 466, Japan, JP aut NATIONALLICENCE 700 1- Haba Toshihito Department of Transplant Surgery, Nagoya 2nd Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya 466, Japan, JP aut NATIONALLICENCE 700 1- Uchida Kazuharu Department of Transplant Surgery, Nagoya 2nd Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya 466, Japan, JP aut NATIONALLICENCE 700 1- Numano Masahiro Department of Transplant Surgery, Kakegawa General Hospital, Shizuoka, Japan, JP aut NATIONALLICENCE 700 1- Tanaka Yuji Department of Surgery II, Nagoya University School of Medicine, Nagoya, Japan, JP aut NATIONALLICENCE 700 1- Takagi Hiroshi Department of Surgery II, Nagoya University School of Medicine, Nagoya, Japan, JP aut Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer