Expression of proliferating cell nuclear antigens in parathyroid glands of renal hyperparathyroidism.

Total parathyroidectomy with autotransplantation of a small piece of the resected hyperplastic gland is currently the usual surgical procedure for renal hyperparathyroidism in Japan. Empirically, the smallest glands showing diffuse growth are selected for the graft. In order to seek the rationale for this procedure, we examined 50 cases of both nodular and diffuse hyperplastic parathyroid glands and five cases of recurrent grafted tissues histologically and immunohistochemically with anti-proliferating cell nuclear antigen (PCNA) antibody. The proliferative activity of the glands growing in diffuse fashion was much lower than that of those growing in nodular fashion (p < 0.05). All the parathyroid glands selected for grafting in the recurrent cases showed nodular growth. No relation was revealed between PCNA expression and the size of the glands, or between the former and the type of cell components (chief and oxyphilic cells). In nodular lesions, immunopositive cells were frequently distributed near the thick fibrous capsule. From these results, we conclude that parathyroid glands showing a diffuse growth pattern are indeed suitable for the graft. When only a nodular hyperplastic parathyroid gland is available, it is suggested that the central portion of the nodule may provide a better source for the graft with little change of recurrence.