EPITHELIAL BODIES (glandulae parathyroideae; synonym: parathyroids, parathyroid glands, it is rare - epithelial little bodies) — the hemadens producing the parathormone participating in regulation of calcic and phosphoric exchange. Usually at the person contain two couples of the Item. — upper (gl. parathyroidea sup.) and lower (gl. parathyroidea inf.), however number of the Item. can vary from 4 to 12.
For the first time as independent anatomic formation of the Item. were described in 1880 by I. V. Sandstrom, to-ry found in the person and animals the epithelial little bodies of an oval form closely adjacent to a back surface of shares of a thyroid gland (see). I. V. Sandstrom called these educations epithelial bodies, assuming, as well as his nek-ry contemporaries that they represent sites of a little differentiated parenchyma of the thyroid gland which did not undergo the corresponding development in the course of ontogenesis. In 1891. E. Gley observed tetany (see), developed after removal «glands lying about thyroid», but explained it with the accompanying dysfunction of a thyroid gland. In 1895. A. Kohn found the lower couple of the Item., then G. Vassale and F. Generali in 1901 experimentally proved that removal of the Item. is an origin of spasms. The same year A. Biedl for the first time drew the attention of surgeons to special importance of saving the Item. at a strumectomy (see. Thyroidectomy ) for prevention of development of a postoperative tetany. It became known is later about possible existence of additional Items. in a mediastinum, in a parenchyma of a thymus (see) etc. In 1908 and Fegtlin (S. of Voegt-lin) established by Mack-W. G. MacCallum that the main reason for tetanic spasms after removal of the Item. reduction of concentration of calcium in blood is and that administration of salts of calcium, as a rule, stops attacks of spasms. Thus, these researchers approached understanding fiziol, roles of the Item.
In 1911 Greenwald found reduction of removal with urine of phosphorus and increase in its concentration in blood after a parathyroidectomy (see) that demonstrated influence of the Item. on phosphoric exchange (see). Item, essentially important for final clarification of a role. Kollip's research was (J. Century of Collip), to-ry in 1925 from the Item. cattle received the extract having hormonal activity. In our country since 1924. A. V. Rusakov fundamentally developed a problem of hyperfunction of the Item. He considered a hyperparathyreosis the reason of nek-ry types of an osteodystrophy and recommended a parathyroidectomy as their pathogenetic treatment. In 1926 Mr. F. Mandi for the first time removed adenoma of the Item. at a generalized form of a fibrous osteodystrophy (see. A parathyroid osteodystrophy), result of what was a wedge, recovery.
Thanks to achievements of biochemistry in 60 — the 70th the hormone produced by the Item was succeeded to allocate 20 century. — parathormone (see) and to decipher its chemical structure. It was established also that at the person and at nek-ry mammals in fabric of the Item. *, as well as in tissue of a thyroid gland, exist so-called. K-cells, to-rye develop a calcitonin (see) — hormone, action to-rogo antithetically effect of parathormone; it slows down resorptive processes in a bone tissue, has gipokaltsiyemichesky and hypophosphathat-chesky effect.
Embryology, anatomy, histology
Item. are found in all vertebrata standing in an evolutionary row above fishes. As defined morfol, structure they for the first time appear at amphibians.
Item. there are together with a thymus (thymus gland) from an epithelium III and IV couples of pharyngeal (branchiate) pockets of a head gut of a germ, and rudiments of the Item. are located a little behind a rudiment of a thymus. Within the 2nd month of embryonic development rudiments of the Item. separate from walls of pharyngeal pockets; owing to movement in the caudal direction rudiments of glands III of couple appear below rudiments of glands IV of couple of pharyngeal pockets. Epithelial outgrowths of the Item. are located on a back surface of shares of a thyroid gland and edges are surrounded with connecting fabric, getting deep into, divides the Item. on small segments.
Upper Items. are located on border of an upper and average third of shares of a thyroid gland, to-rykh they adjoin to back surfaces. In relation to a throat upper Items. are located at the level of bottom edge of a cricoid. Lower Items. are located at the level of the lower third of shares of a thyroid gland (fig. 1), but can be located and on a side surface of a trachea is lower than a thyroid gland. Sometimes Item. find included in fabric of thyroid or thymic glands.
Form of the Item. roundish or extended, slightly flattened. Size of the Item. it is very insignificant: length of each gland is from 2 to 8 mm, width is 3 — 4 mm, thickness is from 1,5 to 3 mm. The weight of all glands is from 0,25 to 0,5 g. Consistence of the Item. is slightly more dense, than a consistence of a thyroid gland. At children of the Item. have light pink coloring, at adults they are painted in the yellowish or brownish color a little different from color of a thyroid gland therefore at adult Items. it is difficult to differentiate from additional thyroid glands, small limf, small knots or sites of tissue of thymus. Sometimes Item. it is possible to confuse with segments of fatty tissue.
Main source of blood supply of the Item. the lower thyroid artery is (a. thyroidea inf.) and, to a lesser extent, upper thyroid artery (. thyroidea sup.), and also branches of arteries of a gullet and trachea. A venous blood from the Item. gathers in veins of a thyroid gland, a trachea and a gullet.
Each epithelial body is innervated by sympathetic fibers of top and bottom cervical, and also star-shaped nodes of a sympathetic trunk of the party, and their parasympathetic innervation is provided with a vagus nerve (see).
Histologically in the Item. distinguish the capsule (capsula glandulae parathyroideae), a stroma (stroma glandulae para thyroideae) and a parenchyma (parenchyma glandulae para-thyroideae). The stroma is very gentle n is connected by hl. obr. with the blood vessels passing in iron, to-rykh in the Item. it is a lot of; between arterioles and venules wide sinusoidny capillaries are located.
Parenchyma of the Item. at adults consists preferential of large polygonal light cells (brilliant paratirotsit) called still by the main paratirotsi-ta (parathyrocytus principalis, parathyrocytus lucidus), and a small amount of the paratirotsit which are painted acid dyes and called therefore by oxyphilic or acidophilic (parathyrocytus acidophilus). The main iaratirotsita have slightly basphilic, lilac-tinged, badly painted cytoplasm and a large kernel with clear structure of chromatin. Distinguish still dense iaratirotsita (parathyrocytus densus). In cytoplasm of the main paratirotsit find lipoid inclusions, accumulations of a glycogen in the form of kernels and glybok, and sometimes droplets of the substance of homogeneous structure having looking alike a colloid of tirotsit. They are characterized by well developed lamellar complex (Golgi's device) located about a kernel, a significant amount of mitochondrions and phagolysosomes. Elements of a granular cytoplasmatic reticulum are expressed poorly. Intercellular borders have difficult character (fig. 2).
In the pre-natal period of ontogenesis parenchyma of the Item. the person consists of the main paratirotsit. In the post-natal period similar structure of the Item. remains, however groups of the main cells are located more compactly. In the first months of life a parenchyma of the Item. represents tyazh of juicy light cells (the main tirotsit) with large oval kernels. Connective tissue trabeculas (epithelial crossbeams) of the Item. (trabecula epithelialis) almost splovd are constructed of argyrophil fabric. Collagenic fibers are found only in walls of the largest vessels. Elastic fibrils histologically come to light in the capsule of the Item.
Throughout the first — 8 years of life gistol, structure of the Item. changes a little. It is possible to note only increase in amount of collagenic fibers in walls and around vessels and occasionally emergence of fatty tissue. Parenchyma of the Item. consists almost only of the main paratirotsit. Only after 6 — 8 years and it is especially distinct to 40-mu to year of life in fabric of the Item. there are acidophilic cells. At the same time in it also the amount of fatty tissue increases. With age there is coarsening of an argyrophil stroma of body, its loops become more dense, close. In some cases at adults formation of the streamed homogeneous colloid in the form of the follicles surrounded with light main cells is observed.
From comparison of development of the Item. and other hemadens in ontogenesis it is possible to draw a conclusion that the Item. already at early children's age are well presented morphologically and that the Item. in ontogenesis rather involute processes, such as development of a connective tissue stroma, increase in quantity of a fatty tissue, emergence of acidophilic paratirotsit are inherent not evolutive, but. Ontogenetic structural change of the Item. reminds a histogenesis of a thymus.
The K-cells interspersed in fabric of the Item., produce a calcitonin. In cytoplasm of K-cells a significant amount of light vesicles with a transparent matrix and the dense granules containing hormone is visible. The granular cytoplasmic reticulum of K-cells is developed poorly, mitochondrions are not enough, a lamellar complex (Golgi's device) large. K-cells preferential in an okolokapillyarny zone lower II are found.
Physiology and biochemistry
Value of the Item. for an organism consists in secretion of parathormone (see), to-ry together with a calcitonin (see), too partly the cosecreted Item., and provides with vitamin D maintenance of optimum ion concentration of calcium and phosphorus in blood, extracellular liquid and cells, creating thereby conditions for normal growth, development and functioning of a bone part of a skeleton and for normal course of the enzymatic reactions catalyzed by Ca 2+ - dependent enzymes, for normal functioning of system of a blood coagulation etc.
The main target organs for parathormone are bones, kidneys and a small bowel where it stimulates absorption of calcium. In bones parathormone activates resorptive processes, increase in content of calcium in blood is connected with this its action. Since in kidneys parathormone causes reduction of a reabsorption of phosphate in distal departments of nephron, excretion of phosphate increases, and the content of phosphate in blood considerably decreases. Fosfaturichesky ef-.fekt parathormone serves as counterbalance for active removal from a bone of ions of Sa2 + and interferes with adjournment of calcium phosphate in soft tissues. Other renal effect of a paratgorkhmon is its ability to raise a reabsorption of calcium owing to what its excretion with urine decreases. However the resistant hypercalcemia increases filtrational ability of kidneys, leading to a polyuria and a polydipsia. At the same time the long hypercalcemia promotes calcification of bodies and fabrics.
Metabolism of parathormone proceeds generally in a liver and kidneys. Time biol, semi-lives of parathormone in an organism apprx. 18 min. Parathormone is completely inactivated within several hours (generally in kidneys) and quickly removed from an organism.
Regulation of secretion of parathormone in an organism is carried out by the principle of a feed-back by change of concentration of calcium in blood (at decrease in ion concentration of Ca 2+ emission of parathormone in blood increases and vice versa). Also the control exercised by change of concentration of the bivalent cations circulating in blood, generally ions of Mg belongs to mechanisms of control of secretion of parathormone 2+ and Sa 2+ , and also contents cyclic 3', 5 '-AMF in Items. Introduction to an organism of large amounts of magnesium considerably reduces secretion of parathormone that is used in clinic at nek-ry forms of a hyperparathyreosis for blockade of the Item. solution of sulfate magnesia.
Methods of a research
Methods of a research of the Item. include a wedge, inspection of the patient with detailed studying of the anamnesis, definition of concentration of calcium and phosphorus in blood and urine (see. Mineral metabolism), X-ray analysis of a bone part of a skeleton.
Basic biochemical, parameter for assessment funkts, conditions of the Item. definition in blood of concentration of calcium and phosphorus is. Normal content of calcium in a blood plasma makes at adult from 8,5 to 12 mg in 100 ml and at newborn from 7,5 to 13,9 mg in 100 ml. Decrease in concentration of calcium in blood lower than 8,5 mg in 100 ml has a promoting effect on the Item., and increase, on the contrary, brakes products of parathormone. Content in blood of free ions of Sa 2+ most precisely reflects funkts, a condition of the Item. There is a number of straight lines and indirect methods of definition of ion concentration of Sa 2+ (see. Calcium, methods of definition of calcium in biological liquids) .
Normal concentration of inorganic phosphorus (see) in a blood plasma at adults makes 3,96 ± 0,46 mg in 100 ml, children of chest age have 4 — 7 mg in 100 ml. In case of hyperfunction of the Item. content of inorganic phosphorus in blood decreases, and at its hypofunction increases. Exerts a hyperphosphatemia the stimulating impact on products of parathormone.
For the characteristic funkts, conditions of the Item. has a certain value ion concentration of Mg 2+ in a blood plasma, normal making 1,6 — 2,9 mg in 100 ml. At decrease in contents magnesium (see) parathormone does not show the usual giperkaltsiyemichesky effect. At a hyperparathyreosis note hypomagnesiemia). In turn, spasms at a hypoparathyrosis can be stopped administration of drugs of magnesium. However repeated administration of magnesium renders on the Item. the braking action.
Funkts, condition of the Item. it is possible to estimate directly — by determination of content in blood of parathormone by biological and radio immunological methods (see Hormones), use also cytochemical method based on ability of parathormone to activate glyukozo-6-phosphate — a dehydrogenase (KF 18.104.22.168) of distal department of nephron of cortical substance of kidneys of Guinea pigs of in vitro. The content of parathormone in blood of the healthy person measured by this method is ranging from 2 to 40 pg/ml.
The research funkts, conditions of the Item is more rare. carry out by means of methionine, marked 75 Se (see. Metionin ). Activity 75 The Se-methionine entered intravenously at a research of the Item. it is equal 250 — 300 mkkyur. In 24 — 72 hours after introduction on the scanning installation or in the gamma camera determination of quantity T58e-metionina is carried out to the Item.
There is a close interrelation between parathormone and vitamin D. Parathormone stimulates education in kidneys of an active metabolite of vitamin D — 1,25 dioxycholecalciferols, to-ry increases absorption of calcium in intestines in much bigger degree, than vitamin D. Thus, parathormone can influence absorption of calcium in intestines an indirect way.
Pathology of epithelial bodies
two groups patol Are known, processes, to-rykh defeat of the Item is the cornerstone. — a hyperparathyreosis (see) and a hypoparathyrosis (see). A wedge, manifestations of a hypoparathyrosis are characterized by the difficult symptom complex of a tetany (see) caused funkts, insufficiency or lack of the Item. (aparathyreosis). The main biochemical, indicators in this case are the hypocalcemia and a hyperphosphatemia. Damage of the Item is the most frequent reason of a hypoparathyrosis. during a thyroid gland operations, owing to what in the Item. the dystrophic processes caused by disturbance of blood circulation and an innervation can develop. In some cases observed radiation damage of the Item. as a result of radioiodine therapy of a craw. Cases of postinfectious damage of the Item are described., and also inborn hypoparathyrosis. At it is hidden the proceeding hypoparathyrosis a tetany can provoke a hypovitaminosis of D, shift of acid-base equilibrium towards an alkalosis, a stress. Disturbances of c. N of page at a hypoparathyrosis are characterized by vascular dystonia (see Dystonia vascular), unconscious states with enileptoidny attacks. Are observed also a visual disturbance and hearing. Carry to trophic disturbances a hypocalcium-michesky cataract, fragility of nails, diseases of skin, teeth. At diagnosis of a hypoparathyrosis it is necessary to consider a possibility of manifestation of those forms of a tetany, to-rye are not caused by defeat of the Item.
In treatment of a hypoparathyrosis the main role belongs to replacement therapy by parathyroidin (see); besides, apply intravenous administration of Calcium chloratum, appoint per os vitamin D, a milk and vegetable diet.
Pseudohypoparathyroidism (see) is a peculiar pathology, at a cut there is no disturbance of secretion of parathormone, however peripheral fabrics of a rezistentna to parathormone. This inborn disease which is characterized by a delay of intellectual and physical development; the picture of a gipokal-tsiyemichesky tetany can develop.
A hyperparathyreosis — patol, hyperfunction of the Item., G1 most often caused by existence of adenoma. or hyperplasia of the Item. It meets rather seldom, women aged from 30 up to 50 years suffer more often. The beginning of a disease is characterized by increased fatigue, an adynamia, etc. Further preferential damage of kidneys, bone system or visceral bodies is observed depending on what distinguish three a wedge, forms of a hyperparathyreosis: renal, bone and visceral. At a renal form the bilateral recurrent nephrolithiasis is observed (see. Nephrolithiasis ). In kidneys are formed oxalic or phosphatic stones. Excess of the formed parathormone promotes development of pyelonephritis (see) and the renal failure (see) which is followed by a polyuria and a polydipsia, the nephrocalcinosis (see) happens the reason of a renal failure most often. Adjournment of salts of calcium at excess formation of parathormone happens also in other fabrics.
Damage of bones at a hyperparathyreosis differs in polymorphism. Patients complain of backbone pains, especially at an exercise stress. Characteristic rentgenol, symptoms of a disease — decrease in height of bodies of vertebrae and a subperios-talny resorption of phalanxes of fingers.
Changes from a nervous system are caused by a hypercalcemia with disturbance of electrolytic balance of blood and are characterized by an adynamia, paresis, paralyzes, decrease in neuromuscular excitability. The hyperparathyreosis quite often is followed by defeat went. - kish. a path, up to development of a peptic ulcer. A heavy complication of a hyperparathyreosis is parathyrocardiac crisis, the content of calcium in blood at Krom exceeds 16 mg in 100 ml (see Prizes, giperkaltsiyemichesky). At patients, besides, the content in blood of phosphorus and residual nitrogen sharply increases, note an anury.
Due to a variety the wedge, manifestations of a hyperparathyreosis and their looking alike displays of other diseases special value at diagnosis has definition of concentration of calcium, phosphorus and activity of an alkaline phosphatase in blood. Biochemical, shifts consist in a considerable hypercalcemia, a hypophosphatemia with the expressed fosfaturiya and increase in blood of activity of an alkaline phosphatase, especially in case of destruction of bones. Important diagnostic test is the test with a cortisone, introduction to-rogo at a hyperparathyreosis does not cause decrease in content of calcium in blood that usually happens normal. A drastic remedy of treatment of a hyperparathyreosis is the timely parathyroidectomy (see). Cancer of the Item. treats exclusively rare gormonalnoaktivny tumors.
Age features at children
About the beginning of functioning of the Item. at the person in ontogenesis is known a little. However studying of fabric of glands of an embryo of the person of in vitro showed that to function the Item. at an embryo of the person can begin very much early: on 12 — the 13th week of pre-natal development. Fabric of the Item. an embryo of the person at this stage at an incubation with a neonatal bone tissue caused its resorption.
At newborns one of frequent diseases is the so-called tetany of newborns which is followed by a hypocalcemia and frequent a hypophosphatemia. It is possible that etiol, a factor in a pathogeny of a neonatal hypocalcemia is resistance of target organs to parathormone and a tranzitorny hypoparathyrosis (in blood of healthy newborns concentration of parathormone either it is very low or is not defined absolutely, and only for the 4th days after the birth parallel increase in blood of content of the parathormone connected and the ionized calcium begins). In the period of a neonatality reserves of the Item. at children are small. However reduction of concentration of calcium in blood is not always followed by depression of function of the Item., what demonstrates participation of accessory unknown factors in genesis of a neonatal hypocalcemia.
Funkts, condition of the Item. mothers during pregnancy can influence function. newborn. It is known that during normal pregnancy mother has a hyperplasia of the Item. and a secondary hyperparathyreosis (in the last trimester of pregnancy note the high content of parathormone in blood). Increase in concentration of immunoreactive parathormone in blood of the pregnant woman, apparently, suppresses function of the Item. at a fruit by means of increase in ion concentration of Ca 2+ in blood of a fruit. It is possible that it is connected with effect of maternal parathormone on chresplatsentarny transport of ions of Ca 2+ or with effect of parathormone on reserves of ions of Ca 2+ at a fruit. Assume also that maternal parathormone passes through a placenta. Detection hypocalcium of a michesky tetany at the children who were born from mothers with primary hyperparathyreosis caused by adenoma of the Item., confirms the assumption that hyperfunction of the Item. at mothers leads to suppression of function of the Item. at a fruit.
The syndrome of an idiopathic hypoparathyrosis is among rare forms of endocrinopathies, however cases of its development at children's age are quite frequent. Primary gi-ioparatireoz occurs at children in several forms.
The hypoparathyrosis at children of early age has two forms: form of a disease, connected with a floor and transferred retsessivno and sporadic, observed at children of both sexes. Dependent on floor, have the favorable forecast, and sporadic — adverse, to-ry, however, often is result joined heavy inf. diseases or the accompanying serious illness. Find a hypoplasia or an ectopia of the Item in children of this group., hypoplasia or lack of a thymus. Accession inf. diseases to a hypoparathyrosis at such children it is caused by a weak immune response due to the lack of a thymus or its hypoplasia.
Primary hypoparathyrosis, to-ry comes to light after the first year of life, is observed with an identical frequency both at boys, and at girls. Distinguish two a wedge, forms: a hypoparathyrosis in combination with a moniliasis (see Candidiasis) and an addisonovy disease (see) and the isolated primary hypoparathyrosis. The hypoparathyrosis in combination with an addisonovy disease and a superficial moniliasis is a family disease, however also sporadic cases are described. On a wedge, a picture and biochemical, the hypoparathyrosis reminds indicators (a hypocalcemia and hyperphosphatemias) a pseudohypoparathyroidism.
In literature it is described apprx. 50 cases of children of primary hyperparathyreosis, generally it is children aged from 10 up to 16 years (the attitude of number of sick boys towards number of sick girls equally 3:2). As well as at adults, primary hyperparathyreosis at children is connected with adenoma of the Item. Approximately at 20% of sick children the diffusion hyperplasia of the Item was observed. (only at boys aged up to 3 years). There are data testimonial of the hereditary nature of a disease. At family members the disease in most cases began at mature age, however in nek-ry cases the beginning of a disease belonged to early age. The disease is inherited on autosomal dominantly type. Primary hyperplasia of the main paratirotsit and multiple adenomas of the Item is described. There is no accurate classification of a disease, to differentiate multiple adenomas with a hyperplasia too difficult. Existence of adenomas and giperplaziya in other bodies (adrenal glands, a thyroid gland, a hypophysis, a pancreas) allows to assume that the hereditary hyperparathyreosis is only a part of the syndrome described as «hereditary endocrine adenomatosis».
At children of chest age observe two types of a hyperparathyreosis: the hyperparathyreosis caused by a hyperplasia of the Item., i.e. an inborn hyperparathyreosis (secondary in relation to the hypoparathyrosis observed at mother), and the hyperparathyreosis caused by a hereditary hyperplasia of the Item. Forecast adverse. Usually children die on 7 — the 8th days after the birth. On opening find the expressed hyperplasia of the Item. At the survived children the expressed changes of bones come to light.
Cases of a hereditary hyperplasia of the Item. is described a little. The family nature of a disease is established in all cases. Distribution of patients on a floor was identical. Hereditary hyperplasia of the Item. demands surgical intervention at early children's age. At uncured children the disease quickly progresses and death comes in the first 2 — 7 months of life. The best effect is noted at a total parathyroidectomy. In the subsequent children develop normally on condition of continuous replacement therapy by parathormone.
Anomaly of development of the Item. change of their quantity and situation is. Total absence (aplasia) of the Item. meets extremely seldom, usually in combination with malformations of thyroid and thymic glands and other bodies. Additional Items. are found in fabric of thyroid and thymic glands, and also in cellulose of a front mediastinum.
Disturbances of blood circulation in the Item. have an appearance of the angioneurotic hyperemia observed at defeat of nodes of a sympathetic nervous system, and the collateral hyperemia observed at difficulty of a blood-groove as a result of development of a tumor of the Item., and also hemorrhages, to-rye can be extensive and melkoochagovy, and plasmorrhagias. The birth trauma, an idiopathic hypertensia, system vasculites, inf can be the reasons of hemorrhages. diseases (typhus, sepsis), diseases of blood (leukosis, anemias). Plasmorrhagias develop at disturbance of permeability of walls of vessels of a microcirculator bed. At the same time microscopically note flattening of an endothelium or its hyper-vesiculation, swelled, fibrinoid swelling, a fibrinoid necrosis of a vascular wall.
Among dystrophies there is an Item. distinguish several forms. To parenchymatous proteinaceous dystrophies of the Item. carry granular and gidropichesky dystrophies (see. Proteinaceous dystrophy, Vacuolar dystrophy), to-rye result from disturbances of the metabolic processes happening in cytoplasm of the main and acidophilic paratirotsit. At granular dystrophy of the Item. microscopically observe swelling of mitochondrions, expansion of tanks of a cytoplasmic reticulum, in to-rykh protein accumulates; at gidropichesky dystrophy in cytoplasm, is more rare in a kernel, there are vacuoles filled with cytosol.
Mesenchymal mucous dystrophy of the Item. happens at a hypothyroidism, a cachexia of any genesis. It is shown by swelling of collagenic fibers and transformation of stromal cells to star-shaped cells (see. Mucous dystrophy).
Mineral dystrophies in the form of calcification (see) are characterized by adjournment of calcium in II. in the form of the smallest grains, is more rare than macrolitas. As a matrix for these deposits serve mitochondrions and lysosomes of epithelial cells, collagenic fibers of a stroma. The hypercalcemia resulting from hyperproduction of parathormone, a lack of a calcitonin, the strengthened exit of calcium from depot, reduction of release of calcium from an organism is the reason of calcification.
Amyloidosis of the Item. — usually manifestation of a generalized amyloidosis (see). Adjournment of amyloid is observed in a stroma, walls of veins and capillaries of the Item. (fig. 3).
Lipidosis of the Item. note at the general obesity, Itsenko's disease — Cushing, etc. Histologically it is shown by substitution of epithelial cells of the Item. lipoblasts (see Lipidoses).
The disturbance of exchange of iron observed at a hemosiderosis (see) and hemochromatosis (see), it is expressed by adjournment of salts of iron in the Item. on the course of collagenic fibers and in a tsi-topl*azma of stromal cells.
Inflammatory diseases of the Item. meet seldom. Isolated cases of an acute purulent inflammation of a stroma of the Item are described. at the septicopyemia caused by staphylococcus or a pyocyanic stick. At tuberculosis in the Item. epithelioid and cellular, lymphoid, giant-cell granulomas and granulomas of the mixed type can come to light; at syphilis — limfoepitelio-idny granulomas with a large number of vessels and the phenomena of a vasculitis.
Atrophy of the Item. is followed by reduction of quantity and the sizes main (dense and brilliant) acidophilic paratirotsit and K-cells and it is observed at debilitating diseases, a diabetes mellitus, a diffusion toxic craw, an adrenal struma, a pellagra, at people of senile age.
Cysts of the Item. arise as a result of the former hemorrhages or as a result of a malformation. Cysts are various by the sizes, are often covered by an epithelium (cubic or cylindrical). The wall of cysts usually consists of fibrous connecting fabric and cells of the Item.
Adenomas of the Item. usually happen very small sizes (from 0,2 to 8 — 10 mm in the diameter), their consistence can be so soft that they are found visually easier (at operation), than palpatorno. Color of adenoma Oran-zhevo-brown. ormonalno-ak-tivnye adenomas most often cause an atrophy or reduction in sizes separate G1.
Giperplazirovanny Items. are characterized by uniformity of cellular structure. The hyperplasia arises at the disturbances of calcic exchange observed at hron, diseases, malformations of kidneys, a contracted kidney at an idiopathic hypertensia, pathology of a front share of a hypophysis. The hyperplasia usually takes all Items. also can be the cause of a hyperparathyreosis that allows to differentiate a hyperplasia of the Item. with a malignant tumor of the Item., edges meets extremely seldom and at a cut one Item is surprised usually. Histologically in giperpla-zirovanny Items. note dominance of brilliant main paratirotsit over the main dense and acidophilic paratirotsita. Snowballing of elements of a granular cytoplasmic reticulum, a lamellar complex, prosekre-even granules in cytoplasm is peculiar to microscopically brilliant main paratirotsita. The difficult lipidic little bodies consisting of 12 — 14 lipidic granules, numerous granules of a glycogen come to light. In a karyolemma observe large nuclear pores. Acidophilic paratirotsita are characterized by polymorphism of numerous mitochondrions; K-cells are single, in cytoplasm argyrophil granularity is expressed. Hyperplasia of the Item. the considerable sizes it is possible to take for a tumor. Differential diagnosis is carried out on the basis gistol, structures.
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A. P. Popov; L. F. Marchenko (ped.), V. A. Odinokova (stalemate. An.), V. I. Puzik (An., gist., embr.).