,572 



OSKAK KLOTZ 



parathyroid tumors. In 1919 Ewing reported a case without any details. 

 Other tumors, have been described by de Paoli, Pepere (a), Claude and 

 Schmiergeld, Makai, Walther, and Bernard Alamartine. 



As is evident from these reported cases, it is not clear that all of 

 them represent masses arising in parathyroids, nor that those which have 

 occurred within the glandules are to be considered in terms of neoplasm 

 as we find it elsewhere. The frequency with which all of the parathyroids 

 are involved in enlargement,, suggests that a functional demand has led to 

 the compensatory hyperplasia. In not a few cases, such hyperplasia, or 



even true tumor, shows 

 an alteration in its in- 

 ternal structure with in- 

 crease of stroma, the 

 development of hyaline 

 bands about the vessels, 

 and the presence of col- 

 loid within, the acini, 

 making them resemble 



thyroid origin. Depend- 



wfc - %|fcfc ^-illft ?: f $v ^m^SSf * n ' upon the extent of 



WlL - : ^^ *//'' ^ '^W^BPSj&jSp these microscopic alter- 



V^fc; CnUfliBH^NG^L ** ations, we find increas- 



ing difficulty in estab- 

 1 i s h i n g satisfactory 

 differentiation, particu- 

 larly when the aberrant 

 nodule lies within, or is 

 closely attached to the 

 thyroid. The tumor de- 

 scribed by Benjamins and some of those of Langhans and Kocher are given 

 as examples of malignant parathyroid tumors. 



Cysts. Cysts of the parathyroids are not uncommon, and at times 

 are of such size as to lead to an enlargement of the gland to make it re- 

 semble tumor. The tissue surrounding the cyst may be compressed and 

 have evidence of an increase in the stroma. Inflammation is usually want- 

 ing and seems to bear no relation to their occurrence. All gradations of 

 cystic change are to be found and a study of the parathyroids of individ- 

 uals from the age of twenty reveals the fact that these lesions are of very 

 common occurrence. Many of them are of microscopic size, and illustrate 

 small acini with well developed lumina containing colloid (Fig. 3). One 

 or more of these may enlarge, to crowd out the neighboring parenchyma 

 and fuse with contiguous cavities. Some authors speak of this as a type 

 of cystic degeneration, and emphasize the presence of fatty change and 



Fig. 3. Cysts of parathyroid. 



