Parathyroid carcinoma:Criteria for the diagnosis and appropriate therapy of recurrence.

为评价甲状旁腺癌病理诊断标准的可靠性，本工作对160例原发性甲状旁腺功能亢进症患者进行了17年的长期随访研究，(2)明确的甲状旁腺癌进行了电子显微镜检查，(3)对符合病理诊断标准的甲状旁腺肿瘤进行了流式细胞仪DNA分析。其中8例主要根据病理检查有丝分裂像诊断为癌，但随访时均未发现复发。结论：有丝分裂的存在不是甲状旁腺癌诊断的确切依据，但仍需更长时间的观察。(2)2例明确的甲状旁腺癌为嗜氧细胞型。没有可接受的嗜氧性细胞…有更多甲状旁腺癌的报道。(3)采用石蜡包埋的甲状旁腺癌档案标本进行流式细胞术DNA分析。由于本研究检查的所有原发肿瘤均显示整倍体DNA值，因此核DNA测量不能用于恶性生物学行为的评估。然而，在2例复发的患者中，四倍体细胞异常增加，这些患者中发生了进一步的复发。因此，在复发或转移的肿瘤中，DNA超倍体可能显示其恶性潜能和扩散能力。对于复发的甲状旁腺癌，铊-201扫描是发现局部复发和区域淋巴结转移的最有用的方法。胸部X线片和CT扫描有助于显示肺转移灶。如果复发的甲状旁腺癌是局部性的，那么这些肿瘤的积极手术治疗是合理的。当手术无法控制高钙血症时，建议使用达卡巴肼进行化疗。较少

In an attempt to assess the reliability of pathological criteria for the diagnosis of parathyroid carcinoma, this work underwent (1)long term follow-up study of 160 patient undergoing surgery for primary hyperparathyroidism during a 17-year period, (2)electron microscopic examination of definite parathyroid carcinoma and (3)flow cytometric DNA analysis of parathyroid tumors that met the pathological criteria for carcinoma.(1)Of the 160 cases, 16 cases emerged wherein a possibility of carcinoma existed. Eight of those were diagnosed as carcinoma mainly based on the presence of the mitotic figures on pathological examination, but recurrence was not found in any of these cases on follow-up study. It was concluded that the presence of mitoses was not a definite evidence in making diagnosis of parathyroid carcinoma, althogh longer observation was needed. (2)Electron microscopic study revealed that 2 of our unequivocal parathyroid carcinoma were oxyphil cell type. No acceptable oxyphil cell … More carcinoma of the parathyroid had reported. (3)Flow cytometric DNA analysis using paraffin embedded archival specimen of parathyroid carcinoma was carried out. Since all the primary tumors examined in this study displayed euploid DNA values, the nuclear DNA measurement was not useful in the evaluation of malignant biologic behavior. However, the unusual increase in tetraploid cells in recurrent tumors of 2 patients in whom further recurrent episodes occured. Thus, DNA hyperploidy in recurrent or metastatic tumors might show their malignant potential and ability to spread.In case of recurrent parathyroid carcinoma thallium-201 scan was the most useful method for detecting the local recurrence and the regional lymph nodes metastases. Chest x rays and computed tomographic scan were useful for delineating the metastatic pulmonary lesions. If the recurrent parathyroid carcinoma was localized, aggressive surgical treatment for those tumors was justified. When surgery failed to control hypercalcemia, chemotherapy with dacarbazine was advised. Less