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

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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