Flow-cytometric DNA analysis for pathological diagnosis of parathyroid carcinoma.

我们对49例原发性甲状旁腺功能亢进患者的68个石蜡包埋的甲状旁腺瘤进行了流式细胞DNA分析（15例癌症-13例原发，11例局部复发或转移性病变；30例腺瘤；5例增生-15个腺体）。在27%的癌症、10%的腺瘤和0%的增生病例中发现了明确的非整倍体。所有4例非整倍体癌患者均表现出局部复发或/和远处转移，需要重新检查，其中1例死于该病。11例非异倍体癌中，7例术后2 ~ 5年无复发，4例复发。然而，在后者中，2例患者在再手术后3年和6年仍维持正常钙血症，另外2例患者仍维持轻度高钙血症。因此，本研究表明，非整倍体甲状旁腺癌可能比非整倍体癌表现出更多的恶性行为，尽管石蜡材料中的非整倍体与甲状旁腺肿瘤的良性组织学诊断并不矛盾。对63例原发性甲状旁腺功能亢进手术患者进行了新鲜甲状旁腺肿瘤的DNA分析。其中3例为甲状旁腺癌转移灶。其余49例原发病变包括4例组织学癌，41例腺瘤，4例增生（MEN 1型）。100%的转移性癌、75%的组织学癌、8%的腺瘤和50%的增生病例均存在非整倍体。因此甲状旁腺癌比腺瘤更易呈非整倍体。结论：在非家族性原发性甲状旁腺功能亢进症患者中，新鲜材料甲状旁腺肿瘤的流式细胞DNA分析必须是一种有价值的辅助肿瘤病理诊断。

Flow cytometric DNA analysis was performed on 68 paraffin-embedded parathyroid tumors from 49 patients with primary hyperparathyroidism (15 cancers-13 primary and 11 locally recurrent or metastatic lesions; 30 adenomas; and 5 hyperplasia-15 glands). Unequivocal evidence of aneuploidy was found in 27% of cancer, 10% of adenoma, and 0% of hyperplasia cases. All 4 patients with aneuploid carcinoma have shown local recurrence or/and distant metastases and have required reexplorations, one of whom died of the disease. Of the 11 patients with non-aneu-ploid carcinoma, 7 patients have no recurrence 2 to 5 years after the initial operation, and 4 showed recurrence. Of the latter, however, 2 are living with normocalcemia 3 and 6 years after reoperation and 2 other are alive with mild hypercalcemia. Thus this study indicates that aneuploid parathroid carcinoma are likely to show more malignant behavior than non-aneuploid ones, although aneuploidy in paraffin materials is not incompatible with a benign histologic diagnosis of parathyroid tumors.Sixty-three patients operated on for primary hyperparathyroidism had DNA analysis from the excised fresh parathyroid tumors. Three of the tumors were metastatic lesions of parathyroid carcinoma. The remaining 49 primary lesions included 4 histologic carcinoma, 41 adenoma, and 4 hyperplasia (MEN type 1). Unequivocal evidence of aneuploidy was found in 100% of metastatic carcinoma, 75% of histologic carcinoma, and 8% of adenoma, and 50% of hyperplasia cases. Thus parathyroid carcinomas are apt to be aneuploid than adenomas. It is concluded that in patients with nonfamilial primary hyperparthyroidism, flow cytometric DNA analysis of parathyroid tumors from fresh meterials must be a valuable adjunct to the pathological diagnosis of carcinoma.