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

为了评估甲状旁腺癌诊断病理标准的可靠性，本工作进行了（1）17年内对160例原发性甲状旁腺功能亢进症手术患者的长期随访研究，（2）对确诊的甲状旁腺癌进行电子显微镜检查，（3）对符合癌病理标准的甲状旁腺肿瘤进行流式细胞术DNA分析。(1)Of 160例中，16例出现癌的可能性。其中8例主要根据病理检查核分裂象诊断为癌，随访均未发现复发。结论：核分裂相的出现不是诊断甲状旁腺癌的明确依据，但仍需长期观察。（2）电镜观察2例甲状旁腺癌为嗜酸性细胞型。无可接受的嗜酸性细胞 ...更多信息 甲状旁腺癌的报道。（3）对甲状旁腺癌石蜡包埋标本进行流式细胞术DNA分析。由于本研究中检查的所有原发性肿瘤均显示整倍体DNA值，因此核DNA测量在评价恶性生物学行为方面没有用处。但2例复发患者肿瘤中四倍体细胞异常增多，并进一步复发。因此，DNA超倍体可反映复发或转移性肿瘤的恶性潜能和扩散能力，对复发性甲状旁腺癌，~（201）铊扫描是检测局部复发和区域淋巴结转移的最有效方法。胸部X线和计算机断层扫描有助于描绘肺转移灶。如果复发的甲状旁腺癌是局部的，积极的手术治疗是合理的。当手术不能控制高钙血症时，建议用达卡巴嗪化疗。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