Flow cytometric DNA analysis of parathyroid glands. Relationship between nuclear DNA and pathologic classifications

Nuclear DNA contents of 95 paraffin-embedded parathyroid glands (2 carcinomas, 56 adenomas, 10 primary and 17 secondary chief cell hyperplasias, and 10 normal glands) were determined by flow cytometric analysis. All normal parathyroid glands and secondary hyperplasias, 80% of the primary hyperplasias, and 73% of the adenomas had diploid DNA patterns, with 15% or less tetraploid cells. Twenty-one percent of the adenomas, 29% of the primary hyperplasias, and all carcinomas had diploid and tetraploid DNA distribution patterns, with greater than 15% of the cells in the tetraploid region. One of the carcinomas (Figure 4B, Case 2) had an additional near-triploid aneuploid peak. Three of the adenomas (5.4%) had near-triploid aneuploid patterns. One of the patients with carcinoma (Figure 4A, Case 1) died, 32 months after initial diagnosis, of disease-related causes. The remaining patient with carcinoma (Case 2) had a 47-month disease-free interval. All of the patients with hyperplastic and adenomatous glands are free of disease, after a mean follow-up interval of 25 months. This study indicated that flow cytometric analysis of nuclear DNA content does not complement conventional pathologic methods in distinguishing between parathyroid gland chief cell hyperplasia, adenoma, or carcinoma; however, it did suggest the possibility that parathyroid adenomas and primary chief cell hyperplasias may contain a subset of tumors that could manifest biologic malignancy if allowed to progress untreated.