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Histopathological variables and DNA cytometry in parathyroid carcinoma
L Bondeson1, K Sandelin, L Grimelius
1Department of Cytology, Malmö General Hospital, Sweden.
The American Journal of Surgical Pathology
|August 1, 1993
Summary
Histopathological variables like necrosis and nuclear atypia help diagnose parathyroid carcinoma. Certain features, including macronucleoli and high mitotic rates, indicate aggressive tumor behavior and recurrence.
Area of Science:
- Endocrinology
- Oncology
- Pathology
Background:
- Parathyroid carcinoma is a rare endocrine malignancy.
- Accurate histopathological diagnosis is crucial for patient management.
Purpose of the Study:
- To evaluate histopathological variables for diagnosing parathyroid carcinoma.
- To identify features associated with aggressive tumor behavior.
Main Methods:
- Retrospective review of 95 parathyroid carcinoma cases from 37 hospitals.
- Classification into definitive carcinoma (56 cases) and equivocal (39 cases) based on invasiveness or recurrence.
- Analysis of morphological variables including fibrosis, necrosis, nuclear atypia, and mitotic figures.
- Correlation with DNA ploidy patterns using image cytometry.
Main Results:
- Definitive carcinomas showed significantly higher frequencies of fibrosis, necrosis, nuclear atypia (especially macronucleoli), and mitotic figures compared to equivocal cases.
- These variables correlated positively with aberrant DNA patterns.
- The triad of macronucleoli, >5 mitoses/50 HPF, and necrosis predicted aggressive behavior and recurrence.
- Some carcinomas exhibited bland cytology, differing from benign lesions only by invasiveness.
- Mitotic activity was a prognostic factor but had limited diagnostic value, with half of carcinomas showing mitotic frequencies similar to benign lesions.
Conclusions:
- Histopathological features beyond invasiveness are critical for diagnosing parathyroid carcinoma.
- Specific morphological criteria, including macronucleoli, mitotic rate, and necrosis, are associated with aggressive disease.
- Image cytometry can complement morphological assessment.