Truran Peter P, Johnson Sarah J, Bliss Richard D, Lennard Thomas W J, Aspinall Sebastian R
Newcastle Upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK,
World J Surg. 2014 Nov;38(11):2845-54. doi: 10.1007/s00268-014-2700-2.
Parathyroid cancer is rare. Differentiating parathyroid carcinoma from degenerative changes at histopathology can be difficult and studies investigating the value of single immunohistochemical markers have had variable results. In this study we aimed to investigate whether a panel of immunohistochemistry markers could aid the diagnosis of parathyroid cancer.
All cases of parathyroid cancer at our institution from 1998 to 2012 were identified retrospectively. Cases were classified as definite cancers (those with evidence of metastatic spread) or histological cancers (those with features of carcinoma without evidence of metastasis). Controls with benign parathyroid disease were included for comparison. Immunohistochemistry for parafibromin, galectin-3, PGP9.5, Ki67, and cyclin D1 was analysed by an experienced endocrine pathologist.
There were 24 cases and 14 benign adenomas. Four cases had evidence of metastatic spread and 20 were diagnosed on histological criteria alone. Sixteen of the 24 cases had further surgery with ipsilateral thyroid lobectomy and 15 also had a prophylactic level VI lymph node dissection. Apart from one patient with distant metastases at presentation, none developed recurrence at follow-up (median = 38 months). Immunohistochemistry results associated with parathyroid cancer were seen in 11/24 parafibromin, 13/24 galectin-3, 8/24 PGP9.5, 5/24 Ki67, and 2/24 cyclin D1. None of the controls had immunohistochemical staining suggestive of cancer. Nineteen of the 24 patients had at least one immunohistochemical result associated with parathyroid cancer (sensitivity 79 %, specificity 100 %). Cyclin D1 did not suggest malignancy in any case that did not already have another abnormal marker, and so did not add value to the panel in this study.
A panel of immunohistochemistry (PGP9.5, galectin-3, parafibromin, and Ki67) is better than any single marker and can be used to supplement classical histopathology in diagnosing parathyroid cancer.
甲状旁腺癌很罕见。在组织病理学上区分甲状旁腺癌与退行性变可能很困难，并且研究单一免疫组化标志物价值的研究结果各异。在本研究中，我们旨在探讨一组免疫组化标志物是否有助于甲状旁腺癌的诊断。
回顾性识别1998年至2012年我们机构的所有甲状旁腺癌病例。病例分为确诊癌症（有转移扩散证据者）或组织学癌症（有癌特征但无转移证据者）。纳入良性甲状旁腺疾病对照进行比较。由一位经验丰富的内分泌病理学家分析副纤维蛋白、半乳糖凝集素-3、PGP9.5、Ki67和细胞周期蛋白D1的免疫组化情况。
有24例病例和14例良性腺瘤。4例有转移扩散证据，20例仅根据组织学标准诊断。24例中的16例接受了进一步手术，包括同侧甲状腺叶切除术，15例还进行了预防性VI区淋巴结清扫。除1例初诊时有远处转移的患者外，随访期间（中位时间 = 38个月）无患者复发。24例中有11例副纤维蛋白、13例半乳糖凝集素-3、8例PGP9.5、5例Ki67和2例细胞周期蛋白D1的免疫组化结果与甲状旁腺癌相关。对照中无免疫组化染色提示癌症者。24例患者中有19例至少有一项与甲状旁腺癌相关的免疫组化结果（敏感性79%，特异性100%）。在任何没有其他异常标志物已有病例中，细胞周期蛋白D1均未提示恶性，因此在本研究中该标志物对这一组标志物无额外价值。
一组免疫组化（PGP9.5、半乳糖凝集素-3、副纤维蛋白和Ki67）优于任何单一标志物，可用于辅助经典组织病理学诊断甲状旁腺癌。
