Kim E I, Lavreniuk A A, Urusova L S, Eremkina A K, Elfimova A R, Mokrysheva N G
Endocrinology Research Centre, Moscow, Russia.
Arkh Patol. 2024;86(4):5-12. doi: 10.17116/patol2024860415.
Differential diagnosis of atypical parathyroid tumors (APT) and parathyroid carcinomas (PC) is important in determining further management and prognosis. Morphologic diagnosis is sometimes difficult, in which case it is supplemented by immunohistochemical (IHC) examination.
Studying the role of IHC analysis in the differential diagnosis of APT and PC.
The study included 44 patients with morphologic diagnosis of the APT established after surgical treatment for primary hyperparathyroidism on the basis of Endocrinology Research Centre during 2018-2023. All cases underwent IHC examination with evaluation of CD31/CD34 and parathormone (PTH) expression for identification of vascular invasion, Ki-67, parafibromin.
According to the results of IHC analysis in 8/44 patients (18.2%) the diagnosis of APT was revised in favor of the PC: in 7 of them vascular invasion was detected; in 1 patient the additional series of slices in the surrounding fatty tissue revealed foci of tumor growth, confirmed by positive reaction with antibodies to PTH. According to IHC results, the material was divided into 2 groups: APT and PC. There were no differences in clinical and morphological characteristics, Ki-67% level and parafibromin expression between the groups.
Assessment of clinical and laboratory-instrumental data at the preoperative stage does not allow differentiating APT from PC. In case of APT diagnosis and detection of suspicious morphological features, it is necessary to perform IHC examination to exclude PC.
非典型甲状旁腺肿瘤（APT）和甲状旁腺癌（PC）的鉴别诊断对于确定进一步的治疗和预后至关重要。形态学诊断有时很困难，在这种情况下，需通过免疫组织化学（IHC）检查进行补充。
研究IHC分析在APT和PC鉴别诊断中的作用。
该研究纳入了44例在2018 - 2023年期间于内分泌研究中心接受原发性甲状旁腺功能亢进手术治疗后经形态学诊断为APT的患者。所有病例均进行了IHC检查，评估CD31/CD34和甲状旁腺激素（PTH）表达以确定血管侵犯情况，检测Ki-67、副纤维蛋白。
根据IHC分析结果，44例患者中有8例（18.2%）的APT诊断被修正为PC：其中7例检测到血管侵犯；1例患者在周围脂肪组织的额外切片系列中发现肿瘤生长灶，经PTH抗体阳性反应证实。根据IHC结果，将材料分为两组：APT和PC。两组在临床和形态学特征、Ki-67%水平及副纤维蛋白表达方面均无差异。
术前阶段评估临床和实验室仪器数据无法区分APT和PC。在诊断为APT且发现可疑形态学特征时，有必要进行IHC检查以排除PC。
