Suzuki S, Ando Y, Ami H, Furukawa H, Tsuchiya A, Abe R
Dept. of Surgery II, Fukushima Medical College.
Gan To Kagaku Ryoho. 1998 Apr;25 Suppl 3:486-91.
It is not easy to make a differential diagnosis among adenoma, hyperplasia and carcinoma with hyperparathyroidism (HPT). We investigated the flowcytometric nuclear DNA content and analysis of cell cycle for 29 patients (39 parathyroid glands) with HPT and 16 normal parathyroid glands at the Department of Surgery II, Fukushima Medical College. Flowcytometry was performed by EPICS 751 flowcytometer (Coulter Co.) in paraffin-embedded tissue. Each fraction of cell cycle was analyzed by the PARAI software program. All controls and secondary hyperplasia showed diploid. Aneuploid pattern was found in 27.6% of all HPTs (50% of carcinomas, 30% of adenomas and 6.7% of primary hyperplasia). The S phase fraction (SPF) and proliferative index (PI) were increased in carcinomas. PIs, especially the fraction of G2M, in primary and secondary hyperplasias were more decreased than those in normal controls and adenomas. Preoperative intact-PTH, c-PTH, ionized calcium, ALP and weight of parathyroid gland had no significant correlation with DNA ploidy, DNA index and SPF. PI had tended to correlate only with the weight of parathyroid gland. When DNA content shows aneuploid, high SPF or PI in parathyroid adenoma and hyperplasia, strict follow-up is required because of the malignant potential. If G2M or PI is lower, we should pay attention not to leave any remaining glands in parathyroidectomy in the light of hyperplasia.
对伴有甲状旁腺功能亢进（HPT）的腺瘤、增生和癌进行鉴别诊断并非易事。我们在福岛医学院第二外科，对29例患有HPT的患者（39个甲状旁腺）和16个正常甲状旁腺进行了流式细胞术检测核DNA含量及细胞周期分析。采用库尔特公司的EPICS 751流式细胞仪对石蜡包埋组织进行流式细胞术检测。通过PARAI软件程序分析细胞周期的各个部分。所有对照和继发性增生均显示为二倍体。在所有HPT中，27.6%发现非整倍体模式（癌为50%，腺瘤为30%，原发性增生为6.7%）。癌组织中的S期分数（SPF）和增殖指数（PI）升高。原发性和继发性增生中的PI，尤其是G2M分数，比正常对照和腺瘤中的降低得更多。术前完整甲状旁腺激素（iPTH）、C端甲状旁腺激素（c-PTH）、离子钙、碱性磷酸酶（ALP）和甲状旁腺重量与DNA倍体、DNA指数和SPF均无显著相关性。PI仅与甲状旁腺重量有一定相关性。当甲状旁腺腺瘤和增生的DNA含量显示为非整倍体、高SPF或PI时，由于存在恶变潜能，需要进行严格的随访。如果G2M或PI较低，鉴于增生情况，我们在甲状旁腺切除术中应注意不要残留任何腺体。
