Flow cytometric DNA analysis of parathyroid benign lesions
Abstract
Introduction: It is difficult to differentiate benign and malignant lesions just by histopathological evaluation due to lack of clear criteria of diagnosis. Moreover, the group of benign pathologies of parathyroids is not homogenous, and recurrence of symptoms of hyperparathyroidism after surgical management was also noted in this group. This complication is not always due to inappropriate surgical technique. The goal of this work was to find the relationship between cellular ploidy and proliferative activity of adenomas and hyperplasia of parathyroids and preoperative levels of calcium and parathormone in the serum of patients surgically treated for primary hyperparathyroidism.
Material and methods: A total of 98 parathyroid glands were tested, of which 81 (82.7%) were from female patients and 17 (17.3%) from male; the age of the patients was from 22 to 82 years, with an average of 58 years.
Results: In resected glands pathological evaluation showed the following results: in 53 (54.1%) adenoma was present, and in 45 (45.9%) there was hyperplasia. Sixty-seven of the samples (68.4%) were characterised as diploid and 31 (31.6%) as aneuploid. There is important positive correlation (r = 0.34595; p = 0.011) between the percentage of S-phase cells (% SPF) and calcium levels measured prior to surgical resection of adenoma. The further analysis of patients with adenoma characterised by aneuploidy proved a statistically valid, positive correlation between %SPF and ionised calcium levels in blood serum of patients both before (r = 0.7189; p = 0.003) and after the surgical treatment (r = 0.6313; p = 0.012).
Conclusions: 1. Benign lesions of parathyroid with ploidy indicates their heterogeneity. 2. In aneuploid benign adenomas of parathyroid glands an increased percentage of cells in S phase (% SPF) correlates with a high level of calcium in serum pre- and post-parathyroidectomy.
Keywords: parathyroid benign lesionsflow cytometryserum calcium level
References
- Adler JT, Sippel RS, Chen H. New trends in parathyroid surgery. Curr Probl Surg. 2010; 47(12): 958–1017.
- Segiet OA, Deska M, Michalski M, et al. Molecular profiling in primary hyperparathyroidism. Head Neck. 2015; 37(2): 299–307.
- DeLellis R. Parathyroid tumors and related disorders. Modern Pathol. 2011; 24(S2): S78–S93.
- Duan K, Mete O. Parathyroid carcinoma: diagnosis and clinical implications. Turk Patoloji Derg . 2015; 31(Suppl 1): 80–97.
- Medas F, Erdas E, Loi G, et al. Controversies in the management of parathyroid carcinoma: A case series and review of the literature. Int J Surg. 2016; 28: S94–S98.
- Shankey TV, Rabinovitch PS, Bagwell B, et al. Guidelines for implementation of clinical DNA cytometry. International Society for Analytical Cytology. Cytometry. 1993; 14(5): 472–477.
- Kowalski GJ, Buła G, Żądło D, et al. Primary hyperparathyroidism. Endokrynol Pol. 2020; 71(3): 260–270.
- Buła G, Kowalski G, Koziołek H. Surgical treatment of patients with primary hyperparathyroidism with a risk of hypercalcaemic crisis. Endokrynol Pol. 2020; 71(5).
- Levin KE, Chew KL, Ljung BM, et al. Deoxyribonucleic acid cytometry helps identify parathyroid carcinomas. J Clin Endocrinol Metab. 1988; 67(4): 779–784.
- Bowly LS, DeBault LE, Abraham SR. Flow cytometric DNA analysis of parathyroid glands: Relationship between nuclar DNA and pathologic classifications. Am J Pathol. 1987; 128(2): 338–344.
- Gawrychowski J, Tyczyński A, Danik A, et al. Wartość ploidii komórkowej w ocenie odległych wyników operacyjnego leczenia chorych z powodu gruczolakoraków żołądka. Pol Prz Chir. 2007; 79: 1364–1378.
- Fujimoto Y, Obara T. How to Recognize and Treat Parathyroid Carcinoma. Surg Clin North Am . 1987; 67(2): 343–357.
- Obara T, Fujimoto Y, Hirayama A, et al. Flow cytometric DNA analysis of parathyroid tumors with special reference to its diagnostic and prognostic value in parathyroid carcinoma. Cancer. 1990; 65(8): 1789–1793, doi: 10.1002/1097-0142(19900415)65:8<1789::aid-cncr2820650820>3.0.co;2-n.
- Buła G, Truchanowski W, Koziołek H. A follow-up study of patients with MEN syndromes — five case reports. Endokrynol Pol . 2018; 69(2): 163–167.
- Obara T, Fujimoto Y, Kanaji Y, et al. Flow cytometric DNA analysis of parathyroid tumors. Implication of aneuploidy for pathologic and biologic classification. Cancer. 1990; 66(7): 1555–1562, doi: 10.1002/1097-0142(19901001)66:7<1555::aid-cncr2820660721>3.0.co;2-s.
- Howard S, Anderson C, Diels W, et al. Nuclear DNA density of parathyroid lesions. Pathol Res Pract. 1992; 188(4-5): 497–499.
- Mangili F, Sassi I, Schiaffino E, et al. [The use of flow cytometry in the study of parathyroid hyperplasia and adenomas]. Pathologica. 1992; 84: 459–465.
- Takada M. he relationship between morphology and cell activy in hyperparathyreodism. Nippon Hinyokika Gakkai Zasshi. 1992; 83(11): 1774–1780.
- Falkmer UG, Falkmer S. The Value of Cytometric DNA Analysis as a Prognostic Tool in Neuroendocrine Neoplastic Diseases. Pathol Res Pract. 1995; 191(4): 281–303.
- Chryssochoos JT, Weber CJ, Cohen C, et al. DNA index and ploidy distinguish normal human parathyroids from parathyroid adenomas and primary hyperplastic parathyroids. Surgery. 1995; 118(6): 1041–9; discussion 1049.
- Frierson HF. The need for improvement in flow cytometric analysis of ploidy and S-phase fraction. Am J Clin Pathol. 1991; 95(4): 439–441.
- Hedley DW. Flow cytometry using paraffin-embedded tissue: five years on. Cytometry. 1989; 10(3): 229–241.
- Buła G, Niemiec A, Koziołek H, et al. Przyczyny pierwotnej nadczynności przytarczyc — 27 lat leczenia chirurgicznego. Pol PrzChir. 2011; 83(Suppl 1): 30.
- Żebracka-Gala J, Waler J, Gawrychowski J, et al. Obniżona ekspresja genu JUN w gruczolakach przytarczyc. Pol PrzChir. 2009; 81: 845–810.
- Niemiec A, Waler J, Koziołek H, et al. Bezpośrednie wyniki leczenia chirurgicznego pierwotnej nadczynności przytarczyc. Now Lek. 2007; 76(Suppl 1): 43.
