Clinicopathologic features of patients with primary hyperparathyroidism : an analysis of 84 cases

ZHANG Dong-xue; JIANG Tao; FU Yue-yue; YAN Feng-cai

doi:10.3969/j.issn.1007-8096.2017.07.001

Abstract：Objective To summarize the clinicopathologic features of patients with primary hyperparathyroidism (PHPT).Methods 84 cases of PHPT in our institution from 2010 to 2014 were reevaluated retrospectively.54 patients (64.29％) had been diagnosed as parathyroid adenoma (PA) pathologically,17 patients (20.24％) as hyperplasia (PH),and 13 (4％) cases as cancer (PC).Results There was no significant difference in age at diagnosis and gender among patients with different pathology types,while the elevated level of Ca and PTH had been observed in cases with carcinoma (P ＜ 0.05).Parathyroid adenoma and carcinoma were often found in single-gland (n =46 85.19％ vs n =9 69.2％,P ＞ 0.05).However,multiple glands diseases were almost observed in the ones with hyperplasia (n =3,17.6％,P ＜ 0.05).There was no significant difference in size of tumor among patients with adenoma,carcinoma and hyperplasia (2.12 ±1.48cm,2.26 ± 1.38cm vs 1.99 ± 1.11cm,P ＞0.05).Most masses of PA had intact fibrous capsule,and mitotic figures were not encountered.On the other hand,foci of capsular invasion and vascular permeation and mitotic figures were identified in PC.PTH and p53 expression in PC was almost the same as in PA and PH (P ＞0.05).The Ki-67 proliferative index was higher than 5％ in 6 (30.77％) carcinomas,7 (9.26％) adenomas,and none of the hyperplasia (P ＜ 0.05).Ki-67 ＞ 5％ was shown to be a useful marker for distinguishing PCs from other diseases,as the sensitivity and specificity were 46.15％ and 90.14％,respectively.More PC specimens demonstrated complete loss of Syn and CgA staining than PA and PH (P ＜ 0.05).Conclusions These data suggests that elevated level of Ca and PTH,overexpression of Ki-67 ＞ 5％ and underexpression of Syn and CgA may help to distinguish parathyroid carcinoma from other tumors.