The histologic distinction between benign and malignant parathyroid tumors is difficult to make. Although cell type is not known to be of prognostic significance, histologic cell types include chief cell, transitional clear cell, and mixed cell types. Standard criteria of malignancy often cannot be confirmed in retrospective reviews of patients with carcinoma. Macroscopic and microscopic infiltrations often do not correlate, and adhesion to surrounding structures does not necessarily imply malignancy. Features such as dense fibrous trabeculae, trabecular growth patterns, mitoses, and capsular invasions, which have been classically associated with carcinomas, have also been found in parathyroid adenomas.[2,3,4] Capsular and vascular invasion appears to correlate best with tumor recurrence.[3,5] In a study of 286 patients, pathologists described well-differentiated carcinomas in approximately 80% of the patients.
An aneuploid DNA pattern is more common, and mean nuclear DNA content is greater in carcinomas than in adenomas; when present in a carcinoma, aneuploidy appears to be associated with a poorer prognosis.[7,8,9] Aneuploidy occurs too frequently in parathyroid adenomas to be significant in differentiating benign from malignant parathyroid lesions.[9,10,11] In general, the clinical course and the gross pathology observed at surgery are as important as the histology to define a lesion as a parathyroid carcinoma.
The level of evidence required for informed decision making about genetic testing depends on the circumstances of testing. Evidence from a sample of high-risk families may be sufficient to provide useful information for testing decisions among people with similar family histories but is likely to be insufficient to make early recommendations for, or decisions about, testing in families with less dramatic histories or in the general population. Even among people with similar family histories, however,...
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Hundahl SA, Fleming ID, Fremgen AM, et al.: Two hundred eighty-six cases of parathyroid carcinoma treated in the U.S. between 1985-1995: a National Cancer Data Base Report. The American College of Surgeons Commission on Cancer and the American Cancer Society. Cancer 86 (3): 538-44, 1999.
Obara T, Fujimoto Y: Diagnosis and treatment of patients with parathyroid carcinoma: an update and review. World J Surg 15 (6): 738-44, 1991 Nov-Dec.
Sandelin K, Auer G, Bondeson L, et al.: Prognostic factors in parathyroid cancer: a review of 95 cases. World J Surg 16 (4): 724-31, 1992 Jul-Aug.
Mallette LE: DNA quantitation in the study of parathyroid lesions. A review. Am J Clin Pathol 98 (3): 305-11, 1992.
Obara T, Okamoto T, Kanbe M, et al.: Functioning parathyroid carcinoma: clinicopathologic features and rational treatment. Semin Surg Oncol 13 (2): 134-41, 1997 Mar-Apr.
Fraker DL: Parathyroid Tumors. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds.: Cancer: Principles and Practice of Oncology. 7th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2005, pp 1521-27.