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Silva-Figueroa AM, Bassett R, Christakis I, Moreno P, Clarke CN, Busaidy NL, Grubbs EG, Lee JE, Perrier ND, Williams MD. Using a Novel Diagnostic Nomogram to Differentiate Malignant from Benign Parathyroid Neoplasms. Endocr Pathol 2019; 30:285-296. [PMID: 31734935 DOI: 10.1007/s12022-019-09592-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We sought to develop an immunohistochemical (IHC) tool to support the diagnosis of parathyroid carcinoma (PC) and help differentiate it from atypical parathyroid neoplasms (atypical) and benign adenomas. Distinguishing PC from benign parathyroid neoplasms can be challenging. Many cases of PC are histopathologically borderline for definitive malignancy. Recently, individual IHC biomarkers have been evaluated to aid in discrimination between parathyroid neoplasms. PC, atypical parathyroid neoplasms, and parathyroid adenomas treated at our institution from 1997 to 2014 were studied retrospectively. IHC analysis was performed to evaluate parafibromin, retinoblastoma (RB), protein gene product 9.5 (PGP9.5), Ki67, galectin-3, and E-cadherin expression. Receiver operating characteristic (ROC) analysis and multivariable logistic regression model for combinations of biomarkers were evaluated to classify patients as PC or atypical/adenoma. A diagnostic nomogram using 5 biomarkers was created for PC. Sixty-three patients were evaluated. The percent staining of parafibromin (p < 0.0001), RB (p = 0.04), Ki67 (p = 0.02), PGP9.5 (p = 0.04), and Galectin-3 (p = 0.01) differed significantly in the three diagnostic groups. ROC analysis demonstrated that parafibromin had the best performance in discriminating PC from atypical/adenoma; area under the curve (AUC) was 81% (cutoff, 92.5%; sensitivity rate, 64%; specificity rate, 87%). We created a diagnostic nomogram using a combination of biomarkers; AUC was 84.9% (95% confidence interval, 73.4-96.4%). The optimism-adjusted AUC for this model was 80.5% (mean absolute error, 0.043). A diagnostic nomogram utilizing an immunoexpression, a combination of immunohistochemical biomarkers, can be used to help differentiate PC from other parathyroid neoplasms, thus potentially improving diagnostic classification.
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Affiliation(s)
- Angelica M Silva-Figueroa
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Unit 1484, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
- Division of Surgery, Universidad Finis Terrae, Santiago, Chile
| | - Roland Bassett
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ioannis Christakis
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Unit 1484, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Pablo Moreno
- Division of Endocrine Surgery, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Callisia N Clarke
- Division of Surgical Oncology, Medical College Wisconsin, Milwaukee, WI, USA
| | - Naifa L Busaidy
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elizabeth G Grubbs
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Unit 1484, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Jeffrey E Lee
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Unit 1484, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Nancy D Perrier
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Unit 1484, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
| | - Michelle D Williams
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Unit 85, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
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Abstract
Pathologists are usually readily able to diagnose parathyroid tissues and diseases, particularly when they have knowledge of the clinical information, laboratory findings, and radiographic imaging studies. However, the identification of parathyroid tissue or lesions can be difficult in small biopsies, ectopic locations, supranumerary glands, and in some oxyphil/oncocytic lesions. Widely available immunohistochemical studies such as chromogranin-A, synaptophysin, keratin, parathyroid hormone, thyroglobulin, and thyroid transcription factor-1 can help in difficult cases. One of the most difficult diagnostic aspects faced by the pathologist in evaluating parathyroid is distinguishing between parathyroid adenoma, particularly atypical adenoma, and parathyroid carcinoma. Many markers have and continue to be evaluated for diagnostic utility, and are even beginning to be studied for prognostic utility. Single immunohistochemical markers such as parafibromin and Ki-67 are among the most studied and most utilized, but many additional markers have and continue to be evaluated such as galectin-3, PGP9.5, Rb, bcl2, p27, hTERT, mdm2, and APC. Although not widely available in many laboratories, a panel of immunohistochemical markers may prove most useful as an adjunct in the evaluation of challenging parathyroid tumors.
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Affiliation(s)
- Lori A Erickson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Ozgur Mete
- Department of Pathology, Laboratory Medicine Program, University Health System, Toronto, Canada
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Sciacchitano S, Lavra L, Morgante A, Ulivieri A, Magi F, De Francesco GP, Bellotti C, Salehi LB, Ricci A. Galectin-3: One Molecule for an Alphabet of Diseases, from A to Z. Int J Mol Sci 2018; 19:ijms19020379. [PMID: 29373564 PMCID: PMC5855601 DOI: 10.3390/ijms19020379] [Citation(s) in RCA: 213] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 01/18/2018] [Accepted: 01/22/2018] [Indexed: 02/07/2023] Open
Abstract
Galectin-3 (Gal-3) regulates basic cellular functions such as cell-cell and cell-matrix interactions, growth, proliferation, differentiation, and inflammation. It is not surprising, therefore, that this protein is involved in the pathogenesis of many relevant human diseases, including cancer, fibrosis, chronic inflammation and scarring affecting many different tissues. The papers published in the literature have progressively increased in number during the last decades, testifying the great interest given to this protein by numerous researchers involved in many different clinical contexts. Considering the crucial role exerted by Gal-3 in many different clinical conditions, Gal-3 is emerging as a new diagnostic, prognostic biomarker and as a new promising therapeutic target. The current review aims to extensively examine the studies published so far on the role of Gal-3 in all the clinical conditions and diseases, listed in alphabetical order, where it was analyzed.
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Affiliation(s)
- Salvatore Sciacchitano
- Department of Clinical and Molecular Medicine, Sapienza University, Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy.
- Laboratory of Biomedical Research, Niccolò Cusano University Foundation, Via Don Carlo Gnocchi 3, 00166 Rome, Italy.
| | - Luca Lavra
- Laboratory of Biomedical Research, Niccolò Cusano University Foundation, Via Don Carlo Gnocchi 3, 00166 Rome, Italy.
| | - Alessandra Morgante
- Laboratory of Biomedical Research, Niccolò Cusano University Foundation, Via Don Carlo Gnocchi 3, 00166 Rome, Italy.
| | - Alessandra Ulivieri
- Laboratory of Biomedical Research, Niccolò Cusano University Foundation, Via Don Carlo Gnocchi 3, 00166 Rome, Italy.
| | - Fiorenza Magi
- Laboratory of Biomedical Research, Niccolò Cusano University Foundation, Via Don Carlo Gnocchi 3, 00166 Rome, Italy.
| | - Gian Paolo De Francesco
- Department of Oncological Science, Breast Unit, St Andrea University Hospital, Via di Grottarossa, 1035/39, 00189 Rome, Italy.
| | - Carlo Bellotti
- Operative Unit Surgery of Thyroid and Parathyroid, Sapienza University of Rome, S. Andrea Hospital, Via di Grottarossa, 1035/39, 00189 Rome, Italy.
| | - Leila B Salehi
- Laboratory of Biomedical Research, Niccolò Cusano University Foundation, Via Don Carlo Gnocchi 3, 00166 Rome, Italy.
- Department of Biopathology and Diagnostic Imaging, Tor Vergata University, Via Montpellier 1, 00133 Rome, Italy.
| | - Alberto Ricci
- Department of Clinical and Molecular Medicine, Sapienza University, Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy.
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Cocorullo G, Scerrino G, Melfa G, Raspanti C, Rotolo G, Mannino V, Richiusa P, Cabibi D, Giannone AG, Porrello C, Gulotta G. Non-functioning parathyroid cystic tumour: malignant or not? Report of a case. G Chir 2017; 38:243-249. [PMID: 29280705 DOI: 10.11138/gchir/2017.38.5.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Parathyroid carcinoma (PC) is a very rare endocrine tumour, usually characterized by symptoms such as a neck mass, dysphonia, severe hypercalcemia exceeding 140 mg/L and elevated serum parathyroid hormone levels, even more than 5 times the upper limit of normal. Non-functioning parathyroid cancer is extremely rare and, in this case, its pre-operative diagnosis is often difficult. A 54-year old female patient, referring dysphagia and dysphonia, underwent neck ultrasound and neck CT. A left thyroid nodule, probably cystic, was found. It presented caudal extent on anterior mediastinum causing compression of the left lateral wall of the trachea. The preoperative calcemia was into the normal range. The patient underwent left thyroid lobectomy. Histological exam showed a cystic lesion, immunohistochemically originating from parathyroid that oriented for carcinoma. The 18 months follow-up did not show a residual-recurrent disease. The parathyroid origin of a neck lesion could not be suspected before surgery when specific laboratory tests are not available and clinical effects of hyperparathyroidism syndrome are not present. Histological features are not always sufficient for the differential diagnosis between the parathyroid adenoma and carcinoma. The immunohistochemistry is an useful tool that can aid to reach the definite diagnosis.
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Muzafar A, Bukhari MH, Qureshi IU. A study of Galactin-3 on fine needle aspiration as a diagnostic marker differentiating benign from malignant thyroid neoplasm. Pak J Med Sci 2017; 33:726-731. [PMID: 28811803 PMCID: PMC5510135 DOI: 10.12669/pjms.333.12251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background & Objective: Thyroid nodules are very common in our setup and their diagnosis on fine needle aspiration is not easy and is a taxing affair. It is a challenge to differentiate between follicular adenoma and follicular carcinoma without histology. Our objective was to investigate the role of Galectin-3 in fine needle aspirates of thyroid nodules as a prospective diagnostic marker and consequently its ability to differentiate benign from malignant neoplasms. Methods: The research was conducted at the department of Pathology, King Edward Medical University, in association with other teaching institutions of Lahore from June 2012 to July 2014.. Sixty cases of solitary thyroid nodules were included in the study. Haematoxylin and eosin staining of the fixed smears and Galectin-3 immunohistochemical staining of the sections prepared from the cell block was performed. Results: There were 60 patients in our study with a mean age of 33.35 years. The Bethesda system for reporting thyroid cytopathology was used to classify the smears and only categories IV, V and VI were included. On histological examination of the resected nodules there were 38.3% (23/60) cases of follicular adenoma, 46.6% (28/60) were of papillary carcinoma and follicular carcinoma made up to 15% (9/60) of all cases. Galectin-3 was negative in 100% (23/23) cases of follicular adenomas. Out of 37 malignant cases 65% lesions showed positivity, while 35% showed negativity for this immunomarker. Considering the malignant lesions, 75% cases of papillary carcinomas showed a positive reaction while only 33% of follicular carcinomas were positive for the immunomarker. This showed that the positive expression was more common in papillary as compared to follicular carcinomas. Conclusion: Galectin-3immunomarker is considerably expressed in malignant tumors, but it is not expressed in benign follicular lesions.
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Affiliation(s)
- Alliya Muzafar
- Dr. Alliya Muzafar, MBBS, M.Phil. Senior Demonstrator Pathology, King Edward Medical University, Lahore, Pakistan
| | - Mulazim Hussain Bukhari
- Prof. Dr. Mulazim Hussain Bukhari, MBBS, FCPS, PhD. Head of Department Pathology, University Medical College, University of Lahore, Lahore, Pakistan
| | - Ihtesham Uddin Qureshi
- Prof. Dr. Ihtesham uddin Qureshi, MBBS, M.Phil. Professor of Pathology, Postgraduate Medical Institute, Lahore, Pakistan
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Walls GV, Stevenson M, Lines KE, Newey PJ, Reed AAC, Bowl MR, Jeyabalan J, Harding B, Bradley KJ, Manek S, Chen J, Wang P, Williams BO, Teh BT, Thakker RV. Mice deleted for cell division cycle 73 gene develop parathyroid and uterine tumours: model for the hyperparathyroidism-jaw tumour syndrome. Oncogene 2017; 36:4025-4036. [PMID: 28288139 PMCID: PMC5472200 DOI: 10.1038/onc.2017.43] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 12/22/2016] [Accepted: 01/24/2017] [Indexed: 02/06/2023]
Abstract
The hyperparathyroidism-jaw tumour (HPT-JT) syndrome is an autosomal dominant disorder characterized by occurrence of parathyroid tumours, often atypical adenomas and carcinomas, ossifying jaw fibromas, renal tumours and uterine benign and malignant neoplasms. HPT-JT is caused by mutations of the cell division cycle 73 (CDC73) gene, located on chromosome 1q31.2 and encodes a 531 amino acid protein, parafibromin. To facilitate in vivo studies of Cdc73 in tumourigenesis we generated conventional (Cdc73+/-) and conditional parathyroid-specific (Cdc73+/L/PTH-Cre and Cdc73L/L/PTH-Cre) mouse models. Mice were aged to 18-21 months and studied for survival, tumour development and proliferation, and serum biochemistry, and compared to age-matched wild-type (Cdc73+/+ and Cdc73+/+/PTH-Cre) littermates. Survival of Cdc73+/- mice, when compared to Cdc73+/+ mice was reduced (Cdc73+/-=80%; Cdc73+/+=90% at 18 months of age, P<0.05). Cdc73+/-, Cdc73+/L/PTH-Cre and Cdc73L/L/PTH-Cre mice developed parathyroid tumours, which had nuclear pleomorphism, fibrous septation and increased galectin-3 expression, consistent with atypical parathyroid adenomas, from 9 months of age. Parathyroid tumours in Cdc73+/-, Cdc73+/L/PTH-Cre and Cdc73L/L/PTH-Cre mice had significantly increased proliferation, with rates >fourfold higher than that in parathyroid glands of wild-type littermates (P<0.0001). Cdc73+/-, Cdc73+/L/PTH-Cre and Cdc73L/L/PTH-Cre mice had higher mean serum calcium concentrations than wild-type littermates, and Cdc73+/- mice also had increased mean serum parathyroid hormone (PTH) concentrations. Parathyroid tumour development, and elevations in serum calcium and PTH, were similar in males and females. Cdc73+/- mice did not develop bone or renal tumours but female Cdc73+/- mice, at 18 months of age, had uterine neoplasms comprising squamous metaplasia, adenofibroma and adenomyoma. Uterine neoplasms, myometria and jaw bones of Cdc73+/- mice had increased proliferation rates that were 2-fold higher than in Cdc73+/+ mice (P<0.05). Thus, our studies, which have established mouse models for parathyroid tumours and uterine neoplasms that develop in the HPT-JT syndrome, provide in vivo models for future studies of these tumours.
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Affiliation(s)
- G V Walls
- Academic Endocrine Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Radcliffe Department of Medicine, University of Oxford, Churchill Hospital, Oxford, UK
| | - M Stevenson
- Academic Endocrine Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Radcliffe Department of Medicine, University of Oxford, Churchill Hospital, Oxford, UK
| | - K E Lines
- Academic Endocrine Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Radcliffe Department of Medicine, University of Oxford, Churchill Hospital, Oxford, UK
| | - P J Newey
- Academic Endocrine Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Radcliffe Department of Medicine, University of Oxford, Churchill Hospital, Oxford, UK
| | - A A C Reed
- Academic Endocrine Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Radcliffe Department of Medicine, University of Oxford, Churchill Hospital, Oxford, UK
| | - M R Bowl
- Academic Endocrine Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Radcliffe Department of Medicine, University of Oxford, Churchill Hospital, Oxford, UK
| | - J Jeyabalan
- Academic Endocrine Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Radcliffe Department of Medicine, University of Oxford, Churchill Hospital, Oxford, UK
| | - B Harding
- Academic Endocrine Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Radcliffe Department of Medicine, University of Oxford, Churchill Hospital, Oxford, UK
| | - K J Bradley
- Academic Endocrine Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Radcliffe Department of Medicine, University of Oxford, Churchill Hospital, Oxford, UK
| | - S Manek
- Department of Pathology, John Radcliffe Hospital, Headley Way, Oxford, UK
| | - J Chen
- Laboratory of Cancer Genetics, Van Andel Research Institute, Grand Rapids, MI, USA
| | - P Wang
- Laboratory of Cancer Genetics, Van Andel Research Institute, Grand Rapids, MI, USA
| | - B O Williams
- Center for Cancer and Cell Biology, Van Andel Research Institute, Grand Rapids, MI, USA
| | - B T Teh
- Laboratory of Cancer Genetics, Van Andel Research Institute, Grand Rapids, MI, USA
| | - R V Thakker
- Academic Endocrine Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Radcliffe Department of Medicine, University of Oxford, Churchill Hospital, Oxford, UK
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Kumari N, Chaudhary N, Pradhan R, Agarwal A, Krishnani N. Role of Histological Criteria and Immunohistochemical Markers in Predicting Risk of Malignancy in Parathyroid Neoplasms. Endocr Pathol 2016; 27:87-96. [PMID: 26984237 DOI: 10.1007/s12022-016-9426-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Parathyroid carcinoma (PC) is a rare neoplasm accounting for 0.5-6 % of primary hyperparathyroidism. Histological criteria are currently considered as established means to diagnose malignancy in parathyroid neoplasms; however, it does not accurately predict the risk of aggressive behaviour of PC. Immunohistochemical (IHC) markers have been used in the literature with variable results. This work was planned to study whether IHC markers would have any added advantage over histology in predicting outcome in parathyroid neoplasms. Two hundred twenty-seven parathyroid neoplasms were reviewed according to older and revised histological criteria. IHC was performed for parafibromin, APC, galectin-3, PGP9.5 and Ki67. Diagnostic categories were correlated with clinical, biochemical, histological features and IHC markers. Chi-square test was used to analyse categorical variables. Review of histology by earlier and revised criteria showed a change in diagnosis of five cases of atypical adenoma (15.1 %), all of which were diagnosed as carcinoma according to earlier criteria. Change in diagnosis did not affect behaviour of disease as none of the cases showed recurrence or metastasis on follow-up. Combination of PF, Gal-3 and PGP9.5 showed 50 % sensitivity, 97.9 % specificity and 95.4 % predictive accuracy for PC. Histological criteria still remains the most established method for predicting risk of malignancy in parathyroid neoplasms irrespective of whether old or revised criteria are used. Combination of positive (Gal-3, PGP9.5) and negative (PF) IHC markers may be used as an adjunct to histology in histological, atypical and malignant parathyroid neoplasms to obviate the need for repeated follow-up.
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Affiliation(s)
- Niraj Kumari
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Nandita Chaudhary
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Roma Pradhan
- Department of Surgical Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Amit Agarwal
- Department of Surgical Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Narendra Krishnani
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
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Karaarslan S, Yurum FN, Kumbaraci BS, Pala EE, Sivrikoz ON, Akyildiz M, Bugdayci MH. The Role of Parafibromin, Galectin-3, HBME-1,
and Ki-67 in the Differential Diagnosis of Parathyroid Tumors. Oman Med J 2015; 30:421-7. [PMID: 26675091 DOI: 10.5001/omj.2015.84] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Parathyroid carcinoma (PC) is a rare parathyroid tumor compared to parathyroid adenoma (PA) and atypical parathyroid adenoma (APA). Recent studies have suggested parafibromin has a role in the differential diagnosis of parathyroid tumors. We sought to determine the role of parafibromin as well as galectin-3, Ki-67, and HBME-1 as diagnostic markers in the differential diagnosis of parathyroid tumors. METHODS A total of 92 cases diagnosed with PA, APA, or PC at Sifa University and Private Ege Pathology Laboratory between 2006-2012 were included in the study. Parafibromin (microarray), galectin-3, Ki-67, and HBME-1 were evaluated using immunohistochemistry in all parathyroid tumors. RESULTS Eighty-four cases were diagnosed with PA, six with APA, and two with PC. The study group consisted of 82 females and 10 males. Their mean age was 50.9 years, and the mean tumor diameter was 1.97 cm. Parafibromin was negative in the two PC cases but positive in all APA and PA cases. Positivity was observed with galectin-3 in 17 adenoma cases, three atypical adenomas, and two carcinoma cases. Positivity with HBME-1 was found in 26 PA cases and one PC case. Parafibromin and galectin-3 expression was significant between the three tumor groups but not for HBME-1 expression. Parafibromin expression increased in PA whereas galectin-3 expression decreased. A statistical significance was found between the three tumor groups according to the Ki-67 score (p=0.010). Additionally, the Ki-67 proliferation index was under 1% in PAs. CONCLUSION The number of PCs in our series was small so our data mostly reflects the immunohistochemical characteristics of PAs. Parafibromin expression, galectin-3 negativity, and a Ki-67 proliferation index under 1% were estimated as beneficial in the differential diagnosis of difficult parathyroid tumors.
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Affiliation(s)
| | | | | | - Emel E Pala
- Pathology Department, Tepecik Training And Research Hospıtal, Izmır, Turkey
| | | | - Mahir Akyildiz
- General Surgıcal Department, Ege University, Izmır, Turkey
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Yamaki S, Fujii T, Yajima R, Hirakata T, Yamaguchi S, Fujisawa T, Tsutsumi S, Asao T, Yanagita Y, Iijima M, Kuwano H. Clinicopathological significance of decreased galectin-3 expression and the long-term prognosis in patients with breast cancer. Surg Today 2012; 43:901-5. [PMID: 23090139 DOI: 10.1007/s00595-012-0378-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 06/24/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE Galectin-3 expression is modulated in cancer cells, and that finding has led to the recognition of galectin-3 as a diagnostic or prognostic marker for various cancers, including breast cancer. This study investigated the correlation between galectin-3 expression and the clinicopathological features in patients with breast cancer, in order to determine the relevance and role of galectin-3 in breast cancer progression. METHODS Galectin-3 expression was investigated immunohistochemically in 116 patients with breast cancer, and a statistical analysis was performed. RESULTS Galectin-3 expression in breast cancer was significantly associated with tumor vascular invasion. However, galectin-3 expression was not associated with Ki-67 expression, which reflects tumor proliferation. Disease-free survival and long-term overall survival were significantly shorter for patients with reduced galectin-3 expression. CONCLUSIONS This study demonstrated that the galectin-3 expression was associated with tumor vascular invasion and metastasis, suggesting that galectin-3 plays a critical role in tumor progression via an invasive mechanism but not via proliferation in breast cancer. Furthermore, reduced expression of galectin-3 is useful for predicting a long-term poor prognosis in patients with breast cancer.
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Affiliation(s)
- Sayaka Yamaki
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
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Aksoy-Altinboga A, Akder Sari A, Rezanko T, Haciyanli M, Orgen Calli A. Parathyromatosis: critical diagnosis regarding surgery and pathologic evaluation. KOREAN JOURNAL OF PATHOLOGY 2012; 46:197-200. [PMID: 23110001 PMCID: PMC3479781 DOI: 10.4132/koreanjpathol.2012.46.2.197] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 03/15/2011] [Accepted: 04/18/2011] [Indexed: 11/17/2022]
Abstract
Parathyromatosis, in which several nodules of hyperfunctioning parathyroid tissue form in the neck and mediastinum, is a rare cause of recurrent hyperparathyroidism. However, there are some theories regarding the origin of parathyromatosis, and seeding after rupture of the parathyroid gland capsule during surgical removal of a parathyroid lesions is the most regarded one. Herein, we report a 41-year-old man who presented with multiple parathyroid nodules in and around the left thyroid lobe 5 years after parathyroid surgery for secondary hyperparathyroidism that was finally diagnosed as parathyromatosis. We discuss the differential diagnosis of parathyromatosis from other parathyroid tumors, particularly from parathyroid carcinoma, which is important in the management of a suspected lesion.
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Affiliation(s)
- Ayşegül Aksoy-Altinboga
- Department of Pathology, Izmir Atatürk Training and Research Hospital, Yesilyurt, Izmir, Turkey
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Abstract
OBJECTIVE To report the use of immunohistochemical staining for parafibromin, APC, and galectin-3 to evaluate the malignant potential of a resected parathyroid specimen in a patient initially presenting with primary hyperparathyroidism attributable to 4-gland hyperplasia, who subsequently developed metastatic parathyroid carcinoma. METHODS We describe a patient with primary hyperparathyroidism who underwent a 3-gland resection of hypercellular parathyroid glands, with postoperative normalization of her serum calcium and parathyroid hormone levels. She returned 4 years later with recurrent hypercalcemia and underwent partial resection of her remaining hypercellular parathyroid gland, without improvement of her hypercalcemia. Selective venous sampling localized the source as draining into her azygos vein, and metastatic parathyroid carcinoma was ultimately diagnosed. RESULTS Immunohistochemical staining for parafibromin, APC, and galectin-3 suggested the malignant potential of the atypical adenoma removed during the patient's original operation, which is believed to be the source of her metastatic disease. Access to this information by the treating surgeon may have prompted a more extensive en bloc resection or more vigilant follow-up that could have altered the patient's clinical course. CONCLUSION Immunohistochemical staining for parafibromin, APC, and galectin-3 can be used to help distinguish the source of metastatic disease in patients with parathyroid carcinoma. Selective venous sampling may help localize metastatic parathyroid carcinoma when the source is otherwise not apparent.
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Affiliation(s)
- Rondi M Kauffmann
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - C Christofer Juhlin
- Department of Molecular Medicine and Surgery, Center for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Laurel E Fohn
- Department of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, TN
| | - James T Broome
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - John E Phay
- Department of Surgery, Ohio State University, Columbus, OH
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Sitges-Serra A, Díaz-Aguirregoitia FJ, de la Quintana A, Gil-Sánchez J, Jimeno J, Prieto R, Sancho JJ. Weight difference between double parathyroid adenomas is the cause of false-positive IOPTH test after resection of the first lesion. World J Surg 2010; 34:1337-42. [PMID: 20107797 DOI: 10.1007/s00268-010-0413-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Some patients with double parathyroid adenoma show a greater than 50% decline in intraoperative parathyroid hormone (IOPTH) after resection of the first lesion. The present study was designed to test the hypothesis that significant adenoma weight differences may explain this inappropriate decline of IOPTH. METHODS We reviewed prospective database records at two tertiary institutions. Patients with a histopathologic diagnosis of double adenoma and no familial history of hyperparathyroidism were included. Diagnosis of double adenoma was confirmed either preoperatively (double uptake), intraoperatively (bilateral exploration), or at reintervention. IOPTH was determined following the Miami protocol. The 10-min postexcision sample was considered as the 0-min sample for IOPTH determinations at the time of resection of the second lesion. RESULTS Thirteen patients met the inclusion criteria. After resection of the first lesion, IOPTH failed to decline in four patients and a second adenoma was removed. They had similar weight (404 vs. 598 mg). In nine patients IOPTH showed a false greater than 50% decline. These patients had the largest adenoma removed first (846 +/- 226 mg), and only two had normal PTH serum concentrations 10 min after resection. The second adenoma was always smaller (284 +/- 177 mg; P = 0.02) and its resection either during the same operation (7 cases) or at reoperation (2 cases) led to normalization of IOPTH at 10 min in all cases. CONCLUSIONS Two-thirds of patients with double parathyroid adenoma show a false-positive decline of IOPTH after resection of the first adenoma. This appears to be due to the initial removal of the larger lesion.
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Kaczmarek E, Lacka K, Majewski P, Trzeciak P, Gorna A, Jarmolowska-Jurczyszyn D, Kluk A. Selected markers of proliferation and apoptosis in the parathyroid lesions: a spatial visualization and quantification. J Mol Histol 2008; 39:509-17. [PMID: 18726191 DOI: 10.1007/s10735-008-9190-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Accepted: 08/05/2008] [Indexed: 01/09/2023]
Abstract
The aim of the paper was to apply a method for quantitative assessment of proliferation and apoptosis markers, based on their 3D visualization, in cases of parathyroid adenoma and hyperplasia. Material was obtained from 49 patients (32 females and 17 males) with primary hyperparahyroidism. Quantitative immunohistochemistry studies of Ki-67, proliferating cell nuclear antigen (PCNA) and bcl-2 were performed on digital microscopy images with the use of 3D visualization. The use of spatial visualization method allowed us to perform objective quantitative assessment of the studied immunohistochemical markers. The average cell nuclear fraction of Ki67+ was 1.8% in hyperplasia and 1.9% in adenoma cases while 3.5% in the controls. The highest expression of PCNA was found in parathyroid hyperplasia (22.9%) and significantly decreased in adenoma (12.5%) and in the control group (16.8%). The lower expression of bcl-2 in hyperplasia cases (mean area fraction of 0.172 per 1 mum(2), in contrast to 0.643 in adenomas and 0.648 in control) suggested that principal cells can be ready for apoptosis and may confirm the important role of bcl-2 protein in etiopathogenesis of hyperplasia of the parathyroid gland while PCNA might be a useful marker for differentiating adenoma from early hyperplasia in primary hyperparahyroidism cases.
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Affiliation(s)
- Elzbieta Kaczmarek
- Department of Pathomorphology, University of Medical Sciences in Poznan, Przybyszewski Str. 49, 60355, Poznan, Poland.
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