原发性甲状旁腺功能亢进症84例临床病理分析

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

目的探讨原发性甲状旁腺功能亢进症(PHPT)的临床病理特征。方法回顾性分析2010-01—2014-04间北京世纪坛医院84例手术治疗PHPT的临床病理资料,其中甲状旁腺腺瘤54例(64.3%),甲状旁腺增生17例(20.2%),甲状旁腺癌13例(15.4%)。结果 3组患者诊断年龄、性别均无差异,但癌组患者术前血钙及PTH水平明显高于腺瘤组及增生组(P<0.05)。甲状旁腺腺瘤(46/54)及腺癌(9/13)中单发肿瘤多见(85.2%和69.2%,P>0.05),增生(3/17)中单发少见(17.6%,P<0.05),3组标本最大径差异不显著(P>0.05)。甲状旁腺腺瘤有完整包膜,肿瘤细胞无异型性;甲状旁腺癌包膜不完整,可见肿瘤细胞侵犯包膜,血管内瘤栓形成,瘤细胞核仁明显,染色质粗,部分可见核分裂象;甲状旁腺增生外形不规则,多数无包膜。免疫组化:PTH和p53在3组中阳性率差异不显著(P>0.05);Ki-67>5%在癌组中阳性率较腺瘤组、增生组明显升高分别为30.8%、9.3%和0(P<0.05);Syn和CgA在癌组中阳性率较腺瘤组、增生组明显降低(P<0.05)。结论原发性甲状旁腺功能亢进症的不同病理学类型在临床表现、大体标本、HE染色及免疫组化等方面各有特点,血钙和血PTH,免疫组化Ki-67、Syn和Cg A可辅助鉴别甲状旁腺肿瘤的良、恶性,为甲状旁腺疾病的诊断提供依据。

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. 48 cm,2. 26 ± 1. 38 cm vs 1. 99 ± 1. 11 cm,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.