title: P53 as a marker of differentiation between hyperplastic and adenomatous parathyroids.
abstract: Primary hyperparathyroidism is the clinical result of parathyroid adenoma or hyperplasia, rarely of carcinoma. Clinical, serologic, and radiologic data are unable to discriminate a single parathyroid adenoma from an enlarged hyperplastic gland. Morphologic features also overlap in adenoma and small hyperplastic gland. Studying immunohistochemical expression of fatty acid synthase (FAS), p53, Ki67 and bcl-2, we found that among 21 adenomas 19 (90.5%) were positive for FAS, 12 (57.2%) for Ki67, 11 (52.4%) for p53, and 16 (76.2%) for bcl-2; among 12 hyperplasias, 12 (100%) were positive for FAS, 6 (50%) for KI67, 8 (66.7%) for p53, and 8 (66.7%) for bcl-2. Statistical analysis showed that FAS was associated with parathormone (PTH) (P =.001), Ki67 (P =.01), and p53 (P =.01). Moreover, FAS was associated with hyperplastic (P =.0001) and adenomatous glands (P =.0001). Ki67 was associated with both adenomatous (P =.02) and hyperplastic glands (P =.005). P53 protein were associated only with hyperplastic glands (P =.01). The different occurrence of p53 in parathyroids adenoma and hyperplasia may enable a different management and follow-up of the patients with primary hyperparathyroidism, stratifing them into two groups. The first, with a "false" adenoma having a high risk of relapse, may necessitate exams like serum calcium levels, PTH concentrations, urinary calcium levels for 24 hours, kidney functional tests, and radiology and ultrasound every 3 to 6 months, whereas the second with "true" adenoma, at low risk of relapse, may be checked less frequently with serum calcium levels and PTH concentrations.
authors.affiliation: Department of Experimental Medicine and Pathology, Pietro Valdoni, University of Rome La Sapienza, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Ricci
authors.forename: Pietro Luigi
authors.initials: PL
authors.lastname: Mingazzini
authors.forename: Valeria
authors.initials: V
authors.lastname: Sebastiani
authors.forename: Emilio
authors.initials: E
authors.lastname: D'Erasmo
authors.forename: Claudio
authors.initials: C
authors.lastname: Letizia
authors.forename: Giorgio
authors.initials: G
authors.lastname: De Toma
authors.forename: Piero Luigi
authors.initials: PL
authors.lastname: Alò
mesh_terms: D000236:Adenoma / Q000150:complications / Q000473:pathology*; D000328:Adult; D000368:Aged; D051017:Apoptosis Regulatory Proteins; D014408:Biomarkers, Tumor / Q000032:analysis*; D002352:Carrier Proteins / Q000032:analysis; D003937:Diagnosis, Differential; D064429:Fatty Acid Synthases / Q000032:analysis; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000209:etiology; D006965:Hyperplasia / Q000150:complications / Q000473:pathology; D007124:Immunoenzyme Techniques; D019394:Ki-67 Antigen / Q000032:analysis; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000473:pathology*; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000150:complications / Q000473:pathology*; D016159:Tumor Suppressor Protein p53 / Q000032:analysis*
chemical_list: D051017:Apoptosis Regulatory Proteins; D014408:Biomarkers, Tumor; D002352:Carrier Proteins; D019394:Ki-67 Antigen; D010281:Parathyroid Hormone; C090468:TP53BP2 protein, human; D016159:Tumor Suppressor Protein p53; D064429:Fatty Acid Synthases