title: Role of Histological Criteria and Immunohistochemical Markers in Predicting Risk of Malignancy in Parathyroid Neoplasms.
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.
authors.affiliation: Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
authors.forename: Niraj
authors.initials: N
authors.lastname: Kumari
authors.affiliation: Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
authors.forename: Nandita
authors.initials: N
authors.lastname: Chaudhary
authors.affiliation: Department of Surgical Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
authors.forename: Roma
authors.initials: R
authors.lastname: Pradhan
authors.affiliation: Department of Surgical Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Agarwal
authors.affiliation: Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. narendrakrishnani@yahoo.co.in.
authors.forename: Narendra
authors.initials: N
authors.lastname: Krishnani
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis*; D001798:Blood Proteins; D005260:Female; D037502:Galectin 3 / Q000032:analysis / Q000096:biosynthesis; D037161:Galectins; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D010282:Parathyroid Neoplasms / Q000473:pathology*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D025521:Tumor Suppressor Proteins / Q000032:analysis / Q000096:biosynthesis; D043222:Ubiquitin Thiolesterase / Q000032:analysis / Q000096:biosynthesis
chemical_list: D014408:Biomarkers, Tumor; D001798:Blood Proteins; C454900:CDC73 protein, human; D037502:Galectin 3; D037161:Galectins; C428445:LGALS3 protein, human; D025521:Tumor Suppressor Proteins; C482860:UCHL1 protein, human; D043222:Ubiquitin Thiolesterase
keywords: Galectin-3; PGP9.5; Parafibromin; Parathyroid carcinoma