The nuclear
DNA content of
paraffin-embedded parathyroid
tumors from 49 patients with proven
primary hyperparathyroidism was determined by flow cytometric analysis. The lesions included 14 primary and 11 locally recurrent or metastatic lesions from 16
carcinoma patients, 28 single
adenomas from 28 patients, and 15 hyperplastic glands from five patients with familial
multiple endocrine neoplasia type 1. No abnormal
DNA stemline was found in any of the hyperplastic glands. One (3.6%) of the
adenomas was
aneuploid. There was no difference in ploidy patterns between the primary and recurrent lesions of the
carcinomas and five (31%) of the
carcinomas expressed
aneuploidy. Four of the five patients with
aneuploid carcinoma had recurrences including pulmonary
metastases. One of them died of this disease 12 years after the initial operation, and all except one of the others are hypercalcemic even after removal of the successive recurrent or metastatic
tumors. Of the 11 patients with diploid
carcinoma, four had either local recurrence or pulmonary
metastasis. Two of them are living with normocalcemia 3 and 6 years, respectively, after removal of the recurrent
tumors and the others are alive with mild
hypercalcemia. The remaining seven patients with diploid
carcinoma, however, have no recurrence 2 to 5 years after the initial operation. Thus
aneuploid parathyroid carcinomas are likely to show more malignant behavior than those with a diploid
DNA pattern. All of the patients with
adenoma and
hyperplasia have been normocalcemic after a mean follow-up interval of 37 months. This study indicates that flow cytometric analysis of nuclear
DNA content is a valuable adjunct to histologic examination in the diagnosis of
parathyroid carcinoma and the prediction of the clinical outcome.