VALUE OF PLOIDY PATTERN AND NUCLEAR TEXTURE IN THE DIAGNOSIS OF PRIMARY HYPERPARATHYROIDISM

OBJECTIVE: To determine if there are subvisual differences (quantitati on of DNA and study of chromatin texture) that distinguish single-glan d parathyroid disease (adenoma) from multiple-gland disease (hyperplas ia). STUDY DESIGN: Forty-eight parathyroid glands from 41 patients wit h primary hyperparathyroidism were studied. Cytometric differences bet ween the chief cells and clear cells were sought. An image cytometer w as used to study histologic sections stained with DNA stain reagent. I n each case a total of 200 cells were measured in consecutive fields. To distinguish chief cells from clear cells, a sample of 15,600 cells collected in consecutive fields in 78 histologic sections was analyzed . RESULTS: The results indicated that none of the continuous variables differentiated between single-gland and multiple-gland parathyroid di sease. The most common ploidy pattern was diploid (25/45), followed by hypodiploid (7/45) and polyploid (5/45). A tetraploid population >3% was found in 18/45 of the cases and was more frequent in single-gland lesions (15/34) than in multiple-gland lesions (3/11). The most signif icant discrete variables were growth pattern and binucleation or multi nucleation. Clear and chief cells were classified correctly in 61.3% o f the crossover validation tests using the standard deviation of nucle ar shape karyometric variable and in 76.3% using the standard deviatio n of maximal correlation coefficient karyometric variable. Although pl oidy pattern did not show significant differences, polyploidy, aneuplo idy and tetraploidy >3% were slightly more common in chief cells. CONC LUSION: In primary hyperparathyroidism there are no subvisual differen ces that can distinguish adenoma from hyperplasia. Nonetheless, by cyt ometry, most parathyroid cells can be classified correctly as clear or chief cells.