Metastatic disease to the parathyroid gland is poorly documented. When performing surgery for primary thyroid cancer, the search for parathyroid gland metastases is often overlooked because of the desire to preserve parathyroid function. Metastatic disease from other cancers to a benign parathyroid gland or to a parathyroid adenoma probably suggests a grave prognosis because it likely indicates widespread metastatic disease; however, isolated metastases to the parathyroid may occur. Although these lesions may be uncommon they may not be as rare as once thought.

High-grade neuroendocrine carcinomas (NECs) are aggressive tumors with limited treatment options. Recently, studies have observed that the tyrosine kinase receptor CD117 is often overexpressed in this malignancy. As a result, CD117 has been identified as a target for therapy via the small molecule, tyrosine kinase inhibitor imatinib mesylate. In the present study, 17 low-grade, 4 intermediate-grade, and 76 high-grade NECs were immunostained for CD117, Ki-67, and p53. Overexpression of the three markers was mainly, but not exclusively seen in the high-grade NECs. Patients with overexpression of CD117 and p53 and increased Ki-67 expression showed reduced survival. However, no difference in survival was observed when the same analysis was applied solely to small cell lung cancer patients, the largest subset studied. These findings suggest that overexpression of CD117, p53, and Ki-67 reflects tumor grade and predicts survival in NECs, but fail as prognostic markers in the subset of small cell lung cancer patients.

Hepatocellular carcinoma is often difficult to diagnose in cytologic material and biopsy specimens. To demonstrate the utility of image analysis in discriminating benign and malignant hepatocytes, 42 malignant cell groups were compared with 26 benign cell groups with a wide range of nuclear morphology in hematoxylin and eosin-stained histologic sections from 42 patients with hepatocellular carcinoma. Nuclear measurements were performed with a relatively inexpensive microcomputer-based image analysis system using a highly flexible imaging software package. Twenty-two nuclear morphometric and densitometric parameters were evaluated. The best single discriminator of benign and malignant cells was the nuclear major axis. Classification of the test samples using optimized linear discriminant functions achieved the following positive predictive values (PV+) and negative predictive values (PV-) for hepatocellular carcinoma: 95.0% PV+ and 85.7% PV- for the major axis; 90.5% PV+ and 84.6% PV- for five densitometric parameters; 100% PV+ and 86.7% PV- for three morphometric parameters; and 95.5% PV+ and 100% PV- for nine combined morphometric/densitometric parameters. These results demonstrate that multivariate linear discriminant functions of nuclear features measured by image analysis can be used to classify benign and malignant hepatocytes accurately.

Background and Objectives: Intraoperative evaluation of the uterus has been reported to predict risk of lymph node spread in endometrial cancer. Four criteria have been prospectively validated by the Mayo Clinic; histopathology, grade, tumor size, and depth of myometrial invasion. The objective of this study is to assess the accuracy of intraoperative evaluation in a university-affiliated teaching setting. Methods: This study was a retrospective chart review of 105 cases of endometrial cancer who underwent roboticassisted staging from January 2016 through December 2017. Results: Seventy-five cases were included. The mean age was 65 y and mean body mass index was 33 kg/m 2. Fifty-eight patients (80.6%) had no change between intraoperative and postoperative grade. This yielded a 19.4% discordance rate with a significant disagreement (P ϭ .003, Cohen's ϭ 0.705). Fifty-eight patients (82.9%) had no change in depth of invasion. This yielded a 17.1% discordance rate with a significant disagreement (P ϭ .0498, Cohen's kappa of 0.69 [95% confidence interval, 0.53-0.85]). Average tumor diameter was 3.4 cm. Seven patients (11.7%) were upsized from the low-risk (Յ2 cm) to the high-risk category (Ͼ2 cm). This led to an 11.7% discordance rate, with a significant disagreement (P ϭ .008, Cohen's kappa of 0.69 [95% confidence interval, 0.48-0.89]). In 15 of 75 cases (20%), intraoperative evaluation of the size of the tumor was not possible and deferred to the final pathology report. Conclusion: We conclude the Mayo Clinic Criteria cannot be universally adopted until all four criteria can be validated through a prospective study that includes institutions that have variable resources.