RESUMO
Adrenal myelolipoma is a benign tumour characterized by the presence of macroscopic fat. Further workup is not necessary if a diagnosis of adrenal myelolipoma is obtained via imaging. We report the first case of adrenal collision tumour comprised of adrenocortical carcinoma and myelolipoma in a patient with bilateral myelolipomas and congenital adrenal hyperplasia. Computed tomography showed a large right adrenal mass consisting of two different components: soft tissue with peripheral heterogeneous enhancement and macroscopic fat. Imaging findings reflected features of both adrenocortical carcinoma and myelolipoma. Although this entity is rare, collision tumour containing an adrenocortical carcinoma component should be suspected if portions of an adrenal mass partially consist of peripheral heterogeneous enhancement.
Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Hiperplasia Suprarrenal Congênita/complicações , Carcinoma Adrenocortical/diagnóstico por imagem , Mielolipoma/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Córtex Suprarrenal/diagnóstico por imagem , Córtex Suprarrenal/cirurgia , Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/cirurgia , Carcinoma Adrenocortical/complicações , Carcinoma Adrenocortical/cirurgia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Mielolipoma/complicações , Mielolipoma/cirurgiaRESUMO
TAZ (WWTR1) and YAP are transcriptional coactivators and oncoproteins inhibited by the Hippo pathway. Herein we evaluate 159 sarcomas representing the most prevalent sarcoma types by immunohistochemistry for expression and activation (nuclear localization) of TAZ and YAP. We show that 50% of sarcomas demonstrate activation of YAP while 66% of sarcomas demonstrate activated TAZ. Differential activation of TAZ and YAP are identified in various sarcoma types. At an RNA level, expression of WWTR1 or YAP1 predicts overall survival in undifferentiated pleomorphic sarcoma and dedifferentiated liposarcoma. Immunohistochemistry demonstrates that TAZ and YAP expression and activation are positively correlated with grade in the well-differentiated liposarcoma to dedifferentiated liposarcoma tumor progression sequence as well as conventional chondrosarcomas. TAZ and YAP are constitutively activated oncoproteins in sarcoma cell lines. Knock-down of TAZ and YAP demonstrate differential activity for the two proteins. Verteporfin decreases colony formation in soft agar as well as CTGF expression in sarcoma cell lines harboring activated TAZ and YAP.
Assuntos
Proteínas Adaptadoras de Transdução de Sinal/metabolismo , Antineoplásicos/farmacologia , Carcinogênese/metabolismo , Proteínas de Ligação a DNA/metabolismo , Peptídeos e Proteínas de Sinalização Intracelular/metabolismo , Proteínas Musculares/metabolismo , Proteínas Oncogênicas/metabolismo , Fosfoproteínas/metabolismo , Porfirinas/farmacologia , Sarcoma/metabolismo , Fatores de Transcrição/metabolismo , Proteínas Adaptadoras de Transdução de Sinal/genética , Antineoplásicos/uso terapêutico , Linhagem Celular Tumoral , Núcleo Celular/metabolismo , Proliferação de Células/efeitos dos fármacos , Fator de Crescimento do Tecido Conjuntivo/metabolismo , Progressão da Doença , Técnicas de Silenciamento de Genes , Humanos , Imuno-Histoquímica , Peptídeos e Proteínas de Sinalização Intracelular/genética , Gradação de Tumores , Proteínas Oncogênicas/genética , Fosfoproteínas/genética , Proteínas Serina-Treonina Quinases , Interferência de RNA , RNA Interferente Pequeno , Sarcoma/tratamento farmacológico , Sarcoma/patologia , Transdução de Sinais/efeitos dos fármacos , Fatores de Transcrição de Domínio TEA , Análise Serial de Tecidos , Transativadores , Proteínas com Motivo de Ligação a PDZ com Coativador Transcricional , Verteporfina , Proteínas de Sinalização YAPAssuntos
Fibroma/patologia , Neoplasias Palatinas/patologia , Palato Duro/patologia , Adulto , Edema/etiologia , Feminino , Fibroma/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Dor/etiologia , Neoplasias Palatinas/diagnóstico por imagem , Palato Duro/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Pentobarbital is used for management of intractable seizures and for reducing elevated intracranial pressure. Dosing of pentobarbital can be aided by therapeutic drug monitoring (TDM). There is no commercially available automated assay for measurement of pentobarbital serum/plasma concentrations; consequently, chromatography-based assays are often used. METHODS: Pentobarbital TDM was studied over a 14-year period at an academic medical center. 154 patients (94 adult, 60 pediatric) were identified who had pentobarbital levels ordered at least once during a hospital encounter. Chart review included patient diagnosis, indication for pentobarbital therapy, recent or concomitant medication with other barbiturates, patient disposition, organ donation, pentobarbital dosing changes, and neurosurgical procedures. Pentobarbital serum/plasma concentrations were determined on an automated clinical chemistry platform with a laboratory-developed test adapted from a urine barbiturates immunoassay. RESULTS: Chart review showed therapeutic use of pentobarbital generally consistent with previously published literature. The most common errors observed involved confusion in barbiturate names (eg, mix-up of pentobarbital and phenobarbital in test ordering or in provider notes) that seemed to have minimal impact on TDM effectiveness, with pentobarbital serum/plasma concentrations generally within target ranges. The laboratory-developed pentobarbital immunoassay showed cross-reactivity with phenobarbital and butalbital that was eliminated by alkaline and heat pretreatment. The immunoassay was linear to 20 mcg/mL and correlated closely with gas chromatography-mass spectrometry measurements at a reference laboratory. CONCLUSIONS: Pentobarbital TDM can be performed by immunoassay on an automated clinical chemistry platform, providing an alternative to chromatography-based methods. Confusion in barbiturate names is common, especially pentobarbital and phenobarbital.
Assuntos
Monitoramento de Medicamentos/métodos , Hipnóticos e Sedativos/farmacocinética , Pentobarbital/farmacocinética , Centros Médicos Acadêmicos , Adulto , Criança , Pré-Escolar , Feminino , Cromatografia Gasosa-Espectrometria de Massas/métodos , Humanos , Imunoensaio/métodos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
Kerstersia gyiorum is infrequently associated with human infection. We report the isolation of Kerstersia gyiorum from two patients: the first, a patient with chronic ear infections, and the second, a patient with a chronic leg wound. Both isolates were resistant to ciprofloxacin, which has not been previously reported.
Assuntos
Alcaligenaceae/isolamento & purificação , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/microbiologia , Otite/diagnóstico , Otite/microbiologia , Infecção dos Ferimentos/diagnóstico , Infecção dos Ferimentos/microbiologia , Alcaligenaceae/classificação , Alcaligenaceae/efeitos dos fármacos , Antibacterianos/farmacologia , Técnicas Bacteriológicas , Doença Crônica , Ciprofloxacina/farmacologia , Farmacorresistência Bacteriana , Feminino , Infecções por Bactérias Gram-Negativas/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Otite/patologia , Infecção dos Ferimentos/patologiaRESUMO
Endoscopic management of vesicoureteral reflux with dextranomer/hyaluronic copolymer (Deflux(®), Oceana Therapeutics, Inc., Edison, NJ, USA) has gained widespread acceptance with increasing success rates and minimal morbidity. Formation of a pseudocapsule and calcification are known histologic changes at the injection site. Postoperative ureteral obstruction has been reported in cases of severe voiding dysfunction, neurogenic bladder and abnormal ureteral anatomy. We present a case of chronic asymptomatic obstruction in a normal ureter following injection of 0.7 ml Deflux.