RESUMO
N/A.
Assuntos
Ecocardiografia Transesofagiana , Neoplasias Cardíacas/diagnóstico por imagem , Imageamento por Ressonância Magnética , Imagem Multimodal/métodos , Paraganglioma Extrassuprarrenal/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Adulto , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/cirurgia , Humanos , Masculino , Paraganglioma Extrassuprarrenal/patologia , Paraganglioma Extrassuprarrenal/cirurgia , Valor Preditivo dos TestesRESUMO
Pheochromocytomas and paragangliomas (PPGLs) are rare catecholamine-secreting tumors which arise from the adrenal glands or sympathetic neuronal tissue. Malignant transformation of these tumors occurs in a significant proportion and may therefore lower overall survival rates. In patients with PPGLs it is impossible to identify malignant disease without the presence of metastatic disease, something which can occur as long as 20 years after initial surgery. Early identification of malignant disease would necessitate a more aggressive treatment approach, something which may result in better disease outcome. We have therefore reviewed possible predictors of malignancy and current developments in order to help clinicians to swiftly assess malignant potential in patients with PPGLs. Currently, there is no absolute marker which can objectively reflect malignant potential. Tumor size is the most reliable predictor and should therefore be used as the baseline characteristic. The combination of various clinical markers (extra-adrenal disease and post-operative hypertension), biochemical markers (high dopamine, high norepinephrine and epinephrine to total catecholamine ratio) and/or histological markers (SNAIL, microRNAs and/or microarray results) can raise or lower the suspicion of malignancy. Furthermore, we discuss how clinical markers may affect biochemical results linked to malignancy, how biochemical results may distinguish hereditary syndromes, the role of imaging in determining malignant potential and tumor detection, and recent results of proposed histological markers.
Assuntos
Neoplasias das Glândulas Suprarrenais/patologia , Transformação Celular Neoplásica/patologia , Paraganglioma Extrassuprarrenal/patologia , Feocromocitoma/patologia , Lesões Pré-Cancerosas/patologia , Neoplasias das Glândulas Suprarrenais/metabolismo , Doenças do Sistema Nervoso Autônomo/patologia , Biomarcadores Tumorais/classificação , Biomarcadores Tumorais/metabolismo , Transformação Celular Neoplásica/metabolismo , Humanos , Paraganglioma Extrassuprarrenal/metabolismo , Patologia Molecular , Feocromocitoma/metabolismo , Lesões Pré-Cancerosas/metabolismo , Valor Preditivo dos TestesRESUMO
The clinical and pathologic findings in eleven cases of parapharyngeal space tumors are described. The anatomy of this area and diagnostic procedures are discussed. Investigations should include a few basic examinations such as sialogram-computed tomographic (CT) scan, carotid angiogram, and echography. Several surgical approaches are considered in relation to the site and the size of the neoplasm. Prognosis depends on the histologic type of the tumor.
