Associação do polimorfismo genético da Cromogranina A com pacientes portadores de câncer de tireoide / Association of chrogranin A (CHGA) genetic polymorphism with patients with thyroid câncer / Asociación del polimorfismo genético de la crogranina A (CHGA) con pacientes con cáncer de tiroides

Objetivo: Descrever a presença do polimorfismo da região codante do gene CHGA Glu264Asp e associa-lo com as características clinicas da doença. Método: Trata-se de um estudo transversal, descritivo e de caso controle para investigar o polimorfismo da CHGA Glu264Asp por meio de amostras de sangue de 53 indivíduos sendo o grupo caso, formado por 23 pacientes, de ambos os sexos, que sofreram a tireoidectomia e foram submetidos ao tratamento com o Radiofármaco Iodeto de Sódio (I131). Para a genotipagem foi utilizada a técnica PCRRFLP. Foi adotado o nível de significância de 5%. Resultados: Houve diferença estatística significativa na distribuição alélica entre indivíduos com câncer papilífero da tireoide e os sadios. Com tudo, a presença do alelo G é um fator de risco para o câncer papilífero da tireoide. Observou-se uma correlação entre o genótipo GG com o aumento do nível de TSH em pacientes que apresentavam essa patologia. Conclusão: Demostrou-se que o alelo selvagem pode ser um fator de risco para o desenvolvimento da neoplasia tireoidiana do tipo papilar. Por ser uma doença de etiologia multifatorial, são necessários outros estudos em populações diferentes para melhor compreensão da doença.

Objective: To describe the presence of polymorphism of the codante region of the CHGA Glu264Asp gene and to associate it with the clinical characteristics of the disease. Method: This is a cross-sectional, descriptive and case-control study to investigate chga glu264Asp polymorphism through blood samples from 53 individuals, consisting of 23 patients of both sexes who underwent thyroidectomy and underwent treatment with the Radiopharmaceutical Sodium Iodide (I131). Pcr-RFLP technique was used for genotyping. The significance level of 5% was adopted. Results: There was a statistically significant difference in the allelic distribution between individuals with papillary thyroid cancer and healthy individuals. With everything, the presence of the G alllet is a risk factor for papillary thyroid cancer. A correlation was observed between the GG genotype and the increased level of TSH in patients with this pathology. Conclusion: It was shown that the wild allomay be a risk factor for the development of the thyroid neoplasm of the papilar type. As it is a disease of multifactorial etiology, further studies in different populations are needed to better understand the disease

Objetivo: Describir la presencia de polimorfismo de la región codante del gen CHGA Glu264Asp y asociarlo con las características clínicas de la enfermedad. Método: Estudio transversal, descriptivo y de casos y controles para investigar el polimorfismo chga glu264Asp a través de muestras de sangre de 53 individuos, constituido por 23 pacientes de ambos sexos sometidos a tiroidectomía y tratamiento con yoduro de sodio radiofarmacéutico (I131). Se utilizó la técnica Pcr-RFLP para el genotipado. Se adoptó el nivel de significancia del 5%. Resultados: Hubo una diferencia estadísticamente significativa en la distribución alélica entre individuos con cáncer papilar de tiroides e individuos sanos. Con todo, la presencia del Gallete G es un factor de riesgo para el cáncer papilar de tiroides. Se observó una correlación entre el genotipo GG y el aumento del nivel de TSH en pacientes con esta patología. Conclusión: Se demostró que el aloplasma silvestre puede ser un factor de riesgo para el desarrollo de la neoplasia tiroidea del tipo papilar. Como es una enfermedad de etiología multifactorial, se necesitan más estudios en diferentes poblaciones para comprender mejor la enfermedad

Non-functional paraganglioma of urinary bladder managed by transurethral resection

ABSTRACT Purpose As a rare bladder tumor, paraganglioma of the urinary bladder (PUB) is frequently misdiagnosed as bladder cancer, particularly for the non-functional type. To date, transurethral resection remains a controversial treatment for non-functional PUB. This study aimed to identify the clinical features, pathological characteristics, prognosis, and safe/effective treatment of non-functional PUB using transurethral resection of the bladder tumor (TURBT). Materials and Methods The clinical records, radiological data, pathological characteristics and follow-up times were retrospectively reviewed in 10 patients with clinically and pathologically proven non-functional PUB in our hospital from January 2008 to November 2016. All patients underwent TURBT treatment. Results The incidence of non-functional PUB in patients with bladder cancer was 0.17%. The mean age at diagnosis was 44.5 ± 13.6 years (range, 29-70 years), and the patient population had a female: male ratio of 3: 2. No patients had excess catecholamine (CA) whilst four patients had painless hematuria. All neoplasms were completely resected via TURBT. The majority of samples were positive for immunohistochemical markers including chromogranin A (CgA) and Synaptophysin (Syn), but were negative for cytokeratins (CKs). Only a single recurrence was observed from the mean follow-up period of 36.4 ± 24.8 months. Conclusion Complete TURBT is a safe and efficient treatment that serves both diagnostic and therapeutic purposes. Histopathological and immunohistochemistry examinations are mandatory for diagnostic confirmation. Long-term follow-up is recommended for patients with non-functional PUB.

Prognostic Threshold of Neuroendocrine Differentiation in Gastric Carcinoma: a Clinicopathological Study of 945 Cases

PURPOSE: The significance of neuroendocrine differentiation (NED) in gastric carcinoma (GC) is controversial, leading to ambiguous concepts in traditional classifications. This study aimed to determine the prognostic threshold of meaningful NED in GC and clarify its unclear features in existing classifications. MATERIALS AND METHODS: Immunohistochemical staining for synaptophysin, chromogranin A, and neural cell adhesion molecule was performed for 945 GC specimens. Survival analysis was performed using the log-rank test and univariate/multivariate models with percentages of NED (PNED) and demographic and clinicopathological parameters. RESULTS: In total, 275 (29.1%) cases were immunoreactive to at least 1 neuroendocrine (NE) marker. GC-NED was more common in the upper third of the stomach. PNED, and Borrmann's classification and tumor, lymph node, metastasis stages were independent prognostic factors. The cutoff PNED was 10%, beyond which patients had significantly worse outcomes, although the risk did not increase with higher PNED. Tumors with ≥10% NED tended to manifest as Borrmann type III lesion with mixed/diffuse morphology and poorer histological differentiation; the NE components in this population mainly grew in insulae/nests, which differed from the predominant growth pattern (glandular/acinar) in GC with <10% NED. CONCLUSIONS: GC with ≥10% NED should be classified as a distinct subtype because of its worse prognosis, and more attention should be paid to the necessity of additional therapeutics for NE components.

How Strong is the Evidence for the Anxiolytic Efficacy of Lavender?: Systematic Review and Meta-analysis of Randomized Controlled Trials

PURPOSE: Although lavender is purported to possess anxiolytic and sedative properties and is often recommended for relieving anxiety, the efficacy of lavender has not been well established. Thus, this review aimed to evaluate the anxiolytic effects of lavender aromatherapy.METHODS: Ten data bases were searched for studies published between 2000 and 2018. Randomized controlled trials investigating the anxiolytic effects of lavender aromatherapy with any type of application for persons with or without clinical anxiety were included. The outcome variables included self-rated anxiety, vital signs, and salivary cortisol and chromogranin A (CgA) levels. In the meta-analysis, standardized mean difference and 95% confidence interval were calculated as effect measures by applying the random effect model and inverse variance method.RESULTS: Twenty-two trials met our inclusion criteria. Lavender aromatherapy was found to have favorable effects in relieving anxiety (Hedges' ĝ = −0.65; 95% CI, −0.84 to −0.46) and decreasing systolic blood pressure (ĝ = −0.22; 95% CI, −0.43 to −0.02), heart rate (ĝ = −0.53; 95% CI, −0.74 to −0.32), and salivary cortisol (ĝ = −1.29; 95% CI, −2.23 to −0.35) and CgA (ĝ = −2.29; 95% CI, −3.24 to −1.34) levels. However, the meta-analysis did not reveal any significant effects of lavender on diastolic blood pressure (effect size: −0.17; 95% CI, −0.37e0.04).CONCLUSION: Aromatherapy using lavender oil might have favorable effects on anxiety and its physiological manifestations. Future studies are recommended with an emphasis on methodological quality. In nursing practice, it is suggested that lavender aromatherapy be included in programs intended to manage anxiety in patients across diverse healthcare settings.

Gallbladder Paraganglioma Associated with SDHD Mutation: a Potential Pitfall on ¹⁸F-FDOPA PET Imaging / 대한핵의학회잡지

A 36-year-old male patient initially presented with hypertension, tinnitus, bilateral carotid masses, a right jugular foramen, and a periaortic arch mass with an elevated plasma dopamine level but an otherwise normal biochemical profile. On surveillance MRI 4 years after initial presentation, he was found to have a 2.2-cm T2 hyperintense lesion with arterial enhancement adjacent to the gallbladder, which demonstrated avidity on ⁶⁸Ga-DOTATATE PET/CTand retrospectively on ¹⁸F-FDOPA PET/CT but was nonavid on ¹⁸F-FDG PET/CT. Biochemical work-up including plasma catecholamines, metanephrines, and chromogranin A levels were found to be within normal limits. This lesion was surgically resected and was confirmed to be a paraganglioma (PGL) originating from the gallbladder wall on histopathology. Pheochromocytoma (PHEO) and PGL are rare tumors of the autonomic nervous system. Succinate dehydrogenase subunit D (SDHD) pathogenic variants of the succinate dehydrogenase complex are usually involved in parasympathetic, extra-adrenal, multifocal head, and neck PGLs. We report an unusual location of PGL in the gallbladder associated with SDHD mutation which could present as a potential pitfall on ¹⁸F-FDOPA PET/CT as its normal excretion occurs through biliary system and gallbladder. This case highlights the superiority of ⁶⁸Ga-DOTATATE in comparison to ¹⁸F-FDOPA and ¹⁸F-FDG in the detection of SDHD-related parasympathetic PGL.ClinicalTrials.gov Identifier: NCT00004847.

Os biomarcadores como tendência inovadora para auxiliar no diagnóstico de doenças mentais em trabalhadores / Biomarkers as innovative trend for aid in the diagnosis of mental diseases among workers

Com as fragilidades dos avanços tecnológicos e as transformações ocorridas no mundo do trabalho no século XXI, os trabalhadores passaram a ser mais exigidos no ambiente laboral, aumentando a sua carga física e psíquica. Tais cargas podem levar ao aumento de doenças relacionadas ao estresse, a quadros ansiosos e depressivos, que podem ser vistas como consequência da interação entre outras variáveis psicossociais e a organização laboral. Uma possibilidade de diagnosticar tais enfermidades é a utilização de biomarcadores específicos, que têm sido utilizados para o diagnóstico de doenças em diversas populações, entre elas a de trabalhadores, resultando em melhores prognósticos. A Cromogranina A pode ser um biomarcador útil para investigar doenças mentais como a ansiedade. Além desse, o cortisol salivar tem sido utilizado para avaliar o funcionamento do eixo hipotálamo-hipófise-adrenal em alterações da função cognitiva, em situações de estresse, ansiedade e depressão. O cortisol presente nos fios de cabelos também é considerado um biomarcador útil para avaliar o estresse crônico relacionado à depressão e aos episódios depressivos. A prevenção em relação aos riscos psicossociais e o diagnóstico precoce por meio do auxílio dos biomarcadores, junto ao exame clínico e anamnese, podem diminuir o presenteísmo e absenteísmo e promover melhorias na saúde mental dos trabalhadores. O aprofundamento do conhecimento sobre ansiedade, estresse e depressão e o diagnostico com o auxílio os biomarcadores pode contribuir para a melhoria das condições laborais e de saúde dos trabalhadores e, sobretudo, reverter-se na qualidade do trabalho executado por eles

Given the weaknesses of technological advances, and the transformations in the world of work occurred in the 21st century, the demands on workers are increasing, with consequent elevation of their physical and psychological load. Such higher load might increase the frequency of stress-related diseases, anxiety and depression disorders, which might be seen as a consequence of the interaction between other psychosocial variables and the organization of work. An approach to the diagnosis of these diseases involves the use of specific biomarkers, which have been used for diagnosis of diseases in several populations, including workers, resulting in better prognosis. Chromogranin A might be a useful biomarker for investigation of mental diseases such as anxiety. The salivary cortisol has been used to assess the functioning of the hypothalamic-pituitary-adrenal axis in cases of cognitive dysfunction, stress, anxiety and depression. Hair cortisol is considered a useful biomarker for assessment of chronic stress associated with depression and depressive episodes. Prevention of psychosocial hazards and early diagnosis with the help of biomarkers in combination with the clinical interview and examination might reduce presenteeism and absenteeism, and promote improvement of the mental health of workers. More thorough knowledge on anxiety, stress and depression, and diagnosis with the help of biomarkers might contribute to improve the working and health conditions of workers, with reflection on the quality of the work they perform

Ganglion cardiacum or juxtaductal body of human fetuses / 대한해부학회지

The ganglion cardiacum or juxtaductal body is situated along the left recurrent laryngeal nerve in the aortic window and is an extremely large component of the cardiac nerve plexus. This study was performed to describe the morphologies of the ganglion cardiacum or juxtaductal body in human fetuses and to compare characteristics with intracardiac ganglion. Ganglia were immunostained in specimens from five fetuses of gestational age 12–16 weeks and seven fetuses of gestational age 28–34 weeks. Many ganglion cells in the ganglia were positive for tyrosine hydroxylase (TH; sympathetic nerve marker) and chromogranin A, while a few neurons were positive for neuronal nitric oxide synthase (NOS; parasympathetic nerve marker) or calretinin. Another ganglion at the base of the ascending aorta carried almost the same neuronal populations, whereas a ganglion along the left common cardinal vein contained neurons positive for chromogranin A and NOS but no or few TH-positive neurons, suggesting a site-dependent difference in composite neurons. Mixtures of sympathetic and parasympathetic neurons within a single ganglion are consistent with the morphology of the cranial base and pelvic ganglia. Most of the intracardiac neurons are likely to have a non-adrenergic non-cholinergic phenotype, whereas fewer neurons have a dual cholinergic/noradrenergic phenotype. However, there was no evidence showing that chromogranin A- and/or calretinin-positive cardiac neurons corresponded to these specific phenotypes. The present study suggested that the ganglion cardiacum was composed of a mixture of sympathetic and parasympathetic neurons, which were characterized the site-dependent differences in and near the heart.

Effect of non-surgical periodontal therapy on the degree of gingival inflammation and stress markers related to pregnancy

Abstract Objectives The purpose of this study was to determine the impact of nonsurgical periodontal therapy considering the salivary stress-related hormone and cytokine levels in the gingival crevicular fluid (GCF) on pregnant and nonpregnant women. Material and Methods Thirty non-pregnant (control group) and 30 pregnant women (test group) that met the study inclusion criteria were chosen. Only participants with gingivitis were included. Clinical data and samples of GCF and saliva were collected at baseline and after periodontal therapy. The levels of interleukin-1 beta (Κ-1β) and IL-10, and concentration of salivary chromogranin A (CgA) hormone were analyzed by enzyme-linked immunosorbent assay (ELISA). The repeated measures analysis of variance was used for intragroup and intergroup analyses. Results A major decrease in the gingival inflammation was observed in both groups after periodontal therapy (p<0.05). Periodontal treatment decreased the level of IL-1β in GCF (p<0.05) in control group, but no statistical difference was determined for GCF IL-1β in the test group. However, after periodontal therapy, the CgA hormone concentration was reduced in both groups (p<0.05). However, there was no difference in salivary CgA concentration, GCF IL-10 levels, and perceived stress scale (PSS)-10 between the groups (p>0.05). Conclusions Within the limitations of this study, periodontal therapy significantly improved the periodontal status and stress level. In addition, the severity of the gingival inflammation during pregnancy was related to stress. However, further studies will be needed to substantiate these early findings.

Pancreatic Neuroendocrine Tumor Presenting as Acute Pancreatitis / 대한소화기학회지

We report a case of acute pancreatitis secondary to pancreatic neuroendocrine tumor. A 46-year old man presented with upper abdominal pain. The serum amylase and lipase were elevated. Abdominal computed tomography (CT) and magnetic resonance cholangiopancreatography revealed a 1.7 cm sized mass at the pancreas body with a dilatation of the upstream pancreatic duct and mild infiltrations of peripancreatic fat. An endoscopic ultrasound-guided fine needle biopsy was performed for the pancreatic mass, but only necrotic tissue was observed on the pathologic examination. A chest and neck CT scan revealed anterior mediastinal, paratracheal, and cervical lymph node enlargement, which were indicative of metastasis. An ultrasound-guided core needle biopsy was performed for the enlarged neck lymph node, and pathologic examination revealed a metastatic poorly differentiated carcinoma. Immunohistochemical analysis showed positive staining for synaptophysin, chromogranin A, and CD 56, indicative of a neuroendocrine carcinoma.

An Intrarenal Adrenocortical Carcinoma Arising in an Adrenal Rest

We describe a case of a 61-year-old Korean man who was diagnosed with renal cell carcinoma that was discovered on abdominopelvic computed tomography obtained after the patient complained of back pain. A radical nephrectomy was performed, and the surgical specimen showed a relatively well-circumscribed and yellowish lobulated hard mass. Microscopically, the tumor showed sheets and nests of hypercellular pleomorphic cells with thick fibrous septation, frequent mitoses, and areas of adrenal cortical-like tissue. Immunohistochemical staining revealed that the tumor cells were positive for inhibin-α, vimentin, synaptophysin, and melan A. It also revealed that the tumor cells were negative for pan-cytokeratin, epithelial membrane antigen, paired box 8, α-methylacyl-coenzyme A racemase, CD10, cytokeratin 7, carbonic anhydrase 9, c-Kit, renal cell carcinoma, transcription factor E3, human melanoma black 45, desmin, smooth muscle actin, S-100, chromogranin A, CD34, anaplastic lymphoma kinase, and integrase interactor 1. Based on these histopathological and immunohistochemical findings, we diagnosed the tumor as intrarenal adrenocortical carcinoma arising in an adrenal rest. Several cases of intrarenal adrenocortical carcinoma have been reported, although they are very rare. Due to its poor prognosis and common recurrence or metastasis, clinicians and pathologists must be aware of this entity.

Intra-nasal mass presenting with Cushing's syndrome and CSF rhinorrhea: A case report

@#<p style="text-align: justify;">This  is  a  case  of  a  47  year-old  female  presenting  with  typical Cushingoid appearance and CSF rhinorrhea. MRI revealed a 4.4 cm x 2.9 cm x 4.5 cm enhancing intranasal mass with evidence of erosion of the left cribriform extending to the left anterior cranial fossa. Dexamethasone suppression  test  yielded  elevated  cortisol  level. Endoscopic nasal biopsy done showed a round cell tumor positive for  ACTH,  synaptophysin,  chromogranin  A,  and  S-100.  Patient subsequently  underwent  endoscopic  endonasal  excision  of  left intranasal mass with creation of pericranial flap for repair of CSF leak.  This  report  is  presented  to  discuss  a  rare  case  of  ACTH secreting esthesioneurblastoma including its diagnostic challenges and surgical options for repair of anterior cranial fossa defect to address CSF leak particularly by means of a vascularized pericranial flap.</p>

Advances of circulating biomarkers in gastroenteropancreatic neuroendocrine neoplasms / 中华胃肠外科杂志

Gastroenteropancreatic neuroendocrine neoplam (GEP-NEN) is a rare group of tumors with its incidence rising significantly in recent decades. Because of the late presentation of the disease and limitations in conventional biomarkers, about 50% of GEP-NEN patients manifests advanced disease when diagnosed. Therefore, it is vital to identify circulating biomarkers which can not only be used for early diagnosis but also accurately evaluating the biological behavior of GEP-NEN. This review summarizes the advances of circulating biomarkers in diagnosing and evaluating efficacy of treatment in GEP-NEN. Well-known circulating biomarkers include chromogranin A (CgA), pancreastatin (PST), chromogranin B (CgB), neuron-specific enolase (NSE) and pancreatic peptide(PP). Novel biomarkers including circulating tumor cell(CTC), microRNA and NETest are promising biomarkers with potential clinical benefit, but further researches are needed before their clinical applications.

Changes in serum chromogranin A and urotensin II levels in children with chronic heart failure / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To examine the changes in serum chromogranin A (CgA) and urotensin II (U II) levels in children with chronic heart failure (CHF) and their clinical significance.</p><p><b>METHODS</b>A total of 58 children with CHF, among whom 17 had endocardial fibroelastosis (EFE) and 41 had dilated cardiomyopathy (DCM), were selected as CHF group, and 20 healthy children were selected as control group. Serum levels of CgA and U II were measured using enzyme-linked immunosorbent assay, and the level of N-terminal pro-brain natriuretic peptide (NT-proBNP) was determined by bi-directional lateral flow immunoassay. Ventricular remodeling indices were measured using echocardiography. The correlation between serum CgA and U II levels and ventricular remodeling was evaluated by Pearson correlation or Spearman's rank correlation analysis.</p><p><b>RESULTS</b>There were no significant differences in serum CgA and NT-proBNP levels between children with grade II heart function and the control group (P>0.05). However, the serum CgA and NT-proBNP levels gradually increased as the heart function grade increased, and were significantly higher in grade III and IV children compared to those in the control group (P<0.05). U II levels were lower in children with grade II, III, or IV heart function than those in the control group (P<0.05), and significantly decreased with the aggravation of CHF (P<0.05). There were no significant differences in CgA and U II levels between patients with EFE and DCM (P>0.05). Serum CgA concentration was positively correlated with left ventricular mass index (LVMI), NT-proBNP, and cardiac function classification (r=0.279, 0.649, and 0.778 respectively; P<0.05), but was negatively correlated with left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS), and U II (r=-0.369, -0.322, and -0.718 respectively; P<0.05). Serum U II concentration was negatively correlated with NT-proBNP and cardiac function classification (r=-0.472 and -0.591 respectively; P<0.05), but was not correlated with LVMI, LVEF, and LVFS (P>0.05).</p><p><b>CONCLUSIONS</b>CgA may play a role in ventricular remodeling in children with CHF. Serum CgA and U II may serve as a reference for the diagnosis and functional classification of heart failure.</p>

Diagnosis of Pancreatic Neuroendocrine Tumors

Pancreatic neuroendocrine tumors (PNETs) are relatively rare; however, the incidence has increased over the last few decades. They are classified as functional or non-functional tumors according to the presence of associated clinical symptoms. The majority are non-functional tumors. For classification and staging, the World Health Organization 2010 classification system is the most commonly accepted. Chromogranin A is the most sensitive marker but has insufficient specificity. In general, PNETs are hypervascular tumors, and multiphasic contrast-enhanced computed tomography is considered the first choice for imaging study. Multiphasic magnetic resonance imaging can detect PNETs smaller than 2 cm and small liver metastasis compared with other modalities. Somatostatin receptor scintigraphy is often used in cases where functional PNETs are suspected. Positron emission tomography (PET) scan with 18F-fluorodeoxyglucose cannot visualize PNETs, but PET with 68-Ga DOTATATE can. Endoscopic ultrasonography can characterize smaller PNETs using contrast and confirm histology through fine needle aspiration or biopsy. In this article, we review the characteristics of grading systems and diagnostic modalities commonly used for PNETs.

Tumor Carcinoide de testículo / Testicular carcinoid tumor

Los tumores carcinoides de testículo son extremadamente raros, representando el 0.23% de los tumores de dicha localización. Se dividen en tres grupos: tumor carcinoide primario de testículo, teratoma de testículo con áreas de carcinoide y tumor carcinoide metastásico de otra localización. Presentamos un paciente de 52 años que consultó por dolor y tumefacción testicular. Se realizó orquiectomía derecha. LDH, alfa feto proteína y beta HCG: normales. Anatomía patológica: tumor blanco amarillento, constituido por células neoplásicas. Inmunohistoquímica: inmunofenotipo correspondiente a tumor neuroendocrino. 5HIAA urinario: normal. Centellografía con (Tc99) octreotide: normal. Se decidió control. Los tumores carcinoides primarios de testículo son infrecuentes, es fundamental descartar localizaciones primarias intestinales para confirmar el diagnóstico. Las herramientas diagnósticas más utilizadas son 5HIAA en orina y centellografía con (TC99) octreotide. El tumor carcinoide primario de testículo presenta un pronóstico favorable luego de la orquiectomía (AU)

Testicular carcinoid tumors are extremely rare. They are divided into three groups: primary testicular carcinoid tumor, testicular teratoma with areas of carcinoid and metastatic carcinoid tumor from another location. We present a 52 years old patient that was admitted with testicular pain and swelling. Right orchiectomy was performed. Serum LDH and alpha, fetoprotein and beta human chorionic gonadotropin were normal. Pathology: white yellowish tumor consisting of neoplastic cells. Immunohistochemistry: immunophenotype corresponding to neuroendocrine tumor. 5HIAA urinary and somatostatin receptor scintigraphy were normal. It was decided to control the patient. Primary testicular carcinoid tumors are uncommon. It is essential to rule out intestinal primary locations to confirm the diagnosis. The diagnostic tools used are 5 HIAA urinary and somatostatin receptor scintigraphy. The primary carcinoid tumor of the testis presents a favorable prognosis after orchiectomy (AU)

Diagnostic analysis for 52 cases of gastrointestinal neuroendocrine tumor / 中南大学学报(医学版)

OBJECTIVE@#To investigate the clinical features, diagnosis, treatments and prognosis for gastrointestinal neuroendocrine tumors (GI-NETs).
@*METHODS@#Clincal data of 52 patients, who were diagnosed as GI-NETs between January 2004 and October 2014, were reviewed. The patients were divided into a local excision group (n=21) and a transabdominal excision group (n=30), and the major clinical features, treatment modalities and outcomes were analyzed.
@*RESULTS@#The clinical features of GI-NETs were nonspecific, and most of the clinical manifestation were local invasiveness. CT scan was lack of specific findings. GI-NETs greater than 1 cm often showed local incrassation, upheaval and soft tissue shadow. In the case of lager GI-NETs, necrosis and moderate enhancement could be seen. Positive ratio for expression of chromogranin A (CgA) and synaptophysin (Syn) in the 52 cases of specimen were 63.5% and 88.5%, respectively. Except 1 patient, whose surgery was canceled because of poor health, other 51 patients were treated with surgery through different approaches. Among them, 30 cases were transabdominal resection (57.7%) and 21 were local resection (40.4%). Chemotherapy and/or radiotherapy was only applied for 7 patients. After a follow-up of 40 (3-132) months, 7 patients died, the rest were alive. The median survival in the local resection group and the transabdominal resection group was 43.0 and 39.5 months, respectively (P>0.05).
@*CONCLUSION@#Under the condition of fully understanding the biological characteristics of GI-NETs, early diagnosis and timely personalized treatment is hopeful to reach the relative good prognosis and survival.

Association of neuroendocrine differentiation with progression and prognosis of gastric adenocarcinoma / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate the association of neuroendocrine differentiation with progression and prognosis of gastric adenocarcinoma.</p><p><b>METHODS</b>Clinicopathological data of 240 patients with gastric adenocarcinomas were retrospectively analyzed. The expression of chromogranin A, synaptophysin and secrectagogin in cancer tissue was assessed by immunohistochemistry. The association of neuoroendocrine differentiation parameters with disease progression and survival of patients was analyzed.</p><p><b>RESULTS</b>The expression of synaptophysin was positively correlated with depth of invasion and secretagogin more often expressed in cases with lymph node metastasis. In Lauren diffuse type of cancer, expression of chromogranin A and secretagogin was unfavorable prognostic predictor. In TNM stage II adenocarcinoma, expression of chromogranin A and synaptophysin related to poor survival, and multivariate Cox proportional hazard model showed that synaptophysin was an independent predictor for poor survival.</p><p><b>CONCLUSION</b>Neuroendocrine differentiation predicts deeper depth of invasion, more possibility of lymph node metastasis and poor survival in gastric adenocarcinoma.</p>

A Case of Endoscopically Complete Remission of Esophageal Neuroendocrine Tumors by Concurrent Chemoradiation Therapy / 대한소화기학회지

Neuroendocrine tumors (NETs) of the esophagus are extremely rare, aggressive and have a poor prognosis. Combined therapy using chemotherapy, radiotherapy and/or surgery appear effective. Here, we present a patient with a complaint of dysphagia who was diagnosed with this rare tumor. Upper gastrointestinal endoscope of a 46-year-old female revealed a localized ulcerative lesion in the middle esophagus. Histologic exam of biopsy specimens indicated a neuroendocrine carcinoma. The tumor cells were arranged in microtubular structures, with small and round cells containing scanty cytoplasm. They were positive for synaptophysin and chromogranin A on immunohistochemical staining. A computed tomography scan showed an esophageal tumor with enlarged superior mediastinal lymph nodes and about 1.2 cm sized liver metastasis, similar to findings in PET-CT scanning. The patient was prescribed chemotherapy consisting of etoposide and cisplatin, which led to regression of disease on follow-up imaging study. She continues under clinical observation. We seek to increase awareness of this exceedingly rare but hazardous disease by sharing our unexpected finding.

The Role of Plasma Chromogranin A as Assessment of Treatment Response in Non-functioning Gastroenteropancreatic Neuroendocrine Tumors / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Chromogranin A (CgA) has been considered to be valuable not only in the diagnosis but also in monitoring the disease response to treatment. However, only a few studies have been published on this issue. We purposed to evaluate whether biochemical response using plasma CgA level is reliable in concordance with the clinical response of grade 1-3 nonfunctiong gastroenteropancreatic neuroendocrine tumors (GEP-NETs). MATERIALS AND METHODS: Between March 2011 and September 2013, a total of 27 cases in 18 patients were analysed, clinically and radiologically while serial CgA tests were also conducted during treatment. Tumor responses were defined by both Response Evaluation Criteria in Solid Tumors (RECIST) criteria ver. 1.1 and biochemical criteria based on the CgA level. RESULTS: Among the 27 cases analysed, no difference in the basal CgA level was observed with regard to gender, primary tumor site, tumor grade (World Health Organization classification), liver metastasis, number of metastatic site, and line of chemotherapy. The overall response rate (RR) by RECIST criteria ver. 1.1 was six out of the 27 cases (22.2%) and eight out of the 27 cases (29.6%) for biochemical RR. The overall concordance rates of the response based on RECIST and biochemical criteria were 74%. In grades 1 and 2 GEP-NETs (n=17), the concordance rate of the disease control was 94.1%. There was a significant difference for progression-free survival (PFS) between responders and non-responder in accordance to biochemical criteria (35.73 months vs. 5.93 months, p=0.05). CONCLUSION: This study revealed that changes of the plasma CgA levels were associated with tumour response. Additionally, biochemical response based on serial CgA may be a predictive marker for PFS in GEP-NETs.

A Calcitonin-Negative Neuroendocrine Tumor Derived from Follicular Lesions of the Thyroid

Neuroendocrine lesions of the thyroid are rare. The most common types are medullary thyroid carcinomas (MTCs) and C-cell hyperplasia. MTCs originate from thyroid parafollicular cells that secrete calcitonin which serves as a serum marker of MTCs. Here, the rare case of a calcitonin-negative neuroendocrine tumor (NET) derived from follicular lesions of the thyroid is described. A 34-year-old man presented at our hospital for the surgical management of an incidental thyroid nodule that was observed on an ultrasound sonography (USG) of the neck. Initially, USG-guided aspiration cytology was performed, and a MTC was suspected. The expressions of thyroglobulin and thyroid transcription factor-1, which are thyroid follicular cell markers, and synaptophysin and chromogranin A, which are neuroendocrine markers, was confirmed following surgical pathology. However, the staining of calcitonin, a marker of MTCs, was not observed. A nonmedullary NET of the thyroid is uncommon, and the distinction between calcitonin-negative NETs and MTCs of the thyroid may be important due to differences in their clinical courses and management.