Clinical characteristics of primary parathyroid adenoma and its relationship with coexisting papillary thyroid carcinoma: a clinical retrospective study.

Background: Parathyroid adenoma (PA) is a common but relatively poorly understood endocrine tumor. A significant number of PA patients also have papillary thyroid carcinoma (PTC). The clinicopathological characteristics of PA and its relationship with PTC need further study. Methods: The clinical data of 99 PA patients were reviewed and the clinicopathologic features of PA were analyzed. PTC occurred in 22 PA patients. The clinicopathologic features of 22 patients with PA + PTC and 77 patients with PA alone were compared. According to age, gender and thyroid surgery methods, 22 PA + PTC patients were matched with 1,123 patients with PTC alone during the same period. The pathological characteristics of the two groups of patients were compared. All data analysis was performed using SPSS23.0, variables were compared by t-test, chi square test or Mann Whitney U-test as appropriate. Results: Ninety-nine PA patients (21 males, 78 females) with a median age of 51 [10-80] years were included. The preoperative parathyroid hormone (PTH) (P=0.007) and preoperative blood calcium (P=0.036) of male patients were higher than those of female patients, and the proportion of asymptomatic patients (P=0.008) and postoperative PTH level (P=0.013) were lower. The preoperative PTH level (P=0.002), preoperative blood calcium level (P=0.004), preoperative alkaline phosphatase (ALP) level (P=0.018) and postoperative PTH levels (P=0.023) in PA + PTC group were lower than those in PA group. The asymptomatic rate was higher in PTC + PA group than that in PA group (P<0.001). There was no statistical difference between PA + PTC group and PTC group in multifocal tumor, capsule invasion, lymph node metastasis (P>0.05). The lymph node metastasis rate in PA + PTC group (9/215) was significantly lower than that in PTC group (37/337) (P=0.005). Conclusions: PA exhibited the following characteristics: occurred in all age groups; more common in women but more severe in men; more located in the lower pole. The coexistence of PTC and PA did not promote the progression of PA, nor did it increase the aggressiveness of PTC. Conversely, their co-existence may lead to early diagnosis of the disease. PA patients (22.2%) also have PTC, so surgeons should pay attention to thyroid disease to prevent the need for reoperation.

Case report and literature review: Malignant adenomyoepithelioma after breast augmentation.

Background: Breast malignant adenomyoepithelioma (MAME) after breast augmentation has never been reported. Case summary: We reported a case of a 55-year-old woman who was diagnosed with breast MAME 16 years after breast augmentation. Breast augmentation was performed on the patient with two 200 ml round textured prostheses in the subpectoral plane through axillary incisions in 2004. However, a breast ultrasound in 2020 revealed a suspicious malignant lump in the right breast, which was finally confirmed as MAME by pathology. Skin-sparing modified radical mastectomy and immediate breast reconstruction with expander implantation were performed. Subsequently, the patient received three cycles of chemotherapy with the regimen of anthracycline and cyclophosphamide. In the following nearly 2 years of follow-up, no tumor recurrence and metastasis were found, and the overall treatment was satisfactory for the patient. Conclusion: Here, we present a unique case in which a patient was diagnosed with breast MAME after breast augmentation. Skin-sparing modified radical mastectomy and immediate breast reconstruction with expander implantation are feasible approaches that yield at least short-term oncological safety and acceptable aesthetic results. However, whether there is a potential relationship between MAME and breast implants remains to be further explored. Meanwhile, due to the rarity of breast MAME, more authoritative strategies considering both oncological safety and aesthetics to seek better long-term therapeutic effects are needed.

HDAC5 Loss Enhances Phospholipid-Derived Arachidonic Acid Generation and Confers Sensitivity to cPLA2 Inhibition in Pancreatic Cancer.

HDAC5 is a class IIa histone deacetylase member that is downregulated in multiple solid tumors, including pancreatic cancer, and loss of HDAC5 is associated with unfavorable prognosis. In this study, assessment of The Cancer Genome Atlas pancreatic adenocarcinoma dataset revealed that expression of HDAC5 correlates negatively with arachidonic acid (AA) metabolism, which has been implicated in inflammatory responses and cancer progression. Nontargeted metabolomics analysis revealed that HDAC5 knockdown resulted in a significant increase in AA and its downstream metabolites, such as eicosanoids and prostaglandins. HDAC5 negatively regulated the expression of the gene encoding calcium-dependent phospholipase A2 (cPLA2), the key enzyme in the production of AA from phospholipids. Mechanistically, HDAC5 repressed cPLA2 expression via deacetylation of GATA1. HDAC5 knockdown in cancer cells enhanced sensitivity to genetic or pharmacologic inhibition of cPLA2 in vitro and in vivo. Fatty acid supplementation in the diet reversed the sensitivity of HDAC5-deficient tumors to cPLA2 inhibition. These data indicate that HDAC5 loss in pancreatic cancer results in the hyperacetylation of GATA1, enabling the upregulation of cPLA2, which contributes to overproduction of AA. Dietary management plus cPLA2-targeted therapy could serve as a viable strategy for treating HDAC5-deficient pancreatic cancer patients. SIGNIFICANCE: The HDAC5-GATA1-cPLA2-AA signaling axis regulates sensitivity to fat restriction plus cPLA2 inhibition in pancreatic ductal adenocarcinoma, proposing dietary management as a feasible strategy for treating a subset of patients with pancreatic cancer.

Real-time intraoperative near-infrared autofluorescence imaging to locate the parathyroid glands: A preliminary report.

Identification and localization of parathyroid glands (PGs) remains a challenge for surgeons. The aim of this study was to evaluate the efficiency of intraoperative near-infrared autofluorescence (NIRAF) imaging to detect PGs in thyroid and parathyroid diseases. Seventy-six patients undergoing surgery for thyroid or parathyroid diseases between July 9, 2020 and August 20, 2021 were retrospectively analyzed. Intraoperative carbon nanoparticle (CN) negative imaging and handheld NIRAF imaging were successively performed for each patient. Of 206 PGs that needed to be identified for surgery, 162 were identified by NIRAF imaging, with a theoretical rate of identification of 78.64%. This was higher than the rate of identification with CN negative imaging, which was 75.73%. The number of PGs identified by NIRAF imaging and CN negative imaging did not differ significantly in either total thyroidectomy or thyroid lobectomy. In addition, the autofluorescence (AF) intensity of secondary parathyroid adenoma was weaker than that of normal PGs. NIRAF imaging is potentially a more efficient tool for identification of PGs than CN negative imaging, with a shorter learning curve and lower risk. It may not be well-suited to secondary hyperthyroidism or adenoma, but it was more efficient at identifying excised specimens than visual identification by a surgeon.