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1.
Front Endocrinol (Lausanne) ; 13: 756855, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35498411

RESUMO

Acromegaly is a systemic disease that requires multidisciplinary treatment to achieve the best clinical outcome. This study aimed to evaluate the outcomes of the endoscopic transsphenoidal approach (TSA) as the primary treatment for somatotroph adenomas and further investigate patients who had suboptimal surgical results. This retrospective study included 83 patients with somatotroph adenomas treated by TSA at our institution from 1999 to 2010. Biochemical remission was defined as hGH <1 and <2.5 ng/ml. Factors associated with failure of TSA and strategy of secondary treatments for refractory and recurrent disease were analyzed. The mean age of patients was 41.1 ± 11.3 years, and the mean follow-up time was 54.2 ± 44.3 months. Approximately 44.5% of patients had residual tumors after TSA. Larger tumor size, higher GH level before the operation, and the existence of residual tumors were associated with TSA failure. Forty-one patients had an inadequate response to TSA or a recurrent lesion, and of these patients, 37 had residual tumor after TSA. Octreotide results in good outcomes in the treatment of DGSA patients, and SRS/EXRT generates good results in treating patients who receive second treatments when remission cannot be reached 6 months after TSA operation.


Assuntos
Adenoma , Adenoma Hipofisário Secretor de Hormônio do Crescimento , Hipopituitarismo , Adenoma/cirurgia , Adulto , Adenoma Hipofisário Secretor de Hormônio do Crescimento/cirurgia , Humanos , Pessoa de Meia-Idade , Neoplasia Residual , Estudos Retrospectivos , Resultado do Tratamento
2.
Neuroimaging Clin N Am ; 32(2): 413-431, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35526965

RESUMO

Parathyroid imaging is predominantly used for preoperative localization of parathyroid lesions in patients with the biochemical diagnosis of primary hyperparathyroidism. Although imaging algorithms vary, in the era of minimally invasive parathyroidectomy for single parathyroid adenomas, multiphase parathyroid computed tomography (CT) (4-dimensional CT) has emerged as a favored modality for presurgical mapping of parathyroid lesions. Implementation and correct interpretation of these studies can be challenging, although confidence and accuracy improve with experience and volume. This article reviews our approach to parathyroid imaging, focusing on pearls and pitfalls in parathyroid CT with ultrasound as a supportive and complementary modality.


Assuntos
Adenoma , Hiperparatireoidismo Primário , Neoplasias das Paratireoides , Adenoma/diagnóstico por imagem , Adenoma/patologia , Adenoma/cirurgia , Tomografia Computadorizada Quadridimensional/métodos , Humanos , Hiperparatireoidismo Primário/diagnóstico por imagem , Hiperparatireoidismo Primário/cirurgia , Glândulas Paratireoides/diagnóstico por imagem , Glândulas Paratireoides/patologia , Glândulas Paratireoides/cirurgia , Neoplasias das Paratireoides/diagnóstico por imagem , Neoplasias das Paratireoides/patologia , Neoplasias das Paratireoides/cirurgia
3.
Front Endocrinol (Lausanne) ; 13: 864780, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35528020

RESUMO

The small RWD domain-containing protein called RSUME or RWDD3 was cloned from pituitary tumor cells with increasing tumorigenic and angiogenic proficiency. RSUME expression is induced under hypoxia or heat shock and is upregulated, at several pathophysiological stages, in tissues like pituitary, kidney, heart, pancreas, or adrenal gland. To date, several factors with essential roles in endocrine-related cancer appear to be modulated by RWDD3. RSUME regulates, through its post-translational (PTM) modification, pituitary tumor transforming gene (PTTG) protein stability in pituitary tumors. Interestingly, in these tumors, another PTM, the regulation of EGFR levels by USP8, plays a pathogenic role. Furthermore, RSUME suppresses ubiquitin conjugation to hypoxia-inducible factor (HIF) by blocking VHL E3-ubiquitin ligase activity, contributing to the development of von Hippel-Lindau disease. RSUME enhances protein SUMOylation of specific targets involved in inflammation such as IkB and the glucocorticoid receptor. For many of its actions, RSUME associates with regulatory proteins of ubiquitin and SUMO cascades, such as the E2-SUMO conjugase Ubc9 or the E3 ubiquitin ligase VHL. New evidence about RSUME involvement in inflammatory and hypoxic conditions, such as cardiac tissue response to ischemia and neuropathic pain, and its role in several developmental processes, is discussed as well. Given the modulation of PTMs by RSUME in neuroendocrine tumors, we focus on its interactors and its mode of action. Insights into functional implications and molecular mechanisms of RSUME action on biomolecular modifications of key factors of pituitary adenomas and renal cell carcinoma provide renewed information about new targets to treat these pathologies.


Assuntos
Adenoma , Neoplasias Hipofisárias , Adenoma/metabolismo , Humanos , Hipóxia , Neoplasias Hipofisárias/metabolismo , Fatores de Transcrição/metabolismo , Ubiquitinas
4.
Horm Metab Res ; 54(5): 294-299, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35533674

RESUMO

Work up of adrenal masses includes assessment of endocrine activity and malignancy risk. There is no indication for surgical removal of nonfunctional adrenal adenomas, according to the guidelines. In the present study, we aimed at evaluating the impact of a university endocrine tumor board on the quality of the indications for adrenal surgery at our institution. One hundred consecutive patients receiving primary adrenal surgery at the University Hospital of Cologne, Germany were included. Their demographics, clinic-pathologic characteristics, treatment and outcome were analyzed. In 55 (55%) cases, indication for surgery consisted in functional benign tumors, including Conn, Cushing adenomas and pheochromocytomas. Forty (40%) tumors were referred to surgery for malignancy suspicion and 5 (5%) myelolipomas were removed due to their size. Eighty-nine percent of surgeries were performed as minimally invasive procedures. Overall morbidity included two (2%) self-limiting pancreatic fistulas after left laparoscopic adrenalectomy for pheochromocytoma. All functional tumors were confirmed benign by final histology. Only 33 (82.5%) of 40 suspicious cases turned out to be malignant. Consequently, nonfunctional benign adenomas were "unnecessarily" removed in only 7 (7%) patients, with 6 (85.7%) of them having a history of extra-adrenal cancer and all of them fulfilling criteria for surgery, according to the international guidelines. In conclusion, the endocrine tumor board provided an excellent adherence to the guidelines with most surgeries being performed either for functional or malignant tumors. In nonfunctional tumors with history of extra adrenal cancer, CT guided biopsy might be considered for obviating surgery.


Assuntos
Adenoma , Neoplasias das Glândulas Suprarrenais , Laparoscopia , Feocromocitoma , Adenoma/patologia , Neoplasias das Glândulas Suprarrenais/patologia , Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia , Humanos , Laparoscopia/métodos , Feocromocitoma/patologia , Feocromocitoma/cirurgia
5.
BMC Gastroenterol ; 22(1): 221, 2022 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-35508985

RESUMO

BACKGROUND: Sporadic gastric foveolar-type adenomas are extremely rare and are usually small, flat or slightly raised lesions that occur in the oxyntic mucosa. CASE PRESENTATION: We reported here a case of a 70-year-old female with a sporadic gastric foveolar-type adenoma occurring in the mucosa at the junction of the gastric body/antrum. The adenoma was a protruding lesion of 2 × 1.8 cm sized, causing symptoms of upper gastrointestinal bleeding, and the basal and surrounding mucosa showed pseudopyloric gland metaplasia without atrophy, intestinal metaplasia, H. pylori infection, or active inflammation. It had somatic mutations in both APC and KRAS genes. CONCLUSIONS: This is the first reported case of a large sporadic gastric foveolar-type adenoma that occurred in the mucosa of pseudopyloric gland metaplasia and with Gastritis Cystica Profunda, which modify our understanding of the morphological features and molecular underpinnings of this type of lesion.


Assuntos
Adenoma , Cistos , Gastrite , Neoplasias Gastrointestinais , Infecções por Helicobacter , Helicobacter pylori , Neoplasias Gástricas , Adenoma/patologia , Pólipos Adenomatosos , Idoso , Cistos/patologia , Feminino , Mucosa Gástrica/patologia , Gastrite/patologia , Neoplasias Gastrointestinais/patologia , Infecções por Helicobacter/complicações , Infecções por Helicobacter/patologia , Humanos , Metaplasia/patologia , Neoplasias Gástricas/genética , Neoplasias Gástricas/patologia
6.
Artigo em Alemão | MEDLINE | ID: mdl-35523168

RESUMO

Tumors originating from eccrine glands are rare findings in dogs and cats. In most cases, the tumors are malignant, while adenomas are only reported anecdotally. In the present case, a one-year-old female, spayed cat was presented with a swelling of the footpad of the right forelimb. Initially, the mass possessed a diameter of 2 cm which progressed to 4 cm within the following two months. At the latter time point the tumor was ulcerated. After surgical removal, histological and immunohistochemical analyses were performed. Histologically, a well demarcated, nodular, multilobular mass was present. The cuboidal to columnar neoplastic cells were arranged in tubular and acinar structures. Tumor cells possessed large, round to oval nuclei with moderately distinct nucleoli. Mitotic figures averaged 0-1 per high power field. Additionally, large areas of chondroid metaplasia were evident. Immunohistochemically, neoplastic cells were positive for pan-cytokeratin AE1/AE3 whereas thyroid transcription factor 1 (TTF1) was not expressed. Based on the histological and immunohistochemical findings an adenoma of the eccrine glands was diagnosed.


Assuntos
Adenoma , Doenças do Gato , Doenças do Cão , Adenoma/diagnóstico , Adenoma/cirurgia , Adenoma/veterinária , Animais , Doenças do Gato/diagnóstico , Doenças do Gato/cirurgia , Gatos , Doenças do Cão/diagnóstico , Doenças do Cão/cirurgia , Cães , Feminino
7.
Ugeskr Laeger ; 184(18)2022 May 02.
Artigo em Dinamarquês | MEDLINE | ID: mdl-35506619

RESUMO

This review summarizes the work-up and treatment of gastric polyps. Fundic gland polyps can be identified macroscopically, and they generally bear no malignancy potential. Hyperplastic polyps and adenomas require histology to be diagnosed. Adenomas should always be resected, whereas resection of hyperplastic polyps is recommended if they bear atypical features. Eradication of concomitant Helicobacter pylori is recommended as it may causes regression of the polyp(s). Standardized biopsies from the surrounding mucosa should be taken on the smallest indication. The discovery of adenomas or dysplasia calls for a one-year followup.


Assuntos
Adenoma , Pólipos Adenomatosos , Infecções por Helicobacter , Neoplasias Gástricas , Adenoma/complicações , Pólipos Adenomatosos/complicações , Pólipos Adenomatosos/patologia , Infecções por Helicobacter/complicações , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/tratamento farmacológico , Humanos , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia
8.
Appl Immunohistochem Mol Morphol ; 30(5): 389-396, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35510774

RESUMO

Loss of CD56 expression has been regarded as a diagnostic marker of papillary thyroid carcinoma (PTC). However, certain variants of PTC can aberrantly express CD56. Using a digital image analysis tool, we evaluated H-scores of CD56 immunostaining in 216 thyroid tumors. The H-score of the CD56 of all PTCs was lower than that of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) (P<0.001). The H-scores of CD56 were lower in classic PTC, the infiltrative follicular variant, and the diffuse sclerosing variant than in other PTC variants (P<0.001), whereas the H-scores were higher in tall cell variant, Warthin-like variant, and cribriform-morular variant than in classic PTC (P<0.001). The optimal cutoff value of H-scores for the CD56 expression was 180 for differentiating the NIFTP from the follicular adenoma and 30 for the differential diagnosis of NIFTP and infiltrative follicular variant PTC. CD56 expression is predominantly lost in classic and infiltrative follicular variants of PTCs and more preserved in the other histologic subtypes of PTC and NIFTP. CD56 is particularly useful for differentiating PTC from follicular-pattern thyroid neoplasms, but the aberrant expression in uncommon variants of PTC could be a diagnostic pitfall.


Assuntos
Adenocarcinoma Folicular , Adenoma , Neoplasias da Glândula Tireoide , Adenocarcinoma Folicular/metabolismo , Adenoma/diagnóstico , Diagnóstico Diferencial , Humanos , Câncer Papilífero da Tireoide/metabolismo , Neoplasias da Glândula Tireoide/metabolismo
9.
J Healthc Eng ; 2022: 8280540, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35494529

RESUMO

The incidence of pituitary adenoma is second only to glioma and meningioma, and its incidence ranks third among intracranial tumors. Most pituitary adenomas are benign and noninvasive tumors, but invasive pituitary adenomas pose a great threat to human health. In order to explore the risk factors that affect the clinical aggressive behavior of patients with pituitary adenoma, analyze the correlation between different classification methods and clinical aggressive behavior, and lay the foundation for early judgment and individualized treatment of clinical aggressive behavior of patients with pituitary adenoma. We conducted statistical research on patients who were treated for pituitary adenomas in the city's Yangzhou Hongquan Hospital. The results of the study showed that six patients in this study showed aggressiveness in the clinical symptomatic outcome, six patients showed aggressiveness in the serological outcome, and seven patients showed aggressiveness in imaging. In the multimodal classification, the clinical aggressiveness of pituitary adenomas in the invasion + atypical group was significantly higher than that in other groups, and the difference was statistically significant (P < 0.05). The correlation analysis of magnetic resonance imaging features and prognosis of invasive pituitary adenomas were verified to be feasible for the treatment of patients.


Assuntos
Adenoma , Neurocirurgia , Neoplasias Hipofisárias , Adenoma/diagnóstico por imagem , Adenoma/patologia , Adenoma/cirurgia , Hospitais , Humanos , Imageamento por Ressonância Magnética , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias/cirurgia , Prognóstico
10.
Front Endocrinol (Lausanne) ; 13: 848762, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35370935

RESUMO

Objective: To investigate the clinicopathologic features of pituitary adenoma with neuronal differentiation. Methods: Four patients with mixed gangliocytoma-pituitary adenomas between January 2011 and January 2021 and 111 new-onset patients with adenomas between January 2019 and June 2021 who attended the First Affiliated Hospital of Fujian Medical University were included in the study. The histological and immunohistochemical findings were analyzed. Neuronal differentiation marker staining was performed on new-onset adenomas, and the related literature was reviewed. Results: Altogether, more than 100 mixed gangliocytoma-pituitary adenoma cases have been reported in the literature until now, of which pituitary-specific POU-class homeodomain transcription 1 (PIT1) positive adenomas are more frequently observed. In the present study, all 4 patients we described were female, aged 29 to 53 years (mean 39 years). Clinically, 3/4 patients presented with acromegaly, and 1/2 patients presented with headache. Histologically, the tumor was composed of two distinct mixed components. The one was a population of neoplastic ganglionic cells with large nuclei, prominent nucleoli, and abundant basophilic cytoplasm embedded in a fibrillary background. Stains of chromograninA (CgA), synaptophysin (Syn), Calretinin (CR) were positive. Axotomy-like expression was observed in neurofilament (NF) staining. PIT1 was expressed in partial ganglionic cells in all cases. The other component was a population of small uniform cells with round nuclei and acidophilic cytoplasm. Prolactin (PRL) and growth hormone (GH) were positive in all 4 cases. PIT1 was positive in the nuclei of adenomas. Although adenomas and ganglionic regions varied in histology, there was a population of cells with neuronal differentiation expressing PIT1. Additionally, axotomy-like expression of NF staining could be seen in a distant area of adenoma regions. A total of 111 cases of adenomas without ganglionic cells were included in this study, including 7 cases with neuronal differentiation. Among them, 4 cases were prolactinomas, 2 cases were somatotroph adenomas, and 1 case was corticotroph adenoma. 6/7 cases were PIT1-positive adenomas. And the remaining one case is T-PIT-positive adenoma. Conclusions: Mixed gangliocytoma-pituitary adenomas are rare tumors with neuronal differentiation. The majority of MGAs are associated with endocrinopathies, mainly acromegaly. Our results suggest that PIT1-positive pituitary adenomas may have neural differentiation potential, which may not be unusual. This indication supports the possibility that the neuronal transdifferentiation of adenomatous cells is a possible mechanism, and the underlying mechanism requires further elucidation.


Assuntos
Acromegalia , Adenoma , Ganglioneuroma , Neoplasias Hipofisárias , Adenoma/patologia , Adulto , Feminino , Ganglioneuroma/genética , Ganglioneuroma/patologia , Humanos , Imuno-Histoquímica , Pessoa de Meia-Idade , Neoplasias Hipofisárias/patologia
11.
BMC Med Imaging ; 22(1): 60, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35365091

RESUMO

INTRODUCTION: Maintaining the pituitary function after surgery is highly important. The aim of this study was to investigate the relationship between preoperative magnetic resonance imaging (MRI) characteristics and pituitary function after surgery of non-functional pituitary macroadenoma. METHODS: This retrospective study was performed between 2016 and 2018. Preoperative and postoperative MRI imaging data were retrieved from electronic registration system. The relationship between preoperative MRI characteristics and postoperative pituitary function as well as reconstruction of pituitary gland was investigated using regression models. RESULTS: Complete data were available for 44 patients. Before surgery, invisible normal tissue was observed in 23 patients (53.5%). Suprasellar extension and cavernous sinus invasion were seen in 36 patients (each one 49.1%). There was a significant reverse relationship between preoperative tumor size and postoperative thyroid stimulating hormone (TSH) (odds ratio (OR): - 0.99 (- 0.18, - 0.003), p = 0.04). In addition, we found a significant positive correlation between prolactin level after surgery and tumor size before surgery, (OR: 5.29 (1.65, 8.92), p = 0006). Moreover, postoperative panhypopituitarism was observed in 25% of patients with complete morphologic reconstitution of pituitary tissue. While the rate was 50% in patients with no or partial morphologic reconstruction of pituitary tissue. CONCLUSION: Preoperative MRI characteristics predict TSH and prolactin level after operation. Furthermore, the adenoma size and volume prior to surgery are the main determinants of normal morphologic reconstruction of pituitary gland.


Assuntos
Adenoma , Neoplasias Hipofisárias , Adenoma/diagnóstico por imagem , Adenoma/patologia , Adenoma/cirurgia , Humanos , Imageamento por Ressonância Magnética , Hipófise/diagnóstico por imagem , Hipófise/patologia , Hipófise/cirurgia , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias/cirurgia , Estudos Retrospectivos
12.
Otolaryngol Clin North Am ; 55(2): 343-350, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35365312

RESUMO

Nonfunctioning pituitary lesions represent a subset of pituitary adenomas that do not manifest with clinical features of hormone hypersecretion. Because of their indolent nature, their diagnosis is elusive, often resulting in presentation after the tumors have grown large enough to cause compressive symptoms. Although they are clinically silent, the various subtypes correspond to the predominant cell line of origin and therefore are biochemically distinct from one another. This article reviews the biochemical, clinical, and histopathologic features of each of these subtypes. A rubric is provided for diagnostic work-up of these lesions and the management options available to the treating clinician.


Assuntos
Adenoma , Neoplasias Hipofisárias , Adenoma/terapia , Humanos , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/metabolismo , Neoplasias Hipofisárias/terapia
13.
Otolaryngol Clin North Am ; 55(2): 351-379, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35365313

RESUMO

Giant pituitary adenomas (GPAs) comprise 5% to 15% of pituitary adenomas, but have higher rates of extrasellar invasion, subtotal resection, surgical morbidity, and recurrence. With the possible exception of giant prolactinomas, GPAs require surgical decompression. On review of 3 decades of case series encompassing 699 microsurgical transsphenoidal (MT), 1060 endoscopic endonasal trans-sphenoidal (EET), and 513 transcranial (TC) patients, gross total resection and recurrence rates were comparable across modalities, but the EET approach had lower perioperative mortality and superior restoration of visual function. Each approach has unique indications. Combined EET-TC approaches for minimizing residual tumor represent another area of study.


Assuntos
Adenoma , Neoplasias Hipofisárias , Adenoma/cirurgia , Endoscopia , Humanos , Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
14.
Otolaryngol Clin North Am ; 55(2): 411-420, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35365314

RESUMO

Developed over 50 years ago, the microscopic transsphenoidal approach is a simple, efficient technique with proven efficacy for the surgical treatment of an array of sellar and parasellar diseases. Although utilization of fully endoscopic transsphenoidal approaches has dramatically increased recently because it offers enhanced visualization, current outcomes data do not clearly favor either approach. Potential advantages of the microscope that persist in the endoscopic era include decreased operative time; preservation of a single-surgeon, unobstructed, twohanded microsurgical technique; and limited disruption of the nasal mucosa. Endoscope-assisted microsurgical approaches can also be used to overcome limitations in visualization while preserving the aforementioned advantages.


Assuntos
Adenoma , Neoplasias Hipofisárias , Adenoma/cirurgia , Endoscopia/métodos , Humanos , Microscopia , Microcirurgia/métodos , Neoplasias Hipofisárias/cirurgia
15.
Trials ; 23(1): 345, 2022 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-35461237

RESUMO

BACKGROUND: Colorectal adenomas (CRAs) are precancerous lesions of the large intestine presenting as colorectal polyps. At present, the conventional treatment methods for CRA mainly include high-frequency electrocoagulation and electroexcision, biopsy forceps polypectomy, cauterization by laser and microwave, and other endoscopic interventions. The principal advantages conferred by these treatment strategies include less trauma, quick postoperative recovery, and simplicity to perform. However, the higher recurrence rates and insignificant improvement of postoperative symptoms after endoscopic surgery are considerable drawbacks to this approach. Besides, there is currently no effective pharmacotherapy to prevent the recurrence of CRA. Jianpi Lishi Jiedu (JLJ) granules are a form of traditional Chinese medicine (TCM) used to manage postoperative patients with CRA, which has shown a certain degree of efficacy in clinical practice. However, its effectiveness and safety profile have not been convincingly evaluated. The purpose of this study is to evaluate the clinical efficacy and safety profile of JLJ granules in the management of postoperative patients with CRA and to observe the recurrence rate of adenoma in these patients. METHODS: A randomized, double-blind, and placebo-controlled clinical trial is performed in this study. A total of 80 postoperative patients with CRA will be randomly classified into the Jianpi Lishi Jiedu granules group or the placebo control group. Patients in both groups shall receive 3 months of intervention, after which medical follow-up and safety evaluation will be performed for all of the patients. The primary outcome is the recurrence rate of adenomas within 12 months. The secondary outcomes are the cardinal TCM symptom scores, minor TCM symptom scores, Bristol Stool Scale, efficacy of TCM symptoms, safety indicators, and blinding assessment. DISCUSSION: In this study, the impact on the recurrence of adenomas and the efficacy and safety of JLJ granules in terms of improving the clinical symptoms of postoperative patients with CRA will be evaluated. TRIAL REGISTRATION: Trial registration Chinese Clinical Trial Registry ChiCTR 2100044297. Registered on March 16, 2021.


Assuntos
Adenoma , Neoplasias Colorretais , Medicamentos de Ervas Chinesas , Adenoma/tratamento farmacológico , Adenoma/cirurgia , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/cirurgia , Método Duplo-Cego , Medicamentos de Ervas Chinesas/efeitos adversos , Humanos , Medicina Tradicional Chinesa , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
16.
Sci Rep ; 12(1): 6529, 2022 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-35444169

RESUMO

Hormone-secreting adenomas are treated in many neurosurgical centers within Europe. The goal of the survey is to understand variance in practice management of pituitary tumors amongst neurosurgical centers. A list of departments performing pituitary surgery was created. The survey consisted of 58 questions. This study focuses on neurosurgical care of hormone-secreting adenomas. For analysis, the departments were divided into four subgroups: academic/non-academic, high-volume/low-volume, "mainly endoscopic/mainly microscopic practice" and geographical regions. Data from 254 departments from 34 countries were obtained. Most centers surgically treat 1-5 hormone-secreting adenomas per year. In prolactinomas this is the case in 194 centers, (76.4%), in GH-secreting adenomas: 133 centers, (52.4%), ACTH-secreting adenomas: 172 centers, (69.8%). Surgery as a primary treatment of prolactinomas is considered in 64 centers (25.2%). In 47 centers (18.8%), GH-secreting microadenomas are often treated pharmacologically first. Debulking surgery for an invasive GH-secreting adenoma in which hormonal remission is not a realistic goal of the surgery and the patient has no visual deficit surgery is always or mostly indicated in 156 centers (62.9%). Routine postoperative hydrocortisone replacement therapy is administered in 147 centers (58.6%). Our survey shows that in most centers, few hormone-secreting adenomas are treated per year. In about 25% of the centers, prolactinoma surgery may be regarded as first-line treatment; in about 20% of the centers, medical treatment is the first-line treatment for GH-secreting adenomas. Pretreatment for ACTH-secreting adenomas is routinely used in 21% of centers. This survey may serve as plea for neurosurgical care centralization of hormone-secreting adenomas.


Assuntos
Adenoma , Neoplasias Hipofisárias , Prolactinoma , Adenoma/patologia , Adenoma/cirurgia , Hormônio Adrenocorticotrópico , Humanos , Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias/cirurgia , Prolactinoma/patologia , Prolactinoma/cirurgia , Estudos Retrospectivos
17.
Pathologica ; 114(2): 164-169, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35481568

RESUMO

Metastasis to the thyroid gland is a rare event. To date, only 11 cases of metastasis from neuroendocrine tumors (NETs) originating in the lung have been reported. We present a case of a patient in his 40s harboring two nodules in the thyroid gland that were diagnosed as well-differentiated NET (G1). Eighteen years before the patient underwent a lung lobectomy of the right upper lobe for a bronchial typical carcinoid with metastasis in one lymph node. Normal blood levels of calcitonin virtually ruled out the diagnosis of medullary thyroid carcinoma (MTC) and supported the diagnosis of a possible thyroid metastasis of the previous bronchial NET. Mutational analysis performed on both primary and metastasis tumor tissue did not show any mutation in the 409 genes analyzed.


Assuntos
Adenoma , Tumor Carcinoide , Carcinoma Neuroendócrino , Neoplasias Pulmonares , Neoplasias da Glândula Tireoide , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/secundário , Tumor Carcinoide/cirurgia , Carcinoma Neuroendócrino/diagnóstico , Carcinoma Neuroendócrino/genética , Carcinoma Neuroendócrino/cirurgia , Humanos , Pulmão/patologia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/genética , Neoplasias da Glândula Tireoide/cirurgia
18.
PLoS One ; 17(4): e0267732, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35482752

RESUMO

Primary aldosteronism (PA) usually accompanies suppressed plasma renin activity (PRA) through a negative feedback mechanism. While some cases of PA with unsuppressed PRA were reported, there have been no studies about the characteristics of PA with unsuppressed PRA; thus, these characteristics were examined herein. Nine patients with unsuppressed PRA and 86 patients with suppressed PRA were examined. All patients underwent segmental adrenal venous sampling (sAVS) and adrenalectomy, and were pathologically confirmed to have cytochrome P450 11B2 (CYP11B2)-positive aldosterone-producing adenoma according to international histopathology consensus criteria. Unsuppressed and suppressed PRA were defined as PRA levels of > 1.0 and ≤ 1.0 ng/mL/hr, respectively, in multiple blood samples obtained in the resting position. The unsuppressed PRA group had higher morning cortisol levels (12.6 [8.5, 13.5] vs. 8.5 [7.1, 11.0] µg/dL, P = 0.03) and higher cortisol levels after a 1 mg dexamethasone suppression test (DST) (2.2 [1.6, 2.5] vs. 1.3 [1.0, 1.9] µ g/dL, P = 0.004) than the suppressed PRA group. The unsuppressed PRA group also showed higher aldosterone levels on the non-surgical side during sAVS (P = 0.02 before adrenocorticotropic hormone (ACTH) stimulation, P = 0.002 after ACTH stimulation), a higher intensity of CYP17 expression in the resected adrenal gland (P = 0.02), and a lower clinical complete success rate 1 year after surgery (P = 0.04) compared with those in the suppressed PRA group. These findings suggest that PA should not be ruled out by unsuppressed PRA among patients with hypertension, particularly when their cortisol levels remain unsuppressed in the 1 mg DST. Meanwhile, it should be acknowledged that patients with unsuppressed PRA have higher aldosterone levels on the non-surgical side, and a lower likelihood of postoperative complete clinical success is to be expected.


Assuntos
Adenoma , Adenoma Adrenocortical , Hiperaldosteronismo , Adenoma/cirurgia , Hormônio Adrenocorticotrópico/metabolismo , Aldosterona , Humanos , Hidrocortisona , Renina
20.
Ulus Travma Acil Cerrahi Derg ; 28(4): 483-489, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35485523

RESUMO

BACKGROUND: Pituitary apoplexy is an emergent and potential life-threatening complication of pituitary adenomas if not managed properly. The aim of our study is to present our series of pituitary adenomas and to focus on the clinical, radiological, and surgical characteristics of this rare complication. METHODS: In this study, a total of 143 patients with pituitary adenoma underwent surgical treatment between 2016 and 2018. All patients were operated using endoscopic endonasal transsphenoidal (EET) technique. The data of pituitary apoplexy cases were recorded. Resection rates, hormonal results, and visual outcomes of patients with pituitary apoplexy were evaluated. RESULTS: Of the 143 patients, 8 (5.59%) were presented with the symptoms and radiological findings of pituitary apoplexy. The mean age was 26.75 years, and 4 (50%) of them were male and 4 were female. Pre-operative mean Knosp grading score was 2.1 All of eight patients underwent emergent surgical intervention and total resection was achieved in 75% of patients with apoplexy. Hormone levels were significantly decreased after surgery (p<0.05), except prolactin (p>0.05). Cerebrospinal fluid leakage occurred in one pa-tient. None of the patient with pituitary apoplexy died in our series. CONCLUSION: Pituitary apoplexy is an important complication of pituitary adenomas. Early diagnosis and surgical intervention provide excellent ophthalmological and hormonal outcomes. Emergent EET approach is crucial for patients with ophthalmological findings and macroadenomas.


Assuntos
Adenoma , Apoplexia Hipofisária , Neoplasias Hipofisárias , Adenoma/complicações , Adenoma/cirurgia , Adulto , Endoscopia/efeitos adversos , Endoscopia/métodos , Feminino , Humanos , Masculino , Apoplexia Hipofisária/complicações , Apoplexia Hipofisária/cirurgia , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/cirurgia , Estudos Retrospectivos
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