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1.
Medicine (Baltimore) ; 100(34): e27025, 2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-34449477

RESUMO

RATIONALE: Nephrogenic adenoma (NA) is a rare benign lesion of the urinary tract, which rarely occurs in the renal pelvis. Only 19 cases have been reported in the literature. However, there is no detailed report on the clinicopathological features of NA of the renal pelvis. PATIENT CONCERNS: This case report describes a 46-year-old male patient who was admitted to the hospital for one month because of painless gross hematuria with blood clots. He had a history of hyperuricemia and a family history of gastric cancer. DIAGNOSES: NA of the renal pelvis was diagnosed pathologically and immunohistochemical. INTERVENTIONS: The patient underwent laparoscopic nephroureterectomy. OUTCOMES: The patient recovered well after the operation with no discomfort. In addition, we followed up with the patient regularly post-discharge (approximately 20 months). There were no obvious abnormalities in the results of routine urine culture, computed tomography scan of the abdomen, and cystoscopy during the follow-up period, and the symptoms disappeared completely and did not recur. LESSONS: NA of the renal pelvis is extremely rare in the clinic, which can be easily misdiagnosed and overtreated. However, for pathological diagnosis of this disease, specific immunohistochemical staining for preoperative biopsy was reported to be significant, which should be considered by the urologists and pathologists.


Assuntos
Adenoma/patologia , Neoplasias Renais/patologia , Pelve Renal/patologia , Adenoma/diagnóstico , Adenoma/cirurgia , Humanos , Neoplasias Renais/diagnóstico , Neoplasias Renais/cirurgia , Pelve Renal/cirurgia , Laparoscopia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Nefroureterectomia
2.
J Stroke Cerebrovasc Dis ; 30(9): 105969, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34303962

RESUMO

OBJECTIVES: To report a case of isolated third nerve palsy from pituitary apoplexy and perform a systematic literature review. MATERIALS AND METHODS: MEDLINE/EMBASE databases were searched up to September 2020. INCLUSION CRITERIA: Age≥18, isolated third nerve palsy from pituitary apoplexy. EXCLUSION CRITERIA: Age<18, presence of other neurological findings, no hemorrhage or infarction of pituitary. RESULTS: Case report: A 76-year-old woman presented with headache and right-sided ptosis. Right-eye exam revealed complete ptosis, absent pupillary constriction and accommodation, depressed and abducted eye on primary gaze, and -1 impaired depression, adduction, elevation, without other neurological findings. Brain MRI was suggestive of pituitary apoplexy. Pathology after transsphenoidal resection revealed an infarcted pituitary adenoma. Third nerve palsy resolved completely in 21 days. Systematic review: Twenty-three studies reporting 35 patients were selected from 182 abstracts. Twenty-nine (83%) had complete isolated third nerve palsy. Headache was reported in 31 (97%). Thirty-one had hemorrhage and 1 had infarction of pituitary. Cavernous sinus invasion occurred in 14 (50%). Twenty-eight were managed surgically (80%) and 7 medically (20%). Nerve palsy resolved completely in 27 (82%) and partially in 4 (11%). CONCLUSIONS: Pituitary apoplexy is an important differential diagnosis in patients with isolated third nerve palsy. Isolated third nerve palsy in apoplexy appears to have favorable prognosis.


Assuntos
Adenoma/complicações , Doenças do Nervo Oculomotor/etiologia , Nervo Oculomotor/fisiopatologia , Apoplexia Hipofisária/etiologia , Neoplasias Hipofisárias/complicações , Adenoma/diagnóstico por imagem , Adenoma/patologia , Adenoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Nervo Oculomotor/diagnóstico , Doenças do Nervo Oculomotor/fisiopatologia , Apoplexia Hipofisária/diagnóstico por imagem , Apoplexia Hipofisária/patologia , Apoplexia Hipofisária/cirurgia , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias/cirurgia , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
3.
Eur J Endocrinol ; 185(4): D11-D20, 2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-34288884

RESUMO

Non-functioning pituitary adenomas (NFPA) usually present with symptoms of mass effect. Thus, the first-line treatment generally consists of transsphenoidal surgery. Since these tumors are usually large and invasive, post-surgical tumor remnants are common. Active surveillance is the follow-up strategy adopted by most pituitary centers, although the prevalence of residual tumor growth may reach 50% in 5-10 years, often leading to repeat surgery, radiation therapy, or both. NFPA remain the only pituitary tumor type for which no medical therapy has been approved. In this debate, we consider the evidence in favor and against using cabergoline to treat progressing NFPA.


Assuntos
Adenoma/tratamento farmacológico , Cabergolina/uso terapêutico , Neoplasias Hipofisárias/tratamento farmacológico , Adenoma/epidemiologia , Adenoma/patologia , Adenoma/cirurgia , Quimioterapia Adjuvante , Progressão da Doença , Humanos , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/prevenção & controle , Neoplasia Residual , Procedimentos Neurocirúrgicos , Seleção de Pacientes , Neoplasias Hipofisárias/epidemiologia , Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias/cirurgia , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Carga Tumoral/efeitos dos fármacos
4.
J Clin Neurosci ; 90: 262-267, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34275561

RESUMO

Cavernous sinus invasion (CSI) by pituitary tumors is associated with subtotal resection and persistent endocrinopathy. The Knosp classification is a magnetic resonance imaging (MRI) tool used to define CSI in the 2017 World Health Organization Classification. However, alternative criteria may have superior diagnostic performance. This study aimed to assess the diagnostic performance of four MRI criteria, using a combination of endoscopy and day 1 MRI as the reference standard for CSI. A cross-sectional study was conducted including patients treated with endoscopic endonasal transsphenoidal surgery for pituitary macroadenomas, recruited from a tertiary pituitary multidisciplinary center in Sydney, Australia between September 2013, and February 2021. The diagnostic performances of four MRI criteria were assessed: the Knosp criteria, percentage encasement of the internal carotid (PEICA), venous compartment obliteration (VCO), and the Fernandez-Miranda classification. Reference CSI was defined using a combination of intraoperative endoscopy and day 1 MRI. A total of 210 cavernous sinuses (105 patients), were analyzed, (51.7 ±â€¯16.3yrs, 43% female), of which 18% had CSI. CSI was best diagnosed by Knosp ≥ 2 (63% sensitivity and 89% specificity), PEICA ≥ 28% (84% sensitivity and 77% specificity) and VCO of ≥ 3 compartments (65% sensitivity and 89% specificity). CSI was unlikely if any of the following signs were present: Knosp < 1, PEICA < 28%, preservation of the medial or superior compartments or sparing of the superior Fernandez-Miranda compartment (negative predictive value 95%, 95%, 94%, 91% and 92% respectively). In conclusion, alternatives to the Knops criteria including PEICA and VCO can aid CSI diagnosis.


Assuntos
Adenoma/diagnóstico por imagem , Seio Cavernoso/diagnóstico por imagem , Endoscopia/métodos , Imageamento por Ressonância Magnética/métodos , Procedimentos Neurocirúrgicos/métodos , Neoplasias Hipofisárias/diagnóstico por imagem , Adenoma/patologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cavidade Nasal/cirurgia , Invasividade Neoplásica , Neoplasias Hipofisárias/patologia , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Osso Esfenoide/cirurgia
5.
Pan Afr Med J ; 38: 337, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34285759

RESUMO

Canalicular adenoma (CA) is a rare, unique benign salivary gland neoplasm, which usually involves the minor salivary glands of the upper lip, buccal mucosa and palate. It is usually seen in middle-aged or older individuals, has a female predilection, and commonly presents as a painless, slow-growing, non-ulcerated nodule or swelling. Its treatment involves surgical excision or enucleation. This case report describes a case of CA of the ventrum of the tongue diagnosed in a 41-year-old male patient, which could possibly be the first reported case of this lesion involving the tongue.


Assuntos
Adenoma/diagnóstico , Neoplasias da Língua/diagnóstico , Adenoma/patologia , Adenoma/cirurgia , Adulto , Humanos , Masculino , Neoplasias da Língua/patologia , Neoplasias da Língua/cirurgia
6.
Medicine (Baltimore) ; 100(23): e26267, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34115021

RESUMO

ABSTRACT: Endoscopic resection (ER) for non-ampullary duodenal lesions (NADLs) is technically more difficult than lesions of the stomach. However, endoscopic treatment of duodenal lesions has been increasingly performed in recent years. This study aimed to evaluate the efficacy and safety of ER for NADLs.Patients who underwent ER for NADLs between 2004 and 2019 were retrospectively reviewed. Clinical and pathologic features of the lesions including the clinical outcomes and adverse events were analyzed.The study included 80 patients with NADLs. The mean age of patients was 59.3 years (22-80 years), the mean size of the lesion was 8.8 ±â€Š7.0 mm, and the mean procedure time was 13.2 ±â€Š11.2 min. Half (40/80) of the lesions were in the duodenal bulb including the superior duodenal angle. Final histological data showed 56 adenomas (70.5%), 13 Brunner gland tumors (16.2%), and 4 pyloric gland tumors (5.0%). The final diagnoses of 5 lesions after ER showed higher-grade dysplasia compared to pre-ER biopsy findings. The en bloc resection rate was 93.8% (75/80), and the complete resection rate with clear margins was 90.0% (72/80). Micro-perforation occurred in 2 of 80 patients and was successfully treated with conservative treatment. There were no cases of delayed bleeding. The mean follow-up period was 27.0 months (2-119 months) with no cases of recurrence.ER may be an effective treatment for NADLs with favorable long-term outcomes. However, the possibility of perforation complications should always be considered during ER.


Assuntos
Adenoma , Neoplasias Duodenais , Duodenoscopia , Ressecção Endoscópica de Mucosa , Complicações Intraoperatórias , Adenoma/epidemiologia , Adenoma/patologia , Adenoma/cirurgia , Biópsia/métodos , Neoplasias Duodenais/epidemiologia , Neoplasias Duodenais/patologia , Neoplasias Duodenais/cirurgia , Duodenoscopia/efeitos adversos , Duodenoscopia/métodos , Duodeno/diagnóstico por imagem , Duodeno/patologia , Duodeno/cirurgia , Ressecção Endoscópica de Mucosa/efeitos adversos , Ressecção Endoscópica de Mucosa/métodos , Feminino , Humanos , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/prevenção & controle , Efeitos Adversos de Longa Duração/epidemiologia , Efeitos Adversos de Longa Duração/prevenção & controle , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Recidiva , República da Coreia/epidemiologia , Estudos Retrospectivos
7.
Am J Gastroenterol ; 116(7): 1398-1405, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34074815

RESUMO

INTRODUCTION: One-piece endoscopic mucosal resection (EMR) for lesions >15 mm is still unsatisfactory, and attempted 1-piece EMR for lesions >25 mm can increase perforation risk. Therefore, modifications to ensure 1-piece EMR of 15- to 25-mm lesions would be beneficial. The aim of this study was to investigate whether Tip-in EMR, which anchors the snare tip within the submucosal layer, increases en bloc resection for 15- to 25-mm colorectal lesions compared with EMR. METHODS: In this prospective randomized controlled trial, patients with nonpolypoid colorectal neoplasms of 15-25 mm in size were recruited and randomly assigned in a 1:1 ratio to undergo Tip-in EMR or standard EMR, stratified by age, sex, tumor size category, and tumor location. The primary endpoint was the odds ratio of en bloc resection adjusted by location and size category. Adverse events and procedure time were also evaluated. RESULTS: We analyzed 41 lesions in the Tip-in EMR group and 41 lesions in the EMR group. En bloc resection was achieved in 37 (90.2%) patients undergoing Tip-in EMR and 30 (73.1%) who had EMR. The adjusted odds ratio of en bloc resection in Tip-in EMR vs EMR was 3.46 (95% confidence interval: 1.06-13.6, P = 0.040). The Tip-in EMR and EMR groups did not differ significantly in adverse event rates (0% vs 4.8%) or median procedure times (7 vs 5 minutes). DISCUSSION: In this single-center randomized controlled trial, we found that Tip-in EMR significantly improved the en bloc resection rate for nonpolypoid lesions 15-25 mm in size, with no increase in adverse events or procedure time.


Assuntos
Adenoma/cirurgia , Neoplasias Colorretais/cirurgia , Ressecção Endoscópica de Mucosa/métodos , Adenoma/patologia , Colonoscopia/métodos , Neoplasias Colorretais/patologia , Humanos , Modelos Logísticos , Margens de Excisão , Complicações Pós-Operatórias/epidemiologia , Hemorragia Pós-Operatória/epidemiologia , Carga Tumoral
8.
J Cancer Res Clin Oncol ; 147(8): 2337-2347, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34156518

RESUMO

OBJECTIVE: We aimed to review of literature on the clinical presentation, management and outcomes of pituitary apoplexy following gonadotrophic release hormone (GnRH) agonist administration for the treatment of prostate cancer. METHODS: We used PRISMA guidelines for our systematic review and included all English language original articles on pituitary apoplexy following GnRH agonist administration among prostate cancer patients from Jan 1, 1995 to Dec 31, 2020. Data on patient demographics, prostate cancer type, Gleason score at diagnosis, history of pituitary adenoma, clinical presentation, GnRH agonist, interval to pituitary apoplexy, laboratory evaluation at admission, radiologic findings, treatment of pituitary apoplexy, time to surgery if performed, pathology findings, and clinical/hormonal outcomes were collected and analyzed. RESULTS: Twenty-one patients with pituitary apoplexy met our inclusion criteria. The mean age of patients was 70 (60-83) years. Leuprolide was the most common used GnRH agonist, used in 61.9% of patients. Median duration to symptom onset was 5 h (few minutes to 6 months). Headache was reported by all patients followed by ophthalmoplegia (85.7%) and nausea/vomiting (71.4%). Three patients had blindness at presentation. Only 8 cases reported complete anterior pituitary hormone evaluation on presentation and the most common endocrine abnormality was FSH elevation. Tumor size was described only in 15 cases and the mean tumor size was 26.26 mm (18-48 mm). Suprasellar extension was the most common imaging finding seen in 7 patients. 71.4% of patients underwent pituitary surgery, while 23.8% were managed conservatively. Interval between symptoms onset to pituitary surgery was 7 days (1-90 days). Gonadotroph adenoma was most common histopathologic finding. Clinical resolution was comparable, while endocrine outcomes were variable among patients with conservative vs surgical management. CONCLUSION: Although the use of GnRH agonists is relatively safe, it can rarely lead to pituitary apoplexy especially in patients with pre-existing pituitary adenoma. Physicians should be aware of this complication as it can be life threatening. A multidisciplinary team approach is recommended in treating individuals with pituitary apoplexy.


Assuntos
Adenoma/tratamento farmacológico , Antineoplásicos Hormonais/efeitos adversos , Hormônio Liberador de Gonadotropina/agonistas , Apoplexia Hipofisária/induzido quimicamente , Neoplasias da Próstata/tratamento farmacológico , Adenoma/epidemiologia , Adenoma/patologia , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos Hormonais/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Apoplexia Hipofisária/diagnóstico , Apoplexia Hipofisária/epidemiologia , Apoplexia Hipofisária/terapia , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/patologia
9.
Eur J Endocrinol ; 185(2): R65-R74, 2021 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-34132199

RESUMO

Background and aims: Thyrotropin-secreting pituitary adenomas (TSHomas) are a rare entity, occurring in one per million people. We performed a systematic review of 535 adult cases summarizing the clinical, biochemical, hormonal and radiological characteristics of TSHoma. Furthermore, we discussed the current guidelines for diagnosis and treatment. Methods: A structured research was conducted using Pubmed and Web of Science with the following MeSH terms: 'thyrotropin secreting pituitary adenoma' OR 'TSHoma' OR 'thyrotropinoma.' Results: Our analysis included 535 cases originating from 18 case series, 5 cohort studies and 91 case reports. The mean age at diagnosis was 46 years. At presentation, 75% had symptoms of hyperthyroidism, 55.5% presented with a goitre and 24.9% had visual field defects. The median TSH at diagnosis was 5.16 (3.20-7.43) mU/L with a mean FT4 of 41.5 ± 15.3 pmol/L. The majority (76.9%) of the TSHomas were macroadenoma. Plurihormonality was seen in 37.4% of the adenoma with a higher incidence in macroadenoma. Surgical resection of the adenoma was performed in 87.7% of patients of which 33.5% had residual pituitary adenoma. Post-operative treatment with a somatostatin analogue (SSA) led to a stable disease in 81.3% of the cases with residual tumour. We noticed a significant correlation between the diameter of the adenoma and residual pituitary adenoma (r = 0.490, P < 0.001). However, in patients preoperatively treated with an SSA, this correlation was absent. Conclusion: TSHomas are a rare cause of hyperthyroidism and are frequently misdiagnosed. Based on our structured analysis of case series, cohort studies and case reports, we conclude that the majority of TSHomas are macroadenoma being diagnosed in the fifth to sixth decade of life and presenting with symptoms of hyperthyroidism. Plurihormonalitiy is observed in one-third of TSHomas. Treatment consists of neurosurgical resection and SSA in case of surgical failure.


Assuntos
Adenoma/metabolismo , Hipertireoidismo/metabolismo , Neoplasias Hipofisárias/metabolismo , Tireotropina/metabolismo , Tiroxina/metabolismo , Adenoma/patologia , Adenoma/fisiopatologia , Adenoma/terapia , Fibrilação Atrial/fisiopatologia , Quimioterapia Adjuvante , Bócio/fisiopatologia , Gonadotropinas Hipofisárias/metabolismo , Adenoma Hipofisário Secretor de Hormônio do Crescimento/metabolismo , Insuficiência Cardíaca/fisiopatologia , Hormônios/uso terapêutico , Humanos , Hipertireoidismo/fisiopatologia , Neoplasia Residual , Procedimentos Neurocirúrgicos , Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias/fisiopatologia , Neoplasias Hipofisárias/terapia , Prolactinoma/metabolismo , Radioterapia Adjuvante , Somatostatina/análogos & derivados , Somatostatina/uso terapêutico , Carga Tumoral , Transtornos da Visão/fisiopatologia
10.
Medicine (Baltimore) ; 100(25): e26378, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160413

RESUMO

RATIONALE: Pyloric gland adenoma (PGA) is often associated with pyloric gland metaplasia. It has high malignant potential but a low clinical diagnosis rate. Therefore, we reported a case of PGA and reviewed the literature to summarize the clinicopathological features of pyloric adenoma. PATIENT CONCERNS: A 62-year-old female underwent gastroscopy due to intermittent acid regurgitation and heartburn, which revealed a 4×6 mm flat, elevated lesion in the greater curvature of the upper gastric body, with depression in the central region and blood scab attachment. DIAGNOSIS AND INTERVENTION: Biopsy revealed gastric adenoma with low-grade intraepithelial neoplasia. The patient was treated with ESD, and pathology showed gastric pyloric gland adenoma with low-grade dysplasia. The cells were positive for MUC6 and MUC5AC immunohistochemically. OUTCOMES: The patient received proton pump inhibitors and gastric mucosal protective agents for one month after ESD. She occasionally presented acid regurgitation and heartburn, with no abdominal pain, abdominal distension, melena, or hematochezia. Follow-up gastroscopy will be reexamined 1 year later. LESSONS: PGA has nonspecific performance under endoscopy, and its diagnosis mainly depends on pathology. Clinicians need to increase their ability to recognize such lesions and treat them in time to improve the prognosis.


Assuntos
Adenoma/diagnóstico , Carcinoma in Situ/diagnóstico , Mucosa Gástrica/patologia , Antro Pilórico/patologia , Neoplasias Gástricas/diagnóstico , Adenoma/patologia , Adenoma/cirurgia , Biomarcadores Tumorais/análise , Carcinoma in Situ/patologia , Carcinoma in Situ/cirurgia , Ressecção Endoscópica de Mucosa , Feminino , Mucosa Gástrica/diagnóstico por imagem , Mucosa Gástrica/cirurgia , Gastroscopia , Humanos , Pessoa de Meia-Idade , Antro Pilórico/diagnóstico por imagem , Antro Pilórico/cirurgia , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Resultado do Tratamento
11.
Medicine (Baltimore) ; 100(23): e26296, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34115035

RESUMO

TRIAL DESIGN: Elimination of small colorectal polyps with cold snare polypectomy (CSP) is reported to be as safe as hot snare polypectomy (HSP). The effectiveness of CSP has not been clearly defined, and the incidence of long-term recurrence has not been determined. We conducted a randomized control study and one-year follow-up study to assess their safety and efficacy. METHODS: Patients with small colorectal polyps were randomized to receive CSP or HSP. Polypectomy was performed to determine the pathological curability, and patients completed a questionnaire about the tolerability of the procedure. Follow-up colonoscopy was performed to determine the local recurrence of adenoma. The major outcome was the non-inferiority of CSP to HSP in the rate of delayed bleeding and minor outcomes, including the incidence of immediate bleeding and perforation, procedural time, and the resection rate. RESULTS: A total of 119 participants were recruited in this randomized study and underwent polypectomy. Among the 458 polyps, 332 eligible polyps were analyzed. The rate of adverse events was 0.6% (1/175) for CSP and 0% (0/157) for HSP, which showed the non-inferiority of CSP. While the complete resection rate of CSP was very high (100%), the R0 rate was not satisfactory (horizontal margin, 65.5%; vertical margin, 89.1%). Two local recurrences (2.5%) were observed in the follow-up of 80 adenomas treated with CSP. No recurrence was found in 79 lesions in the HSP group, which was not significant (P = .06). CONCLUSIONS: Colorectal polyps were safely resected using CSP, similar to HSP. Most would agree to say that CSP is considered safer than HSP. The main question is then related to efficacy. Our results of the present study demonstrate that recurrence after CSP should be carefully managed for curative treatment.


Assuntos
Adenoma , Pólipos do Colo , Colonoscopia , Preferência do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/diagnóstico , Adenoma/patologia , Adenoma/cirurgia , Assistência ao Convalescente/métodos , Idoso , Biópsia/métodos , Pólipos do Colo/patologia , Pólipos do Colo/cirurgia , Colonoscopia/efeitos adversos , Colonoscopia/métodos , Colonoscopia/psicologia , Dissecação/métodos , Feminino , Humanos , Masculino , Recidiva , Resultado do Tratamento
12.
J Cancer Res Clin Oncol ; 147(8): 2199-2207, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34115239

RESUMO

Colorectal cancer is an important public health concern leading to significant cancer associate mortality. A vast majority of colon cancer arises from polyp which later follows adenoma, adenocarcinoma, and carcinoma sequence. This whole process takes several years to complete and recent genomic and proteomic technologies are identifying several targets involved in each step of polyp to carcinoma transformation in a large number of studies. Current text presents interaction network of targets involved in polyp to carcinoma transformation. In addition, important targets involved in each step according to network biological parameters are also presented. The functional overrepresentation analysis of each step targets and common top biological processes and pathways involved in carcinoma indicate several insights about this whole mechanism. Interaction networks indicate TP53, AKT1, GAPDH, INS, EGFR, and ALB as the most important targets commonly involved in polyp to carcinoma sequence. Though several important pathways are known to be involved in CRC, the central common involvement of PI3K-AKT indicates its potential for devising CRC management strategies. The common and central targets and pathways involved in polyp to carcinoma progression can shed light on its mechanism and potential management strategies. The data-driven approach aims to add valuable inputs to the mechanism of the years-long polyp-carcinoma sequence.


Assuntos
Carcinoma/prevenção & controle , Transformação Celular Neoplásica , Neoplasias do Colo/prevenção & controle , Pólipos do Colo/terapia , Terapia de Alvo Molecular/métodos , Adenocarcinoma/genética , Adenocarcinoma/metabolismo , Adenocarcinoma/patologia , Adenocarcinoma/prevenção & controle , Adenoma/genética , Adenoma/metabolismo , Adenoma/patologia , Adenoma/prevenção & controle , Pólipos Adenomatosos/genética , Pólipos Adenomatosos/metabolismo , Pólipos Adenomatosos/patologia , Pólipos Adenomatosos/prevenção & controle , Antineoplásicos/uso terapêutico , Carcinoma/genética , Carcinoma/metabolismo , Carcinoma/patologia , Transformação Celular Neoplásica/efeitos dos fármacos , Transformação Celular Neoplásica/genética , Transformação Celular Neoplásica/metabolismo , Transformação Celular Neoplásica/patologia , Neoplasias do Colo/metabolismo , Neoplasias do Colo/patologia , Pólipos do Colo/genética , Pólipos do Colo/metabolismo , Pólipos do Colo/patologia , Progressão da Doença , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Redes Reguladoras de Genes/efeitos dos fármacos , Redes Reguladoras de Genes/fisiologia , Genes de Troca/efeitos dos fármacos , Humanos , Mapas de Interação de Proteínas/efeitos dos fármacos , Mapas de Interação de Proteínas/genética , Proteômica , Transdução de Sinais/efeitos dos fármacos , Transdução de Sinais/genética
13.
BMJ Case Rep ; 14(5)2021 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-33975851

RESUMO

A 62-year-old woman was referred to our department for further investigation of anaemia. Blood test showed macrocytic anaemia. Oesophagogastroduodenoscopy (OGD) revealed proximal-predominant gastric atrophy and flat elevated lesion in the gastric body. Several days after OGD, she complained of gait disturbance and was diagnosed with subacute combined degeneration of the spinal cord. Furthermore, laboratory tests showed positive for both anti-parietal cell and anti-intrinsic factor antibodies, as well as increased serum gastrin level and decreased pepsinogen I level, which confirmed the diagnosis of autoimmune gastritis (AIG). Anaemia and neurological symptoms were improved after vitamin B12 supplementation. Subsequently, the patient underwent gastric endoscopic submucosal dissection; histopathological examination revealed gastric adenoma. AIG can cause gastric neoplasms and vitamin B12 deficiency, with the latter resulting in pernicious anaemia and neurological disorders. These diseases are treatable but potentially life-threatening. This case highlights the importance of early diagnosis of AIG and proper management of its comorbidities.


Assuntos
Adenoma , Doenças Autoimunes , Gastrite , Neoplasias Gástricas , Degeneração Combinada Subaguda , Deficiência de Vitamina B 12 , Adenoma/patologia , Doenças Autoimunes/complicações , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/patologia , Feminino , Gastrite/complicações , Gastrite/diagnóstico , Gastrite/patologia , Humanos , Pessoa de Meia-Idade , Medula Espinal/patologia , Neoplasias Gástricas/complicações , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/cirurgia , Deficiência de Vitamina B 12/complicações , Deficiência de Vitamina B 12/diagnóstico , Deficiência de Vitamina B 12/tratamento farmacológico
14.
Adv Anat Pathol ; 28(4): 228-250, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34009777

RESUMO

Renal neoplasms largely favor male patients; however, there is a growing list of tumors that are more frequently diagnosed in females. These tumors include metanephric adenoma, mixed epithelial and stromal tumor, juxtaglomerular cell tumor, mucinous tubular and spindle cell carcinoma, Xp11.2 (TFE3) translocation-associated renal cell carcinoma, and tuberous sclerosis complex (somatic or germline) associated renal neoplasms. The latter category is a heterogenous group with entities still being delineated. Eosinophilic solid and cystic renal cell carcinoma is the best-described entity, whereas, eosinophilic vacuolated tumor is a proposed entity, and the remaining tumors are currently grouped together under the umbrella of tuberous sclerosis complex/mammalian target of rapamycin-related renal neoplasms. The entities described in this review are often diagnostic considerations when evaluating renal mass tissue on biopsy or resection. For example, Xp11.2 translocation renal cell carcinoma is in the differential when a tumor has clear cell cytology and papillary architecture and occurs in a young or middle-aged patient. In contrast, tuberous sclerosis complex-related neoplasms often enter the differential for tumors with eosinophilic cytology. This review provides an overview of the clinical, gross, microscopic, immunohistochemical, genetic, and molecular alterations in key renal neoplasms occurring more commonly in females; differential diagnoses are also discussed regardless of sex predilection.


Assuntos
Adenoma/patologia , Carcinoma/patologia , Neoplasias Renais/patologia , Biomarcadores Tumorais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Fatores Sexuais
15.
Virchows Arch ; 479(1): 209-214, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34019179

RESUMO

CD73 converts AMP to adenosine, an immunosuppressive metabolite that promotes tumorigenesis. This study presents a systematic evaluation of CD73 expression in benign, hyperplastic, and neoplastic thyroid. CD73 expression was assessed by immunohistochemistry in 142 thyroid samples. CD73 was expressed in normal thyroid (3/6) and goiter (5/6), with an apical pattern and mild intensity. Apical and mild CD73 expression was also present in oncocytic cell adenomas/carcinomas (9/10; 5/8) and in follicular adenomas/carcinomas (12/18; 23/27). In contrast, papillary thyroid carcinomas featured extensive and intense CD73 staining (49/50) (vs. normal thyroid/goiter, p < 0.001). Seven of nine anaplastic carcinomas were CD73-positive with heterogeneous extensiveness of staining. Medullary and poorly differentiated carcinomas were mostly CD73-negative (1/6; 2/2). These results were corroborated by NT5E mRNA profiling. Papillary carcinomas feature enhanced CD73 protein and mRNA expression with distinct and intense staining, more pronounced in the invasive fronts of the tumors.


Assuntos
5'-Nucleotidase/análise , Biomarcadores Tumorais/análise , Câncer Papilífero da Tireoide/enzimologia , Neoplasias da Glândula Tireoide/enzimologia , 5'-Nucleotidase/genética , Adenoma/enzimologia , Adenoma/patologia , Biomarcadores Tumorais/genética , Estudos de Casos e Controles , Proteínas Ligadas por GPI/análise , Proteínas Ligadas por GPI/genética , Regulação Neoplásica da Expressão Gênica , Bócio/enzimologia , Bócio/patologia , Humanos , Hiperplasia , Imuno-Histoquímica , Valor Preditivo dos Testes , Câncer Papilífero da Tireoide/genética , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/genética , Neoplasias da Glândula Tireoide/patologia , Regulação para Cima
16.
Biomed Pharmacother ; 140: 111761, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34044278

RESUMO

BACKGROUND: Accumulating data suggest that the tumour stroma rapidly undergoes dynamic mechanical and cellular changes by which creates a supportive milieu to promote disease progression and metastasis. Cytokines are reported to play a key role in the modulation of tumour stromal response. METHODS: The activation of TH17/interleukin (IL)-17A network in association with tumour stromal proliferative and cellular response in samples from 50 patients with colorectal adenoma, 45 with colorectal cancer (CRCs) were elucidated with quantitative real-time PCR (q-PCR), immunohistochemistry and double immunofluorescence. RESULTS: q-PCR results showed that retinoic acid-receptor-related orphan receptor-C, a critical transcriptional factor for TH17 cell differentiation, was significantly increased at the adenoma stage and slightly decreased at the CRC stage, but was still higher than that at normal controls. The level of TH17 signature cytokine IL-17A was shown in an increasing gradient throughout the adenoma-carcinoma sequence. Immunohistochemistry revealed an activated proliferative rate evaluated by Ki67 and population expansion of myofibroblasts in the adenoma/CRC stroma. Notably, densities of IL-17A-expressing cells were associated with populations of Ki67-positive cells and myofibroblasts in the adenoma/CRC stroma. Finally, CD146-positive stromal cells are an important participator for stroma remodelling, double immunofluorescence image demonstrated that IL-17 receptor C, one of the key elements for IL-17 receptor complex, was highly expressed in CD146-positive adenoma/CRC stromal cells. CONCLUSIONS: An activated TH17/IL-17A network in the tumour microenvironment is significantly associated with dynamic stromal cellular response throughout the adenoma-carcinoma sequence, which might provide a supportive environment for the initiation and progression of CRC.


Assuntos
Adenoma/imunologia , Neoplasias Colorretais/imunologia , Interleucina-17/imunologia , Células Estromais/imunologia , Células Th17/imunologia , Adenoma/genética , Adenoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/genética , Neoplasias Colorretais/patologia , Feminino , Humanos , Interleucina-17/genética , Masculino , Pessoa de Meia-Idade , Microambiente Tumoral/genética , Microambiente Tumoral/imunologia
17.
Ann Clin Lab Sci ; 51(2): 190-197, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33941558

RESUMO

Pituitary adenomas (PA) are neoplasms that arise predominantly in the adenohypophysis. They are generally divided into three categories depending on their biological behavior: benign adenomas, invasive adenomas, and carcinomas. They represent 10%-25% of all intracranial neoplasms, and their estimated prevalence in the general population is 17%. RAB7L1, located at the PARK16 locus, is a Rab GTPase key regulator in vesicle trafficking. Recent genome-wide association studies have linked variants in RAB7L1 to the risk of Parkinson's disease. However, the association between RAB7L1 and PAs is still unexplored. Thirty patients with pituitary adenomas who had undergone surgical resection at Jiangyin People's Hospital (Jiangsu, China) from 2014 to 2019 were selected. The RAB7L1 expression level was assessed by qPCR, Western blot, and immunohistochemical staining. The level of the RAB7L1 differential expression was closely related to the patients' age and size of the PAs. In contrast, the RAB7L1 expression level was found to be unrelated to gender, Knosp classification, or type of PA. Our study found that the RAB7L1 expression level was higher in adenoma tissues from older PA patients, and the RAB7L1 expression level was higher in adenoma tissues from patients with smaller adenomas (size≤2cm) than those with larger adenomas (size>2cm).


Assuntos
Neoplasias Hipofisárias/genética , Proteínas rab de Ligação ao GTP/genética , Adenoma/patologia , Adulto , Fatores Etários , Idoso , China , Feminino , Expressão Gênica/genética , Regulação Neoplásica da Expressão Gênica/genética , Predisposição Genética para Doença/genética , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/metabolismo , Polimorfismo de Nucleotídeo Único/genética , Proteínas rab de Ligação ao GTP/metabolismo
18.
Aging (Albany NY) ; 13(10): 14342-14354, 2021 05 19.
Artigo em Inglês | MEDLINE | ID: mdl-34016788

RESUMO

There are few studies on the mechanism of pituitary adenoma (PA) destroying bone. The current study aimed to investigate the role of MEG8/miR-454-3p/TNF-α in bone-invasive pituitary adenomas (BIPAs). In this study, we report that lncRNA MEG8 and TNF-α are upregulated in BIPA tissues while miR-454-3p is downregulated, which is associated with poor progression-free survival (PFS). Functional assays revealed the role of up-regulated MEG8 and down-regulated miR-454-3p in promoting bone destruction. Mechanistically, MEG8 promotes TNF-α expression by sponging miR-454-3p, which ultimately leads to the occurrence of bone destruction. The mechanism is confirmed in vivo and in vitro. Therefore, our data illustrated a new regulatory mechanism of MEG8/miR-454-3p/TNF-α in BIPAs. It may provide a useful strategy for diagnosis and treatment for BIPA patients.


Assuntos
Adenoma/genética , Adenoma/patologia , Osso e Ossos/patologia , MicroRNAs/metabolismo , Neoplasias Hipofisárias/genética , Neoplasias Hipofisárias/patologia , RNA Longo não Codificante/metabolismo , Fator de Necrose Tumoral alfa/metabolismo , Adulto , Idoso , Animais , Sequência de Bases , Linhagem Celular Tumoral , Progressão da Doença , Regulação para Baixo/genética , Feminino , Regulação Neoplásica da Expressão Gênica , Humanos , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Nus , MicroRNAs/genética , Pessoa de Meia-Idade , Modelos Biológicos , Invasividade Neoplásica , Prognóstico , Células RAW 264.7 , RNA Longo não Codificante/genética , Regulação para Cima/genética
19.
World Neurosurg ; 151: e185-e191, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33862299

RESUMO

OBJECTIVE: The 2017 World Health Organization classification of pituitary adenomas identified the plurihormonal PIT-1-positive (PP1) adenoma as a distinct subtype. The reported data suggest that PP1 adenomas encompass the former class of silent subtype 3 (SS3) adenomas and might have an aggressive phenotype. In the present study, we summarized the current clinical data on PP1 and SS3 adenomas and compared the reported data with the data from a single institutional cohort. METHODS: Medline and Google Scholar were searched from 1990 to 2020 for clinical series of PP1 and SS3 adenomas in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. Studies were included if they had reported pituitary pathology as PP1 or SS3 adenomas and had reported the clinical outcomes after surgical intervention. To better define the PP1 phenotype compared with non-PP1 adenomas, we also reviewed the adenomas treated surgically at our institution from 2012 to 2019. RESULTS: Of all the tumors reported in the studies as PP1 or SS3, 99% were macroadenomas and 18% were giant adenomas (>4 cm). Of the reported patients, 31.8% had received radiotherapy, and 22.9% had undergone multiple surgeries for their pituitary tumor. In our single-center experience, 20 patients had an adenoma that met the criteria for a PP1 adenoma. Compared with the 1146 non-PP1 tumors, the PP1 tumors did not show statistically significant differences in the extent of resection, size, number of previous surgeries, future reoperations, rate of radiotherapy, p53 staining, or MIB-1 labeling index. CONCLUSIONS: The findings from the present large, single-center study comparing PP1 and non-PP1 adenomas do not suggest that PP1 tumors are more aggressive. Further work is warranted to identify the pathologic subtypes of pituitary adenomas that are consistently more clinically aggressive.


Assuntos
Adenoma/patologia , Neoplasias Hipofisárias/patologia , Adenoma/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Neoplasias Hipofisárias/cirurgia
20.
Medicine (Baltimore) ; 100(14): e25306, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33832102

RESUMO

ABSTRACT: Pituitary tumors commonly cause visual impairment and the degree of impairment can depend on the size, location, and type of the tumor. However, no studies have been made regarding the differences caused by functioning pituitary adenoma (FPA) and non-functioning pituitary adenoma (NFPA). We aimed to investigate the relationship between clinical characteristics and visual impairment in patients with FPA and NFPA.This case series study included 73 pituitary adenoma patients. All patients underwent ophthalmic evaluations, and we retrospectively reviewed their medical records. Tumor types were confirmed by histological analysis, and the tumor volume was calculated. Magnetic resonance imaging was used to determine the tumor diameter. The observation indices of the two groups were compared. The correlation between the visual field and tumor volume was analysed using scatter plots.We enrolled 30 patients in the FPA group and 43 in the NFPA group. The first symptoms presented in the eyes in 23% of FPA patients and 41.9% of NFPA patients. The best-corrected visual acuity of the FPA group was better than that of the NFPA group, and 34 (56.7%) and 73 (84.9%) eyes in these groups had visual field defects, respectively. The visual field defects of the FPA patients were lighter than those of the NFPA patients. Except for the anteroposterior diameter, there were no differences in the other parameters of tumor diameter between the groups. The tumor volume of the FPA group was smaller than that of the NFPA group. The tumor size was positively correlated with the mean deviation and negatively correlated with the mean sensitivity in both groups.There was a longer delay between the onset of signs and symptoms and treatment in the FPA group than in the NFPA group. Future studies should focus on visual field defects caused by FPA and NFPA.


Assuntos
Adenoma/complicações , Adenoma/patologia , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/patologia , Transtornos da Visão/etiologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Carga Tumoral/fisiologia , Adulto Jovem
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