Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 17.753
Filtrar
1.
Medicine (Baltimore) ; 99(40): e22432, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019423

RESUMO

Nesfatin-1 was identified as a satiety factor involved in the regulation of metabolism. Altered levels of circulating nesfatin-1 had been observed in a variety of diseases characterized by energy imbalance. However, there was no published data about nesfatin-1 levels in acromegaly.We evaluated serum nesfatin-1 levels in 13 patients with acromegaly at baseline and postoperatively, and in 21 age- and body mass index (BMI)-matched healthy subjects.Compared with the healthy subjects, patients with acromegaly had significantly increased levels of serum insulin, high-density lipoprotein cholesterol, triglyceride, and growth hormone (GH). Moreover, the acromegaly group had nesfatin-1 levels higher than controls (1.96 ±â€Š0.56 ng/mL vs 0.61 ±â€Š0.10 ng/mL, P = .004). There was a positive correlation of serum nesfatin-1 levels with diastolic blood pressure (r = 0.579, P = .038) and homeostasis model assessment of insulin resistance (HOMA-IR) (r = 0.598, P = .031) in patients with acromegaly. While a successful surgery decreased serum GH levels, the serum nesfatin-1 levels did not change in acromegaly (P = .965). At last, we compared serum GH/nesfatin-1 levels with predictive markers for aggressive behaviors in pituitary adenomas. There was no relationship between serum nesfatin-1 levels and tumor's size, Ki-67 index, mutant p53, or MGMT proteins. However, increased serum GH levels were positively correlated with tumors' size (P = .023) and mutant p53 proteins expression (P = .028).Circulating nesfatin-1 was increased in acromegaly, which was involved in metabolism regulation.


Assuntos
Acromegalia/sangue , Nucleobindinas/sangue , Adenoma/sangue , Adenoma/patologia , Adenoma/cirurgia , Adulto , Pressão Sanguínea , Estudos de Casos e Controles , Feminino , Hormônio do Crescimento Humano/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/sangue , Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias/cirurgia , Curva ROC
2.
Niger J Clin Pract ; 23(8): 1048-1053, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32788480

RESUMO

Aims: To describe the clinical characteristics, colonoscopic features, histological findings, dysplasia patterns, and clinical outcome of endoscopically detected colonic polyps in the Saudi population. Methods: This retrospective record review was conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, on patients who underwent colonoscopy between 2005 and 2015. Patients with colorectal cancer were excluded. Data were analyzed using SPSS software. Results: Among 211 patients recruited, 66.8% were males and 66.2% were Saudi. Single polyps were detected in 45.5% of cases, while 29.9%, 18%, and 6.6% had 2, 3, and 4 polyps, respectively. Regarding the size, 81%, 17%, and 2% of the polyps were <1 cm, 1-2 cm, and >2 cm, respectively. The endoscopic examination revealed that 16.4% of the polyps were pedunculated, 82.6% were sessile, and 1% were sessile and pedunculated. About 45%, 30%, 21%, and 6.6% of the polyps were located at the rectum/sigmoid, left colon, right colon, and transverse/ascending colon, respectively. Histologically, 68.6% of polyps were adenomatous and 21.3% were non-adenomatous. Mild dysplasia was detected in almost half of the studied sample (42.3%) while moderate and severe grades of dysplasia were demonstrated in 19.2% and 38.5% of the examined polyps. Surgical intervention was required in 8.1% of cases. Conclusion: Single small-sized sessile polyps of adenomatous type and mild dysplasia are the most common polyps in the Saudi population. Sigmoid/rectum is the most common site affected, and the outcome of polyps is generally favorable.


Assuntos
Adenoma/patologia , Colo Ascendente/diagnóstico por imagem , Neoplasias do Colo/patologia , Pólipos do Colo/patologia , Colonoscopia/métodos , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Colo Ascendente/patologia , Neoplasias do Colo/epidemiologia , Pólipos do Colo/epidemiologia , Endoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Lesões Pré-Cancerosas/diagnóstico por imagem , Lesões Pré-Cancerosas/epidemiologia , Estudos Retrospectivos , Arábia Saudita , Distribuição por Sexo
3.
Eur J Endocrinol ; 183(4): 369-379, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32621582

RESUMO

Background: The '3PAs' syndrome, associating pituitary adenoma (PA) and pheochromocytoma/paraganglioma (PPGL), is sometimes associated with mutations in PPGL-predisposing genes, such as SDHx or MAX. In '3PAs' syndrome, PAs can occur before PPGL, suggesting a new gateway into SDHx/MAX-related diseases. Objective: To determine the SDHx/MAX mutation prevalence in patients with isolated PAs and characterize PAs of patients with SDHx/MAX mutations. Design: Genes involved in PAs (AIP/MEN1/CDKN1B) or PPGLs (SDHx/MAX) were sequenced in patients with isolated PAs. We then conducted a review of cases of PA in the setting of '3PAs' syndrome. Results: A total of 263 patients were recruited. Seven (likely) pathogenic variants were found in AIP, two in MEN1, two in SDHA, and one in SDHC. The prevalence of SDHx mutations reached 1.1% (3/263). Of 31 reported patients with PAs harboring SDHx/MAX mutations (28 published cases and 3 cases reported here), 6/31 (19%) developed PA before PPGL and 8/31 (26%) had isolated PA. The age of onset was later than in patients with AIP/MEN1 mutations. PAs were mainly macroprolactinomas and showed intracytoplasmic vacuoles seen on histopathology. Conclusions: We discovered SDHx mutations in patients bearing PA who had no familial or personal history of PPGL. However, the question of incidental association remains unresolved and data to determine the benefit of SDHx/MAX screening in these patients are lacking. We recommend that patients with isolated PA should be carefully examined for a family history of PPGLs. A family history of PPGL, as well as the presence of intracytoplasmic vacuoles in PA, requires SDHx/MAX genetic testing of patients.


Assuntos
Adenoma/genética , Mutação em Linhagem Germinativa , Neoplasias Hipofisárias/genética , Succinato Desidrogenase/genética , Adenoma/epidemiologia , Adenoma/patologia , Adolescente , Neoplasias das Glândulas Suprarrenais/epidemiologia , Neoplasias das Glândulas Suprarrenais/genética , Neoplasias das Glândulas Suprarrenais/patologia , Adulto , Idade de Início , Idoso , Fatores de Transcrição de Zíper de Leucina e Hélice-Alça-Hélix Básicos/genética , Criança , Análise Mutacional de DNA/métodos , Feminino , França/epidemiologia , Predisposição Genética para Doença , Testes Genéticos , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Isoenzimas/genética , Masculino , Pessoa de Meia-Idade , Paraganglioma/epidemiologia , Paraganglioma/genética , Paraganglioma/patologia , Feocromocitoma/epidemiologia , Feocromocitoma/genética , Feocromocitoma/patologia , Neoplasias Hipofisárias/epidemiologia , Neoplasias Hipofisárias/patologia , Prolactinoma/epidemiologia , Prolactinoma/genética , Prolactinoma/patologia , Subunidades Proteicas/genética , Estudos Retrospectivos , Adulto Jovem
4.
Medicine (Baltimore) ; 99(29): e20799, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702823

RESUMO

Sessile serrated adenomas (SSAs) are precursors of colorectal cancer (CRC). However, there are limited data on detection rates of this premalignant lesion during colonoscopy surveillance in patients with a history of left side colonic resection for cancer. We aimed to identify the incidence and risk factors of SSAs in post-left side colectomy patients.We retrospectively reviewed the medical records of patients who had undergone left side colectomy for colon and rectal cancer between September 2009 and September 2016 and had at least 1 follow-up colonoscopy. Patient baseline characteristics, SSA diagnoses and characteristics, and colonoscopy information were collected.In total, 539 patients were enrolled. At the first follow-up (mean duration 11.5 months), 98 SSAs were identified (22.2%). At the second follow-up (mean duration 25.8 months), 51 SSAs were identified in 212 patients (24.0%). Multivariate analysis showed that alcohol intake (hazard ratio [HR] 1.524; 95% confidence interval [CI] .963-2.411, P = .041), excellent bowel preparation (HR 2.081; 95% CI 1.214-3.567, P = .049), and use of a transparent cap (HR 1.702; 95% CI 1.060-2.735, P = .013) were associated with higher SSA incidence in the first surveillance colonoscopy, while body mass index (BMI) ≥ 25.0 (HR 1.602; 95% CI 1.060-2.836) was associated with a significantly increased risk of SSAs in the second surveillance.Considering the endoscopic appearance of SSAs, adequate bowel preparation and use of transparent caps during postoperative surveillance colonoscopy can increase the diagnosis rate. Modification of alcohol intake and BMI may reduce the incidence of SSAs in left side colon cancer patients.


Assuntos
Adenoma/epidemiologia , Adenoma/patologia , Neoplasias Colorretais/cirurgia , Idoso , Consumo de Bebidas Alcoólicas/efeitos adversos , Índice de Massa Corporal , Catárticos/efeitos adversos , Colectomia/efeitos adversos , Colonoscopia/métodos , Neoplasias Colorretais/complicações , Neoplasias Colorretais/patologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias/métodos , Cuidados Pós-Operatórios/métodos , Estudos Retrospectivos , Fatores de Risco
5.
Signal Transduct Target Ther ; 5(1): 121, 2020 07 08.
Artigo em Inglês | MEDLINE | ID: mdl-32641705
6.
Br J Radiol ; 93(1113): 20200321, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32628097

RESUMO

OBJECTIVE: Pituitary macroadenomas (PAs) are usually defined as benign intracranial tumors. However, they may present local aggressive course. High Ki67 labelling index (LI) values have been related to an aggressive tumor behavior. A recent clinicopathological classification of PA based on local invasiveness and proliferation indexes, divided them in groups with different prognosis. We evaluated the utility of conventional MRI (cMRI) and diffusion-weighted imaging (DWI), in predicting the Ki67- LI according the clinicopathological classification. METHODS: 17 patients (12 M and 5 F) who underwent surgical removal of a PA were studied. cMRI features, quantification of T1W and T2W signal intensity, degree of contrast uptake (enhancement ratio, ER) and apparent diffusion coefficient (ADC) values were evaluated by using a 3 T scan. Statistics included Mann-Whitney test, Spearman's test, and receiver operating characteristic analysis. A value of p ≤ 0.05 was considered significant for all the tests. RESULTS: Negative correlations were observed between Ki-67 LI, ADCm (ρ = - 0.67, p value = 0.005) and ER values (ρ = -0.62; p = 0.008). ER values were significantly lower in the proliferative PA group (p = 0.028; p = 0.017). ADCm showed sensitivity and specificity of 90 and 85% respectively into predict Ki67-LI value. A value of ADCm ≤0, 711 x 10-6 mm2 emerged as a cut-off of a value of Ki67-LI ≥ 3%. CONCLUSION: Adding quantitative measures of ADC values to cMRI could be used routinely as a non-invasive marker of specific predictive biomarker of the proliferative activity of PA. ADVANCES IN KNOWLEDGE: Routinely use of DWI on diagnostic work-up of pituitary adenomas may help in establish the likely biological aggressive lesions.


Assuntos
Adenoma/diagnóstico por imagem , Antígeno Ki-67/análise , Imagem por Ressonância Magnética/métodos , Neoplasias Hipofisárias/diagnóstico por imagem , Adenoma/química , Adenoma/patologia , Adenoma/cirurgia , Núcleo Celular/química , Proliferação de Células , Imagem de Difusão por Ressonância Magnética/métodos , Imagem de Tensor de Difusão/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores/métodos , Invasividade Neoplásica , Neoplasias Hipofisárias/química , Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias/cirurgia , Curva ROC , Sensibilidade e Especificidade , Estatísticas não Paramétricas
7.
Br J Radiol ; 93(1113): 20200052, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32649236

RESUMO

OBJECTIVE: To evaluate the feasibility of using imaging parameters (D, ß and µ) obtained from fractional order calculus (FROC) diffusion model to differentiate salivary gland tumors. METHODS: 15 b-value (0-2000 s/mm2) diffusion-weighted imaging (DWI) was scanned in 62 patients with salivary gland tumors (47 benign and 15 malignant). Diffusion coefficient D, fractional order parameter ß (which correlates with tissue heterogeneity) and a microstructural quantity µ of the solid portion within the tumor were calculated, and compared between benign and malignant groups, or among pleomorphic adenoma (PA), Warthin's tumor (WT), and malignant tumor (MT) groups. Performance of FROC parameters for differentiation was assessed using receiver operating characteristic analysis. RESULTS: None of the FROC parameters exhibited significant differences between benign and malignant group (D, p = 0.150; ß, p = 0.967; µ, p = 0.693). WT showed significantly lower D (p < 0.001) and ß (p < 0.001), while higher µ (p = 0.001) than PA. Combination of D, ß and µ showed optimal diagnostic performance (area under the curve, AUC, 0.998). MT showed significantly lower D (p = 0.001) and ß (p = 0.025) than PA, while no significant difference was found on µ (p = 0.064). Combination of D and ß showed optimal diagnostic performance (AUC, 0.933). Significant difference was found on ß (p = 0.027) between MT and WT, while not on D (p = 0.806) and µ (p = 0.789). Setting a ßof 0.615 as the cut-off value, optimal diagnostic performance could be obtained (AUC = 0.806). CONCLUSION: A non-Gaussian FROC diffusion model can serve as a noninvasive and quantitative imaging technique for differentiating salivary gland tumors. ADVANCES IN KNOWLEDGE: (1) PA showed higher D and ß and lower µ than WT. (2) PA had higher D and ß than MT. (3) WT demonstrated lower ß than MT. (4) ß, as a new FROC parameter, could offer an added value to the differentiation.


Assuntos
Imagem de Difusão por Ressonância Magnética/métodos , Neoplasias das Glândulas Salivares/diagnóstico por imagem , Adenolinfoma/diagnóstico por imagem , Adenolinfoma/patologia , Adenoma/diagnóstico por imagem , Adenoma/patologia , Algoritmos , Diagnóstico Diferencial , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Neoplasias das Glândulas Salivares/patologia
8.
Am J Gastroenterol ; 115(7): 980-988, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32618646

RESUMO

Advanced adenomas represent a subset of colorectal polyps that are known to confer an increased risk of colorectal neoplasia to the affected individual and their first-degree relatives (FDRs). Accordingly, professional guidelines suggest earlier and more intensive screening for FDRs of those with advanced adenomas similar to FDRs of those with colorectal cancer (CRC). Although the risk to family members is less clear among patients with advanced serrated polyps, they are often considered in the same category. Unfortunately, there is a growing concern that patients, endoscopists, and primary care providers are unaware of the familial risk associated with these polyps, leaving a wide gap in screening these high-risk individuals. Herein, we propose a standardized language around advanced colorectal polyps and present a detailed review of the literature on associated familial risk. We outline the challenges to implementing the current screening recommendations and suggest approaches to overcome these limitations, including a proposed new colonoscopy quality metric to capture communication of familial CRC risk. Improving screening in these high-risk groups has the potential to substantially reduce the burden of CRC.


Assuntos
Adenoma/genética , Adenoma/patologia , Pólipos do Colo/genética , Pólipos do Colo/patologia , Neoplasias Colorretais/genética , Neoplasias Colorretais/patologia , Programas de Rastreamento/métodos , Colonoscopia , Detecção Precoce de Câncer , Humanos , Risco
9.
Medicine (Baltimore) ; 99(22): e20414, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481436

RESUMO

Endoscopic treatment of duodenal papillary tumors is well described. This study aims to provide new evidence for the treatment of benign papillary tumors through comparisons between endoscopic snare papillectomy (ESP) and endoscopic mucosal resection (EMR).Between May 2010 and December 2017, 72 patients were enrolled. Diagnosis and treatment procedures were ESP and EMR. Endoscopic follow-up evaluation was done periodically as a surveillance measurement for recurrence.Seventy-two patients with ampullary tumors were enrolled, of which 66 had adenomas including 9 high-grade intraepithelial neoplasias and 2 carcinomas in adenoma. Complete resections with tumor-free lateral and basal margins were achieved in all patients. Postoperative complications were bleeding (9.5% in EMR vs 10% in ESP) and pancreatitis (2.4% in EMR and 3.3% in ESP), with no occurrence of perforation, cholangitis or papillary stenosis. Adenoma recurrence was found in 7 patients (14.3% in EMR vs 3.3% in ESP) at 1 year.The ESP procedure is safe and effective for benign ampullary adenoma, high-grade intraepithelial neoplasias, and noninvasive cancer without intraductal tumor growth, which has a shorter procedural duration, as well as lower complication, recurrence rates and hospitalization costs.


Assuntos
Neoplasias Duodenais/cirurgia , Endoscopia Gastrointestinal , Adenoma/diagnóstico por imagem , Adenoma/patologia , Adenoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma/diagnóstico por imagem , Carcinoma/patologia , Carcinoma/cirurgia , Neoplasias Duodenais/diagnóstico por imagem , Neoplasias Duodenais/patologia , Endoscopia Gastrointestinal/economia , Endoscopia Gastrointestinal/métodos , Feminino , Seguimentos , Hospitalização/economia , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Duração da Cirurgia , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
10.
Am J Gastroenterol ; 115(8): 1275-1282, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32483010

RESUMO

INTRODUCTION: Limited data inform the current postpolypectomy surveillance guidelines, which suggest a shortened interval to third colonoscopy after a negative second examination if high-risk adenomas (HRA) were present on the initial screening colonoscopy. Therefore, we examined the risk of HRA at third colonoscopy stratified by findings on 2 previous examinations in a prospective screening colonoscopy cohort of US veterans. METHODS: We identified participants who had 3 or more colonoscopies from CSP#380. We examined the risk of HRA on the third examination based on findings from the previous 2 examinations. Multivariate logistic regression was used to adjust for multiple covariates. RESULTS: HRA were found at the third examination in 114 (12.8%) of 891 participants. Those with HRA on both previous examinations had the greatest incidence of HRA at third examination (14/56, 25.0%). Compared with those with no adenomas on both previous examinations, participants with HRA on the first examination remained at significantly increased risk for HRA at the third examination at 3 years after a negative second examination (odds ratio [OR] 3.41, 95% confidence interval [CI] 1.28-9.08), 5 years (OR 3.14, 95% CI 1.49-6.61), and 7 years (OR 2.89, 95% CI 1.08-7.74). DISCUSSION: In a screening population, HRA on the first examination identified individuals who remained at increased risk for HRA at the third examination, even after a negative second examination. This finding supports current colorectal cancer surveillance guidelines, which suggest a shortened, 5-year time interval to third colonoscopy after a negative second examination if high-risk findings were present on the baseline examination.


Assuntos
Adenoma/epidemiologia , Neoplasias Colorretais/epidemiologia , Adenoma/diagnóstico , Adenoma/diagnóstico por imagem , Adenoma/patologia , Idoso , Colonoscopia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/diagnóstico por imagem , Neoplasias Colorretais/patologia , Feminino , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fatores de Risco , Fatores de Tempo , Estados Unidos/epidemiologia , United States Department of Veterans Affairs , Veteranos
11.
Dig Dis ; 38(5): 364-372, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32516770

RESUMO

BACKGROUND AND AIMS: Endoscopic treatment for duodenal neoplasms is associated with a high risk of perforation. This study aimed to determine the feasibility of endoscopic treatment for sporadic nonampullary duodenal adenoma (SNDA). METHODS: Consecutive patients undergoing endoscopic treatment for SNDA between January 2005 and December 2015 were included in the study. Clinical characteristics and endoscopic outcomes were analyzed using medical records. Long-term outcome was assessed in patients whose follow-up period was >12 months >1 year. RESULTS: A total of 95 lesions (92 patients) were treated with argon plasma coagulation (APC) ablation (n = 25), endoscopic mucosal resection (EMR, n = 59), or endoscopic submucosal dissection (ESD, n= 11). The median age was 54.9 years, and 63% were male. In patients who underwent EMR and ESD, the en bloc resection rate was 83.1 and 90.0% (p > 0.99); and the complete resection rate was 81.4 and 80% (p > 0.99), respectively. Perforation occurred in 8 patients (8.7%), 4 of whom required surgery. The ESD group showed a significantly higher perforation rate than APC or EMR group (45.5 vs. 0 and 5.1%; p < 0.001). During the median follow-up period of 19 months (range 12-137 months), one patient in the APC ablation group experienced recurrence; no recurrences were seen among EMR and ESD groups. CONCLUSIONS: Favorable long-term outcomes indicate that endoscopic treatment is an effective approach for the treatment of SNDA. Considering the high risk of perforation associated with ESD, APC, or EMR may be an acceptable alternative.


Assuntos
Adenoma/cirurgia , Neoplasias Duodenais/cirurgia , Endoscopia , Adenoma/patologia , Coagulação com Plasma de Argônio , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
12.
Crit Rev Oncol Hematol ; 150: 102970, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32371339

RESUMO

To characterize metanephric tumours in children, we performed a literature review investigating paediatric metanephric adenomas (MA), metanephric stromal tumours (MST) and metanephric adenofibromas (MAF). Including two patients from our own institution (MA, MAF), 110 individual cases (41 MA, 20 MAF, 49 MST) were identified. Additionally, fifteen composite tumours were identified, with areas of MA/MAF and Wilms tumour (WT) or papillary carcinoma. No distinct clinical or radiological features could be defined. In pure metanephric tumours, histologically proven distant metastases were reported once (MA), relapse was reported once (MST) and one tumour-related death occurred (MST). Somatic BRAF-V600E mutations were tested in 15 cases, and identified in 3/6 MA, 3/3 MAF, and 6/6 MST. In our institution the MA harboured a somatic KRAS-G12R mutation. Overall, paediatric metanephric tumours are difficult to discriminate from other renal tumours at presentation, behave relatively benign, and the occurrence of composite tumours warrants analysis of underlying (genetic) pathways.


Assuntos
Adenoma/genética , Adenoma/patologia , Carcinoma Papilar/genética , Carcinoma Papilar/patologia , Neoplasias Renais/genética , Neoplasias Renais/patologia , Proteínas Proto-Oncogênicas p21(ras)/genética , Tumor de Wilms/genética , Tumor de Wilms/patologia , Biomarcadores Tumorais/genética , Criança , Análise Mutacional de DNA , Humanos , Imuno-Histoquímica , Imunofenotipagem , Recidiva Local de Neoplasia
13.
Z Gastroenterol ; 58(8): 767-772, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32380553

RESUMO

BACKGROUND: Pyloric gland adenomas (PGAs) are very rare and underdiagnosed, mostly be founded in the stomach. Similar to colorectal adenomas they have a high risk of malignant transformation to adenocarcinoma up to 12-47 %. Endoscopic resections in the duodenum harbor a significant risk of complications. EMR is the current standard technique for treatment of duodenal non-ampullary adenomas. Complete resection rates are considerably high at about 90 %. Adverse events as bleeding was reported up to 25 %. ESD is not recommended for resection of duodenal lesions since the perforation rate may be as high as 35 %. Use of EFTR in the duodenum are limited to a single case study of 20 patients. CASE: A 67 year old patient with attenuated polyposis coli presented for screening. Gastroscopy showed a 20 mm large, non-ampullary lesions in the proximal duodenum (pars I). The margins of the duodenal lesions were marked with a high-frequency (HF) probe. An integrated balloon dilatation (20 mm) of the upper esophageal sphincter and the pylorus was performed to facilitate advancing of the gastroduodenal FTRD® (Ovesco Endoscopy AG). After pulling the duodenal lesion into the cap with a grasper the FTRD clip was deployed and the lesion immediately resected with the preloaded snare. A single-shot antibiotic prophylaxis with 2 g ceftriaxone i. v. was administered during the intervention. Second-look endoscopy was scheduled 24 h after resection. The resectat showed histologically a gastric type adenoma of 18 mm in the proximal duodenum (immunohistochemistry positive for Mucin-1, Mucin-5, Mib 1). CONCLUSION: Herein we present the first case of duodenal EFTR in a patient with attenuated FAP and a PGA. There are currently no specific guidelines for the removal and surveillance. ASGE recommends resection and surveillance endoscopy at 3-5 years interval.


Assuntos
Adenoma/cirurgia , Polipose Adenomatosa do Colo/cirurgia , Neoplasias Duodenais/cirurgia , Duodenoscopia/métodos , Adenoma/patologia , Polipose Adenomatosa do Colo/patologia , Idoso , Neoplasias Duodenais/patologia , Duodenoscopia/instrumentação , Duodeno , Humanos , Masculino , Piloro , Resultado do Tratamento
15.
Cancer Causes Control ; 31(7): 631-640, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32358694

RESUMO

PURPOSE: BRAF mutation and DNA hypermethylation have linked sessile serrated adenomas/polyps (SSA/Ps) to serrated colorectal cancer (CRC) in cross-sectional studies, but they have not been evaluated in a longitudinal study. We aimed to evaluate the associations between molecular markers of serrated polyps and subsequent advanced colorectal neoplasia. METHODS: Study subjects included Kaiser Permanente Washington members aged 20-75 years who received an index colonoscopy between 1/1/1998 and 12/31/2007 and had hyperplastic polyps (HPs) or SSA/Ps according to study pathology review. Polyps from index colonoscopies were removed and assayed for BRAF mutation, CpG island methylator phenotype (CIMP), and MLH1 methylation. Pathology reports and biopsies from the subsequent lower gastrointestinal endoscopy through 1/1/2013 were reviewed for advanced colorectal neoplasia. We identified additional incident CRC cases through linkage to the Seattle-Puget Sound Surveillance Epidemiology and End Results registry. We used generalized estimating equations to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI) for subsequent advanced colorectal neoplasia, comparing index serrated polyps with different molecular markers. RESULTS: We included 553 individuals with index serrated polyps (420 HPs and 133 SSA/Ps) and 795 subsequent endoscopies. The prevalence of BRAF-mutant, CIMP-high, and MLH1-methylated serrated polyps were 51%, 4%, and 2%, respectively. BRAF and CIMP were not associated with subsequent advanced colorectal neoplasia. MLH1-methylated SSP/As were significantly more likely to have subsequent advanced neoplasia (OR = 4.66, 95% CI 1.06-20.51). CONCLUSION: Our results suggest that BRAF-mutant and CIMP-high serrated polyps are not associated with subsequent advanced colorectal neoplasia. Among SSA/Ps, MLH1 methylation may be an important marker to identify high-risk CRC precursors.


Assuntos
Neoplasias Colorretais/genética , Neoplasias Colorretais/patologia , Pólipos Intestinais/genética , Pólipos Intestinais/patologia , Adenoma/genética , Adenoma/patologia , Adulto , Idoso , Estudos de Casos e Controles , Colonoscopia , Neoplasias Colorretais/epidemiologia , Estudos Transversais , Metilação de DNA , Feminino , Humanos , Pólipos Intestinais/epidemiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Mutação , Fenótipo , Proteínas Proto-Oncogênicas B-raf/genética , Programa de SEER , Washington/epidemiologia , Adulto Jovem
16.
J Comput Assist Tomogr ; 44(3): 419-425, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32345808

RESUMO

PURPOSE: The aims of the study were to assess the typical and atypical radiologic features of pathologically proven adrenal adenomas and to determine the relationship between the radiologic and histopathologic classification. METHODS: We retrospectively studied 156 pathologically proven adrenal adenomas in 154 patients from our institutional databases who have computed tomography (CT) and/or magnetic resonance imaging (MRI) examinations before intervention. We determined the histopathologic diagnosis (typical or atypical) using Weiss scoring and classified the adenomas radiologically into typical, atypical, or indeterminate based on lesion size, precontrast CT attenuation, absolute percentage washout, calcification, and necrosis. The κ statistic was used to assess the agreement between radiologists. The Fisher exact test was used to compare the radiologic and pathological classifications. RESULTS: In consensus, there were 83 typical, 42 atypical, and 31 indeterminate adrenal lesions. Logistic regression model showed that radiologically atypical adenoma was significantly associated with larger size, lobulated shape, higher unenhanced CT attenuation, heterogeneous appearance, nonfunctioning status, absolute percentage washout of less than 60%, and a signal intensity index of less than 16.5%.Pathologically, 147 adenomas were pathologically typical (Weiss 0), and 9 adenomas were pathologically atypical (Weiss 1-2). Radiologically, there was substantial agreement between both readers, with Cohen κ at 0.71. Approximately 98% of radiologically typical adenomas were pathologically typical. Only 17% of radiologically atypical adenomas were pathologically atypical. All radiologically indeterminate adenomas were pathologically typical. However, some of the radiologically indeterminate and typical adenomas still had an atypical component on pathologic analysis, such as necrosis, nuclear atypia, or oncocytic features. CONCLUSIONS: Radiologically atypical lesion was significantly associated with larger size and higher unenhanced CT attenuation. Approximately 27% of the cases demonstrated atypical features on imaging. Most radiologically atypical adrenal adenomas are pathologically typical.


Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/patologia , Cuidados Pré-Operatórios/métodos , Tomografia Computadorizada por Raios X/métodos , Adenoma/diagnóstico por imagem , Adenoma/patologia , Adolescente , Neoplasias das Glândulas Suprarrenais/cirurgia , Glândulas Suprarrenais/diagnóstico por imagem , Glândulas Suprarrenais/patologia , Glândulas Suprarrenais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
17.
PLoS One ; 15(4): e0231880, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32315365

RESUMO

BACKGROUND: Evidence has shown that deep learning computer aided detection (CADe) system achieved high overall detection accuracy for polyp detection during colonoscopy. AIM: The detection performance of CADe system on non-polypoid laterally spreading tumors (LSTs) and sessile serrated adenomas/polyps (SSA/Ps), with higher risk for malignancy transformation and miss rate, has not been exclusively investigated. METHODS: A previously validated deep learning CADe system for polyp detection was tested exclusively on LSTs and SSA/Ps. 1451 LST images from 184 patients were collected between July 2015 and January 2019, 82 SSA/Ps videos from 26 patients were collected between September 2018 and January 2019. The per-frame sensitivity and per-lesion sensitivity were calculated. RESULTS: (1) For LSTs image dataset, the system achieved an overall per-image sensitivity and per-lesion sensitivity of 94.07% (1365/1451) and 98.99% (197/199) respectively. The per-frame sensitivity for LST-G(H), LST-G(M), LST-NG(F), LST-NG(PD) was 93.97% (343/365), 98.72% (692/701), 85.71% (324/378) and 85.71% (6/7) respectively. The per-lesion sensitivity of each subgroup was 100.00% (71/71), 100.00% (64/64), 98.31% (58/59) and 80.00% (4/5). (2) For SSA/Ps video dataset, the system achieved an overall per-frame sensitivity and per-lesion sensitivity of 84.10% (15883/18885) and 100.00% (42/42), respectively. CONCLUSIONS: This study demonstrated that a local-feature-prioritized automatic CADe system could detect LSTs and SSA/Ps with high sensitivity. The per-frame sensitivity for non-granular LSTs and small SSA/Ps should be further improved.


Assuntos
Adenoma/diagnóstico , Colonoscopia , Neoplasias Colorretais/diagnóstico , Processamento de Imagem Assistida por Computador/métodos , Adenoma/patologia , Pólipos do Colo/patologia , Neoplasias Colorretais/patologia , Aprendizado Profundo , Humanos
18.
PLoS One ; 15(4): e0231888, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32343708

RESUMO

BACKGROUND AND AIMS: Inadequate bowel preparation (BP) is an unfavorable factor that influence the success of colonoscopy. Although standard education (SE) given to patients are proved useful to avoid inadequate BP. Studies concerning the effects of reinforced education (RE) on the quality of BP were inconsistent. The aim of this updated meta-analysis of randomized controlled trial was to compare the quality of BP between patients receiving RE in addition to SE and those receiving SE alone. METHODS: MEDLINE, EMBASE, Web of Science and the Cochrane Library were systemically searched to identify the relevant studies published through April 2019. The primary outcome was the rate of adequate BP. Subgroup analyses were conducted. Secondary outcomes included BP score, adenoma detection rate (ADR), polyp detection rate (PDR), insertion time, withdrawal time, adverse events, >80% purgative intake and diet compliance. Dichotomous variables were reported as odds ratio (OR) with 95% confidence interval (CI). Continuous data were reported as mean difference (MD) with 95%CI. Pooled estimates of OR or MD were calculated using a random-effects model. Statistical heterogeneity was accessed by calculating the I2 value. A P value less than 0.05 was considered significant. RESULTS: A total of 18 randomized controlled trails (N = 6536) were included in this meta-analysis. Patients who received RE had a better BP quality than those only receiving SE (OR 2.59, 95%CI: 2.09-3.19; P<0.001). A higher ADR (OR 1.35; 95%CI: 1.06-1.72; P = 0.020) and PDR (OR 1.24, 95%CI: 1.02-1.50; P = 0.030), shorter insertion (MD -0.76; 95%CI: -1.48-(-0.04); P = 0.040) and withdrawal time (MD -0.83; 95%CI: -1.83-(-0.28); P = 0.003), less nausea/vomiting (OR 0.78; 95%CI: 0.64-0.97; P = 0.020) and abdominal distension (OR 0.72; 95%CI: 0.68-0.92; P = 0.020) were achieved in the RE group. More patients had >80% purgative intake (OR 2.17; 95%CI, 1.09-4.32; P = 0.030) and were compliant with diet restriction (OR 2.38; 95%CI: 1.79-3.17; P<0.001) in the RE group. CONCLUSION: RE significantly improved BP quality, increased ADR and PDR, decreased insertion and withdrawal time and adverse events.


Assuntos
Colonoscopia , Educação de Pacientes como Assunto , Adenoma/patologia , Humanos , Laxantes/administração & dosagem , Laxantes/efeitos adversos , Náusea/etiologia , Razão de Chances , Polietilenoglicóis/administração & dosagem , Polietilenoglicóis/efeitos adversos , Pólipos/patologia , Ensaios Clínicos Controlados Aleatórios como Assunto
19.
Medicine (Baltimore) ; 99(15): e19728, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282731

RESUMO

BACKGROUND: The aim of this study was to present several cases of benign and malignant nipple lesions and contribute to diagnosis and differential diagnosis. METHODS: A retrospective study was conducted on 13 patients. All of the patients were evaluated by ultrasonography, and 11 of them had pathological results. We analyzed the clinical and sonographic features. RESULTS: There were 3 malignant lesions, 7 benign lesions, and 3 congenital nipple dysplasia, listed as follows:Malignant lesions (n = 3, 23%): Paget's disease (PD, n = 3, 23%). All of the patients with PD showed unilateral nipple erosion, discharge, and pain. The ultrasound showed abundant blood flow (n = 3, 23%); 2 patients (n = 2, 15%) had microcalcifications.Benign lesions (n = 7, 54%): Adenoma of the nipple (n = 2, 15%). One patient (n = 1, 8%) had nipple erosion and discharge. Two patients (n = 2, 15%) had a palpable nodule in the nipple. The ultrasound of both patients (n = 2, 15%) showed regular-shaped, clear border nodule with abundant blood flow (n = 2, 15%).Leiomyoma of the nipple (n = 1, 8%): This male patient was characterized by unilateral nipple enlargement and pain. The ultrasound showed a regular nodule with absent blood flow.Plasma cell mastitis (n = 2, 15%): Two patients showed unilateral nipple inversion and pain. One patient (n = 1, 8%) showed swollen and redness. The 2 patients showed a lesion in the gland around the nipple present as an irregular shape and unclear boundary hypoechoic mass.Nipple wart (n = 2, 15%): Two patients showed a unilateral soft exogenous neoplasm. Both of the patients showed a hypoechoic wart; the echo was similar to the nipple, the border was clear, and had no blood flow in the wart.Nipple Dysplasia (n = 3, 23%): Accessory nipple (n = 3, 23%). Two patients (n = 2, 15%) had accessory nipples in the subcoastal area, 1 patient (n = 1, 8%) in the areolar. All of the patients' sonographic features were the same as the nipple.The positive predict value (PPV) of the clinical symptoms: Erosion and discharge are both 75% (P < 0.05). The PPV of the US manifestations: irregular shape, indictinct margin, abundant blood flow, microcalcification, thicken skin in diagnosing malignant lesions are 60%,60%,60%,100%,100%, respectively (P < 0.05). CONCLUSIONS: The characteristic sonographic features together with clinical symptoms contribute to the diagnosis of nipple lesions.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Mamilos/irrigação sanguínea , Mamilos/diagnóstico por imagem , Ultrassonografia/métodos , Adenoma/patologia , Adulto , Neoplasias da Mama/patologia , Calcinose/patologia , Diagnóstico Diferencial , Feminino , Doença da Mama Fibrocística/patologia , Humanos , Leiomioma/patologia , Masculino , Mastite , Pessoa de Meia-Idade , Mamilos/patologia , Doença de Paget Mamária/patologia , Dor/diagnóstico , Plasmócitos/patologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Ultrassonografia/tendências , Verrugas
20.
World Neurosurg ; 138: e898-e904, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32251826

RESUMO

BACKGROUND: Crooke cell adenoma is a very rare subtype of pituitary neoplasm that is known to be clinically aggressive. These tumors can secrete adrenocorticotropic hormone or may be endocrinologically silent. We evaluated the effect of Gamma Knife radiosurgery (GKRS) on endocrine remission and tumor control. MATERIALS AND METHODS: This study comprised 5 patients (2 men, 3 women; median age at GKRS, 55 years [range, 21-65 years]) with pathology-confirmed Crooke cell adenoma treated with GKRS at the Gamma Knife Center of the University of Virginia. The median time interval between transsphenoidal resection and GKRS was 5.8 months. The median margin dose was 25 Gy (range, 18-25 Gy). Median treated adenoma volume was 3.12 mL. Median follow-up was 107 months (range, 44-122 months). RESULTS: Tumor control was achieved in all patients. Three patients achieved endocrine remission at the last follow-up. The median time interval to cortisol normalization when off of anti-hormone secreting medication was 12 months (range, 6-24 months). Newly developed or worsening endocrinopathy occurred in 3 patients at 6, 15, and 18 months, respectively. Cranial nerve III neuropathy developed in 1 patient. Two patients required bilateral adrenalectomy at 44 months and 50 months, respectively, following GKRS. CONCLUSIONS: GKRS appears to be a safe and reasonably effective treatment option for Crooke cell adenoma. Multicenter studies with larger numbers of patients are needed to verify these findings.


Assuntos
Adenoma/cirurgia , Neoplasias Hipofisárias/cirurgia , Radiocirurgia , Adenoma/patologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/metabolismo , Neoplasias Hipofisárias/patologia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA