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1.
Urology ; 135: 71-75, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31195014

RESUMO

OBJECTIVE: To summarize the clinical characteristics and surgical management of adrenal teratoma in adults. PATIENTS AND METHODS: We retrospectively reviewed 14 patients with adrenal teratoma from January 2002 to June 2017, at 2 large centers in China and performed a systematic review of 39 patients from our series and published literatures. The clinicopathological characteristics, imaging features, surgical management and outcomes of this rare disease were analyzed. RESULTS: Our series includes 12 females and 2 males with the median age of 35. Seven patients were treated by open adrenalectomy (OA) and 7 by laparoscopic adrenalectomy (LA) without perioperative complications. All patients were alive without recurrence or canceration over a mean follow-up of 77.1 months. In the systemic review, the male-female ratio was nearly 1:3, with a median age of 29 years. Mean tumor size was 9.4 cm and the distribution was almost the same between left and right side (53.8% vs 46.2%). The most common symptoms were flank or abdominal pain (46.2%), whereas 53.8% patients were asymptomatic. Tumors were often cystic (63.9%) with intratumoral fat (91.7%) and calcifications (80.6%). All patients underwent surgery including 17 (43.6%) OA and 22 (56.4%) minimally invasive surgery. All tumors were pathologically confirmed mature teratoma except for one. CONCLUSION: Adrenal teratoma is an extremely rare entity, frequently found to be large, benign and cystic. The patient's prognosis is generally good. As for its large volume, OA is the first choice for teratoma in most cases, while the LA can be an option in the small one.


Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Glândulas Suprarrenais/patologia , Doenças Assintomáticas/terapia , Doenças Raras/cirurgia , Teratoma/cirurgia , Neoplasias das Glândulas Suprarrenais/diagnóstico , Neoplasias das Glândulas Suprarrenais/patologia , Glândulas Suprarrenais/cirurgia , Adrenalectomia , Adulto , China , Feminino , Seguimentos , Humanos , Laparoscopia , Masculino , Prognóstico , Doenças Raras/diagnóstico , Doenças Raras/patologia , Estudos Retrospectivos , Teratoma/diagnóstico , Teratoma/patologia , Resultado do Tratamento
2.
Orv Hetil ; 160(52): 2073-2078, 2019 Dec.
Artigo em Húngaro | MEDLINE | ID: mdl-31868009

RESUMO

The confirmed incidence of new-onset adrenal gland hemorrhage has increased with the development of ultrasound diagnostics in recent years. Intrauterine developed cases are rarely recognized. Differential diagnosis of cystic lesions of the adrenal gland is often only possible after birth. In our case study, we report the ultrasonographic diagnosis and follow-up of a cystic lesion measuring 4 × 3 cm in the left fetal epigastrium in the 33rd gestational week. During pregnancy, multimodal imaging methods (both ultrasound and magnetic resonance) have confirmed the diagnosis of hemorrhage in the left adrenal gland. In the 37th gestational week, the hematoma completely resolved. At term, a 4150 gram neonate was delivered in good condition by an elective cesarean section. Postnatal endocrinological and follow-up ultrasound examinations did not find any disorder. This study is the first published case report in the literature that proves that fetal adrenal hemorrhage can intrauterin spontaneously absorb within a short period of time. Our case draws attention to the fact that adrenal bleeding may occur in the newborn regardless of birth trauma. It can also be assumed that the incidence of adrenal bleeding during pregnancy is higher than that reported in neonatal cases. Orv Hetil. 2019; 160(52): 2073-2078.


Assuntos
Doenças das Glândulas Suprarrenais/diagnóstico por imagem , Doenças das Glândulas Suprarrenais/diagnóstico , Glândulas Suprarrenais/diagnóstico por imagem , Glândulas Suprarrenais/patologia , Doenças Fetais/diagnóstico , Hemorragia/patologia , Ultrassonografia Pré-Natal/métodos , Cesárea , Diagnóstico Diferencial , Feminino , Humanos , Recém-Nascido , Gravidez
3.
J Med Life ; 12(3): 215-220, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31666819

RESUMO

The final stage of the diagnostic of primary hyperaldosteronism is to identify the causes of excessive secretion of aldosterone and determination of its variants. Based on the analysis of literature data, the diagnostic value, sensitivity and specificity of the methods of radiation diagnostics for primary hyperaldosteronism were assessed: ultrasound, computed tomography, magnetic resonance imaging, photon emission tomography, magnetic resonance spectroscopy, scintigraphy with iodine radiopharmaceuticals. The causes of false-positive and false-negative evaluations of changes in adrenal glands in the application of these diagnostics have been analyzed. There are many genetic and morphological studies when searching the literature data on the principles and methods of distinguishing the nosological forms of primary hyperaldosteronism based on the results of the aldosterone level estimation in the separated blood from the central veins of both adrenal glands or segmental veins of one gland with subsequent determination of the concentration gradient. It was noted that topical diagnostics and, especially, the determination of nosological forms of primary hyperaldosteronism are complex and expensive, but their results allow choosing an appropriate treatment approach for each particular case.


Assuntos
Técnicas de Laboratório Clínico , Hiperaldosteronismo/diagnóstico , Glândulas Suprarrenais/diagnóstico por imagem , Glândulas Suprarrenais/patologia , Aldosterona/metabolismo , Humanos , Hiperaldosteronismo/diagnóstico por imagem , Hiperaldosteronismo/patologia , Tomografia Computadorizada por Raios X
4.
BMJ Case Rep ; 12(9)2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31570355

RESUMO

Pheochromocytoma (PCC) may present as a cystic or solid tumour. Cystic PCCs are difficult to differentiate from simple cysts in the absence of classic symptoms of PCCs. Cystic nature develops due to intralesional bleeding and necrosis. We present a case of young man without any comorbidity who was diagnosed as a simple adrenal cyst and planned for laparoscopic excision but found to be functional PCC during the time of surgery only. The patient was managed with extensive monitoring and use of multiple drugs to control blood pressure. Surgery was completed without any complication laparoscopically and postoperative period was also uneventful. Histopathology confirmed the diagnosis of cystic PCC. Our case also shows the importance of functional imaging like metaiodobenzylguanidine (MIBG) scan in doubtful cases of adrenal cysts when other biochemical markers are unremarkable to diagnosis. We emphasise the importance of meticulous preparation for any intraoperative disasters even for apparently simple adrenal cyst.


Assuntos
Neoplasias das Glândulas Suprarrenais/patologia , Glândulas Suprarrenais/patologia , Cistos/patologia , Feocromocitoma/patologia , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/cirurgia , Glândulas Suprarrenais/diagnóstico por imagem , Adulto , Dor nas Costas , Cistos/diagnóstico por imagem , Diagnóstico Diferencial , Dor no Flanco , Humanos , Hipertensão , Laparoscopia , Masculino , Posicionamento do Paciente , Feocromocitoma/diagnóstico por imagem , Feocromocitoma/cirurgia , Radiografia Abdominal , Tomografia Computadorizada por Raios X , Resultado do Tratamento
5.
J Toxicol Sci ; 44(9): 601-610, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31474741

RESUMO

To verify simultaneous measurement of blood levels of adrenal steroids as a tool to evaluate drug effects on adrenal steroidogenesis, dose- and time-dependent changes in blood levels of corticosterone and its precursors (pregnenolone, progesterone and deoxycorticosterone), as well as their relationship with the pathological changes in the adrenal gland, were examined in rats dosed with ketoconazole (KET). Also examined were whether effects on adrenal steroidogenesis that were not obvious in the blood steroid levels after sole administration of KET could be revealed by post-administration of ACTH, and the correlation between the blood and adrenal steroid levels. Male rats were dosed with 15, 50, or 150 mg/kg of KET for 1 or 7 days with or without ACTH, and the blood and adrenal concentrations of the steroids were measured. KET increased the blood deoxycorticosterone level even at a dose level and time point at which histopathological changes were not obvious. KET-induced changes in blood levels of other steroids were revealed by ACTH, and the blood and adrenal levels were generally correlated especially after ACTH post-administration. Thus, blood levels of adrenal steroids, including precursors, can be a sensitive and early marker of drug effects on the adrenal steroidogenesis that reflect adrenal levels of steroids. The usefulness of the multiple steroid measurement as a method for mechanism investigation of drug effects on the adrenal gland can be further enhanced by ACTH.


Assuntos
Glândulas Suprarrenais/efeitos dos fármacos , Glândulas Suprarrenais/metabolismo , Hormônio Adrenocorticotrópico/farmacologia , Desoxicorticosterona/sangue , Desoxicorticosterona/metabolismo , Cetoconazol/toxicidade , Pregnenolona/sangue , Pregnenolona/metabolismo , Progesterona/sangue , Progesterona/metabolismo , Glândulas Suprarrenais/patologia , Hormônio Adrenocorticotrópico/administração & dosagem , Animais , Cromatografia Líquida , Relação Dose-Resposta a Droga , Masculino , Ratos , Ratos Sprague-Dawley , Espectrometria de Massas em Tandem , Fatores de Tempo
6.
Medicine (Baltimore) ; 98(36): e17038, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490393

RESUMO

RATIONALE: Neuroblastoma is one of the most common tumors found in children, and mostly arises in the adrenal gland and paravertebral regions. Orbital neuroblastoma metastasis is relatively rare, and is associated with poor prognosis. Since the symptoms and signs of orbital neuroblastoma are not specific, its diagnosis remains challenging. PATIENT CONCERNS: A 3-year-old girl presented with periorbital ecchymoses (raccoon eyes) and proptosis for 40 days. DIAGNOSES: Abdominal magnetic resonance imaging (MRI) and sonography analysis revealed a large mass in the left adrenal gland (primary tumor). The computed tomography and MRI further revealed multiple soft tissue masses in the skull and both orbits with erosion of the adjacent bones (the metastasis). The histological analysis of the tumor removed from the right orbit confirmed the diagnosis of neuroblastoma. INTERVENTIONS: The mass on the right face was surgically removed. OUTCOMES: The patient exhibited no deteriorative signs at the 6-month follow-up. LESSONS: Clinical manifestations, such as periorbital ecchymoses and proptosis, in combination with radiological analysis and histological findings, are important for the diagnosis of orbital neuroblastoma metastasis.


Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Equimose/etiologia , Exoftalmia/etiologia , Neuroblastoma/diagnóstico por imagem , Neoplasias Orbitárias/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/patologia , Glândulas Suprarrenais/patologia , Pré-Escolar , Feminino , Humanos , Neuroblastoma/complicações , Neuroblastoma/patologia , Neuroblastoma/secundário , Neoplasias Orbitárias/complicações , Neoplasias Orbitárias/patologia , Neoplasias Orbitárias/secundário
7.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(7): 402-409, ago.-sept. 2019. graf, tab
Artigo em Inglês | IBECS | ID: ibc-182859

RESUMO

Background: This study was designed to detect the potential association of a nonfunctional adrenal incidentaloma (NFAI) with insulin resistance and associated metabolic disturbances, with a subsequent increase in cardiovascular risk factors. Methods: Eighty-three NFAI patients and 56 volunteers (controls) without any adrenal abnormalities on computed tomography (CT) were included. Fasting blood glucose (FBG), fasting insulin, lipid profiles, uric acid, homocysteine, fibrinogen, high sensitivity C-reactive protein (hs-CRP), and adiponectin levels were measured in both groups. Blood pressure (BP), waist circumference, body mass index (BMI), and carotid intima media thickness (CIMT) were evaluated in both the patients and volunteers. Results: There were no significant difference between the NFAI and control groups with respect to age, sex, BMI, waist circumference, systolic and diastolic BP, smoking, concomitant disease, and medications. Fasting insulin and glucose levels and homeostasis model of assessment-insulin resistance (HOMA-IR) scores were significantly higher in the NFAI group as compared with those in the control group (p<0.01). The frequency of metabolic syndrome in the NFAI group was higher than that in the control group (p<0.01). All the lipid fractions, except triglyceride (TG), (p<0.05), homocysteine (p=0.01), and fibrinogen levels (p<0.001), were significantly higher in the NFAI group as compared with the levels in the control group. There were no significant differences between the NFAI and control groups in terms of uric acid, hs-CRP, and adiponectin levels. The CIMT values in the NFAI group were significantly higher than those in the control group (0.74±0.14 vs. 0.53±0.09, p<0.001). The mean CIMT value showed a statistically positive correlation with age (r=0.245, p=0.004); the HOMA-IR score (r=0.490, p<0.001); and FBG (r=0.521, p<0.001), fasting insulin (r=0.432, p<0.001), total cholesterol (TC) (r=0.267, p=0.002), and fibrinogen (r=0.398, p<0.001) levels in the NFAI group. Conclusions: The results indicated that the NFAI patients had an elevated risk of insulin resistance, with metabolic syndrome and increased CIMT values. Long-term follow-up studies should be designed to evaluate postsurgical alterations in metabolic parameters and cardiovascular risk factors in NFAI patients


Antecedentes: Este estudio se diseñó para detectar la posible asociación del incidentaloma suprarrenal no funcionante (ISNF) con resistencia a la insulina y trastornos metabólicos asociados, con un incremento subsecuente en los factores de riesgo cardiovascular. Métodos: Se incluyó a 83 pacientes con ISNF y a 56 voluntarios (controles) sin anomalías suprarrenales en la tomografía computarizada (TC). Se determinaron en ambos grupos los valores de glucemia en ayunas (GA), insulina en ayunas, perfiles lipídicos, ácido úrico, homocisteína, fibrinógeno, proteína C reactiva de alta sensibilidad (PCRas) y adiponectina. Se evaluaron la presión arterial (PA), el perímetro de la cintura, el índice de masa corporal (IMC) y el grosor íntima-media carotídea (GIMC) tanto en los pacientes como en los voluntarios. Resultados: No había una diferencia significativa entre los grupos con ISNF y de control en cuanto a edad, sexo, IMC, perímetro de la cintura, PA sistólica y diastólica, tabaquismo, enfermedades concomitantes y medicamentos. Las concentraciones de insulina y glucosa en ayunas y las puntuaciones del modelo homeostático de evaluación de la resistencia a la insulina (HOMA-IR) fueron significativamente mayores en el grupo con ISNF que en el de control (p<0,01). La frecuencia de síndrome metabólico fue mayor en el grupo con ISNF que en el de control (p<0,01). Los valores de todas las fracciones lipídicas, excepto los de triglicéridos (TG) (p<0,05), homocisteína (p=0,01) y fibrinógeno (p<0,001), fueron significativamente mayores en el grupo con ISNF que en el de control. No hubo diferencias significativas entre los grupos con ISNF y de control en las concentraciones de ácido úrico, PCRas y adiponectina. Los valores del GIMC en el grupo con ISNF fueron significativamente mayores que los del grupo de control (0,74±0,14 frente a 0,53±0,09; p<0,001). El valor medio del GIMC mostró una correlación estadísticamente positiva con la edad (r=0,245; p=0,004); la puntuación del HOMA-IR (r=0,490; p<0,001), y la GA (r=0,521; p<0,001), la insulina en ayunas (r=0,432; p<0,001), el colesterol total (CT) (r=0,267; p=0,002) y el fibrinógeno (r=0,398; p<0,001) en el grupo con ISNF. Conclusión: Los resultados indicaban que los pacientes con ISNF tenían un riesgo elevado de resistencia a la insulina, con síndrome metabólico y aumento de los valores del GIMC. Deben diseñarse estudios de seguimiento a largo plazo para evaluar los cambios posquirúrgicos de los parámetros metabólicos y los factores de riesgo cardiovascular en pacientes con ISFN


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Achados Incidentais , Fatores de Risco , Neoplasias das Glândulas Suprarrenais/complicações , Doenças Cardiovasculares/metabolismo , Espessura Intima-Media Carotídea , Síndrome Metabólica/complicações , Resistência à Insulina , Glândulas Suprarrenais/patologia , Síndrome Metabólica/diagnóstico , Neoplasias das Glândulas Suprarrenais/diagnóstico , Doenças Cardiovasculares/complicações , Síndrome Metabólica/fisiopatologia , Voluntários Saudáveis , Pressão Arterial , Índice de Massa Corporal , Relação Cintura-Quadril
8.
Bratisl Lek Listy ; 120(8): 593-600, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31379183

RESUMO

OBJECTIVES: The incidence of obesity and obesity-assosiated pathologies continues to increase with profound adverse effects on health status in the developed countries. BACKGROUND: We aimed to investigate the effect of high fat diet on the adrenal gland morphology. METHODS: We fed the mice with either high-fat diet (60 % kcal from fat) or low-fat diet (10 % kcal from fat) for nine weeks. Unbiased stereological methods were used to evaluate the adrenal gland morphology. The sections were evaluated using Cavalieri's method and volume fraction approach. We calculated mean volume of adrenal gland, mean volume of adrenal medulla, VVadrenal medulla/adrenal gland, mean diameter of cromaffin cells, number of chromaffin cells in per unit volume (NVcc mm‒3), total number of cromaffin cells, VVzona glomerulosa/adrenal cortex, VVzona fasciculata/adrenal cortex , VVzona reticulosa/adrenal cortex. RESULTS: The weight of adrenal gland, body weight intraperitoneal adipose tissue and adrenal gland weight in the obese mice significantly increased when compared with the control group. No changes were observed in the mean volume of adrenal gland, mean volume of adrenal medulla, VVzona glomerulosa/adrenal cortex, VVzona fasciculata/adrenal cortex, total number of cromaffin cells and diameter of cromaffin cells. However, NVcc mm-3 and VVzona reticulosa/adrenal cortex in the obese mice considerably increased compared with the control group. CONCLUSION: The present results suggest that high fat diet adversely affects the adrenal gland morphology (Tab. 2, Fig. 6, Ref. 28).


Assuntos
Glândulas Suprarrenais/patologia , Dieta Hiperlipídica/efeitos adversos , Córtex Suprarrenal/patologia , Medula Suprarrenal/patologia , Animais , Peso Corporal , Camundongos , Tamanho do Órgão
9.
Hypertension ; 74(4): 809-816, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31446799

RESUMO

Aldosterone-producing adenomas with somatic mutations in the KCNJ5 G-protein-coupled inwardly rectifying potassium channel are a cause of primary aldosteronism. These mutations drive aldosterone excess, but their role in cell growth is undefined. Our objective was to determine the role of KCNJ5 mutations in adrenal cell proliferation and apoptosis. The Ki67 proliferative index was positively correlated with adenoma diameter in aldosterone-producing adenomas with a KCNJ5 mutation (r=0.435, P=0.007), a negative correlation was noted in adenomas with no mutation detected (r=-0.548, P=0.023). Human adrenocortical cell lines were established with stable expression of cumate-inducible wild-type or mutated KCNJ5. Increased cell proliferation was induced by low-level induction of KCNJ5-T158A expression compared with control cells (P=0.009), but increased induction ablated this difference. KCNJ5-G151R displayed no apparent proliferative effect, but KCNJ5-G151E and L168R mutations each resulted in decreased cell proliferation (difference P<0.0001 from control cells, both comparisons). Under conditions tested, T158A had no effect on apoptosis, but apoptosis increased with expression of G151R (P<0.0001), G151E (P=0.008), and L168R (P<0.0001). We generated a specific KCNJ5 monoclonal antibody which was used in immunohistochemistry to demonstrate strong KCNJ5 expression in adenomas without a KCNJ5 mutation and in the zona glomerulosa adjacent to adenomas irrespective of genotype as well as in aldosterone-producing cell clusters. Double immunofluorescence staining for KCNJ5 and CYP11B2 (aldosterone synthase) showed markedly decreased KCNJ5 immunostaining in CYP11B2-positive cells compared with CYP11B2-negative cells in aldosterone-producing adenomas with a KCNJ5 mutation. Together, these findings support the concept that cell growth effects of KCNJ5 mutations are determined by the expression level of the mutated channel.


Assuntos
Glândulas Suprarrenais/metabolismo , Proliferação de Células/fisiologia , Canais de Potássio Corretores do Fluxo de Internalização Acoplados a Proteínas G/genética , Hiperaldosteronismo/genética , Glândulas Suprarrenais/patologia , Adulto , Idoso , Apoptose/fisiologia , Linhagem Celular , Feminino , Humanos , Hiperaldosteronismo/patologia , Masculino , Pessoa de Meia-Idade , Mutação
10.
BMJ Case Rep ; 12(7)2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31272994

RESUMO

Extranodal adrenal involvement in non-Hodgkin's lymphoma is very rare, estimated to be around less than 0.2%. Most common sites involved are stomach, intestine and testis. It is very rare for adrenal tumours to present as primary adrenal insufficiency, with an incidence of around 1.2% in patients diagnosed with adrenal masses. Diffuse large B cell lymphoma (DLBL) originating from the stomach and metastasizing to bilateral adrenal glands is an extremely uncommon occurrence with only three cases found on review of the literature. We present a case of a 62-year-old African-American man who presented with nausea, vomiting, abdominal pain and hypotension, later being diagnosed as DLBL of the gastric antrum metastasized to bilateral adrenal glands. Initial laboratory workup revealed including hormonal analysis and cosyntropin test revealed adrenal insufficiency. The patient later died during the hospitalisation after developing respiratory failure, severe hypotension refractory to vasopressors and severe metabolic acidosis.


Assuntos
Neoplasias das Glândulas Suprarrenais/secundário , Linfoma Difuso de Grandes Células B/patologia , Linfoma não Hodgkin/patologia , Neoplasias Gástricas/patologia , Glândulas Suprarrenais/patologia , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade
11.
Rinsho Ketsueki ; 60(6): 570-576, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31281146

RESUMO

Primary adrenal lymphoma is a rare lymphoma, accounting for <0.2% of non-Hodgkin lymphoma. The leading histopathological subtype of adrenal lymphoma is diffuse large B-cell lymphoma, and intravascular large B-cell lymphoma (IVLBCL) is rare. Here, we report a case of IVLBCL occurrence as a bilateral adrenal gland tumor, which was diagnosed by CT-guided biopsy. Tumor cells were positive for CD20 and MUM-1 but not for CD10 on immunostaining, suggesting non-germinal center B-cell subtype lymphoma. In addition, the triple expression of BCL2, BCL6, and MYC was demonstrated on tumor cells. The bone marrow examination revealed the involvement of lymphoma cells but not hemophagocytosis. The chromosomal analysis revealed complex karyotypic abnormalities without a rearrangement of BCL2 or MYC using FISH analysis. Although the patient responded to R-CHOP chemotherapy, he developed central nervous system involvement by lymphoma. To date, the significance of the triple expression of BCL2, BCL6, and MYC without gene translocation remains partially elucidated. Therefore, an accumulation of similar cases is needed to elucidate the pathogenesis and clinical significance of the triple expression of these oncoproteins.


Assuntos
Glândulas Suprarrenais/patologia , Linfoma Difuso de Grandes Células B/diagnóstico , Humanos , Linfoma Difuso de Grandes Células B/patologia , Masculino , Proteínas Proto-Oncogênicas c-bcl-2/metabolismo , Proteínas Proto-Oncogênicas c-bcl-6/metabolismo , Proteínas Proto-Oncogênicas c-myc/metabolismo
12.
Indian J Pathol Microbiol ; 62(3): 473-476, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31361245

RESUMO

Extranodal Natural Killer/T-cell lymphoma (ENKL) is an aggressive NK or cytotoxic T-cell neoplasm. The cytological features of NK/T-cell lymphoma have been rarely described, mainly focusing on the fine needle aspiration cytology from lymph nodes or soft tissue, except for a few cases focused on body fluid. A 46-year-old man visited the hospital due to generalized weakness and weight loss. Three months prior, computed tomographic scan revealed mesenteric panniculitis and reactive lymph nodal enlargement, as well as a mildly thickened left adrenal gland, suggesting an inflammatory condition. About 100 days later, marked enlargement of both adrenal glands with pericardial effusion was noted. The pericardial effusion contained medium-sized atypical lymphocytes, suspicious for malignant lymphoma, and the left adrenal mass was histologically confirmed as ENKL on biopsied specimen. Herein, we describe the cytological features of NK/T-cell lymphoma in body fluid cytology along with a review of the literature.


Assuntos
Linfoma Extranodal de Células T-NK/diagnóstico por imagem , Derrame Pericárdico/citologia , Glândulas Suprarrenais/patologia , Biópsia por Agulha Fina , Técnicas Citológicas , Humanos , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Linfoma Extranodal de Células T-NK/patologia , Masculino , Pessoa de Meia-Idade , Paniculite Peritoneal/diagnóstico por imagem , Tomografia Computadorizada por Raios X
13.
Surgery ; 166(5): 901-906, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31239074

RESUMO

BACKGROUND: A pathologic tumor-node-metastasis staging algorithm for pheochromocytoma and sympathetic paraganglioma was introduced recently in the 8th Edition of the cancer staging manual of the American Joint Committee on Cancer. There is no information, however, as to how this staging correlates to well-established clinical cohorts of pheochromocytoma and sympathetic paraganglioma with extensive follow-up. METHODS: We applied the pathologic tumor-node-metastasis staging retrospectively to a cohort of 118 patients with pheochromocytoma and sympathetic paraganglioma, in which the majority has been characterized for susceptibility gene mutations and global mRNA expressional patterns as well as histologic risk criteria using the pheochromocytoma of the adrenal gland scaled score (PASS). RESULTS: The overall tumor stage correlated with the presence of metastases, disease-related death, and PASS scores as well as established mutational and expressional clusters. CONCLUSION: Stage III to IV pheochromocytomas and sympathetic paragangliomas are associated with increased mortality, increased PASS scores, and mutational and expressional aberrancies in the pseudo-hypoxia pathway cluster. These findings validate the stratification proposed by the American Joint Committee on Cancer staging manual by linking malignancy-associated pheno- and genotypes to more advanced stages. Moreover, because few pheochromocytomas and sympathetic paragangliomas are metastatic at the time of the original presentation, the staging relies heavily on identifying histologic signs of extra-adrenal invasion.


Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico , Glândulas Suprarrenais/patologia , Paraganglioma/diagnóstico , Feocromocitoma/diagnóstico , Adolescente , Neoplasias das Glândulas Suprarrenais/genética , Neoplasias das Glândulas Suprarrenais/mortalidade , Neoplasias das Glândulas Suprarrenais/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/genética , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Mutação , Estadiamento de Neoplasias , Paraganglioma/genética , Paraganglioma/mortalidade , Paraganglioma/patologia , Feocromocitoma/genética , Feocromocitoma/mortalidade , Feocromocitoma/patologia , Estudos Retrospectivos , Medição de Risco/métodos , Adulto Jovem
14.
World J Surg ; 43(10): 2469-2476, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31214831

RESUMO

INTRODUCTION: Patients undergoing unilateral adrenalectomy for primary aldosteronism (PA) may have a solitary adenoma, unilateral hyperplasia, or multiple adenomas on final pathology. This study investigated whether the underlying pathological diagnosis was associated with differences in clinical presentation and postoperative outcomes. METHODS: A retrospective cohort study of patients undergoing unilateral adrenalectomy for PA from 2004 to 2015 at our institution was performed. Baseline clinical and laboratory parameters, as well as postoperative biochemical and hypertension cure rates, were compared across the three aforementioned pathological groups. RESULTS: Of 206 patients who met criteria for inclusion, 152 (73.8%) had a single adenoma, 33 (16%) had unilateral hyperplasia, and 21 (10.2%) had multiple unilateral adenomas. Patients with unilateral hyperplasia were more likely to be male (81.2% vs 57.9%, P = .03), undergo left-sided adrenalectomy (78.8% vs 47.4%, P < .01), and had a lower median adrenal venous sampling lateralization index (9.8 vs 19.8, P = .04) compared to those with solitary, but not multiple unilateral adenomas. No differences were seen in age, duration of hypertension, preoperative plasma aldosterone levels, plasma renin activities, 24-h urinary aldosterone excretion, serum potassium concentrations, and the number of preoperative antihypertensive medications across all three pathological groups. All patients achieved biochemical cure following adrenalectomy, and no significant differences in the rates of hypertension cure or improvement were observed in comparisons across pathological subtype. CONCLUSIONS: Clinical presentation and postoperative outcomes are similar regardless of underlying pathology in patients with PA. Because one in four patients may harbor unilateral hyperplasia or multiple adenomas, total unilateral adrenalectomy should be performed as the operation of choice over adrenal-sparing approaches.


Assuntos
Adenoma/patologia , Neoplasias das Glândulas Suprarrenais/patologia , Glândulas Suprarrenais/patologia , Adrenalectomia , Hiperaldosteronismo/cirurgia , Adenoma/complicações , Adenoma/cirurgia , Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/cirurgia , Glândulas Suprarrenais/diagnóstico por imagem , Adulto , Aldosterona/sangue , Feminino , Humanos , Hiperaldosteronismo/etiologia , Hiperaldosteronismo/patologia , Hiperplasia/complicações , Hipertensão/etiologia , Masculino , Pessoa de Meia-Idade , Renina/sangue , Estudos Retrospectivos
15.
Int J Mol Sci ; 20(12)2019 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-31234562

RESUMO

The evidence from post-mortem biochemical studies conducted on cortisol and catecholamines suggest that analysis of the adrenal gland could provide useful information about its role in human pathophysiology and the stress response. Authors designed an immunohistochemical study on the expression of the adrenal ß2-adrenergic receptor (ß2-AR), a receptor with high-affinity for catecholamines, with the aim to show which zones it is expressed in and how its expression differs in relation to the cause of death. The immunohistochemical study was performed on adrenal glands obtained from 48 forensic autopsies of subjects that died as a result of different pathogenic mechanisms using a mouse monoclonal ß2-AR antibody. The results show that immunoreactivity for ß2-AR was observed in all adrenal zones. Furthermore, immunoreactivity for ß2-AR has shown variation in the localization and intensity of different patterns in relation to the original cause of death. To the best of our knowledge, this is the first study that demonstrates ß2-AR expression in the human cortex and provides suggestions on the possible involvement of ß2-AR in human cortex hormonal stimulation. In conclusion, the authors provide a possible explanation for the observed differences in expression in relation to the cause of death.


Assuntos
Glândulas Suprarrenais/metabolismo , Expressão Gênica , Receptores Adrenérgicos beta 2/metabolismo , Adolescente , Glândulas Suprarrenais/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Autopsia , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Receptores Adrenérgicos beta 2/genética , Adulto Jovem
16.
Anticancer Res ; 39(6): 2699-2710, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31177104

RESUMO

BACKGROUND/AIM: Adrenal glands are one of the most common sites of cancer metastasis. The treatment options include either surgery or chemotherapy and/or radiotherapy while certain diagnosis is made via percutaneous biopsy or fine needle aspiration (FNA), guided by CT scan. This review aimed to present the current practice regarding the diagnosis and treatment of adrenal cancer metastasis. MATERIALS AND METHODS: A PRISMA-compliant systematic search of the PubMed, Cochrane, EMBASE, AMED, CINAHL, WoS, BIOSIS, LILACS, ASSIA, SCEH, SCIRUS databases, and JIT medical feed sources was performed through November 5th, 2018. RESULTS: A total of 87 original studies including 660 patients with adrenal metastasis were analyzed. Most preferred treatment was excision of the gland in 76.58% of the cases, while most of adrenal metastases were found at autopsy (43.88%) followed by computed tomography guided biopsy (33.09%). CONCLUSION: Adrenalectomy following metastatic disease to the adrenals should be performed when the lesion is isolated in the gland and the site of primary cancer has or can be resected.


Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico , Neoplasias das Glândulas Suprarrenais/secundário , Neoplasias das Glândulas Suprarrenais/terapia , Glândulas Suprarrenais/patologia , Adrenalectomia , Biópsia por Agulha Fina , Tratamento Farmacológico , Feminino , Humanos , Biópsia Guiada por Imagem/métodos , Masculino , Radioterapia , Análise de Sobrevida , Tomografia Computadorizada por Raios X , Resultado do Tratamento
17.
PLoS One ; 14(6): e0216658, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31170163

RESUMO

BACKGROUND: There are limited data about the role of endoscopic ultrasound-guided tissue acquisition (EUS-TA), by fine needle aspiration (EUS-FNA) or biopsy (EUS-FNB), in the evaluation of the adrenal glands (AG). The primary aim was to assess the diagnostic yield and safety. The secondary aims were the malignancy predictors, and to create a predictive model of malignancy. METHODS: This was a retrospective nationwide study involving all Spanish hospitals experienced in EUS-TA of AGs. Inclusion period was from April-2003 to April-2016. Inclusion criteria: all consecutive cases that underwent EUS-TA of AGs. EUS and cytopathology findings were evaluated. Statistical analyses: diagnostic accuracy of echoendoscopist's suspicion using cytology by EUS-TA, as gold standard; multivariate logistic regression model to predict tumor malignancy. RESULTS: A total of 204 EUS-TA of AGs were evaluated. Primary tumor locations were lung70%, others19%, and unknown11%. AG samples were adequate for cytological diagnosis in 91%, and confirmed malignancy in 60%. Diagnostic accuracy of the endosonographer's suspicion was 68%. The most common technique was: a 22-G (65%) and cytological needle (75%) with suction-syringe (66%). No serious adverse events were described. The variables most associated with malignancy were size>30mm (OR2.27; 95%CI, 1.16-4.05), heterogeneous echo-pattern (OR2.11; 95%CI, 1.1-3.9), variegated AG shape (OR2.46; 95%CI, 1-6.24), and endosonographer suspicion (OR17.46; 95%CI, 6.2-58.5). The best variables for a predictive multivariate logistic model of malignancy were age, sex, echo-pattern, and AG-shape. CONCLUSIONS: EUS-TA of the AGs is a safe, minimally invasive procedure, allowing an excellent diagnostic yield. These results suggest the possibility of developing a pre-EUS procedure predictive malignancy model.


Assuntos
Glândulas Suprarrenais/patologia , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Neoplasias das Glândulas Suprarrenais/patologia , Idoso , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/efeitos adversos , Feminino , Humanos , Masculino , Análise Multivariada , Estudos Retrospectivos , Segurança
18.
Pathologe ; 40(4): 467-492, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-31250089

RESUMO

Nodular hyperplasias and adenomas are by far the most frequently resected tumors of the adrenal cortex followed by pheochromocytomas, which are either discovered incidentally or become conspicuous due to hormonal hypersecretions. Cortical nodes and adenomas are easy to diagnose using simple staining methods. Uncertain cortical carcinomas, pheochromocytomas and other tumors of the adrenal region require additional immunohistochemical staining methods. Determination of the dignity of tumors of the adrenal cortex necessitates at least the Weiss score (possibly in its modified form), for oncocytic tumors the Bisceglia score and for pediatric tumors the Wieneke score. The Ki-67 index must also be taken into consideration. For pheochromocytomas the PASS and the GAPP systeme are used.


Assuntos
Neoplasias das Glândulas Suprarrenais , Carcinoma Adrenocortical , Feocromocitoma , Adenoma , Neoplasias do Córtex Suprarrenal/patologia , Neoplasias das Glândulas Suprarrenais/patologia , Glândulas Suprarrenais/patologia , Criança , Humanos , Feocromocitoma/patologia
19.
Nutrients ; 11(5)2019 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-31035471

RESUMO

The consumption of high levels of dietary caffeine has increased in children and adolescents. Human and animal studies have shown that chronic intake of high doses of caffeine affects serum glucocorticoid levels. Given that glucocorticoids play a role in peripubertal organ growth and development, chronic high doses of caffeine during puberty might impair maturation of the adrenal glands. To evaluate any effects of caffeine exposure on growing adrenal glands, 22-day-old male (n = 30) and female Sprague Dawley rats (n = 30) were divided into three groups (n = 10/group); group 1 received tap water (control) and groups 2 and 3 received water containing 120 and 180 mg/kg/day caffeine, respectively, via gavage for 4 weeks. At the end of the experiment, adrenal glands were weighed and processed for histological analysis. Relative adrenal weights increased in both groups of caffeine-fed males and females, whereas absolute weights were decreased in the females. In the female caffeine-fed groups the adrenal cortical areas resembled irregularly arranged cords and the medullary area was significantly increased, whereas no such effects were seen in the male rats. Our results indicate that the harmful effects of caffeine on the adrenal glands of immature rats differ between females and males. Although female rats seemed to be more susceptible to damage based on the changes in the microarchitecture of the adrenal glands, caffeine affected corticosterone production in both female and male rats. In addition, increased basal adrenocorticotropic hormone levels in caffeine-fed groups may reflect decreased cortical function. Therefore, caffeine may induce an endocrine imbalance that disturbs the establishment of the hypothalamo-pituitary adrenal axis during puberty, thereby leading to abnormal stress responses.


Assuntos
Glândulas Suprarrenais/efeitos dos fármacos , Cafeína/efeitos adversos , Maturidade Sexual , Glândulas Suprarrenais/patologia , Hormônio Adrenocorticotrópico/sangue , Animais , Cafeína/administração & dosagem , Corticosterona/sangue , Relação Dose-Resposta a Droga , Feminino , Masculino , Tamanho do Órgão , Ratos , Ratos Sprague-Dawley
20.
J Coll Physicians Surg Pak ; 29(6): S16-S17, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31142408

RESUMO

Adrenal endothelial cyst is a rare entity which has female predilection and usually presents with abdominal pain. Smaller cysts are mostly asymptomatic and detected as incidental finding during surgery. Without biopsy, it is almost impossible to depict the nature of larger cysts as benign or malignant. Herein, we report two such cases. The first case was a 24-year female who presented with a large cyst in the abdomen. The second case was of a 35-year female, who presented with a cystic lesion of right adrenal gland. The clinical, radiological and histopathological findings are discussed. These reports highlight the salient gross, microscopic and immunohistochemical features of these cysts.


Assuntos
Doenças das Glândulas Suprarrenais/diagnóstico , Glândulas Suprarrenais/diagnóstico por imagem , Cistos/patologia , Doenças das Glândulas Suprarrenais/cirurgia , Glândulas Suprarrenais/patologia , Adrenalectomia , Adulto , Biópsia , Cistos/diagnóstico por imagem , Feminino , Humanos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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