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1.
Zhonghua Yi Xue Za Zhi ; 101(20): 1513-1517, 2021 Jun 01.
Artigo em Chinês | MEDLINE | ID: mdl-34044519

RESUMO

Objective: To compare the therapeutic effect of transperitoneal transmesenteric approach versus paracolic sulci approach laparoscopic adrenal tumorectomy for treatment of left-sided primary hyperaldosteronism. Methods: From January 2017 to July 2019, the clinical data of 70 patients with left-sided primary hyperaldosteronism (PHA) who underwent surgery in the First Hospital of Lanzhou University and five other hospitals in Gansu Province were retrospectively analyzed. There are 43 male and 27 female patients. Among them,28 patients were performed transperitoneal transmesenteric approach laparoscopic adrenal tumorectomy and 42 patients were performed transperitoneal paracolic sulci approach laparoscopic adrenal tumorectomy. The general information and perioperative data of the two groups were compared. Results: All 70 cases of surgery were successfully completed. As compared with the paracolic sulci approach group, the operation time was significantly shorter in the transmesenteric approach group[(26.7±8.8)vs (38.9±7.1)min,P<0.001)], and the estimated blood loss was less in the transmesenteric approach group[45(30,50) vs 50(40,60)ml,P=0.042]. There was no statistically significant difference in the postoperative hospitalization days between the two groups[(4.4±1.0)vs(4.5±1.0)d, P=0.669)]. The electrolytes and aldosterone to renin ratio returned to a healthy level in the postoperative one month, and the blood pressure also returned to a healthy level in 53 (75.7%) patients. Conclusion: Transperitoneal transmesenteric approach laparoscopic adrenal tumorectomy is safe and feasible, with a short operation time and relatively less estimated blood loss.


Assuntos
Neoplasias das Glândulas Suprarrenais , Hiperaldosteronismo , Laparoscopia , Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia , Feminino , Humanos , Hiperaldosteronismo/cirurgia , Masculino , Estudos Retrospectivos
2.
J Med Case Rep ; 15(1): 282, 2021 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-34020699

RESUMO

BACKGROUND: Pheochromocytoma and paraganglioma caused by succinate dehydrogenase gene mutations is called hereditary pheochromocytoma/paraganglioma syndrome. In particular, succinate dehydrogenase subunit B mutations are important because they are strongly associated with the malignant behavior of pheochromocytoma and paraganglioma . This is a case report of a family of hereditary pheochromocytoma/paraganglioma syndrome carrying a novel mutation in succinate dehydrogenase subunit B. CASE PRESENTATION: A 19-year-old Japanese woman, whose father died of metastatic paraganglioma, was diagnosed with abdominal paraganglioma, and underwent total resection. Succinate dehydrogenase subunit B genetic testing detected a splice-site mutation, c.424-2delA, in her germline and paraganglioma tissue. Afterwards, the same succinate dehydrogenase subunit B mutation was detected in her father's paraganglioma tissues. In silico analysis predicted the mutation as "disease causing." She is under close follow-up, and no recurrence or metastasis has been observed for 4 years since surgery. CONCLUSIONS: We detected a novel succinate dehydrogenase subunit B mutation, c.424-2delA, in a Japanese family afflicted with hereditary pheochromocytoma/paraganglioma syndrome and found the mutation to be responsible for hereditary pheochromocytoma/paraganglioma syndrome. This case emphasizes the importance of performing genetic testing for patients with pheochromocytoma and paraganglioma suspected of harboring the succinate dehydrogenase subunit B mutation (that is, metastatic, extra-adrenal, multiple, early onset, and family history of pheochromocytoma and paraganglioma) and offer surveillance screening to mutation carriers.


Assuntos
Neoplasias das Glândulas Suprarrenais , Paraganglioma , Feocromocitoma , Neoplasias das Glândulas Suprarrenais/genética , Neoplasias das Glândulas Suprarrenais/cirurgia , Adulto , Feminino , Humanos , Japão , Mutação , Recidiva Local de Neoplasia , Paraganglioma/genética , Paraganglioma/cirurgia , Feocromocitoma/genética , Succinato Desidrogenase/genética , Ácido Succínico , Adulto Jovem
3.
Curr Cardiol Rep ; 23(6): 60, 2021 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-33961120

RESUMO

PURPOSE OF REVIEW: Pheochromocytoma and paraganglioma (PPGL) in pregnancy is a rare entity and management of these patients is fraught with uncertainty. Our objective is to review current literature and discuss diagnosis and management of these patients. RECENT FINDINGS: Outcomes of PPGL in pregnancy have improved in recent years. The greatest risk for adverse maternal and fetal outcomes is the diagnosis of PPGL after delivery. Alpha- and beta-adrenergic blockade is well tolerated and is associated with less adverse outcomes. Antepartum surgery is not associated with improved maternal or fetal outcomes. Biochemical testing and cross-sectional imaging should be performed prior to conception for patients with a known germline variant associated with PPGL. CONCLUSIONS: Medical therapy should be initiated when PPGL is diagnosed in pregnancy. Antepartum surgery should be reserved for special circumstances. Case detection testing in high-risk patients can identify PPGL before pregnancy.


Assuntos
Neoplasias das Glândulas Suprarrenais , Paraganglioma , Feocromocitoma , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/cirurgia , Feminino , Humanos , Paraganglioma/diagnóstico por imagem , Paraganglioma/cirurgia , Feocromocitoma/diagnóstico por imagem , Feocromocitoma/cirurgia , Gravidez
4.
Anticancer Res ; 41(5): 2647-2652, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33952495

RESUMO

BACKGROUND/AIM: Primary adrenal lymphoma (PAL) is rare and aggressive. The aim of this retrospective study was to compare the results of surgery and chemotherapy compared to chemotherapy alone for the treatment of this condition. PATIENTS AND METHODS: Sixteen patients, 10 men and 6 women of a median age of 63 years (IQR=56-70.5 years), admitted for the treatment of PAL, were retrospectively reviewed. Six patients (37.5%) underwent surgical resection of the mass followed by CHOP (cyclophosphamide, doxorubicin, vincristine, bleomycin and prednisone) - based chemotherapy (Group A). Ten patients (62.5%) underwent chemotherapy alone, consisting of CHOP alone in one case and Rituximab-CHOP (R-CHOP) in 9 cases (Group B). As primary study endpoints of the study, overall survival (OS) and progression-free survival (PFS) were considered. RESULTS: At two years follow-up, OS was 50% in Group A and 60% in group B (p=0.69). The PFS was 50% in group A and 30% in group B (p=0.42). CONCLUSION: PAL exhibits overall a dismal prognosis. Chemotherapy remains the most appropriate treatment, although unable to ensure long-term survival. Surgery combined with chemotherapy is ineffective in improving survival and may, at best, have a limited role in relieving the pain related to the local mass effect.


Assuntos
Neoplasias das Glândulas Suprarrenais/tratamento farmacológico , Neoplasias das Glândulas Suprarrenais/cirurgia , Linfoma/tratamento farmacológico , Linfoma/cirurgia , Neoplasias das Glândulas Suprarrenais/patologia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Estudos de Coortes , Terapia Combinada , Ciclofosfamida/administração & dosagem , Ciclofosfamida/efeitos adversos , Doxorrubicina/administração & dosagem , Doxorrubicina/efeitos adversos , Feminino , Humanos , Linfoma/patologia , Masculino , Pessoa de Meia-Idade , Prednisona/administração & dosagem , Prednisona/efeitos adversos , Intervalo Livre de Progressão , Estudos Retrospectivos , Resultado do Tratamento , Vincristina/administração & dosagem , Vincristina/efeitos adversos
5.
Harefuah ; 160(4): 221-225, 2021 Apr.
Artigo em Hebraico | MEDLINE | ID: mdl-33899370

RESUMO

INTRODUCTION: This is a case study of a thirty-five year old woman with a past medical history of anxiety disorder and hypertension which has been elevated up to 180/100 mmHg during the previous year. She had no cardiovascular risk factors or family history of hypertension. Her high blood pressure was initially attributed to emotional stress, however, she was later referred for additional evaluation for secondary causes of hypertension. Her lab test results demonstrated significantly elevated plasma aldosterone levels and suppressed renin levels. A computed tomography scan demonstrated a left adrenal mass consistent with adrenal adenoma, with a normal adrenal gland on the right. Immediately after left adrenalectomy, plasma aldosterone level normalized and blood pressure was controlled with only minimal pharmacotherapy. Approximately 10 days post-surgery, her blood pressure values were measured in a range of 125/90 and anxiety significantly improved, under treatment only with 12.5mg Atenolol.


Assuntos
Neoplasias das Glândulas Suprarrenais , Adenoma Adrenocortical , Hiperaldosteronismo , Hipertensão , Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia , Adenoma Adrenocortical/cirurgia , Adulto , Aldosterona , Transtornos de Ansiedade , Feminino , Humanos , Hiperaldosteronismo/complicações , Hiperaldosteronismo/diagnóstico , Hipertensão/diagnóstico , Hipertensão/etiologia
6.
BMC Surg ; 21(1): 210, 2021 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-33902538

RESUMO

BACKGROUND: Adrenal hemangioma is a rare benign adrenal tumor that is usually misdiagnosed preoperatively. We here present a case of adrenal cavernous hemangioma that was successfully treated with retroperitoneal laparoscopic adrenalectomy. CASE PRESENTATION: A 67-year-old man with dull right back pain attended our clinic for examination of a mass on the right adrenal gland for 1 week. Pheochromocytoma was considered according to the preoperative computed tomography angiography + computed tomography urography findings and was subsequently corrected to adrenal gland hemangioma according to postoperative pathological findings. The patient showed no recurrence of adrenal hemangioma during the 1-year follow-up period after surgery. CONCLUSION: Adrenal gland hemangioma is rare with a high rate of misdiagnosis, and it should be considered in imaging findings of adrenal tumors with typical hemangioma. Surgery is an effective treatment method.


Assuntos
Neoplasias das Glândulas Suprarrenais , Hemangioma Cavernoso , Feocromocitoma , Neoplasias das Glândulas Suprarrenais/diagnóstico , Neoplasias das Glândulas Suprarrenais/cirurgia , Idoso , Erros de Diagnóstico , Hemangioma Cavernoso/diagnóstico por imagem , Hemangioma Cavernoso/cirurgia , Humanos , Masculino , Recidiva Local de Neoplasia , Feocromocitoma/diagnóstico por imagem , Feocromocitoma/cirurgia
7.
Ann Afr Med ; 20(1): 42-45, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33727511

RESUMO

Introduction: Pheochromocytomas are catecholamine-producing tumors presenting with various clinical symptoms and a serious potentially lethal cardiovascular complications due to the potent effects of secreted catecholamines. Glucoregulation disorders could also occur leading to impaired glucose tolerance and diabetes mellitus. The aim of our study was to determine the effects of adrenalectomy on patient recovery with regard to their glycemic status. Materials and Methods: Case notes of all patients who underwent adrenalectomy surgery for pheochromocytoma from 2009 to 2018, followed up in the Department of Diabetology, Endocrinology, and Nutrition at University Hospital Center Hassan II of Fez, were retrieved, and data were collected from them to identify those with preoperative diagnosis of glucoregulation disorder and to verify if adrenalectomy can reverse or improve glycemic abnormality. Results: Overall, 23 patients underwent surgery for pheochromocytoma, 26% of cases had diabetes mellitus, whereas 34.78% had glucose intolerance. One year after surgery, diabetes and glucose intolerance were cured in 57.14% of cases. We noticed also that patients with large and symptomatic tumors were more likely to develop preoperative diabetes; it was also more likely to persist in patients who had an elevated body mass index (BMI). Conclusions: In our data, diabetes and glucose intolerance were found concurrently with pheochromocytoma in 60.78% of patients. Thus, it is important for clinicians to screen for glycemic disorder when pheochromocytoma is diagnosed, especially in patients with other risk factors for developing type 2 diabetes such as elevated BMI. Removal of these tumors can reduce insulin secretion and severe peripheral insulin resistance making early diagnosis important.


Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia/efeitos adversos , Catecolaminas/metabolismo , Diabetes Mellitus Tipo 2/complicações , Intolerância à Glucose/complicações , Resistência à Insulina/fisiologia , Feocromocitoma/cirurgia , Neoplasias das Glândulas Suprarrenais/epidemiologia , Neoplasias das Glândulas Suprarrenais/patologia , Adulto , Glicemia , Diabetes Mellitus Tipo 2/sangue , Feminino , Intolerância à Glucose/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Feocromocitoma/epidemiologia , Feocromocitoma/patologia , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Estudos Retrospectivos , Resultado do Tratamento
8.
BMJ Case Rep ; 14(3)2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33741570

RESUMO

A postpartum patient with acute-onset dyspnoea and hypotention, associated with reduced left ventricular function requiring intensive blood pressure control, was initially misdiagnosed as having peripartum cardiomyopathy. Her clinical symptoms rapidly resolved. Echocardiography revealed reversible left ventricular dysfunction with apical ballooning and coronary angiography was normal. Based on these findings, we diagnosed takotsubo syndrome. Over the next two months, the patient experienced repeated bouts of elevated sympathetic activity. On workup, we found an adrenal mass and elevated urine metanephrines. After adrenalectomy, histology confirmed pheochromocytoma. Our patient had the rare diagnosis of postpartum pheochromocytoma-induced takotsubo syndrome.


Assuntos
Neoplasias das Glândulas Suprarrenais , Feocromocitoma , Cardiomiopatia de Takotsubo , Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/diagnóstico , Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia , Feminino , Humanos , Feocromocitoma/complicações , Feocromocitoma/diagnóstico , Feocromocitoma/cirurgia , Período Pós-Parto , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/etiologia
9.
BMJ Case Rep ; 14(3)2021 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-33664040

RESUMO

We present a unique case of metachronous adrenal and hepatic myelolipomas in a 62-year-old man. Myelolipomas are most commonly found in the adrenal gland, with extra-adrenal sites such as the lung, retroperitoneum and liver reported. They are a form of benign mesenchymal tumour, with only 25 case reports of a hepatic location published to date. The are no guidelines to its management. Our patient underwent resection due to pain, and after a complicated postoperative period is pain free.


Assuntos
Neoplasias das Glândulas Suprarrenais , Mielolipoma , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/cirurgia , Glândulas Suprarrenais/diagnóstico por imagem , Glândulas Suprarrenais/cirurgia , Humanos , Fígado , Masculino , Pessoa de Meia-Idade , Mielolipoma/diagnóstico por imagem , Mielolipoma/cirurgia
10.
Georgian Med News ; (310): 7-11, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33658401

RESUMO

We present a case of androgen and glucocorticoid secreting adrenocortical carcinoma with concomitant myelolipoma. A giant adrenal tumor which was initially nonfunctional was reassessed four years later due to the patient's refusal to treat. The patient was a 48-year-old woman with hypertension and acne lesions on the face. Laboratory findings were consistent with glucocorticoid and androgen hypersecretion. Computed tomography revealed a heterogeneously contrasting mass of 145x118x100 mm with lobular contour and soft tissue areas. The patient underwent left laparoscopic transperitoneal adrenalectomy with three port technique. There were no complications in the perioperative period. The resected specimen weighed 850 grams. Pathological findings showed a combination of myelolipoma-adrenal cortical cancer. In the postoperative period, hypertension improved and the hormone panel was normalized. Postoperative computed tomography and PET-CT showed no residual mass and metastasis. Although imaging is compatible with benign masses such as myelolipoma, coexistence of ACC-myelolipoma should be kept in mind and functional evaluation should be performed.


Assuntos
Neoplasias do Córtex Suprarrenal , Neoplasias das Glândulas Suprarrenais , Carcinoma Adrenocortical , Mielolipoma , Neoplasias do Córtex Suprarrenal/complicações , Neoplasias do Córtex Suprarrenal/diagnóstico por imagem , Neoplasias do Córtex Suprarrenal/cirurgia , Neoplasias das Glândulas Suprarrenais/cirurgia , Carcinoma Adrenocortical/complicações , Carcinoma Adrenocortical/diagnóstico por imagem , Carcinoma Adrenocortical/cirurgia , Androgênios , Feminino , Glucocorticoides , Humanos , Pessoa de Meia-Idade , Mielolipoma/complicações , Mielolipoma/diagnóstico , Mielolipoma/cirurgia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada
12.
BMJ Case Rep ; 14(2)2021 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-33619138

RESUMO

We report two cases highlighting the role of fluorine-18-fluorodeoxyglucose positron emission tomography/computerised tomography (18F FDG PET/CT) in the diagnostic and preoperative workup of indeterminate adrenal masses. Case 1: a 60-year-old man was diagnosed with a large left-sided adrenal mass with indeterminate radiological characteristics on CT. Biochemical investigations ruled out tumour hypersecretion. 18F FDG PET/CT was performed to exclude metastases and identified a pulmonary nodule in the left upper lobe. Histology of the resected adrenal tumour demonstrated a secondary metastasis from an adenocarcinoma of the lung. Case 2: an 88-year-old male was found to have a heterogeneous and vascular left-sided suprarenal mass and a smaller right-sided adrenal nodule. Both adrenal nodules had indeterminate radiological characteristics. Biochemical investigations were negative. PET/CT demonstrated high avidity in the bilateral adrenal nodules but no extra-adrenal FDG avid disease. Histology demonstrated a metastatic carcinoma of pulmonary origin.


Assuntos
Neoplasias das Glândulas Suprarrenais , Neoplasias Pulmonares , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/cirurgia , Idoso de 80 Anos ou mais , Fluordesoxiglucose F18 , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos
13.
ANZ J Surg ; 91(4): 730-739, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33543578

RESUMO

BACKGROUND: Large right adrenal tumours may invade the liver and mimic primary hepatic malignancy, presenting diagnostic and management challenges. The 'anterior approach hepatectomy' (AAH) using hanging manoeuvre may be safe for resection of such tumours. METHODS: Prospectively maintained database was analysed to identify the large tumours of adreno-hepatic region subjected to hepatectomy. Clinico-biochemical, radiological and surgical details were reviewed. AAH and hanging manoeuvre was adopted for the patients requiring right hepatectomy. RESULTS: Out of the eight patients with adreno-hepatic tumour, four had indeterminate origin of the mass, two had complex cysts, and two were diagnosed as hepatocellular carcinoma on the pre-operative imaging. The median age was 38 years (23-66); male:female ratio was 5:3. AAH was performed in four patients, while others underwent non-anatomical resection of involved segment(s). This accounted for 1.01% of 789 hepatectomies performed during the study period. The median intra-operative blood loss was 525 mL (150-2200 mL) and the median tumour size was 9 cm (6-17 cm). All patients underwent R0 resection. The final histopathological diagnoses were: three phaeochromocytomas (two malignant and one benign), two adrenocortical carcinomas, one malignant paraganglionomas and two adrenal cysts. Major complication (grade IVa) was experienced in one patient. On median follow-up of 67.5 months (7-84), all were alive and one patient had tumour recurrence. CONCLUSION: Adrenal tumours mimicking primary hepatic malignancy are rare but pose diagnostic challenges. The AAH is a safe approach with acceptable R0 resection, blood loss, surgical complications and overall outcome for the patients requiring right hepatectomy.


Assuntos
Neoplasias das Glândulas Suprarrenais , Carcinoma Hepatocelular , Neoplasias Hepáticas , Neoplasias das Glândulas Suprarrenais/diagnóstico , Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia , Adulto , Carcinoma Hepatocelular/cirurgia , Feminino , Hepatectomia , Humanos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/cirurgia , Masculino , Recidiva Local de Neoplasia , Resultado do Tratamento
14.
Hinyokika Kiyo ; 67(1): 7-10, 2021 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-33535290

RESUMO

An 83-year-old man with left lower back pain was found to have a 5 cm mass in contact with the right adrenal gland and a 12 mm left ureteral stone by abdominal plain computed tomography. An abdominal plain magnetic resonance imaging T2-weighted image revealed a heterogeneous high signal mass in the right adrenal gland. Pheochromocytoma, adrenal carcinoma, and retroperitoneal neurogenic tumor were suspected. Tumor markers and endocrine examinations were within standard values. Laparoscopic right adrenalectomy was performed. A 4×3.6 cm, 62 g solid tumor was found in contact with right adrenal gland. Histopathologically, hobnail-like vascular endothelial cells were found in the tumor, but no malignant findings such as multi-layered vascular endothelial cells and nuclear atypia were observed. This tumorwas diagnosed to be an anastomosing hemangioma.


Assuntos
Neoplasias das Glândulas Suprarrenais , Hemangioma , Feocromocitoma , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia , Idoso de 80 Anos ou mais , Células Endoteliais , Hemangioma/diagnóstico por imagem , Hemangioma/cirurgia , Humanos , Masculino , Feocromocitoma/cirurgia
15.
BMC Surg ; 21(1): 68, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33522915

RESUMO

BACKGROUND: The role of laparoscopic adrenalectomy (LA) in a large adrenal tumor is controversial due to the risk of malignancy and technical difficulty. In this study, we compared the perioperative outcomes and complications of LA on large (≥ 6 cm) and (< 6 cm) adrenal tumors. METHODS: We retrospectively reviewed all clinical data of patients who underwent unilateral transperitoneal LA in our institution between April 2000 and June 2019. Patients were classified by tumor size into 2 groups. Patients in group 1 had tumor size < 6 cm (n = 408) and patient in group 2 had tumor size ≥ 6 cm (n = 48). Demographic data, perioperative outcomes, complications, and pathologic reports were compared between groups. RESULTS: Patients in group 2 were significant older (p = 0.04), thinner (p = 0.001) and had lower incident of hypertension (p = 0.001), with a significantly higher median operative time (75 vs 120 min), estimated blood loss (20 vs 100 ml), transfusion rate (0 vs 20.8%), conversion rate (0.25 vs 14.6%) and length of postoperative stays ( 4 vs 5.5 days) than in group 2 (all p < 0.001). Group 2 patients also had significantly higher frequency of intraoperative complication (4.7 vs 31.3%; adjust Odds Ratio [OR] = 9.67 (95% CI 4.22-22.17), p-value < 0.001) and postoperative complication (5.4 vs 31.3%; adjust OR = 5.67 (95% CI 2.48-12.97), p-value < 0.001). Only eight (1.8%) major complications occurred in this study. The most common pathology in group 2 patient was pheochromocytoma and metastasis. CONCLUSIONS: Laparoscopic transperitoneal adrenalectomy in large adrenal tumor ≥ 6 cm is feasible but associated with significantly worse intraoperative complications, postoperative complications, and recovery. However, most of the complications were minor and could be managed conservatively. Careful patient selection with the expert surgeon in adrenal surgery is the key factor for successful laparoscopic surgery in a large adrenal tumor. TRIAL REGISTRATION: This study was retrospectively registered in the Thai Clinical Trials Registry on 02/03/2020. The registration number was TCTR20200312004.


Assuntos
Neoplasias das Glândulas Suprarrenais , Adrenalectomia , Laparoscopia , Carga Tumoral , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/patologia , Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia/efeitos adversos , Adrenalectomia/métodos , Adulto , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
18.
Medicine (Baltimore) ; 100(2): e24011, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466142

RESUMO

RATIONALE: Salivary duct carcinoma (SDC) is a rare and highly aggressive cancer with a poor prognosis. SDC demonstrates a potential for invasive growth with early regional and distant metastasis to organs, such as bone, lung, liver, and brain. Because, adrenal gland metastasis from SDC is rare, its treatment options are not well established. Herein, we report a case of SDC metastasis from the parotid gland to the adrenal gland, which was successfully treated by surgery. PATIENT CONCERNS: The patient had an abnormal but painless lump on the right parotid gland. The size of the mass had increased over a period of 3 years. The patient underwent complete removal of the right parotid gland and radical neck dissection followed by adjuvant radiotherapy and chemotherapy. Two years later, a mass was identified in the left adrenal gland by computed tomography. As no local recurrence or metastasis to other organs was observed, the patient underwent adrenalectomy. DIAGNOSES: Metastasis of SDC in the adrenal gland was confirmed by histopathological examination of the adrenalectomized specimen. INTERVENTIONS: After adrenalectomy, the patient was followed-up without adjuvant therapy. OUTCOMES: The patient was well and alive during the 13-month postoperative follow-up period without any complications. LESSONS: Surgical resection of solitary metastatic lesion may show a survival benefit with metastatic SDC.


Assuntos
Neoplasias das Glândulas Suprarrenais/secundário , Neoplasias das Glândulas Suprarrenais/cirurgia , Glândula Parótida/patologia , Neoplasias das Glândulas Salivares/patologia , Neoplasias das Glândulas Suprarrenais/terapia , Quimiorradioterapia Adjuvante , Humanos , Masculino , Pessoa de Meia-Idade , Ductos Salivares/patologia
19.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431458

RESUMO

A 55-year-old man presented with severe right upper quadrant abdominal pain and hypertension up to 231/171 mm Hg on a background of a known adrenal mass, intravenous drug use and recurrent anxiety attacks. CT showed heterogenous lesion of the right adrenal gland but the sudden severe pain remained unexplained. After correction of the blood pressure with analgesia and antihypertensives, the patient developed a type 2 non-ST-elevation myocardial infarction that was treated with aspirin and therapeutic enoxaparin. This resulted in worsening pain and a repeat CT angiogram showed a haemoretroperitoneum around the right adrenal lesion. On review, an occult intra-adrenal haemorrhage was identified on the initial CT scan. Presumably this concealed haemorrhage caused the initial pain crisis and later decompressed into the retroperitoneal space. Raised metanephrine levels confirmed the diagnosis of pheochromocytoma and after preoperative optimisation with phenoxybenzamine, an open right adrenalectomy was performed.


Assuntos
Dor Abdominal/etiologia , Neoplasias das Glândulas Suprarrenais/diagnóstico , Hemorragia/diagnóstico , Hipertensão/etiologia , Infarto do Miocárdio/diagnóstico , Feocromocitoma/diagnóstico , Dor Abdominal/diagnóstico , Neoplasias das Glândulas Suprarrenais/sangue , Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/cirurgia , Glândulas Suprarrenais/diagnóstico por imagem , Glândulas Suprarrenais/patologia , Glândulas Suprarrenais/cirurgia , Adrenalectomia , Anti-Hipertensivos/administração & dosagem , Angiografia por Tomografia Computadorizada , Eletrocardiografia , Hemorragia/sangue , Hemorragia/etiologia , Hemorragia/cirurgia , Humanos , Hipertensão/sangue , Hipertensão/tratamento farmacológico , Masculino , Metanefrina/sangue , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/etiologia , Medição da Dor , Feocromocitoma/sangue , Feocromocitoma/complicações , Feocromocitoma/cirurgia , Espaço Retroperitoneal , Tomografia Computadorizada por Raios X
20.
BMC Surg ; 21(1): 13, 2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33407379

RESUMO

BACKGROUND: Pheochromocytoma is a catecholamine-secreting tumour that leads to various symptoms. Haemoptysis is rarely caused by a pheochromocytoma occurring outside the bronchus or thoracic cavity. Here, we report the case of an extra-adrenal abdominal pheochromocytoma initially manifesting as haemoptysis/dyspnoea during exercise without classic symptoms. CASE PRESENTATION: A 22-year-old man with a history of severe dyspnoea experienced difficulties in breathing following a marathon owing to haemoptysis that required ventilator management 1 year before presentation. His father had undergone surgery for ectopic pheochromocytoma. Computed tomography (CT) revealed a 30-mm tumour between the inferior vena cava and pancreatic head while urinalysis revealed abnormally high noradrenaline levels. He was clinically diagnosed with an extra-adrenal abdominal ectopic pheochromocytoma. After controlling blood pressure, surgery was performed, and the tumour was successfully removed. Histopathology revealed chromogranin A (+), synaptophysin (+), S100 protein (+), and MIB-1 index of 1%. Therefore, the patient was finally diagnosed with extra-adrenal abdominal ectopic pheochromocytoma. CONCLUSIONS: Haemoptysis is a rare manifestation of abdominal ectopic paraganglioma. Prompt consideration of pheochromocytoma/paraganglioma when patients experience haemoptysis without any other possible aetiology may prevent inappropriate diagnosis and treatment and ultimately fatalities.


Assuntos
Neoplasias das Glândulas Suprarrenais , Hemoptise , Feocromocitoma , Neoplasias das Glândulas Suprarrenais/diagnóstico , Neoplasias das Glândulas Suprarrenais/cirurgia , Adulto , Hemoptise/etiologia , Humanos , Masculino , Recidiva Local de Neoplasia , Feocromocitoma/diagnóstico , Feocromocitoma/cirurgia , Tomografia Computadorizada por Raios X , Adulto Jovem
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