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NCBI: db=pubmed; Term=adrenal tumor
Updated: 2 days 13 hours ago

Glomus vagale tumour, can it be diagnosed only on sonography?

Wed, 03/22/2017 - 15:56
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Glomus vagale tumour, can it be diagnosed only on sonography?

J Ultrasound. 2017 Mar;20(1):73-79

Authors: Bhatt S, Verma P, Meena N, Tandon A, Tanveer N, Bansal D

Abstract
Vagal paragangliomas are rare benign tumors accounting for only 3% of head and neck paragangliomas and arise from vagal ganglions, predominately the nodose ganglion in the carotid sheath. Imaging plays an important role in their diagnosis, differentiation from more common lesions presenting in the carotid space, and management. MRI is the method of choice for investigation when paragangliomas are clinically suspected. The typical salt-and-pepper appearance in T1-weighted images is well known but not specific to paragangliomas. Demonstration of the continuity of the lesion with the vagus nerve on magnetic resonance imaging (MRI) further asserts the diagnosis of glomus vagale. Although this tumor can be diagnosed on a contrast-enhanced computed tomography (CECT) examination, it is limited by the non-demonstration of its neural origin. Sonography is considered only a preliminary investigation in patients, and a CECT and/or MRI study of the neck is conducted before treatment planning. This case is unique as a confident diagnosis of glomus vagale was made on high-resolution sonography of the neck. A middle-aged male patient presenting with a neck swelling was diagnosed with a glomus vagale tumor on USG by the direct demonstration of its continuity with the vagus nerve, and Doppler examination confirmed its vascularity. The diagnosis was confirmed on histopathology after surgical excision. The sonographic appearance, Doppler characteristics, and imaging differential diagnosis of glomus vagale are discussed in detail.

PMID: 28298947 [PubMed - in process]

Modified approach to the characterization of adrenal nodules using a standard abdominal magnetic resonance imaging protocol.

Wed, 03/22/2017 - 15:56
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Modified approach to the characterization of adrenal nodules using a standard abdominal magnetic resonance imaging protocol.

Radiol Bras. 2017 Jan-Feb;50(1):19-25

Authors: Matos AP, Semelka RC, Herédia V, AlObaidiy M, Gomes FV, Ramalho M

Abstract
OBJECTIVE: To describe a modified approach to the evaluation of adrenal nodules using a standard abdominal magnetic resonance imaging protocol.
MATERIALS AND METHODS: Our sample comprised 149 subjects (collectively presenting with 132 adenomas and 40 nonadenomas). The adrenal signal intensity index was calculated. Lesions were grouped by pattern of enhancement (PE), according to the phase during which the wash-in peaked: arterial phase (type 1 PE); portal venous phase (type 2 PE); and interstitial phase (type 3 PE). The relative and absolute wash-out values were calculated. To test for mean differences between adenomas and nonadenomas, Student's t-tests were used. Receiver operating characteristic curve analysis was also performed.
RESULTS: The mean adrenal signal intensity index was significantly higher for the adenomas than for the nonadenomas (p < 0.0001). Chemical shift imaging showed a sensitivity and specificity of 94.4% and 100%, respectively, for differentiating adenomas from nonadenomas. Of the adenomas, 47.6%, 48.5%, and 3.9%, respectively, exhibited type 1, 2, and 3 PEs. For the mean wash-in proportions, significant differences were found among the enhancement patterns. The wash-out calculations revealed a trend toward better lesion differentiation for lesions exhibiting a type 1 PE, showing a sensitivity and specificity of 71.4% and 80.0%, respectively, when the absolute values were referenced, as well as for lesions exhibiting a type 2 PE, showing a sensitivity and specificity of 68.0% and 100%, respectively, when the relative values were referenced. The calculated probability of a lipid-poor lesion that exhibited a type 3 PE being a nonadenoma was > 99%.
CONCLUSION: Subgrouping dynamic enhancement patterns yields high diagnostic accuracy in differentiating adenomas from nonadenomas.

PMID: 28298728 [PubMed - in process]

[Tumor of posterior mediastinum - rare case of extramedullar myelolipoma].

Wed, 03/22/2017 - 15:56
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[Tumor of posterior mediastinum - rare case of extramedullar myelolipoma].

Magy Seb. 2017 Mar;70(1):74-77

Authors: Zombori T, Tóth N, Furák J, Berényi Z, Tiszlavicz L

Abstract
CASE REPORT: A 71-year-old male with acute exacerbation of chronic bronchitis was treated in summer of 2015. The CT scan has revealed a mass on the right side of 11th thoracic vertebra in the adipose tissue with a sharp edge towards the lung and containing a small amount of contrast agent. The radiologist recommended histological sampling of the mass. The tumor was removed by Video-Assisted Thoracic Surgery (VATS) in August of 2015. The patient was discharged on the fifth postoperative day without complication. Myelolipoma was diagnosed by histological examination. Recurrence was not detected during the one-year-follow-up period.
DISCUSSION: Myelolipoma is a benign tumor consisting of mature lobulated adipose tissue and hemopoetic bone marrow. It arises mainly from the adrenal gland. Surgical resection is recommended due to the potential of progressive enlargement. Although the extraadrenal myelolipoma is an uncommon entity, in case of mediastinal, encapsulated, slow-growing tumor, myelolipoma should be considered as a differential diagnosis.

PMID: 28294675 [PubMed - in process]

[Primary epithelioid adrenal angiosarcoma mimicking undifferentiated carcinoma].

Wed, 03/22/2017 - 15:56
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[Primary epithelioid adrenal angiosarcoma mimicking undifferentiated carcinoma].

Ann Pathol. 2017 Mar 11;:

Authors: Miladi S, Harrar Y, Battistella M, Bertheau P, Meignin V, Roche B, Bouhidel FA

Abstract
The adrenal primary epithelioid angiosarcoma (ASE) is a rare malignant tumor which can be histologically confused with other neoplasms. We report one case in a 79-year-old man who underwent adrenal tumor surgery for a mass fortuitly discovered by imaging for examination of an inflammatory syndrome associated with anemia. The histological diagnosis was difficult because of the undifferentiated and epithelioid appearance of tumor cells, whose immunohistochemical epithelial markers positivity led to frequent confusion with a metastatic carcinoma. Careful research for vascular differentiation at histopathological study and expression of immunohistochimical endothelial markers, are crucial to confirm the diagnosis.

PMID: 28291558 [PubMed - as supplied by publisher]

A Family with Von Hippel-Lindau Syndrome: The Findings of Indium-111 Somatostatin Receptor Scintigraphy, Iodine-123 Metaiodobenzylguanidine Scintigraphy and Single Photon Emission Computerized Tomography.

Wed, 03/22/2017 - 15:56
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A Family with Von Hippel-Lindau Syndrome: The Findings of Indium-111 Somatostatin Receptor Scintigraphy, Iodine-123 Metaiodobenzylguanidine Scintigraphy and Single Photon Emission Computerized Tomography.

Mol Imaging Radionucl Ther. 2017 Feb 05;26(1):38-42

Authors: Arıcan P, Okudan Tekin B, Naldöken S, Şefizade R, Berker D

Abstract
Von Hippel-Lindau syndrome (VHLS) is an autosomal dominant hereditary familial disorder characterized by development of malignant and benign neoplasms. Differential diagnosis of the adrenal and pancreatic masses are difficult in patients with VHLS. Iodine-123 metaiodobenzylguanidine (I-123 MIBG) and indium-111 somatostatin receptor scintigraphies (In-111 SRS) have important roles in the differential diagnosis of adrenal and pancreatic masses in those patients. In this case report, we present the findings of I-123 MIBG single-photon emission computerized tomography (SPECT/CT) and In-111 SRS SPECT/CT in three members of a family with VHLS. In case 1, a residual neuroendocrine tumor (NET) was detected in the head of pancreas on In-111 SRS SPECT/CT images. In case 2 and 3, I-123 MIBG SPECT/CT confirmed the adrenal masses as pheochromocytoma, and the extra-adrenal mass as NET, before surgery. We thought that In-111 SRS and I-123 MIBG scan might be helpful in the routine work up of VHLS patients for diagnostic and therapeutic purposes. Hybrid SPECT/CT system may improve diagnostic accuracy of planar images since it assesses morphologic and functional information together.

PMID: 28291009 [PubMed - in process]

Management issues of congenital adrenal hyperplasia during the transition from pediatric to adult care.

Wed, 03/22/2017 - 15:56
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Management issues of congenital adrenal hyperplasia during the transition from pediatric to adult care.

Korean J Pediatr. 2017 Feb;60(2):31-37

Authors: Choi JH, Yoo HW

Abstract
Steroid 21-hydroxylase deficiency is the most prevalent form of congenital adrenal hyperplasia (CAH), accounting for approximately 95% of cases. With the advent of newborn screening and hormone replacement therapy, most children with CAH survive into adulthood. Adolescents and adults with CAH experience a number of complications, including short stature, obesity, infertility, tumor, osteoporosis, and reduced quality of life. Transition from pediatric to adult care and management of long-term complications are challenging for both patients and health-care providers. Psychosocial issues frequently affect adherence to glucocorticoid treatment. Therefore, the safe transition of adolescents to adult care requires regular follow-up of patients by a multidisciplinary team including pediatric and adult endocrinologists. The major goals for management of adults with 21-hydroxylase deficiency are to minimize the long-term complications of glucocorticoid therapy, reduce hyperandrogenism, prevent adrenal or testicular adrenal rest tumors, maintain fertility, and improve quality of life. Optimized medical or surgical treatment strategies should be developed through coordinated care, both during transition periods and throughout patients' lifetimes. This review will summarize current knowledge on the management of adults with CAH, and suggested appropriate approaches to the transition from pediatric to adult care.

PMID: 28289431 [PubMed - in process]

An exploratory study of immune markers in acute and transient psychosis.

Wed, 03/22/2017 - 15:56
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An exploratory study of immune markers in acute and transient psychosis.

Asian J Psychiatr. 2017 Feb;25:219-223

Authors: Mahadevan J, Sundaresh A, Rajkumar RP, Muthuramalingam A, Menon V, Negi VS, Sridhar MG

Abstract
The aim of this study was to look into the balance of pro-inflammatory (TNF-α, IL-6) and anti-inflammatory (TGF-β) cytokines and their association with stress, alterations in HPA axis activity and the disease severity in acute psychosis. Socio-demographic and clinical details were collected from 41 in-patients with a diagnosis of Acute and Transient Psychotic Disorder. Holmes and Rahe Stress Scale for stress in the preceding year, and Brief Psychiatric Rating Scale at baseline and follow up (4-12 weeks) for psychopathology were applied. IL-6, TNF-α (pro-inflammatory), TGF-β (anti-inflammatory) and Cortisol (morning and afternoon values) were measured at baseline and follow up. A total of 30 out of 41 cases recruited had follow up data available. The levels of IL-6 (p<0.001), TNF-α (p<0.001) and TGF-β (p<0.001) at baseline were all found to be significantly elevated compared to 42 age and gender matched healthy controls. There was a significant increase in the levels of TNF-α (p=0.020) and morning levels of cortisol (p=0.009) and a significant decrease in the levels of TGF-β (p=0.004) and afternoon levels of cortisol (p=0.043) from baseline to follow up. This study showed that there was an increased level of both pro and anti-inflammatory cytokines at baseline and a prolonged pro - inflammatory compared to anti - inflammatory response which warrants larger prospective studies and comparative studies to patients with schizophrenia and bipolar disorders.

PMID: 28262155 [PubMed - indexed for MEDLINE]

Surgical treatment of pulmonary metastases in pediatric solid tumors.

Wed, 03/22/2017 - 15:56
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Surgical treatment of pulmonary metastases in pediatric solid tumors.

Semin Pediatr Surg. 2016 Oct;25(5):311-317

Authors: Heaton TE, Davidoff AM

Abstract
Most children who succumb to solid malignancies do so because of the burden of metastatic disease or due to complications associated with the therapy administered to treat metastatic disease. Approximately one-quarter of children with solid tumors will present with metastatic disease, and an additional 20% ultimately develop metastatic disease, most commonly in the lung. The role of surgery in the treatment of metastatic solid tumors, given its disseminated nature, is not intuitive, yet there are circumstances in which surgical resection of metastatic disease can potentially be curative. However, the utility of surgery is very much dependent on histology, and generally is most appropriate for those malignancies with histologies that are refractory to other adjuvant therapies.

PMID: 27955735 [PubMed - indexed for MEDLINE]

PD-1 Antibody-induced Guillain-Barré Syndrome in a Patient with Metastatic Melanoma.

Wed, 03/22/2017 - 15:56
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PD-1 Antibody-induced Guillain-Barré Syndrome in a Patient with Metastatic Melanoma.

Acta Derm Venereol. 2017 Mar 10;97(3):395-396

Authors: Schneiderbauer R, Schneiderbauer M, Wick W, Enk AH, Haenssle HA, Hassel JC

Abstract
is missing (Short communication).

PMID: 27868138 [PubMed - indexed for MEDLINE]

Tumor lysis syndrome and metastatic melanoma.

Wed, 03/22/2017 - 15:56
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Tumor lysis syndrome and metastatic melanoma.

Med Oncol. 2016 Dec;33(12):134

Authors: Meeks MW, Hammami MB, Robbins KJ, Cheng KL, Lionberger JM

Abstract
Tumor lysis syndrome (TLS) is a potential emergent complication of oncologic treatment. TLS is commonly reported in hematological malignancies with rapid cell turnover rates, but is relatively rare in solid tumors. TLS is most frequently a result of cancer treatment in combination with a large tumor burden, but has occasionally been reported to occur spontaneously, especially in cases of advanced or metastatic disease. In this article, we describe the case of a patient with newly diagnosed metastatic melanoma that developed TLS two days after initiation of corticosteroids. In addition, we present a brief literature review of melanoma-associated TLS and review the etiology, diagnosis, and management of TLS.

PMID: 27807723 [PubMed - indexed for MEDLINE]

Determination of urinary biogenic amines' biomarker profile in neuroblastoma and pheochromocytoma patients by MEKC method with preceding dispersive liquid-liquid microextraction.

Wed, 03/22/2017 - 15:56
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Determination of urinary biogenic amines' biomarker profile in neuroblastoma and pheochromocytoma patients by MEKC method with preceding dispersive liquid-liquid microextraction.

J Chromatogr B Analyt Technol Biomed Life Sci. 2016 Nov 15;1036-1037:114-123

Authors: Miękus N, Olędzka I, Plenis A, Kowalski P, Bień E, Miękus A, Krawczyk MA, Adamkiewicz-Drożyńska E, Bączek T

Abstract
The unbalanced secretion of biogenic amines (BAs) is considered to be a relevant biochemical biomarker in the screening for neuroendocrine tumors, such as: neuroblastoma and pheochromocytoma. However, there is still a need to improve the bioanalytical procedures for BA determination in biological samples due to their instability (photo- and thermosensitivity, easy oxidation) and low concentration in the body fluids. In this study, the primary analytical challenge was to optimize the method of extraction of seven compounds from among BAs and their precursors from urine samples. Several methods based on liquid-liquid extraction (LLE) or solid phase extraction (SPE) techniques were tested. By optimization of the extraction and data analysis using chemometric tool, the dispersive liquid-liquid microextraction (DLLME) has been chosen due to its low solvents consumption, high efficiency of isolation, preconcentration and suitable clean-up of biological matrix. Further, α-cyclodextrin-modified micellar electrokinetic chromatography (MEKC) with ultraviolet detection (UV) has been applied for quantification of the analyzed biologically active compounds with limits of detection (LOD) and limits of quantification (LOQ) at 0.15 and 0.5μgmL(-1), respectively. Finally, the optimized and validated DLLME-MEKC-UV method has been employed for the analysis of real urine samples, obtained from 6 children with neuroendocrine tumors and 6 healthy children. It was stated that concentrations of BA could serve to differentiate between the patients and healthy children. This pilot study indicates that the elaborated fast and sensitive DLLME-MEKC-UV method for determination of panel of biomarkers could be successfully applied in everyday clinical practice to help to confirm the clinical diagnosis of neuroendocrine tumors in children.

PMID: 27750192 [PubMed - indexed for MEDLINE]

Diurnal Plasma Cortisol Measurements Utility in Differentiating Various Etiologies of Endogenous Cushing Syndrome.

Wed, 03/22/2017 - 15:56
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Diurnal Plasma Cortisol Measurements Utility in Differentiating Various Etiologies of Endogenous Cushing Syndrome.

Horm Metab Res. 2016 Sep;48(10):677-681

Authors: Tirosh A, Lodish MB, Papadakis GZ, Lyssikatos C, Belyavskaya E, Stratakis CA

Abstract
Cortisol diurnal variation may be abnormal among patients with endogenous Cushing syndrome (CS). The study objective was to compare the plasma cortisol AM/PM ratios between different etiologies of CS. This is a retrospective cohort study, conducted at a clinical research center. Adult patients with CS that underwent adrenalectomy or trans-sphenoidal surgery (n=105) were divided to those with a pathologically confirmed diagnosis of Cushing disease (n=21) and those with primary adrenal CS, including unilateral adrenal adenoma (n=28), adrenocortical hyperplasia (n=45), and primary pigmented nodular adrenocortical disease (PPNAD, n=11). Diurnal plasma cortisol measurements were obtained at 11:30 PM and midnight and at 7:30 and 8:00 AM. The ratios between the mean morning levels and mean late-night levels were calculated. Mean plasma cortisol AM/PM ratio was lower among CD patients compared to those with primary adrenal CS (1.4±0.6 vs. 2.3±1.5, p<0.001, respectively). An AM/PM cortisol ratio≥2.0 among patients with unsuppressed ACTH (>15 pg/ml) excludes CD with a 85.0% specificity and a negative predictive value (NPV) of 90.9%. Among patients with primary adrenal CS, an AM/PM cortisol≥1.2 had specificity and NPV of 100% for ruling out a diagnosis of PPNAD. Plasma cortisol AM/PM ratios are lower among patients with CD compared with primary adrenal CS, and may aid in the differential diagnosis of endogenous hypercortisolemia.

PMID: 27643448 [PubMed - indexed for MEDLINE]

Primary adrenal leiomyosarcoma with lymph node metastasis: a case report.

Wed, 03/22/2017 - 15:56
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Primary adrenal leiomyosarcoma with lymph node metastasis: a case report.

World J Surg Oncol. 2016 Jul 02;14(1):176

Authors: Onishi T, Yanagihara Y, Kikugawa T, Miura N, Noda T, Kakuda T, Kitazawa R, Tanji N

Abstract
BACKGROUND: Leiomyosarcomas typically originate in smooth muscle cell. Leiomyosarcoma potentially arising from the adrenal gland is an extremely rare mesenchymal tumors associated with delayed diagnosis and poor prognosis.
CASE PRESENTATION: A 34-year-old man visited our department complaining of right hypochondriac pain. Computed tomography demonstrated a solid mass measuring 5.2 cm in diameter above the right kidney, corresponding to the right adrenal gland, and a lymph node mass, which appeared to have invaded the IVC wall. Right adrenalectomy and lymphadenectomy were performed. A microscopic examination revealed primary adrenal leiomyosarcoma with lymph node metastasis. No adjuvant therapy was performed, and the patient remains recurrence-free at 10 months postoperatively.
CONCLUSIONS: We experienced a very rare case of primary adrenal leiomyosarcoma. Aggressive surgical resection including vascular reconstruction may be associated with improved survival.

PMID: 27368929 [PubMed - indexed for MEDLINE]

Survival of high-risk pediatric neuroblastoma patients in a developing country.

Wed, 03/22/2017 - 15:56
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Survival of high-risk pediatric neuroblastoma patients in a developing country.

Pediatr Transplant. 2016 Sep;20(6):825-30

Authors: Easton JC, Gomez S, Asdahl PH, Conner JM, Fynn AB, Ruiz C, Ojha RP

Abstract
Little information is available about survival of high-risk pediatric neuroblastoma patients in developing countries. We aimed to assess survival among high-risk pediatric neuroblastoma patients in La Plata, Argentina. Individuals eligible for our cohort were aged <20 yr when diagnosed with high-risk neuroblastoma and received cancer-directed therapy including stem cell transplantation at Hospital de Niños Sor Maria Ludovica between February 1999 and February 2015. We estimated overall survival probabilities using an extended Kaplan-Meier approach. Our study population comprised 39 high-risk neuroblastoma patients, of whom 39% were aged >4 yr at diagnosis, 54% were male, and 62% had adrenal neuroblastoma. We observed 18 deaths, and the median survival time of our study population was 1.7 yr. The five-yr overall survival probability was 24% (95% CL: 10%, 41%). In contrast, five-yr survival of high-risk neuroblastoma patients ranges between 23% and 76% in developed countries. Survival among high-risk neuroblastoma patients is generally poor regardless of geographic location, but our results illustrate dramatically worse survival for patients in a developing country. We speculate that the observed survival differences could be attenuated or eliminated with improvements in treatment and supportive care, but addressing these issues will require creative solutions because of resource limitations.

PMID: 27235336 [PubMed - indexed for MEDLINE]

Transcriptional changes in steroidogenesis by perfluoroalkyl acids (PFOA and PFOS) regulate the synthesis of sex hormones in H295R cells.

Wed, 03/22/2017 - 15:56
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Transcriptional changes in steroidogenesis by perfluoroalkyl acids (PFOA and PFOS) regulate the synthesis of sex hormones in H295R cells.

Chemosphere. 2016 Jul;155:436-43

Authors: Kang JS, Choi JS, Park JW

Abstract
Perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) are two of the most widely used perfluoroalkyl acids (PFAAs). Because of their strong persistence, they have become widely distributed throughout the environment and human bodies. PFOA and PFOS are suspected to disrupt the endocrine system based upon many in vivo studies, but the underlying mechanisms are currently unclear. In this study, we investigated the endocrine-related effects of PFOA and PFOS using in vitro estrogen receptor (ER) and androgen receptor (AR) transactivation assays and steroidogenesis assay. The results showed that PFOA and PFOS exhibited weak antagonistic ER transactivation but did not exhibit agonistic ER or AR transactivation. In the steroidogenesis assay, PFOA and PFOS induced 17β-estradiol (E2) level and reduced testosterone level, which would be caused by the induction of aromatase activity. The qPCR analysis of genes involved in steroidogenesis indicates that PFOA and PFOS associate with sex hormone synthesis by the transcriptional induction of two genes, cyp19 and 3β-hsd2. Moreover, the transcriptional induction of cyp11b2 by PFOS suggests that this chemical may underlie the disruption of several physiological functions related to aldosterone. The results of the current study suggest that PFOA and PFOS are potential endocrine disrupting chemicals (EDCs) and provide information for further studies on the molecular events that initiate the adverse endocrine effects.

PMID: 27139122 [PubMed - indexed for MEDLINE]

[Acantholytic squamous cell carcinoma of larynx as an uncommon variant of squamous cell carcinoma].

Wed, 03/22/2017 - 15:56
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[Acantholytic squamous cell carcinoma of larynx as an uncommon variant of squamous cell carcinoma].

Kulak Burun Bogaz Ihtis Derg. 2016 May-Jun;26(3):176-80

Authors: Tiken EE, Çolpan Öksüz D, Batur Ş, Uzel EK, Öz B, Öz F, Uzel Ö, Turkan S

Abstract
Acantholytic squamous cell carcinoma is an uncommon variant of squamous cell carcinoma. Acantholytic squamous cell carcinoma occurs in the sun-exposed areas of the skin and lip. It is rarely observed in the respiratory and digestive tract and may present more aggressively. The incidence of distant metastases of squamous cell head and neck cancers is low and the lungs are the most common metastatic sites. Metastasis to the soft tissue, skin, and adrenal glands from the laryngeal region is very uncommon. In this article, we report a 58-year-old female case who underwent postoperative radiation therapy with the diagnosis of acantholytic squamous cell carcinoma of the larynx and developed metastasis to the soft tissue and adrenal gland at the early period.

PMID: 27107606 [PubMed - indexed for MEDLINE]

Adrenal incidentaloma in adults - management recommendations by the Polish Society of Endocrinology.

Wed, 03/22/2017 - 15:56
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Adrenal incidentaloma in adults - management recommendations by the Polish Society of Endocrinology.

Endokrynol Pol. 2016;67(2):234-58

Authors: Bednarczuk T, Bolanowski M, Sworczak K, Górnicka B, Cieszanowski A, Otto M, Ambroziak U, Pachucki J, Kubicka E, Babińska A, Koperski Ł, Januszewicz A, Prejbisz A, Górska M, Jarząb B, Hubalewska-Dydejczyk A, Glinicki P, Ruchała M, Kasperlik-Załuska A

Abstract
INTRODUCTION: A wide use of imaging techniques results in more frequent diagnosis of adrenal incidenataloma.
AIM: To analyse the current state of knowledge on adrenal incidentaloma in adults in order to prepare practical management recommendations.
METHODS: Following a discussion, the Polish Society of Endocrinology expert working group have analysed the available data and summarised the analysis results in the form of recommendations.
IMAGING AND HORMONAL ASSESSMENT: Unenhanced adrenal computed tomography (CT) may be recommended as an initial assessment examination helpful in the differentiation between adenomas and "non-adenomatous" lesions. In the case of density > 10 Hounsfield units, CT with contrast medium washout assessment or MRI are recommended. However, in all patients with adrenal incidentaloma, hormonal assessment is recommended in order to exclude pheochromocytoma and hypercortisolism, notwithstanding the clinical picture or concomitant diseases. In addition, examination to exclude primary hyperaldosteronism is suggested in patients with diagnosed hypertension or hypokalaemia.
TREATMENT: Surgical treatment should be recommended in patients with adrenal incidentaloma, where imaging examinations suggest a malignant lesion (oncological indication) or with confirmed hormonal activity (endocrinological indication). The basis of the surgical treatment is laparoscopic adrenalectomy. Patients with suspected pheochromocytoma must be pharmacologically prepared prior to surgery. In patients not qualified for surgery, control examinations (imaging and laboratory tests) should be established individually, taking into consideration such features as the size, image, and growth dynamics of the tumour, clinical symptoms, hormonal tests results, and concomitant diseases.

PMID: 27082051 [PubMed - indexed for MEDLINE]

Glomuvenous Malformation: A Rare Periorbital Lesion of the Thermoregulatory Apparatus.

Wed, 03/22/2017 - 15:56
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Glomuvenous Malformation: A Rare Periorbital Lesion of the Thermoregulatory Apparatus.

Ophthal Plast Reconstr Surg. 2017 Mar/Apr;33(2):e36-e37

Authors: Whipple KM, Godfrey KJ, Solomon JP, Lin JH, Korn BS, Kikkawa DO

Abstract
Glomuvenous malformations (GVMs), previously referred to as glomus tumors or glomangiomas, are benign, mesenchymal venous malformations arising from glomus bodies. Glomus bodies are modified smooth muscle neuromyoarterial structures involved in temperature regulation via blood shunting. These classically occur in the digits but can occur in other locations. The authors present a case of a periorbital GVM presented following blunt trauma to the area.

PMID: 27065433 [PubMed - indexed for MEDLINE]

Extent of Resection, Visual and Endocrinological Outcomes for Endoscopic Endonasal Surgery for Recurrent Pituitary Adenomas.

Wed, 03/15/2017 - 15:49
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Extent of Resection, Visual and Endocrinological Outcomes for Endoscopic Endonasal Surgery for Recurrent Pituitary Adenomas.

World Neurosurg. 2017 Mar 09;:

Authors: Do H, Kshettry VR, Siu A, Belinsky I, Farrell CJ, Nyquist G, Rosen M, Evans JJ

Abstract
OBJECTIVE: To assess outcomes after endoscopic endonasal surgery for recurrent or residual pituitary adenomas.
METHODS: We retrospectively analyzed 61 patients from 2009 - 2016 that underwent endoscopic endonasal surgery for recurrent or residual pituitary adenomas after prior microscopic or endoscopic transphenoidal operation.
RESULTS: Prior surgical approach was endoscopic endonasal in 55.7% and microscopic in 44.2%. The mean preoperative maximal tumor diameter was 2.3cm. Tumor commonly invaded the suprasellar cistern (63.9%). Gross total resection (GTR) was achieved in 31 (51.7%) patients. GTR rate was 68.4% and 21.7% for Knosp grade 0-2 and grade 3-4 tumors, respectively (p<0.001). GTR was 73.1% and 35.3% for patients with previous microscopic and endoscopic transphenoidal surgery, respectively (p=0.002). On multivariate analysis, smaller tumor size (odds ratio [OR] 1.1 per cm, p=0.007), Knosp grade 0-2 (OR 9.7, p=0.002), and prior microscopic approach (OR 12.7, p=0.007) were independent predictors of GTR. Preoperative visual deficit outcome was improvement in 32.5%, unchanged in 62.5%, and worse in 5.0%. New postoperative endocrinopathies included adrenal insufficiency (6.5%), hypothyroidism (8.1%), hypogonadism (6.5%), and diabetes insipidus (4.9%). Complications included postoperative CSF leak (4.9%), meningitis (1.6%), medical complications (4.9%), and postoperative hematoma requiring re-exploration (3.2%).
CONCLUSION: The endoscopic endonasal approach provides a safe and effective option for recurrent pituitary adenomas. Smaller tumor size, absence of cavernous sinus invasion, and prior microscopic approach were independent predictors of GTR. This might suggest inadequate exposure or limited viewing angle may adversely affect extent of resection in primary microscopic surgeries.

PMID: 28286277 [PubMed - as supplied by publisher]

Clear cell colorectal carcinoma: Time to clarify diagnosis.

Wed, 03/15/2017 - 15:49
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Clear cell colorectal carcinoma: Time to clarify diagnosis.

Pathol Res Pract. 2017 Feb 24;:

Authors: Remo A, Grillo F, Mastracci L, Fassan M, Sina S, Zanella C, Parcesepe P, Damiano Urso E, Pancione M, Bortuzzo G, Scarpa A, Manfrin E

Abstract
Primary clear cell colorectal carcinoma (CCC) is a very rare entity accounting for only 35 cases reported in the Literature. CCC is neither classified as a distinct entity nor is it defined as a CRC variant because its ontogeny remains unclear. Most of the reported CCC were found in the distal colon in patients with a mean age of 56 years. Histologically, clear cell change is the main morphologic feature and may present in a "pure" form, composed exclusively of clear cells, or in a "composite" form, admixed with other morphologically different components. It is possible to distinguish two biologically different types of CCC, with different clinical-pathologic features, therapeutic management and diagnostic criteria: a) Intestinal CCC consisting of an aggressive neoplasm, affecting mainly adult men, characterized by an intestinal-type immunoprofile (CK20+, CK7-, CEA+, CDX-2+) and b) Müllerian CCC consisting of an indolent carcinoma of the sigmoid-rectum, affecting young women, characterized by a different (CK7+, CK20-, CEA-, CA125 +) immunoprofile. Considerable diagnostic difficulties can arise in distinguishing CCC and primary or secondary clear cell neoplasms, such as metastases from renal carcinoma, lower urinary tract, female genital tract, adrenal gland, mesothelioma, melanoma and primary intestinal PEComa. In this paper we review the Literature with two additional cases in order to define the diagnostic criteria of CCC.

PMID: 28285963 [PubMed - as supplied by publisher]

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