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NCBI: db=pubmed; Term=adrenal tumor
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Primary Adrenal Angiosarcoma: A Rare and Potentially Misdiagnosed Tumor.

Wed, 04/26/2017 - 19:25
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Primary Adrenal Angiosarcoma: A Rare and Potentially Misdiagnosed Tumor.

Cancer Control. 2017 Apr;24(2):198-201

Authors: Grajales-Cruz A, Baco-Viera F, Rive-Mora E, Ramirez-Tanchez C, Tasso D, Arroyo-Portela N, Calderon E, Padua-Octaviani IJ, Caceres-Perkins W

Abstract
A man aged 69 years presented with acute right flank pain secondary to a hemorrhagic large adrenal tumor. En bloc resection was performed to repair the inferior vena cava. Immunoperoxidase levels in the tumor were positive for factor VIII and CD31 and negative for S100, protein Melan-A, CD34, synaptophysin, chromogranin, desmin, muscle specific actin, ETFA (EMA), KRT20 (CK20), CDX2, TTF1, LNPEP (PLAP), inhibin, ?-fetoprotein, CD30, hepatocyte paraffin, and aberrant expression of cytokeratin 7 and pankeratin. The pathological diagnosis was consistent with adrenal angiosarcoma. Obtaining appropriate immunoperoxidase stains and multidisciplinary evaluation helped make the diagnosis of this rare adrenal tumor and determine its management. The patient had an uneventful postoperative course and completed 4 cycles of adjuvant chemotherapy with doxorubicin/ifosfamide and adequately tolerated the treatment. However, positive surgical margins were found, so he was referred to radiation oncology specialists for possible adjuvant radiotherapy to the surgical bed. Weeks after the first initiation of therapy, the patient presented to the emergency department complaining of shortness of breath, fatigue, and generalized weakness for 3 days. He was admitted and found to have new-onset anemia and a new-onset, large, right pleural effusion. Thoracentesis performed showed sanguinolent fluid that, after microscopic evaluation, was suggestive of recurrent malignancy. Thoracic aortography performed with subselective catheterization to several arteries (right bronchial, right phrenic, and right renal arteries) did not show any active bleeding. However, the right inferior intercostal and adrenal arteries were presumed to be the reason for the bleeding event, so they were embolized until stasis. The patient remained hemodynamically unstable but eventually experienced multiorgan failure. In spite of aggressive measures, he died 10 days after admission to the hospital.

PMID: 28441375 [PubMed - in process]

Surgical Management of Non-small Cell Lung Cancer with Solitary Hematogenous Metastases.

Wed, 04/26/2017 - 19:25
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Surgical Management of Non-small Cell Lung Cancer with Solitary Hematogenous Metastases.

In Vivo. 2017 May-Jun;31(3):451-454

Authors: Karagkiouzis G, Spartalis E, Moris D, Patsouras D, Athanasiou A, Karathanasis I, Verveniotis A, Konstantinou F, Kouerinis IA, Potaris K, Dimitroulis D, Tomos P

Abstract
BACKGROUND/AIM: The treatment of patients with solitary hematogenous metastases from non-small cell lung cancer (NSCLC) remains controversial, although numerous retrospective studies have reported favorable results for patients offered combined surgical therapy. Our aim was to determine the role of surgical resection in the management of NSCLC with solitary extrapulmonary metastases and to investigate for possible prognostic factors.
PATIENTS AND METHODS: Between January 2004 and December 2012, 12 patients with NSCLC, from two Institutions, underwent metastasectomy for their solitary metastatic lesion. Sites of metastases included brain (n=3), adrenal gland (n=6), thoracic wall (n=2) and diaphragm (n=1). All patients had undergone pulmonary resections for their primary NSCLC.
RESULTS: Median survival for the entire cohort was 24.1 months, whereas 1- and 5-year survival rates were 73% and 39%, respectively. Patients with stage III intrathoracic disease had significantly worse survival than those with lower tumor stage. A tendency for adenocarcinomatous histology to positively affect survival was recognized, although it was proven not to be statistically significant.
CONCLUSION: Despite the retrospective nature of our study and the small cohort size, it is emerging that combined surgical resection might offer patients with NSCLC with solitary hematogenous metastases a survival benefit. Limited intrathoracic disease and adenocarcinomatous histology might be associated with better outcomes.

PMID: 28438878 [PubMed - in process]

Performance of 18F-FDG PET/CT in the characterization of adrenal masses in non-cancer patients: A prospective study.

Wed, 04/26/2017 - 19:25
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Performance of 18F-FDG PET/CT in the characterization of adrenal masses in non-cancer patients: A prospective study.

J Clin Endocrinol Metab. 2017 Apr 20;:

Authors: Guerin C, Pattou F, Brunaud L, Lifante JC, Mirallié E, Haissaguerre M, Huglo D, Olivier P, Houzard C, Ansquer C, Hindié E, Loundou A, Archange C, Tabarin A, Sebag F, Baumstarck K, Taïeb D

Abstract
Context: Few prospective studies have evaluated the role of 18F-Fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in the characterization of adrenal masses.
Objective: To assess the performance of 18F-FDG PET/CT in the malignancy diagnosis of adrenal masses in non-cancer patients.
Design: Prospective multicenter study.
Material and methods: The study population consisted of 87 patients (87 adrenal masses) referred to endocrine surgeons: 56 with mass diameter ≥40 mm and 31 with a diameter <40 mm and of indeterminate nature based on unenhanced and washout CT attenuation densities. Fourteen patients had hypercortisolism. Adrenal masses were characterized by 18F-FDG PET/CT. Histology was the gold standard for the diagnosis of malignancy. In the absence of pathological proof (n=23), the nature of the lesion was based on the 12-month imaging follow-up.
Results: Fifteen adrenal masses were classified as malignant (including 11 adrenocortical carcinomas-ACC) and 72 as benign. Compared to benign lesions, malignant lesions were larger in size (p=0.003), had higher unenhanced densities (p=0.002), lower relative washout values (p=0.007), and higher 18F-FDG uptake parameters (p<10-3). The optimal threshold value of (Tumor SUVmax:Liver SUVmax) the ratio for malignancy was >1.5 with sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 86.7%, 86.1%, 56.5, 96.9, and 86.2%, respectively.
Conclusions: Our results show that 18F-FDG-PET/CT complements adrenal washout CT in the evaluation of adrenal masses and should be recommended in the evaluation of large and/or indeterminate adrenal masses.

PMID: 28431167 [PubMed - as supplied by publisher]

Primary Ewing Sarcoma / Primitive Neuroectodermal Tumor of the Kidney: A Clinicopathologic Study of 23 Cases.

Wed, 04/26/2017 - 19:25
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Primary Ewing Sarcoma / Primitive Neuroectodermal Tumor of the Kidney: A Clinicopathologic Study of 23 Cases.

Pathol Oncol Res. 2017 Apr 20;:

Authors: Murugan P, Rao P, Tamboli P, Czerniak B, Guo CC

Abstract
Primary Ewing sarcoma / primitive neuroectodermal tumor (ES) of the kidney is a rare neoplasm with limited clinicopathologic data. We report 23 such cases with no history of ES elsewhere in the body. The patients included 13 male and 10 female, aged 8-70 years (mean, 31 years). The average tumor size was 11.7 cm (range, 5-20 cm). Microscopic analysis showed predominantly lobular growth (n = 14), with focal papillary (n = 3), alveolar (n = 1), and hemangiopericytoma-like (n = 1) patterns. Several tumors (n = 11) exhibited robust mitotic activity (>10 mitoses/10 high-power fields). Necrosis (n = 13) and lymphovascular invasion (n = 14) were common. Homer Wright rosettes (n = 6) and perivascular pseudorosettes (n = 1) were also identified. The tumors invaded the renal sinus or perinephric fat (n = 11), renal vein (n = 13), and adrenal gland (n = 2). Molecular and fluorescence in situ hybridization analysis showed rearrangement of EWSR1 gene (10/10), associated with EWSR1-FLI1 gene fusion (7/10). All patients with follow-up information (n = 18) had metastasis, commonly in the lungs (n = 12) and bone (n = 6). Twelve patients died of disease in a mean of 21 months; 6 patients were alive at a mean of 49 months after diagnosis. Primary kidney ES usually present at an advanced stage with extrarenal spread and metastasis. Although renal ES share histologic, immunohistochemical, and molecular features with their bone and soft tissue counterparts, they appear to be more aggressive tumors with poorer clinical outcome.

PMID: 28429277 [PubMed - as supplied by publisher]

Incidental posterior mediastinal paraganglioma: The safe approach to management, case report.

Wed, 04/26/2017 - 19:25
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Incidental posterior mediastinal paraganglioma: The safe approach to management, case report.

Int J Surg Case Rep. 2017 Mar 31;35:25-28

Authors: Muñoz-Largacha JA, Glocker RJ, Moalem J, Singh MJ, Litle VR

Abstract
INTRODUCTION: Paragangliomas are neuroendocrine tumors arising from chromaffin cells located in sympathetic paraganglia. Mediastinal paragangliomas are extremely rare and can be classified as functional or non-functional according to their ability for secreting catecholamines. Patients can be asymptomatic and the diagnosis is usually incidental. Complete surgical resection remains the standard of care for paragangliomas.
PRESENTATION OF CASE: We present a 44-year-old woman with a functional mediastinal paraganglioma incidentally found during the perioperative imaging workup for a diagnosed breast carcinoma. Chest radiograph and computed tomography (CT) showed a well-defined lesion in the posterior mediastinum suspicious for an esophageal malignancy. Endoscopic and CT-guided biopsies were performed confirming the diagnosis of a neuroendocrine tumor. Laboratory studies showed elevated catecholamines and chromogranin A levels, consistent with a paraganglioma. Appropriate pre-operative management was done and successful surgical resection without catecholamine related complications was achieved.
DISCUSSION: The workup and treatment of incidentally discovered adrenal and extra-adrenal lesions are controversial. Because of the absence of symptoms and the wider differential diagnosis of extra-adrenal lesions, an attempt for biopsying and surgically remove these lesions prior to biochemical testing is not an uncommon scenario, although this could be potentially harmful. Surgeons should have an index of suspicion for catecholamine-secreting tumors and hormonal levels should be assessed prior to biopsy or surgical resection.
CONCLUSION: Surgeons should consider paragangliomas as a differential diagnosis for extra-adrenal lesions. Biochemical testing with catecholamines and chromogranin A levels should be performed prior to biopsy or surgical removal in order to avoid catastrophic complications.

PMID: 28427002 [PubMed - as supplied by publisher]

Anthracyclines suppress pheochromocytoma cell characteristics, including metastasis, through inhibition of the hypoxia signaling pathway.

Wed, 04/26/2017 - 19:25
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Anthracyclines suppress pheochromocytoma cell characteristics, including metastasis, through inhibition of the hypoxia signaling pathway.

Oncotarget. 2017 Apr 04;8(14):22313-22324

Authors: Pang Y, Yang C, Schovanek J, Wang H, Bullova P, Caisova V, Gupta G, Wolf KI, Semenza GL, Zhuang Z, Pacak K

Abstract
Pheochromocytomas (PHEOs) and paragangliomas (PGLs) are rare, neuroendocrine tumors derived from adrenal or extra-adrenal chromaffin cells, respectively. Metastases are discovered in 3-36% of patients at the time of diagnosis. Currently, only suboptimal treatment options exist. Therefore, new therapeutic compounds targeting metastatic PHEOs/PGLs are urgently needed. Here, we investigated if anthracyclines were able to suppress the progression of metastatic PHEO. We explored their effects on experimental mouse PHEO tumor cells using in vitro and in vivo models, and demonstrated that anthracyclines, particularly idarubicin (IDA), suppressed hypoxia signaling by preventing the binding of hypoxia-inducible factor 1 and 2 (HIF-1 and HIF-2) to the hypoxia response element (HRE) sites on DNA. This resulted in reduced transcriptional activation of HIF target genes, including erythropoietin (EPO), phosphoglycerate kinase 1 (PGK1), endothelin 1 (EDN1), glucose transporter 1 (GLUT1), lactate dehydrogenase A (LDHA), and vascular endothelial growth factor (VEGFA), which consequently inhibited the growth of metastatic PHEO. Additionally, IDA downregulated hypoxia signaling by interfering with the transcriptional activation of HIF1A and HIF2A. Furthermore, our animal model demonstrated the dose-dependent suppressive effect of IDA on metastatic PHEO growth in vivo. Our results indicate that anthracyclines are prospective candidates for inclusion in metastatic PHEO/PGL therapy, especially in patients with gene mutations involved in the hypoxia signaling pathway.

PMID: 28423608 [PubMed - in process]

Synthesis of Neutral Ether Lipid Monoalkyl-diacylglycerol (MADAG) by Lipid Acyltransferases.

Wed, 04/26/2017 - 19:25
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Synthesis of Neutral Ether Lipid Monoalkyl-diacylglycerol (MADAG) by Lipid Acyltransferases.

J Lipid Res. 2017 Apr 18;:

Authors: Ma Z, Onorato JM, Chen L, Nelson DW, Yen CE, Cheng D

Abstract
In mammals, ether lipids exert a wide spectrum of signaling and structural functions such as stimulation of immune responses, anti-tumor activities and enhancement of sperm functions. Abnormal accumulation of monoalkyl-diacylglycerol (MADAG) was found in Wolman disease, a human genetic disorder defined by a deficiency in lysosomal acid lipase. In the current study, we found that among the 9 recombinant human lipid acyltransferases examined, DGAT1, DGAT2, MGAT2, MGAT3, AWAT2/MFAT and DC3 were able to use 1-monoalkylglycerol (1-MAkG) as an acyl acceptor for the synthesis of monoalkyl-monoacylglycerol (MAMAG). These enzymes demonstrated different enzymatic turnover rates and relative efficiencies for the first and second acylation steps leading to the synthesis of MAMAG and MADAG, respectively. They also exhibited different degrees of substrate preference when presented with 1-monooleoylglycerol versus 1-MAkG. In CHO-K1 cells, treatment with DGAT1 selective inhibitor XP-620 completely blocked the synthesis of MADAG, indicating that DGAT1 is the predominant enzyme responsible for the intracellular synthesis of MADAG in this model system. The levels of MADAG in the adrenal gland of DGAT1 knockout (KO) mice were reduced as compared to those of the wild type mice, suggesting that DGAT1 is a major enzyme for the synthesis of MADAG in this tissue. Our findings indicate that several of these lipid acyltransferases may be able to synthesize neutral ether lipids in mammals.

PMID: 28420705 [PubMed - as supplied by publisher]

Case report: ACTH-secreting pituitary carcinoma metastatic to the liver in a patient with a history of atypical pituitary adenoma and Cushing's disease.

Wed, 04/26/2017 - 19:25
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Case report: ACTH-secreting pituitary carcinoma metastatic to the liver in a patient with a history of atypical pituitary adenoma and Cushing's disease.

Diagn Pathol. 2017 Apr 18;12(1):34

Authors: Joehlin-Price AS, Hardesty DA, Arnold CA, Kirschner LS, Prevedello DM, Lehman NL

Abstract
BACKGROUND: Pituitary carcinoma is a rare entity requiring the presence of metastasis to confirm its malignant potential. We report a case of pituitary carcinoma and discuss the diagnosis and management of this lesion in relation to the existing literature.
CASE PRESENTATION: The patient is a 51-year-old woman with Cushing's disease and intact adrenal glands who was diagnosed with metastatic pituitary carcinoma to the liver, 29 months after initial resection of an ACTH-secreting primary atypical pituitary adenoma (APA). Prior to detection of this metastasis the patient underwent repeat resection and radiotherapy for residual cavernous sinus disease. The metastatic lesion was detected by interval surveillance of serum ACTH and 24-hour urine cortisol, which despite stable pituitary MRI, were significantly elevated. These abnormalities prompted a PET scan that demonstrated hypermetabolic liver parenchyma, which was suspicious for metastasis on abdominal MRI. An ultrasound-guided liver biopsy demonstrated nests of moderately-differentiated cells with intermediate-sized, monotonous nuclei, distinct nucleoli, and abundant basophilic cytoplasm, confirmed by immunohistochemistry to represent metastatic pituitary carcinoma. The liver lesion was subsequently successfully removed by wedge resection. One year later, the patient's residual cavernous sinus disease grew markedly, and she was placed on dual-agent chemotherapy consisting of oral temozolomide and capecitabine, with stabilization of her intracranial disease to present, although liver metastases recurred.
CONCLUSIONS: Pituitary carcinoma is a rare entity impossible to recognize as a primary tumor because its diagnosis by definition requires the presence of metastasis. Maintaining awareness of the entity and its precursor lesion APA is essential for its accurate pathologic diagnosis and appropriate management.

PMID: 28420444 [PubMed - in process]

Simultaneous assay of cortisol and dexamethasone improved diagnostic accuracy of the dexamethasone suppression test.

Wed, 04/26/2017 - 19:25
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Simultaneous assay of cortisol and dexamethasone improved diagnostic accuracy of the dexamethasone suppression test.

Eur J Endocrinol. 2017 Jun;176(6):705-713

Authors: Ueland GÅ, Methlie P, Kellmann R, Bjørgaas M, Åsvold BO, Thorstensen K, Kelp O, Thordarson HB, Mellgren G, Løvås K, Husebye ES

Abstract
OBJECTIVES: The overnight dexamethasone (DXM) suppression test (DST) has high sensitivity, but moderate specificity, for diagnosing hypercortisolism. We have evaluated if simultaneous measurement of S-DXM may correct for variable DXM bioavailability and increase the diagnostic performance of DST, and if saliva (sa) is a feasible adjunct or alternative to serum.
DESIGN AND METHODS: Prospective study of DST was carried out in patients with suspected Cushing's syndrome (CS) (n = 49), incidentaloma (n = 152) and healthy controls (n = 101). Cortisol, cortisone and DXM were assayed by liquid chromatography-tandem mass spectrometry (LC-MS/MS).
RESULTS: Three hundred and two subjects underwent DST; S-cortisol was ≥50 nmol/L in 83 patients, of whom 11 had CS and 27 had autonomous cortisol secretion. The lower 2.5 percentile of S-DXM in subjects with negative DST (n = 208) was 3.3 nmol/L, which was selected as the DXM cut-off level. Nine patients had the combination of low S-DXM and positive DST. Of these, three had been misdiagnosed as having autonomous cortisol secretion. DST results were highly reproducible and confirmed in a replication cohort (n = 58). Patients with overt CS had significantly elevated post-DST sa-cortisol and sa-cortisone levels compared with controls; 23 of 25 with autonomous cortisol secretion had elevated sa-cortisone and 14 had elevated sa-cortisol.
CONCLUSIONS: Simultaneous measurement of serum DXM and cortisol reduced false-positive DSTs by 20% and improved the specificity. S-DXM >3.3 nmol/L is sufficient for the suppression of cortisol <50 nmol/L. Measurement of glucocorticoids in saliva is a non-invasive and easy procedure and post-DST sa-cortisone was found particularly useful in the diagnosis of CS.

PMID: 28298353 [PubMed - indexed for MEDLINE]

Validation of the prognostic role of the "Helsinki Score" in 225 cases of adrenocortical carcinoma.

Wed, 04/26/2017 - 19:25
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Validation of the prognostic role of the "Helsinki Score" in 225 cases of adrenocortical carcinoma.

Hum Pathol. 2017 Apr;62:1-7

Authors: Duregon E, Cappellesso R, Maffeis V, Zaggia B, Ventura L, Berruti A, Terzolo M, Fassina A, Volante M, Papotti M

Abstract
Adrenocortical carcinoma patient prognosis is extremely variable and poorly predictable. The newly introduced Helsinki Score is the first so far proposed diagnostic and prognostic system based on the combined evaluation of morphological (mitoses and necrosis) and immunohistochemical (Ki-67) parameters. The aim of the study was to validate the prognostic role of the Helsinki Score for adrenocortical carcinoma characterization. Thus, 225 adrenocortical carcinomas were reclassified using the Weiss Score and the Helsinki Score (3× mitotic count + 5 × necrosis + Ki-67 index). At univariate analysis, statistically significant prognostic values were observed at the log-rank test for mitotic count (cutoff values: <6 and ≥55; P<.0001), Ki-67 (cutoff values: <20 and ≥50; P<.0001), Weiss Score (cutoff values: <5 and ≥8; P<.0001), Helsinki Score (cutoff values: <13 and ≥19; P<.0001), histological variant (conventional versus oncocytic; P=.009), necrosis (P=.001), and stage (P=.005). Cox multivariate analysis using a backward stepwise selection method retained only Helsinki Score and Weiss Score as predictors of poor prognosis (P<.0001 and P=.0005, respectively). Helsinki Score (with a threshold of 28.5 points; area under the curve [AUC]=0.729, 95% confidence interval=0.66-0.79) and Ki-67 (with a threshold of 20.5%; AUC=0.727, 95% confidence interval=0.66-0.79) showed the best and equivalent AUCs predicting disease-related deaths determined using receiver operating characteristic statistics. In conclusion, the Helsinki Score is a valuable system to predict prognosis in adrenocortical carcinoma, outperforming the currently established prognostic parameters.

PMID: 27916625 [PubMed - indexed for MEDLINE]

Dermatologic Manifestations of Monogenic Autoinflammatory Diseases.

Wed, 04/26/2017 - 19:25
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Dermatologic Manifestations of Monogenic Autoinflammatory Diseases.

Dermatol Clin. 2017 Jan;35(1):21-38

Authors: Shwin KW, Lee CR, Goldbach-Mansky R

Abstract
Autoinflammatory disorders are sterile inflammatory conditions characterized by episodes of early-onset fever, rash, and disease-specific patterns of organ inflammation. Gain-of-function mutations in innate danger-sensing pathways, including the inflammasomes and the nucleic acid sensing pathways, play critical roles in the pathogenesis of IL-1 and Type-I IFN-mediated disorders and point to an important role of excessive proinflammatory cytokine signaling, including interleukin (IL)-1b , Type-I interferons, IL-18, TNF and others in causing the organ specific immune dysregulation. The article discusses the concept of targeting proinflammatory cytokines and their signaling pathways with cytokine blocking treatments that have been life changing for some patients.

PMID: 27890235 [PubMed - indexed for MEDLINE]

Adrenal incidentalomas: A guide to assessment, treatment and follow-up.

Wed, 04/26/2017 - 19:25
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Adrenal incidentalomas: A guide to assessment, treatment and follow-up.

Maturitas. 2016 10;92:79-85

Authors: Paschou SA, Vryonidou A, Goulis DG

Abstract
Adrenal incidentalomas are clinically unsuspected lesions that are detected in adrenal glands during imaging procedures for other causes. With widespread use of imaging - both computed tomography (CT) and magnetic resonance imaging (MRI) - adrenal incidentalomas are now a common clinical problem. The two main clinical issues to be determined in this setting are the risk of malignancy and the hormonal activity of these lesions. The answers to these two questions, along with the clinical characteristics of each individual patient and co-morbidities, will guide the treatment strategy, which can vary from simple follow-up to surgical resection. The objective of this article is to present updated information on the definition, prevalence, imaging and functional features of adrenal incidentalomas and to provide a guide to their optimal assessment, treatment and follow-up. This review collected, analyzed and qualitatively re-synthesized information regarding: (1) the various clinical entities known as "adrenal incidentalomas", (2) the initial assessment of risk of malignancy, (3) the initial assessment of whether the lesion is hormonally active or non-functioning, (4) the absolute and relative indications for surgical treatment, (5) the follow-up of patients who are not deemed to need surgical treatment after initial assessment, and (6) the post-operative follow-up of patients who undergo surgical treatment. The evidence calls for clinicians to bear in mind the Hippocratian advice "ωϕελέειν ή μη βλάπτειν" ("first do no harm").

PMID: 27621243 [PubMed - indexed for MEDLINE]

Epithelial Cell Adhesion Molecule Expression in Canine Tumours.

Wed, 04/26/2017 - 19:25
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Epithelial Cell Adhesion Molecule Expression in Canine Tumours.

J Comp Pathol. 2016 Nov;155(4):299-304

Authors: Thamm DH, Hayes DF, Meuten T, Laver T, Thomas DG

Abstract
Epithelial cell adhesion molecule (EpCAM) is expressed in most human normal and neoplastic tissues of epithelial derivation and may have an association with tumour cell aggressiveness, a stem cell-like phenotype and clinical outcome. Antibody-based strategies for the targeting and capture of EpCAM-expressing tumour cells are showing promise, both as diagnostic tools and potential therapies. The aim of this study was to assess EpCAM expression in canine tumours. EpCAM expression was assessed in tumour cell lines via gene expression profiling and in formalin-fixed and paraffin wax-embedded tissues from canine carcinomas representing various anatomical sites by immunohistochemistry. EpCAM mRNA expression was higher in cell lines from carcinomas than those derived from sarcomas or haemopoietic tumours. EpCAM was expressed by >2/3 of tumour cells in 71% of canine carcinomas evaluated, irrespective of histotype, with the exception of carcinomas of the adrenal gland. Canine sarcomas and haemopoietic tumours were uniformly negative. Most canine carcinomas express EpCAM and so could be suitable for the study of EpCAM-directed diagnostics and therapeutics.

PMID: 27567927 [PubMed - indexed for MEDLINE]

Adrenocortical Oncocytic Carcinoma: A Case Report and Review of the Histopathologic Diagnostic Criteria.

Wed, 04/26/2017 - 19:25
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Adrenocortical Oncocytic Carcinoma: A Case Report and Review of the Histopathologic Diagnostic Criteria.

Turk Patoloji Derg. 2016;32(3):211-5

Authors: Arik D, Canaz F, Dündar E

Abstract
Oncocytic tumors are rare in the adrenal gland. The histopathological diagnosis of adrenocortical carcinoma is difficult due to the lack of precise diagnostic criteria for malignancy. A 44-year-old man was admitted to our hospital with left flank pain. Radiologically an adrenal mass was detected. After the excision and histopathologic evaluation of the mass, a diagnosis of adrenocortical oncocytic carcinoma was made. At least one of the features of more than 5 mitoses in 50 high power fields, atypical mitotic figures or venous invasion is required for the diagnosis of malignancy in adrenocortical tumors. It has been suggested that tumors that have more than one of the minor criteria of large size ( > 10 cm or > 200 gr), necrosis, capsular or sinusoidal invasion, should be evaluated as having uncertain malignant potential.

PMID: 27562395 [PubMed - indexed for MEDLINE]

Nasal Polyp - An Incidental Paraganglioma.

Wed, 04/26/2017 - 19:25
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Nasal Polyp - An Incidental Paraganglioma.

Turk Patoloji Derg. 2016;32(3):196-9

Authors: Srivastava R, Wadhwa N, Gupta S, Razdan U

Abstract
The nose is an uncommon site for head and neck paraganglioma. The diagnosis is seldom established pre-operatively; its rarity, infrequent functionality and often benign biologic outcome underlie this fact. We present one such case in a 60-year-old man who presented with right nasal obstruction and episodic epistaxis. Rhinoscopy revealed a fleshy polypoid mass arising from the anterior cartilaginous nasal septum. Imaging studies excluded extra-nasal extension. The tumor was highly vascular showing numerous variable sized, mostly thin walled branching blood vessels akin to stag-horn shape simulating a vascular neoplasm. There were large areas of hyalinization. The typical tumor morphology was discernible only in focal areas. Immuno-histochemistry confirmed the diagnosis. The tumor cells expressed neuron specific enolase; S-100 stain demonstrated a vague zell-ballen pattern. Paraganglioma is a rare histologic diagnosis in nasal polypectomy specimen. We discuss the approach to exclude its morphologic mimics including vascular tumors.

PMID: 27562394 [PubMed - indexed for MEDLINE]

Virilizing adrenocortical oncocytic neoplasm with uncertain malignant potential in a child: A rare case report.

Wed, 04/26/2017 - 19:25
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Virilizing adrenocortical oncocytic neoplasm with uncertain malignant potential in a child: A rare case report.

Indian J Cancer. 2016 Jan-Mar;53(1):203-4

Authors: Mardi K

PMID: 27146779 [PubMed - indexed for MEDLINE]

Characterization of Adrenal Adenoma by Gaussian Model-Based Algorithm.

Wed, 04/26/2017 - 19:25
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Characterization of Adrenal Adenoma by Gaussian Model-Based Algorithm.

Curr Probl Diagn Radiol. 2016 Sep-Oct;45(5):312-8

Authors: Hsu LD, Wang CL, Clark TJ

Abstract
We confirmed that computed tomography (CT) attenuation values of pixels in an adrenal nodule approximate a Gaussian distribution. Building on this and the previously described histogram analysis method, we created an algorithm that uses mean and standard deviation to estimate the percentage of negative attenuation pixels in an adrenal nodule, thereby allowing differentiation of adenomas and nonadenomas. The institutional review board approved both components of this study in which we developed and then validated our criteria. In the first, we retrospectively assessed CT attenuation values of adrenal nodules for normality using a 2-sample Kolmogorov-Smirnov test. In the second, we evaluated a separate cohort of patients with adrenal nodules using both the conventional 10HU unit mean attenuation method and our Gaussian model-based algorithm. We compared the sensitivities of the 2 methods using McNemar's test. A total of 183 of 185 observations (98.9%) demonstrated a Gaussian distribution in adrenal nodule pixel attenuation values. The sensitivity and specificity of our Gaussian model-based algorithm for identifying adrenal adenoma were 86.1% and 83.3%, respectively. The sensitivity and specificity of the mean attenuation method were 53.2% and 94.4%, respectively. The sensitivities of the 2 methods were significantly different (P value < 0.001). In conclusion, the CT attenuation values within an adrenal nodule follow a Gaussian distribution. Our Gaussian model-based algorithm can characterize adrenal adenomas with higher sensitivity than the conventional mean attenuation method. The use of our algorithm, which does not require additional postprocessing, may increase workflow efficiency and reduce unnecessary workup of benign nodules.

PMID: 27020253 [PubMed - indexed for MEDLINE]

adrenal tumor; +33 new citations

Wed, 04/19/2017 - 19:23

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Characterization of pancreatic islet cell tumors and renal tumors induced by a combined treatment of streptozotocin and nicotinamide in male SD rats.

Wed, 04/12/2017 - 19:23
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Characterization of pancreatic islet cell tumors and renal tumors induced by a combined treatment of streptozotocin and nicotinamide in male SD rats.

Exp Toxicol Pathol. 2017 Apr 05;:

Authors: Kato Y, Masuno K, Fujisawa K, Tsuchiya N, Torii M, Hishikawa A, Izawa T, Kuwamura M, Yamate J

Abstract
We herein investigated the histopathological features, including proliferative activity and immunoexpression, of pancreatic islet cell tumors (ICTs) in male SD rats induced by streptozotocin (STZ) and nicotinamide (NA), and discussed their relevance to biological behaviors and prognoses. A total of 70 and 43% of rats developed ICTs 37-45 weeks after the treatment with STZ (50 or 75mg/kg, i.v.) and NA (350mg/kg, twice, p.o.), respectively. Among the islet tumors observed in the STZ/NA-treated groups, 75% were adenomas, while 25% were carcinomas. Most STZ/NA-induced carcinomas were characterized by well-differentiated tumor cells with/without local invasion into the surrounding tissues, and weak proliferative activity. No outcome such as distance metastasis and death was noted. All of the ICTs strongly expressed insulin, part of which had hormone productivity; however there were no hypoglycemia-related clinical signs such as convulsion in these rats 36 weeks after the treatment. These results suggested that rat ICTs induced STZ/NA have small impact on biological activity or prognosis. STZ/NA treatment significantly increased of focal proliferative lesions in the kidney, liver and adrenal glands other than pancreatic islets. Of the STZ/NA-induced kidney tumors, more than 60% were renal cell adenomas, and many of them were basophilic type. The incidence of eosinophilic or clear cell type of tumors was less than 10%, respectively. Immunohistochemical analyses revealed that many of the STZ/NA-induced basophilic type of renal tumors were derived from proximal tubules, whereas the clear cell and eosinophilic types were derived from collecting tubules.

PMID: 28390812 [PubMed - as supplied by publisher]

Outcome of laparoscopic adrenalectomy for resection of unilateral noninvasive adrenocortical tumors in 11 cats.

Wed, 04/12/2017 - 19:23
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Outcome of laparoscopic adrenalectomy for resection of unilateral noninvasive adrenocortical tumors in 11 cats.

Vet Surg. 2017 Apr 08;:

Authors: Mitchell JW, Mayhew PD, Culp WT, Brad Case J, Singh A, Fuller MC, Della Maggiore A

Abstract
OBJECTIVE: To describe the technique and outcomes of laparoscopic adrenalectomy (LA) in cats with adrenocortical neoplasia.
STUDY DESIGN: Retrospective case series.
ANIMALS: Eleven client-owned cats with unilateral adrenal tumors.
METHODS: Medical records of cats that underwent LA for unilateral functional adrenal tumors at 3 veterinary teaching hospitals were reviewed. Data collected included signalment, clinical signs, physical examination findings, diagnostic imaging results, preoperative laboratory tests, laparoscopic port placement and techniques, duration of anesthesia and surgery, complications, concomitant procedures, need for conversion to an open celiotomy, histopathological diagnosis, and postoperative survival.
RESULTS: Eleven cats were included, 5 with right-sided and 6 with left-sided tumors. Tumors were aldosterone-secreting (n = 8), progesterone-secreting (n = 2), or testosterone-secreting (n = 1). Adrenalectomy was successfully performed in all 11 cats although 4 cases required conversion to an open celiotomy, due to poor visualization (n = 2), close adherence of the tumor to the caudal vena cava (n = 1), and inability to maintain adequate pneumoperitoneum (n = 1). Ten of the 11 cats were discharged from the hospital, with a median survival time of 803 days (range 467-1123 days). One cat died from severe pancreatitis and cardiogenic pulmonary edema.
CONCLUSION: Adrenalectomy can be performed in cats via laparoscopy but is technically challenging, and associated with a relatively high conversion rate (36%).

PMID: 28390062 [PubMed - as supplied by publisher]

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