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Updated: 14 hours 34 min ago

Applications of Immunohistochemistry to Endocrine Pathology.

Tue, 09/04/2018 - 09:58
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Applications of Immunohistochemistry to Endocrine Pathology.

Adv Anat Pathol. 2018 Aug 28;:

Authors: Higgins SE, Barletta JA

Abstract
The role of immunohistochemistry (IHC) in endocrine pathology is similar to that in other organ systems in that it can aid in the subclassification of tumors within an organ, confirm site of primary in metastatic disease, provide prognostic information, identify underlying genetic alterations, and predict response to treatment. Although most endocrine tumors do not require IHC to render a diagnosis, there are certain scenarios in which IHC can be extremely helpful. For example, in thyroid, IHC can be used to support tumor dedifferentiation, in the adrenal it can aid in the diagnosis of low-grade adrenocortical carcinomas, and in paragangliomas it can help identify tumors arising as part of an inherited tumor syndrome. This review will focus on the applications of IHC in tumors of the thyroid, parathyroids, adrenals, and paraganglia in adults.

PMID: 30157042 [PubMed - as supplied by publisher]

Catecholamine-Synthesizing Enzymes in Pheochromocytoma and Extraadrenal Paraganglioma.

Tue, 09/04/2018 - 09:58
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Catecholamine-Synthesizing Enzymes in Pheochromocytoma and Extraadrenal Paraganglioma.

Endocr Pathol. 2018 Aug 28;:

Authors: Konosu-Fukaya S, Omata K, Tezuka Y, Ono Y, Aoyama Y, Satoh F, Fujishima F, Sasano H, Nakamura Y

Abstract
In chromaffin cells, tyrosine hydroxylase (TH), aromatic L-amino acid decarboxylase (AADC), dopamine β-hydroxylase (DBH), and phenylethanolamine N-methyltransferase (PNMT) are mainly involved in catecholamine synthesis. In this study, we evaluated the association between the status of catecholamine-synthesizing enzymes and histopathological features of pheochromocytoma and extraadrenal paraganglioma with special emphasis upon their postoperative clinical behavior. Immunohistochemical evaluation of TH, DBH, AADC, PNMT, Ki 67, and S-100 was performed in 29 pheochromocytoma and 10 extraadrenal paraganglioma and one lymph node harboring metastatic pheochromocytoma. Among these cases, metastasis was subsequently developed in three cases. Urinary normetanephrine (U-NM) levels were significantly higher in clinical metastatic cases than non-metastatic ones. Ki 67 labeling index was significantly higher in both clinical metastatic cases and the Adrenal Gland Scaled Score (PASS) score of ≧ 4 cases than PASS < 4 cases, although this score was originally used in pheochromocytoma. H-score of AADC and DBH were significantly lower in PASS ≧ 4 cases than those with < 4 cases, and in the cases associated with intratumoral necrosis (n = 4), the presence of spindle shaped tumor cells (n = 4), and large nests of cells or diffuse growth (n = 5). Lower status of intratumoral AADC could be related to poor differentiation of tumor cells in both catecholamine production and morphology and could be related to aggressive biological behavior of both pheochromocytoma and extraadrenal paraganglioma.

PMID: 30155766 [PubMed - as supplied by publisher]

Perioperative complications of adrenalectomy - 12 years of experience from a single center/teaching hospital and literature review.

Tue, 09/04/2018 - 09:58
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Perioperative complications of adrenalectomy - 12 years of experience from a single center/teaching hospital and literature review.

Arch Med Sci. 2018 Aug;14(5):1010-1019

Authors: Aporowicz M, Domosławski P, Czopnik P, Sutkowski K, Kaliszewski K

Abstract
Introduction: The perioperative complication rate of adrenalectomy varies between 1.7% and 30.7% in the medical literature. This study presents outcomes of adrenalectomy in our center and tries to point out risk factors for perioperative problems.
Material and methods: We retrospectively analyzed all patients who underwent adrenalectomy in our department from January 2004 to June 2015. Patient's sex, indication for procedure, tumor laterality, surgical approach and surgeon's case volume were taken into consideration as possible risk factors for complications.
Results: There were 177 adrenalectomies performed on 170 patients. We reported 18 (10.2%) perioperative complications, 12 (6.8%) surgical and 6 (3.4%) medical. Laparotomy was a significant risk factor for medical (p < 0.01) and overall problems (p = 0.02). Operations more expansive than just adrenalectomy were associated with higher risk of medical complications (p = 0.01). Procedures performed by surgeons with higher volume were associated with smaller risk of medical complications (p < 0.01). Right and left adrenalectomies seem to be related to different kinds of risk - bleeding on the right, injury of surrounding structures on the left (p = 0.05). Patient's sex, indication for procedure, bilateral procedure and side of operation were not statistically significant risk factors for complications.
Conclusions: Adrenal glands are surrounded by various anatomic structures (colon, pancreas, spleen, diaphragm) that may be injured during adrenalectomy. Complications following a laparoscopic procedure may arise from the use of monopolar coagulation and the patient's position on the operating table. High insufflation pressure during retroperitoneoscopic procedures may cause subcutaneous emphysema.

PMID: 30154882 [PubMed]

Educational Case: Pheochromocytoma.

Tue, 09/04/2018 - 09:58
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Educational Case: Pheochromocytoma.

Acad Pathol. 2018 Jan-Dec;5:2374289518780500

Authors: Westover C, Conran RM

Abstract
The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see http://journals.sagepub.com/doi/10.1177/2374289517715040.

PMID: 30151422 [PubMed]

Adrenal Metastasis of Hepatocellular Carcinoma in Patients following Liver Resection or Liver Transplantation: Experience from a Tertiary Referral Center.

Tue, 09/04/2018 - 09:58
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Adrenal Metastasis of Hepatocellular Carcinoma in Patients following Liver Resection or Liver Transplantation: Experience from a Tertiary Referral Center.

Int J Surg Oncol. 2018;2018:4195076

Authors: Teegen EM, Mogl MT, Pratschke J, Rayes N

Abstract
Introduction: Adrenal metastasis of hepatocellular carcinoma (HCC) is a rare entity and can be treated by resection, local ablative therapy, or systemic therapy. Unfortunately, data about treatment outcome, especially in liver transplant recipients, are rare.
Patients and Methods: From 2005 to 2015, 990 liver resections and 303 liver transplantations because of HCC were performed at our clinic. We retrospectively analyzed treatment outcome of the patients with metachronous adrenal metastasis of HCC, who received either resection, local ablation, or surveillance only.
Results: 10 patients were identified (0.8%). 7 patients received liver transplantation for primary HCC therapy, 3 liver resection, and 1 a local ablative therapy. 8 patients underwent adrenalectomy (one via retroperitoneoscopy), one was treated with local ablation, and one had surveillance only. Seven out of eight patients had no surgical complications and one experienced a pancreatic fistula, treated conservatively. 37.5% of the resected patients had recurrence 1 year after adrenalectomy and 75% after 2 years. The mean survival time after primary diagnosis of HCC was 96.6±22.4 months. After adrenalectomy, the mean survival time was 112.4±25.2 months. The mean time until tumor recurrence was 13.2±3.8 in the total cohort and 15.8±3.8 months in patients after adrenalectomy. The estimated overall survival after adrenalectomy was 77.2±17.4 months.
Conclusion: Metachronous adrenal metastasis occured in less than 1% of HCC patients. Adrenalectomy is a safe procedure and leads to acceptable survival rates even after liver transplantion. Therefore, it should be performed whenever the primary tumor is well controlled and the patient is in adequate physical condition.

PMID: 30151282 [PubMed - in process]

'Malignant' hypertension from hyperaldosteronism: a case report.

Tue, 09/04/2018 - 09:58
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'Malignant' hypertension from hyperaldosteronism: a case report.

Pan Afr Med J. 2018;30:10

Authors: Baradhi KM, Tran T, Mittadodla PS

Abstract
Adrenocortical carcinomas (ACC) are rare with an incidence of 0.7-2 per million population per year and account for only 0.05%-2% of all malignant tumors. While majority of the functional ACC present as Cushing syndrome, recurrent hyperaldosteronism from metastatic ACC is exceedingly rare. We describe a 67-year old female presented with hypertensive urgency & hypokalemia as a result of hyperaldosteronism from an 8-cm right ACC. She underwent a radical right nephrectomy with adrenalectomy that normalized her blood pressure. However, a few years later she presented again with resistant hypertension from hyperaldosteronism, raising the suspicion of recurrence of ACC. A contrast-enhanced CT scan showed a normal left adrenal gland but revealed pulmonary metastases of ACC based on a lung biopsy. Chemotherapy was complicated with side effects leading to refusal of further chemotherapy, henceforth requiring high dose of spironolactone for blood pressure control. Despite curative surgery, metastatic functional ACC should be considered in patients presenting with secondary hypertension from recurrent hyperaldosteronism, due to its high recurrence rate. Besides standard cancer surveillance after a curative surgery, meticulous monitoring of blood pressure is a simple yet crucial way to detect cancer recurrence early.

PMID: 30123413 [PubMed - indexed for MEDLINE]

[Appleby procedure - an option for surgical treatment of pancreatic body tumour infiltrating the celiac axis].

Tue, 09/04/2018 - 09:58
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[Appleby procedure - an option for surgical treatment of pancreatic body tumour infiltrating the celiac axis].

Magy Seb. 2018 03;71(1):16-20

Authors: Kelemen D, Lőcsei Z, Papp R, Ferencz S, Vereczkei A

Abstract
CASE PRESENTATION: After neoadjuvant oncological therapy the surgical treatment of distal pancreatic tumour - infiltrating the celiac axis and the stomach - was reported. During the operation resection of the trunc, distal pancreatectomy, splenectomy, total gastrectomy, resection of the left adrenal gland and cholecystectomy were carried out. The patient's clinical course was uneventful, only transient alteration of liver functions was detected. Histological work-up revealed R1 resection, so adjuvant oncological therapy was decided.
DISCUSSION: Distal pancreatic tumours are frequently inoperable. Infiltration of the celiac axis was similarly considered, however there is a chance for radical operation by the resection of the trunc, when the pancreaticoduodenal arcade will provide the arterial blood supply to the liver. Based on the above case the operative technique and the relevant questions were discussed. In pancreatic tumour and arterial infiltration the preoperative chemotherapy is absolutely recommended, because there is a chance for radical surgery in case of good response.

PMID: 29536751 [PubMed - indexed for MEDLINE]

A case of adrenocortical carcinoma accompanying secondary acute adrenal hypofunction postoperation.

Tue, 09/04/2018 - 09:58
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A case of adrenocortical carcinoma accompanying secondary acute adrenal hypofunction postoperation.

World J Surg Oncol. 2018 Mar 05;16(1):43

Authors: Kou K, Zhang H, Zhang C, Xie E, Chen Y, Wang G, Lv G

Abstract
BACKGROUND: Adrenocortical carcinoma (ACC) is a rare, heterogeneous malignancy with a poor prognosis. ACCs are classified as functioning and non-functioning. The pathogenesis of ACC remains elusive, and diagnosis of ACC is currently based on pathology. In the absence of other effective approaches, surgical resection is the preferred treatment option.
CASE PRESENTATION: Here, we report a case of ACC in the retroperitoneum. The patient underwent radical adrenalectomy and remained disease-free throughout a 6-month follow-up.
CONCLUSIONS: Radical surgical resection is an efficient therapy for ACC, and hydrocortisone can be used to alleviate symptoms of secondary acute adrenal hypofunction.

PMID: 29506536 [PubMed - indexed for MEDLINE]

Managing a Large-Size Adrenal Cyst by Hand-Assisted Laparoscopic Surgery in a Young Male.

Tue, 09/04/2018 - 09:58
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Managing a Large-Size Adrenal Cyst by Hand-Assisted Laparoscopic Surgery in a Young Male.

J Coll Physicians Surg Pak. 2018 Mar;28(3):S28-S30

Authors: Hasan A, Iqbal N, Khawaja MA, Yousuf A, Masood A, Malik Y

Abstract
Adrenal cysts are not common and are most often non-functional and asymptomatic. Most of these cysts are found incidentally. These lesions exhibit a broad histomorphologic spectrum and may vary from benign cysts to malignant cystic neoplasms. Our patient was a 21-year male who presented with abdominal discomfort and epigastric pain and was diagnosed with left adrenal cyst on ultrasound, which was later confirmed by CT scan.

PMID: 29482697 [PubMed - indexed for MEDLINE]

Crotamine-like from Southern Pacific rattlesnake (Crotalus oreganus helleri) Venom acts on human leukemia (K-562) cell lines and produces ultrastructural changes on mice adrenal gland.

Tue, 09/04/2018 - 09:58
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Crotamine-like from Southern Pacific rattlesnake (Crotalus oreganus helleri) Venom acts on human leukemia (K-562) cell lines and produces ultrastructural changes on mice adrenal gland.

Ultrastruct Pathol. 2018 Mar-Apr;42(2):116-123

Authors: Sánchez EE, González R, Lucena S, García S, Finol HJ, Suntravat M, Girón ME, Fernández I, Rodríguez-Acosta A

Abstract
Crotamine is a cationic, non-enzymatic, protein integrating a minor family of myotoxins, composed of 42 amino acid residues, described in Viperidae and Crotalidae snake's families that has been used in neuroscience research, drug progressing and molecular diversity reports. Crotamine-like protein (CLP) from C.o.helleri venom was isolated in fraction 5 from 7 peaks obtained by sulfopropyl waters protein pak cationic exchange column. In tricine-SDS-PAGE under non-reduced conditions this CLP showed a single band of ~8 kDa molecular weight. CLP induced toxicity of K-562 cells with a CC50 of 11.09 µM. In mice adrenal gland after 24 h of CLP injection, cortical cells exhibited swollen mitochondria with scarce tubular cristae, some elements of smooth and rough endoplasmic reticula, widened nuclear envelope, slightly osmiophilic lipid droplets, and autophagic vacuoles. In some areas cortical cells plasma membrane and endothelial walls disappeared, which indicated a necrosis process. In other areas, endothelial cell cytoplasm did not present the normal caveolae and pinocytotic vesicles. To our knowledge, this is the first report on mice adrenal gland damages, caused by the injection of CLP from rattlesnakes. Our results propose that adrenal cortex lesions may be significant in the envenoming etiopathogenesis by CLP.

PMID: 29466088 [PubMed - indexed for MEDLINE]

Risk factors of post-operative severe hyperlactatemia and lactic acidosis following laparoscopic resection for pheochromocytoma.

Tue, 09/04/2018 - 09:58
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Risk factors of post-operative severe hyperlactatemia and lactic acidosis following laparoscopic resection for pheochromocytoma.

Sci Rep. 2017 03 24;7(1):403

Authors: Wu S, Chen W, Shen L, Xu L, Zhu A, Huang Y

Abstract
Severe hyperlactatemia (SH)/lactic acidosis (LA) after laparoscopic resection of pheochromocytoma is an infrequently reported complication. The study aims to investigate the incidence of this complication and to determine the clinical risk factors. Patients who underwent laparoscopic resection for pheochromocytoma between 2011 and 2014 at Peking Union Medical College Hospital were enrolled. LA was defined as pH < 7.35, bicarbonate <20 mmol/L, and serum lactate ≥5 mmol/L; SH as lactate ≥5 mmol/L; and moderate hyperlactatemia (MH) as lactate 2.5-5.0 mmol/L without evidence of acidosis (pH > 7.35 and/or bicarbonate >20 mmol/L). Data concerning patient demographics, clinical history, and laboratory results were collected and statistical analyses were performed. Out of 145 patients, 59 (40.7%) developed post-operative hyperlactatemia. The incidences of MH and SH/LA were 25.5% and 15.2%, respectively. Multivariate analysis demonstrated that body mass index (BMI) (odds ratio [OR], 1.204; 95% confidence interval [CI], 1.016-1.426), 24-hour urine epinephrine concentration (OR, 1.012; 95% CI, 1.002-1.022), and tumor size (OR, 1.571; 95% CI, 1.102-2.240) were independent predictors of post-operative SH/LA. The data show that post-operative SH/LA is not a rare complication after pheochromocytoma resection and may be closely associated with higher BMI, larger tumor size, and higher levels of urine epinephrine.

PMID: 28341846 [PubMed - indexed for MEDLINE]

adrenal tumor; +25 new citations

Tue, 08/28/2018 - 09:00

25 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

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Glycometabolic Alterations in Secondary Adrenal Insufficiency: Does Replacement Therapy Play a Role?

Tue, 08/21/2018 - 06:22
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Glycometabolic Alterations in Secondary Adrenal Insufficiency: Does Replacement Therapy Play a Role?

Front Endocrinol (Lausanne). 2018;9:434

Authors: Graziadio C, Hasenmajer V, Venneri MA, Gianfrilli D, Isidori AM, Sbardella E

Abstract
Secondary adrenal insufficiency (SAI) is a potentially life-threatening endocrine disorder due to an impairment of corticotropin (ACTH) secretion from any process affecting the hypothalamus or pituitary gland. ACTH deficit can be isolated or associated with other pituitary failures (hypopituitarism). An increased mortality due to cardiovascular, metabolic, and infectious diseases has been described in both primary and secondary adrenal insufficiency. However, few studies have provided compelling evidences on the underlying mechanism in SAI, because of the heterogeneity of the condition. Recently, some studies suggested that inappropriate glucocorticoid (GCs) replacement therapy, as for dose and/or timing of administration, may play a role. Hypertension, insulin resistance, weight gain, visceral obesity, increased body mass index, metabolic syndrome, impaired glucose tolerance, diabetes mellitus, dyslipidemia have all been associated with GC excess. These conditions are particularly significant when SAI coexists with other pituitary alterations, such as growth hormone deficiency, hypogonadism, and residual tumor. Novel regimen schemes and GC preparations have been introduced to improve compliance and better mimick endogenous cortisol rhythm. The controlled trials on the improved replacement therapies, albeit in the short-term, show some beneficial effects on cardiovascular risk, glucose metabolism, and quality of life. This review examines the current evidence from the available clinical trials investigating the association between different glucocorticoid replacement therapies (type, dose, frequency, and timing of treatment) and glycometabolic alterations in SAI.

PMID: 30123187 [PubMed]

Staging Uveal Melanoma with Whole-Body Positron-Emission Tomography/Computed Tomography and Abdominal Ultrasound: Low Incidence of Metastatic Disease, High Incidence of Second Primary Cancers.

Tue, 08/21/2018 - 06:22
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Staging Uveal Melanoma with Whole-Body Positron-Emission Tomography/Computed Tomography and Abdominal Ultrasound: Low Incidence of Metastatic Disease, High Incidence of Second Primary Cancers.

Middle East Afr J Ophthalmol. 2018 Apr-Jun;25(2):91-95

Authors: Cohen VML, Pavlidou E, DaCosta J, Arora AK, Szyszko T, Sagoo MS, Szlosarek P

Abstract
PURPOSE: The purpose of this study was to report the results of staging primary uveal melanoma with whole-body (18) fluorodeoxyglucose (FDG) positron-emission tomography/computed tomography (PET/CT) and abdominal ultrasound.
MATERIALS AND METHODS: From January 2012, patients with uveal melanoma over 4 mm in thickness were staged with FDG PET/CT and abdominal ultrasound.
RESULTS: Over 2 years, 108 patients with medium-to-large melanoma underwent dual imaging. According to the tumor, node, and metastasis classification, there were 75% T3, 11% T2, and 14% T1 uveal melanomas. Only, three of 108 patients (2.8%) were found to have metastatic uveal melanoma. All three had liver metastases confirmed following biopsy; one of three had additional extrahepatic widespread metastases. In these three patients, liver findings using both imaging techniques were consistent in one patient. In the second case, abdominal ultrasound missed the diagnosis of metastatic disease; however, FDG PET/CT revealed intense metabolic activity of the liver. In the third case, PET/CT missed the liver metastases; however, this was identified on abdominal ultrasound. PET/CT identified incidental second primary malignancies in 10 patients (9%). Second malignancies were found in the lung, breast, colon, thyroid, and adrenal gland. Abdominal ultrasound detected benign hepatic abnormalities in 20 patients (18%).
CONCLUSIONS: Whole-body PET/CT and abdominal ultrasound complement each other in the staging of uveal melanoma. Benign hepatic abnormalities found using ultrasound is common. Of importance, a second asymptomatic primary malignancy associated with uveal melanoma was detected almost one in 10 patients.

PMID: 30122854 [PubMed - in process]

Diagnostic performance of 11C-choline PET/CT and FDG PET/CT for staging and restaging of renal cell cancer.

Tue, 08/21/2018 - 06:22
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Diagnostic performance of 11C-choline PET/CT and FDG PET/CT for staging and restaging of renal cell cancer.

Ann Nucl Med. 2018 Aug 17;:

Authors: Nakanishi Y, Kitajima K, Yamada Y, Hashimoto T, Suzuki T, Go S, Kanematsu A, Nojima M, Yamakado K, Yamamoto S

Abstract
PURPOSE: To compare findings obtained with 11C-choline and FDG PET/CT scanning for renal cell carcinoma staging and restaging.
MATERIALS AND METHODS: Twenty-eight renal cell carcinoma patients whose histological subtype was clear cell type in 26 and papillary type in 2, while Fuhrman nuclear grade was G1,2 in 16 and G3,4 in 12, underwent both 11C-choline and FDG PET/CT examinations before (n = 10) and/or after (n = 18) treatment, then those scanning modalities were compared in regard to patient- and lesion-based diagnostic performance using 5 grading scores. Final diagnosis in each case was obtained based on histopathology, conventional radiological imaging, and clinical follow-up findings. The differences between 11C-choline and FDG PET/CT findings were evaluated using receiver-operating-characteristic (ROC) analysis and a McNemar test.
RESULTS: Patient-based sensitivity, specificity, positive predictive, negative predictive, accuracy, and area under the ROC curve (AUC) values for 11C-choline PET/CT for staging and restaging were 88.0% (22/25), 66.7% (2/3), 95.7% (22/23), 40.0% (2/5), 85.7% (24/28), and 0.887, respectively, while those for FDG-PET/CT were 56.0% (14/25), 66.7% (2/3), 93.3% (14/15), 15.4% (2/13), 57.1% (16/28), and 0.647, respectively. Sensitivity, accuracy, and AUC were significantly different (p = 0.013, p = 0.013, p = 0.012, respectively). Among the 120 lesions, those with kidney, lung, lymph node, bone, pancreas, venous tumor thrombosis, adrenal gland, liver, or skin localization numbered 15, 64, 16, 13, 4, 3, 2, 2, and 1, respectively. For all 120 lesions, 75 (62.5%) and 47 (39.2%) were detected by 11C-choline and FDG PET/CT, respectively (p < 0.0001).
CONCLUSION: For staging and restaging of renal cell carcinoma patients, 11C-choline-PET/CT is significantly more useful than FDG-PET/CT.

PMID: 30120698 [PubMed - as supplied by publisher]

Decision-making for adrenocortical carcinoma: surgical, systemic, and endocrine management options.

Tue, 08/21/2018 - 06:22
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Decision-making for adrenocortical carcinoma: surgical, systemic, and endocrine management options.

Expert Rev Anticancer Ther. 2018 Aug 17;:

Authors: Puglisi S, Perotti P, Cosentini D, Roca E, Basile V, Berruti A, Terzolo M

Abstract
INTRODUCTION: Adrenocortical carcinoma (ACC) is a rare tumor characterized by poor prognosis in most cases. Moreover, in most cases ACC produces an excess of adrenal steroid hormones with relevant clinical consequences. Areas covered: After an extensive literature search, this narrative review addresses diagnostic management, including hormonal, radiological and pathological assessment, and treatment, which should be directed toward both cancer and hormone related problems. While surgery is the first option in ACC without evidence of metastatic disease, and the only possibility of cure, the therapeutic management of metastatic patients is centered on systemic therapy including mitotane alone or in combination with chemotherapy. Mitotane is also used in the adjuvant setting, because up to 80% of patients with non-metastatic ACC show loco-regional or distant metastases after an apparent complete surgical excision. Expert Commentary: Management of ACC patients is fraught with many difficulties and should be limited to experienced physicians. Each step of clinical management, such as diagnosis, prognostication, treatment (both surgical and medical) is challenging and carries the possibility of severe mistakes. For this reason, each step of the management strategy should be decided in the setting of a multi-disciplinary team including different expertise (endocrinology, radiology, pathology, oncology), in expert centers.

PMID: 30117750 [PubMed - as supplied by publisher]

Preliminary clinical experience with robotic retroperitoneoscopic pancreatic surgery.

Tue, 08/21/2018 - 06:22
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Preliminary clinical experience with robotic retroperitoneoscopic pancreatic surgery.

World J Surg Oncol. 2018 Aug 16;16(1):171

Authors: Zhao G, Wang Z, Hu M, Chou S, Ma X, Lv X, Zhao Z, Xu Y, Zhou Z, Liu R

Abstract
BACKGROUNDS: Retroperitoneoscopic surgery has shown advantages in urological surgery. However, its application in pancreatic surgery for neoplasm is rare. Robotic surgical system with its magnified view and flexible instruments may provide a superior alternative to conventional laparoscopic system in retroperitoneoscopic surgery. We aimed to evaluate the safety, feasibility, and short-term outcomes in a series of patients treated by robotic retroperitoneoscopic pancreatic surgery.
CASE PRESENTATION: Between March 2016 and May 2016, four patients with solitary pancreatic neuroendocrine neoplasms were treated with robotic retroperitoneoscopic surgery. Prospective collected clinical data were retrospectively analyzed. Three patients underwent distal pancreatectomy (one combined with resection of left adrenal adenoma), and one patient enucleation. The mean operative time was 80 min (range 30-110 min). The estimated blood loss was insignificant. There was no conversion to open procedure. The mean postoperative hospital stay was 5.25 days (range 4-6 days). The mean tumor size was 1.375 cm (range 1.0-1.8 cm) in diameter. All patients' blood glucose level returned to normal range within 1 week postoperatively. Two patients had pancreatic biochemical leak. No patients underwent subsequent treatment, and no recurrence occurred during the 12-month follow-up period.
CONCLUSIONS: This study preliminarily indicates that robotic retroperitoneoscopic pancreatic surgery is safe and feasible for neoplasms in the dorsal portion of distal pancreas in selected patients, with some potential advantages of straightforward access, simple and fine manipulation, short operative time, and fast recovery.

PMID: 30115072 [PubMed - in process]

Adrenocortical adenoma manifesting as false-positive iodine accumulation in a patient with history of thyroid carcinoma.

Tue, 08/21/2018 - 06:22
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Adrenocortical adenoma manifesting as false-positive iodine accumulation in a patient with history of thyroid carcinoma.

Radiol Case Rep. 2018 Oct;13(5):949-951

Authors: Haghighatafshar M, Shekoohi-Shooli F

Abstract
A 47-year-old female diagnosed with well-differentiated papillary thyroid carcinoma was referred to our center for a 131Iodine whole body scintigraphy as follow-up. The patient had been previously treated with total thyroidectomy and ablative dose of 175mCi 131I three years ago. Diagnostic 131I scan showed a zone of radioiodine uptake in posterior aspect of the left upper quadrant of the abdomen. Spiral abdominal and pelvic CT scan showed an enhancing solid mass in superior aspect of the left adrenal gland, which was in favor of metastasis to the lymph node or an adrenal tumor. A biopsy was performed from the lesion. Histological examination of the surgical specimen was consistent with adrenocortical adenoma. Even though rare, adrenocortical adenoma should be included in the potential causes of false-positive results of radioiodine scans.

PMID: 30108672 [PubMed]

Immune checkpoint inhibitor therapy-induced hypophysitis ∼ a case series of Taiwanese patients.

Tue, 08/21/2018 - 06:22
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Immune checkpoint inhibitor therapy-induced hypophysitis ∼ a case series of Taiwanese patients.

J Formos Med Assoc. 2018 Aug 10;:

Authors: Lin CH, Chen KH, Chen KY, Shih SR, Lu JY

Abstract
Immune checkpoint blockade-based immunotherapy is a new modality of cancer treatment with a unique mechanism that has gained increased numbers of indication and is now used in several cancer types. However, immune-related adverse events (irAEs) emerge as a new entity of diseases involving one or multiple organ systems. irAEs could result in interruption of immunotherapy, morbidities or even death. Among various manifestations of irAEs, immune-mediated hypophysitis is rare but important, requiring prompt diagnosis and treatment to avoid life-threatening conditions. We report seven cases of immune-mediated hypophysitis in Taiwan. They suffered from various types of advanced cancer and received different regimens of immune checkpoint inhibitors. The time of onset after initiation of immunotherapy ranged from 5 to 36 weeks. All seven subjects were diagnosed of central adrenal insufficiency, while four of them had primary hypothyroidism. There was no typical finding of infiltrative hypophysitis on the pituitary MRI. There was no documented hormone recovery after diagnosis of hypophysitis, and the tumor responses to immunotherapy were variable in these seven patients. In conclusion, immune-mediated hypophysitis is often irreversible. Fortunately, it can be managed adequately with hormone replacements. Further investigations are warranted to unveil underlying mechanisms and ethnic differences to guide the solutions.

PMID: 30104119 [PubMed - as supplied by publisher]

[A case of leptomeningeal carcinomatosis involving loss of eyesight after total gastrectomy for gastric cancer].

Tue, 08/21/2018 - 06:22
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[A case of leptomeningeal carcinomatosis involving loss of eyesight after total gastrectomy for gastric cancer].

Nihon Shokakibyo Gakkai Zasshi. 2018;115(8):755-759

Authors: Kurebayashi M, Hashimoto A, Ikenoyama Y, Tahara Y, Fuke H, Shimizu A, Kondo M, Nakano H, Kosaka T

Abstract
A 78-year-old woman had undergone total gastrectomy and chemotherapy for gastric cancer (pT4N3bM0 Stage IIIC, poorly differentiated adenocarcinoma). She received S-1 monotherapy 3 times weekly (S-1 at 80mg twice daily for 14 days, every 3 weeks). She underwent routine examinations, including tumor markers and computed tomography. She had no signs of recurrent disease, but she suffered from a loss of eyesight 2 years and 8 months after the operation. A choked disc was found, but she had no headaches, nausea, or unconsciousness, which indicated high intraventricular pressure. Enhanced T2-weighted magnetic resonance imaging showed high intensity around the optic nerve. We performed cerebrospinal fluid cytological analysis, which showed poorly differentiated adenocarcinoma. She was diagnosed as having leptomeningeal carcinomatosis of gastric cancer. The patient chose best supportive care and died 2 months after symptoms appearance. Histological analysis during the autopsy showed moderately to poorly differentiated adenocarcinoma. The carcinoma had also infiltrated the spinal cord, peritoneum, and adrenal glands. Histologically, the carcinoma had infiltrated the optic nerve, which caused loss of eyesight. We have not yet established effective therapies for leptomeningeal carcinomatosis, and the prognosis is poor. Leptomeningeal carcinomatosis of gastric cancer that appears by loss of eyesight is very rare. This case illustrates that the possibility of leptomeningeal carcinomatosis should be considered when we treat patients with loss of eyesight of an unknown cause after surgery.

PMID: 30101877 [PubMed - in process]

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