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NCBI: db=pubmed; Term=adrenal tumor
Updated: 23 hours 25 min ago

Gastrointestinal Stromal Tumor of the Adrenal Gland:A Case Report and Review of the Literature.

Wed, 12/17/2014 - 11:04

Gastrointestinal Stromal Tumor of the Adrenal Gland:A Case Report and Review of the Literature.

Endocr Pathol. 2014 Dec 16;

Authors: Abou Al-Shaar H, Solimanie S, Azzam A, Amin T, Abu-Zaid A

Abstract
Gastrointestinal stromal tumors (GISTs) are rare neoplasms of the gastrointestinal (GI) tract. The occurrence of these neoplasms ectopically outside the GI tract is extremely uncommon. Only one case of primary adrenal GIST has been reported in the literature. In this account, we report a second case of primary adrenal GIST in a 34-year-old male who presented with a 5-week history of gradually progressive left flank pain and early satiety. Whole-body positron emission tomography (PET)/computed tomography (CT) scan showed a 14 × 11 cm hypermetabolic (18)fluorodeoxyglucose (FDG)-avid mass lesion involving the left adrenal gland and dorsal part of the left hemi-diaphragm. Biopsy of the lesion revealed tumor cells that are immunoreactive to CD-117 and CD-34 and negative to CD-31, S-100, cytokeratin, desmin, and vimentin, features characteristic of GIST. The patient was given imatinib, which drastically decreased his complaints with almost complete resolution of the tumor on his last follow-up radiographic images. Primary left adrenal GIST is an extremely rare neoplasm and can be confused with GISTs arising from the greater curvature of the stomach. Imatinib therapy is optimal in the management of these tumors.

PMID: 25510634 [PubMed - as supplied by publisher]

A case of anterior mediastinum paraganglioma presented with pericardial effusion two years before symptoms of catecholamine excess: first case report in Thailand.

Wed, 12/17/2014 - 11:04

A case of anterior mediastinum paraganglioma presented with pericardial effusion two years before symptoms of catecholamine excess: first case report in Thailand.

J Med Assoc Thai. 2014 Nov;97 Suppl 11:S145-9

Authors: Sarinnapakorn V, Natthapongwipas P

Abstract
Pheochromocytoma (PCC) and paraganglioma (PGL) are uncommon tumors. Clinical manifestations are mass effect or hormone secretion. The initial manifestation with pericardial effusion is rare. The author presented a case of anterior mediastinum paraganglioma presenting with pericardial effusion two years before symptoms of catecholamine excess. This is the first case reported in Thailand. A 34 year-old female patient presented with dyspnea. There was pericardial effusion from echocardiography was diagnosed with no definite causes of pericardial effusion. After treatment with ibuprofen, pericardial effusion was absolutely resolved from repeated echocardiography. Two years later she had headache and hypertension. Chest X-ray, there was an anterior mediastinal mass. Her 24 hours urine metanephrine was very high. By imaging, an anterior mediastinal mass was observed from CT chest without adrenal mass from CT abdomen. The result of metaiodobenzylguanidine (MIBG) scan was compatible with paraganglioma. Symptoms of headache and hypertension disappeared after surgical removal of the mass. Pericardial effusion may be the first manifestation of paraganglioma especially if the patient had hypertension or could not find the etiology. Thus, pericardial effusion should be investigated for paraganglioma. Due to long term follow-up, this indolent growing tumor may respond to NSAIDs or regress spontaneously.

PMID: 25509709 [PubMed - in process]

Incidental ganglioneuromas: a presentation of 14 surgical cases and literature review.

Wed, 12/17/2014 - 11:04

Incidental ganglioneuromas: a presentation of 14 surgical cases and literature review.

J Endocrinol Invest. 2014 Dec 13;

Authors: Spinelli C, Rossi L, Barbetta A, Ugolini C, Strambi S

Abstract
BACKGROUND AND AIMS: Ganglioneuromas are benign tumors which originate from the neural crest. This tumor affects mainly young patients rather than adult ones, and its most frequent localizations are mediastinum, retroperitoneum, adrenal glands and cervical region. Usually, ganglioneuromas are discovered as incidentalomas since they are often asymptomatic, even if they could present sympathetic or mass-related symptoms. To obtain a definitive diagnosis, histological exam is necessary since CT scan and MRI are not capable of distinguishing ganglioneuromas from other tumors, such as neuroblastomas or pheocromocytomas. The surgical excision is the chosen treatment and it offers an excellent prognosis.
METHODS: We conducted a retrospective analysis of our cases of ganglioneuroma from 2004 to 2014; this study aims to compare our experience with literature review (2000-2014). Data about patients' features, tumor localization, symptoms, treatment and follow-up were analyzed and reported in detailed tables.
RESULTS: Between 2004 and 2014 we treated 14 patients affected by ganglioneuroma. For all of them the diagnosis was incidental; 9 out of 12 (64.3 %) patients presented an adrenal mass; in 2 patients (14.3 %) the tumor was localized in cervical region; in other 2 patients (14.3 %) the tumor was in the retroperitoneum and one patient (7.1 %) presented a ganglioneuroma in the costo-vertebral space. All our patients underwent surgical removal and none of them present surgery-related complications or recurrences to date.
CONCLUSIONS: Our data widen the knowledge about ganglioneuroma and confirm that the surgical approach has an excellent prognosis with very low incidence of surgery-related complications and recurrences.

PMID: 25501841 [PubMed - as supplied by publisher]

Survival Outcome Assessed According to Tumor Burden and Progression Patterns in Patients With Epidermal Growth Factor Receptor Mutant Lung Adenocarcinoma Undergoing Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor Therapy.

Wed, 12/17/2014 - 11:04

Survival Outcome Assessed According to Tumor Burden and Progression Patterns in Patients With Epidermal Growth Factor Receptor Mutant Lung Adenocarcinoma Undergoing Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor Therapy.

Clin Lung Cancer. 2014 Nov 18;

Authors: Cha YK, Lee HY, Ahn MJ, Choi YL, Lee JH, Park K, Lee KS

Abstract
BACKGROUND: Mutations in the epidermal growth factor receptor (EGFR) have been associated with a marked therapeutic response to EGFR-tyrosine kinase inhibitors (TKIs) in patients with advanced non-small-cell lung cancer (NSCLC). However, the clinical predictors of the survival benefit of EGFR-TKI therapy for NSCLC with EGFR-activating mutations have not been well elucidated. Therefore, the present study evaluated the clinical predictors of survival outcome in patients with EGFR-mutant NSCLC who had been treated with EGFR-TKIs.
MATERIAL AND METHODS: The data from 224 patients with EGFR-mutant lung adenocarcinoma treated with EGFR-TKIs were retrospectively reviewed. The treatment outcomes were evaluated according to the clinical factors, number of metastasis sites, and progression patterns.
RESULTS: The clinical factors associated with reduced progression-free survival (PFS) and overall survival (OS) on univariate analysis were Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≥ 2, intra- and extrathoracic metastasis, extrathoracic metastasis, a high number of metastatic sites, metastasis to the liver or adrenal gland at baseline, and rapid progression at the diagnosis of progressive disease (PD). On multivariate analysis, the factors that remained significantly associated with a shorter PFS were ECOG PS ≥ 2 (odds ratio [OR], 2.189; 95% confidence interval [CI], 1.374-3.437; P < .001) and rapid tumor progression at PD (OR, 1.800; 95% CI, 1.059-3.058; P = .030).
CONCLUSION: Thus, the tumor burden, expressed as the number of metastatic sites at EGFR-TKI treatment, and rapid tumor progression at PD were predictive of inferior survival in patients with lung adenocarcinoma with activating EGFR mutations.

PMID: 25499173 [PubMed - as supplied by publisher]

Toying with fate: Redirecting the differentiation of adrenocortical progenitor cells into gonadal-like tissue.

Wed, 12/17/2014 - 11:04

Toying with fate: Redirecting the differentiation of adrenocortical progenitor cells into gonadal-like tissue.

Mol Cell Endocrinol. 2014 Dec 8;

Authors: Röhrig T, Pihlajoki M, Ziegler R, Cochran RS, Schrade A, Schillebeeckx M, Mitra RD, Heikinheimo M, Wilson DB

Abstract
Cell fate decisions are integral to zonation and remodeling of the adrenal cortex. Animal models exhibiting ectopic differentiation of gonadal-like cells in the adrenal cortex can shed light on the molecular mechanisms regulating steroidogenic cell fate. In one such model, prepubertal gonadectomy (GDX) of mice triggers the formation of adrenocortical neoplasms that resemble luteinized ovarian stroma. Transcriptomic analysis and genome-wide DNA methylation mapping have identified genetic and epigenetic markers of GDX-induced adrenocortical neoplasia. Members of the GATA transcription factor family have emerged as key regulators of cell fate in this model. Expression of Gata4 is pivotal for the accumulation of gonadal-like cells in the adrenal glands of gonadectomized mice, whereas expression of Gata6 limits the spontaneous and GDX-induced differentiation of gonadal-like cells in the adrenal cortex. Additionally, Gata6 is essential for proper development of the adrenal X-zone, a layer analogous to the fetal zone of the human adrenal cortex. The relevance of these observations to developmental signaling pathways in the adrenal cortex, to other animal models of altered adrenocortical cell fate, and to human diseases is discussed.

PMID: 25498963 [PubMed - as supplied by publisher]

Surgical management of adrenal cysts: a single-institution experience.

Wed, 12/17/2014 - 11:04

Surgical management of adrenal cysts: a single-institution experience.

Int Braz J Urol. 2014 september-october;40(5):656-665

Authors: Lyu X, Liu L, Yang L, Gao L, Wei Q

Abstract
OBJECTIVE: To analyze surgical methods and evaluate treatment efficacy and safety for managing adrenal cystic lesions.
MATERIALS AND METHODS: All patients presenting with adrenal lesions of the West China Hospital were reviewed retrospectively from January 2003 to April 2013 and 47 were diagnosed as adrenal cysts. Basic information, clinical history, physical examination, laboratory investigations, abdominal ultrasound and enhanced computed tomography were detailed noted. Cysts with different surgical management were analyzed and surgery option,operative time, postoperative complications and after-surgery hospital stay were all noted. The final diagnosis was judged by histopathology. Patients were followed from 3 month to 10 years.
RESULTS: All the 47 patients with a mean age of 43.8 years were managed by surgical intervention. Compared laparoscopic technology with open technology, the laparoscopic has the advantage of a shorter operation time, shorter hospital stay after surgery and enhanced cosmesis. The histopathologic result was: 23 (50%) were endothelial cysts and 16 (35%) were pseudocysts. One patient had evidence to recurrence at the followed-up stage.
CONCLUSION: Adrenal cysts are rare and with the development of imaging techniques many of these are diagnosed incidentally. CT has advantages in detecting the cysts with haemorrhage, intracystic debris, calcification and mixed adrenal mass. Minimally invasive surgery offers equivalent efficacy to traditional open procedures, while providing a shorter operation time, shorter convalescence and improved cosmesis. Patients after surgical resection should be followed up closely especially if functional cysts and histopathology of cystic tumor are present.

PMID: 25498277 [PubMed - as supplied by publisher]

SLC17A9 protein functions as a lysosomal ATP transporter and regulates cell viability.

Wed, 12/17/2014 - 11:04
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SLC17A9 protein functions as a lysosomal ATP transporter and regulates cell viability.

J Biol Chem. 2014 Aug 15;289(33):23189-99

Authors: Cao Q, Zhao K, Zhong XZ, Zou Y, Yu H, Huang P, Xu TL, Dong XP

Abstract
Lysosomes contain abundant ATP, which is released through lysosomal exocytosis following exposure to various stimuli. However, the molecular mechanisms underlying lysosomal ATP accumulation remain unknown. The vesicular nucleotide transporter, also known as solute carrier family 17 member 9 (SLC17A9), has been shown to function in ATP transport across secretory vesicles/granules membrane in adrenal chromaffin cells, T cells, and pancreatic cells. Here, using mammalian cell lines, we report that SLC17A9 is highly enriched in lysosomes and functions as an ATP transporter in those organelles. SLC17A9 deficiency reduced lysosome ATP accumulation and compromised lysosome function, resulting in cell death. Our data suggest that SLC17A9 activity mediates lysosomal ATP accumulation and plays an important role in lysosomal physiology and cell viability.

PMID: 24962569 [PubMed - indexed for MEDLINE]

Inflammatory pseudotumor of the pleura.

Wed, 12/17/2014 - 11:04
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Inflammatory pseudotumor of the pleura.

J Bronchology Interv Pulmonol. 2014 Apr;21(2):154-7

Authors: Girdhar A, Singh A, Bajwa A, Shujaat A

Abstract
Inflammatory pseudotumors are rare solid, non-neoplastic masses that can mimic pulmonary malignancy. It occurs most commonly in children and young adults and is usually found incidentally. There are many reports of the existence of this tumor in various organs in the human body. The occurrence of this tumor exclusively in the pleura has not been described before. We present a case of inflammatory pseudotumor of the pleura and its successful management.

PMID: 24739691 [PubMed - indexed for MEDLINE]

Laparoscopic transperitoneal anterior adrenalectomy in pheochromocytoma: experience in 62 patients.

Wed, 12/17/2014 - 11:04
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Laparoscopic transperitoneal anterior adrenalectomy in pheochromocytoma: experience in 62 patients.

Surg Endosc. 2014 Sep;28(9):2683-9

Authors: Paganini AM, Balla A, Guerrieri M, Lezoche G, Campagnacci R, D'Ambrosio G, Quaresima S, Antonica MV, Lezoche E

Abstract
BACKGROUND: Aim was to evaluate the results in 62 patients undergoing laparoscopic adrenalectomy (LA) for the treatment of pheochromocytoma (PHE), with a transperitoneal anterior approach for lesions on the right side, and with a transperitoneal anterior submesocolic approach in case of left-sided lesions.
METHODS: Sixty-two patients underwent LA for the treatment of PHE at two centers in Rome and Ancona (Italy). Two patients had bilateral lesions, for a total of 64 adrenalectomies. Sporadic PHE occurred in 57 patients (91.9 %) and in 5 (8.0 %) it was familiar. Thirty-six patients (58.0 %) underwent right adrenalectomy, 24 (38.7 %) left adrenalectomy, and in 2 cases (3.2 %) LA was bilateral. In 38 cases of right adrenalectomy (59.3 %) and in 5 cases of left adrenalectomy (7.8 %), the approach was a transperitoneal anterior one. A transperitoneal anterior submesocolic approach was used in 21 left adrenalectomy cases (32.8 %).
RESULTS: Mean operative time for right and left transperitoneal anterior LA was 101 min (range 50-240) and 163 min (range 50-190), respectively. Mean operative time for left transperitoneal anterior submesocolic LA was 92 min (range 50-195). For bilateral adrenalectomy, mean operative time was 210 min (range 200-220). Conversion to open surgery occurred in 2 cases (3.22 %) due to extensive adhesions (1) and hemorrhage (1). One major and three minor complications were observed. Mobilization occurred on the first postoperative day. Hospitalization was 4.8 days (range 2-19). The lesions had a mean diameter of 4.5 cm (range 0.5-10).
CONCLUSIONS: Early identification with no gland manipulation prior to closure of the adrenal vein is the main advantages of the transperitoneal anterior approach. PHE may be treated safely and effectively by a laparoscopic transperitoneal anterior approach for right-sided lesions and with a transperitoneal anterior submesocolic approach for left-sided ones.

PMID: 24737532 [PubMed - indexed for MEDLINE]

Biochemical and radiological relationships in patients with pheochromocytoma: lessons from a case control study.

Wed, 12/17/2014 - 11:04
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Biochemical and radiological relationships in patients with pheochromocytoma: lessons from a case control study.

Clin Endocrinol (Oxf). 2014 Jun;80(6):790-6

Authors: Kannan S, Purysko A, Faiman C, Remer EM, Shah L, Bena J, Siperstein A, Berber E, Fergany A, Bravo E, Hamrahian AH

Abstract
BACKGROUND: An elevation of fractionated plasma or urinary metanephrine (MN) or nor-metanephrine (NMN), collectively called metanephrines (MN and NMN), >4-fold above the upper limit of normal (ULN) is usually considered to be diagnostic for pheochromocytoma (PHEO). There are a greater number of false positive results when the elevations are more modest.
AIM: To identify biochemical and radiological features in PHEOs with modest elevations (<4-fold above ULN) of metanephrines.
METHODOLOGY: We retrospectively reviewed the charts of 112 patients with PHEO (10% extra-adrenal) and 208 patients with a non-PHEO adrenal mass operated from 1997-2011, who had metanephrines measured pre-operatively. We divided PHEO into group 1 (n = 90) with metanephrines ≥4-fold ULN and group 2 (n = 22) with metanephrines <4-fold ULN. The non-PHEO group was designated as group 3.
RESULTS: The median (range) tumour size in group 1 and group 2 was 4·8 cm (1·7-22) and 3·0 cm (1·7-5) respectively (P < 0·001). All patients with PHEO in group 2 had a tumour <5 cm in size. The MN fraction was elevated in about 65% of groups 1 and 2; only 2 (1%) patients in group 3 had an elevated urinary MN fraction, and none were associated with an elevated plasma MN fraction. All PHEOs had a pre-contrast attenuation ≥17 Hounsfield Units (HU).
CONCLUSIONS: Modest elevations (<4-fold ULN) of the NMN fraction in an adrenal mass >5 cm are almost always falsely positive. Elevations in plasma and urinary MN fraction are less likely to be false positive. The CT pre-contrast attenuation of PHEOs is >10 HU.

PMID: 24494743 [PubMed - indexed for MEDLINE]

The collection of five interesting cases of adrenal tumors from one center.

Wed, 12/10/2014 - 09:32
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The collection of five interesting cases of adrenal tumors from one center.

World J Surg Oncol. 2014 Dec 8;12(1):377

Authors: Babi Ska A, P Ksa R, Wi Tkowska-Stodulska R, Sworczak K

Abstract
INTRODUCTION: Adrenal tumors are detected incidentally in 4-8% of patients in imaging studies. Adenomas, pheochromocytomas and adrenocortical carcinomas represent the most common tumors of the adrenal glands. Rarely final histopathological reports are surprising.Aim: The aim of our study is a retrospective analysis of selected clinical characteristics and hormonal studies in five cases of rare adrenal tumors.Material and method: We present five interesting cases of adrenal tumors: two medullary hyperplasia, one adenomatoid tumor, one hydatid cyst and primary angiosarcoma of the adrenal gland. The final diagnosis was established by means of microscopic examination of the specimens.
CONCLUSION: The number of adrenal tumors was increased due to widespread use of imaging procedures. In patients without any known extra-adrenal malignancy most lesions are benign, non hyper functioning adenomas. Adrenal tumors should be evaluated biochemically and radiologically.

PMID: 25487416 [PubMed - as supplied by publisher]

Dexmedetomidine improves early postoperative cognitive dysfunction in aged mice.

Wed, 12/03/2014 - 08:16

Dexmedetomidine improves early postoperative cognitive dysfunction in aged mice.

Eur J Pharmacol. 2014 Nov 20;

Authors: Qian XL, Zhang W, Liu MZ, Zhou YB, Zhang JM, Han L, Peng YM, Jiang JH, Wang QD

Abstract
Postoperative cognitive dysfunction (POCD) is a frequent complication following major surgery in the elderly. However, the exact pathogenic mechanisms are still unknown. Dexmedetomidine, a selective alpha 2 adrenal receptor agonist, was revealed anesthesia and brain protective role. The present study aimed to examine whether dexmedetomdine protects against POCD induced by major surgical trauma under general anesthesia in aged mice. In the present study, cognitive function was assessed by Y-maze. Proinflammatory cytokines interleukin-1β (IL-1β) and tumor necrosis factor (TNF-α), apoptosis-related factor casepase-3 and Bax were detected by real-time PCR, Western blot or immunohistochemistry. The results showed that anesthesia alone caused weak cognitive dysfunction on the first day after general anesthesia. Cognitive function in mice with splenectomy under general anesthesia was significantly exacerbated at the first and third days after surgery, and was significantly improved by dexmedetomidine administration. Splenectomy increased the expression of IL-1β, TNF-α, Bax and casepase-3 in hippocampus. These changes were significantly inversed by dexmedetomidine. These results suggest that hippocampal inflammatory response and neuronal apoptosis may contribute to POCD, and selective alpha 2 adrenal receptor excitation play a protective role.

PMID: 25460022 [PubMed - as supplied by publisher]

Neuroendocrine tumor in the mandible: a case report with imaging and histopathologic findings.

Wed, 12/03/2014 - 08:16

Neuroendocrine tumor in the mandible: a case report with imaging and histopathologic findings.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2014 Sep 30;

Authors: Sugawara C, Takahashi A, Kawano F, Kudoh T, Yamada A, Ishimaru N, Hara K, Miyamoto Y

Abstract
Neuroendocrine tumors (NETs) arise from neuroendocrine cells and are mostly observed in the gastrointestinal tract, pancreas, and lungs. NETs in the oral and maxillofacial region are extremely rare. We report a case of a 59-year-old woman with an NET in the mandible. The patient did not show any symptoms except for remarkable swelling and bleeding. The lesion appeared as a radiolucent honeycomb abnormality with bone destruction on panoramic radiography. The histopathologic diagnosis following a biopsy was NET. Contrast-enhanced computed tomography (CT), (18)F-fluorodeoxyglucose positron emission computed tomography ((18)F-FDG PET/CT), and adrenal scintigraphy-labeled meta-iodobenylguanidine were the modalities added to identify the primary site. Multiple lesions were confirmed in the gastrointestinal tract. Endoscopy was performed to identify the lesions, and several lesions were observed protruding from the mucous membranes. However, the endoscopy specimens did not yield an accurate diagnosis because adequate samples were not acquired. Blood and urine tests revealed no functional activity caused by the tumors. Although the origin was not histopathologically confirmed with endoscopy, this patient was situationally diagnosed with nonfunctional NET originating from the duodenum, as demonstrated by the metastases in the mandible.

PMID: 25459356 [PubMed - as supplied by publisher]

A novel staging system for adrenocortical carcinoma better predicts survival in patients with stage I/II disease.

Wed, 12/03/2014 - 08:16

A novel staging system for adrenocortical carcinoma better predicts survival in patients with stage I/II disease.

Surgery. 2014 Dec;156(6):1378-1386

Authors: Asare EA, Wang TS, Winchester DP, Mallin K, Kebebew E, Sturgeon C

Abstract
BACKGROUND: Current American Joint Committee on Cancer/International Union against Cancer (AJCC/UICC) and European Network for the Study of Adrenal Tumors staging for adrenocortical carcinoma (ACC) have not shown a survival difference between patients with stage I/II disease. This study evaluates current staging systems for survival prediction using a larger cohort and assesses whether incorporating age into ACC staging improves survival predictions.
METHODS: Patients in the National Cancer Data Base (1985-2006) with a diagnosis of ACC were identified and staged using a novel TNM-A staging system: Stage I (T1/T2N0M0, age ≤55), stage II (T1/T2N0M0, age >55), stage III (T1/T2N1M0 or T3/T4N0-N1M0, any age), or stage IV (any T any NM1, any age). Differences in overall survival (OS) by stage were compared using a Cox proportional hazards model.
RESULTS: Staging was derived for 1,579 of 3,262 patients. Median age was 54 years; mean tumor size was 11.6 cm. Using current staging, differences in 5-year OS was observed only between patients with stages II/III and III/IV ACC. With TNM-A staging, differences in 5-year OS between all stages was significant (I/II [P < .003], II/III [P < .0001], III/IV [P < .0001]).
CONCLUSION: A staging system that incorporates patient age better predicts 5-year OS among patients with stages I/II ACC. Consideration should be given to including age in staging for ACC, because it may better inform providers about treatment and prognosis.

PMID: 25456914 [PubMed - as supplied by publisher]

(-)-Epigallocatechin-3-gallate induces cancer cell apoptosis via acetylation of amyloid precursor protein.

Wed, 12/03/2014 - 08:16

(-)-Epigallocatechin-3-gallate induces cancer cell apoptosis via acetylation of amyloid precursor protein.

Med Oncol. 2015 Jan;32(1):390

Authors: Hu Q, Chang X, Yan R, Rong C, Yang C, Cheng S, Gu X, Yao H, Hou X, Mo Y, Zhao L, Chen Y, Dinlin X, Wang Q, Fang S

Abstract
Epigenetic modifications are involved in cancer pathogenesis, and HDACis are considered potential therapeutic agents. We and others have shown the inhibitory activity of EGCG on HDAC1. But little is known about the effect of EGCG as on epigenetic regulation in cancer. Here, we try to demonstrate that EGCG acts as an HDACi downregulated APP expression, which was pathophysiologically upregulated in cancers and exerts a key role in cancer cell growth. We used PC-12 cells, SK-N-SH cells and primary tumor tissues for our analysis. Male 4-week-old athymic nude mice were used for heterotopic tumor growth assay. We employed Western blotting analysis to detect Bcl-2, Bax, APP, caspase-3, caspase-7, HDAC1 and H4Ac. We used AnnexinV-FITC and TUNEL staining for apoptosis detection. Tumor tissues were examined by immunohistochemical staining. We demonstrated that EGCG suppresses the growth of xenografted adrenal pheochromocytoma. Flow cytometry analysis and TUNEL staining showed that EGCG induced the apoptosis. Treatment with EGCG resulted in decrease in Bcl-2 but increase in Bax and activated caspase-3 and caspase-7. HDAC inhibitor EGCG leaded to hyperacetylated histone H4 by immunofluorescence. EGCG decreased APP levels by immunofluorescence staining and Western blot analysis. Silencing specific to HDAC1 leaded to caspase-3 and caspase-7 activation and cleavage. Our results are the first to demonstrate a functional interaction between EGCG and APP in suppression tumor growth, and provide a new epigenetic effects of EGCG on antitumor.

PMID: 25452172 [PubMed - in process]

Bilateral metachronous adrenal metastases of operated renal cell carcinoma.

Wed, 12/03/2014 - 08:16

Bilateral metachronous adrenal metastases of operated renal cell carcinoma.

Urologia. 2014 Nov 25;0(0):0

Authors: Ozturk H, Karapolat I, Saklamaz A

Abstract
BACKGROUND: The adrenal glands are among the target metastatic organs due to the potential of systemic metastasis from renal cell carcinoma (RCC). The number of cases with bilateral metachronous metastases from RCC is about twenty.
PATIENTS AND METHODS: A sixty-one-year-old man presented for routine checks due to an operated left renal tumor (clear cell carcinoma, PT2N0M0, Fuhrman grade III). The patient underwent 18FDG-PET/CT in order to re-stage the disease upon observation of bilateral adrenal masses on ultrasound and CT. A bilateral metachronous metastasis was found, whose SUVmax was 6.7 x 50 x 38 x 20 cm on the left adrenal gland, and another metastasis whose SUVmax was 5.5 40 x 29 x 20 on the right adrenal gland.
RESULTS: The patient underwent a CT-guided biopsy and diagnosis of adrenal metastasis was made by pathological and immunohistochemical examination. The laparoscopic treatment was performed.
CONCLUSIONS: There is no standard approach for the treatment of these patients in the literature. But metastasectomy is the most realistic part of the treatment. Making definitive diagnosis with biopsy, following hormonal examination and treatment with minimally invasive adrenal sparing surgical procedure containing frozen-section are strongly recommended. Cancer specific survival significantly increases with metastasectomy.

PMID: 25451879 [PubMed - as supplied by publisher]

Laparoscopic adrenalectomy for adrenal tumors: A 21-year single-institution experience.

Wed, 12/03/2014 - 08:16

Laparoscopic adrenalectomy for adrenal tumors: A 21-year single-institution experience.

Asian J Surg. 2014 Nov 3;

Authors: Hirano D, Hasegawa R, Igarashi T, Satoh K, Mochida J, Takahashi S, Yoshida T, Saitoh T, Kiyotaki S, Okada K

Abstract
OBJECTIVE: We have performed laparoscopic adrenalectomy including retroperitoneoscopic adrenalectomy via a single large port (RASLP) and conventional laparoscopic adrenalectomy (CLA) for adrenal tumors since 1992, and report our experience to date.
METHODS: The study population consisted of 134 patients who underwent laparoscopic adrenalectomy from 1992 to 2012. Fifty-eight patients (18 aldosterone-producing adenomas, 13 adenomas with Cushing's syndrome, 1 adenoma with preclinical Cushing's syndrome, and 26 nonfunctioning tumors) were treated using RASLP, and 76 patients (33 aldosterone-producing adenomas, 17 adenomas with Cushing's syndrome, 6 adenomas with preclinical Cushing's syndrome, 17 pheochromocytomas, and 3 nonfunctioning tumors) were treated using CLA. Complications were graded according to the modified Clavien system.
RESULTS: The majority of RASLPs were performed during the 1990s, whereas all patients underwent CLA after 2000. The mean operation times (166 vs. 205 minutes, p < 0.01) and intraoperative estimated blood loss (85 vs. 247 mL, p < 0.01) were significantly lower in the CLA group. Conversion to open surgery was required in three patients (5%) in the RASLP group and five patients (7%) in the CLA group (p = 0.73). Postoperative complications were grade 1 in three patients and grades 4 and 5 in one patient each in the RASLP group, whereas grade 2 in one patient was observed in the CLA group (p = 0.085).
CONCLUSION: Although this study included biases such as different eras and indications, CLA resulted in decreased operative times, blood loss, and postoperative complications compared with RASLP. CLA has so far become our preferred procedure for patients with adrenal tumor in our experience.

PMID: 25451632 [PubMed - as supplied by publisher]

Germline PRKACA amplification leads to Cushing syndrome caused by 3 adrenocortical pathologic phenotypes.

Wed, 12/03/2014 - 08:16

Germline PRKACA amplification leads to Cushing syndrome caused by 3 adrenocortical pathologic phenotypes.

Hum Pathol. 2014 Oct 2;

Authors: Carney JA, Lyssikatos C, Lodish MB, Stratakis CA

Abstract
We describe the pathology of 5 patients with germline PRKACA copy number gain and Cushing syndrome: 4 males and 1 female, aged 2 to 43 years, including a mother and son. Imaging showed normal or slightly enlarged adrenal glands in 4 patients and a unilateral mass in the fifth. Biochemically, the patients had corticotropin-independent hypercortisolism. Four underwent bilateral adrenalectomy; unilateral adrenalectomy was performed in the patient with the adrenal mass. Pathologically, 3 patients, including the 1 with the tumor (adenoma), had primary pigmented nodular adrenocortical disease with extranodular cortical atrophy and mild intracapsular and extracapsular extension of cortical cells. The other 2 patients had cortical hyperplasia and prominent capsular and extracapsular micronodular cortical hyperplasia. Immunoperoxidase staining revealed differences for synaptophysin, inhibin-A, and Ki-67 (nuclei) in the atrophic cortices (patients 1, 2, and 3) and hyperplastic cortices (patients 4 and 5) and for Ki-67 (nuclei) and vimentin in the extracortical nodules in the 2 groups of patients. β-Catenin stained the cell membrane, cytoplasm, and nuclei of the adenoma. The patients were well at follow-up (1-23 years); 24-hour urinary cortisol excretion was elevated in the patient who had unilateral adrenalectomy.

PMID: 25449630 [PubMed - as supplied by publisher]

Medical Management of Functioning Pituitary Adenoma: An Update.

Wed, 12/03/2014 - 08:16

Medical Management of Functioning Pituitary Adenoma: An Update.

Neurol Med Chir (Tokyo). 2014 Nov 29;

Authors: Oki Y

Abstract
The treatment of functioning pituitary adenoma (FPA) must achieve endocrinological remission as well as tumor size reduction. The first-line treatment of FPA except prolactinoma is transsphenoidal surgery (TSS). Medical treatments and/or radiation will be applied as adjuvant therapies succeeding to TSS. In patients with prolactinoma, dopamine agonists, especially cabergoline, are quite efficient. Dopamine agonists decrease plasma prolactin levels and induce shrinkage in most patients and can be ceased in some of them. In patients with acromegaly, dopamine agonists, somatostatin analogues, and growth hormone receptor antagonist have been used as a monotherapy or the combination, and the high remission rate can be achieved. Pasireotide having high affinity to type 5 somatostatin receptors will be available for the patients presenting resistance against type 2 receptor agonists, such as octreotide and lanreotide. The preceding treatment with somatostatin analogues is beneficial for improving the success rate of TSS. The chimera compounds of somatostatin analogues and dopamine agonists have been investigated. The medical treatments of Cushing's disease are challenging, if TSS is not successful. To suppress ACTH secretion, dopamine agonists and somatostatin analogues have been examined, but neither came to show a sufficient effect. Pasireotide reduces urinary cortisol excretion with a high remission rate. Adrenal enzyme inhibitors (AEIs), such as metyrapone, can inhibit cortisol synthesis form adrenal glands promptly and sufficiently in most of patients. LCI699, a newly developed AEI, is more potent than metyrapone and will be available. We should use available medical treatments for improving the prognosis and quality of life.

PMID: 25446388 [PubMed - as supplied by publisher]

Aggressive and nonaggressive translocation t(6;11) renal cell carcinoma: comparative study of 6 cases and review of the literature.

Wed, 12/03/2014 - 08:16

Aggressive and nonaggressive translocation t(6;11) renal cell carcinoma: comparative study of 6 cases and review of the literature.

Ann Diagn Pathol. 2014 Dec;18(6):351-7

Authors: Peckova K, Vanecek T, Martinek P, Spagnolo D, Kuroda N, Brunelli M, Vranic S, Djuricic S, Rotterova P, Daum O, Kokoskova B, Vesela P, Pivovarcikova K, Bauleth K, Dubova M, Kalusova K, Hora M, Michal M, Hes O

Abstract
UNLABELLED: t(6;11) renal cell carcinoma (RCC) has been recognized as a rare and mostly nonaggressive tumor (NAT). The criteria for distinguishing aggressive tumors (AT) from NATs are not well established. A total of 6 cases were selected for the study. Five cases of t(6;11) RCCs behaved nonaggressively, and 1 was carcinoma with aggressive behavior. The tumors were analyzed morphologically using immunohistochemistry and by molecular-genetic methods. The specimen of aggressive t(6;11) RCC was from a 77-year-old woman who died of the disease 2.5 months after diagnosis. The specimens of nonaggressive t(6;11) RCCs were from 3 women and 2 men whose ages range between 15 and 54 years. Follow-up was available in all cases (2.5 months-8 years). The tumor size ranged from 3 to 14 cm in nonaggressive t(6;11) RCC. In the aggressive carcinoma, the tumor size was 12 cm. All tumors (6/6) were well circumscribed. Aggressive t(6;11) RCC was widely necrotic. Six (100%) of 6 all tumors displayed a solid/alveolar architecture with occasional tubules and pseudorosettes. Pseudopapillary formations lined by bizarre polymorphic cells were found focally in the aggressive t(6;11) RCC case. Mitoses, though rare, were found as well. All cases (AT and NAT) were positive for HMB-45, Melan-A, Cathepsin K, and cytokeratins. CD117 positivity was seen in 4 of 5 NATs, as well as in the primary and metastatic lesions of the AT. mTOR was positive in 2 of 5 NATs and vimentin in 4 of 5 NATs. Vimentin was negative in the primary lesion of the AT, as well as in the metastasis found in the adrenal gland. Translocation t(6;11)(Alpha-TFEB) or TFEB break was detected in 4 of 5 NATs and in the AT case. Aggressive tumor showed amplification of TFEB locus. Losses of part of chromosome 1 and chromosome 22 were found in 1 of 5 NATs and in the AT.
CONCLUSIONS: (1) Aggressive t(6;11) RCCs generally occur in the older population in comparison with their indolent counterparts. (2) In regard to the histologic findings in ATs, 3 of 5 so far published cases were morphologically not typical for t(6;11) RCC. Of the 3 cases, 2 cases lacked a small cell component and 1 closely mimicked clear cell-type RCC. (3) Necroses were only present in aggressive t(6;11) RCC. (4) Amplification of TFEB locus was also found only in the aggressive t(6;11) RCC.

PMID: 25438924 [PubMed - in process]

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