Crisis hipercalcémica, presentación inusual de adenoma paratiroideo: reporte de 2 casos / Hypercalcemic crisis, unusual presentation of parathyroid adenoma

La crisis hipercalcémica (CH) es una emergencia endocrina inusual, definida por la presencia de calcemia > 14 mg/dl asociada a disfunción renal, alteraciones cardiovasculares, gastrointestinales y del sensorio; también podría considerarse en pacientes con síntomas graves y calcemia menor. El hiperparatiroidismo primario (HPTP) y las neoplasias malignas son las etiologías más comunes de la hipercalcemia (90% de los casos); sin embargo, rara vez el primero se presenta como CH. Debido a la alta mortalidad asociada a esta entidad, es de gran importancia establecer diagnóstico y tratamiento precoces. Presentamos dos pacientes con crisis hipercalcémica como primera manifestación del HPTP, el 1.° con bloqueo auriculoventricular (AV) completo y el 2.° con pancreatitis aguda. La anatomía patológica (AP) reveló adenoma oxifílico en ambos casos, que es una variante histológica poco frecuente y puede manifestarse clínicamente de forma grave. Conclusiones: los adenomas paratiroideos son causa poco frecuente de CH. Consideramos el tipo histológico observado (adenoma oxifílico) como probable factor condicionante. La pancreatitis y especialmente el bloqueo AV son manifestaciones poco frecuentes de la CH. Resaltamos la importancia de la determinación de los niveles de calcio dentro de la evaluación inicial de todo paciente con bloqueo AV. (AU)

Hypercalcemic crisis (HC) is an unusual endocrine emergency, defined as the presence of serum calcium > 14 mg/dl related to kidney dysfunction, cardiovascular, gastrointestinal and sensory disturbances. It could also be considered in patients with severe symptoms and lower serum calcium levels. Primary hyperparathyroidism (PHPT) and malignant neoplasms are the most common hypercalcemia etiologies (90% of cases), nevertheless, the former hardly ever occurs as HC. Due to the high mortality associated with HC, it is crucial to establish early diagnosis and treatment.We report two patients with HC as the first manifestation of PHPT; the former with atrioventricular (AV) block and the latter with acute pancreatitis. Pathology revealed oxyphilic adenoma in both cases, which is an infrequent histological variant that can have a severe clinical manifestation. Conclusions: parathyroid adenomas are a rare cause of HC. We consider the histological type observed (oxyphilic adenoma) as a probable conditioning factor. Pancreatitis and especially AV block are rare manifestations of HC. We emphasize the importance of determining calcium levels in the initial evaluation of all patients with AV block. (AU)

Nasolacrimal Duct Obstruction Caused by Oncocytic Carcinoma

Here, we report an extremely rare case of acquired nasolacrimal duct obstruction caused by oncocytic carcinoma. A 64-year-old man presented to the hospital complaining of epiphora and left-side nasal obstruction. Ophthalmic and otolaryngology examination revealed a left lacrimal duct obstruction caused by a mass in the left nasal cavity and lacrimal drainage system. The mass was removed and confirmed as an oncocytic carcinoma. Nine months after surgery, without adjuvant radiotherapy, a left orbital mass was observed and the patient underwent reoperation. The mass proved to be recurrent oncocytic carcinoma. The patient underwent adjuvant radiotherapy to eradicate any residual tumor and the patient remains tumor-free one year post-radiotherapy.

Nasolacrimal Duct Obstruction Caused by Oncocytic Carcinoma

Here, we report an extremely rare case of acquired nasolacrimal duct obstruction caused by oncocytic carcinoma. A 64-year-old man presented to the hospital complaining of epiphora and left-side nasal obstruction. Ophthalmic and otolaryngology examination revealed a left lacrimal duct obstruction caused by a mass in the left nasal cavity and lacrimal drainage system. The mass was removed and confirmed as an oncocytic carcinoma. Nine months after surgery, without adjuvant radiotherapy, a left orbital mass was observed and the patient underwent reoperation. The mass proved to be recurrent oncocytic carcinoma. The patient underwent adjuvant radiotherapy to eradicate any residual tumor and the patient remains tumor-free one year post-radiotherapy.

Carcinoma e oncocitoma em mesmo rim- relato de caso / Carcinoma and oncocytoma in the same kidney- case report

Oncocitoma e carcinoma de células renais representam2 a 3% dos tumores no adulto. O oncocitoma é benigno,do córtex renal, normalmente unilateral, sendo 3,1-6,6%de todas as neoplasias renais. Os carcinomas são tumoresde células epiteliais, malignos, com tendência à invasãotecidual, podendo originar metástases. Os carcinomas representam85% dos cânceres renais, sendo prevalente o decélulas claras. No relato de caso os autores evidenciam,através do estudo histopatológico, a presença de oncocitomae carcinoma de células claras em um único rim.

Oncocytoma and renal cell carcinoma correspond to 2-3% of all tumors in adults. Oncocytomas are benign, usuallyin the kidney cortex and unilateral, correspondingto 3,1 to 6,6 % of all renal neoplasm. Carcinomas aremalignant tumors of epithelial cells which tend to tissueinvasion and can result in metastasis. Carcinoma represents85% of kidney neoplasm, with the clear cell carcinomabeing the most prevalent type. In the case reportthe authors demonstrate, through the histopathologicalstudies, the presence of oncocytoma and clear-cell carcinomain the same kidney.

Oxyphilic Adenoma Involving Floor of The Mouth : A Case Report.

Oxyphilic adenomas are unusual neoplasm of the head and neck region affecting the glandular epithelial tissue. They were first called as oncocytoma, which is composed of oncocytes and were first described by Schaffer and Hamperl. Oncocytes are polyhedral cells and contain abundant cytoplasm filled with eosinophilic granules. Oxyphilic adenomas are benign neoplasm and represent approximately less than 1% of all salivary gland tumors. They are found generally in the parotid gland, affecting parotid gland region extraorally and rarely encountered in various other sites. Involvement of floor of the mouth is very rare. Presented in this article is a case report of patient suffering from neoplasm, which was histopathologically diagnosed as oxyphilic adenoma.

A Functioning Adrenocortical Oncocytoma

Adrenocortical oncocytomas are exceptionally rare and most are benign and nonfunctioning. Only 3 cases of adrenal oncocytomas have been reported in the Korean literature and all of them were nonfunctioning. Herein, we report a case of a functioning adrenocortical oncocytoma in a 49-year-old man who presented with Cushing syndrome.