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1.
Prensa méd. argent ; 108(3): 165-189, 20220000. tab, fig, graf
Article in Spanish | LILACS, BINACIS | ID: biblio-1373279

ABSTRACT

Introducción. Los adenomas gigantes de hipófisis (AGHs) son aquellos tumores con un diámetro máximo ≥4 cm en cualquier dirección, representando del 5% al 14% del total de los adenomas que se tratan quirúrgicamente. Su manejo terapéutico es desafiante ya que, debido a su extensión hacia otras estructuras cerebrales,está asociado a un riesgo mayor de complicaciones quirúrgicas, con una menor tasa de resección total. El objetivo de este trabajo fue evaluar el impacto de la cirugía endoscópica transesfenoidal en AGHs, analizando las variables asociadas a resultados visuales, endocrinológicos y según el grado de resección. Pacientes y Métodos. Se evaluó en 44 pacientes con AGHs(diámetro ≥4 cm y/o volumen ≥10 ml) la presentación visual, endocrinológica e imágenes. Se analizaron estadísticamente resultados visuales, endocrinológicos, grado de resección y complicaciones quirúrgicas. Resultados. Edad promedio de 48.8 años, 24 mujeres y 20 hombres. Presentación: déficit del campo visual (93.1%), hipopituitarismo (61.3%), cefalea (54.5%). Diámetro, volumen y extensión supraselar promedios: 4.8 cm, 20.3 ml, 1.8 cm, respectivamente. Campo visual: mejoría: 83.3%, sin cambios: 9.5%, mayormente en síntomas bilaterales (p<0.0001). Desmejoríavisual: 0%. En resección total: mayor posibilidad de mejoría visual (p=0.040). Buenos resultados endocrinológicos: 85.7%. Tasa de resección total: 52.3%. Resección subtotal: más frecuente con invasión del seno cavernoso (p=0.014). Sin diferencias en el grado de resección según diámetro, volumen, extensión supraselar, forma ni aspecto. Hipopituitarismo: 4.2%. Diabetes insípida: 9.5%, asociada a mayor diámetro (p=0.038) o extensión supraselar (p=0.010) y aspecto sólido (p=0.023). Fístula de LCR: 7.1%. Conclusión. La resección total puede lograrse en la mitad de los casos, siendo la limitante principal el grado de invasión del seno cavernoso y no el aspecto morfológico del AGH per se. Aun así, los resultados visuales y endocrinológicos son muy buenos. En resecciones incompletas se logra el control de la enfermedad mediante tratamientos complementarios


Introduction. Giant pituitary adenomas (sGAs) are those tumors with a maximum diame- ter ≥4 cm in any direction, representing 5% to 14% of all adenomas that are treated surgi- cally. Its therapeutic management is challenging since, due to its extension to other brain structures, it is associated with a higher risk of surgical complications, with a lower rate of total resection. Te objective of this work was to evaluate the impact of transsphenoidal endoscopic surgery on AGHs, analyzing the variables associated with visual and endocri- nological results and according to the degree of resection. Patients and Methods. Visual, endocrinological and imaging presentation were evaluated in 44 patients with sHAA (dia- meter ≥4 cm and/or volume ≥10 ml). Visual and endocrinological results, degree of resection and surgical complications were statistically analyzed. Results. Average age of 48.8 years, 24 women and 20 men. Presentation: visual field deficit (93.1%), hypopituitarism (61.3%), headache (54.5%). Average diameter, volume and suprasellar extension: 4.8 cm, 20.3 ml, 1.8 cm, respectively. Visual field: improvement: 83.3%, no changes: 9.5%, mostly in bilate- ral symptoms (p<0.0001). Visual impairment: 0%. In total resection: greater possibility of visual improvement (p=0.040). Good endocrinological results: 85.7%. Total resection rate: 52.3%. Subtotal resection: more frequent with invasion of the cavernous sinus (p=0.014). No differences in the degree of resection according to diameter, volume, suprasellar exten- sion, shape or appearance. Hypopituitarism: 4.2%. Diabetes insipidus: 9.5%, associated with greater diameter (p=0.038) or suprasellar extension (p=0.010) and solid appearance (p=0.023). CSF fistula: 7.1%. Conclusion. Total resection can be achieved in half of the cases, the main limitation being the degree of invasion of the cavernous sinus and not the morphological appearance of the HGA per se. Even so, the visual and endocrinological results are very good. In incomplete resections, disease control is achieved through com- plementary treatments


Subject(s)
Humans , Pituitary Gland/pathology , Postoperative Complications , Adenoma/pathology , Chi-Square Distribution , Data Interpretation, Statistical , Endoscopy/methods , Surgical Clearance , Margins of Excision , Hypophysectomy/methods
2.
Arq. bras. med. vet. zootec. (Online) ; 73(5): 1099-1104, Sept.-Oct. 2021. tab, ilus
Article in English | LILACS, VETINDEX | ID: biblio-1345269

ABSTRACT

A senile male captive bush dog (Speothos venaticus) presented a small perianal cutaneous nodule. Histologically, there was an ulcerated round cell tumor composed of well differentiated mast cells with abundant intracytoplasmic purple Giemsa-positive granules, with a diffuse eosinophilic infiltrate. Immunohistochemistry revealed that 30% of the neoplastic cells were positive for Kit in the cytoplasm and cell membrane, and all neoplastic cells were negative for MAC and CD3. Less than 10% of the neoplastic cells were positive for Ki67. At necropsy other primary tumors were identified in this animal, including an intestinal adenoma, an adrenal cortex adenoma and a testicular interstitial cell tumor.(AU)


Um cachorro-vinagre (Speothos venaticus) apresentou um nódulo cutâneo pequeno na região perianal. Histologicamente havia neoplasia cutânea de células redondas e ulcerada, constituída por mastócitos bem diferenciados, com abundantes grânulos citoplasmáticos metacromáticos na coloração de Giemsa e infiltrado eosinofílico difuso. A imuno-histoquímica demonstrou que 30% das células neoplásicas eram positivas para a proteína Kit no citoplasma e na membrana celular. As células foram negativas para MAC e CD3. Menos de 10% das células neoplásicas foram positivas para Ki67. Durante a necropsia, foram identificados outros tumores primários, como adenoma intestinal, adenoma cortical da adrenal e tumor de células intersticiais do testículo.(AU)


Subject(s)
Canidae , Mastocytoma, Skin/diagnosis , Mastocytoma, Skin/pathology , Adenoma/pathology , Animals, Zoo
3.
Autops. Case Rep ; 11: e2021270, 2021. tab, graf
Article in English | LILACS | ID: biblio-1249033

ABSTRACT

Background Hemangiomas are benign neoplasms of capillary proliferation that arise from a developmental anomaly where angioblastic mesenchyme fails to form canals. Most hemangiomas arise in the head and neck region, either superficially in the skin or deeper within endocrine organs such as the parotid gland. Parathyroid hemangiomas, however, are extremely rare, with only five cases previously reported in the literature. Case presentation Herein, we present a case of a 68-year-old man with a hemangioma almost completely replacing the right upper parathyroid gland, grossly measuring 1.3 × 1.3 × 1.2 cm and weighing 700 mg, associated with primary hyperparathyroidism. Conclusions Parathyroid gland enlargement due to vascular neoplasms such as hemangiomas can mimic, both clinically and radiographically, hyperplasias and/or adenomas. Surgeons need to be aware of the presence of this entity and should consider it in the differential diagnosis of hyperparathyroidism or parathyroid gland enlargement.


Subject(s)
Humans , Male , Aged , Parathyroid Neoplasms/pathology , Adenoma/pathology , Hemangioma/pathology , Parathyroid Diseases/complications , Diagnosis, Differential
4.
Autops. Case Rep ; 11: e2020228, 2021. graf
Article in English | LILACS | ID: biblio-1142405

ABSTRACT

Tuberculosis is an infectious disease that involves any organ. However, the primary pituitary tuberculosis is an extremely rare disease. Intracranial tuberculomas account for 0.15-5% of intracranial space-occupying lesions, of which, pituitary as the primary site is unusual, and easily misdiagnosed as pituitary adenoma. In this setting, the late diagnosis can result in permanent endocrine dysfunction. We report the case of a 50-year-old woman who presented to the neurosurgery outpatient department with complaints of progressively increasing headache and diminished vision over the last year. On the clinical examination, the patient was conscious and oriented. The routine hematological and biochemical workup showed an increased erythrocyte sedimentation rate (ESR) and increased prolactin levels. The radiological working diagnosis was consistent with pituitary macroadenoma. No other radiological and/or clinical clue that could elicit the suspicion of pulmonary or extrapulmonary lesions of tuberculosis was found. The transsphenoidal endonasal tumor excision was done. The histopathology showed numerous epithelioid cell granulomas, Langhans giant cells along with scant necrosis. Ziehl Neelsen staining demonstrated acid-fast bacilli, and the final diagnosis of pituitary tuberculoma was made. We report this rare case of pituitary lesion that may be included in the differential diagnosis of sellar lesions to avoid unnecessary surgical interventions, especially in regions where the disease is endemic.


Subject(s)
Humans , Female , Middle Aged , Pituitary Gland/pathology , Pituitary Neoplasms , Tuberculosis/pathology , Adenoma/pathology , Epithelioid Cells , Giant Cells, Langhans , Rare Diseases , Diagnosis, Differential , Granuloma/pathology
5.
Autops. Case Rep ; 11: e2021252, 2021. graf
Article in English | LILACS | ID: biblio-1285405

ABSTRACT

Lactating adenoma is a rare benign breast lesion that most often presents as a small (up to 3 cm), solid, well-circumscribed, solitary, painless, mobile, lobulated mass. The highest incidence occurs in primiparous women (20 to 40 years old) during the third trimester of pregnancy. However, in the rare case presented herein, in addition to its giant size (more than 10 centimeters on palpation), this lactating adenoma is distinctive due to the presence of multiple nodules, poorly defined ultrasonographic margins, worrisome radiologic features, growth since early pregnancy, presence of infarction and association with chronic mastitis. From the clinical-radiologic perspective, the differential diagnoses included abscess associated with puerperal mastitis, phyllodes tumor, and galactocele. Biopsy was performed, and pathologic examination revealed the classic characteristics of lactating adenoma with multiple infarcted areas, leading to an unexpected confirmed case of giant lactating adenoma.


Subject(s)
Humans , Male , Pregnancy , Adult , Breast Neoplasms/pathology , Adenoma/pathology , Lactation Disorders/pathology , Diagnosis, Differential , Mastitis
6.
Autops. Case Rep ; 10(3): e2020148, 2020. graf
Article in English | LILACS | ID: biblio-1131827

ABSTRACT

Metanephric adenoma (MA) is a rare benign neoplasm of the kidney that is usually asymptomatic and incidentally diagnosed. MA usually present as a solid mass; however, a cystic presentation has been reported. The main differential diagnosis of MA is the epithelial predominant Wilms tumor (e-WT) and the solid variant of papillary renal cell carcinoma (pRCC). The presence of the BRAF gene mutation has recently been reported in 85% of MA, and less than 10% of cases of MA do not express this specific gene mutation. Herein we report a 22-year-old man who presented with back pain and abdominal discomfort with a renal mass on the computed tomographic scan. The diagnosis of metanephric adenoma was confirmed histopathologically. In our case, the tumor presented as a solid and cystic mass hence mimicking a papillary renal cell carcinoma. The VE1 protein, which correlates with BRAF gene mutation, did not show any significant expression. We want to highlight that MA can present as a cystic lesion that should be taken into account to avoid unnecessary radical nephrectomy. Also, we demonstrated that a subset of MA might not harbor the BRAF gene and, they are classified as the BRAF wild type MA.


Subject(s)
Humans , Male , Adult , Adenoma/pathology , Proto-Oncogene Proteins B-raf , Kidney Neoplasms/pathology , Wilms Tumor , Diagnosis, Differential , Nephrectomy
7.
Arq. gastroenterol ; 56(3): 276-279, July-Sept. 2019. tab, graf
Article in English | LILACS | ID: biblio-1038713

ABSTRACT

ABSTRACT BACKGROUND: Endoscopic mucosal resection is one of the most frequent therapeutic alternatives for large colorectal lateral spreading tumors. There are few data on the prevalence of synchronous lesions on these patients. OBJECTIVE: To describe the prevalence of synchronous colorectal lesions in patients referred for endoscopic mucosal resection of lateral spreading tumors >20 mm. METHODS: We reviewed the endoscopic database of our Department and identified adult patients who were referred for the resection of a colorectal lateral spreading tumor >20 mm and had a diagnostic colonoscopy performed up to six months before. The proportion of patients with at least one synchronous lesion was estimated. The following features were compared between patients with and without synchronous lesions: age, gender, bowel preparation quality and cecal intubation on index colonoscopy and therapeutic colonoscopy, serrated adenoma as index lesion. RESULTS: From December 2016 to November 2017, we identified 70 patients who fulfilled inclusion criteria. Median size of lesions was 25 mm (20-45). Eighty percent were located in the right colon and 35.71% were serrated adenomas. Synchronous lesion rate was 38.57%. Bowel preparation quality was similar in both groups when comparing both index and therapeutic colonoscopies. Patients with synchronous lesions had a higher proportion of serrated adenoma as index lesion than patients without synchronous lesions [51.85% vs 25.58%, OR 3.13 (1.13-8.68), P=0.03]. CONCLUSION: We found a high prevalence of synchronous lesions among patients with a large colorectal lateral spreading tumor. This risk seems to be increased if index lesions are serrated adenomas.


DESCRITORES CONTEXTO: A ressecção endoscópica de mucosa é uma das alternativas terapêuticas frequentes para grandes tumores colorretais de propagação lateral. Há poucos dados sobre a prevalência de lesões síncronas nesses pacientes. OBJETIVO: Descrever a prevalência de lesões colorretais síncronas em pacientes encaminhados para ressecção endoscópica da mucosa de tumores de disseminação lateral >20 mm. MÉTODOS: Realizou-se a revisão de banco de dados endoscópicos de nosso departamento e foram identificados pacientes adultos encaminhados para a ressecção de um tumor colorretal com propagação lateral >20 mm e que tiveram colonoscopia diagnóstica realizada até seis meses antes. Estimou-se a proporção de pacientes com pelo menos uma lesão síncrona. As seguintes características foram comparadas entre pacientes com e sem lesões síncronas: idade, sexo, qualidade da preparação intestinal e intubação cecal pelo índice de colonoscopia e adenoma serrilhado como lesão índice. RESULTADOS: De dezembro de 2016 a novembro de 2017, identificamos 70 pacientes que preencheram os critérios de inclusão. O tamanho mediano das lesões foi de 25 mm (20-45). Foram 80% situados no cólon direito e 35,71% eram adenomas serrilhados. A taxa de lesão síncrona foi de 38,57%. A qualidade da preparação intestinal foi semelhante em ambos os grupos comparando-se os índices e colonoscopia terapêutica. Pacientes com lesões síncronas apresentaram maior proporção de adenoma serrilhado como lesão índice do que pacientes sem lesões síncronas [51,85% vs 25,58%, or 3,13 (1,13-8,68), P=0,03]. CONCLUSÃO: Encontramos alta prevalência de lesões síncronas entre pacientes com grande tumor de propagação lateral colorretal. Este risco parece ser aumentado se as lesões índice forem adenomas serrilhados.


Subject(s)
Humans , Male , Female , Adult , Aged , Colorectal Neoplasms/surgery , Adenoma/surgery , Colonoscopy/methods , Endoscopic Mucosal Resection/methods , Colorectal Neoplasms/pathology , Adenoma/pathology , Colonic Polyps/surgery , Middle Aged
8.
Arch. endocrinol. metab. (Online) ; 63(3): 300-305, May-June 2019. tab, graf
Article in English | LILACS | ID: biblio-1011171

ABSTRACT

ABSTRACT Objective Hürthle cell carcinomas (HCCs) of the thyroid have been recently reclassified as a separate entity due to their distinct clinical and molecular profiles. Few studies have assessed the ability of preoperative characteristics in differentiating HCCs from Hürthle cell adenomas (HCAs) due to the low prevalence of both lesions. This study aimed to compare the preoperative features of HCCs and HCAs and evaluate the diagnostic performance of ultrasound in distinguishing between both. Subjetcs and methods Retrospective study including 101 patients (52 HCCs and 49 HCAs) who underwent thyroid surgery from 2000 to 2016. Clinical, ultrasonographic, and histological data were reviewed. Diagnostic performance of suspicious sonographic features was analyzed in 51 cases (24 HCCs and 27 HCAs). Results Hürthle cell neoplasms were predominant in females. Subjects ≥ 55 years represented 58% of the cases of HCCs and 53% of those of HCAs. Carcinomas were significantly larger (p < 0.001), and a tumor size ≥ 4 cm significantly increased the risk of malignancy (odds ratio 3.67). Other clinical, cytologic, and sonographic data were similar between HCCs and HCAs. Among the HCCs, the lesions were purely solid in 54.2%, hypoechoic in 37.5%, and had coarse calcifications in 12.5%, microcalcifications in 8.3%, irregular contours in 4.2%, and a taller-than-wide shape in 16.7%. Predominantly/exclusive intranodular vascularization was observed in 52.6%. Overall, 58% of the HCCs were classified as TI-RADS 4 or 5 compared with 48% of the HCAs. TI-RADS 4 or 5 had a specificity of only 51.8% and a positive likelihood ratio of 1.21. Conclusions Apart from the lesion size, no other preoperative feature adequately distinguished HCCs from HCAs. Sonographic characteristics raising suspicion for malignancy, which are mostly present in papillary carcinomas, were infrequent in HCCs. New tools must be developed to improve preoperative diagnosis and deferral of surgery in cases of adenomas.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Thyroid Gland/diagnostic imaging , Thyroid Neoplasms/diagnostic imaging , Adenoma/diagnostic imaging , Carcinoma, Papillary, Follicular/diagnostic imaging , Ultrasonography, Doppler/methods , Thyroid Gland/surgery , Thyroid Gland/pathology , Thyroid Neoplasms/surgery , Thyroid Neoplasms/pathology , Adenoma/surgery , Adenoma/pathology , Retrospective Studies , Carcinoma, Papillary, Follicular/surgery , Carcinoma, Papillary, Follicular/pathology , Diagnosis, Differential
9.
Braz. j. med. biol. res ; 52(4): e7728, 2019. graf
Article in English | LILACS | ID: biblio-1001506

ABSTRACT

Pituitary adenoma is one of the most common tumors in the neuroendocrine system. This study investigated the effects of long non-coding RNAs (lncRNAs) highly up-regulated in liver cancer (HULC) on rat secreting pituitary adenoma GH3 cell viability, migration, invasion, apoptosis, and hormone secretion, as well as the underlying potential mechanisms. Cell transfection and qRT-PCR were used to change and measure the expression levels of HULC, miR-130b, and FOXM1. Cell viability, migration, invasion, and apoptosis were assessed using trypan blue staining assay, MTT assay, two-chamber transwell assay, Guava Nexin assay, and western blotting. The concentrations of prolactin (PRL) and growth hormone (GH) in culture supernatant of GH3 cells were assessed using ELISA. The targeting relationship between miR-130b and FOXM1 was verified using dual luciferase activity. Finally, the expression levels of key factors involved in PI3K/AKT/mTOR and JAK1/STAT3 pathways were evaluated using western blotting. We found that HULC was highly expressed in GH3 cells. Overexpression of HULC promoted GH3 cell viability, migration, invasion, PRL and GH secretion, as well as activated PI3K/AKT/mTOR and JAK1/STAT3 pathways. Knockdown of HULC had opposite effects and induced cell apoptosis. HULC negatively regulated the expression of miR-130b, and miR-130b participated in the effects of HULC on GH3 cells. FOXM1 was a target gene of miR-130b, which was involved in the regulation of GH3 cell viability, migration, invasion, and apoptosis, as well as PI3K/AKT/mTOR and JAK1/STAT3 pathways. In conclusion, HULC tumor-promoting roles in secreting pituitary adenoma might be via down-regulating miR-130b, up-regulating FOXM1, and activating PI3K/AKT/mTOR and JAK1/STAT3 pathways.


Subject(s)
Humans , Animals , Rats , Pituitary Neoplasms/pathology , Adenoma/pathology , RNA, Long Noncoding/physiology , Enzyme-Linked Immunosorbent Assay , Transfection , Adenoma/genetics , Adenoma/metabolism , Cell Movement/physiology , Cell Survival/physiology , Blotting, Western , Apoptosis/physiology , MicroRNAs/analysis , Cell Line, Tumor , STAT3 Transcription Factor/analysis , Janus Kinase 1/analysis , Janus Kinase 1/metabolism , Cell Migration Assays , Forkhead Box Protein M1/analysis , Forkhead Box Protein M1/metabolism , Luciferases
11.
Int. braz. j. urol ; 44(3): 506-511, May-June 2018. tab, graf
Article in English | LILACS | ID: biblio-954043

ABSTRACT

ABSTRACT Introduction: Nephrogenic adenoma (NA) was first described by Davis in 1949 as a "hamartoma" of the bladder. There are many proposed predisposing factors for NA including chronic inflammation, renal transplantation, and bladder cancer. We examined our experience with NA to determine predisposing factors and determine if there was any increased risk for development of subsequent malignancy. Materials and Methods: All patients with a pathologic diagnosis of bladder NA from 2001-2013 were included. Patient history, clinical factors including possible predisposing factors for NA, and follow-up were reviewed. Results: Among 60 patients, 68% were males with an average age of 61, an average BMI of 28.7, and 60% had a smoking history. In evaluating pro-inflammatory factors, 26.7% underwent either Bacillus Calmette-Guerin or mitomycin C, 30% had recurrent urinary tract infections, and 25% had a history of catheterization. Recurrence of NA after initial resection occurred only in 14.7% of patients who underwent follow-up cystoscopy. A history of concurrent bladder cancer was seen in 41.7% of patients, but there were no cases of de novo bladder cancer diagnosed after NA. Conclusion: To the best of our knowledge, this is the largest series of patients with NA of the bladder. NA occurs in a heterogeneous population of patients, but most often with underlying inflammation. NA occurred concurrent with bladder cancer; however there were no cases of de novo bladder cancer after NA, reassuring that NA is likely a benign reactive condition.


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Aged , Aged, 80 and over , Young Adult , Urinary Bladder Neoplasms/etiology , Urinary Bladder Neoplasms/pathology , Adenoma/etiology , Adenoma/pathology , Biopsy , Urinary Bladder/pathology , Retrospective Studies , Risk Factors , Risk Assessment , Cystoscopy , Diagnosis, Differential , Hematuria , Middle Aged
12.
Rev. méd. Chile ; 146(6): 685-692, jun. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-961448

ABSTRACT

Background: Colorectal Cancer Screening Programs (CRCSP) are widely accepted in developed countries. Unfortunately, financial restrictions, low adherence rate and variability on colonoscopy standardization hamper the implementation of CRCSP in developing countries. Aim: To analyze a multicentric pilot model of CRCSP in Chile. Material and Methods: A prospective model of CRCSP was carried out in three cities, from 2012 to 2015. The model was based on CRC risk assessment and patient education. Health care personnel were trained about logistics and protocols. The endoscopy team was trained about colonoscopy standards. A registered nurse was the coordinator in each center. We screened asymptomatic population aged between 50 and 75 years. Immunological fecal occult blood test (FIT) was offered to all participants. Subjects with positive FIT underwent colonoscopy. Results: A total of 12,668 individuals were enrolled, with a FIT compliance rate of 93.9% and 2,358 colonoscopies were performed. Two hundred and fifty high-risk adenomas and 110 cancer cases were diagnosed. One patient died before treatment due to cardiovascular disease, 74 patients (67%) underwent endoscopic resection and 35 had surgical treatment. Ninety one percent of patients had an early stage CRC (0-I-II). Among colonoscopy indicators, 80% of cases had an adequate bowel preparation (Boston > 6), cecal intubation rate was 97.7%, adenoma detection rate was 36.5%, and in 94.5% of colonoscopies, withdrawal time was adequate (> 8 min). Conclusions: This CRCS pilot model was associated to a high rate of FIT return and colonoscopy quality standards. Most CRCs detected with the program were treated by endoscopic resection.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Colorectal Neoplasms/diagnosis , Program Evaluation , Adenoma/diagnosis , Colonoscopy/methods , Risk Assessment/methods , Early Detection of Cancer/methods , Colorectal Neoplasms/pathology , Adenoma/pathology , Chile , Pilot Projects , Nutritional Status , Patient Education as Topic , Prospective Studies , Reproducibility of Results , Risk Factors , Analysis of Variance , Colonoscopy/standards , Early Detection of Cancer/standards , Occult Blood
13.
Braz. j. med. biol. res ; 51(9): e7427, 2018. tab, graf
Article in English | LILACS | ID: biblio-951761

ABSTRACT

Genetic and functional aberrations of guanine nucleotide-binding protein, alpha stimulating (GNAS), aryl hydrocarbon receptor interacting protein (AIP), and pituitary tumor transforming gene (PTTG) are among the most prominent events in pituitary tumorigenesis. A cohort of Brazilian patients with somatotropinomas (n=41) and non-functioning pituitary adenomas (NFPA, n=21) from a single tertiary-referral center were evaluated for GNAS and AIP mutations and gene expression of AIP and PTTG. Results were compared to the clinical and biological (Ki67 and p53 expression) characteristics of tumors and their response to therapy, if applicable. Genetic analysis revealed that 27% of somatotropinomas and 4.8% of NFPA harbored GNAS mutations (P=0.05). However, no differences were observed in clinical characteristics, tumor extension, response to somatostatin analog therapy, hormonal/surgical remission rates, Ki67 index, and p53 expression between mutated and non-mutated somatotropinomas patients. PTTG overexpression (RQ mean=10.6, min=4.39, max=11.9) and AIP underexpression (RQ mean=0.56, min=0.46-max=0.92) were found in virtually all cases without a statistically significant relationship with clinical and biological tumor features. No patients exhibited somatic or germline pathogenic AIP mutations. In conclusion, mutations in GNAS and abnormal PTTG and AIP expression had no impact on tumor features and treatment outcomes in this cohort. Our data support some previous studies and point to the need for further investigations, probably involving epigenetic and transcriptome analysis, to improve our understanding of pituitary tumor behavior.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Pituitary Neoplasms/genetics , Adenoma/genetics , Germ-Line Mutation/genetics , Growth Hormone-Secreting Pituitary Adenoma/genetics , Pituitary Gland/pathology , Pituitary Neoplasms/pathology , Brazil , DNA, Neoplasm , Genetic Markers , Adenoma/pathology , Cell Transformation, Neoplastic , Cohort Studies , Intracellular Signaling Peptides and Proteins , Growth Hormone-Secreting Pituitary Adenoma/pathology , Carcinogenesis
14.
Braz. j. med. biol. res ; 51(2): e6808, 2018. tab, graf
Article in English | LILACS | ID: biblio-889020

ABSTRACT

Pituitary adenomas account for 10-15% of primary intracranial tumors. Growth hormone (GH)-secreting adenomas account for 13% of all pituitary adenomas and cause acromegaly. These tumors can be aggressive, invade surrounding structures and are highly recurrent. The objective of this study was to evaluate E-cadherin, Slug and neural cell adhesion molecule (NCAM) expression in GH-secreting pituitary adenomas and its relationship to tumor invasiveness. A cross-sectional study of patients who underwent hypophysectomy due to GH-secreting pituitary adenoma from April 2007 to December 2014 was carried out. The medical records were reviewed to collect clinical data. Immediately after surgery, tumor samples were frozen in liquid nitrogen and stored in a biofreezer at -80°C for assessment of E-cadherin 1 (CDH1), SLUG (SNAI2), and NCAM (NCAM1) by real-time PCR. The samples were fixed in formalin and embedded in paraffin for immunohistochemical analysis of E-cadherin and NCAM. Thirty-five patients with acromegaly were included in the study. Of these, 65.7% had invasive tumors. Immunohistochemically, E-cadherin was expressed in 96.7% of patients, and NCAM in 80% of patients. There was no statistically significant relationship between tumor grade or invasiveness and immunohistochemical expression of these markers. Regarding gene expression, 50% of cases expressed CDH1, none expressed SNAI2, and 53.3% expressed NCAM1. There was no statistically significant relationship between tumor grade or invasiveness and gene expression of CDH1, SNAI2, and NCAM1. The absence of Slug overexpression and of E-cadherin and NCAM suppression suggests that expression of these markers is not associated with tumor invasiveness in GH-secreting pituitary adenomas.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Acromegaly/pathology , Adenoma/pathology , Cadherins/analysis , Neural Cell Adhesion Molecules/analysis , Snail Family Transcription Factors/analysis , Acromegaly/genetics , Acromegaly/metabolism , Immunohistochemistry , Biomarkers, Tumor/analysis , Adenoma/genetics , Adenoma/chemistry , Gene Expression , Cross-Sectional Studies , Neoplasm Grading
15.
Clinics ; 73(supl.1): e553s, 2018. tab
Article in English | LILACS | ID: biblio-974947

ABSTRACT

OBJECTIVE: Our aim was to evaluate the Japan Gastroenterological Endoscopy Society criteria for endoscopic submucosal resection of early gastric cancer (EGC) based on the experience in a Brazilian cancer center. METHODS: We included all patients who underwent endoscopic submucosal resection for gastric lesions between February 2009 and October 2016. Demographic data and information regarding the endoscopic resection, pathological report and follow-up were obtained. Statistical calculations were performed with Fisher's exact test and chi-square tests, with 95% confidence intervals. RESULTS: In total, 76% of the 51 lesions were adenocarcinomas, 16% were adenomas, and 8% had other diagnoses. The average size was 19.9 mm (±11.7). The average procedure length was 113.9 minutes (±71.4). The complication rate was 21.3%, with only one patient who needed surgical treatment (transmural perforation). Among the adenocarcinomas, 39.5% met the classic criteria for curability, 31.6% met the expanded criteria and 28.9% met the criteria for noncurative resection. Analysis of the indication criteria and curability revealed differences among cases with "only-by-size" expanded criteria (64.28%), other expanded criteria (40%) and classic criteria (89.47%), with a p-value of 0.049. During follow-up (15.8 months; ±14.3), 86.1% of the EGC patients had no recurrence. When well-differentiated and poorly differentiated lesions or lesions included in the classic and expanded criteria were compared, there were no differences in recurrence. The noncurative group presented a higher recurrence rate than the classic group (p=0.014). CONCLUSION: These results suggest that the Japanese endoscopic submucosal resection criteria might be useful for endoscopic treatment of EGC in Western countries.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Stomach Neoplasms/surgery , Adenocarcinoma/surgery , Adenoma/surgery , Endoscopic Mucosal Resection/standards , Neoplasm Recurrence, Local/surgery , Stomach Neoplasms/pathology , Brazil , Adenocarcinoma/pathology , Adenoma/pathology , Reproducibility of Results , Retrospective Studies , Treatment Outcome , Tumor Burden , Tertiary Care Centers , Endoscopic Mucosal Resection/methods , Neoplasm Recurrence, Local/pathology
16.
Rev. méd. Chile ; 145(8): 1021-1027, ago. 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-902580

ABSTRACT

Background: 99mTc-sestamibi parathyroid SPECT scintigraphy is a useful tool in the pre-operative study of hyperparathyroidism. False negatives (FN) have been reported in 5.7-14% of the examinations. Aim: To characterize 99mTc-sestamibi FN in cases referred for primary hyperparathyroidism (PHP) to a university hospital. Material and Methods: Descriptive retrospective analysis. We included patients with PHP, studied with SPECT scintigraphy, operated at our center between 2008 and 2015. Clinical and surgical data were recorded; biopsies of the FN were blindly reviewed by one pathologist. Results: One hundred twenty one scintigraphies fulfilled the inclusion criteria. Seven (5.8%) were negative and 114 positive. There was no difference in age, sex and PTH levels between FN and true positive scintigraphies. At surgery, one FN case had two hyperplasic glands and two cases had ectopic glands. Pathology reported adenoma in three cases, hyperplasia in three and carcinoma in one. The largest diameter of the lesion was lower in FN (1.3 and 2.1 cm respectively, p = 0.02) and the proportion of adenomas was higher in true positive cases (29% and 75% respectively; p < 0.01). The interval between scintigraphy and parathyroidectomy was greater in FN with a median of 92 days (range 20 days-3.2 years, p < 0.01). The percentage of oxyphilic cells observed was similar in both groups. Conclusions: FN parathyroid SPECT scintigraphies in PHP are uncommon. They corresponded to lesions under the equipment's resolution limit and resulted in longer time lags between scintigraphy and surgery.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Parathyroid Glands/diagnostic imaging , Tomography, Emission-Computed, Single-Photon/methods , Technetium Tc 99m Sestamibi , Radiopharmaceuticals , Hyperparathyroidism, Primary/diagnostic imaging , Parathyroid Neoplasms/pathology , Parathyroid Neoplasms/diagnostic imaging , Parathyroid Glands/pathology , Reference Standards , Reference Values , Carcinoma/pathology , Carcinoma/diagnostic imaging , Adenoma/pathology , Adenoma/diagnostic imaging , Retrospective Studies , Statistics, Nonparametric , Hyperparathyroidism, Primary/pathology , False Negative Reactions , Hyperplasia/pathology , Hyperplasia/diagnostic imaging
17.
Neuroendocrinology ; 104(2): 183-193, 2017.
Article in English | LILACS, SES-SP, SESSP-IALPROD, SES-SP, SESSP-IALACERVO | ID: biblio-1024761

ABSTRACT

Background/Aims: Although craniopharyngioma (CP) is histologically benign, it is a pituitary tumour that grows rapidly and often recurs. Adamantinomatous CP (ACP) was associated with an activating mutation in ß-catenin, and it has been postulated that pituitary stem cells might play a role in oncogenesis in human ACP. Stem cells have also been identified in pituitary adenoma. Our aim was to characterize the expression pattern of ABCG2, CD44, DLL4, NANOG, NOTCH2, POU5F1/OCT4, SOX2, and SOX9 stem cell markers in human ACP and pituitary adenoma. Methods and Results: We studied 33 patients (9 ACP and 24 adenoma) using real-time quantitative PCR (RT-qPCR) and immunohistochemistry. SOX9 was up-regulated in ACP, exhibiting positive immunostaining in the epithelium and stroma, with the highest expression in patients with recurrence. CD44 was overexpressed in ACP as confirmed by immunohistochemistry. SOX2 did not significantly differ among the tumour types. The RT-qPCR array showed an increased expression of MKI67,OCT4/POU5F1, and DLL4 in all tumours. NANOG was decreased in ACP. ABCG2 was down-regulated in most of the tumours. NOTCH2 was significantly decreased in the adenomas. Conclusion: Our results confirm the presence of stem cell markers in human pituitary tumours as well as the different expression patterns of ACP and adenoma. These findings suggest that ACP may originate from a more undifferentiated cell cluster. Additionally, SOX9 immunodetection in the stroma and the highest expression levels related to the relapse of patients suggest a contribution to the aggressive behaviour and high recurrence of this tumour type.


Subject(s)
Pituitary Neoplasms/metabolism , Aged , Humans , Biomarkers, Tumor/metabolism , Adenoma/metabolism , Adenoma/pathology , Gene Expression , Child , Child, Preschool , Adolescent , Hyaluronan Receptors/metabolism , Craniopharyngioma/metabolism , Craniopharyngioma/pathology , Neural Stem Cells/metabolism
18.
Arch. endocrinol. metab. (Online) ; 60(6): 537-544, Nov.-Dec. 2016. tab, graf
Article in English | LILACS | ID: biblio-827783

ABSTRACT

ABSTRACT Objective Parathyroid cancer (PC) represents < 1% of cases of PHPT. Tumors demonstrating atypical histopathologic features and don’t fulfill criteria for carcinoma are classified as atypical adenomas (APA). The purpose of this study was to determine a biochemical or ultrasonographic feature that can predict aggressive disease requiring more extensive surgery and closer follow-up. Subjects and methods Twenty eight patients operated for PHPT and diagnosed with atypical adenoma (23 patients) or carcinoma (5 patients) were enrolled in this study. The control group consisted of 102 patients operated between the same dates and diagnosed with classical PA. Classical adenomas, atypical adenomas, and carcinomas were compared according to their biochemical and ultrasonographic parameters. Results Serum Ca levels were significantly higher in the PC group compared with the APA and classical PA groups. Serum median PTH, Serum ALP and UCa was significantly higher in the APA and carcinoma groups compared to the classical PA group. ROC analysis was made to determine the best cut off values for predicting aggressive disease were 12.45 mg/dL, 265.05 pg/mL, 154.5 IU/l, 348.5 mg/day and 21.5 mm for Ca, PTH, ALP, UCa and the adenoma diameter, respectively. Multivariate analysis showed that serum Ca, ALP and isoechoic/cystic appearance were independent predictors for aggressive disease. Conclusion Preoperatively high PTH, ALP, and UCa levels and large lesions with isoechoic or cystic appearances may be predictive of atypical adenoma or carcinoma in patients being evaluated for PHPT. In such cases, surgeons may prefer en bloc parathyroidectomy to minimally invasive surgery.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Parathyroid Neoplasms/blood , Parathyroid Neoplasms/diagnostic imaging , Biomarkers, Tumor/blood , Adenoma/surgery , Adenoma/pathology , Adenoma/blood , Adenoma/diagnostic imaging , Parathyroid Hormone/blood , Parathyroid Neoplasms/surgery , Parathyroid Neoplasms/pathology , Preoperative Care , Case-Control Studies , Calcium/urine , Calcium/blood , Predictive Value of Tests , Ultrasonography/methods , Alkaline Phosphatase/blood
19.
Rev. Assoc. Med. Bras. (1992) ; 62(5): 399-406, Sept.-Oct. 2016. tab, graf
Article in English | LILACS | ID: lil-794917

ABSTRACT

SUMMARY Objective: As a result of the use of neuroimaging techniques, silent pituitary lesions are diagnosed more and more frequently; however, there are few published post-mortem studies about this gland. Incidence data of pituitary lesions are rare and in Portugal they are outdated or even non-existent. The aim of this study is to determine the prevalence of normal patterns and incidental post-mortem pituitary pathology at Centro Hospitalar Lisboa Norte, analyzing the associations with clinical data and assessing the clinical relevance of the findings. Method: We reviewed retrospectively and histologically 167 pituitaries of a consecutive series of autopsies from the Department of Pathology of this centre. They were done between 2012 and 2014, and in all cases medical records were reviewed. The morphological patterns observed, were classified into three major groups: 1) Normal histological patterns and variants; 2) Infectious-inflammatory pathology, metabolic and vascular disorders; 3) Incidental primary proliferation and secondary to systemic diseases. Results: The subjects included in this study were of all age groups (from 1 day to 91 years old), 71 were female and 96 male. Fifty-seven of these glands didn’t show any alteration; 51 showed colloid cysts arising from Rathke cleft; 44 presented hyperplasia in adenohypophysis and we identified 20 adenomas in 19 glands (immunohistochemically, eight PRL-producing and five ACTH-producing tumors), ten of which associated with obesity, 11 to hypertension and six to diabetes mellitus. There were two cases with metastasis. Conclusion: Subclinical pathology in our country is similar to that seen in other parts of the world, but at older ages.


RESUMO Objetivo: como resultado da utilização de técnicas de neuroimagem, cada vez se diagnosticam mais lesões hipofisárias silentes; porém, há poucos estudos post mortem publicados sobre essa glândula. Os dados de incidência existentes sobre lesões hipofisárias são raros, sendo em Portugal desatualizados ou inexistentes. O objetivo é determinar a prevalência dos padrões normais e da patologia hipofisária incidental post mortem no Centro Hospitalar Lisboa Norte, analisando as associações com dados clínicos e avaliando a relevância clínica dos achados. Método: revisaram-se histologicamente de forma retrospectiva 167 hipófises de uma série consecutiva de autópsias do Serviço de Anatomia Patológica desse centro, realizadas entre 2012 e 2014, sendo revisadas em todos os casos as histórias clínicas. Os padrões morfológicos observados classificaram-se em três grandes grupos: 1) padrões histológicos de normalidade e variantes; 2) patologia infeccioso-inflamatória, distúrbios metabólicos e transtornos vasculares; 3) proliferação primária incidental e secundária a doenças sistêmicas. Resultados: os doentes incluíam todas as faixas etárias (de 1 dia a 91 anos), sendo 71 do sexo feminino e 96 do masculino. Cinquenta e sete das glândulas não apresentaram qualquer alteração; 51 mostraram cistos coloides derivados da fissura de Rathke; em 44, observou-se hiperplasia da adeno-hipófise e identificaram-se 20 adenomas em 19 glândulas (oito imuno-histoquimicamente produtores de PRL e cinco de ACTH), dos quais dez associados à obesidade, 11 à hipertensão arterial e seis a diabetes mellitus. Houve dois casos com metástases. Conclusão: a patologia subclínica em nosso meio é similar à observada em outras partes do mundo, mas em idades mais avançadas.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Aged , Aged, 80 and over , Young Adult , Pituitary Gland/pathology , Adenoma/pathology , Pituitary Diseases/pathology , Portugal , Autopsy , Retrospective Studies , Sex Distribution , Age Distribution , Middle Aged
20.
Arq. bras. oftalmol ; 79(4): 253-254, July-Aug. 2016. graf
Article in English | LILACS | ID: lil-794581

ABSTRACT

ABSTRACT Our patient was a 34 year-old male who presented with a painless conjunctival mass that had developed 3 months before his first visit. On performing slit-lamp biomicroscopy, a lobulated pink-yellowish solid mobile mass was observed on the nasal bulbar conjunctival surface of his left eye. The tumor was excised, and histopathologic examination of the tumor revealed a sebaceous adenoma. Systemic examination was normal. No recurrence was observed during the 24-month follow-up period. Sebaceous adenoma of the bulbar conjunctiva is an extremely rare benign tumor, which may be observed to be isolated in the absence of malignancy.


RESUMO Nosso paciente era um homem de 34 anos que apresentou uma massa conjuntival indolor desde há 3 meses antes da primeira consulta. Na biomicroscopia por lâmpada de fenda, observa-se uma massa rosa-amarelada, sólida, móvel e lobulada na superfície conjuntival bulbar nasal, em seu olho esquerdo. O tumor foi retirado e o exame histopatológico demonstrou um adenoma sebáceo. O exame sistêmico era normal. Nenhuma recidiva foi observada durante os 24 meses de acompanhamento. Adenoma sebáceo da conjuntiva bulbar é um tumor benigno extremamente raro e pode ser visto isolado, sem quaisquer doenças malignas associadas.


Subject(s)
Humans , Male , Adult , Sebaceous Gland Neoplasms/pathology , Adenoma/pathology , Conjunctival Neoplasms/pathology , Sebaceous Gland Neoplasms/surgery , Adenoma/surgery , Conjunctiva/pathology , Conjunctival Neoplasms/surgery
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