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Objective To explore the clinical manifestations,diagnosis,misdiagnosis and treatment of primary hyperparathyroidism.Methods The clinical data of 36 patients with primary hyperparathyroidism admitted into the First Affiliated Hospital of Chongqing Medical University from January 2009 to October 2014 were reviewed and analyzed retrospectively.Results The manifestations of primary hyperparathyroidism were various and atypical.Primary hyperparathyroidism was often misdiagnosed as other diseases by 25.0％ (9/36).Among the patients,the ratio of male to female was 1:1,and median age was 58 years old.Of all patients,there were 9 persons with joint pain,digestive system symptoms in 7 cases,cervical mass discovered in 6 cases(3 cases were found when B ultrasonic examination),urinary calculus in 5 cases,fatigue symptoms in 4 cases,osteoporosis and urinary calculus in 2 cases,1 case with fracture,2 cases without any symptoms.Their calcium and parathyroid hormone level were increased by various degree.The accuracy rates of level diagnosis of Color Doppler ultrasound combine with CT or 99Tcm-MIBI were improved obviously,85.2％ and 93.1％ respectively.Twenty-eight patients received surgical treatment and pathology examination confirmed the accurate pathological types after surgery.There were 23 cases of parathyroid adenoma,1 case parathyroid hyperplasia,1 case parathyroid carcinoma,2 cases of parathyroid adenoma with nodular goiter,parathyroid adenoma merged thyroid carcinoma in 1 case.Serum calcium and parathyroid hormone level declined obviously after operation.The other 8 patients received non-surgical treatment,7 cases were alleviated and 1 case died due to irreformable high blood calcium crisis.Conclusion There should be pay attention to recognize primary hyperparathyroidism,check the blood calcium,and about suspected cases should be performed as early as parathyroid tested,neck color Doppler ultrasound.Early surgical treatment can significantly improve the prognosis and quality of life.
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Objective To explore the expression,correlation and clinical significance of mammalian target of rapamycin (mTOR) and vascular endothelial growth factor (VEGF) in gastroenteropancreatic neuroendocrine neoplasm (GEP-NEN).Methods From October 1995 to December 2012,the paraffin tissue specimens of 114 pathological diagnosed GEP-NEN were collected.The expressions of mTOR and VEGF at protein level were detected with EnVision immunohistochemical staining method.Chi-square test was performed to compare the differences in the expressions of mTOR and VEGF among every clinicopathological factors of patients.Spearman's correlation analysis was used to find out the correlation between the expressions of mTOR and VEGF.Kaplan Meier method and Log-rank test were implemented for survival analysis.Results The overall positive expression rates of mTOR and VEGF in GEP-NEN tissues were 66.7％ (76/114) and 71.1％ (81/114),respectively.The expressions ofmTORand VEGF at protein level were not correlated with gender,age,functional status of tumor,location of tumor,grading and classification of tumor and distant metastasis (all P＞0.05).The co-expression rate of mTOR and VEGF in GEP-NEN tissues was 51.8％ (59/114).The expression of mTOR was positively correlated with the expression of VEGF at protein level (r=0.205,P=0.029).Among 82 followed-up patients,the mean survival time of patients with mTOR positive or negative expression was 8.3 and 7.9 years,and respectively,and there was no statistical significance (x2 =0.201,P=0.654).The mean survival time of patients with VEGF positive or negative expression was 9.6 and 5.9 years,respectively,and the difference was statistically significant (x2 =4.415,P=0.036).Among the patients with G1 grading tumor,classified as neuroendocrine tumor and without distant metastasis,the survival time of patients with positive VEGF expression was longer than that of patients with negative VEGF expression (11.8 years vs 7.3 years,x2 =5.349,P=0.021; 11.2 years vs 6.8 years,x2=6.375,P=0.012; 11.2 years vs 7.2 years,x2 =4.630,P=0.031).Conclusions mTOR and VEGF proteins are highly expressed in GEP-NEN with different location,grading and classification.The expression of them is positively correlated.The prognosis of GEP-NEN patients with positive VEGF expression is better.
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Objective To explore the value of serum chromogranin A (CgA) in clinical diagnosis and efficacy evaluation of gastroenteropancreatic neuroendocrine neoplasm (GEP-NEN).Methods From January 2011 to December 2012,87 GEP-NEN patients were enrolled,which included 50 patients with lesions and 37 patients without lesions after surgery.Eighty-four healthy subjects were taken as control group.The serum CgA levels of all subjects were measured with enzyme linked immunosorbent assay.Nonparametric test,receiver operating characteristic curve and Cox regression univariate analysis were performed for analysis.Results The median of serum CgA level of GEP-NEN patients with lesions was 97μg/L,which was significantly higher than that of patients without lesions after surgery (42 μg/L,Z=3.451,P=0.001) and healthy control (47 μg/L,Z=3.149,P=0.002).The value of 95 μg/L was taken as diagnostic cut-off value for healthy controls,patients without lesions and patients with lesions,the sensitivity and specificity were 54.0％ and 90.1％,respectively.The median of serum CgA level of the patients with distant metastasis was 231 μg/L,which was higher than that of patients without distant metastasis (46 μg/L,Z=3.340,P=0.001).After treatment,the serum CgA levels of 12 patients with complete remission,partial remission or stable tumor decreased more than 20％ of baseline values.The serum CgA levels of five patients increased more than 20 ％ of baseline values and the tumors of them showed progress.Cox regression analysis showed that there was no correlation between CgA levels of patients with lesions and prognosis (r=1.000,P=0.252).Conclusion Neuroendocrine marker CgA has high diagnostic value in GEP-NEN,and can be used as an important biomarker in clinical diagnosis and efficacy evaluation of GEP-NEN.