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Abdominal Radiology (New York) Feb 2023To describe the appearance of chronically hemorrhagic adenomas on adrenal protocol CT and correlate imaging with pathologic findings.
PURPOSE
To describe the appearance of chronically hemorrhagic adenomas on adrenal protocol CT and correlate imaging with pathologic findings.
METHODS
Retrospective case series of adult patients with resected adrenal adenomas showing internal hemorrhage at histology. Seven of nine patients underwent pre-operative adrenal protocol CT and 2/7 underwent unenhanced CT with portal venous phase CT. Two abdominal radiologists in consensus assessed the CT images for the presence of calcifications, macroscopic fat, cystic/necrotic appearance, and the presence, pattern, and percent nodule volume of areas < 10 HU on unenhanced CT. Absolute washout was calculated using a large ROI, and ROIs on the highest and lowest attenuating regions on the portal venous phase.
RESULTS
Mean adenoma length was 4.9 cm. All adenomas had areas measuring < 10 HU on unenhanced CT, ranging from < 20 to > 80% nodule volume. Calcifications were present in 4/9 adenomas and gross fat in 4/9 on CT. Of the seven cases with adrenal protocol CT, the absolute washout was < 60% in 5/7 using the large ROI, 5/7 using the low attenuation ROI, and 7/7 using the high attenuation ROI. At histology, all nine cases had microscopic evidence of hemorrhage, lipid rich adenoma cells, and fibrosclerosis. Myelolipomatous changes were identified in 4/9 cases, with the remaining five cases showing lipomatous metaplasia without a myeloid component.
CONCLUSION
Chronically hemorrhagic adrenal adenomas demonstrated variable areas < 10 HU on unenhanced CT corresponding to lipid rich adenoma cells. Absolute washout was most often < 60%, hypothesized to be due to fibrosclerosis within the adenomas.
Topics: Adult; Humans; Adrenal Gland Neoplasms; Retrospective Studies; Tomography, X-Ray Computed; Adrenocortical Adenoma; Adenoma; Hemorrhage; Lipids; Sensitivity and Specificity; Diagnosis, Differential
PubMed: 36380211
DOI: 10.1007/s00261-022-03741-9 -
Reviews in Endocrine & Metabolic... Jun 2020Surgery of aggressive pituitary adenomas and pituitary carcinomas is part of the interdisciplinary management of these difficult to treat tumors. Invasion, giant size... (Review)
Review
Surgery of aggressive pituitary adenomas and pituitary carcinomas is part of the interdisciplinary management of these difficult to treat tumors. Invasion, giant size and unusual, asymmetric extent of these tumors frequently require modifications or extensions of the standard approaches for transsphenoidal and transcranial surgery. Frequently, only debulking procedures can be performed. In aggressive and hormone secreting adenomas, the remission rates achieved by surgery alone are relatively poor and adjuvant medical treatments or irradiation are needed. Safe resection of as much tumor as possible and symptomatic control is aimed at, rather than remission. Many procedures are required for rapid progression of lesions or recurrences, in order to extend the survival of the patients. Metastases of pituitary carcinomas within the cranial cavity or spine can be attacked. Since they can occur anywhere in the brain or spinal canal they require the entire battery of neurosurgical approaches. Unfortunately, in this group of pituitary tumors, the complication rates are higher than in primary operations of enclosed adenomas. The respective techniques with their facilities and limitations are reviewed in this article.
Topics: Adenoma; Carcinoma; Humans; Neoplasm Invasiveness; Pituitary Neoplasms
PubMed: 32500483
DOI: 10.1007/s11154-020-09563-8 -
Gastroenterology Jan 2021Mutations in the APC gene and other genes in the Wnt signaling pathway contribute to development of colorectal carcinomas. R-spondins (RSPOs) are secreted proteins that...
BACKGROUND & AIMS
Mutations in the APC gene and other genes in the Wnt signaling pathway contribute to development of colorectal carcinomas. R-spondins (RSPOs) are secreted proteins that amplify Wnt signaling in intestinal stem cells. Alterations in RSPO genes have been identified in human colorectal tumors. We studied the effects of RSPO1 overexpression in Apc mutant mice.
METHODS
An adeno associated viral vector encoding RSPO1-Fc fusion protein, or control vector, was injected into Apcmice. Their intestinal crypts were isolated and cultured as organoids. which were incubated with or without RSPO1-Fc and an inhibitor of transforming growth factor beta receptor (TGFBR). Livers were collected from mice and analyzed by immunohistochemistry. Organoids and adenomas were analyzed by quantitative reverse-transcription PCR, single cell RNA sequencing, and immunohistochemistry.
RESULTS
Intestines from Apc mice injected with the vector encoding RSPO1-Fc had significantly deeper crypts, longer villi, with increased EdU labeling, indicating increased proliferation of epithelial cells, in comparison to mice given control vector. AAV-RSPO1-Fc-transduced Apc mice also developed fewer and smaller intestinal tumors and had significantly longer survival times. Adenomas of Apc mice injected with the RSPO1-Fc vector showed a rapid increase in apoptosis and in the expression of Wnt target genes, followed by reduced expression of messenger RNAs and proteins regulated by the Wnt pathway, reduced cell proliferation, and less crypt branching than adenomas of mice given the control vector. Addition of RSPO1 reduced the number of adenoma organoids derived from Apc mice and suppressed expression of Wnt target genes but increased phosphorylation of SMAD2 and transcription of genes regulated by SMAD. Inhibition of TGFBR signaling in organoids stimulated with RSPO1-Fc restored organoid formation and expression of genes regulated by Wnt. The TGFBR inhibitor restored apoptosis in adenomas from Apc mice expressing RSPO1-Fc back to the same level as in the adenomas from mice given the control vector.
CONCLUSIONS
Expression of RSPO1 in Apc mice increases apoptosis and reduces proliferation and Wnt signaling in adenoma cells, resulting in development of fewer and smaller intestinal tumors and longer mouse survival. Addition of RSPO1 to organoids derived from adenomas inhibits their growth and promotes proliferation of intestinal stem cells that retain the APC protein; these effects are reversed by TGFB inhibitor. Strategies to increase the expression of RSPO1 might be developed for the treatment of intestinal adenomas.
Topics: Adenoma; Animals; Disease Models, Animal; Intestinal Neoplasms; Mice; Organoids; Thrombospondins; Transforming Growth Factor beta; Wnt Signaling Pathway
PubMed: 32941878
DOI: 10.1053/j.gastro.2020.09.011 -
Graefe's Archive For Clinical and... Dec 2020This study aims to evaluate the clinical features of adenoma of the retinal pigment epithelium (RPE) and eye-sparing treatment for it.
PURPOSE
This study aims to evaluate the clinical features of adenoma of the retinal pigment epithelium (RPE) and eye-sparing treatment for it.
METHODS
The patients underwent measurement of visual acuity and intraocular pressure, slit-lamp examination, ophthalmoscopy, fluorescein fundus angiography (FFA), indocyanine green angiography (ICGA), color Doppler imaging (CDI), and magnetic resonance imaging (MRI). The tumors were endoresected and studied histopathologically.
RESULTS
Of the 16 Asian patients, 15 had RPE adenoma and 1 had RPE adenocarcinoma. Visual acuity decreased in three cases, mainly due to the macular detachment. All tumors were solitary and unilateral and measured from 1.7 × 3.2 × 2.4 to 9.3 × 8.0 × 6.6 mm. The tumor was located in the macular area in 2 patients, in the juxtapapillary area in 1 patient, and in the peripheral fundus in 13 patients. The tumors were yellow-pink in 3 patients and brown in 13 patients. The tumors showed hypofluorescence in early stage and mottled hyperfluorescence with prominent leakage in late stage on fluorescein angiography. CDI demonstrated arterial blood signals within tumor, and MRI demonstrated hyperintensity and hypointensity in the T1- and T2-weighted images, respectively. The tumors were positive for S-100, neuron-specific enolase (NSE), CK, epithelial membrane antigen (EMA), and vimentin; occasionally positive for melanin-A; and usually negative for melanoma-specific antigen HMB45 and synaptophysin (Syn). The endoresection surgery was performed in all 16 patients by the microinvasive vitrectomy for the excision of intraocular tumors and reconstruction of the eyeball. The follow-up time was 1.5-13 years (mean, 5 years). No tumor recurrence occurred, and the retina remained attached in 16 eyes.
CONCLUSIONS
RPE-derived adenomas are rare and difficult to diagnose clinically. Local resection by the mircoinvasive vitrectomy is a feasible alternative treatment for RPE adenoma.
Topics: Adenoma; Fluorescein Angiography; Humans; Neoplasm Recurrence, Local; Ophthalmoscopy; Retinal Pigment Epithelium
PubMed: 32535672
DOI: 10.1007/s00417-020-04784-8 -
Vitamins and Hormones 2022A parathyroid adenoma comprises 80-85% as a cause of primary hyperparathyroidism. The clonal origin of most parathyroid adenomas suggests a defect at the level of the...
A parathyroid adenoma comprises 80-85% as a cause of primary hyperparathyroidism. The clonal origin of most parathyroid adenomas suggests a defect at the level of the gene controlling growth of the parathyroid cell or the expression of parathyroid hormone (PTH). Two genes, MEN1 and CCND1, a tumor suppressor and a proto-oncogene respectively, have been solidly established as primary tumorigenic drivers in parathyroid adenomas. As well, germline and somatic mutation of other genes involved in cell cycle regulation or PTH regulation have been discovered in parathyroid adenomas. Moreover, comparative genomic studies between parathyroid adenomas and normal parathyroid tissues have suggested more complex genetic landscape. Microarray analysis have revealed differential expression profiles of genes involved in cell cycle regulation, growth factors, apoptotic pathway, or PTH synthesis or regulation pathway such as CASR, GCM2 and KL (Klotho). Furthermore, recent next-generation sequencing analysis reconfirmed previous finding or revealed novel finding, suggesting signal peptidase complex subunit (SPCS2), ribosomal proteins (RPL23, RPL26, RPN1, RPS25), the endoplasmic reticulum membrane (SEC11C, SEC11A, SEC61G), Klotho, cyclin D1, β-catenin, VDR, CaSR and GCM2 may be important factors contributing to the parathyroid adenoma.
Topics: Adenoma; Humans; Parathyroid Glands; Parathyroid Hormone; Parathyroid Neoplasms; Peptide Hydrolases; SEC Translocation Channels; Transcriptome
PubMed: 35953114
DOI: 10.1016/bs.vh.2022.04.003 -
Expert Review of Gastroenterology &... 2023The introduction of widespread colonoscopy screening programs has helped in decreasing the incidence of Colorectal Cancer (CRC). However, 'back-to-back' colonoscopies... (Review)
Review
INTRODUCTION
The introduction of widespread colonoscopy screening programs has helped in decreasing the incidence of Colorectal Cancer (CRC). However, 'back-to-back' colonoscopies revealed relevant percentage of missed adenomas. Quality indicators were created to further homogenize detection performances and decrease the incidence of post-colonoscopy CRC. Among them, the Adenoma Detection Rate (ADR), defined as the percentage obtained by dividing the number of endoscopic procedures in which at least one adenoma was resected, by the total number of procedures, was found to be inversely associated with the risks of interval colorectal cancer, advanced-stage interval cancer, and fatal interval cancer.
AREAS COVERED
In this paper, we performed a comprehensive review of the literature focusing on promising new devices and technologies, which are meant to positively affect the endoscopist performance in detecting adenomas, therefore increasing ADR.
EXPERT OPINION
Considering the current knowledge, although several devices and technologies have been proposed with this intent, the recent implementation of AI ranked over all of the other strategies and it is likely to become the new standard within few years. However, the combination of different device/technologies need to be investigated in the future aiming at even further increasing of endoscopist detection performances.
Topics: Humans; Early Detection of Cancer; Colonoscopy; Adenoma; Incidence; Colorectal Neoplasms
PubMed: 37869781
DOI: 10.1080/17474124.2023.2273990 -
Digestive Diseases and Sciences Jan 2023
Topics: Humans; Colonic Polyps; Colonoscopy; Adenoma; Colorectal Neoplasms; Risk Factors; Retrospective Studies
PubMed: 35810267
DOI: 10.1007/s10620-022-07612-7 -
European Neurology 2022Pituitary adenomas (PAs) account for the top three primary intracranial tumors in terms of total incidence rate. PAs can cause severe endocrine disorders and even... (Review)
Review
Pituitary adenomas (PAs) account for the top three primary intracranial tumors in terms of total incidence rate. PAs can cause severe endocrine disorders and even malignant features, such as invasion, metastasis, and recurrence. Therefore, the early diagnosis and accurate prognosis would be greatly beneficial for clinical treatment of PAs. MicroRNAs (miRNAs) are small, protein-noncoding RNAs that regulate gene expression posttranscriptionally. They regulate essential physiological processes, including proliferation, growth, and apoptosis, and also they involve in the invasion and metastasis of malignant tumors. At the tissue level, differential miRNA expression in endocrine malignancies including PAs has been reported. When miRNAs have been successfully detected in various biofluids and cell-free environments, their important roles as potential screening or prognostic biomarkers have been extensively investigated. The current work reviews recent studies on the emerging roles of miRNAs in PAs and the clinical significance.
Topics: Adenoma; Humans; MicroRNAs; Pituitary Neoplasms; Prognosis
PubMed: 35034033
DOI: 10.1159/000521388 -
Reviews in Endocrine & Metabolic... Jun 2020Pituitary tumors are not rare if prevalence rates from autopsy or radiological series are considered; approximately 0.5% of all pituitary adenomas will come to medical... (Review)
Review
Pituitary tumors are not rare if prevalence rates from autopsy or radiological series are considered; approximately 0.5% of all pituitary adenomas will come to medical attention. Less than 0.1% of these pituitary adenomas will become malignant, and probably around 0.5% of all detected adenomas will display an aggressive course. However, the exact incidence of both aggressive pituitary adenomas and pituitary carcinomas is unknown, as most data come from series with selected patients, such as surgically treated patients, which is likely not a reflection of all patients with a pituitary adenoma. An aggressive pituitary adenoma is not well-defined; even though an overarching definition, capturing both immunohistochemical and clinical characteristics is probably not waterproof, adoption of a widely accepted definition will be very helpful to harmonize research and establish more reliable epidemiological data.
Topics: Adenoma; Humans; Neoplasm Invasiveness; Pituitary Neoplasms
PubMed: 32361816
DOI: 10.1007/s11154-020-09556-7 -
International Journal of Molecular... May 2020Colorectal cancer (CRC) is a malignant disease with an incidence of over 1.8 million new cases per year worldwide. CRC outcome is closely related to the respective stage... (Review)
Review
Colorectal cancer (CRC) is a malignant disease with an incidence of over 1.8 million new cases per year worldwide. CRC outcome is closely related to the respective stage of CRC and is more favorable at less advanced stages. Detection of early colorectal adenomas is the key to survival. In spite of implemented screening programs showing efficiency in the detection of early precancerous lesions and CRC in asymptomatic patients, a significant number of patients are still diagnosed in advanced stages. Research on CRC accomplished during the last decade has improved our understanding of the etiology and development of colorectal adenomas and revealed weaknesses in the general approach to their detection and elimination. Recent studies seek to find a reliable non-invasive biomarker detectable even in the blood. New candidate biomarkers could be selected on the basis of so-called liquid biopsy, such as long non-coding RNA, microRNA, circulating cell-free DNA, circulating tumor cells, and inflammatory factors released from the adenoma into circulation. In this work, we focused on both genetic and epigenetic changes associated with the development of colorectal adenomas into colorectal carcinoma and we also discuss new possible biomarkers that are detectable even in adenomas prior to cancer development.
Topics: Adenoma; Animals; Biomarkers, Tumor; Cell Transformation, Neoplastic; Colorectal Neoplasms; Disease Susceptibility; Early Detection of Cancer; Gene Expression Regulation, Neoplastic; Genetic Variation; Humans
PubMed: 32380676
DOI: 10.3390/ijms21093260