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Seminars in Diagnostic Pathology Sep 2021Ciliated muconodular papillary tumor (CMPT) is an uncommon tumor of the lung, usually detected incidentally in the peripheral lung fields on computed tomography. It is... (Review)
Review
Ciliated muconodular papillary tumor (CMPT) is an uncommon tumor of the lung, usually detected incidentally in the peripheral lung fields on computed tomography. It is most commonly diagnosed in patients between the sixth and last decades of life. The canonical microscopic feature is a tripartite mixture of ciliated columnar, mucous, and basal cells with papillary architecture. However, studies have shown wide morphological variations in this tumor, such as a lack of ciliated columnar or mucous cells and flat instead of papillary architecture. Hence, a new umbrella term, bronchiolar adenoma (BA), has been proposed to encompass all tumors comprising a uniform layer of basal cells underneath the luminal epithelium displaying bronchiolar differentiation. Recent molecular studies on CMPT/BA discovered a high frequency of driver gene alterations, including mutations in the BRAF, EGFR, AKT1, KRAS, and HRAS genes, as well as ALK gene rearrangements. The tumor follows an indolent clinical course, as no recurrences or metastases have been reported in patients who underwent surgical resection. In this article we review the clinical, radiological, and pathological features, and molecular characteristics of CMPTs/BAs.
Topics: Adenoma; Humans; Lung; Lung Neoplasms; Mutation; Tomography, X-Ray Computed
PubMed: 33985833
DOI: 10.1053/j.semdp.2021.04.002 -
Head & Neck Sep 2019We evaluate our initial experience of transoral vestibular approach parathyroidectomy (TOEPVA) for the treatment of primary hyperparathyroidism. (Observational Study)
Observational Study
BACKGROUND
We evaluate our initial experience of transoral vestibular approach parathyroidectomy (TOEPVA) for the treatment of primary hyperparathyroidism.
METHODS
We conducted a prospective study of patients with single parathyroid adenoma, using TOEPVA to perform the parathyroidectomy. The variables we analyzed were size, volume, and location of the adenoma, bleeding, identification, and preservation of the recurrent laryngeal nerve, injury to the mental nerve, and the effective cure rate, using measures of central tendency.
RESULTS
Our study included 21 women, with an average age of 43 years. The recurrent laryngeal nerve and mental nerve suffered no permanent damage, the average size of the adenoma was 26.6 mm, and a volume of 3.95 mL. We were able to identify the adenoma and cure the hyperparathyroidism in 20 of the patients (95.2%).
CONCLUSIONS
TOEPVA is viable and safe in who wish to avoid the cervical scar resulting for the patient with primary hyperparathyroidism.
Topics: Adenoma; Adult; Female; Humans; Hyperparathyroidism, Primary; Longitudinal Studies; Middle Aged; Natural Orifice Endoscopic Surgery; Parathyroid Neoplasms; Parathyroidectomy; Prospective Studies; Treatment Outcome
PubMed: 31157933
DOI: 10.1002/hed.25828 -
The American Journal of Surgical... Aug 2023Nipple adenoma (NA) is a rare, benign proliferation of the nipple ducts. It may be clinically mistaken for Paget disease or squamous cell carcinoma; thus, microscopic...
Nipple adenoma (NA) is a rare, benign proliferation of the nipple ducts. It may be clinically mistaken for Paget disease or squamous cell carcinoma; thus, microscopic evaluation is paramount. A large case series of NA has not been undertaken since the 1980s. Therefore, we undertook this study to evaluate the clinicopathologic characteristics of NA, emphasizing differential diagnoses and follow-up data. We retrieved 50 cases from our in-house archives or consultation files between 2003 and 2022. Available slides were reviewed, and clinical data and follow-up information were obtained. Cases must have exhibited a dense ductal proliferation in the breast tissue with proximity to the nipple epidermis. All patients were women; median age was 56 years. In all, 68% of patients were symptomatic; 53% demonstrated a skin growth. Overall, 67% were excised completely, either primarily (33%) or via re-excision after biopsy (33%). Four histologic patterns were noted: adenosis (dense proliferation of small-to-medium ducts); large duct (medium-to-large caliber ducts); papillary-like (frond-like architecture with branching, slit-like lumens); and pseudoinfiltrative (ducts squished and distorted by dense stromal fibrosis). Follow-up in 44 patients (88%) with a median time of 66 months showed no evidence of recurrence. NA demonstrates a wide spectrum of histopathologic variation. Subtyping of this entity is unlikely to be clinically relevant. Differentiation from invasive carcinoma or other histologic mimics (syringocystadenoma papilliferum, syringomatous adenoma) may be difficult. Simple excision is curative, and recurrence is rare. A definitive link to invasive carcinoma has not been established.
Topics: Humans; Female; Middle Aged; Male; Breast Neoplasms; Adenoma; Nipples; Adenocarcinoma
PubMed: 37272622
DOI: 10.1097/PAS.0000000000002063 -
Abdominal Radiology (New York) Mar 2022To assess whether heterogeneous adrenal adenomas can be distinguished from heterogeneous non-adenomas with Computed Tomography (CT) and/or Magnetic Resonance Imaging...
PURPOSE
To assess whether heterogeneous adrenal adenomas can be distinguished from heterogeneous non-adenomas with Computed Tomography (CT) and/or Magnetic Resonance Imaging (MRI).
METHOD
From 2009 to 2019, 980 consecutive adrenalectomies were retrospectively identified. Patients without adequate CT/MRI, with homogeneous and/or < 1 cm lesions were excluded. Differences between adenomas and non-adenomas were analyzed using Chi-square, Student t or Fischer tests, and interobserver agreement using weighted kappa test or intraclass correlation coefficient. Independent variables associated with adenomas were searched for using multivariable analysis. Area under the receiver operating characteristic curve (AUC) of the final model and its diagnostic performances were calculated.
RESULTS
Final population comprised 183 patients (106 women, 77 men, mean age 53.2 ± 14.4 years) with 124 non-adenomas and 59 heterogeneous adenomas. Macroscopic or microscopic fat on CT/MRI allowed diagnosis of adenoma with 98% specificity and 63% sensitivity. Interobserver agreement was almost perfect for macroscopic fat (k = 0.82; 95% CI 0.66; 0.94) and substantial for microscopic fat (k = 0.75; 95% CI 0.62; 0.86). A multivariable model including micro- or macroscopic fat [Odds ratio (OR) 81.19; 95% CI 20.17; 572.27], diameter < 5.5 cm (OR 7.32; 95% CI 2.17; 31.28), calcifications (OR 5.68; 95% CI 2.08; 16.18), and hemorrhage (OR 3.10; 95% CI 0.70; 15.35) had an AUC of 0.91 (95% CI 0.86; 0.96), 71% (42/59, 95% CI 58; 82) sensitivity, 93% (115/124; 95% CI 87; 97) specificity, and 86% (157/183; 95% CI 79; 90) accuracy for the diagnosis of adenoma.
CONCLUSION
A multivariable model enables CT/MR diagnosis of heterogeneous adenomas. Presence of microscopic fat, even if partial, in a heterogeneous mass is highly specific of adenoma.
Topics: Adenoma; Adrenal Gland Neoplasms; Adult; Aged; Diagnosis, Differential; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed
PubMed: 35037990
DOI: 10.1007/s00261-022-03409-4 -
Veterinary Pathology Nov 2021Although pyloric and duodenal adenomas occasionally occur in cats, limited information is currently available on their phenotypes and molecular features. The present...
Although pyloric and duodenal adenomas occasionally occur in cats, limited information is currently available on their phenotypes and molecular features. The present study investigated the pathological features of these tumors and the mechanisms underlying their tumorigenesis. Biopsy samples from 8 cats diagnosed with pyloric or duodenal adenomas were examined by histopathology and immunohistochemistry. Normal pyloric and duodenal tissues of cats were assessed for comparison. All cases showed a papillary growth of cuboidal to columnar cells with eosinophilic, ground-glass cytoplasm. Mucin in tumor cells was positive for periodic acid-Schiff and paradoxical concanavalin-A staining, but was negative for Alcian blue. Immunohistochemically, tumor cells were positive for cytokeratin (CK) 19 in 8/8 cases and for CK20 in 5/8 cases, and weakly positive for CD10 in 4/8 cases, CK7 in 3/8 cases, and β-catenin in 2/8 cases. Nuclear accumulation of p53 was not detected in any case. DNA sequencing analysis identified no or mutations in the 4/8 cases and 5/8 cases for which the KRAS and GNAS genes could be amplified. The histological and immunohistochemical features of tumor cells were similar to those of mucous neck cells and the pyloric gland of normal feline tissue. The morphology of feline pyloric and duodenal adenomas was consistent with that of pyloric gland adenoma in humans; however, its molecular pathogenesis may differ given the lack of and mutations in the feline tumors.
Topics: Adenoma; Animals; Cat Diseases; Cats; Duodenal Neoplasms; Duodenum; Gastric Mucosa; Immunohistochemistry
PubMed: 34269112
DOI: 10.1177/03009858211030542 -
Innere Medizin (Heidelberg, Germany) Jul 2024The widespread use of diagnostic imaging has led to an increase in the incidence of pituitary tumors. The majority of incidentalomas are hormone-inactive (HI) pituitary... (Review)
Review
The widespread use of diagnostic imaging has led to an increase in the incidence of pituitary tumors. The majority of incidentalomas are hormone-inactive (HI) pituitary microadenomas. The most common clinically relevant pituitary adenomas are prolactin-secreting, followed by HI, and far less common are growth hormone (GH)-, adrenocorticotropic hormone (ACTH)- and thyroid-stimulating hormone (TSH)-secreting adenomas. Pituitary adenomas are usually benign, although aggressive growth and invasion occurs in individual cases. Very rarely, they give rise to metastases and are then termed pituitary carcinomas. All pituitary tumors require endocrine testing for pituitary hormone excess. In addition to the medical history and clinical examination, laboratory diagnostics are very important. Symptoms such as irregular menstruation, loss of libido or galactorrhea often lead to the timely diagnosis of prolactinomas, and hyperprolactinemia can easily confirm the diagnosis (considering the differential diagnoses). Diagnosis is more difficult for all other hormone-secreting pituitary adenomas (acromegaly, Cushing's disease, TSHoma), as the symptoms are often non-specific (i.e., headaches, weight gain, fatigue, joint pain). Furthermore, comorbidities such as hypertension, diabetes, and depression are such widespread diseases that pituitary adenomas are rarely considered as the underlying cause. Timely diagnosis and appropriate treatment have a significant impact on morbidity, mortality, and quality of life. Therefore, the role of primary care physicians is very important for achieving an early diagnosis. In addition, patients with pituitary adenomas should always be referred to endocrinologists to ensure optimal diagnosis as well as treatment.
Topics: Humans; Pituitary Neoplasms; Diagnosis, Differential; Adenoma; Prolactinoma
PubMed: 38869654
DOI: 10.1007/s00108-024-01729-9 -
BMC Medicine Sep 2023Colorectal adenoma (CA), especially high-risk CA (HRCA), is a precancerous lesion with high prevalence and recurrence rate and accounts for about 90% incidence of...
BACKGROUND
Colorectal adenoma (CA), especially high-risk CA (HRCA), is a precancerous lesion with high prevalence and recurrence rate and accounts for about 90% incidence of sporadic colorectal cancer cases worldwide. Currently, recurrent CA can only be treated with repeated invasive polypectomies, while safe and promising pharmaceutical invention strategies are still missing due to the lack of reliable in vitro model for CA-related drug screening.
METHODS
We have established a large-scale patient-derived high-risk colorectal adenoma organoid (HRCA-PDO) biobank containing 37 PDO lines derived from 33 patients and then conducted a series of high-throughput and high-content HRCA drug screening.
RESULTS
We established the primary culture system with the non-WNT3a medium which highly improved the purity while maintained the viability of HRCA-PDOs. We also proved that the HRCA-PDOs replicated the histological features, cellular diversity, genetic mutations, and molecular characteristics of the primary adenomas. Especially, we identified the dysregulated stem genes including LGR5, c-Myc, and OLFM4 as the markers of adenoma, which are well preserved in HRCA-PDOs. Based on the HRCA-PDO biobank, a customized 139 compound library was applied for drug screening. Four drugs including metformin, BMS754807, panobinostat and AT9283 were screened out as potential hits with generally consistent inhibitory efficacy on HRCA-PDOs. As a representative, metformin was discovered to hinder HRCA-PDO growth in vitro and in vivo by restricting the stemness maintenance.
CONCLUSIONS
This study established a promising HRCA-PDO biobank and conducted the first high-throughput and high-content HRCA drug screening in order to shed light on the prevention of colorectal cancer.
Topics: Humans; Biological Specimen Banks; Drug Evaluation, Preclinical; Organoids; Adenoma; Colorectal Neoplasms; Metformin
PubMed: 37667332
DOI: 10.1186/s12916-023-03034-y -
World Journal of Gastroenterology Dec 2022There are differences in the diagnoses of superficial gastric lesions between Japan and other countries. In Japan, superficial gastric lesions are classified as adenoma... (Review)
Review
There are differences in the diagnoses of superficial gastric lesions between Japan and other countries. In Japan, superficial gastric lesions are classified as adenoma or cancer. Conversely, outside Japan, the same lesion is classified as low-grade dysplasia (LGD), high-grade dysplasia, or invasive neoplasia. Gastric carcinogenesis occurs mostly , and the adenoma-carcinoma sequence does not appear to be the main pathway of carcinogenesis. Superficial gastric tumors can be roughly divided into the mutation type and the mutation type, which are mutually exclusive. -type tumors have low malignancy and develop into LGD, whereas -type tumors have high malignancy and are considered cancerous even if small. For lesions diagnosed as category 3 or 4 in the Vienna classification, it is desirable to perform complete resection by endoscopic submucosal dissection followed by staging. If there is lymphovascular or submucosal invasion after mucosal resection, additional surgical treatment of gastrectomy with lymph node dissection is required. In such cases, function-preserving curative gastrectomy guided by sentinel lymph node biopsy may be a good alternative.
Topics: Humans; Adenoma; Carcinogenesis; Endoscopic Mucosal Resection; Gastric Mucosa; Stomach Neoplasms; Mutation
PubMed: 36632315
DOI: 10.3748/wjg.v28.i48.6900 -
Expert Review of Endocrinology &... Jul 2022Pituitary adenomas are a common and diverse group of intracranial tumors arising from the anterior pituitary that are usually slow-growing and benign, but still pose a... (Review)
Review
INTRODUCTION
Pituitary adenomas are a common and diverse group of intracranial tumors arising from the anterior pituitary that are usually slow-growing and benign, but still pose a significant healthcare burden to patients. Additionally, they are increasing in both incidence and prevalence, leading to a need for better understanding of molecular changes in the development of these tumors.
AREAS COVERED
A PubMed literature search was conducted using the terms 'pituitary adenoma' in combination with keywords related to secretory subtype: lactotroph, somatotroph, corticotroph, gonadotroph and null cell, in addition to their transcription factor expression: PIT1, TPIT, and SF-1. Articles resulting from this search were analyzed, as well as relevant articles cited as their references. In this review, we highlight recent advances in the genetic and epigenetic characterization of individual pituitary adenoma subtypes and the effect it may have on guiding future clinical treatment of these tumors.
EXPERT OPINION
Understanding the molecular biology of pituitary adenomas is a fundamental step toward advancing the treatment of these tumors. Yet crucial knowledge gaps exist in our understanding of the underlying molecular biology of pituitary adenomas which can potentially be addressed by turning to differentially activated molecular pathways in tumor relative to normal gland.
Topics: Adenoma; Humans; Molecular Biology; Pituitary Neoplasms
PubMed: 35702013
DOI: 10.1080/17446651.2022.2082942 -
Presse Medicale (Paris, France : 1983) Dec 2021Clinically non functioning pituitary adenomas (NFPAs) include all pituitary adenomas that are not hormonally active. They are not associated with clinical syndromes such... (Review)
Review
Clinically non functioning pituitary adenomas (NFPAs) include all pituitary adenomas that are not hormonally active. They are not associated with clinical syndromes such as amenorrhea-galactorrhea (prolactinomas), acromegaly, Cushing's disease or hyperthyroidism (TSH-secreting adenomas) and are therefore usually diagnosed by signs and symptoms related to a mass effect (headache, visual impairment, sometimes pituitary apoplexy), but also incidentally. Biochemical work up often documents several pituitary insufficiencies. In histopathology, the majority of NFPAs are gonadotroph. In the absence of an established medical therapy, surgery is the mainstay of treatment, unless contraindicated or in particular situations (e.g. small incidentalomas, distance from optic pathways). Resection, generally via a trans-sphenoidal approach (with the help of an endoscope), should be performed by a neurosurgeon with extensive experience in pituitary surgery, in order to maximize the chances of complete resection and to minimize complications. If a tumor remnant persists, watchful waiting is preferred to routine radiotherapy, as long as the tumor residue does not grow and is distant from the optic pathways. NFPA can sometimes recur even after complete resection, but predicting the individual risk of tumor remnant progression is difficult. Postoperative irradiation is only considered in case of residual tumor growth or relapse, due to its potential side effects.
Topics: Adenoma; Contraindications, Procedure; Humans; Neoplasm, Residual; Pituitary Neoplasms; Sphenoid Bone; Symptom Assessment; Watchful Waiting
PubMed: 34718111
DOI: 10.1016/j.lpm.2021.104086