-
Cirugia Y Cirujanos 2017Hepatic adenomas are uncommon epithelial tumours. They usually appear in women between 20 and 44 years old. They are commonly located in the right hepatic lobe and are... (Review)
Review
BACKGROUND
Hepatic adenomas are uncommon epithelial tumours. They usually appear in women between 20 and 44 years old. They are commonly located in the right hepatic lobe and are typically solitary masses. Multiple adenomas can present in patients with prolonged use of oral contraceptive pills, glycogen storage diseases and hepatic adenomatosis.
CLINICAL CASE
A 35 year-old woman without any significant past medical history, with a chief complaint that started in December 2012 with oppressive, mild intensity abdominal pain located in right upper quadrant in the abdomen on deep palpation. With an abdominal ultrasound showing a mass of 91×82×65cm located in the right flank, isoechogenic with internal vascularity. Contrast computed tomography scan showing an ovoid tumour with circumscribed borders, with heterogenic intense reinforcement and displacement of adjacent structures with dimensions of 88×71×80cm. In laparotomy, excision of the tumour and cholecystectomy with the trans surgical findings of an 8cm tumour with a pedicle containing one artery and one vein coming from the hepatic free border with strong adhesions to the gallbladder. Pathologic diagnosis: Extracapsular hepatic adenoma.
CONCLUSIONS
Incidence of hepatic adenomas has increased in the last decades, in a parallel fashion with the introduction of oral contraceptive pills, showing association with glycogen storage diseases and to a lesser degree with diabetes and pregnancy. Diagnosis is clinical with the aid of imaging studies. Prognosis of hepatic adenomas is not well established, therefore, management depends on symptoms, size, number, location and certainty of diagnosis.
Topics: Adenoma; Adult; Female; Humans; Liver Neoplasms
PubMed: 26920214
DOI: 10.1016/j.circir.2015.12.006 -
The Korean Journal of Internal Medicine Jul 2020We evaluated the miss rates of polyps, adenomas, and advanced neoplasia of polypectomy-referring hospitals and risk factors for missed adenomas.
BACKGROUND/AIMS
We evaluated the miss rates of polyps, adenomas, and advanced neoplasia of polypectomy-referring hospitals and risk factors for missed adenomas.
METHODS
We compared medical records and electronic images of initial colonoscopies from polypectomy-referring hospitals with those of corresponding therapeutic colonoscopies from Seoul St. Mary's Hospital obtained from May 2014 to February 2016.
RESULTS
A total of 147 patients (56.6 ± 12.1 years, 37 females) were included. The mean number of polyps and adenomas detected on initial colonoscopy was 2.4 ± 1.7 and 1.7 ± 1.4, respectively. The mean number of additionally detected polyps and adenomas per patient during therapeutic colonoscopy was 1.4 ± 1.8 and 1.0 ± 1.5, respectively. Pooled miss rate for polyps, adenomas, and advanced neoplasia was 36%, 37%, and 11%, respectively. Pooled miss rate for adenomas was significantly higher for right-sided, non-pedunculated, and small (< 1 cm) adenomas (p = 0.031, p = 0.000, and p = 0.000, respectively). The miss rate of polyps, adenomas, and advanced neoplasia per patient was 60%, 49%, and 7%, respectively. Multivariate analysis revealed age and number of adenoma on initial colonoscopy were significantly related with risk for adenoma-missing (p = 0.005 and p = 0.023, respectively).
CONCLUSION
Among patients referred for polypectomy, adenoma is missed in one of two patients and advanced neoplasm is missed in one of 13. Patients with advanced age or multiple adenoma on initial colonoscopy have a higher possibility of missed adenoma. Total colon exploration should be performed carefully during therapeutic colonoscopy.
Topics: Adenoma; Colonic Neoplasms; Colonic Polyps; Colonoscopy; Diagnostic Errors; Female; Hospitals; Humans; Republic of Korea; Seoul
PubMed: 31610632
DOI: 10.3904/kjim.2018.099 -
Ophthalmic Plastic and Reconstructive...Chronic granulomatous inflammation occurs rarely alongside pleomorphic adenomas of the major salivary glands but would not appear to have been reported with lacrimal...
Chronic granulomatous inflammation occurs rarely alongside pleomorphic adenomas of the major salivary glands but would not appear to have been reported with lacrimal gland adenomas. We describe the clinical features, imaging and histopathology for 4 patients (3 female) who had granulomatous inflammation alongside lacrimal gland adenomas-the patients being with age 39, 44, 48, and 53 years at time of surgery. One patient had an asymptomatic lesion found on imaging, and the other 3 had symptoms for between 3 years and several decades. Conjecturally, this rare phenomenon might arise from an inflammatory response to leakage of secretions from the ductular components of the glands.
Topics: Adenoma; Adenoma, Pleomorphic; Dacryocystitis; Female; Humans; Inflammation; Lacrimal Apparatus Diseases; Male; Salivary Gland Neoplasms
PubMed: 34812181
DOI: 10.1097/IOP.0000000000002096 -
Journal of Minimally Invasive Gynecology Jul 2023Tubulovillous adenomas are colonic polyps with a relatively high potential for malignancy that are typically identified on colonoscopy. We present a case of colonic...
Tubulovillous adenomas are colonic polyps with a relatively high potential for malignancy that are typically identified on colonoscopy. We present a case of colonic tubulovillous adenoma first discovered on gynecologic transvaginal ultrasound. The patient was a 42-year-old gravida 2 para 2 female with symptoms suggestive of endometriosis, including left lower quadrant pain, heavy menstrual bleeding, urinary urgency, and dyschezia. The patient underwent transvaginal ultrasound following the International Deep Endometriosis Analysis protocol that identified an intermediate echogenicity, vascular solid mass of the rectosigmoid lumen. Consequent colonoscopy and polypectomy revealed tubulovillous tissue negative for high-grade dysplasia or malignancy. This case report highlights the importance of gynecologists developing an acute awareness of colonic pathologies that might be encountered while performing endometriosis ultrasounds with direct assessment of the rectum.
Topics: Humans; Female; Adult; Endometriosis; Colonic Polyps; Adenoma; Colonoscopy; Ultrasonography
PubMed: 36948244
DOI: 10.1016/j.jmig.2023.03.009 -
BMJ Case Reports Mar 2015Undescended parathyroid adenomas are rare, representing 0.08% of all parathyroid adenomas; however, they make up 7% of the underlying cause of failed cervical...
Undescended parathyroid adenomas are rare, representing 0.08% of all parathyroid adenomas; however, they make up 7% of the underlying cause of failed cervical exploration in patients with persistent primary hyperparathyroidism. A 43-year-old woman with no significant medical or family history presented with fatigue and was diagnosed with primary hyperparathyroidism; however, preoperative imaging including sestamibi scan and ultrasound was unable to identify the hyperfunctioning gland. She underwent a neck exploration and hemithyroidectomy and partial parathyroidectomy with failure of resolution of her disease. Subsequent work up including a CT of the neck demonstrated a 1.9 cm mass adjacent to the left submandibular gland. This was removed with postoperative normalisation of the patient's serum calcium and parathyroid hormone levels.
Topics: Adenoma; Adult; Female; Humans; Hyperparathyroidism; Hyperparathyroidism, Primary; Parathyroid Neoplasms; Parathyroidectomy; Treatment Outcome
PubMed: 25737222
DOI: 10.1136/bcr-2014-208277 -
World Neurosurgery Nov 2018Pituitary adenomas are one of the most common tumors of adulthood; however, subtypes such as Crooke cell adenoma are relatively rare. (Review)
Review
BACKGROUND
Pituitary adenomas are one of the most common tumors of adulthood; however, subtypes such as Crooke cell adenoma are relatively rare.
CASE DESCRIPTION
We present the case of a 55-year-old woman who presented with new-onset intermittent headache and dizziness. Clinical and laboratory investigations were not suggestive of corticotroph tumor. However, subsequent computed tomography and magnetic resonance imaging scans revealed the presence of a suprasellar pituitary adenoma displacing the optic chiasma superiorly, with hemorrhage and sellar expansion. The lesion was removed by transsphenoidal surgery and the biopsy confirmed the lesion to be a nonfunctioning pituitary macroadenoma. Further investigation revealed that the specimen demonstrated Crooke hyaline changes, with strong immunoreactivity for adrenocorticotropic hormone. However, initial workup and postoperative testing lacked evidence of Cushing disease. There was no sign of recurrence after 1-year follow-up.
CONCLUSIONS
Clinically silent Crooke cell adenomas are rare occurrences, and as such we report this case with investigation of past cases.
Topics: ACTH-Secreting Pituitary Adenoma; Adenoma; Diagnosis, Differential; Disease Management; Female; Humans; Middle Aged
PubMed: 30077745
DOI: 10.1016/j.wneu.2018.07.233 -
Tumori 1995The current clinical interest in large bowel adenoma is due to the evidence that most carcinomas arise in benign adenomas and therefore endoscopic removal of adenomas... (Review)
Review
The current clinical interest in large bowel adenoma is due to the evidence that most carcinomas arise in benign adenomas and therefore endoscopic removal of adenomas interrupts the sequence that leads to cancer. Colonoscopy is the best method for the detection and treatment of adenomas, with a diagnostic accuracy of 94% and a low incidence of complications. The majority of polyps can be resected by snare polypectomy. Regarding small polyps, snare polypectomy without current application is recommendable and hot biopsy should be avoided owing to a non negligible risk of hemorrage. Though clinical significance of small polyps is controversial, in our experience and in other studies they have a potential for malignant progression (2.4% of adenomas containing invasive carcinoma are 6 mm or less in diameter) and those located in the rectosigmoid are predictive of proximal neoplasms. If endoscopic polypectomy significantly reduces the incidence of colorectal cancer, patients submitted to adenoma removal have an increased risk for metachronous adenomas. Surveillance is therefore mandatory, once the presence of synchronous adenomas has been ruled out (clean colon). Risk factors for adenoma recurrence are family history, age, size of adenoma, multiple adenomas, dysplasia, villous histotype. Holding in due consideration compliance, risk of complications, logistic problems and costs, the following guide-lines can be proposed: total colonoscopy at the time of endoscopic polypectomy (to obtain a "clean colon") and, in the case of unsatisfactory examination, within one year. first check at 3 years and, if negative, subsequent check at 5 years. for small tubular adenomas surveillance is indicated only in the case they are multiple. The evaluation of some intermediate bio-markers might contribute to the predictive determination of adenoma recurrence, with the goal to select groups of patients with the highest risk of recurrence of adenomas.
Topics: Adenoma; Adenomatous Polyposis Coli; Carcinoma; Cell Transformation, Neoplastic; Colonoscopy; Colorectal Neoplasms; Humans; Population Surveillance; Treatment Outcome
PubMed: 7571051
DOI: No ID Found -
Revista Medica Del Instituto Mexicano... Apr 2019Non-functional pituitary adenomas (NFPAs) present low growth rates; however, some are aggressive and invasive. In 2017 the World Health Organization recognized...
BACKGROUND
Non-functional pituitary adenomas (NFPAs) present low growth rates; however, some are aggressive and invasive. In 2017 the World Health Organization recognized clinically aggressive adenomas as “high-risk pituitary adenomas”. These include the sparsely granulated somatotroph adenoma, the Crooke’s cell adenoma, the silent corticotroph adenoma and the plurihormonal Pit-1-positive adenoma (subtype 3).
CLINICAL CASE
25-year-old woman who presented oligomenorrhea, increased weight, decreased visual acuity and chronic headache. Biochemical and imaging evaluation showed a NFPA. Transsphenoidal surgery was performed with complete resection of lesion, and during short-term follow-up it was observed recurrence, which is why the patient needed two more interventions. The immunohistochemistry reported: ACTH ++ 90%, prolactin ++ 20%, GH ++ 5%, CKAE1-AE3 +++ 90%, Ki-67 10%. The final diagnosis was plurihormonal adenoma, since the immunohistochemical analysis was positive for more than one pituitary hormone and suggested two distinct cell lineages: Pit-1 and Tpit, both recognized as aggressive adenomas.
CONCLUSIONS
This case report highlights the significance of a comprehensive immunohistochemical study, which includes transcriptional factors to classify cell lineage, in order to predict aggressiveness and provide personalized treatment.
Topics: Adenoma; Adult; Biomarkers, Tumor; Female; Growth Hormone-Secreting Pituitary Adenoma; Humans; Immunohistochemistry
PubMed: 31071255
DOI: No ID Found -
Pituitary Jun 2023The majority of corticotroph adenomas are benign but some are locally invasive, demonstrate high rates of recurrence, and exhibit a relatively poor response to often... (Review)
Review
The majority of corticotroph adenomas are benign but some are locally invasive, demonstrate high rates of recurrence, and exhibit a relatively poor response to often repeated surgical, medical, and radiation treatment. Herein, we summarize the currently known somatic and genetic mutations and other molecular factors that influence the pathogenesis of these tumors and discuss currently available therapies. Although recent molecular studies have advanced our understanding of the pathogenesis and behavior of these refractory corticotroph adenomas, these insights do not reliably guide treatment choices at present. Development of additional diagnostic tools and novel tumor-directed therapies that offer efficacious treatment choices for patients with refractory corticotroph adenomas are needed.
Topics: Humans; ACTH-Secreting Pituitary Adenoma; Adenoma; Pituitary Neoplasms
PubMed: 36917358
DOI: 10.1007/s11102-023-01308-5 -
International Journal of Colorectal... Jan 2024Adenoma's detection rates have been reported to vary with the participation status of endoscopic nurses during colonoscopy. This meta-analysis was conducted to determine... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Adenoma's detection rates have been reported to vary with the participation status of endoscopic nurses during colonoscopy. This meta-analysis was conducted to determine whether the participation of endoscopy nurses during colonoscopy contributed to the improved detection rate of polyps and adenomas.
METHODS
We retrieved English original research from PubMed, Embase, Web of Science, and Cochrane library databases and Chinese original research from the CNKI Data database. We searched for randomized controlled trials (RCTs) comparing the effect of participation of endoscopy nurses during colonoscopy of colorectal polyps and adenomas on polyp detection rates to that of nonparticipation. RevMan5.4 software was used to perform the meta-analysis.
RESULTS
This meta-analysis included 11 randomized controlled trials involving 8278 patients. The results showed no significant difference between colonoscopies performed by nurses and endoscopists, but colonoscopies performed by two nurses significantly improved the detection rate of polyps and adenomas. In the random effects model, there was a significant difference in PDR between the single-observation and dual-observation groups (RR, 1.27; 95%CI, 1.05, 1.54; Z = 2.51; P = 0.01). The ADR difference between the single observation group and the double observation group was statistically significant (RR, 1.15; 95%CI, 1.05, 1.26; Z = 2.91; P = 0.004).
CONCLUSION
Endoscopy nurses' participation in colonoscopy can improve the detection rate of polyps and adenomas, However, more research is needed to confirm the results.
Topics: Humans; Adenoma; Colonoscopy; Databases, Factual; Polyps; Randomized Controlled Trials as Topic; Nurses
PubMed: 38227195
DOI: 10.1007/s00384-023-04585-5