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BMJ Case Reports Jun 2024Adrenocortical tumours are rare in children and account for only 0.3%-0.4% of all neoplasms in childhood. They present with variable signs and symptoms, depending on the...
Adrenocortical tumours are rare in children and account for only 0.3%-0.4% of all neoplasms in childhood. They present with variable signs and symptoms, depending on the type of hormonal hypersecretion. The majority of the adrenocortical tumours in children are functional (90%) and malignant (88%). Here, we describe a functional plurihormonal oncocytic adrenal cortical adenoma in a young girl, that mimicked a malignant adrenal lesion, clinically as well as on imaging and biochemical features. This report bears the objective of being aware of the atypical biochemical as well as imaging characteristics of oncocytic adrenal tumours.
Topics: Female; Humans; Adenoma, Oxyphilic; Adrenal Cortex Neoplasms; Adrenocortical Adenoma; Diagnosis, Differential; Tomography, X-Ray Computed; Adolescent
PubMed: 38851224
DOI: 10.1136/bcr-2023-259327 -
The British Journal of Radiology May 2024Quantitative comparison of the diagnostic efficacy of conventional diffusion-weighted imaging (DWI) and intravoxel incoherent motion (IVIM) in differentiating between... (Comparative Study)
Comparative Study
Comparison of conventional diffusion-weighted imaging and intravoxel incoherent motion in differentiating between chromophobe renal cell carcinoma and renal oncocytoma: a preliminary study.
OBJECTIVE
Quantitative comparison of the diagnostic efficacy of conventional diffusion-weighted imaging (DWI) and intravoxel incoherent motion (IVIM) in differentiating between chromophobe renal cell carcinoma (ChRCC) from renal oncocytoma (RO).
METHODS
A total of 48 patients with renal tumours who had undergone DWI and IVIM were divided into two groups-ChRCC (n = 28) and RO (n = 20) groups, and the apparent diffusion coefficient (ADC), true diffusivity (D), pseudo-diffusion coefficient (D*), perfusion fraction (f) and their diagnostic efficacy were compared between the two groups.
RESULTS
The D* values were higher in the ChRCCs group compared to the RO groups (0.019 ± 0.003 mm2/s vs 0.008 ± 0.002 mm2/s, P < .05). Moreover, the ADC, D and f values were higher in ROs compared to ChRCCs (0.61 ± 0.08 × 10-3 mm2/s vs 0.51 ± 0.06 × 10-3 mm2/s, 1.02 ± 0.15 × 10-3 mm2/s vs 0.86 ± 0.07 × 10-3 mm2/s, 0.41 ± 0.05 vs 0.28 ± 0.02, P < .05). The areas of the ADC, D, D* and f values under the ROC curves in differentiating ChRCCs from ROs were 0.713, 0.839, 0.856 and 0.906, respectively. The cut-off values of ADC, D, D* and f were 0.54, 0.91, 0.013 and 0.31, respectively. The AUC, sensitivity, specificity and accuracy of the f values were 0.906, 89.3%, 80.0% and 89.6%, respectively. For pairwise comparisons of ROC curves and diagnostic efficacy, IVIM parameters, that is, D, D* and f offered better diagnostic accuracy than ADC in differentiating ChRCCs from ROs (P = .013, .016, and .008) with f having the highest diagnostic accuracy.
CONCLUSION
IVIM parameters presented better performance than ADC in differentiating ChRCCs from ROs.
ADVANCES IN KNOWLEDGE
(1) D* values of ChRCCs were higher, while ADC, D and f values were lower than those of RO tumours. (2) f values had the highest diagnostic efficacy in differentiating ChRCC from RO. (3) IVIM parameters, that is, D, D* and f offered better diagnostic accuracy than ADC in differentiating ChRCC from RO (P=.013, .016, and .008).
Topics: Humans; Kidney Neoplasms; Carcinoma, Renal Cell; Adenoma, Oxyphilic; Diffusion Magnetic Resonance Imaging; Diagnosis, Differential; Female; Middle Aged; Male; Aged; Adult; Sensitivity and Specificity; Retrospective Studies
PubMed: 38688580
DOI: 10.1093/bjr/tqae088 -
Endokrynologia Polska 2024Not required for Clinical Vignettes.
Not required for Clinical Vignettes.
Topics: Humans; Adenoma, Oxyphilic; Adrenal Gland Neoplasms; Adrenal Glands
PubMed: 38646992
DOI: 10.5603/ep.99035 -
Acta Neurochirurgica Apr 2024Spindle cell oncocytomas (SCO) and granular cell tumors (GCT) are rare primary pituitary neoplasms; the optimal treatment paradigms for these lesions are unknown and...
BACKGROUND
Spindle cell oncocytomas (SCO) and granular cell tumors (GCT) are rare primary pituitary neoplasms; the optimal treatment paradigms for these lesions are unknown and largely unexplored. Thus, using national registries, we analyze the epidemiology, management patterns, and surgical outcomes of SCOs and GCTs.
METHODS
The National Cancer Database (NCDB; years 2003-2017) and the Surveillance, Epidemiology, and End Results Program (SEER; years 2004-2018) were queried for patients with pituitary SCOs or GCTs. Incidence, extent of surgical resection, and rate of postoperative radiation use for subtotally resected lesions comprised the primary outcomes of interest. All-cause mortality was also analyzed via time-to-event Kaplan-Meier curves.
RESULTS
SCOs and GCTs have an annual incidence of 0.017 and 0.023 per 1,000,000, respectively. They comprise 0.1% of the benign pituitary tumors registered in NCDB. A total of 112,241 benign pituitary tumors were identified in NCDB during the study period, of which 83 (0.07%) were SCOs and 59 (0.05%) were GCTs. Median age at diagnosis was 55 years, 44% were females, and median maximal tumor diameter at presentation was 2.1 cm. Gross total resection was achieved in 54% patients. Ten patients (7%) had postoperative radiation. Comparing patients with GCTs versus SCOs, the former were more likely to be younger at diagnosis (48.0 vs. 59.0, respectively; p < 0.01) and female (59% vs. 34%, p = 0.01). GCTs and SCOs did not differ in terms of size at diagnoses (median maximal diameter: 1.9 cm vs. 2.2 cm, respectively; p = 0.59) or gross total resection rates (62% vs. 49%, p = 0.32). After matching SCOs and GCTs with pituitary adenomas on age, sex, and tumor size, the former were less likely to undergo gross total resection (53% vs. 72%; p = 0.03). Patients with SCOs and GCTs had a shorter overall survival when compared to patients with pituitary adenomas (p < 0.01) and a higher rate of thirty-day mortality (3.1% vs 0.0%; p = 0.013).
CONCLUSION
SCOs and GCTs are rare pituitary tumors, and their management entails particular challenges. Gross total resection is often not possible, and adjuvant radiation might be employed following subtotal resection.
Topics: Humans; Female; Male; Pituitary Neoplasms; Adenoma, Oxyphilic; Granular Cell Tumor; Pituitary Gland; Adenoma; Craniopharyngioma
PubMed: 38578465
DOI: 10.1007/s00701-024-06054-6 -
Head and Neck Pathology Mar 2024Oncocytoid salivary tumors include several entities such as oncocytoma, Warthin tumor, secretory carcinoma (SC), salivary duct carcinoma (SDC), acinic cell carcinoma... (Review)
Review
BACKGROUND
Oncocytoid salivary tumors include several entities such as oncocytoma, Warthin tumor, secretory carcinoma (SC), salivary duct carcinoma (SDC), acinic cell carcinoma (AciCC), oncocytic mucoepidermoid carcinoma (OMEC), intraductal carcinoma, and epithelial myoepithelial carcinoma (EMC). This review investigates the differential diagnosis of oncocytoid salivary tumors and explore the role of newly described immunostains as valuable tools for their diagnosing and potentially guiding treatment options.
METHODS
We assess the utility of incorporating new immunohistochemical markers in routine practice to aid in diagnosing oncocytoid salivary tumors and potentially provide treatment options.
RESULTS
In SDC, AR and Her2 immunostains are utilized as diagnostic tools and biomarkers for selecting patients who might benefit from Androgen-deprivation therapy (ADT) and HER2-targeted therapy. Furthermore, nuclear Pan-Trk immunostaining can aid in diagnosing SC. Additionally, NR4A3 immunostaining has been shown high sensitivity and specificity in identifying AciCC in both surgical and cytologic specimens. Similarly, RAS Q61R mutant-specific immunostaining, detected in EMC, may offer a cost-effective diagnostic marker for this tumor. Although further studies are required to evaluate the role of BSND, this marker has been reported to be positive in Warthin tumor and oncocytoma, aiding in differentiating them from other oncocytoid tumors, particularly OMEC. In addition, BRAFV600E mutant-specific immunostaining can serve as a diagnostic and potentially therapeutic marker for oncocytic intraductal carcinoma in mutation positive cases.
CONCLUSION
Oncocytoid salivary tumors may have overlapping morphologies, posing diagnostic challenges for pathologists. Recently described immunohistochemical markers may offer valuable tools for diagnosing and potentially guiding treatment options for these tumors.
Topics: Male; Humans; Adenoma, Oxyphilic; Adenolymphoma; Immunohistochemistry; Diagnosis, Differential; Carcinoma, Intraductal, Noninfiltrating; Androgen Antagonists; Biomarkers, Tumor; Prostatic Neoplasms; Salivary Gland Neoplasms; Carcinoma, Acinar Cell; Carcinoma, Ductal; Breast Neoplasms; Carcinoma
PubMed: 38502259
DOI: 10.1007/s12105-024-01622-9 -
The American Journal of Surgical... May 2024Recurrent gene fusions are common in salivary gland tumors including benign tumors, such as pleomorphic adenoma (PA) and myoepithelioma (ME). In cases where chromosomal...
Recurrent gene fusions are common in salivary gland tumors including benign tumors, such as pleomorphic adenoma (PA) and myoepithelioma (ME). In cases where chromosomal rearrangement is identified in the pleomorphic adenoma gene 1 (PLAG1) gene, different gene partners are found. Oncocytic metaplasia, characterized by oncocytes with abundant eosinophilic granular cytoplasm and hyperchromatic nuclei, is a well-known phenomenon in salivary gland neoplasms. However, the pure oncocytic variant of PA/ME showed PLAG1 gene rearrangements involving various gene partners at the molecular level, without any recurrent fusion being found. Our study includes 20 cases of PA/ME, with 11 females and 9 males. The age of patients ranged from 37 to 96 years, with a median age of 62.8 years. Most tumors originate from the parotid gland. The median size of the tumor was 26.5 mm (range: 13 to 60 mm). Among the 20 cases, 14 were a pure oncocytic variant of PA/ME, whereas 6 cases showed focal oncocytic or oncocytic-like aspects. Molecular studies on 20 cases of PA/ME were conducted. A novel recurrent ZBTB47-AS1::PLAG1 fusion was identified in 6 of 12 cases with pure oncocytic metaplasia, whereas the other cases had PLAG1 gene fusion with different gene partners. The transcriptomic analysis of the cases harboring ZBTB47-AS1::PLAG1 fusion demonstrated that these tumors have a distinct molecular profile from conventional PA/ME. This study reveals a unique subset in the oncocytic PA/ME spectrum characterized by pure oncocytic morphology with larger oncocytic cells and recurrent ZBTB47-AS1::PLAG1 fusion. It also highlights the transcriptomic distinctness of salivary gland adenomas with pure oncocytic metaplasia in the spectrum of salivary gland neoplasms. Further studies are needed to better understand the oncocytic variant of PA/ME and to determine the true nature of oncocytic cells in PA/ME.
Topics: Male; Female; Humans; Middle Aged; Adult; Aged; Aged, 80 and over; Adenoma, Pleomorphic; Myoepithelioma; DNA-Binding Proteins; Salivary Gland Neoplasms; Gene Fusion; Adenoma, Oxyphilic; Metaplasia
PubMed: 38497430
DOI: 10.1097/PAS.0000000000002206 -
Hua Xi Kou Qiang Yi Xue Za Zhi = Huaxi... Feb 2024Oncocytoma is a benign tumor of the salivary gland. Its incidence is very low and very seldom documen-ted in literature. Clear-cell dominant oncocytoma is even less... (Review)
Review
Oncocytoma is a benign tumor of the salivary gland. Its incidence is very low and very seldom documen-ted in literature. Clear-cell dominant oncocytoma is even less common. The tumor's clinical symptoms and imaging results are nonspecific, so distinguishing other salivary gland tumors (such as oncocytic carcinoma) from clear-cell renal carcinoma is difficult, possibly leading to misdiagnosis and maltreatment. Here, a case of clear-cell dominant oncocytoma was presented, and the relevant literature was evaluated to investigate the diagnosis and management of clear-cell dominant oncocytoma.
Topics: Humans; Parotid Gland; Adenoma, Oxyphilic; Salivary Gland Neoplasms; Diagnosis, Differential
PubMed: 38475961
DOI: 10.7518/hxkq.2024.2023185 -
Modern Pathology : An Official Journal... May 2024Renal low-grade oncocytic tumor (LOT) is a recently recognized renal cell neoplasm designated within the "other oncocytic tumors" category in the 2022 World Health...
Renal low-grade oncocytic tumor (LOT) is a recently recognized renal cell neoplasm designated within the "other oncocytic tumors" category in the 2022 World Health Organization classification system. Although the clinicopathologic, immunohistochemical, and molecular features reported for LOT have been largely consistent, the data are relatively limited. The morphologic overlap between LOT and other low-grade oncocytic neoplasms, particularly eosinophilic chromophobe renal cell carcinoma (E-chRCC), remains a controversial area in renal tumor classification. To address this uncertainty, we characterized and compared large cohorts of LOT (n = 67) and E-chRCC (n = 69) and revealed notable differences between the 2 entities. Clinically, LOT predominantly affected women, whereas E-chRCC showed a male predilection. Histologically, although almost all LOTs were dominated by a small-nested pattern, E-chRCC mainly showed solid and tubular architectures. Molecular analysis revealed that 87% of LOT cases harbored mutations in the tuberous sclerosis complex (TSC)-mTOR complex 1 (mTORC1) pathway, most frequently in MTOR and RHEB genes; a subset of LOT cases had chromosomal 7 and 19q gains. In contrast, E-chRCC lacked mTORC1 mutations, and 60% of cases displayed chromosomal losses characteristic of chRCC. We also explored the cell of origin for LOT and identified L1 cell adhesion molecule (L1CAM), a collecting duct and connecting tubule principal cell marker, as a highly sensitive and specific ancillary test for differentiating LOT from E-chRCC. This distinctive L1CAM immunohistochemical labeling suggests the principal cells as the cell of origin for LOT, unlike the intercalated cell origin of E-chRCC and oncocytoma. The ultrastructural analysis of LOT showed normal-appearing mitochondria and intracytoplasmic lumina with microvilli, different from what has been described for chRCC. Our study further supports LOT as a unique entity with a benign clinical course. Based on the likely cell of origin and its clinicopathologic characteristics, we propose that changing the nomenclature of LOT to "Oncocytic Principal Cell Adenoma of the Kidney" may be a better way to define and describe this entity.
Topics: Humans; Kidney Neoplasms; Carcinoma, Renal Cell; Female; Male; Middle Aged; Biomarkers, Tumor; Neural Cell Adhesion Molecule L1; Aged; Adult; Adenoma, Oxyphilic; Diagnosis, Differential; Aged, 80 and over; Immunohistochemistry; Neoplasm Grading; Mutation
PubMed: 38460672
DOI: 10.1016/j.modpat.2024.100467 -
Mayo Clinic Proceedings Mar 2024
Topics: Humans; Adenoma, Oxyphilic; Thyroid Neoplasms
PubMed: 38432755
DOI: 10.1016/j.mayocp.2023.11.002 -
Asian Journal of Surgery Jun 2024
Topics: Humans; Female; Kidney Neoplasms; Adenoma, Oxyphilic; Adult; Carcinoma, Renal Cell; Nephrectomy; Tomography, X-Ray Computed
PubMed: 38383182
DOI: 10.1016/j.asjsur.2024.02.028