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Nutrients Dec 2018In chronic kidney disease (CKD), hyperphosphatemia induces fibroblast growth factor-23 (FGF-23) expression that disturbs renal 1,25-dihydroxy vitamin D (1,25D)... (Review)
Review
In chronic kidney disease (CKD), hyperphosphatemia induces fibroblast growth factor-23 (FGF-23) expression that disturbs renal 1,25-dihydroxy vitamin D (1,25D) synthesis; thereby increasing parathyroid hormone (PTH) production. FGF-23 acts on the parathyroid gland (PTG) to increase 1α-hydroxylase activity and results in increase intra-gland 1,25D production that attenuates PTH secretion efficiently if sufficient 25D are available. Interesting, calcimimetics can further increase PTG 1α-hydroxylase activity that emphasizes the demand for nutritional vitamin D (NVD) under high PTH status. In addition, the changes in hydroxylase enzyme activity highlight the greater parathyroid 25-hydroxyvitmain D (25D) requirement in secondary hyperparathyroidism (SHPT); the higher proportion of oxyphil cells as hyperplastic parathyroid progression; lower cytosolic vitamin D binding protein (DBP) content in the oxyphil cell; and calcitriol promote vitamin D degradation are all possible reasons supports nutritional vitamin D (NVD; e.g., Cholecalciferol) supplement is crucial in SHPT. Clinically, NVD can effectively restore serum 25D concentration and prevent the further increase in PTH level. Therefore, NVD might have the benefit of alleviating the development of SHPT in early CKD and further lowering PTH in moderate to severe SHPT in dialysis patients.
Topics: Dietary Supplements; Fibroblast Growth Factor-23; Humans; Hyperparathyroidism, Secondary; Parathyroid Glands; Renal Insufficiency, Chronic; Vitamin D
PubMed: 30513912
DOI: 10.3390/nu10121890 -
Physiological Research Nov 2018(18)F-fluorocholine positron emission tomography/computed tomography (FCH) was performed after inconclusive neck ultrasound and (99)Tc-sestaMIBI SPECT (MIBI)...
(18)F-fluorocholine positron emission tomography/computed tomography (FCH) was performed after inconclusive neck ultrasound and (99)Tc-sestaMIBI SPECT (MIBI) scintigraphy in patients with primary hyperparathyroidism (PHPT) to localize abnormal parathyroid glands before surgery. The results were retrospectively evaluated and compared to postoperative histopathological findings. 13 patients with PHPT were enrolled (mean age 64.3 years, preoperative calcium 2.74 mmol/l and parathyroid hormone 114.6 ng/l). FCH localized hyperfunctioning parathyroid glands in 12 patients of 13 (per patient sensitivity 92 % and positive predictive value (PPV) 100 %). Fourteen parathyroid lesions (11 adenomas, 3 hyperplastic glands) were resected with a mean size of 11.9 mm (per lesion sensitivity 93 % and PPV 81 %). Four adenomas and one hyperplastic gland were composed of only chief cells, whereas five lesions contained both chief and oxyphil cells. In three patients an exclusively oxyphil adenoma was found, surprisingly with negative MIBI scintigraphy in spite of a high mitochondria content in the oxyphil parathyroid cells. 12 of 13 patients had thyroid disease. In our limited study sample, FCH correctly identified parathyroid adenomas and/or hyperplastic glands in 92 % of patients with previously inconclusive conventional imaging. Unlike MIBI, FCH successfully localized small, hyperplastic and multiple hyperfunctioning parathyroid glands, irrespective of their histopathological composition.
Topics: Adult; Aged; Choline; Female; Fluorine Radioisotopes; Humans; Hyperparathyroidism, Primary; Male; Middle Aged; Parathyroid Glands; Positron Emission Tomography Computed Tomography; Retrospective Studies
PubMed: 30484682
DOI: 10.33549/physiolres.934029 -
Medical Science Monitor : International... Jul 2018BACKGROUND There are few studies that address how to quickly locate the renal vein after processing the renal artery during retroperitoneal laparoscopic radical...
BACKGROUND There are few studies that address how to quickly locate the renal vein after processing the renal artery during retroperitoneal laparoscopic radical nephrectomy (RLRN) for renal cell carcinoma (RCC). This study aimed to evaluate the feasibility of an easy and effective method to locate the renal vein in RLRN. MATERIAL AND METHODS Between September 2016 and October 2017, a total of 44 consecutive cases of RLRN were performed. All the surgeries used the proposed study method to locate the renal vein, in which surgeons located the renal artery following the medial arcuate ligament on the posterior abdominal wall, then the surgeon directly searched for the renal vein caudally relative to renal artery when performing left nephrectomy, but cranially when performing right nephrectomy. RESULTS Among the 44 enrolled RLRN patients, there were 28 left nephrectomies and 16 right nephrectomies. We found the renal vein in most cases successfully by our proposed method. The renal vein was located caudally relative to the renal artery in 27 cases of the left kidney (96.4%), and was located cranially in 14 cases of the right kidney (87.5%). The mean operative time was 135.0±27.8 minutes. No intraoperative complications occurred. Postoperative complications (fever) developed in 5 patients. Pathological examination revealed: clear cell carcinoma in 34 cases (77.3%), chromophobe renal cell carcinoma (RCC) in 5 cases (11.4%), papillary RCC in 3 cases (6.8%), multilocular cystic RCC in 1 case (2.3%), and oxyphil cell adenoma in 1 case (2.3%). CONCLUSIONS Our proposed method to search for the renal vein might be a safe and feasible procedure to accelerate the process of handling the renal pedicle and of great practical significance in RLRN surgery.
Topics: Adult; Aged; Female; Humans; Kidney; Laparoscopy; Male; Middle Aged; Nephrectomy; Operative Time; Postoperative Complications; Renal Artery; Renal Veins; Retroperitoneal Space; Treatment Outcome
PubMed: 30040793
DOI: 10.12659/MSM.911199 -
Experimental Animals Jul 2018The aim of this study is to investigate the changes with age on morphology and sex hormone receptor expression in the mammary glands of male Sprague-Dawley rats,...
The aim of this study is to investigate the changes with age on morphology and sex hormone receptor expression in the mammary glands of male Sprague-Dawley rats, focusing on male-specific cells, "oxyphilic cells", observed after sexual maturity. The mammary glands of male rats at 14, 21, 35, 50, 75 and 100 days old were examined by gross observation, microscopic observation using whole mount specimens, histological and immunohistochemical sections. Grossly, mammary glands showed brown color at 50-100 days old. In whole mount specimens, terminal end buds (TEBs) were observed at 14-50 days old and the number of TEBs was highest at 35 days old. Histologically, the male mammary glands contained small epithelial cells with scanty cytoplasm at 14-35 days old while ductal and lobular epithelial cells were changed into oxyphilic cells with abundant cytoplasm at 50-100 days old. Immunohistochemicaly, androgen receptor (AR), estrogen receptor (ER) and progesterone receptor (PgR) expressions were found in both mammary glands found at a young age and oxyphilic cells. In oxyphilic cells, AR expression was dominant compared to ER and PgR expressions and increased with age. From these results, the development at 50-100 days old might be strongly related to AR. Ultrastructural observation of oxyphilic cells confirmed a number of lipid droplets, deformed and/or enlarged mitochondria, lysosomes and peroxisomes in their cytoplasm.
Topics: Aging; Animals; Humans; Immunohistochemistry; Lipid Droplets; Lysosomes; Male; Mammary Glands, Human; Mitochondria; Oxyphil Cells; Peroxisomes; Rats, Sprague-Dawley; Receptors, Androgen; Receptors, Estrogen; Receptors, Progesterone; Sexual Maturation
PubMed: 29526866
DOI: 10.1538/expanim.17-0134 -
Kidney International Nov 2017Parathyroid glands of young adults consist primarily of chief cells. However, with age or after excessive functional stress, another cell type increases...
Parathyroid glands of young adults consist primarily of chief cells. However, with age or after excessive functional stress, another cell type increases progressively-the oxyphil cell. There is evidence for a chief-to-oxyphil cell transdifferentiation in chronic kidney disease. The latter may represent a defense mechanism, transforming the actively secreting chief cells to a less actively secreting cell type. However, even if this strategy is able to delay the development of secondary hyperparathyroidism, it cannot prevent it.
Topics: Adenoma; Humans; Hyperparathyroidism, Secondary; Oxyphil Cells; Parathyroid Glands; Parathyroid Neoplasms; Renal Insufficiency, Chronic; Uremia
PubMed: 29055426
DOI: 10.1016/j.kint.2017.06.024 -
Kidney International Nov 2017The parathyroid oxyphil cell content increases in patients with chronic kidney disease (CKD), and even more in patients treated with the calcimimetic cinacalcet and/or... (Comparative Study)
Comparative Study
The parathyroid oxyphil cell content increases in patients with chronic kidney disease (CKD), and even more in patients treated with the calcimimetic cinacalcet and/or calcitriol for hyperparathyroidism. Oxyphil cells have significantly more calcium-sensing receptors than chief cells, suggesting that the calcium-sensing receptor and calcimimetics are involved in the transdifferentiation of a chief cell to an oxyphil cell type. Here, we compared the effect of the vitamin D analog paricalcitol (a less calcemic analog of calcitriol) and/or cinacalcet on the oxyphil cell content in patients with CKD to further investigate the genesis of these cells. Parathyroid tissue from four normal individuals and 27 patients with CKD who underwent parathyroidectomy for secondary hyperparathyroidism were analyzed. Prior to parathyroidectomy, patients had received the following treatment: seven with no treatment, seven with cinacalcet only, eight with paricalcitol only, or cinacalcet plus paricalcitol in five. Oxyphilic areas of parathyroid tissue, reported as the mean percent of total tissue area per patient, were normal, 1.03; no treatment, 5.3; cinacalcet, 26.7 (significant vs. no treatment); paricalcitol, 6.9 (significant vs. cinacalcet; not significant vs. no treatment); and cinacalcet plus paricalcitol, 12.7. Cinacalcet treatment leads to a significant increase in parathyroid oxyphil cell content but paricalcitol does not, reinforcing a role for the calcium-sensing receptor activation in the transdifferentiation of chief-to-oxyphil cell type. Thus, two conventional treatments for hyperparathyroidism have disparate effects on parathyroid composition, and perhaps function. This finding is provocative and may be useful when evaluating future drugs for hyperparathyroidism.
Topics: Adult; Calcimimetic Agents; Calcitriol; Cell Transdifferentiation; Cinacalcet; Drug Therapy, Combination; Ergocalciferols; Female; Humans; Hyperparathyroidism, Secondary; Male; Middle Aged; Oxyphil Cells; Parathyroid Glands; Parathyroidectomy; Receptors, Calcium-Sensing; Renal Insufficiency, Chronic; Uremia; Vitamin D
PubMed: 28750928
DOI: 10.1016/j.kint.2017.05.003 -
Romanian Journal of Morphology and... 2017Chronic thyroiditis may present a focal lesion, often-palpable abnormality, simulating nodular disease. The number and morphology of the Hürthle cells (HC) vary in the...
Chronic thyroiditis may present a focal lesion, often-palpable abnormality, simulating nodular disease. The number and morphology of the Hürthle cells (HC) vary in the thyroid aspirate. Distinguishing between neoplastic and non-neoplastic HC lesions is difficult when using the fine-needle aspiration cytology (FNAC). We present the case of a 46-year-old female with a large right nodular goiter and hypothyroidism and high titer of anti-thyroid peroxidase antibody (TPO). The thyroid ultrasound showed a large well-defined nodule (more than 6.8 cm) with hypoechogenicity and microcalcification. FNAC (Mayo Clinic technique) smears revealed HC arranged in flat sheets in 75% in the sample with moderate nuclear pleomorphism, abundant granular cytoplasm showing eosinophilia and well-defined cytoplasmic borders, a lightly eccentric enlarged nuclei; the colloid was reduced and lymphocytes were also described. The final histological examination revealed that oncocyte cell proliferation is limited to the thyroid parenchyma and does not exceed the capsule and has no vascular invasion. The presence of lymphocytic infiltration and a performing FNAC (like Mayo Clinic technique) is absolutely necessary in a focal autoimmune thyroiditis in order to exclude HC carcinoma.
Topics: Biopsy, Fine-Needle; Female; Hashimoto Disease; Humans; Inflammation; Middle Aged; Oxyphil Cells; Thyroid Gland; Thyroid Neoplasms
PubMed: 28523326
DOI: No ID Found -
Cancer Cytopathology Aug 2017Nodular oncocytic hyperplasia (oncocytosis) of the salivary glands is a benign process that does not inherently require surgical excision. However, cytologic findings in...
BACKGROUND
Nodular oncocytic hyperplasia (oncocytosis) of the salivary glands is a benign process that does not inherently require surgical excision. However, cytologic findings in fine-needle aspiration (FNA) of oncocytosis cases have not been well characterized previously, limiting preoperative identification.
METHODS
All available cases of oncocytosis with corresponding FNA specimens were identified from the pathology archives of 3 academic institutions. Clinical, cytologic, and histologic findings were tabulated for all cases.
RESULTS
Twelve cases of oncocytosis were identified from 11 patients, including 11 parotid FNA specimens and 1 submandibular FNA specimen. On the original diagnoses, 6 specimens were classified as benign, 4 as atypical, and 2 as nondiagnostic. Oncocytosis was listed in the differential diagnosis in only 1 case. Among diagnostic aspirates, 8 demonstrated low cellularity and 2 demonstrated moderate cellularity. All 10 cases demonstrated oncocytic cells in small to medium groups, with single cells in just 1 case. Spindled and squamous morphology were each noted in 3 cases. Four cases demonstrated cystic change and 1 showed background mucin without goblet cells. No necrosis or mitoses were observed.
CONCLUSIONS
Although oncocytosis demonstrates some overlap with Warthin tumor and oncocytoma, it lacks the diagnostic findings specific to oncocytic salivary gland malignancies such as salivary duct carcinoma, acinic cell carcinoma, mammary analog secretory carcinoma, and mucoepidermoid carcinoma. Despite current limitations in the understanding of oncocytic salivary gland lesions, the presence of a paucicellular specimen comprised of small groups of oncocytic cells should raise the possibility of oncocytosis in the differential diagnosis and can favor it in elderly patients with multiple salivary nodules. Cancer Cytopathol 2017;125:627-34. © 2017 American Cancer Society.
Topics: Adenolymphoma; Adenoma, Oxyphilic; Aged; Aged, 80 and over; Biopsy, Fine-Needle; Carcinoma; Carcinoma, Acinar Cell; Carcinoma, Mucoepidermoid; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Oxyphil Cells; Parotid Diseases; Salivary Gland Diseases; Salivary Gland Neoplasms; Submandibular Gland Diseases
PubMed: 28411376
DOI: 10.1002/cncy.21865 -
Chirurgia (Bucharest, Romania : 1990) 2017Our study underline scarcity of isolated case reports or small case series of parathyroid adenoma (PA) published in autochthonous medical literature,their variable...
UNLABELLED
Our study underline scarcity of isolated case reports or small case series of parathyroid adenoma (PA) published in autochthonous medical literature,their variable clinical expression among the "historic" varieties but also the diagnostic difficulties and delays of diagnosis as well consecration of surgery as the golden therapeutic standard of this disorder.
PATIENTS AND METHOD
Demographic, clinical presentations, laboratory and imaging data, operative findings and procedures together with pathology account and outcome from the case reports of 18 patients with documented PHP were retrospectively analyzed. The male/female ratio was 1/5, with ages ranging from 16 to 58 (mean 46) years. Renal stones (n=9) and bone sufferings (n=6) were the most common modes of presentation. To these were added psychiatric and neuromuscular complaints, digestive disorders (pancreatitis and peptic ulcer) arterial hypertension and presence of a palpable nodule. Mean serum calcium and phospho-rus, alkaline phosphatase and PTH dosage together with parathyroid ultrasound and 99m Tc sestamibi scintigraphy are the most useful parameters for diagnosis. Eighteen adenomectomies were performed of which bilateral neck exploration was done in 16 patients and minimally invasive approach in the remaining two cases. In 9 situations concomitant thyroid exeresis for associated lesions or tactical purpose were done. Pathology revealed single adenoma consisting of main and oxyphil cells in 17 cases. In one case an atypical adenoma was identified and in another case three years after removal of a benign adenoma the subject presented a clinical ipsilateral recurrence which provided to be a carcinoma. Postoperative clinical and humoral outcome was favorable in all situations less the case of carcinoma which died after 14 months. Despite the rarity and difficulties of diagnosis in cases of PA, practitioners must be aware of potential existence of these lesions in order to apply as early and appropriate treatment where surgery is the gold standard.
Topics: Adenoma; Adolescent; Adult; Alkaline Phosphatase; Biomarkers; Calcium; Female; Humans; Kidney Calculi; Male; Middle Aged; Parathyroid Hormone; Parathyroid Neoplasms; Parathyroidectomy; Phosphorus; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Sestamibi; Treatment Outcome; Ultrasonography
PubMed: 28266288
DOI: 10.21614/chirurgia.112.1.18 -
Medicine Sep 2016Oncocytic carcinoma (OC) arising in the submandibular gland is an unusual malignant neoplasm, with <20 cases previously reported. The cancer is characterized by numerous...
BACKGROUND
Oncocytic carcinoma (OC) arising in the submandibular gland is an unusual malignant neoplasm, with <20 cases previously reported. The cancer is characterized by numerous morphologically abnormal mitochondria present in the cytoplasm and marked cellular pleomorphism. At its most severe, the tumor may invade into the surrounding tissues, including intravascular, lymphatic, or perineural invasion, and lead to regional nodal or distant metastasis.
METHODS
The current study describes a novel OC case in a 46-year-old male, the youngest case of the review. The patient presented with a 5-month history of an intermittently painful mass.
RESULTS
Following magnetic resonance imaging, excisional biopsy, hematoxylin-eosin staining, phosphotungstic acid-hematoxylin staining, and immunohistochemical examination, an OC of the submandibular gland was diagnosed.
CONCLUSION
The current study summarizes the pathogenesis, diagnosis, therapeutics, and the prognosis of OC. The literature review regarding this rare disease is also presented to emphasize the lack of specific markers of OC and the risk of cervical lymph metastasis.
Topics: Adult; Carcinoma; Humans; Male; Oxyphil Cells; Submandibular Gland; Submandibular Gland Neoplasms
PubMed: 27631263
DOI: 10.1097/MD.0000000000004897