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Cirugia Espanola Sep 2007In the last few years, laparoscopic adrenalectomy has become widely used in the management of adrenal disease.
INTRODUCTION
In the last few years, laparoscopic adrenalectomy has become widely used in the management of adrenal disease.
MATERIAL AND METHOD
We reviewed our experience of 24 patients who underwent laparoscopic adrenalectomy between 1998 and 2006.
RESULTS
Surgery was indicated for Cushing's syndrome in 46% of the patients, aldosteronoma in 25%, incidentaloma in 21% and pheochromocytoma in 8%. A lateral transabdominal approach was employed in all patients. The mean age of the patients was 50.4 years (17 women and 7 men). Left unilateral adrenalectomy was performed in 63% of the patients, right unilateral adrenalectomy in 29% and bilateral adrenalectomy in 8%. The conversion rate was 4%. The mean operating time was 134 minutes in unilateral approaches and 245 minutes in bilateral approaches. The mean size of the gland was 4 cm. The complications rate was 4% and there was no mortality. Disease control was achieved in 96% of the patients after a mean follow-up of 49 months.
CONCLUSIONS
Laparoscopic adrenalectomy should be considered the procedure of choice for the surgical management of benign adrenal disease.
Topics: Adrenalectomy; Female; Humans; Hyperaldosteronism; Laparoscopy; Male; Middle Aged; Pheochromocytoma; Pituitary ACTH Hypersecretion
PubMed: 17916287
DOI: 10.1016/s0009-739x(07)71692-5 -
European Annals of Otorhinolaryngology,... Sep 2014Surgery has been long considered to be the treatment of choice for glomus jugulare paragangliomas, as it is the only modality able to totally eradicate the tumour.... (Review)
Review
Surgery has been long considered to be the treatment of choice for glomus jugulare paragangliomas, as it is the only modality able to totally eradicate the tumour. However, despite considerable progress in interventional radiology and nerve monitoring, surgery is associated with an unacceptably high complication rate for a benign tumour, explaining the growing place of radiotherapy in the management of these tumours. This review of the literature confirms the efficacy of conformal radiotherapy with or without intensity modulation and stereotactic radiotherapy, which both achieve tumour control rates ranging from 90% to almost 100% of cases, but for different tumour volumes, almost constant stabilization or even improvement of symptoms, and a considerably lower rate of adverse effects than with surgery. However, radiotherapy remains contraindicated in the presence of intracranial invasion or extensive osteomyelitis. In the light of these results, together with the improved quality of life and a better knowledge of the natural history of this disease, many authors propose radiotherapy as first-line treatment for all glomus jugulare paragangliomas regardless of their size, particularly in patients with no preoperative deficits.
Topics: Glomus Jugulare; Humans; Paraganglioma; Radiotherapy
PubMed: 24908634
DOI: 10.1016/j.anorl.2014.01.003 -
BioMed Research International 2020The aim of this study was to investigate the expression of Snail, galectin-3, and IGF1R in benign and malignant pheochromocytoma and paraganglioma (PPGL) and explore...
OBJECTIVE
The aim of this study was to investigate the expression of Snail, galectin-3, and IGF1R in benign and malignant pheochromocytoma and paraganglioma (PPGL) and explore their role in the diagnosis of malignant PPGL.
METHODS
We retrospectively collected and analyzed surgical tumor tissue from 226 patients initially diagnosed with PPGL who underwent surgery from Jan. 2009 to Jan. 2016 at West China Hospital, Sichuan University. We observed and quantified the expression of Snail, galectin-3, and IGF1R in paraffin-embedded samples by immunohistochemical staining.
RESULTS
The significant difference in survival time among the three groups (benign PHEO, benign PGL, and potentially malignant PPGL) was compared by Kaplan-Meier survival analysis. The positive staining of Snail, galectin-3, and IGF1R in the benign PHEO group was significantly lower than that in the other three groups ( < 0.001). The Kaplan-Meier survival plots indicated that the survival time of the patients with intense positive staining was significantly lower than that of the patients with weak positive staining.
CONCLUSION
The intense expression of Snail, galectin-3, and IGF1R may be valuable indicators for the diagnosis of malignant PPGL.
Topics: Adrenal Gland Neoplasms; Adult; Aged; Biomarkers, Tumor; Blood Proteins; China; Diagnosis, Differential; Female; Galectin 3; Galectins; Humans; Immunohistochemistry; Kaplan-Meier Estimate; Male; Middle Aged; Paraganglioma; Pheochromocytoma; Receptor, IGF Type 1; Retrospective Studies; Snail Family Transcription Factors; Software
PubMed: 32190664
DOI: 10.1155/2020/4150735 -
Cytogenetic and Genome Research 2016Pheochromocytomas (PCC) and sympathetic paragangliomas (PGL) are rare neuroendocrine tumors, which derive from chromaffin cells occurring in the adrenal medulla and... (Review)
Review
Pheochromocytomas (PCC) and sympathetic paragangliomas (PGL) are rare neuroendocrine tumors, which derive from chromaffin cells occurring in the adrenal medulla and extra-adrenal sympathetic paraganglia. PCC and PGL are often benign, catecholamine-producing tumors, responsible for a myriad of symptoms that may be potentially hazardous to the patient. In contrast, nonsecreting parasympathetic PGL, derived from chief cells, develop mainly in the head and neck region. Although PCC/PGL are more commonly sporadic tumors, germline mutations are present in up to 40% of the patients, ranking these tumors among those with the highest degree of heritability. PCC/PGL are associated with a variety of hereditary syndromes, comprising genetic alterations in RET, NF1, VHL, and SDHx genes, the last 2 being involved in regulating the hypoxia pathway. Additional hypoxia pathway-related genes have been recently associated with PCC/PGL development, namely EGLN1 and EPAS1. Thus, dysregulation of the hypoxia pathway seems to play a major role in PCC/PGL development, in particular through the stabilization of hypoxia-inducible factors and the appearance of a pseudohypoxia signature. This article is focused on reviewing the tumorigenic mechanisms resultant from VHL, SDHx, EGLN1, and EPAS1 mutations, as well as the associated tumors, namely PCC/PGL, and extra manifestations such as polycythemia. In the light of the recent discoveries, hypoxia pathway molecules appear as key players in PCC/PGL development.
Topics: Cell Hypoxia; Humans; Mutation; Neovascularization, Pathologic; Paraganglioma; Pheochromocytoma
PubMed: 28231563
DOI: 10.1159/000457479 -
Reports of Practical Oncology and... 2022Benign diseases include tumours or localized growths with low potential for progression. The use of radiotherapy (RT) at a low dose (LD) or intermediate dose for benign...
BACKGROUND
Benign diseases include tumours or localized growths with low potential for progression. The use of radiotherapy (RT) at a low dose (LD) or intermediate dose for benign pathologies has been widely proposed and studied. Currently, the use of RT is limited mainly to hyperproliferative and inflammatory diseases as a first or second line of treatment.
MATERIALS AND METHODS
This was a retrospective, observational and descriptive study conducted in the Radiotherapy Unit of the Oncology Service of the General Hospital of Mexico "Dr. Eduardo Liceaga" from January 2, 2016, to December 31, 2020. Patients diagnosed with benign pathology and treated with RT were included. The response to treatment was recorded based on the imaging study report and/or clinical review that determined control of the disease, and toxicity was recorded based on the RTOG evaluation for acute effects and CTCAE V. 4.0 for chronic effects.
RESULTS
The records of 222 patients were analysed. The mean follow-up duration was 31.53 months (range 6-61), and the median was 24 months. Of all of the analysed pathologies that were treated with RT, keloid scars predominated in 112 patients (50.5%), and paragangliomas predominated in 72 patients (32.4%); the other patients were treated for rare pathologies. The prescribed dose was dependent on the diagnosis, with the mean dose being 31.63 Gy (1500-6000 cGy) and the median being 2000 cGy. Most of the cases of acute and chronic toxicity were grades 1 and 2, and a disease response was achieved in 94.1% of the patients.
CONCLUSION
Our series shows that for cases of benign pathology, RT offers acceptable toxicity, improves quality of life and yields a good response, achieving disease control. These results suggest the inclusion of inflammatory pathology among the indications for treatment.
PubMed: 36196421
DOI: 10.5603/RPOR.a2022.0072 -
Revue Medicale de Liege Nov 2011Conventional radiotherapy is known to be an effective treatment approach even for "benign" pathologies. However, this kind of treatment yields a high potential for side... (Review)
Review
Conventional radiotherapy is known to be an effective treatment approach even for "benign" pathologies. However, this kind of treatment yields a high potential for side effects. The Cyberknife, a robotic stereotactic radiotherapy device, enables to offset a large proportion of the disadvantages encountered with conventional radiotherapy essentially through the high precision of dose administration and sparing of healthy tissues. Therefore, it seems to be a treatment of choice in the approach of some benign intracranial diseases. We review published data on indications and outcome of Cyberknife for intracranial "non-malignant" disease.
Topics: Adenoma; Epilepsy, Temporal Lobe; Glomus Jugulare Tumor; Humans; Intracranial Arteriovenous Malformations; Meningeal Neoplasms; Meningioma; Pituitary Neoplasms; Quality of Life; Radiation Oncology; Radiosurgery; Radiotherapy Dosage; Treatment Outcome; Trigeminal Neuralgia
PubMed: 22216729
DOI: No ID Found -
Journal of Nuclear Medicine : Official... Feb 2012Paragangliomas are rare neuroendocrine tumors that may arise anywhere along the paraganglial system, with a high frequency of hereditary forms or multifocal disease.... (Review)
Review
Paragangliomas are rare neuroendocrine tumors that may arise anywhere along the paraganglial system, with a high frequency of hereditary forms or multifocal disease. Most often, paragangliomas are benign and progress slowly, but metastases may occur in about 10% of patients. In this respect, nuclear imaging in combination with anatomic imaging may be required to fully delineate the extent of the disease. PET has been increasingly used in imaging paraganglioma, paralleled by great efforts toward the development of new tracers. Recent data indicate that the choice of PET tracers should be tailored to tumor localization and to the patient's genetic status. This article provides insight into the many PET radiotracers that are currently available and others that are still only under research and guides clinicians toward appropriate use in relation to genetic carrier status. In addition, this article provides nuclear medicine physicians with the background knowledge required for understanding relationships between imaging phenotypes and molecular genetics.
Topics: Diagnostic Imaging; Genotype; Humans; Mutation; Nuclear Medicine; Paraganglioma; Phenotype
PubMed: 22302963
DOI: 10.2967/jnumed.111.098152 -
Archives of Pathology & Laboratory... Nov 2007Nested variant of urothelial carcinoma is a rare neoplasm that is histologically characterized by large numbers of small, closely packed, haphazardly arranged, poorly... (Review)
Review
Nested variant of urothelial carcinoma is a rare neoplasm that is histologically characterized by large numbers of small, closely packed, haphazardly arranged, poorly defined, confluent irregular nests of bland-appearing urothelial cells infiltrating the lamina propria and the muscularis propria. Due to the cells' deceptively bland appearance, the tumors are sometimes misdiagnosed as benign lesions, leading in some cases to a significant delay in establishing the correct diagnosis and thus contributing to this neoplasm's advanced stage. Nested variant of urothelial carcinoma must be differentiated from the benign proliferative lesions of urothelium, such as von Brunn nests, cystitis cystica, cystitis glandularis, nephrogenic adenoma, inverted papilloma, and paraganglioma.
Topics: Aged; Aged, 80 and over; Carcinoma, Transitional Cell; Diagnosis, Differential; Epithelial Cells; Humans; Keratin-20; Keratin-7; Middle Aged; Urinary Bladder Neoplasms; Urothelium
PubMed: 17979494
DOI: 10.5858/2007-131-1725-NVOUC -
Cureus Oct 2022Paraganglioma-pheochromocytoma (PPGLs) are relatively rare catecholamine-secreting tumors of chromaffin origin. Due to the sympathetic effects of catecholamine excess,...
Paraganglioma-pheochromocytoma (PPGLs) are relatively rare catecholamine-secreting tumors of chromaffin origin. Due to the sympathetic effects of catecholamine excess, their presentation may range from non-specific symptoms to dangerous hypertensive crises. We present the case of a 36-year-old lady with recurrent paraganglioma (PGL) who presented in emergency with hypertensive crisis. She had a history of surgery for left-sided PGL 18 years earlier. Imaging showed local recurrence with pulmonary metastases and blood biochemistry showed raised urinary metanephrines. In view of her poor general condition, we undertook a staged surgical approach for management. She first underwent en-bloc excision of recurrent PGL with left nephrectomy. Nine weeks later, she underwent a pulmonary metastasectomy. This staged surgical approach resulted in the stabilization of blood pressure and normalization of urinary catecholamine. Although most of these tumors are indolent by nature, this case highlights the metastatic potential of apparently benign PGL. This case explores the possibility of a staged surgical approach in a high-risk patient and emphasizes the need for long-term follow-up in these cases.
PubMed: 36348854
DOI: 10.7759/cureus.29874 -
Journal of Visceral Surgery Sep 2011Laparoscopic adrenalectomy has become the preferred method for removal of almost all adrenal tumors. An important component in selecting patients for this operation is a... (Review)
Review
Laparoscopic adrenalectomy has become the preferred method for removal of almost all adrenal tumors. An important component in selecting patients for this operation is a thorough understanding of the clinical presentation (mainly hypertension) and diagnostic workup for the full variety of functioning and nonfunctioning adrenal tumors including genetic evaluation when necessary (MEN2, VonHippel-Landau [VHL], type 1 neurofibromatosis [NF1], succinate dehydrogenase mutations [SDH], and MEN1). The indications and contraindications for a laparoscopic approach are discussed with regard to each tumor type. Relevant literature about partial and bilateral adrenalectomy is also summarized. Main areas of controversy are discussed including the size threshold to avoid risk of adrenal capsular effraction and the appropriateness of laparoscopic resection for suspected and known malignancy. This article presents recent data to help the surgeon make well-informed decisions and to optimize the operative approach for a wide variety of adrenal pathologies (secreting vs. non-secreting, benign vs. malignant tumors).
Topics: Adenoma; Adrenal Gland Neoplasms; Adrenalectomy; Humans; Laparoscopy; Patient Selection; Pheochromocytoma; Robotics
PubMed: 21820984
DOI: 10.1016/j.jviscsurg.2011.06.003