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Sample records for traditional serrated adenoma

  1. Sessile serrated adenoma (SSA) vs. traditional serrated adenoma (TSA).

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    Torlakovic, Emina Emilia; Gomez, Jose D; Driman, David K; Parfitt, Jeremy R; Wang, Chang; Benerjee, Tama; Snover, Dale C

    2008-01-01

    The morphologic distinction between various serrated polyps of the colorectum may be challenging. The distinction between sessile serrated adenoma (SSA) and traditional serrated adenoma (TSA) may be difficult using currently available criteria mostly based on cytologic characteristics. We have evaluated 66 serrated polyps including 29 SSA, 18 TSA, and 19 hyperplastic polyps for overall shape of the polyps, architectural features of individual crypts, the presence of eosinophilic cytoplasm, size and distribution of the proliferation and maturation zones, as well as Ki-67 and CK20 expression. The extent of the expression of CK20 and Ki-67 could not distinguish between the 3 types of serrated polyps, but the distribution of their expression was very helpful and differences were statistically significant. The distribution of Ki-67+ cells was the single most helpful distinguishing feature of the serrated polyp type (PTSA had low Ki-67 expression, which was limited to "ectopic crypts" and admixed tubular adenomalike areas. In serrated polyps, ectopic crypt formation (ECF) defined by the presence of ectopic crypts with their bases not seated adjacent to the muscularis mucosae was nearly exclusive to TSA and was found in all cases, while the presence of cytologic atypia and eosinophilia of the cytoplasm were characteristic, but not limited to TSA. No evidence of ECF, but nevertheless abnormal distribution of proliferation zone was characteristic of SSA, whereas HP had neither. The presence of the ECF defines TSA in a more rigorous fashion than previous diagnostic criteria and also explains the biologic basis of exuberant protuberant growth associated with TSA and the lack of such growth in SSA. Recognition of this phenomenon may also help in exploring the genetic and molecular basis for differences between SSA and TSA, because these architectural abnormalities may well be a reflection of abnormalities in genetically programmed mucosal development.

  2. Traditional serrated adenoma (TSA): morphological questions, queries and quandaries.

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    Chetty, Runjan

    2016-01-01

    Traditional serrated adenoma (TSA) is an uncommon type of serrated adenoma that can be a precursor to biologically aggressive colorectal cancer that invokes the serrated (accelerated) pathway. The purpose of this review is to address some of the more contentious issues around nomenclature, diagnostic criteria, histological variants, coexistence with other polyp types, the occurrence of dysplasia and the differential diagnosis. While the vast majority of TSAs are exophytic villiform polyps composed of deeply eosinophilic cells, flat top luminal serrations and numerous ectopic crypt foci, histological variants include flat TSA, filiform TSA and one composed of large numbers of mucin-containing cells. It is unlikely that there is any biological difference between the histological variants. There is a contention that TSAs are not dysplastic ab initio and that the majority do not show cytological atypia. Two types of dysplasia are associated with TSA. Serrated dysplasia is less well recognised and less commonly encountered than adenomatous dysplasia. TSA with dysplasia must be separated from TSA with coexisting conventional adenoma. TSA is a characteristic polyp that may be extremely exophytic, flat or composed of mucin-rich cells and is typified by numerous ectopic crypt foci. They may coexist with other serrated polyps and conventional adenomas. Approximately 20-25% will be accompanied by adenomatous dysplasia. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  3. Cyclooxygenase-2 overexpression is common in serrated and non-serrated colorectal adenoma, but uncommon in hyperplastic polyp and sessile serrated polyp/adenoma

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    Kirkner Gregory J

    2008-01-01

    Full Text Available Abstract Background Cyclooxygenase-2 (COX-2, PTGS2 plays an important role in colorectal carcinogenesis. COX-2 overexpression in colorectal cancer is inversely associated with microsatellite instability (MSI and the CpG island methylator phenotype (CIMP. Evidence suggests that MSI/CIMP+ colorectal cancer may arise through the serrated tumorigenic pathway through various forms of serrated neoplasias. Therefore, we hypothesized that COX-2 may play a less important role in the serrated pathway. Methods By immunohistochemistry, we assessed COX-2 expression in 24 hyperplastic polyps, 7 sessile serrated polyp/adenomas (SSA, 5 mixed polyps with SSA and adenoma, 27 traditional serrated adenomas, 515 non-serrated adenomas (tubular adenoma, tubulovillous adenoma and villous adenoma, 33 adenomas with intramucosal carcinomas, 96 adenocarcinomas with serration (corkscrew gland and 111 adenocarcinomas without serration. Results Strong (2+ COX-2 overexpression was more common in non-serrated adenomas (28% = 143/515 than in hyperplastic polyps (4.2% = 1/24, p = 0.008 and serrated polyps (7 SSAs and 5 mixed polyps (0% = 0/12, p = 0.04. Furthermore, any (1+/2+ COX-2 overexpression was more frequent in non-serrated adenomas (60% = 307/515 than in hyperplastic polyps (13% = 3/24, p Conclusion COX-2 overexpression is infrequent in hyperplastic polyp, SSA and mixed polyp with SSA and adenoma, compared to non-serrated and serrated adenoma. COX-2 overexpression becomes more frequent as tumors progress to higher grade neoplasias. Our observations suggest that COX-2 may play a less significant role in the serrated pathway of tumorigenesis; however, COX-2 may still play a role in later stage of the serrated pathway.

  4. Serrated adenoma of stomach: A premalignancy?

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    Divya Achutha Ail

    2015-01-01

    Full Text Available Serrated adenoma is a newly described entity in the group of gastric adenomas. Until date only 20 cases of gastric serrated adenoma have been reported. It is an important entity to be diagnosed accurately as it has a very high-risk of malignant transformation, especially those located in the cardia of stomach. Serrated adenoma associated with adenocarcinoma is more frequent in the elderly, but pure serrated adenoma is common in the young, in whom follow-up is mandatory. Gastric serrated adenoma has distinct location, definite histomorphology and characteristic Ki-67 immunohistochemical staining. Ki-67 staining helps to differentiated pure serrated adenoma from those associated with adenocarcinoma. We present a young adult male, incidentally detected to have gastric serrated adenoma.

  5. Identification of risk factors for sessile and traditional serrated adenomas of the colon by using big data analysis.

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    Pyo, Jeung Hui; Ha, Sang Yun; Hong, Sung Noh; Chang, Dong Kyung; Son, Hee Jung; Kim, Kyoung-Mee; Kim, Hyeseung; Kim, Kyunga; Kim, Jee Eun; Choi, Yoon-Ho; Kim, Young-Ho

    2018-05-01

    Little is known about the risk factors associated with serrated polyps, because the early studies, which occurred before the new World Health Organization classification was introduced, included mixtures of serrated polyps. This study aimed to evaluate the risk factors associated with the presence of sessile serrated adenomas (SSAs) and traditional serrated adenomas (TSAs) using big data analytics. Using a case-control design, we evaluated the risk factors associated with the presence of SSAs and TSAs. Subjects who underwent colonoscopies from 2002 to 2012 as part of the comprehensive health screening programs undertaken at the Samsung Medical Center, Korea, participated in this study. Of the 48 677 individuals who underwent colonoscopies, 183 (0.4%) had SSAs and 212 (0.4%) had TSAs. The multivariate analysis determined that being aged ≥ 50 years (odds ratio [OR] 1.91, 95% confidential interval [CI] 1.27-2.90, P = 0.002) and a history of colorectal cancer among first-degree relatives (OR 3.14, 95% CI 1.57-6.27, P = 0.001) were significant risk factors associated with the presence of SSAs and that being aged ≥ 50 years (OR 2.61, 95% CI 1.79-3.80, P < 0.001), obesity (OR 1.63, 95% CI 1.12-2.36, P = 0.010), and a higher triglyceride level (OR 1.63, 95% CI 1.12-2.36, P = 0.010) were independent risk factors associated with the presence of TSAs. We used big data analytics to determine the risk factors associated with the presence of specific polyp subgroups, and individuals who have these risk factors should be carefully scrutinized for the presence of SSAs or TSAs during screening colonoscopies. © 2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

  6. The expression and mutation of β-catenin in colorectal traditional serrated adenomas

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    Xiaojun Dai

    2012-01-01

    Full Text Available Context : Exon 3 mutation of β-catenin is associated with the carcinogenesis. Aims: In this study we aimed to detect the expression of exon 3 mutations of β-catenin in colorectal TSA, TA/VTA, and CRC. Materials and Methods : Immunohistochemistry staining for β-catenin was performed for 30 TSA, 20 tubular adenomas (TA/villous tubular adenomas (VTA, and 21 colorectal carcinoma (CRC cases. DNA sequencing of the exon 3 of β-catenin gene was performed for 8 TSA cases, 6 TA cases, 5 VTA cases, and 10 CRC cases with positive staining in the nuclei and cytoplasm. Statistical Analysis: A Fisher exact test and chi-square test were used to analyze the differentiations of the expression of β-catenin in TSA, TA/VTA, and CRC. Results : The percentages of β-catenin expression in TSA, TA/VTA, and CRC were 76.6% (23/30, 70.0% (14/20, and 95.2% (20/21, respectively, and were significantly different among these three types of tissue specimens (χ2 = 22.805, P < 0.001. Although β-catenin expression levels in TSA were not related to it in TA/VTA, they were significantly different between TSA/TA/VTA and CRC. The degree of dysplasia was well correlated with β-catenin expression (TSA: P < 0.01; TA/VTA: P < 0.05. But β-catenin exon 3 mutations were not detected in any of these tissue specimens. Conclusions : Aberrant β-catenin expression is associated with the degree of dysplasia in TSA. β-catenin likely plays an important role in the pathogenesis of colorectal TSA and conventional adenomas.

  7. Sessile serrated adenomas with dysplasia: morphological patterns and correlations with MLH1 immunohistochemistry.

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    Liu, Cheng; Walker, Neal I; Leggett, Barbara A; Whitehall, Vicki Lj; Bettington, Mark L; Rosty, Christophe

    2017-12-01

    Sessile serrated adenomas are the precursor polyp of approximately 20% of colorectal carcinomas. Sessile serrated adenomas with dysplasia are rarely encountered and represent an intermediate step to malignant progression, frequently associated with loss of MLH1 expression. Accurate diagnosis of these lesions is important to facilitate appropriate surveillance, particularly because progression from dysplasia to carcinoma can be rapid. The current World Health Organization classification describes two main patterns of dysplasia occurring in sessile serrated adenomas, namely, serrated and conventional. However, this may not adequately reflect the spectrum of changes seen by pathologists in routine practice. Furthermore, subtle patterns of dysplasia that are nevertheless associated with loss of MLH1 expression are not encompassed in this classification. We performed a morphological analysis of 266 sessile serrated adenomas with dysplasia with concurrent MLH1 immunohistochemistry with the aims of better defining the spectrum of dysplasia occurring in these lesions and correlating dysplasia patterns with MLH1 expression. We found that dysplasia can be divided morphologically into four major patterns, comprising minimal deviation (19%), serrated (12%), adenomatous (8%) and not otherwise specified (79%) groups. Minimal deviation dysplasia is defined by minor architectural and cytological changes that typically requires loss of MLH1 immunohistochemical expression to support the diagnosis. Serrated dysplasia and adenomatous dysplasia have distinctive histological features and are less frequently associated with loss of MLH1 expression (13 and 5%, respectively). Finally, dysplasia not otherwise specified encompasses most cases and shows a diverse range of morphological changes that do not fall into the other subgroups and are frequently associated with loss of MLH1 expression (83%). This morphological classification of sessile serrated adenomas with dysplasia may represent an

  8. [Clinical and endoscopic features of a selected population with serrated colorectal adenomas in a private clinic in Lima - Peru].

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    Castillo, Ofelia; Barreda, Carlos; Recavarren, Sixto; Barriga, José A; Salazar M, Fernando; Yriberry, Simón; Barriga, Eduardo; Salazar C, Fernando

    2013-01-01

    To describe the clinical and endoscopic caracteristics of a population that has only serrated polyps of colon (mainly sessile serrated adenomas) in a private clinic in Lima, Perú, from 2009-2011. Retrospective study conducted at the endoscopy center of Clinic Ricardo Palma, Lima, Peru. Olympus colonoscope was used with high definition, including NBI (narrow band imaging) and electronic magnification. Patients had pathologic diagnosis of “polyps and / or colorectal serrated adenomas” and excluded those with synchronous tubular or villous adenomas. Images were evaluated by two endoscopists and then by a third gastroenterologist. We found 201 serrated polyps in 108 patients. Women were 60.2% and overweight predominated. Eighty (74.1%) had only one serrated adenoma and 23 (21.3%) with at least one synchronous hyperplastic polyp. The average size of sessile serrated adenomas was 5.12 mm (± 3.87 DS) and the flat type was 91 (58.7%). There were significant differences in the diameter of sessile serrated adenomas between the distal and proximal colon (4.47 mm ± 2.23 vs. 6.90 mm ± 6.25; p<0.000). The common features of sessile serrated adenomas were: White (31/36, 86.1%), smooth (28/36, 77.8%) and regular margins (26/36, 72.2%). There was a relationship between vascular pattern according NBI and serrated polyp histology (p=0.024). The endoscopic features of sessile serrated adenomas can evade detection to white light. NBI is a useful tool to define some features of these lesions.

  9. Loss of expression and promoter methylation of SLIT2 are associated with sessile serrated adenoma formation.

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    Andrew D Beggs

    2013-05-01

    Full Text Available Serrated adenomas form a distinct subtype of colorectal pre-malignant lesions that may progress to malignancy along a different molecular pathway than the conventional adenoma-carcinoma pathway. Previous studies have hypothesised that BRAF mutation and promoter hypermethylation plays a role, but the evidence for this is not robust. We aimed to carry out a whole-genome loss of heterozygosity analysis, followed by targeted promoter methylation and expression analysis to identify potential pathways in serrated adenomas. An initial panel of 9 sessile serrated adenomas (SSA and one TSA were analysed using Illumina Goldengate HumanLinkage panel arrays to ascertain regions of loss of heterozygosity. This was verified via molecular inversion probe analysis and microsatellite analysis of a further 32 samples. Methylation analysis of genes of interest was carried out using methylation specific PCR (verified by pyrosequencing and immunohistochemistry used to correlate loss of expression of genes of interest. All experiments used adenoma samples and normal tissue samples as control. SSA samples were found on whole-genome analysis to have consistent loss of heterozygosity at 4p15.1-4p15.31, which was not found in the sole TSA, adenomas, or normal tissues. Genes of interest in this region were PDCH7 and SLIT2, and combined MSP/IHC analysis of these genes revealed significant loss of SLIT2 expression associated with promoter methylation of SLIT2. Loss of expression of SLIT2 by promoter hypermethylation and loss of heterozygosity events is significantly associated with serrated adenoma development, and SLIT2 may represent a epimutated tumour suppressor gene according to the Knudson "two hit" hypothesis.

  10. Prevalence, distribution and risk of sessile serrated adenomas/polyps at a center with a high adenoma detection rate and experienced pathologists

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    IJspeert, Joep E. G.; de Wit, Koos; van der Vlugt, Manon; Bastiaansen, Barbara A. J.; Fockens, Paul; Dekker, Evelien

    2016-01-01

    Sessile serrated adenomas/polyps (SSA/Ps) are the precursors of 15 % - 30 % of colorectal cancers (CRC). We aimed to determine the prevalence and distribution of SSA/Ps and to evaluate the association between SSA/Ps and the risk of synchronous advanced neoplasia at a high quality colonoscopy center.

  11. Molecular features of colorectal hyperplastic polyps and sessile serrated adenoma/polyps from Korea.

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    Kim, Kyoung-Mee; Lee, Eui Jin; Ha, Sangyun; Kang, So Young; Jang, Kee-Taek; Park, Cheol Keun; Kim, Jin Yong; Kim, Young Ho; Chang, Dong Kyung; Odze, Robert Daniel

    2011-09-01

    Abundant recent data suggest that sessile serrated adenoma/polyp (SSA/P) is an early precursor lesion in the serrated pathway of carcinogenesis. It is believed that SSA/Ps develop cancer by an SSA/P-dysplasia-carcinoma sequence. Hyperplastic polyps (HPs) share some histologic and molecular characteristics with SSA/P, but it is unclear whether SSA/Ps are derived from HPs or whether they develop by a different pathogenetic pathway. Previous studies have shown that serrated polyps from Korean patients show different prevalence rates of certain molecular abnormalities compared with similar lesions from American patients, and this suggests that lifestyle and dietary factors may influence the serrated neoplasia pathway. The purpose of this study was to evaluate the molecular features of HPs and SSA/Ps, the latter both with and without dysplasia, from Korean patients and to compare the findings with similar lesions from American patients. One hundred and eleven serrated polyps, consisting of 45 HPs (30 microvesicular, 11 goblet cell, 4 mucin depleted) and 56 SSA/Ps (36 with dysplasia, 20 without dysplasia), were retrieved from the pathology files of a large medical center in Korea and 38 SSA/P from American patients were evaluated for BRAF and KRAS mutations, microsatellite instability, and hypermethylation of O6-methylguanine-DNA methyltransferase (MGMT), hMLH1, adenomatous polyposis coli (APC), p16, methylated in tumor-1 (MINT-1), MINT2, and MINT31. Methylation of hMLH1 was performed using 2 different sets of primers. Twenty-three conventional adenomas from Korean patients were included as controls. The data were compared between polyp subtypes and between polyps in the right versus the left colon. With regard to HP, KRAS mutations were present in 31.1% of polyps and BRAF mutations in 46.7% of polyps. KRAS mutations were significantly more common in goblet cell HP and BRAF in microvesicular HP (MVHP). Methylation of MGMT, hMLH1, APC, p16, MINT1, MINT2, and MINT31 were

  12. Evaluación de la reproducibilidad del diagnóstico microscópico del adenoma serrado de sésil de colon Assessing the reproducibility of the microscopic diagnosis of sessile serrated adenoma of the colon

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    M. Bustamante-Balén

    2009-04-01

    serrated lesions of the colon was studied for 195 lesions (187 hyperplastic polyps and 7 serrated adenomas. Size, location, morphology, and sampling method were collected of each lesion. Both pathologists were unaware of the previous diagnosis, macroscopic characteristics, and location of lesions. Possible diagnoses were: SSA, traditional serrated adenoma (TSA, hyperplastic polyp (HP, serrated polyp, tubular adenoma, or mixed lesions. Diagnostic doubts had to be described. Concordance between both observers was assessed using the kappa index (κ. The influence of collected variables on concordance degree was also evaluated. Results: overall agreement on the histological diagnosis was poor (κ = 0.14, and so was agreement on the diagnosis of SSA (κ = 0.23. Concordance in the diagnosis of SSA improved with size > 5 mm (κ = 0.64 and proximal location (κ = 0.43. Conclusion: in a real clinical setting, the existing morphological criteria for SSA identification may be difficult to use.

  13. Clinical outcomes of surveillance colonoscopy for patients with sessile serrated adenoma

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    Sung Jae Park

    2018-01-01

    Full Text Available Background/Aims: Sessile serrated adenomas (SSAs are known to be precursors of colorectal cancer (CRC. The proper interval of follow-up colonoscopy for SSAs is still being debated. We sought to determine the proper interval of colonoscopy surveillance in patients diagnosed with SSAs in South Korea. Methods: We retrospectively reviewed the medical records of patients diagnosed with SSAs who received 1 or more follow-up colonoscopies. The information reviewed included patient baseline characteristics, SSA characteristics, and colonoscopy information. Results: From January 2007 to December 2011, 152 SSAs and 8 synchronous adenocarcinomas were identified in 138 patients. The mean age of the patients was 62.2 years and 60.1% patients were men. SSAs were located in the right colon (i.e., from the cecum to the hepatic flexure in 68.4% patients. At the first follow-up, 27 SSAs were identified in 138 patients (right colon, 66.7%. At the second follow-up, 6 SSAs were identified in 65 patients (right colon, 66.7%. At the 3rd and 4th follow-up, 21 and 11 patients underwent colonoscopy, respectively, and no SSAs were detected. The total mean follow-up duration was 33.9 months. The mean size of SSAs was 8.1±5.0 mm. SSAs were most commonly found in the right colon (126/185, 68.1%. During annual follow-up colonoscopy surveillance, no cancer was detected. Conclusions: Annual colonoscopy surveillance is not necessary for identifying new CRCs in all patients diagnosed with SSAs. In addition, the right colon should be examined more carefully because SSAs occur more frequently in the right colon during initial and follow-up colonoscopies.

  14. Advantages of magnifying narrow-band imaging for diagnosing colorectal cancer coexisting with sessile serrated adenoma/polyp.

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    Chino, Akiko; Osumi, Hiroki; Kishihara, Teruhito; Morishige, Kenjiro; Ishikawa, Hirotaka; Tamegai, Yoshiro; Igarashi, Masahiro

    2016-04-01

    In the present study, we investigated the advantages of narrow-band imaging (NBI) for efficient diagnosis of sessile serrated adenoma/polyp (SSA/P). The main objective of this study was to analyze the characteristic features of cancer coexisting with serrated lesion by carrying out NBI. We evaluated 264 non-malignant serrated lesions by using three modalities (conventional white light colonoscopy, magnifying chromoendoscopy, and magnifying NBI). Of the evaluated cancer cases with serrated lesions, 37 fulfilled the inclusion criteria. In diagnosing non-malignant SSA/P, an expanded crypt opening (ECO) under magnifying NBI is a useful sign. One hundred and twenty-five lesions (87%) of observed ECO were, at the same time, detected to have type II open pit pattern, which is known to be a valuable indicator when using magnifying chromoendoscopy. ECO had high sensitivity of 80% for identifying SSA/P, with 62% specificity and 83% positive predictive value (PPV). In detecting the cancer with SSA/P, irregular vessels under magnifying NBI were frequently observed with 100% sensitivity and 99% specificity, 86% PPV and 100% negative predictive value. A focus on irregular vessels in serrated lesions might be useful for identification of cancer with SSA/P. This is an advantage of carrying out magnifying NBI in addition to being used simultaneously with other modalities by switching, and observations can be made by using wash-in water alone. We can carry out advanced examinations for selected lesions with irregular vessels. To confirm cancerous demarcation and invasion depth, a combination of all three aforementioned modalities should be done. © 2016 The Authors Digestive Endoscopy © 2016 Japan Gastroenterological Endoscopy Society.

  15. The role of APC in WNT pathway activation in serrated neoplasia.

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    Borowsky, Jennifer; Dumenil, Troy; Bettington, Mark; Pearson, Sally-Ann; Bond, Catherine; Fennell, Lochlan; Liu, Cheng; McKeone, Diane; Rosty, Christophe; Brown, Ian; Walker, Neal; Leggett, Barbara; Whitehall, Vicki

    2018-03-01

    Conventional adenomas are initiated by APC gene mutation that activates the WNT signal. Serrated neoplasia is commonly initiated by BRAF or KRAS mutation. WNT pathway activation may also occur, however, to what extent this is owing to APC mutation is unknown. We examined aberrant nuclear β-catenin immunolocalization as a surrogate for WNT pathway activation and analyzed the entire APC gene coding sequence in serrated and conventional pathway polyps and cancers. WNT pathway activation was a common event in conventional pathway lesions with aberrant nuclear immunolocalization of β-catenin and truncating APC mutations in 90% and 89% of conventional adenomas and 82% and 70% of BRAF wild-type cancers, respectively. WNT pathway activation was seen to a lesser extent in serrated pathway lesions. It occurred at the transition to dysplasia in serrated polyps with a significant increase in nuclear β-catenin labeling from sessile serrated adenomas (10%) to sessile serrated adenomas with dysplasia (55%) and traditional serrated adenomas (9%) to traditional serrated adenomas with dysplasia (39%) (P=0.0001). However, unlike the conventional pathway, truncating APC mutations were rare in the serrated pathway lesions especially sessile serrated adenomas even when dysplastic (15%) and in the BRAF mutant cancers with microsatellite instability that arise from them (8%). In contrast, APC missense mutations that were rare in conventional pathway adenomas and cancers (3% in BRAF wild-type cancers) were more frequent in BRAF mutant cancers with microsatellite instability (32%). We conclude that increased WNT signaling is important in the transition to malignancy in the serrated pathway but that APC mutation is less common and the spectrum of mutations is different than in conventional colorectal carcinogenesis. Moderate impact APC mutations and non-APC-related causes of increased WNT signaling may have a more important role in serrated neoplasia than the truncating APC mutations

  16. A CpG island methylator phenotype of colorectal cancer that is contiguous with conventional adenomas, but not serrated polyps.

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    Hokazono, Koji; Ueki, Takashi; Nagayoshi, Kinuko; Nishioka, Yasunobu; Hatae, Tatsunobu; Koga, Yutaka; Hirahashi, Minako; Oda, Yoshinao; Tanaka, Masao

    2014-11-01

    A subset of colorectal cancers (CRCs) harbor the CpG island methylator phenotype (CIMP), with concurrent multiple promoter hypermethylation of tumor-related genes. A serrated pathway in which CIMP is developed from serrated polyps is proposed. The present study characterized CIMP and morphologically examined precursor lesions of CIMP. In total, 104 CRCs treated between January 1996 and December 2004 were examined. Aberrant promoter methylation of 15 cancer-related genes was analyzed. CIMP status was classified according to the number of methylated genes and was correlated with the clinicopathological features, including the concomitant polyps in and around the tumors. The frequency of aberrant methylation in each CRC showed a bimodal pattern, and the CRCs were classified as CIMP-high (CIMP-H), CIMP-low (CIMP-L) and CIMP-negative (CIMP-N). CIMP-H was associated with aberrant methylation of MLH1 (P=0.005) and with an improved recurrence-free survival (RFS) rate following curative resection compared with CIMP-L/N (five-year RFS rate, 93.8 vs. 67.1%; P=0.044), while CIMP-N tumors were associated with frequent distant metastases at diagnosis (P=0.023). No concomitant serrated lesions were present in the tumors, whereas conventional adenoma was contiguous with 11 (10.6%) of 104 CRCs, including four CIMP-H CRCs. CIMP-H was classified in CRCs by a novel CIMP marker panel and the presence of concomitant tumors revealed that certain CIMP-H CRCs may have arisen from conventional adenomas.

  17. Conventional colon adenomas harbor various disturbances in microsatellite stability and contain micro-serrated foci with microsatellite instability.

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    Piotr Lewitowicz

    Full Text Available Colorectal cancer belongs to the most frequent occurring malignancies. A prediction of the clinical outcome and appropriate choice of neoadjuvant chemotherapy needs personalized insight to the main driving pathways. Because most CRCs have polyps as progenitor lesions, studying the pathways driving to adenomagenesis is no less important.Our purpose was the evaluation of microsatellite stability status within conventional colon adenomas and also β-catenin, BRAFV600E and p53 contribution.The cohort included 101 cases of typical colon adenomas with high grade epithelial dysplasia according to WHO. An immunohistochemistry method was used for the depiction of the expression of targeted proteins, as also their heterogeneity.Generally, we noted a 10% frequency of MSI events where MSI-H reached a 5% share occurred within the left colon and rectal polyps. β-catenin nuclear overexpression was noted with a 70% frequency and p53 with close to a 24% frequency. In addition, we found a presence of micro-serration foci more often within tubular adenomas, where focal MSI took place more often. Our results indicate that MSI events occur more often than had been theorized earlier. It results in tumour heterogeneity, more complex underlying pathways and finally ontogenetic molecular-diversity of tumours besides similar occurring histopathological features.

  18. A CpG island methylator phenotype of colorectal cancer that is contiguous with conventional adenomas, but not serrated polyps

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    HOKAZONO, KOJI; UEKI, TAKASHI; NAGAYOSHI, KINUKO; NISHIOKA, YASUNOBU; HATAE, TATSUNOBU; KOGA, YUTAKA; HIRAHASHI, MINAKO; ODA, YOSHINAO; TANAKA, MASAO

    2014-01-01

    A subset of colorectal cancers (CRCs) harbor the CpG island methylator phenotype (CIMP), with concurrent multiple promoter hypermethylation of tumor-related genes. A serrated pathway in which CIMP is developed from serrated polyps is proposed. The present study characterized CIMP and morphologically examined precursor lesions of CIMP. In total, 104 CRCs treated between January 1996 and December 2004 were examined. Aberrant promoter methylation of 15 cancer-related genes was analyzed. CIMP sta...

  19. MLH1-93 G/a polymorphism is associated with MLH1 promoter methylation and protein loss in dysplastic sessile serrated adenomas with BRAFV600E mutation.

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    Fennell, Lochlan J; Jamieson, Saara; McKeone, Diane; Corish, Tracie; Rohdmann, Megan; Furner, Tori; Bettington, Mark; Liu, Cheng; Kawamata, Futoshi; Bond, Catherine; Van De Pols, Jolieke; Leggett, Barbara; Whitehall, Vicki

    2018-01-05

    Sessile serrated adenomas with BRAF mutation progress rapidly to cancer following the development of dysplasia (SSAD). Approximately 75% of SSADs methylate the mismatch repair gene MLH1, develop mismatch repair deficiency and the resultant cancers have a good prognosis. The remaining SSADs and BRAF mutant traditional serrated adenomas (TSA) develop into microsatellite stable cancers with a poor prognosis. The reason for this dichotomy is unknown. In this study, we assessed the genotypic frequency of the MLH1-93 polymorphism rs1800734 in SSADs and TSAs to determine if the uncommon variant A allele predisposes to MLH1 promoter hypermethylation. We performed genotyping for the MLH1-93 polymorphism, quantitative methylation specific PCR, and MLH1 immunohistochemistry on 124 SSAD, 128 TSA, 203 BRAF mutant CRCs and 147 control subjects with normal colonoscopy. The minor A allele was significantly associated with a dose dependent increase in methylation at the MLH1 promoter in SSADs (p = 0.022). The AA genotype was only observed in SSADs with MLH1 loss. The A allele was also overrepresented in BRAF mutant cancers with MLH1 loss. Only one of the TSAs showed loss of MLH1 and the overall genotype distribution in TSAs did not differ from controls. The MLH1-93 AA genotype is significantly associated with promoter hypermethylation and MLH1 loss in the context of SSADs. BRAF mutant microsatellite stable colorectal cancers with the AA genotype most likely arise in TSAs since the A allele does not predispose to methylation in this context.

  20. Risk factors for colorectal cancer in patients with multiple serrated polyps: a cross-sectional case series from genetics clinics.

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    Daniel D Buchanan

    2010-07-01

    Full Text Available Patients with multiple serrated polyps are at an increased risk for developing colorectal cancer (CRC. Recent reports have linked cigarette smoking with the subset of CRC that develops from serrated polyps. The aim of this work therefore was to investigate the association between smoking and the risk of CRC in high-risk genetics clinic patients presenting with multiple serrated polyps.We identified 151 Caucasian individuals with multiple serrated polyps including at least 5 outside the rectum, and classified patients into non-smokers, current or former smokers at the time of initial diagnosis of polyposis. Cases were individuals with multiple serrated polyps who presented with CRC. Controls were individuals with multiple serrated polyps and no CRC. Multivariate logistic regression was performed to estimate associations between smoking and CRC with adjustment for age at first presentation, sex and co-existing traditional adenomas, a feature that has been consistently linked with CRC risk in patients with multiple serrated polyps. CRC was present in 56 (37% individuals at presentation. Patients with at least one adenoma were 4 times more likely to present with CRC compared with patients without adenomas (OR = 4.09; 95%CI 1.27 to 13.14; P = 0.02. For females, the odds of CRC decreased by 90% in current smokers as compared to never smokers (OR = 0.10; 95%CI 0.02 to 0.47; P = 0.004 after adjusting for age and adenomas. For males, there was no relationship between current smoking and CRC. There was no statistical evidence of an association between former smoking and CRC for both sexes.A decreased odds for CRC was identified in females with multiple serrated polyps who currently smoke, independent of age and the presence of a traditional adenoma. Investigations into the biological basis for these observations could lead to non-smoking-related therapies being developed to decrease the risk of CRC and colectomy in these patients.

  1. Sessile serrated polyps of the colorectum are rare in patients with Lynch syndrome and in familial colorectal cancer families

    DEFF Research Database (Denmark)

    Andersen, S H; Lykke, E; Folker, M B

    2008-01-01

    Whereas the generally accepted carcinogenesis pathway of the microsatellite instabile high (MSI-H) colorectal carcinoma (CRC) involves the traditional adenoma in patients with Lynch syndrome, a serrate pathway involving serrate adenomas (SA) and sessile serrate polyps (SSP) characterize...... the sporadic MSI-H counterpart. Recent studies have, however, challenged such simple one-pathway models, inviting the consideration of alternative, unexpected pathways. Here, the issue as to the possible role of SSP, primarily in the context of Lynch syndrome, but also in subjects from familial CRC families...... (FCF) is addressed. Polyps coded as hyperplastic polyps (HP) from subjects with Lynch syndrome and FCF enrolled in the HNPCC-register at the Hvidovre University Hospital as well as adenomas from this population were retrieved and reviewed for features of SSP. Ninety-eight polyps coded as HP and 41...

  2. The serrated neoplasia pathway of colorectal tumors: Identification of MUC5AC hypomethylation as an early marker of polyps with malignant potential.

    Science.gov (United States)

    Renaud, Florence; Mariette, Christophe; Vincent, Audrey; Wacrenier, Agnès; Maunoury, Vincent; Leclerc, Julie; Coppin, Lucie; Crépin, Michel; Van Seuningen, Isabelle; Leteurtre, Emmanuelle; Buisine, Marie-Pierre

    2016-03-15

    The serrated neoplasia pathway accounts for 20-30% of colorectal cancers (CRC), which are characterized by extensive methylation (CpG island methylation phenotype, CIMP), frequent BRAF mutation and high microsatellite instability (MSI). We recently identified MUC5AC mucin gene hypomethylation as a specific marker of MSI CRC. The early identification of preneoplastic lesions among serrated polyps is currently challenging. Here, we performed a detailed pathological and molecular analysis of a large series of colorectal serrated polyps and evaluated the usefulness of mucin genes MUC2 and MUC5AC to differentiate serrated polyps and to identify lesions with malignant potential. A series of 330 colorectal polyps including 218 serrated polyps [42 goblet cell-rich hyperplastic polyps (GCHP), 68 microvesicular hyperplastic polyps (MVHP), 100 sessile serrated adenoma (SSA) and eight traditional serrated adenoma (TSA)] and 112 conventional adenomas was analyzed for BRAF/KRAS mutations, MSI, CIMP, MLH1 and MGMT methylation, and MUC2 and MUC5AC expression and methylation. We show that MUC5AC hypomethylation is an early event in the serrated neoplasia pathway, and specifically detects MVHP and SSA, arguing for a filiation between MVHP, SSA and CIMP-H/MSI CRC, whereas GCHP and TSA arise from a distinct pathway. Moreover, MUC5AC hypomethylation specifically identified serrated lesions with BRAF mutation, CIMP-H or MSI, suggesting that it may be useful to identify serrated neoplasia pathway-related precursor lesions. Our data suggest that MVHP should be recognized among HP and require particular attention. © 2015 UICC.

  3. A role for the epidermal growth factor receptor signaling in development of intestinal serrated polyps in mice and humans.

    Science.gov (United States)

    Bongers, Gerold; Muniz, Luciana R; Pacer, Michelle E; Iuga, Alina C; Thirunarayanan, Nanthakumar; Slinger, Erik; Smit, Martine J; Reddy, E Premkumar; Mayer, Lloyd; Furtado, Glaucia C; Harpaz, Noam; Lira, Sergio A

    2012-09-01

    Epithelial cancers can be initiated by activating mutations in components of the mitogen-activated protein kinase signaling pathway such as v-raf murine sarcoma viral oncogene homolog B1 (BRAF), v-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog (KRAS), or epidermal growth factor receptor (EGFR). Human intestinal serrated polyps are a heterogeneous group of benign lesions, but some progress to colorectal cancer. Tumors that arise from these polyps frequently contain activating mutations in BRAF or KRAS, but little is known about the role of EGFR activation in their development. Polyp samples were obtained from adults during screening colonoscopies at Mount Sinai Hospital in New York. We measured levels of EGFR protein and phosphorylation in human serrated polyps by immunohistochemical and immunoblot analyses. We generated transgenic mice that express the ligand for EGFR, Heparin-binding EGF-like growth factor (HB-EGF), in the intestine. EGFR and the extracellular-regulated kinases (ERK)1/2 were phosphorylated in serrated areas of human hyperplastic polyps (HPPs), sessile serrated adenomas, and traditional serrated adenomas. EGFR and ERK1/2 were phosphorylated in the absence of KRAS or BRAF activating mutations in a subset of HPP. Transgenic expression of the EGFR ligand HB-EGF in the intestines of mice promoted development of small cecal serrated polyps. Mice that expressed a combination of HB-EGF and US28 (a constitutively active, G-protein-coupled receptor that increases processing of HB-EGF from the membrane) rapidly developed large cecal serrated polyps. These polyps were similar to HPPs and had increased phosphorylation of EGFR and ERK1/2 within the serrated epithelium. Administration of pharmacologic inhibitors of EGFR or MAPK to these transgenic mice significantly reduced polyp development. Activation of EGFR signaling in the intestine of mice promotes development of serrated polyps. EGFR signaling also is activated in human HPPs, sessile serrated adenomas

  4. British Society of Gastroenterology position statement on serrated polyps in the colon and rectum.

    Science.gov (United States)

    East, James E; Atkin, Wendy S; Bateman, Adrian C; Clark, Susan K; Dolwani, Sunil; Ket, Shara N; Leedham, Simon J; Phull, Perminder S; Rutter, Matt D; Shepherd, Neil A; Tomlinson, Ian; Rees, Colin J

    2017-07-01

    Serrated polyps have been recognised in the last decade as important premalignant lesions accounting for between 15% and 30% of colorectal cancers. There is therefore a clinical need for guidance on how to manage these lesions; however, the evidence base is limited. A working group was commission by the British Society of Gastroenterology (BSG) Endoscopy section to review the available evidence and develop a position statement to provide clinical guidance until the evidence becomes available to support a formal guideline. The scope of the position statement was wide-ranging and included: evidence that serrated lesions have premalignant potential; detection and resection of serrated lesions; surveillance strategies after detection of serrated lesions; special situations-serrated polyposis syndrome (including surgery) and serrated lesions in colitis; education, audit and benchmarks and research questions. Statements on these issues were proposed where the evidence was deemed sufficient, and re-evaluated modified via a Delphi process until >80% agreement was reached. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool was used to assess the strength of evidence and strength of recommendation for finalised statements. Key recommendation : we suggest that until further evidence on the efficacy or otherwise of surveillance are published, patients with sessile serrated lesions (SSLs) that appear associated with a higher risk of future neoplasia or colorectal cancer (SSLs ≥10 mm or serrated lesions harbouring dysplasia including traditional serrated adenomas) should be offered a one-off colonoscopic surveillance examination at 3 years ( weak recommendation, low quality evidence, 90% agreement ). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  5. MicroRNA-31 expression in relation to BRAF mutation, CpG island methylation and colorectal continuum in serrated lesions.

    Science.gov (United States)

    Ito, Miki; Mitsuhashi, Kei; Igarashi, Hisayoshi; Nosho, Katsuhiko; Naito, Takafumi; Yoshii, Shinji; Takahashi, Hiroaki; Fujita, Masahiro; Sukawa, Yasutaka; Yamamoto, Eiichiro; Takahashi, Taiga; Adachi, Yasushi; Nojima, Masanori; Sasaki, Yasushi; Tokino, Takashi; Baba, Yoshifumi; Maruyama, Reo; Suzuki, Hiromu; Imai, Kohzoh; Yamamoto, Hiroyuki; Shinomura, Yasuhisa

    2014-12-01

    The CpG island methylator phenotype (CIMP) is a distinct form of epigenomic instability. Many CIMP-high colorectal cancers (CRCs) with BRAF mutation are considered to arise from serrated pathway. We recently reported that microRNA-31 (miR-31) is associated with BRAF mutation in colorectal tumors. Emerging new approaches have revealed gradual changes in BRAF mutation and CIMP-high throughout the colorectum in CRCs. Here, we attempted to identify a possible association between miR-31 and epigenetic features in serrated pathway, and hypothesized that miR-31 supports the "colorectal continuum" concept. We evaluated miR-31 expression, BRAF mutation and epigenetic features including CIMP status in 381 serrated lesions and 222 non-serrated adenomas and examined associations between them and tumor location (rectum; sigmoid, descending, transverse and ascending colon and cecum). A significant association was observed between high miR-31 expression and CIMP-high status in serrated lesions with BRAF mutation (p = 0.0001). In contrast, miR-31 was slightly but insignificantly associated with CIMP status in the cases with wild-type BRAF. miR-31 expression in sessile serrated adenomas (SSAs) with cytological dysplasia was higher than that in SSAs, whereas, no significant difference was observed between traditional serrated adenomas (TSAs) and TSAs with high-grade dysplasia. The frequency of miR-31, BRAF mutation CIMP-high and MLH1 methylation increased gradually from the rectum to cecum in serrated lesions. In conclusion, miR-31 expression was associated with CIMP-high status in serrated lesions with BRAF mutation. Our data also suggested that miR-31 plays an important role in SSA evolution and may be a molecule supporting the colorectal continuum. © 2014 UICC.

  6. CpG Island Methylator Phenotype-High Colorectal Cancers and Their Prognostic Implications and Relationships with the Serrated Neoplasia Pathway.

    Science.gov (United States)

    Rhee, Ye-Young; Kim, Kyung-Ju; Kang, Gyeong Hoon

    2017-01-15

    The concept of a CpG island methylator phenotype (CIMP) was first introduced by Toyota and Issa to describe a subset of colorectal cancers (CRCs) with concurrent hypermethylation of multiple CpG island loci. The concept of CIMP as a molecular carcinogenesis mechanism was consolidated by the identification of the serrated neoplasia pathway, in which CIMP participates in the initiation and progression of serrated adenomas. Distinct clinicopathological and molecular features of CIMP-high (CIMP-H) CRCs have been characterized, including proximal colon location, older age of onset, female preponderance, and frequent associations of high-level microsatellite instability and BRAF mutations. CIMP-H CRCs arise in sessile or traditional serrated adenomas and thus tend to display the morphological characteristics of serrated adenomas, including epithelial serration, vesicular nuclei, and abundant cytoplasm. Both the frequent association of CIMP and poor prognosis and different responses of CRCs to adjuvant therapy depending on CIMP status indicate clinical implications. In this review, we present an overview of the literature documenting the relevant findings of CIMP-H CRCs and their relationships with the serrated neoplasia pathway.

  7. Hyper-Methylated Loci Persisting from Sessile Serrated Polyps to Serrated Cancers.

    Science.gov (United States)

    Andrew, Angeline S; Baron, John A; Butterly, Lynn F; Suriawinata, Arief A; Tsongalis, Gregory J; Robinson, Christina M; Amos, Christopher I

    2017-03-02

    Although serrated polyps were historically considered to pose little risk, it is now understood that progression down the serrated pathway could account for as many as 15%-35% of colorectal cancers. The sessile serrated adenoma/polyp (SSA/P) is the most prevalent pre-invasive serrated lesion. Our objective was to identify the CpG loci that are persistently hyper-methylated during serrated carcinogenesis, from the early SSA/P lesion through the later cancer phases of neoplasia development. We queried the loci hyper-methylated in serrated cancers within our rightsided SSA/Ps from the New Hampshire Colonoscopy Registry, using the Illumina Infinium Human Methylation 450 k panel to comprehensively assess the DNA methylation status. We identified CpG loci and regions consistently hyper-methylated throughout the serrated carcinogenesis spectrum, in both our SSA/P specimens and in serrated cancers. Hyper-methylated CpG loci included the known the tumor suppressor gene RET (p = 5.72 x 10-10), as well as loci in differentially methylated regions for GSG1L, MIR4493, NTNG1, MCIDAS, ZNF568, and RERG. The hyper-methylated loci that we identified help characterize the biology of SSA/P development, and could be useful as therapeutic targets, or for future identification of patients who may benefit from shorter surveillance intervals.

  8. Subtypes of the Type II Pit Pattern Reflect Distinct Molecular Subclasses in the Serrated Neoplastic Pathway.

    Science.gov (United States)

    Aoki, Hironori; Yamamoto, Eiichiro; Yamano, Hiro-O; Sugai, Tamotsu; Kimura, Tomoaki; Tanaka, Yoshihito; Matsushita, Hiro-O; Yoshikawa, Kenjiro; Takagi, Ryo; Harada, Eiji; Nakaoka, Michiko; Yoshida, Yuko; Harada, Taku; Sudo, Gota; Eizuka, Makoto; Yorozu, Akira; Kitajima, Hiroshi; Niinuma, Takeshi; Kai, Masahiro; Nojima, Masanori; Suzuki, Hiromu; Nakase, Hiroshi

    2018-03-15

    Colorectal serrated lesions (SLs) are important premalignant lesions whose clinical and biological features are not fully understood. We aimed to establish accurate colonoscopic diagnosis and treatment of SLs through evaluation of associations among the morphological, pathological, and molecular characteristics of SLs. A total of 388 premalignant and 18 malignant colorectal lesions were studied. Using magnifying colonoscopy, microsurface structures were assessed based on Kudo's pit pattern classification system, and the Type II pit pattern was subcategorized into classical Type II, Type II-Open (Type II-O) and Type II-Long (Type II-L). BRAF/KRAS mutations and DNA methylation of CpG island methylator phenotype (CIMP) markers (MINT1, - 2, - 12, - 31, p16, and MLH1) were analyzed through pyrosequencing. Type II-O was tightly associated with sessile serrated adenoma/polyps (SSA/Ps) with BRAF mutation and CIMP-high. Most lesions with simple Type II or Type II-L were hyperplastic polyps, while mixtures of Type II or Type II-L plus more advanced pit patterns (III/IV) were characteristic of traditional serrated adenomas (TSAs). Type II-positive TSAs frequently exhibited BRAF mutation and CIMP-low, while Type II-L-positive TSAs were tightly associated with KRAS mutation and CIMP-low. Analysis of lesions containing both premalignant and cancerous components suggested Type II-L-positive TSAs may develop into KRAS-mutated/CIMP-low/microsatellite stable cancers, while Type II-O-positive SSA/Ps develop into BRAF-mutated/CIMP-high/microsatellite unstable cancers. These results suggest that Type II subtypes reflect distinct molecular subclasses in the serrated neoplasia pathway and that they could be useful hallmarks for identifying SLs at high risk of developing into CRC.

  9. Distinct features between MLH1-methylated and unmethylated colorectal carcinomas with the CpG island methylator phenotype: implications in the serrated neoplasia pathway.

    Science.gov (United States)

    Kim, Jung Ho; Bae, Jeong Mo; Cho, Nam-Yun; Kang, Gyeong Hoon

    2016-03-22

    The presence or absence of MLH1 methylation may critically affect the heterogeneity of colorectal carcinoma (CRC) with the CpG island methylator phenotype (CIMP). Here, we investigated the differential characteristics of CIMP-high (CIMP-H) CRCs according to MLH1 methylation status. To further confirm the MLH1-dependent features in CIMP-H CRC, an independent analysis was performed using data from The Cancer Genome Atlas (TCGA). In our CIMP-H CRC samples, MLH1-methylated tumors were characterized by older patient age, proximal colonic location, mucinous histology, intense lymphoid reactions, RUNX3/SOCS1 promoter methylation, BRAF mutations, and microsatellite instability-high (MSI-H) status. By contrast, MLH1-unmethylated tumors were associated with earlier age of onset, increased distal colorectal localization, adverse pathologic features, and KRAS mutations. In the TCGA dataset, the MLH1-silenced CIMP-H CRC demonstrated proximal location, MSI-H status, hypermutated phenotype, and frequent BRAF mutations, but the MLH1-non-silenced CIMP-H CRC was significantly associated with high frequencies of KRAS and APC mutations. In conclusion, the differential nature of CIMP-H CRCs depends primarily on the MLH1 methylation status. Based on the current knowledge, the sessile serrated adenoma/polyp may be the major precursor of MLH1-methylated CIMP-H CRCs, whereas MLH1-unmethylated CIMP-H CRCs may develop predominantly from KRAS-mutated traditional serrated adenomas and less commonly from BRAF-mutated traditional serrated adenomas and/or sessile serrated adenomas/polyps.

  10. Adenoma detection in patients undergoing a comprehensive colonoscopy screening

    International Nuclear Information System (INIS)

    Raju, Gottumukkala S; Vadyala, Vikram; Slack, Rebecca; Krishna, Somashekar G; Ross, William A; Lynch, Patrick M; Bresalier, Robert S; Hawk, Ernest; Stroehlein, John R

    2013-01-01

    Measures shown to improve the adenoma detection during colonoscopy (excellent bowel preparation, cecal intubation, cap fitted colonoscope to examine behind folds, patient position change to optimize colon distention, trained endoscopy team focusing on detection of subtle flat lesions, and incorporation of optimum endoscopic examination with adequate withdrawal time) are applicable to clinical practice and, if incorporated are projected to facilitate comprehensive colonoscopy screening program for colon cancer prevention. To determine adenoma and serrated polyp detection rate under conditions designed to optimize quality parameters for comprehensive screening colonoscopy. Retrospective analysis of data obtained from a comprehensive colon cancer screening program designed to optimize quality parameters. Academic medical center. Three hundred and forty-three patients between the ages of 50 years and 75 years who underwent first screening colonoscopy between 2009 and 2011 among 535 consecutive patients undergoing colonoscopy. Comprehensive colonoscopy screening program was utilized to screen all patients. Cecal intubation was successful in 98.8% of patients. The Boston Bowel Preparation Scale for quality of colonoscopy was 8.97 (95% confidence interval [CI]; 8.94, 9.00). The rate of adenoma detection was 60% and serrated lesion (defined as serrated adenomas or hyperplastic polyps proximal to the splenic flexure) detection was 23%. The rate of precancerous lesion detection (adenomas and serrated lesions) was 66%. The mean number of adenomas per screening procedure was 1.4 (1.2, 1.6) and the mean number of precancerous lesions (adenomas or serrated lesions) per screening procedure was 1.6 (1.4, 1.8). Retrospective study and single endoscopist experience. A comprehensive colonoscopy screening program results in high-quality screening with high detection of adenomas, advanced adenomas, serrated adenomas, and multiple adenomas

  11. The CIMP Phenotype in BRAF Mutant Serrated Polyps from a Prospective Colonoscopy Patient Cohort

    Directory of Open Access Journals (Sweden)

    Winnie C. Fernando

    2014-01-01

    Full Text Available Colorectal cancers arising via the serrated pathway are often associated with BRAF V600E mutation, CpG island methylator phenotype (CIMP, and microsatellite instability. Previous studies have shown a strong association between BRAF V600E mutation and serrated polyps. This study aims to evaluate CIMP status of all the serrated polyp subtypes and its association with functionally important genes such as MLH1, p16, and IGFBP7. CIMP status and methylation were evaluated using the real-time based MethyLight assay in 154 serrated polyps and 63 conventional adenomas. Results showed that CIMP-high serrated polyps were strongly associated with BRAF mutation and proximal colon. CIMP-high was uncommon in conventional adenomas (1.59%, occurred in 8.25% of hyperplastic polyps (HPs, and became common in sessile serrated adenomas (SSAs (51.43%. MLH1 methylation was mainly observed in the proximal colon and was significantly associated with BRAF mutation and CIMP-high. The number of samples methylated for p16 and IGFBP7 was the highest in SSAs. The methylation panel we used to detect CIMP is highly specific for CIMP-high cancers. With this panel, we demonstrate that CIMP-high is much more common in SSAs than HPs. This suggests that CIMP-high correlates with increased risk of malignant transformation which was also observed in methylation of functionally important genes.

  12. The CIMP Phenotype in BRAF Mutant Serrated Polyps from a Prospective Colonoscopy Patient Cohort.

    Science.gov (United States)

    Fernando, Winnie C; Miranda, Mariska S; Worthley, Daniel L; Togashi, Kazutomo; Watters, Dianne J; Leggett, Barbara A; Spring, Kevin J

    2014-01-01

    Colorectal cancers arising via the serrated pathway are often associated with BRAF V600E mutation, CpG island methylator phenotype (CIMP), and microsatellite instability. Previous studies have shown a strong association between BRAF V600E mutation and serrated polyps. This study aims to evaluate CIMP status of all the serrated polyp subtypes and its association with functionally important genes such as MLH1, p16, and IGFBP7. CIMP status and methylation were evaluated using the real-time based MethyLight assay in 154 serrated polyps and 63 conventional adenomas. Results showed that CIMP-high serrated polyps were strongly associated with BRAF mutation and proximal colon. CIMP-high was uncommon in conventional adenomas (1.59%), occurred in 8.25% of hyperplastic polyps (HPs), and became common in sessile serrated adenomas (SSAs) (51.43%). MLH1 methylation was mainly observed in the proximal colon and was significantly associated with BRAF mutation and CIMP-high. The number of samples methylated for p16 and IGFBP7 was the highest in SSAs. The methylation panel we used to detect CIMP is highly specific for CIMP-high cancers. With this panel, we demonstrate that CIMP-high is much more common in SSAs than HPs. This suggests that CIMP-high correlates with increased risk of malignant transformation which was also observed in methylation of functionally important genes.

  13. PLEOMORPHIC ADENOMA

    African Journals Online (AJOL)

    This is a case of a 68 year-old man from Tanga who was suffering from pleomophic adenoma for 6 years. The tumor started as slowly growing mass which increased to attain a shiny, lobulated appearance. The patient had been treated unsuccessfully by various tradition healers. Finally, he went to Teule. Hospital were he ...

  14. Colorectal Adenocarcinoma with an Alternative Serrated Pathway

    Directory of Open Access Journals (Sweden)

    Makoto Eizuka

    2018-04-01

    Full Text Available In a 64-year-old woman, we identified a flat, elevated lesion that was located at the caecum and was composed of 3 different areas (areas A, B, and C. We diagnosed it as “carcinoma with sessile serrated adenoma/polyp (SSA/P” histologically. Although area A was diagnosed as classical SSA/P, area B was regarded as a high-grade SSA/P. In contrast, area C showed a differentiated-type adenocarcinoma that invaded the submucosa. The patient had a recurrence of cancer 1.5 years after endoscopic resection. Overexpression of TP53 was detected in area C. Although BRAF mutation was detected in all areas, CpG island methylator phenotype-high cancer was found only in area C. The genomic phenotype of the cancerous tissue was classified as microsatellite stable (MLH1 gene not methylated. In the present case, we showed that a lesion with genetic alterations based on the histological sequence SSA/P → high-grade SSA/P → cancer in SSA/P and an alternative serrated pathway may exhibit aggressive behavior.

  15. The somatic mutation landscape of premalignant colorectal adenoma.

    Science.gov (United States)

    Lin, Shu-Hong; Raju, Gottumukkala S; Huff, Chad; Ye, Yuanqing; Gu, Jian; Chen, Jiun-Sheng; Hildebrandt, Michelle A T; Liang, Han; Menter, David G; Morris, Jeffery; Hawk, Ernest; Stroehlein, John R; Futreal, Andrew; Kopetz, Scott; Mishra, Lopa; Wu, Xifeng

    2017-06-12

    There are few studies which characterised the molecular alterations in premalignant colorectal adenomas. Our major goal was to establish colorectal adenoma genome atlas and identify molecular markers of progression from colorectal adenoma to adenocarcinoma. Whole-exome sequencing and targeted sequencing were carried out in 149 adenoma samples and paired blood from patients with conventional adenoma or sessile serrated adenoma to characterise the somatic mutation landscape for premalignant colorectal lesions. The identified somatic mutations were compared with those in colorectal cancer (CRC) samples from The Cancer Genome Atlas. A supervised random forest model was employed to identify gene panels differentiating adenoma from CRC. Similar somatic mutation frequencies, but distinctive driver mutations, were observed in sessile serrated adenomas and conventional adenomas. The final model included 20 genes and was able to separate the somatic mutation profile of colorectal adenoma and adenocarcinoma with an area under the curve of 0.941. The findings of this project hold potential to better identify patients with adenoma who may be candidates for targeted surveillance programmes and preventive interventions to reduce the incidence of CRC. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  16. Gene Signature in Sessile Serrated Polyps Identifies Colon Cancer Subtype

    Science.gov (United States)

    Kanth, Priyanka; Bronner, Mary P.; Boucher, Kenneth M.; Burt, Randall W.; Neklason, Deborah W.; Hagedorn, Curt H.; Delker, Don A.

    2016-01-01

    Sessile serrated colon adenoma/polyps (SSA/Ps) are found during routine screening colonoscopy and may account for 20–30% of colon cancers. However, differentiating SSA/Ps from hyperplastic polyps (HP) with little risk of cancer is challenging and complementary molecular markers are needed. Additionally, the molecular mechanisms of colon cancer development from SSA/Ps are poorly understood. RNA sequencing was performed on 21 SSA/Ps, 10 HPs, 10 adenomas, 21 uninvolved colon and 20 control colon specimens. Differential expression and leave-one-out cross validation methods were used to define a unique gene signature of SSA/Ps. Our SSA/P gene signature was evaluated in colon cancer RNA-Seq data from The Cancer Genome Atlas (TCGA) to identify a subtype of colon cancers that may develop from SSA/Ps. A total of 1422 differentially expressed genes were found in SSA/Ps relative to controls. Serrated polyposis syndrome (n=12) and sporadic SSA/Ps (n=9) exhibited almost complete (96%) gene overlap. A 51-gene panel in SSA/P showed similar expression in a subset of TCGA colon cancers with high microsatellite instability (MSI-H). A smaller seven-gene panel showed high sensitivity and specificity in identifying BRAF mutant, CpG island methylator phenotype high (CIMP-H) and MLH1 silenced colon cancers. We describe a unique gene signature in SSA/Ps that identifies a subset of colon cancers likely to develop through the serrated pathway. These gene panels may be utilized for improved differentiation of SSA/Ps from HPs and provide insights into novel molecular pathways altered in colon cancer arising from the serrated pathway. PMID:27026680

  17. Endoscopic detection rate of sessile serrated lesions in Lynch syndrome patients is comparable to an age- and gender-matched control population: case-control study with expert pathology review

    NARCIS (Netherlands)

    Vleugels, Jasper L. A.; Sahin, Husna; Hazewinkel, Yark; Koens, Lianne; van den Berg, Jose G.; van Leerdam, Monique E.; Dekker, Evelien

    2017-01-01

    Carcinogenesis in Lynch syndrome involves fast progression of adenomas to colorectal cancer (CRC) due to microsatellite instability. The role of sessile serrated lesions (SSLs) and the serrated neoplasia pathway in these patients is unknown. The aim of this matched case-control study was to compare

  18. How does the serrated polyp pathway alter CRC screening and surveillance?

    Science.gov (United States)

    Kahi, Charles J

    2015-03-01

    Screening and surveillance for colorectal cancer (CRC) reduces mortality through the detection of early-stage adenocarcinoma, and more importantly the detection and removal of premalignant polyps. While adenomas have historically been considered the most common and screening-relevant precursor lesions, there is accumulating evidence showing that the serrated pathway is an important contributor to CRC, and a disproportionate contributor to interval or postcolonoscopy CRC, particularly in the proximal colon. The serrated pathway is characterized by mutations in the BRAF gene, high levels of methylation of promoter CpG islands (CIMP-high), and the sessile serrated adenoma/polyp (SSA/P) is the most important precursor lesion. The study of serrated polyps has been complicated by evolving nomenclature, substantial variation among pathologists in the identification of SSA/Ps, high variability in endoscopic detection rates, and uncertainty regarding the relation to synchronous and metachronous colonic neoplasia. This paper presents an overview of the serrated polyp pathway and discusses its clinical implications including its impact on CRC screening.

  19. [Serrated polyps and their association with synchronous advanced colorectal neoplasia].

    Science.gov (United States)

    Urman, Jesús; Gomez, Marta; Basterra, Marta; Mercado, María Del Rosario; Montes, Marta; Gómez Dorronsoro, Marisa; Garaigorta, Maitane; Fraile, María; Rubio, Eva; Aisa, Gregorio; Galbete, Arkaitz

    2016-11-01

    Large serrated polyps (SP), proximal SP, SP with dysplasia and the presence of multiple sessile serrated adenomas/polyps (SSA/P), which we refer to as SP with increased risk of metachronous lesions (SPIRML), have been associated with an increased risk of advanced colon lesions on follow-up. It is unclear, however, whether SPIRML are also associated with an increased risk of synchronous advanced colorectal neoplasia (ACN). The aim of this study was to estimate the prevalence of SPIRML and to evaluate the association between SPIRML and synchronous ACN. A cross-sectional population-based study in all patients (1,538) with histological diagnosis of SP obtained from colonoscopies, sigmoidoscopies and colonic surgery performed in Navarra Health Service hospitals (Spain) in 2011. Demographic parameters and synchronous colonic lesions (adenomas, advanced adenomas [AA] and ACN) were analyzed. One fourth of the sample (384 patients) presented SPIRML. These were older patients, with a slight predominance of women, and with no differences in body mass index (BMI) compared to patients without SPIRML. In the univariate analysis, patients with SPIRML showed an increased risk of adenoma, AA and ACN. In the multivariate analysis, the SPIRML group had a higher risk of synchronous AA and ACN (odds ratio [OR]: 2.38 [1.77-3.21] and OR: 2.29 [1.72-3.05], respectively); in the case of ACN, this risk was statistically significant in both locations (proximal or distal), with OR slightly higher for the proximal location. Different subtypes of SPIRML had a higher risk of AA and synchronous NA. SPIRML were common in patients with SP, and their presence was associated with an increased risk of synchronous ACN. Copyright © 2016 Elsevier España, S.L.U. y AEEH y AEG. All rights reserved.

  20. Clinical characteristics of patients with serrated polyposis syndrome in Korea: comparison with Western patients

    Directory of Open Access Journals (Sweden)

    Eun Ran Kim

    2017-07-01

    Full Text Available Background/Aims: Serrated polyposis syndrome (SPS has been shown to increase the risk of colorectal cancer (CRC. However, little is known about the characteristics of Asian patients with SPS. This study aimed to identify the clinicopathological features and risk of CRC in Korean patients with SPS as well as the differences between Korean and Western patients based on a literature review.Methods: This retrospective study included 30 patients with SPS as defined by World Health Organization classification treated at Samsung Medical Center, Korea, between March 1999 and May 2011.Results: Twenty patients (67% were male. The median patient age at diagnosis was 56 years (range, 39–76 years. A total of 702 polyps were identified during a median follow-up of 43 months (range, 0–149 months. Serrated polyps were noted more frequently in the distal colon (298/702, 55%. However, large serrated polyps and serrated adenomas were mainly distributed throughout the proximal colon (75% vs. 25% and 81% vs. 19%, respectively; 73.3% had synchronous adenomatous polyps. The incidence of CRC was 10% (3/30 patients, but no interval CRC was detected. A total of 87% of the patients underwent esophagogastroduodenoscopy and 19.2% had significant lesions.Conclusions: The phenotype of SPS in Korean patients is different from that of Western patients. In Korean patients, SPS is more common in men, there were fewer total numbers of serrated adenoma/polyps, and the incidence of CRC was lower than that in Western patients. Korean patients tend to more frequently have abnormal gastric lesions. However, the prevalence of synchronous adenomatous polyps is high in both Western and Korean patients.

  1. Long-Term Impact of the Dutch Colorectal Cancer Screening Program on Cancer Incidence and Mortality-Model-Based Exploration of the Serrated Pathway

    NARCIS (Netherlands)

    Greuter, Marjolein J. E.; Demirel, Erhan; Lew, Jie-Bin; Berkhof, Johannes; Xu, Xiang-Ming; Canfell, Karen; Dekker, Evelien; Meijer, Gerrit A.; Coupé, Veerle M. H.

    2016-01-01

    We aimed to predict the long-term colorectal cancer incidence, mortality, and colonoscopy demand of the recently implemented Dutch colorectal cancer screening program. The Adenoma and Serrated pathway to Colorectal Cancer model was set up to simulate the Dutch screening program consisting of

  2. Radiosurgery for pituitary adenomas

    International Nuclear Information System (INIS)

    Castro, Douglas Guedes de; Salvajoli, Joao Victor; Canteras, Miguel Montes; Cecilio, Soraya A. Jorge

    2006-01-01

    Pituitary adenomas represent nearly 15% of all intracranial tumors. Multimodal treatment includes microsurgery, medical management and radiotherapy. Microsurgery is the primary recommendation for nonfunctioning and most of functioning adenomas, except for prolactinomas that are usually managed with dopamine agonist drugs. However, about 30% of patients require additional treatment after microsurgery for recurrent or residual tumors. In these cases, fractionated radiation therapy has been the traditional treatment. More recently, radiosurgery has been established as a treatment option. Radiosurgery allows the delivery of prescribed dose with high precision strictly to the target and spares the surrounding tissues. Therefore, the risks of hypopituitarism, visual damage and vasculopathy are significantly lower. Furthermore, the latency of the radiation response after radiosurgery is substantially shorter than that of fractionated radiotherapy. The goal of this review is to define the efficacy, safety and role of radiosurgery for treatment of pituitary adenomas and to present the preliminary results of our institution. (author)

  3. Filiform serrated adenomatous polyposis arising in a diverted rectum of an inflammatory bowel disease patient

    DEFF Research Database (Denmark)

    Klarskov, Louise; Mogensen, Anne Mellon; Jespersen, Niels

    2011-01-01

    Klarskov L, Mogensen AM, Jespersen N, Ingeholm P, Holck S. Filiform serrated adenomatous polyposis arising in a diverted rectum of an inflammatory bowel disease patient. APMIS 2011; 119: 393-8. A 54-year-old man, previously colectomized for inflammatory bowel disease, developed carcinoma in the i......Klarskov L, Mogensen AM, Jespersen N, Ingeholm P, Holck S. Filiform serrated adenomatous polyposis arising in a diverted rectum of an inflammatory bowel disease patient. APMIS 2011; 119: 393-8. A 54-year-old man, previously colectomized for inflammatory bowel disease, developed carcinoma...... during the adenoma carcinoma sequence included the acquisition of CK7 expression in the malignant portion. Gastric mucin may play a role in the initial step of the neoplastic evolution and CK7 may denote neoplastic progression. This case confirms the notion of a widely variegated morphology of precursor...

  4. Porous Anodic Aluminum Oxide with Serrated Nanochannels

    Science.gov (United States)

    Li, Dongdong; Zhao, Liang; Lu, Jia G.

    2010-03-01

    Self-assembled nanoporous anodic aluminum oxide (AAO) membrane with straight channels has long been an important tool in synthesizing highly ordered and vertically aligned quasi-1D nanostructures for various applications. Recently shape-selective nanomaterials have been achieved using AAO as a template. It is envisioned that nanowires with multi-branches will significantly increase the active functional sites for applications as sensors, catalysts, chemical cells, etc. Here AAO membranes with serrated nanochannels have been successfully fabricated via a two-step annodization method. The serrated channels with periodic intervals are aligned at an angle of ˜25^circ along the stem channels. The formation of the serrated channels is attributed to the evolution of oxygen gas bubbles and the resulted plastic deformation in oxide membrane. In order to reveal the inside channel structure, Platinum are electrodeposited into the AAO template. The as-synthesized serrated Pt nanowires demonstrate a superior electrocatalytic activity. This is attributed to the enhanced electric field strength around serrated tips as shown in the electric field simulation by COMOSL. Moreover, hierarchical serrated/straight hybrid structures can be constructed using this simple and novel self assembly technique.

  5. Water Exchange Produces Significantly Higher Adenoma Detection Rate Than Water Immersion: Pooled Data From 2 Multisite Randomized Controlled Trials.

    Science.gov (United States)

    Leung, Felix W; Koo, Malcolm; Cadoni, Sergio; Falt, Premysl; Hsieh, Yu-Hsi; Amato, Arnaldo; Erriu, Matteo; Fojtik, Petr; Gallittu, Paolo; Hu, Chi-Tan; Leung, Joseph W; Liggi, Mauro; Paggi, Silvia; Radaelli, Franco; Rondonotti, Emanuele; Smajstrla, Vit; Tseng, Chih-Wei; Urban, Ondrej

    2018-03-02

    To test the hypothesis that water exchange (WE) significantly increases adenoma detection rates (ADR) compared with water immersion (WI). Low ADR was linked to increased risk for interval colorectal cancers and related deaths. Two recent randomized controlled trials of head-to-head comparison of WE, WI, and traditional air insufflation (AI) each showed that WE achieved significantly higher ADR than AI, but not WI. The data were pooled from these 2 studies to test the above hypothesis. Two trials (5 sites, 14 colonoscopists) that randomized 1875 patients 1:1:1 to AI, WI, or WE were pooled and analyzed with ADR as the primary outcome. The ADR of AI (39.5%) and WI (42.4%) were comparable, significantly lower than that of WE (49.6%) (vs. AI P=0.001; vs. WI P=0.033). WE insertion time was 3 minutes longer than that of AI (Prate (vs. AI) of the >10 mm advanced adenomas. Right colon combined advanced and sessile serrated ADR of AI (3.4%) and WI (5%) were comparable and were significantly lower than that of WE (8.5%) (vs. AI P<0.001; vs. WI P=0.039). Compared with AI and WI, the superior ADR of WE offsets the drawback of a significantly longer insertion time. For quality improvement focused on increasing adenoma detection, WE is preferred over WI. The hypothesis that WE could lower the risk of interval colorectal cancers and related deaths should be tested.

  6. Serrate, hyperplastiske – og hyperplasilignende,kolorektale polypper

    DEFF Research Database (Denmark)

    Brunbjerg Folker, Mille; Bernstein, Inge Thomsen; Holck, Susanne

    2006-01-01

    The colorectal hyperplastic polyp has generally been considered a finding of no clinical significance. Recent research has, however, called attention to the existence of some variants of hyperplastic polyp which are potentially malignant. The term "advanced serrated polyp" has been coined...... regarding the optimal management of such patients has not been obtained, but if the polyp is sizeable and located in the right colon, control should be considered. The small, usually left-sided traditional polyp as a rule needs no follow-up, but the context in which such a lesion is found and its morphology...

  7. Sessile serrated lesion and its borderline variant - Variables with impact on recorded data

    DEFF Research Database (Denmark)

    Mohammadi, Mahin; Garbyal, Rajendra S; Kristensen, Michael H.

    2011-01-01

    Sessile serrated lesion (SSL), belonging to non-dysplastic serrated polyps (SP), has lately received much focus. Its role in the serrated neoplasia pathway(s) seems well established. Data on prevalence rate, demography, and some polyp characteristics remain, however, to be firmly established. Nor...... has its relation to SPs with subtle aberrant features, falling short of definite SSL-histology, been sufficiently addressed. The aim of this study was to highlight variables that may influence recorded data on SSL and to further discuss the appropriate place of SPs that possess histological attributes...... intermediate between traditional hyperplastic polyp (HP) and SSL, termed borderline SSL (BSSL). Upon review of 8.324 consecutive colorectal polyps signed-out as HP, 219 SSLs and 206 BSSLs were segregated, using strict predetermined criteria. Predominant left-sidedness and equal gender distribution...

  8. Morphological Variations of Leading-Edge Serrations in Owls (Strigiformes.

    Directory of Open Access Journals (Sweden)

    Matthias Weger

    Full Text Available Owls have developed serrations, comb-like structures, along the leading edge of their wings. Serrations were investigated from a morphological and a mechanical point of view, but were not yet quantitatively compared for different species. Such a comparative investigation of serrations from species of different sizes and activity patterns may provide new information about the function of the serrations.Serrations on complete wings and on tenth primary remiges of seven owl species were investigated. Small, middle-sized, and large owl species were investigated as well as species being more active during the day and owls being more active during the night. Serrations occurred at the outer parts of the wings, predominantly at tenth primary remiges, but also on further wing feathers in most species. Serration tips were oriented away from the feather rachis so that they faced into the air stream during flight. The serrations of nocturnal owl species were higher developed as demonstrated by a larger inclination angle (the angle between the base of the barb and the rachis, a larger tip displacement angle (the angle between the tip of the serration and the base of the serration and a longer length. Putting the measured data into a clustering algorithm yielded dendrograms that suggested a strong influence of activity pattern, but only a weak influence of size on the development of the serrations.Serrations are supposed to be involved in noise reduction during flight and also depend on the aerodynamic properties that in turn depend on body size. Since especially nocturnal owls have to rely on hearing during prey capture, the more pronounced serrations of nocturnal species lend further support to the notion that serrations have an important function in noise reduction. The differences in shape of the serrations investigated indicate that a silent flight requires well-developed serrations.

  9. Morphological Variations of Leading-Edge Serrations in Owls (Strigiformes)

    Science.gov (United States)

    Weger, Matthias; Wagner, Hermann

    2016-01-01

    Background Owls have developed serrations, comb-like structures, along the leading edge of their wings. Serrations were investigated from a morphological and a mechanical point of view, but were not yet quantitatively compared for different species. Such a comparative investigation of serrations from species of different sizes and activity patterns may provide new information about the function of the serrations. Results Serrations on complete wings and on tenth primary remiges of seven owl species were investigated. Small, middle-sized, and large owl species were investigated as well as species being more active during the day and owls being more active during the night. Serrations occurred at the outer parts of the wings, predominantly at tenth primary remiges, but also on further wing feathers in most species. Serration tips were oriented away from the feather rachis so that they faced into the air stream during flight. The serrations of nocturnal owl species were higher developed as demonstrated by a larger inclination angle (the angle between the base of the barb and the rachis), a larger tip displacement angle (the angle between the tip of the serration and the base of the serration) and a longer length. Putting the measured data into a clustering algorithm yielded dendrograms that suggested a strong influence of activity pattern, but only a weak influence of size on the development of the serrations. Conclusions Serrations are supposed to be involved in noise reduction during flight and also depend on the aerodynamic properties that in turn depend on body size. Since especially nocturnal owls have to rely on hearing during prey capture, the more pronounced serrations of nocturnal species lend further support to the notion that serrations have an important function in noise reduction. The differences in shape of the serrations investigated indicate that a silent flight requires well-developed serrations. PMID:26934104

  10. LES tests on airfoil trailing edge serration

    DEFF Research Database (Denmark)

    Zhu, Wei Jun; Shen, Wen Zhong

    2016-01-01

    In the present study, a large number of acoustic simulations are carried out for a low noise airfoil with different Trailing Edge Serrations (TES). The Ffowcs Williams-Hawkings (FWH) acoustic analogy is used for noise prediction at trailing edge. The acoustic solver is running on the platform...

  11. Unmetabolized Folic Acid, Tetrahydrofolate, and Colorectal Adenoma Risk.

    Science.gov (United States)

    Rees, Judy R; Morris, Carolyn B; Peacock, Janet L; Ueland, Per M; Barry, Elizabeth L; McKeown-Eyssen, Gail E; Figueiredo, Jane C; Snover, Dale C; Baron, John A

    2017-08-01

    In a randomized trial of folic acid supplementation for the prevention of colorectal adenomas, we previously found indications of increased risk during later treatment and follow-up. This could have been due to the unmetabolized folic acid (UFA) or natural reduced and methylated folates (mF) to which it is metabolized. In post hoc analyses, we measured mF (the sum of 5-methyl-tetrahydrofolate and 4-alfa-hydroxy-5-methyl-THF) and UFA concentrations in the serum of 924 participants. Using binomial regression models with a log link, we assessed the associations between plasma mF or UFA and adenoma occurrence. We found no association between plasma mF or UFA and overall adenoma risk. However, during later follow-up, the prespecified, composite endpoint of high-risk findings (advanced or multiple adenomas) was positively associated with plasma mF ( P linear trend = 0.009), with a 58% increased risk for participants in the upper versus lowest quartile. An irregular association was seen with plasma UFA, with suggestions of an inverse trend ( P linear trend =0.049). A modest, significant inverse association was also seen between mF and risk of serrated lesions, with a 39% lower risk for upper versus lower quartile participants ( P linear trend = 0.03). In conclusion, during the later follow-up period in which folic acid supplementation was previously seen to increase the risk of advanced and multiple adenomas, higher serum mF was associated with a higher risk of multiple and/or advanced adenomas, but no clear indication that UFA played a direct role. There were indications that higher mF was associated with reduced risk of serrated polyps. Cancer Prev Res; 10(8); 451-8. ©2017 AACR . ©2017 American Association for Cancer Research.

  12. Radiosurgery for pituitary adenomas; Radiocirurgia nos adenomas hipofisarios

    Energy Technology Data Exchange (ETDEWEB)

    Castro, Douglas Guedes de; Salvajoli, Joao Victor; Canteras, Miguel Montes; Cecilio, Soraya A. Jorge [Instituto de Radiocirurgia Neurologica, Sao Paulo, SP (Brazil)]. E-mail: dougguedes@uol.com.br

    2006-12-15

    Pituitary adenomas represent nearly 15% of all intracranial tumors. Multimodal treatment includes microsurgery, medical management and radiotherapy. Microsurgery is the primary recommendation for nonfunctioning and most of functioning adenomas, except for prolactinomas that are usually managed with dopamine agonist drugs. However, about 30% of patients require additional treatment after microsurgery for recurrent or residual tumors. In these cases, fractionated radiation therapy has been the traditional treatment. More recently, radiosurgery has been established as a treatment option. Radiosurgery allows the delivery of prescribed dose with high precision strictly to the target and spares the surrounding tissues. Therefore, the risks of hypopituitarism, visual damage and vasculopathy are significantly lower. Furthermore, the latency of the radiation response after radiosurgery is substantially shorter than that of fractionated radiotherapy. The goal of this review is to define the efficacy, safety and role of radiosurgery for treatment of pituitary adenomas and to present the preliminary results of our institution. (author)

  13. A standardized imaging protocol for the endoscopic prediction of dysplasia within sessile serrated polyps (with video).

    Science.gov (United States)

    Tate, David J; Jayanna, Mahesh; Awadie, Halim; Desomer, Lobke; Lee, Ralph; Heitman, Steven J; Sidhu, Mayenaaz; Goodrick, Kathleen; Burgess, Nicholas G; Mahajan, Hema; McLeod, Duncan; Bourke, Michael J

    2018-01-01

    Dysplasia within sessile serrated polyps (SSPs) is difficult to detect and may be mistaken for an adenoma, risking incomplete resection of the background serrated tissue, and is strongly implicated in interval cancer after colonoscopy. The use of endoscopic imaging to detect dysplasia within SSPs has not been systematically studied. Consecutively detected SSPs ≥8 mm in size were evaluated by using a standardized imaging protocol at a tertiary-care endoscopy center over 3 years. Lesions suspected as SSPs were analyzed with high-definition white light then narrow-band imaging. A demarcated area with a neoplastic pit pattern (Kudo type III/IV, NICE type II) was sought among the serrated tissue. If this was detected, the lesion was labeled dysplastic (sessile serrated polyp with dysplasia); if not, it was labeled non-dysplastic (sessile serrated polyp without dysplasia). Histopathology was reviewed by 2 blinded specialist GI pathologists. A total of 141 SSPs were assessed in 83 patients. Median lesion size was 15.0 mm (interquartile range 10-20), and 54.6% were in the right side of the colon. Endoscopic evidence of dysplasia was detected in 36 of 141 (25.5%) SSPs; of these, 5 of 36 (13.9%) lacked dysplasia at histopathology. Two of 105 (1.9%) endoscopically designated non-dysplastic SSPs had dysplasia at histopathology. Endoscopic imaging, therefore, had an accuracy of 95.0% (95% confidence interval [CI], 90.1%-97.6%) and a negative predictive value of 98.1% (95% CI, 92.6%-99.7%) for detection of dysplasia within SSPs. Dysplasia within SSPs can be detected accurately by using a simple, broadly applicable endoscopic imaging protocol that allows complete resection. Independent validation of this protocol and its dissemination to the wider endoscopic community may have a significant impact on rates of interval cancer. (Clinical trial registration number: NCT03100552.). Copyright © 2018 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All

  14. A novel serrated columnar phased array ultrasonic transducer

    Science.gov (United States)

    Zou, Cheng; Sun, Zhenguo; Cai, Dong; Song, Hongwei; Chen, Qiang

    2016-02-01

    Traditionally, wedges are required to generate transverse waves in a solid specimen and mechanical rotation device is needed for interrogation of a specimen with a hollow bore, such as high speed railway locomotive axles, turbine rotors, etc. In order to eliminate the mechanical rotation process, a novel array pattern of phased array ultrasonic transducers named as serrated columnar phased array ultrasonic transducer (SCPAUT) is designed. The elementary transducers are planar rectangular, located on the outside surface of a cylinder. This layout is aimed to generate electrically rotating transverse waveforms so as to inspect the longitudinal cracks on the outside surface of a specimen which has a hollow bore at the center, such as the high speed railway locomotive axles. The general geometry of the SCPAUT and the inspection system are illustrated. A FEM model and mockup experiment has been carried out. The experiment results are in good agreement with the FEM simulation results.

  15. The clinical significance and synchronous polyp burden of large (≥ 20 mm) sessile serrated polyps in patients without serrated polyposis syndrome.

    Science.gov (United States)

    Desomer, Lobke; Tate, David J; Jayanna, Mahesh; Pellise, Maria; Awadie, Halim; Burgess, Nicholas G; McLeod, Duncan; Mahajan, Hema; Lee, Eric Y T; Williams, Stephen J; Bourke, Michael J

    2018-05-08

     Sessile serrated polyps (SSPs) are important precursors of colorectal carcinoma and interval cancer. Large SSPs (≥ 20 mm) outside the definition of serrated polyposis syndrome (SPS) have not been studied in comparison with SPS. We aimed to describe the characteristics of patients with large SSPs in this context.  Patients with at least one SSP (≥ 20 mm) were eligible. Data from three consecutive colonoscopies were used to compare clinical and endoscopic characteristics in three patient groups: SPS, a solitary large SSP, and patients with at least two SSPs without fulfilling the criteria for SPS (oligo-SSP). Data on the diagnostic colonoscopy were collected retrospectively, whereas the remaining data was collected prospectively.  67/146 patients (45.9 %) had SPS, 53/146 (36.3 %) had a solitary SSP, and 26/146 (17.8 %) were categorized as oligo-SSP. Personal (16.4 %, 9.4 %, and 11.5 %, respectively) and family (17.9 %, 17.0 %, and 23.1 %, respectively) history of colorectal carcinoma did not differ significantly between groups. Polyp burden was greater in SPS compared with solitary SSP but was not different from oligo-SSP (advanced adenomas: SPS 32.8 % vs. solitary SSP 9.4 % [ P  = 0.002] vs. oligo-SSP 34.6 % [ P  = 0.87]; ≥ 10 conventional adenomas: 11.9 % vs. 0 % [ P  = 0.01] vs. 3.8 % [ P  = 0.44], respectively). Dysplasia in large SSPs was frequent in all groups (41.1 % overall). SPS was recognized by referring endoscopists in only 9.0 % of cases.  Patients with oligo-SSPs have similar synchronous polyp burden and clinical characteristics as patients with SPS and may require similar surveillance. Modification of the criteria for the diagnosis of SPS to include this group seems warranted. Patients with a solitary SSP have a lower risk of synchronous polyps, including advanced adenomas. Larger studies are warranted to determine whether these patients may return to standard surveillance

  16. Investigation of Fastening Performance of Subminiature Serrated Bolt

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Myung Guen; Jeong, Jin Hwan; Jang, Yeon Hui; Kim, Hee Cheol; Kim, Jong-Bong [Seoul Nat’l Univ. of Science & Tech, Seoul (Korea, Republic of)

    2017-04-15

    As the size of electric products such as mobile phones and smart watches decrease, the bolts used to assemble these products should also be miniaturized. A miniature-sized bolt has to provide sufficient joining torque and anti-releasing torque to keep the components together. We studied a serrated bolt as a candidate for a miniature-sized fastener to increase the anti-releasing torque. In a serrated bolt, a serrated shape is formed on the bottom surface of the bolt head to create an obstacle to releasing. In this study, finite element analyses for the joining and releasing of bolts were carried out, and the anti-releasing performance was predicted. Based on the results of analyses using various numbers of serrations and fastening depths, the effects of the number of serrations and fastening depth on the anti-releasing performance were investigated.

  17. Investigation of Fastening Performance of Subminiature Serrated Bolt

    International Nuclear Information System (INIS)

    Jang, Myung Guen; Jeong, Jin Hwan; Jang, Yeon Hui; Kim, Hee Cheol; Kim, Jong-Bong

    2017-01-01

    As the size of electric products such as mobile phones and smart watches decrease, the bolts used to assemble these products should also be miniaturized. A miniature-sized bolt has to provide sufficient joining torque and anti-releasing torque to keep the components together. We studied a serrated bolt as a candidate for a miniature-sized fastener to increase the anti-releasing torque. In a serrated bolt, a serrated shape is formed on the bottom surface of the bolt head to create an obstacle to releasing. In this study, finite element analyses for the joining and releasing of bolts were carried out, and the anti-releasing performance was predicted. Based on the results of analyses using various numbers of serrations and fastening depths, the effects of the number of serrations and fastening depth on the anti-releasing performance were investigated.

  18. Serrated Polyposis: An Enigmatic Model of Colorectal Cancer Predisposition

    Directory of Open Access Journals (Sweden)

    Christophe Rosty

    2011-01-01

    Full Text Available Serrated polyposis has only recently been accepted as a condition which carries an increased personal and familial risk of colorectal cancer. Described over four decades ago, it remains one of the most underrecognized and poorly understood of all the intestinal polyposes. With a variety of phenotypic presentations, it is likely that serrated polyposis represents a group of diseases rather than a single entity. Further, neoplastic progression in serrated polyposis may be associated with premature aging in the normal mucosa, typified by widespread gene promoter hypermethylation. From this epigenetically altered field, arise diverse polyps and cancers which show a range of molecular features. Despite a high serrated polyp count, only one-third of colorectal cancers demonstrate a BRAF V600E mutation, the molecular hallmark of the canonical serrated pathway, suggesting that though multiple serrated polyps act as a marker of an abnormal mucosa, the majority of CRC in these patients arise within lesions other than BRAF-mutated serrated polyps.

  19. The mechanism of critical strain and serration type of the serrated flow in Mg–Nd–Zn alloy

    Energy Technology Data Exchange (ETDEWEB)

    Wang, W.H. [The Group of Magnesium Alloys and Their Applications, Institute of Metal Research Chinese Academy of Sciences, 62 Wencui Road, Shenyang 110016 (China); School of Materials Science and Engineering, Shenyang Ligong University, 6 Nanpingzhong Road, Shenyang 110159 (China); Wu, D., E-mail: dwu@imr.ac.cn [The Group of Magnesium Alloys and Their Applications, Institute of Metal Research Chinese Academy of Sciences, 62 Wencui Road, Shenyang 110016 (China); Shah, S.S.A. [The Group of Magnesium Alloys and Their Applications, Institute of Metal Research Chinese Academy of Sciences, 62 Wencui Road, Shenyang 110016 (China); Chen, R.S., E-mail: rschen@imr.ac.cn [The Group of Magnesium Alloys and Their Applications, Institute of Metal Research Chinese Academy of Sciences, 62 Wencui Road, Shenyang 110016 (China); Lou, C.S. [School of Materials Science and Engineering, Shenyang Ligong University, 6 Nanpingzhong Road, Shenyang 110159 (China)

    2016-01-01

    In present research the serrated flow has been observed successfully after a critical amount of strain. Two relationships between the critical strain and temperature i.e. normal and inverse, corresponding to each serration type were studied. In order to investigate systematically the onset of serrated flow and serration type in NZ31 alloy, samples in solutionized condition were tensile tested at the temperature ranging from 100 °C to 300 °C with the strain rate ranging from 1×10{sup −4} s{sup −1} to 1×10{sup −2} s{sup −1}. Results showed that normal critical strain appeared with type A and B serrated flow at temperature from 150°C to 250 °C, and inverse critical strain appeared with type C at temperature from 275 °C to 300 °C. Through analyzing the mechanism of three serration types, we found that the production of serration required improvement in diffusion for solute atoms for pinning process at low temperature, and enhance the moving ability of dislocations for unpinning process at high temperature, which need the assistance of the strain and stress respectively. So, in this work, the critical strain for pinning and the critical stress for unpinning processes were defined, which give a better explanation to the variation tendency of two definitions in accordance with temperature. Furthermore, this relationship results in the critical strain for onset of serrated flow changing from normal to inverse and corresponding different serrations.

  20. Mechanism of serrated flow in binary Al-Li alloys

    Energy Technology Data Exchange (ETDEWEB)

    Kumar, S.; Pink, E. [Austrian Academy of Sciences, Leoben (Austria). Erich-Schmid-Inst. of Solid State Physics; Krol, J. [Polish Academy of Sciences, Krakow (Poland). Alexander-Krupkowski-Inst. of Metallurgy and Materials Science

    1996-09-15

    The work on serrated flow in Al-Li alloys has given rise to a controversy--whether serrations in these alloys are caused by lithium atoms in solid solution or by {delta}{prime}(Al{sub 3}Li)-precipitates. This controversy calls for further work to clarify the mechanism of serrated flow in the Al-Li alloys. Kumar and McShane have shown that in an Al-2.5Li-2Mg-0.14Zr alloy, non-shearable {delta}{prime}-precipitates, which are obtained in the under-aged and peak-aged conditions, might directly initiate serrated flow. However, the latter result was ambiguous because of the presence of other alloying elements, and the need to work on a binary Al-Li alloy was emphasized. The present work discusses the results from the binary Al-Li alloys.

  1. Shark teeth as edged weapons: serrated teeth of three species of selachians.

    Science.gov (United States)

    Moyer, Joshua K; Bemis, William E

    2017-02-01

    Prior to European contact, South Pacific islanders used serrated shark teeth as components of tools and weapons. They did this because serrated shark teeth are remarkably effective at slicing through soft tissues. To understand more about the forms and functions of serrated shark teeth, we examined the morphology and histology of tooth serrations in three species: the Tiger Shark (Galeocerdo cuvier), Blue Shark (Prionace glauca), and White Shark (Carcharodon carcharias). We show that there are two basic types of serrations. A primary serration consists of three layers of enameloid with underlying dentine filling the serration's base. All three species studied have primary serrations, although the dentine component differs (orthodentine in Tiger and Blue Sharks; osteodentine in the White Shark). Smaller secondary serrations are found in the Tiger Shark, formed solely by enameloid with no contribution from underlying dentine. Secondary serrations are effectively "serrations within serrations" that allow teeth to cut at different scales. We propose that the cutting edges of Tiger Shark teeth, equipped with serrations at different scales, are linked to a diet that includes large, hard-shelled prey (e.g., sea turtles) as well as smaller, softer prey such as fishes. We discuss other aspects of serration form and function by making analogies to man-made cutting implements, such as knives and saws. Copyright © 2016 Elsevier GmbH. All rights reserved.

  2. Tradition

    DEFF Research Database (Denmark)

    Otto, Ton

    2016-01-01

    : beliefs, practices, institutions, and also things. In this sense, the meaning of the term in social research is very close to its usage in common language and is not always theoretically well developed (see Shils, 1971: 123). But the concept of tradition has also been central to major theoretical debates...... on the nature of social change, especially in connection with the notion of modernity. Here tradition is linked to various forms of agency as a factor of both stability and intentional change....

  3. Assessment of finite element and smoothed particles hydrodynamics methods for modeling serrated chip formation in hardened steel

    Directory of Open Access Journals (Sweden)

    Usama Umer

    2016-05-01

    Full Text Available This study aims to perform comparative analyses in modeling serrated chip morphologies using traditional finite element and smoothed particles hydrodynamics methods. Although finite element models are being employed in predicting machining performance variables for the last two decades, many drawbacks and limitations exist with the current finite element models. The problems like excessive mesh distortions, high numerical cost of adaptive meshing techniques, and need of geometric chip separation criteria hinder its practical implementation in metal cutting industries. In this study, a mesh free method, namely, smoothed particles hydrodynamics, is implemented for modeling serrated chip morphology while machining AISI H13 hardened tool steel. The smoothed particles hydrodynamics models are compared with the traditional finite element models, and it has been found that the smoothed particles hydrodynamics models have good capabilities in handling large distortions and do not need any geometric or mesh-based chip separation criterion.

  4. LES tests on airfoil trailing edge serration

    International Nuclear Information System (INIS)

    Zhu, Wei Jun; Shen, Wen Zhong

    2016-01-01

    In the present study, a large number of acoustic simulations are carried out for a low noise airfoil with different Trailing Edge Serrations (TES). The Ffowcs Williams-Hawkings (FWH) acoustic analogy is used for noise prediction at trailing edge. The acoustic solver is running on the platform of our in-house incompressible flow solver EllipSys3D. The flow solution is first obtained from the Large Eddy Simulation (LES), the acoustic part is then carried out based on the instantaneous hydrodynamic pressure and velocity field. To obtain the time history data of sound pressure, the flow quantities are integrated around the airfoil surface through the FWH approach. For all the simulations, the chord based Reynolds number is around 1.5x10 6 . In the test matrix, the effects from angle of attack, the TE flap angle, the length/width of the TES are investigated. Even though the airfoil under investigation is already optimized for low noise emission, most numerical simulations and wind tunnel experiments show that the noise level is further decreased by adding the TES device. (paper)

  5. CT scan of pituitary adenomas

    International Nuclear Information System (INIS)

    Sakoda, K.; Mukada, K.; Yonezawa, M.; Matsumura, S.; Yoshimoto, H.; Mori, S.; Uozumi, T.

    1981-01-01

    CT scan is an extremely useful, almost harmless means of diagnosing pituitary adenomas. Growth hormone (GH)-secreting adenomas tend to have higher absorption coefficent in plain CT than the nonfunctioning and prolactin (PRL)-secreting adenomas. The absorption coefficent on contrast-enhanced CT does not identify the specific type of adenoma. Ring-like enhancement was observed in five nonfunctioning and four PRL-secreting adenomas with suprasellar extension, while cystic components were observed in four nonfunctioning and four PRL-secreting adenomas. In three of ten cases of PRL-secreting microadenomas, the site corresponding to the adenoma was not enhanced, whereas the normal pituitary was. A correlation exists between the size of PRL-secreting adenoma and the serum PRL level, but not between the size of GH-secreting adenomas and the serum GH level. (orig.)

  6. Colorectal cancer diagnosis in 2012: A new focus for CRC prevention--more serration, less inflammation

    NARCIS (Netherlands)

    East, James E.; Dekker, Evelien

    2013-01-01

    Knowledge of colorectal cancer (CRC) risks has been rebalanced in 2012. The 'serrated pathway' to CRC, exemplified by serrated polyposis syndrome, emphasizes the importance of serrated lesions. The dogma that patients with IBD are at high risk of CRC, however, might be overstated; optimizing CRC

  7. Numerical simulation of airfoil trailing edge serration noise

    DEFF Research Database (Denmark)

    Zhu, Wei Jun; Shen, Wen Zhong

    In the present work, numerical simulations are carried out for a low noise airfoil with and without serrated Trailing Edge. The Ffowcs Williams-Hawkings acoustic analogy is implemented into the in-house incompressible flow solver EllipSys3D. The instantaneous hydrodynamic pressure and velocity...... field are obtained using Large Eddy Simulation. To obtain the time history data of sound pressure, the flow quantities are integrated around the airfoil surface through the FW-H approach. The extended length of the serration is about 16.7% of the airfoil chord and the geometric angle of the serration...... is 28 degrees. The chord based Reynolds number is around 1.5x106. Simulations are compared with existing wind tunnel experiments at various angles of attack. Even though the airfoil under investigation is already optimized for low noise emission, numerical simulations and wind tunnel experiments show...

  8. Parathyroid adenoma with concurrent toxic thyroid adenoma: A rare ...

    African Journals Online (AJOL)

    recognized phenomenon. Primary hyperparathyroidism due to parathyroid adenoma in association with thyroid adenoma is extremely rare. These cases can present a diagnostic and therapeutic challenge to the treating physician as the patient may ...

  9. Endoscopic management of colorectal adenomas.

    Science.gov (United States)

    Meier, Benjamin; Caca, Karel; Fischer, Andreas; Schmidt, Arthur

    2017-01-01

    Colorectal adenomas are well known precursors of invasive adenocarcinoma. Colonoscopy is the gold standard for adenoma detection. Colonoscopy is far more than a diagnostic tool, as it allows effective treatment of colorectal adenomas. Endoscopic resection of colorectal adenomas has been shown to reduce the incidence and mortality of colorectal cancer. Difficult resection techniques are available, such as endoscopic mucosal resection, endoscopic submucosal dissection and endoscopic full-thickness resection. This review aims to provide an overview of the different endoscopic resection techniques and their indications, and summarizes the current recommendations in the recently published guideline of the European Society of Gastrointestinal Endoscopy.

  10. Lacrimal Gland Pleomorphic Adenoma and Carcinoma ex Pleomorphic Adenoma

    DEFF Research Database (Denmark)

    von Holstein, Sarah L; Fehr, André; Persson, Marta

    2014-01-01

    To study genetic alterations in lacrimal gland pleomorphic adenoma (PA) and carcinoma ex pleomorphic adenoma (Ca-ex-PA) with focus on copy number changes and expression patterns of the translocation target genes PLAG1, HMGA2, and CRTC1-MAML2 in relation to clinical data....

  11. Detection of colorectal serrated polyps by stool DNA testing: comparison with fecal immunochemical testing for occult blood (FIT.

    Directory of Open Access Journals (Sweden)

    Russell I Heigh

    Full Text Available Precursors to 1/3 of colorectal cancer (CRC, serrated polyps have been under-detected by screening due to their inconspicuous, non-hemorrhagic, and proximal nature. A new multi-target stool DNA test (multi-target sDNA shows high sensitivity for both CRC and advanced adenomas. Screen detection of serrated polyps by this approach requires further validation. We sought to assess and compare noninvasive detection of sessile serrated polyps (SSP ≥ 1 cm by sDNA and an occult blood fecal immunochemical test (FIT.In a blinded prospective study, a single stool sample used for both tests was collected from 456 asymptomatic adults prior to screening or surveillance colonoscopy (criterion standard. All 29 patients with SSP ≥ 1 cm were included as cases and all 232 with no neoplastic findings as controls. Buffered stool samples were processed and frozen on receipt; Exact Sciences performed sDNA in batches using optimized analytical methods. The sDNA multi-marker panel targets methylated BMP3 (mBMP3 and NDRG4, mutant KRAS, β-actin, and hemoglobin. FIT (Polymedco OC-FIT Check was performed in separate lab ≤ 2 days post defecation and evaluated at cutoffs of 50 (FIT-50 and 100 ng/ml (FIT-100.MEDIAN AGES: cases 61 (range 57-77, controls 62 (52-70, p = NS. Women comprised 59% and 51%, p = NS, respectively. SSP median size was 1.2 cm (1-3 cm, 93% were proximal, and 64% had synchronous diminutive polyps. Among multi-target sDNA markers, mBMP3 proved highly discriminant for detection of SSP ≥ 1 cm (AUC = 0.87, p<0.00001; other DNA markers provided no incremental sensitivity. Hemoglobin alone showed no discrimination (AUC = 0.50, p = NS. At matched specificities, detection of SSP ≥ 1 cm by stool mBMP3 was significantly greater than by FIT-50 (66% vs 10%, p = 0.0003 or FIT-100 (63% vs 0%, p<0.0001.In a screening and surveillance setting, SSP ≥ 1 cm can be detected noninvasively by stool assay of exfoliated DNA markers, especially mBMP3. FIT appears to

  12. Diagnostic accuracy of 18F-FDG PET/CT for detection of advanced colorectal adenoma

    International Nuclear Information System (INIS)

    Gollub, M.J.; Grewal, R.K.; Panu, N.; Thipphavong, S.; Sohn, M.; Zheng, J.; Moskowitz, C.S.

    2014-01-01

    Aim: To determine the accuracy of 2-[ 18 F]-fluoro-2-deoxy-D-glucose (FDG) positron-emission tomography (PET) in the detection of advanced colorectal adenomas. Materials and methods: In this retrospective study, patient consent was waived by the institutional review board. Combined FDG whole-body PET and computed tomography (CT) images (2000–2009) were re-read and compared with reports of complete colonoscopy performed up to 1 year after the PET examination. One or more areas of focal colonic uptake greater than the background indicated a positive PET result, irrespective of standardized uptake value (SUV). Lesion and patient-level measures of PET accuracy with their 95% confidence intervals (CI) were calculated. Results: One hundred and eighty patients undergoing colonoscopy with or without biopsy underwent PET within 1 year prior to colonoscopy. There were 92 women and 88 men (mean age 63.3 years). Indications for PET were extent of disease and treatment response in all cases. Patients had non-colorectal cancer (n = 160) or colon cancer (n = 20). One hundred and fourteen FDG-avid lesions were present. In 33, there was no colonoscopic correlate. Two hundred and fifty-eight biopsies revealed tubular adenomas (n = 91, one with intra-mucosal cancer), tubulovillous adenomas (n = 28), adenocarcinoma (n = 37), inflammation (n = 22), hyperplastic polyps (n = 54), serrated adenoma (n = 5), metastatic disease (n = 5), normal/benign mucosa or submucosal benign tumors (n = 13) or miscellaneous (n = 3). Per-lesion performance of PET showed a sensitivity of 38% (95% CI: 31–46; 64/167) for all adenomas and carcinomas and 58% (95% CI: 49–67; 57/98) for lesions ≥10 mm. At the patient level, for all adenomas and carcinomas the sensitivity was 54% (95% CI: 44–63; 61/113), specificity 100% (pre-defined), positive predictive value (PPV) 100% (pre-defined), and negative predictive value (NPV) 56% (95% CI: 47–65; 67/119). For patients with advanced

  13. MLH1-deficient Colorectal Carcinoma With Wild-type BRAF and MLH1 Promoter Hypermethylation Harbor KRAS Mutations and Arise From Conventional Adenomas.

    Science.gov (United States)

    Farchoukh, Lama; Kuan, Shih-Fan; Dudley, Beth; Brand, Randall; Nikiforova, Marina; Pai, Reetesh K

    2016-10-01

    Between 10% and 15% of colorectal carcinomas demonstrate sporadic DNA mismatch-repair protein deficiency as a result of MLH1 promoter methylation and are thought to arise from sessile serrated adenomas, termed the serrated neoplasia pathway. Although the presence of the BRAF V600E mutation is indicative of a sporadic cancer, up to 30% to 50% of colorectal carcinomas with MLH1 promoter hypermethylation will lack a BRAF mutation. We report the clinicopathologic and molecular features of MLH1-deficient colorectal carcinoma with wild-type BRAF and MLH1 promoter hypermethylation (referred to as MLH1-hypermethylated BRAF wild-type colorectal carcinoma, n=36) in comparison with MLH1-deficient BRAF-mutated colorectal carcinoma (n=113) and Lynch syndrome-associated colorectal carcinoma (n=36). KRAS mutations were identified in 31% of MLH1-hypermethylated BRAF wild-type colorectal carcinomas compared with 0% of MLH1-deficient BRAF-mutated colorectal carcinomas and 37% of Lynch syndrome-associated colorectal carcinomas. When a precursor polyp was identified, MLH1-hypermethylated BRAF wild-type colorectal carcinomas arose from precursor polyps resembling conventional tubular/tubulovillous adenomas in contrast to MLH1-deficient BRAF-mutated colorectal carcinomas, which arose from precursor sessile serrated adenomas (PMLH1-hypermethylated BRAF wild-type colorectal carcinoma and MLH1-deficient BRAF-mutated colorectal carcinoma had a predilection for the right colon compared with Lynch syndrome-associated colorectal carcinoma (86% vs. 92% vs. 49%, P0.05). In conclusion, our results indicate that MLH1-hypermethylated BRAF wild-type colorectal carcinomas can harbor KRAS mutations and arise from precursor polyps resembling conventional tubular/tubulovillous adenomas.

  14. Characterization of serrated yielding in service exposed Inconel 625 alloy

    International Nuclear Information System (INIS)

    Chatterjee, Arnomitra; Sharma, Garima; Chakravartty, J.K.

    2016-01-01

    The Alloy-625 is an austentic alloy which is being used for a variety of components in the aerospace, marine, chemical and nuclear industries. Tensile tests have been carried out on service exposed Inconel 625 ammonia cracker tube used at heavy water production plant to study the effect of microstructure on the mechanical properties of the material. Owing to temperature gradient during in service condition the microstructure was different in top (T), middle (M) and bottom (B) sections of the tube. The stress-strain curve obtained from conventional tensile test was found to exhibit serrated yielding with in an intermediate temperature regime of 250-600 °C. Both normal and inverse Portevin-Le Chatelier (PLC) effect could be identified at lower and higher temperature regime respectively. The normal behavior was associated with type (A+B) serrations and interstitial atom C was held responsible for the aging of dislocations in this region. On the contrary, the serrations were of type C in nature in inverse PLC regime and were attributed to the locking of dislocations by substitutional Mo atoms. Further analyses of activation energy and transition temperature for normal to inverse PLC dynamics, supported with Transmission Electron Microscopy (TEM) observation revealed that the basic deformation mechanism was different in M and B samples than that in the T samples. While the deformation in T samples were achieved by usual dislocation migration, in M and B samples it was through the propagation of stacking faults in large γ” precipitates. The transition temperature from normal to inverse PLC dynamics also varied appreciably in T samples than that of the M and B ones which could be explained in terms of the delayed depletion of Mo solutes in solution for T samples. (author)

  15. Imaging of giant pituitary adenomas

    Energy Technology Data Exchange (ETDEWEB)

    Majos, C.; Coll, S.; Aguilera, C.; Pons, L.C. [Bellvitge Univ., Barcelona (Spain). Inst. de Diagnostice per la Imatge; Acebes, J.J. [Department of Neurosurgery, Ciutat Sanitaria i Universitaria de Bellvitge, L`Hospitalet de Llobregat, Barcelona (Spain)

    1998-10-01

    We present five proven giant pituitary adenomas studied by CT and MRI, and review the clinical and imaging findings. Our aim was to examine the radiologic appearances and to search for criteria useful in distinguishing these tumors from other sellar and suprasellar tumours, mainly craniopharyngioma. The main differences from small adenomas were high prevalence of macrocysts, a more invasive behaviour and a clinical picture dominated by mass effect rather than endocrine disturbance. Factors supporting the diagnosis of pituitary adenoma in a giant intra- and suprasellar mass include: infrasellar extension, absence of calcification and presence of low-signal cysts on T1-weighted images. (orig.) (orig.) With 4 figs., 2 tabs., 9 refs.

  16. Endoscopic detection rate of sessile serrated lesions in Lynch syndrome patients is comparable with an age- and gender-matched control population: case-control study with expert pathology review.

    Science.gov (United States)

    Vleugels, Jasper L A; Sahin, Husna; Hazewinkel, Yark; Koens, Lianne; van den Berg, Jose G; van Leerdam, Monique E; Dekker, Evelien

    2018-05-01

    Carcinogenesis in Lynch syndrome involves fast progression of adenomas to colorectal cancer (CRC) because of microsatellite instability. The role of sessile serrated lesions (SSLs) and the serrated neoplasia pathway in these patients is unknown. The aim of this matched case-control study was to compare endoscopic detection rates and distribution of SSLs in Lynch syndrome patients with a matched control population. We collected data of Lynch syndrome patients with a proven germline mutation who underwent colonoscopy between January 2011 and April 2016 in 2 tertiary referral hospitals. Control subjects undergoing elective colonoscopy from 2011 and onward for symptoms or surveillance were selected from a prospectively collected database. Patients were matched 1:1 for age, gender, and index versus surveillance colonoscopy. An expert pathology review of serrated polyps was performed. The primary outcomes included the detection rates and distribution of SSLs. We identified 321 patients with Lynch syndrome who underwent at least 1 colonoscopy. Of these, 223 Lynch syndrome patients (mean age, 49.3; 59% women; index colonoscopy, 56%) were matched to 223 control subjects. SSLs were detected in 7.6% (95% confidence interval, 4.8-11.9) of colonoscopies performed in Lynch syndrome patients and in 6.7% (95% confidence interval, 4.1-10.8) of control subjects (P = .86). None of the detected SSLs in Lynch syndrome patients contained dysplasia. The detection rate of SSLs in Lynch syndrome patients undergoing colonoscopy is comparable with a matched population. These findings suggest that the role of the serrated neoplasia pathway in CRC development in Lynch syndrome seems to be comparable with that in the general population. Copyright © 2018 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  17. Serrated leaf mutant in mungbean (Vigna radiata (L) Wilczek)

    International Nuclear Information System (INIS)

    Malik, I.A.; Ghulam, Sarwar; Yousaf, Ali; Saleem, M.

    1988-01-01

    Dry dormant seeds of mungbean (Vigna radiata (L) Wilczek) were treated with gamma rays (15, 30 and 60 kR). The serrated leaf mutation was noticed in M 2 of cultivar Pak 32 treated with 60 kR. Cf 14 plants, 3 showed the altered leaf structure and the others were normal. The feature of this mutant was the deep serration of leaflet margins. The mutant had large thick leaflets with prominent venation. The mutant bred true in the M 3 and successive generation. Details of the morphological characteristics of the mutant are presented. The mutant exhibited slower growth particularly during the early stages of development, flowered later and attained shorter height. There was an increase in the number of pods, in seed weight and in seed protein content, but number of seed per pod was considerably reduced. The seed coat colour showed a change from green to yellowish green. In the mutant's flowers the stamina were placed much below the stigma level and the stigma sometimes protruded the corolla. Outcrossing of 4% recorded in some of the mutant lines revealed a reduced cleistogamy. The low number of seeds per pod in the mutant could be due to reduced pollen fertility. The mutant behaved as monogenic recessive. The symbols SL/sl are proposed for this allelic pair. The mutant may have use as a green manure crop because of its large foliage and for the breeders as a genetic marker

  18. Endoscopic endonasal surgery for giant pituitary adenomas: advantages and limitations.

    Science.gov (United States)

    Koutourousiou, Maria; Gardner, Paul A; Fernandez-Miranda, Juan C; Paluzzi, Alessandro; Wang, Eric W; Snyderman, Carl H

    2013-03-01

    Giant pituitary adenomas (> 4 cm in maximum diameter) represent a significant surgical challenge. Endoscopic endonasal surgery (EES) has recently been introduced as a treatment option for these tumors. The authors present the results of EES for giant adenomas and analyze the advantages and limitations of this technique. The authors retrospectively reviewed the medical files and imaging studies of 54 patients with giant pituitary adenomas who underwent EES and studied the factors affecting surgical outcome. Preoperative visual impairment was present in 45 patients (83%) and partial or complete pituitary deficiency in 28 cases (52%), and 7 patients (13%) presented with apoplexy. Near-total resection (> 90%) was achieved in 36 patients (66.7%). Vision was improved or normalized in 36 cases (80%) and worsened in 2 cases due to apoplexy of residual tumor. Significant factors that limited the degree of resection were a multilobular configuration of the adenoma (p = 0.002) and extension to the middle fossa (p = 0.045). Cavernous sinus invasion, tumor size, and intraventricular or posterior fossa extension did not influence the surgical outcome. Complications included apoplexy of residual adenoma (3.7%), permanent diabetes insipidus (9.6%), new pituitary insufficiency (16.7%), and CSF leak (16.7%, which was reduced to 7.4% in recent years). Fourteen patients underwent radiation therapy after EES for residual mass or, in a later stage, for recurrence, and 10 with functional pituitary adenomas received medical treatment. During a mean follow-up of 37.9 months (range 1-114 months), 7 patients were reoperated on for tumor recurrence. Three patients were lost to follow-up. Endoscopic endonasal surgery provides effective initial management of giant pituitary adenomas with favorable results compared with traditional microscopic transsphenoidal and transcranial approaches.

  19. BRAF, KRAS and PIK3CA mutations in colorectal serrated polyps and cancer: Primary or secondary genetic events in colorectal carcinogenesis?

    International Nuclear Information System (INIS)

    Velho, Sérgia; Moutinho, Cátia; Cirnes, Luís; Albuquerque, Cristina; Hamelin, Richard; Schmitt, Fernando; Carneiro, Fátima; Oliveira, Carla; Seruca, Raquel

    2008-01-01

    BRAF, KRAS and PIK3CA mutations are frequently found in sporadic colorectal cancer (CRC). In contrast to KRAS and PIK3CA mutations, BRAF mutations are associated with tumours harbouring CpG Island methylation phenotype (CIMP), MLH1 methylation and microsatellite instability (MSI). We aimed at determine the frequency of KRAS, BRAF and PIK3CA mutations in the process of colorectal tumourigenesis using a series of colorectal polyps and carcinomas. In the series of polyps CIMP, MLH1 methylation and MSI were also studied. Mutation analyses were performed by PCR/sequencing. Bisulfite treated DNA was used to study CIMP and MLH1 methylation. MSI was detected by pentaplex PCR and Genescan analysis of quasimonomorphic mononucleotide repeats. Chi Square test and Fisher's Exact test were used to perform association studies. KRAS, PIK3CA or BRAF occur in 71% of polyps and were mutually exclusive. KRAS mutations occur in 35% of polyps. PIK3CA was found in one of the polyps. V600E BRAF mutations occur in 29% of cases, all of them classified as serrated adenoma. CIMP phenotype occurred in 25% of the polyps and all were mutated for BRAF. MLH1 methylation was not detected and all the polyps were microsatellite stable. The comparison between the frequency of oncogenic mutations in polyps and CRC (MSI and MSS) lead us to demonstrate that KRAS and PIK3CA are likely to precede both types of CRC. BRAF mutations are likely to precede MSI carcinomas since the frequency found in serrated polyps is similar to what is found in MSI CRC (P = 0.9112), but statistically different from what is found in microsatellite stable (MSS) tumours (P = 0.0191). Our results show that BRAF, KRAS and PIK3CA mutations occur prior to malignant transformation demonstrating that these oncogenic alterations are primary genetic events in colorectal carcinogenesis. Further, we show that BRAF mutations occur in association with CIMP phenotype in colorectal serrated polyps and verified that colorectal serrated

  20. BRAF, KRAS and PIK3CA mutations in colorectal serrated polyps and cancer: Primary or secondary genetic events in colorectal carcinogenesis?

    Directory of Open Access Journals (Sweden)

    Schmitt Fernando

    2008-09-01

    Full Text Available Abstract Background BRAF, KRAS and PIK3CA mutations are frequently found in sporadic colorectal cancer (CRC. In contrast to KRAS and PIK3CA mutations, BRAF mutations are associated with tumours harbouring CpG Island methylation phenotype (CIMP, MLH1 methylation and microsatellite instability (MSI. We aimed at determine the frequency of KRAS, BRAF and PIK3CA mutations in the process of colorectal tumourigenesis using a series of colorectal polyps and carcinomas. In the series of polyps CIMP, MLH1 methylation and MSI were also studied. Methods Mutation analyses were performed by PCR/sequencing. Bisulfite treated DNA was used to study CIMP and MLH1 methylation. MSI was detected by pentaplex PCR and Genescan analysis of quasimonomorphic mononucleotide repeats. Chi Square test and Fisher's Exact test were used to perform association studies. Results KRAS, PIK3CA or BRAF occur in 71% of polyps and were mutually exclusive. KRAS mutations occur in 35% of polyps. PIK3CA was found in one of the polyps. V600E BRAF mutations occur in 29% of cases, all of them classified as serrated adenoma. CIMP phenotype occurred in 25% of the polyps and all were mutated for BRAF. MLH1 methylation was not detected and all the polyps were microsatellite stable. The comparison between the frequency of oncogenic mutations in polyps and CRC (MSI and MSS lead us to demonstrate that KRAS and PIK3CA are likely to precede both types of CRC. BRAF mutations are likely to precede MSI carcinomas since the frequency found in serrated polyps is similar to what is found in MSI CRC (P = 0.9112, but statistically different from what is found in microsatellite stable (MSS tumours (P = 0.0191. Conclusion Our results show that BRAF, KRAS and PIK3CA mutations occur prior to malignant transformation demonstrating that these oncogenic alterations are primary genetic events in colorectal carcinogenesis. Further, we show that BRAF mutations occur in association with CIMP phenotype in colorectal

  1. CT of intranasal pleomorphic adenoma

    Energy Technology Data Exchange (ETDEWEB)

    Clark, M.; Fatterpekar, G.M.; Mukherji, S.K.; Buenting, J. [Department of Radiology, 3324 Infirmary CB F 7510, University of North Carolina, School of Medicine, Chapel Hill, NC 27599-7510 (United States)

    1999-08-01

    Intranasal pleomorphic adenoma is rare. We report the CT features this tumor in a 41-year-old woman who presented to us with right nasal obstruction and a 2-day history of epistaxis. (orig.) With 3 figs., 9 refs.

  2. Optimization of the poro-serrated trailing edges for airfoil broadband noise reduction.

    Science.gov (United States)

    Chong, Tze Pei; Dubois, Elisa

    2016-08-01

    This paper reports an aeroacoustic investigation of a NACA0012 airfoil with a number of poro-serrated trailing edge devices that contain porous materials of various air flow resistances at the gaps between adjacent members of the serrated-sawtooth trailing edge. The main objective of this work is to determine whether multiple-mechanisms on the broadband noise reduction can co-exist on a poro-serrated trailing edge. When the sawtooth gaps are filled with porous material of low-flow resistivity, the vortex shedding tone at low-frequency could not be completely suppressed at high-velocity, but a reasonably good broadband noise reduction can be achieved at high-frequency. When the sawtooth gaps are filled with porous material of very high-flow resistivity, no vortex shedding tone is present, but the serration effect on the broadband noise reduction becomes less effective. An optimal choice of the flow resistivity for a poro-serrated configuration has been identified, where it can surpass the conventional serrated trailing edge of the same geometry by achieving a further 1.5 dB reduction in the broadband noise while completely suppressing the vortex shedding tone. A weakened turbulent boundary layer noise scattering at the poro-serrated trailing edge is reflected by the lower-turbulence intensity at the near wake centreline across the whole spanwise wavelength of the sawtooth.

  3. Radiosurgery of pituitary adenomas

    International Nuclear Information System (INIS)

    Kida, Yoshihisa

    2008-01-01

    The efficacy and role of gamma knife (GK) in the treatment of various pituitary adenomas are described on author's experience and discussed with literature. GK subjects are 328 patients (M 126/F 202, av. age of 47.8 y) in author's hospital, and satisfactory follow-up (32-44 mo) for evaluation has been possible in 253 cases, who had tumors non-functional (129 cases), producing ACTH (23), HGH (70) and PRL (31). Stereotactic GK radiosurgery is done with navigation by Gamma Plan based on enhanced MRI images at various doses, and evaluation in the follow-up period is performed by hormonal levels and MRI which give efficacy of complete response (CR), partial response (PR), MR and standard deviation (SD)/ progressive disease (PD) on the tumor size. The overall tumor control rate is found to be 95-100%. Effectiveness (CR and PR) is found as high as 77.4% in PRL-producing tumor (marginal dose 14-32 Gy), 65% in non-functioning (15-25 Gy), 61% in ACTH (19-30 Gy) and 60% in GH (19-31 Gy), of which tendency is similar to that in literature. Even in ACTH-producing tumor, low ACTH and cortisol levels persisted with tendency of improved obese and hypertensive symptoms. GK radiosurgery has limitations in the tissue size and distance between the tumor and optic nerve/chiasm, but for the enough small tumor, it gives satisfactorily long term efficacy. (R.T.)

  4. Detection rate of serrated polyps and serrated polyposis syndrome in colorectal cancer screening cohorts: a European overview.

    Science.gov (United States)

    IJspeert, J E G; Bevan, R; Senore, C; Kaminski, M F; Kuipers, E J; Mroz, A; Bessa, X; Cassoni, P; Hassan, C; Repici, A; Balaguer, F; Rees, C J; Dekker, E

    2017-07-01

    The role of serrated polyps (SPs) as colorectal cancer precursor is increasingly recognised. However, the true prevalence SPs is largely unknown. We aimed to evaluate the detection rate of SPs subtypes as well as serrated polyposis syndrome (SPS) among European screening cohorts. Prospectively collected screening cohorts of ≥1000 individuals were eligible for inclusion. Colonoscopies performed before 2009 and/or in individuals aged below 50 were excluded. Rate of SPs was assessed, categorised for histology, location and size. Age-sex-standardised number needed to screen (NNS) to detect SPs were calculated. Rate of SPS was assessed in cohorts with known colonoscopy follow-up data. Clinically relevant SPs (regarded as a separate entity) were defined as SPs ≥10 mm and/or SPs >5 mm in the proximal colon. Three faecal occult blood test (FOBT) screening cohorts and two primary colonoscopy screening cohorts (range 1.426-205.949 individuals) were included. Rate of SPs ranged between 15.1% and 27.2% (median 19.5%), of sessile serrated polyps between 2.2% and 4.8% (median 3.3%) and of clinically relevant SPs between 2.1% and 7.8% (median 4.6%). Rate of SPs was similar in FOBT-based cohorts as in colonoscopy screening cohorts. No apparent association between the rate of SP and gender or age was shown. Rate of SPS ranged from 0% to 0.5%, which increased to 0.4% to 0.8% after follow-up colonoscopy. The detection rate of SPs is variable among screening cohorts, and standards for reporting, detection and histopathological assessment should be established. The median rate, as found in this study, may contribute to define uniform minimum standards for males and females between 50 and 75 years of age. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  5. A study of serrated plastic flow behavior in an aluminum-lithium binary alloy

    International Nuclear Information System (INIS)

    Sun, D.L.; Yang, D.Z.; Lei, T.Q.

    1990-01-01

    The serrated plastic flow behavior of an Al-2.73wt%Li alloy at various aging conditions is investigated. The stress-strain curve of the alloy is examined using an Instron machine. The microstructure of the alloy before and after deformation is observed using a transmission electron microscope. It has been shown that the stress-strain curve in the alloy is serrated and both time and/or temperature of aging affect the formation of serrations. The δ' phase (Al 3 Li) which is induced by plastic deformation precipitates along dislocations. The formation mechanism of the serrated stress-strain curve in the Al-Li binary alloy is discussed. (orig.)

  6. Aerodynamic robustness in owl-inspired leading-edge serrations: a computational wind-gust model.

    Science.gov (United States)

    Rao, Chen; Liu, Hao

    2018-06-08

    Owls are a master to achieve silent flight in gliding and flapping flights under natural turbulent environments owing to their unique wing morphologies. While the leading-edge serrations are recently revealed, as a passive flow control micro-device, to play a crucial role in aerodynamic force production and sound suppression [25], the characteristics of wind-gust rejection associated with leading-edge serrations remain unclear. Here we address a large-eddy simulation (LES)-based study of aerodynamic robustness in owl-inspired leading-edge serrations, which is conducted with clean and serrated wing models through mimicking wind-gusts under a longitudinal fluctuation in free-stream inflow and a lateral fluctuation in pitch angle over a broad range of angles of attack (AoAs) over 0° ≤ Φ ≤ 20°. Our results show that the leading-edge serration-based passive flow control mechanisms associated with laminar-turbulent transition work effectively under fluctuated inflow and wing pitch, indicating that the leading-edge serrations are of potential gust fluctuation rejection or robustness in aerodynamic performance. Moreover, it is revealed that the tradeoff between turbulent flow control (i.e., aero-acoustic suppression) and force production in the serrated model holds independently to the wind-gust environments: poor at lower AoAs but capable of achieving equivalent aerodynamic performance at higher AoAs > 15o compared to the clean model. Our results reveal that the owl-inspired leading-edge serrations can be a robust micro-device for aero-acoustic control coping with unsteady and complex wind environments in biomimetic rotor designs for various fluid machineries. © 2018 IOP Publishing Ltd.

  7. The Association Between Molecular Markers in Colorectal Sessile Serrated Polyps and Colorectal Cancer Risk

    Science.gov (United States)

    2017-08-01

    AWARD NUMBER: W81XWH-15-1-0273 TITLE: The Association between Molecular Markers in Colorectal Sessile Serrated Polyps and Colorectal Cancer ... Colorectal Cancer Risk 5a. CONTRACT NUMBER 5b. GRANT NUMBER W81XWH-15-1-0273 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Andrea Burnett-Hartman 5d... cancer in patients with sessile serrated colorectal polyps (SSPs). The project’s specific aims are as follows: 1) Estimate the risk of colorectal

  8. Microsurgical therapy of pituitary adenomas.

    Science.gov (United States)

    Mortini, Pietro; Barzaghi, Lina Raffaella; Albano, Luigi; Panni, Pietro; Losa, Marco

    2018-01-01

    We report the efficacy and safety of transsphenoidal microsurgery in a large and homogeneous cohort of patients with pituitary adenomas (PAs) treated at a single Institute by a single neurosurgeon. A total of 2145 consecutive patients undergoing first surgery for a PA were included: 795 (37.1%) had a nonfunctioning pituitary adenoma (NFPA), 595 (27.7%) acromegaly, 496 (23.1%) Cushing's disease, 208 (9.7%) a PRL-secreting adenoma, and 51 patients (2.4%) a TSH-secreting adenoma. Remission was achieved when strict hormonal and radiological criteria were met. Early surgical remission was achieved in 66% of acromegalic patients, 79.6% of patients with Cushing's disease, 64.4% of prolactinomas, 74.5% of patients with a TSH-secreting adenoma, and 66.9% of NFPAs. The mean (±SE) follow-up was 60.1 ± 1.3 months. The recurrence-free survival at 10 years was 78.2% in acromegalic patients, 68.1% in prolactinomas, 74.3% in Cushing's disease, 70.3% in TSH-secreting adenomas, and 75.3% in NFPAs. Preoperative hypoadrenalism recovered in 35.3%, hypogonadism in 43.3% and hypothyroidism in 37.4% of patients with impaired function before surgery. The mortality rate was 0.2% and major morbidity 2.1%. New onset hypoadrenalism occurred after surgery in 2.5% of patients at risk, hypogonadism in 4.1%, and hypothyroidism in 1.8%. Permanent diabetes insipidus (DI) occurred in 0.9% of patients. In experienced hands, transsphenoidal microsurgery for PAs achieves remission in most patients with a low complication rate. Pituitary function is preserved in most cases and can recover in more than one-third of patients with preoperative hypopituitarism.

  9. The Lateralizing Asymmetry of Adrenal Adenomas

    Science.gov (United States)

    Hao, Meng; Lopez, Diana; Luque-Fernandez, Miguel Angel; Cote, Kathryn; Newfield, Jessica; Connors, Molly; Vaidya, Anand

    2018-01-01

    Abstract Context It is presumed that the incidence of adrenal adenomas is symmetric between the left and right adrenal gland; however, anecdotal observations suggest a potential lateralizing asymmetry. Objective To investigate the symmetry in detection of adrenal adenomas and relevance to patient care. Design Cross-sectional and longitudinal studies. Population and Setting One thousand three hundred seventy-six patients with abdominal computed tomography or magnetic resonance imaging demonstrating benign-appearing adrenal adenomas. Main Outcome Location and size of adrenal adenomas. Results Left-sided adenomas were discovered in 65% of patients, right-sided in 21%, and bilateral adenomas in 14%. Among unilateral adenomas, 75% were left-sided. Left-sided adenomas were more prevalent than right-sided adenomas in each size category except the largest: Adrenal adenomas are substantially more likely to be identified on the left adrenal than the right. This observation may be due to detection bias attributed to the location of the right adrenal, which may preclude identification of right-sided adenomas until they are substantially larger. These findings suggest the potential for an underrecognition of right-sided adenomas that may also impair the accurate detection of bilateral adrenal diseases. PMID:29644340

  10. External radiotherapy of pituitary adenomas

    International Nuclear Information System (INIS)

    Zierhut, Dietmar; Flentje, Michael; Adolph, Juergen; Erdmann, Johannes; Raue, Friedhelm; Wannenmacher, Michael

    1995-01-01

    Purpose: To evaluate therapeutic outcome and side effects of radiotherapy in pituitary adenomas as sole or combined treatment. Methods and Materials: Retrospective analysis of 138 patients (74 male, 64 female) irradiated for pituitary adenoma from 1972 to 1991 was performed. Mean age was 49.7 years (15-80 years). Regular follow-up (in the mean 6.53 ± 3.99 years) included radiodiagnostical [computed tomography (CT), magnetic resonance imaging (MRI), x-ray], endocrinological, and ophthalmological examinations. Seventy patients suffered from nonfunctional pituitary adenoma, 50 patients suffered from growth-hormone producing adenomas, 11 had prolactinomas, and 7 patients had adrenocorticotropic hormone (ACTH) producing pituitary adenomas. In 99 patients surgery was followed by radiotherapy in case of suspected remaining tumor (invasive growth of the adenoma, assessment of the surgeon, pathologic CT after surgery, persisting hormonal overproduction). Twenty-three patients were treated for recurrence of disease after surgery and 16 patients received radiation as primary treatment. Total doses from 40-60 Gy (mean: 45.5 Gy) were given with single doses of 2 Gy 4 to five times a week. Results: Tumor control was achieved in 131 patients (94.9%). In seven patients, recurrence of disease was diagnosed in the mean 2.9 years (9-98 months) after radiotherapy and salvaged by surgery. A statistically significant dose-response relationship was found in favor of doses ≥ 45 Gy. Ninety percent of the patients with hormonally active pituitary adenomas had a benefit from radiotherapy in means of complete termination (38%) or at least reduction (52%) of hormonal overproduction. Partial or complete hypopituitarism after radiotherapy developed, depending on hormonal axis, in 12 (prolactin) to 27% (follicle-stimulating hormone FSH) of patients who had not already had hypopituitarism prior to radiation. Two out of 138 patients suffered reduction of visual acuity, which was, in part

  11. Forensic implications of the variation in morphology of marginal serrations on the teeth of the great white shark

    OpenAIRE

    Nambiar, P.; Brown, K. A.; Bridges, T. E.

    2017-01-01

    The teeth of the Great White Shark have been examined to ascertain whether there is any commonality in the arrangement or number of the marginal serrations (peaks) or, indeed, whether individual sharks have a unique pattern of shapes or size of the peaks. The teeth of the White Shark are characteristic in size and shape with serrations along almost the entire mesial and distal margins. This study has revealed no consistent pattern of size or arrangement of the marginal serrations that was suf...

  12. Klinefelter's syndrome and liver adenoma

    NARCIS (Netherlands)

    Beuers, U.; RICHTER, W. O.; RITTER, M. M.; WIEBECKE, B.; SCHWANDT, P.

    1991-01-01

    We describe the occurrence of a liver adenoma in a young patient with Klinefelter's syndrome, diagnosed by classic 47,XXY karyotype in all investigated cells and a sex hormone imbalance. To our knowledge, this is the first report of such an association, which might suggest a simple coincidence.

  13. Gallbladder adenoma with focal adenocarcinoma.

    Science.gov (United States)

    Ciurea, S; Matei, E; Petrisor, P; Luca, L; Boros, Mirela; Herlea, V; Popescu, I

    2008-01-01

    The majority of polypoid lesions of the gallbladder are cholesterolosis pseudopolyps. True neoplastic GB polyps are represented mainly by adenomas. The case of a 52-year old male patient with an adenomatous polyp of the GB with focal adenocarcinoma is presented.

  14. Deep learning of contrast-coated serrated polyps for computer-aided detection in CT colonography

    Science.gov (United States)

    Näppi, Janne J.; Pickhardt, Perry; Kim, David H.; Hironaka, Toru; Yoshida, Hiroyuki

    2017-03-01

    Serrated polyps were previously believed to be benign lesions with no cancer potential. However, recent studies have revealed a novel molecular pathway where also serrated polyps can develop into colorectal cancer. CT colonography (CTC) can detect serrated polyps using the radiomic biomarker of contrast coating, but this requires expertise from the reader and current computer-aided detection (CADe) systems have not been designed to detect the contrast coating. The purpose of this study was to develop a novel CADe method that makes use of deep learning to detect serrated polyps based on their contrast-coating biomarker in CTC. In the method, volumetric shape-based features are used to detect polyp sites over soft-tissue and fecal-tagging surfaces of the colon. The detected sites are imaged using multi-angular 2D image patches. A deep convolutional neural network (DCNN) is used to review the image patches for the presence of polyps. The DCNN-based polyp-likelihood estimates are merged into an aggregate likelihood index where highest values indicate the presence of a polyp. For pilot evaluation, the proposed DCNN-CADe method was evaluated with a 10-fold cross-validation scheme using 101 colonoscopy-confirmed cases with 144 biopsy-confirmed serrated polyps from a CTC screening program, where the patients had been prepared for CTC with saline laxative and fecal tagging by barium and iodine-based diatrizoate. The average per-polyp sensitivity for serrated polyps >=6 mm in size was 93+/-7% at 0:8+/-1:8 false positives per patient on average. The detection accuracy was substantially higher that of a conventional CADe system. Our results indicate that serrated polyps can be detected automatically at high accuracy in CTC.

  15. The association between location, age and advanced colorectal adenoma characteristics

    DEFF Research Database (Denmark)

    Pommergaard, Hans-Christian; Burcharth, Jakob; Rosenberg, Jacob

    2017-01-01

    PURPOSE: Evidence supports an association between certain colorectal adenoma characteristics and predisposition to cancer. The association between anatomical location of colorectal adenoma, age and advanced adenomas needs attention. The objective of this study was to evaluate the possible....... Inclusion criteria for patients were one adenoma of >1 cm in diameter or multiple adenomas of any size, or an adenoma of any size and familial disposition for colorectal cancer. Multivariate regression and propensity score-matched analyses were used to correlate location of adenomas and age with advanced...... adenoma features. RESULTS: In this study, 2149 adenomas were removed in 1215 patients. Advanced colorectal adenomas primarily occurred in the anal part of the colon. Older age was associated with more adenomas and more oral occurrence of adenomas, as well as a higher risk of advanced adenomas...

  16. Computed tomography of adrenal Cushing's adenoma

    International Nuclear Information System (INIS)

    Yamada, Takayuki

    1990-01-01

    CT findings of 22 patients with surgically confirmed adrenal Cushing's adenomas were compared with pathologic findings. The cut surfaces of the adenomas showed mixture of yellow and brown areas in various proportions and were classified into three patterns; speckled brown areas in yellow background, geometrically brown areas in yellow background, totally brown or black surface. The maximum diameters of the cut surfaces were measured. The CT appearances of Cushing's adenomas after intravenous contrast administration have various patterns of enhancement and classified into three patterns; speckled, geometrical, and homoenous. The maximum diameters of the adenomas in CT images were also measured. Correlation between the CT and gross appearances of the specimens showed that while brown areas in adenomas were strongly enhanced, yellow areas were poorly enhanced. Histologically, brown areas in adenomas consist of compact-like cells with rich intercellular space and yellow areas consist of clear-like cells with poor intercellular space. The patterns of contrast enhancement some to depend on the cell types of adenomas. Difference in the intercellular space between compact and clear-like cells may have altered the patterns of contrast enhancement. The study also revealed that predominantly brownish adenomas were smaller in size than predominantly yellowish ones. As compact-like cells which make up the brown areas in Cushing's adenoma are thought to be more active in producing and secreting steroid hormones than clear-like cells, this result suggests that clinical symptoms may appear earlier in predominantly brownish adenomas than in predominantly yellowish ones. (author)

  17. Colorectal adenoma stem-like cell populations: associations with adenoma characteristics and metachronous colorectal neoplasia.

    Science.gov (United States)

    Bartley, Angela N; Parikh, Nila; Hsu, Chiu-Hsieh; Roe, Denise J; Buckmeier, Julie A; Corley, Lynda; Phipps, Ron A; Gallick, Gary; Lance, Peter; Thompson, Patricia A; Hamilton, Stanley R

    2013-11-01

    Cancer stem cells have tumor-initiation and tumor-maintenance capabilities. Stem-like cells are present in colorectal adenomas, but their relationship to adenoma pathology and patient characteristics, including metachronous development of an additional adenoma ("recurrence"), has not been studied extensively. We evaluated the expression of aldehyde dehydrogenase isoform 1A1 (ALDH1A1), a putative stem cell marker, in baseline adenomas from the placebo arm of chemoprevention trial participants with colonoscopic follow-up. An exploratory set of 20 baseline adenomas was analyzed by ALDH1A1 immunohistochemistry with morphometry, and a replication set of 89 adenomas from 76 high-risk participants was evaluated by computerized image analysis. ALDH1A1-labeling indices (ALI) were similar across patient characteristics and in advanced and nonadvanced adenomas. There was a trend toward higher ALIs in adenomas occurring in the right than left colon (P = 0.09). ALIs of synchronous adenomas were correlated (intraclass correlation coefficient 0.67). Participants in both sample sets who developed a metachronous adenoma had significantly higher ALIs in their baseline adenoma than participants who remained adenoma free. In the replication set, the adjusted odds for metachronous adenoma increased 1.46 for each 10% increase in ALIs (P = 0.03). A best-fit algorithm-based cutoff point of 22.4% had specificity of 75.0% and positive predictive value of 70.0% for metachronous adenoma development. A larger population of ALDH1A1-expressing cells in an adenoma is associated with a higher risk for metachronous adenoma, independent of adenoma size or histopathology. If confirmed, ALDH1A1 has potential as a novel biomarker in risk assessment and as a potential stem cell target for chemoprevention. ©2013 AACR

  18. Giant tubular adenoma with malignancy clinical characteristics in a female teenager: Case report and a review of the literature.

    Science.gov (United States)

    Mărginean, Cristina Oana; Mărginean, Maria Oana; Simu, Iunius; Horvath, Adrienne; Meliţ, Lorena Elena

    2016-10-01

    Adenomas of the colon are usually benign tumors which carry a tendency for malignancy. These tumors can be villous, tubular, tubulovillous, or sessile serrated. Those with adenomatous structure can develop malignant characteristics in 1.5% to 9.4% of cases. We present a case report of a 16-year-old female adolescent with an adenoma of the descending colon. History revealed prolonged diarrheic syndrome for the past 6 months, repeated headache, and a weight loss of ∼5 kg in the past month. One week before the admission, the patient presented an episode of inferior digestive hemorrhage. On admission laboratory tests revealed iron deficiency anemia, and a mildly increased erythrocyte sedimentation rate. The abdominal ultrasound revealed an inhomogeneous mass of the descending colon and 2 hyperechoic lesions in the liver. The colonoscopy showed a tumor of the descending colon, a tubular adenoma according to the pathological examination. Additionally, we noted an atypical presentation of the tumor and the signs of mild dysplasia identified at the pathological examination. Weight loss, bowel transit alterations, loss of appetite, and inferior hemorrhage in an adolescent can be symptoms of a benign or malignant tumor of the colon.

  19. Microcystic adenoma of the pancreas

    Directory of Open Access Journals (Sweden)

    Čolović Radoje B.

    2002-01-01

    Full Text Available Microcystic adenoma of the pancreas is a rare benign tumour of the pancreas without malignant potential which usually appears in older women. Pain weight loss, palpable mass and jaundice (if the tumor is localized in the head of the pancreas are the main symptoms. Thanks to the modern imaging techniques (US, CT, FNB the tumor is discovered and with rising frequency exactly preoperatively diagnosed. Surgical excision is the treatment of choice. In risk patients without symptoms surgery is not necessary but patients have to be regularly followed-up. The authors present a 70-year old woman in whom, because of constant epigastric pain, a multicystic mass of the pancreatic body, 58 x 40 mm in diameter, was discovered and removed by distal pancreatectomy. The spleen could not be saved. Histologic examination showed a microcystic adenoma. Three years after surgery the patient is symptom-free with normal ultra-sonographic findings.

  20. Adenoma metanéfrico

    Directory of Open Access Journals (Sweden)

    Ana Sayuri Ota

    Full Text Available Metanephric adenoma is a recently described, rare and benign renal tumor that generally occurs in adults and has an excellent prognosis. Pain, hematuria and palpable mass are the most commonly presented signs. We report the case of a 49-year old female with a 14-cm solitary right renal tumor. Radiological features of the tumor were non-specific and histopathological examination was essential to establish a definitive diagnosis.

  1. Nephrogenic adenoma of the ureter

    Directory of Open Access Journals (Sweden)

    Mustafa Burak Hoscan

    2012-04-01

    Full Text Available Nephrogenic adenoma (NA is an uncommon benign lesion of the urothelial tract. The diagnostic features that are useful in the recognition of this benign entity are: the characteristic mixture of various architectural patterns, associated stromal edema and inflammation, hyaline sheath around tubules, and lack of mitotic activity. Although NA appears with hematuria or obstruction, frequently found incidentally in endoscopy or imaging modalities.

  2. Giant hepatocellular adenoma; case report

    Energy Technology Data Exchange (ETDEWEB)

    Pitella, F.A.; Coutinho, A.M.N.; Coura Filho, G.B.; Costa, P.L.A.; Ono, C.R.; Watanabe, T.; Sapienza, M.T.; Hironaka, F.; Cerri, G.G.; Buchpiguel, C.A. [Universidade de Sao Paulo (FM/USP), SP (Brazil). Inst. de Radiologia. Servico de Medicina Nuclear

    2008-07-01

    Full text: Introduction: Hepatocellular adenoma is a benign hepatic tumor identified mainly in women during fertility age, with estimated incidence of 4/1000 inhabitants. It is usually unique, well circumscribed, with or without a capsule, size varying from 1 to 30 cm, with possible central areas of necrosis and hemorrhage. Case Report: A 37-year-old female patient presenting with no comorbities, use of hormonal birth control pills for 18 years, a condition of reduction in the consistency of feces, increase in number of daily defecations, abdominal cramps, and a stuffed sensation after meals for two years. A palpable abdominal mass extending from the right hypochondriac to the right iliac fossa was noticed four months ago. A computerized tomography (CT) showed an extensive hepatic mass on the right which was considered, within the diagnostic hypotheses, hepatic adenomatosis, without ruling out secondary lesions. A hepatic scintillography with {sup 99m}Tc-DISIDA showed an extensive exophytic area from segment V to the right iliac fossa with arterialized blood flow and hepatocytic activity, as well as a hepatic nodule in segment VII with hepatocytic activity consistent with the hepatic adenomas hypothesis. The biopsy confirmed the hepatic adenoma diagnosis and the patient was submitted to a partial hepatectomy and cholecystectomy with good clinical evolution. Conclusion: Nuclear Medicine may supplement the assessment of hepatic nodules, including giant masses, thus suggesting new hypotheses and direction to therapeutic conduct. (author)

  3. MRI of pituitary adenomas in acromegaly

    International Nuclear Information System (INIS)

    Marro, B.; Zouaoui, A.; Sahel, M.; Crozat, N.; Gerber, S.; Sourour, N.; Sag, K.; Marsault, C.

    1997-01-01

    Adenomas causing acromegaly represent at least a quarter of pituitary adenomas. We studied 12 patients presenting with active acromegaly due to a pituitary adenoma with a 1.5 T superconductive MRI unit. All had T1-weighted sagittal and coronal sections before and after Gd-DTPA; six had coronal T2-weighted images. Surgical correlation was obtained in seven patients. Histologically, there were eight growth hormone (GH)-secreting and three mixed [GH and prolactin (PRL) secreting[ adenomas, and one secreting GH, PRL and follicle-stimulating hormone. Macroadenomas (10) were more frequent than microadenomas (2). No correlation was found between serum GH and tumour size. There were nine adenomas in the lateral part of the pituitary gland; seven showed lateral or infrasellar invasion. Homogeneous, isointense signal on T1-and T2-weighted images was observed in six cases. Heterogeneous adenomas had cystic or necrotic components. (orig.). With 5 figs., 3 tabs

  4. MRI of pituitary adenomas in acromegaly

    Energy Technology Data Exchange (ETDEWEB)

    Marro, B. [Service de Neuroradiologie, Batiment Babinsky, Hopital Salpetriere, 47, Bd de l`Hopital, F-75013 Paris (France); Zouaoui, A. [Service de Neuroradiologie, Batiment Babinsky, Hopital Salpetriere, 47, Bd de l`Hopital, F-75013 Paris (France); Sahel, M. [Service de Neuroradiologie, Batiment Babinsky, Hopital Salpetriere, 47, Bd de l`Hopital, F-75013 Paris (France); Crozat, N. [Service de Neuroradiologie, Batiment Babinsky, Hopital Salpetriere, 47, Bd de l`Hopital, F-75013 Paris (France); Gerber, S. [Service de Neuroradiologie, Batiment Babinsky, Hopital Salpetriere, 47, Bd de l`Hopital, F-75013 Paris (France); Sourour, N. [Service de Neuroradiologie, Batiment Babinsky, Hopital Salpetriere, 47, Bd de l`Hopital, F-75013 Paris (France); Sag, K. [Service de Neuroradiologie, Batiment Babinsky, Hopital Salpetriere, 47, Bd de l`Hopital, F-75013 Paris (France); Marsault, C. [Service de Neuroradiologie, Batiment Babinsky, Hopital Salpetriere, 47, Bd de l`Hopital, F-75013 Paris (France)

    1997-06-01

    Adenomas causing acromegaly represent at least a quarter of pituitary adenomas. We studied 12 patients presenting with active acromegaly due to a pituitary adenoma with a 1.5 T superconductive MRI unit. All had T1-weighted sagittal and coronal sections before and after Gd-DTPA; six had coronal T2-weighted images. Surgical correlation was obtained in seven patients. Histologically, there were eight growth hormone (GH)-secreting and three mixed [GH and prolactin (PRL) secreting] adenomas, and one secreting GH, PRL and follicle-stimulating hormone. Macroadenomas (10) were more frequent than microadenomas (2). No correlation was found between serum GH and tumour size. There were nine adenomas in the lateral part of the pituitary gland; seven showed lateral or infrasellar invasion. Homogeneous, isointense signal on T1- and T2-weighted images was observed in six cases. Heterogeneous adenomas had cystic or necrotic components. (orig.). With 5 figs., 3 tabs.

  5. Variation of leaf margin serration in Populus nigra of industrial dumps

    Directory of Open Access Journals (Sweden)

    Yu. A. Shtirs

    2017-07-01

    Full Text Available The variability of leaf margin serration of Populus nigra L. in conditions of industrial dumps (coal mines dumps and overburden dumps and city park is estimated. The value of this indicator is in the range from 1.25 to 1.76 and significantly increases along the gradient: coal mines dumps – overburden dumps – city park. From the number of selected gradations of P. nigra leaf blades, the gradation with values of 1.45-1.55 is most pronounced according to the analyzed index for industrial dumps, for the park – with the values of 1.55-1.65. The degree of serration of edge leaf blade is characterized by low values of variation – coefficient of variation is less than 10.0%. We registered the significant positive correlation between the average values of leaf margin serration and the length of P. nigra leaf blade.

  6. An analytically-based method for predicting the noise generated by the interaction between turbulence and a serrated leading edge

    Science.gov (United States)

    Mathews, J. R.; Peake, N.

    2018-05-01

    This paper considers the interaction of turbulence with a serrated leading edge. We investigate the noise produced by an aerofoil moving through a turbulent perturbation to uniform flow by considering the scattered pressure from the leading edge. We model the aerofoil as an infinite half plane with a leading edge serration, and develop an analytical model using a Green's function based upon the work of Howe. This allows us to consider both deterministic eddies and synthetic turbulence interacting with the leading edge. We show that it is possible to reduce the noise by using a serrated leading edge compared with a straight edge, but the optimal noise-reducing choice of serration is hard to predict due to the complex interaction. We also consider the effect of angle of attack, and find that in general the serrations are less effective at higher angles of attack.

  7. Noise model for serrated trailing edges compared to wind tunnel measurements

    DEFF Research Database (Denmark)

    Fischer, Andreas; Bertagnolio, Franck; Shen, Wen Zhong

    2016-01-01

    A new CFD RANS based method to predict the far field sound pressure emitted from an aerofoil with serrated trailing edge has been developed. The model was validated by comparison to measurements conducted in the Virginia Tech Stability Wind Tunnel. The model predicted 3 dB lower sound pressure...... levels, but the tendencies for the different configurations were predicted correctly. Therefore the model can be used to optimise the serration geometry. A disadvantage of the new model is that the computational costs are significantly higher than for the Amiet model for a straight trailing edge. However...

  8. Atomistic Origin of Rate-Dependent Serrated Plastic Flow in Metallic Glasses

    Directory of Open Access Journals (Sweden)

    Yao YG

    2008-01-01

    Full Text Available Abstract Nanoindentation simulations on a binary metallic glass were performed under various strain rates by using molecular dynamics. The rate-dependent serrated plastic flow was clearly observed, and the spatiotemporal behavior of its underlying irreversible atomic rearrangement was probed. Our findings clearly validate that the serration is a temporally inhomogeneous characteristic of such rearrangements and not directly dependent on the resultant shear-banding spatiality. The unique spatiotemporal distribution of shear banding during nanoindentation is highlighted in terms of the potential energy landscape (PEL theory.

  9. Adenoma corticosuprarrenal no funcionante Non-functional corticosuprarenal adenoma

    Directory of Open Access Journals (Sweden)

    Evelio Salvador Reyes Balseiro

    2011-12-01

    Full Text Available Alrededor del 50 % de las tumoraciones corticosuprerrenales son benignas y funcionales, muchas son sólidas con signos y síntomas de exceso de glucocorticoides (Cushing o mineralocorticoides (Conn. El otro 50 % de neoplasias sólidas corresponde a carcinomas adrenocorticales primarios, la mitad funcionales. Dentro de las tumoraciones sólidas benignas la más frecuente es el adenoma. Se presenta un paciente de 36 años de edad, de piel blanca, sexo masculino, con buena salud anterior, que ingresó por astenia desde hace 6 meses y dolor abdominal en el flanco derecho, de ligera intensidad, irradiado a la espalda, además de la pérdida de peso. Al examen físico se constata tumoración en flanco derecho. Se diagnostica tumoración suprarrenal voluminosa por ultrasonografía, tomografía axial computarizada y elevación del cortisol en sangre. Se extirpa el tumor por una incisión combinada anterior y lateral en posición semidecúbito, que brindó un buen campo, y se obtuvieron excelentes resultados. El diagnóstico anatomopatológico fue adenoma corticosuprarrenal, que se analizan y comparan con otros reportes.About the 50 % of the cortical-suprarenal tumor are benign and functional, much of them are solid with signs and symptoms of glucocorticoids (Cushing or mineralocorticoid (Conn. The remainder 50 % of solid neoplasm corresponds to primary adrenocortical carcinomas whose half is functional. Within the benign solid tumors the more frequent is the adenoma. This is the case of a white male patient aged 36 with a prior good health admitted due to asthenia from 6 months ago and slightly intensive abdominal pain the right flank irradiating to back as well as weight loss. In physical examination it was verified a right flank tumor. A bulky suprarenal tumor was diagnosed by ultrasonography, computerized axial tomography and a rise of blood cortisol. Tumor is removed b y anterior and lateral combined incision in semi-decubitus position allowed a

  10. Proton therapy of hypophyseal adenomas

    International Nuclear Information System (INIS)

    Mirakova, E.I.; Kirpatovskaya, L.E.; Lyass, F.M.; Snigireva, R.Ya.; Krymskij, V.A.; Akademiya Meditsinskikh Nauk SSSR, Moscow. Inst. Ehksperimental'noj Ehndokrinologii i Khimii Gormonov)

    1983-01-01

    The authors present the results of proton therapy in 59 patients with different hypophyseal adenomas. The period of observation lasted from 6 mos. to 5 yrs. Irradiation was done using a multifield-convergent method and a proton beam of the ITEF synchrotron. The beam energy was 200 MeV, the beam diameter 7-15 mm. Radiation response and immediate results were evaluated for all the patients. The least favorable results were noted in the patients with prolactinomas, for which, in addition to irradiation, parlodel therapy is needed. No marked radiation reactions, neurological complications and manifestations of hypopituitarism were observed with the chosen doses and schemes of irradiation

  11. Villous adenoma of the urinary bladder

    Directory of Open Access Journals (Sweden)

    Dilip Kumar Pal

    2015-01-01

    Full Text Available Villous adenoma is a known entity in the gastrointestinal tract, but very rare in the urinary tract. It is a benign tumor with excellent prognosis, but its progression to adenocarcinoma is not established. Here, we report an additional case of villous adenoma of the urinary bladder.

  12. Effect of a serrated trailing edge on sound radiation from nearby quadrupoles.

    Science.gov (United States)

    Karimi, Mahmoud; Croaker, Paul; Kinns, Roger; Kessissoglou, Nicole

    2017-05-01

    A periodic boundary element technique is implemented to study the noise reduction capability of a plate with a serrated trailing edge under quadrupole excitation. It is assumed for this purpose that the quadrupole source tensor is independent of the trailing edge configuration and that the effect of the trailing edge shape is to modify sound radiation from prescribed boundary layer sources. The flat plate is modelled as a continuous structure with a finite repetition of small spanwise segments. The matrix equation formulated by the periodic boundary element method for this 3D acoustic scattering problem is represented as a block Toeplitz matrix. The discrete Fourier transform is employed in an iterative algorithm to solve the block Toeplitz system. The noise reduction mechanism for a serrated trailing edge in the near field is investigated by comparing contour plots obtained from each component of the quadrupole for unserrated and serrated trailing edge plate models. The noise reduction due to the serrated trailing edge is also examined as a function of the source location.

  13. Improvement of creep-rupture properties by serrated grain boundaries in high-tungsten cobalt-base superalloys

    International Nuclear Information System (INIS)

    Tanaka, Manabu

    1993-01-01

    The improvement of creep-rupture properties by serrated grain boundaries was investigated using cobalt-base superalloys containing about 14 to 20 wt.% tungsten at 1089 and 1311 K. Serrated grain boundaries improved both the rupture life and the ductility, especially under lower stresses at 1089 K. The increase in rupture life was larger in the alloys containing a larger amount of W. Ductile grain boundary fracture surfaces, which involved dimple patterns and grain boundary ledges, were observed in the specimens with serrated grain boundaries whereas brittle grain boundary facets were observed in the specimens with normal straight grain boundaries ruptured at 1089 K. The strengthening by serrated grain boundaries was also effective at 1311 K, but there was little difference in rupture life between the specimens with serrated grain boundaries and those with straight grain boundaries under lower stresses, since serrated grain boundaries developed also in the specimens with straight grain boundaries according to grain boundary precipitates forming during creep at 1311 K. The increase in W content of the alloys led to the increase in rupture life of the specimens with serrated grain boundaries at 1089 and 1311 K. (orig.) [de

  14. Ovarian hyperstimulation, hyperprolactinaemia and LH gonadotroph adenoma.

    Science.gov (United States)

    Castelo-Branco, Camil; del Pino, Marta; Valladares, Esther

    2009-08-01

    This report considers a highly exceptional case of ovarian hyperstimulation syndrome due to a gonadotroph adenoma secreting LH in a 31-year-old patient who presented with amenorrhoea and galactorrhoea syndrome and a complex bilateral ovarian mass. Magnetic resonance imaging revealed a pituitary adenoma, and laboratory tests corroborated the hyperprolactinaemia without other hormonal pituitary abnormalities. Ovarian hyperstimulation syndrome due to a gonadotroph adenoma with normal gonadotrophins is extremely rare. Most of the described cases are caused by FSH adenomas. Due to the originality of the case, it was considered useful for understanding the management of this entity, and it is proposed that LH adenomas should also be considered in the differential diagnosis of patients with spontaneous ovarian hyperstimulation syndrome.

  15. Magnetic resonance imaging of pituitary adenomas

    Energy Technology Data Exchange (ETDEWEB)

    Bonneville, Jean-Francois; Bonneville, Fabrice; Cattin, Francoise [University Hospital, Department of Neuroradiology, Besancon (France)

    2005-03-01

    Today, MR is the only method needed for the morphological investigation of endocrine-active pituitary adenomas. In acromegaly and Cushing's syndrome, the therapeutic attitude is directly dictated by MR data. We present the MR aspect of pituitary adenomas according to size, sex, age, endocrine activity and a few particular conditions such as hemorrhagic pituitary adenomas, pituitary adenomas during pregnancy, cavernous sinus invasion and postsurgical changes. When an intrasellar mass extending out of the sella turcica is detected, the goal of the MR examination is to indicate precisely the origin of the tumor, its extension in relation to the various surrounding structures, its structure and its enhancement in order to help in the differential diagnosis. Demonstration of very small pituitary adenomas remains a challenge. When SE T1- and Turbo SE T2-weighted sequences are non-diagnostic, enhanced imaging becomes mandatory; half-dose gadolinium injection, delayed sequence, dynamic imaging can be of some help. (orig.)

  16. Predictive value of diminutive colonic adenoma trial: the PREDICT trial.

    Science.gov (United States)

    Schoenfeld, Philip; Shad, Javaid; Ormseth, Eric; Coyle, Walter; Cash, Brooks; Butler, James; Schindler, William; Kikendall, Walter J; Furlong, Christopher; Sobin, Leslie H; Hobbs, Christine M; Cruess, David; Rex, Douglas

    2003-05-01

    Diminutive adenomas (1-9 mm in diameter) are frequently found during colon cancer screening with flexible sigmoidoscopy (FS). This trial assessed the predictive value of these diminutive adenomas for advanced adenomas in the proximal colon. In a multicenter, prospective cohort trial, we matched 200 patients with normal FS and 200 patients with diminutive adenomas on FS for age and gender. All patients underwent colonoscopy. The presence of advanced adenomas (adenoma >or= 10 mm in diameter, villous adenoma, adenoma with high grade dysplasia, and colon cancer) and adenomas (any size) was recorded. Before colonoscopy, patients completed questionnaires about risk factors for adenomas. The prevalence of advanced adenomas in the proximal colon was similar in patients with diminutive adenomas and patients with normal FS (6% vs. 5.5%, respectively) (relative risk, 1.1; 95% confidence interval [CI], 0.5-2.6). Diminutive adenomas on FS did not accurately predict advanced adenomas in the proximal colon: sensitivity, 52% (95% CI, 32%-72%); specificity, 50% (95% CI, 49%-51%); positive predictive value, 6% (95% CI, 4%-8%); and negative predictive value, 95% (95% CI, 92%-97%). Male gender (odds ratio, 1.63; 95% CI, 1.01-2.61) was associated with an increased risk of proximal colon adenomas. Diminutive adenomas on sigmoidoscopy may not accurately predict advanced adenomas in the proximal colon.

  17. Octreotide Uptake in Parathyroid Adenoma

    Directory of Open Access Journals (Sweden)

    Seyhan Karaçavuş

    2012-08-01

    Full Text Available The patient with a history of bone pain and muscle weakness, was thought to have oncogenic osteomalacia as a result of biochemical investigations and directed to Nuclear Medicine Department for a whole-body bone scintigraphy and 111In-octreotide scintigraphy. There was no focal pathologic tracer uptake, but generalized marked increase in skeletal uptake on bone scintigraphy. Octreotide scintigraphy showed accumulation of octreotide in the region of the left lobe of the thyroid gland in the neck. Thereafter, parathyroid scintigraphy was performed with technetium-99m labeled metroxy-isobutyl-isonitryl (99mTc-MIB and MIBI scan demonstrated radiotracer uptake at the same location with octreotide scintigraphy. The patient underwent left inferior parathyroidectomy and histopathology confirmed a parathyroid adenoma. Somatostatin receptor positive parathyroid adenoma may show octreotide uptake. Octreotide scintigraphy may be promising and indicate a possibility of using somatostatin analogues for the medical treatment of somatostatin receptor positive parathyroid tumors. (MIRT 2012;21:77-79

  18. Colorectal polyps

    Science.gov (United States)

    Intestinal polyps; Polyps - colorectal; Adenomatous polyps; Hyperplastic polyps; Villous adenomas; Serrated polyp; Serrated adenoma; Precancerous polyps; Colon cancer - polyps; Bleeding - colorectal polyps

  19. Giant Parotid Pleomorphic Adenoma Involving Parapharyngeal Space

    Directory of Open Access Journals (Sweden)

    Sukri Rahman

    2013-09-01

    Full Text Available AbstrakLatar belakang: Pleomorfik adenoma parotis merupakan tumor jinak kelenjar liur yang paling sering ditemukan, namun pleomorfik adenoma parotis yang sangat besar sehingga melibatkan ruang parafaring (RPF sangat jarang. Diagnosis ini sulit ditegakkan karena gejala klinisnya tidak khas. Penatalaksanaanya harus hati-hati mengingat banyak struktur vital yang beresiko mengalami trauma. Tujuan: Bagaimana menegakkan diagnosis dan penatalaksanaan pleomorfik adenoma parotis yang melibatkan RPF. Kasus: Seorang pasien perempuan 27 tahun ditegakkan diagnosis pleomorfik adenoma parotis kanan dengan melibatkan RPF. Terdapat pembengkakan pada leher yang bersifat asimtomatis dan gejala pendorongan faring dan laring yang menyebabkan disfonia, disfagia, dan defisit saraf kranial IX,X,XII. Penatalaksanaan: Pasien telah dilakukan operasi parotidektomi pendekatan transervikal–transparotid dengan preservasi arteri karotis eksterna dan saraf fasialis. Kesimpulan: Biopsi Aspirasi Jarum Halus (BAJAH dan radiologi merupakan pemeriksaan yang penting untuk menegakkan diagnosis. Penatalaksanaan pleomorfik adenoma parotis yang melibatkan RPF adalah bedah ekstirpasi komplit dengan beberapa pendekatan. .Kata kunci: tumor jinak kelenjar liur, pleomorfik adenoma, ruang parafaringAbstractBackground: Parotid pleomorphic adenoma is the most common benign salivary gland tumor, while giant parotid pleomorphic adenoma involving the parapharyngeal space (PPS is rare. It was difficult to diagnose because the clinical presentation of this tumor can be subtle. The management must be performed carefully due to anatomy relation to complex vital structure lead to traumatic injury highrisk. Purposes: How to make diagnosis and management parotid pleomorphic adenoma involving PPS. Case: A female 27 years old with diagnosis was giant parotid pleomorphic adenoma involving PPS. There was asymptomatic swelling of the neck and presence of pushing the pharynx and larynx medially causes

  20. Canalicular adenoma: A rare case report

    Directory of Open Access Journals (Sweden)

    Swati Phore

    2018-01-01

    Full Text Available Canalicular adenomas (CAs are uncommon benign salivary gland neoplasms of the oral cavity. They are typically located on the upper lip, buccal mucosa, and infrequently found on the palate and derived from minor salivary glands. Due to benign character of the tumor, CAs rarely present with bone erosion. Histologically, trabecular type of basal cell adenoma, pleomorphic adenoma, and polymorphous low-grade adenocarcinoma should be discriminated from CAs. A-36-year-old female patient with CA was presented. The lesion was managed surgically under local anesthesia, and 2 months follow-up was uneventful.

  1. MR of pituitary micro-adenomas

    International Nuclear Information System (INIS)

    Le Marec, E.; Ait Ameur, A.; David, H.; Pharaboz, C.

    1997-01-01

    Most of the time, rationales to look for pituitary micro-adenomas are based on endocrinal disorder. MRI is often helpful to confirm diagnosis. It gives information about micro-adenomas size and localisation. If conventional sequence are inadequate, a dynamic sequence has then to be performed after Gadolinium injection. Any disorder observed from the pituitary gland must be correlated with the clinical observation and results from biochemistry analysis. False positive happens quite open because of gland morphological variation, incidentalomas and partial volumes. MRI offers the possibility to follow-up treated micro-adenomas evolution especially to detect recurrence. (author)

  2. Forensic implications of the variation in morphology of marginal serrations on the teeth of the great white shark.

    Science.gov (United States)

    Nambiar, P; Brown, K A; Bridges, T E

    1996-06-01

    The teeth of the Great White Shark have been examined to ascertain whether there is any commonality in the arrangement or number of the marginal serrations (peaks) or, indeed, whether individual sharks have a unique pattern of shapes or size of the peaks. The teeth of the White Shark are characteristic in size and shape with serrations along almost the entire mesial and distal margins. This study has revealed no consistent pattern of size or arrangement of the marginal serrations that was sufficiently characteristic within an individual shark to serve as a reliable index of identification of a tooth as originating from that particular shark. Nonetheless, the serrations are sufficiently distinctive to enable the potential identification of an individual tooth as having been the cause of a particular bitemark.

  3. Nanoindentation study on the characteristic of shear transformation zone in a Pd-based bulk metallic glass during serrated flow

    Science.gov (United States)

    Liao, G. K.; Long, Z. L.; Zhao, M. S. Z.; Peng, L.; Chai, W.; Ping, Z. H.

    2018-04-01

    This paper presents the research on the evolution of shear transformation zone (STZ) in a Pd-based bulk metallic glass (BMG) during serrated flow under nanoindentation. A novel method of estimating the STZ volume through statistical analysis of the serrated flow behavior was proposed for the first time. Based on the proposed method, the STZ volume of the studied BMG at various peak loads have been systematically investigated. The results indicate that the measured STZ volumes are in good agreement with that documented in literature, and the STZ size exhibits an increasing trend during indentation. Moreover, the correlation between the serrated flow dynamics and the STZ activation has also been evaluated. It is found that the STZ activation can promote the formation of self-organized critical (SOC) state during serrated flow.

  4. Gene mutations in hepatocellular adenomas

    DEFF Research Database (Denmark)

    Raft, Marie B; Jørgensen, Ernö N; Vainer, Ben

    2015-01-01

    is associated with bi-allelic mutations in the TCF1 gene and morphologically has marked steatosis. β-catenin activating HCA has increased activity of the Wnt/β-catenin pathway and is associated with possible malignant transformation. Inflammatory HCA is characterized by an oncogene-induced inflammation due...... to alterations in the Janus kinase/signal transducer and activator of transcription (JAK/STAT) pathway. In the diagnostic setting, sub classification of HCA is based primarily on immunohistochemical analyzes, and has had an increasing impact on choice of treatment and individual prognostic assessment....... This review offers an overview of the reported gene mutations associated with hepatocellular adenomas together with a discussion of the diagnostic and prognostic value....

  5. An investigation into the anti-releasing performance of a serrated bolt

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Jin Hwan; Lee, Hyun Kyu; Park, Ke Un; Kim, Jong Bong [Seoul Natinal University, Seoul (Korea, Republic of)

    2015-11-15

    As the sizes of electric products, such as mobile phones and watch phones, decrease, the joining bolt for the electric product should also be miniaturized. However, the miniature-sized bolt has to support sufficient joining torque and joining force. The bolt also has to support sufficient anti-releasing torque to keep the product fastened. We investigated a serrated bolt as a candidate for a miniature-sized fastener to increase the anti-release torque. In the serrated bolt, serration shapes are formed on the bottom surface of a bolt head to create an obstacle to releasing. In this study, finite element analyses were carried out on joining and releasing, and the anti-release torque was predicted. Through the joining and releasing analyses for various values of the elastic modulus and yield strength of the joined part, the effect of the mechanical properties of the joined part on the anti-releasing performance were investigated. The analysis results showed that a high strength insert nut is needed to increase the anti-releasing torque when the yield strength of the joined part is low, such as a plastic board in a mobile phone.

  6. Parametric study on the characteristics of a SDBD actuator with a serrated electrode

    Science.gov (United States)

    Gao, Guoqiang; Peng, Kaisheng; Dong, Lei; Wei, Wenfu; Wu, Guangning

    2017-06-01

    Active flow control based on surface dielectric barrier discharge (SDBD) has become a focus of research in recent years, due to its unique advantages and diverse potential applications. Compared with the conventional SDBD with straight electrodes, the serrated electrode-based SDBD has a great advantage due to its 3D flow topology. It is believed that the boundary layer separation of moving objects can be controlled more effectively with this new type of SDBD. In SDBD with a serrated electrode, the R (tip sharpness) and N (tip number per unit length) have a great influence on the discharge and induced airflow characteristics. In this paper, a parametric study of the characteristics of SDBD with a serrated electrode has been conducted with different ranges of R and N. Aspects of the power consumption, the steady medium temperature distribution, and the maximum induced airflow velocity have been investigated. The results indicate that there is a critical value of R and N where the maximum power consumption and induced airflow velocity are achieved. The uniformity of the steady temperature distribution of the medium surface is found to be more dependent on N. We found that the accelerating effects of the induced airflow can be evaluated with the Schlieren technique, which agree well with the results from the pitot tube.

  7. Invasive Mucinous Adenocarcinoma Associated with Adjacent Sessile Serrated Lesion of the Appendix Vermiform: A Case Report

    Directory of Open Access Journals (Sweden)

    Osamu Kinoshita

    2014-01-01

    Full Text Available Although the definition of sessile serrated lesion (SSL of colon is controversial and the risk of progression to malignancy is also under investigation at present, SSL is generally described as a polyp characterized by a serrated architecture. It is estimated to represent a feature of a new cancerization pathway, coined “serrated neoplasia pathway,” particularly in right-sided colon adenocarcinomas. On the other hand, in appendix, the role of this pathway remains uncertain, probably because very few cases of appendiceal adenocarcinoma associated with SSL were reported, and furthermore, immunohistochemical examination was rarely carried out. We herein report an interesting case of invasive appendiceal mucinous adenocarcinoma exhibiting SSL, which was pathologically estimated as a potential precursor lesion, and performed representative immunohistochemistry for both the mucinous adenocarcinoma and SSL in the same specimen. To further elucidate the progression of the appendiceal carcinoma from SSL, both an adequate sectioning of the lesion and systematic immunohistochemical examination of a large number of appendiceal carcinoma cases containing adjacent SSL would be required.

  8. Secondary hypertension due to concomitant aldosterone-producing adenoma and parathyroid adenoma.

    Science.gov (United States)

    Chau, Katrina; Holmes, Daniel; Melck, Adrienne; Chan-Yan, Clifford

    2015-02-01

    There is a growing body of evidence supporting a bidirectional relationship between parathyroid hormone (PTH) and aldosterone (Aldo). We report a case of secondary hypertension due to concomitant Aldo-producing adenoma (APA) and parathyroid adenoma (PA) requiring both unilateral adrenalectomy and parathyroidectomy. © American Journal of Hypertension, Ltd 2014. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  9. Immunohistochemical Expression of p53 in Pleomorphic Adenoma and Carcinoma Ex Pleomorphic Adenoma

    International Nuclear Information System (INIS)

    Tarakji, B.; Kujan, O.; Nassani, M. Z.

    2010-01-01

    Context. Immunohistochemical stains for p53 are used as a diagnostic marker associated with malignancy in several histologic types of salivary gland tumors. This marker may be useful in differentiating pleomorphic adenoma (PA) from carcinoma ex pleomorphic adenoma (CPA), as these tumors are often difficult to distinguish on the basis of morphology alone. Objective. to evaluate whatever inactivation of tumor suppressor gene (p53) increases with the tumor progression from normal salivary tissue to PA and eventually CPA. Design. Paraffin blocks of 29 cases of PA, which were surrounded by normal parotid gland, and 27 cases of carcinoma ex pleomorphic adenoma were retrieved and validated. In all cases of carcinoma ex pleomorphic adenoma, a PA “ghost” was identified, and the malignant element was either undifferentiated carcinoma or adenocarcinoma. Results. The results showed negative nuclear expression of P53 in normal parotid gland. Nuclear P53 was expressed strongly in 6/29 (20.7%) pleomorphic salivary adenoma and 10/27 (37%) carcinoma ex pleomorphic adenoma. Conclusion. Our data suggest that inactivation of p53 may play an important role in the evolution of pleomorphic salivary adenoma and carcinoma ex pleomorphic adenoma.

  10. Cáncer de colon, secuencia adenoma carcinoma y pólipo aserrado

    Directory of Open Access Journals (Sweden)

    MSc. Juan Carlos Calderón Reza

    2018-02-01

    Full Text Available Los pólipos adenomatosos son muy frecuentes y presentan gran potencial de malignización. De entre ellos el velloso es el de mayor potencial maligno, pero todos los tipos histológicos presentan componente velloso en mayor o menor proporción, por lo que todos se pueden considerar premalignos, este proceso degenerativo conocido como secuencia adenoma carcinoma explicó efectivamente un 85 % de los cánceres colorrectales por décadas. Hoy en día gracias a los avances tecnológicos, se conoce que no todos los cánceres colorrectales presentan la mencionada secuencia, el 10 a 15% restantes, están incluidos dentro del denominado “Serrated neoplasia pathway” cuya característica es la inestabilidad de micro satélites, caracterizada por la inactivación de los genes reparadores del ADN por cambios epigenéticos como la hipermetilación del promotor del gen MLH1 observado en el Síndrome de Lynch

  11. Giant serous microcystic pancreas adenoma

    Directory of Open Access Journals (Sweden)

    Mustafa Kerem

    2012-10-01

    Full Text Available Serous cystadenomas are rare tumors comprising 1-2% of exocrine pancreas tumors. They are mostly known as benign conditions but malign transformation as serous cystadenocarcinoma is also reported. It is usually seen in females. Non-specific symptoms, such as abdominal pain or symptoms due to mass affect, are usually seen. A 64-year old female patient was investigated for abdominal pain. Physical and laboratory findings were normal. Abdomen ultrasonography confirmed an 11x9.5 cm solid cystic lesion and abdomen computed tomography scan confirmed a 12x11 cm lobulated cystic solid lesion which had central cystic necrotic areas extending from liver hilus inferiorly. Fine needle biopsy confirmed benign cytology and trucut biopsy of the pan creatic mass reported chronic inflamation. Nevertheless, this mass could have malignant contents and transformation potential. A laparatomy was decided due to patient’s symptoms and mass effect. Due to vascular invasion of the tumor, Whipple procedure was performed. The pathology report confirmed serous microcystic adenoma. These rare tumors are usually benign but pre-operative malignity criterias are not identified. There are few differential diagnostic tools for excluding malignity. We suggest surgical resection as best treatment approach for selected cases.

  12. Surgical management of spontaneous ruptured hepatocellular adenoma

    Directory of Open Access Journals (Sweden)

    Marcelo Augusto Fontenelle Ribeiro Junior

    2009-01-01

    Full Text Available AIMS: Spontaneous ruptured hepatocellular adenoma (SRHA is a rare life-threatening condition that may require surgical treatment to control hemorrhaging and also stabilize the patient. We report a series of emergency surgeries performed at our institution for this condition. METHODS: We reviewed medical records and radiology files of 28 patients (from 1989 to 2006 with a proven diagnosis of hepatocellular adenoma (HA. Three (10.7% of 28 patients had spontaneous ruptured hepatocellular adenoma, two of which were associated with intrahepatic hemorrhage while one had intraperitoneal bleeding. Two patients were female and one was male. Both female patients had a background history of oral contraceptive use. Sudden abdominal pain associated with hemodynamic instability occurred in all patients who suffered from spontaneous ruptured hepatocellular adenoma. The mean age was 41.6 years old. The preoperative assessment included liver function tests, ultrasonography and computed tomography. RESULTS: The surgical approaches were as follows: right hemihepatectomy for controlling intraperitoneal bleeding, and right extended hepatectomy and non-anatomic resection of the liver for intrahepatic hemorrhage. There were no deaths, and the postoperative complications were bile leakage and wound infection (re-operation, as well as intraperitoneal abscess (re-operation and pleural effusion. CONCLUSION: Spontaneous ruptured hepatocellular adenoma may be treated by surgery for controlling hemorrhages and stabilizing the patient, and the decision to operate depends upon both the patient's condition and the expertise of the surgical team.

  13. Radiotherapy for pituitary adenomas: an endocrinologist`s perspective

    Energy Technology Data Exchange (ETDEWEB)

    O`Halloran, D.J.; Shalet, S.M. [Christie Hospital and Holt Radium Inst., Manchester (United Kingdom)

    1996-10-01

    A brief review is given of the clinical management of patients with pituitary adenomas such as prolactinomas, adenomasin acromegoly and Leushin`s disease, and non-functioning pituitary adenomas. In particular the complications of radiotherapy are explored. (UK).

  14. Growth hormone receptor expression and function in pituitary adenomas

    DEFF Research Database (Denmark)

    Clausen, Lene R; Kristiansen, Mikkel T; Rasmussen, Lars M

    2004-01-01

    OBJECTIVE AND DESIGN: Hypopituitarism, in particular GH deficiency, is prevalent in patients with clinically nonfunctioning pituitary adenomas (NFPAs) both before and after surgery. The factors regulating the growth of pituitary adenomas in general and residual tumour tissue in particular...

  15. Light bodies in human pituitary adenomas

    DEFF Research Database (Denmark)

    Holck, S; Wewer, U M; Albrechtsen, R

    1987-01-01

    Light bodies are large cytoplasmic granules originally described in the gonadotrophic cells of the rat pituitary gland. In order to determine whether similar bodies occur in the human anterior pituitary gland, 89 pituitary adenomas and periadenomatous tissue from 20 cases were examined...... cells in periadenomatous tissue from 20 cases. These results show that some human pituitary adenomas may contain light bodies identical to those seen in gonadotrophs of rat pituitary....... by transmission electron microscopy. Double membrane bound bodies with filamentous internal structure identical to rodent light bodies were identified in 10 hormone-producing adenomas: 5 PRL, 1 PRL-GH, 2 GH, and 2 ACTH-producing tumours. No light bodies were found in the remaining 79 tumours nor in the pituitary...

  16. Dietary patterns and the risk of colorectal cancer and adenomas.

    Science.gov (United States)

    Randi, Giorgia; Edefonti, Valeria; Ferraroni, Monica; La Vecchia, Carlo; Decarli, Adriano

    2010-07-01

    The association of colorectal cancer risk with select foods has been evaluated by dietary pattern analysis. This review of the literature was conducted to thoroughly examine the available evidence for the association between dietary patterns and colorectal cancers and adenomas. A total of 32 articles based on worldwide epidemiological studies were identified. Pattern identification was achieved by exploratory data analyses (principal component, factor, and cluster analyses) in most articles, and only a few used a priori-defined scores. Dietary patterns named as healthy, prudent, fruit and vegetables, fat-reduced/diet foods, vegetable/fish/poultry, fruit/whole grain/dairy, and healthy eating index-2005, recommended food and Mediterranean diet scores were all associated with reduced risk of colorectal cancer and the risk estimates varied from 0.45 to 0.90. In contrast, diets named Western, pork-processed meat-potatoes, meat-eaters, meat and potatoes, traditional patterns, and dietary risk and life summary scores were associated with increased risk of colorectal cancer with risk estimates varying from 1.18 to 11.7. Dietary patterns for adenomas were consistent with those identified for colorectal cancer.

  17. Dynamic MR imaging of pituitary adenoma

    International Nuclear Information System (INIS)

    Miki, Yukio; Nishizawa, Sadahiko; Kuroda, Yasumasa; Keyaki, Atsushi; Nabeshima, Sachio; Kawamura, Junichiro; Matsuo, Michimasa

    1990-01-01

    The authors performed serial dynamic MR imaging in patients with 10 normal pituitary and 21 pituitary adenoma utilizing spin-echo sequence with a very short repetition time (SE 100/15) every minute immediately after a bolus injection of Gd-DTPA. Usual T 1 -weighted images (SE 600/15) were also obtained before and after the dynamic study. Pituitary adenomas included 10 adenomas confirmed by surgery, 4 adenomas confirmed by biologic data, and 7 postoperative adenomas. Out of 10 patients who underwent surgery after dynamic MRI, 9 patients underwent postoperative dynamic MRI. In normal patients, the pituitary gland was markedly enhanced on the early-phase images of the dynamic study, followed by gradual decrease of intensity throughout the dynamic study. In cases of microadenomas, the contrast between the normal pituitary gland and adenoma is better than that on the usual T 1 -weighted images by marked enhancement of the normal pituitary gland. Dynamic images clearly showed the residual normal pituitary glands in all cases of macroadenoma larger than 15 mm in diameter, whereas usual contrast-enhanced images showed the normal pituitary gland only in one case. In all patients who underwent both preoperative and postoperative dynamic MRI, postoperative dynamic MRI showed the normal pituitary glands which are markedly enhanced on the early-phase images in the sites which correspond to the preoperative dynamic study. The normal residual anterior gland was also visualized in four out of 7 patients who received only postoperative dynamic MRI. Dynamic MRI is a strong diagnostic modality for visualizing microadenoma and for visualizing the normal pituitary gland in cases of preoperative and postoperative macroadenoma. (author)

  18. Hypopituitarism after stereotactic radiosurgery for pituitary adenomas.

    Science.gov (United States)

    Xu, Zhiyuan; Lee Vance, Mary; Schlesinger, David; Sheehan, Jason P

    2013-04-01

    Studies of new-onset Gamma Knife stereotactic radiosurgery (SRS)-induced hypopituitarism in large cohort of pituitary adenoma patients with long-term follow-up are lacking. We investigated the outcomes of SRS for pituitary adenoma patients with regard to newly developed hypopituitarism. This was a retrospective review of patients treated with SRS at the University of Virginia between 1994 and 2006. A total of 262 patients with a pituitary adenoma treated with SRS were reviewed. Thorough endocrine assessment was performed immediately before SRS and in regular follow-ups. Assessment consisted of 24-hour urine free cortisol (patients with Cushing disease), serum adrenocorticotropic hormone, cortisol, follicle-stimulating hormone, luteinizing hormone, insulin-like growth factor-1, growth hormone, testosterone (men), prolactin, thyroid-stimulating hormone, and free T(4). Endocrine remission occurred in 144 of 199 patients with a functioning adenoma. Tumor control rate was 89%. Eighty patients experienced at least 1 axis of new-onset SRS-induced hypopituitarism. The new hypopituitarism rate was 30% based on endocrine follow-up ranging from 6 to 150 months; the actuarial rate of new pituitary hormone deficiency was 31.5% at 5 years after SRS. On univariate and multivariate analyses, variables regarding the increased risk of hypopituitarism included suprasellar extension and higher radiation dose to the tumor margin; there were no correlations among tumor volume, prior transsphenoidal adenomectomy, prior radiation therapy, and age at SRS. SRS provides an effective and safe treatment option for patients with a pituitary adenoma. Higher margin radiation dose to the adenoma and suprasellar extension were 2 independent predictors of SRS-induced hypopituitarism.

  19. Modification of hormonal secretion in clinically silent pituitary adenomas.

    Science.gov (United States)

    Daems, Tania; Verhelst, Johan; Michotte, Alex; Abrams, Pascale; De Ridder, Dirk; Abs, Roger

    2009-01-01

    Silent pituitary adenomas are a subtype of adenomas characterized by positive immunoreactivity for one or more hormones classically secreted by normal pituitary cells but without clinical expression, although in some occasions enhanced or changed secretory activity can develop over time. Silent corticotroph adenomas are the classical example of this phenomenon. A series of about 500 pituitary adenomas seen over a period of 20 years were screened for modification in hormonal secretion. Biochemical and immunohistochemical data were reviewed. Two cases were retrieved, one silent somatotroph adenoma and one thyrotroph adenoma, both without specific clinical features or biochemical abnormalities, which presented 20 years after initial surgery with evidence of acromegaly and hyperthyroidism, respectively. While the acromegaly was controlled by a combination of somatostatin analogs and growth hormone (GH) receptor antagonist therapy, neurosurgery was necessary to manage the thyrotroph adenoma. Immunohistochemical examination demonstrated an increase in the number of thyroid stimulating hormone (TSH)-immunoreactive cells compared to the first tissue. Apparently, the mechanisms responsible for the secretory modifications are different, being a change in secretory capacity in the silent somatotroph adenoma and a quantitative change in the silent thyrotroph adenoma. These two cases, one somatotroph and one thyrotroph adenoma, are an illustration that clinically silent pituitary adenomas may in rare circumstances evolve over time and become active, as previously demonstrated in silent corticotroph adenomas.

  20. Tubulovillous Adenoma in a Urethral Neobladder Anastomosis

    Directory of Open Access Journals (Sweden)

    Bradley A. Morganstern

    2015-11-01

    Full Text Available We present a case of a tubulovillous adenoma arising in a neobladder that was managed by cystoscopic resection. A 64 year-old male underwent a cystectomy with creation of an ileocolic neobladder urinary diversion for T2 urothelial carcinoma of the bladder. Nine years following his surgery, the patient noted several episodes of gross hematuria. Cystoscopic evaluation revealed the rare occurrence of a 3 cm tubulovillous adenoma with high-grade dysplasia at the neck of the neobladder.

  1. Serrated Flow and Dynamic Strain Aging in Fe-Mn-C TWIP Steel

    Science.gov (United States)

    Lan, Peng; Zhang, Jiaquan

    2018-01-01

    The tensile behavior, serrated flow, and dynamic strain aging of Fe-(20 to 24)Mn-(0.4 to 0.6)C twinning-induced plasticity (TWIP) steel have been investigated. A mathematical approach to analyze the DSA and PLC band parameters has been developed. For Fe-(20 to 24)Mn-(0.4 to 0.6)C TWIP steel with a theoretical ordering index (TOI) between 0.1 and 0.3, DSA can occur at the very beginning of plastic deformation and provide serrations during work hardening, while for TOI less than 0.1 the occurrence of DSA is delayed and twinning-dominant work hardening remains relatively smooth. The critical strain for the onset of DSA and PLC bands in Fe-Mn-C TWIP steels decreases as C content increases, while the numbers of serrations and bands increase. As Mn content increases, the critical strain for DSA and PLC band varies irregularly, but the numbers of serrations and bands increase. For Fe-(20 to 24)Mn-(0.4 to 0.6)C TWIP steel with grain size of about 10 to 20 μm, the twinning-induced work hardening rate is about 2.5 to 3.0 GPa, while the DSA-dominant hardening rate is about 2.0 GPa on average. With increasing engineering strain from 0.01 to 0.55 at an applied strain rate of 0.001s-1, the cycle time for PLC bands in Fe-Mn-C TWIP steel increases from 6.5 to 162 seconds, while the band velocity decreases from 4.5 to 0.5 mm s-1, and the band strain increases from 0.005 to 0.08. Increasing applied strain rate leads to a linear increase of band velocity despite composition differences. In addition, the influence of the Mn and C content on the tensile properties of Fe-Mn-C TWIP steel has been also studied. As C content increases, the yield strength and tensile strength of Fe-Mn-C TWIP steel increase, but the total elongation variation against C content is dependent on Mn content. As Mn content increases, the yield strength and tensile strength decrease, while the total elongation increases, despite C content. Taking both tensile properties and serrated flow behavior into

  2. Theoretical performance of serrated external occulters for solar coronagraphy. Application to ASPIICS

    Science.gov (United States)

    Rougeot, R.; Aime, C.

    2018-04-01

    Context. This study is made in the context of the future solar coronagraph ASPIICS of the ESA formation-flying mission Proba-3. Aims: In the context of solar coronagraphy, we provide a comparative study of the theoretical performance of serrated (or toothed) external occulters by varying the number and size of the teeth, which we compare to the sharp-edged and apodized disks. The tooth height is small (a few centimeters), to avoid hindering the observation of the solar corona near the limb. We first analyze the diffraction pattern produced by such occulters. In a second step, we compute the umbra profile by integration over the Sun. Methods: We explored a few methods to compute the diffraction pattern. Two of them were implemented. The first is based on 2D fast Fourier transformation (FFT) routines and a multiplication by the Fresnel filter of the form exp(-iπλzu2). Simple rules were derived and discussed to set the sampling conditions. The Maggi-Rubinowicz representation is then proposed as an alternative method, and is proven to be very efficient for this study. Results: Serrated occulters tend to create a two-level intensity pattern, the inner being the darker, which perfectly matches a previously reported geometrical prediction. The diffraction in this central region is lower by two to four orders of magnitude when compared to the sharp-edged disk. The achieved umbra level at the center ranges from 10-4 to below 10-7, depending on the geometry of the teeth. Conclusions: Our study shows that serrated occulters can achieve a high rejection and can almost reach the performance of the apodized disk when very many teeth are used. We prove that shaped occulters must be preferred to simple disks in solar and stellar coronagraphy.

  3. MRI of pituitary adenomas following treatment

    Energy Technology Data Exchange (ETDEWEB)

    Gouliamos, A. [Dept. of Radiology, CT and MRI Section, Areteion Hospital, Univ. of Athens (Greece); Athanassopoulou, A. [Dept. of Radiology, CT and MRI Section, Areteion Hospital, Univ. of Athens (Greece); Rologis, D. [Neurosurgical Clinic, Athens General Hospital (Greece); Kalovidouris, A. [Dept. of Radiology, CT and MRI Section, Areteion Hospital, Univ. of Athens (Greece); Kotoulas, G. [Dept. of Radiology, CT and MRI Section, Areteion Hospital, Univ. of Athens (Greece); Vlahos, L. [Dept. of Radiology, CT and MRI Section, Areteion Hospital, Univ. of Athens (Greece); Papavassiliou, C. [Dept. of Radiology, CT and MRI Section, Areteion Hospital, Univ. of Athens (Greece)

    1993-10-01

    The purpose of this study was to assess pituitary adenomas following surgical and/or medical treatment in 28 patients. All patients were evaluated with both computed tomography (CT) and magnetic resonance imaging (MRI). The results were correlated with the clinical findings. Apart from the visualization of the adenoma itself (either residual or recurrent) other findings and in particular, morphological changes of the optic chiasm, the pituitary stalk and the sellar floor were evaluated with both imaging modalities. By comparing the two imaging modalities it was found that MRI was superior to CT in demonstrating residual/recurrent adenoma as well as evaluating the morphological changes of the optic chiasm and optic nerves. CT was superior or equal to MR in demonstrating the sellar floor changes. The intra-operatively implanted fat was equally seen by CT and MR. In conclusion, the anatomical variations of the optic chiasm and pituitary stalk are better visualized by MRI and allow a more precise evaluation of changes attributed to surgical or medical treatment of pituitary adenomas. (orig.)

  4. MRI of pituitary adenomas following treatment

    International Nuclear Information System (INIS)

    Gouliamos, A.; Athanassopoulou, A.; Rologis, D.; Kalovidouris, A.; Kotoulas, G.; Vlahos, L.; Papavassiliou, C.

    1993-01-01

    The purpose of this study was to assess pituitary adenomas following surgical and/or medical treatment in 28 patients. All patients were evaluated with both computed tomography (CT) and magnetic resonance imaging (MRI). The results were correlated with the clinical findings. Apart from the visualization of the adenoma itself (either residual or recurrent) other findings and in particular, morphological changes of the optic chiasm, the pituitary stalk and the sellar floor were evaluated with both imaging modalities. By comparing the two imaging modalities it was found that MRI was superior to CT in demonstrating residual/recurrent adenoma as well as evaluating the morphological changes of the optic chiasm and optic nerves. CT was superior or equal to MR in demonstrating the sellar floor changes. The intra-operatively implanted fat was equally seen by CT and MR. In conclusion, the anatomical variations of the optic chiasm and pituitary stalk are better visualized by MRI and allow a more precise evaluation of changes attributed to surgical or medical treatment of pituitary adenomas. (orig.)

  5. Nephrogenic adenoma. Reports of two cases

    DEFF Research Database (Denmark)

    Osther, P J; Starklint, H

    1989-01-01

    Nephrogenic adenoma is a rare lesion of the urinary tract. Two cases in the urinary bladder are described. Histologically the tumor consists of cystic and tubular structures resembling the distal part of the nephron. The etiology and pathogenesis are discussed and a new etiologic theory is presen...

  6. Fractionated proton beam irradiation of pituitary adenomas

    International Nuclear Information System (INIS)

    Ronson, Brian B.; Schulte, Reinhard W.; Han, Khanh P.; Loredo, Lilia N.; Slater, James M.; Slater, Jerry D.

    2006-01-01

    Purpose: Various radiation techniques and modalities have been used to treat pituitary adenomas. This report details our experience with proton treatment of these tumors. Methods and Materials: Forty-seven patients with pituitary adenomas treated with protons, who had at least 6 months of follow-up, were included in this analysis. Forty-two patients underwent a prior surgical resection; 5 were treated with primary radiation. Approximately half the tumors were functional. The median dose was 54 cobalt-gray equivalent. Results: Tumor stabilization occurred in all 41 patients available for follow-up imaging; 10 patients had no residual tumor, and 3 had greater than 50% reduction in tumor size. Seventeen patients with functional adenomas had normalized or decreased hormone levels; progression occurred in 3 patients. Six patients have died; 2 deaths were attributed to functional progression. Complications included temporal lobe necrosis in 1 patient, new significant visual deficits in 3 patients, and incident hypopituitarism in 11 patients. Conclusion: Fractionated conformal proton-beam irradiation achieved effective radiologic, endocrinological, and symptomatic control of pituitary adenomas. Significant morbidity was uncommon, with the exception of postradiation hypopituitarism, which we attribute in part to concomitant risk factors for hypopituitarism present in our patient population

  7. Synchronous parathyroid adenoma and papillary thyroid carcinoma ...

    African Journals Online (AJOL)

    Simultaneous existence of parathyroid adenoma and thyroid nonmedullary carcinoma is rarely observed. A 52‑year‑old female was diagnosed approximately 4 years ago with primary hyperparathyroidism (PHPT) on the basis of hypercalcemia and elevated serum parathyroid hormone (PTH) level. Clinically, PHPT ...

  8. A parathyroid adenoma case study: Protocol review

    International Nuclear Information System (INIS)

    Sorensen, B.J.; Chu, J.M.G.

    1998-01-01

    Full text: Technetium-99m ( 99m Tc) Sestamibi as opposed to Thallous-201 Chloride and 99m Tc Sodium Pertechnetate subtraction, has become the radiopharmaceutical of choice for detection of parathyroid adenomas. A 17-year-old female patient presented to the department for a parathyroid 99m Tc Sestamibi scan to evaluate possible parathyroid adenoma/s. She was initially admitted with increasing serum Calcium levels, polyuria, abdominal pain and general malaise. The patient was injected with 900MBq of 99m Tc Sestamibi, and a pinhole dynamic at a distance of 10 cm from the neck was acquired followed by a 5-minute static image at 7 cm. Single Photon Emission Computed Tomography (SPECT) was then performed on a dual-head gamma camera followed by an anterior and posterior 10-minute static image. At 3 and 5 hours post injection the 10-minute static image was repeated. This study was reported as normal with uniform uptake and washout of the tracer over the 5-hour period. An ultrasound study was performed, and it showed a lesion believed to be a parathyroid adenoma measuring 2.2 x 0.8 x 0.4 cm in size in the right upper lobe of the thyroid. A subsequent thyroid scan was performed to confirm that it was non-functioning thyroid tissue. The patient was injected with 250MBq of 99m Tc Sodium Pertechnetate and scanned with a pinhole collimator at a distance of 7 cm. When the 99m Tc Sestamibi and 99m Tc Sodium Pertechnetate scan were viewed together, it was clear that there was excess 99m Tc Sestamibi distribution on the right upper lobe of the thyroid, which washed out over time. This corresponded to the ultrasound findings and was confirmed at surgery to be a parathyroid adenoma. A 99m Tc Sodium Pertechnetate scan and an ultrasound are now also routinely performed on patients presenting for 99m Tc Sestamibi parathyroid scans

  9. Thyroid Adenomas After Solid Cancer in Childhood

    Energy Technology Data Exchange (ETDEWEB)

    Haddy, Nadia; El-Fayech, Chiraz; Guibout, Catherine; Adjadj, Elisabeth [Radiation Epidemiology Group, INSERM, Villejuif (France); Institut Gustave Roussy, Villejuif (France); Univ. Paris-Sud, Villejuif (France); Thomas-Teinturier, Cecile [Radiation Epidemiology Group, INSERM, Villejuif (France); Hopital Bicetre, Bicetre (France); Oberlin, Odile [Radiation Epidemiology Group, INSERM, Villejuif (France); Institut Gustave Roussy, Villejuif (France); Veres, Cristina [Radiation Epidemiology Group, INSERM, Villejuif (France); Institut Gustave Roussy, Villejuif (France); Univ. Paris-Sud, Villejuif (France); Pacquement, Helene [Institut Curie, Paris (France); Jackson, Angela [Radiation Epidemiology Group, INSERM, Villejuif (France); Institut Gustave Roussy, Villejuif (France); Univ. Paris-Sud, Villejuif (France); Munzer, Martine; N' Guyen, Tan Dat [Institut Jean Godinot, Reims (France); Bondiau, Pierre-Yves [Centre Antoine Lacassagne, Nice (France); Berchery, Delphine; Laprie, Anne [Centre Claudius Regaud, Toulouse (France); Bridier, Andre; Lefkopoulos, Dimitri [Institut Gustave Roussy, Villejuif (France); Schlumberger, Martin [Institut Gustave Roussy, Villejuif (France); Univ. Paris-Sud, Villejuif (France); Rubino, Carole; Diallo, Ibrahima [Radiation Epidemiology Group, INSERM, Villejuif (France); Institut Gustave Roussy, Villejuif (France); Univ. Paris-Sud, Villejuif (France); Vathaire, Florent de, E-mail: florent.devathaire@igr.fr [Radiation Epidemiology Group, INSERM, Villejuif (France); Institut Gustave Roussy, Villejuif (France); Univ. Paris-Sud, Villejuif (France)

    2012-10-01

    Purpose: Very few childhood cancer survivor studies have been devoted to thyroid adenomas. We assessed the role of chemotherapy and the radiation dose to the thyroid in the risk of thyroid adenoma after childhood cancer. Methods and Materials: A cohort of 3254 2-year survivors of a solid childhood cancer treated in 5 French centers before 1986 was established. The dose received by the isthmus and the 2 lobes of the thyroid gland during each course of radiation therapy was estimated after reconstruction of the actual radiation therapy conditions in which each child was treated as well as the dose received at other anatomical sites of interest. Results: After a median follow-up of 25 years, 71 patients had developed a thyroid adenoma. The risk strongly increased with the radiation dose to the thyroid up to a few Gray, plateaued, and declined for high doses. Chemotherapy slightly increased the risk when administered alone but also lowered the slope of the dose-response curve for the radiation dose to the thyroid. Overall, for doses up to a few Gray, the excess relative risk of thyroid adenoma per Gray was 2.8 (90% CI: 1.2-6.9), but it was 5.5 (90% CI: 1.9-25.9) in patients who had not received chemotherapy or who had received only 1 drug, and 1.1 (90% CI: 0.4-3.4) in the children who had received more than 1 drug (P=.06, for the difference). The excess relative risk per Gray was also higher for younger children at the time of radiation therapy than for their older counterparts and was higher before attaining 40 years of age than subsequently. Conclusions: The overall pattern of thyroid adenoma after radiation therapy for a childhood cancer appears to be similar to that observed for thyroid carcinoma.

  10. Thyroid Adenomas After Solid Cancer in Childhood

    International Nuclear Information System (INIS)

    Haddy, Nadia; El-Fayech, Chiraz; Guibout, Catherine; Adjadj, Elisabeth; Thomas-Teinturier, Cécile; Oberlin, Odile; Veres, Cristina; Pacquement, Hélène; Jackson, Angela; Munzer, Martine; N'Guyen, Tan Dat; Bondiau, Pierre-Yves; Berchery, Delphine; Laprie, Anne; Bridier, André; Lefkopoulos, Dimitri; Schlumberger, Martin; Rubino, Carole; Diallo, Ibrahima; Vathaire, Florent de

    2012-01-01

    Purpose: Very few childhood cancer survivor studies have been devoted to thyroid adenomas. We assessed the role of chemotherapy and the radiation dose to the thyroid in the risk of thyroid adenoma after childhood cancer. Methods and Materials: A cohort of 3254 2-year survivors of a solid childhood cancer treated in 5 French centers before 1986 was established. The dose received by the isthmus and the 2 lobes of the thyroid gland during each course of radiation therapy was estimated after reconstruction of the actual radiation therapy conditions in which each child was treated as well as the dose received at other anatomical sites of interest. Results: After a median follow-up of 25 years, 71 patients had developed a thyroid adenoma. The risk strongly increased with the radiation dose to the thyroid up to a few Gray, plateaued, and declined for high doses. Chemotherapy slightly increased the risk when administered alone but also lowered the slope of the dose-response curve for the radiation dose to the thyroid. Overall, for doses up to a few Gray, the excess relative risk of thyroid adenoma per Gray was 2.8 (90% CI: 1.2-6.9), but it was 5.5 (90% CI: 1.9-25.9) in patients who had not received chemotherapy or who had received only 1 drug, and 1.1 (90% CI: 0.4-3.4) in the children who had received more than 1 drug (P=.06, for the difference). The excess relative risk per Gray was also higher for younger children at the time of radiation therapy than for their older counterparts and was higher before attaining 40 years of age than subsequently. Conclusions: The overall pattern of thyroid adenoma after radiation therapy for a childhood cancer appears to be similar to that observed for thyroid carcinoma.

  11. Performance Testing Of A Modified Centrifugal Fan With Serrated Blade Impeller

    Directory of Open Access Journals (Sweden)

    Zaimar

    2017-10-01

    Full Text Available Changes of shape dimension and component part of impeller might change of characteristic fluid flow so that pressure static in the fan housing changed. Changing some geometric characteristics of the centrifugal fan has more efficiency taking with energy crises into consideration. Several factors that can affect fan performance namely design and type size rotation speed air condition or gas through a fan operating point on the nature of the relationship between a volume of air flow and pressure. The purpose of this research was to test of fan performance of the modified centrifugal fan with the serrated blade impeller. The addition of a percentage of closing the inlet causes the air volumetric rate the airflow energy BHP and total efficiency except for the fan total and static pressure. The experimental test results there are static pressure data and the resulting total pressure is different or distorted 10-17 of deviation from calculation data based on the fan laws. This is possible because of changes in the shape of the blade with serrated on the inside of the impeller. Based on the performance curve shows that the selection of impeller speeds of 800 RPM produces a relatively high air volumetric rate is proportional to the total pressure of the fan and the flow energy so that it is more efficient than other impeller speeds.

  12. Experimental demonstration of wind turbine noise reduction through optimized airfoil shape and trailing-edge serrations

    Energy Technology Data Exchange (ETDEWEB)

    Oerlemans, S. [National Aerospace Laboratory NLR, Emmeloord (Netherlands); Schepers, J.G. [Unit Wind Energy, Energy research Centre of the Netherlands ECN, Petten (Netherlands); Guidati, G.; Wagner, S. [Institut fuer Aerodynamik und Gasdynamik IAG, Universitaet Stuttgart (Germany)

    2001-07-15

    The objective of the European project DATA (Design and Testing of Acoustically Optimized Airfoils for Wind Turbines) is a reduction of trailing-edge (TE) noise by modifying the airfoil shape and/or the application of trailing-edge serrations. This paper describes validation measurements that were performed in the DNW-LLF wind tunnel, on a model scale wind turbine with a two-bladed 4.5 m diameter rotor which was designed in the project. Measurements were done for one reference- and two acoustically optimized rotors, for varying flow conditions. The aerodynamic performance of the rotors was measured using a torque meter in the hub, and further aerodynamic information was obtained from flow visualization on the blades. The acoustic measurements were done with a 136 microphone out-of-flow acoustic array. Besides the location of the noise sources in the (stationary) rotor plane, a new acoustic processing method enabled identification of dominant noise source regions on the rotating blades. The results show dominant noise sources at the trailing-edge of the blade, close to the tip. The optimized airfoil shapes result in a significant reduction of TE noise levels with respect to the reference rotor, without loss in power production. A further reduction can be achieved by the application of trailing-edge serrations. The aerodynamic measurements are generally in good agreement with the aerodynamic predictions made during the design of the model turbine.

  13. The effect of metformin on the recurrence of colorectal adenoma in diabetic patients with previous colorectal adenoma.

    Science.gov (United States)

    Han, Min Seok; Lee, Hyun Jung; Park, Soo Jung; Hong, Sung Pil; Cheon, Jae Hee; Kim, Won Ho; Kim, Tae Il

    2017-08-01

    Existing studies suggest that metformin lowers the risk and mortality of colorectal cancer. However, the effect of metformin on the suppression and prevention of colorectal adenomas is not clear. The aim of this study was to evaluate the effect of metformin on the recurrence of colorectal adenoma in diabetic patients with previous colorectal adenoma. Among 423 diabetic patients who underwent surveillance colonoscopy after resection of colorectal adenoma between 2005 and 2011, 257 patients were retrospectively reviewed. The patients were divided into two groups: one group comprising 106 patients who took metformin and another group comprising 151 patients who did not take metformin. The clinical characteristics, colorectal adenoma recurrence, and valuable factors for adenoma recurrence were analyzed. At surveillance colonoscopy after colonoscopic polypectomy for adenoma, 38 patients (35.8%) exhibited colorectal adenoma among 106 patients who took metformin, compared with 85 patients (56.3%) with colorectal adenoma among 151 patients who did not take metformin (odds ratio 0.434, 95% confidence interval 0.260-0.723, P = 0.001). Multivariate Cox analysis showed that metformin was associated with decreased recurrence of colorectal adenoma (hazard ratio 0.572, 95% confidence interval 0.385-0.852, P = 0.006) in diabetic patients with previous colorectal adenoma. The cumulative probability of colorectal adenoma recurrence was significantly lower in the metformin group than in the non-metformin group (P = 0.001). Metformin use in diabetic patients with previous colorectal adenoma is associated with a lower risk of colorectal adenoma recurrence.

  14. G protein abnormalities in pituitary adenomas.

    Science.gov (United States)

    Spada, A; Lania, A; Ballarè, E

    1998-07-25

    It has been demonstrated that the majority of secreting and nonsecreting adenomas is monoclonal in origin suggesting that these neoplasia arise from the replication of a single mutated cell, in which growth advantage results from either activation of protooncogenes or inactivation of antioncogenes. Although a large number of genes has been screened for mutations, only few genetic abnormalities have been found in pituitary tumors such as allelic deletion of chromosome 11q13 where the MEN-1 gene has been localised, and mutations in the gene encoding the alpha subunit of the stimulatory Gs and Gi2 protein. These mutations constitutively activate the alpha subunit of the Gs and Gi2 protein by inhibiting their intrinsic GTPase activity. Both Gs alpha and Gi2alpha can be considered products of protooncogenes (gsp and gip2, respectively) since gain of function mutations that activate mitogenic signals have been recognized in human tumors. Gsp oncogene is found in 30-40% of GH-secreting adenomas, in a low percentage of nonfunctioning and ACTH-secreting pituitary adenomas, in toxic thyroid adenomas and differentiated thyroid carcinomas. The same mutations, occurred early in embriogenesis, have been also identified in tissues from patients affected with the McCune Albright syndrome. These mutations result in an increased cAMP production and in the subsequent overactivation of specific pathways involved in both cell growth and specific programmes of cell differentiation. By consequence, the endocrine tumors expressing gsp oncogene retain differentiated functions. The gip2 oncogene has been identified in about 10% of nonfunctioning pituitary adenomas, in tumors of the ovary and the adrenal cortex. However, it remains to be established whether Gi proteins activate mitogenic signals in pituitary cells. Since Gi proteins are involved in mediating the effect of inhibitory neurohormones on intracellular effectors, it has been proposed that in pituitary tumors the low expression of

  15. Owl-inspired leading-edge serrations play a crucial role in aerodynamic force production and sound suppression.

    Science.gov (United States)

    Rao, Chen; Ikeda, Teruaki; Nakata, Toshiyuki; Liu, Hao

    2017-07-04

    Owls are widely known for silent flight, achieving remarkably low noise gliding and flapping flights owing to their unique wing morphologies, which are normally characterized by leading-edge serrations, trailing-edge fringes and velvet-like surfaces. How these morphological features affect aerodynamic force production and sound suppression or noise reduction, however, is still not well known. Here we address an integrated study of owl-inspired single feather wing models with and without leading-edge serrations by combining large-eddy simulations (LES) with particle-image velocimetry (PIV) and force measurements in a low-speed wind tunnel. With velocity and pressure spectra analysis, we demonstrate that leading-edge serrations can passively control the laminar-turbulent transition over the upper wing surface, i.e. the suction surface at all angles of attack (0°    15° where owl wings often reach in flight. Our results indicate that the owl-inspired leading-edge serrations may be a useful device for aero-acoustic control in biomimetic rotor designs for wind turbines, aircrafts, multi-rotor drones as well as other fluid machinery.

  16. Colonic diverticulosis is not a risk factor for colonic adenoma.

    Science.gov (United States)

    Hong, Wandong; Dong, Lemei; Zippi, Maddalena; Stock, Simon; Geng, Wujun; Xu, Chunfang; Zhou, Mengtao

    2018-01-01

    Colonic diverticulosis may represent a risk factor for colonic adenomas by virtue of the fact that evolving data suggest that these 2 conditions may share common risk factors such as Western dietary pattern and physical inactivity. This study aims to investigate the association between colonic diverticulosis and colonic adenomas in mainland China. We conducted a cross-sectional study on patients who underwent colonoscopic examination between October 2013 and December 2014 in a university hospital in mainland China. Age, gender, colonic adenomas, advanced adenomas, and distribution of diverticulosis were recorded during the procedures. Multivariate logistic regression and stratified analysis were used to evaluate the associations between the prevalence of diverticulosis and age, sex, and presence of colonic adenomas and advanced adenomas. A total of 17,456 subjects were enrolled. The prevalence of colonic diverticulosis and adenoma was 2.4% and 13.2%, respectively. With regard to distribution of diverticula, most (365/424, 86.1%) were right-sided. Multiple logistic regression analysis suggested that age and male gender were independent risk factors for adenoma and advanced adenoma. There was no relationship between diverticulosis or location of diverticulosis and presence of adenoma and advanced adenoma adjusting by age and gender. In a stratified analysis according to age and gender, similar results were also noted. There was no statistical relationship between diverticulosis and the risk of adenoma and advanced adenoma. Our results may not be generalized to the Western population due to the fact that left-sided diverticular cases were very small in our study.

  17. Pleomorphic Adenomas of the Parapharyngeal Space

    Directory of Open Access Journals (Sweden)

    İstemihan Akın

    2014-01-01

    Full Text Available Background. Parapharyngeal space is one of potential facial planes for neoplasms and infections and represents less than 1% of all head and neck tumours. Occurrence of the pleomorphic adenoma in the parapharyngeal space is a rarity. Case Presentation. Here, three giant pleomorphic adenomas of different sizes occupying the parapharyngeal space in three patients are reported. Extensive preoperative diagnostic workup was done in order to verify the nature and size of the tumour and the proximity to the large vessels. Review of the literature, clinical features, pathology, radiological findings, and treatment of these tumours are discussed. Conclusion. The excision of the tumor through submandibular transcervical approach, without cutting the mandible, turned out to be a safe and radical approach in all three cases.

  18. Adenoma viloso da ampola de Vater

    Directory of Open Access Journals (Sweden)

    Julio Cesar Wiederkehr

    Full Text Available The aim of this paper is to present a case of a 37-year-old female patient with a benign tumor of the Ampulla of Vater and a brief review of the literature. The patient presented with progressive obstructive jaundice and weigth loss due to the presence of two adenomas of the second portion of duodenum. Laboratory tests confirmed the presence of obstruction of the biliary tree. Ultrasound and CT scan of the abdomen revealed bile duct dilatation. ERCP showed a tumor at the site of the Ampulla of Vater. The biopsies revealed tubular adenoma. She was submitted to local resection of the tumors and sphincteroplasty, since the frozen biopsy at the time of surgery showed no malignancy. During the post-operative follow-up she presented recurrence of symptoms. An upper GI endoscopy revealed a tumor at the Ampulla of Vater. She was then submitted to Whipple procedure with an uneventful recovery.

  19. Comprehensive radiodiagnosis of toxic thyroid adenoma

    International Nuclear Information System (INIS)

    Filatov, A.A.; Ginzburg, L.I.; Tatsievskij, V.A.

    1984-01-01

    The results of a comprehensive radionuclide, ultrasound and thermographic study of 18 patients, with toxic, thyroid adenoma are presented. It has been shown that during thermographic examination temperature difference over the node and the symmetrical region is insignificant and does not exceed 1 deg C in most of the patients. It equally pertains to the comparison of temperatures over the node and the hottest and coldest points in the cervical region. Ultrasound examination makes it possible to determine the shape, size, exact location of the node and its internal structure but gives no opportunity to udge its functional activity. It has been shown that a node in toxic adenoma may have homogeneous as well as heterogeneous echo-structure, elevated or lowered echo-density; changes of degenerative-dystrophic nature are not infrequent

  20. Pressure flaking to serrate bifacial points for the hunt during the MIS5 at Sibudu Cave (South Africa.

    Directory of Open Access Journals (Sweden)

    Veerle Rots

    Full Text Available Projectile technology is considered to appear early in the southern African Middle Stone Age (MSA and the rich and high resolution MSA sequence of Sibudu Cave in KwaZulu-Natal has provided many new insights about the use and hafting of various projectile forms. We present the results of a functional and technological analysis on a series of unpublished serrated bifacial points recently recovered from the basal deposits of Sibudu Cave. These serrated tools, which only find equivalents in the neighbouring site of Umhlatuzana, precede the Still Bay techno-complex and are older than 77 ka BP. Independent residue and use-wear analyses were performed in a phased procedure involving two separate analysts, which allowed the engagement between two separate lines of functional evidence. Thanks to the excellent preservation at Sibudu Cave, a wide range of animal, plant and mineral residues were observed in direct relation with diagnostic wear patterns. The combination of technological, wear and residue evidence allowed us to confirm that the serration was manufactured with bone compressors and that the serrated points were mounted with a composite adhesive as the tips of projectiles used in hunting activities. The suite of technological and functional data pushes back the evidence for the use of pressure flaking during the MSA and highlights the diversity of the technical innovations adopted by southern African MSA populations. We suggest the serrated points from the stratigraphic units Adam to Darya of Sibudu illustrate one important technological adaptation of the southern African MSA and provide another example of the variability of MSA bifacial technologies.

  1. The result of radiotherapy for pituitary adenoma

    International Nuclear Information System (INIS)

    Lee, H. J.; Yang, K. M.; Suh, S. H.

    1997-01-01

    To evaluate the prognostic factors for disease-free survival and long-term results of radiotherapy for pituitary adenoma. The study involved a retrospective review of outcome in a series of 27 patients with pituitary adenoma, between 1984 and 1995 at Paik hospital. The study included 20 patients treated with surgery and postoperative radiotherapy and 7 with radiotherapy alone. The patients were followed for 12-146 months (median: 97 months). Seventeen were men and 10 were women. The numbers of functioning and non-functioning pituitary adenoma were 22 and 5 respectively and those of microadenoma and macroadenoma were 4 and 23 respectively. The radiation doses of 5040-5580cGy(median: 5040cGy) were delivered over 5-7 weeks, using 4MV LINAC. The prognostic factors were analyzed by log-rank test. For radiation therapy alone, the 5 YSR was 100% and progression free survival rate was 85.8%. The tumor was controlled in 6/7 (85.8%). For surgery and postoperative radiotherapy , the 5YSR, progression free survival rate and local control rate were 95%, 84.8%, and 89.5% respectively. The parameters of tumor size, hormone secretion, radiation dose, radiotherapy field size were evaluated in a uni- and multivariate analysis and all the factors were not statistically significant (P>0.05). Eleven of 12 (92%) with visual field defect experienced normalization or improvement, and 5 for 7 evaluable patients with hyperprolactinoma achieved normalization in 4 and decrement in 5 patients. Only 2 patients developed mild degree of panhypopituitarism. The radiotherapy appears to be effective in controlling clinical symptoms and signs resulting from pituitary adenoma. Local control rate with radiotherapy alone or with surgery and postoperative radiotherapy was comparable. There was a trend toward high recurrence rate in patients with nonfunctioning or prolactin secreting tumor and larger radiation field sizes. (author)

  2. The result of radiotherapy for pituitary adenoma

    Energy Technology Data Exchange (ETDEWEB)

    Lee, H. J.; Yang, K. M.; Suh, S. H. [Inje Univ., Seoul (Korea, Republic of). Coll. of Medicine; Cho, H. L.; Shon, S. C. [Pusan Paik Hospital, Pusan (Korea, Republic of)

    1997-12-01

    To evaluate the prognostic factors for disease-free survival and long-term results of radiotherapy for pituitary adenoma. The study involved a retrospective review of outcome in a series of 27 patients with pituitary adenoma, between 1984 and 1995 at Paik hospital. The study included 20 patients treated with surgery and postoperative radiotherapy and 7 with radiotherapy alone. The patients were followed for 12-146 months (median: 97 months). Seventeen were men and 10 were women. The numbers of functioning and non-functioning pituitary adenoma were 22 and 5 respectively and those of microadenoma and macroadenoma were 4 and 23 respectively. The radiation doses of 5040-5580cGy(median: 5040cGy) were delivered over 5-7 weeks, using 4MV LINAC. The prognostic factors were analyzed by log-rank test. For radiation therapy alone, the 5 YSR was 100% and progression free survival rate was 85.8%. The tumor was controlled in 6/7 (85.8%). For surgery and postoperative radiotherapy , the 5YSR, progression free survival rate and local control rate were 95%, 84.8%, and 89.5% respectively. The parameters of tumor size, hormone secretion, radiation dose, radiotherapy field size were evaluated in a uni- and multivariate analysis and all the factors were not statistically significant (P>0.05). Eleven of 12 (92%) with visual field defect experienced normalization or improvement, and 5 for 7 evaluable patients with hyperprolactinoma achieved normalization in 4 and decrement in 5 patients. Only 2 patients developed mild degree of panhypopituitarism. The radiotherapy appears to be effective in controlling clinical symptoms and signs resulting from pituitary adenoma. Local control rate with radiotherapy alone or with surgery and postoperative radiotherapy was comparable. There was a trend toward high recurrence rate in patients with nonfunctioning or prolactin secreting tumor and larger radiation field sizes. (author).

  3. Metanephric Adenoma: clinical, imaging, and histological findings

    Energy Technology Data Exchange (ETDEWEB)

    Torricelli, Fabio Cesar Miranda; Marchini, Giovanni Scala, E-mail: fabio_torri@yahoo.com.b [Universidade de Sao Paulo (USP), SP (Brazil). Faculdade de Medicina. Dept. de Urologica; Campos, Rodrigo Sousa Madeira [Hospital do Servidor Publico Estadual, Sao Paulo, SP (Brazil). Dept. de Urologia; Gil, Antonio Otero [Instituto Dante Pazanezzi, Sao Paulo, SP (Brazil)

    2011-07-01

    Metanephric adenoma (MA), also designated nephrogenic nephroma or renal epithelial tumor resembling immature nephron, has just been recently recognized as a special type of benign renal epithelial tumor. Only few reports are found in the literature regarding this rare renal tumor. The purpose of this paper is to describe our clinical, imaging and histological / immunohistochemical observations of MA diagnosed in two patients and compare these data to previous information reported in medical databases (author)

  4. Paratiroid gland adenoma and single pulmonary fibroma

    International Nuclear Information System (INIS)

    Aguirre Carpio, Roberto; Jimenez Torres, Victor

    2005-01-01

    The case of a 62 year old woman with diagnose of parathyroid gland adenoma and single pulmonary fibroma admitted at the ION SOLCA in Quito by the surgery service. At her admission she was classified as a paraneoplasic syndrome associated witha a pulmonary mass + hypercalcemia. This case was presented because of the importance of the primary hyperparathyroidism as one of the principal endocrine pathologies, that in oncology are associated with the multiple neoplasia syndromes. (The author)

  5. ROLE OF RADIOFREQUENCY ABLATION IN ADENOMA SEBACEUM

    Directory of Open Access Journals (Sweden)

    Ch. Madh

    2016-03-01

    Full Text Available Adenoma sebaceum, pathognomonic of tuberous sclerosis, are tiny angiofibromas which commonly occur over central part of face. Recurrence after treatment is common and hence a need for inexpensive, safe and efficient treatment is required. Radiofrequency ablation is a safe and an economical procedure and has been known to cause less scarring with good aesthetic results compared to other ablative methods such as electrocautery.

  6. Bile Duct Adenoma with Oncocytic Features

    Directory of Open Access Journals (Sweden)

    E. J. Johannesen

    2014-01-01

    Full Text Available Bile duct adenomas are benign bile duct proliferations usually encountered as an incidental finding. Oncocytic bile duct neoplasms are rare and the majority are malignant. A 61-year-old male with a diagnosis of colorectal adenocarcinoma was undergoing surgery when a small white nodule was discovered on the surface of the right lobe of his liver. This lesion was composed of cytologically bland cells arranged in tightly packed glands. These cells were immunopositive for cytokeratin 7, negative for Hep Par 1, contained mucin, and had a Ki67 proliferation index of 8%. The morphology, immunophenotype, presence of mucin, and normal appearing bile ducts, as well as the increased Ki67 proliferation rate, were consistent with a bile duct adenoma with oxyphilic (oncocytic change. Oncocytic tumors in the liver are rare; the first described in 1992. Only two bile duct adenomas with oncocytic change have been reported and neither of them had reported mucin production or the presence of normal appearing bile ducts within the lesion.

  7. Lymphocitic infundibuloneurohypophysitis mimicking a pituitary adenoma

    Directory of Open Access Journals (Sweden)

    Hubertus Maximilian Mehdorn

    2011-04-01

    Full Text Available A rare case of infundibulo-neurohypophysitis mimicking a pituitary adenoma is presented. A 69-years-old female patient developed polyuria and polydipsia. Laboratory analysis revealed central diabetes insipidus. No hormonal abnormalities. Cranial-magnetic resonance imaging (MRI showed a left sided mass in the adenohypophysis presuming a pituitary adenoma. The mass had contact to both internal carotids. Admission to our department for neurosurgical treatment followed. Ophthalmo - logic examination and neurological examination yielded normal findings. A second MRI focussing on the sellar-region showed a leftsided (T2-MRI.hyperintense, distended adenohypophysis, without contrast enhancement in T1. The stalk appeared thickened. T1- weighted sequences of the neurohypophysis showed loss of signal intensity. We diagnosed an infundibulo-neurohypophysitis and abstai - ned from surgical removal. The patient was discharged under treatment with corticosteroids and desmopressin. Hypophysitis is rare and shows special clinical characteristics. Despite defined radiological features to differentiate between hypophysitis and adenoma the possibility of misdiagnosis, and unnecessary surgical procedures, should always kept in mind.

  8. Pituitary adenoma with adipose tissue: A new metaplastic variant.

    Science.gov (United States)

    Caporalini, Chiara; Buccoliero, Anna Maria; Pansini, Luigi; Moscardi, Selene; Novelli, Luca; Baroni, Gianna; Bordi, Lorenzo; Ammannati, Franco; Taddei, Gian Luigi

    2017-08-01

    Pituitary adenomas are benign tumors representing approximately 15-20% of intracranial neoplasms. There have been few reports of metaplastic osseous transformation and about 60 cases of neuronal metaplasia in pituitary adenoma but adipose metaplasia has not been previously described in the English literature. Here we report a case of pituitary adenoma with metaplastic adipose tissue in a 58-year-old male patient. Histologically this case fulfilled the criteria of a non-functioning pituitary adenoma, and moreover a central area of adipose tissue, made by mature adipocytes, and many tumor cells, containing fat droplet were evident. Lipomatous transformation of tumor cells in the CNS has been previously observed but, to the best of our knowledge, our case is the first pituitary adenoma with such change. The histogenesis of the adipose element in pituitary adenoma is not well understood, and could be a result of a metaplastic change or divergent differentiation from a common progenitor cell. © 2017 Japanese Society of Neuropathology.

  9. Nipple adenoma in a 2-year-old boy.

    Science.gov (United States)

    Fujisawa, Kou; Kato, Motoi; Kono, Tatsuki; Utsunomiya, Hiroki; Watanabe, Azusa; Watanabe, Shoji

    2018-05-01

    Nipple adenoma is an uncommon proliferative process of the breast and predominantly occurs in women aged 40-50. Its incidence is extremely low in men, and it has not been reported in a boy. Although nipple adenoma is rare and benign, being familiar with it is important because it clinically resembles Paget disease and histologically adenocarcinoma. We report a case of nipple adenoma in a boy. © 2018 Wiley Periodicals, Inc.

  10. Some problems of the diagnosis of hypophysis adenomas

    International Nuclear Information System (INIS)

    Shul'man, Kh.M.; Danilov, V.I.; Solomatina, A.Kh.

    1995-01-01

    It is shown that positive changes in the diagnostics of hypophysis adenomas took place due to the introduction into the diagnostics practice of radioimmunoassay technique of hormon spectrum determination, as well as MR-and computer tomography and angiography. The analysis of 60 patients operated for hypophysis adenoma shows that the earliest manifestations of this disease include endocrine disorders, ocular disorders and neurological deficits. The application of new diagnostic methods enables early detection of hypophysis adenomas. 3 refs

  11. Developmental and evolutionary novelty in the serrated teeth of theropod dinosaurs.

    Science.gov (United States)

    Brink, K S; Reisz, R R; LeBlanc, A R H; Chang, R S; Lee, Y C; Chiang, C C; Huang, T; Evans, D C

    2015-07-28

    Tooth morphology and development can provide valuable insights into the feeding behaviour and evolution of extinct organisms. The teeth of Theropoda, the only clade of predominantly predatory dinosaurs, are characterized by ziphodonty, the presence of serrations (denticles) on their cutting edges. Known today only in varanid lizards, ziphodonty is much more pervasive in the fossil record. Here we present the first model for the development of ziphodont teeth in theropods through histological, SEM, and SR-FTIR analyses, revealing that structures previously hypothesized to prevent tooth breakage instead first evolved to shape and maintain the characteristic denticles through the life of the tooth. We show that this novel complex of dental morphology and tissues characterizes Theropoda, with the exception of species with modified feeding behaviours, suggesting that these characters are important for facilitating the hypercarnivorous diet of most theropods. This adaptation may have played an important role in the initial radiation and subsequent success of theropods as terrestrial apex predators.

  12. A parathyroid adenoma case study: Protocol review

    Energy Technology Data Exchange (ETDEWEB)

    Sorensen, B.J.; Chu, J.M.G. [Liverpool Hospital, NSW (Australia). Department of Nuclear Medicine and Clinical Ultrasound

    1998-06-01

    Full text: Technetium-99m ({sup 99m}Tc) Sestamibi as opposed to Thallous-201 Chloride and {sup 99m}Tc Sodium Pertechnetate subtraction, has become the radiopharmaceutical of choice for detection of parathyroid adenomas. A 17-year-old female patient presented to the department for a parathyroid {sup 99m}Tc Sestamibi scan to evaluate possible parathyroid adenoma/s. She was initially admitted with increasing serum Calcium levels, polyuria, abdominal pain and general malaise. The patient was injected with 900MBq of {sup 99m}Tc Sestamibi, and a pinhole dynamic at a distance of 10 cm from the neck was acquired followed by a 5-minute static image at 7 cm. Single Photon Emission Computed Tomography (SPECT) was then performed on a dual-head gamma camera followed by an anterior and posterior 10-minute static image. At 3 and 5 hours post injection the 10-minute static image was repeated. This study was reported as normal with uniform uptake and washout of the tracer over the 5-hour period. An ultrasound study was performed, and it showed a lesion believed to be a parathyroid adenoma measuring 2.2 x 0.8 x 0.4 cm in size in the right upper lobe of the thyroid. A subsequent thyroid scan was performed to confirm that it was non-functioning thyroid tissue. The patient was injected with 250MBq of {sup 99m}Tc Sodium Pertechnetate and scanned with a pinhole collimator at a distance of 7 cm. When the {sup 99m}Tc Sestamibi and {sup 99m}Tc Sodium Pertechnetate scan were viewed together, it was clear that there was excess {sup 99m}Tc Sestamibi distribution on the right upper lobe of the thyroid, which washed out over time. This corresponded to the ultrasound findings and was confirmed at surgery to be a parathyroid adenoma. A {sup 99m}Tc Sodium Pertechnetate scan and an ultrasound are now also routinely performed on patients presenting for {sup 99m}Tc Sestamibi parathyroid scans

  13. Combined parathyroid adenoma and an occult papillary carcinoma

    International Nuclear Information System (INIS)

    Meshikhes, Abdul-Wahid N.; Al-Saihati, Basima A.; Butt, Mohammad S.

    2004-01-01

    Although the pathological association of thyroid and parathyroid disease is common, the association of both parathyroid adenoma and thyroid cancer is rare. We report here a case of a 45-year-old saudi women who diagnosed to have primary hyperparathyrodism due to single parathyroid adenoma as confirmed biochemically and radiologically. At operation, the adenoma was found to be an intrathyroid and therefore a thyroid lobectomy was performed. Histology of the excised lobe revealed in addition to the intrathyroid parathyroid adenoma a concurrent occult thyroid papillary carcinoma. The interesting association is discussed based on a literature review. (author)

  14. Simple numerical chromosome aberrations in two pituitary adenomas

    DEFF Research Database (Denmark)

    Dietrich, C U; Pandis, N; Bjerre, P

    1993-01-01

    Cytogenetic analysis of short-term cultures of one non-secreting and one prolactin-producing pituitary adenoma revealed simple clonal numerical abnormalities in both tumors. The karyotype of the non-secreting adenoma was 48,XX, +4, +9[42]/49,XX, +4, +9, +20[2]/46,XX[6]. In the prolactin-secreting......Cytogenetic analysis of short-term cultures of one non-secreting and one prolactin-producing pituitary adenoma revealed simple clonal numerical abnormalities in both tumors. The karyotype of the non-secreting adenoma was 48,XX, +4, +9[42]/49,XX, +4, +9, +20[2]/46,XX[6]. In the prolactin...

  15. Sequels after radiotherapy of adenoma of adenohypophysis. Folgen einer Hypophysenadenombestrahlung

    Energy Technology Data Exchange (ETDEWEB)

    Knuepffer, J.; Helpap, B. (Staedtisches Krankenhaus, Singen (Germany). Inst. fuer Pathologie); Saeger, W. (Marienkrankenhaus, Hamburg (Germany). Abt. fuer Pathologie)

    1991-10-01

    14 years before his death, iridium seeds were implanted in the adenohypophysis of a 69-year-old patient with a STH producing adenoma of the adenohypophysis and acromegaly. 5 years after recurrence, transsphenoidal hypophysectomy was done. The patient died of central dysregulation due to cerebral insults. At autopsy, a recurrence of the undifferentiated acidophilic adenoma was found within the sphenoidal bone corpus. Immunohistochemistry was positive for STH, prolactin, TSH, LH, and FSH. Besides the adenoma, a mucoepidermoid carcinoma was found within the sphenoid cavity. This carcinoma may be a consequence of the radiotherapy of the adenoma of the adenohypophysis. (orig.).

  16. Differential diagnosis between adrenal adenomas and non-adenomas with gadolinium MR in delayed scans: another diagnostic possibility

    International Nuclear Information System (INIS)

    Mondello, Eduardo J.; Eyheremendy, Eduardo P.; Stoisa, Daniela

    2001-01-01

    Purpose: To determine the value of measuring delayed post gadolinium signal intensity by displaying a curve, to make the differential diagnosis between adrenal adenomas and non-adenomas, and compare it to chemical shift MR imaging and unenhanced/delayed contrast enhanced CT. Material and methods: Nine adrenal masses have been evaluated by unenhanced/delayed contrast enhanced CT, chemical shift MR imaging and Dynamic Scan at 5, 15, 30 minutes or more, with measurement curves. The 'in phase' imaging have been compared to the 'out phase' ones. Results: Adenomas have shown drop of the curve at 30 minutes of the contrast injection. Non-adenomas have conserved an ascending curve with the same delay. Conclusion: Gadolinium-enhanced MR imaging at delayed scans can characterize adrenal masses as adenomas or non-adenomas. This technique could be considered as a new complementary diagnostic method. (author)

  17. Diagnosis and treatment of pituitary adenomas.

    Science.gov (United States)

    Chanson, P; Salenave, S

    2004-12-01

    Pituitary tumors cause symptoms by secreting hormones (prolactin, PRL, responsible for amenorrhea-galactorrhea in women and decreased libido in men; growth hormone, GH, responsible for acromegaly; adrenocorticotropic hormone, ACTH, responsible for Cushing's syndrome; thyroid-stimulating hormone, TSH, responsible for hyperthyroidism), depressing the secretion of hormones (hypopituitarism), or by mass-related effects (headaches, visual field abnormalities...). All patients with pituitary tumors should be evaluated for gonadal, thyroid and adrenal function as well as PRL and GH secretion. Specific stimulation and suppression tests for pituitary hormones are performed in selected situations for detecting the type of hypersecretion or the response to treatment. Imaging procedures (mainly magnetic resonance imaging, MRI, nowadays) determine the presence, size and extent of the lesion. The classification of pituitary tumors is based on the staining properties of the cell cytoplasm viewed by light microscopy and immunocytochemistry revealing the secretory pattern of the adenoma. Treatment of pituitary adenomas consists of surgery (performed in more than 99% of cases via a transphenoidal route) and radiotherapy, generally fractionated or, in selected cases, using stereotactic techniques such as gamma-knife. The availability of medical treatment (dopamine, DA, agonists, somatostatin analogs, GH-receptor antagonists...) has profoundly modified the indications of radiotherapy, drugs being now generally used as a second-line treatment, after surgery (or even as first-line treatment). Based on the results of the different treatment modalities for each type of pituitary adenoma, recommendations will be proposed. They may be summarized as follows. For treatment of GH-secreting adenomas, trans-sphenoidal surgery is the first-line therapy except when the macroadenoma is giant or if surgery is contra-indicated; postoperative radiation therapy (fractionated, or by gamma-knife) is

  18. Advanced colorectal adenoma related gene expression signature may predict prognostic for colorectal cancer patients with adenoma-carcinoma sequence

    OpenAIRE

    Li, Bing; Shi, Xiao-Yu; Liao, Dai-Xiang; Cao, Bang-Rong; Luo, Cheng-Hua; Cheng, Shu-Jun

    2015-01-01

    Background: There are still no absolute parameters predicting progression of adenoma into cancer. The present study aimed to characterize functional differences on the multistep carcinogenetic process from the adenoma-carcinoma sequence. Methods: All samples were collected and mRNA expression profiling was performed by using Agilent Microarray high-throughput gene-chip technology. Then, the characteristics of mRNA expression profiles of adenoma-carcinoma sequence were described with bioinform...

  19. Chaotic state to self-organized critical state transition of serrated flow dynamics during brittle-to-ductile transition in metallic glass

    Energy Technology Data Exchange (ETDEWEB)

    Wang, C.; Wang, W. H.; Bai, H. Y., E-mail: hybai@aphy.iphy.ac.cn [Institute of Physics, Chinese Academy of Sciences, Beijing 100190 (China); Sun, B. A. [Centre for Advanced Structural Materials, Department of Mechanical and Biomedical Engineering, City University of Hong Kong, Kowloon Tong, Kowloon (Hong Kong)

    2016-02-07

    We study serrated flow dynamics during brittle-to-ductile transition induced by tuning the sample aspect ratio in a Zr-based metallic glass. The statistical analysis reveals that the serrated flow dynamics transforms from a chaotic state characterized by Gaussian-distribution serrations corresponding to stick-slip motion of randomly generated and uncorrelated single shear band and brittle behavior, into a self-organized critical state featured by intermittent scale-free distribution of shear avalanches corresponding to a collective motion of multiple shear bands and ductile behavior. The correlation found between serrated flow dynamics and plastic deformation might shed light on the plastic deformation dynamic and mechanism in metallic glasses.

  20. DNA aneuploidy in colorectal adenomas: Role in the adenoma-carcinoma sequence Aneuploidía del ADN en adenomas colónicos: Papel en la secuencia adenoma-carcinoma

    Directory of Open Access Journals (Sweden)

    M. Alcántara Torres

    2005-01-01

    Full Text Available Introduction: aneuploidy has been observed in 6-27% of lesions known to be precursors of colorectal cancer, such as adenomas or ulcerative colitis. It has been suggested that aneuploidy may predispose to malignancy in these cases. However, its role in the adenoma-carcinoma sequence has not been definitely established. The objective of this study was to assess the incidence of aneuploidy in colon adenomas, as well as to study its possible role in the adenoma-carcinoma sequence. Material and methods: the study was performed on a series of 57 large bowel adenomas measuring 10 mm or more, collected from 54 consecutive patients. All specimens were obtained either by endoscopic or by surgical resection. There were 49 adenomas with low-grade dysplasia, two with high-grade dysplasia, two intramucous carcinomas, and four microinvasive carcinomas. A flow cytometric DNA analysis was performed in fresh specimens following Vindelov´s method. Results: aneuploid DNA was detected in five out of 49 low-grade dysplasia adenomas (10%, in all four high-grade dysplasia adenomas or intramucous carcinomas (100%, and in three out of four microinvasive carcinomas (75%. The association between aneuploidy and high-grade dysplasia adenomas, intramucous, or microinvasive carcinoma was statistically significant (p Introducción: en patología benigna de intestino grueso precursora del cáncer colorrectal, como adenomas o colitis ulcerosa, se ha observado aneuploidía en el 6-27% de los casos y se ha sugerido que su presencia predispone al desarrollo de malignidad. Sin embargo, su papel en la secuencia adenoma-carcinoma no se ha demostrado de forma concluyente. El objetivo de nuestro trabajo fue valorar la incidencia de aneuploidía en adenomas colónicos, con y sin signos de malignidad, y estudiar su posible papel en la secuencia adenoma-carcinoma. Material y métodos: el estudio se realizó en una serie de 57 adenomas de intestino grueso, de 10 o más mil

  1. Endotracheal ectopic parathyroid adenoma mimicking asthma

    Directory of Open Access Journals (Sweden)

    M. Akif Özgül

    2014-01-01

    Full Text Available Primary benign tumors of the trachea are uncommon. These tumors may cause tracheal occlusion and lead to a misdiagnosis of asthma. Ectopic parathyroid adenoma (EPA can be seen anywhere between the mandibular angle and the mediastinum. The distal part of the trachea is a rare location for EPA, and EPA obstructing the endotracheal lumen has not been reported in the literature. We herein describe a 52-year-old female with a several-year history of asthma treatment who presented with progressive dyspnea. Computed tomography revealed a mass that was obstructing the tracheal lumen. Total mass excision was performed via endobronchial treatment, and pathologic examination revealed EPA.

  2. Thyroid-stimulating hormone pituitary adenomas.

    Science.gov (United States)

    Clarke, Michelle J; Erickson, Dana; Castro, M Regina; Atkinson, John L D

    2008-07-01

    Thyroid-stimulating hormone (TSH)-secreting pituitary adenomas are rare, representing secreting or clinically silent TSH-immunostaining pituitary tumors among all pituitary adenomas followed at their institution between 1987 and 2003. Patient records, including clinical, imaging, and pathological and surgical characteristics were reviewed. Twenty-one patients (6 women and 15 men; mean age 46 years, range 26-73 years) were identified. Of these, 10 patients had a history of clinical hyperthyroidism, of whom 7 had undergone ablative thyroid procedures (thyroid surgery/(131)I ablation) prior to the diagnosis of pituitary adenoma. Ten patients had elevated TSH preoperatively. Seven patients presented with headache, and 8 presented with visual field defects. All patients underwent imaging, of which 19 were available for imaging review. Sixteen patients had macroadenomas. Of the 21 patients, 18 underwent transsphenoidal surgery at the authors' institution, 2 patients underwent transsphenoidal surgery at another facility, and 1 was treated medically. Patients with TSH-secreting tumors were defined as in remission after surgery if they had no residual adenoma on imaging and had biochemical evidence of hypo-or euthyroidism. Patients with TSH-immunostaining tumors were considered in remission if they had no residual tumor. Of these 18 patients, 9 (50%) were in remission following surgery. Seven patients had residual tumor; 2 of these patients underwent further transsphenoidal resection, 1 underwent a craniotomy, and 4 underwent postoperative radiation therapy (2 conventional radiation therapy, 1 Gamma Knife surgery, and 1 had both types of radiation treatment). Two patients had persistently elevated TSH levels despite the lack of evidence of residual tumor. On pathological analysis and immunostaining of the surgical specimen, 17 patients had samples that stained positively for TSH, 8 for alpha-subunit, 10 for growth hormone, 7 for prolactin, 2 for adrenocorticotrophic hormone

  3. Transnasal stereotactic surgery of pituitary adenomas concomitant with acromegaly.

    Science.gov (United States)

    Metyolkina, L; Peresedov, V

    1995-01-01

    Since 1960 we have performed stereotactic transsphenoidal cryohypophysectomy in 70 patients with pituitary adenomas, 42 women and 28 men, aged 11-59 years. The dominant clinical syndrome was acromegaly in 50 patients, galactorrhea in 9, amenorrhea in 5, adiposogenital dystrophy in 4 and gigantism with mild endocrine symptomatology in 2 patients. In 67 patients the histological structure of the tumor was established by biopsy (50 patients with eosinophil adenoma, 10 with mixed-type adenoma, 4 with chromophobe adenoma and 3 with basophil adenoma). Somatotropic hormone, human growth hormone, prolactin, ACTH and 17-ketosteroid levels indicated active/inactive adenomas. In 42 cases the adenoma was only intrasellar, which was confirmed by contrast X-ray investigations, CT scanning, angiography and ophthalmological investigation. Transnasal stereotactic cryohypophysectomy was performed in all 70 cases using a stereotactic apparatus especially designed for operations on the pituitary. All patients (except 2) tolerated the operation well. No complications occurred. Vision deteriorated after operation in 1 patient. Thrombosis of the left middle cerebral artery developed in another patient. All the other patients noted improvement directly after operation - rapid diminution of signs of acromegaly and rapid restoration of normal values in hormonal tests. Six patients with continuing growth of the tumor underwent a second operation 1.5-6 years after the first operation. We conclude from our own clinical experience and information from the literature that transnasal stereotactic cryodestruction is highly effective and relatively safe in the management of pituitary adenoma.

  4. Pleomorphic adenoma of the palate in a child.

    Science.gov (United States)

    Bovino, Brian F; Sohn, Andy; Winston, Daniel

    2013-01-01

    Presented is a pleomorphic adenoma of the palate in a 12-year-old boy. Pleomorphic adenoma is usually found in adults and is rarely found in patients under 20 years of age. We present initial exam, diagnosis, treatment and a review of literature.

  5. Demonstration of specific dopamine receptors on human pituitary adenomas

    International Nuclear Information System (INIS)

    Koga, Masafumi; Nakao, Haruyoshi; Arao, Masayo; Sato, Bunzo; Noma, Keizo; Morimoto, Yasuhiko; Kishimoto, Susumu; Mori, Shintaro; Uozumi, Toru

    1987-01-01

    Dopamine receptors on human pituitary adenoma membranes were characterized using [ 3 H]spiperone as the radioligand. The specific [ 3 H]spiperone binding sites on prolactin (PRL)-secreting adenoma membranes were recognized as a dopamine receptor, based upon the data showing high affinity binding, saturability, specificity, temperature dependence, and reversibility. All of 14 PRL-secreting adenomas had high affinity dopamine receptors, with a dissociation constant (Kd) of 0.85±0.11 nmol/l (mean±SEM) and a maximal binding capacity (Bmax) of 428±48.6 fmol/mg protein. Among 14 growth hormone (GH)-secreting adenomas examined, 8 (57%) had dopamine receptors with a Kd of 1.90±0.47 nmol/l and a Bmax of 131±36.9 fmol/mg protein. Furthermore, 15 of 24 (58%) nonsecreting pituitary adenomas also had dopamine receptors with a Kd of 1.86±0.37 nmol/l and a Bmax of 162±26.0 fmol/mg protein. These results indicate that some GH-secreting adenomas as well as some nonsecreting pituitary adenomas contain dopamine receptors. But their affinity and number of binding sites are significantly lower (P<0.05) and fewer (P<0.001) respectively, than those in PRL-secreting adenomas. (author)

  6. Demonstration of specific dopamine receptors on human pituitary adenomas

    Energy Technology Data Exchange (ETDEWEB)

    Koga, Masafumi; Nakao, Haruyoshi; Arao, Masayo; Sato, Bunzo; Noma, Keizo; Morimoto, Yasuhiko; Kishimoto, Susumu; Mori, Shintaro; Uozumi, Toru

    1987-01-01

    Dopamine receptors on human pituitary adenoma membranes were characterized using (/sup 3/H)spiperone as the radioligand. The specific (/sup 3/H)spiperone binding sites on prolactin (PRL)-secreting adenoma membranes were recognized as a dopamine receptor, based upon the data showing high affinity binding, saturability, specificity, temperature dependence, and reversibility. All of 14 PRL-secreting adenomas had high affinity dopamine receptors, with a dissociation constant (Kd) of 0.85 +- 0.11 nmol/l (mean+-SEM) and a maximal binding capacity (Bmax) of 428 +- 48.6 fmol/mg protein. Among 14 growth hormone (GH)-secreting adenomas examined, 8 (57%) had dopamine receptors with a Kd of 1.90 +- 0.47 nmol/l and a Bmax of 131 +- 36.9 fmol/mg protein. Furthermore, 15 of 24 (58%) nonsecreting pituitary adenomas also had dopamine receptors with a Kd of 1.86 +- 0.37 nmol/l and a Bmax of 162 +- 26.0 fmol/mg protein. These results indicate that some GH-secreting adenomas as well as some nonsecreting pituitary adenomas contain dopamine receptors. But their affinity and number of binding sites are significantly lower (P<0.05) and fewer (P<0.001) respectively, than those in PRL-secreting adenomas.

  7. Design and simulation of Macro-Fiber composite based serrated microflap for wind turbine blade fatigue load reduction

    Science.gov (United States)

    Sun, Xiao; Dai, Qingli; Bilgen, Onur

    2018-05-01

    A Macro-Fiber Composite (MFC) based active serrated microflap is designed in this research for wind turbine blades. Its fatigue load reduction potential is evaluated in normal operating conditions. The force and displacement output of the MFC-based actuator are simulated using a bimorph beam model. The work done by the aerodynamic, centripetal and gravitational forces acting on the microflap were calculated to determine the required capacity of the MFC-based actuator. MFC-based actuators with a lever mechanical linkage are designed to achieve the required force and displacement to activate the microflap. A feedback control scheme is designed to control the microflap during operation. Through an aerodynamic-aeroelastic time marching simulation with the designed control scheme, the time responses of the wind turbine blades are obtained. The fatigue analysis shows that the serrated microflap can reduce the standard deviation of the blade root flapwise bending moment and the fatigue damage equivalent loads.

  8. Ectopic pituitary adenoma presenting as midline nasopharyngeal mass.

    LENUS (Irish Health Repository)

    Ali, R

    2012-02-01

    INTRODUCTION: Ectopic pituitary adenomas are extremely rare. We report a case of ectopic pituitary adenoma in the midline of the nasopharynx. This adenoma probably arose from the pharyngeal remnant of Rathke\\'s pouch. METHODS: We discuss a case of a lady who presented to our unit with 2 months history of dryness and sensation of lump in her throat and a long standing history of hypothyroidism. Examination of nasopharynx revealed a smooth and fluctuant midline mass. CT scan of nose and paranasal sinuses confirmed the midline mass with small defect communicating with the sphenoid sinus. An initial diagnosis of Thornwaldt\\'s cyst was made and she underwent upper aerodigestive tract endoscopy and marsupialization of the mass. Histopathological examination revealed ectopic pituitary adenoma. CONCLUSION: Ectopic pituitary adenoma is an important differential diagnosis for a midline nasopharyngeal mass. It is recommended that prior to surgical resection of midline nasopharyngeal mass biopsy is taken and MRI is performed.

  9. A Serrate-Notch-Canoe complex mediates essential interactions between glia and neuroepithelial cells during Drosophila optic lobe development

    Czech Academy of Sciences Publication Activity Database

    Pérez-Gómez, R.; Slováková, J.; Rives-Quinto, N.; Krejčí, Alena; Carmena, A.

    2013-01-01

    Roč. 126, č. 21 (2013), s. 4873-4884 ISSN 0021-9533 Grant - others:Spanish Government(ES) BFU2009-08833; Spanish Government(ES) BFU2012-33020; Spanish Government(ES) CSD2007-00023 Institutional support: RVO:60077344 Keywords : glia * Serrate- Notch signaling * optic lobe Subject RIV: EB - Genetics ; Molecular Biology Impact factor: 5.325, year: 2013

  10. Clinical and genetic aspects of familial isolated pituitary adenomas

    Directory of Open Access Journals (Sweden)

    Vladimir Vasilev

    2012-01-01

    Full Text Available Pituitary adenomas represent a group of functionally diverse neoplasms with relatively high prevalence in the general population. Most occur sporadically, but inherited genetic predisposing factors are increasingly recognized. Familial isolated pituitary adenoma is a recently defined clinical entity, and is characterized by hereditary presentation of pituitary adenomas in the absence of clinical and genetic features of syndromic disease such as multiple endocrine neoplasia type 1 and Carney complex. Familial isolated pituitary adenoma is inherited in an autosomal dominant manner and accounted for approximately 2-3% of pituitary tumors in some series. Germline mutations in the aryl-hydrocarbon interacting protein gene are identified in around 25% of familial isolated pituitary adenoma kindreds. Pituitary adenomas with mutations of the aryl-hydrocarbon interacting protein gene are predominantly somatotropinomas and prolactinomas, but non-functioning adenomas, Cushing disease, and thyrotropinoma may also occur. These tumors may present as macroadenomas in young patients and are often relatively difficult to control. Furthermore, recent evidence indicates that aryl-hydrocarbon interacting protein gene mutations occur in >10% of patients with sporadic macroadenomas that occur before 30 years of age, and in >20% of children with macroadenomas. Genetic screening for aryl-hydrocarbon interacting protein gene mutations is warranted in selected high-risk patients who may benefit from early recognition and follow-up.

  11. 3D volumetry comparison using 3T magnetic resonance imaging between normal and adenoma-containing pituitary glands

    OpenAIRE

    Ernesto Roldan-Valadez; Ana Cristina Garcia-Ulloa; Omar Gonzalez-Gutierrez; Manuel Martinez-Lopez

    2011-01-01

    Background: Computed-assisted three-dimensional data (3D) allows for an accurate evaluation of volumes compared with traditional measurements. Aims: An in vitro method comparison between geometric volume and 3D volumetry to obtain reference data for pituitary volumes in normal pituitary glands (PGs) and PGs containing adenomas. Design: Prospective, transverse, analytical study. Materials and Methods: Forty-eight subjects underwent brain magnetic resonance imaging (MRI) with 3D sequencing for ...

  12. Adenomas of the common bile duct in familial adenomatous polyposis

    Science.gov (United States)

    Yan, Mao-Lin; Pan, Jun-Yong; Bai, Yan-Nan; Lai, Zhi-De; Chen, Zhong; Wang, Yao-Dong

    2015-01-01

    Familial adenomatous polyposis (FAP) or Gardner’s syndrome is often accompanied by adenomas of the stomach and duodenum. We experienced a case of adenomas of the common bile duct in a 40-year-old woman with FAP presenting with acute cholangitis. Only 8 cases of adenomas or adenocarcinoma of the common bile duct have been reported in the literature in patients with FAP or Gardner’s syndrome. Those patients presented with acute cholangitis or pancreatitis. Local excision or Whipple procedure may be the reasonable surgical option. PMID:25780319

  13. Adenoma-carcinoma Sequence in the Bladder After Augmentation Cystoplasty

    Directory of Open Access Journals (Sweden)

    Akihiro Naito

    2014-05-01

    Full Text Available We present a case of a 64-year-old woman showing multistep progression from adenoma to adenocarcinoma in the bladder 46 years after augmentation ileocystoplasty. She underwent augmentation ileocystoplasty for tuberculous contracted bladder at 18 years. After 44 years, tubulovillous adenomas were found and resected at the ileovesical anastomosis site. After 2 more years, bladder tumors recurred and revealed adenocarcinomas. Finally, radical cystectomy was required because of frequent recurrence and tumor extensiveness. To our knowledge, this is the first case demonstrating adenoma-carcinoma sequence histopathologically in the bladder after augmentation cystoplasty, indicating multistep carcinogenesis similar to intestinal carcinogenesis.

  14. Preoperative localization of parathyroid adenomas is cost-effective

    International Nuclear Information System (INIS)

    Wilson, M.A.; Mack, E.; Rowe, B.; Perlman, S.B.

    1986-01-01

    The preoperative localization of parathyroid adenomas is cost-effective because it reduces anesthesia and surgery times. The technique is sensitive in single and double adenomas (90%), and some surgeons have modified their operative technique because of its introduction. The practical experience of one surgeon is presented, with similar patient subsets (n = 22) compared before and after use of a localization scan was instituted. The average operative time fell by 94%, from 2 hours 35 minutes to 1 hour 19 minutes. The reduction in operative time was possible because the surgeon did not seek to identify the remaining normal parathyroids when the scanned lesion was excised and proved to be the adenoma

  15. Laparoscopic Partial Adrenalectomy for Bilateral Cortisol-secreting Adenomas

    Directory of Open Access Journals (Sweden)

    Jeffrey P. Domino

    2007-04-01

    Full Text Available Bilateral cortisol-secreting adenomas are a rare cause of Cushing's syndrome. We report a case of a 35-year-old woman who presented with ACTH-independent Cushing's syndrome and bilateral adrenal adenomas. Adrenal venous sampling confirmed both adenomas to be hyper-secreting cortisol. She underwent bilateral laparoscopic adrenalectomy; total right and partial left adrenalectomies. At 2-year follow-up, she is maintained on low-dose fludrocortisone and hydrocortisone, and without recurrence of hypercorticolism. Laparoscopic partial adrenalectomy is a feasible option for this rare condition; however, long-term follow-up is needed to determine her total independence from steroid usage.

  16. Detection rate and predictive factors of sessile serrated polyps in an organised colorectal cancer screening programme with immunochemical faecal occult blood test: the EQuIPE study (Evaluating Quality Indicators of the Performance of Endoscopy).

    Science.gov (United States)

    Zorzi, Manuel; Senore, Carlo; Da Re, Filippo; Barca, Alessandra; Bonelli, Luigina Ada; Cannizzaro, Renato; de Pretis, Giovanni; Di Furia, Lucia; Di Giulio, Emilio; Mantellini, Paola; Naldoni, Carlo; Sassatelli, Romano; Rex, Douglas K; Zappa, Marco; Hassan, Cesare

    2017-07-01

    To assess detection rate and predictive factors of sessile serrated polyps (SSPs) in organised colorectal cancer (CRC) screening programmes based on the faecal immunochemical test (FIT). Data from a case series of colonoscopies of FIT-positive subjects were provided by 44 Italian CRC screening programmes. Data on screening history, endoscopic procedure and histology results, and additional information on the endoscopy centre and the endoscopists were collected, including the age-standardised and sex-standardised adenoma detection rate (ADR) of the individual endoscopists. The SSP detection rate (SSP-DR) was assessed for the study population. To identify SSP-predictive factors, multilevel analyses were performed according to patient/centre/endoscopist characteristics. We analysed 72 021 colonoscopies, of which 1295 presented with at least one SSP (SSP-DR 1.8%; 95% CI 1.7% to 1.9%). At the per-patient level, SSP-DR was associated with males (OR 1.35; 95% CI 1.17 to 1.54) and caecal intubation (OR 3.75; 95% CI 2.22 to 6.34), but not with the FIT round. The presence of at least one advanced adenoma was more frequent among subjects with SSPs than those without (OR 2.08; 95% CI 1.86 to 2.33). At the per-endoscopist level, SSP-DR was associated with ADR (third vs first ADR quartile: OR 1.55; 95% CI 1.03 to 2.35; fourth vs first quartile: OR 1.89; 95% CI 1.24 to 2.90). The low prevalence of SSPs and the lack of association with the FIT round argue against SSP as a suitable target for FIT-based organised programmes. Strict association of SSP-DR with the key colonoscopy quality indicators, namely caecal intubation rate and high ADR further marginalises the need for SSP-specific quality indicators in FIT-based programmes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  17. Radiolabelled spiroperidol: Possible pituitary adenoma imaging agent

    International Nuclear Information System (INIS)

    Otto, C.A.; Marshall, J.C.; Lloyd, R.V.; Sherman, P.S.; Wieland, D.M.

    1984-01-01

    Prolactin-secreting pituitary adenomas are the most common type of pituitary tumors. Detection currently depends on physical symptoms, elevated serum prolactin levels and CT scans. An imaging agent which specifically localized in prolactinomas based on some functional characteristic of the tumor would be of considerable clinical value not only for early detection but also for monitoring of therapy. Tritiated spiroperidol ( 3 H-Sp) was selected for evaluation based on 1) the presence of D-2 receptors in normal anterior pituitary and adenoma tissue and 2) the high affinity of spiroperidol for D-2 receptors. Recent data have established that implantation of diethylstilbestrol (DES) in Fischer F344 rats induced prolactin-secreting tumors in the pituitary. 3 HSp was evaluated in pituitary tissue of both control and DES-treated rats. 3 HSp concentration in normal female anterior pituitary tissue was found to be about 0.27% kg dose/g from 5 min to 4hrs. This value was about 10 times levels in cortex, cerebellum and striatum. In DES-treated rats the % kg dose/g values remained approximately the same. A 5-fold increase in serum prolactin was associated with a 6-fold increase in both pituitary weight and % dose/organ. The data suggests that although total pituitary weight has increased due to tumor growth (reflected in increased values for % dose/organ), the relative number of receptors per g of tissue has remained constant. This result is in agreement with observations of others on D-2 receptor concentration in prolactinomas

  18. Advanced colorectal adenoma related gene expression signature may predict prognostic for colorectal cancer patients with adenoma-carcinoma sequence.

    Science.gov (United States)

    Li, Bing; Shi, Xiao-Yu; Liao, Dai-Xiang; Cao, Bang-Rong; Luo, Cheng-Hua; Cheng, Shu-Jun

    2015-01-01

    There are still no absolute parameters predicting progression of adenoma into cancer. The present study aimed to characterize functional differences on the multistep carcinogenetic process from the adenoma-carcinoma sequence. All samples were collected and mRNA expression profiling was performed by using Agilent Microarray high-throughput gene-chip technology. Then, the characteristics of mRNA expression profiles of adenoma-carcinoma sequence were described with bioinformatics software, and we analyzed the relationship between gene expression profiles of adenoma-adenocarcinoma sequence and clinical prognosis of colorectal cancer. The mRNA expressions of adenoma-carcinoma sequence were significantly different between high-grade intraepithelial neoplasia group and adenocarcinoma group. The biological process of gene ontology function enrichment analysis on differentially expressed genes between high-grade intraepithelial neoplasia group and adenocarcinoma group showed that genes enriched in the extracellular structure organization, skeletal system development, biological adhesion and itself regulated growth regulation, with the P value after FDR correction of less than 0.05. In addition, IPR-related protein mainly focused on the insulin-like growth factor binding proteins. The variable trends of gene expression profiles for adenoma-carcinoma sequence were mainly concentrated in high-grade intraepithelial neoplasia and adenocarcinoma. The differentially expressed genes are significantly correlated between high-grade intraepithelial neoplasia group and adenocarcinoma group. Bioinformatics analysis is an effective way to study the gene expression profiles in the adenoma-carcinoma sequence, and may provide an effective tool to involve colorectal cancer research strategy into colorectal adenoma or advanced adenoma.

  19. Coffee intake and the risk of colorectal adenoma: The colorectal adenoma study in Tokyo.

    Science.gov (United States)

    Budhathoki, Sanjeev; Iwasaki, Motoki; Yamaji, Taiki; Sasazuki, Shizuka; Tsugane, Shoichiro

    2015-07-15

    Coffee is a commonly consumed beverage which contains several potential anticarcinogenic and chemopreventive compounds, and has been hypothesized to have protective effects in colorectal neoplasia. However, the limited available data on coffee consumption in relation to colorectal adenoma (CRA), a precursor lesion to most colorectal cancers, remain largely inconsistent. In this study, we evaluated the association of coffee intake with the risk of CRA in a middle-aged Japanese population. Study subjects were selected from examinees who underwent total colonoscopy as part of a cancer screening program and responded to self-administered dietary and lifestyle questionnaires. A total of 738 patients with adenoma and 697 controls were included in the study. Coffee intake was assessed with a food frequency questionnaire, and divided into quartiles based on the distribution among controls. Unconditional logistic regression models were used to estimate odds ratio (OR) and 95% confidence interval (CI) of CRA, with adjustment for potential confounding factors. High coffee consumption was associated with a reduced risk of CRA, with a multivariate-adjusted OR for the highest versus lowest quartile of coffee intake of 0.67 (95% CI = 0.48-0.93; ptrend  = 0.02). The inverse association of coffee intake was limited to proximal (OR = 0.64; 95%CI = 0.44-0.95; ptrend  = 0.04) and distal colon adenoma (OR = 0.62; 95%CI = 0.39-0.99; ptrend  = 0.06), and appeared to be more evident with small (OR = 0.68; 95%CI = 0.49-0.96; ptrend  = 0.04) and single adenomas (OR = 0.65; 95%CI = 0.44-0.95; ptrend  = 0.02). Green tea intake was not found to be associated with CRA risk. This study provides support for the protective effect of coffee drinking on colon adenomas, a precursor of colon cancer. © 2014 UICC.

  20. Annotating and quantifying pri-miRNA transcripts using RNA-Seq data of wild type and serrate-1 globular stage embryos of Arabidopsis thaliana

    Directory of Open Access Journals (Sweden)

    Daniel Lepe-Soltero

    2017-12-01

    Full Text Available The genome annotation for the model plant Arabidopsis thaliana does not include the primary transcripts from which MIRNAs are processed. Here we present and analyze the raw mRNA sequencing data from wild type and serrate-1 globular stage embryos of A. thaliana, ecotype Columbia. Because SERRATE is required for pri-miRNA processing, these precursors accumulate in serrate-1 mutants, facilitating their detection using standard RNA-Seq protocols. We first use the mapping of the RNA-Seq reads to the reference genome to annotate the potential primary transcripts of MIRNAs expressed in the embryo. We then quantify these pri-miRNAs in wild type and serrate-1 mutants. Finally, we use differential expression analysis to determine which are up-regulated in serrate-1 compared to wild type, to select the best candidates for bona fide pri-miRNAs expressed in the globular stage embryos. In addition, we analyze a previously published RNA-Seq dataset of wild type and dicer-like 1 mutant embryos at the globular stage [1]. Our data are interpreted and discussed in a separate article [2].

  1. Annotating and quantifying pri-miRNA transcripts using RNA-Seq data of wild type and serrate-1 globular stage embryos of Arabidopsis thaliana.

    Science.gov (United States)

    Lepe-Soltero, Daniel; Armenta-Medina, Alma; Xiang, Daoquan; Datla, Raju; Gillmor, C Stewart; Abreu-Goodger, Cei

    2017-12-01

    The genome annotation for the model plant Arabidopsis thaliana does not include the primary transcripts from which MIRNAs are processed. Here we present and analyze the raw mRNA sequencing data from wild type and serrate-1 globular stage embryos of A. thaliana , ecotype Columbia. Because SERRATE is required for pri-miRNA processing, these precursors accumulate in serrate-1 mutants, facilitating their detection using standard RNA-Seq protocols. We first use the mapping of the RNA-Seq reads to the reference genome to annotate the potential primary transcripts of MIRNAs expressed in the embryo. We then quantify these pri-miRNAs in wild type and serrate-1 mutants. Finally, we use differential expression analysis to determine which are up-regulated in serrate-1 compared to wild type, to select the best candidates for bona fide pri-miRNAs expressed in the globular stage embryos. In addition, we analyze a previously published RNA-Seq dataset of wild type and dicer-like 1 mutant embryos at the globular stage [1]. Our data are interpreted and discussed in a separate article [2].

  2. Gut microbiome development along the colorectal adenoma-carcinoma sequence.

    Science.gov (United States)

    Feng, Qiang; Liang, Suisha; Jia, Huijue; Stadlmayr, Andreas; Tang, Longqing; Lan, Zhou; Zhang, Dongya; Xia, Huihua; Xu, Xiaoying; Jie, Zhuye; Su, Lili; Li, Xiaoping; Li, Xin; Li, Junhua; Xiao, Liang; Huber-Schönauer, Ursula; Niederseer, David; Xu, Xun; Al-Aama, Jumana Yousuf; Yang, Huanming; Wang, Jian; Kristiansen, Karsten; Arumugam, Manimozhiyan; Tilg, Herbert; Datz, Christian; Wang, Jun

    2015-03-11

    Colorectal cancer, a commonly diagnosed cancer in the elderly, often develops slowly from benign polyps called adenoma. The gut microbiota is believed to be directly involved in colorectal carcinogenesis. The identity and functional capacity of the adenoma- or carcinoma-related gut microbe(s), however, have not been surveyed in a comprehensive manner. Here we perform a metagenome-wide association study (MGWAS) on stools from advanced adenoma and carcinoma patients and from healthy subjects, revealing microbial genes, strains and functions enriched in each group. An analysis of potential risk factors indicates that high intake of red meat relative to fruits and vegetables appears to associate with outgrowth of bacteria that might contribute to a more hostile gut environment. These findings suggest that faecal microbiome-based strategies may be useful for early diagnosis and treatment of colorectal adenoma or carcinoma.

  3. Immunophenotype of nipple adenoma in a male patient.

    Science.gov (United States)

    Fernandez-Flores, Angel; Suarez-Peñaranda, Jose-Manuel

    2011-03-01

    Adenoma of the nipple is rare in men. It must be distinguished from a breast carcinoma and from Paget disease. In this sense, immunohistochemistry can be of some help. In women, for instance, immunoexpression of c-erbB-2 favors a diagnosis of Paget disease, according to some studies. Nevertheless, we have not found any studies on HER2/neu status, estrogen receptors, or progesterone receptors in nipple adenoma of male patients. We present a case of an adenoma of the nipple in a 21-year-old man in which we carried out a wide immunohistochemical study. The lesion did not express estrogen receptors, progesterone receptors, or androgen receptors. The HercepTest was negative. Smooth muscle Actin and p63 were remarked in the basal layer of the tumoral tubules, supporting the benignancy of the lesion. This case of adenoma of the nipple in a male shows an immunophenotype that is similar to the ones reported in female patients.

  4. Thyrotropin-producing adenoma. Report of two clinical cases

    Directory of Open Access Journals (Sweden)

    Ani R. Karapetyan

    2017-03-01

    Full Text Available Diagnosis of hyperthyroidism does not present serious difficulties currently. Distribution of imaging techniques increasing the detection of pituitary adenomas every year. Thyrotropin-producing adenoma is a rare cause of hyperthyroidism. Early detection will alert its errors in treatment strategy, unjustified surgery on the thyroid gland, and will improve the quality of patients life. The article presents two clinical cases of thyroid-stimulating hormone (TSH-secreting pituitary adenomas in patients with different disease duration, and thus the presence of hyperthyroidism complications. Both patients were operated in the Federal Center of Neurosurgery Novosibirsk by transnasal transsphenoidal approach. The resistant euthyroidism was reached postoperatively, but in patients with long-term history of the disease, large size of adenoma in the postoperative period developed secondary adrenal insufficiency and her quality of life is significantly lower, taking into account comorbidities. The period of follow-up consists 3 years and one year respectively.

  5. Metanephric adenoma: Management in a 7-year-old child

    Directory of Open Access Journals (Sweden)

    Katharine Caldwell

    2015-12-01

    Full Text Available We report the case of a 7-year-old girl in whom a left renal mass was incidentally discovered on computerized tomography (CT scan during evaluation for acute perforated appendicitis. The presence of polycythemia and the radiographic characteristics of the mass suggested a metanephric adenoma but a Wilm's tumor could not be excluded with preoperative studies. Gross inspection and intra-operative ultrasound of the tumor supported the suspicion of a metanephric adenoma and a partial nephrectomy was performed. Frozen section and permanent pathologic analysis confirmed a benign metanephric adenoma. At current date, patient is recovering well and polycythemia has resolved. A review of the management of metanephric adenoma in the child is presented.

  6. Molecular screening of pituitary adenomas for gene mutations and rearrangements

    Energy Technology Data Exchange (ETDEWEB)

    Herman, V.; Drazin, N.Z.; Gonskey, R.; Melmed, S. (Cedars-Sinai Medical Center, Los Angeles, CA (United States))

    1993-07-01

    Although pituitary tumors arise as benign monoclonal neoplasms, genetic alterations have not readily been identified in these adenomas. The authors studied restriction fragment abnormalities involving the GH gene locus, and mutations in the p53 and H-, K-, and N-ras genes in 22 human GH cell adenomas. Twenty two nonsecretory adenomas were also examined for p53 and ras gene mutations. Seven prolactinoma DNA samples were tested for deletions in the multiple endocrine neoplasia-1 (MEN-1) locus, as well as for rearrangements in the hst gene, a member of the fibroblast growth factor family. In DNA from GH-cell adenomas, identical GH restriction patterns were detected in both pituitary and lymphocyte DNA in all patients and in one patient with a mixed GH-TSH cell adenoma. Using polymerase chain reaction (PCR)-single stranded conformation polymorphism analysis, no mutations were detected in exons 5, 6, 7 and 8 of the p53 gene in GH cell adenomas nor in 22 nonsecretory adenomas. Codons 12/13 and 61 of H-ras, K-ras, and N-ras genes were also intact on GH cell adenomas and in nonsecretory adenomas. Site-specific probes for chromosome 11q13 including, PYGM, D11S146, and INT2 were used in 7 sporadic PRL-secreting adenomas to detect deletions of the MEN-1 locus on chromosome 11. One patient was identified with a loss of 11p, and the remaining 6 patients did not demonstrate loss of heterozygosity in the pituitary 11q13 locus, compared to lymphocyte DNA. None of these patients demonstrated hst gene rearrangements which also maps to this locus. These results show that p53 and ras gene mutations are not common events in the pathogenesis of acromegaly and nonsecretory tumors. Although hst gene rearrangements and deletions of 11q13 are not associated with sporadic PRl-cell adenoma formation, a single patient was detected with a partial loss of chromosome 11, including the putative MEN-1 site. 31 refs., 5 figs., 2 tabs.

  7. Gamma knife radiosurgery for endocrine-inactive pituitary adenomas

    International Nuclear Information System (INIS)

    Liscak, R.; Vladyka, V.; Simonova, G.; Marek, J.; Vymazal, J.

    2007-01-01

    The goal of nonsecreting pituitary adenoma radiosurgery is to halt tumor growth and to maintain normal performance of the hypophysis and the functionally important structures around the sella. The effectiveness of gamma knife radiosurgery was evaluated. Over a period of 10 years (1993-2003), 140 patients with nonsecreting pituitary adenoma were treated by Leksell gamma knife at our Centre. Seventy-nine of them were followed up for longer than 3 years. Their age range was 24-73 years, with a median of 54 years. Eighty-five percent of them had previous open surgery. Fifteen patients had adenoma contact with the optic tract. Fourteen patients had a normally functioning hypophysis, 48 patients had complete panhypopituitarism, while the rest retained partial functions of the normal hypophysis. Adenoma volumes ranged between 0.1 and 31.3, the median being 3.45 ccm. The marginal dose ranged between 12 and -35 Gy, with a median of 20 Gy. The follow-up ranged from 36 to 122 months, with a median of 60 months. No adenoma growth was detected; 89 % of treated adenomas decreased in size, with a median volume reduction of 61 %. There was no perimeter vision impairment after radiosurgery, while 4 out of 52 patients with abnormal perimeter vision reported improvement. There was no impairment of oculomotor nerve function. Impairment of hypophysis function was observed in 2 patients. Radiosurgery has a reliable antiproliferative effect on nonsecreting pituitary adenomas. It is a safe treatment with a low risk of morbidity. Short contact between a nonsecreting pituitary adenoma and the optic pathway is not an absolute contraindication for Gamma knife radiosurgery. (author)

  8. Functioning and nonfunctioning thyroid adenomas involve different molecular pathogenetic mechanisms.

    Science.gov (United States)

    Tonacchera, M; Vitti, P; Agretti, P; Ceccarini, G; Perri, A; Cavaliere, R; Mazzi, B; Naccarato, A G; Viacava, P; Miccoli, P; Pinchera, A; Chiovato, L

    1999-11-01

    The molecular biology of follicular cell growth in thyroid nodules is still poorly understood. Because gain-of-function (activating) mutations of the thyroid-stimulating hormone receptor (TShR) and/or Gs alpha genes may confer TSh-independent growth advantage to neoplastic thyroid cells, we searched for somatic mutations of these genes in a series of hyperfunctioning and nonfunctioning follicular thyroid adenomas specifically selected for their homogeneous gross anatomy (single nodule in an otherwise normal thyroid gland). TShR gene mutations were identified by direct sequencing of exons 9 and 10 of the TShR gene in genomic DNA obtained from surgical specimens. Codons 201 and 227 of the Gs alpha gene were also analyzed. At histology, all hyperfunctioning nodules and 13 of 15 nonfunctioning nodules were diagnosed as follicular adenomas. Two nonfunctioning thyroid nodules, although showing a prevalent microfollicular pattern of growth, had histological features indicating malignant transformation (a minimally invasive follicular carcinoma and a focal papillary carcinoma). Activating mutations of the TShR gene were found in 12 of 15 hyperfunctioning follicular thyroid adenomas. In one hyperfunctioning adenoma, which was negative for TShR mutations, a mutation in codon 227 of the Gs alpha gene was identified. At variance with hyperfunctioning thyroid adenomas, no mutation of the TShR or Gs alpha genes was detected in nonfunctioning thyroid nodules. In conclusion, our findings clearly define a different molecular pathogenetic mechanism in hyperfunctioning and nonfunctioning follicular thyroid adenomas. Activation of the cAMP cascade, which leads to proliferation but maintains differentiation of follicular thyroid cells, typically occurs in hyperfunctioning thyroid adenomas. Oncogenes other than the TShR and Gs alpha genes are probably involved in nonfunctioning follicular adenomas.

  9. Minimally invasive treatment of hepatic adenoma in special cases

    Energy Technology Data Exchange (ETDEWEB)

    Nasser, Felipe; Affonso, Breno Boueri; Galastri, Francisco Leonardo [Hospital Israelita Albert Einstein, São Paulo, SP (Brazil); Odisio, Bruno Calazans [MD Anderson Cancer Center, Houston (United States); Garcia, Rodrigo Gobbo [Hospital Israelita Albert Einstein, São Paulo, SP (Brazil)

    2013-07-01

    Hepatocellular adenoma is a rare benign tumor that was increasingly diagnosed in the 1980s and 1990s. This increase has been attributed to the widespread use of oral hormonal contraceptives and the broader availability and advances of radiological tests. We report two cases of patients with large hepatic adenomas who were subjected to minimally invasive treatment using arterial embolization. One case underwent elective embolization due to the presence of multiple adenomas and recent bleeding in one of the nodules. The second case was a victim of blunt abdominal trauma with rupture of a hepatic adenoma and clinical signs of hemodynamic shock secondary to intra-abdominal hemorrhage, which required urgent treatment. The development of minimally invasive locoregional treatments, such as arterial embolization, introduced novel approaches for the treatment of individuals with hepatic adenoma. The mortality rate of emergency resection of ruptured hepatic adenomas varies from 5 to 10%, but this rate decreases to 1% when resection is elective. Arterial embolization of hepatic adenomas in the presence of bleeding is a subject of debate. This observation suggests a role for transarterial embolization in the treatment of ruptured and non-ruptured adenomas, which might reduce the indication for surgery in selected cases and decrease morbidity and mortality. Magnetic resonance imaging showed a reduction of the embolized lesions and significant avascular component 30 days after treatment in the two cases in this report. No novel lesions were observed, and a reduction in the embolized lesions was demonstrated upon radiological assessment at a 12-month follow-up examination.

  10. Minimally invasive treatment of hepatic adenoma in special cases

    International Nuclear Information System (INIS)

    Nasser, Felipe; Affonso, Breno Boueri; Galastri, Francisco Leonardo; Odisio, Bruno Calazans; Garcia, Rodrigo Gobbo

    2013-01-01

    Hepatocellular adenoma is a rare benign tumor that was increasingly diagnosed in the 1980s and 1990s. This increase has been attributed to the widespread use of oral hormonal contraceptives and the broader availability and advances of radiological tests. We report two cases of patients with large hepatic adenomas who were subjected to minimally invasive treatment using arterial embolization. One case underwent elective embolization due to the presence of multiple adenomas and recent bleeding in one of the nodules. The second case was a victim of blunt abdominal trauma with rupture of a hepatic adenoma and clinical signs of hemodynamic shock secondary to intra-abdominal hemorrhage, which required urgent treatment. The development of minimally invasive locoregional treatments, such as arterial embolization, introduced novel approaches for the treatment of individuals with hepatic adenoma. The mortality rate of emergency resection of ruptured hepatic adenomas varies from 5 to 10%, but this rate decreases to 1% when resection is elective. Arterial embolization of hepatic adenomas in the presence of bleeding is a subject of debate. This observation suggests a role for transarterial embolization in the treatment of ruptured and non-ruptured adenomas, which might reduce the indication for surgery in selected cases and decrease morbidity and mortality. Magnetic resonance imaging showed a reduction of the embolized lesions and significant avascular component 30 days after treatment in the two cases in this report. No novel lesions were observed, and a reduction in the embolized lesions was demonstrated upon radiological assessment at a 12-month follow-up examination

  11. Costs of Finding an Advanced Adenoma in Colorectal Screening

    Directory of Open Access Journals (Sweden)

    Jerome B Simon

    2004-01-01

    Full Text Available The authors used computerized decision analysis to estimate the costs of finding and removing an advanced colonic adenoma in patients referred because of a positive fecal occult blood test. An advanced adenoma was defined as a villous adenoma, a tubular adenoma 10 mm or more in size, or a lesion that harboured highgrade dysplasia or cancer. Four strategies were compared: flexible sigmoidoscopy, flexible sigmoidoscopy plus air contrast barium enema, virtual colonoscopy (CT colography and colonoscopy. Colonoscopy with polypectomy was undertaken if any of the methods detected a polyp. Probabilities and test characteristics were determined from the literature, and costs were estimated from the provincial fee schedule (Ontario and local hospital sources. With an assumed 17% probability of an advanced adenoma being present, sigmoidoscopy was the most cost effective strategy at $1930 to find and clear an advanced lesion, but the procredure missed between one-third and almost one-half of the lesions, depending on the depth of insertion. At $2290, colonoscopy was slightly more expensive than sigmoidoscopy and more cost effective than either sigmoidoscopy plus barium enema ($2840 or virtual colonoscopy ($3681, neither of which detected as many advanced adenomas. The authors concluded that colonoscopy is the preferred investigative strategy and that improved access to colonoscopy is an important goal for occult blood screening programs.

  12. Nipple adenoma arising from axillary accessory breast: a case report

    Directory of Open Access Journals (Sweden)

    Shioi Yoshihiro

    2012-11-01

    Full Text Available Abstract Nipple adenoma is a relatively rare benign breast neoplasm, and cases of the disease arising from the axillary accessory breast have very seldom been reported in the English literature. We report a case of nipple adenoma arising from axillary accessory breast including clinical and pathological findings. An 82-year-old woman presented with the complaint of a small painful mass in the right axilla. Physical examination confirmed a well-defined eczematous crusted mass that was 8 mm in size. The diagnosis of nipple adenoma was made from an excisional specimen on the basis of characteristic histological findings. Microscopic structural features included a compact proliferation of small tubules lined by epithelial and myoepithelial cells, and the merging of glandular epithelial cells of the adenoma into squamous epithelial cells in the superficial epidermal layer. Because clinically nipple adenoma may resemble Paget’s disease and pathologically can be misinterpreted as tubular carcinoma, the correct identification of nipple adenoma is an important factor in the differential diagnosis for axillary tumor neoplasms. Virtual slides The virtual slide(s for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1186821489769063

  13. Leaf Serration in Seedlings of Hetero blastic Woody Species Enhance Plasticity and Performance in Gaps But Not in the Under story

    International Nuclear Information System (INIS)

    Gamage, H.K.; Gamage, H.K.

    2010-01-01

    Leaf heteroblasty refers to dramatic ontogenetic changes in leaf size and shape, in contrast to homoblasty that exhibits little change, between seedling and adult stages. This study examined whether the plasticity in leaf morphology of heteroblastic species would be an advantage for their survival and growth over homoblastic congeners to changes in light. Two congeneric pairs of homoblastic (Hoheria lyallii, Aristotelia serrata) and heteroblastic species (H. sexstylosa, A. fruticosa) were grown for 18 months in canopy gap and forest understory sites in a temperate rainforest in New Zealand. Heteroblastic species that initially had serrated leaves reduced leaf serration in the understory, but increased in the gaps. Heteroblastic species also produced thicker leaves and had higher stomatal pore area (density x aperture length), maximum photosynthetic rate, survival, and greater biomass allocation to shoots than homoblastic relatives in the gaps. Findings indicate that increased leaf serration in heteroblastic species is an advantage over homoblastic congeners in high light.

  14. Coexistence of atypical adenoma, adenoma with bizarre nuclei and follicular variant of papillary carcinoma of the thyroid

    Directory of Open Access Journals (Sweden)

    Teresa Pusiol

    2013-01-01

    Full Text Available Coexistence of atypical adenoma, adenoma with bizarre nuclei and follicular variant of papillary carcinoma is described in the same thyroid, with study of p53 expression. A 72-year-old woman presented to the endocrinology out-patient unit for a routine follow-up visit. Patient underwent a total thyroidectomy. Histological examination revealed a solid nodular neoplasm with the longest diameter of 0.8 cm in the upper pole of the left lobe. The neoplasm showed the histological features of follicular variant of papillary carcinoma with moderate diffuse immunoreactivity for p53. The lower pole of the right lobe showed two adjacent nodules with histological features respectively of atypical adenoma and adenoma with bizarre nuclei, with strong diffuse immunoreactivity for p53.

  15. Rotating night shift work, sleep, and colorectal adenoma in women.

    Science.gov (United States)

    Devore, Elizabeth E; Massa, Jennifer; Papantoniou, Kyriaki; Schernhammer, Eva S; Wu, Kana; Zhang, Xuehong; Willett, Walter C; Fuchs, Charles S; Chan, Andrew T; Ogino, Shuji; Giovannucci, Edward; Wei, Esther K

    2017-07-01

    This study aims to investigate the associations of rotating night shift work history and sleep duration with risk of colorectal adenoma. We evaluated 56,275 cancer-free participants of the Nurses' Health Study II, who had their first colonoscopy or sigmoidoscopy between 1991 and 2011; rotating night shift work and sleep duration were reported by mailed questionnaire. Multivariable-adjusted logistic regression was used to estimate relative risks (RR) of colorectal adenoma, with 95% confidence intervals (CI), across categories of rotating night shift work history (none, 1-4, 5-9, and ≥10 years) and sleep duration (≤5, 6, 7, 8, and ≥9 h/day). We found no association between duration of rotating night shift work and occurrence of colorectal adenoma (p-trend across shift work categories = 0.5). Women with the longest durations of rotating night shift work (≥10 years) had a similar risk of adenoma compared to women without a history of rotating night shift work (multivariable-adjusted RR = 0.96, 95% CI = 0.83-1.11). Similarly, there were no associations of shorter or longer sleep durations with adenoma risk (p-trend = 0.2 across sleep durations of ≤5 through 7 h/day and p-trend = 0.5 across sleep durations of 7 through ≥9 h/day). Results were similar when we examined associations according to adenoma location and subtype. Our results do not support an association between rotating night shift work or sleep duration and risk of colorectal adenoma in women.

  16. Comparison of the Blood and Lymphatic Microvessel Density of Pleomorphic Adenoma and Basal Cell Adenoma

    Directory of Open Access Journals (Sweden)

    Andresa Borges Soares

    2015-01-01

    Full Text Available Background Pleomorphic adenoma (PA is the most common tumor of the salivary gland, while basal cell adenoma (BCA is an uncommon neoplasm. Blood and lymphatic vessels are crucial for tumor metabolism. The aim of this study was to compare the blood and lymphatic vascular density and vascular and endothelial growth factor (VEGF expression in PA and BCA tumors. In addition, cell proliferation was evaluated in these tumors. Methods Blood and lymphatic vessel content, VEGF expression, and cell proliferation were analyzed in 30 cases of PA and 13 cases of BCA by immu-nohistochemistry using antibodies for CD34, CD105, D2-40, VEGF, and Mcm -2. Results Regarding CD34 and CD105 expression, PA demonstrated a high vascularity and a low number of positive vessels, respectively. D2-40-positive lymphatic vessels were mainly located in the tumor capsules, with small intratumoral lymphatic vessels observed occasionally. VEGF expression revealed a remarkably heterogeneous immunoreactivity, alternating from weak or negative to positive or intense. BCA presented significantly higher CD34, CD34, CD105, D2-40, and VEGF expression compared to PA. No significant difference was found in cell proliferation between the tumors. Conclusion Although PA and BCA are considered part of the same spectrum of differentiation, this study showed that the blood and lymphatic vascularization of these tumors is different.

  17. Pediatric adrenocortical neoplasms: can imaging reliably discriminate adenomas from carcinomas?

    International Nuclear Information System (INIS)

    Flynt, Kelsey A.; Dillman, Jonathan R.; Smith, Ethan A.; Strouse, Peter J.; Davenport, Matthew S.; Caoili, Elaine M.; Else, Tobias

    2015-01-01

    There is a paucity of literature describing and comparing the imaging features of adrenocortical adenomas and carcinomas in children and adolescents. To document the CT and MRI features of adrenocortical neoplasms in a pediatric population and to determine whether imaging findings (other than metastatic disease) can distinguish adenomas from carcinomas. We searched institutional medical records to identify pediatric patients with adrenocortical neoplasms. Pre-treatment CT and MRI examinations were reviewed by two radiologists in consensus, and pertinent imaging findings were documented. We also recorded relevant histopathological, demographic, clinical follow-up and survival data. We used the Student's t-test and Wilcoxon rank sum test to compare parametric and nonparametric continuous data, and the Fisher exact test to compare proportions. We used receiver operating characteristic (ROC) curve analyses to evaluate the diagnostic performances of tumor diameter and volume for discriminating carcinoma from adenoma. A P-value ≤0.05 was considered statistically significant. Among the adrenocortical lesions, 9 were adenomas, 15 were carcinomas, and 1 was of uncertain malignant potential. There were no differences in mean age, gender or sidedness between adenomas and carcinomas. Carcinomas were significantly larger than adenomas based on mean estimated volume (581 ml, range 16-2,101 vs. 54 ml, range 3-197 ml; P-value = 0.003; ROC area under the curve = 0.92) and mean maximum transverse plane diameter (9.9 cm, range 3.0-14.9 vs. 4.4 cm, range 1.9-8.2 cm; P-value = 0.0001; ROC area under the curve = 0.92). Carcinomas also were more heterogeneous than adenomas on post-contrast imaging (13/14 vs. 2/9; odds ratio [OR] = 45.5; P-value = 0.001). Six of 13 carcinomas and 1 of 8 adenomas contained calcification at CT (OR = 6.0; P-value = 0.17). Seven of 15 children with carcinomas exhibited metastatic disease at diagnosis, and three had inferior vena cava invasion. Median

  18. Signaling pathway networks mined from human pituitary adenoma proteomics data

    Directory of Open Access Journals (Sweden)

    Zhan Xianquan

    2010-04-01

    Full Text Available Abstract Background We obtained a series of pituitary adenoma proteomic expression data, including protein-mapping data (111 proteins, comparative proteomic data (56 differentially expressed proteins, and nitroproteomic data (17 nitroproteins. There is a pressing need to clarify the significant signaling pathway networks that derive from those proteins in order to clarify and to better understand the molecular basis of pituitary adenoma pathogenesis and to discover biomarkers. Here, we describe the significant signaling pathway networks that were mined from human pituitary adenoma proteomic data with the Ingenuity pathway analysis system. Methods The Ingenuity pathway analysis system was used to analyze signal pathway networks and canonical pathways from protein-mapping data, comparative proteomic data, adenoma nitroproteomic data, and control nitroproteomic data. A Fisher's exact test was used to test the statistical significance with a significance level of 0.05. Statistical significant results were rationalized within the pituitary adenoma biological system with literature-based bioinformatics analyses. Results For the protein-mapping data, the top pathway networks were related to cancer, cell death, and lipid metabolism; the top canonical toxicity pathways included acute-phase response, oxidative-stress response, oxidative stress, and cell-cycle G2/M transition regulation. For the comparative proteomic data, top pathway networks were related to cancer, endocrine system development and function, and lipid metabolism; the top canonical toxicity pathways included mitochondrial dysfunction, oxidative phosphorylation, oxidative-stress response, and ERK/MAPK signaling. The nitroproteomic data from a pituitary adenoma were related to cancer, cell death, lipid metabolism, and reproductive system disease, and the top canonical toxicity pathways mainly related to p38 MAPK signaling and cell-cycle G2/M transition regulation. Nitroproteins from a

  19. Pediatric adrenocortical neoplasms: can imaging reliably discriminate adenomas from carcinomas?

    Energy Technology Data Exchange (ETDEWEB)

    Flynt, Kelsey A.; Dillman, Jonathan R.; Smith, Ethan A.; Strouse, Peter J. [University of Michigan Health System, Section of Pediatric Radiology, C. S. Mott Children' s Hospital, Department of Radiology, Ann Arbor, MI (United States); Davenport, Matthew S.; Caoili, Elaine M. [University of Michigan Health System, Division of Abdominal Imaging, Department of Radiology, Ann Arbor, MI (United States); Else, Tobias [University of Michigan Health System, Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, Ann Arbor, MI (United States)

    2015-08-15

    There is a paucity of literature describing and comparing the imaging features of adrenocortical adenomas and carcinomas in children and adolescents. To document the CT and MRI features of adrenocortical neoplasms in a pediatric population and to determine whether imaging findings (other than metastatic disease) can distinguish adenomas from carcinomas. We searched institutional medical records to identify pediatric patients with adrenocortical neoplasms. Pre-treatment CT and MRI examinations were reviewed by two radiologists in consensus, and pertinent imaging findings were documented. We also recorded relevant histopathological, demographic, clinical follow-up and survival data. We used the Student's t-test and Wilcoxon rank sum test to compare parametric and nonparametric continuous data, and the Fisher exact test to compare proportions. We used receiver operating characteristic (ROC) curve analyses to evaluate the diagnostic performances of tumor diameter and volume for discriminating carcinoma from adenoma. A P-value ≤0.05 was considered statistically significant. Among the adrenocortical lesions, 9 were adenomas, 15 were carcinomas, and 1 was of uncertain malignant potential. There were no differences in mean age, gender or sidedness between adenomas and carcinomas. Carcinomas were significantly larger than adenomas based on mean estimated volume (581 ml, range 16-2,101 vs. 54 ml, range 3-197 ml; P-value = 0.003; ROC area under the curve = 0.92) and mean maximum transverse plane diameter (9.9 cm, range 3.0-14.9 vs. 4.4 cm, range 1.9-8.2 cm; P-value = 0.0001; ROC area under the curve = 0.92). Carcinomas also were more heterogeneous than adenomas on post-contrast imaging (13/14 vs. 2/9; odds ratio [OR] = 45.5; P-value = 0.001). Six of 13 carcinomas and 1 of 8 adenomas contained calcification at CT (OR = 6.0; P-value = 0.17). Seven of 15 children with carcinomas exhibited metastatic disease at diagnosis, and three had inferior vena cava invasion. Median

  20. Adenoma pleomórfico de septo nasal: relato de caso Pleomorphic adenoma of the nasal septum: a case report

    Directory of Open Access Journals (Sweden)

    Mauren P. Rocha

    2004-06-01

    Full Text Available As neoplasias nasais são bastante raras. Os tumores mais observados na cavidade nasal são papilomas epiteliais, angiomas, carcinoma de células transicionais, carcinoma pavimentoso e adenocarcinoma. O adenoma pleomórfico pertence ao grupo de tumores que aparecem com menor freqüência na fossa nasal, e é o tumor benigno glandular mais comum originado na cabeça e pescoço. A apresentação clínica típica dos pacientes com adenoma pleomórfico do septo nasal é de obstrução nasal unilateral, epistaxe e massa indolor na cavidade nasal. Em vista da raridade da apresentação clínica do adenoma pleomórfico nesta localização, os autores descrevem um caso de adenoma pleomórfico nasal em um paciente do sexo masculino, com 69 anos de idade, onde relatam os achados clínicos, critérios diagnósticos, tratamento, prognóstico e revisão da literatura.Nasal tumours are very rare. The neoplasms most frequently seen in the nasal cavity are epithelial papillomas, angiomas, transitional cells carcinoma, pavement carcinoma and adenocarcinoma. The pleomorphic adenoma belongs to the group of tumours less commonly observed in the nasal cavity, and is the most common head and neck benign glandular tumour. The typical clinical presentation of the nasal pleomorphic adenoma is of unilateral nasal obstruction, epistaxis and a painless mass in the nasal cavity. The authors reported an adenoma pleomorphic case that highlights itself by its unusual nasal presentation in the nasal septum of a 45-year-old male patient who was submitted to surgical treatment, and discuss the clinical findings, diagnostic criteria, treatment, prognosis and literature review.

  1. Cushing-type ectopic pituitary adenoma with unusual pathologic features

    Directory of Open Access Journals (Sweden)

    Kristopher T. Kimmell, MD

    2014-06-01

    Full Text Available Ectopic pituitary adenomas comprise, by varying reports, approximately 1-2% of all pituitary adenomas. They are often located in the nasopharyngeal region associated with the pharyngeal pituitary. The location and pathologic features of these masses make them atypical when compared with intrasellar pituitary adenomas. A 54-year-old man presented with vertebral compression fracture and physical stigmata of Cushing’s disease. Biochemical testing confirmed hypercortisolemia responsive to high dose dexamethasone suppression. MRI of the head demonstrated an enhancing mass in the posterior aspect of the sphenoid sinus not involving the sella turcica. Endoscopic biopsy followed by resection confirmed this mass to be a pituitary adenoma with unusual pathologic features. Most notably, the tumor cells demonstrated large, eosinophilic, vacuolated cytoplasm. Immunohistochemical profile of the tumor was typical of an ACTH secreting tumor, notably with positivity for ACTH. The patient did well from his surgery. Post-operatively his serum cortisol level normalized and he remains in chemical remission one year after surgery. Ectopic pituitary adenomas are an unusual manifestation of hormonally active pituitary neoplastic disease. Their atypical clinical presentations, location, and pathologic features can make them a diagnostic challenge. Clinicians should be aware of these entities, especially when considering differential diagnosis for a mass in the sphenoid sinus and nasopharyngeal region.

  2. HIGLE is a bifunctional homing endonuclease that directly interacts with HYL1 and SERRATE in Arabidopsis thaliana

    DEFF Research Database (Denmark)

    Cho, Seok Keun; Ryu, Moon Young; Poulsen, Christian

    2017-01-01

    A highly coordinated complex known as the microprocessor precisely processes primary transcripts of MIRNA genes into mature miRNAs. In plants, the microprocessor minimally consists of three components: Dicer-like protein 1 (DCL1), HYPONASTIC LEAF 1 (HYL1), and SERRATE (SE). To precisely modulate ...

  3. Villous Adenoma of the Ureter with Manifestation of Mucus Hydroureteronephrosis

    Directory of Open Access Journals (Sweden)

    Chi-Min Shih

    2007-01-01

    Full Text Available Ureteral tumor is prone to result in lumen obstruction. Villous adenoma is most frequently found in the colon and rectum, seldom in the urinary tract and even more rarely in the ureter or pelvis. Herein, we present a case of bilateral renal stones of more than 10 years' duration with the chief complaint of right flank pain. Obstruction of the right upper ureter with hydroureteronephrosis was observed on sonography, computed tomography and retrograde pyelography. Ureteroscopy revealed papillary tumor obstructing the upper third of the ureter and inducing hydroureteronephrosis with abundant mucoid content. The ureteral tumor proved to be villous adenoma by pathologic examination. It should be noted that ureteral villous adenoma may be related to previous enteric-type metaplastic mucosa or ureteritis glandularis, demonstrates profuse production of mucus, and may eventually undergo malignant transformation.

  4. Pleomorphic adenoma of minor salivary gland: hard palate

    International Nuclear Information System (INIS)

    Garcia Canas, Wilmer; Benitez Narvaez, N.

    2006-01-01

    The pleomorphic adenoma or mixed tumor occurs in 4 to 14% of the accessory glands salivary. Different localizations exist: AEC, nasal block, lips, maxillary sinus, nasopharynx or in any other localization where salivate tissue exists, but the palate constitutes the most frequent localization, because it gathers more than 50% of minor salivary glands. In the palate, it can be developed a wide variety of tumors coming from the connective and epithelial tissue, 44% arise in the minor salivary glands. In 49 to 65% of them are benign tumors, principally pleomorphic adenomas, located preferably in the hard palate, nearby or in the union with the soft palate as in our case. We present a 42 year old patient with at pleomorphic adenoma of hard palate. (The author)

  5. Thyrotropin secreting pituitary adenoma accompanying a silent somatotropinoma.

    Science.gov (United States)

    Berker, Dilek; Isik, Serhat; Aydin, Yusuf; Tutuncu, Yasemin; Akdemir, Gokhan; Ozcan, Hatice Nursun; Guler, Serdar

    2011-01-01

    Thyroid stimulating hormone (TSH) secreting pituitary adenomas are rare tumors manifested as hyperthyroidism with goiter in the presence of elevated TSH. We present a case with pituitary adenoma secreting both TSH and growth hormone (GH) with the prominent clinical findings of hyperthyroidism but without clinical findings of acromegaly. Pituitary magnetic resonance imaging revealed a macroadenoma. Transsphenoidal surgery was performed twice. The immunohistochemical staining showed that tumor cells were strongly reactive to GH and relatively mildly reactive to TSH. Control pituitary imaging revealed a residual macroadenoma, and long acting octreotide treatment was administered. After two years of the treatment, tumor size remained the same while thyroid function tests and insulin-like growth factor 1 (IGF-I) values returned to normal ranges. In conclusion, we always recommend hormonal examinations for all patients who have pituitary adenoma without signs and symptoms of acromegaly.

  6. Matrix metalloproteinase-13 expression in the progression of colorectal adenoma to carcinoma : Matrix metalloproteinase-13 expression in the colorectal adenoma and carcinoma.

    Science.gov (United States)

    Foda, Abd Al-Rahman Mohammad; El-Hawary, Amira K; Abdel-Aziz, Azza

    2014-06-01

    Most colorectal carcinomas (CRCs) are considered to arise from conventional adenoma based on the concept of the adenoma-carcinoma sequence. Matrix metalloproteinases (MMPs) are known to be overexpressed as normal mucosa progresses to adenomas and carcinomas. There has been little previous investigation about MMP-13 expression in adenoma-carcinoma sequence. In this study, we aimed to investigate the immunohistochemical expression of MMP-13 in colorectal adenoma and CRC specimens using tissue microarray (TMA) technique. A total of 40 cases of CRC associated with adenoma were collected from files of the Pathology laboratory at Mansoura Gastroenterology Center between January 2007 and January 2012. Sections from TMA blocks were prepared and stained for MMP-13. Immunoreactivity to MMP-13 staining was localized to the cytoplasm of mildly, moderately, and severely dysplatic cells of adenomas and CRC tumor cells that were either homogenous or heterogeneous. There was no significant difference in MMP-13 expression between adenomas and CRCs either non-mucinous or mucinous. Adenomas with high MMP-13 expression were significantly associated with moderate to marked degree of inflammatory cellular infiltrate and presence of familial adenomatous polyps. In conclusion, MMP-13 may be a potential biological marker of early tumorigenesis in the adenoma-carcinoma sequence.

  7. Familial Isolated Pituitary Adenomas (FIPA) and the Pituitary Adenoma Predisposition due to Mutations in the Aryl Hydrocarbon Receptor Interacting Protein (AIP) Gene

    Science.gov (United States)

    Aaltonen, Lauri A.; Daly, Adrian F.

    2013-01-01

    Pituitary adenomas are one of the most frequent intracranial tumors and occur with a prevalence of approximately 1:1000 in the developed world. Pituitary adenomas have a serious disease burden, and their management involves neurosurgery, biological therapies, and radiotherapy. Early diagnosis of pituitary tumors while they are smaller may help increase cure rates. Few genetic predictors of pituitary adenoma development exist. Recent years have seen two separate, complimentary advances in inherited pituitary tumor research. The clinical condition of familial isolated pituitary adenomas (FIPA) has been described, which encompasses the familial occurrence of isolated pituitary adenomas outside of the setting of syndromic conditions like multiple endocrine neoplasia type 1 and Carney complex. FIPA families comprise approximately 2% of pituitary adenomas and represent a clinical entity with homogeneous or heterogeneous pituitary adenoma types occurring within the same kindred. The aryl hydrocarbon receptor interacting protein (AIP) gene has been identified as causing a pituitary adenoma predisposition of variable penetrance that accounts for 20% of FIPA families. Germline AIP mutations have been shown to associate with the occurrence of large pituitary adenomas that occur at a young age, predominantly in children/adolescents and young adults. AIP mutations are usually associated with somatotropinomas, but prolactinomas, nonfunctioning pituitary adenomas, Cushing disease, and other infrequent clinical adenoma types can also occur. Gigantism is a particular feature of AIP mutations and occurs in more than one third of affected somatotropinoma patients. Study of pituitary adenoma patients with AIP mutations has demonstrated that these cases raise clinical challenges to successful treatment. Extensive research on the biology of AIP and new advances in mouse Aip knockout models demonstrate multiple pathways by which AIP may contribute to tumorigenesis. This review assesses

  8. Non-functioning pituitary adenoma: immunohistochemical analysis of 85 cases.

    Science.gov (United States)

    Mahta, Ali; Haghpanah, Vahid; Lashkari, Anahita; Heshmat, Ramin; Larijani, Bagher; Tavangar, Seyed Mohammad

    2007-01-01

    Pituitary adenomas without clinically active hypersecretion are summarized under the term non-functioning pituitary adenoma (NFPA). Since there are no specific serum markers, the differential diagnosis and treatment imply special difficulties. By using immunohistochemical methods we will have new insight into the nature and pathogenesis of these tumours. Ki-67 is a nuclear antigen detected by the monoclonal antibody MIB-1 and its labelling index (LI) is considered a marker of normal and abnormal cell proliferation. The aim of this study was to investigate the possible role of immunohistochemistry and MIB1-LI determination in NFPAs to predict tumoural behaviour and better management. In this clinicopathological study, 85 cases of NFPAs were analysed immunohistochemically. MIB1-LI was also determined in studied cases. Clinical presentation, treatment and follow-up data were also reviewed and the correlation between clinical and pathologic findings was established. Eighteen adenomas (21.2%) were immunoreactive to one or two adenohypophysial hormones of which 4 GH positive adenomas had aggressive behaviour (2 significant juxtasellar extensions and 2 recurrences). MIB-1 LI was more than 5% in only 5 cases including 2 invasive adenomas but with no evidence of recurrence. No significant statistical difference between clinical presentations in immunoreactive and non-immunoreactive NFPAs was observed except for unilateral temporal hemianopia which was more common in immunoreactive adenomas (P=0.022). NFPAs comprise several pathologically different types of tumours, some of which are potentially hormone producing, but some defects in hormone secretion or production of biologically inactive or insufficient amount of hormone may be the culprit in the lack of evidence of rising serum hormone levels. MIB-1 LI may be indicative of invasiveness but not a predictor of recurrence. Silent somatotropinomas may have more aggressive behaviour in comparison with other NFPAs.

  9. File list: ALL.Dig.10.AllAg.Intestinal_adenoma [Chip-atlas[Archive

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  15. Análisis de un registro de adenomas pituitarios Analysis of a pituitary adenoma registry

    Directory of Open Access Journals (Sweden)

    Carolina Albiero

    2010-10-01

    Full Text Available Dada la complejidad que reviste el enfoque diagnóstico y terapéutico de los tumores pituitarios, el registro y análisis de la experiencia clínica acumulada es de gran ayuda en la toma de decisiones. En este trabajo se informan datos clínico-terapéuticos, extraídos de un registro computarizado, sobre 519 de un total de 670 pacientes con adenomas pituitarios. Trescientos cuarenta y cinco fueron mujeres (66% y 174 varones (34%, de 14 a 80 años de edad. El diagnóstico final fue: acromegalia en 176, enfermedad de Cushing en 153, prolactinoma en 101 y adenoma clínicamente no-funcionante (ANF en 89. La edad media al momento del diagnóstico de acromegalia fue 43.9 ± 13.5 (16-80, para enfermedad de Cushing 35.7 ± 12.9 (14-72, para prolactinomas 30.0 ± 13.4 (15-79 y para ANF 52.1 ± 15.2 (17-79 años. La creación de un registro institucional de tumores de hipófisis es un instrumento de gran utilidad para el análisis de la experiencia adquirida y constituye una herramienta valiosa para mejorar la estrategia terapéutica, optimizar la relación costo/beneficio y mejorar el cuidado del paciente. Contribuye a la docencia médica, tanto en el pre como en el posgrado y da base a la realización de trabajos de investigación clínica, aportando a la difusión y transferencia de conocimientos.Collection and analysis of data obtained during the clinical treatment of pituitary tumours are of great utility in the decision making process, when facing clinical situations. We report here data on 519 from 670 patients with pituitary adenomas obtained from a computerized registry. Three hundred and forty five were females (66% and 174 males (34%, aged 14-80. Final diagnosis was acromegaly in 176, Cushing's disease in 153, prolactinoma in 101 and clinically non-functioning adenoma in 89. Mean age at diagnosis was 43.9 ± 13.5 (16-80 for acromegalics, 35.7 ± 12.9 (14-72 for Cushing's, 30.0 ± 13.4 (15-79 for prolactinoma and 52.1 ± 15.2 (17-79, for non

  16. Two cases of giant parathyroid adenoma in atomic bomb survivors

    International Nuclear Information System (INIS)

    Takeichi, Nobuo; Nishida, Toshihiro; Fujikura, Toshio

    1983-12-01

    In a study of parathyroid tumor among autopsy cases at RERF in Hiroshima, 16 cases of parathyroid adenoma were detected among 4,136 autopsies during 1961-77. Of these, two cases were giant adenoma (5 cm in diameter) accompanied by hyperparathyroidism. Both cases were atomic bomb survivors from Hiroshima. One was exposed to 55 rad at age 51 and died at age 71, and the other was exposed to 28 rad at age 45 and died at age 71. These two cases will be reported together with a review of the literature on parathyroid tumors developed following irradiation on the head and neck. (author)

  17. Cerebral hemorrhagic infarction after radiation for pituitary adenoma

    International Nuclear Information System (INIS)

    Ogaki, Satoko; Suzuki, Masatsune; Shimano, Hitoshi; Toyoshima, Hideo; Sone, Hirohito; Okuda, Yukichi; Yamada, Nobuhiro

    2002-01-01

    We report a case of cerebral hemorrhagic infarction after radiation for pituitary adenoma. A 55-year-old woman was hospitalized to check for aldosteronism, post-operative pituitary function, and recurrence of thyroid cancer. She had short-term memory disturbance beginning two months prior to admission. Brain MRI showed a T1 and T2 high intensity lesion of her left anterolateral thalamus. Brain MRA revealed a narrowing in her left middle cerebral artery. The abnormal brain lesion was diagnosed as cerebral hemorrhagic infarction. She had received radiation therapy for pituitary adenoma 20 years earlier. It was considered that her cerebral hemorrhagic infarction was caused by radiation therapy. (author)

  18. Cushing's syndrome associated with a bronchial adenoma. Possible periodic hormonogenesis.

    Science.gov (United States)

    Shapiro, M S; Gutman, A; Bruderman, I; Myers, B; Griffel, W B

    1975-09-01

    Diagnostic and therapeutic problems in a patient with ectopic ACTH syndrome caused by a malignant bronchial adenoma are discussed. Persistent Cushing's syndrome was present following apparent total adrenalectomy, but radioactive scanning with 131I-19-iodocholesterol showed the presence of residual adrenal tissue in the right suprarenal bed. Amelioration of the hypercortisolism occurred after removal of the bronchial adenoma. A paradoxical elevation of adrenocortical activity followed administration of dexamethasone and data are presented which suggest that periodic secretion of ACTH accounted for this phenomenon.

  19. Gut microbiome development along the colorectal adenoma-carcinoma sequence

    DEFF Research Database (Denmark)

    Feng, Qiang; Liang, Suisha; Jia, Huijue

    2015-01-01

    factors indicates that high intake of red meat relative to fruits and vegetables appears to associate with outgrowth of bacteria that might contribute to a more hostile gut environment. These findings suggest that faecal microbiome-based strategies may be useful for early diagnosis and treatment......Colorectal cancer, a commonly diagnosed cancer in the elderly, often develops slowly from benign polyps called adenoma. The gut microbiota is believed to be directly involved in colorectal carcinogenesis. The identity and functional capacity of the adenoma- or carcinoma-related gut microbe...

  20. Mucin-producing signet ring cell adenoma of the thyroid

    Directory of Open Access Journals (Sweden)

    Gulwani Hanni

    2008-10-01

    Full Text Available Signet ring cell adenoma of the thyroid, though rare, is well documented. This change is chiefly due to intracellular accumulation of thyroglobulin that appears mucinous. Awareness of this entity is important as it may closely simulate a metastatic mucin-secreting signet ring cell carcinoma. Although the mucinous material in signet ring cells has been reported to stain positive with thyroglobulin, in some cases it may not be so. We herein describe a rare case of a 46-year-old man who was hypothyroid and the mass removed from the thyroid showed a mucin-producing signet ring cell adenoma of the thyroid.

  1. PHLEOMORPHIC ADENOMA (BENIGN MIXED TUMOR PADA PALATUM MOLLE (LAPORAN KASUS

    Directory of Open Access Journals (Sweden)

    Sigit Supartono

    2015-07-01

    Full Text Available Phleomorphic adenoma is the most commonly found tumor of the salivary glands. This tumor is usually found in the postero-lateral region of the hard palate. In this case, a phelomorphic adenoma situated in the oropharynx region was reported. The CT-Scan results showed an expansive and infiltrative appearance, suspected to be a malignancy, where wide excision was previously planned to be carried out. During surgery, the mass was found pedunculated in the soft palate. It was then decided to perform an exicision as the choice of therapy.

  2. 3D volumetry comparison using 3T magnetic resonance imaging between normal and adenoma-containing pituitary glands.

    Science.gov (United States)

    Roldan-Valadez, Ernesto; Garcia-Ulloa, Ana Cristina; Gonzalez-Gutierrez, Omar; Martinez-Lopez, Manuel

    2011-01-01

    Computed-assisted three-dimensional data (3D) allows for an accurate evaluation of volumes compared with traditional measurements. An in vitro method comparison between geometric volume and 3D volumetry to obtain reference data for pituitary volumes in normal pituitary glands (PGs) and PGs containing adenomas. Prospective, transverse, analytical study. Forty-eight subjects underwent brain magnetic resonance imaging (MRI) with 3D sequencing for computer-aided volumetry. PG phantom volumes by both methods were compared. Using the best volumetric method, volumes of normal PGs and PGs with adenoma were compared. Statistical analysis used the Bland-Altman method, t-statistics, effect size and linear regression analysis. Method comparison between 3D volumetry and geometric volume revealed a lower bias and precision for 3D volumetry. A total of 27 patients exhibited normal PGs (mean age, 42.07 ± 16.17 years), although length, height, width, geometric volume and 3D volumetry were greater in women than in men. A total of 21 patients exhibited adenomas (mean age 39.62 ± 10.79 years), and length, height, width, geometric volume and 3D volumetry were greater in men than in women, with significant volumetric differences. Age did not influence pituitary volumes on linear regression analysis. Results from the present study showed that 3D volumetry was more accurate than the geometric method. In addition, the upper normal limits of PGs overlapped with lower volume limits during early stage microadenomas.

  3. The Importance of Clinical and Diagnostic Markers of Aggression of Non-Functional Pituitary Adenomas

    Directory of Open Access Journals (Sweden)

    Yu.M. Urmanova

    2015-09-01

    Full Text Available Sixty patients with non-functional pituitary adenomas were observed. Most patients had large-cell chromophobe pituitary adenomas (81.6%. Small-cell chromophobe adenomas occurred in 10 % cases. Only 1 patient (3.3 % had giant carcinoma with regrowth and metastasis into the brain. Markers of aggression of non-functional pituitary adenomas are the young age of a patient, expressed first symptoms of disease manifestation, large size of tumor, asymmetry and deformation of pituitary, invasion of tumor to the neighboring tissues/arteries/cavernous sinus, presence of small cell and dark-cell chromophobe adenoma, panhypopituitarism.

  4. Sensitive detection of a small parathyroid adenoma using fluorocholine PET/CT: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Padinhare-Keloth, Thanseer N. T. K.; Bhadada, Sanjay K.; Sood, Ashwani; Kumar, Rajender; Behera, Arunanshu; Radotra, Bishan D.; Mittal, Bhagwant R. [PGIMER, Chandigarh (India)

    2017-06-15

    Primary hyperparathyroidism is caused by parathyroid adenoma in the majority of cases and diagnosis is usually made biochemically. Pre-surgical localization of parathyroid adenoma is essential to limit the extent of surgery and avoid missing them at ectopic sites. Anatomical and functional imaging are used for the localization, but may fail to identify the small and ectopic parathyroid adenoma. We present a case of small sized ectopic parathyroid adenoma at unusual location detected by F-18 fluorocholine (FCH) PET/CT, where other imaging modalities failed. The post-operative histopathology confirmed the diagnosis of ectopic parathyroid adenoma.

  5. Preoperative Localization of Mediastinal Parathyroid Adenoma with Intra-arterial Methylene Blue

    Energy Technology Data Exchange (ETDEWEB)

    Salman, Rida; Sebaaly, Mikhael G. [American University of Beirut Medical Center, Department of Diagnostic Radiology (Lebanon); Wehbe, Mohammad Rachad; Sfeir, Pierre; Khalife, Mohamad [American University of Beirut Medical Center, Department of General Surgery (Lebanon); Al-Kutoubi, Aghiad, E-mail: mk00@aub.edu.lb [American University of Beirut Medical Center, Department of Diagnostic Radiology (Lebanon)

    2017-06-15

    Ectopic parathyroid is found in 16% of patients with hyperparathyroidism. 2% of ectopic parathyroid adenomas are not accessible to standard cervical excision. In such cases, video-assisted thoracoscopic resection is the recommended definitive treatment. We present a case of mediastinal parathyroid adenoma localized preoperatively by injecting methylene blue within a branch of the internal mammary artery that is supplying the adenoma. Intra-arterial methylene blue injection facilitated visualization and resection of the adenoma. The preoperative intra-arterial infusion of methylene blue appears to be an effective and safe method for localization of ectopic mediastinal parathyroid adenomas and allows rapid identification during thoracoscopic resection.

  6. Results of the radiotherapic treatment of 35 patients with pituitary adenoma

    Energy Technology Data Exchange (ETDEWEB)

    Herruzo, I.; Errazquin, L.; Acosta, D.; Erruzo, R.; Garcia Fernandez, J.L.; Jimenez, M.; Zaragoza, J.R.

    1988-01-01

    A group of 35 patents with pituitary adenoma who underwent postoperative irradiation were analyzed. Hormone values, both pre and post treatment, as well as the result of treatment on the symptoms and visual involvement were assessed. Best results were obtained in non-functioning adenomas, with a 100 % disease control in the first 3 years, whereas the this percentage was 70 % in GH secreting adenomas and 76.9 % in prolactinomas. However, after five years, disease control decreases to 85.7 % in those with non-secretory adenoma, to 46.7 % in patients with GH secreting adenoma and to 30.8 % in those presenting prolactinomas.

  7. Dissection of the complex phenotype in cuticular mutants of Arabidopsis reveals a role of SERRATE as a mediator.

    Directory of Open Access Journals (Sweden)

    Derry Voisin

    2009-10-01

    Full Text Available Mutations in LACERATA (LCR, FIDDLEHEAD (FDH, and BODYGUARD (BDG cause a complex developmental syndrome that is consistent with an important role for these Arabidopsis genes in cuticle biogenesis. The genesis of their pleiotropic phenotypes is, however, poorly understood. We provide evidence that neither distorted depositions of cutin, nor deficiencies in the chemical composition of cuticular lipids, account for these features, instead suggesting that the mutants alleviate the functional disorder of the cuticle by reinforcing their defenses. To better understand how plants adapt to these mutations, we performed a genome-wide gene expression analysis. We found that apparent compensatory transcriptional responses in these mutants involve the induction of wax, cutin, cell wall, and defense genes. To gain greater insight into the mechanism by which cuticular mutations trigger this response in the plants, we performed an overlap meta-analysis, which is termed MASTA (MicroArray overlap Search Tool and Analysis, of differentially expressed genes. This suggested that different cell integrity pathways are recruited in cesA cellulose synthase and cuticular mutants. Using MASTA for an in silico suppressor/enhancer screen, we identified SERRATE (SE, which encodes a protein of RNA-processing multi-protein complexes, as a likely enhancer. In confirmation of this notion, the se lcr and se bdg double mutants eradicate severe leaf deformations as well as the organ fusions that are typical of lcr and bdg and other cuticular mutants. Also, lcr does not confer resistance to Botrytis cinerea in a se mutant background. We propose that there is a role for SERRATE-mediated RNA signaling in the cuticle integrity pathway.

  8. Wide-field piecemeal cold snare polypectomy of large sessile serrated polyps without a submucosal injection is safe.

    Science.gov (United States)

    Tate, David J; Awadie, Halim; Bahin, Farzan F; Desomer, Lobke; Lee, Ralph; Heitman, Steven J; Goodrick, Kathleen; Bourke, Michael J

    2018-03-01

    BACKGROUND AND STUDY AIMS : Large series suggest endoscopic mucosal resection is safe and effective for the removal of large (≥ 10 mm) sessile serrated polyps (SSPs), but it exposes the patient to the risks of electrocautery, including delayed bleeding. We examined the feasibility and safety of piecemeal cold snare polypectomy (pCSP) for the resection of large SSPs.  Sequential large SSPs (10 - 35 mm) without endoscopic evidence of dysplasia referred over 12 months to a tertiary endoscopy center were considered for pCSP. A thin-wire snare was used in all cases. Submucosal injection was not performed. High definition imaging of the defect margin was used to ensure the absence of residual serrated tissue. Adverse events were assessed at 2 weeks and surveillance was planned for between 6 and 12 months.  41 SSPs were completely removed by pCSP in 34 patients. The median SSP size was 15 mm (interquartile range [IQR] 14.5 - 20 mm; range 10 - 35 mm). The median procedure duration was 4.5 minutes (IQR 1.4 - 6.3 minutes). There was no evidence of perforation or significant intraprocedural bleeding. At 2-week follow-up, there were no significant adverse events, including delayed bleeding and post polypectomy syndrome. First follow-up has been undertaken for 15 /41 lesions at a median of 6 months with no evidence of recurrence.  There is potential for pCSP to become the standard of care for non-dysplastic large SSPs. This could reduce the burden of removing SSPs on patients and healthcare systems, particularly by avoidance of delayed bleeding. © Georg Thieme Verlag KG Stuttgart · New York.

  9. Alcohol consumption, alcohol dehydrogenase 3 polymorphism, and colorectal adenomas

    NARCIS (Netherlands)

    Tiemersma, E.W.; Wark, P.A.; Ocké, M.C.; Bunschoten, A.; Otten, M.H.; Kok, F.J.; Kampman, E.

    2003-01-01

    Alcohol is a probable risk factor with regard to colorectal neoplasm and is metabolized to the carcinogen acetaldehyde by the genetically polymorphic alcohol dehydrogenase 3 (ADH3) enzyme. We evaluated whether the association between alcohol and colorectal adenomas is modified by ADH3 polymorphism.

  10. Outcomes following Purely Endoscopic Endonasal Resection of Pituitary adenomas

    Directory of Open Access Journals (Sweden)

    Rezaul Amin

    2013-01-01

    Full Text Available Background: The use of endoscope for the management of pituitary adenoma is not new. The better magnification and illumination provided by the endoscope gives better outcome than microscopic pituitary surgery. Objective: To find out the benefits of endoscope in relation to microscopic surgery. Materials and Methods: We performed 45 cases of pituitary adenoma surgery by endoscopic endonasal approach from July 2008 to July 2010. Results: Forty five cases underwent endoscopic transsphenoidal approach. Gross total removal was done in 35 cases and subtotal removal was done in 10 cases. Residual tumours were seen in 10 cases (22% in postoperative follow-up MRI scan. Visual improvement was satisfactory, and hormonal improvement of functional adenoma was nice. Postoperative visual acuity and visual field were improved in 75% cases. There were 37% cases of temporary diabetes insipidus and about 4.5% cases of permanent diabetes insipidus. The average duration of follow-up was 20 months. One patient required reexploration to correct visual deterioration in the immediate postoperative period. There were 4.5% cases of CSF leak and 6.6% mortality. Mortality was due to electrolyte imbalance and improper management of infection and hydrocephalus. Conclusion: Endoscopic endonasal pituitary surgery now has become a gold standard surgery for most of the pituitary adenomas because of its better advantages in relation to microscopic surgery and less complications and less hospital stay.

  11. MRI of the TSH (thyroid stimulating hormone) -secreting pituitary adenoma

    International Nuclear Information System (INIS)

    Kang, Byung Chul; Kim, Dong Ik; Chung, Tae Sup; Cho, Yong Kook; Lee, Eun Gig; Jung, Joon Keun

    1995-01-01

    To demonstrate and evaluate the value of MRI findings of the TSH(Thyroid-Stimulating Hormone, TSH, Thyrotropin)-secreting pituitary adenoma. The authors reviewed retrospectively the MR images of 4 patients with TSH-secreting pituitary adenoma. Evaluation of the anatomical location, signal characteristics, enhancement patterns, size, shape and circunferential changes were made. No characteristic common MR findings in size, shape, signal intensity, and circumferential changes of TSH-secreting pituitary adenoma waere observed among 4 cases (size; 5 x 7 mm to 10 x 11 mm, shape; ovoid to round signal intensity; high in 1 case on T1 and T2WI, isosignal intensity in the other 3 cases, circumferential change; stalk deviation in 1 case, no stalk deviation in 3 cases). But, the tumors were centrally located at the anterior pituitary gland and showed relatively homogeneous signal intensity on MR images of all 4 patients. We conclude that centrally-located mass at the anterior pituitary gland with homogeneous signal intensity on MR image may be suggestive of the TSH-secreting pituitary adenoma, although the MR findings are not specific for the disease

  12. Primary Endoscopic Transnasal Transsphenoidal Surgery for Giant Pituitary Adenoma.

    Science.gov (United States)

    Kuo, Chao-Hung; Yen, Yu-Shu; Wu, Jau-Ching; Chang, Peng-Yuan; Chang, Hsuan-Kan; Tu, Tsung-Hsi; Huang, Wen-Cheng; Cheng, Henrich

    2016-07-01

    Giant pituitary adenoma (>4 cm) remains challenging because the optimal surgical approach is uncertain. Consecutive patients with giant pituitary adenoma who underwent endoscopic transnasal transsphenoidal surgery (ETTS) as the first and primary treatment were retrospectively reviewed. Inclusion criteria were tumor diameter ≥4 cm in at least 1 direction, and tumor volume ≥10 cm(3). Exclusion criteria were follow-ups surgery. Residual and recurrent tumors (n = 30) were managed with 1 of the following: Gamma Knife radiosurgery (GKRS), reoperation (redo ETTS), both GKRS and ETTS, medication, conventional radiotherapy, or none. At last follow-up, most of the patients had favorable outcomes, including 8 (21.1%) who were cured and 29 (76.3%) who had a stable residual condition without progression. Only 1 (2.6%) had late recurrence at 66 months after GKRS. The overall progression-free rate was 97.4%, with few complications. In this series of giant pituitary adenoma, primary (ie, the first) ETTS yielded complete resection and cure in 21.1%. Along with adjuvant therapies, including GKRS, most patients (97.4%) were stable and free of disease progression. Therefore, primary ETTS appeared to be an effective surgical approach for giant pituitary adenoma. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Adenoma detection rate varies greatly during colonoscopy training

    NARCIS (Netherlands)

    van Doorn, Sascha C.; Klanderman, Robert B.; Hazewinkel, Yark; Fockens, Paul; Dekker, Evelien

    2015-01-01

    The adenoma detection rate (ADR) is considered the most important quality indicator for colonoscopy and varies widely among colonoscopists. It is unknown whether the ADR of gastroenterology consultants can already be predicted during their colonoscopy training. To evaluate the ADR of fellows in

  14. Fractionated stereotactic radiotherapy in the treatment of pituitary adenomas

    International Nuclear Information System (INIS)

    Kopp, C.; Theodorou, M.; Poullos, N.; Astner, S.T.; Geinitz, H.; Molls, M.; Stalla, G.K.; Meyer, B.; Nieder, C.; Tromsoe Univ.; Grosu, A.L

    2013-01-01

    Purpose: The purpose of this work was to evaluate tumor control and side effects associated with fractionated stereotactic radiotherapy (FSRT) in the management of residual or recurrent pituitary adenomas. Patients and methods: We report on 37 consecutive patients with pituitary adenomas treated with FSRT at our department. All patients had previously undergone surgery. Twenty-nine patients had nonfunctioning, 8 had hormone-producing adenoma. The mean total dose delivered by a linear accelerator was 49.4 Gy (range 45-52.2 Gy), 5 x 1.8 Gy weekly. The mean PTV was 22.8 ccm (range 2.0-78.3 ccm). Evaluation included serial imaging tests, endocrinologic and ophthalmologic examination. Results: Tumor control was 91.9 % for a median follow-up time of 57 months (range 2-111 months). Before FSRT partial hypopituitarism was present in 41 % of patients, while 35 % had anterior panhypopituitarism. After FSRT pituitary function remained normal in 22 %, 43 % had partial pituitary dysfunction, and 35 % had anterior panhypopituitarism. Visual acuity was stable in 76 % of patients, improved in 19 %, and deteriorated in 5 %. Visual fields remained stable in 35 patients (95 %), improved in one and worsened in 1 patient (2.7 %). Conclusion: FSRT is an effective and safe treatment for recurrent or residual pituitary adenoma. Good local tumor control and preservation of adjacent structures can be reached, even for large tumors. (orig.)

  15. Hypertrophic osteopathy in a pony with a pituitary adenoma

    International Nuclear Information System (INIS)

    Sweeney, C.R.; Stebbins, K.E.; Schelling, C.G.; Beech, J.; Schilling, D.A.

    1989-01-01

    Hypertrophic osteopathy was diagnosed in a pony that had no antemortem or postmortem evidence of an intrathoracic lesion. With a history of hirsutism in an aged pony, a pituitary adenoma was suspected, and evaluation of plasma cortisol and insulin values and their response to thyrotropin-releasing hormone supported the diagnosis

  16. Proliferaton index in pituitary adenomas from a black African ...

    African Journals Online (AJOL)

    Ayodeji Salami

    2016-12-31

    Dec 31, 2016 ... tumours show invasion of surrounding structures with increase in proliferation.4 The ... of pituitary adenomas in the black African population. This is a pre- ... ized and diluted (1:200) KI67 rabbit primary antibody. (Thermofisher ...

  17. Histochemical alterations in colorectal carcinoma and adenoma in Egyptian patients

    Directory of Open Access Journals (Sweden)

    Saber A Sakr

    2016-01-01

    Full Text Available Objective: To evaluate the histochemical alterations in DNA and total carbohydrates, in colorectal cancer cells. Methods: This study was carried out on 48 colorectal carcinoma and 10 adenoma specimens. Hematoxylin and Eosin staining was carried out for histopathological examination to confirm the diagnosis and to evaluate the histopathological characteristics of tumor. Histologic grade and pathologic stage was assessed according to TNM staging system. Staging was also assessed according to original Dukes’ staging system. DNA was demonstrated by Feulgen method and carbohydrates were demonstrated by periodic acid Schiff’s reaction. Results: Adenoma cases showed that the cells lining the glands of the polyp have more crowded, irregular and darker nuclei (hyperchromatic, anisonucleosis, abnormal mitotic figures with prominent nucleoli and variability in the size and shape of nuclei. Colorectal carcinoma cases showed a condensation and reduction in the size of a cell nucleus associated with hyperchromatosis, pyknotic nuclei, abnormal mitotic figures, anisonucleosis, irregular nuclear membrane and inequality in the size of the nuclei (Pleomorphosis. There was a statistical significant differences between adenoma and carcinoma regarding number of mitotic cells (P = 0.03 that was in favour of malignant group. Adenoma and colorectal carcinoma cases showed periodic acid Schiff’s reactivity with different degree. Conclusions: These histochemical alterations can be so characteristic of a given tumor type and stage that they are used in cancer diagnosis and might also be related to the altered functional properties of cancer cells.

  18. Proton therapy of hormone-secreting hypophyseal adenomas: gluconeogenesis assessment

    International Nuclear Information System (INIS)

    Konnova, L.A.; Konnov, B.A.; Mel'nikov, L.A.; Lebedeva, N.A.

    1993-01-01

    Analysis of blood plasma aminograms of patients with hormone secreting hypophyseal adenomas (somatotropinomas and prolactinomas), that were obtained before and after a course of proton therapy, has confirmed the gluconeogenic effect of hypophyseal hormones and evidenced the relationship between this effect and dismetabolism of some amino acids

  19. Pleomorphic adenoma of the parotid gland 1985-2010

    DEFF Research Database (Denmark)

    Andreasen, Simon; Therkildsen, Marianne H; Bjørndal, Kristine

    2016-01-01

    -up on these topics. METHODS: The Danish Pathology Data Bank was searched for parotid pleomorphic adenoma and Ca-ex-PA in the period 1985 to 2010 and all pathology descriptions were reviewed. Ca-ex-PA specimens were reviewed by a pathologist. RESULTS: A total of 5.497 patients were identified and 2.86% had at least...

  20. Gamma-knife surgery for secreting pituitary adenomas

    International Nuclear Information System (INIS)

    Morange-Ramos, I.; Andrieu, J.M.; Jaquet, P.; Regis, J.; Dufour, H.; Grisoli, F.; Peragut, J.C.

    1998-01-01

    We report our preliminary results concerning 25 patients with secreting pituitary adenomas treated with stereotactic radiosurgery after partial transsphenoidal surgery and followed over a 6-36 month-period. Among the 15 acromegalic patients, a decrease of 65% in mean GH levels was achieved after 6 months and of 77% at 12 months after radiosurgery. Presently, only 3 patients (20%) are considered as in remission (mean GH and IGF1 level into the normal range). A decrease of 46% and 64% was observed at 6 and 12 months after radiosurgery in 4 patients with prolactinomas although no normalization of PRL levels occurred. Presently, 3/4 patients have individual PRL levels slightly above the normal range. A normalization of Urinary Free Cortisol (UFC) was noticed in 4/6 (66%) patients with Cushing's disease within 6-12 months. No pituitary deficiency was noticed in this series with the exception of 4/25 patients (16%) who received subtotal or total pituitary irradiation for post-operative remnants of secreting adenomas poorly defined on MRI. One woman, who had undergone previously a conventional irradiation and presenting with a cavernous sinus adenoma reaching the optic nerve, developed an optic neuropathy. A second woman, with a cavernous sinus remnant, presented a cranial nerve palsy (VI) after the irradiation. We can conclude that radiosurgery using the Cobalt-60 Gamma-unit is, at least, as effective as conventional radiotherapy in the control of pituitary hormone hypersecretion from postoperative adenomas remnants with less adverse effects. (author)

  1. Evaluation of pituitary adenomas by multidirectional multislice dynamic CT

    International Nuclear Information System (INIS)

    Abe, T.; Izumiyama, H.; Fujisawa, I.

    2002-01-01

    Purpose: Multidetector-row CT is a new technology with a short scanning time. Multislice dynamic CT (MSDCT) in various directions can be obtained using the multidetector-row CT with multiplanar reformatting (MPR) technique. Material and Methods: We evaluated the initial results of sagittal and coronal MSDCT images reconstructed by MPR (MSDCT-MPR) in 3 pituitary adenoma patients with a pacemaker. Results: In a patient with microadenoma, the maximum contrast between the normal anterior pituitary gland and the adenoma occurred approximately 50 s after the start of the contrast medium injection. A microadenoma was depicted as a less enhanced area relative to normal pituitary tissue. The macroadenomas were depicted as a less enhanced mass with cavernous sinus invasion in 1 patient and as a non-uniformly enhanced mass in another patient. Bone destruction and incomplete opening of the sellar floor during previous surgery were clearly detected in 2 patients with macroadenomas. These pituitary adenomas were removed via the transnasal route based on information from the MSDCT-MPR images only. The findings were verified surgically. Conclusion: The MSDCT-MPR provided the information needed for surgery with good image quality in the 3 patients with pacemakers. MSDCT-MPR appears to be a useful technique for patients with a pituitary adenoma in whom MR imaging is not available. This is the first report, to our knowledge, of the MSDCT-MPR technique being used to demonstrate pituitary disorders

  2. Evaluation of pituitary adenomas by multidirectional multislice dynamic CT

    Energy Technology Data Exchange (ETDEWEB)

    Abe, T.; Izumiyama, H. [Showa Univ. School of Medicine, Tokyo (Japan). Dept. of Neurosurgery; Fujisawa, I. [Kishiwada City Hospital, Kishiwada (Japan). Dept. of Radiology

    2002-11-01

    Purpose: Multidetector-row CT is a new technology with a short scanning time. Multislice dynamic CT (MSDCT) in various directions can be obtained using the multidetector-row CT with multiplanar reformatting (MPR) technique. Material and Methods: We evaluated the initial results of sagittal and coronal MSDCT images reconstructed by MPR (MSDCT-MPR) in 3 pituitary adenoma patients with a pacemaker. Results: In a patient with microadenoma, the maximum contrast between the normal anterior pituitary gland and the adenoma occurred approximately 50 s after the start of the contrast medium injection. A microadenoma was depicted as a less enhanced area relative to normal pituitary tissue. The macroadenomas were depicted as a less enhanced mass with cavernous sinus invasion in 1 patient and as a non-uniformly enhanced mass in another patient. Bone destruction and incomplete opening of the sellar floor during previous surgery were clearly detected in 2 patients with macroadenomas. These pituitary adenomas were removed via the transnasal route based on information from the MSDCT-MPR images only. The findings were verified surgically. Conclusion: The MSDCT-MPR provided the information needed for surgery with good image quality in the 3 patients with pacemakers. MSDCT-MPR appears to be a useful technique for patients with a pituitary adenoma in whom MR imaging is not available. This is the first report, to our knowledge, of the MSDCT-MPR technique being used to demonstrate pituitary disorders.

  3. Fractionated stereotactic radiotherapy in the treatment of pituitary adenomas

    Energy Technology Data Exchange (ETDEWEB)

    Kopp, C.; Theodorou, M.; Poullos, N.; Astner, S.T.; Geinitz, H.; Molls, M. [Technische Univ. Muenchen, Klinikum rechts der Isar (Germany). Klinik und Poliklinik fuer Strahlentherapie und Radiologische Onkologie; Stalla, G.K. [Max-Planck-Institut fuer Psychiatrie, Muenchen (Germany). Klinische Neuroendokrinologie; Meyer, B. [Technische Univ. Muenchen, Klinikum rechts der Isar (Germany). Neurochirurgische Klinik und Poliklinik; Nieder, C. [Nordland Hospital, Bodoe (Norway). Dept. of Oncology and Palliative Medicine; Tromsoe Univ. (Norway). Inst. of Clinical Medicine; Grosu, A.L [Freiburg Univ. (Germany). Klinik fuer Strahlenheilkunde

    2013-11-15

    Purpose: The purpose of this work was to evaluate tumor control and side effects associated with fractionated stereotactic radiotherapy (FSRT) in the management of residual or recurrent pituitary adenomas. Patients and methods: We report on 37 consecutive patients with pituitary adenomas treated with FSRT at our department. All patients had previously undergone surgery. Twenty-nine patients had nonfunctioning, 8 had hormone-producing adenoma. The mean total dose delivered by a linear accelerator was 49.4 Gy (range 45-52.2 Gy), 5 x 1.8 Gy weekly. The mean PTV was 22.8 ccm (range 2.0-78.3 ccm). Evaluation included serial imaging tests, endocrinologic and ophthalmologic examination. Results: Tumor control was 91.9 % for a median follow-up time of 57 months (range 2-111 months). Before FSRT partial hypopituitarism was present in 41 % of patients, while 35 % had anterior panhypopituitarism. After FSRT pituitary function remained normal in 22 %, 43 % had partial pituitary dysfunction, and 35 % had anterior panhypopituitarism. Visual acuity was stable in 76 % of patients, improved in 19 %, and deteriorated in 5 %. Visual fields remained stable in 35 patients (95 %), improved in one and worsened in 1 patient (2.7 %). Conclusion: FSRT is an effective and safe treatment for recurrent or residual pituitary adenoma. Good local tumor control and preservation of adjacent structures can be reached, even for large tumors. (orig.)

  4. Endosonography in diagnosing and staging duodenal villous adenoma

    NARCIS (Netherlands)

    Tio, T. L.; Sie, L. H.; Verbeek, P. C.; Dé Wit, L. T.; Tytgat, G. N.

    1992-01-01

    Endosonography was carried out in a patient with an extensive juxtapapillary tumour. Radiology and endoscopy were unable to distinguish a villous adenoma from an invasive carcinoma. Endosonography revealed a mucosal hypoechoic tumour without penetration into the submucosa and muscularis propria. The

  5. Unusual mixed gangliocytoma-pituitary adenoma in sellar region

    Directory of Open Access Journals (Sweden)

    Jie-tian JIN

    2016-10-01

    Full Text Available Background The presence of ganglion cells within an endocrine pituitary adenoma in sellar region is rare, and is usually diagnosed as "mixed gangliocytoma-pituitary adenoma". Due to lack of radiological characteristics, it is very difficult to make an accurate diagnosis preoperatively. Herein we describe one case of unusual mixed gangliocytoma - growth hormone (GH secreting pituitary adenoma in sellar region and review related literatures, so as to summarize the clinicopathological characteristics and improve the diagnosis and differential diagnosis of this tumor. Methods and Results A 28 - year - old female presented with headache and blurred vision for 8 months. She also complained of acromegaly and amenorrhea. Head CT and MRI examinations showed a sellar and suprasellar mass with clear boundary compressing the optic chiasm and buttom of the third ventricle. The mass exhibited isointense signal or mild hypointensity on T1WI and mild hyperintensity on T2WI with heterogeneous enhancement on the contrast MRI. The tumor was removed totally. The histological sections demonstrated two parts of intermixed areas. One part of areas was marked by a proliferation of scattered gangliocyte - like cells arranged in a fibrillary background. Other areas were marked by a sheet - like or locally papillary proliferation of round and oval cells. Immunohistochemically, cytoplasm of gangliocyte-cells were diffusely positive for synaptophysin (Syn, and negative for adenohypophysial hormones; cytoplasm of round and oval cells were diffusely positive for Syn, and almost 30% cells were positive for GH, and negative for other neurohypophysial hormones. A final diagnosis of mixed gangliocytoma-GH secreting pituitary adenoma in sellar region (WHO grade Ⅰ was made. The patient did not receive postoperatively adjuvant therapy and was followed-up for one year, without any neurological deficit or signs of recurrence. Conclusions Mixed gangliocytoma - pituitary

  6. Management of Duodenal Adenomas Involving the Ampulla of Vater – A Warning against Limited Resection

    Directory of Open Access Journals (Sweden)

    Jeremy Rossaak

    2008-03-01

    Full Text Available Duodenal adenomas are uncommon, however, when present a proportion have dysplasia associated with the adenoma and therefore require treatment. The options range from less invasive endoscopic treatments to a pancreaticoduodenectomy. This case report describes two patients with adenomas involving the ampulla of Vater. One patient had familial adenomatous polyposis, the other was a renal transplant patient with a large adenoma. Both patients’ adenomas contained high-grade dysplasia. Both patients underwent a pancreaticoduodenectomy. Histology of both specimens demonstrated that the adenoma had migrated up the bile duct for at least 7 mm, and the pancreatic duct for 8 mm in one patient. Limited resection of ampullary adenomas may leave residual adenomatous tissue in the bile duct with the risk of recurrent adenomatous disease and malignant transformation.

  7. Mediastinum Ectopic Parathyroid Adenoma Localized by Sestamibi-SPECT and

    International Nuclear Information System (INIS)

    Mazilu, C.; Mititelu, R.; Ghita, S.; Rimbu, A.; Marinescu, G.; Mazilu, A.; Codorean, I.

    2006-01-01

    Full text: Objective: Localizing of ectopic parathyroid adenomas, mainly of those located at large distal from cervical anterior region is very difficult by imaging methods, due to reduced number of specific imaging features. Material and Method: We present the case of a patient with hyper functional parathyroid tissue located in anterior mediastinum, detected by using nuclear medicine techniques (planar imaging and 99-m-Tc-Sestamibi) and CT with contrast agent. Results and discussions: Parathyroid scintigraphic imaging with metabolic radiotracer (99-m-Tc-Sestamibi) have shown normal uptake in thyroid area but shown a focal area with increased uptake in anterior mediastinum, on early and late planar images, transverse, sagittal and coronal SPECT images and on 3D reconstruction, suggesting the presence of ectopic parathyroid adenoma, which correlated with symptoms and laboratory analysis (high-modified values of PTH, Urinary Ca, Normal serum Ca). Thyroid ultrasonography normal aspect. CT native and with contrast agent showed remnant thymic tissue (?), pre-aortic anterior mediastinum nodule; normal thyroid aspect. Correlating this data was established the diagnosis of primary hyperparathyroidism due to mediastinum ectopic parathyroid adenoma. Surgical intervention showed intra thymic nodular process, well-defined, with 1 cm diameter in right thymic lobe. Thymectomy was realized. AP exam confirmed diagnosis of parathyroid adenoma. Post surgical determination of serum, urinary and PTH showed normalization of these values. Conclusions: In assessing parathyroid adenomas, mainly with ectopic location, combination of morphologic and functional techniques allows an accurate location of these processes, ensuring a correct diagnosis, adequate therapeutical management and optimal long-term prognosis for patient. (author)

  8. Transsphenoidal Surgery for Mixed Pituitary Gangliocytoma-Adenomas.

    Science.gov (United States)

    Shepard, Matthew J; Elzoghby, Mohamed A; Ghanim, Daffer; Lopes, M Beatriz S; Jane, John A

    2017-12-01

    Most sellar gangliocytomas are discovered with a concurrent pituitary adenoma, also known as a mixed gangliocytoma-adenoma (MGA). MGAs are rare, with fewer than 100 cases reported in the literature to date and only 1 previously documented surgical series. Because MGAs are radiologically indistinguishable from pituitary adenomas, they are often diagnosed after surgery. Combined with the paucity of clinical outcome data for these tumors, this makes their diagnosis and management challenging. Here we describe the clinical presentation and outcomes of 10 individuals who were diagnosed with a MGA at a single institution. This retrospective case series study included patients diagnosed with a combined sellar MGA between 1993 and 2016. This series comprised 10 patients, mean age of 44 years (range, 28-63 years) diagnosed with an MGA. The mean tumor size was 1.6 cm (range, 0.4-2.4 cm). Five patients presented with acromegaly, and 1 patient had recurrent Cushing disease. Transsphenoidal surgery was performed in all cases, and gross total resection was achieved in 7 patients (70%). Histologically, 9 of the 10 MGAs were identified as mixed somatotroph adenoma-gangliocytomas. The median duration of follow-up was 74 months (range, 2-180 months). Following adjuvant treatment (n = 3), all patients with acromegaly (n = 4) achieved biochemical remission, and no patient experienced recurrence of the pituitary tumor with a median radiographic follow-up of 48 months. MGAs are often associated with a hypersecretory adenoma. Transsphenoidal surgery is well tolerated by most patients, and when performed in combination with adjuvant therapy, a low rate of recurrence and reversal of preoperative endocrinopathy can be expected. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Long-Term Outcomes of Radiotherapy for Pituitary Adenomas

    International Nuclear Information System (INIS)

    Snead, Felicia E.; Amdur, Robert J. M.D.; Morris, Christopher G. M.S.; Mendenhall, William M.

    2008-01-01

    Purpose: To evaluate long-term local control and toxicity for pituitary adenomas treated with fractionated radiotherapy (RT). Methods and Materials: The records of 100 patients with pituitary adenomas treated between 1983 and 2003 were retrospectively reviewed. Thirty-one patients had hormone-secreting tumors; 69 patients were treated with surgery and postoperative RT. Median follow-up was 6.7 years (range, 0.6-20.2 years) for all patients and 6.2 years (range, 2-20.2 years) for living patients. The mean dose delivered was 45 Gy (range, 43-50.4 Gy). Results: The 10-year actuarial local control rates for nonsecreting and secreting adenomas were 98% and 73%, respectively (p 0.0015). Actuarial 10-year cause-specific survival (CSS) rates were 95% and 88%, and overall survival rates were 66% and 79% for nonsecreting and secreting adenomas, respectively. Involvement of the sphenoid sinus was found to be significantly associated with decreased 10-year CSS (p = 0.0453). When compared with the two- or three-field techniques, stereotactic RT was associated with improved CSS (p = 0.0775). CSS was not significantly associated with hormone excretion, extent of surgery, or whether RT was administrated postoperatively or for salvage after a postsurgical recurrence. New cases of hypopituitarism occurred in 35 patients. One patient experienced vision loss, and one patient developed a post-treatment glioma. Conclusions: This is one of the most mature series in the literature that documents excellent results with fractionated RT for pituitary adenoma. We recommend 45 Gy at 1.8 Gy per fraction using stereotactic noncoplanar fields

  10. Gigantism caused by growth hormone secreting pituitary adenoma.

    Science.gov (United States)

    Rhee, Noorisaem; Jeong, Kumi; Yang, Eun Mi; Kim, Chan Jong

    2014-06-01

    Gigantism indicates excessive secretion of growth hormones (GH) during childhood when open epiphyseal growth plates allow for excessive linear growth. Case one involved a 14.7-year-old boy presented with extreme tall stature. His random serum GH level was 38.4 ng/mL, and failure of GH suppression was noted during an oral glucose tolerance test (OGTT; nadir serum GH, 22.7 ng/mL). Magnetic resonance imaging (MRI) of the brain revealed a 12-mm-sized pituitary adenoma. Transsphenoidal surgery was performed and a pituitary adenoma displaying positive immunohistochemical staining for GH was reported. Pituitary MRI scan was performed 4 months after surgery and showed recurrence/residual tumor. Medical treatment with a long-acting somatostatin analogue for six months was unsuccessful. As a result, secondary surgery was performed. Three months after reoperation, the GH level was 0.2 ng/mL and insulin-like growth factor 1 was 205 ng/mL. Case two involved a 14.9-year-old boy, who was referred to our department for his tall stature. His basal GH level was 9.3 ng/mL, and failure of GH suppression was reported during OGTT (nadir GH, 9.0 ng/mL). Pituitary MRI showed a 6-mm-sized pituitary adenoma. Surgery was done and histopathological examination demonstrated a pituitary adenoma with positive staining for GH. Three months after surgery, the GH level was 0.2 ng/mL and nadir GH during OGTT was less than 0.1 ng/mL. Pituitary MRI scans showed no residual tumor. We present two cases of gigantism caused by a GH-secreting pituitary adenoma with clinical and microscopic findings.

  11. Gigantism caused by growth hormone secreting pituitary adenoma

    Directory of Open Access Journals (Sweden)

    Noorisaem Rhee

    2014-06-01

    Full Text Available Gigantism indicates excessive secretion of growth hormones (GH during childhood when open epiphyseal growth plates allow for excessive linear growth. Case one involved a 14.7-year-old boy presented with extreme tall stature. His random serum GH level was 38.4 ng/mL, and failure of GH suppression was noted during an oral glucose tolerance test (OGTT; nadir serum GH, 22.7 ng/mL. Magnetic resonance imaging (MRI of the brain revealed a 12-mm-sized pituitary adenoma. Transsphenoidal surgery was performed and a pituitary adenoma displaying positive immunohistochemical staining for GH was reported. Pituitary MRI scan was performed 4 months after surgery and showed recurrence/residual tumor. Medical treatment with a long-acting somatostatin analogue for six months was unsuccessful. As a result, secondary surgery was performed. Three months after reoperation, the GH level was 0.2 ng/mL and insulin-like growth factor 1 was 205 ng/mL. Case two involved a 14.9-year-old boy, who was referred to our department for his tall stature. His basal GH level was 9.3 ng/mL, and failure of GH suppression was reported during OGTT (nadir GH, 9.0 ng/mL. Pituitary MRI showed a 6-mm-sized pituitary adenoma. Surgery was done and histopathological examination demonstrated a pituitary adenoma with positive staining for GH. Three months after surgery, the GH level was 0.2 ng/mL and nadir GH during OGTT was less than 0.1 ng/mL. Pituitary MRI scans showed no residual tumor. We present two cases of gigantism caused by a GH-secreting pituitary adenoma with clinical and microscopic findings.

  12. Gigantism caused by growth hormone secreting pituitary adenoma

    Science.gov (United States)

    Rhee, Noorisaem; Jeong, Kumi; Yang, Eun Mi

    2014-01-01

    Gigantism indicates excessive secretion of growth hormones (GH) during childhood when open epiphyseal growth plates allow for excessive linear growth. Case one involved a 14.7-year-old boy presented with extreme tall stature. His random serum GH level was 38.4 ng/mL, and failure of GH suppression was noted during an oral glucose tolerance test (OGTT; nadir serum GH, 22.7 ng/mL). Magnetic resonance imaging (MRI) of the brain revealed a 12-mm-sized pituitary adenoma. Transsphenoidal surgery was performed and a pituitary adenoma displaying positive immunohistochemical staining for GH was reported. Pituitary MRI scan was performed 4 months after surgery and showed recurrence/residual tumor. Medical treatment with a long-acting somatostatin analogue for six months was unsuccessful. As a result, secondary surgery was performed. Three months after reoperation, the GH level was 0.2 ng/mL and insulin-like growth factor 1 was 205 ng/mL. Case two involved a 14.9-year-old boy, who was referred to our department for his tall stature. His basal GH level was 9.3 ng/mL, and failure of GH suppression was reported during OGTT (nadir GH, 9.0 ng/mL). Pituitary MRI showed a 6-mm-sized pituitary adenoma. Surgery was done and histopathological examination demonstrated a pituitary adenoma with positive staining for GH. Three months after surgery, the GH level was 0.2 ng/mL and nadir GH during OGTT was less than 0.1 ng/mL. Pituitary MRI scans showed no residual tumor. We present two cases of gigantism caused by a GH-secreting pituitary adenoma with clinical and microscopic findings. PMID:25077093

  13. Mismatch repair deficiency commonly precedes adenoma formation in Lynch Syndrome-Associated colorectal tumorigenesis.

    Science.gov (United States)

    Sekine, Shigeki; Mori, Taisuke; Ogawa, Reiko; Tanaka, Masahiro; Yoshida, Hiroshi; Taniguchi, Hirokazu; Nakajima, Takeshi; Sugano, Kokichi; Yoshida, Teruhiko; Kato, Mamoru; Furukawa, Eisaku; Ochiai, Atsushi; Hiraoka, Nobuyoshi

    2017-08-01

    Lynch syndrome is a cancer predisposition syndrome caused by germline mutations in mismatch repair (MMR) genes. MMR deficiency is a ubiquitous feature of Lynch syndrome-associated colorectal adenocarcinomas; however, it remains unclear when the MMR-deficient phenotype is acquired during tumorigenesis. To probe this issue, the present study examined genetic alterations and MMR statuses in Lynch syndrome-associated colorectal adenomas and adenocarcinomas, in comparison with sporadic adenomas. Among the Lynch syndrome-associated colorectal tumors, 68 of 86 adenomas (79%) and all adenocarcinomas were MMR-deficient, whereas all the sporadic adenomas were MMR-proficient, as determined by microsatellite instability testing and immunohistochemistry for MMR proteins. Sequencing analyses identified APC or CTNNB1 mutations in the majority of sporadic adenomas (58/84, 69%) and MMR-proficient Lynch syndrome-associated adenomas (13/18, 72%). However, MMR-deficient Lynch syndrome-associated adenomas had less APC or CTNNB1 mutations (25/68, 37%) and frequent frameshift RNF43 mutations involving mononucleotide repeats (45/68, 66%). Furthermore, frameshift mutations affecting repeat sequences constituted 14 of 26 APC mutations (54%) in MMR-deficient adenomas whereas these frameshift mutations were rare in MMR-proficient adenomas in patients with Lynch syndrome (1/12, 8%) and in sporadic adenomas (3/52, 6%). Lynch syndrome-associated adenocarcinomas exhibited mutation profiles similar to those of MMR-deficient adenomas. Considering that WNT pathway activation sufficiently drives colorectal adenoma formation, the distinct mutation profiles of WNT pathway genes in Lynch syndrome-associated adenomas suggest that MMR deficiency commonly precedes adenoma formation.

  14. Prognostic model for patients treated for colorectal adenomas with regard to development of recurrent adenomas and carcinoma

    DEFF Research Database (Denmark)

    Jensen, P; Krogsgaard, M R; Christiansen, J

    1996-01-01

    -80. INTERVENTIONS: All patients were followed up by rectoscopy and double contrast barium enema. The survival data were analysed by Cox's proportional hazards model. MAIN OUTCOME MEASURES: Variables of significant prognostic importance for recurrence of adenomas and the development of cancer were identified...

  15. Clonal karyotypic abnormalities in colorectal adenomas: clues to the early genetic events in the adenoma-carcinoma sequence

    DEFF Research Database (Denmark)

    Bomme, L; Bardi, G; Pandis, N

    1994-01-01

    and together with other numerical changes in another. A +7 was also present in one case with structural aberrations. Other recurrent numerical aberrations were -14 and -18, both found in 2 adenomas with structural karyotypic changes; in addition, one chromosome 14 was lost in one of the tumors with only...

  16. Keeping Tradition

    NARCIS (Netherlands)

    Zenhong, C.; Buwalda, P.L.

    2011-01-01

    Chinese dumplings such as Jiao Zi and Bao Zi are two of the popular traditional foods in Asia. They are usually made from wheat flour dough (rice flour or starch is sometimes used) that contains fillings. They can be steamed, boiled and fried and are consumed either as a main meal or dessert. As

  17. The incidence of cerebrovascular accidents in patients with pituitary adenoma

    International Nuclear Information System (INIS)

    Brada, M.; Burchell, L.; Ashley, S.; Traish, D.

    1999-01-01

    Background and Purpose: Patients with pituitary adenomas are effectively treated with a combination of surgery, radiotherapy, and medical therapy. Nevertheless, long-term studies suggest increased mortality that is independent of tumor control, with cerebrovascular accidents (CVA) as the major contributing cause. The purpose of this study was to define the frequency of CVAs in a cohort of patients with pituitary adenoma and identify potential predisposing factors. Patients and Methods: A cohort of 331 United Kingdom (UK) residents with pituitary adenoma treated at the Royal Marsden Hospital (RMH) between 1962 and 1986 was studied. The frequency of CVA was assessed from RMH and referring hospital records and clinicians, by postal questionnaire of referring hospitals and general practitioners, and by examination of all death certificates. The data were analyzed by actuarial methods, and risk factors were assessed by multivariate analysis. The data were compared to the incidence of CVA in the general population using a published UK population cohort. Results: Sixty-four of 331 patients developed CVA after primary treatment of pituitary adenoma. The actuarial incidence of CVA was 4% (95% CI: 2-7%) at 5 years, 11% (95% CI: 8-14%) at 10 years, and 21% (95% CI: 16-28%) at 20 years measured from the date of radiotherapy. The relative risk of CVA compared to the general population in the UK was 4.1. Age was an independent predictive factor for CVA. However, the relative risk in comparison to the general population was independent of age. The relative risk of developing CVA was higher in women compared to men, in patients undergoing debulking surgery compared to less radical procedures, and in patients diagnosed and treated in the 1980s compared to previous decades. The dose of radiotherapy was an additional independent prognostic factor on multivariate analysis. Conclusion: Patients with pituitary adenoma treated with surgery and radiotherapy have a significantly increased

  18. Radiosurgery for pituitary adenomas: evaluation of its efficacy and safety

    International Nuclear Information System (INIS)

    Castro, Douglas G; Cecílio, Soraya AJ; Canteras, Miguel M

    2010-01-01

    To assess the effects of radiosurgery (RS) on the radiological and hormonal control and its toxicity in the treatment of pituitary adenomas. Retrospective analysis of 42 patients out of the first 48 consecutive patients with pituitary adenomas treated with RS between 1999 and 2008 with a 6 months minimum follow-up. RS was delivered with Gamma Knife as a primary or adjuvant treatment. There were 14 patients with non-secretory adenomas and, among functioning adenomas, 9 were prolactinomas, 9 were adrenocorticotropic hormone-secreting and 10 were growth hormone-secreting tumors. Hormonal control was defined as hormonal response (decline of more than 50% from the pre-RS levels) and hormonal normalization. Radiological control was defined as stasis or shrinkage of the tumor. Hypopituitarism and visual deficit were the morbidity outcomes. Hypopituitarism was defined as the initiation of any hormone replacement therapy and visual deficit as loss of visual acuity or visual field after RS. The median follow-up was 42 months (6-109 months). The median dose was 12,5 Gy (9 - 15 Gy) and 20 Gy (12 - 28 Gy) for non-secretory and secretory adenomas, respectively. Tumor growth was controlled in 98% (41 in 42) of the cases and tumor shrinkage ocurred in 10% (4 in 42) of the cases. The 3-year actuarial rate of hormonal control and normalization were 62,4% and 37,6%, respectively, and the 5-year actuarial rate were 81,2% and 55,4%, respectively. The median latency period for hormonal control and normalization was, respectively, 15 and 18 months. On univariate analysis, there were no relationships between median dose or tumoral volume and hormonal control or normalization. There were no patients with visual deficit and 1 patient had hypopituitarism after RS. RS is an effective and safe therapeutic option in the management of selected patients with pituitary adenomas. The short latency of the radiation response, the highly acceptable radiological and hormonal control and absence of

  19. Radiosurgery for pituitary adenomas: evaluation of its efficacy and safety

    Directory of Open Access Journals (Sweden)

    Canteras Miguel M

    2010-11-01

    Full Text Available Abstract Object To assess the effects of radiosurgery (RS on the radiological and hormonal control and its toxicity in the treatment of pituitary adenomas. Methods Retrospective analysis of 42 patients out of the first 48 consecutive patients with pituitary adenomas treated with RS between 1999 and 2008 with a 6 months minimum follow-up. RS was delivered with Gamma Knife as a primary or adjuvant treatment. There were 14 patients with non-secretory adenomas and, among functioning adenomas, 9 were prolactinomas, 9 were adrenocorticotropic hormone-secreting and 10 were growth hormone-secreting tumors. Hormonal control was defined as hormonal response (decline of more than 50% from the pre-RS levels and hormonal normalization. Radiological control was defined as stasis or shrinkage of the tumor. Hypopituitarism and visual deficit were the morbidity outcomes. Hypopituitarism was defined as the initiation of any hormone replacement therapy and visual deficit as loss of visual acuity or visual field after RS. Results The median follow-up was 42 months (6-109 months. The median dose was 12,5 Gy (9 - 15 Gy and 20 Gy (12 - 28 Gy for non-secretory and secretory adenomas, respectively. Tumor growth was controlled in 98% (41 in 42 of the cases and tumor shrinkage ocurred in 10% (4 in 42 of the cases. The 3-year actuarial rate of hormonal control and normalization were 62,4% and 37,6%, respectively, and the 5-year actuarial rate were 81,2% and 55,4%, respectively. The median latency period for hormonal control and normalization was, respectively, 15 and 18 months. On univariate analysis, there were no relationships between median dose or tumoral volume and hormonal control or normalization. There were no patients with visual deficit and 1 patient had hypopituitarism after RS. Conclusions RS is an effective and safe therapeutic option in the management of selected patients with pituitary adenomas. The short latency of the radiation response, the highly

  20. Promoter methylation of Wnt-antagonists in polypoid and nonpolypoid colorectal adenomas

    International Nuclear Information System (INIS)

    Voorham, Quirinus JM; Mulder, Chris JJ; Engeland, Manon van; Meijer, Gerrit A; Steenbergen, Renske DM; Carvalho, Beatriz; Janssen, Jerry; Tijssen, Marianne; Snellenberg, Suzanne; Mongera, Sandra; Grieken, Nicole CT van; Grabsch, Heike; Kliment, Martin; Rembacken, Bjorn J

    2013-01-01

    Nonpolypoid adenomas are a subgroup of colorectal adenomas that have been associated with a more aggressive clinical behaviour compared to their polypoid counterparts. A substantial proportion of nonpolypoid and polypoid adenomas lack APC mutations, APC methylation or chromosomal loss of the APC locus on chromosome 5q, suggesting the involvement of other Wnt-pathway genes. The present study investigated promoter methylation of several Wnt-pathway antagonists in both nonpolypoid and polypoid adenomas. Quantitative methylation-specific PCR (qMSP) was used to evaluate methylation of four Wnt-antagonists, SFRP2, WIF-1, DKK3 and SOX17 in 18 normal colorectal mucosa samples, 9 colorectal cancer cell lines, 18 carcinomas, 44 nonpolypoid and 44 polypoid adenomas. Results were integrated with previously obtained data on APC mutation, methylation and chromosome 5q status from the same samples. Increased methylation of all genes was found in the majority of cell lines, adenomas and carcinomas compared to normal controls. WIF-1 and DKK3 showed a significantly lower level of methylation in nonpolypoid compared to polypoid adenomas (p < 0.01). Combining both adenoma types, a positive trend between APC mutation and both WIF-1 and DKK3 methylation was observed (p < 0.05). Methylation of Wnt-pathway antagonists represents an additional mechanism of constitutive Wnt-pathway activation in colorectal adenomas. Current results further substantiate the existence of partially alternative Wnt-pathway disruption mechanisms in nonpolypoid compared to polypoid adenomas, in line with previous observations

  1. A clinical feature and therapeutic strategy in pituitary adenomas associated with intracranial aneurysms

    International Nuclear Information System (INIS)

    Sasagawa, Yasuo; Tachibana, Osamu; Shiraga, Shunsuke; Takata, Hisasi; Akai, Takuya; Iizuka, Hideaki

    2012-01-01

    We studied the clinical feature and treatment strategy of pituitary adenomas associated with intracranial aneurysms. Among 102 pituitary adenoma patients (mean age: 54.8 years old) who received MR angiography and/or 3D-CT angiography,seven patients (6.9%) had intracranial aneurysms. The association of an aneurysm was more common in large size adenomas (p<0.05). According to the location of the aneurysms,five patients had these in the paraclinoid portion or cavernous portion of the internal carotid artery. Using MR images,we classified the aneurysms associated with pituitary adenomas as non-adjacent,adjacent,and intra-adenoma types. In non-adjacent types,an aneurysm is located apart from the adenoma,and has less chance of exposure during transsphenoidal surgery. In adjacent types,an aneurysm is located adjacent to the adenoma,and could be exposed during transsphenoidal surgery. In intra-adenoma types,an aneurysm is encased in the adenoma. In non-adjacent type aneurysms,a resection of the pituitary adenoma can be carried out before aneurysm treatment due to the low risk of rupture during surgery. In adjacent types,a tumor resection can precede aneurysm treatment in cases of low rupture risk aneurysms and untreatable aneurysms. In intra-adenoma types,adenoma resection should come after treatment of the aneurysms. Neurosurgeons should be careful about not only the presence of aneurysms in preoperative images during transsphenoidal surgery planning,but also their locations and proximity to adenomas. Such information may be crucial in deciding the order of treatment. (author)

  2. Characteristics of adenomas detected by fecal immunochemical test in colorectal cancer screening.

    Science.gov (United States)

    Cubiella, Joaquín; Castro, Inés; Hernandez, Vicent; González-Mao, Carmen; Rivera, Concepción; Iglesias, Felipe; Cid, Lucía; Soto, Santiago; de-Castro, Luisa; Vega, Pablo; Hermo, Jose Antonio; Macenlle, Ramiro; Martínez, Alfonso; Martínez-Ares, David; Estevez, Pamela; Cid, Estela; Herreros-Villanueva, Marta; Portillo, Isabel; Bujanda, Luis; Fernández-Seara, Javier

    2014-09-01

    Fecal immunochemical test (FIT) diagnostic accuracy for colorectal adenoma detection in colorectal cancer screening is limited. We analyzed 474 asymptomatic subjects with adenomas detected on colonoscopy in two blinded diagnostic tests studies designed to assess FIT diagnostic accuracy. We determined the characteristics of adenomas (number, size, histology, morphology, and location) and the risk of metachronous lesions (according to European guidelines). Finally, we performed a logistic regression to identify those variables independently associated with a positive result. Advanced adenomas were found in 145 patients (75.6% distal and 24.3% only proximal to splenic flexure). Patients were classified as low (59.5%), intermediate (30.2%), and high risk (10.3%) according to European guidelines. At a 100-ng/mL threshold, FIT was positive in 61 patients (12.8%). Patients with advanced adenomas [odds ratio (OR), 8.8; 95% confidence interval (CI), 4.76-16.25], distal advanced adenomas (OR, 6.7; 95% CI, 1.9-8.8), high risk (OR, 20.1; 95% CI, 8.8-45.8), or intermediate risk lesions (OR, 6; 95% CI, 2.9-12.4) had more probabilities to have a positive test. The characteristics of adenomas independently associated were number of adenomas (OR, 1.22; 95% CI, 1.04-1.42), distal flat adenomas (OR, 0.44; 95% CI, 0.21-0.96), pedunculated adenomas (OR, 2.28; 95% CI, 1.48-3.5), and maximum size of distal adenomas (mm; OR, 1.24; 95% CI, 1.16-1.32). European guidelines classification and adenoma location correlates with the likelihood of a positive FIT result. This information allows us to understand the FIT impact in colorectal cancer prevention. Likewise, it should be taken into account in the development of new colorectal adenomas biomarkers. ©2014 American Association for Cancer Research.

  3. Pure Androgen-Secreting Adrenal Adenoma Associated with Resistant Hypertension

    Directory of Open Access Journals (Sweden)

    René Rodríguez-Gutiérrez

    2013-01-01

    Full Text Available Pure androgen-secreting adrenal adenoma is very rare, and its diagnosis remains a clinical challenge. Its association with resistant hypertension is uncommon and not well understood. We present an 18-year-old female with a 10-year history of hirsutism that was accidentally diagnosed with an adrenal mass during the evaluation of a hypertensive crisis. She had a long-standing history of hirsutism, clitorimegaly, deepening of the voice, and primary amenorrhea. She was phenotypically and socially a male. FSH, LH, prolactin, estradiol, 17-hydroxyprogesterone, and progesterone were normal. Total testosterone and DHEA-S were elevated. Cushing syndrome, primary aldosteronism, pheochromocytoma, and nonclassic congenital adrenal hyperplasia were ruled out. She underwent adrenalectomy and pathology reported an adenoma. At 2-month followup, hirsutism and virilizing symptoms clearly improved and blood pressure normalized without antihypertensive medications, current literature of this unusual illness and it association with hypertension is presented and discussed.

  4. Anabolic steroid abuse causing recurrent hepatic adenomas and hemorrhage

    Science.gov (United States)

    Martin, Nicole M; Dayyeh, Barham K Abu; Chung, Raymond T

    2008-01-01

    Anabolic steroid abuse is common among athletes and is associated with a number of medical complications. We describe a case of a 27-year-old male bodybuilder with multiple hepatic adenomas induced by anabolic steroids. He initially presented with tumor hemorrhage and was treated with left lateral hepatic segmentectomy. Regression of the remaining tumors was observed with cessation of steroid use. However, 3 years and a half after his initial hepatic segmentectomy, he presented with recurrent tumor enlargement and intraperitoneal hemorrhage in the setting of steroid abuse relapse. Given his limited hepatic reserve, he was conservatively managed with embolization of the right accessory hepatic artery. This is the first reported case of hepatic adenoma re-growth with recidivistic steroid abuse, complicated by life-threatening hemorrhage. While athletes and bodybuilders are often aware of the legal and social ramifications of steroid abuse, they should continue to be counseled about its serious medical risks. PMID:18680242

  5. Pituitary adenoma with extensive calcaficcations mimicking crainopharyngioma: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Jin, Sung Chan; Lee, Seoung Ro; Kwon, Bae Ju; Moon, Won Jin; Jeon, Eui Yong [Hanyang Univ. College of Medicine, Seoul (Korea, Republic of)

    2001-01-01

    A 27-year-old man presented with complaints of headache and visual disturbance, first noted six months earlier. Simple radiographs of skull sellar widening and calcification. Brian CT revealed a 3 x 3 x 4 cm-sized sellar suprasellar mass with heavy calcification. T1-weighted MR images showed that the signal intencity of the mass was slightly lower than that of the gray matter, while T2-weighted images showed heterogeneous high signal intensity with centrl low-signal-intensity foci, suggesting calcification After contrast infusion, enancement was irregular. Surgery revealed a 4 x 5 cm sized, well-demarcated, lobulated mass adhering to the meninges. Papillary-type pituitary adenoma was histologically confirmed. We report the CT and MR findings of atypical pituitary adenoma with extensive internal calcification mimicking craniopharyngioma.

  6. Pituitary adenomas: historical perspective, surgical management and future directions

    Science.gov (United States)

    Theodros, Debebe; Patel, Mira; Ruzevick, Jacob; Lim, Michael; Bettegowda, Chetan

    2016-01-01

    Pituitary adenomas are among the most common central nervous system tumors. They represent a diverse group of neoplasms that may or may not secrete hormones based on their cell of origin. Epidemiologic studies have documented the incidence of pituitary adenomas within the general population to be as high as 16.7%. A growing body of work has helped to elucidate the pathogenesis of these tumors. Each subtype has been shown to demonstrate unique cellular changes potentially leading to tumorigenesis. Surgical advancements over several decades have included microsurgery and the employment of the endoscope for surgical resection. These advancements increase the likelihood of gross-total resection and have resulted in decreased patient morbidity. PMID:26497533

  7. Radiation therapy alone for growth hormone-producing pituitary adenomas

    Energy Technology Data Exchange (ETDEWEB)

    Plataniotis, G.A.; Kouvaris, J.R.; Vlahos, L.; Papavasiliou, C. [Athens Univ. (Greece). Dept. of Radiology

    1998-09-01

    We present our experience in the treatment of growth hormone (GH)-producing pituitary adenomas using irradiation alone. Between 1983 and 1991, 21 patients suffering from GH-secreting pituitary adenomas were treated with radiotherapy alone. Two bilateral opposing coaxial fields were used in 10 patients and in the remaining 11 a third frontovertex field was added. Treatment was given in 1.8-2 Gy daily fractions and total dose ranged between 45 and 54 Gy. Treatment was given using a cobalt unit. Four patients treated with somatostatin prior to and 14 patients treated after the end of radiotherapy experienced symptom relief for 6-28 weeks. The 5-year actuarial rate of disease control was 72%. Five out of six failed patients had macroadenomas. Hypopituitarism was observed in 5/21 (24%) patients. Whereas RT alone is effective in the treatment of microadenomas, this is not true for large infiltrative macroadenomas. (orig.)

  8. Radiation therapy alone for growth hormone-producing pituitary adenomas

    International Nuclear Information System (INIS)

    Plataniotis, G.A.; Kouvaris, J.R.; Vlahos, L.; Papavasiliou, C.

    1998-01-01

    We present our experience in the treatment of growth hormone (GH)-producing pituitary adenomas using irradiation alone. Between 1983 and 1991, 21 patients suffering from GH-secreting pituitary adenomas were treated with radiotherapy alone. Two bilateral opposing coaxial fields were used in 10 patients and in the remaining 11 a third frontovertex field was added. Treatment was given in 1.8-2 Gy daily fractions and total dose ranged between 45 and 54 Gy. Treatment was given using a cobalt unit. Four patients treated with somatostatin prior to and 14 patients treated after the end of radiotherapy experienced symptom relief for 6-28 weeks. The 5-year actuarial rate of disease control was 72%. Five out of six failed patients had macroadenomas. Hypopituitarism was observed in 5/21 (24%) patients. Whereas RT alone is effective in the treatment of microadenomas, this is not true for large infiltrative macroadenomas. (orig.)

  9. Anabolic steroid abuse causing recurrent hepatic adenomas and hemorrhage.

    Science.gov (United States)

    Martin, Nicole M; Abu Dayyeh, Barham K; Chung, Raymond T

    2008-07-28

    Anabolic steroid abuse is common among athletes and is associated with a number of medical complications. We describe a case of a 27-year-old male bodybuilder with multiple hepatic adenomas induced by anabolic steroids. He initially presented with tumor hemorrhage and was treated with left lateral hepatic segmentectomy. Regression of the remaining tumors was observed with cessation of steroid use. However, 3 years and a half after his initial hepatic segmentectomy, he presented with recurrent tumor enlargement and intraperitoneal hemorrhage in the setting of steroid abuse relapse. Given his limited hepatic reserve, he was conservatively managed with embolization of the right accessory hepatic artery. This is the first reported case of hepatic adenoma re-growth with recidivistic steroid abuse, complicated by life-threatening hemorrhage. While athletes and bodybuilders are often aware of the legal and social ramifications of steroid abuse, they should continue to be counseled about its serious medical risks.

  10. Radiation therapy in the multimodal treatment approach of pituitary adenoma

    Energy Technology Data Exchange (ETDEWEB)

    Becker, G. [Klinik am Eichert, Goeppingen (Germany). Dept. of Radiooncology and Radiation Therapy; Radiooncologic Univ. Clinic, Tuebingen (Germany); Kocher, M.; Mueller, R.P. [Koeln Univ. (Germany). Clinic of Radiation Therapy; Kortmann, R.D.; Paulsen, F.; Jeremic, B.; Bamberg, M. [Radiooncologic Univ. Clinic, Tuebingen (Germany)

    2002-04-01

    In this paper, literature will be reviewed to assess the role of modern radiotherapy and radiosurgery in the management of pituitary adenomas. Material and Methods: Nowadays, magnetic resonance imaging for the definition of the target volume and a real three-dimensional (3-D) treatment planning with field conformation and the possibility for non-coplanar irradiation has to be recommended. Most groups irradiate these benign tumors with single doses of 1.8-2.0 Gy up to a total dose of 45 Gy or 50.4 Gy in extensive parasellar adenomas. Adenomas are mostly small, well circumscribed lesions, and have, therefore, attracted the use of stereotactically guided high-precision irradiation techniques which allow extreme focussing and provide steep dose gradients with selective treatment of the target and optimal protection of the surrounding brain tissue. Results: Radiation therapy controls tumor growth in 80-98% of patients with non-secreting adenomas and 67-89% for endocrine active tumors. Reviewing the recent literature including endocrine active and non-secreting adenomas, irradiated postoperatively or in case of recurrence the 5-, 10- and 15-year local control rates amount 92%, 89% and 79%. In cases of microprolactinoma primary therapy consists of dopamine agonists. Irradiation should be preferred in patients with macroprolactinomas, when drug therapy and/or surgery failed or for patients medically unsuitable for surgery. Reduction and control of prolactin secretion can be achieved in 44-70% of patients. After radiotherapy in acromegaly patients somatomedin-C and growth hormone concentrations decrease to normal levels in 70-90%, with a decrease rate of 10-30% per year. Hypercortisolism is controlled in 50-83% of adults and 80% of children with Cushing's disease, generally in less than 9 months. Hypopituitarism is the most common side effect of pituitary irradiation with an incidence of 13-56%. Long-term overall risk for brain necrosis in a total of 1,388 analyzed

  11. Radiation therapy in the multimodal treatment approach of pituitary adenoma

    International Nuclear Information System (INIS)

    Becker, G.; Kocher, M.; Mueller, R.P.

    2002-01-01

    In this paper, literature will be reviewed to assess the role of modern radiotherapy and radiosurgery in the management of pituitary adenomas. Material and Methods: Nowadays, magnetic resonance imaging for the definition of the target volume and a real three-dimensional (3-D) treatment planning with field conformation and the possibility for non-coplanar irradiation has to be recommended. Most groups irradiate these benign tumors with single doses of 1.8-2.0 Gy up to a total dose of 45 Gy or 50.4 Gy in extensive parasellar adenomas. Adenomas are mostly small, well circumscribed lesions, and have, therefore, attracted the use of stereotactically guided high-precision irradiation techniques which allow extreme focussing and provide steep dose gradients with selective treatment of the target and optimal protection of the surrounding brain tissue. Results: Radiation therapy controls tumor growth in 80-98% of patients with non-secreting adenomas and 67-89% for endocrine active tumors. Reviewing the recent literature including endocrine active and non-secreting adenomas, irradiated postoperatively or in case of recurrence the 5-, 10- and 15-year local control rates amount 92%, 89% and 79%. In cases of microprolactinoma primary therapy consists of dopamine agonists. Irradiation should be preferred in patients with macroprolactinomas, when drug therapy and/or surgery failed or for patients medically unsuitable for surgery. Reduction and control of prolactin secretion can be achieved in 44-70% of patients. After radiotherapy in acromegaly patients somatomedin-C and growth hormone concentrations decrease to normal levels in 70-90%, with a decrease rate of 10-30% per year. Hypercortisolism is controlled in 50-83% of adults and 80% of children with Cushing's disease, generally in less than 9 months. Hypopituitarism is the most common side effect of pituitary irradiation with an incidence of 13-56%. Long-term overall risk for brain necrosis in a total of 1,388 analyzed patients

  12. US-guided percutaneous ethanol injection in Plummer's adenoma

    International Nuclear Information System (INIS)

    Lagalla, R.; Iovane, A.; Caruso, G.; Midiri, N.; Oliveri, D.; Brancato, G.; Cardinale, A.

    1991-01-01

    The authors report their experience in the study of 8 patients showing sympoms of thyroid hyperfunction (Plummer's adenoma) and treated with US-guided percutaneous ethanol injection. The treatment consisted in injecting sterile ethanol in varying amounts (2 to 5 ml) according to nodule size, using a fine needle under US guidance. The patients underwent 3 to 6 injections, according to biochemical (T3-T4-TSH) and scintigraphic findings. Follow-up ay 12 months showed regression of clinical symptoms, a trend of hormone levels toward normalization and recovery of previously suppressed parenchymal function. No significant complications were observed, except for a transient thyrotoxic crisis in the patient bearing the largest nodule. The treatment of Plummer's adenoma by means of percutaneous ethanol injection under us guidance appears to provide specific clinical and technical advantages over other conventional treatments

  13. Three cases of ectopic sphenoid sinus pituitary adenoma.

    Science.gov (United States)

    Bobeff, Ernest Jan; Wiśniewski, Karol; Papierz, Wielisław; Stefańczyk, Ludomir; Jaskólski, Dariusz Jan

    2017-01-01

    Introduction: Ectopic sphenoid sinus pituitary adenoma is a rare tumour originating from embryologic remnants of Rathke's pouch. Although it is considered a clinically benign neoplasm, necrosis is encountered in 25% of cases and it can invade adjacent bone structures. Aims: To establish clinical, radiological and histopathological features of ectopic sphenoid sinus pituitary adenoma. Material and methods: Analysis of three cases: two females and one man, aged 61-70. Results: One patient presented with a unilateral hearing loss, the other two with headache and vertigo. They all suffered from type 2 diabetes mellitus. Neurological examination revealed no abnormality. Radiological imaging showed a sphenoid sinus space-occupying soft-tissue lesion with bone erosion in 2 cases and empty sella in 2 patients whereas one had a normal pituitary gland. All were operated on via the transnasal approach. Total resection was achieved in one patient and subtotal in two; in two cases we observed intact sellar dura and in one intact sellar floor. Histopathology showed immunoreactivity for synaptophysin in all cases and cytokeratin in two. The Ki-67 index was less than 2%. Immunohistochemical staining demonstrated growth hormone cells in all cases whereas prolactin and adrenocorticotropin in two. The patients were discharged home in good condition with no neurological deficits. Conclusions: Ectopic sphenoid sinus pituitary adenoma should always be considered in differential diagnosis of sphenoid sinus lesion in the elderly, especially in coexistence with empty sella or type 2 diabetes mellitus. Since ectopic sphenoid sinus pituitary adenoma is a benign lesion, surgical removal is an effective treatment. .

  14. Prothymosin-alpha and Ki-67 expression in pituitary adenomas

    Directory of Open Access Journals (Sweden)

    Iga Wierzbicka-Tutka

    2016-11-01

    Full Text Available Introduction: Prothymosin alpha (PTMA, a nuclear oncoprotein involved in cell cycle regulation, is used as a prognostic marker in many cancers. The histopathology of pituitary carcinomas and locally invasive adenomas is indistinguishable from that of benign tumors. A new marker is needed to differentiate these lesions. We evaluated PTMA in pituitary adenomas to determine its usefulness as a prognostic factor of tumor proliferation.Material/Methods: We conducted a retrospective analysis of a group of 27 patients, including 15 females (56% and 12 males (44% with a mean age of 58.6±12 years, who underwent pituitary tumor surgery between 2003 and 2012. The Ki-67 and PTMA-nuclear (PTMA-n and PTMA-cytoplasmic (PTMA-c indices were determined by immunohistochemical staining. We studied histopathological features, clinical symptoms, and magnetic resonance imaging or computed tomography performed before surgery and one year following surgery to evaluate tumor size and progression.Results: The expression of Ki-67 was revealed in 77.8% of adenomas, PTMA-n in 81.5% and PTMA-c in 92.6%. The mean value of the Ki-67 index was 1.8%, PTMA-n was 1.84%, and PTMA-c was 35.6%. There was a significant positive correlation between Ki-67 and PTMA-n (p=0.009. We did not find any correlation between Ki-67, PTMA-c, and tumor progression. PTMA-n was found to be correlated with tumor size (p=0.045 and was higher in the case of gonadotropinomas (p=0.026.Conclusions: The positive nuclear expression of Ki-67 and PTMA was observed in the majority of pituitary adenomas. Neither the expression of Ki-67 nor that of PTMA-c was related to tumor recurrence or local invasion.

  15. Surgical management of pituitary adenomas by transsphenoidal approach

    International Nuclear Information System (INIS)

    Liebert, W.; Szyfter, W.; Tokarz, F.; Szmeja, Z.; Paprzycki, W.

    1994-01-01

    In the years 1976-1993 we have performed 90 transsphenoidal approaches for pituitary adenomas. This paper presents a detail report concerning 23 cases, operated in the last 2 years, with CT and NMR documentation. A preoperative visual deficit was very common in this group of patients. In the postoperative period the dramatic improvement of the vision was observed in 86% of cases. In our opinion the transsphenoidal approach is very useful for the operation of the tumors with suprasellar expansion. (author)

  16. Three cases of ectopic sphenoid sinus pituitary adenoma

    Directory of Open Access Journals (Sweden)

    Ernest Jan Bobeff

    2017-03-01

    Full Text Available Introduction : Ectopic sphenoid sinus pituitary adenoma is a rare tumour originating from embryologic remnants of Rathke’s pouch. Although it is considered a clinically benign neoplasm, necrosis is encountered in 25% of cases and it can invade adjacent bone structures. Aims : To establish clinical, radiological and histopathological features of ectopic sphenoid sinus pituitary adenoma. Material and methods: Analysis of three cases: two females and one man, aged 61-70. Results : One patient presented with a unilateral hearing loss, the other two with headache and vertigo. They all suffered from type 2 diabetes mellitus. Neurological examination revealed no abnormality. Radiological imaging showed a sphenoid sinus space-occupying soft-tissue lesion with bone erosion in 2 cases and empty sella in 2 patients whereas one had a normal pituitary gland. All were operated on via the transnasal approach. Total resection was achieved in one patient and subtotal in two; in two cases we observed intact sellar dura and in one intact sellar floor. Histopathology showed immunoreactivity for synaptophysin in all cases and cytokeratin in two. The Ki-67 index was less than 2%. Immunohistochemical staining demonstrated growth hormone cells in all cases whereas prolactin and adrenocorticotropin in two. The patients were discharged home in good condition with no neurological deficits. Conclusions : Ectopic sphenoid sinus pituitary adenoma should always be considered in differential diagnosis of sphenoid sinus lesion in the elderly, especially in coexistence with empty sella or type 2 diabetes mellitus. Since ectopic sphenoid sinus pituitary adenoma is a benign lesion, surgical removal is an effective treatment.

  17. 68Ga-DOTA-TOC Uptake in Pleomorphic Adenoma.

    Science.gov (United States)

    Laurens, S Tom; Netea-Maier, Romana T; Aarntzen, Erik J H G

    2018-07-01

    A 56-year-old man who was recently diagnosed with a carcinoid tumor of the os petrosum was referred for a Ga-DOTA-TOC PET/CT scan. Besides the moderately increased Ga-DOTA-TOC accumulation in the carcinoid tumor, the scan showed strongly increased and focal Ga-DOTA-TOC uptake in an additional lesion in the right parotid gland. The markedly different Ga-DOTA-TOC avidity suggested a different etiology, and histological examination demonstrated a pleomorphic adenoma.

  18. Visual complications following irradiation for pituitary adenomas and craniopharyngiomas

    International Nuclear Information System (INIS)

    Harris, J.R.; Levene, M.B.

    1976-01-01

    Of 55 patients with pituitary adenomas or craniopharyngiomas treated with irradiation, a retrospective study revealed that 5 sustained a visual loss compatible with radiation damage to the optic nerve. No patient who received less than 250 rads/day fractions showed such visual loss. Within the range of total dosages used in this series, total dose was not an important determinant of this complication. The time to occurrence of visual disturbance ranged from 5 to 34 months following therapy

  19. Abdominal obesity as the colorectal adenomas risk factor

    Directory of Open Access Journals (Sweden)

    K. N. Mylytsya

    2016-10-01

    Full Text Available Obesity is a risk factor for many diseases, including colorectal cancer. Aim: to study association of the constitutional features (height, weight, waist circumference with detection of colon polyps on the screening colonoscopy. Materials and methods: Constitutional features (height, weight, waist circumference of 145 patients were assessed with detection of colon polyps on the screening colonoscopy for the period from 2013to 2015. Exclusion criteria were: cancer of any location in history, surgery within the past two years, the inflammatory bowel diseases (Crohn's disease, ulcerative colitis, autoimmune diseases (rheumatoid arthritis, HIV, AIDS, SLE, diabetes, chronic liver or kidney disease, family polyposis. Results: the presence of adenomas (OR = 6.0 CI: 2,2-16,7; multiplicity of polyps (the possibility that there will be ≥ 3 polyps was 6.4, CI: 1,4-29,9 were significantly higher in obese patients than in those with normal weight. Subjects with a waist circumference in the highest tertile (>115 cm, were 4.6 times more likely to identify ≥ 3 polyps than those with waist circumference in the lowest tertile (<96 cm . The probability of detection of adenomas in patients with a waist circumference in the highest tertile were 6.2 times higher than in the lowest tertile. Conclusions. Visceral obesity is associated with a morphological type and number of colon polyps. The presence of visceral obesity significantly increases the risk of colon adenomas. Increased visceral fat layer is an indication for colonoscopy especially of the right half of the colon examination. Screening colonoscopy should be recommended for the obese patients after 50 y.o. in order to diagnose adenomas of the colon and colorectal cancer.

  20. Therapeutic options in the management of autonomously functioning thyroid adenomas

    International Nuclear Information System (INIS)

    Barrenechea, E.A.; Ong, A.

    2005-01-01

    Full text: Autonomously functioning thyroid nodules or adenomas (AFTN or AFTA) was established as a clinical entity in 1918 by Goetsch correlating cellular mitochondrial content with nodular function and showing the inverse correlation between AFTN function and extra nodular tissue function. They are almost always benign and degeneration, which is common in AFTN, can result in the development of hyperthyroidism. It is therefore important to know the function of these nodules by requesting for the thyroid function tests namely T3, T4, and TSH. They are diagnosed by thyroid scans using I-131 or Tc 99m as a hot solitary nodule in one lobe with the other lobe not appearing on scan or suppressed. The frequency of AFTA worldwide is quite variable depending on geography. It ranges from 1% in North America to 10 % in some areas in Europe and Asia or in areas of iodine deficiency. The traditional methods of treatment of these nodules have been surgery and radioactive iodine ablation. Surgical treatment as a rule is indicated in young patients with nodules larger than 3 cm and those with local compressive symptoms. RAI is used in elderly patients and those who are poor surgical risks. The usual dose ranges from 20 to 30 mCi and is definitely larger that when treating Graves' disease. Others have resorted to PEI or percutaneous ethanol injection with reported success. There has been no definite management of these AFTA due to the variable natural history and some would only recommend observation for asymptomatic small adenomas, which are euthyroid. Therefore this paper studied the results of treatment using RAI ablation, surgery or plain observation for AFTA. Percutaneous ethanol injection is not being done in our center. In the local setting, where thyroid disease is still endemic, the incidence of AFTA is not so high. Graves' disease is still the predominating cause of hyperthyroidism followed by multinodular goiter. Toxic AFTA occurs in 3% of the total hyperthyroid

  1. Follicular adenoma in ectopic thyroid. A case-report.

    Science.gov (United States)

    Consalvo, Vincenzo; Barbieri, Gerarda; Rossetti, Amalia Rosaria Rita; Romano, Mafalda; Contieri, Rosaria; Tramontano, Salvatore; Rescigno, Carmela; Infranzi, Massimo; Lombardi, Domenico

    2017-01-01

    The term ectopic thyroid refers to the presence of thyroid tissue located far from its usual anatomic placement and with no vascular connection to the main gland. The presence of swelling in atypical locations is diagnostically differentiated from other pathologies like pleomorphic adenoma or carcinoma, inflammatory lesions like sialadenitis, neurogenic tumors, paraganglioma, fibrolipoma and lymphadenopaties of diverse etiologies. Here we present the case of a submandibular ectopic thyroid in a 67year old woman. She came to our attention for a left submandibular swelling. The anamnesis did not show related pathologies, as well as blood tests. Diagnostic image studies and a FNAC were performed. The mass was surgically removed and histopatology showed a follicular adenoma in the contest of the capsulated lesion. It is important to not underestimate these types of lesions and procede with hematochemical, instrumental tests and above all surgery that can eliminate any diagnostic uncertainty and on the whole be therapeutic. It should not be forgotten that ectopic thyroid tissue can be a site for adenoma or papillary carcinoma and thus any watch and wait strategy should be avoided. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  2. Shift of the pituitary stalk in intrasellar pituitary adenomas

    International Nuclear Information System (INIS)

    Ito, Jusuke; Tokiguchi, Susumu; Nakamori, Akitoshi; Watanabe, Akira; Yokoyama, Motoharu.

    1982-01-01

    Fifty-one patients from a group of 344 patients undergoing the evaluation of intrasellar or parasellar tumors were diagnosed on CT as having an intrasellar pituitary adenoma. Axial transverse sections were performed at -10 0 to Reid's basal line, using 1.5-mm-thick slices and sagittal and coronal reformation. Of these 51 patients, 17 showed a shift of the pituitary stalk. The area where a tumor was thought to be located within the sella turcica on preoperative CT became defective on CT after transsphenoidal surgery in all cases. Histological verification was obtained in all cases. Also, the shift of the pituitary stalk was normalized or markedly improved after surgery in all cases. In functioning tumors, all cases except two showed an endocrinologically normal state or a marked improvement after transsphenoidal surgery. On the basis of the above-mentioned facts, it was concluded that the shift of the pituitary stalk in intrasellar pituitary adenomas indicated the evidence of a mass and its location in the sella turcica. However, a shift of the pituitary stalk was also observed under other conditions, such as empty sella and tuberculum sellae meningioma, and so it is not a pathognomonic finding in intrasellar pituitary adenomas. (author)

  3. Therapy of benign thyroid diseases (hyperthyroidism, autonomic adenomas, euthyreotic struma)

    International Nuclear Information System (INIS)

    Glanzmann, C.; Horst, W.

    1976-01-01

    The study deals with methods of treatment of benign thyroid affections: diffuse hyperthyroidism, autonomous adenoma, euthyreotic struma. 70% of the patients examined require resective therapy for diffuse hyperthyroidism. In the majority of the cases radio-iodine resection is the method to be chosen. The risk of an eventual X-ray cancer is smaller than the operation mortality. As far as children and adolescents are concerned, 131-iodine therapy is generally not advisable because of the carcinogenic risk which might be heightened. The autonomous adenoma can be eliminated without any problems by using 131-iodine. In case of a large adenoma with considerable regressive changes operation should be preferred. The therapeutic measures in the case of a struma mainly depend on the question if there are any clinical symptoms or any signs indicating an increased risk of malignancy. In case of mechanical complaints caused by a struma nodosa without important regressive changes parenchyma can be reduced by administering 131-iodine once or several times. The reduction of the thyroid function to the middle or lower limit of the normal range in case of euthyreosis is carried out by 131-iodine administration. (GSE) [de

  4. Trophic and neurotrophic factors in human pituitary adenomas (Review).

    Science.gov (United States)

    Spoletini, Marialuisa; Taurone, Samanta; Tombolini, Mario; Minni, Antonio; Altissimi, Giancarlo; Wierzbicki, Venceslao; Giangaspero, Felice; Parnigotto, Pier Paolo; Artico, Marco; Bardella, Lia; Agostinelli, Enzo; Pastore, Francesco Saverio

    2017-10-01

    The pituitary gland is an organ that functionally connects the hypothalamus with the peripheral organs. The pituitary gland is an important regulator of body homeostasis during development, stress, and other processes. Pituitary adenomas are a group of tumors arising from the pituitary gland: they may be subdivided in functional or non-functional, depending on their hormonal activity. Some trophic and neurotrophic factors seem to play a key role in the development and maintenance of the pituitary function and in the regulation of hypothalamo-pituitary-adrenocortical axis activity. Several lines of evidence suggest that trophic and neurotrophic factors may be involved in pituitary function, thus suggesting a possible role of the trophic and neurotrophic factors in the normal development of pituitary gland and in the progression of pituitary adenomas. Additional studies might be necessary to better explain the biological role of these molecules in the development and progression of this type of tumor. In this review, in light of the available literature, data on the following neurotrophic factors are discussed: ciliary neurotrophic factor (CNTF), transforming growth factors β (TGF‑β), glial cell line-derived neurotrophic factor (GDNF), nerve growth factor (NGF), vascular endothelial growth factor (VEGF), vascular endothelial growth inhibitor (VEGI), fibroblast growth factors (FGFs) and epidermal growth factor (EGF) which influence the proliferation and growth of pituitary adenomas.

  5. Bartholin’s gland adenoma in a Saanen goat

    Directory of Open Access Journals (Sweden)

    Jessica Regina Moreira

    2017-12-01

    Full Text Available ABSTRACT: Tumors affecting Bartholin’s gland are considered rare in human medicine; there are few reports in the veterinary literature, with descriptions occurring only in cows. This article described the clinical and pathological findings associated with Bartholin’s gland adenoma in a goat. Clinically, a 7-year-old pregnant Saanen goat presented bilateral enlargement of the vulva that did not regress spontaneously after parturition. Grossly, these vulvar masses were multilobulated, contained cystic areas from which oozed a whitish fluid. Histopathology revealed an adenoma characterized by the proliferation of irregularly shaped neoplastic epithelial cells that formed tubular to glandular-like structures. These neoplastic cells demonstrated moderate anisokaryosis and evident nucleoli. The intratumoral proliferation index (PI was estimated by immunoreactivity with the protein ki-67. Further, the glandular-like structures produced a Periodic Acid-Schiff positive secretion. A diagnosis of Bartholin’s gland adenoma was established due to the anatomic location of the neoplastic growths, the histopathological features, and the PI of the tumor.

  6. The clinical pathologic research of invasive pituitary adenomas

    International Nuclear Information System (INIS)

    Guo Lingchuan; Zheng Yushuang; Wang Shouli; Hui Guozhen; Li Xiangdong

    2012-01-01

    Objective: To study the pathological morphologic characteristics of invasive pituitary tumor and the affect of vascularization to the tumor's invasion. Methods: One hundred and thirty cases of pituitary adenoma patients were divided into two groups, including invasive pituitary adenomas and non-invasive pituitary adenomas, and the clinical data of two groups were analysed and compared. Results : The difference was statistically significant between the invasive group and the non-invasive group in the incidence rate of pathological morphologic characteristics such as high nuclear cytoplasmic ratio, cell pleomorphism, nuclear atypia and nucleoli appearance (P<0.05); there were nuclear atypia and nucleolus margination in the invasive group through electron microscopy. And there was statistical significant difference in rate of MVD expression which was higher in the invasive group than that of noninvasive group (P<0.05). Conclusion: The pathological morphologic characteristics of pituitary tumor and the high expression of MVD are significantly reference valuable in tumor aggression diagnosis, which provides valuable indicators for early clinical diagnosis of tumor invasion. (authors)

  7. Intraosseous pleomorphic adenoma: case report and review of the literature.

    Science.gov (United States)

    Aver-De-Araujo, L M; Chaves-Tarquinio, S B; Neuzling-Gomes, A P; Etges, A

    2002-01-01

    Pleomorphic adenoma is the most common neoplasm of the salivary glands, affecting mainly the parotid gland. The preferential intraoral site of this tumor is the palate. A case of a 31-year-old woman with an intraosseous pleomorphic adenoma located in the maxilla (left paramedian region), showing an approximate evolution of one year is reported. The present intraosseous case represents a rare location, with the tumor probably originating from glandular epithelial remnants captured during embryogenesis. In a review of the literature of 142 cases of intragnathic localization (24% in the maxilla) are identified. A slight predominance of women was observed (56%), with 55% of the patients being affected during the 5th to 7th decade of life. The tumors were malignant in 94% of the cases, with special predominance of mucoepidermoid carcinoma (65%). Intraosseous pleomorphic adenomas are rare, with the present patient being the 6th case reported in the literature and the second found in the maxilla. Mean age of the 5 previously reported cases was 58.8 years.

  8. Anaplastic astrocytoma 14 years after radiotherapy for pituitary adenoma

    International Nuclear Information System (INIS)

    Tamura, Masaru; Misumi, Syuuzou; Kurosaki, Syuuhei; Shibasaki, Takashi; Ohye, Chihiro

    1992-01-01

    A case of anaplastic astrocytoma following radiotherapy for growth hormone secreting pituitary adenoma is presented with a review of the literature. A 43 year old female was admitted with signs of acromegaly and hypertension. An eosinophilic pituitary adenoma was subtotally removed by transsphenoidal approach, followed by 60 Gy irradiation using a 2x2 cm lateral field. Fourteen years later at the age of 57, she suffered from headache, recent-memory disturbance and uncinate fits. CT scan and MRI disclosed ring-like enhanced mass lesion in the left temporal lobe, corresponding to the previous irradiated field. 18 F-FDG PET showed hypermetabolism at the lesion. Left frontotemporal craniotomy was performed, and a reddish gray gelatinous tumor containing necrotic center and cyst was partially removed. Histologically, the tumor consisted of hypercellular astrocytic cells with perivascular pseudorosette. Coagulation necrosis at the center of the tumor, and hyalinosis and fibrosis of the blood vessels in and around the tumor, which might have been caused by the antecedent radiotherapy, were recognized. Postoperative radiotherapy and chemotherapy, were given, however, she expired 13 months after the operation. Seven cases, including ours, of malignant glioma following radiotherapy for pituitary adenoma were reported in the literature. A total dose of irradiation varies from 45 to 95 Gy with a mean of 50 Gy. The period of latency before tumor occurrence ranges from 5 to 22 years with a mean of 10 years. The differentiation of radiation-induced gliomas from radionecrosis of the brain is also discussed. (author)

  9. Anaplastic astrocytoma 14 years after radiotherapy for pituitary adenoma

    Energy Technology Data Exchange (ETDEWEB)

    Tamura, Masaru; Misumi, Syuuzou; Kurosaki, Syuuhei; Shibasaki, Takashi; Ohye, Chihiro (Gunma Univ., Maebashi (Japan). School of Medicine)

    1992-04-01

    A case of anaplastic astrocytoma following radiotherapy for growth hormone secreting pituitary adenoma is presented with a review of the literature. A 43 year old female was admitted with signs of acromegaly and hypertension. An eosinophilic pituitary adenoma was subtotally removed by transsphenoidal approach, followed by 60 Gy irradiation using a 2x2 cm lateral field. Fourteen years later at the age of 57, she suffered from headache, recent-memory disturbance and uncinate fits. CT scan and MRI disclosed ring-like enhanced mass lesion in the left temporal lobe, corresponding to the previous irradiated field. {sup 18}F-FDG PET showed hypermetabolism at the lesion. Left frontotemporal craniotomy was performed, and a reddish gray gelatinous tumor containing necrotic center and cyst was partially removed. Histologically, the tumor consisted of hypercellular astrocytic cells with perivascular pseudorosette. Coagulation necrosis at the center of the tumor, and hyalinosis and fibrosis of the blood vessels in and around the tumor, which might have been caused by the antecedent radiotherapy, were recognized. Postoperative radiotherapy and chemotherapy, were given, however, she expired 13 months after the operation. Seven cases, including ours, of malignant glioma following radiotherapy for pituitary adenoma were reported in the literature. A total dose of irradiation varies from 45 to 95 Gy with a mean of 50 Gy. The period of latency before tumor occurrence ranges from 5 to 22 years with a mean of 10 years. The differentiation of radiation-induced gliomas from radionecrosis of the brain is also discussed. (author).

  10. Correlation between scintillographic-and morphologic findings in 78 follicular adenomas of thyroid

    International Nuclear Information System (INIS)

    Santos, M.E.; Silva, W.; Andreghetti, C.R.; Kiy, Y.; Franco, M.F.

    1981-01-01

    Correlation between Scintilographic and morphologic findings was investigated in 78 follicular adenomas of thyroid found in 249 thyroidectomies carried out at the University Hospital of the Botucatu Medical School from 1973 to 1978. Most patients were female ranging from 20 to 59 yaars of age. There was agreement between Scintilography and morphology in 75% of the 48 cold nodules: low 131 I - uptake and cystic of histologically non - non functioning adenomas (embrionary, fetal or macrofollicular types). Among the 12 warm nodules there was Scintilographic - morphological agreement in 50% of the cases (normal 135 I - uptake and simple adenoma) and disagreement in 50% (normal 135 I - uptake and cystic or histologically non-functioning adenomas). Most of the 18 hot adenomas showed hyperplastic follicular histology goth in the toxic and non-toxic nodules. In the thyroid surrounding the adenomas, histological foci of follicular hyperplasia in 8.9% and of lymphocitic thyroiditis in 33.3% of the cases were found. (Author) [pt

  11. Recurrent rearrangements of the PLAG1 and HMGA2 genes in lacrimal gland pleomorphic adenoma and carcinoma ex pleomorphic adenoma

    DEFF Research Database (Denmark)

    Andreasen, Simon; von Holstein, Sarah L; Homøe, Preben

    2018-01-01

    PURPOSE: Lacrimal gland tumours constitute a wide spectrum of neoplastic lesions that are histologically similar to tumours of the salivary gland. In the salivary gland, pleomorphic adenoma (PA) is frequently characterized by recurrent chromosomal rearrangements of the PLAG1 and HMGA2 genes......, a genetic feature retained in carcinoma ex pleomorphic adenoma (ca-ex-PA) that makes it possible to distinguish ca-ex-PA from de novo carcinomas. However, whether PLAG1 and HMGA2 gene rearrangements are found in lacrimal gland PA and ca-ex-PA is not known. METHODS: Twenty-one lacrimal gland PAs and four ca......-ex-PAs were retrospectively reviewed and subjected to break-apart fluorescence in situ hybridization (FISH) for rearrangements of the PLAG1 gene. Cases without PLAG1 abnormalities were subjected to HMGA2 break-apart FISH. Immunohistochemical staining for PLAG1 and HMGA2 protein was performed and correlated...

  12. Successful repeat transcatheter ablation of a mediastinal parathyroid adenoma 6 years after alcohol embolization

    International Nuclear Information System (INIS)

    Cook, Gary J. R.; Fogelman, Ignac; Reidy, John F.

    1997-01-01

    Recurrent hyperparathyroidism is rare following transcatheter ablation of mediastinal parathyroid adenomas. When it occurs it is usually early and resistant to further attempts at ablation. We present a patient with primary hyperparathyroidism in whom two surgical attempts at cure had been unsuccessful. Subsequently, a mediastinal adenoma was demonstrated angiographically and embolized with absolute alcohol. Hyperparathyroidism recurred 6 years later and the mediastinal adenoma was subsequently successfully ablated a second time by angiographic embolization with ionic contrast medium

  13. Diagnosis of adrenal adenoma and hyperplasia by CT and adrenal scintigraphy

    International Nuclear Information System (INIS)

    Miura, Kentaro; Itami, Jun; Nawano, Shigeru; Okada, Junichi; Ogino, Takashi; Uno, Koichi; Arimizu, Noboru

    1985-01-01

    The evaluation of X-CT and adrenal scintigraphy in diagnosis of Cushing syndrome and primary aldosteronism was studied in 18 patients. In Cushing syndrome, CT appearance of adenoma is commonly larger than that of primary aldosteronism and cleary deliniated by surrounding fat. So, in Cushing syndrome, diagnosis of adenoma on CT is much easier than that of primary aldosteronism, and absence of adenoma on CT suggests adrenal hyperplasia. In primary aldosteronism both of CT and scintigraphy must be performed. (author)

  14. Increased rectal microbial richness is associated with the presence of colorectal adenomas in humans

    OpenAIRE

    Sanapareddy, Nina; Legge, Ryan M; Jovov, Biljana; McCoy, Amber; Burcal, Lauren; Araujo-Perez, Felix; Randall, Thomas A; Galanko, Joseph; Benson, Andrew; Sandler, Robert S; Rawls, John F; Abdo, Zaid; Fodor, Anthony A; Keku, Temitope O

    2012-01-01

    Differences in the composition of the gut microbial community have been associated with diseases such as obesity, Crohn's disease, ulcerative colitis and colorectal cancer (CRC). We used 454 titanium pyrosequencing of the V1–V2 region of the 16S rRNA gene to characterize adherent bacterial communities in mucosal biopsy samples from 33 subjects with adenomas and 38 subjects without adenomas (controls). Biopsy samples from subjects with adenomas had greater numbers of bacteria fr...

  15. Radiotherapy for pituitary adenomas: long-term outcome and complications

    Energy Technology Data Exchange (ETDEWEB)

    Rim, Chai Hong; Yang, Dae Sik; Park, Young Je; Yoon, Won Sup; Lee, Jung AE; Kim, Chul Yong [Korea University Medical Center, Seoul (Korea, Republic of)

    2011-09-15

    To evaluate long-term local control rate and toxicity in patients treated with external beam radiotherapy (EBRT) for pituitary adenomas. We retrospectively reviewed the medical records of 60 patients treated with EBRT for pituitary adenoma at Korea University Medical Center from 1996 and 2006. Thirty-fi ve patients had hormone secreting tumors, 25 patients had non-secreting tumors. Fifty-seven patients had received postoperative radiotherapy (RT), and 3 had received RT alone. Median total dose was 54 Gy (range, 36 to 61.2 Gy). The definition of tumor progression were as follows: evidence of tumor progression on computed tomography or magnetic resonance imaging, worsening of clinical sign requiring additional operation or others, rising serum hormone level against a previously stable or falling value, and failure of controlling serum hormone level so that the hormone level had been far from optimal range until last follow-up. Age, sex, hormone secretion, tumor extension, tumor size, and radiation dose were analyzed for prognostic significance in tumor control. Median follow-up was 5.7 years (range, 2 to 14.4 years). The 10-year actuarial local control rates for non-secreting and secreting adenomas were 96% and 66%, respectively. In univariate analysis, hormone secretion was significant prognostic factor (p = 0.042) and cavernous sinus extension was marginally significant factor (p = 0.054) for adverse local control. All other factors were not significant. In multivariate analysis, hormone secretion and gender were significant. Fifty-three patients had mass-effect symptoms (headache, dizziness, visual disturbance, hypopituitarism, loss of consciousness, and cranial nerve palsy). A total of 17 of 23 patients with headache and 27 of 34 patients with visual impairment were improved. Twenty-seven patients experienced symptoms of endocrine hypersecretion (galactorrhea, amenorrhea, irregular menstruation, decreased libido, gynecomastia, acromegaly, and Cushing

  16. Radiotherapy for pituitary adenomas: long-term outcome and complications

    International Nuclear Information System (INIS)

    Rim, Chai Hong; Yang, Dae Sik; Park, Young Je; Yoon, Won Sup; Lee, Jung AE; Kim, Chul Yong

    2011-01-01

    To evaluate long-term local control rate and toxicity in patients treated with external beam radiotherapy (EBRT) for pituitary adenomas. We retrospectively reviewed the medical records of 60 patients treated with EBRT for pituitary adenoma at Korea University Medical Center from 1996 and 2006. Thirty-fi ve patients had hormone secreting tumors, 25 patients had non-secreting tumors. Fifty-seven patients had received postoperative radiotherapy (RT), and 3 had received RT alone. Median total dose was 54 Gy (range, 36 to 61.2 Gy). The definition of tumor progression were as follows: evidence of tumor progression on computed tomography or magnetic resonance imaging, worsening of clinical sign requiring additional operation or others, rising serum hormone level against a previously stable or falling value, and failure of controlling serum hormone level so that the hormone level had been far from optimal range until last follow-up. Age, sex, hormone secretion, tumor extension, tumor size, and radiation dose were analyzed for prognostic significance in tumor control. Median follow-up was 5.7 years (range, 2 to 14.4 years). The 10-year actuarial local control rates for non-secreting and secreting adenomas were 96% and 66%, respectively. In univariate analysis, hormone secretion was significant prognostic factor (p = 0.042) and cavernous sinus extension was marginally significant factor (p = 0.054) for adverse local control. All other factors were not significant. In multivariate analysis, hormone secretion and gender were significant. Fifty-three patients had mass-effect symptoms (headache, dizziness, visual disturbance, hypopituitarism, loss of consciousness, and cranial nerve palsy). A total of 17 of 23 patients with headache and 27 of 34 patients with visual impairment were improved. Twenty-seven patients experienced symptoms of endocrine hypersecretion (galactorrhea, amenorrhea, irregular menstruation, decreased libido, gynecomastia, acromegaly, and Cushing's disease

  17. Migratory patterns and population structure among breeding and wintering red-breasted mergansers (Mergus serrator) and common mergansers (M. merganser)

    Science.gov (United States)

    Pearce, J.M.; McCracken, K.G.; Christensen, Thomas K.; Zhuravlev, Y.N.

    2009-01-01

    Philopatry has long been assumed to structure populations of waterfowl and other species of birds genetically, especially via maternally transmitted mitochondrial DNA (mtDNA), yet other migratory behaviors and nesting ecology (use of ground vs. cavity sites) may also contribute to population genetic structure. We investigated the effects of migration and nesting ecology on the population genetic structure of two Holarctic waterfowl, the Red-breasted Merganser (Mergus serrator) and Common Merganser (M. merganser), using mtDNA control-region sequence data. Red-breasted Mergansers (a ground-nesting species) exhibited lower levels of population differentiation across their North American range, possibly as a result of post-Pleistocene range expansion and population growth. By contrast, Common Mergansers (a cavity-nesting species) breeding in western and eastern North America were strongly differentiated, as were continental groups in North America and Europe. Our hypothesis that population differentiation of breeding female Common Mergansers results from limited migration during non-breeding periods was not supported, in that equally heterogeneous mtDNA lineages were observed in males and females on several wintering areas. The interspecific differences in mtDNA patterns for these two closely related species may have resulted from factors related to nesting ecology (ground vs. cavity nesting) and responses to historical climate change.

  18. Dissecting the interactions of SERRATE with RNA and DICER-LIKE 1 in Arabidopsis microRNA precursor processing

    KAUST Repository

    Iwata, Yuji

    2013-08-05

    Efficient and precise microRNA (miRNA) biogenesis in Arabidopsis is mediated by the RNaseIII-family enzyme DICER-LIKE 1 (DCL1), double-stranded RNA-binding protein HYPONASTIC LEAVES 1 and the zinc-finger (ZnF) domain-containing protein SERRATE (SE). In the present study, we examined primary miRNA precursor (pri-miRNA) processing by highly purified recombinant DCL1 and SE proteins and found that SE is integral to pri-miRNA processing by DCL1. SE stimulates DCL1 cleavage of the pri-miRNA in an ionic strength-dependent manner. SE uses its N-terminal domain to bind to RNA and requires both N-terminal and ZnF domains to bind to DCL1. However, when DCL1 is bound to RNA, the interaction with the ZnF domain of SE becomes indispensible and stimulates the activity of DCL1 without requiring SE binding to RNA. Our results suggest that the interactions among SE, DCL1 and RNA are a potential point for regulating pri-miRNA processing. 2013 The Author(s) 2013.

  19. A standardized method to create peripheral nerve injury in dogs using an automatic non-serrated forceps

    Institute of Scientific and Technical Information of China (English)

    Xuhui Wang; Shiting Li; Liang Wan; Xinyuan Li; Youqiang Meng; Ningxi Zhu; Min Yang; Baohui Feng; Wenchuan Zhang; Shugan Zhu

    2012-01-01

    This study describes a method that not only generates an automatic and standardized crush injury in the skull base, but also provides investigators with the option to choose from a range of varying pressure levels. We designed an automatic, non-serrated forceps that exerts a varying force of 0 to 100 g and lasts for a defined period of 0 to 60 seconds. This device was then used to generate a crush injury to the right oculomotor nerve of dogs with a force of 10 g for 15 seconds, resulting in a deficit in the pupil-light reflex and ptosis. Further testing of our model with Toluidine-blue staining demonstrated that, at 2 weeks post-surgery disordered oculomotor nerve fibers, axonal loss, and a thinner than normal myelin sheath were visible. Electrophysiological examination showed occasional spontaneous potentials. Together, these data verified that the model for oculomotor nerve injury was successful, and that the forceps we designed can be used to establish standard mechanical injury models of peripheral nerves.

  20. Two distinct E3 ubiquitin ligases have complementary functions in the regulation of delta and serrate signaling in Drosophila.

    Directory of Open Access Journals (Sweden)

    Roland Le Borgne

    2005-04-01

    Full Text Available Signaling by the Notch ligands Delta (Dl and Serrate (Ser regulates a wide variety of essential cell-fate decisions during animal development. Two distinct E3 ubiquitin ligases, Neuralized (Neur and Mind bomb (Mib, have been shown to regulate Dl signaling in Drosophila melanogaster and Danio rerio, respectively. While the neur and mib genes are evolutionarily conserved, their respective roles in the context of a single organism have not yet been examined. We show here that the Drosophila mind bomb (D-mib gene regulates a subset of Notch signaling events, including wing margin specification, leg segmentation, and vein determination, that are distinct from those events requiring neur activity. D-mib also modulates lateral inhibition, a neur- and Dl-dependent signaling event, suggesting that D-mib regulates Dl signaling. During wing development, expression of D-mib in dorsal cells appears to be necessary and sufficient for wing margin specification, indicating that D-mib also regulates Ser signaling. Moreover, the activity of the D-mib gene is required for the endocytosis of Ser in wing imaginal disc cells. Finally, ectopic expression of neur in D-mib mutant larvae rescues the wing D-mib phenotype, indicating that Neur can compensate for the lack of D-mib activity. We conclude that D-mib and Neur are two structurally distinct proteins that have similar molecular activities but distinct developmental functions in Drosophila.

  1. [Traditional nostrum].

    Science.gov (United States)

    Sugiyama, Shigeru

    2006-01-01

    The commercialization of drugs started toward the end of Heian period (794-1192) when not only aristocrats and monks who were traditional patrons to drug makers, but also local clans and landlords who became powerful as a result of the disbanding of aristocratic manors accumulated enough wealth to spend money on medicine. Although traveling around the country was still a dangerous endeavor, merchants assembled groups to bring lucrative foreign drugs (mainly Chinese) to remote areas. The spread of commercial drugs to common people, however, did not happen until the early Edo period (1603-1867), when the so-called barrier system was installed nationwide to make domestic travel safe. Commercialization started in large cities and gradually spread to other areas. Many nostrums popular until recently appeared in the Genroku period (1688-1703) or later. Many such nostrums were all-cures, often consisting of such active ingredients as Saussureae radix, Agalloch, or Gambir. Even in the Edo period, many people living in agricultural or fishing villages, as well as those in the lower tier, were still poor. Much of the medication available to those people was therefore made of various plant or animal-derived substances that were traditionally used as folk medicines.

  2. Imaging characteristics of hepatocellular adenoma compared with pathologic findings

    International Nuclear Information System (INIS)

    Zhao Jing; Zhao Xinming; Ouyang Han; Huang Wenting; Zhou Chunwu

    2012-01-01

    Objective: To retrospectively compare CT and MR features of hepatocellular adenoma with pathologic findings. Methods: Twelve patients with histopathologically proved hepatocellular adenoma were classified on the basis of pathologic and genotype phenotype findings into four groups: steatotic type, cytological abnormality type, telangiectatic adenoma with inflammatory infiltrates type and atypical adenoma type. The CT and MR features of each type were reviewed retrospectively compared with the pathological results. Results: In this retrospective study, 12 patients were examined with CT (8 patients) and MR (8 patients). Among 12 patients, 4 patients showed a steatotic type. One patient showed hypo-density on the non-enhanced CT and 3 patients demonstrated hypo-density on all phases of the post-contrast scans. Two lesions showed iso-intense signal on the in-phase T 1 WI with signal dropout on the out-of-phase T 1 WI, and hypo-intense signal on the T 2 WI with fat suppression sequences. One lesion demonstrated moderate hypointense signal on all phases of the post-contrast MRI scans. Two patients with the telangiectatic adenoma inflammatory infiltrates type were found. One patient showed hypo-density on the non-enhanced CT scans and hyper-density on all phases of the post-contrast CT scans. One patient demonstrated iso-intense signal and the other hypo-intense signal on the T 1 WI, and both displayed moderate hyper-intense signal on the T 2 WI with fat suppression sequences and hyper-intense signal with gradual enhancement on all phases of post-contrast MR scans. There were 3 patients with a cytological abnormality type. One patient appeared hypo-density and 1 patient showed uniform iso-density on non-enhanced CT scans. All patients who had undergone contrast-enhanced CT scans were found to have hyper-density on the hepatic arterial-dominant phase and became slightly lower on the portal venous phase. On the delay phase the density reduced further. One mass showed iso

  3. Dietary patterns and the risk of colorectal adenomas: the Black Women's Health Study.

    Science.gov (United States)

    Makambi, Kepher H; Agurs-Collins, Tanya; Bright-Gbebry, Mireille; Rosenberg, Lynn; Palmer, Julie R; Adams-Campbell, Lucile L

    2011-05-01

    Colorectal adenomas are benign lesions that may be precursors to colorectal cancer. No studies of African American women have investigated dietary patterns and the risk of developing colorectal adenomas. We examined data from the Black Women's Health Study to determine whether dietary patterns are associated with the risk of developing colorectal adenomas. This is a prospective cohort study of 59,000 participants followed biennially since 1995. During 155,414 person-years of follow-up from 1997 to 2007 among women who had had at least one screening colonoscopy, 620 incident cases of colorectal adenomas were identified. By using Cox regression models, we obtained incidence rate ratios (IRR) for colorectal adenoma in relation to quintiles of each of two dietary patterns, adjusting for other colorectal adenoma risk factors. Two dietary patterns, Western and prudent, were utilized to assess the association between dietary intake and adenoma risk. The highest quintile of prudent diet, relative to the lowest quintile, was significantly associated with 34% lower colorectal adenoma risk overall (IRR = 0.66; 95% CI, 0.50-0.88; P(trend) pattern were associated with a higher risk of developing colorectal adenoma (IRR = 1.42; 95% CI, 1.09-1.85 for the highest quintile relative to the lowest; P(trend) = 0.01). Our findings suggest that African American women may be able to reduce their risk of developing colorectal adenomas by following a prudent dietary pattern and avoiding a more Western pattern. A dietary modification could have a strong impact in colorectal adenoma prevention in African American women. ©2011 AACR.

  4. High serum alanine aminotransferase is associated with the risk of colorectal adenoma in Korean men.

    Science.gov (United States)

    Moon, Chang Mo; Yun, Kyung Eun; Ryu, Seungho; Chang, Yoosoo; Park, Dong Il

    2017-07-01

    An elevated alanine aminotransferase (ALT) is frequently observed in subjects with metabolic syndrome, which is associated with the risk of colorectal adenoma (CRA). However, the relationship between ALT and CRA remains unclear. Therefore, we aimed to investigate whether high serum ALT is associated with the risk of CRA in a metabolically healthy population. We conducted this cross-sectional study in 27,717 asymptomatic Korean adults who underwent a health checkup. Subjects were categorized as adenoma-free, hyperplastic polyp, low-risk adenoma, or high-risk adenoma. High-risk adenoma was defined as three or more adenomas, any adenoma ≥ 10 mm, or adenoma with high-grade dysplasia or villous features. Among all participants, 10.3% and 1.5% of cases were categorized as low-risk and high-risk adenoma, respectively. In multivariate analyses adjusting for age, sex, body mass index, smoking habits, alcohol intake, regular exercise, aspirin and analgesics use, family history of colon cancer, education level, fatty liver, high-sensitivity C reactive protein, homeostasis model assessment of insulin resistance, total cholesterol, and triglyceride, an increase in ALT was positively associated with the prevalence of low-risk and high-risk adenoma (P for trend = 0.029 and 0.027, respectively). The highest quartile group of ALT level showed a significantly increased prevalence in low-risk (odds ratio, 1.17) and high-risk adenoma (odds ratio, 1.48) groups compared with the lowest quartile group. This phenomenon persisted in the subgroup analysis in men, but not in women. In the asymptomatic healthy population, high serum ALT is significantly associated with the risk of CRA. © 2016 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

  5. Role of stem cells in large bowel carcinogenesis

    Directory of Open Access Journals (Sweden)

    N. A. Nefedova

    2015-01-01

    Full Text Available Сancer stem cells (CSC play a significant role in the development and progression of colorectal cancer. They are capable of self-senewal and multipotent differentiation. CSC can be formed from stem cells or mutant by dedifferentiation of crypt epithelial cells. Recently, much attention is paid to CSC in colon cancer, but very little has been published regarding their expression in colon polyps. In 2010 The World Health Organization attributed the so-called serrated lesions, including hyperplastic polyp, serrated sessile adenoma and traditional serrated adenoma to a group of precancerous lesions of the colon in addition to the classical tubular, villous and tubulo-villous adenomas. Despite the large number of publications devoted to the newly selected category, a full understanding of the processes involved in the formation of polyps and their progression into colon cancer, there is still no. Identification of CSC in colon polyps will assess their potential malignancy conduct adequate therapy, determine the amount of the operation and further treatment strategy. This in turn will contribute to the early detection and prevention of cancer. Identification of CSC, an assessment of their localization and distribution in tubular adenomas, serrated adenoma broad-based, traditional serrated adenoma and hyperplastic polyps allow to evaluate the potential of malignancy and prognosis for each of the polyps. In this regard, the definition of markers characteristic of colon CSC, is interesting not only from a scientific, but also from a practical point of view.

  6. Diagnosis of pituitary adenoma by dynamic CT scanning

    International Nuclear Information System (INIS)

    Tanabe, Sumiyoshi; Uede, Teiji; Daibo, Masahiko; Niwa, Jun; Hashi, Kazuo

    1988-01-01

    The advantage of high resolution CT in the diagnosis of pituitary microadenomas has been established, but the diagnosis becomes more difficult when the pituitary microadenoma is less than 5 mm in diameter. We have studied the usefulness of dynamic CT scans particularly for diagnosis of small microadenomas. The dynamic CT scans were performed for 61 normal pituitary glands and 68 pituitary adenomas (36 microadenomas, 32 macroadenomas) with a GECT/T 9800 scanner. Coronal sections of 1.5 mm thickness were taken at the plane just in front of the pituitary stalk of the pituitary gland. Following a bolus intra-venous injection of 40 - 60 ml of contrast media using an automatic injector, ten consecutive CT scans of 2 seconds scan time were obtained, beginning 2 seconds from the start of intravenous injection. The first seven scans were taken with an interval of 2.3 seconds, and the last three scans with an interval of 10 seconds. Then, time-density curves were obtained at the ROI which were set on the anterior pituitary gland, the vascular bed of the pituitary gland, the pituitary stalk and the area of the pituitary adenoma respectively. In a normal pituitary gland, the density increases gradually and makes an S shaped curve, then attains the maximum density value (92.3 CT number) approximately 60 seconds after the administration of contrast media. The pituitary vascular bed is located in midline on the upper surface of the pituitary gland, and shows a symmetrical square, triangular or rhomboid shape. In case of pituitary adenoma, the time-density curve makes a plateau curve and attains the maximum density value (60.1 CT number) approximately 60 seconds after the administration of contrast media. In microadenoma, the pituitary vascular bed is either deformed or compressed, showing an asymmetrical shape. (author)

  7. Outcome of visual acuity after surgical removal of pituitary adenomas

    Directory of Open Access Journals (Sweden)

    Grković Desanka

    2013-01-01

    Full Text Available Introduction. Pituitary adenomas with suprasellar extension may produce anterior visual pathway compression, resulting in characteristic visual deficit. Surgical decompression of these structures prevents further visual deterioration and its postop­ erative recovery. Objective. The aim of this study was to investigate pre­ and postoperative visual acuity (VA in patients with pituitary ad­ enomas, and to detect the influence of prognostic factors, such as symptoms duration, degree of visual acuity reduction and tumor size in the assessment of the prognosis of postoperative visual function. Methods. We analyzed 40 consecutive patients who fulfilled three criteria: evidence of preoperative visual dysfunction, transsphenoidal or transfrontal tumor resection and hystologically verified pituitary adenoma. A visual examination was performed under standard conditions, pre and postoperatively (10 days, one month and six months after surgery. A paired t­test was used to assess the differences of pre­ and postoperative characteristics values, and the Chisquare test of independence in the assessment of the influence of prognostic factors. Results. Postoperative improvement of VA was seen in 84.61% patients (68% eyes. Eyes with preoperative mild and moderate degree of VA reduction showed improvement in 89.65% eyes in contrast to 22.60% eyes with preoperative severe reduction of VA, which was all statistically significant. Eyes in patients with tumor smaller than 20 mm had improvement of VA in 91.66% eyes, while eyes with tumor larger than 40 mm had improvement of VA in 61.11% eyes, which was statistically significant. When symptoms duration was below two years the improvement of VA was detected in 65.38% eyes as related to 50% eyes with symptoms duration exceeding two years, which was not statistically significant. Conclusion. Pituitary adenomas commonly cause visual impairment. Postoperatively the majority of patients show a distinct improvement of

  8. Clinical characteristics of patients with thyrotropin-secreting pituitary adenoma.

    Science.gov (United States)

    Wu, Yung-Yen; Chang, Hung-Yu; Lin, Jen-Der; Chen, Kwang-Wen; Huang, Yu-Yao; Jung, Shih-Ming

    2003-03-01

    Thyroid-stimulating hormone (thyrotropin, TSH)-secreting pituitary adenoma is a very rare cause of hyperthyroidism. Diagnosis of this condition is often delayed due to lack of availability of TSH radioimmunoassay (RIA), the failure to recognize the utility of RIA and the incorrect attribution of the condition to other causes of thyrotoxicosis. This retrospective study analyzed the clinical characteristics of patients with this disorder treated from 1991 to 2002. Seven patients (6 females, 1 male; mean age, 48 years; range, 33 to 72 years) with a diagnosis of TSHsecreting pituitary adenoma based on detectable TSH levels with high serum free thyroid hormone or triiodothyronine concentrations and pituitary lesions found on neuroimaging were included in this study. Patient records including clinical features, endocrine studies, immunohistochemistry studies, and response to treatment were reviewed. All 7 patients had hyperthyroidism, elevated free thyroxine or triiodothyronine levels, and unsuppressed levels of TSH. Imaging studies demonstrated a pituitary mass or lesion in all patients. Six patients had macroadenomas and 1 patient had a microadenoma. One of the patients had coexisting acromegalic features and hypersecretion of growth hormone was diagnosed. All of the patients had been treated with thionamides or thyroidectomy for presumed primary hyperthyroidism. Serum alpha-subunit level was uncharacteristically normal in 2 patients and elevated in 1 patient. Alpha-subunit/TSH molar ratios were elevated in 3 patients. Five patients underwent transsphenoidal adenomectomy but only one of them remained well-controlled at follow-up. Three patients received administration of somatostatin analogs and they achieved normalization of serum TSH and free thyroid hormones during the period of therapy. TSH immunoassay has an important role in the evaluation of hyperthyroid patients to determine the presence of inappropriate secretion. TSH-secreting pituitary adenoma exhibits

  9. Gigantism caused by growth hormone secreting pituitary adenoma

    OpenAIRE

    Rhee, Noorisaem; Jeong, Kumi; Yang, Eun Mi; Kim, Chan Jong

    2014-01-01

    Gigantism indicates excessive secretion of growth hormones (GH) during childhood when open epiphyseal growth plates allow for excessive linear growth. Case one involved a 14.7-year-old boy presented with extreme tall stature. His random serum GH level was 38.4 ng/mL, and failure of GH suppression was noted during an oral glucose tolerance test (OGTT; nadir serum GH, 22.7 ng/mL). Magnetic resonance imaging (MRI) of the brain revealed a 12-mm-sized pituitary adenoma. Transsphenoidal surgery was...

  10. Simple mucin-type carbohydrate antigens in pleomorphic adenomas

    DEFF Research Database (Denmark)

    Therkildsen, M H; Mandel, U; Christensen, M

    1993-01-01

    Simple mucin-type carbohydrate structures, T, Tn and sialosyl-Tn, are regarded as general markers of carcinomas in several epithelial tissues as a result of incomplete synthesis with precursor accumulation. The structures have a very limited distribution in normal tissues and secretions, including...... saliva and salivary glands. The expression of simple mucin-type carbohydrate structures and ABH(O) variants was studied in paraffin-embedded and frozen tissue sections from 37 pleomorphic adenomas with associated normal parotid tissue, using immunohistology and a panel of MAbs with well...

  11. Radiotherapy for pituitary adenoma: long-term outcome and sequelae

    International Nuclear Information System (INIS)

    McCord, Mark W.; Buatti, John M.; Fennell, Eileen M.; Mendenhall, William M.; Marcus, Robert B.; Rhoton, Albert L.; Grant, Maria B.; Friedman, William A.

    1997-01-01

    Purpose: To review outcome and treatment sequelae in patients treated with external beam radiotherapy for pituitary adenomas. Methods and Materials: One hundred forty-one patients with pituitary adenomas received radiotherapy at the University of Florida and had 2-year minimum potential follow-up. One hundred twenty-one had newly diagnosed adenomas, and 20 had recurrent tumors. Newly diagnosed tumors were treated with surgery and radiotherapy (n = 98) or radiotherapy alone (n = 23). Patients with recurrent tumors received salvage treatment with surgery and radiotherapy (n = 10) or radiotherapy alone (n = 10). The impact of age, sex, presenting symptoms, tumor extent, surgery type, degree of resection, hormonal activity, primary or salvage therapy, and radiotherapy dose on tumor control was analyzed. Tumor control is defined by the absence of radiographic progression and stable or decreased hormone level (in hormonally active tumors) after treatment. Effect of therapy on vision, hormonal function, neurocognitive function, life satisfaction, and affective symptoms were examined. A Likert categorical scale survey was used for assessment of neurocognitive, life satisfaction, and affective symptom status. Survey results from the radiotherapy patients were compared with a control group treated with transsphenoidal surgery alone. Multivariate analysis used the forward step-wise sequence of chi squares for the log rank test. Results: At 10 years, tumor control for the surgery and radiotherapy group (S + RT) was 95% and not statistically different (p = 0.58) than for patients treated with radiotherapy alone (RT) (90%). Patients with prolactin- and ACTH-secreting tumors had significantly worse tumor control, as did patients treated for recurrent tumors. Multivariate analysis for tumor control revealed that only young age was predictive of worse outcome (p = 0.0354). Visual function was either unaffected or improved in most patients, although four patients developed visual

  12. Radiotherapy for pituitary adenoma: long-term outcome and sequelae

    International Nuclear Information System (INIS)

    McCord, Mark W.; Buatti, John M.; Fennel, Eileen M.; Mendenhall, William M.; Marcus, Robert B.; Friedman, William A.; Rhoton, Albert L.

    1996-01-01

    Purpose/Objective: To review outcome and treatment sequelae in patients treated with external-beam radiotherapy for pituitary adenomas. Materials and Methods: One hundred forty-one patients with pituitary adenomas received radiotherapy and had 2-year minimum follow-up. One hundred twenty-one patients had newly diagnosed adenomas and 20 patients had recurrent tumors. Newly diagnosed tumors were treated with surgery and radiotherapy (S + RT; n=98) or radiotherapy alone (RT; n=23). Patients with recurrent tumors received salvage treatment with S+RT (n=10) or RT (n=10). The impact of age, sex, presenting symptoms, tumor extent, surgery type, degree of resection, hormonal activity, primary or salvage therapy, and radiotherapy dose on local control and cause-specific survival was analyzed. Effect of therapy on vision, hormonal function, life satisfaction, neurocognitive function, and affective symptoms was examined. A Likert scale survey was used for assessment of life satisfaction, neurocognitive status, and affective symptoms after therapy. Survey results from the RT patients were compared to a control group treated with transsphenoidal surgery alone (S). Survival analysis employed the Kaplan-Meier method. Multivariate analysis used the forward step-wise sequence of chi-squares for the log-rank test. Results: At 10 years, local control for the S+RT group (S + RT) was 95% and not statistically different (p=.58) than for patients in the RT group (90%). Cause-specific survival rates were also similar (p=.88) between the S+RT (97%) and RT (99%) groups. Patients with prolactin- and ACTH-secreting tumors had significantly worse local control, as did patients treated for recurrent tumors. Cause-specific survival was not decreased in any patient group. Multivariate analysis for local control and cause-specific survival revealed only young age to be predictive of worse outcome (p=.0354 and p=.0355 respectively). Visual function was either unaffected or improved in most patients

  13. Spontaneous Resolution of Primary Hyperparathyroidism in Parathyroid Adenoma

    Directory of Open Access Journals (Sweden)

    Sara J. Micale

    2012-01-01

    Full Text Available A 71 yo woman with primary hyperparathyroidism awaiting surgery because of significant hypercalcemia and hypercalciuria presented to the local emergency department with the chief complaints of discomfort in her neck, sore throat, and difficulty swallowing. She was found to be hypocalcemic with a calcium level of 8.1 mg/dL. She was seen by her endocrinologist three days later at which time serum calcium, iPTH, and serum phosphate levels were all within normal limits. Based on history and a series of ultrasounds the patient was diagnosed with spontaneous infarction of her parathyroid adenoma, which resulted in resolution of her primary hyperparathyroidism.

  14. Carcinoma ex-pleomorphic adenoma derived from recurrent pleomorphic adenoma shows important difference by array CGH compared to recurrent pleomorphic adenoma without malignant transformation

    Directory of Open Access Journals (Sweden)

    Fernanda Viviane Mariano

    Full Text Available Abstract Introduction: A key step of cancer development is the progressive accumulation of genomic changes resulting in disruption of several biological mechanisms. Carcinoma ex-pleomorphic adenoma (CXPA is an aggressive neoplasm that arises from a pleomorphic adenoma. CXPA derived from a recurrent PA (RPA has been rarely reported, and the genomic changes associated with these tumors have not yet been studied. Objective: We analyzed CXPA from RPAs and RPAs without malignant transformation using array-comparative genomic hybridization (array-CGH to identify somatic copy number alterations and affected genes. Methods: DNA samples extracted from FFPE tumors were submitted to array-CGH investigation, and data was analyzed by Nexus Copy Number Discovery Edition v.7. Results: No somatic copy number alterations were found in RPAs without malignant transformation. As for CXPA from RPA, although genomic profiles were unique for each case, we detected some chromosomal regions that appear to be preferentially affected by copy number alterations. The first case of CXPA-RPA (frankly invasive myoepithelial carcinoma showed copy number alterations affecting 1p36.33p13, 5p and chromosomes 3 and 8. The second case of CXPA-RPA (frankly invasive epithelial-myoepithelial carcinoma showed several alterations at chromosomes 3, 8, and 16, with two amplifications at 8p12p11.21 and 12q14.3q21.2. The third case of CXPA-RPA (minimally invasive epithelial-myoepithelial carcinoma exhibited amplifications at 12q13.3q14.1, 12q14.3, and 12q15. Conclusion: The occurrence of gains at chromosomes 3 and 8 and genomic amplifications at 8p and 12q, mainly those encompassing the HMGA2, MDM2, WIF1, WHSC1L1, LIRG3, CDK4 in CXAP from RPA can be a significant promotional factor in malignant transformation.

  15. Clinical Characteristics of Multiple Colorectal Adenoma Patients Without Germline APC or MYH Mutations

    NARCIS (Netherlands)

    Tieu, Alan H; Edelstein, Daniel; Axilbund, Jennifer; Romans, Katharine E; Brosens, Lodewijk; Wiley, Elizabeth; Hylind, Linda; Giardiello, Francis M

    BACKGROUND: Patients with multiple colorectal adenomas (MCRA) without genetic cause are increasingly being diagnosed. The characteristics and natural history of this condition are not well studied. MATERIALS AND METHODS: Twenty-seven patients with MCRA, with cumulatively 10 to 99 colorectal adenomas

  16. Uneven Distribution of Regional Blood Supply Prompts the Cystic Change of Pituitary Adenoma.

    Science.gov (United States)

    Zhang, Jianhe; Gu, Jianjun; Ma, Yiming; Huang, Yinxing; Wang, Jiaxing; Wu, Zhifeng; Zhong, Qun; Wang, Shousen

    2017-07-01

    Previous studies have suggested that the cystic change of pituitary adenoma might be related to the blood supply and metabolism of the tumor; however, the exact pathologic mechanism underlying the cystic change remains unknown. We aimed to assess the features of regional blood supply of pituitary adenoma and examine its relationship with the cystic change of pituitary adenoma. Patients (N = 79) with pituitary adenoma admitted to our hospital were divided into the parenchyma group (n = 40) or the cystic change group (n = 39). Dynamic contrast-enhanced magnetic resonance imaging of the pituitary adenoma was conducted for the parenchyma group and the steepest slopes (SS max , reflecting regional blood supply) at different areas were calculated. The location of cystic change of the pituitary adenoma was recorded and analyzed for the cystic change group. The parenchyma group showed an upper SS max of 2.52 ± 1.18, a lower SS max of 2.89 ± 1.46, a left SS max of 2.71 ± 1.31, and a right SS max of 2.66 ± 1.29. The difference between the upper and lower SS max was statistically significant (P supply is unevenly distributed in the parenchymal pituitary adenoma, with reduced blood supply in the upper than the lower region. Cystic change mainly occurs in the upper region of pituitary adenoma. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. CpG island methylator phenotype and its association with malignancy in sporadic duodenal adenomas.

    Science.gov (United States)

    Sun, Lifeng; Guzzetta, Angela A; Fu, Tao; Chen, Jinming; Jeschke, Jana; Kwak, Ruby; Vatapalli, Rajita; Baylin, Stephen B; Iacobuzio-Donahue, Christine A; Wolfgang, Christopher L; Ahuja, Nita

    2014-05-01

    CpG island methylator phenotype (CIMP) has been found in multiple precancerous and cancerous lesions, including colorectal adenomas, colorectal cancers, and duodenal adenocarcinomas. There are no reports in the literature of a relationship between CIMP status and clinicopathologic features of sporadic duodenal adenomas. This study sought to elucidate the role of methylation in duodenal adenomas and correlate it with KRAS and BRAF mutations. CIMP+ (with more than 2 markers methylated) was seen in 33.3% of duodenal adenomas; 61% of these CIMP+ adenomas were CIMP-high (with more than 3 markers methylated). Furthermore, CIMP+ status significantly correlated with older age of patients, larger size and villous type of tumor, coexistent dysplasia and periampullary location. MLH1 methylation was seen in 11.1% of duodenal adenomas and was significantly associated with CIMP+ tumors, while p16 methylation was an infrequent event. KRAS mutations were frequent and seen in 26.3% of adenomas; however, no BRAF mutations were detected. Furthermore, CIMP-high status was associated with larger size and villous type of tumor and race (non-white). These results suggest that CIMP+ duodenal adenomas may have a higher risk for developing malignancy and may require more aggressive management and surveillance.

  18. Tumour budding and other prognostic pathological features at invasive margins in serrated colorectal adenocarcinoma: a comparative study with conventional carcinoma.

    Science.gov (United States)

    García-Solano, José; Conesa-Zamora, Pablo; Trujillo-Santos, Javier; Mäkinen, Markus J; Pérez-Guillermo, Miguel

    2011-12-01

    To assess the incidence of tumour budding (TB), cytoplasmic pseudo-fragments (CyPs), tumour growth pattern (TGP) and peritumoural lymphocytic infiltration (PLI) in a series of serrated adenocarcinoma (SAC) and conventional carcinomas (CCs) of the colorectum in order to ascertain whether such features could explain the worse prognosis of SAC and whether they have prognostic value in SACs. Tumour budding, CyPs, TGP and PLI were evaluated in 81 SACs and 81 matched CCs. Kaplan-Meier survival curves and Cox logistic regression analysis were obtained for histological parameters. SACs had more high-grade (HG) TB (HG-TB) (69.1%), HG-CyPs (47%), infiltrative TGP (42%) and weak PLI (W-PLI) (65.4%) than CCs (40.7%, P = 0.0003; 19.7%, P = 0.0002; 29.7%, P = 0.07; 45.7%, P = 0.0087). SACs with HG-TB (P = 0.017), HG-CyPs (P = 0.045), infiltrating TGP (P TGP (P = 0.047) and W-PLI (P = 0.04) compared with CCs. For SACs, infiltrative TGP and W-PLI were independent prognostic parameters on multivariate analysis, as was location and regional node status. Compared to CC, SAC displayed more HG-TB, HG-CyPs and fewer PLI at the invasive margins and this may account for its poorer clinical outcome. TB, CyPs, TGP and PLI are useful histological prognostic aids in SAC. © 2011 Blackwell Publishing Limited.

  19. Using the marker CD34 as tool to discriminate adenoma versus hepatocellular; Uso del marcador de CD34 como herramienta para discriminar adenoma versus hepatocarcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Mohs Alfaro, Monica

    2011-07-01

    The CD34 marker is used as immunohistochemistry technique to detect and differentiate between the hepatocellular adenoma of the hepatocellular carcinoma. The liver lesions are described. The hepatic angiogenesis is explained [Spanish] El marcador CD34 es usado como tecnica de inmunohistoquimica para detectar y diferenciar entre el adenoma hepatocelular del carcinoma hepatocelular. La lesiones en el higado son descritas. La angiogenesis hepatica es explicada.

  20. Aspirin, Calcitriol, and Calcium Do Not Prevent Adenoma Recurrence in a Randomized Controlled Trial

    DEFF Research Database (Denmark)

    Pommergaard, Hans Christian; Burcharth, Jakob; Rosenberg, Jacob

    2016-01-01

    , and calcium carbonate could prevent colorectal adenoma recurrence. METHODS: We included 1107 patients with 1 or more sporadic adenoma(s) removed from the colon or rectum at centers in Europe, Russia, or the United States, from 2004 through 2010. Inclusion criteria were 1 adenoma greater than 1 cm in diameter...... found no differences between groups in the rate of recurrence (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.61-1.48), adverse effects, or secondary outcomes. Subgroup analyses indicated that the treatment effects may be influenced by smoking status (nonsmokers OR, 0.65; 95% CI, 0.26-1.22 vs...... current smokers OR, 1.70; 95% CI, 0.70-4.09; P value interaction prevent recurrence of colorectal adenomas over a 3-year period...

  1. Collision tumors of the sella: coexistence of pituitary adenoma and craniopharyngioma in the sellar region

    Science.gov (United States)

    2013-01-01

    Collision tumors of the sellar region are relatively uncommon and consist mainly of more than one type of pituitary adenoma or a cyst or cystic tumor. The association of a pituitary adenoma and a craniopharyngioma is particularly rare. This study describes a rare occurrence in which a pituitary adenoma and a craniopharyngioma coexisted in the sellar region. The case involves a 47-year-old woman who underwent transsphenoidal surgery with subtotal tumor resection and reoperation using an interhemispheric transcallosal approach for total microsurgical resection of the tumor because the visual acuity in her left eye had re-deteriorated. Histopathological and immunohistochemical examinations of the excised tissue revealed a pituitary adenoma in the first operation and a craniopharyngioma in the second operation. Retrospective analysis found the coexistence of a pituitary adenoma and a craniopharyngioma, known as a collision tumor. Instead of the transsphenoidal approach, a craniotomy should be performed, to explore the suprasellar region. PMID:23919255

  2. Differential diagnosis of gastric adenoma and type IIa early gastric cancer

    International Nuclear Information System (INIS)

    Tsuchigame, T.; Ogata, Y.; Sumi, M.; Fukui, K.; Saito, R.; Nakashima, K.; Urata, J.; Arakawa, A.; Saito, Y.; Takahashi, M.

    1991-01-01

    The endoscopic and radiographic findings of 45 gastric adenomas in 39 patients were followed for 6 months to 13 years and compared with type IIa early gastric cancer observed in 9 patients. Difficulties in the diffential diagnosis of these disorders were evaluated. The following features were suggestive of gastric adenomas: clustered lesions; protuberance with gentle slope; smooth surface; and relatively young patients. Discrimination of adenoma from type IIa early gastric cancer is often difficult by visual observation alone; biopsy was essential in most patients. A group III adenoma verified on biopsy should be followed closely because the lesion may harbor a cancer (so-called carcinoma-in-adenoma) or a cancer may later develop. (orig.)

  3. Detection of Dysplastic Intestinal Adenomas Using a Fluorescent Folate Imaging Probe

    Directory of Open Access Journals (Sweden)

    Wei-Tsung Chen

    2005-01-01

    Full Text Available Macrophages have long been recognized as a prominent component of tumors. Activated macrophages overexpress folate receptors and we used this phenomenon to image inflammatory reactions in colon dysplasia using a fluorescent folate probe (FFP. APCΔ468 mice injected with FFP showed fluorescent adenomas (target-to-background ratio, adenoma vs. adjacent normal mucosa, of 2.46 ± 0.41, significantly higher (p < .001 than adenomas in animals injected with a non-folate-containing control probe. Fluorescence-activated cell-sorting analysis revealed a 3-fold higher content of Mac1-positive cells in colonic adenomas compared with normal adjacent mucosa (6.8% vs. 2.2%, and confirmed the source of FFP-positive cells to be primarily an F4/80-positive macrophage subpopulation. Taken together, these results indicate that FFP potentially can be used to image dysplastic intestinal adenomas in vivo.

  4. Acromegaly with no pituitary adenoma and no evidence of ectopic source

    Directory of Open Access Journals (Sweden)

    Deepak Khandelwal

    2011-01-01

    Full Text Available More than 99% of patients with acromegaly harbor a growth hormone (GH secreting pituitary adenoma. As the time from onset of signs/symptoms to diagnosis of acromegaly is long (symptom onset to diagnosis is often 4-10 years, pituitary adenomas that cause GH excess are often large and are nearly always visible on conventional magnetic resonance imaging (MRI. However, in rare circumstances, acromegalic patients without an ectopic source will not have imaging evidence of a pituitary adenoma. Management of these patients poses special challenge, and once ectopic source of GH/growth-hormone-releasing hormone (GHRH is ruled out, an exploration of pituitary might be useful. We herein report a case of acromegaly with imaging evidence of sellar floor osteoma, but no pituitary adenoma, and negative work up for an ectopic source of GH/GHRH tumor, and on surgical exploration pituitary adenoma could be identified and removed and confirmed on histopathologic examination.

  5. Increased rectal microbial richness is associated with the presence of colorectal adenomas in humans.

    Science.gov (United States)

    Sanapareddy, Nina; Legge, Ryan M; Jovov, Biljana; McCoy, Amber; Burcal, Lauren; Araujo-Perez, Felix; Randall, Thomas A; Galanko, Joseph; Benson, Andrew; Sandler, Robert S; Rawls, John F; Abdo, Zaid; Fodor, Anthony A; Keku, Temitope O

    2012-10-01

    Differences in the composition of the gut microbial community have been associated with diseases such as obesity, Crohn's disease, ulcerative colitis and colorectal cancer (CRC). We used 454 titanium pyrosequencing of the V1-V2 region of the 16S rRNA gene to characterize adherent bacterial communities in mucosal biopsy samples from 33 subjects with adenomas and 38 subjects without adenomas (controls). Biopsy samples from subjects with adenomas had greater numbers of bacteria from 87 taxa than controls; only 5 taxa were more abundant in control samples. The magnitude of the differences in the distal gut microbiota between patients with adenomas and controls was more pronounced than that of any other clinical parameters including obesity, diet or family history of CRC. This suggests that sequence analysis of the microbiota could be used to identify patients at risk for developing adenomas.

  6.  Immunohistochemical Expression of ki-67 and p53 in Colorectal Adenomas: A Clinicopathological Study

    Directory of Open Access Journals (Sweden)

    Hussam Hasson Ali

    2011-07-01

    Full Text Available  Objectives: To evaluate the significance of P53 and Ki-67 expression as immunohistochemical markers in early detection of premalignant changes in different types of colorectal adenomas. Also, to correlate immunohistochemical expression of the two markers with different clinicopathological parameters including; age, and sex of the patient, type, site, size and grade of dysplasia of colorectal adenomas.Methods: Forty-seven polypectomy specimens of colorectal adenomas were retrieved from the archival materials of the Gastrointestinal and Hepatic Diseases Teaching Hospital in Baghdad from 2009 - 2010. Four µm section specimens were stained by immunohistochemical technique with Ki-67 and P53 tumor markers. P-values <0.05 were considered statistically significant.Results: Immunohistochemical expressions of Ki-67 and P53 had a significant correlation with the size and grade of dysplasia in colorectal adenomas. However, there was no significant correlation among the immunohistochemical expression of Ki-67 and P53 with the age and gender of the patient, and the type and site of colorectal adenomas. There was no significant correlation between Ki-67 and P53 expressions in colorectal adenomas. Villous adenomas of colorectum showed a significant correlation with the grade of dysplasia, while there was no significant correlation between size and site of colorectal adenoma with the grade of dysplasia.Conclusion: High grade dysplasia with significant positive immunohistochemical markers of Ki-67 and P53 could be valuable parameters for selecting from the total colorectal adenoma population, those most deserving of close surveillance in follow-up cancer prevention programs. It is closely linked with increasing age particularly in patients with a large size adenoma of villous component in their histology.

  7. Testosterone-secreting adrenal adenoma in a peripubertal girl

    International Nuclear Information System (INIS)

    Kamilaris, T.C.; DeBold, C.R.; Manolas, K.J.; Hoursanidis, A.; Panageas, S.; Yiannatos, J.

    1987-01-01

    A 15-year-old girl who presented with primary amenorrhea and virilization had an adrenocortical adenoma that secreted predominantly testosterone. To the authors' knowledge, she is the first peripubertal and second youngest patient with a testosterone-secreting adrenal tumor described. Serum dehydroepiandrosterone sulfate and urinary 17-ketosteroid an 17-hydroxycorticosteroid levels were normal. A tumor was located by a computed tomographic (CT) scan and by uptake of 6-β-[ 75 Se] selenomethylnorcholesterol. Microscopic examination of the tumor showed typical features of an adrenocortical adenoma with no histologic features characteristic of Leydig cells. Postoperatively, her hirsutism regressed, she rapidly went through puberty, and regular monthly menstruation started four months later. Finding the source of testosterone in a virilized patient can be difficult. Eleven of the 14 previously described patients with testosterone-secreting adrenal tumors initially underwent misdirected surgery on the ovaries. Review of these cases revealed that results of hormone stimulation and suppression tests are unreliable and that these tumors are usually large. Therefore, CT scanning of the adrenal glands is recommended in all patients suspected of having a testosterone-secreting tumor

  8. Pituitary null cell adenoma in a domestic llama (Lama glama).

    Science.gov (United States)

    Chalkley, M D; Kiupel, M; Draper, A C E

    2014-07-01

    Pituitary gland neoplasia has been reported rarely in camelids. A 12-year-old neutered male llama (Lama glama) presented with lethargy, inappetence and neurological signs. On physical examination, the llama was mentally dull and exhibited compulsive pacing and circling to the left. Complete blood count and serum biochemistry revealed haemoconcentration, mild hypophosphataemia, hyperglycaemia, hypercreatininaemia and hyperalbuminaemia. Humane destruction was elected due to rapid clinical deterioration and poor prognosis. Post-mortem examination revealed a pituitary macroadenoma and bilateral internal hydrocephalus. Microscopically, the pituitary tumour was composed of neoplastic chromophobic pituitary cells. Ultrastructural studies revealed similar neoplastic cells to those previously described in human null cell adenomas. Immunohistochemically, the neoplastic cells were strongly immunoreactive for neuroendocrine markers (synaptophysin and chromogranin A), but did not exhibit immunoreactivity for epithelial, mesenchymal, neuronal and all major pituitary hormone markers (adrenocorticotropic hormone, follicle stimulating hormone, growth hormone, luteinizing hormone, melanocyte-stimulating hormone, prolactin and thyroid stimulating hormone), consistent with the diagnosis of a pituitary null cell adenoma. This is the first report of pituitary neoplasia in a llama. Copyright © 2014 Elsevier Ltd. All rights reserved.

  9. Repeated transsphenoidal surgery for resection of pituitary adenoma.

    Science.gov (United States)

    Wang, Shousen; Xiao, Deyong; Wang, Rumi; Wei, Liangfeng; Hong, Jingfang

    2015-03-01

    To investigate the surgical strategy of repeated microscopic transsphenoidal surgery (TSS) for treatment of pituitary adenoma, surgical techniques and treatment outcomes for 29 patients with pituitary adenoma were reviewed and analyzed. There were 17 patients who underwent TSS 18 times and 12 patients who underwent TSS 13 times. The interval between each TSS ranged from 3 months to 18 years, with a median time of 4 years. The tumor height was 15 to 45 mm on the last surgery. Among the 29 patients, 16 patients underwent total tumor resection, 11 patients underwent subtotal resection, and 2 patients underwent partial resection. Cerebrospinal fluid leak occurred in 10 patients. Among 24 patients who were followed up effectively, 1 patient developed abducens paralysis after surgery, 1 patient had chronic diabetes insipidus, and 1 patient received steroid-dependent alternative treatment. The repeated TSS may present satisfied outcomes in experienced hands. The upper edge of the posterior choanae should be identified to ensure the right orientation. The openings of the anterior wall of the sphenoid sinus and the sellar floor should be appropriately expanded to improve tumor exposure. The artificial materials should be identified and removed carefully. Intraoperative cerebrospinal fluid leakage should be managed well.

  10. Pheochromocytoma and Adrenocortical Adenoma in the Same Gland

    Directory of Open Access Journals (Sweden)

    Wei-Ren Hwang

    2007-07-01

    Full Text Available A right adrenal tumor was found incidentally during abdominal computed tomography exam in a 51-year-old female patient, who had had diabetes and hypertension for more than 10 years. The computed tomography scan was arranged for possible pancreatic lesion by a neurologist. Norepinephrine level was high in the plasma and urine. Vanillylmandelic acid level was elevated in the urine. Diurnal cortisol rhythm, plasma adrenocorticotropic hormone and urine free cortisol were all normal, but the plasma cortisol concentration could not be suppressed after a standard low-dose dexamethasone suppression test. Therefore, adrenal cortical adenoma with subclinical Cushing's syndrome was highly suspected; however, further imaging studies, including magnetic resonance image and 131I-6β-iodomethylnorcholesterol adrenal scintigraphy failed to discriminate an additional tumor. After right adrenalectomy, a small adrenal cortical adenoma and a large pheochromocytoma were noted. This is an extremely rare case of an adrenal incidentaloma consisting of both medullary and cortical tumors in the same gland.

  11. Testosterone-secreting adrenal adenoma in a peripubertal girl

    Energy Technology Data Exchange (ETDEWEB)

    Kamilaris, T.C.; DeBold, C.R.; Manolas, K.J.; Hoursanidis, A.; Panageas, S.; Yiannatos, J.

    1987-11-13

    A 15-year-old girl who presented with primary amenorrhea and virilization had an adrenocortical adenoma that secreted predominantly testosterone. To the authors' knowledge, she is the first peripubertal and second youngest patient with a testosterone-secreting adrenal tumor described. Serum dehydroepiandrosterone sulfate and urinary 17-ketosteroid an 17-hydroxycorticosteroid levels were normal. A tumor was located by a computed tomographic (CT) scan and by uptake of 6-..beta..-(/sup 75/Se) selenomethylnorcholesterol. Microscopic examination of the tumor showed typical features of an adrenocortical adenoma with no histologic features characteristic of Leydig cells. Postoperatively, her hirsutism regressed, she rapidly went through puberty, and regular monthly menstruation started four months later. Finding the source of testosterone in a virilized patient can be difficult. Eleven of the 14 previously described patients with testosterone-secreting adrenal tumors initially underwent misdirected surgery on the ovaries. Review of these cases revealed that results of hormone stimulation and suppression tests are unreliable and that these tumors are usually large. Therefore, CT scanning of the adrenal glands is recommended in all patients suspected of having a testosterone-secreting tumor.

  12. Radiologic findings of tubular adenoma of the breast

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Mi Gyoung; Oh, Ki Keun [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

    1996-10-01

    Tubular adenoma (TA) is known as a rare lesion of the breast which is difficult to diagnosis preoperatively because of its rarity and similarity to fibroadenoma. Hence, our purpose is to suggest the characteristic sonographic features for its correct diagnosis. We retrospectively analyzed the clinical data and mammographic and sonographic findings. of seven patients(mean age, 23) who during the previous five years had presented at our hospital with pathologically-proven tubular adenoma. TA was misdiagnosed as fibroadenoma, since on physical examination of these young females, the lesions presented a palpable, non-tender mass. Mammographically, they showed a well defined mass similar to fibroadenoma. However, sonographic findings were characteristic of TA and compared to fibroadenoma, showed a well demarcated and smooth bordered mass with transverse long axis, posterior enhancement and homogeneous lower internal echogenecity. No case showed lateral wall refractive shadowing. In young females, the clinical and mammographic findings of TA are similar to those of fibroadenoma. However, sonographic findings of TA can, be helpful in the differential diagnosis of this entity and fibroadenoma.

  13. Radiologic findings of tubular adenoma of the breast

    International Nuclear Information System (INIS)

    Jeong, Mi Gyoung; Oh, Ki Keun

    1996-01-01

    Tubular adenoma (TA) is known as a rare lesion of the breast which is difficult to diagnosis preoperatively because of its rarity and similarity to fibroadenoma. Hence, our purpose is to suggest the characteristic sonographic features for its correct diagnosis. We retrospectively analyzed the clinical data and mammographic and sonographic findings. of seven patients(mean age, 23) who during the previous five years had presented at our hospital with pathologically-proven tubular adenoma. TA was misdiagnosed as fibroadenoma, since on physical examination of these young females, the lesions presented a palpable, non-tender mass. Mammographically, they showed a well defined mass similar to fibroadenoma. However, sonographic findings were characteristic of TA and compared to fibroadenoma, showed a well demarcated and smooth bordered mass with transverse long axis, posterior enhancement and homogeneous lower internal echogenecity. No case showed lateral wall refractive shadowing. In young females, the clinical and mammographic findings of TA are similar to those of fibroadenoma. However, sonographic findings of TA can, be helpful in the differential diagnosis of this entity and fibroadenoma

  14. A Rare Complication following Thyroid Percutaneous Ethanol Injection: Plummer Adenoma

    Directory of Open Access Journals (Sweden)

    Roberto Cesareo

    2017-01-01

    Full Text Available Percutaneous ethanol injection (PEI is a technique used only for benign thyroid nodules, cystic or mixed cystic-solid with a large fluid component. It is a quite low-cost, safe, and outpatient method of treatment. Rare and severe complications have been described after PEI: jugular vein thrombosis and severe ethanol toxic necrosis of the larynx combined with necrotic dermatitis. Moreover, only four thyrotoxicosis cases due to Graves’ disease have been reported. We report a case of 58-year-old female with a voluminous thyroid cystic nodule, occupying almost the entire left thyroid lobe. Our patient had already performed surgical visit and intervention of thyroidectomy had been proposed to her, which she refused. At baseline, our patient has a normal thyroid function with negative autoantibodies. According to the nodular structure, intervention of PEI has been performed with a significant improvement of compressive symptoms and cosmetic disorders. About 30 days after treatment, there was a significant volume reduction, but patient developed an acclaimed symptomatic thyrotoxicosis. After ruling out several causes of hyperthyroidism and according to the thyroid scintigraphy findings, we made the diagnosis of Plummer adenoma. To our knowledge, our patient is the first case of Plummer adenoma following PEI treatment of nontoxic thyroid nodule.

  15. A Case of Ectopic Parathyroid Adenoma at an Unexpected Location

    Directory of Open Access Journals (Sweden)

    Halil ibrahim Tasci

    2015-03-01

    Full Text Available Ectopic parathyroid tissue can be seen at any location from the mandibula to the mediastinum. The main problem in parathyroid surgery are determination of these ectopic parathyroid tissues' location and their resection. About 1-2% of patients with hyperparathyroidism have a deep mediastinal located parathyroid and transsternal or transthoracic approach should have to be employed most of the time. A 63-year-old female patient, presenting with widespread joint pain and fatigue complaints going on for about a year, was diagnosed with parathyroid adenoma in the mediastinal area as shown by the results of analyses conducted upon the detection of high levels of calcium and parathormone. Accordingly she was taken into surgery with a cervical incision and adenoma in a posterior localization in the carotid artery sheath on the upper mediastinum was seen. The patient, whose calcium, phosphor, and parathormone levels returned to normal levels following the surgery, was discharged with no problems on post-op day 2. Consequently, parathyroid is a tissue whose atypical localization is quite frequent. Nevertheless, atypical localized parathyroid surgeries can be performed by experienced surgeons without having to resort to a secondary procedure with minimally invasive methods with the contribution of localization studies before and/or during the procedure. [Cukurova Med J 2015; 40(Suppl 1: 127-130

  16. The efficacy of conventional radiation therapy in the management of pituitary adenoma

    International Nuclear Information System (INIS)

    Sasaki, Ryohei; Murakami, Masao; Okamoto, Yoshiaki; Kono, Koichi; Yoden, Eisaku; Nakajima, Toshifumi; Nabeshima, Sachio; Kuroda, Yasumasa

    2000-01-01

    Purpose: To evaluate the efficacy of conventional radiotherapy for reducing tumor size and endocrine hypersecretion of pituitary adenomas. Methods and Materials: We reviewed the records of 91 patients with pituitary adenoma, who were first treated between 1969 and 1994 and had been followed for more than 2 years (median, 8.2 years.) Of these patients, 86 had received postoperative radiotherapy, and 5 had received radiotherapy alone. The median total dose was 51 Gy. Clinical symptoms related to mass effects or endocrine hypersecretion were assessed. The efficacy of radiotherapy was evaluated before treatment and during the follow-up period (1-14 years; median, 3 years) by estimating tumor size on computed tomography or magnetic resonance imaging in 56 patients, as well as by endocrine testing in the 22 patients who had secreting adenomas. Local control rate, prognostic factors, and side effects were analyzed. Results: Mass-effect symptoms improved in 72% and 79% of patients who had such symptoms due to nonsecreting adenomas and secreting adenomas, respectively. Symptoms of endocrine hypersecretion abated in 67% of patients who had such symptoms. Excessive hormone levels normalized in 74% of patients who showed endocrine hypersecretions. The greatest size reduction was seen 3 years after the completion of radiotherapy (24% CR, 62% PR, 12% NC, and 3% PD in nonsecreting adenomas, and 32% CR, 36% PR, 27% NC, and 5% PD in secreting adenomas). Three patients with secreting adenomas (2 with prolactinoma and 1 with Cushing's disease) showed a mismatch between reduction in tumor size and normalization of endocrine hypersecretion. The 10-year local control rates were 98%, 85%, 83%, and 67% for nonsecreting adenoma, growth-hormone-secreting adenoma, prolactinoma, and Cushing's disease, respectively. Univariate analyses showed that disease type and radiation field size were significant prognostic factors. Brain necrosis occurred in 1 patient who received a 60-Gy dose of

  17. Carbon Dioxide Insufflation Increases Colonoscopic Adenoma Detection Rate Compared With Air Insufflation.

    Science.gov (United States)

    Mills, Christopher D; McCamley, Chere; Swan, Michael P

    2018-03-07

    To determine the effect of carbon dioxide insufflation on the most important outcome measure of colonoscopic quality: adenoma detection rate (ADR). Bowel cancer is the second most common cause of cancer deaths in males and females in Australia. Carbon dioxide has in recent times become the insufflation methodology of choice for screening colonoscopy for bowel cancer, as this has been shown to have significant advantages when compared with traditional air insufflation. Endoscopies performed over a period of 9 months immediately before and after the implementation of carbon dioxide insufflation at endoscopy centers were eligible for inclusion. The difference in ADR between the carbon dioxide and air insufflation methods was statistically significant, with an increased ADR in the carbon dioxide group. The superiority of carbon dioxide insufflation was sustained with a logistic regression model, which showed ADR was significantly impacted by insufflation method. Carbon dioxide insufflation is known to reduce abdominal pain, postprocedural duration of abdominal pain, abdominal distension, and analgesic requirements. This study represents for the first time the beneficial effect of carbon dioxide insufflation upon the key quality colonoscopy indicator of ADR.

  18. The Occurrence of Primary Hepatic Adenoma in Deceased Donor Renal Transplant Recipient

    Directory of Open Access Journals (Sweden)

    Yu-Tso Liao

    2014-01-01

    Full Text Available Main findings: We reported a case of new-onset, multi-focal hepatic adenoma in an 18 year-old man with no classic risk factors occurring forty months after a renal transplant from a cadaver donor. Histopathology of the adenoma was examined and genotype and phenotype were also analyzed. Histopathologic examination of the adenoma showed no malignancy. Genotype and phenotype analysis revealed no HNF1α or β-catenin gene mutations and no inflammatory infiltration. The patient was well and disease-free postoperatively. Case hypothesis: Hepatic adenoma occurs mostly in those taking oral contraceptives or androgenic-anabolic steroids or in those with hereditary diseases. Hepatic adenoma in a renal transplant recipient is rare and has only been reported in one case with glycogen storage disease type Ia. Immunosuppressive treatment might have contributed to the development of the neoplasm. Promising future implications: Although malignant change occurs most often in β-catenin gene mutation hepatic adenoma, surgical resection of the adenoma in a patient under immunosuppressive therapy should be considered in order to avoid the possibility of malignant transformation or hemorrhagic rupture.

  19. Identification of an epigenetic biomarker panel with high sensitivity and specificity for colorectal cancer and adenomas

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    Lind Guro E

    2011-07-01

    Full Text Available Abstract Background The presence of cancer-specific DNA methylation patterns in epithelial colorectal cells in human feces provides the prospect of a simple, non-invasive screening test for colorectal cancer and its precursor, the adenoma. This study investigates a panel of epigenetic markers for the detection of colorectal cancer and adenomas. Methods Candidate biomarkers were subjected to quantitative methylation analysis in test sets of tissue samples from colorectal cancers, adenomas, and normal colonic mucosa. All findings were verified in independent clinical validation series. A total of 523 human samples were included in the study. Receiver operating characteristic (ROC curve analysis was used to evaluate the performance of the biomarker panel. Results Promoter hypermethylation of the genes CNRIP1, FBN1, INA, MAL, SNCA, and SPG20 was frequent in both colorectal cancers (65-94% and adenomas (35-91%, whereas normal mucosa samples were rarely (0-5% methylated. The combined sensitivity of at least two positives among the six markers was 94% for colorectal cancers and 93% for adenoma samples, with a specificity of 98%. The resulting areas under the ROC curve were 0.984 for cancers and 0.968 for adenomas versus normal mucosa. Conclusions The novel epigenetic marker panel shows very high sensitivity and specificity for both colorectal cancers and adenomas. Our findings suggest this biomarker panel to be highly suitable for early tumor detection.

  20. The Influence of Smoking, Gender, and Family History on Colorectal Adenomas

    Directory of Open Access Journals (Sweden)

    Tracy Onega

    2010-01-01

    Full Text Available Evidence independently links smoking, family history, and gender with increased risk of adenomatous polyps. Using data from the New Hampshire Colonoscopy Registry (2004–2006, we examined the relation of combined risk factors with adenoma occurrence in 5,395 individuals undergoing screening colonoscopy. Self-reported data on smoking, family history and other factors were linked to pathology reports identifying adenomatous polyps and modeled with multiple logistic regression. In adjusted models a >15 pack-year smoking history increased the likelihood of an adenoma (OR=1.54, 95% CI 1.28–1.86, although ≤15 pack-years did not (OR=1.07, 95% CI 0.87–1.32. Gender-stratified models showed a significantly increased risk of adenoma at lower smoking exposure even for men (OR=1.32; 95% CI:1.00–1.76, but not for women (OR=0.85; 95% CI:0.61–1.14. An ordered logistic regression model of adenoma occurrence showed a smoking history of ≥15 pack-years associated with 61% higher odds of adenoma at successively larger size categories (95% CI 1.34–1.93. For individuals with a family history of colorectal cancer, smoking does not further increase the risk of adenomas. Smoking duration is linked to occurrence and size of adenoma, especially for men.

  1. A Case of Cushing's Syndrome with Multiple Adrenocortical Adenomas Composed of Compact Cells and Clear Cells.

    Science.gov (United States)

    Asakawa, Masahiro; Yoshimoto, Takanobu; Ota, Mitsutane; Numasawa, Mitsuyuki; Sasahara, Yuriko; Takeuchi, Takato; Nakano, Yujiro; Oohara, Norihiko; Murakami, Masanori; Bouchi, Ryotaro; Minami, Isao; Tsuchiya, Kyoichiro; Hashimoto, Koshi; Izumiyama, Hajime; Kawamura, Naoko; Kihara, Kazunori; Negi, Mariko; Akashi, Takumi; Eishi, Yoshinobu; Sasano, Hironobu; Ogawa, Yoshihiro

    2016-06-01

    A 58-year-old woman was referred to our hospital for Cushingoid features and diagnosed as adrenal Cushing's syndrome due to a right adrenocortical mass (60 × 55 mm). The mass was composed of three different tumors; the first one was homogeneously lipid-poor neoplasm measuring 20 × 13 mm located at the most dorsal region, the second one was heterogeneous and lipid-rich tumor containing multiple foci of calcification measuring 50 × 32 mm located at the central region, and the last one was heterogeneous harboring dilated and tortuous vessels and lipid-poor one measuring 35 × 18 mm at the most ventral region of the adrenal gland. A right adrenalectomy was subsequently performed by open surgery. Macroscopic and microscopic analyses revealed that all three tumors were adrenocortical adenomas; the first one represents a pigmented adrenocortical adenoma, the second one adrenocortical adenoma associated with degeneration, and the third one adrenocortical adenoma harboring extensive degeneration. Immunohistochemical analysis of the steroidogenic enzymes also revealed that all of the tumors had the capacity of synthesizing cortisol. This is a very rare case of Cushing's syndrome caused by multiple adrenocortical adenomas including a pigmented adenoma. Immunohistochemical analysis of steroidogenic enzymes contributed to understanding of steroidogenesis in each of these three different adrenocortical adenomas in this case.

  2. The Influence of Smoking, Gender, and Family History on Colorectal Adenomas

    International Nuclear Information System (INIS)

    Onega, T.; Goodrich, M.; Dietrich, A.; Onega, T.; Goodrich, M.; Dietrich, A.; Butterly, L.; Butterly, L.

    2010-01-01

    Evidence independently links smoking, family history, and gender with increased risk of adenomatous polyps. Using data from the New Hampshire Colonoscopy Registry (2004-2006), we examined the relation of combined risk factors with adenoma occurrence in 5,395 individuals undergoing screening colonoscopy. Self-reported data on smoking, family history and other factors were linked to pathology reports identifying adenomatous polyps and modeled with multiple logistic regression. In adjusted models a >15 pack-year smoking history increased the likelihood of an adenoma (OR=1.54 , 95% CI 1.28-1.86), although ≤15 pack-years did not (OR=1.07, 95% CI 0.87-1.32). Gender-stratified models showed a significantly increased risk of adenoma at lower smoking exposure even for men ( OR = 1.32; 95% CI:1.00-1.76. but not for women (OR = 0.85; 95% CI:0.61-1.14). An ordered logistic regression model of adenoma occurrence showed a smoking history of ≥15 pack-years associated with 61% higher odds of adenoma at successively larger size categories (95% CI 1.34-1.93). For individuals with a family history of colorectal cancer, smoking does not further increase the risk of adenomas. Smoking duration is linked to occurrence and size of adenoma, especially for men.

  3. Silent Crooke’s cell corticotroph adenoma of the pituitary gland presenting as delayed puberty

    Directory of Open Access Journals (Sweden)

    Dinesh Giri

    2017-03-01

    Full Text Available Corticotroph adenomas are extremely rare in children and adolescents. We present a 15-year-old boy who was investigated for delayed puberty (A1P2G1, bilateral testicular volumes of 3 mL each. There was no clinical or laboratory evidence suggestive of chronic illness, and the initial clinical impression was constitutional delay in puberty. Subsequently, MRI scan of the brain revealed the presence of a mixed cystic and solid pituitary lesion slightly displacing the optic chiasma. The lesion was removed by transphenoidal surgery and the biopsy confirmed the lesion to be pituitary adenoma. Furthermore, the adenoma cells also had Crooke’s hyaline changes and were intensely positive for ACTH. However there was no clinical/biochemical evidence of ACTH excess. There was a spontaneous pubertal progression twelve months after the surgery (A2P4G4, with bilateral testicular volume of 8 mL. Crooke’s cell adenoma is an extremely rare and aggressive variant of corticotroph adenoma that can uncommonly present as a silent corticotroph adenoma in adults. We report for the first time Crooke’s cell adenoma in an adolescent boy presenting with delayed puberty.

  4. Metallurgical production from North-east of the Iberian Peninsula during III millennium cal. BC: the Bauma del Serrat del Pont (Tortellá, Girona workshop

    Directory of Open Access Journals (Sweden)

    Alcalde, Gabriel

    1998-06-01

    Full Text Available We examine the third millennium cal. BC levels from the small rockshelter of Bauma del Serrat del Pont. The site was settled by a small group, building a perishable structure except in the II. 5 level. Some evidence suggests a seasonal occupation of the site. Multidisciplinary research shows a broad spectrum of local resources involved in the dairy life of this people, including those related to metallurgical activity. We find very old tin alloys, plain or bell beaker decorated pot-furnaces (used to smelt copper ores and clay tuyeres.

    Se presentan los resultados de la excavación en los niveles del III milenio cal. AC del pequeño abrigo rocoso de la Bauma del Serrat del Pont. El yacimiento fue ocupado por un grupo pequeño que organizó el espacio interno con una estructura de material perecedero, excepto en el nivel II.5. Algunos datos indican que las ocupaciones pudieron tener un carácter estacional. Los estudios multidisciplinares reconstruyen un aprovechamiento diversificado de recursos locales, entre los que se integran los dedicados a las tareas metalúrgicas. Se documentan aleaciones intencionadas de bronce de gran antigüedad, el empleo de vasijas horno con o sin decoración campaniforme, y toberas de arcilla.

  5. Discriminatory power of MRI for differentiation of adrenal non-adenomas vs adenomas evaluated by means of ROC analysis: Can biopsy be obviated?

    Energy Technology Data Exchange (ETDEWEB)

    Slapa, R.Z.; Jakubowski, W.; Krolicki, L. [Department of Imaging, Warsaw Medical School (Poland); Januszewicz, A. [Department of Hypertension, National Institute of Cardiology, Warsaw (Poland); Kasperlik-Zaluska, A.A. [Department of Endocrinology, Center for Postgraduate Medical Education, Warsaw (Poland); Dabrowska, E.; Feltynowski, T. [Department of Hypertension, Warsaw Medical School, Warsaw (Poland); Fijuth, J. [Department of Teleradiotherapy, Institute of Oncology, Warsaw (Poland); Tarnawski, R. [Department of Radiotherapy, Institute of Oncology, Gliwice Branch, Gliwice (Poland)

    2000-01-01

    The purpose of our study was to evaluate the discriminatory power of MRI in high-field magnet (1.5 T) for differentiation of adrenal non-adenomas vs adenomas assessing the following parameters separately and in combination: mean diameter of adrenal mass; previously described and new ratios as well as index calculated from signal intensity (SI) on SE T2-weighted images, chemical shift imaging (CSI), and Gd-DTPA-enhanced dynamic studies. One hundred eight adrenal masses (36 non-hyperfunctioning adenomas, 27 pheochromocytomas, 23 aldosterone-secreting adenomas, 20 malignant masses and 2 cortisol-secreting adenomas) in 95 patients were evaluated with SE sequences, CSI and Gd-DTPA dynamic studies. Indices and ratios of SI for all examined MRI methods were calculated and examined retrospectively for significance of differences between the groups with calculation of sensitivity and specificity. Receiver operating characteristics (ROC) analysis of calculated parameters in combination was performed. The multifactorial analysis of all four parameters, including size of the tumor, T2{sub liver} index, CSI ratio reflecting lipid content in the tumor and Wo{sub max/last} ratio reflecting maximal washout of contrast agent from the tumor had 100 % sensitivity and 100 % specificity in characterization of adrenal non-adenoma. The best performance of combination of mean tumor diameter with single MRI SI parameter was achieved in combination with T2{sub liver} index for all adrenal masses (area under ROC 0.987) and CSI ratio for non-hyperfunctioning adrenal masses (area under ROC 0.991). Magnetic resonance imaging enables sensitive and specific diagnosis of adrenal non-adenoma. (orig.)

  6. Prevalence of advanced adenomas in small and diminutive colon polyps using direct measurement of size.

    Science.gov (United States)

    Tsai, Franklin C; Strum, Williamson B

    2011-08-01

    Most studies reporting polyp size use visual estimates. Determining the prevalence of advanced histology based on direct measurement of polyp size may help guide the management of polyps found at optical colonoscopy (OC) and CT colonography (CTC). We designed a large, prospective study to assess the prevalence of advanced adenomas based on direct measurement of polyp size by a certified pathologists' assistant as reported in the pathology report. Patients between 40 and 89 years of age who presented for screening colonoscopy were included in our study. Advanced adenomas were defined as ≥10 mm or ≥25% villous features, high grade dysplasia or cancer. Polyps were divided by size into three groups: diminutive (≤5 mm), small (6-9 mm) and large (≥10 mm). If more than one adenoma was present, the most advanced was used for analysis. We evaluated 6,905 consecutive patients referred for colonoscopy between January 2005 and December 2006. Of the 4,967 who met the inclusion criteria, the mean age was 58.8 and consisted of 59% women. Overall, 930 (18.7%) had an adenoma; 248 (5%) were advanced adenomas including 8 (0.16%) cancers. Of 89 polyps≥10 mm, 76 (85%) had advanced histology; of 247 polyps 6-9 mm, 67 (27%) were advanced; of 1,025 polyps ≤5 mm, 105 (10%) were advanced. Thus, 172 of 248 (69%) patients with advanced adenomas had small or diminutive adenomas. Our data indicate the majority (69%) of advanced adenomas are advanced adenomas (10%). These findings may help guide the management of sub-centimeter colon polyps found by OC or CTC.

  7. The prevalence of colorectal adenomas in asymptomatic Korean men and women.

    Science.gov (United States)

    Yang, Moon Hee; Rampal, Sanjay; Sung, Jidong; Choi, Yoon-Ho; Son, Hee Jung; Lee, Jun Haeng; Kim, Young-Ho; Chang, Dong Kyung; Rhee, Poong-Lyul; Rhee, Jong Chul; Guallar, Eliseo; Cho, Juhee

    2014-03-01

    Colorectal cancer incidence is rapidly rising in many Asian countries, with rates approaching those of Western countries. This study aimed to evaluate the prevalence and trends of colorectal adenomas by age, sex, and risk strata in asymptomatic Koreans. Cross-sectional study of 19,372 consecutive participants aged 20 to 79 years undergoing screening colonoscopy at the Center for Health Promotion of the Samsung Medical Center in Korea from January 2006 to June 2009. Among participants at average risk, those without a history of colorectal polyps or a family history of colorectal cancer, the prevalence of colorectal adenomas and advanced adenomas were 34.5% and 3.1%, respectively, in men and 20.0% and 1.6%, respectively, in women. The prevalence of adenomas increased with age in both men and women, with a more marked increase for advanced adenoma. Participants with a family history of colorectal cancer or with a history of colorectal polyps had significantly higher prevalence of adenomas compared with participants of average risk (36.9% vs. 26.9%; age- and sex-adjusted prevalence ratio = 1.16; 95% confidence interval, 1.09-1.22). The prevalence of adenomas increased annually in both men and women. In this large study of asymptomatic Korean men and women participating in a colonoscopy screening program, the prevalence of colorectal adenomas was comparable and possibly higher than previously reported in Western countries. Cost-effectiveness studies investigating the optimal age for starting colonoscopy screening and etiological studies to identify the reasons for the increasing trend in colorectal adenomas in Koreans are needed. ©2014 AACR.

  8. Genetic variation in the base excision repair pathway, environmental risk factors, and colorectal adenoma risk.

    Directory of Open Access Journals (Sweden)

    Roman Corral

    Full Text Available Cigarette smoking, high alcohol intake, and low dietary folate levels are risk factors for colorectal adenomas. Oxidative damage caused by these three factors can be repaired through the base excision repair pathway (BER. We hypothesized that genetic variation in BER might modify colorectal adenoma risk. In a sigmoidoscopy-based study, we examined associations between 182 haplotype tagging SNPs in 14 BER genes, and colorectal adenoma risk, and examined their potential role as modifiers of the effect cigarette smoking, alcohol intake, and dietary folate levels. Among all individuals, no statistically significant associations between BER SNPs and adenoma risk persisted after correction for multiple comparisons. However, among Asian-Pacific Islanders we observed two SNPs in FEN1 and one in NTHL1, and among African-Americans one SNP in APEX1 that were associated with colorectal adenoma risk. Significant associations were also observed between SNPs in the NEIL2 gene and rectal adenoma risk. Three SNPS modified the effect of smoking (MUTYH interaction p = 0.002; OGG1 interaction p = 0.013; FEN1 interaction p = 0.013, one SNP in LIG3 modified the effect of alcohol consumption (interaction p = 0.024 and two SNPs in LIG3 modified the effect of dietary folate (interaction p = 0.001 and p = 0.08 on colorectal adenoma risk. These findings support a role for genetic variants in the BER pathway as potential modifiers of colorectal adenoma risk. Our findings strengthen the role of oxidative damage induced by key lifestyle and dietary risk factors in colorectal adenoma formation.

  9. Hepatic adenoma: incidence and management between the year 2002-2006 Hospital R. Calderon Guardia

    International Nuclear Information System (INIS)

    Pages Zamora, Alberto

    2008-01-01

    The incidence and management of hepatic adenoma at the Hospital Calderon Guardia are analyzed between the years 2002-2006. The main hepatic pathologies diagnosed by biopsy are shown. The relationship of hepatic adenoma with the above risk factors and presentation of each case of hepatic adenoma found are analyzed. The media diagnosed in this type of pathology were investigated. The evolution and control of each case of hepatic adenoma have been studied. The results of the management of each case are compared with the recommended in literature. The ideal management of this type of pathology is analyzed. Among the conclusions is given benign liver pathology as the most frequent cause of liver biopsy in the Hospital Calderon Guardia. Metastatic disease of the digestive tract has been the primary neoplastic disease at the hepatic level. Focal nodular hyperplasia has been the biopsy of benign tumor that is performed more frequently. Hepatic adenoma has been a rare entity, but with significant mortality rates. All cases were presented as solitary lesions. It is more common in women of childbearing age but can occur also in older people and in men. A close relationship has existed between the use of oral gestagens and the incidence of hepatic adenoma. Hepatic adenomas and its complications have been related to its size. Most cases of hepatic adenoma were presented with symptoms. The preoperative studies have shown high sensitivity in the detection of lesions, but little specificity. A protocol for the study of hepatic masses is required. A relationship between the size of the adenoma and possible complications was demonstrated. The reason for surgery in most cases has been the possibility of malignancy in the liver injury. The correlation between preoperative diagnosis and the end was unsuccessful in 75 percent of cases. The mortality related to the procedures did not exist, but if a case of morbidity. The study of liver masses should be more exhaustive to improve

  10. Imaging Findings of Intrahepatic Bile Duct Adenoma (Peribiliary Gland Hamartoma): a Case Report and Literature Review

    Energy Technology Data Exchange (ETDEWEB)

    Kim, You Sung; Rha, Sung Eun; Oh, Soon Nam; Jung, Seung Eun; Shin, Yu Ri; Choi, Byung Gil; Byun, Jae Young; Jung, Eun Sun; Kim, Dong Goo [Catholic University of Korea, Seoul St.Mary' s Hospital, Seoul (Korea, Republic of)

    2010-10-15

    Intrahepatic bile duct adenoma is a rare benign epithelial hepatic tumor derived from bile duct cells. We report the imaging findings of a patient with bile duct adenoma, which appeared as a small heterogeneously enhancing mass with focal small cystic change on CT and MRI. Follow-up images at seven months showed a slight increase in tumor size, which could be partly explained by intratumoral hemorrhage on pathologic examination. Although rare, bile duct adenoma should be considered as a differential diagnosis of a small hypervascular tumor located in the periphery of liver. Focal cystic change and intratumoral hemorrhage may occur

  11. Water-clear cell adenoma of the parathyroid. A case report with immunohistochemistry and electron microscopy.

    Science.gov (United States)

    Grenko, R T; Anderson, K M; Kauffman, G; Abt, A B

    1995-11-01

    We report a water-clear cell adenoma of the parathyroid gland, a lesion which to our knowledge has not been described previously. Like its rare but well-described hyperplastic counterpart, water-clear cell hyperplasia, this adenoma is composed of cells with abundant foamy-to-granular cytoplasm and mild nuclear pleomorphism. The cells form glandular structures and cell nests separated by fine fibrovascular septae. The tumor cells stain positively with anti-parathyroid hormone and show characteristic glassy and flocculate material by electron microscopy. Unlike water-clear cell hyperplasia, water-clear cell adenoma is a solitary lesion that compresses the residual nonneoplastic parathyroid gland.

  12. Vulvar lactating adenoma associated to a fibroadenoma: common neoplasms in an uncommon site.

    Science.gov (United States)

    Dhaoui, Amen; Nfoussi, Haifa; Kchir, Nidhameddine; Haouet, Slim

    2012-01-01

    Ectopic breast tissue is defined as glands located outside of the breast. Ectopic breast tissue should be excised because it may develop benign (fibroadenoma) or malignant pathologic processes. Less than forty cases of fibroadenomas have been reported in the literature. Although lactation changes can occur, lactating adenoma in the vulva are extremely rare. Only four cases have been reported. We report a case of a young woman who presented with vulvar mass during her lactation. The mass was excised, and histology confirmed vulvar lactating adenoma associated with fibroadenoma. This is the first case of vulvar heterotopic breast lesion associating lactating adenoma and fibroadenoma.

  13. BAGE Hypomethylation Is an Early Event in Colon Transformation and Is Frequent in Histologically Advanced Adenomas

    Energy Technology Data Exchange (ETDEWEB)

    Lana, Erica [INSERM U827, Montpellier (France); Brun, Marie-Elisabeth [Institut de Génétique Humaine, CNRS UPR 1142, Montpellier (France); Rivals, Isabelle [Equipe de Statistique Appliquée, ESPCI ParisTech, Paris (France); Selves, Janick; Kirzin, Sylvain [CHU Purpan and INSERM U563, Toulouse (France); Lutsyk, Andriy P. [O.O. Bogomoletz National Medical University, Kyiv (Ukraine); Gordiyuk, Vasily V. [Department of Functional Genomics, Institute of Molecular Biology and Genetics NASU, Kyiv (Ukraine); Bibeau, Frédéric [CRLC, Montpellier (France); Rynditch, Alla [Department of Functional Genomics, Institute of Molecular Biology and Genetics NASU, Kyiv (Ukraine); De Sario, Albertina, E-mail: albertina.de-sario@inserm.fr [INSERM U827, Montpellier (France)

    2009-11-18

    We showed earlier that BAGE (B melanoma antigen) loci are hypermethylated in normal tissues and hypomethylated in 98% of human cancers. More recently, we provided evidence that hypomethylation of BAGE loci represents an informative marker for colon cancer detection. In this study, we show that hypomethylation of BAGE loci was an early event that occurred in 43% of colorectal adenomas. Interestingly, hypomethylation of BAGE loci was frequent (50%) in tubulo-villous and villous adenomas, these adenomas having a high probability of being transformed into colorectal cancers.

  14. BAGE Hypomethylation Is an Early Event in Colon Transformation and Is Frequent in Histologically Advanced Adenomas

    Directory of Open Access Journals (Sweden)

    Alla Rynditch

    2009-11-01

    Full Text Available We showed earlier that BAGE (B melanoma antigen loci are hypermethylated in normal tissues and hypomethylated in 98% of human cancers. More recently, we provided evidence that hypomethylation of BAGE loci represents an informative marker for colon cancer detection. In this study, we show that hypomethylation of BAGE loci was an early event that occurred in 43% of colorectal adenomas. Interestingly, hypomethylation of BAGE loci was frequent (50% in tubulo-villous and villous adenomas, these adenomas having a high probability of being transformed into colorectal cancers.

  15. Comprehensive radionuclide study of the functional status of hypophyseal-thyroid system in autonomous thyroid adenomas

    Energy Technology Data Exchange (ETDEWEB)

    Kashkadamov, A.V. (Kievskij Nauchno-Issledovatel' skij Inst. Ehndokrinologii i Obmena Veshchestv (Ukrainian SSR))

    1981-10-01

    The significance of radionuclide investigation methods in the diagnosis of the functional state of thyroid and the role of these methods in the diagnosis of compensated and decompensated toxic adenomas, are found out. It is established that thyrotropic pituitary body function is decreased in patients with autonomous thyroid adenomas. The general thyroxine and triiodothyronine concentration is higher in patients with clinical thyrotoxicosis manifestations. It is shown that complex, radioisotope and radioimmunologic investigations are of great value in the diagnosis of compensated and decompensated toxic adenoma.

  16. Comprehensive radionuclide study of the functional status of hypophyseal-thyroid system in autonomous thyroid adenomas

    International Nuclear Information System (INIS)

    Kashkadamov, A.V.

    1981-01-01

    The significance of radionuclide investigation methods in the diagnosis of the functional state of thyroid and the role of these methods in the diagnosis of compensated and decompensated toxic adenomas, are found out. It is established that thyrotropic pituitary body function is decreased in patients with autonomous thyroid adenomas. The general thyroxine and triiodothyronine concentration is higher in patients with clinical thyrotoxicosis manifestations. It is shown that complex, radioisotope and radioimmunologic investigations are of great value in the diagnosis of compensated and decompensated toxic adenoma [ru

  17. Recurrence of chromophobe pituitary adenomas after operation and postoperative radiotherapy

    International Nuclear Information System (INIS)

    Salmi, J.; Pelkonen, R.; Grahne, B.; Valtonen, S.

    1982-01-01

    The rate of recurrence is reported in a prospective study of 56 patients (28 men, 28 women) with large chromophobe pituitary adenoma (with or without hyperprolactinemia). The surgical approach was transfrontal in 44 and transseptospehnoidal in 12 patients. Cryoapplication was combined with the transsphenoidal operation. All but one patient received postopertive pituitary irradiation. Altogether, 11 (20 %) clinical relapses (10 men) occurred between 0.5 and 6 years after the transfrontal operation. Patients that relapsed had had larger tumors than those remaining in remission. Occurence of the tumors appeared with a deterioration of the visual field defect in 9 patients. There were no differences in the degrees of hypopituitarism in patients who relapsed as compared to patients remaining in remission. (author)

  18. Giant parathyroid adenoma: differential aspects compared to parathyroid carcinoma

    Directory of Open Access Journals (Sweden)

    Marta Araujo Castro

    2017-05-01

    Full Text Available The 85% of cases of primary hyperparathyroidism (PHPT are due to parathyroid adenomas (PA and less than 1% to parathyroid carcinomas (PC. The PA usually measure <2 cm, weigh <1 g and generate a mild PHPT, whereas the PC usually exceeds these dimensions and are associated with a severe PHPT. However, giant PA (GPA, which is defined as those larger than 3 g, has been documented. Those may be associated with very high levels of PTH and calcium. In these cases, their differentiation before and after surgery with PC is very difficult. We present a case of severe PHPT associated with a large parathyroid lesion, and we discuss the differential aspects between the GPA and PC.

  19. Dual pathology of the submandibular gland: plasmacytoma and pleomorphic adenoma.

    Science.gov (United States)

    Menon, Shalini; Pujary, Kailesh; Valiathan, Manna

    2014-03-03

    Synchronous tumours of different histological types involving the salivary gland are very rare. There have been cases reported in the literature of such tumours occurring in the parotid gland. A 52-year-old man presented with a 4-year history of gradually increasing painless swelling in the right submandibular region. The ultrasound scan of the neck showed features suggestive of a submandibular sialadenitis. The right submandibular gland was then surgically excised and sent for histopathological examination. The features showed a unique dual pathology of the submandibular gland, that is, a plasmacytoma and a pleomorphic adenoma. Such a synchronous double pathology involving the submandibular gland has not been reported in the literature. A review of the literature suggests a good prognosis for the extramedullary plasmacytoma, provided multiple myeloma is ruled out. In 18 months of follow-up, the patient has been asymptomatic with a negative myeloma workup.

  20. Serotonin, ATRX, and DAXX Expression in Pituitary Adenomas

    DEFF Research Database (Denmark)

    Casar-Borota, Olivera; Botling, Johan; Granberg, Dan

    2017-01-01

    that remain localized to the sellar and perisellar region. A lack of ATRX or DAXX in a sellar NET suggests a nonpituitary NET, probably of pancreatic origin. One of the 2 examined corticotroph carcinomas, however, demonstrated negative ATRX immunolabeling due to an ATRX gene mutation. Further studies......Differential diagnosis based on morphology and immunohistochemistry between a clinically nonfunctioning pituitary neuroendocrine tumor (NET)/pituitary adenoma and a primary or secondary NET of nonpituitary origin in the sellar region may be difficult. Serotonin, a frequently expressed marker...... in the NETs, has not been systematically evaluated in pituitary NETs. Although mutations in ATRX or DAXX have been reported in a significant proportion of pancreatic NETs, the mutational status of ATRX and DAXX and their possible pathogenetic role in pituitary NETs are unknown. Facing a difficult diagnostic...

  1. Clear cell HCC: an imitator of hepatic adenoma

    International Nuclear Information System (INIS)

    Incedayi, M.; Sivrioglu, A.

    2012-01-01

    Full text: A 60-year old male patient was complaining of a postprandial heartburn and of abdominal distension. Physical examination was normal except for nodular, painless hepatomegaly. Ultrasonographic examination of the liver showed diffuse increased echogenicity and coarse echotexture. A large mixed echogenic mass is seen in the right hepatic lobe. Computerized tomography showed heterogeneously hypodense mass lesions with fatty change on non-contrast scans and enhance heterogeneously on both arterial phase and venous phase postcontrast scans. Following true-cut biopsy, it was ascertained to be a clear cell HCC. Clear cell HCC may include large fatty areas and this is often misdiagnosed to be an adenoma. Clear cell HCC is characterized by high female prevalence, high rate of association with liver cirrhosis and has no significant difference in prognosis compared with non-clear cell HCC

  2. Does the corticoadrenal adenoma with ''pre-Cushing's syndrome'' exist

    International Nuclear Information System (INIS)

    Charbonnel, B.; Chatal, J.F.; Ozanne, P.

    1981-01-01

    An adrenal tumor was discovered fortuitously in a patient with no clinical features of Cushing's syndrome. On adrenal imaging, there was good uptake in the nodule but no visualization of the contralateral adrenal. The latter was seen, however, in a second scan performed under ACTH treatment. In the hormone assessment, basal cortisol and 17-hydroxycorticoids were normal and cortisol diurnal variation was near normal, but a dexamethasone suppression test and ACTH responses to metyrapone and insulin hypoglycemia were abnormal. Eight months after excision of a spongiocytic-type adenoma, the remaining adrenal was visible on scintigram and the hormonal tests were normal. This pattern suggests that the clinical Cushing's syndrome was enough to partially suppress ACTH and, consequently, visualization of the contralateral gland

  3. Virilization in a Girl with Adrenocortical Adenoma: A Case Report

    Directory of Open Access Journals (Sweden)

    Tahniyah Haq

    2012-07-01

    Full Text Available We present a case of Cushing’s syndrome and virilization in a 15 year old girl which was suspected to be due to an adrenal carcinoma. She presented with features of virilization in addition to those of hypercortisilism. Her high androgen levels especially dehydroepiandrosterone sulfate (DHEAS were also in favor of an adrenal carcinoma. An unenhanced computerized tomography (CT scan showed a mass (size: 5.3 cm in the right adrenal gland with a soft tissue intensity of more than 10 HU which was suggestive of adrenal carcinoma. But, histopathology of the resected mass revealed a benign adrenocortical adenoma. Ibrahim Med. Coll. J. 2012; 6(2: 70-72

  4. Progress in the diagnosis and classification of pituitary adenomas

    Directory of Open Access Journals (Sweden)

    Luis V Syro

    2015-06-01

    Full Text Available Pituitary adenomas are common neoplasms. Their classification is based upon size, invasion of adjacent structures, sporadic or familial cases, biochemical activity, clinical manifestations, morphological characteristics, response to treatment and recurrence. Although they are considered benign tumors, some of them are difficult to treat due to their tendency to recur, despite standardized treatment. Functional tumors present other challenges for normalizing their biochemical activity. Novel approaches for early diagnosis as well as different perspectives on classification may help to identify subgroups of patients with similar characteristics, creating opportunities to match each patient with the best personalized treatment option. In this paper we present the progress in the diagnosis and classification of different subgroups of patients with pituitary tumors that may be managed with specific considerations according to their tumor subtype.

  5. Análisis de un registro de adenomas pituitarios

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    Carolina Albiero

    2010-10-01

    Full Text Available Dada la complejidad que reviste el enfoque diagnóstico y terapéutico de los tumores pituitarios, el registro y análisis de la experiencia clínica acumulada es de gran ayuda en la toma de decisiones. En este trabajo se informan datos clínico-terapéuticos, extraídos de un registro computarizado, sobre 519 de un total de 670 pacientes con adenomas pituitarios. Trescientos cuarenta y cinco fueron mujeres (66% y 174 varones (34%, de 14 a 80 años de edad. El diagnóstico final fue: acromegalia en 176, enfermedad de Cushing en 153, prolactinoma en 101 y adenoma clínicamente no-funcionante (ANF en 89. La edad media al momento del diagnóstico de acromegalia fue 43.9 ± 13.5 (16-80, para enfermedad de Cushing 35.7 ± 12.9 (14-72, para prolactinomas 30.0 ± 13.4 (15-79 y para ANF 52.1 ± 15.2 (17-79 años. La creación de un registro institucional de tumores de hipófisis es un instrumento de gran utilidad para el análisis de la experiencia adquirida y constituye una herramienta valiosa para mejorar la estrategia terapéutica, optimizar la relación costo/beneficio y mejorar el cuidado del paciente. Contribuye a la docencia médica, tanto en el pre como en el posgrado y da base a la realización de trabajos de investigación clínica, aportando a la difusión y transferencia de conocimientos.

  6. Pigmented hepatocellular adenoma with complete CD34 immunostaining pattern: A diagnostic dilemma

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    Mukul Vij

    2012-01-01

    Full Text Available WHO defines hepatocellular adenoma (HCA as a benign tumor composed of cells closely resembling normal hepatocytes, which are arranged in plates separated by sinusoids. It is more common in women. The present concerns a 41 years female who was found to have a mass lesion in liver on ultrasound while undergoing routine evaluation for dyspepsia. Computed tomography scan of abdomen showed 10 × 8 cm lesion in liver. Extended left hepatectomy was performed. Grossly hepatic cut surface showed circumscribed tumor with dark gray or black color. Microscopy revealed hepatocellular adenoma with abundant Dubin Johnson like pigment deposition. CD34 immunostaining showed complete sinusoidal pattern. We labeled the tumor as pigmented hepatic adenoma with complete CD34 staining pattern. To the best of author′s knowledge only eight cases of pigmented hepatocellular adenoma are described in world literature.

  7. Mammosomatotroph adenoma of the pituitary associated with gigantism and hyperprolactinemia. A morphological study including immunoelectron microscopy.

    Science.gov (United States)

    Felix, I A; Horvath, E; Kovacs, K; Smyth, H S; Killinger, D W; Vale, J

    1986-01-01

    A 29-year old giantess with growth hormone excess and hyperprolactinemia underwent transsphenoidal surgery to remove her pituitary tumor. Electron microscopy revealed a mammosomatotroph adenoma composed of one cell type. Immunoelectron microscopy, using the immunogold technique, demonstrated predominantly growth hormone or prolactin or a varying mixture of both growth hormone and prolactin in the adenoma cells. The presence of growth hormone and prolactin was found not only in the cytoplasm of the same adenoma cells but also in the same secretory granules. In the nontumorous adenohypophysis, somatotrophs and lactotrophs showed ultrastructural signs of hyperactivity. This finding is in contrast with the presence of suppressed somatotrophs and lactotrophs seen in nontumorous portions of adult pituitaries harboring growth hormone or prolactin-secreting adenomas. Our morphological study reinforces the view that growth hormone-producing pituitary tumors, originating in childhood, are different from those of the adult gland.

  8. Microcystic adenoma of the pancreas associated with non-functioning islet cell tumor: a case report

    International Nuclear Information System (INIS)

    Kong, Keun Young; Lee, Dong Ho; Ko, Young Tae; Kim, Youn Wha

    1997-01-01

    Among cystic tumors arising in the pancreas, microcystic adenoma is relatively uncommon;it is usually benign, and is comprised of cysts that vary in size from microscopic to 2 cm in diameter. It has recently been reported to be associated with other pancreatic tumors with malignant potential; in particular, microcystic adenoma with coexistent islet cell tumor has been reported in von Hippel-Lindau disease. We report a case of microcystic adenoma of the pancreas associated with coexistent surgically-proven islet cell tumor. On spiral CT, the islet cell tumor was seen as a highly enhanced inhomogeneous solid mass in the pancreatic head, and microcystic adenoma as numerous small cysts throughout the pancreas.=20

  9. Using the marker CD34 as tool to discriminate adenoma versus hepatocellular

    International Nuclear Information System (INIS)

    Mohs Alfaro, Monica

    2011-01-01

    The CD34 marker is used as immunohistochemistry technique to detect and differentiate between the hepatocellular adenoma of the hepatocellular carcinoma. The liver lesions are described. The hepatic angiogenesis is explained [es

  10. Tubular adenoma of the breast in a pregnant girl: report on a case.

    Science.gov (United States)

    Palnaes Hansen, C; Fahrenkrug, L; Hastrup, N

    1991-12-01

    A rare case of a tubular breast adenoma in a 13-year-old pregnant girl is presented. The tumor which developed during pregnancy measured 10 x 8 x 4 cm, was well demarcated and could be totally removed.

  11. Magnetic resonance imaging of the pituitary adenoma: Analysis of the enhancement patterns

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Ik; Choi, Woo Suk; Shin, In Soo; Ryu, Kyung Nam; Yoon, Yup [Kyung Hee University Hospital, Seoul (Korea, Republic of)

    1993-11-15

    The magnetic resonance images (MRI) of 30 patients with surgically or biochemically confirmed pituitary adenomas (20 macroadenomas, 10 microadenomas) were retrospectively evaluated. Ten patients had hyperprolactinaemia, another eight had acromegaly, another eight had nonfunctioning adenoma and four had cushing disease. The examinations were performed at a1.5 T superconducting MR system using a multisection spin-echo technique with 3 mm thick sections and a 256 X 224 matrix. TI weighted sagittal and coronal images were obtained before and within 30 minutes after the administration of Gd-DTPA (0.1 mmol/kg). Analysis of the MRI was focused on the signal intensity and enhancement patterns of the pituitary adenoma before and after Gd-DTPA administration. Compared with endocrinological diagnosis, macroadenoma showed heterogeneous enhancement in 55%, rim enhancement in 35% and homogeneous enhancement in 10%. Conclusively, the enhancement patterns of the pituitary adenoma did not correlate with the subtypes made according to hormone production.

  12. Coincidence of scintigraphic false positive and false negative findings in parathyroid and thyroid adenomas (case report)

    Energy Technology Data Exchange (ETDEWEB)

    Mana, O.; Zatta, G.; Boccolari, S.; Barbesti, S.; Tarolo, G.L.

    1987-04-01

    The subtractive double tracer scintigraphy with /sup 201/Tl and /sup 99m/Tc is a useful technique in studying parathyroid nodules; nevertheless, this method can give misleading informations especially in presence of thyroid nodules with false positive and false negative findings. In this case report the technique was applied in studying a patient with three nodules (two thyroid adenomas and one parathyroid adenoma), where both scintigraphic and echographic methods provided misleading informations. The selective uptake of /sup 201/Tl in the upper region of the right thyroid lobe gave a false positive finding, while the increased uptake of /sup 99m/Tc in a hyperfunctioning thyroid adenoma of left lobe masked the parathyroid adenoma laying below, giving a false negative finding.

  13. Simultaneous Serous Cyst Adenoma and Ovarian Pregnancy in An Infertile Woman

    Directory of Open Access Journals (Sweden)

    Mahbod Ebrahimi

    2014-03-01

    Full Text Available Ovarian pregnancy is a rare form of extra uterine pregnancy. Serous cyst adenoma is a benign variant of epithelial cell tumors of ovary. The coexistence of a cyst adenoma with an ovarian pregnancy in the same ovary is extremely rare. Some studies suggested that infertility or ovulation-inducing drugs can be involved in increased risk of ovarian tumors and ovarian pregnancies. A 28-year-old infertile woman presented with a ruptured ovarian pregnancy following ovulation induction with metformin. She had a concurrent benign serous cyst adenoma in the same ovary. Resection of both ovarian pregnancy and tumoral mass were performed. The ovary was preserved. Removal of gestational tissue and preservation of the involved ovary are the best options for management of ovarian pregnancy in young patient. Although there is an association between infertility/ovulation inducting medications and ovarian gestation, their connections with serous cyst adenoma are undetermined.

  14. Endoscopic mucosal resection of flat and sessile colorectal adenomas: Our experience with long-term follow-ups

    Directory of Open Access Journals (Sweden)

    Grgov Saša

    2014-01-01

    Full Text Available Bacground/Aim. Endoscopic mucosal resection (EMR or mucosectomy is a removing method of flat or sessile lesions, laterally spreading tumors and carcinoma of the colon or the rectum limited to mucosa or the surface part of the submucosa. The aim of the study was to estimate the efficacy and safety of EMR in removing flat and sessile colorectal adenomas. Methods. This prospective study involved 140 patients during the period of 8 years. A total of 187 colorectal adenomas were removed using the EMR method “inject and cut with snare”. Results. The approximate size of mucosectomised adenomas was 13.6 mm (from 8 mm to 60 mm. There was a total of 48 (25.7% flat adenomas and 139 (74.3% sessile adenomas, (p < 0.01. Using “en bloc” and “piecemeal” resection, 173 (92.5% and 14 (7.5% of colorectal adenomas were removed, respectively. In all the cases, a complete removal of colorectal adenomas was achieved. Two (1.4% patients had adenoma removal with intramucosal carcinoma each. In the average follow-up period of 21.2 ± 17.8 months, 2 (1.4% patients had adenoma relapse after EMR. Considering complications, there was bleeding in 1 (0.7% patient with a big rectum adenoma removed with EMR. Furthermore, one (0.7% patient had a postcoagulation syndrome after cecal adenoma was removed by EMR. Conclusion. EMR is an efficient, safe and minimally invasive technique of removing flat and sessile adenomas in the colon and the rectum, with a very low percentage of adenoma recurrence over a long period of monitoring.

  15. Technetium-99m methoxyisobutylisonitrile imaging for parathyroid adenoma: relationship to P-glycoprotein or multidrug resistance-related protein expression

    Energy Technology Data Exchange (ETDEWEB)

    Kao, Albert [Departments of Nuclear Medicine and Medical Research, China Medical College Hospital, No. 2, Yuh-Der Road, Taichung 404 (Taiwan); Shiau, Yu-Chien [Department of Nuclear Medicine, Far Eastern Memorial Hospital, Institute of Biomedical Engineering, College of Electrical Engineering, National Taiwan University, Taipei (Taiwan); Tsai, Shih-Chuan [Department of Nuclear Medicine, Show-Chwan Memorial Hospital, Chunghua (Taiwan); Wang, Jhi-Joung [Department of Medical Research, Chi-Mei Medical Center, Tainan (Taiwan); Ho, Shung-Tai [School of Medicine, National Defense Medical Center, Taipe (Taiwan)

    2002-08-01

    Gland size has been reported to have a major influence on localisation of parathyroid adenomas by technetium-99m methoxyisobutylisonitrile ({sup 99m}Tc-MIBI) imaging. It has also been suggested that P-glycoprotein (Pgp) expression in parathyroid adenomas may influence localisation because false negative studies have been reported with large tumours and true positives with very small tumours. Therefore, the purpose of this study was to retrospectively evaluate the relationship between {sup 99m}Tc-MIBI parathyroid imaging results and Pgp or multidrug resistance-related protein (MRP) expression in parathyroid adenomas. Before surgery, 47 patients with large parathyroid adenomas (larger than 1.5 g) underwent early and delayed parathyroid imaging, 10 min and 2 h after intravenous injection of {sup 99m}Tc-MIBI. Immunohistochemical analyses (IHA) were performed, using multiple non-consecutive sections of the operative specimens, to detect Pgp or MRP expression. According to the results of IHA, the 34 parathyroid adenomas were separated into four groups: (1) three adenomas positive for both Pgp and MRP expression, (2) one adenoma positive for Pgp but negative for MRP expression, (3) four adenomas negative for Pgp but positive for MRP expression and (4) 39 adenomas with negative for both Pgp and MRP expression. All 39 adenomas in group 4 could be detected by {sup 99m}Tc-MIBI parathyroid imaging. None of the eight adenomas in groups 1-3 could be detected by {sup 99m}Tc-MIBI parathyroid imaging (P<0.05). It is concluded that not only the size of parathyroid adenomas but also significant Pgp or MRP expression limits the sensitivity of {sup 99m}Tc-MIBI imaging in localising parathyroid adenomas preoperatively. (orig.)

  16. Sonography of intrathyroid parathyroid adenomas: Are there distinctive features that allow for preoperative identification?

    International Nuclear Information System (INIS)

    Heller, Matthew T.; Yip, Linwah; Tublin, Mitchell E.

    2013-01-01

    Objective: The purpose of our study was to determine if intra-thyroid parathyroid adenomas can be accurately identified by applying proposed criteria to preoperative ultrasound examinations in patients with primary hyperparathyroidism. Materials/methods: Fifty-three patients with pathology proven intra-thyroid parathyroid adenomas and pre-operative ultrasounds were identified from a surgical database for a blinded, retrospective review. A contemporary, age-matched cohort of 54 patients with extra-thyroid parathyroid adenomas was identified as a control. A total of 64 patients within these cohorts had co-existing thyroid nodules. Proposed ultrasound criteria for identifying a parathyroid adenoma included solid composition, profound hypoechogenicity, and presence of a feeding polar vessel. Parathyroid adenomas were classified as extra-thyroid or intra-thyroid (partial or complete) based on their relationship with the thyroid gland during ultrasound evaluation and results were compared to surgical and histopathology reports as the gold standard. The results from the blinded, retrospective review during which the proposed, specific ultrasound criteria were applied were compared to the initial, pre-operative reports during which the proposed criteria were not applied. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the blinded, retrospective review and initial, pre-operative reports were calculated. Additionally, in patients with co-existing thyroid nodules, an attempt was made to differentiate parathyroid adenomas from the thyroid nodules. Results: Application of the proposed ultrasound criteria during blinded retrospective review yielded a sensitivity and specificity for detecting intra-thyroid parathyroid adenomas of 76% and 92%, respectively. The sensitivity and specificity of ultrasound for detecting intra-thyroid parathyroid adenomas on the initial reports was 29% and 95%, respectively. The sensitivity and

  17. Meat, vegetables and genetic polymorphisms and the risk of colorectal carcinomas and adenomas

    International Nuclear Information System (INIS)

    Skjelbred, Camilla F; Sæbø, Mona; Hjartåker, Anette; Grotmol, Tom; Hansteen, Inger-Lise; Tveit, Kjell M; Hoff, Geir; Kure, Elin H

    2007-01-01

    The risk of sporadic colorectal cancer (CRC) is mainly associated with lifestyle factors, particularly dietary factors. Diets high in red meat and fat and low in fruit and vegetables are associated with an increased risk of CRC. The dietary effects may be modulated by genetic polymorphisms in biotransformation genes. In this study we aimed to evaluate the role of dietary factors in combination with genetic factors in the different stages of colorectal carcinogenesis in a Norwegian population. We used a case-control study design (234 carcinomas, 229 high-risk adenomas, 762 low-risk adenomas and 400 controls) to test the association between dietary factors (meat versus fruit, berries and vegetables) genetic polymorphisms in biotransformation genes (GSTM1, GSTT1, GSTP1 Ile 105 Val, EPHX1 Tyr 113 His and EPHX1 His 139 Arg), and risk of colorectal carcinomas and adenomas. Odds ratio (OR) and 95% confidence interval (95% CI) were estimated by binary logistic regression. A higher ratio of total meat to total fruit, berry and vegetable intake was positively associated with both high and low-risk adenomas, with approximately twice the higher risk in the 2 nd quartile compared to the lowest quartile. For the high-risk adenomas this positive association was more obvious for the common allele (Tyr allele) of the EPHX1 codon 113 polymorphism. An association was also observed for the EPHX1 codon 113 polymorphism in the low-risk adenomas, although not as obvious. Although, the majority of the comparison groups are not significant, our results suggest an increased risk of colorectal adenomas in individuals for some of the higher ratios of total meat to total fruit, berry and vegetable intake. In addition the study supports the notion that the biotransformation enzymes GSTM1, GSTP1 and EPHX1 may modify the effect of dietary factors on the risk of developing colorectal carcinoma and adenoma

  18. Risk of colorectal adenomas in patients with celiac disease: a systematic review and meta-analysis.

    Science.gov (United States)

    Lasa, J; Rausch, A; Zubiaurre, I

    2018-02-05

    Whether celiac disease increases the risk of presenting with colorectal adenoma or not, has not been extensively evaluated. This question becomes relevant when considering early screening methods in patients with the disease. The aim of our article was to determine the risk of colorectal adenomas in celiac disease patients. A computer-assisted search of the MEDLINE-Pubmed, EMBASE, LILACS, Cochrane Library, and Google Scholar databases was carried out, encompassing the time frame of 1966 to December 2016. The search strategy consisted of the following MESH terms: 'celiac disease' OR 'celiac sprue' AND 'colorectal' OR 'colorectal neoplasia' OR 'colorectal adenoma'. A fixed-effect model was used for the analyses. The first analysis dealt with the prevalence of all presentations of colorectal adenoma in patients with celiac disease and the second was on the prevalence of advanced adenomas. The outcomes were described as odds ratios (OR) with their 95% confidence intervals. The search identified 480 bibliographic citations, 17 of which were chosen for evaluation. Fourteen of those studies were rejected, leaving a final total of three for the analysis. Those studies included 367 cases of celiac disease and 682 controls. No significant heterogeneity was observed (I 2 =26%). There was no increased prevalence of colorectal adenomas in the celiac disease patients, when compared with the controls (OR: 0.94 [0.65-1.38]), and no significant difference was observed when assessing the prevalence of advanced adenomas (OR: 0.97 [0.48-1.97]). Celiac disease was not associated with an increased risk of colorectal adenomas. However, due to the limited evidence available, more studies are necessary to determine whether there is an actual association. Copyright © 2018 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.

  19. Advancing Treatment of Pituitary Adenomas through Targeted Molecular Therapies: The Acromegaly & Cushing Disease Paradigms

    Directory of Open Access Journals (Sweden)

    Michael Anthony Mooney

    2016-07-01

    Full Text Available The current treatment of pituitary adenomas requires a balance of conservative management, surgical resection, and in select tumor types, molecular therapy. Acromegaly treatment is an evolving field where our understanding of molecular targets and drug therapies has improved treatment options for patients with excess growth hormone levels. We highlight the use of molecular therapies in this disease process and advances in this field, which may represent a paradigm shift for the future of pituitary adenoma treatment.

  20. K-ras2 Activation and Genome Instability Increase Proliferation and Size of FAP Adenomas

    Directory of Open Access Journals (Sweden)

    Anna Rapallo

    1999-01-01

    Full Text Available The possible role of K‐ras2 mutations and aneuploidy toward increase of proliferation and adenoma size in Familial Adenomatous Polyposis (FAP adenomas is not known. The present study addresses these issues by investigating 147 colorectal adenomas obtained from four FAP patients. The majority of adenomas had size lower than or equal to 10 mm (86%, low grade dysplasia (63%, and were preferentially located in the right colon (60%. Normal mucosa samples were obtained from 19 healthy donors. Three synchronous adenocarcinomas were also investigated. K‐ras2 mutation spectrum was analysed by PCR and Sequence Specific Oligonucleotide (SSO hybridization, while flow cytometry (FCM was used for evaluating degree of DNA ploidy and S‐phase fraction. Overall, incidences of K‐ras2 mutations, DNA aneuploidy and high S‐phase values (>7.2% were 6.6%, 5.4% and 10.5%, respectively. In particular, among the adenomas with size lower than 5 mm, K‐ras2 mutation and DNA aneuploidy frequencies were only slightly above 1%. Statistically significant correlations were found between K‐ras2 and size, DNA ploidy and size and K‐ras2 and S‐phase (p. In particular, among the wild type K‐ras2 adenomas, high S‐phase values were detected in 8% of the cases versus 57% among the K‐ras2 mutated adenomas (p=0.0005. The present series of FAP adenomas indicates that K‐ras2 activation and gross genomic changes play a role toward a proliferative gain and tumour growth in size.

  1. Adenoma viloso com transformação carcinomatosa da ampola de Vater

    Directory of Open Access Journals (Sweden)

    Guilherme Pinto Bravo Neto

    Full Text Available Villous adenomas of the duodenum and ampulla of Vater are uncommon, but they have been diagnosed more frequently with the increasing use of upper gastrointestinal endoscopy. Differential diagnosis with villous adenocarcinoma may be difficult. The authors present a case of a 47-year-old man with a giant villous adenoma of the duodenum, with intermittent jaundice, that was treated by pancreatoduodenectomy.

  2. A black adrenocortical adenoma causing Cushing's syndrome not imaged by radiocholesterol scintigraphy

    International Nuclear Information System (INIS)

    Reschini, E.; Baldini, M.; Cantalamessa, L.

    1990-01-01

    In a 33-year-old female patient with left adrenal tumour and Cushing's syndrome, adrenocortical scintigraphy with radiocholesterol did not image the tumour nor the suppressed contralateral gland. Histology showed a black adrenocortical adenoma composed only of compact cells; there was no evidence of malignancy. This demonstrates that non-visualization of the adrenal glands in a patient with Cushing's syndrome is not invariably due to adrenal carcinoma. The literature on black adrenal adenomas causing Cushing's syndrome is reviewed. (orig.)

  3. Adrenal incidentalomas showing unilateral concordant visualization by adrenocortical scintigraphy. Comparison with adenomas in Cushing's syndrome

    International Nuclear Information System (INIS)

    Tani, Atsushi; Nakajo, Masayuki; Tsuchimochi, Shinsaku; Nakabeppu, Yoshiaki; Umanodan, Tomokazu

    2000-01-01

    An adrenocortical adenoma causing Cushing's syndrome (Cushing's adenoma) produces a unilateral concordant visualization (UCV) imaging pattern in which the adenoma is only visualized on radioiodocholesterol adrenocortical scintigraphy. But because this imaging pattern is also noted in some patients with adrenal incidentalomas, we examined whether the UCV-incidentaloma was essentially identical with Cushing's adenoma and would develop Cushing's syndrome. The subjects were 9 patients with UCV-incidentalomas (mean size, 30 mm; range, 20-45 mm) and 6 patients with Cushing's adenomas (mean size, 28 mm; range, 25-35 mm). Endocrinological evaluations showed several abnormalities including blunted diurnal rhythm of plasma cortisol within the normal range, low plasma ACTH and/or high 24-hr urinary 17-OHCS levels in 8 of 9 patients with UCV-incidentalomas, but these abnormalities did not meet the diagnostic criteria of Cushing's syndrome. Adrenal uptake of the tracer in the patients with UCV-incidentalomas was not statistically different from that in the patients with Cushing's adenomas and had no relationship with hormonal values in either patient group. Tumor size on CT correlated with the levels of 24-hr urinary 17-OHCS (r=0.75, p=0.02) and plasma cortisol at 7:00 (r=0.82, p=0.007) in the patients with UCV-incidentalomas, but not in the patients with Cushing's adenomas. Although 3 UCV-incidentalomas increased slightly in size, none of 9 patients with UCV-incidentalomas has developed Cushing's syndrome for 4 to 52 months. These results suggest that the UCV-incidentaloma may be essentially different from the Cushing's adenoma and unlikely to develop Cushing's syndrome. (author)

  4. CT and MR images of pleomorphic adenoma in major and minor salivary glands

    International Nuclear Information System (INIS)

    Kakimoto, Naoya; Gamoh, Shoko; Tamaki, Junko; Kishino, Mitsunobu; Murakami, Shumei; Furukawa, Souhei

    2009-01-01

    Purpose: To investigate the CT and MR imaging features of pleomorphic adenoma in the head and neck area. Materials and methods: Our materials of this study consisted of 50 pleomorphic adenomas from 50 patients which were all histopathologically diagnosed. The CT and MR images were retrospectively evaluated. The following features were evaluated: the detectability of the lesion, the tumor margin, the border of the lesion, the aspect of the lesion, the contrast between the lesion and surrounding tissue, the signal intensity of the lesion, the enhancement of contrast medium, the aspect of the lesion after the injection of contrast medium, the detectability of the capsule, and the detectability of bone resorption of the lesion. Results: The tumor detectabilities were 77% on axial plain CT images and 90% on axial CE CT images, respectively. On CT images, pleomorphic adenoma tended to show a well-defined margin, a smooth border, an inhomogeneous aspect, a low or high contrast, and intermediate or high signal intensity. After contrast medium administration, pleomorphic adenoma tended to show a slightly high enhancement and either an inhomogeneous or a periphery enhancement on the CE CT images. The capsule could be hardly detected on CT images. The tumor detectabilities were 86% on axial T1-weighted MR images, 88% on axial T2-weighted MR images, and 85% on axial CE T1-weighted MR images, respectively. On MR images, pleomorphic adenomas tended to show well-defined margin, a lobulate border, an inhomogeneous aspect, a high contrast, and intermediate or high signal intensity. After contrast medium administration, pleomorphic adenoma tended to show a high enhancement and either an inhomogeneous or a periphery enhancement on MR images. The capsule could be detected in many cases on MR images. Conclusions: It was possible to detect the capsule in pleomorphic adenoma using MR images. The pleomorphic adenomas in head and neck area should be evaluated with MR images.

  5. Advancing Treatment of Pituitary Adenomas through Targeted Molecular Therapies: The Acromegaly and Cushing Disease Paradigms.

    Science.gov (United States)

    Mooney, Michael A; Simon, Elias D; Little, Andrew S

    2016-01-01

    The current treatment of pituitary adenomas requires a balance of conservative management, surgical resection, and in select tumor types, molecular therapy. Acromegaly treatment is an evolving field where our understanding of molecular targets and drug therapies has improved treatment options for patients with excess growth hormone levels. We highlight the use of molecular therapies in this disease process and advances in this field, which may represent a paradigm shift for the future of pituitary adenoma treatment.

  6. Image guidance in trans-sphenoidal surgery for giant pituitary adenomas: Luxury or necessity?

    OpenAIRE

    Deepak Agrawal

    2012-01-01

    Background: In spite of availability of image guidance (neuronavigation) at major centers around the world, most trans-sphenoidal surgeries for pituitary adenomas continue to be done under fluoroscopic control. On the other hand, the high mortality and morbidity for giant pituitary adenomas is mainly due to inadequate tumor removal. Aims and Objectives: The objective of this study was to study to utility of image guidance in trans-sphenoidal surgeries for optimizing tumor removal in giant pit...

  7. Adipokines Do Not Mediate the Association of Obesity and Colorectal Adenoma

    International Nuclear Information System (INIS)

    Balcom, H. M. O.; Cannioto, R.; Nie, J.; Millen, A. E.; Freudenheim, J. L.; Chen, Z.; Thompson, C. L.; Li, L.; Tracy, R.

    2014-01-01

    The association between obesity and colon neoplasia is well established but the underlying biological mechanisms are not fully understood. Rates of both obesity and colon cancer differ by race. Adipokines have been postulated as contributors to the observed association; however, few studies have examined the mediating effect of adipokines on the obesity-colon adenoma association with consideration of racial differences. Methods. We determined prediagnostic levels of adiponectin and leptin in Caucasians (217 cases and 650 controls) and African Americans (175 cases and 378 controls) participating in the Case Transdisciplinary Research on Energetics and Cancer Colon Adenoma Study. We evaluated mediating effects of adiponectin and leptin on the association of abdominal adiposity and colon adenoma separately according to race using mediational pathway analysis. Results. We observed differences in circulating adipokine concentrations by race; African Americans had higher levels of leptin and lower levels of adiponectin than Caucasians for both adenoma cases and controls ( P values <0.001). Leptin and adiponectin did not mediate the waist-to-hip ratio (WHR) adenoma association in either group (all Sobel P values >0.27). Conclusions. We found no evidence that leptin or adiponectin mediates the abdominal obesity-colorectal adenoma pathway. Larger studies on how these associations vary by race, sex, and obesity are needed.

  8. Pre-operative localization of parathyroid adenoma by Tc-99m-sestamibi scintigraphy (MIBI)

    International Nuclear Information System (INIS)

    Ramadan, Edward; Vishne, Tal H; Koren, Romelia; Lerner, Igor; Melloul, Moshe; Dreznik, Zeev

    2002-01-01

    The use of pre-operative imaging for localization of primary parathyroid adenoma may influence the duration and results of parathyroidectomy. The current study was aimed to evaluate the efficiency of localization of parathyroid adenoma by Tc-99m-sestamibi (MIBI) scintigraphy and compare the results with those achieved by the use of preoperative ultrasound. Seventy five patients, aged 25 to 83 years with primary hyperparathyroidism were operated due to primary adenoma in Rabin Medical Center from January 1995 to April 1997. Fifty of them had a preoperative MIBI scintigraphy and ultrasound for localization of parathyroid adenoma, while 25 had a preoperative ultrasound alone. Ultrasound identified correctly the adenoma in 84 percent of the cases, as compared to 96 percent identified by MIBI scintigraphy (p<0.01). MIBI scintigraphy shortened operation length from 120±20 min to 80±15 min (p<0.05) and reduced the number of frozen sections from 2.2±0.4 to 1.1±0.3 (p<0.001). MIBI scintigraphy is the most efficient modality for preoperative localization of parathyroid adenoma as compared to other imaging procedures, and can shorten operative time (Au)

  9. Clinical results of LINAC-based stereotactic radiosurgery for pituitary adenoma

    International Nuclear Information System (INIS)

    Muramatsu, Julia; Yoshida, Masanori; Shioura, Hiroki; Kawamura, Yasutaka; Ito, Harumi; Takeuchi, Hiroaki; Kubota, Toshihiko; Maruyama, Ichiro

    2003-01-01

    We retrospectively evaluated our clinical results of stereotactic radiosurgery (SRS) for pituitary adenoma. Between 1995 and 2000, 13 patients were treated with SRS for pituitary adenoma. In all cases, the tumors had already been surgically resected. The adenomas were functional in 5 and non-functional in 8 patients. The median follow-up period was 30 months. SRS was performed with the use of a dedicated stereotactic 10-MV linear accelerator (LINAC). The median dose to the tumor margin was 15 Gy. The dose to the optic apparatus was limited to less than 8 Gy. MR images of 12 patients revealed tumor complete response (CR) in one case and partial response (PR) in 9 cases; in the remaining two patients, tumor size decreased by less than 50%. There was no recognizable regrowth of any of the tumors. In two of four GH-secreting adenomas, hormonal overproduction normalized, while the other two showed reduced hormonal production. One PRL-secreting adenoma did not respond. Reduction of visual acuity and field was seen in one patient. This patient also had a brain infarction. None of the patients developed brain radionecrosis or radiation-induced hypopituitarism. Although further studies based on greater numbers of cases and longer follow-up periods are needed, our results suggest that SRS seems to be a safe, effective treatment for pituitary adenoma. (author)

  10. Advanced age is a risk factor for proximal adenoma recurrence following colonoscopy and polypectomy

    DEFF Research Database (Denmark)

    Pommergaard, H C; Burcharth, J; Rosenberg, J.

    2016-01-01

    a randomized clinical trial that showed no effect of aspirin-calcitriol-calcium treatment on colorectal adenoma recurrence. Patients at high risk of colorectal cancer who had one or more sporadic colorectal adenomas removed during colonoscopy were followed up for 3 years. Independent risk factors associated...... with recurrence and characteristics of recurrent adenomas were investigated in a generalized linear model. Results After 3 years, the recurrence rate was 25·8 per cent in 427 patients. For younger subjects (aged 50 years or less), the recurrence rate was 19 per cent; 18 of 20 recurrent adenomas were located...... in the distal part of the colon. For older subjects (aged over 70 years), the recurrence rate was 35 per cent, and 16 of 25 recurrent adenomas were in the proximal colon. Age (odds ratio (OR) 1·04, 95 per cent c.i. 1·01 to 1·07) and number of adenomas (OR 1·27, 1·11 to 1·46) at the time of inclusion...

  11. The value of paramagnetic contrast agent gadolinium-DTPA in the diagnosis of pituitary adenomas

    International Nuclear Information System (INIS)

    Nakamura, T.; Schoerner, W.; Bittner, R.C.; Felix, R.

    1988-01-01

    The purpose of this study was to assess the role of MR imaging and the paramagnetic contrast agent Gadolinium-DYPA(Gd-DTPA) in the diagnosis of pituitary macroadenomas. 44 macroadenomas were examined with MRI before and after intravenous application of Gd-DTPA. Gd-DTPA produced excellent enhancement of solid adenoma. The best contrast between adenoma and surrounding structures could be gained on post-Gd T1-weighted images. Post-Gd images were equivalent to pre-Gd images in the evaluation of supra- and infrasellar extensions of macroadenomas. Post-Gd images had advantages in the evaluation of cavernous sinus invasion by adenoma. The difference in degree of contrast enhancement between adenoma and cavernous sinus facilitated the exact evaluation of lateral extension by adenoma in 18 cases. Almost equal degree of enhancement of both structures impaired tumor-sinus contrast in 2 cases. In the other 24 cases the tumor filled the cavernous sinus completely. It is our opinion that Gd-DTPA can be used on a widerspread basis because of its excellent capability to highlight and delineate pituitary adenomas. (orig.)

  12. Implementation of an e-learning module improves consistency in the histopathological diagnosis of sessile serrated lesions within a nationwide population screening programme.

    Science.gov (United States)

    IJspeert, Joep E G; Madani, Ariana; Overbeek, Lucy I H; Dekker, Evelien; Nagtegaal, Iris D

    2017-05-01

    Distinguishing premalignant sessile serrated lesions (SSLs) from hyperplastic polyps (HPs) is difficult for pathologists in daily practice. We aimed to evaluate nationwide variability within histopathology laboratories in the frequency of diagnosing an SSL as compared with an HP within the Dutch population-based screening programme for colorectal cancer and to assess the effect of an e-learning module on interlaboratory consistency. Data were retrieved from the Dutch Pathology Registry from the start of the nationwide population screening programme, January 2014, until December 2015. An obligatory e-learning module was implemented among pathologists in October 2014. The ratio between SSL and HP diagnosis was determined per laboratory. Odds ratios (ORs) for the diagnosis of an SSL per laboratory were compared with the laboratory with the median odds (median laboratory), before and after implementation of the e-learning module. In total, 14 997 individuals with 27 879 serrated polyps were included; 6665 (23.9%) were diagnosed as SSLs, and 21 214 as HPs (76.1%). The ratio of diagnosing an SSL ranged from 5% to 47% (median 23%) within 44 laboratories. Half of the laboratories showed a significantly different OR (range 3.47-0.16) for diagnosing an SSL than the median laboratory. Variability decreased after implementation of the e-learning module (P = 0.02). Of all pathology laboratories, 70% became more consistent with the median laboratory after e-learning implementation. We demonstrated substantial interlaboratory variability in the histopathological diagnosis of SSLs, which significantly decreased after implementation of a structured e-learning module. Widespread implementation of education might contribute to more homogeneous practice among pathologists. © 2016 John Wiley & Sons Ltd.

  13. Investigation into the controversial association of Streptococcus gallolyticus with colorectal cancer and adenoma

    International Nuclear Information System (INIS)

    Abdulamir, Ahmed S; Hafidh, Rand R; Mahdi, Layla K; Al-jeboori, Tarik; Abubaker, Fatimah

    2009-01-01

    The seroprevalence of IgG antibodies of Streptococcus gallolyticus subspecies gallolyticus, CIP 105428, was evaluated to investigate the controversial association of S. gallolyticus with colorectal carcinoma and adenoma in attempt to investigate the nature of such association if any, by exploring the mRNA expression of NF-κB and IL-8. Moreover, the serological behavior of S. gallolyticus IgG antibodies was compared to that of an indicator bacterium of bowel, Bacteroides fragilis. ELISA was used to measure IgG antibodies of S. gallolyticus and B. fragilis in sera of 50 colorectal cancer, 14 colorectal adenoma patients, 30 age- and sex- matched apparently healthy volunteers (HV) and 30 age- and sex- matched colonoscopically-proven tumor-free control subjects. NF-κB and IL-8 mRNA expression was evaluated in tumorous and non-tumorous tissue sections of carcinoma and adenoma patients in comparison with that of control subjects by using in situ hybridization assay. Colorectal cancer and adenoma patients were associated with higher levels of serum S. gallolyticus IgG antibodies in comparison with HV and control subjects (P < 0.05) while no similar association was found with serum IgG antibodies of B. fragilis (P > 0.05). ELISA cutoff value for the seropositivity of S. gallolyticus IgG was calculated from tumor-free control group. The expression of NF-κB mRNA was higher in tumorous than non-tumorous tissue sections of adenoma and carcinoma, higher in carcinoma/adenoma sections than in control subjects, higher in tumorous sections of carcinoma than in adenoma patients, and higher in S. gallolyticus IgG seropositive than in seronegative groups in both tumorous and non-tumorous sections (P < 0.05). IL-8 mRNA expression in tumorous sections of adenoma and carcinoma was higher than in non-tumorous sections, higher in carcinoma/adenoma than in control subjects, and higher in S. gallolyticus IgG seropositive than in seronegative groups in tumorous rather than non

  14. Technetium-99m methoxyisobutylisonitrile imaging for parathyroid adenoma: relationship to P-glycoprotein or multidrug resistance-related protein expression

    International Nuclear Information System (INIS)

    Kao, Albert; Shiau, Yu-Chien; Tsai, Shih-Chuan; Wang, Jhi-Joung; Ho, Shung-Tai

    2002-01-01

    Gland size has been reported to have a major influence on localisation of parathyroid adenomas by technetium-99m methoxyisobutylisonitrile ( 99m Tc-MIBI) imaging. It has also been suggested that P-glycoprotein (Pgp) expression in parathyroid adenomas may influence localisation because false negative studies have been reported with large tumours and true positives with very small tumours. Therefore, the purpose of this study was to retrospectively evaluate the relationship between 99m Tc-MIBI parathyroid imaging results and Pgp or multidrug resistance-related protein (MRP) expression in parathyroid adenomas. Before surgery, 47 patients with large parathyroid adenomas (larger than 1.5 g) underwent early and delayed parathyroid imaging, 10 min and 2 h after intravenous injection of 99m Tc-MIBI. Immunohistochemical analyses (IHA) were performed, using multiple non-consecutive sections of the operative specimens, to detect Pgp or MRP expression. According to the results of IHA, the 34 parathyroid adenomas were separated into four groups: (1) three adenomas positive for both Pgp and MRP expression, (2) one adenoma positive for Pgp but negative for MRP expression, (3) four adenomas negative for Pgp but positive for MRP expression and (4) 39 adenomas with negative for both Pgp and MRP expression. All 39 adenomas in group 4 could be detected by 99m Tc-MIBI parathyroid imaging. None of the eight adenomas in groups 1-3 could be detected by 99m Tc-MIBI parathyroid imaging (P 99m Tc-MIBI imaging in localising parathyroid adenomas preoperatively. (orig.)

  15. Dynamic contrast enhanced MRI in the differential diagnosis of adrenal adenomas and malignant adrenal masses

    International Nuclear Information System (INIS)

    Inan, Nagihan; Arslan, Arzu; Akansel, Gur; Anik, Yonca; Balci, N. Cem; Demirci, Ali

    2008-01-01

    Objective: To evaluate the value of dynamic MR imaging in the differential diagnosis of adrenal adenomas and malignant tumors, especially in cases with atypical adenomas. Materials and methods: Sixty-four masses (48 adenomas, 16 malignant tumors) were included in this prospective study. Signal loss of masses was evaluated using chemical shift MR imaging. Five dynamic series of T1-weighted spoiled gradient echo (FFE) images were obtained, with the acquisition starting simultaneously with i.v. contrast administration (0-100 s) followed by a T1-weighted FFE sequence in the late phase (5th minute). Contrast enhancement patterns in the early (25th second) and late (5th minute) phase images were evaluated. For the quantitative evaluation, signal intensity (SI)-time curves were obtained according to the SIs on the 0th, 25th, 50th 75th and 100th second. Also, the wash-in rate, maximum relative enhancement, time-to-peak, and wash-out of contrast at 100 s of masses in both groups were calculated. The statistical significance was determined by Mann-Whitney U test. To evaluate the diagnostic performance of the quantitative tests, receiver operating characteristic (ROC) analysis was performed. Results: Chemical shift MR imaging was able to differentiate 44 out of 48 adenomas (91.7%) from non-adenomas. The 4 adenomas (8.3%) which could not be differentiated from non-adenomas by this technique did not exhibit signal loss on out-of-phase images. With a cut-off value of 30, SI indices of adenomas had a sensitivity of 93.8%, specificity of 100% and a positive predictive value of 100%. On visual evaluation of dynamic MR imaging, early phase contrast enhancement patterns were homogeneous in 75% and punctate in 20,83% of the adenomas; while patchy in 56.25% and peripheral in 25% of the malignant tumors. On the late phase images 58.33% of the adenomas showed peripheral ring-shaped enhancement and 10.41% showed heterogeneous enhancement. All of the malignant masses showed heterogeneous

  16. Recurrent nephrogenic adenoma in a 10-year-old boy with prune belly syndrome : a case presentation.

    Science.gov (United States)

    Vemulakonda, Vijaya M; Kopp, Ryan P; Sorensen, Mathew D; Grady, Richard W

    2008-05-01

    Nephrogenic adenoma is a rare benign lesion of the urinary tract that is associated with a history of irritation or injury of the urothelium. Predisposing factors include infection, calculi, surgery, trauma, and renal transplantation. Nephrogenic adenoma commonly presents with lower urinary tract symptoms or hematuria. We present the case of recurrent nephrogenic adenoma in a 10-year-old boy with a history of prune belly syndrome and discuss management of this disease in the pediatric population. To our knowledge this represents the first reported case of recurrent nephrogenic adenoma associated with prune belly syndrome.

  17. Down-regulation of E-cadherin and catenins in human pituitary growth hormone-producing adenomas.

    Science.gov (United States)

    Sano, Toshiaki; Rong, Qian Zhi; Kagawa, Noriko; Yamada, Shozo

    2004-01-01

    Growth hormone (GH)-producing pituitary adenomas can be ultrastructurally divided into two major types: densely granulated and sparsely granulated. The latter type of adenoma characteristically exhibits globular accumulations of cytokeratin filaments known as fibrous bodies, which are immunohistochemically identifiable as juxtanuclear dot-like immunoreactivity. We hypothesize that the formation of fibrous body might be related to dysfunction of adhesion molecules, because of the functional relationship between intermediate filaments and the cadherin-catenin complex and frequent observation of loss of cohesiveness of the adenoma cells. Our recent immunohistochemical study showed that expression of E-cadherin and its undercoat proteins, alpha-, beta- and gamma-catenin, in GH cell adenomas with prominent fibrous bodies was significantly reduced compared with GH cell adenomas without fibrous bodies and the normal adenohypophysial cells. Although no mutation of exon 3 of the beta-catenin gene was found in any GH cell adenomas with fibrous bodies, methylation-specific polymerase chain reaction analysis revealed that the E-cadherin promoter region was methylated in 37.5% of these adenomas, two of which displayed total methylation, but not in GH cell adenomas without fibrous bodies. We conclude that the decreased expression of the E-cadherin-catenin complex and methylation of the E-cadherin gene promoter region are events associated with the formation of fibrous bodies in GH cell adenomas. It remains to be clarified to explain the mechanism by which down-regulation of adhesion molecules is involved in the abnormal assembly of intermediate filaments.

  18. Differentiation of pituitary adenomas from other sellar and parasellar tumors by {sup 99m}Tc(V)-DMSA scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Yamamura, Koji [Yokohama City Univ. (Japan). Medical Center; Suzuki, Shinichi; Yamamoto, Isao [Yokohama City Univ. (Japan). School of Medicine

    2003-04-01

    Pentavalent technetium-99m dimercaptosuccinic acid [{sup 99m}Tc(V)-DMSA] scintigraphy was evaluated for the differentiation of pituitary adenomas, especially non-functioning adenomas, from other sellar and parasellar lesions. Diffuse {sup 99m}Tc(V)-DMSA accumulation within the tumor was found in seven of seven non-functioning, three of four growth hormone-secreting, and seven of eight prolactin-secreting adenomas, but only partial accumulation in only two of 16 non-pituitary adenomas and normal pituitary glands. There were no significant relationship between tumor-to-background ratios and tumor size or serum hormone level. {sup 99m}Tc(V)-DMSA scintigraphy showed overall sensitivity of 81% (17/21 cases) for detecting pituitary adenomas, in particular 100% for non-functioning adenomas. {sup 99m}Tc(V)-DMSA may be useful for detecting pituitary adenomas, especially non-functioning adenomas, and for the differentiation of non-functioning pituitary adenomas from other sellar and parasellar lesions. (author)

  19. Primary aldosteronism and hypercortisolism due to bilateral functioning adrenocortical adenomas.

    Science.gov (United States)

    Oki, Kenji; Yamane, Kiminori; Sakashita, Yu; Kamei, Nozomu; Watanabe, Hiroshi; Toyota, Naoyuki; Shigeta, Masanobu; Sasano, Hironobu; Kohno, Nobuoki

    2008-10-01

    A 50-year-old male patient with a 15-year history of hypertension was referred to our hospital for evaluation of bilateral adrenal tumors. No Cushingoid features were observed. Computed tomographic scan showed 10-mm masses in each adrenal gland. Preoperative endocrinological examinations revealed autonomous cortisol and aldosterone secretion in this patient. The results of a subsequent adrenal venous catheterization study were consistent with the presence of a left cortisol-producing tumor and a right aldosterone-producing tumor. A left partial adrenalectomy was performed initially, but cortisol and aldosterone over-secretion persisted. Accordingly, the patient underwent a right adrenalectomy. Pathological examination of the resected specimens, including immunohistochemical analysis, demonstrated that both adenomas possibly produced cortisol and aldosterone. This is an extremely rare case of bilateral adrenal tumors, in which the left adrenocortical tumor produced and secreted cortisol or both cortisol and aldosterone and the right one produced and secreted both aldosterone and cortisol, as confirmed by clinical findings and pathological studies using immunohistochemical analysis.

  20. Killian-Jamieson Diverticula Presenting Synchronously with Thyroid Adenoma

    Directory of Open Access Journals (Sweden)

    Kenji Mimatsu

    2013-04-01

    Full Text Available Killian-Jamieson diverticulum is a rare hypopharyngeal diverticulum, less commonly encountered compared with Zenker's diverticulum. These hypopharyngeal diverticula that cause dysphagia often mimic a thyroid tumor incidentally detected on neck ultrasonography. However, to our knowledge, Killian-Jamieson diverticula complicated by a thyroid tumor have not been previously described. We experienced a rare case of bilateral Killian-Jamieson diverticula synchronously complicated by a thyroid adenoma in a 74-year-old woman who became aware of dysphagia and a tumor in the left side of her neck. Pharyngoesophagography revealed bilateral diverticula protruding from the lateral wall of the esophagopharyngeal junction, but the appearance of the cricopharyngeal bar representing the cricopharyngeus muscle above the diverticula had become unclear because the thyroid tumor was pressing on the diverticula and the cervical esophagus. However, the diverticula were diagnosed as Killian-Jamieson diverticula because cervical computed tomography showed bilateral diverticula arising from the cervical esophagus just below the level of the cricoid cartilage, and operative finding showed that the diverticula were located above the upper esophageal longitudinal muscle. Radiographic imaging is useful for diagnosis as cause of dysphagia and cervical tumor.

  1. Endoscopic endonasal transsphenoidal surgery in elderly patients with pituitary adenomas.

    Science.gov (United States)

    Gondim, Jackson A; Almeida, João Paulo; de Albuquerque, Lucas Alverne F; Gomes, Erika; Schops, Michele; Mota, Jose Italo

    2015-07-01

    With the increase in the average life expectancy, medical care of elderly patients with symptomatic pituitary adenoma (PA) will continue to grow. Little information exists in the literature about the surgical treatment of these patients. The aim of this study was to present the results of a single pituitary center in the surgical treatment of PAs in patients > 70 years of age. In this retrospective study, 55 consecutive elderly patients (age ≥ 70 years) with nonfunctioning PAs underwent endoscopic transsphenoidal surgery at the General Hospital of Fortaleza, Brazil, between May 2000 and December 2012. The clinical and radiological results in this group were compared with 2 groups of younger patients: surgery for treatment of PAs. The mean follow-up period was 50 months (range 12-144 months). The most common symptoms were visual impairment in 38 (69%) patients, headache in 16 (29%) patients, and complete ophthalmoplegia in 6 (10.9%). Elderly patients presented a higher incidence of ophthalmoplegia (p = 0.032) and a lower frequency of pituitary apoplexy before surgery (p transsphenoidal surgery for elderly patients with PAs may be associated with higher complication rates, especially secondary to early transitory complications, when compared with surgery performed in younger patients. Although the worst preoperative clinical status might be observed in this group, age alone is not associated with a worst final prognosis after endoscopic removal of nonfunctioning PAs.

  2. Delayed Complications After Transsphenoidal Surgery for Pituitary Adenomas.

    Science.gov (United States)

    Alzhrani, Gmaan; Sivakumar, Walavan; Park, Min S; Taussky, Philipp; Couldwell, William T

    2018-01-01

    Perioperative complications after transsphenoidal surgery for pituitary adenomas have been well documented in the literature; however, some complications can occur in a delayed fashion postoperatively, and reports are sparse about their occurrence, management, and outcome. Here, we describe delayed complications after transsphenoidal surgery and discuss the incidence, temporality from the surgery, and management of these complications based on the findings of studies that reported delayed postoperative epistaxis, delayed postoperative cavernous carotid pseudoaneurysm formation and rupture, vasospasm, delayed symptomatic hyponatremia, hypopituitarism, hydrocephalus, and sinonasal complications. Our findings from this review revealed an incidence of 0.6%-3.3% for delayed postoperative epistaxis at 1-3 weeks postoperatively, 18 reported cases of delayed carotid artery pseudoaneurysm formation at 2 days to 10 years postoperatively, 30 reported cases of postoperative vasospasm occurring 8 days postoperatively, a 3.6%-19.8% rate of delayed symptomatic hyponatremia at 4-7 days postoperatively, a 3.1% rate of new-onset hypopituitarism at 2 months postoperatively, and a 0.4%-5.8% rate of hydrocephalus within 2.2 months postoperatively. Sinonasal complications are commonly reported after transsphenoidal surgery, but spontaneous resolutions within 3-12 months have been reported. Although the incidence of some of these complications is low, providing preoperative counseling to patients with pituitary tumors regarding these delayed complications and proper postoperative follow-up planning is an important part of treatment planning. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Holmium laser enucleation versus laparoscopic simple prostatectomy for large adenomas.

    Science.gov (United States)

    Juaneda, R; Thanigasalam, R; Rizk, J; Perrot, E; Theveniaud, P E; Baumert, H

    2016-01-01

    The aim of this study is to compare Holmium laser enucleation of the prostate with another minimally invasive technique, the laparoscopic simple prostatectomy. We compared outcomes of a series of 40 patients who underwent laparoscopic simple prostatectomy (n=20) with laser enucleation of the prostate (n=20) for large adenomas (>100 grams) at our institution. Study variables included operative time and catheterization time, hospital stay, pre- and post-operative International Prostate Symptom Score and maximum urinary flow rate, complications and economic evaluation. Statistical analyses were performed using the Student t test and Fisher test. There were no significant differences in patient age, preoperative prostatic size, operating time or specimen weight between the 2 groups. Duration of catheterization (P=.0008) and hospital stay (P.99). Holmium enucleation of the prostate has similar short term functional results and complication rates compared to laparoscopic simple prostatectomy performed in large glands with the advantage of less catheterization time, lower economic costs and a reduced hospital stay. Copyright © 2015 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Myoepithelial cells are the main component in pleomorphic adenomas?

    Science.gov (United States)

    Ponce Bravo, Santa; Ledesma Montes, Constantino; López Becerril, Uriel; Morales Sánchez, Israel

    2007-03-01

    The aim of this study was to quantify by immunohistochemistry the number of myoepithelial cells (MyECs) in pleomorphic adenomas (PAs). We retrieved the paraffin cubes of 27 PAs, new slides were done and they were stained with anti-S100 protein antibody. The amount of S-100 protein positive cells was quantified, their morphology was recorded and comparison among MyEC number with age, gender and involved gland were also done. With S-100 protein, MyECs in normal salivary gland tissue were seen surrounding the ductual structures only. In the analysed PAs a mean of 27.4% of the neoplastic cells were positive to the antibody. With the exception of one PA, in all the analysed cases the plasmacytoid cells were the most commonly identified cells (48,6%). Results of this study suggest that MyECs do not constitute the main cellular component of the neoplastic compartment in PAs and corroborate the previously reported evidence by different authors, who studying the PAs suggested that MyECs does not comprise the main cellular neoplastic component of these entities.

  5. Cushing’s Syndrome During Pregnancy Secondary to Adrenal Adenoma

    Directory of Open Access Journals (Sweden)

    Fateme Mostaan

    2012-01-01

    Full Text Available Pregnancy rarely occurs in untreated cases of Cushing's syndrome (CS , because most of them are infertile due to significant maternal and fetal complications during pregnancy. Diagnosis of CS may be difficult during pregnancy. Since physiological changes of pregnancy are overlapped by classical presentation and biological confirmation of CS. Therefore the high clinical suspicious is needed for diagnosis. We present a 33 years old pregnant woman with a history of chronic hypertension from 10 years ago that referred to Imam Khomeini hospital for uncontrolled hypertension, gestational diabetes and fetal tachycardia at the 30 weeks of gestation. After initial studies abdominal MRI detected a 43 x 35 x 29 mm right adrenal mass. She was treated by anti-hypertensive drugs. But at 31.5 weeks of gestational age cesarean section was performed due to sever preeclampsia. Then two weeks after delivery open right adrenalectomy was carried out without any complications and in the histopathological evaluation benign adrenocortical adenoma was reported. CS is associated with considerable fetal and maternal morbidity and mortality. Selection of treatment method is variable and it depends on gestational age. Medical and surgical approaches have been used in managing CS in pregnancy. Surgical treatment is the first choice for CS which is recommended at the second trimester and in the late pregnancy medical treatment is preferred.

  6. Multiple intracranial aneurysms following radiation therapy for pituitary adenoma

    International Nuclear Information System (INIS)

    Moriyama, Takumi; Shigemori, Minoru; Hirohata, Yu; Konishi, Jun; Yuge, Tatuo; Tokunaga, Takayuki; Kuramoto, Shinken.

    1992-01-01

    A rare case is reported in which multiple cerebral aneurysm occurred after radiotherapy. A female aged 51 was hospitalized with a chief complaint of consciousness disorder. The patient was discharged from the hospital 1 year before, after undergoing subtotal extirpation of a tumor through the transsphenoidal sinus in a case of pituitary adenoma, and post-operative radiotherapy (topical 50 Gy). Mild hyperlipidemia associated with hypothyroidism was observed by blood biochemical test during hospitalization. Multiple cerebral infarction was observed by CT scanning and MR imaging. Conservative treatment including intensified endocrine-supplementing treatment was performed. Thyroid gland function and hyperlipidemia improved, but the consciousness disorder occurred suddenly 6 weeks after hospitalization. Subarachnoid hemorrhage and hydrocephalus were observed by CT scanning. Cerebral angiography detected a saccular aneurysm in the trifuraction of the right middle cerebral artery, 3 fusiform aneurysms in the periphery of the right middle cerebral artery, 2 fusiform aneurysms in the posterior cerebral artery. These findings were not observed at the initial hospitalization but were unexceptionally confined to all the irradiation fields. The patient died 8 weeks after hospitalization, and no autoptic findings was obtained. We presumed that radiation vasculopathy, caused by radiation therapy done one year previously, had led to the occurrence of multiple cerebral aneurysms. We think that hyperlipidemia may have acted as an exacerbating factor responsible for these aneurysms. (author)

  7. MR imaging of pituitary adenomas: Role of Gd-DTPA

    International Nuclear Information System (INIS)

    Dooms, G.; Mathurin, P.; Cornelis, G.; Demeure, R.

    1988-01-01

    A prospective study was performed to compare the results of CT and MR imaging in the detection of pituitary adenomas. Fifty consecutive unselected patients (40 female and ten male; mean age, 37 years) were studied by both modalities, which were always performed within a 1-week interval. The results were interpreted independently by two different investigators. Findings were confirmed by follow-up (clinical data and repeated examination), surgery, or biologic data for each patient. CT was performed with mainly the Philips Tomoscan 350 and with intravenous bolus of contrast material, at least in the direct coronal plane. MR imaging was performed with a superconducting magnet Philips Gyroscan S15 operating at 1.5 T. Coronal and sagittal T1-weighted images (repetition time = 470 msec, echo time = 30 msec) were performed in every patient (four averages, field of view = 200 mm, 3-mm section thickness with 0.6-mm gap between contiguous sections). Results of both modalities were identical in all 25 patients with macroadenomas (>10mm). However, MR imaging distinction between empty sell and necrotic (or cystic) macroadenomas was easier than that of CT (two patients)

  8. Histological and Immunohistochemical Revision of Hepatocellular Adenomas: A Learning Experience

    Directory of Open Access Journals (Sweden)

    S. Fonseca

    2013-01-01

    Full Text Available Light has been shed on the genotype/phenotype correlation in hepatocellular adenoma (HCA recognizing HNF1α-inactivated HCA (H-HCA, inflammatory HCA (IHCA, and β-catenin-activated HCA (b-HCA. We reviewed retrospectively our surgical HCA series to learn how to recognize the different subtypes histopathologically and how to interpret adequately their immunohistochemical staining. From January 1992 to January 2012, 37 patients underwent surgical resection for HCA in our institution. Nine had H-HCA (25% characterized by steatosis and loss of L-FABP expression; 20 had IHCA (55.5% showing CRP and/or SAA expression, sinusoidal dilatation, and variable inflammation; and 1 patient had both H-HCA and IHCA. In 5 patients (14%, b-HCA with GS and β-catenin nuclear positivity was diagnosed, two already with hepatocellular carcinoma. Two cases (5.5% remained unclassified. One of the b-HCA showed also the H-HCA histological and immunohistochemical characteristics suggesting a subgroup of β-catenin-activated/HNF1α-inactivated HCA, another b-HCA exhibited the IHCA histological and immunohistochemical characteristics suggesting a subgroup of β-catenin-activated/inflammatory HCA. Interestingly, three patients had underlying vascular abnormalities. Using the recently published criteria enabled us to classify histopathologically our retrospective HCA surgical series with accurate recognition of b-HCA for which we confirm the higher risk of malignant transformation. We also underlined the association between HCA and vascular abnormalities.

  9. Experimental induction of parathyroid adenomas in the rat

    International Nuclear Information System (INIS)

    Wynford-Thomas, V.; Wynford-Thomas, D.; Williams, E.D.

    1983-01-01

    Neonatal inbred Wistar albino rats were given either 5 or 10 microCi radioiodine ( 131 I) within 24 hours of birth. After weaning, animals were placed on diets high, normal, or deficient in vitamin D3 (cholecalciferol) for periods up to 2 years. In animals aged 12 months and older, adenomas were found in 0 of 67 unirradiated controls, in 22 of 67 given 5 microCi 131 I, and in 25 of 67 given to microCi 131 I. The incidence of tumors in irradiated animals was highest (55%) in those on a low-vitamin D diet and lowest (20%) in those on a high-vitamin D diet. Plasma calcium levels were significantly increased by the high-vitamin D diet, but the low-vitamin D diet did not lead to any significant decrease as compared to the calcium levels of the normal vitamin D diet group. Small but significant calcium increases were found in tumor-bearing animals. These findings indicate that parathyroid tumors in the rat can be induced by radiation and that their incidence is strongly influenced by dietary vitamin D content. The possibility that metabolites of vitamin D3 may influence parathyroid growth and tumor formation directly is discussed

  10. Histologic correlation of MR signal intensity in parathyroid adenomas

    International Nuclear Information System (INIS)

    Rumancik, W.M.; Khan, A.; Mir, R.N.; Attie, J.N.; Davis, J.E.; Ashtari, M.; Herman, P.G.

    1988-01-01

    The classic MR signal intensity pattern of parathyroid adenoma (PTA) is bright enhancement on T2-weighted images. However, variations in SI pattern have been observed in clinical practice. The purpose of this report is to describe the histologic characteristics of surgically removed PTAs as correlated with their in vivo MR imaging appearance. From May 1987 to April 1988, 51 consecutive patients with primary hyperparathyroidism were evaluated with MR imaging for preoperative localization of PTA. Surgical confirmation was obtained in all patients, with histologic evaluation available in 40. MR imaging was performed on 1.0-T system (Siemens, Magnetom) using a Helmhotz surface coil positioned at the neck. Spin-echo T1-weighted and T2-weighted multisection images were evaluated retrospectively. Signal intensities of PTA, adjacent thyroid, fat, and skeletal muscle were obtained (1) from direct region of interest determinations, and (2) visually as respective relationships of PTA to thyroid, fat, and muscle. Histologic classification was graded for (1) predominant cell type (i.e., chief or oxyphil cells), (2) acinar or solid growth pattern, (3) cystic change, (4) presence or absence of residual fat, (5) cell count per high power field, (6) heterogeneous histology, (7) gland weight, and (8) giant size (≥3 cm). The relationship of MR signal intensity to histology appears multifactorial

  11. Surgical Outcome of Endoscopic Endonasal Surgery for Non-Functional Pituitary Adenoma by a Team of Neurosurgeons and Otolaryngologists Adenoma by a Team of Neurosurgeons and Otolaryngologists.

    Science.gov (United States)

    Kikuchi, Ryogo; Toda, Masahiro; Tomita, Toshiki; Ogawa, Kaoru; Yoshida, Kazunari

    2017-01-01

    This study aimed to assess the efficacy of endoscopic endonasal surgery, conducted by a team of neurosurgeons and otolaryngologists. We studied 40 patients who were undergoing surgery for primary non-functional pituitary adenomas with Knosp grades 1 to 3, at Keio University Hospital between 2005 and 2012. We compared the endoscopic endonasal transsphenoidal approach (team-eTSS; T-eTSS), with a microscopic transsphenoidal approach (mTSS). Analyses were conducted for differences between the two groups in tumor resection rates, operating durations, and complications from the non-functional pituitary adenomas. We also compared the heminostril and binostril approaches for T-eTSS. Tumor resection rates were higher when the surgeries were conducted by T-eTSS than mTSS. In particular, when the maximum tumor diameter was more than 25 mm, resection rates were significantly higher for T-eTSS than for mTSS. There were no unexpected complications in either group. There was no significant difference in resection rates between the heminostril and binostril approaches when T-eTSS was performed. T-eTSS is an efficacious surgical option for non-functional pituitary adenomas, particularly when the adenoma is of large size. Benefits of the heminostril approach are evident.

  12. Endoscopic Transsphenoidal Surgery Outcomes in 331 Nonfunctioning Pituitary Adenoma Cases After a Single Surgeon Learning Curve.

    Science.gov (United States)

    Kim, Jung Hee; Lee, Jung Hyun; Lee, Ji Hyun; Hong, A Ram; Kim, Yoon Ji; Kim, Yong Hwy

    2018-01-01

    The outcomes of recent endoscopic surgery of nonfunctioning pituitary adenomas (NFPAs) are controversial when compared with traditional microscopic surgery. We aimed to assess the outcomes of endoscopic transsphenoidal surgeries performed by 1 surgeon with 7 years of experience and elucidate the predictive factors for surgical outcomes for NFPAs. We included 331 patients (155 men and 176 women) with clinical NFPAs who underwent transsphenoidal surgery because of visual symptoms by a single surgeon in Seoul National University Hospital from March 2010 to May 2016. We assessed the tumor removal rate, hormonal outcomes, visual outcomes, and complications. The gross total resection rate of endoscopic transsphenoidal surgery for NFPAs by a single surgeon was 74.9%. Cavernous sinus invasion, a high Knosp grade, large tumor size, previous surgery, and lack of surgical experience in the neurosurgeon elevated the risk for residual tumors. Visual deficits were improved in 73.4% of the patients, which was associated with tumor size, preoperative visual impairment score, previous radiation, and surgical experience. Hormonal status was improved in 15.4% and aggravated in 32.9% after surgery. There were no predictors for hormonal recovery. Transient diabetes insipidus (DI) was the most common complication (9.1%), and among these patients, 3.0% had persistent DI. Endoscopic transsphenoidal surgery by a well-experienced surgeon was an effective and safe treatment for NFPAs, but the hormonal outcomes were not changed compared with previous reports of microscopic surgery. Large tumor size and cavernous sinus invasion were still the barriers for achieving total resection. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Dietary patterns and colorectal adenomas in Lynch syndrome: the GEOLynch cohort study.

    Science.gov (United States)

    Botma, Akke; Vasen, Hans F A; van Duijnhoven, Fränzel J B; Kleibeuker, Jan H; Nagengast, Fokko M; Kampman, Ellen

    2013-02-01

    Patients with Lynch syndrome (LS) have a high risk of developing colorectal cancer due to mutations in mismatch repair genes. Because dietary factors, alone and in combination, influence sporadic colorectal carcinogenesis, the association of dietary patterns with colorectal adenomas in LS patients was assessed. In the GEOLynch cohort of 486 persons with LS, dietary information was collected, using a food frequency questionnaire. Dietary pattern scores were obtained by principal components analysis. Hazard ratios (HR) between dietary patterns and colorectal adenomas were calculated using Cox regression models. Robust sandwich variance estimates were used to control for dependency within families. Final models were adjusted for age, sex, smoking habits, colorectal adenoma history, and extent of colon resection. During a median follow-up of 20 months, colorectal adenomas were detected in 58 persons. Four dietary patterns were identified: a "Prudent," "Meat," "Snack," and "Cosmopolitan" pattern. Individuals within the highest tertile of the "Prudent" pattern had a HR of 0.73 (95% confidence interval [CI], 0.32-1.66) for colorectal adenomas, compared with the lowest tertile. Those with high "Meat" pattern scores had a HR of 1.70 (95% CI, 0.83-3.52). A high "Snack" pattern was associated with an increased risk of colorectal adenomas (HR, 2.16; 95% CI, 1.03-4.49). A HR of 1.25 (95% CI, 0.61-2.55) was observed for persons in the highest tertile of the "Cosmopolitan" pattern. These findings suggest that dietary patterns may be associated with development of colorectal adenoma in patients with Lynch syndrome. The directions of these findings are corroborative with those observed in studies investigating sporadic colorectal cancer. Copyright © 2012 American Cancer Society.

  14. A diet high in fruits and low in meats reduces the risk of colorectal adenomas.

    Science.gov (United States)

    Austin, Gregory L; Adair, Linda S; Galanko, Joseph A; Martin, Christopher F; Satia, Jessie A; Sandler, Robert S

    2007-04-01

    Recent evidence suggests overall dietary patterns, rather than specific dietary components, may be a better predictor of colorectal adenomas or cancers. Using cluster analysis, we aimed to assess the association between dietary patterns and colorectal adenomas and whether adjusting for total energy consumption prior to creating clusters affects this relation. Data from a case-control study of 725 individuals undergoing a colonoscopy were utilized. Cases (n = 203) had > or =1 adenoma on colonoscopy, and controls (n = 522) were those who had no adenomas. Dietary data were obtained from an FFQ. Daily intake for 18 different food groups was calculated. The values were transformed into Z-scores. Participants were first clustered without energy adjustment, then again based on their consumption per 1000 kcal (4187 kJ). There was no association between dietary patterns and colorectal adenomas without energy adjustment prior to creating dietary clusters, as clusters formed as a by-product of energy consumption. After adjusting for energy consumption, 3 distinct clusters emerged: 1) high fruit-low meat cluster; 2) high vegetable-moderate meat cluster; and 3) high meat cluster. After adjusting for potential confounders, the high vegetable-moderate meat cluster (odds ratio [OR] 2.17: [95% CI] 1.20-3.90) and high meat cluster (OR 1.70: [95% CI] 1.04-2.80) were at significantly increased odds of having had an adenoma compared with the high fruit-low meat cluster. A high-fruit, low-meat diet appears to be protective against colorectal adenomas compared with a dietary pattern of increased vegetable and meat consumption.

  15. Local IGFBP-3 mRNA expression, apoptosis and risk of colorectal adenomas

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    Omofoye Oluwaseun

    2008-05-01

    Full Text Available Abstract Background IGF binding protein-3 (IGFBP-3 regulates the bioavailability of insulin-like growth factors I and II, and has both anti-proliferative and pro-apoptotic properties. Elevated plasma IGFBP-3 has been associated with reduced risk of colorectal cancer (CRC, but the role of tissue IGFBP-3 is not well defined. We evaluated the association between tissue or plasma IGFBP-3 and risk of colorectal adenomas or low apoptosis. Methods Subjects were consenting patients who underwent a clinically indicated colonoscopy at UNC Hospitals and provided information on diet and lifestyle. IGFBP-3 mRNA in normal colon was assessed by real time RT-PCR. Plasma IGFBP-3 was measured by ELISA and apoptosis was determined by morphology on H & E slides. Logistic regression was used to compute odds ratio (OR and 95% confidence intervals. Results We observed a modest correlation between plasma IGFBP-3 and tissue IGFBP-3 expression (p = 0.007. There was no significant association between plasma IGFBP-3 and adenomas or apoptosis. Tissue IGFBP-3 mRNA expression was significantly lower in cases than controls. Subjects in the lowest three quartiles of tissue IGFBP-3 gene expression were more likely to have adenomas. Consistent with previous reports, low apoptosis was significantly associated with increased risk of adenomas (p = 0.003. Surprisingly, local IGFBP-3 mRNA expression was inversely associated with apoptosis. Conclusion Low expression of IGFBP-3 mRNA in normal colonic mucosa predicts increased risk of adenomas. Our findings suggest that local IGFBP-3 in the colon may directly increase adenoma risk but IGFBP-3 may act through a pathway other than apoptosis to influence adenoma risk.

  16. Polymorphisms in heterocyclic aromatic amines metabolism-related genes are associated with colorectal adenoma risk.

    Science.gov (United States)

    Eichholzer, Monika; Rohrmann, Sabine; Barbir, Aline; Hermann, Silke; Teucher, Birgit; Kaaks, Rudolf; Linseisen, Jakob

    2012-01-01

    Colorectal adenoma (CRA) and colorectal cancer (CRC) risks have been linked to the intake of red and processed meat. Heterocyclic aromatic amines (HCA) formed herein during high temperature cooking, are metabolized by a variety of enzymes, and allelic variation in the coding genes could influence individual CRA risk. Associations of polymorphisms in NAT1, NAT2, GSTA1, SULT1A1, CYP1A2, UGT1A7, UGT1A9, GSTP1 genes with colorectal adenoma risk were investigated in a nested case-control study of the EPIC-Heidelberg cohort including 428 cases matched by age, sex and year of recruitment with one or two controls (n=828) with negative colonoscopy per case. Genoyping was preformed with the Sequenom MassArray system and the LightCycler 480. Conditional logistic regression was used to compute odds ratios (OR) and corresponding 95% confidence intervals (CI). For rs15561 (NAT1) and rs1057126 (NAT1), the rarer allel was significantly inversely associated with adenoma risk OR=0.80 (95% CI 0.65-0.97) and (OR=0.81 (95% CI 0.65-0.99) and, respectively). For the combined NAT2 alleles encoding for enzymes with medium (versus slow) activity we also observed a significantly inverse association with adenoma risk (OR=0.75; 95% CI 0.85-0.97). In addition, homozygous carriers of the A allele of rs3957357 (GSTA1), i.e., those with a decreased enzyme activity, had a decreased risk of colorectal adenoma with an OR of 0.68 (95% CI 0.50-0.92; AA versus GG/GA). Polymorphisms in the other tested genes did not modify the risk of colorectal adenomas. In conclusion, polymorphisms in NAT1, NAT2, and GSTA1 are related to colorectal adenoma risk in this German cohort.

  17. Serum Interleukin-6, insulin, and HOMA-IR in male individuals with colorectal adenoma.

    Science.gov (United States)

    Sasaki, Yu; Takeda, Hiroaki; Sato, Takeshi; Orii, Tomohiko; Nishise, Shoichi; Nagino, Ko; Iwano, Daisuke; Yaoita, Takao; Yoshizawa, Kazuya; Saito, Hideki; Tanaka, Yasuhisa; Kawata, Sumio

    2012-01-15

    It is widely acknowledged that chronic low-grade inflammation plays a key role in the development of obesity-related insulin resistance and type 2 diabetes. The level of circulating interleukin-6 (IL-6), one of the major proinflammatory adipokines, is correlated with obesity and insulin resistance, which are known to be risk factors for colorectal adenoma. We examined the association between the circulating level of IL-6 and the presence of colorectal adenoma. In a total colonoscopy-based cross-sectional study conducted between January and December 2008, serum levels of IL-6 were measured in samples of venous blood obtained from 336 male participants attending health checkups (118 individuals with colorectal adenoma and 218 age-matched controls) after an overnight fast. In the colorectal adenoma group, the median levels of serum IL-6 (1.24 vs. 1.04 pg/mL; P = 0.01), triglyceride, insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) were to be significantly higher than those in the control group. When restricted to individuals with adenoma, levels of IL-6 were positively correlated with body mass index, insulin, and HOMA-IR. Multiple logistic analyses adjusted to include insulin or HOMA-IR showed that high levels of IL-6 were associated with the presence of colorectal adenoma. There was no significant interaction of IL-6 with HOMA-IR to modify this association. Our findings suggest that increased serum levels of IL-6 are positively associated with the presence of colorectal adenoma in men, independently of insulin and HOMA-IR. ©2011 AACR.

  18. Hyperfunctioning thyroid nodules in toxic multinodular goiter share activating thyrotropin receptor mutations with solitary toxic adenoma.

    Science.gov (United States)

    Tonacchera, M; Chiovato, L; Pinchera, A; Agretti, P; Fiore, E; Cetani, F; Rocchi, R; Viacava, P; Miccoli, P; Vitti, P

    1998-02-01

    Toxic multinodular goiter is a cause of nonautoimmune hyperthyroidism and is believed to differ in its nature and pathogenesis from toxic adenoma. Gain-of-function mutations of the TSH receptor gene have been identified as a cause of toxic adenoma. The pathogenesis at the molecular level of hyperfunctioning nodules in toxic multinodular goiter has yet not been reported. Six patients with a single hot nodule within a multinodular goiter and 11 patients with toxic thyroid adenoma were enrolled in our study. At histology five hyperfunctioning nodules in multinodular goiters showed the features of adenomas, and one was identified as a hyperplastic nodule. The entire exon 10 of the TSH receptor gene was directly sequenced after PCR amplification from genomic DNA obtained from surgical specimens. Functional studies of mutated receptors were performed in COS-7 cells. Five out of 6 (83%) hyperfunctioning nodules within toxic multinodular goiters harbored a TSH receptor mutation. A TSH receptor mutation was also evident in the hyperfunctioning nodule that at histology had the features of noncapsulated hyperplastic nodule. Among toxic adenomas, 8 out of 11 (72%) nodules harbored a TSH receptor mutation. All the mutations were heterozygotic and somatic. Nonfunctioning nodules, whether adenomas or hyperplastic nodules present in association with hyperfunctioning nodules in the same multinodular goiters, had no TSH receptor mutation. All the mutations identified had constitutive activity as assessed by cAMP production after expression in COS-7 cells. Hyperfunctioning thyroid nodules in multinodular goiters recognize the same pathogenetic event (TSH receptor mutation) as toxic adenoma. Other mechanisms are implicated in the growth of nonfunctioning thyroid nodules coexistent in the same gland.

  19. Local IGFBP-3 mRNA expression, apoptosis and risk of colorectal adenomas

    International Nuclear Information System (INIS)

    Keku, Temitope O; Sandler, Robert S; Simmons, James G; Galanko, Joseph; Woosley, John T; Proffitt, Michelle; Omofoye, Oluwaseun; McDoom, Maya; Lund, Pauline K

    2008-01-01

    IGF binding protein-3 (IGFBP-3) regulates the bioavailability of insulin-like growth factors I and II, and has both anti-proliferative and pro-apoptotic properties. Elevated plasma IGFBP-3 has been associated with reduced risk of colorectal cancer (CRC), but the role of tissue IGFBP-3 is not well defined. We evaluated the association between tissue or plasma IGFBP-3 and risk of colorectal adenomas or low apoptosis. Subjects were consenting patients who underwent a clinically indicated colonoscopy at UNC Hospitals and provided information on diet and lifestyle. IGFBP-3 mRNA in normal colon was assessed by real time RT-PCR. Plasma IGFBP-3 was measured by ELISA and apoptosis was determined by morphology on H & E slides. Logistic regression was used to compute odds ratio (OR) and 95% confidence intervals. We observed a modest correlation between plasma IGFBP-3 and tissue IGFBP-3 expression (p = 0.007). There was no significant association between plasma IGFBP-3 and adenomas or apoptosis. Tissue IGFBP-3 mRNA expression was significantly lower in cases than controls. Subjects in the lowest three quartiles of tissue IGFBP-3 gene expression were more likely to have adenomas. Consistent with previous reports, low apoptosis was significantly associated with increased risk of adenomas (p = 0.003). Surprisingly, local IGFBP-3 mRNA expression was inversely associated with apoptosis. Low expression of IGFBP-3 mRNA in normal colonic mucosa predicts increased risk of adenomas. Our findings suggest that local IGFBP-3 in the colon may directly increase adenoma risk but IGFBP-3 may act through a pathway other than apoptosis to influence adenoma risk

  20. Thyrotropin-secreting pituitary adenomas: biological and molecular features, diagnosis and therapy.

    Science.gov (United States)

    Losa, M; Fortunato, M; Molteni, L; Peretti, E; Mortini, P

    2008-12-01

    Central hyperthyroidism due to a thyrotropin (TSH)-secreting pituitary adenoma is a rare cause of hyperthyroidism, representing 0.5-1.0% of all pituitary adenomas. The etiopathogenesis of TSH-secreting-adenomas is unknown and no definite role for various oncogenes has been proven. Patients with TSH-secreting adenoma usually present with signs and symptoms of hyperthyroidism milder than those in patients with hyperthyroidism of thyroid origin, in addition to symptoms secondary to mass effects of the pituitary tumour. Mixed pituitary tumours co-secrete growth hormone and prolactin. The characteristic biochemical abnormalities are normal or high serum TSH concentrations in the presence of elevated total and/or free thyroid hormones concentrations. Measurement of markers of peripheral thyroid hormone action and dynamic tests may aid in the differential diagnosis with the syndrome of resistance to thyroid hormone. Neuroimaging is fundamental to visualize the pituitary tumor. Therapy of TSH-secreting adenomas can be accomplished by surgery, radiation therapies, and medical treatment with somatostatin analogs or dopamine agonists. Nowadays, and in contrast with the first reports on this rare disease, most patients are well controlled by current therapies.

  1. Monomorphous Plurihormonal Pituitary Adenoma of Pit-1 Lineage in a Giant Adolescent with Central Hyperthyroidism.

    Science.gov (United States)

    Pereira, Bernardo Dias; Raimundo, Luísa; Mete, Ozgur; Oliveira, Ana; Portugal, Jorge; Asa, Sylvia L

    2016-03-01

    Thyrotropin (TSH)-secreting pituitary adenomas are exceedingly rare at the pediatric age and no cases of co-secretion with other pituitary hormones in these tumors have been described in this age range. We present a case of a monomorphous plurihormonal pituitary adenoma that co-secreted TSH and GH in a pediatric patient. A 13-year-old male presented with increasing height velocity (17.75 cm/year, 9.55SD), weight loss, and visual impairment. Initial biochemical evaluations revealed secondary hyperthyroidism. A giant pituitary tumor compressing the surrounding structures was detected by magnetic resonance, and a transsphenoidal surgery was initially performed. Pathological examinations revealed an atypical, monomorphous plurihormonal Pit-1 lineage tumor with mixed features of silent subtype 3 adenoma and acidophil stem cell adenoma. In the postoperative period, secondary hyperthyroidism recurred with high levels of both GH and IGF1. In addition, due to tumor re-growth, a multimodality treatment plan was undertaken including surgery, somatostatin analogs, and radiotherapy. We report the first pediatric case of a plurihormonal TSH- and GH-secreting pituitary adenoma, further expanding the clinical manifestations of pediatric pituitary tumors. Comprehensive pathological evaluation and close follow-up surveillance are crucial to the prompt delivery of the best therapeutic options in the context of this particularly aggressive pituitary tumor.

  2. Acromegaly due to a Macroinvasive Plurihormonal Pituitary Adenoma and a Rectal Carcinoid Tumor

    Directory of Open Access Journals (Sweden)

    Sang Ouk Chin

    2015-09-01

    Full Text Available A macroinvasive pituitary adenoma with plurihormonality usually causes acromegaly and hyperprolactinemia, and also accompanies with neurologic symptoms such as visual disturbances. However, its concurrent presentation with a rectal carcinoid tumor is rarely observed. This study reports the history, biochemical, colonoscopic and immunohistochemical results of a 48-year-old female with acromegaly and hyperprolactinemia. Despite the large size and invasive nature of the pituitary adenoma to adjacent anatomical structures, she did not complain of any neurologic symptoms such as visual disturbance or headache. Immunohistochemical staining of the surgical specimen from the pituitary adenoma revealed that the tumor cells were positive for growth hormone (GH, prolactin (PRL, and thyroid stimulating hormone (TSH. Staining for pituitary-specific transcription factor-1 (Pit-1 was shown to be strongly positive, which could have been possibly contributing to the plurihormonality of this adenoma. Colonoscopy found a rectal polyp that was identified to be a carcinoid tumor using immunohistochemical staining. A macroinvasive pituitary adenoma with concomitant rectal carcinoid tumor was secreting GH, PRL, and TSH, which were believed to be in association with over-expression of Pit-1. This is the first case report of double primary tumors comprising a plurihormonal pituitary macroadenoma and rectal carcinoid tumor.

  3. Understanding traditional African healing

    OpenAIRE

    MOKGOBI, M.G.

    2014-01-01

    Traditional African healing has been in existence for many centuries yet many people still seem not to understand how it relates to God and religion/spirituality. Some people seem to believe that traditional healers worship the ancestors and not God. It is therefore the aim of this paper to clarify this relationship by discussing a chain of communication between the worshipers and the Almighty God. Other aspects of traditional healing namely types of traditional healers, training of tradition...

  4. Molecular and cellular mechanisms of aldosterone producing adenoma development

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    Sheerazed eBoulkroun

    2015-06-01

    Full Text Available Primary aldosteronism (PA is the most common form of secondary hypertension with an estimated prevalence of ~10% in referred patients. PA occurs as a result of a dysregulation of the normal mechanisms controlling adrenal aldosterone production. It is characterized by hypertension with low plasma renin and elevated aldosterone and often associated with hypokalemia. The two major causes of PA are unilateral aldosterone producing adenoma (APA and bilateral adrenal hyperplasia, accounting together for ~95% of cases. In addition to the well-characterized effect of excess mineralocorticoids on blood pressure, high levels of aldosterone also have cardiovascular, renal and metabolic consequences. Hence, long-term consequences of PA include increased risk of coronary artery disease, myocardial infarction, heart failure and atrial fibrillation. Despite recent progress in the management of patients with PA, critical issues related to diagnosis, subtype differentiation and treatment of non-surgically correctable forms still persist. A better understanding of the pathogenic mechanisms of the disease should lead to the identification of more reliable diagnostic and prognostic biomarkers for a more sensitive and specific screening and new therapeutic options. In this review we will summarize our current knowledge on the molecular and cellular mechanisms of APA development. On one hand, we will discuss how various animal models have improved our understanding of the pathophysiology of excess aldosterone production. On the other hand, we will summarize the major advances made during the last few years in the genetics of APA due to transcriptomic studies and whole exome sequencing. The identification of recurrent and somatic mutations in genes coding for ion channels (KCNJ5 and CACNA1D and ATPases (ATP1A1 and ATP2B3 allowed highlighting the central role of calcium signaling in autonomous aldosterone production by the adrenal.

  5. Radiotherapy for pituitary adenomas: Long-term efficacy and toxicity

    International Nuclear Information System (INIS)

    Erridge, Sara C.; Conkey, David S.; Stockton, Diane; Strachan, Mark W.J.; Statham, Patrick F.X.; Whittle, Ian R.; Grant, Robin; Kerr, Gillian R.; Gregor, Anna

    2009-01-01

    Background: Radiotherapy for pituitary adenomas is an effective treatment but remains controversial due to toxicity concerns. Materials and methods: A retrospective audit of patients referred for radiotherapy during 1974-2003 was conducted, the case records were examined and data linkage to cancer registry and hospital discharge records was performed to assess the overall survival (OS), progression-free survival (PFS) and late effects (hormone deficiency, reduced vision, second cancer and stroke). Results: Three hundred and eighty-five patients had radiotherapy (median 45 Gy). The OS was 74% and 49%, PFS was 97% and 96%, at 10 and 20 years, respectively. No specific factors influenced local control. Additional hormone deficiencies occurred in 19% (ACTH) and 26% (TSH). Actuarial rate optic neuropathy at 10 years was 0.8%. Seventy-eight patients had a stroke, a RR for a matched Scottish population of 1.45 (CI 1.05-1.18, p = 0.03) men and 2.22 (1.56-3.08, p < 0.01) women. Four intra-cranial tumours were identified; 20-year actuarial risk 1.9% (CI 0-2.6%), a RR of 5.65 (0.53-20.77, p = 0.10) men and 9.94 (0.94-36.56, p = 0.04) women. Conclusions: This treatment is effective with good local control rates at 20 years. A significant proportion developed hypo-pituitarism. The risk of optic neuropathy was low but risk of stroke increased, particularly in women who had slight increased risk of intra-cranial tumours.

  6. Postoperative Cerebral Vasospasm Following Transsphenoidal Pituitary Adenoma Surgery.

    Science.gov (United States)

    Eseonu, Chikezie I; ReFaey, Karim; Geocadin, Romergryko G; Quinones-Hinojosa, Alfredo

    2016-08-01

    Cerebral vasospasm following a transsphenoidal resection of a pituitary adenoma is a devastating occurrence that can lead to delayed cerebral ischemia and poor neurologic outcome if not diagnosed and treated in a timely manner. The etiology of this condition is not well understood but can lead to significant arterial vasospasm that causes severe ischemic insults. In this paper, we identify common presenting symptoms and essential management strategies to treat this harmful disease. A retrospective case report and literature review of presentation, treatment, and outcome of cerebral vasospasm following transsphenoidal surgery. We present 1 case and review 12 known cases in the literature on vasospasm following transsphenoidal surgery. Mean age was 48 (±13.8) years. There were 46.2% male patients. Factors associated with vasospasm, such as cerebral spinal fluid leaks following surgery, were seen in 38.5% of cases, and postoperative subarachnoid hemorrhage (SAH) was seen in 84.6% of cases. Hemiparesis was the presenting symptom of delayed cerebral ischemia in 61.5% of cases. For management, maintaining at least a euvolemic volume status was used in 76.9%, induced hypertension was used in 61.5%, and nimodipine was administered in 46.2% of cases. Patients returned to their neurologic baseline in 61.5% of cases, had new permanent deficits in 7.7% of cases, and died in 30.8% of cases. Cerebral vasospasm following transsphenoidal surgery is a dangerous disease that can lead to a high likelihood of mortality if not identified and treated. Early postoperative events, such as peritumoral subarachnoid hemorrhage and hemiparesis, may be factors associated with post-transsphenoidal surgery vasospasm. Effective treatment options used in patients that regained complete neurologic recovery were by inducing hypertension, maintaining euvolemia, and administering nimodipine. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Endoscopic endonasal trans-sphenoid surgery of pituitary adenoma

    Directory of Open Access Journals (Sweden)

    Y R Yadav

    2012-01-01

    Full Text Available Endoscopic endonasal trans-sphenoid surgery (EETS is increasingly used for pituitary lesions. Pre-operative CT and MRI scans and peroperative endoscopic visualization can provide useful anatomical information. EETS is indicated in sellar, suprasellar, intraventricular, retro-infundibular, and invasive tumors. Recurrent and residual lesions, pituitary apoplexy and empty sella syndrome can be managed by EETS. Modern neuronavigation techniques, ultrasonic aspirators, ultrasonic bone curette can add to the safety. The binostril approach provides a wider working area. High definition camera is much superior to three-chip camera. Most of the recent reports favor EETS in terms of safety, quality of life and tumor resection, hospital stay, better endocrinological, and visual outcome as compared to the microscopic technique. Nasal symptoms, blood loss, operating time are less in EETS. Various naso-septal flaps and other techniques of CSF leak repair could help reduce complications. Complications can be further reduced after achieving the learning curve, good understanding of limitations with proper patient selection. Use of neuronavigation, proper post-operative care of endocrine function, establishing pituitary center of excellence and more focused residency and endoscopic fellowship training could improve results. The faster and safe transition from microscopic to EETS can be done by the team concept of neurosurgeon/otolaryngologist, attending hands on cadaveric dissection, practice on models, and observation of live surgeries. Conversion to a microscopic or endoscopic-assisted approach may be required in selected patients. Multi-modality treatment could be required in giant and invasive tumors. EETS appears to be a better surgical option in most pituitary adenoma.

  8. Understanding traditional African healing.

    Science.gov (United States)

    Mokgobi, M G

    2014-09-01

    Traditional African healing has been in existence for many centuries yet many people still seem not to understand how it relates to God and religion/spirituality. Some people seem to believe that traditional healers worship the ancestors and not God. It is therefore the aim of this paper to clarify this relationship by discussing a chain of communication between the worshipers and the Almighty God. Other aspects of traditional healing namely types of traditional healers, training of traditional healers as well as the role of traditional healers in their communities are discussed. In conclusion, the services of traditional healers go far beyond the uses of herbs for physical illnesses. Traditional healers serve many roles which include but not limited to custodians of the traditional African religion and customs, educators about culture, counselors, social workers and psychologists.

  9. Recent Evolution of Endoscopic Endonasal Surgery for Treatment of Pituitary Adenomas

    Science.gov (United States)

    NISHIOKA, Hiroshi

    2017-01-01

    For the treatment of pituitary tumors, microscopic transsphenoidal surgery has been considered the “gold standard” since the late 1960s. Over the last two decades, however, a worldwide shift towards endoscopic endonasal surgery is in progress for many reasons. These include a wide panoramic view, improved illumination, an ability to look around anatomical corners using angled tip and, in addition, application to the extended approaches for parasellar tumors. Both endoscopic and microscopic approaches appear equally effective for nonfunctioning adenomas without significant suprasellar or lateral extensions, whereas the endoscopic approach may improve outcomes associated with the extent of resection and postoperative complications for larger tumors. Despite many theoretical benefits in the endoscopic surgery, remission rates of functioning adenomas do not substantially differ between the approaches in experienced hands. The endoscopic approach is a valid alternative to the microscopic approach for adenomas. The benefits will be more appreciated in the extended surgery for parasellar tumors. PMID:28239067

  10. Rare carcinoma ex pleomorphic adenoma of the buccal minor salivary gland causing a therapeutic dilemma

    Directory of Open Access Journals (Sweden)

    Yogesh Kini

    2012-01-01

    Full Text Available Carcinoma ex pleomorphic adenoma (CXPA, as a group, constitutes 12% of malignant salivary gland tumors. We present a case of CXPA of the buccal mucosa in a 17-year-old patient. The buccal mass was of a size of 3.0 cm located in the right cheek. Pleomorphic adenoma was the provisional diagnosis. The tumor was excised under local anesthesia. Histopathological evaluation revealed a pre-existing pleomorphic adenoma. However, on magnification, certain areas showed islands of dysplastic epithelial cells′ invading the fibrous capsule and CXPA was diagnosed. The patient was recalled and secondary surgery of the site performed. No tumor tissue could be detected in the secondary resection specimen. There is no sign of recurrence since 2 years.

  11. Gamma Knife radiosurgery in pituitary adenomas: Why, who, and how to treat?

    Science.gov (United States)

    Castinetti, Frederic; Brue, Thierry

    2010-08-01

    Pituitary adenomas are benign tumors that can be either secreting (acromegaly, Cushing's disease, prolactinomas) or non-secreting. Transsphenoidal neurosurgery is the gold standard treatment; however, it is not always effective. Gamma Knife radiosurgery is a specific modality of stereotactic radiosurgery, a precise radiation technique. Several studies reported the efficacy and low risk of adverse effects induced by this technique: in secreting pituitary adenomas, hypersecretion is controlled in about 50% of cases and tumor volume is stabilized or decreased in 80-90% of cases, making Gamma Knife a valuable adjunctive or first-line treatment. As hormone levels decrease progressively, the main drawback is the longer time to remission (12-60 months), requiring an additional treatment during this period. Hypopituitarism is the main side effect, observed in 20-40% cases. Gamma Knife is thus useful in the therapeutic algorithms of pituitary adenomas in well-defined indications, mainly low secreting small lesions well identified on magnetic resonance imaging (MRI).

  12. Xanthomatous Hypophysitis Mimicking a Pituitary Adenoma: Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Laura Aste

    2010-01-01

    Full Text Available Background. Hypophysitis is an inflammatory disease of the pituitary gland that may mimic pituitary tumors clinically and radiologically. Case Description. We report a case of a xanthomatous hypophysitis initially diagnosed as pituitary adenoma. A 31-year-old woman presented with headache, diabetes insipidus, and amenorrhea. A head CT scan showed no intrasellar changes, while an MRI scan showed a sellar cystic mass. An endocrinological work up revealed mild hypocortisolism and diabetes insipidus (DI. Transsphenoidal surgery was performed. The intraoperative histological examination suggested a pituitary adenoma. The removed tissue showed central necrosis surrounded by accumulation of foamy cells and xanthomatous epithelioid cells. The patient made an uneventful postoperative recovery, Nevertheless, DI persisted and the adenohypophysis hypofunction did not recover. Conclusion. We describe an unusual inflammatory lesion of the pituitary gland mimicking an adenoma. A high level of clinical suspicion of inflammatory disorders is necessary for correct diagnosis and optimal management.

  13. Prolactin-secreting pituitary adenoma in a man with gigantism: a case report.

    Science.gov (United States)

    Peillon, F; Philippon, J; Brandi, A M; Fohanno, D; Laplane, D; Dubois, M P; Decourt, J

    1979-12-01

    A prolactin-secreting pituitary adenoma was removed trans-sphenoidally from a 37 years old man with gigantism (218 cm). Serum levels of prolactin (PRL) were elevated pre-operatively and decreased after administration of L-Dopa with no increase after TRH as is usually observed in PRL-secreting adenomas. Growth hormone (GH) and somatomedin serum levels were normal with no modification of GH after insulin hypoglycemia, oral glucose loading or L-Dopa. Morphological examination of the tumour demonstrated the presence of lactotrophs by light and electron microscopy and by immunofluorescense staining. No somatotrophs were found. In this unique case, the relationship between a PRL-secreting adenoma and gigantism is discussed.

  14. Electrical stimulation treatment for facial palsy after revision pleomorphic adenoma surgery.

    Science.gov (United States)

    Goldie, Simon; Sandeman, Jack; Cole, Richard; Dennis, Simon; Swain, Ian

    2016-04-22

    Surgery for pleomorphic adenoma recurrence presents a significant risk of facial nerve damage that can result in facial weakness effecting patients' ability to communicate, mental health and self-image. We report two case studies that had marked facial weakness after resection of recurrent pleomorphic adenoma and their progress with electrical stimulation. Subjects received electrical stimulation twice daily for 24 weeks during which photographs of expressions, facial measurements and Sunnybrook scores were recorded. Both subjects recovered good facial function demonstrating Sunnybrook scores of 54 and 64 that improved to 88 and 96, respectively. Neither subjects demonstrated adverse effects of treatment. We conclude that electrical stimulation is a safe treatment and may improve facial palsy in patients after resection of recurrent pleomorphic adenoma. Larger studies would be difficult to pursue due to the low incidence of cases. Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2016.

  15. Technological advances for improving adenoma detection rates: The changing face of colonoscopy.

    Science.gov (United States)

    Ishaq, Sauid; Siau, Keith; Harrison, Elizabeth; Tontini, Gian Eugenio; Hoffman, Arthur; Gross, Seth; Kiesslich, Ralf; Neumann, Helmut

    2017-07-01

    Worldwide, colorectal cancer is the third commonest cancer. Over 90% follow an adenoma-to-cancer sequence over many years. Colonoscopy is the gold standard method for cancer screening and early adenoma detection. However, considerable variation exists between endoscopists' detection rates. This review considers the effects of different endoscopic techniques on adenoma detection. Two areas of technological interest were considered: (1) optical technologies and (2) mechanical technologies. Optical solutions, including FICE, NBI, i-SCAN and high definition colonoscopy showed mixed results. In contrast, mechanical advances, such as cap-assisted colonoscopy, FUSE, EndoCuff and G-EYE™, showed promise, with reported detections rates of up to 69%. However, before definitive recommendations can be made for their incorporation into daily practice, further studies and comparison trials are required. Copyright © 2017 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  16. Research progress of MRI in preoperative evaluation of pituitary adenoma's consistency

    International Nuclear Information System (INIS)

    Lu Yiping; Yin Bo; Geng Daoying

    2013-01-01

    As the most common primary disease in pituitary fossa, the incidence of pituitary adenoma ranks 3rd in the primary tumors of the brain. To remove those resectable pituitary adenomas, there are 2 surgical approaches, named trans-sphenoidal endoscopic surgery and craniotomy. Which approach should be used depends on the size, invasive extension and the consistency of the tumors. The trans-sphenoidal endoscopic surgery is more suitable for the tumors with soft consistency which are easy to pull out, while the craniotomy is suitable for the hard ones. So, preoperative evaluation of the tumors' consistency can help to find the best surgical approach and treatments. MRI is not only an ideal method to show the structure of brain, but also can be used to evaluate consistency of tumor. This review illustrated the forming mechanism of the different consistency of pituitary adenoma and the research process in evaluating the consistency. (authors)

  17. Magnetic resonance in the preoperative localization of parathyroid adenomas in patients with primary hyperparathyroidism

    International Nuclear Information System (INIS)

    Cabada, M.T.; Gomez, M.N.; Friera, A.; Carvajal, I.; Garcia, A.

    1995-01-01

    We assess the role of magnetic resonance (MR) as an imaging method for the preoperative localization of pathological parathyroid glands in a series of 14 patients with primary hyperparathyroidism secondary to parathyroid adenoma who underwent surgical resection. We selected 14 patients diagnosed as having primary hyperparathyroidism who underwent preoperative MR. All the studies were carried out with a toshiba MRT 50 MR unit with a 0.5 T superconductor magnet. MR located the adenoma in nine of the 14 patients (64%), including the only two who had previously undergone surgery. Our results indicate that MR without contrast is not effective in the preoperative localization of parathyroid adenomas and should be performed only in patients with recurrent hyperparathyroidism or that persisting after surgical treatment. (Author)

  18. Comparison between the concentration of mast cells and risk criteria of malignancy in intestinal adenomas

    Directory of Open Access Journals (Sweden)

    Bruna Luz Custódio Camargo

    2012-03-01

    Full Text Available Intestinal adenomas are benign neoplasms that present a risk of malignancy associated with three independent characteristics: the polyp size, the histological architecture and the severity of epithelial dysplasia (or atypia. Current evidence suggests that mast cells (CM contribute to the tumorigenesis of colorectal carcinomas. Objective: Compare the concentration of CM in intestinal adenomas and risk criteria for malignancy in these tumors (size, histological type and degree of cellular atypia. METHODS: We conducted a retrospective study with 102 anatomopathological reports of intestinal adenoma excision. We selected paraffin blocks with the central area of the tumor. The CM were stained with toluidine blue. RESULTS: In most cases (89.2%, n=91, the mast cells concentration (MC was less than 6 CM/10 high power field (HPF (p=0.0001. Most adenomas, regardless of their histological type, showed 0 CM/10 HPF (p=0.083. In most adenomas, regardless of their size, MC was 0 CM/10 HPF (p=0.665. Presence or absence of atypia was associated, in most cases, with MC of 0 CM/10 HPF (p=0.524. Conclusion: This study did not show association between the MC and histological type, size or presence of atypical cells in intestinal adenomas.Adenomas intestinais são neoplasias benignas que apresentam risco de malignização relacionado a três características independentes: o tamanho do pólipo, a arquitetura histológica e a gravidade da displasia (ou atipia epitelial. Evidências atuais sugerem que os mastócitos contribuem para a tumorigênese do carcinoma colorretal. OBJETIVO: Analisar comparativamente a concentração de mastócitos em adenomas intestinais e os critérios de risco para malignização nesses tumores (tamanho, tipo histológico e grau de atipia celular. Métodos: Realizou-se um estudo retrospectivo, com seleção de 102 laudos anatomopatológicos de exérese de adenoma intestinal. Foram selecionados os blocos de parafina com a área central da

  19. Incidence, causative mechanisms, and anatomic localization of stroke in pituitary adenoma patients treated with postoperative radiation therapy versus surgery alone

    NARCIS (Netherlands)

    Sattler, Margriet; Vroomen, Patrick; Sluiter, Wim J.; Schers, Henk J.; van den Berg, Gerrit; Langendijk, Johannes A.; Wolffenbuttel, Bruce H. R.; van den Bergh, Alphons C. M.; van Beek, Andre P.

    2013-01-01

    PURPOSE: To assess and compare the incidence of stroke and stroke subtype in pituitary adenoma patients treated with postoperative radiation therapy (RT) and surgery alone. METHODS AND MATERIALS: A cohort of 462 pituitary adenoma patients treated between 1959 and 2008 at the University Medical

  20. Effectiveness of 131I nor-cholesterol uptake per unit volume of adrenal adenoma in the diagnosis of aldosteronoma

    International Nuclear Information System (INIS)

    Kita, Tamotsu; Tomita, Hiroko; Sakaguchi, Chiharu

    2010-01-01

    Diagnosis of adrenal adenomas for patients with primary aldosteronism is sometimes difficult only by referring to the visualization pattern in adrenocortical scintigraphy without regards to standard scintigraphy or suppression scintigraphy with dexamethasone. We studied if quantitative evaluation of the standard scintigraphy without dexamethasone suppression can be useful to diagnose aldosteronomas. Twenty-nine patients who had undergone adrenalectomy with different clinical manifestations (16 patients with primary aldosteronism, 6 patients with Cushing's syndrome and 7 patients without hormonal abnormality) were included in the study. Volume of the adrenocortical adenomas, 131 I nor-cholesterol uptake of the adrenocortical adenomas, and 131 I nor-cholesterol uptake per unit volume of the adrenocortical adenomas were compared between the 3 groups. The volume of adrenocortical adenomas in the patients with primary aldosteronism was significantly lower than those in the other two groups (Cushing's syndrome p 131 I nor-cholesterol uptake of adrenocortical adenoma. The 131 I nor-cholesterol uptake per unit volume of adrenocortical adenomas was significantly higher in the patients with primary aldosteronism than those in the other two groups (Cushing's syndrome p 131 I nor-cholesterol uptake per unit volume of adenoma obtained from adrenocortical scintigraphy without dexamethasone suppression can be useful in the diagnosis of aldosteronoma. (author)

  1. Intercellular deposits of basement membrane material in active human pituitary adenomas detected by immunostaining for laminin and electron microscopy

    DEFF Research Database (Denmark)

    Holck, S; Wewer, U M; Albrechtsen, R

    1986-01-01

    and one patient with Cushing's syndrome). Concurrently, at the ultrastructural level, bunches of basement membrane-like material intermingled between the adenoma cells were demonstrated in seven of these ten active adenomas. Furthermore, secretory granules were entrapped occasionally in this intercellular...

  2. Prevalence of any size adenomas and advanced adenomas in 40- to 49-year-old individuals undergoing screening colonoscopy because of a family history of colorectal carcinoma in a first-degree relative.

    Science.gov (United States)

    Gupta, Akshay K; Samadder, Jewel; Elliott, Eric; Sethi, Saurabh; Schoenfeld, Philip

    2011-07-01

    Per current guidelines, patients with a first-degree relative (FDR) with colorectal cancer (CRC) should get screened at least at age 40. Data about the prevalence of adenomas and advanced adenomas (AAs) in these patients are lacking. To examine the prevalence of adenomas and AAs in 40- to 49-year-old individuals undergoing screening colonoscopy for family history of CRC. Retrospective chart review. Asymptomatic patients 40 to 49 years of age undergoing their first screening colonoscopy at the University of Michigan during the period 1999 to 2009 because of an FDR with CRC. Prevalence of adenomas (any size), AAs, and risk factors associated with adenomas. Among 640 study patients, the prevalence of adenomas (any size) was 15.4% and 3.3% for AAs. Adenoma prevalence was lower if the FDR with CRC was younger than 60 years of age versus an FDR with CRC older than 60 years of age (12.4% vs 19%, P = .034). Male sex (odds ratio 2.6; 95% CI, 1.06-4.4) and advancing age (odds ratio 1.16; 95% CI, 1.03-1.31) were associated with adenomas. Limited data on risk factor exposure and insufficient sample size to assess risk factors for AAs. Among 40- to 49-year-old patients undergoing screening colonoscopy because of an FDR with CRC, the prevalence of adenomas and AAs is low. Further research should determine whether these individuals have a higher prevalence of adenomas compared with average-risk individuals. Copyright © 2011 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

  3. Gallbladder stones and gallbladder polyps associated with increased risk of colorectal adenoma in men.

    Science.gov (United States)

    Liu, Yen-Ling; Wu, Jin-Shang; Yang, Yi-Ching; Lu, Feng-Hwa; Lee, Chih-Ting; Lin, Wan-Ju; Chang, Chih-Jen

    2018-04-01

    Most cases of colorectal cancer develop via an adenoma to carcinoma sequence. Gallbladder polyps share some risk factors with colorectal polyps. Little is known about the relationship between gallbladder diseases and different status of colorectal polyps by gender. This study was to investigate the association of gallbladder stones and polyps with colorectal adenomas by gender in a Taiwanese population. A total of 7066 eligible subjects who underwent a total colonoscopy as a part of health check-up between January 2001 and August 2009 were recruited. Colonoscopic findings were classified into polyp-free, non-neoplastic polyps and colorectal adenomas. Gallbladder stones and gallbladder polyps were diagnosed based on ultrasonographic findings. There was a significant difference in the status of colon polyps between subjects with and without gallbladder polyps. However, the status of colon polyps was not significantly different between subjects with or without gallbladder stones. After adjusting obesity, fasting plasma glucose, and other variables, there was a positive relationship between gallbladder polyps and colorectal adenomas (odds ratio [OR]: 1.396, 95% confidence interval [CI]: 1.115-1.747) but not non-neoplastic polyps in all subjects. In men, gallbladder polyps (OR: 1.560, 95% CI: 1.204-2.019) and gallbladder stones (OR: 1.465, 95% CI 1.081-1.984) were positively associated with colorectal adenomas. In women, neither gallbladder polyps nor gallbladder stones were significantly related to colon polyps. Both gallbladder polyps and gallbladder stones were associated with an increased risk of colorectal adenomas in men but not in women. Gender difference was significant for the association between gallbladder lesions and colorectal polyps. © 2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

  4. Adult weight gain and colorectal adenomas-a systematic review and meta-analysis.

    Science.gov (United States)

    Schlesinger, S; Aleksandrova, K; Abar, L; Vieria, A R; Vingeliene, S; Polemiti, E; Stevens, C A T; Greenwood, D C; Chan, D S M; Aune, D; Norat, T

    2017-06-01

    Colorectal adenomas are known as precursors for the majority of colorectal carcinomas. While weight gain during adulthood has been identified as a risk factor for colorectal cancer, the association is less clear for colorectal adenomas. We conducted a systematic review and meta-analysis to quantify the evidence on this association. We searched Medline up to September 2016 to identify observational (prospective, cross-sectional and retrospective) studies on weight gain during adulthood and colorectal adenoma occurrence and recurrence. We conducted meta-analysis on high weight gain versus stable weight, linear and non-linear dose-response meta-analyses to analyze the association. Summary odds ratios (OR) and 95% confidence intervals (95% CI) were estimated using a random effects model. For colorectal adenoma occurrence, the summary OR was 1.39 (95% CI: 1.17-1.65; I2: 43%, N = 9 studies, cases = 5507) comparing high (midpoint: 17.4 kg) versus stable weight gain during adulthood and with each 5 kg weight gain the odds increased by 7% (2%-11%; I2: 65%, N = 7 studies). Although there was indication of non-linearity (Pnon-linearity firm conclusions. Even a small amount of adult weight gain was related to a higher odds of colorectal adenoma occurrence. Our findings add to the benefits of weight control in adulthood regarding colorectal adenoma occurrence, which might be relevant for early prevention of colorectal cancer. © The Author 2017. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  5. Thyrotropin-producing pituitary adenoma simultaneously existing with Graves' disease: a case report.

    Science.gov (United States)

    Arai, Nobuhiko; Inaba, Makoto; Ichijyo, Takamasa; Kagami, Hiroshi; Mine, Yutaka

    2017-01-06

    Thyrotropin-producing pituitary tumor is relatively rare. In particular, concurrent cases associated with Graves' disease are extremely rare and only nine cases have been reported so far. We describe a case of a thyrotropin-producing pituitary adenoma concomitant with Graves' disease, which was successfully treated. A 40-year-old Japanese woman presented with mild signs of hyperthyroidism. She had positive anti-thyroid-stimulating hormone receptor antibody, anti-thyroglobulin antibody, and anti-thyroid peroxidase antibody. Her levels of serum thyroid-stimulating hormone, which ranged from low to normal in the presence of high levels of serum free thyroid hormones, were considered to be close to a state of syndrome of inappropriate secretion of thyroid-stimulating hormone. Magnetic resonance imaging showed a macropituitary tumor. The coexistence of thyrotropin-producing pituitary adenoma and Graves' disease was suspected. Initial therapy included anti-thyroid medication, which was immediately discontinued due to worsening symptoms. Subsequently, surgical therapy for the pituitary tumor was conducted, and her levels of free thyroid hormones, including the thyroid-stimulating hormone, became normal. On postoperative examination, her anti-thyroid-stimulating hormone receptor antibody levels decreased, and the anti-thyroglobulin antibody became negative. The coexistence of thyrotropin-producing pituitary adenoma and Graves' disease is rarely reported. The diagnosis of this condition is complicated, and the appropriate treatment strategy has not been clearly established. This case suggests that physicians should consider the coexistence of thyrotropin-producing pituitary adenoma with Graves' disease in cases in which thyroid-stimulating hormone values range from low to normal in the presence of thyrotoxicosis, and the surgical treatment of thyrotropin-producing pituitary adenoma could be the first-line therapy in patients with both thyrotropin-producing pituitary adenoma

  6. Dietary meat intake in relation to colorectal adenoma in asymptomatic women.

    Science.gov (United States)

    Ferrucci, Leah M; Sinha, Rashmi; Graubard, Barry I; Mayne, Susan T; Ma, Xiaomei; Schatzkin, Arthur; Schoenfeld, Philip S; Cash, Brooks D; Flood, Andrew; Cross, Amanda J

    2009-05-01

    No previous study has concurrently assessed the associations between meat intake, meat-cooking methods and doneness levels, meat mutagens (heterocyclic amines (HCAs) and polycyclic aromatic hydrocarbons), heme iron, and nitrite from meat and colorectal adenoma in asymptomatic women undergoing colonoscopy. Of the 807 eligible women in a cross-sectional multicenter colonoscopy screening study, 158 prevalent colorectal adenoma cases and 649 controls satisfactorily completed the validated food frequency and meat questionnaires. Using an established meat mutagen database and new heme iron and nitrite databases, we comprehensively investigated the components of meat that may be involved in carcinogenesis. Using logistic regression, we estimated odds ratios (ORs) and 95% confidence intervals (CIs) within quartiles of meat-related variables. Red meat was associated positively with colorectal adenoma (OR fourth vs. first quartile = 2.02; 95% CI = 1.06-3.83; P trend = 0.38). Intake of pan-fried meat (OR = 1.72; 95% CI = 0.96-3.07; P trend = 0.01) and the HCA: 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline (MeIQx) (OR = 1.90; 95% CI = 1.05-3.42; P trend = 0.07) were also associated with an increased risk of colorectal adenoma. The new databases yielded lower estimates of heme iron and nitrite than previous assessment methods, although the two methods were highly correlated for both exposures. Although not statistically significant, there were positive associations between iron and heme iron from meat and colorectal adenoma. In asymptomatic women undergoing colonoscopy, colorectal adenomas were associated with high intake of red meat, pan-fried meat, and the HCA MeIQx. Other meat-related exposures require further investigation.

  7. Missed adenomas with behind-folds visualizing colonoscopy technologies compared with standard colonoscopy: a pooled analysis of 3 randomized back-to-back tandem colonoscopy studies

    NARCIS (Netherlands)

    Brand, E.C.; Dik, V.K.; Oijen, M.G. van; Siersema, P.D.

    2017-01-01

    BACKGROUND AND AIMS: The Third Eye Retroscope, Full Spectrum Endoscope (FUSE), and EndoRings devices have been shown to reduce overall adenoma miss rates. We evaluated the characteristics of adenomas and patient subgroups for which these behind-folds visualizing technologies mostly reduce adenoma

  8. Missed adenomas with behind-folds visualizing colonoscopy technologies compared with standard colonoscopy: a pooled analysis of 3 randomized back-to-back tandem colonoscopy studies

    NARCIS (Netherlands)

    Brand, Eelco C.; Dik, Vincent K.; van Oijen, Martijn G. H.; Siersema, Peter D.

    2017-01-01

    Background and Aims: The Third Eye Retroscope, Full Spectrum Endoscope (FUSE), and EndoRings devices have been shown to reduce overall adenoma miss rates. We evaluated the characteristics of adenomas and patient subgroups for which these behind-folds visualizing technologies mostly reduce adenoma

  9. Cushing's disease due to mixed pituitary adenoma-gangliocytoma of the posterior pituitary gland presenting with Aspergillus sp. sinus infection.

    Science.gov (United States)

    Bridenstine, Mark; Kerr, Janice M; Lillehei, Kevin O; Kleinschmidt-DeMasters, Bette K

    2013-01-01

    Gangliocytic lesions of the pituitary gland producing Cushing's disease are extremely rare entities that may exist with or without a pituitary adenoma. The latter have been designated mixed pituitary adenoma-gangliocytomas, the majority of which produce growth hormone, not adrenocorticotropin (ACTH), and are localized to the anterior gland. We now report an immunocompetent woman with hypercortisolism who presented with an intranasal aspergilloma eroding the bony sellar floor. The fungal ball was contiguous with, and extended into, a large neurohypophyseal-centered mass. Transsphenoidal resection revealed a gangliocytic lesion of the posterior gland with small clusters of intimately admixed ACTH-immunoreactive adenoma cells as the cause of her Cushing's disease. Rare transitional sizes and shapes of cells coupled with immunohistochemical findings supported interpretation as advanced neuronal metaplasia within an ACTH adenoma. This mixed ACTH adenoma-gangliocytoma is the first example to present clinically with an opportunistic infection.

  10. Dietary protein and fat intake in relation to risk of colorectal adenoma in Korean.

    Science.gov (United States)

    Yang, Sun Young; Kim, Young Sun; Lee, Jung Eun; Seol, Jueun; Song, Ji Hyun; Chung, Goh Eun; Yim, Jeong Yoon; Lim, Sun Hee; Kim, Joo Sung

    2016-12-01

    Consumption of red meat and alcohol are known risk factors for colorectal cancer, but associations for dietary fat remain unclear. We investigated the associations of dietary fat, protein, and energy intake with prevalence of colorectal adenoma.We performed a prospective cross-sectional study on asymptomatic persons who underwent a screening colonoscopy at a single center during a routine health check-up from May to December 2011. Dietary data were obtained via a validated Food Frequency Questionnaire (FFQ), assisted by a registered dietician. We also obtained information on alcohol consumption and smoking status, and measured metabolic syndrome markers including abdominal circumference, blood pressure, fasting glucose, serum triglyceride and high-density lipoprotein cholesterol. We calculated odds ratio (OR) and 95% confidence interval (CI) to evaluate the associations using the polytomous logistic regression models. As a secondary analysis, we also conducted a matched analysis, matched by age and sex (557 cases and 557 non-cases).The study sample included 557 cases (406 males and 151 females) with histopathologically confirmed colorectal adenoma, and 1157 controls (650 males and 507 females). The proportion of advanced adenoma was 28.1% of men and 18.5% of female, respectively. Although vegetable protein intake was inversely associated with the prevalence of colorectal adenoma, further adjustment for potential confounding factors attenuated the association, resulting in no significant associations. There were no significant associations between dietary fat intake and colorectal adenoma in energy-adjusted models. For vegetable protein in women, the OR for the comparison of those in the highest tertile with those in the lowest tertile was 0.47 (95% CI 0.25-0.91, P for trend = 0.07) after adjustment for total energy intake. However, after controlling for metabolic syndrome markers, body mass index, smoking status, alcohol consumption, and family history of

  11. Endoscopic endonasal transsphenoidal surgery: surgical results of 228 pituitary adenomas treated in a pituitary center.

    Science.gov (United States)

    Gondim, Jackson A; Schops, Michele; de Almeida, João Paulo C; de Albuquerque, Lucas Alverne F; Gomes, Erika; Ferraz, Tânia; Barroso, Francisca Andréa C

    2010-01-01

    Pituitary tumors are challenging tumors in the sellar region. Surgical approaches to the pituitary have undergone numerous refinements over the last 100 years. The introduction of the endoscope have revolutionized pituitary surgery. The aim of this study is to report the results of a consecutive series of patients undergoing pituitary surgery using a pure endoscopic endonasal approach and to evaluate the efficacy and safety of this procedure. We reviewed the data of 228 consecutive patients who underwent endonasal transsphenoidal adenoma removal over an 10-year period. Pre- and post-operative hormonal status (at least 3 months after surgery) were analyzed and compared with clinical parameters presented by the patients. Tumor removal rate, endocrinological outcomes, and complications were retrospectively assessed in 228 patients with pituitary adenomas who underwent 251 procedures between December 1998 and December 2007. There were 93 nonfunctioning adenomas, 58 growth hormone-secreting, 41 prolactin-secreting, 28 adrenocorticotropin hormone secreting, 7 FSH-LH secreting and 1 thyroid-stimulating hormone-secreting adenomas. Gross total removal was achieved in 79.3% of the cases after a median follow-up of 61.5 months. The remission results for patients with nonfunctioning adenomas was 83% and for functioning adenomas were 76.3% (70.6% for GH hormone-secreting, 85.3% for prolactin hormone-secreting, 71.4% for ACTH hormone-secreting, 85.7% for FSH-LH hormone-secreting and 100% for TSH hormone-secreting), with no recurrence at the time of the last follow-up. Post-operative complications were present in 35 (13.9%) cases. The most frequent complications were temporary and permanent diabetes insipidus (six and two cases, respectively), syndrome of inappropriate antidiuretic hormone secretion (two cases) and CSF leaks (eight cases). There was no death related to the procedure in this series. The endoscopic endonasal approach for resection of pituitary adenomas, provides

  12. Holmium laser enucleation for prostate adenoma greater than 100 gm.: comparison to open prostatectomy.

    Science.gov (United States)

    Moody, J A; Lingeman, J E

    2001-02-01

    Options for treatment of large (greater than 100 gm.) prostatic adenomas have until now been limited to open surgery or transurethral resection by skilled resectionists. Considerable blood loss, morbidity, extended hospital stay and prolonged recovery occur with open surgery for large prostatic adenomas. Endoscopic surgery for benign prostatic hyperplasia has evolved during the last decade to offer the patient and surgeon significant advantages of transurethral removal of prostatic adenomas. Holmium laser enucleation of the prostate with transurethral tissue morcellation provides significant reductions in morbidity, bleeding and hospital stay for patients with large prostate adenomas. A retrospective review of data on 10 cases of holmium laser enucleation and 10 open prostatectomies for greater than 100 gm. prostatic adenomas was performed from 1998 to 1999 at our institution. Patient demographics, indication for surgery, preoperative and postoperative American Urological Association (AUA) symptom scores, operating time, serum hemoglobin, resected prostatic weight, pathological diagnosis, length of stay and complications were compared. Patient age, indications for surgery (retention, failed medical therapy, high post-void residual, bladder calculi, bladder diverticula and azotemia) and preoperative AUA symptom scores were similar in both groups. Postoperative AUA symptom scores were significantly decreased (p gm., p = 0.0003). Resected weight was greater in the holmium laser enucleation group (151 versus 106 gm., p = 0.07). Length of stay was significantly shorter in the holmium laser enucleation group (2.1 versus 6.1 days, p <0.001). Complications in the holmium laser enucleation group included stress urinary incontinence in 4 cases, prostatic perforation in 1 and urinary retention in 1. No patient treated with holmium laser enucleation was discharged home with an indwelling catheter. Complications in the open prostatectomy group included bladder neck contractures

  13. A unique case of isolated sebaceous adenoma of the bulbar conjunctiva

    Directory of Open Access Journals (Sweden)

    Hatice Deniz Ilhan

    Full Text Available ABSTRACT Our patient was a 34 year-old male who presented with a painless conjunctival mass that had developed 3 months before his first visit. On performing slit-lamp biomicroscopy, a lobulated pink-yellowish solid mobile mass was observed on the nasal bulbar conjunctival surface of his left eye. The tumor was excised, and histopathologic examination of the tumor revealed a sebaceous adenoma. Systemic examination was normal. No recurrence was observed during the 24-month follow-up period. Sebaceous adenoma of the bulbar conjunctiva is an extremely rare benign tumor, which may be observed to be isolated in the absence of malignancy.

  14. Pleomorphic adenoma of the parotid gland with cystic degeneration: A rare case report

    Directory of Open Access Journals (Sweden)

    Preeti Dhir

    2014-01-01

    Full Text Available Pleomorphic adenoma, also called benign mixed tumor, is the most common tumor of the salivary glands. Usually they are found as solitary, unilateral, firm and mobile, painless, slow growing masses. Only 10% of them occur in the minor salivary glands and 90% of them occur in the parotid gland. The incidence of parotid tumor is about 2.4 in 100000/year of all neoplasia of head and neck region, the right side being commonly involved and seen more often in males. Management involves surgical resection by superficial or total parotidectomy. This case report illustrates clinical features, imaging characteristics and histopathological features in a case of pleomorphic adenoma.

  15. Atrophic and Metaplastic Progression in the Background Mucosa of Patients with Gastric Adenoma.

    Directory of Open Access Journals (Sweden)

    Hee Kyong Na

    Full Text Available In patients with adenoma, assessing premalignant changes in the surrounding mucosa is important for surveillance. This study evaluated atrophic and metaplastic progression in the background mucosa of adenoma or early gastric cancer (EGC cases.Among 146 consecutive patients who underwent endoscopic resection for intestinal-type gastric neoplasia, the adenoma group included 56 patients with low-grade dysplasia and the ECG group included 90 patients with high-grade dysplasia or invasive carcinoma. For histology, 3 paired biopsies were obtained from the antrum, corpus lesser curvature (CLC, and corpus greater curvature (CGC. Serological atrophy was determined based on pepsinogen A (PGA, progastricsin (PGC, gastrin-17, and total ghrelin levels. Topographic progression of atrophy and/or metaplasia was staged using the operative link on gastritis assessment (OLGA and operative link on gastric intestinal metaplasia assessment (OLGIM systems.Rates of moderate-to-marked histological atrophy/metaplasia in patients with adenoma were 52.7%/78.2% at the antrum (vs. 58.8%/76.4% in EGC group, 63.5%/75.0% at the CLC (vs. 60.2%/69.7% in EGC group, and 10.9%/17.9% at the CGC (vs. 5.6%/7.8% in EGC group. Serological atrophy indicated by PGA and PGC occurred in 23.2% and 15.6% of cases in the adenoma and ECG groups, respectively (p = 0.25. Mean serum gastrin-17 concentrations of the adenoma group and EGC group were 10.4 and 9.0 pmol/L, respectively (p = 0.54. Mean serum total ghrelin levels were 216.6 and 209.5 pg/mL, respectively (p = 0.71. Additionally, between group rates of stage III-IV OLGA and OLGIM were similar (25.9% vs. 25.0%, p = 0.90; 41.8% vs. 44.9%, p = 0.71, respectively.Atrophic and metaplastic progression is extensive and severe in gastric adenoma patients. A surveillance strategy for metachronous tumors should be applied similarly for patients with adenoma or EGC.

  16. Malignant hypertension and hypertensive encephalopathy in primary aldosteronism caused by adrenal adenoma

    Directory of Open Access Journals (Sweden)

    Bortolotto Luiz Aparecido

    2003-01-01

    Full Text Available Two cases are reported as follows: 1 1 female patient with accelerated-malignant hypertension secondary to an aldosterone-producing adrenal adenoma; and 2 1 female patient with adrenal adenoma, severe hypertension, and hypertensive encephalopathy. This association is a rare clinical finding, and malignant hypertension may modify the hormonal characteristic of primary aldosteronism, making its diagnosis more difficult. The diagnosis of primary aldosteronism should be considered in patients with malignant hypertension or hypertensive encephalopathy if persistent hypokalemia occurs. Identification of primary aldosteronism is of paramount importance for the patient's evolution, because the surgical treatment makes the prognosis more favorable.

  17. Vulva Fibroadenoma Associated with Lactating Adenoma in a 26-Year-Old Nigerian Female

    Directory of Open Access Journals (Sweden)

    C. C. Anunobi

    2013-01-01

    Full Text Available Background. Vulva lactating adenoma is rare and may be misdiagnosed as adenocarcinoma in frozen section and aspiration cytology if breast tissue is not anticipated. Objective. To raise the awareness of lactating vulva ectopic breast lesion among clinicians and pathologists. Case Report. We present a case of vulva fibroadenoma associated with lactating adenoma in a 26-year-old Nigerian female. Conclusion. The rarity of vulva ectopic breast tissue can present a diagnostic challenge for both the clinician and the anatomical pathologist. Once excisional biopsy is done and the lesion confirmed histologically, the anxious patient can be reassured.

  18. The destruction complex of beta-catenin in colorectal carcinoma and colonic adenoma.

    Science.gov (United States)

    Bourroul, Guilherme Muniz; Fragoso, Hélio José; Gomes, José Walter Feitosa; Bourroul, Vivian Sati Oba; Oshima, Celina Tizuko Fujiyama; Gomes, Thiago Simão; Saba, Gabriela Tognini; Palma, Rogério Tadeu; Waisberg, Jaques

    2016-01-01

    To evaluate the destruction complex of beta-catenin by the expression of the proteins beta-catetenin, adenomatous polyposis coli, GSK3β, axin and ubiquitin in colorectal carcinoma and colonic adenoma. Tissue samples from 64 patients with colorectal carcinoma and 53 patients with colonic adenoma were analyzed. Tissue microarray blocks and slides were prepared and subjected to immunohistochemistry with polyclonal antibodies in carcinoma, adjacent non-neoplastic mucosa, and adenoma tissues. The immunoreactivity was evaluated by the percentage of positive stained cells and by the intensity assessed through of the stained grade of proteins in the cytoplasm and nucleus of cells. In the statistical analysis, the Spearman correlation coefficient, Student's t, χ2, Mann-Whitney, and McNemar tests, and univariate logistic regression analysis were used. In colorectal carcinoma, the expressions of beta-catenin and adenomatous polyposis coli proteins were significantly higher than in colonic adenomas (pcitoplasma e no núcleo das células. Na análise estatística, foram utilizados o coeficiente de correlação de Spearman, os testes t de Student, χ2, Mann-Whitney e de McNemar, e a análise de regressão logística univariada. No carcinoma colorretal, as expressões da betacatenina e da adenomatous polyposis coli foram significativamente maiores do que em adenomas do colo (p<0,001 e p<0,0001, respectivamente). A imunorreatividade das proteínas GSK3β, axina 1 e ubiquitina foi significativamente maior (p=0,03, p=0,039 e p=0,03, respectivamente) no carcinoma colorretal do que no adenoma e na mucosa não neoplásica adjacente. A coloração imuno-histoquímica dessas proteínas não apresentou diferenças significantes em relação às características clinicopatológicas do câncer colorretal e do adenoma. Em adenomas, as menores expressões de betacatenina, axina 1 e GSK3β indicaram que o complexo de destruição da betacatenina estava conservado, enquanto que, no carcinoma

  19. Heterogeneous genetic background of the association of pheochromocytoma/paraganglioma and pituitary adenoma: results from a large patient cohort.

    Science.gov (United States)

    Dénes, Judit; Swords, Francesca; Rattenberry, Eleanor; Stals, Karen; Owens, Martina; Cranston, Treena; Xekouki, Paraskevi; Moran, Linda; Kumar, Ajith; Wassif, Christopher; Fersht, Naomi; Baldeweg, Stephanie E; Morris, Damian; Lightman, Stafford; Agha, Amar; Rees, Aled; Grieve, Joan; Powell, Michael; Boguszewski, Cesar Luiz; Dutta, Pinaki; Thakker, Rajesh V; Srirangalingam, Umasuthan; Thompson, Chris J; Druce, Maralyn; Higham, Claire; Davis, Julian; Eeles, Rosalind; Stevenson, Mark; O'Sullivan, Brendan; Taniere, Phillipe; Skordilis, Kassiani; Gabrovska, Plamena; Barlier, Anne; Webb, Susan M; Aulinas, Anna; Drake, William M; Bevan, John S; Preda, Cristina; Dalantaeva, Nadezhda; Ribeiro-Oliveira, Antônio; Garcia, Isabel Tena; Yordanova, Galina; Iotova, Violeta; Evanson, Jane; Grossman, Ashley B; Trouillas, Jacqueline; Ellard, Sian; Stratakis, Constantine A; Maher, Eamonn R; Roncaroli, Federico; Korbonits, Márta

    2015-03-01

    Pituitary adenomas and pheochromocytomas/paragangliomas (pheo/PGL) can occur in the same patient or in the same family. Coexistence of the two diseases could be due to either a common pathogenic mechanism or a coincidence. The objective of the investigation was to study the possible coexistence of pituitary adenoma and pheo/PGL. Thirty-nine cases of sporadic or familial pheo/PGL and pituitary adenomas were investigated. Known pheo/PGL genes (SDHA-D, SDHAF2, RET, VHL, TMEM127, MAX, FH) and pituitary adenoma genes (MEN1, AIP, CDKN1B) were sequenced using next generation or Sanger sequencing. Loss of heterozygosity study and pathological studies were performed on the available tumor samples. The study was conducted at university hospitals. Thirty-nine patients with sporadic of familial pituitary adenoma and pheo/PGL participated in the study. Outcomes included genetic screening and clinical characteristics. Eleven germline mutations (five SDHB, one SDHC, one SDHD, two VHL, and two MEN1) and four variants of unknown significance (two SDHA, one SDHB, and one SDHAF2) were identified in the studied genes in our patient cohort. Tumor tissue analysis identified LOH at the SDHB locus in three pituitary adenomas and loss of heterozygosity at the MEN1 locus in two pheochromocytomas. All the pituitary adenomas of patients affected by SDHX alterations have a unique histological feature not previously described in this context. Mutations in the genes known to cause pheo/PGL can rarely be associated with pituitary adenomas, whereas mutation in a gene predisposing to pituitary adenomas (MEN1) can be associated with pheo/PGL. Our findings suggest that genetic testing should be considered in all patients or families with the constellation of pheo/PGL and a pituitary adenoma.

  20. Heterogeneous Genetic Background of the Association of Pheochromocytoma/Paraganglioma and Pituitary Adenoma: Results From a Large Patient Cohort

    Science.gov (United States)

    Dénes, Judit; Swords, Francesca; Rattenberry, Eleanor; Stals, Karen; Owens, Martina; Cranston, Treena; Xekouki, Paraskevi; Moran, Linda; Kumar, Ajith; Wassif, Christopher; Fersht, Naomi; Baldeweg, Stephanie E.; Morris, Damian; Lightman, Stafford; Agha, Amar; Rees, Aled; Grieve, Joan; Powell, Michael; Boguszewski, Cesar Luiz; Dutta, Pinaki; Thakker, Rajesh V.; Srirangalingam, Umasuthan; Thompson, Chris J.; Druce, Maralyn; Higham, Claire; Davis, Julian; Eeles, Rosalind; Stevenson, Mark; O'Sullivan, Brendan; Taniere, Phillipe; Skordilis, Kassiani; Gabrovska, Plamena; Barlier, Anne; Webb, Susan M.; Aulinas, Anna; Drake, William M.; Bevan, John S.; Preda, Cristina; Dalantaeva, Nadezhda; Ribeiro-Oliveira, Antônio; Garcia, Isabel Tena; Yordanova, Galina; Iotova, Violeta; Evanson, Jane; Grossman, Ashley B.; Trouillas, Jacqueline; Ellard, Sian; Stratakis, Constantine A.; Maher, Eamonn R.; Roncaroli, Federico

    2015-01-01

    Context: Pituitary adenomas and pheochromocytomas/paragangliomas (pheo/PGL) can occur in the same patient or in the same family. Coexistence of the two diseases could be due to either a common pathogenic mechanism or a coincidence. Objective: The objective of the investigation was to study the possible coexistence of pituitary adenoma and pheo/PGL. Design: Thirty-nine cases of sporadic or familial pheo/PGL and pituitary adenomas were investigated. Known pheo/PGL genes (SDHA-D, SDHAF2, RET, VHL, TMEM127, MAX, FH) and pituitary adenoma genes (MEN1, AIP, CDKN1B) were sequenced using next generation or Sanger sequencing. Loss of heterozygosity study and pathological studies were performed on the available tumor samples. Setting: The study was conducted at university hospitals. Patients: Thirty-nine patients with sporadic of familial pituitary adenoma and pheo/PGL participated in the study. Outcome: Outcomes included genetic screening and clinical characteristics. Results: Eleven germline mutations (five SDHB, one SDHC, one SDHD, two VHL, and two MEN1) and four variants of unknown significance (two SDHA, one SDHB, and one SDHAF2) were identified in the studied genes in our patient cohort. Tumor tissue analysis identified LOH at the SDHB locus in three pituitary adenomas and loss of heterozygosity at the MEN1 locus in two pheochromocytomas. All the pituitary adenomas of patients affected by SDHX alterations have a unique histological feature not previously described in this context. Conclusions: Mutations in the genes known to cause pheo/PGL can rarely be associated with pituitary adenomas, whereas mutation in a gene predisposing to pituitary adenomas (MEN1) can be associated with pheo/PGL. Our findings suggest that genetic testing should be considered in all patients or families with the constellation of pheo/PGL and a pituitary adenoma. PMID:25494863

  1. Outcomes of Proton Therapy for Patients With Functional Pituitary Adenomas

    International Nuclear Information System (INIS)

    Wattson, Daniel A.; Tanguturi, Shyam K.; Spiegel, Daphna Y.; Niemierko, Andrzej; Biller, Beverly M.K.; Nachtigall, Lisa B.; Bussière, Marc R.; Swearingen, Brooke; Chapman, Paul H.; Loeffler, Jay S.; Shih, Helen A.

    2014-01-01

    Purpose/Objective(s): This study evaluated the efficacy and toxicity of proton therapy for functional pituitary adenomas (FPAs). Methods and Materials: We analyzed 165 patients with FPAs who were treated at a single institution with proton therapy between 1992 and 2012 and had at least 6 months of follow-up. All but 3 patients underwent prior resection, and 14 received prior photon irradiation. Proton stereotactic radiosurgery was used for 92% of patients, with a median dose of 20 Gy(RBE). The remainder received fractionated stereotactic proton therapy. Time to biochemical complete response (CR, defined as ≥3 months of normal laboratory values with no medical treatment), local control, and adverse effects are reported. Results: With a median follow-up time of 4.3 years (range, 0.5-20.6 years) for 144 evaluable patients, the actuarial 3-year CR rate and the median time to CR were 54% and 32 months among 74 patients with Cushing disease (CD), 63% and 27 months among 8 patients with Nelson syndrome (NS), 26% and 62 months among 50 patients with acromegaly, and 22% and 60 months among 9 patients with prolactinomas, respectively. One of 3 patients with thyroid stimulating hormone—secreting tumors achieved CR. Actuarial time to CR was significantly shorter for corticotroph FPAs (CD/NS) compared with other subtypes (P=.001). At a median imaging follow-up time of 43 months, tumor control was 98% among 140 patients. The actuarial 3-year and 5-year rates of development of new hypopituitarism were 45% and 62%, and the median time to deficiency was 40 months. Larger radiosurgery target volume as a continuous variable was a significant predictor of hypopituitarism (adjusted hazard ratio 1.3, P=.004). Four patients had new-onset postradiosurgery seizures suspected to be related to generously defined target volumes. There were no radiation-induced tumors. Conclusions: Proton irradiation is an effective treatment for FPAs, and hypopituitarism remains the primary

  2. Outcomes of Proton Therapy for Patients With Functional Pituitary Adenomas

    Energy Technology Data Exchange (ETDEWEB)

    Wattson, Daniel A.; Tanguturi, Shyam K. [Harvard Radiation Oncology Program, Boston, Massachusetts (United States); Spiegel, Daphna Y. [Tufts University School of Medicine, Boston, Massachusetts (United States); Niemierko, Andrzej [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Biller, Beverly M.K.; Nachtigall, Lisa B. [Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts (United States); Bussière, Marc R. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Swearingen, Brooke; Chapman, Paul H. [Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts (United States); Loeffler, Jay S. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Shih, Helen A., E-mail: hshih@partners.org [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States)

    2014-11-01

    Purpose/Objective(s): This study evaluated the efficacy and toxicity of proton therapy for functional pituitary adenomas (FPAs). Methods and Materials: We analyzed 165 patients with FPAs who were treated at a single institution with proton therapy between 1992 and 2012 and had at least 6 months of follow-up. All but 3 patients underwent prior resection, and 14 received prior photon irradiation. Proton stereotactic radiosurgery was used for 92% of patients, with a median dose of 20 Gy(RBE). The remainder received fractionated stereotactic proton therapy. Time to biochemical complete response (CR, defined as ≥3 months of normal laboratory values with no medical treatment), local control, and adverse effects are reported. Results: With a median follow-up time of 4.3 years (range, 0.5-20.6 years) for 144 evaluable patients, the actuarial 3-year CR rate and the median time to CR were 54% and 32 months among 74 patients with Cushing disease (CD), 63% and 27 months among 8 patients with Nelson syndrome (NS), 26% and 62 months among 50 patients with acromegaly, and 22% and 60 months among 9 patients with prolactinomas, respectively. One of 3 patients with thyroid stimulating hormone—secreting tumors achieved CR. Actuarial time to CR was significantly shorter for corticotroph FPAs (CD/NS) compared with other subtypes (P=.001). At a median imaging follow-up time of 43 months, tumor control was 98% among 140 patients. The actuarial 3-year and 5-year rates of development of new hypopituitarism were 45% and 62%, and the median time to deficiency was 40 months. Larger radiosurgery target volume as a continuous variable was a significant predictor of hypopituitarism (adjusted hazard ratio 1.3, P=.004). Four patients had new-onset postradiosurgery seizures suspected to be related to generously defined target volumes. There were no radiation-induced tumors. Conclusions: Proton irradiation is an effective treatment for FPAs, and hypopituitarism remains the primary

  3. Expresión de los genes Serrate1 y Notch1 durante el desarrollo del tercio medio facial del embrión de pollo.

    Directory of Open Access Journals (Sweden)

    Daniel Mauricio Meza Lasso

    2016-01-01

    Full Text Available La vía de señalización Notch se caracteriza por mediar la comunicación célula-célula, regulando diferentes procesos celulares como proliferación, apoptosis y definición del destino celular. Esta vía ha sido implicada en el desarrollo de estructuras craneofaciales como paladar, diente y bóveda craneal. El objetivo de esta investigación fue identificar los patrones de expresión de los genes componentes de la vía Notch, Serrate1 y Notch1, durante el desarrollo del tercio medio facial. Se utilizaron embriones de pollo (Gallus gallus seleccionados de acuerdo a los criterios de Hamilton y Hamburger y sobre los cuales se realizó hibridación in situ con ribosondas marcadas con Digoxigenina (DIG, para luego ser detectadas con anticuerpos Anti-Dig. Los resultados mostraron expresión de los genes evaluados, en las prominencias maxilares (pmx y frontonasal (pfn durante el desarrollo del tercio medio facial. Estos resultados sugieren una probable participación de la vía Notch a través de estos genes, en los diferentes procesos celulares que determinan la morfogénesis y el desarrollo del tercio medio facial.

  4. Limit analysis of narrow support elements in W7-X considering the serration effect of the stress-strain relation at 4 K

    International Nuclear Information System (INIS)

    Briani, E.; Gianini, C.; Lucca, F.; Marin, A.; Fellinger, J.; Bykov, V.

    2011-01-01

    The magnet support system of the Wendelstein 7-X (W7-X) fusion stellarator includes challenging components, called Narrow Support Elements (NSEs), placed between the Non Planar Coils (NPCs) at the inboard side and aimed at reducing deformation of the coils. NSEs are small contact elements, with special coating to reduce friction, that have to withstand high compressive and shear forces. The objective of this article is to demonstrate the structural reliability of the NSEs under electromagnetic loading (EML), taking into account in a conservative way the relevant material properties at cryogenic temperatures. To this purpose, an appropriate parametric local Finite Element (FE) model of one highly loaded NSE with its components (pad, pad frame and counter pad) and of a portion of the coils has been developed with ABAQUS code and isotropic elastic-plastic material model with hardening/softening has been used, i