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Adenoma , Imagen por Resonancia Magnética , Neoplasias Hipofisarias , Humanos , Neoplasias Hipofisarias/diagnóstico por imagen , Neoplasias Hipofisarias/diagnóstico , Neoplasias Hipofisarias/patología , Adenoma/patología , Adenoma/diagnóstico por imagen , Femenino , Síndrome , Adulto , Persona de Mediana Edad , MasculinoAsunto(s)
Ubiquitina Tiolesterasa , Humanos , Ubiquitina Tiolesterasa/genética , Endopeptidasas/genética , Reacción en Cadena de la Polimerasa/métodos , Adenoma Hipofisario Secretor de ACTH/genética , Adenoma Hipofisario Secretor de ACTH/patología , Adenoma Hipofisario Secretor de ACTH/diagnóstico , Femenino , Adenoma/genética , Adenoma/diagnóstico , Adenoma/patología , Adulto , Masculino , Persona de Mediana Edad , Complejos de Clasificación Endosomal Requeridos para el TransporteRESUMEN
INTRODUCTION: Striated duct adenoma (SDA) is a rare benign salivary gland tumor with a recently described genetic signature. Recurrent oncogenic mutations affecting the IDH2 gene differentiate SDA from its primary differential diagnosis of canalicular adenoma. Here, we report a case of SDA affecting the parotid gland with IDH1/2 mutation-specific immunohistochemical positivity. Additionally, we provide a scoping review developed according to the Cochrane Methodology and reported following the Joana Briggs Institute (JBI) checklist to synthesize all previously published cases of SDA. The review protocol was registered on the Open Science Framework (OSF) platform ( https://osf.io/7mztg ). The searches were performed using Medline, Embase, Web of Science, and LILACS, with no date or language limit. Studies were evaluated for eligibility, extracted, and compiled in a narrative form. Seven studies with 20 patients with SDA, including ours, were analyzed. The tumors mainly affected the parotid gland (13/20) in patients with a mean age of 62 years and did not display sex predilection. Swelling was the leading clinical symptom. The mean follow-up duration was 26 months with no recurrence or metastasis after resection. CONCLUSION: Awareness of the clinicopathological features and the use of IDH1/2 mutation-specific immunohistochemistry are pivotal for the consistent identification of SDA, and assessment for true biological potential will require increased follow-up and scrutiny.
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Adenoma , Humanos , Adenoma/patología , Adenoma/genética , Isocitrato Deshidrogenasa/genética , Persona de Mediana Edad , Neoplasias de la Parótida/patología , Neoplasias de la Parótida/genética , Biomarcadores de Tumor/análisis , Biomarcadores de Tumor/genética , Masculino , Femenino , AncianoRESUMEN
PURPOSE: To evaluate clinical, laboratory, radiological, therapeutic, and prognostic characteristics of patients with acromegaly according to the size of the growth hormone (GH)-secreting pituitary adenoma at diagnosis. METHODS: Observational, retrospective, single-center study of patients with acromegaly followed at a tertiary center. Data were collected regarding clinical presentation, characteristics of the adenoma in the magnetic resonance imaging, GH and IGF-1 levels, and disease control after surgery or adjuvant treatment (normal IGF-1 levels). Patients were divided according to the adenoma size at diagnosis in: group I < 10 mm; II 10-19 mm; III 20-29 mm; IV 30-39 mm; and V ≥ 40 mm. Comparisons were made between the groups, and correlations of tumor size with disease parameters, ROC curves, and logistic regression analyses were performed to investigate tumor size and confounding factors that could impact the outcomes. RESULTS: 117 patients were studied [59 women, age at diagnosis 43 ± 13 years; group I = 11 patients (9%); group II 54 (46%); group III 34 (29%); group IV 10 (9%); group V 8 (7%)]. Hypopituitarism, cavernous sinus invasion, GH levels, and use of somatostatin receptor ligands had their prevalence increased according to the adenoma size. Age showed a negative correlation with tumor size. A tumor diameter around 20 mm was the best predictor for the presence of hypopituitarism, invasiveness, need of adjuvant therapies, and poorer disease control. CONCLUSION: Adenomas < 20 mm showed lower morbidity and better therapeutic response in acromegaly, while those ≥ 20 mm had similar clinical, therapeutic, and prognostic behavior.
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Acromegalia , Humanos , Acromegalia/patología , Femenino , Masculino , Adulto , Persona de Mediana Edad , Estudios Retrospectivos , Pronóstico , Hormona de Crecimiento Humana/metabolismo , Imagen por Resonancia Magnética , Factor I del Crecimiento Similar a la Insulina/metabolismo , Adenoma/patología , Adenoma/terapia , Adenoma Hipofisario Secretor de Hormona del Crecimiento/patología , Adenoma Hipofisario Secretor de Hormona del Crecimiento/terapia , Neoplasias Hipofisarias/patología , Neoplasias Hipofisarias/terapiaRESUMEN
BACKGROUND: Colorectal cancer is the third most common type of cancer in Brazil, despite the availability of screening methods that reduce its risk. Colonoscopy is the only screening method that also allows therapeutic procedures. The proper screening through colonoscopy is linked to the quality of the exam, which can be evaluated according to quality criteria recommended by various institutions. Among the factors, the most used is the Adenoma Detection Rate, which should be at least 25% for general population. AIMS: To evaluate the quality of the screening colonoscopies performed in a quarternary private Brazilian hospital. METHODS: This is a retrospective study evaluating the quality indicators of colonoscopies performed at a private center since its inauguration. Only asymptomatic patients aged over 45 years who underwent screening colonoscopy were included. The primary outcome was the Adenoma Detection Rate, and secondary outcomes included polyps detection rate and safety profile. Subanalyses evaluated the correlation of endoscopic findings with gender and age and the evolution of detection rates over the years. RESULTS: A total of 2,144 patients were include with a mean age of 60.54 years-old. Polyps were diagnosed in 68.6% of the procedures. Adenoma detection rate was 46.8%, with an increasing rate over the years, mainly in males. A low rate of adverse events was reported in 0.23% of the cases, with no need for surgical intervention and no deaths. CONCLUSIONS: This study shows that high quality screening colonoscopy is possible when performed by experienced endoscopists and trained nurses, under an adequate infrastructure.
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Colonoscopía , Hospitales Privados , Indicadores de Calidad de la Atención de Salud , Humanos , Colonoscopía/normas , Estudios Retrospectivos , Masculino , Persona de Mediana Edad , Femenino , Brasil , Anciano , Detección Precoz del Cáncer/normas , Adenoma/diagnóstico , Neoplasias Colorrectales/diagnósticoRESUMEN
Fecal immunochemical test (FIT) followed by colonoscopy in positive cases is commonly used for population-based colorectal cancer screening. However, specificity of FIT for colorectal cancer is not ideal and has poor performance for advanced adenoma detection. Fecal Fusobacterium nucleatum (Fn) detection has been proposed as a potential noninvasive biomarker for colorectal cancer and advanced adenoma detection. We aimed to evaluate the diagnostic performance of Fn detection using droplet digital PCR (ddPCR) in FIT samples from individuals enrolled in a colorectal cancer screening program with colorectal adenoma or cancer. We evaluated Fn presence in DNA isolated from FIT leftover material of 300 participants in a colorectal cancer screening program using ddPCR. The Fn DNA amount was classified as Fn-low/negative and Fn-high, and the association with patients' clinicopathological features and accuracy measurements was calculated. Fn-high levels were more prevalent in FIT-positive (47.2%, n = 34 of 72) than FIT-negative samples (28.9%, n = 66 of 228; P < 0.04). Among FIT-positive samples, high Fn levels were significantly more frequent in patients with cancer (CA, n = 8) when compared to normal (NT, n = 16; P = 0.02), non-advanced adenomas (NAA, n = 36; P = 0.01), and advanced adenomas (AA, n = 12; P = 0.01). Performance analysis of Fn in FIT-positive samples for colorectal cancer detection yielded an AUC of 0.8203 [confidence interval (CI), 0.6464-0.9942], with high sensitivity (100%) and specificity of 50%. Concluding, we showed the feasibility of detecting Fn in FIT leftovers using the ultrasensitive ddPCR technique. Furthermore, we highlighted the potential use of Fn levels in fecal samples to ameliorate colorectal cancer detection. Prevention Relevance: Fusobacterium nucleatum detection by droplet digital PCR could prioritize the selection of fecal immunochemical test-positive individuals who might benefit the most from the colonoscopy procedure.
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Neoplasias Colorrectales , Detección Precoz del Cáncer , Heces , Fusobacterium nucleatum , Reacción en Cadena de la Polimerasa , Humanos , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/microbiología , Fusobacterium nucleatum/aislamiento & purificación , Fusobacterium nucleatum/genética , Femenino , Masculino , Persona de Mediana Edad , Detección Precoz del Cáncer/métodos , Heces/microbiología , Heces/química , Reacción en Cadena de la Polimerasa/métodos , Anciano , Adenoma/diagnóstico , Adenoma/microbiología , Sangre Oculta , Infecciones por Fusobacterium/diagnóstico , Infecciones por Fusobacterium/microbiología , ADN Bacteriano/análisis , ADN Bacteriano/aislamiento & purificación , ADN Bacteriano/genética , Colonoscopía/métodos , Sensibilidad y Especificidad , Biomarcadores de Tumor/análisis , Biomarcadores de Tumor/genéticaRESUMEN
Variations in parathyroid gland positions often cause failure in initial parathyroid adenoma surgery, especially when imaging fails to localise the adenoma. This report describes a female patient with primary hyperparathyroidism for which preoperative localisation studies did not determine the position of the hyperfunctioning gland. The initial approach with bilateral cervical exploration and intraoperative parathyroid hormone monitoring was performed unsuccessfully. A mediastinal adenoma was suspected due to meticulous negative neck exploration and repeated negative images for a neck adenoma. Subsequently, a second approach involving mediastinal exploration was performed. After the removal of remnant thymic tissue in the mediastinal space, a significant drop in intraoperative parathyroid hormone levels was achieved. The pathological result confirmed the presence of a tiny pathological parathyroid adenoma within the thymus. At 6 months follow-up, postoperative biochemical assessment was consistent with normal calcium and parathyroid hormone levels.
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Adenoma , Hiperparatiroidismo Primario , Neoplasias de las Paratiroides , Humanos , Neoplasias de las Paratiroides/complicaciones , Neoplasias de las Paratiroides/cirugía , Neoplasias de las Paratiroides/diagnóstico por imagen , Femenino , Hiperparatiroidismo Primario/cirugía , Hiperparatiroidismo Primario/etiología , Hiperparatiroidismo Primario/complicaciones , Hiperparatiroidismo Primario/diagnóstico , Hiperparatiroidismo Primario/diagnóstico por imagen , Adenoma/complicaciones , Adenoma/cirugía , Adenoma/diagnóstico por imagen , Neoplasias del Mediastino/complicaciones , Neoplasias del Mediastino/diagnóstico por imagen , Neoplasias del Mediastino/cirugía , Hormona Paratiroidea/sangre , Persona de Mediana Edad , Glándulas Paratiroides/diagnóstico por imagen , ParatiroidectomíaRESUMEN
Salivary glands' neoplasms are hard to diagnose and present a complex etiology. However, several viruses have been detected in these neoplasms, such as HCMV, which can play a role in certain cancers through oncomodulation. The co-infections between HCMV with betaherpesviruses (HHV-6 and HHV-7) and polyomaviruses (JCV and BKV) has been investigated. The aim of the current study is to describe the frequency of HCMV and co-infections in patients presenting neoplastic and non-neoplastic lesions, including in the salivary gland. Multiplex quantitative polymerase chain reaction was used for betaherpesvirus and polyomavirus quantification purposes after DNA extraction. In total, 50.7% of the 67 analyzed samples were mucocele, 40.3% were adenoma pleomorphic, and 8.9% were mucoepidermoid carcinoma. Overall, 20.9% of samples presented triple-infections with HCMV/HHV-6/HHV-7, whereas 9.0% were co-infections with HCMV/HHV-6 and HCMV/HHV-7. The largest number of co-infections was detected in pleomorphic adenoma cases. All samples tested negative for polyomaviruses, such as BKV and JCV. It was possible to conclude that HCMV can be abundant in salivary gland lesions. A high viral load can be useful to help better understand the etiological role played by viruses in these lesions. A lack of JCV and BKV in the samples analyzed herein does not rule out the involvement of these viruses in one or more salivary gland lesion subtypes.
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Coinfección , Infecciones por Citomegalovirus , Citomegalovirus , Neoplasias de las Glándulas Salivales , Glándulas Salivales , Humanos , Coinfección/virología , Infecciones por Citomegalovirus/virología , Infecciones por Citomegalovirus/diagnóstico , Citomegalovirus/genética , Citomegalovirus/aislamiento & purificación , Masculino , Femenino , Neoplasias de las Glándulas Salivales/virología , Persona de Mediana Edad , Adulto , Anciano , Glándulas Salivales/virología , Glándulas Salivales/patología , Adenoma/virología , Anciano de 80 o más Años , Carcinoma/virología , ADN Viral/genética , ADN Viral/análisis , Adulto Joven , AdolescenteRESUMEN
TITLE: Adenoma hemorrágico que imita a un aneurisma de la arteria comunicante anterior.
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Adenoma , Aneurisma Intracraneal , Humanos , Aneurisma Intracraneal/diagnóstico , Aneurisma Intracraneal/diagnóstico por imagen , Diagnóstico Diferencial , Adenoma/diagnóstico , Adenoma/diagnóstico por imagen , Adenoma/complicaciones , Femenino , Neoplasias Hipofisarias/diagnóstico , Neoplasias Hipofisarias/diagnóstico por imagen , Neoplasias Hipofisarias/complicaciones , Masculino , Persona de Mediana Edad , Angiografía CerebralRESUMEN
INTRODUCTION: AMPK (AMP-activated protein kinase) is an enzyme that acts as a metabolic sensor and regulates multiple pathways via phosphorylating proteins in metabolic and proliferative pathways. The aim of this work was to study the activated cellular AMPK (phosphorylated-AMPK at Thr172, pAMPK) levels in pituitary tumor samples from patients with sporadic and familial acromegaly, as well as in samples from normal human pituitary gland. METHODS: We studied pituitary adenoma tissue from patients with sporadic somatotroph adenomas, familial acromegaly with heterozygote germline variants in the aryl hydrocarbon receptor interacting protein (AIP) gene (p.Q164*, p.R304* and p.F269_H275dup) and autopsy from normal pituitary glands without structural alterations. RESULTS: Cellular levels of pAMPK were significantly higher in patients with sporadic acromegaly compared to normal pituitary glands (p < 0.0001). Tissues samples from patients with germline AIP mutations also showed higher cellular levels of pAMPK compared to normal pituitary glands. We did not observe a significant difference in cellular levels of pAMPK according to the cytokeratin (CAM5.2) pattern (sparsely or densely granulated) for tumor samples of sporadic acromegaly. CONCLUSION: Our data show, for the first time in human cells, an increase of cellular levels of pAMPK in sporadic somatotropinomas, regardless of cytokeratin pattern, as well as in GH-secreting adenomas from patients with germline AIP mutations.
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Proteínas Quinasas Activadas por AMP , Adenoma , Adenoma Hipofisario Secretor de Hormona del Crecimiento , Humanos , Proteínas Quinasas Activadas por AMP/metabolismo , Proteínas Quinasas Activadas por AMP/genética , Masculino , Adenoma Hipofisario Secretor de Hormona del Crecimiento/genética , Adenoma Hipofisario Secretor de Hormona del Crecimiento/metabolismo , Adenoma Hipofisario Secretor de Hormona del Crecimiento/patología , Femenino , Persona de Mediana Edad , Adulto , Adenoma/genética , Adenoma/patología , Adenoma/metabolismo , Adenoma/enzimología , Acromegalia/genética , Acromegalia/patología , Acromegalia/metabolismo , Péptidos y Proteínas de Señalización Intracelular/genética , Péptidos y Proteínas de Señalización Intracelular/metabolismo , Anciano , Neoplasias Hipofisarias/genética , Neoplasias Hipofisarias/patología , Neoplasias Hipofisarias/metabolismo , Neoplasias Hipofisarias/enzimología , Fosforilación , Hipófisis/metabolismo , Hipófisis/patología , Regulación Neoplásica de la Expresión GénicaRESUMEN
BACKGROUND: Liver adenomatosis is characterized by multiple adenomas diffusely distributed throughout the liver parenchyma. Studies addressing liver transplantation for those cases are scarce, and the criteria used to indicate transplantation are still debatable. OBJECTIVE: To report a single-center experience of liver transplantation for diffuse adenomatosis. METHODS: Single-center retrospective study involving all adult patients who underwent liver transplantation due to adenomatosis from January/2010 to June/2023. RESULTS: A total of 13 patients were identified, corresponding to 0.89% of liver transplants performed during the study period. The mean age was 33 ± 6.55 years, and most of them were female (n = 9, 69.23%). There were 12 transplants with deceased donors and 1 with a right lobe from a living donor. The most frequent reason to preclude liver resection was multiple and large unresectable adenomas in patients without previous liver disease (n = 8, 61.58%), followed by underlying liver disease (Abernethy Malformation, n = 3, 23.07%) and recurrence after liver resection (n = 2, 15.38%). The indications for liver transplantation were high risk of malignant transformation (n = 7, 53.84%), increasing size and number of nodules (n = 3, 23.07%), confirmed malignant transformation (n = 2, 15.38%), and hemorrhage (n = 2, 15.38%). There was 1 perioperative death due to primary non-function. Another patient died during follow-up because of COVID-19. CONCLUSION: Liver adenomatosis is a rare indication for liver transplantation, with acceptable post-transplant outcomes. Unresectable adenomas with high-risk or confirmed malignant transformation are the main indications for transplant. Reasons for unresectability involve underlying liver disease, multiple and large high-risk nodules, and recurrence after previous resection.
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Neoplasias Hepáticas , Trasplante de Hígado , Humanos , Femenino , Estudios Retrospectivos , Adulto , Masculino , Neoplasias Hepáticas/cirugía , Neoplasias Hepáticas/patología , Adenoma/cirugía , Adenoma/patología , Persona de Mediana Edad , Resultado del Tratamiento , Adulto JovenAsunto(s)
Adenoma , Diabetes Insípida , Neoplasias Hipofisarias , Humanos , Neoplasias Hipofisarias/cirugía , Adenoma/cirugía , Factores de Riesgo , Diabetes Insípida/etiología , Complicaciones Posoperatorias/etiología , Estudios Multicéntricos como Asunto , Procedimientos Neuroquirúrgicos/métodos , Procedimientos Neuroquirúrgicos/efectos adversosAsunto(s)
Adenoma , Neoplasias del Oído , Oído Medio , Humanos , Neoplasias del Oído/cirugía , Neoplasias del Oído/patología , Neoplasias del Oído/diagnóstico por imagen , Oído Medio/diagnóstico por imagen , Oído Medio/cirugía , Oído Medio/patología , Adenoma/cirugía , Adenoma/diagnóstico por imagen , Adenoma/patología , Endoscopía , Tumores Neuroendocrinos/cirugía , Tumores Neuroendocrinos/diagnóstico por imagen , Tumores Neuroendocrinos/patología , Femenino , Tomografía Computarizada por Rayos X , Masculino , Persona de Mediana EdadRESUMEN
Mammary tumors are the most frequent type of neoplasms in intact female dogs. New therapies that target neoplastic cells without affecting normal cells are highly sought. The Bacillus anthracis toxin has been reengineered to target tumor cells that express urokinase plasminogen activators and metalloproteinases. In previous studies carried out in our laboratory, the reengineered anthrax toxin had inhibitory effects on canine oral mucosal melanoma and canine osteosarcoma cells. In this study, five canine neoplastic epithelial cell lines (four adenocarcinomas and one adenoma) and one non-neoplastic canine mammary epithelial cell line were treated with different concentrations of reengineered anthrax toxin components. Cell viability was quantified using an MTT assay and half-maximal inhibitory concentration (IC50) values. Cell lines were considered sensitive when the IC50 was lower than 5000 ng/ml. One canine mammary adenocarcinoma cell line and one mammary adenoma cell line showed significantly decreased viability after treatment, whereas the non-neoplastic cell line was resistant. We conclude that the reengineered anthrax toxin may be considered a targeted therapy for canine mammary neoplasms while preserving normal canine mammary epithelial cells.
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Antígenos Bacterianos , Toxinas Bacterianas , Enfermedades de los Perros , Neoplasias Mamarias Animales , Animales , Perros , Neoplasias Mamarias Animales/tratamiento farmacológico , Toxinas Bacterianas/farmacología , Femenino , Antígenos Bacterianos/farmacología , Línea Celular Tumoral , Enfermedades de los Perros/tratamiento farmacológico , Células Epiteliales/efectos de los fármacos , Adenocarcinoma/veterinaria , Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/patología , Supervivencia Celular/efectos de los fármacos , Adenoma/veterinaria , Adenoma/tratamiento farmacológico , Adenoma/patologíaRESUMEN
Primary hyperparathyroidism (PHPT) is characterized by elevated levels of calcium and parathyroid hormone (PTH). However, the interpretation of diagnostic tests, such as serum calcium and PTH levels, is complex in pregnant women. The aim of this report is to present a case of PHTP in a pregnant adolescent, with a special emphasis on an uncommon complication, as well as diagnostic and treatment strategies. A 17-year-old pregnant female presented with hyperemesis gravidarum and neurological symptoms, leading to the diagnosis of cerebral venous thrombosis. Further investigations revealed hypercalcemia and persistently elevated PTH levels, consistent with PHPT. After localization studies, the patient underwent an emergency parathyroidectomy with a diagnosis of parathyroid adenoma. During follow-up, intrauterine growth restriction and severe preeclampsia developed, necessitating an emergency cesarean section. Both the mother and neonate had favorable outcomes. PHPT is an infrequent condition in the pregnant population, and its diagnosis can be challenging due to the overlap of symptoms with normal physiological changes during pregnancy. The occurrence of uncommon complications, such as thrombotic phenomena, highlights the need for a comprehensive approach to ensure early detection and management. In most cases, parathyroidectomy is the treatment of choice.
El hiperparatiroidismo primario (HPTP) se caracteriza por niveles elevados de calcio y hormona paratiroidea (PTH). Sin embargo, la interpretación de pruebas diagnósticas, como los niveles de calcio sérico y PTH, es compleja en mujeres embarazadas. El objetivo de este reporte es presentar un caso de HPTP en una adolescente embarazada, con especial hincapié en una complicación infrecuente, así como en las estrategias diagnósticas y de tratamiento. Una mujer embarazada de 17 años presentó hiperémesis gravídica y síntomas neurológicos, lo que llevó al diagnóstico de trombosis venosa cerebral. Posteriores investigaciones revelaron hipercalcemia y niveles persistentemente elevados de PTH, consistentes con HPTP. Tras la realización de estudios de localización, la paciente fue sometida a una paratiroidectomía de emergencia con diagnóstico de adenoma de paratiroides. Durante el seguimiento, se desarrolló restricción del crecimiento intrauterino y preeclampsia grave, lo que resultó en la necesidad de realizar una cesárea de emergencia. Tanto la madre como el neonato evolucionaron favorablemente. El HPTP es una condición infrecuente en la población embarazada y su diagnóstico puede ser desafiante por la superposición de síntomas con los cambios fisiológicos normales del embarazo. La aparición de complicaciones infrecuentes, como fenómenos trombóticos, resalta la necesidad de un abordaje integral para garantizar la detección y el manejo temprano. En la mayoría de los casos, la paratiroidectomía es el tratamiento de elección.
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Hiperparatiroidismo Primario , Neoplasias de las Paratiroides , Paratiroidectomía , Humanos , Femenino , Embarazo , Hiperparatiroidismo Primario/complicaciones , Hiperparatiroidismo Primario/diagnóstico , Hiperparatiroidismo Primario/cirugía , Hiperparatiroidismo Primario/sangre , Neoplasias de las Paratiroides/complicaciones , Neoplasias de las Paratiroides/cirugía , Neoplasias de las Paratiroides/diagnóstico , Adolescente , Adenoma/complicaciones , Adenoma/cirugía , Adenoma/diagnóstico , Hormona Paratiroidea/sangre , Complicaciones Neoplásicas del Embarazo/cirugía , Complicaciones Neoplásicas del Embarazo/diagnóstico , Complicaciones del Embarazo/diagnóstico , Hiperemesis Gravídica/complicaciones , Hiperemesis Gravídica/diagnóstico , Hipercalcemia/etiología , Hipercalcemia/sangre , Hipercalcemia/diagnóstico , CesáreaRESUMEN
CONTEXT: The tumor microenvironment (TME) includes diverse cellular components such as mesenchymal stem cells (MSCs) and immune cells, among others. MSC have been isolated from different tumors and they favor tumor cell growth; however, their role in pituitary tumors (PTs) remains unknown. OBJECTIVE: Herein we report the presence of MSCs in 2 adrenocorticotropin (ACTH)-secreting PTs causing Cushing disease (MCU), 2 nonfunctioning adenomas of gonadotrope differentiation (MNF), and 2 nontumoral pituitary glands (MS). METHODS: We have analyzed the transcriptomic profiles by RNA sequencing and compared MSCs in terms of their immunosuppressive effects against lymphoid T-cell and macrophage populations by means of cocultures and flow cytometry. RESULTS: Our transcriptomic analysis revealed molecular differences between MSCs derived from nontumoral pituitaries and MSCs derived from PTs. Two distinct subpopulations of MSC emerged: one displaying immunosuppressive properties and the other with increased proproliferative capabilities, regardless of their origin. MSCs derived from ACTH- and nonfunctioning PTs, but not those derived from nontumoral glands, significantly inhibited the proliferation of activated T cells, favored the generation of regulatory T cells, and promoted M2 macrophage polarization. Such immunosuppressive effects were correlated with an upregulation of programmed death ligand 1 and intracellular expression of macrophage colony-stimulating factor (M-CSF) and interleukin-10. Importantly, MSC derived from ACTH-PTs showed a higher immunosuppressive potential than MSC isolated from nonfunctioning tumors. CONCLUSION: This study demonstrates the presence of at least 2 MSC subpopulations in the pituitary gland and suggests that immunosuppressive effects of MSCs may have important implications in PT growth.
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Células Madre Mesenquimatosas , Neoplasias Hipofisarias , Microambiente Tumoral , Humanos , Células Madre Mesenquimatosas/inmunología , Células Madre Mesenquimatosas/metabolismo , Microambiente Tumoral/inmunología , Neoplasias Hipofisarias/inmunología , Neoplasias Hipofisarias/patología , Femenino , Masculino , Persona de Mediana Edad , Adulto , Adenoma/patología , Adenoma/inmunología , Adenoma/metabolismo , Hipersecreción de la Hormona Adrenocorticotrópica Pituitaria (HACT)/patología , Hipersecreción de la Hormona Adrenocorticotrópica Pituitaria (HACT)/inmunología , Hipófisis/inmunología , Hipófisis/metabolismo , Macrófagos/inmunología , Macrófagos/metabolismoRESUMEN
Transsphenoidal resection of growth hormone-secreting pituitary neuroendocrine tumors remains the first-line treatment for acromegaly. This can be performed through microsurgery or endoscopic surgery. For the past decades, endoscopic surgery has become the preferred technique in an increasing number of centers worldwide. However, whether it offers superior clinical outcomes has yet to be determined. In this paper, we performed a narrative review of the literature comparing both techniques in the treatment of acromegaly. We critically assessed available comparative studies from an objective perspective to determine their suitability for defining superiority of either technique. Available evidence displays substantial methodological variations and reports conflicting findings. Although endoscopic surgery provides a wider exposure and enhanced visibility of the surgical field, this does not consistently translate into better clinical outcomes, as most tumors are equally accessible through both techniques. Postoperative outcomes such as remission and complication rates are similar between both techniques. The management of acromegaly should be performed by experienced pituitary neurosurgeons, regardless of the approach. The involvement of a multidisciplinary team in a dedicated pituitary center is critical to ensure optimal outcomes.
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Acromegalia , Microcirugia , Humanos , Acromegalia/cirugía , Resultado del Tratamiento , Microcirugia/métodos , Adenoma Hipofisario Secretor de Hormona del Crecimiento/cirugía , Endoscopía/métodos , Neoplasias Hipofisarias/cirugía , Adenoma/cirugía , Adenoma/patología , Hueso Esfenoides/cirugía , Procedimientos Neuroquirúrgicos/métodos , Procedimientos Neuroquirúrgicos/efectos adversos , Neuroendoscopía/métodosRESUMEN
BACKGROUND: Giant pituitary adenomas (GPAs) are defined as tumors with ≥40 mm in any maximum diameter, and these tend to invade multiple intracranial compartments. Hence, treatment remains a surgical challenge. OBJECTIVE: To describe the clinical and surgical outcomes of the endoscopic endonasal approach (EEA) for GPA in a pituitary referral center in Latin America and to analyze associated predictive factors. METHODS: 37 patients with histologically-confirmed GPA treated solely through the EEA between a 2-year period were included. Preoperative and postoperative clinical and neuroimaging findings; surgical morbidity and mortality; and binary logistic regression analysis to assess predictive factors were analyzed. RESULTS: Preoperative visual impairment prevalence was 97.3%. Mean tumor volume was 32 cc and gross total resection rate was 40.5%. Favorable visual acuity and visual fields outcome rate was 75% and 82.9%, respectively. In the multivariate analysis, bilateral cavernous sinus invasion (P = 0.018) and postoperative cerebrospinal fluid (CSF) leak (P = 0.036) were associated with an unfavorable visual acuity outcome, while radiation therapy (P = 0.035) was for visual fields. Similarly, intraoperative CSF leak was a predictive factor for postoperative CSF leak (10.8%) (P = 0.042) and vascular injury (13.5%) (P = 0.048). CONCLUSIONS: In this first Mexican clinical series, we demonstrated that the EEA is a safe and effective technique for GPA, although early diagnosis and prompt intervention may promote further visual function preservation without significant endocrine morbidity.
Asunto(s)
Adenoma , Enfermedades de la Hipófisis , Neoplasias Hipofisarias , Humanos , Neoplasias Hipofisarias/diagnóstico por imagen , Neoplasias Hipofisarias/cirugía , Neoplasias Hipofisarias/complicaciones , Adenoma/diagnóstico por imagen , Adenoma/cirugía , Adenoma/complicaciones , Nariz/cirugía , Complicaciones Posoperatorias/epidemiología , Resultado del Tratamiento , Estudios RetrospectivosRESUMEN
BACKGROUND: Pituitary adenomas (PA) are neoplasms of pituitary adenohypophyseal cell lineage, which are the third most common cause of brain tumors among adults. Due to hormone secretion, PAs are closely related to metabolic syndrome (MetS). However, the relationship between these two entities has been scarcely studied to date. PURPOSE: This paper aims to evaluate changes in the metabolic status of patients with PA before and after surgical treatment and to look for differences in metabolic outcomes among patients according to the adenoma type and the surgery success rate. METHODS: We assessed patients with PA who went through transsphenoidal surgery for its treatment, documenting metabolic parameters before and after surgery, analyzed whole sample changes, and then stratified them according to adenoma type (nonfunctioning, somatotroph, lactotroph, and corticotroph), and surgery success (total resection, near-total resection, partial resection, subtotal resection). RESULTS: A total of 214 patients were enrolled for this study. The prevalence of MetS with AACE criteria went from 51.52% before surgery to 28.99% after surgery (P < 0.001). Hyperglycemia (HG) was the most beneficial component; it went from 56% pre-surgery to 40.51% post-surgery (P = 0.03). The total resection group had the best improvement, with a significant decrease of prevalence in MetS from 83 to 16% (P < 0.001), and every component, except hypoalphalipoproteinemia (HA): obesity went from 96 to 67% (P < 0.001), arterial hypertension (AH) 59 to 24% (P < 0.001), HG 74 to 23% (P < 0.001), and hypertriglyceridemia (HTG) from 81 to 54% (P < 0.001). According to MetS prevalence, there was no difference in the improvement according to PA type. CONCLUSION: Surgical treatment in patients with PA is associated with MetS improvement.
Asunto(s)
Adenoma , Síndrome Metabólico , Neoplasias Hipofisarias , Adulto , Humanos , Neoplasias Hipofisarias/cirugía , Neoplasias Hipofisarias/patología , Síndrome Metabólico/cirugía , Síndrome Metabólico/etiología , Procedimientos Neuroquirúrgicos/efectos adversos , Adenoma/cirugía , Adenoma/patología , Seno Esfenoidal/cirugía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
PURPOSE: To prospectively evaluate the usefulness of T1-weighted imaging (T1WI) and diffusion-weighted imaging (DWI) sequences in predicting the consistency of macroadenomas. In addition, to determine their values ââas prognostic factors of surgical outcomes. METHODS: Patients with pituitary macroadenoma and surgical indication were included. All patients underwent pre-surgical magnetic resonance imaging (MRI) that included the sequences T1WI before and after contrast administration and DWI with the apparent diffusion coefficient (ADC) map. Post-surgical MRI was performed at least 3 months after surgery. The consistency of the macroadenomas was evaluated at surgery, and they were grouped into soft and intermediate/hard adenomas. Mean ADC values, signal on T1WI and the ratio of tumor ADC values ââto pons (ADCR) were compared with tumor consistency and grade of surgical resection. RESULTS: A total of 80 patients were included. A softened consistency was found at surgery in 53 patients and hardened in 27 patients. The median ADC in the soft consistency group was 0.532 × 10-3 mm2/sec (0.306 - 1.096 × 10-3 mm2/sec), and in the intermediate/hard consistency group was 0.509 × 10-3 mm2/sec (0.308 - 0.818 × 10-3 mm2/sec). There was no significant difference between the median values ââof ADC, ADCR and signal on T1W between the soft and hard tumor groups, or between patients with and without tumor residue. CONCLUSION: Our results did not show usefulness of the DWI and T1WI for assessing the consistency of pituitary macroadenomas, nor as a predictor of the degree of surgical resection.