Gland Adenoma Research Articles

ODP075 A Rare Case of Intrathymic Parathyroid Adenoma

Abstract BACKGROUND: Parathyroid adenomas are the main cause of primary hyperparathyroidism (PHPT). PHPT most often affects adults between ages 50-60 and is considered rare in children and adolescents, representing less than 5% of cases1. It is more common among females than among males in the proportion 3 to 1. During embryogenesis, both the superior and inferior parathyroid glands detach from their pharyngeal origin and migrate towards their final location, posteriorly to the thyroid gland. Migration can be faulty and ectopic glands can appear along the path of embryologic descent2. We present a case of an adolescent male who presented with symptomatic PHPT in the setting of an intrathymic parathyroid adenoma. CASE PRESENTATION: 17-year-old male with no significant past medical history developed symptoms of anxiety, nausea and fatigue. Laboratory values revealed calcium 14.3 mg/dL (8.6-10.3), PTH 227 pg/mL (15-65), 25-dihydroxyvitamin D (vit-D) 8.31 ng/mL (30-100), and phosphorus 1.5 mg/dL (2.5-5. 0). He denied any personal history of bone fractures or nephrolithiasis. CT parathyroid scan showed an enhancing oblong 1.7×0.6 cm lesion in the left upper mediastinal space suggestive of a parathyroid adenoma. Focal sestamibi uptake confirmed a 1.7×0.6 cm enhancing nodule in the left upper anterior mediastinum within the thymus. He was instructed to take 2,000 IU of vit-D daily. Repeat blood work one month later showed that his serum calcium decreased to 13.4 mg/dL and PTH decreased to 122 pg/mL. Additional labs revealed vit-D 16.81 ng/mL, 1,25-dihydroxyvitamin D (calcitriol) 160 pg/mL (19.9-79.3) and 24-hour urine calcium excretion of 409 mg (0-320). Patient underwent successful excision of an intrathymic hyperplastic parathyroid gland adenoma with a >50% drop in peak PTH levels intraoperatively at 10 minutes post excision, later confirmed by pathology. CONCLUSION: This case highlights an adolescent with symptomatic primary hyperparathyroidism due to an intrathymic parathyroid adenoma. Ectopic adenomas have been reported in approximately 4 to 16% of patients with hyperparathyroidism2. When embryological development of the parathyroid glands is defective, it can predispose to the formation of ectopic glands, which is an important cause of failed parathyroid exploration. Unfortunately, PHPT has greater morbidity in the younger age group since most of these patients develop complications from the hypercalcemia, such as kidney stones, hypercalciuria, bone disease and symptoms of abdominal pain/vomiting. This case emphasizes the importance for clinicians to be aware of ectopic parathyroid adenoma in adolescents who present with symptoms and labs consistent with primary hyperparathyroidism.

PSUN76 Massive Four-Gland Parathyroid Hyperplasia: The Case of the Missing Glands

Abstract Introduction Parathyroid adenoma (PA) and parathyroid hyperplasia (PH) are common causes of primary hyperparathyroidism (PHPT) for which the only definitive treatment is surgical removal. Surgery is often preceded by imaging for localization, including by ultrasound (US), Sestamibi scan (MIBI), positron emission tomography/computer tomography (PET/CT), and four-dimensional computed tomography (4D-CT). While it is common for parathyroid pathology to not be visualized on imaging, non-visualization is more typical of adenomas and hyperplasia of smaller size. Clinical Case A 65-year-old male without history of kidney dysfunction or family history of parathyroid disease was referred to surgery for parathyroidectomy to manage longstanding PHPT. Serology showed a parathyroid hormone (PTH) level of 581 pg/mL (reference range: 12-65 pg/mL) and calcium of 11.8 mg/dL (reference range: 8.6-10.5 mg/dL). Preoperative parathyroid localization US revealed a large well-defined 1.5 cm PA. The patient underwent parathyroidectomy, which detected a large right inferior parathyroid gland, confirmed with pathology to be an atypical parathyroid adenoma weighing 1800 mg. Postoperative PTH level was 550 pg/mL and calcium was 12.6 mg/dL. MIBI did not display any definite parathyroid adenoma or ectopic parathyroid tissue. Further evaluation with PET/CT did not demonstrate any evidence of metabolically active residual or ectopic parathyroid adenoma or metastatic disease, and repeat US showed did not reveal evidence of any abnormal parathyroid tissue. Ultimately, 4D-CT detected a multiglandular parathyroid with a 1.8×1.4×3.0 cm right superior adenoma weighing approximately 3931 mg, 1.2×0.8×2.1cm left superior adenoma weighing approximately 1048 mg, and a 0.3×0.4×0.4cm left superior adenoma weighing approximately 25 mg. The patient underwent re-exploration parathyroidectomy with removal of the right superior adenoma weighing 3105 mg and left superior adenoma weighing 1100 mg. The remaining left inferior gland was biopsied and the majority of it was implanted into the arm. Repeat serology one week post-operatively showed improvement of PTH level to 5 pg/mL and of calcium to 8.9 mg/dL and serology one year post-operatively showed a PTH level of 82 pg/mL and a calcium of 9.4 mg/dL. Conclusion We present a patient with massive four-gland PH who initially presented with findings more typical of PA, but ultimately had additional hyperplasic glands that were identified after removal of the adenomatous gland. These glands were unusually large to be seen in PH and yet still be undetected on multiple imaging modalities; no previously reported non-ectopic hyperplastic glands of this size have been documented that were not detected on US or MIBI. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Minimally Invasive Parathyroidectomy as the Surgical Management of Single Parathyroid Adenomas: A Tertiary Care Experience.

The aim of our study is to assess the feasibility, safety and adequacy of focused parathyroidectomy for single parathyroid adenoma accurately localized preoperatively by ultrasound neck and Tc99m sestamibi scan. The study was conducted in the department of Otorhinolaryngology of SMS Medical College and Hospital, Jaipur on 116 patients of primary hyperparathyroidism who underwent minimally invasive parathyroidectomy (MIP) for single gland adenoma localized by USG neck and tc99m sestamibi scans. S. Calcium and S. PTH followed up on day 1, 6th week and 6th month. Outcomes were determined on the basis of cure rate, duration of hospitalization, complication rates and disease persistence/recurrence rate. 82 (70.68%) females and 34 (29.31%) males belonging to the age group of 21-67years (43.02 ± 14) formed the basis of our study. Skeletal (73.27%) and renal (62.93%) were the most common presentations. Accuracy of USG and sestamibi accurately was 93.10% and 96.55% respectively with combined accuracy of 100%. Preoperative serum calcium levels of 10.7-16.03mg/dl (13.09 ± 2.11) and serum PTH 127-2196pg/ml (846.57 ± 776.55) were observed. Cure rate of MIP was 99.13%. No permanent complications seen. MIP can be used as the surgical procedure of choice for PHPT caused by single gland adenoma aided by USG and sestamibi scan. The cure rates are equivalent to the bilateral neck exploration (> 95%) with minimal morbidity and complications. Hence, it is a more feasible, safe and effective treatment option.

First study on the immunohistochemical expression of cyclooxygenase-2 and clinicopathological association in canine hepatoid gland neoplasms.

Hepatoid gland neoplasms (HGNs) constitute one of the most common cutaneous tumors that arise from perianal glands in dogs and are clinically characterized by rapid growth. Cyclooxygenase-2 (COX-2), the inducible form of the enzyme, is associated with several hallmarks of tumorigenesis. Its expression has been confirmed in several human and animal neoplastic tissues, but there are no reports in hepatoid gland tissues. Therefore, this study aimed to investigate COX-2 immunoexpression in canine HGNs, compare the expression among groups of normal hepatoid glands, hepatoid gland adenomas (HGAs), hepatoid gland epitheliomas (HGEs), and hepatoid gland carcinomas (HGCs), and assess the association of the COX-2 expression with clinicopathological features. Sixty-one formalin-fixed paraffin-embedded canine hepatoid gland tissues (20 samples of HGAs, 16 of HGEs, 15 of HGCs, and 10 of normal hepatoid glands) were analyzed for COX-2 expression using immunohistochemistry with scoring for percentage positivity and intensity. Multiple comparisons of COX-2 expression among normal and neoplastic hepatoid glands and the associations between COX-2 expression and clinicopathological features were analyzed. Cyclooxygenase-2 expression was not detected in 60% of normal hepatoid glands and 25% of HGAs. Seventy-five percent of HGAs had a weak expression, while 43.7% and 56.3% of HGEs showed weak and moderate expression, respectively. The expression of HGCs ranged from weak (13.3%) to moderate (33.3%) and strong (53.3%). The immunoreactivity score of COX-2 labeling was significantly different among the normal and neoplastic hepatoid glands (p < 0.0001). The highest score was observed in the HGCs. Only in HGCs, the strong COX-2 expression was significantly associated with some clinicopathological features, including tissue invasion (p = 0.007) and necrosis (p = 0.029). These results suggest that COX-2 may play a role in the modulation of neoplastic cell growth. These preliminary data lead to further investigation on the potential of COX-2 expression as a prognostic indicator and COX-2 inhibitors for canine HGCs treatment.

Brunner’s Gland Lesions: An uncommon entity mimicking malignancy

Brunner’s gland hyperplasia (BGH) or adenoma is an uncommon benign lesion which mimics malignancy in the duodenum. In the present study, five cases of BGH were reported, out of which one case was presented with large size measuring 5.54×4.05 cm, which has not been yet reported. Computed tomography demonstrated a large obstructing polypoidal mass, on esophagogastroduodenoscopy demonstrated polypoidal growth, and histologic examination revealed brunner’s gland adenoma. Most of the cases presented with gastric outlet obstruction and upper gastrointestinal bleeding with other non-specific symptoms. BGH is an uncommon benign condition of the duodenum, patients were usually asymptomatic or may present with non-specific symptoms or present as an incidental finding on endoscopy. Endoscopic and/or surgical resection represents the ideal approach. Brunner’s gland described by the Swiss anatomist Johann Conrad Brunner in 1688, predominantly present within the submucosa, begin just distal to the gastroduodenal junction, and gradually decrease in size and number distally and are often used as a histological marker of the duodenum. A Brunner’s gland adenoma (BGA), also known as BGH or hamartoma, is an uncommonbenign lesion in the duodenum.

S3504 A 64-Year-Old Male With Recurrent Brunneroma

Introduction: Brunneroma (also termed Brunner's gland hyperplasia, adenoma, or hamartoma) is a rare benign tumor arising within the alkaline-producing exocrine glands located in the submucosal layer of the duodenum. Most patients with brunneroma are asymptomatic, but others may present with gastric obstruction-like symptoms or upper gastrointestinal bleed. Less than 200 cases have been reported. We present a case of a patient with recurrent Brunneroma. Case Description/Methods: A 64-year-old male was evaluated for intermittent achy abdominal pain in the umbilical region associated with postprandial bloating and early satiety. He had a similar presentation twelve years ago and underwent esophagogastroduodenoscopy (EGD), which showed a 3 cm polypoid mass within the duodenal bulb. The mass was removed endoscopically through snare polypectomy and Roth basket retrieval, leading to the resolution of his symptoms. Given his previous history, an EGD was obtained, which showed a 4 cm tan-pink polypoid mass prolapsing from the duodenal bulb through the pylorus into the stomach (Figure A). Endoscopic ultrasound revealed a mucosal mass on a stalk with a cystic component and no submucosal involvement (Figure B). He was evaluated by an advanced endoscopist and felt the mass was appropriate for endoscopic removal. Therefore, an Endoloop was placed around the mass initially with the base injected with epinephrine and then removed with cautery, placing a clip on the base afterward. Removal of the mass led to the resolution of his symptoms. The pathology report demonstrated Brunner gland hyperplasia, benign metaplastic cysts arising from Brunner gland ducts, and no dysplasia (Figure C; H&E stain medium magnification). Discussion: Brunner's gland is located in the proximal part of the duodenum above the hepatopancreatic sphincter. The mechanism Brunneroma remains unclear. There is currently no consensus regarding surgical versus endoscopic management of Brunneroma. However, there is increasing endoscopic utilization avoiding a more invasive surgical procedure.Figure 1

S3697 A Case of a Pyloric Gland Adenoma Presenting as an Intramural Mass

Introduction: Pyloric gland adenomas (PGA) are a subset of gastric adenomas with malignant potential. They are often characterized on endoscopy as an intraluminal polypoid, dome-shaped, ulcerating, or fungating mass. Due to their risk of carcinogenesis, it is important to recognize and resect lesions that are suspicious for PGAs for further pathological examination to confirm the diagnosis. Although PGAs are characterized as mucosal or submucosal lesions, this case reviews an atypical presentation of a PGA that presents intramurally in the stomach without the common features typically visualized on direct endoscopy. Case Description/Methods: A 65-year-old female with history of GERD presented with a one-year history of globus sensation described as irritation in her throat without associated weight loss, dysphagia, or odynophagia. Symptoms were refractory to proton pump inhibitors and H2 blockers. Upon initial endoscopic evaluation, a friable 3-centimeter region of localized nodular mucosa without ulceration was found on the greater curvature of the stomach and biopsied (Figure 1A). Initial pathology report noted epithelial proliferation within gastric mucosa, but malignancy was not excluded. Follow-up CT scan showed a 1.8 × 1.3 × 1.1 centimeter intramural lesion within the greater curvature at the level of the gastric fundus (Figure 1B). Upon repeat endoscopy, re-biopsy of the lesion with snare resection for more robust tissue sampling confirmed an intramucosal adenocarcinoma arising in a pyloric gland adenoma. The patient subsequently underwent a subtotal gastrectomy with Roux-en-Y gastrojejunostomy and has begun receiving adjuvant chemotherapy with folinic acid, fluorouracil and oxaliplatin (FOLFOX). Discussion: This case demonstrates the variability in presentation of PGAs while also highlighting the carcinogenic potential to evolve into an adenocarcinoma. Unlike typical PGAs that are mucosal or submucosal, this case describes an intramural PGA, which to our knowledge, has yet to be reported in the literature. Although their incidence is rare, PGAs should be considered on the differential for atypical lesions visualized on endoscopy due to their malignant potential.Figure 1.: Friable nodular ulceration on greater curvature of stomach (A), Intramural lesion within greater curvature at level of gastric fundus on CT scan (B).

Incidence and natural history of gastric high-grade dysplasia in patients with familial adenomatous polyposis syndrome

Familial adenomatous polyposis (FAP) is characterized by high risks of colonic and extracolonic tumors. Recent studies have suggested a rising risk for gastric cancer (GC). We sought to define the spectrum of premalignant gastric polyps in FAP, focusing on high-grade dysplasia (HGD). The gastric phenotypes of 118 patients diagnosed with FAP or attenuated FAP in our Hereditary Gastrointestinal Cancer Registry were retrospectively reviewed. To analyze the clinical features associated with the diagnosis of HGD, we established an age- and sex-matched control group of FAP patients from our cohort without gastric HGD in a 4:1 ratio. The spectrum and frequency of gastric polyps in individuals with FAP included fundic gland polyps (67.9%), hyperplastic polyps/foveolar hyperplasia (19.6%), tubular adenomas (15.2%), foveolar adenomas (10.7%), and pyloric gland adenomas (6.3%). Ten patients (8.9%) exhibited gastric HGD at a mean age of 55 ± 13 years, and HGD was seen in all polyp types. When compared with control subjects, HGD was associated with a high diversity of gastric polyp histology, prior low-grade dysplasia, severe gastric polyposis, and prior Whipple surgery (P= 2.0E-5, .003, .024, and .04, respectively). Two patients (1.7%) with HGD were diagnosed with GC. However, the remaining 8 patients with HGD have been under surveillance for an average of 5.8 ± 4.5 years without progression to GC. Gastric HGD in FAP may be more common than previously appreciated. The natural history of HGD is variable, and most patients with HGD do not appear to progress to GC.

CLINICO-EPIDEMIOLOGICAL ASPECTS OF 562 SALIVARY GLAND TUMORS: A RETROSPECTIVE STUDY FROM A SINGLE BRAZILIAN INSTITUTION

<h3>Objectives</h3> The aim of this study was to review cases of benign and malignant salivary gland tumor (SGT) and correlate it with clinical and epidemiologic characteristics of affected patients. <h3>Study Design</h3> Clinical and epidemiologic data were obtained from medical records from 1993 to 2019 and tabled in a spreadsheet of the Microsoft Office Excel. <h3>Results</h3> Five hundred sixty-two SGTs were identified, among which most were classified as benign neoplasms. In general, tumors were more frequent in women than in men, with the parotid gland being the most affected site. The mean age of patients affected by malignant tumors was higher than that of patients with benign tumors. Pleomorphic adenoma (PA) and mucoepidermoid carcinoma were the most prevalent tumors in the benign and malignant groups, respectively. PA was the most common SGT. <h3>Conclusions</h3> Our results corroborate the literature and show that SGTs are rare, and benign tumors are more common than malignant tumors. The parotid gland remains the most affected gland and pleomorphic adenoma is the most prevalent neoplasm.

Chromosome Translocations, Gene Fusions, and Their Molecular Consequences in Pleomorphic Salivary Gland Adenomas.

Salivary gland tumors are a heterogeneous group of tumors originating from the major and minor salivary glands. The pleomorphic adenoma (PA), which is the most common subtype, is a benign lesion showing a remarkable morphologic diversity and that, upon recurrence or malignant transformation, can cause significant clinical problems. Cytogenetic studies of >500 PAs have revealed a complex and recurrent pattern of chromosome rearrangements. In this review, we discuss the specificity and frequency of these rearrangements and their molecular/clinical consequences. The genomic hallmark of PA is translocations with breakpoints in 8q12 and 12q13-15 resulting in gene fusions involving the transcription factor genes PLAG1 and HMGA2. Until recently, the association between these two oncogenic drivers was obscure. Studies of the Silver–Russel syndrome, a growth retardation condition infrequently caused by mutations in IGF2/HMGA2/PLAG1, have provided new clues to the understanding of the molecular pathogenesis of PA. These studies have demonstrated that HMGA2 is an upstream regulator of PLAG1 and that HMGA2 regulates the expression of IGF2 via PLAG1. This provides a novel explanation for the 8q12/12q13-15 aberrations in PA and identifies IGF2 as a major oncogenic driver and therapeutic target in PA. These studies have important diagnostic and therapeutic implications for patients with PA.

Identifying factors associated with detection of sessile gastric polyps in patients with familial adenomatous polyposis.

Background and study aims Gastric cancer (GC) is increasingly reported and a leading cause of death in patients with familial adenomatous polyposis (FAP). Identifying features in patients with FAP who harbor sessile gastric polyps, likely precursors to GC, may lead to alterations in endoscopic surveillance in those patients and allow endoscopic intervention to decrease the risk of GC. The aim of this study was to identify demographic and clinical factors in patients with FAP who harbor sessile gastric polyps. Patients and methods We retrospectively compared demographic, clinical, and endoscopic features in consecutive adult patients with FAP who presented for a surveillance endoscopy at a tertiary-care center with a FAP registry who harbor sessile gastric polyps to those without them. Sessile gastric polyps included pyloric gland adenomas, gastric adenomas, hyperplastic polyps, and fundic gland polyps with high-grade dysplasia. We also display the location of germline APC pathogenic variants in patients with and without sessile gastric polyps. Results Eighty patients with FAP were included. Their average age was 48 years and 70 % were male . Nineteen (24 %) had sessile gastric polyps. They were older ( P < 0.03), more likely to have a family history of GC ( P < 0.05), white mucosal patches in the proximal stomach ( P < 0.001), and antral polyps ( P < 0.026) compared to patients without a gastric neoplasm. No difference in Spigelman stage, extra-intestinal manifestations, or surgical history was note. 89 % of patients with a gastric neoplasm had an APC pathogenic variant 5’ to codon 1309. Conclusions Specific demographic, endoscopic, and genotypic features are associated with patients with FAP who harbor sessile gastric polyps. We recommend heightened awareness of these factors when performing endoscopic surveillance of the stomach with resection of gastric neoplasia when identified.

Digital histological morphometry of the human pineal gland in a postmortem study, with endocrine and neurological clinical implications.

The pineal gland is a small-sized, photo neuroendocrine organ in the midline of the brain that synthesises and secretes melatonin and serotonin. Chords and islands of pinealocytes constitute the secretory parenchyma, while glial tissue and calcifications represent degenerative changes. This study examined human postmortem pineal glands to microscopically assess morphological changes possibly associated with clinical data, by using digital techniques. A retrospective autopsy study has been performed on 72 paediatric and adult autopsy cases. The glands have been processed for histological analysis and immunohistochemical staining with synaptophysin (SYN), neuron-specific enolase (NSE), and neurofilament (NF). Slides were digitally scanned. Morphometric data were obtained using CaseViewer and ImageJ. The comorbidities used for correlation with morphometric data were obesity, type 2 diabetes, adrenal gland adenoma, goitre, chronic pancreatitis, arterial hypertension, and mixed dementia. Thirty-three females and 39 males were included in the study. Increased secretory parenchyma was found in patients with chronic pancreatitis, arterial hypertension, and adrenal gland adenoma. Reduced activity was found in patients with type 2 diabetes, obesity, advanced pineal calcification, mixed dementia, and old age. There were no changes associated with goitre, cachexia, or Willis's polygon atherosclerosis. No significant differences between gender were found. The activity of the pineal gland can be assessed by quantitative immunohistochemistry of neuroendocrine and structural pinealocyte markers and observation of glial tissue and calcifications. There is a need for further research to evaluate the clinical impact of these morphological changes on the neuroendocrine systems, with clinical implications in endocrinology, neurology, and even psychiatry. Digital techniques offer a more exact analysis of histological data.

Endoscopic features of oxyntic gland adenoma and gastric adenocarcinoma of the fundic gland type differ between patients with and without Helicobacter pylori infection: a retrospective observational study

BackgroundThe endoscopic features of oxyntic gland adenoma and gastric adenocarcinoma of the fundic gland type have not been fully investigated in relation to Helicobacter pylori infection status. We compared the morphology, color, and location of these lesions between patients with and without H. pylori infection.MethodsWe retrospectively enrolled 165 patients (180 lesions) from 10 institutions. We divided the patients into the (i) Hp group (patients with current H. pylori infection [active gastritis, n = 13] and those with past infection [inactive gastritis, n = 76]) and (ii) uninfected group (H. pylori-uninfected patients, n = 52). We compared the clinical and endoscopic features of the two groups. We also performed an analysis between (i) lesions with atrophy of the surrounding gastric mucosa (atrophy group) and (ii) lesions without atrophy of the surrounding gastric mucosa (non-atrophy group).ResultsThe average age was older in the Hp group than in the uninfected group (68.1 ± 8.1 vs. 63.4 ± 8.7 years, p < 0.01). Although the difference was not statistically significant (p = 0.09), multiple lesions were observed in 9 of 89 patients (10.1%) in the Hp group and in only 1 of 52 patients (1.9%) in the uninfected group. Meanwhile, significant differences were observed in the prevalence of lesions located in the gastric fornix or cardia (uninfected group: 67.3% vs. Hp group: 38.0%, p < 0.01), with an elevated morphology (80.0% vs. 56.0%, p < 0.01), with a subepithelial-like appearance (78.2% vs. 42.0%, p < 0.01), and with a color similar to that of the peripheral mucosa (43.6% vs. 25.0%, p = 0.02). The male-to-female ratio, lesion size, and presence or absence of vascular dilatation or black pigmentation on the surface were not different between the two groups. In the analysis comparing lesions with and without mucosal atrophy, the prevalence of multiple lesions was significantly higher (p = 0.02) in the atrophy group (5/25 patients, 20.0%) than in the non-atrophy group (7/141 patients, 5.0%).ConclusionsThe endoscopic features of oxyntic gland adenoma and gastric adenocarcinoma of the fundic gland type differ between patients with and without H. pylori infection.

An Overview of Neoplasia in Captive Wild Felids in Southern Italy Zoos.

The aim of this study was to evaluate the frequency of neoplasms in captive wild felids in Southern Italy zoos over a 13-year period (2008–2021) and to investigate macroscopic and histologic tumor findings in these animals. A total of 24 cases were necropsied, 9 males and 15 females, with age ranging from 6 to 19 years, including 12 tigers (Panthera tigris), 7 leopards (Panthera pardus), 4 lions (Panthera leo), and 1 black jaguar (Panthera onca). Diagnosis of neoplasm was made in 14/24 cases (58.3%). Tumors diagnosed were two cholangiocarcinomas, two hemangiosarcomas of the liver, two uterine leiomyomas, a renal adenocarcinoma, an adrenal gland adenoma, a thyroid carcinoma, an oral squamous cell carcinoma, an osteoma, a meningioma, a mesothelioma, an esophageal leiomyosarcoma, a muscoloskeletal leiomyosarcoma and a thyroid adenoma. The malignant and benign tumors were 62.5 and 37.5%, respectively. Among malignant tumors, no metastasis was observed in 50% of cases; in 10% of cases metastasis involved only regional lymph nodes; and distant metastases were found in 40% of cases. Based on our findings, the liver was the most frequent primary tumor site (25%). The high rates of malignant and widely metastatic neoplasms suggest the importance of active monitoring and management of neoplasia in these threatened and endangered species.

SP70 is a potential biomarker to identify gastric fundic gland neoplasms

BackgroundGastric neoplasms with fundic gland differentiation include oxyntic gland adenomas (OGAs) and gastric adenocarcinomas of fundic gland type (GA-FGs). Due to their well-differentiated and similar morphology with normal fundic glands, it is usually challenging to identify these lesions in pathological diagnosis, especially in biopsy specimens. This study aims to explore and verify the potential role of a newly developed monoclonal antibody (McAb) NJ001 (SP70) in differentiating fundic neoplasms from non-neoplastic fundic gland lesions.MethodsTwenty-three cases of histological confirmed gastric fundic gland neoplasms were obtained, including 12 cases of OGAs and 11 of GA-FGs. Fifty cases of fundic gland polyps (FGPs) were taken as the control group. Six cases of well-differentiated gastric neuroendocrine tumors (NETs) (easily misdiagnosed) were also obtained. Key clinicopathological information was collected. SP70 immunostaining was performed (with para-tumor normal fundic glands as internal control). The positive intensity and staining pattern of SP70 were analyzed and compared.ResultsIn normal gastric mucosa, SP70 was strongly and diffusely stained on the cytoplasm in fundic glands, but not in the foveolar epithelium. Therefore, a zonal distribution of SP70 was observed in normal mucosa. FGPs (50/50, 100%) shared a similar expression pattern with normal fundic glands. In fundic gland neoplasms, a significant down-expression of SP70 was observed in both OGAs and GA-FGs. The positive rate of SP70 in fundic gland neoplasms (6/23, 26.1%) was significantly lower than that in FGPs (100%) (P<0.0001). There was no difference in SP70 expression between OGAs (3/12, 25.0%) and GA-FGs (3/11, 27.2%) group (P>0.05). In these 6 NET cases, SP70 was weak to moderate intensity in the majority of tumor cells (with a different expression pattern).ConclusionDown-expression of SP70 is a specific feature to fundic gland neoplasms including OGAs and GA-FGs. Therefore, SP70 can serve as a potential biomarker in the identification and differential diagnosis of fundic gland neoplasms.

Surprise Egg in the Nasopharynx: Basal Cell Adenocarcinoma

Basal cell adenocarcinoma is a rare salivary gland neoplasm. It is most commonly seen in the parotid gland, and its involvement in the minor salivary glands or upper respiratory tract is very rare. Surgical excision and/or radiotherapy are the mainstay treatment modalities. The nasopharynx is an unusual location for salivary gland basal cell adenocarcinoma. In this case report, the nasopharyngeal punch biopsy of a 60-year-old male patient was reported as salivary gland adenoma, but the final pathological diagnosis was changed to basal cell adenocarcinoma after endoscopic nasopharyngectomy. The clinical, radiological, and histopathological features of the case are presented in light of the literature. In addition, diagnostic clues are emphasized in cases of suspected non-epithelial tumors of the nasopharynx.

A Patient With Polyuria and Hypercalcemia

A Patient With Polyuria and Hypercalcemia

An Uncommon Type of Gastric Adenoma: Pyloric Gland Adenoma with Foveolar Dysplasia.

An Uncommon Type of Gastric Adenoma: Pyloric Gland Adenoma with Foveolar Dysplasia.

Dependence of the Ki67 Labelling Index of Selected Canine Tumours on Patient Age, Sex and Tumour Size

Cell proliferation is a fundamental criterion in the assessment of malignant progression of many tumours and an essential parameter in several grading schemes. However, proliferation may be dependent on patient age and other variables, as shown in normal tissues, cultured cells and human neoplasms. We thus hypothesized that age or other patient or tumour-related parameters might generally affect proliferation in canine neoplasms, which might be of value for optimizing prognostic algorithms. We performed linear regression analyses to associate age, sex and tumour size with digitally quantified immunohistochemical Ki67 labelling indices (Ki67-LIs) of 495 canine tumours, including cutaneous mast cell tumours (MCTs, n=70), soft tissue sarcomas (n=61), plasmacytomas (n=86), trichoblastomas (n=62) and perianal gland adenomas (PGAs, n=95) as well as testicular interstitial (n=65) and Sertoli cell tumours (n=56). In MCTs, the Ki67-LI increased 1.13-fold per year of age (P<0.05) in bitches but not in males. Conversely, in PGAs it rose 1.10-fold per year in males (P<0.05) while it decreased 0.95-fold in bitches (P=0.37). Only in MCTs and PGAs was the Ki67-LI associated with tumour size, albeit in oppositional directions (MCTs: 1.26-fold per cm diameter, P<0.01; PGAs: 0.76-fold, P<0.01). No correlations were found in the other tumour types. The few sex-dependent correlations with patient age and tumour size established here indicate highly tumour-type specific mechanisms, but the diagnostic consequences are uncertain.

Assessment of MEF2C as a novel myoepithelial marker using normal salivary gland and pleomorphic adenoma: An immunohistochemical study

The myoepithelium of the salivary gland demonstrates smooth muscle properties, and the myoepithelium-rich pleomorphic adenomas (PA) exhibit various cytological guises and frequently produce chondroid tissues. We recently reported that gene expression of myocyte enhancer factor 2 C (MEF2C) was up-regulated in myoepithelial cell lines established from mouse salivary glands. This transcription factor is known to regulate the development of smooth muscle cells and chondrocytes. These findings have led us to postulate that MEF2C may be a new marker of the myoepithelium and thus be of help for exploring myoepithelial participation in PA. The immunoreactivity of MEF2C was semi-quantitatively analyzed in normal salivary glands and in different types of cell in PA. The pattern of staining was also compared with that of α-smooth muscle actin (αSMA) and calponin. In the parenchyma of mouse and human submandibular glands, MEF2C expression was exclusive to the nuclei of myoepithelial cells. In the neoplastic myoepithelium of PA, epithelioid and stellate cells were consistently positive, but spindle and plasmacytoid cells exhibited selective staining. Although variability/loss of expression was evident, αSMA tended to show limited expression, whereas calponin tended to show extensive expression. Intense and uniform immunoreactivity for MEF2C was observed in lacunar cells in chondroid areas of PA. This is the first reported study to have demonstrated MEF2C immunoexpression in normal and neoplastic myoepithelial cells. Among the heterogeneously differentiated elements, MEF2C may be useful to define the myoepithelial/mesenchymal phenotypes of PA cells. Along with other relevant immunohistochemical markers, it may become another standard.