Diagnosis Of Adenoma Research Articles

The expression of UNC5D is abnormal in the early stage of colorectal tumors associated with its proliferation and migration.

Colorectal adenomas are an important precancerous lesion of colorectal adenoma with a high incidence. This study aims to explore new prognostic targets for colorectal adenomas through bioinformatics techniques. In this study, data from 29 colonic adenomas and 38 normal colonic mucosa in GSE37364 were analyzed to screen for differentially expressed genes (DEGs). Then, batch survival analysis, construction of risk model, mutation analysis, Cox regression analysis and expression analysis were performed on DEGs to determine the hub genes of this study. Finally, immune correlation analysis and cell experiments were carried out on the hub gene to explore its potential mechanism. In our study, a total of 431 up-regulated and 809 down-regulated differentially expressed genes (DEGs) were identified. Among these, Unc-5 Netrin Receptor D (UNC5D) emerged as a pivotal gene associated with colorectal adenoma. Notably, UNC5D expression levels were found to be significantly higher in normal tissues compared to colorectal adenoma tissues. Furthermore, our analysis demonstrated that UNC5D showed promising diagnostic potential for patients with colon adenocarcinoma. In vitro experiments revealed that the overexpression of UNC5D had a profound impact on the behavior of colorectal tumor cells. Specifically, it led to a substantial reduction in the proliferation, motility, and invasion of these tumor cells. Additionally, UNC5D was shown to exert control over STAT1/STAT3 phosphorylation, which in turn regulated the expression of PD-L1 in response to interferon (IFN) stimulation. These findings highlight the significant role of UNC5D in modulating immune responses and the development of colorectal adenoma. UNC5D emerges as a potential diagnostic biomarker and an attractive immunotherapeutic target in the context of colorectal malignancies. These results call for further exploration of UNC5D-based strategies for the diagnosis and treatment of colorectal adenoma and adenocarcinoma. In addition to having the potential to be used as a diagnostic biomarker and an immunotherapeutic target in colorectal malignancies, UNC5D is necessary for the growth of colorectal adenomas. Additionally, UNC5D controlled STAT1/STAT3 phosphorylation to suppress the growth of colorectal cancers by regulating IFN-induced PD-L1 expression.

Low libido despite high normal testosterone levels in a male with an FSH-secreting pituitary macroadenoma.

Functioning gonadotroph adenomas with clinical manifestations are extremely rare and the majority of these are FSH-secreting macroadenomas. Clinical symptoms are due to excess gonadotrophins and sex hormones, and these may be present for a long time before the diagnosis of pituitary adenoma is made. We present the case of a 37-year-old Caucasian male with clinical manifestations of an FSH-secreting pituitary macroadenoma. He had sexual dysfunction for a year followed by bilateral testicular pain and enlargement which was initially treated as suspected recurrent epididymitis, but his symptoms did not resolve. He presented a year later with headaches and bilateral superior temporal visual field defects. Brain imaging confirmed a pituitary macroadenoma with optic chiasm compression. Pituitary profile demonstrated an unusually high FSH with high normal LH and normal testosterone level. The patient successfully underwent transsphenoidal hypophysectomy and histology confirmed gonadotroph differentiation and immunoreactivity predominantly with FSH. Gonadotrophin levels and testosterone dropped significantly after surgery, and he was started on testosterone replacement. MR imaging, 2 years post surgery, showed no recurrence of pituitary adenoma. In conclusion, testicular enlargement and hypogonadal symptoms associated with low testosterone levels are recognised features in FSH-secreting pituitary adenomas. Our patient had hypogonadal symptoms but consistently high normal testosterone levels prior to surgery. The reason for low libido despite high testosterone is unclear. Our case highlights the need to suspect such rare underlying pituitary pathology when dealing with unusual combinations of hypogonadal symptoms, testicular enlargement with low or normal testosterone levels. Functioning pituitary adenomas that secrete excess follicle-stimulating hormone (FSH) are very rare and often present with symptoms related to pituitary mass effect. Testicular enlargement alongside sexual dysfunction are commonly reported symptoms amongst male patients. Pituitary profile results demonstrate a raised FSH level with either a low, normal, or even high testosterone level which may not always correlate to clinical symptoms. Pituitary pathology should be considered in males presenting with unusual combinations of testicular enlargement and hypogonadal symptoms even with normal testosterone levels.

Logistic regression analysis of ultrasound diagnosis of thyroid follicular adenoma and follicular carcinoma

Logistic regression analysis of ultrasound diagnosis of thyroid follicular adenoma and follicular carcinoma

Apocrine gland adenoma in a 4-month old golden hamster (Mesocricetus auratus)

Hamsters are popular as pets. Although there are many reports on tumours in laboratory hamsters, tumours in pet hamsters are infrequently reported. The present report describes successful diagnosis, treatment and treatment outcome of apocrine gland adenoma, an uncommon cutaneous neoplasm, identified in the ventral neck region of a 4-month old Golden hamster (Mesocricetus auratus). The initial diagnosis was attempted by cytology. The cytology of benign apocrine glands in hamsters has not been previously described in the literature. Histopathology of the neoplasm was consistent with an apocrine adenoma and positive PAS staining confirmed the secretory nature of the neoplasm. The tumour was surgically excised under local anaesthesia. There was no tumour recurrence or metastasis detected after one year.

Advantages of using PET/CT with 11C-choline compared with other methods of topical diagnosis of parathyroid adenomas

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Application of Three-dimensional Reconstruction in the Pre-operative Diagnosis of Middle Ear Adenoma

Application of Three-dimensional Reconstruction in the Pre-operative Diagnosis of Middle Ear Adenoma

Pleomorphic adenoma with lipometaplasia: Rare histology finding of a common entity

We report a rare case of a pleomorphic adenoma with lipometaplasia. A 32-year-old woman presented with intraoral swelling over right side of palate. Computed tomography revealed a heterogeneously enhancing right hard palatal mass without bony erosions. Preoperative diagnosis was offered with intraoral fine needle aspiration cytology following which excision was performed. On histopatholgy, final diagnosis of pleomorphic adenoma with lipometaplasia offered. Though rare it must be kept in mind as differential in cases of fat containing salivary gland lesions.

Analysis of Diffusion-Weighted and T2-Weighted Imaging in the Prediction of Distinct Granulation Patterns of Somatotroph Adenomas

ObjectiveThe heterogeneity of the somatotroph adenomas, especially for SG and DG subtypes, has attracted great attention in identifying the imaging biomarker of them. The purpose of current study was to compare the diagnostic performance of diffusion-weighted and T2-weighted MRI sequences for preoperatively distinguishing the granulation patterns of somatotroph adenomas. Methods32 patients with clinical diagnosis of somatotroph adenomas from October 2018 to March 2023 were included in this study. Coronal diffusion-weighted imaging (DWI) and T2-weighted MRI sequences data was collected from 3.0T MRI and compared between SG and DG groups. The immunohistochemistry (IHC) was used to confirm the EM pathological subtypes and Ki67 expression levels of somatotroph adenomas postoperatively. ResultsPatients in the SG group had significantly higher signal intensity (SI) ratio of DWI (rDWI) (P<0.001), lower SI ratio of apparent diffusion coefficient (ADC) (rADC) (P<0.001), and higher SI ratio of T2-weighted imaging (rT2) (P=0.011). The combined diagnose index of rDWI and rADC had the highest diagnostic efficiency predicting SG adenomas (sensitivity, 93.3%; specificity, 88.2%; P < 0.001). The rDWI and rADC value had positive and negative correlations with Ki67 index and tumor maximum diameter, respectively. Lower rADC×103 was an independent predictor for SG adenomas. ConclusionsOur results indicated that compared with previously used T2-weighted imaging, the DWI sequence, especially the combined diagnosis index of rDWI and rADC could more efficiently distinguish the granulation patterns of somatotroph adenomas preoperatively.

Pleomorphic Adenoma with a Novel Rearrangement - LINC01606::PLAG1

Abstract Introduction/Objective Pleomorphic adenoma (PA) is characterized by presence of three components including bi- layered ducts, myoepithelial cells, and chondromyxoid/fibrous stroma in varying proportions. Evaluation of molecular aberrations helps recognizing challenging cases. Pleomorphic adenoma gene 1 (PLAG1) and high-mobility group AT- hook 2 (HMGA2) are hallmark genes showing rearrangement with various partner genes. Here, we present a case of myoepithelial cell rich PA, showing PLAG1 rearrangement with a novel partner gene. Methods/Case Report A 77-year-old male with history of slow-growing, right post-auricular mass over 5-year duration, now presented with overlying skin ulceration and bleeding/intermittent oozing. CT scan showed a complex, lobular, enhancing 8.7 x 8.4 x 7.0 cm mass, arising from the right parotid gland. Fine needle aspiration was performed and reported inconclusive with blood and fibrin only. The patient elected to undergo total parotidectomy with cervical lymph node dissection. Histology revealed a circumscribed, cellular salivary neoplasm with extensive hemorrhage/infarction and cystic degeneration. The viable neoplastic cells composed of sheet of spindle and epithelioid/plasmacytoid cells, with focal glandular and cribriform areas. Very focally chondromyxoid change is noted. The tumor cells stained with CK7, S100, and SOX10, few scattered cells positive for SMA, p63, and p40, with Ki67 labeling index of 5-10%. None of the cervical lymph nodes showed metastatic tumor. Overall, the features were compatible with myoepithelial cell rich salivary neoplasm with working diagnosis of cellular pleomorphic adenoma. Next generation RNA sequencing showed a LINC01606::PLAG1 [inv(8;8)(8q12.1;8q12.1)] fusion alteration. Results (if a Case Study enter NA) NA Conclusion PLAG1 is located at 8q12.1 and have been reported to be involved in chromosome rearrangements in various tumors including salivary gland tumors, mainly pleomorphic adenoma. Many fusion partners of PLAG1 have been reported. This report presents LINC01606 gene as a novel fusion partner of PLAG1 in a case of myoepithelial rich PA. This fusion leads to in-frame fusion of exons 1-2 of the LINC01606 gene to exons 3-5 of the PLAG1 gene.

Challenges in Diagnosis of Steatohepatitic Hepatocellular Carcinoma on a Biopsy Specimen

Abstract Introduction/Objective Hepatocellular carcinoma (HCC) is the most common primary liver tumor. Steatohepatitic hepatocellular carcinoma (SH-HCC) is a subtype that is associated with metabolic syndrome and alcoholic hepatitis. Diagnosing SH-HCC can be extremely challenging on a biopsy specimen, given that steatohepatitis-like changes can be seen in focal nodular hyperplasia and hepatic adenoma. Herein, we present a very challenging case of SH-HCC that was initially diagnosed as a well-differentiated lesion after multi-institutional consultations. Methods/Case Report A 54-year-old female with past medical history of diabetes and hypertension presented with flank pain and a 2.7 cm liver mass in a background of diffuse hepatic steatosis by CT scan, concerning for malignancy. Viral hepatitis serology workup was negative. Results (if a Case Study enter NA) The liver core biopsy reveals a well-differentiated hepatic lesion with areas of steatosis, fibrosis, and features of steatohepatitic changes including ballooning hepatocytes and Mallory-Denk bodies. No significant cytological atypia is identified. No definitive loss of reticulin is seen by reticulin stain. The cytological or architectural atypia was insufficient in isolation to diagnose HCC. The lesion cells are positive for HepPar-1 and Arginase-1, while negative for Glypican. Diffuse sinusoidal CD34 staining is present. Ki-67 proliferative index is approximately 2%. These changes did not permit a confident diagnosis of hepatic adenoma or hepatocellular carcinoma. The case was sent for consultation by multiple institutions with a consensus diagnosis of well-differentiated hepatic lesion/neoplasm. A follow-up liver wedge resection shows a hepatic neoplasm with areas of loss of reticulin staining. Focal stromal invasion is present. The neoplastic cells are positive for HepPar-1, Arginase-1, glutamine synthetase and Glypican (patchy). Final diagnose was rendered as SH-HCC. Conclusion The diagnosis of SH-HCC requires high level of suspicion on a biopsy specimen, especially in a background of steatohepatitis. A reticulin stain and immunohistochemical stains may not be helpful. Clinical- radiological correlation should always be considered.

Dexamethasone Suppression Testing in a Contemporary Cohort with Adrenal Incidentalomas in Two U.S. Integrated Healthcare Systems.

Autonomous cortisol secretion (ACS) from an adrenal adenoma can increase the risk for comorbidities and mortality. The dexamethasone suppression test (DST) is the standard method to diagnose ACS. A multi-site, retrospective cohort of adults with diagnosed adrenal tumors was used to understand patient characteristics associated with DST completion and ACS. Time to DST completion was defined using the lab value and result date; follow-up time was from the adrenal adenoma diagnosis to the time of completion or censoring. ACS was defined by a DST > 1.8 µg/dL (50 nmol/L). The Cox proportional hazards regression model assessed associations between DST completion and patient characteristics. In patients completing a DST, a logistic regression model evaluated relationships between elevated ACS and covariates. We included 24,259 adults, with a mean age of 63.1 years, 48.1% obese, and 28.7% with a Charlson comorbidity index ≥ 4. Approximately 7% (n = 1768) completed a DST with a completion rate of 2.36 (95% CI 2.35, 2.37) per 100 person-years. Fully adjusted models reported that male sex and an increased Charlson comorbidity index were associated with a lower likelihood of DST completion. Current or former smoking status and an increased Charlson comorbidity index had higher odds of a DST > 1.8 μg/dL. In conclusion, clinical policies are needed to improve DST completion and the management of adrenal adenomas.

Is Metformin Associated with a Lower Prevalence of Polyps, Adenomas, and Colorectal Carcinoma in Patients with Diabetes Mellitus?

Recent studies suggested a protective role of metformin in the development of colorectal cancer (CRC) and its precursors. We aimed to investigate if metformin was associated with a lower prevalence and number of colorectal polyps in diabetic patients and also adenomas, high-risk adenomas, and CRC. Retrospective study on adult patients with diabetes mellitus followed in our hospital with a total colonoscopy between 2015 and 2019, treated with either metformin for > 5years or other antidiabetic agent (control group). We assessed the number, size, and histopathology examination of proliferative lesions detected on colonoscopy. We included 401 patients aged 69 ± 9years, 57% males, divided into two groups: treated with metformin (n = 260) and without (n = 141). The number of polyps detected was significantly lower in patients under metformin (p = 0.014). There was a nonsignificant trend towards lower polyp detection rates in the metformin compared to the control group both in unadjusted analysis (50% vs 60%, p = 0.058) and multivariable adjusted analysis (odds ratio [OR] 0.68, 95% confidence interval [CI] 0.43-1.09, p = 0.111). In the latter, we identified male gender (OR 2.24, 95%CI 1.44-3.49, p < 0.001), age (OR 1.35 for every 10years, 95%CI 1.07-1.71, p = 0.012), glycated hemoglobin value (OR 1.20 for every 1% increase, 95%CI 1.06-1.37, p = 0.005), and hypertension (OR 1.76, 95%CI 1.01-3.08, p = 0.046) as factors associated with a higher prevalence of polyps. We saw no statistically significant differences regarding adenoma (p = 0.231), high-risk adenoma (p = 0.810), and CRC (p = 0.705) diagnoses between groups. In our study, metformin was associated with less colorectal polyps in diabetic patients compared to other treatment modalities. We observed a nonsignificant trend towards lower polyp detection rates in the metformin group both in unadjusted and adjusted analyses.

Absolute and Relative Washout Rates Associated With Parathyroid Adenoma.

Background Parathyroid adenoma is a benign parathyroid gland tumor that causes excessive parathyroid hormone production, leading to primary hyperparathyroidism. High serum calcium levels characterize it. Accurate diagnosis and localization of adenomas are crucial for effective surgical management. Computed tomography is a fundamental imaging technique used to identify and characterize parathyroid adenomas. This study aimed to provide a comprehensive overview of the absolute and relative contrast washout rates of parathyroid adenoma and the thyroid gland, and compare enhancement patterns to establish the absolute and relative washout rates of parathyroid adenoma. Materials & methods This retrospective study analyzes the CT findings of 33 patients with histopathologically proven parathyroid adenomas. All patients with 4D CT scans have been included with no exclusion criteria. The mean attenuation was measured in Hounsfield units for the parathyroid adenoma and thyroid gland in the non-enhancing, arterial, venous, and delayed phases, depending on the region of interest. All statistical analyses were performed using SPSS (IBM Corp., Armonk, NY, USA). Student's t-test was used to evaluate the differences in measurements between the parathyroid adenoma and thyroid tissue. One-way ANOVA was used to evaluate the difference in calculations between the parathyroid adenoma and thyroid tissue. P-values <0.001 were considered statistically significant. Results The most common location of parathyroid adenomas is inferior to the thyroid gland. The average pre-contrast attenuation of the parathyroid adenoma is 61.8 ± 15.5 HU compared to 105.5 ± 15.2 HU of the thyroid gland. The arterial attenuation of the parathyroid adenoma is 170.3 ± 40.7 HU, relatively comparable to the thyroid gland arterial attenuation, which is 188.0 ± 9.6 HU. The venous and delayed-phase attenuation of the parathyroid adenoma were 146.8 ± 37.5 and 96.8 ± 26.7 HU, respectively,and 178.8 ± 20.2 HU and 149.3 ± 15.2 HU for the thyroid gland, respectively. The calculated absolute and relative arterial washout rates for the parathyroid adenoma were 69.4 ± 13.4% and 43.2 ± 8.0%, respectively, as compared to 46.4 ± 9.9% and 20.6 ± 6.7% for the thyroid gland. The calculated absolute and relative venous washout rates for the parathyroid adenoma were 58.0 ± 21.4% and 33.0 ± 13.7%, respectively, as compared to 37.2 ± 17.2% and 15.9 ± 9.6% for the thyroid gland. Conclusions Parathyroid adenoma demonstrated a significantly higher washout rate than the thyroid gland tissue. Absolute arterial washout ≥69% and relative arterial washout ≥43% indicate parathyroid adenoma. Moreover, absolute venous washout ≥58% and relative venous washout ≥33% can be considered diagnostic factors for parathyroid adenoma. Further, pre-contrast attenuation of <60 Hounsfield units has a substantial predictive value for parathyroid adenoma in addition to the described washout rate. Increased awareness of the washout rate can increase the success rate of four-dimensional computed tomography interpretation.

[Analysis on features of intraoperative pathological diagnosis of bronchial adenoma by frozen section investigation].

[Analysis on features of intraoperative pathological diagnosis of bronchial adenoma by frozen section investigation].

Parathyroid adenoma: multimodal diagnosis capabilities: A retrospective study

Background. Primary hyperparathyroidism is a common endocrinological disease caused mainly by parathyroid adenoma. The main treatment method is surgery (parathyroidectomy). Therefore, the exact determination of adenoma localization is crucial.&#x0D; Aim. To evaluate the current possibilities of multimodal diagnosis of parathyroid adenomas.&#x0D; Materials and methods. A retrospective analysis of 49 patients with primary hyperparathyroidism aged 24 to 82 (median 57.9 years) was performed. Modern radionuclide and hybrid technologies were used for topical diagnosis and metabolic assessment of parathyroid adenomas: scanning, single-photon emission computed tomography, single-photon emission computed tomography combined with computed tomography, positron emission tomography combined with computed tomography with 18F-deoxyglucose and 18F-choline. The diagnosis of primary hyperparathyroidism was confirmed by a biochemical blood test: the level of parathyroid hormone and ionized and total calcium.&#x0D; Results. The study included 43 (87.8%) females and 6 (12.2%) males. The female/male ratio was 7.2:1. Most cases (78.1%) were the hypercalcemic type of primary hyperparathyroidism, and the normocalcemic type was diagnosed in 21.9% of patients. The mean parathyroid hormone level was 145.43 pg/mL, exceeding the reference values by 2.2 times. Parathyroid hormone concentration in patients with primary hyperparathyroidism was 156.38 pg/mL, and mean ionized and total blood calcium levels were 1.43 and 3.04 mmol/L, respectively. The asymptomatic type occurred in 76.7% of patients. The symptomatic type of hyperparathyroidism had 23.3%, manifested with nephrolithiasis, pancreatitis, and bone lesions. Parathyroid adenomas were more often located in the left lobe (42.9%). In 77.6% of patients with primary hyperparathyroidism, solitary adenomas were detected. Ectopia of the parathyroid glands was detected in 16.3% of patients, with intrathyroidal location in the left lobe being the most common. Rare locations include the anterior and posterior mediastinum and the esophageal wall.&#x0D; Conclusion. Modern diagnostic multimodal options based on radionuclide and hybrid technologies are crucial in the personalized treatment of primary hyperparathyroidism.

A case report of tubular apocrine adenoma of lower eyelid

Moll glands are sweat apocrine glands close to the eyelid margin. Tumors derived from Moll glands are rare, although Moll glands cysts are frequent. They originate from their glandular tissue or tubules. In this report we present a rare case of a lower eyelid skin tubular apocrine adenoma occurred in the right eye lower eyelid of a caucasian 45 year old woman. The lesion was nodular and dome shaped and its size was 1.5 × 3.5 × 2 mm. After a complete excision the lesion was analyzed by our pathology unit. Histologic sections were stained with haematoxylin and eosin, alcian blue, periodic acid-Schiff (PAS). Additionally, the following immunohistochemical markers were used: cytokeratin 7 (CK7), cytokeratin 8/18 (CK8/18), cytokeratin 20 (CK20), S-100 protein and gross cystic disease protein 15 (GCDFP-15) (4,5). The immunohistochemical and phenotypic features resulted suggest the diagnosis of lower eyelid tubular apocrine adenoma probably originated from Moll glands. These findings allowed us to diagnose a very rare and benign cutaneous lesion of eyelid skin.

Enhanced CT combined with texture analysis for differential diagnosis of pleomorphic adenoma and adenolymphoma

ObjectiveThis study sought to evaluate the worth of the general characteristics of enhanced CT images and the histogram parameters of each stage in distinguishing pleomorphic adenoma (PA) and adenolymphoma (AL).MethodsThe imaging features and histogram parameters of preoperative enhanced CT images in 20 patients with PA and 29 patients with AL were analyzed. Tumor morphology and histogram parameters of PA and AL were compared. Area under the curve (AUC), sensitivity, and subject operational feature specificity (ROC) analysis were used to determine the differential diagnostic effect of single-stage or multi-stage parameter combinations.ResultsThe difference in CT value and net enhancement value of arterial phase (AP) were significant (p < 0.05); Flat sweep phase (FSP), AP mean, percentiles, 10th, 50th, 90th, 99th and arterial period variance and venous phase (VP) kurtosis in the nine histogram parameters of each period (p < 0.05). An analysis of the ROC curve revealed a maximum area beneath the curve (AUC) in the 90th percentile of FSP for a single-parameter differential diagnosis to be 0.870. The diagnostic efficacy of the mean value of FSP + The 90th percentile of AP + Kurtosis of VP was the best in multi-parameter combination diagnosis, with an AUC of 0.925, and the sensitivity and specificity of 0.900 and 0.850, respectively.ConclusionThe histogram analysis of enhanced CT images is valuable for the differentiation of PA and AL. Moreover, the combination of single-stage parameters or multi-stage parameters can improve the differential diagnosis efficiency.

Parathyroid adenoma in a 33 years female, manifesting as non-traumatic multiple bone fractures

A 33 years old female patient presented to OPD with chief complaints of prolonged fatigue, abnormal gait and difficulty in walking since 7 years. On further evaluation MRI pelvis revealed bilateral non-traumatic pelvic bone fractures, with high Serum parathyroid hormone level (1050 pcg/ml) and hypercalcemia. CECT Neck showed a well-defined soft tissue density lesion involving the posterior-inferior aspect of the right lobe of thyroid gland. Surgical resection was performed and histopathology revealed parathyroid adenoma. Clinical manifestations and PTH and calcium levels gradually decreased to normal after surgery. Patient’s symptoms gradually decreased over a period of 2 month after treatment of the underlying cause. In a young female presenting with bony pains and non-traumatic fractures, a differential diagnosis of parathyroid adenoma must be kept in mind.  

Risk of dementia and psychiatric or sleep disorders after diagnosis of adrenal adenomas: a population-based cohort study.

Adrenal adenomas are commonly encountered in clinical practice. To date, population-based data on their impact on cognition, mental health, and sleep are lacking. We aimed to study possible associations between adrenal adenomas and dementia, psychiatric or sleep disorders. Population-based cohort study, Olmsted County, MN, 1995-2017. Patients with adrenal adenoma and absent overt hormone excess were age- and sex-matched 1:1 to a referent person without adrenal adenoma. Outcomes were baseline and incident diagnoses of dementia, psychiatric or sleep disorders, assessed using ICD codes. Of 1004 patients with adrenal adenomas, 582 (58%) were women, and median age at diagnosis was 63 years. At baseline, and after adjusting for age, sex, education, BMI, and tobacco use, patients with adenoma had higher odds of depression (adjusted odds ratio, aOR: 1.3, 95% CI, 1.1-1.6), anxiety (aOR: 1.4, 95% CI, 1.1-1.8), and substance abuse (aOR: 2.4, 95% CI, 1.7-3.4) compared to referents. During a median follow-up of 6.8 years, and after adjusting for age, sex, socioeconomic status, BMI, tobacco, and substance abuse, patients demonstrated a higher risk of psychiatric and sleep disorders [adjusted hazard ratio (95% CI)]: depression [1.7 (1.3-2.2)], anxiety [1.4, CI (1.1-1.7)], insomnia [1.4 (1.0-1.9)], sleep-related breathing disorders [1.5 (1.1-1.9)], hypersomnias [2.1 (1.0-4.2)], parasomnias [2.1 (1.0-4.2)], and sleep-related movement disorders [1.5 (1.0-2.1)], but not dementia. Patients with adenomas demonstrate a higher incidence of psychiatric and sleep disorders, possibly due to the underlying subtle increase in cortisol secretion.

SAT198 Parathyroid Adenoma Masquerading As A Thyroid Nodule

Abstract Disclosure: A. Arida: None. M. Papaleontiou: None. N. Esfandiari: None. Background: The diagnosis of parathyroid adenomas using a neck ultrasound (US) can be challenging when not performed by an experienced radiologist. Additional methods of diagnosis have been implemented to distinguish the differential diagnosis of a nodule in the neck. Clinical Case: A 48-year-old woman with a history of type 2 diabetes, hypercalcemia, and kidney stones presented for evaluation of a lump in the neck of 5 years duration. Prior thyroid US showed a solid hypoechoic nodule superior to the left thyroid lobe measuring 2.2 x 1.2 x 1.1 cm with hypervascularity. Her first FNA biopsy of this nodule reported benign cytology 5 years ago. A parathyroid scintigraphy scan was negative. Repeat FNA biopsy of this nodule showed follicular lesion of undetermined significance (Bethesda category III). Surgical consultation was recommended but she decided to seek a second opinion. A repeat neck US identified a solid vascular 1.6 cm nodule along the anterior margin of the superior left thyroid lobe. Some vascularity was extending from the thyroid tissue into the nodule. It was noted that this may represent an extrathyroidal nodule or arise from the thyroid gland with a score of TIRADS 4. Laboratory tests confirmed primary hyperparathyroidism with an iPTH of 126 pg/mL (normal range, 10-65 pg/mL) and serum calcium of 10.9 mg/dL (normal range, 8.6-10.3 mg/dL). After normalizing vitamin D levels, these values remained elevated. A repeat FNA biopsy of this nodule showed evidence of intrathyroidal parathyroid tissue. Immunostains were performed on the cell block material from the FNA biopsy. Scattered groups of cells were positive for PTH while being negative for TTF-1. Further needle washout for iPTH measurement revealed an iPTH &amp;gt;2000 pg/mL confirming the diagnosis of a parathyroid adenoma. Parathyroid surgery was recommended as per guidelines. Discussion: Once primary hyperparathyroidism is confirmed, the localization of parathyroid adenoma is pursued by a neck US and/or parathyroid scintigraphy. Parathyroid glands are located in the superior poles and in the inferior poles of the thyroid gland but ectopic locations like retropharyngeal, intrathyroidal, and mediastinal are possible. Typical US appearance is oval, solid, well-circumscribed, homogenous, and hypoechoic compared to the thyroid tissue. The color Doppler shows that the blood supply enters at the center and distributes peripherally presenting a “vascular arch” pattern that helps differentiate them from other lesions such as tumors or lymph nodes where the distribution is more centralized. Further needle washout for PTH level can confirm the diagnosis of parathyroid adenoma. Once a parathyroid adenoma is confirmed, minimally invasive parathyroid surgery can be recommended if surgery is indicated. Conclusion: A needle washout for measuring PTH in an FNA biopsy sample should be recommended when it is unclear whether a nodule is a thyroid nodule or a parathyroid adenoma. Presentation: Saturday, June 17, 2023