Diagnosis Of Adenoma Research Articles

Serous multicystic papillary adenoma of the ovaries and glandular cystic hyperplasia of uterus in a Guinea Pig (Cavia porcellus)

Cystic changes of ovarian tissue are crucial as they cause infertility in laboratory animals. A 4 years old, weighing approximately 500 g adult, intact guinea pig had pruritic progressive alopecia over the flanks at the dorsal area and abdomen symmetrically, bilaterally for a month. Beside, an abdominal enlargement was observed outside on the guinea pig. Large polycystic ovaries were detected behind the kidneys during ultrasonography. Also abdominal radiography revealed the cystic structures at the same region. Ovariohysterectomy was performed on the animal, multiple thin walled, fluctuant fluid-filled, large cysts measured as 3.9x2.5 and 4.5x2.8 cm diameter were detected at the left and right ovary, respectively. The uterine body was observed normal macroscopically. The guinea pig was died after the operation during reanimation because of the hypothermia. The organ pieces were submitted to pathology for histopathological examination after the operation. Histologic examination demonstrated a diagnosis of serous multicystic papillary adenoma of the ovaries and glandular cystic hyperplasia of uterus. In conclusion, this case report describes the necessity of not to ignore the ovarian pathologies with guinea pigs demonstrate symmetric, bilateral alopecia on the skin and indicates the importance of postoperative care in laboratory animals despite a successful anesthethic choice and operation.

Pituitary MRI Standard and Advanced Sequences: Role in the Diagnosis and Characterization of Pituitary Adenomas.

Pituitary adenomas (PAs) represent the most frequently found lesions in the sellar region; however, several other lesions may be encountered in this region, such as meningiomas, craniopharyngiomas, and aneurysms. High-quality imaging is fundamental for diagnosis, characterization, and guidance of treatment planning of PAs. Sellar magnetic resonance imaging (MRI) is considered the imaging modality of choice for the evaluation of lesions in the sella turcica. The sellar MRI standard protocol includes coronal and sagittal T1-weighted spin-echo sequencing with and without gadolinium-based contrast agent and coronal T2-weighted (T2w) fast-spin echo sequencing. A systematic MRI approach to the pituitary region generally provides information that includes the size and shape of the PA, the presence of cysts or hemorrhage within the tumor, its relationship with the optic pathways and surrounding structures, potential cavernous sinus invasion, sphenoid sinus pneumatization type, and differential diagnosis with other sellar lesions. The standard protocol is sufficient for the evaluation of most cases; however, some advanced techniques (susceptibility imaging, diffusion-weighted imaging, 3D T2w high-resolution sequences, magnetic resonance elastography, perfusion-weighted imaging) may render additional information, which may be important for some cases. In this "approach to the patient" manuscript, we will discuss the use of standard and advanced MRI sequences in the diagnosis and characterization of PAs, including MRI features associated with treatment response that may aid in presurgical evaluation and planning, and red flags that may point to an alternative diagnosis.

CLINICAL AND MORPHOLOGICAL FEATURES OF ADRENAL METASTASES OF RENAL CELL CARCINOMA

The problem of adrenal metastases and the need for ipsilateral adrenalectomy during nephrectomy in the patients with renal cell carcinoma has not yet been resolved. To study the clinical and morphological features of adrenal metastases of renal cell carcinoma and to identify a group of patients with a high probability of their development, pathological findings and case histories of 108 patients who underwent surgery included adrenalectomy or adrenal resection were retrospectively examined. Characteristics of patients and tumors in the groups of adrenal metastases and adrenal bulk formations not being cancer metastases were comparatively analyzed. When analyzing the tumors from the group of benign formations of the ipsilateral adrenal gland, it was found that in most cases they were represented by cortical adrenal adenomas without signs of hormonal activity. The histological structure of benign neoplasms was most often represented by clear cell and mixed−cell adenomas, dark−cell adenoma was observed in one case. The patients of this group complained mostly of common a persistent or intermittent rise of blood pressure. Patients with synchronous adrenal metastases of cancer are characterized by large kidney tumors, signs of local spread. According to the study results, it was concluded that the prognostic value in terms of differential diagnosis of adrenal metastases and adenomas in the patients with renal cell carcinoma there was demonstrated only by macroscopic intravenous cancer. The characteristics of the adrenal glands themselves were not objective prognostic parameters for the differential diagnosis between benign and malignant pathology. Ipsilateral adrenalectomy is indicated in the patients with intravenous renal cell carcinoma. Key words: adrenal metastases, renal cell carcinoma, intravenous spread of renal cell carcinoma.

Cyst Type Differentiates Rathke Cleft Cysts From Cystic Pituitary Adenomas.

PurposeA classification system for cystic sellar lesions does not exist. We propose a novel classification scheme for these lesions based on the heterogeneity of the cyst wall/contents and the presence of a solid component on imaging.MethodsWe retrospectively reviewed 205 patients’ medical records (2008–2020) who underwent primary surgery for a cystic sellar lesion. Cysts were classified a priori into 1 of 4 cyst types based on the heterogeneity of the cyst wall/contents and the presence of a solid component imaging. There was high interrater reliability. Univariable and multivariable models were used to estimate the ability of cyst type to predict the two most common diagnoses: Rathke cleft cyst (RCC) and cystic pituitary adenoma.ResultsThe frequencies of RCC and cystic pituitary adenoma in our cohort were 45.4% and 36.4%, respectively. Non-neoplastic lesions (e.g., arachnoid cysts and RCC) were more likely to be Type 1 or 2, whereas cystic neoplasms (e.g., pituitary adenomas and craniopharyngiomas) were more likely to be Type 3 or 4 (p<0.0001). Higher cyst types, compared to Type 1, had higher odds of being cystic pituitary adenomas compared to RCCs (OR: 23.7, p=0.033, and 342.6, p <0.0001, for Types 2 and 4, respectively). Lesions with a fluid-fluid level on preoperative MRI also had higher odds of being pituitary adenomas (OR: 12.7; p=0.023). Cystic pituitary adenomas were more common in patients with obesity (OR: 5.0, p=0.003) or symptomatic hyperprolactinemia (OR: 11.5; p<0.001, respectively). The multivariable model had a positive predictive value of 82.2% and negative predictive value of 86.4%.ConclusionWhen applied to the diagnosis of RCC versus cystic pituitary adenoma, higher cystic lesion types (Type 2 & 4), presence of fluid-fluid level, symptomatic hyperprolactinemia, and obesity were predictors of cystic pituitary adenoma. Further validation is needed, but this classification scheme may prove to be a useful tool for the management of patients with common sellar pathology.

Oral Contraceptive and Menopausal Hormone Therapy Use and Risk of Pituitary Adenoma: Cohort and Case-Control Analyses.

No prospective epidemiologic studies have examined associations between use of oral contraceptives (OCs) or menopausal hormone therapy (MHT) and risk of pituitary adenoma in women. Our aim was to determine the association between use of OC and MHT and risk of pituitary adenoma in two separate datasets. We evaluated the association of OC/MHT with risk of pituitary adenoma in the Nurses' Health Study and Nurses' Health Study II by computing multivariable-adjusted hazard ratios (MVHR) of pituitary adenoma by OC/MHT use using Cox proportional hazards models. Simultaneously, we carried out a matched case-control study using an institutional data repository to compute multivariable-adjusted odds ratios (MVOR) of pituitary adenoma by OC/MHT use. In the cohort analysis, during 6 668 019 person-years, 331 participants reported a diagnosis of pituitary adenoma. Compared to never-users, neither past (MVHR = 1.05; 95% CI, 0.80-1.36) nor current OC use (MVHR = 0.72; 95% CI, 0.40-1.32) was associated with risk. For MHT, compared to never-users, both past (MVHR = 2.00; 95% CI, 1.50-2.68) and current use (MVHR = 1.80; 95% CI, 1.27-2.55) were associated with pituitary adenoma risk, as was longer duration (MVHR = 2.06; 95% CI, 1.42-2.99 comparing more than 5 years of use to never, P trend = .002). Results were similar in lagged analyses, when stratified by body mass index, and among those with recent health care use. In the case-control analysis, we included 5469 cases. Risk of pituitary adenoma was increased with ever use of MHT (MVOR = 1.57; 95% CI, 1.35-1.83) and OC (MVOR = 1.27; 95% CI, 1.14-1.42) compared to never. Compared to never use, current and past MHT use and longer duration of MHT use were positively associated with higher risk of pituitary adenoma in 2 independent data sets. OC use was not associated with risk in the prospective cohort analysis and was associated with only mildly increased risk in the case-control analysis.

MicroRNA-30d target TIMP3 induces pituitary tumor cell growth and invasion.

As one of the most common intracranial tumors, pituitary adenomas, especially the Cushing's disease subtype, have been studied for many years. However, at present, effective methods for the early diagnosis of pituitary adenomas are very limited, especially for subtypes such as Cushing's disease. Therefore, it is of urgent importance to find effective molecular targets to develop new diagnostic and therapeutic methods for pituitary adenomas. We showed the abnormally high expression of miR-30d in pituitary adenomas by analyzing data in the Gene Expression Omnibus (GEO) database and revealed a novel molecular mechanism of miR-30d in regulating the proliferation and invasion of a pituitary adenoma cell line (AtT-20). Cell culture and transfection, and RNA interference (RNAi) were used to treat AtT-20 cells to test the effects of miR-30d and TIMP3 on cells. Quantitative polymerase chain reaction (qPCR) was used to determine the messenger RNA (mRNA) expressions. We used 3-(4,5-diphenyltetrazolium bromide) (MTT) to determine cell viabilities. An invasion assay was performed using Transwell chambers. Luciferase activity was tested with a dual-luciferase assay. We found that the expression of miR-30d in pituitary adenoma was higher than that in normal pituitary tissues. It was revealed that miR-30d promoted the proliferation and invasion of AtT-20 cells by inhibiting the expression of TIMP3. In the above process, miR-30d could bind to the 3'-untranslated region (3'-UTR) of TIMP3 mRNA. The mir-30d/TIMP3 signaling pathway plays an important regulatory role in pituitary adenomas. These new discoveries may reveal more functions of miR-30d and lay the foundation for future clinical development of new drug targets.

The Role of Exhaled Hydrogen Sulfide in the Diagnosis of Colorectal Adenoma.

Purpose Exhaled determination can detect metabolite hydrogen sulfide in the intestine. We aim to analyze the predictive value of hydrogen sulfide in the diagnosis of colorectal adenoma. Methods We recruited seventy patients diagnosed with colorectal adenoma as the observation group and sixty-six healthy subjects as the control group. The colorectal adenoma was diagnosed by colonoscopy at the Endoscopy Center of Huashan Hospital affiliated to Fudan University from June 2018 to November 2019. Exhaled gas was collected through the nose and mouth, respectively, and hydrogen sulfide in exhaled gas was determined according to the manufacturer's instructions. Results Receiver operating characteristic (ROC) curve was analyzed based on the exhaled data of the observation group and the control group. The ROC curve showed an area under ROC curve (AUC) 0.724 for nasal exhaled H2S, which had a diagnostic value. When nasal exhaled H2S was >13.3 part per billion (ppb), the sensitivity and the specificity of predicting colorectal adenoma were 57% and 78%, respectively. The exhaled H2S of the observation group was significantly different from that of the control group. The AUC value was 0.716 as a prognostic factor of colorectal adenoma. As exhaled H2S was >28.8 ppb, the sensitivity and the specificity of predicting colorectal adenoma were 63% and 77%, respectively. Conclusion Exhaled and nasal H2S determination has a predictive value for colorectal adenoma as a novel and noninvasive method. Therefore, it is worth conducting more research to analyze exhaled and nasal H2S.

Risk factors for the histologic discrepancy of gastric adenomatous lesions and long-term outcome.

Although endoscopic forceps biopsies (EFB) have a significant role in diagnosing gastric adenoma, there are still discrepancies between EFBs and finalized pathology results.Therefore, the objective of this study was to find the risk factors that cause this discrepancy and to analyze the effects of this discrepancy on the long-term outcome.In this study patients that had received endoscopic resection due to low-grade gastric adenoma diagnosis from EFB between January of 2011 and January of 2018 at the Chungnam National University Hospital were retrospectively analyzed. According to whether there was histological discrepancy the cumulative incidence of the metachronous lesions were analyzed.A total of 745 lesions diagnosed as low-grade gastric adenoma at EFB were enrolled, and the final pathology results were confirmed to be non-neoplastic (n = 19), low-grade adenoma (n = 614), High-grade adenoma (n = 63), and carcinoma (n = 49), and with the exception of non-neoplastic lesion, the results confirmed 84.6% (n = 614) for the concordant group and 15.4% (n = 112) for the discordant. The results of the multivariate analysis confirmed that depressed lesion (odds ratio [OR]: 2.056; 95% confidence interval [CI]: 1.130–3.451; P = .011), erythema (OR: 2.546; 95% CI: 1.604–4.030; P = .004), and a size >1.5 cm (OR: 1.903; 95% CI: 1.102–3.172; P = .018) were risk factors for discrepancy. The results also confirmed that for the average observation period of (SD) 39.12 (12.31) months, the cumulative incidence of metachronous neoplasm had a higher significance (P = 0.001) in the discordant group when compared to that of the concordant group.The factors related to the histologic discrepancy of low-grade gastric adenoma were depressed lesion, erythema and size >1.5 cm. In the groups with histological discrepancy, the cumulative incidence of the metachronous neoplasm was significantly higher and therefore closer observation of such patients after performing endoscopic resection is necessary.

Preoperative Localization in Colonic Surgery (PLoCoS Study): a multicentric experience on behalf of the Italian Society of Colorectal Surgery (SICCR)

The aim of this prospective multicentric study was to compare the accurate colonic lesion localization ratio between CT and colonoscopy in comparison with surgery. All consecutive patients from 1st January to 31st December 2019 with a histologically confirmed diagnosis of dysplastic adenoma or adenocarcinoma with planned elective, curative colonic resection who underwent both colonoscopy and CT scans were included. Each patient underwent conventional colonoscopy and CT to stage the tumour, and the localization results of each procedure were registered. CT and colonoscopic localization were compared with surgical localization, adopted as the reference. Our analysis included 745 patients from 23 centres. After comparing the accuracy of colonoscopy and CT (for visible lesions) in localizing colonic lesions, no significant differences were found between the two preoperative tools (510/661 vs 499/661 correctly localized lesions, p = 0.518). Furthermore, after analysing only the patients who underwent complete colonoscopy and had a visible lesion on CT, no significant difference was observed between conventional colonoscopy and CT (331/427 vs 340/427, p = 0.505). Considering the intraoperative localization results as a reference, a comparison between colonoscopy and CT showed that colonoscopy significantly failed to correctly locate the lesions localized in the descending colon (17/32 vs 26/32, p = 0.031). We did not identify an advantage in using CT to localize colonic tumours. In this setting, colonoscopy should be considered the reference to properly localize lesions; however, to better identify lesions in the descending colon, CT could be considered a valuable tool to improve the accuracy of lesion localization.

Ectopic Parathyroid Adenoma Mimicking as a Neuroendocrine Tumor on Ga68- DOTANOC Positron Emission Tomography/Computed Tomography Imaging.

Parathyroid adenoma sometimes present in ectopic location and may pose a difficulty in both diagnosis and localization. We report a case of a young lady suspected to have neuroendocrine tumor of the mediastinum demonstrating synaptophysin positivity on an initial core needle biopsy. Ga-68 DOTANOC positron emission tomography–computed tomography revealed a somatostatin receptor-expressing lesion in the anterior mediastinum with tracer avid multiple lytic bone lesions. On further biochemical and imaging workup with Tc-99 m SESTAMIBI, a diagnosis of ectopic parathyroid adenoma was made which was further confirmed with surgical excision.

THE IMPACT OF COLORECTAL CHROMENDOSCOPY WITH ENHANCED MUCOSAL IMAGING ON ADENOMA MISS RATE IN SCREENING COLONOSCOPY.

Colonoscopy is the gold standard for the diagnosis and treatment of adenomas. It is related with decreased colorectal cancer incidence and mortality. However, an important problem is missed colorectal adenoma. All efforts should be undertaken to reduce this rate. Enhancing imaging technologies including electronic chromoendoscopy and magnification has been increasingly adopted for improving the colorectal neoplasia detection rate and the detailed study of its surface, as well. I-scan images (Pentax, Tokyo, Japan) provides virtual chromoendoscopy in real-time during the examination to view the surface pattern, highlighting the microvasculature of the neoplastic lesion. The evidence on the impact of the use of I-scan on the colorectal adenoma detection rate is scarce. To evaluate whether the use of I-scan has impact on the adenoma miss rate (AMR) of screening colonoscopy exams. Observational and prospective study conducted by monitoring patients over 50 years undergoing colonoscopy. There were two groups: Group 1 - first inspection with standard high-definition white-light (HDWL) followed by a second inspection with I-scan 1; Group 2 - first inspection with I-scan 1 followed by a second inspection with standard HDWL. The primary outcome was the AMR from the first exam, calculated with the number of adenomas detected in the second exam, divided by the total number of adenomas detected in both exams. A total of 85 patients participated in the study. 14 were excluded, with a final sample of 71 patients, in the Group 1, 34 patients, and the Group 2, 37. A total of 58 adenomas were detected, 40 in the first inspection (20 in each group) and 18 in the second inspection in group 1. The overall AMR was higher for the Group 1 than the Group 2 (47.4% vs 0% P=0.0002). The use of I-scan 1 during colonoscopy exam reduces the AMR.

The role of Sonoelastography in characterization of solid breast lesions

Abstract Background Mammography and Sonography are the important sensitive imaging modalities available in detection of breast cancer. Sonoelastography is a relatively new imaging technique which acts as a complementary tool to improve the diagnostic ability of ultrasound for evaluating patients with breast masses. Objective To evaluate the role of sonoelastography characterization information on solid breast lesions over conventional sonography and mammography either benign or malignant lesions to reduce the number of benign biopsies performed. Methods A prospective study was carried at private centers, starting from august 2019 till december 2019. Results The study conducted on 40 patients with palpable breast lesions classified to BIRADS 3 and 4a according to conventional ultrasound and mammographic criteria. Their ages ranged from 18 to '75 years with a mean age 47.72 14.91, 22 cases (55%) had no family history of pervious breast disease, and 18 cases (45%) had family history of pervious breast disease. All patients were subjected to full history taking, clinical examination, conventional gray scale ultrasound, and mammography and ultrasound elastography. All patients underwent histopathological assessment to reach the final diagnosis. Among Studied cases , 28 lesions were sampled by fine needle biopsy (70%) and 12 lesions were sampled by true cut needle (30%) .the results revealed 27 breast lesions were benign (67.5%), 9 malignant lesions (22.5%) and 4 lesions shows atypia (10%) according to histopathological assessment. Among final diagnosis of breast lesions fibro adenoma was the most frequent benign breast lesion detected as 12 lesions from 27 benign breast lesions were fibroadenoma., Also infiltrative ductal carcinoma was the moste frequent among malignant breast lesions as 5 lesions from 9 malignant lesions were infiltrative ductal carcinoma. Conclusion Ultrasoundelastography has significant complementray role beside conventional mammogram and ultrasound in characterization of solid breast lesions.

S235 Risk of Incident and Fatal Colorectal Cancer After Young Onset Adenoma Diagnosis: A National Cohort Study

S235 Risk of Incident and Fatal Colorectal Cancer After Young Onset Adenoma Diagnosis: A National Cohort Study

Diagnostic performance of qualitative and radiomics approach to parotid gland tumors: which is the added benefit of texture analysis?

Objective:To investigate whether MRI-based texture analysis improves diagnostic performance for the diagnosis of parotid gland tumors compared to conventional radiological approach.Methods:Patients with parotid gland tumors who underwent salivary glands MRI between 2008 and 2019 were retrospectively selected. MRI analysis included a qualitative assessment by two radiologists (one of which subspecialized on head and neck imaging), and texture analysis on various sequences. Diagnostic performances including sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) of qualitative features, radiologists’ diagnosis, and radiomic models were evaluated.Results:Final study cohort included 57 patients with 74 tumors (27 pleomorphic adenomas, 40 Warthin tumors, 8 malignant tumors). Sensitivity, specificity, and AUROC for the diagnosis of malignancy were 75%, 97% and 0.860 for non-subspecialized radiologist, 100%, 94% and 0.970 for subspecialized radiologist and 57.2%, 93.4%, and 0.927 using a MRI radiomics model obtained combining texture analysis on various MRI sequences. Sensitivity, specificity, and AUROC for the differential diagnosis between pleomorphic adenoma and Warthin tumors were 81.5%, 70%, and 0.757 for non-subspecialized radiologist, 81.5%, 95% and 0.882 for subspecialized radiologist and 70.8%, 82.5%, and 0.808 using a MRI radiomics model based on texture analysis of T2 weighted sequence. A combined radiomics model obtained with all MRI sequences yielded a sensitivity of 91.5% for the diagnosis of pleomorphic adenoma.Conclusion:MRI qualitative radiologist assessment outperforms radiomic analysis for the diagnosis of malignancy. MRI predictive radiomics models improves the diagnostic performance of non-subspecialized radiologist for the differential diagnosis between pleomorphic adenoma and Warthin tumor, achieving similar performance to the subspecialized radiologist.Advances in knowledge:Radiologists outperform radiomic analysis for the diagnosis of malignant parotid gland tumors, with some MRI qualitative features such as ill-defined margins, perineural spread, invasion of adjacent structures and enlarged lymph nodes being highly specific for malignancy. A radiomic model based on texture analysis of T2 weighted images yields higher specificity for the diagnosis of pleomorphic adenoma compared to a radiologist non-subspecialized in head and neck radiology, thus minimizing false-positive pleomorphic adenoma diagnosis rate and reducing unnecessary surgical complications.

Primary Hyperparathyroidism Superimposed on a Pre-existing Familial Hypocalciuric Hypercalcemia Diagnosis

Familial hypocalciuric hypercalcemia is a rare clinical condition of persistently elevated serum calcium and reduced urinary calcium levels with an autosomal dominance inheritance pattern to the three out of four large types of this condition known. This rare condition goes largely undiagnosed as patients are largely asymptomatic and where symptoms are present, other causes of hypercalcemia are considered first. Hyperparathyroidism, super-imposing on FHH, is an even rarer occurrence. We present the case of an adult male with an initial provisional assessment of FHH, which was later confirmed with a genetic study. He went on to develop hyperparathyroidism (with evident enlarged parathyroid glands on Sestamibi parathyroid scan done, and an eventual histologic diagnosis of parathyroid adenoma after surgery). It remains to be established if this is an incidental occurrence or if there is a causal relationship between FHH and an onward development of parathyroid hypertrophy or adenoma(ta).

Diagnosis and treatment of aldosterone-producing adenoma in a young patient: a clinical case

The prevalence of primary hyperaldosteronism (PHA) among individuals with essential arterial hypertension is about 5 to 10%. We present a clinical case of a 32 year old male patient, who despite the full clinical picture of PHA, was managed in primary care setting with the diagnosis of myalgia and treatment-resistant arterial hypertension. The article discusses clinical and laboratory parameters of the patient with the diagnosis of unilateral aldosteroma and the efficacy of its treatment. The generally accepted algorithm of PHA diagnosis with unilateral aldosterone-producing adenoma in young patients does not involve comparative selective blood sampling from adrenal veins. This accelerates the differential diagnosis and facilitates the decision to undertake surgery. This simplified diagnostic algorithm was successfully applied in the patient. Reasonable surgical intervention has led to the recovery of the patient. Awareness of various medical specialties of the up-to-date information on PHA and wide implementation of its screening into clinical practice, first of all, assessment of aldosterone-renin ratio, would allow for detection of the disease as early as possible and prevention of the development of life-threatening cardiovascular complications.

Гігантські аденоми гіпофіза: поширеність, особливості діагностики і клінічного перебігу

На підставі огляду літератури встановлено, що в діагностичному комплексі при гігантських аденомах гіпофіза, крім клінічного обстеження, необхідне застосування комплексу методів нейровізуалізації із визначенням розташування хіазми, ступеня поширення пухлини на основу черепа і деструкції останнього. Хірургічне лікування розглядається методом вибору при встановленні діагнозу гігантської аденоми гіпофіза, виняток становлять поодинокі випадки соматотропін- і пролактинсекретуючих пухлин, при яких можливе лікування агоністами дофаміну. При цьому при гігантських аденомах гіпофіза (діаметр понад 4 см) відсутній єдиний алгоритм оптимальної хірургічної стратегії.

Relative Enhancement Ratio of Portal Venous Phase to Unenhanced CT in the Diagnosis of Lipid-poor Adrenal Adenomas.

Background The development of an accurate, practical, noninvasive, and widely available diagnostic approach to characterize lipid-poor adrenal lesions (greater than 10 HU at unenhanced CT) remains an ongoing demand. Purpose To investigate whether combined assessment of unenhanced and portal venous phase CT allows for the differentiation of lipid-poor adrenal adenomas from nonadenomas. Materials and Methods Patients with lipid-poor adrenal lesions who underwent unenhanced and portal venous phase CT with a single-energy scanner between January 2016 and March 2020 were identified retrospectively. For each lesion, the unenhanced and contrast-enhanced attenuation were measured; the absolute enhancement (contrast-enhanced minus unenhanced attenuation [HU]) and relative enhancement ratio ([absolute enhancement divided by unenhanced attenuation] × 100%) were calculated. The sensitivity achieved at 95% specificity to distinguish adenomas from nonadenomas was determined with receiver operating characteristic curve analysis and compared among parameters with use of the McNemar test. Results A total of 220 patients (mean age ± standard deviation, 66 years ± 12; 134 men) with 131 lipid-poor adenomas and 89 nonadenomas were analyzed. The sensitivity (achieved at 95% specificity) of the relative enhancement ratio (86% [113 of 131 adenomas; 95% CI: 79, 92] at a threshold of >210%) was higher than that of unenhanced attenuation (50% [66 of 131 adenomas; 95% CI: 42, 59] at a threshold of ≤21 HU), contrast-enhanced attenuation (3% [four of 131 adenomas; 95% CI: 1, 8] at a threshold of >120 HU), and absolute enhancement (24% [32 of 131 adenomas; 95% CI: 17, 33] at a threshold of >74 HU; all P < .001). The sensitivities of the relative enhancement ratio were 100% (58 of 58 adenomas; 95% CI: 94, 100), 83% (52 of 63 adenomas; 95% CI: 71, 91), and 30% (three of 10 adenomas; 95% CI: 7, 65) for adenomas measuring unenhanced attenuation of more than 10 HU up to 20 HU, 21-30 HU, and more than 30 HU, respectively. Conclusion A relative enhancement ratio threshold of greater than 210%, measured at unenhanced and portal venous phase CT, accurately differentiated lipid-poor adenomas from nonadenomas, particularly for lesions with unenhanced attenuation of 10-30 HU. © RSNA, 2021 Online supplemental material is available for this article.

Preoperative matching studies in the diagnosis of parathyroid adenoma for primary hyperparathyroidism: Can we avoid intraoperative PTH monitoring?

IntroductionWe aim to determine the utility of intraoperative parathyroid hormone (IOPTH) monitoring in patients with matching preoperative ultrasound and mibi SPECT for primary hyperparathyroidism for a single adenoma. MethodsAll patients who underwent minimally invasive parathyroidectomy (MIP) for pseudohypoparathyroidism (PHP) for a single parathyroid adenoma, were included. An Ultrasound and mibi SPECT were performed in all patients. We defined matching studies when both coincided in the localization of the adenoma. IOPTH was performed in all patients and analyzed in three occasions: a baseline measurement at the anesthetic induction, immediately before, and 15 min after gland excision. Success was defined during the third measurement as a drop of IOPTH of at least 50% compared to the previous maximum value after gland excision. Demographics, intraoperative, postoperative variables and the utility of IOPTH monitoring were analyzed. ResultsA total of 218 MIP were performed. The average age was 60.1 years and 85% were female. Preoperative ultrasound and mibi SPECT coincided 100%. When the adenoma was localized, 15 min after its excision, IOPTH did not decrease in 9 patients (4.2%. OR 1.9%–7.69%); all of them underwent a bilateral neck exploration. The added-value of IOPTH accuracy for disease cure was 3.6%. There was a 99% of cure rate. The mean surgical time was 66.4 min and the waiting time for the third IOPTH result was 31 min. Performing IOPTH monitoring made the surgery about twice more expensive. ConclusionsPreoperative matching ultrasound and mibi SPECT for parathyroid adenoma localization in PHP, could avoid IOPTH monitoring in minimally invasive parathyroidectomies.

Management Of Residual Pituitary Adenoma Patient With Manifestation of Acromegaly and Hyperprolactinemia

Pituitary adenoma is one of intracranial tumors that grows and develops in the pituitary gland which plays a role in regulating the hormonal balance in the body. Most pituitary adenomas are benign and do not spread to other organs. Pituitary adenoma can be classified based on radiological features, tumor size and the type of hormone produced. There are several ways to establish of diagnosis of pituitary adenoma, in addition to recognizing the symptoms and clinical signs are hormonal function tests and imaging. The surgery is the first medical actions. The postoperative recovery rate reached 90% in relatively benign cases and tumor recurrence rate is 5-10% depending on the size of the tumor, the stage of the tumor during surgery, experience of neurosurgical. A woman, 46 years old referred to Soetomo Hospital from Soebandi Jember Hospital for treatment the recurrent adenoma pituitary with complains of headache, double-vision and changing shape of his face, his enlarged lips and nose. Patient was diagnosed based on head CT scan and already had surgery on January, 2015. The head MRI evaluated post surgery was still a residual mass from the previous tumor. 3 monts after surgery no complains any more. The complains reappear at the end of 2017. The head CT scan on January, 8, 2017, size tumor: 1.2 cm x 1.8 cm. The head MRI results on December, 20, 2017 size tumor : size 1.6cm x 2.1cm and abnormal hormonal result, high prolactine, low cortisol and high IGF1. In Soetomo Hospital was diagnosed as pituitary macroadenoma with acromegaly and hyperprolactinemia and received bromocriptine 3x5 mg evaluated for 2 weeks then lowered to 3x 2.5 mg after obtaining a decrease in prolactin levels and methyl prednisolone 3x1 / day until cortisol level was normal. Patients will also plan for surgery of EETH (Endoscopic Endonasal Transphenoidal).