Left Gland Research Articles

The Largest Malignant Pheochromocytoma: A Case Report and Literature Review

: Introduction: Malignant pheochromocytoma is a rare neuroendocrine tumor with an annual incidence of 3–8 cases per 1 million per year in the general population. Its clinical presentation can vary greatly. There are few published cases of giant pheochromocytomas. We report a case of the largest tumor in the world. The literature is reviewed to evaluate the spectrum of disease presentations and the available options for disease management and treatment. Case presentation: A 52-year-old male, originally from El Kelaa des Sraghna in the middle of Morocco, which had a 36cm mass of the left suprarenal gland with metastatic lesions. He was treated with a combination chemotherapy regimen of cyclophosphamide, vincristine and dacarbazine. Conclusion: A heterogeneous clinical presentation of malignant pheochromocytoma and a short response to chemotherapy had been observed in our case. However, controlled studies need to determine a standard of care.

Invasive ductal carcinoma ex pleomorphic adenoma of the lacrimal gland - a long term follow-up case

We experienced a case of malignant orbital tumor in a 72-year-old Japanese man. He noticed protrusion of his left eye, and received resection of the left orbital tumor. The tumor contained several different components such as high-grade invasive ductal carcinoma, low-grade/minimally invasive adenocarcinoma and pleomorphic adenoma. Pathological diagnosis of high-grade invasive ductal carcinoma ex pleomorphic adenoma of the left lacrimal gland was made. He had undergone surgical removal of the left lacrimal gland tumor at the other hospital 19years before, and the surgical specimen revealed that most part of the tumor was pleomorphic adenoma but low-grade/minimally invasive adenocarcinoma was included as a minor component (low-grade/minimally invasive adenocarcinoma ex pleomorphic adenoma). Thus, we could observe the natural course of low-grade/minimally invasive adenocarcinoma ex pleomorphic adenoma which transformed into high-grade invasive ductal carcinoma ex pleomorphic adenoma. Lacrimal gland ductal carcinoma is an extremely rare tumor, and only 25 cases have been reported before in English literature. Moreover, our case is the 5th case of lacrimal gland ductal carcinoma ex pleomorphic adenoma.

Postoperative diagnostics clinical case of the patient with kidney canсer metastasis in the thyroid gland in combination with left internal jugular vein thrombosis

Представлено клиническое наблюдение пациентки 68 лет с жалобами на увеличение в размерах шеи, преимущественно с левой стороны, ощущение першения в горле. В ходе обследования по данным УЗИ органов шеи выявлено конгломератное образование левой доли щитовидной железы. Кроме того, в просвете в верхней трети внутренней яремной вены выявлено образование средней эхогенности. По данным последующей тонкоигольной биопсии левой доли – признаки коллоидного зоба. Пациентке проведено оперативное лечение в объеме левосторонней гемитиреоидэктомии: при ревизии левая доля значительно увеличена в размерах за счет узлового образования, доходящего до левого угла нижней челюсти, располагающегося частично загрудинно и за трахеей. По данным послеоперационного гистологического исследования выявлен метастаз светлоклеточного рака почки в левую долю щитовидной железы с признаками прорастания в окружающие сосуды и мышцы.

Persistent Hypercalcemia Despite Multiple Exploratory Neck Surgeries.

A 46-year-old woman with a complex history of primary hyperparathyroidism presented to the endocrinology clinic for persistent hypercalcemia despite 3 prior neck surgeries with removal of at least 2 parathyroid glands. She was originally diagnosed with primary hyperparathyroidism 27 years earlier at the age of 19 when she developed kidney stones. Since then, she has required intermittent laser lithotripsy with stone removal, eventually requiring a urethral stent placed 2 years before her current presentation. Her first surgery was in 2004 and documentation of this surgery was not available because it was performed at an outside institution. Her second surgery, in 2007, excised the right inferior parathyroid gland and pathologic assessment was consistent with hypercellular parathyroid tissue. In 2012, a 4-gland neck dissection was performed and a left superior parathyroid gland was identified and excised. No parathyroid tissue was identified on the right and no gland was identified in the left inferior aspect. Her intraoperative parathyroid hormone (ioPTH)2 decreased from 495 to 258 pg/mL [reference interval (RI) 12–88 pg/mL] after removal of the left superior parathyroid gland. Despite no residual parathyroid tissue identified at the time of surgery, her hypercalcemia and hyperparathyroidism persisted. Given her persistent increased serum PTH concentrations and her young age at initial presentation, the possibility of a …

Mammary gland tumors in a male Cocker Spaniel

BackgroundMammary gland tumors are the most common tumors in sexually intact female dogs; however, they are rare in male dogs. This study was conducted to investigate the relationship between sexual hormones and mammary gland tumors in a male dog.Case presentationA 13-year-old, intact male Cocker Spaniel presented to the Veterinary Teaching Hospital of Kangwon National University, Republic of Korea, with an acute right ruptured caudal abdominal mass. Physical examination revealed a 14 × 14 cm ruptured mass in the right caudal abdomen, as well as a 1.5 × 1.5 cm mass in the first right mammary gland. The estrogen and progesterone concentrations in serum were within normal levels. Total mastectomy was done on the right side mammary glands. Following surgery, the site was fully recovered; however, a mass that had grown to 2 × 2 cm was found in the left fifth mammary gland and a testis tumor was also found over the period of 4 months. Mastectomy was performed on the left caudal mammary gland and castration was also performed. After the final surgery, the dog fully recovered. Histopathological examination of all three masses revealed high grade mammary adenocarcinoma in the mammary gland and the testis was diagnosed as Leydig cell adenoma. Immunohistochemical analysis revealed that the estrogen and progesterone receptors were expressed on limited cells in mammary and testis tumors.ConclusionThe results of this study suggest that mammary tumors and testes tumors can occur in male dogs without relationship to female sexual hormone.

Effects of Pentadecapeptide BPC 157 on Experimental Rat Model of Dry Eye

AimWe hypothesize the stable gastric pentadecapeptide BPC 157 as a therapy of dry eye syndrome in rats. BPC 157 already cures ocular tissues. BPC 157 eye drops (ug‐ or ng‐regimen) rescued total debridement of corneal epithelium (Coll Antropol 2005;29(1):321–5), successfully closed perforating corneal incisions in rats (Exp Eye Res 2015;136:9–15), counteracted particular NO‐specific parallel miotic effect of L‐NAME and L‐arginine and atropine‐induced mydriasis in rats and guinea pigs (Eur J Pharmacol 2016;771:211–9). In addition, BPC 157 counteracts various ulcerative lesions in skin and gastrointestinal tract, and BPC 157/NO‐relationship is established in various experimental models and species (Curr Pharm Des 2014;20(7):1126–35), providing that it would counteract the damaging effects of lacrimal gland extirpation, and dry eye syndrome. Dry eye syndrome is a relatively common disease with multifactorial causes, which may cause simptoms variating from discomfort to blindness. This study aimed to evaluate the effect of BPC 157 on the rat dry eye model.MethodsWe used male Albino Wistar rats, 200g, randomly divided. After application of Ketmine‐HCl 50–60 mg/kg + Xylazine‐HCl 5–10 mg/kg, Tetrakain 0,5% drops, left extraorbital lacrimal gland was isolated from surrounding tissues and surgically removed. Rats received stable gastric pentadecapeptide BPC 157 (Diagen, Slovenia) topically (5 drops (2 μg/ml)) or an equivolume of destilled water (controls). Corneal defects were analyzed with microcamera observation using blue light after 0.5% fluorescein eye drop instillation. These examinations were performed in both treated and control eyes at baseline and on weeks 1, 2 and 4.ResultsPentadecapeptide BPC 157 administered topically significantly reduced clinical signs of dry eye by decreasing corneal defect in all treated groups (Figure 1), while in control groups corneal defect persisted (Figure 2)ConclusionBPC 157 was originally an anti‐ulcer peptide used in trials for ulcerative colitis and now is in trials for the treatment of multiple sclerosis (Curr Pharm Des 2014;20(7):1126–35). Now, we demonstrated that pentadecapeptide BPC 157 counteracts dry eye lesions in rats.Support or Funding InformationUniverity of Zagreb, Zagreb, Croatia (Grant number BM099)

Calcitonin as a potential tumour marker for medullary thyroid carcinoma in an 11‐year‐old Spanish Pure Bred gelding with two independent carcinomas

SummaryAn 11‐year‐old Spanish Pure Bred gelding was evaluated for progressive weight loss and exercise intolerance. An ante‐mortem biopsy and post‐mortem histopathological examination of the duodenum revealed a duodenal adenocarcinoma. Furthermore, a medullary thyroid carcinoma of the left thyroid gland and multiple bilateral follicular thyroid adenomas were diagnosed post‐mortem. Serum concentration of calcitonin in this case was markedly increased in comparison to two breed and age matched control horses. This case report shows the rare and independent occurrence of two different types of carcinomas in one horse and highlights the diagnostic value of calcitonin measurements for diagnosis of medullary thyroid carcinoma in horses.

Clasper gland morphology and development in Potamotrygon magdalenae (Elasmobranchii: Potamotrygonidae).

Clasper gland morphology and development in Potamotrygon magdalenae and its relation with the acquisition of reproductive maturity is described in males of different developmental stages (embryos, neonates, juveniles, and reproductively active and resting adults). The glands are subcutaneous masses in the proximal base of each clasper. They are partially bilobate organs with a ventral groove that bears a row of papillae. Glands tend to be asymmetric, the left gland has a larger size, a trend that has been observed in other organs of elasmobranchs. Glands are formed by radially organized tubular secretory units lined with a simple columnar epithelium with basal nuclei and granular eosinophilic cytoplasm; vascularized loose connective tissue surrounds the gland units. The gland is covered by two layers of striated muscle tissue in circular and longitudinal arrangement. The clasper glands begin to develop in neonates and their secretory activity begins in juveniles. The active secretion of the clasper gland is observed in mature males, it includes glycoproteins and sulfated mucopolysaccharides. The size of the glands has a positive and direct relationship with body size, measured as disc width. Significant differences in clasper gland size were found between mature (active and resting) and immature (neonates and juveniles) males, suggesting that the acquisition of the sexual maturity involves the increase in the size of the gland due to a highly augmented secretory activity. Therefore, clasper glands are clearly associated with the reproductive activity of males and their secretion should have an endocrine control as other sexual secondary organs. J. Morphol. 278:369-379, 2017. © 2017 Wiley Periodicals, Inc.

Protective effect of cytosine-phosphate-guanosine oligodeoxynucleotide against experimental mastitis induced by Cryptococcus neoformans infection in goats

The present study investigated the effect of synthetic non-methylated oligonucleotides containing Cytosine-phosphate-guanosine dinucleotides (Cytosine-phosphate-guanosine oligodeoxynucleotide) on caprine mastitis with Heat Killed Cryptococcus neoformans Ag. 20 healthy local breed does were used with weight ranging of 25-30 Kg and free of mastitis by examination via California Mastitis Test and Somatic Cell Count. The does were allotted into four equal groups, the first group (G1) was treated intramammary with 100μg/kg of Cytosine-phosphate-guanosine oligodeoxy nucleotide on fifth day postpartum in the right mammary gland while the left mammary gland served as control and were infused with sterile phosphate buffered saline. On day 8 postpartum repeat dosages of Cytosine-phosphate-guanosine oligodeoxynucleotide and phosphate buffered saline were infused respectively. On day 9 pp the right mammary gland was infused with 2ml of 2x108 cell/ml of Heat Killed Cryptococcus neoformans Ag. The second group (G2) was infused at day 9 postpartum with 2ml of 2x108 cell/ml of Heat Killed Cryptococcus neoformans Ag in the right mammary gland only. The third group (G3) was left until the challenge test done after one week of immunization in the G1 and G2, by inoculation of 2ml of 5x106 viable C. neoformans in the right mammary gland. The fourth group (G4) was kept as a control receiving 2ml of sterile PBS. Blood samples were collected at 0, 5, 10, 20, 30 and 40 days of the study, to determine the antibody titer by passive haemagglutination assay, while the cell mediated immunity was evaluated by detecting the goat Interferon Gamma by ELISA test and Phagocytic index. Also the cell mediated immunity was determined by delayed type hypersensitivity test after 21 days of immunization. The results showed a significant variation (P≤0.05) between vaccinated groups (G1 and G2) and the control. However, there was a significant increase (P≤0.05) of skin thickness shown after 48 hrs in the G1compared to G2. High level of Interferon Gamma concentration was noticed in the G1 as compared with other groups. Moreover, cell mediated immunity developed effectively in the G1 which was noted by a significant increase (P≤0.05) of phagocytic activity of polymorphonuclear cells. The high level of antibody titer was observed in the G1 as compared with other groups. In conclusion: These results suggest that vaccination with Cytosine-phosphate-guanosine oligodeoxynucleotide plus Heat Killed Cryptococcus neoformans Ag intramammary lead to a good protection of caprine mammary glands against C. neoformans mastitis.

MAMMARY BIOPSY IN INDUCED LACTATING GOATS: ASSESSMENT OF POST-BIOPSY MILK PROPERTIES AND ULTRASONOGRAPHIC APPEARANCE

Abstract The aim of this study was to evaluate the effects of mammary biopsy procedures on gland function of goats submitted to hormonal lactation. Ten female Caninde goats, at the age of around 3 years, were used, and lactation was induced by using estrogen, progesterone, and prednisolone. Ultrasonographic examinations of mammary gland, milking, and analysis of physicochemical properties of milk were performed immediately before (0 h) and 24, 48, and 72 h after each biopsy procedure. Surgical mammary gland biopsies were obtained at days 5 and 26 of the lactation. Even after drying initiation, all animals produced milk for five months. No abnormalities were observed on the ultrasonographic appearance of biopsied glands. All 20 biopsies were technically successful and any inflammation or infection was associated with biopsy procedures. Regarding the physicochemical properties and volumes of milk produced, no significant differences (P > 0.05) were observed between right and left glands nor in the comparison of the results from time 0 with 24, 48, and 72 h for biopsied teats. The mammary biopsy did not induce neither severe changes in production and physicochemical properties of the milk nor in ultrasonographic appearance of mammary gland of goats in hormonal lactation.

Normal Uptake of 11C-Acetate in Pancreas, Liver, Spleen, and Suprarenal Gland in PET.

Purpose 11C-Acetate is radiotracer being considered an alternative to 18F-fluorodeoxyglucose. Evaluation of 11C-acetate biodistribution in human parenchymal organs is described. Methods and Materials 60 consecutive patients referred to 11C-acetate PET CT suspected of renal or prostate cancer relapse with negative results (no recurrent tumor) were included in the study. Acquisition from the base of skull to upper thigh was made 20 min after i.v. injection of 720 MBq of 11C-acetate. The distribution was evaluated by measuring the uptake in pancreas (uncinate process and body separately), liver, spleen, and left suprarenal gland. Clinical data of included patients showed no abnormalities in these organs. Results Biodistributions of 11C-acetate radiotracer were compared in different organs. Standardized uptake values of 11C-acetate were significantly higher in pancreatic parenchyma (SUV mean 6,4) than in liver (SUV mean 3,3), spleen (SUV mean 4,5), or suprarenal gland (SUV mean 2,7) tissues. No significant difference was found between pancreatic head (SUV mean 6,4) and body (SUV mean 5,9) uptake. In case of all aforementioned organs, there were no differences either between both sexes or between formerly diagnosed tumors (renal and prostate). Conclusions Evaluation of 11C-acetate uptake differences in parenchymal organs will allow establishing normal patterns of distribution. High pancreatic uptake may be used in quantitative assessment of organ function in diffuse nonneoplastic pathology.

Parathyroid Carcinoma: Atypical Presentation, Diagnosed on Ultrasound: A Case Report

Parathyroid Carcinoma is a very rare condition and with a very few cases published in literature. It is often suspected and diagnosed clinically in cases of hyperparathyroidism, when there is are very highly elevated serum calcium levels, along with significantly raised serum PTH levels, and the patient is quite symptomatic. We report here a case where the serum calcium levels and PTH, both were not so high, hence the diagnosis was not thought of clinically, but only suggested by ultrasound imaging. The typical ultrasound diagnostic findings of a likely malignant parathyroid mass, prompted the surgeon to go for Hemi thyroidectomy along with, instead of simple parathyroidectomy. Biopsy came as Parathyroid Carcinoma. Case Report and literature review. A 66 year old male, presented with complaints of weight loss, back pain in medical oncology. CECT Spine showed multiple lytic lesions in D10, D12, and L4. Differential Diagnosis of metastasis or multiple myeloma was given. PET –CT showed metabolically active lesions in bones and posterior to left thyroid. Bone marrow biopsy was negative for both myeloma and metastasis. Serum parathormone and serum calcium levels were then suggested. Serum Calcium was 10.8mg/dL. Serum PTH was 947.0 pg/mL & 25– OH Vitamin D 16.3 g/mL. Sestamibi showed left inferior parathyroid adenoma. With an endocrinology diagnosis of primary Hyperparathyroidism and with a left inferior parathyroid adenoma, patient was referred to Head and neck oncosurgery for parathyroidectomy. ULTRASOUND: showed a heterogeneous hypoechoic solid cystic lobulated mass lesion, measuring 38 x21 x29 mm, volume 11.2 cc below the lower pole of left thyroid gland. The margins of the lesion appeared to be in close proximity to the thyroid and adjoining structures. It showed amorphous calcifications and heterogeneous increased vascularity, suggestive of parathyroid mass, likely carcinomaSURGICAL FINDINGS: Left Thyroid lobectomy with left parathyroidectomy was done. The parathyroid gland (30x30x20 mm) was firm to hard at surgery, and adherent to the thyroid. HISTOPATHOLOGY: Parathyroid tissue showed nuclear polymorphism, with large nucleus and prominent nucleoli. Broad fibrous septa are seen. Mitosis1-2/hpf. Capsular invasion is seen as well as invasion in the surrounding soft tissue and parathyroid tissue. Vascular invasion is seen. On IHC: Ki67:2% A pre-operative suggestion of parathyroid carcinoma instead of parathyroid adenoma improved patient counselling for a planned hemi thyroidectomy along with left parathyroidectomy and resulted in better management of the patient. A dedicated high resolution Colour Doppler Ultrasound is a valuable tool for localization and characterization of parathyroid nodules in all cases of raised serum PTH and must be utilized in all cases along with other imaging modalities.

Syncronous medullar thyroid cancer and primary hyperparathyroidism on a female within the sixth decade of life with positive family history for type 2A MEN syndrome

Medullar thyroid cancer (MTC) may be sporadic or familial, either linked with pheocromocytoma (PHEO) and primary hyperparathyrodism (PHP), as seen in type 2A MEN (Multiple Endocrine Neoplasia) syndrome, either isolated. This is a 56-year old female known with mild arterial hypertension controlled under therapy, having a daughter with type 2A MEN syndrome (PHEO, MTC, PHP). Mild hypercalcemia and high parathormone were consistent for PHP, while calcitonin was 20 times above the upper normal limit for MTC. The PHEO tests were negative. Anterior cervical ultrasound confirmed a 2.7 cm thyroid nodule, local lymph nodes, and enlargement of inferior and superior left prarathyroids. After total thyroidectomy with bilateral neck dissection and excision of the left inferior and superior parathyroid glands, MTC and parathyroid hyperplasia was confirmed. Calcitonin decreased to 5 times above the normal level. Further close follow-up and therapy of residual MTC is needed. MEN 2A Syndrome may embrace various clinical presentations with more or less aggressive tumours, sometimes allowing a long time survival without neoplasia confirmation or incomplete phenotype until advanced age.

Semiquantitative Parameters in PSMA-Targeted PET Imaging with 18F-DCFPyL: Variability in Normal-Organ Uptake.

18F-DCFPyL is a small-molecule inhibitor of the prostate-specific membrane antigen that has shown promise for evaluation of primary and metastatic prostate cancer using PET. Measuring the variability in normal-organ uptake of 18F-DCFPyL is necessary to understand its biodistribution, aid image interpretation, judge the reliability of scan quantification, and provide a basis for therapeutic monitoring. Methods: Sixty-five consecutive 18F-DCFPyL PET/CT scans from 64 patients with a history of prostate cancer were analyzed. Volumes of interest were defined for the lacrimal glands, major salivary glands, liver, spleen, and both kidneys. The mean SUV normalized to body mass or to lean body mass (SUL) was calculated for each volume of interest. The average SUV across all scans, the SD, and the coefficient of variation (COV) for each organ were calculated. The same parameters were also derived for a 3-cm sphere drawn in the center of the right lobe of the liver. Results: The average SUVmean for all selected organs measured was 6.6 ± 1.8 for the right lacrimal gland, 6.4 ± 1.8 for the left lacrimal gland, 9.1 ± 2.0 for the right parotid gland, 9.0 ± 2.1 for the left parotid gland, 9.6 ± 2.3 for the right submandibular gland, 9.4 ± 2.2 for the left submandibular gland, 5.0 ± 0.7 for the whole liver, 5.1 ± 0.7 for a 3-cm sphere in the liver, 4.0 ± 1.5 for the spleen, 20.1 ± 4.6 for the right kidney, and 19.4 ± 4.5 for the left kidney. SULmean was lower overall, although demonstrating similar trends. The COV of SUVmean and SULmean was lower in the liver (13.8% and 14.5%, respectively) than in any other organ and was less than the comparable COV for 18F-FDG PET. The COV of SUVmean and SULmean in the 3-cm sphere in the liver was also low and similar to the variability in the whole liver (14.2% and 14.7%, respectively). Conclusion:18F-DCFPyL uptake in normal liver demonstrates less variability than in other 18F-DCFPyL-avid organs, and its variability is less than the reported variability of 18F-FDG in liver. Variability was slightly less for SUVmean than for SULmean, suggesting that SUVmean may be the preferable parameter for quantification of images obtained with 18F-DCFPyL.

Apparent diffusion coefficient of normal adrenal glands.

ObjectiveTo assess the feasibility and reliability of apparent diffusion coefficient (ADC) measurements of normal adrenal glands.Materials and methodsThis was a retrospective study involving 32 healthy subjects, divided into two groups: prepubertal (PreP, n = 12), aged from 2 months to 12.5 years (4 males; 8 females); and postpubertal (PostP, n = 20), aged from 11.9 to 61 years (5 males; 15 females). Diffusion-weighted magnetic resonance imaging (DW-MRI) sequences were acquired at a 1.5 T scanner using b values of 0, 20, 500, and 1000 s/mm2. Two radiologists evaluated the images. ADC values were measured pixel-by-pixel on DW-MRI scans, and automatic co-registration with the ADC map was obtained.ResultsMean ADC values for the right adrenal glands were 1.44 × 10-3 mm2/s for the PreP group and 1.23 × 10-3 mm2/s for the PostP group, whereas they were 1.58 × 10-3 mm2/s and 1.32 × 10-3 mm2/s, respectively, for the left glands. ADC values were higher in the PreP group than in the PostP group (p < 0.05). Agreement between readers was almost perfect (intraclass correlation coefficient, 0.84-0.94; p < 0.05).ConclusionOur results demonstrate the feasibility and reliability of performing DW-MRI measurements of normal adrenal glands. They could also support the feasibility of ADC measurements of small structures.

Planimetric correlation between the submandibular glands and the pancreas: a postmortem ductographic study.

The salivary glands and pancreas have comparable anatomic and antigenic properties and can share common pathogenetic mechanisms involving toxic or autoimmune processes. The aim of this study is to assess the correlation in size between the normal submandibular glands and the pancreas. The study was based on human autopsy specimens of the pancreas, neck and oral base from 22 adults, both sexes (mean age, 57.9 years). The pancreatic and submandibular ducts were injected with a contrast medium, and the area of the salivary and pancreatic glandular ductograms was measured with the aid of software for quantification of visual information. Samples of tissue from the salivary glands and the pancreas were studied by means of light microscopy. A high correlation was found between the planimetric size of the pancreas and the submandibular glands (correlation coefficient 0.497 and 0.699 for the right and the left gland, respectively). This ratio was close to 5:1. There were no significant differences in size for the left vs. right submandibular gland (p=0.39). The ductograms were significantly larger in size in males than in females (p<0.001). This study has proven a positive correlation in planimetric size between the normal submandibular glands and pancreas, a result that is expected to have possible clinical implications in the long-term follow-up of patients with chronic pancreatitis.

An Orbital Solitary Fibrous Tumor: Report of Two Cases with Different Presentation

Solitary fibrous tumour (SFT) is a rare spindle-cell neoplasm that can occur in the orbit. We report two cases of orbital SFT in a 35-year-old female and a 28-year-old male with different presentations. First patient presented with slowly progressive left lateral upper lid mass which is firm in consistency and non tender. Patient had non axial proptosis as the mass compressed the globe inferonasally. There was also funduscopy evidence of choroidal folds superotemporally. There is slight impairment of vision on the left eye comparing to right eye. Meanwhile, the second patient presented with a painless diffuse swelling of left upper eyelid. It was soft in consistency, non fluctuate and no opening or pus discharge noted. There is mild mechanical ptosis, however there was no proptosis and no evidence of compression into the globe nor visual impairment.Computed tomography (CT) imaging revealed a well circumscribed and contrast enhanced soft tissue mass intraorbital extraconal mass in both cases. However in the first case, the tumour was at the level of lacrimal gland with compression of the globe, while in second case, it was superior and posterior to the left lacrimal gland with no globe compression. Both patients underwent complete resection of their tumors. The histological findings showed alternating hypercellular and hypocellular areas composed of bland spindle cells with a fibrous stroma. The strong immunoreactivity for CD34 supported the diagnosis of orbital SFT. There was no recurrence at the 2nd and 3rd year follow-up visits for both patients. SFT should be considered as one of the differential diagnosis of an orbital tumor. The combination of CT scan, histologic findings and immunohistochemical staining provide accurate diagnosis. En bloc excision of the tumour is the mainstay of treatment.

Contribution of 18-FDG PET/CT to brown tumor detection in a patient with primary hyperparathyroidism

We report the case of a patient who presented with multiple brown tumors as the inaugural manifestation of primary hyperparathyroidism. Tc-99m hexakis methoxyisobutylisonitrile (99mTc-MIBI) scintigraphy demonstrated increased radiotracer uptake by the bone lesions. The patient was a 65-year-old male who sought advice for a swelling on his right shin. An osteolytic lesion was visible on the radiograph. A bone biopsy showed a benign tumor containing abundant osteoclastic cells. Laboratory abnormalities included hypercalcemia (3.63mmol/L with 1.91mmol/L ionized calcium), hypophosphatemia (0.38mmol/L), and parathyroid hormone elevation (880.8pg/mL; N: 10–70). Serum 25-OH Vitamin D level was lower than 4ng/mL (N: 30–60). An 18-FDG PET/CT scan identified numerous high-uptake bone lesions. By 99mTc-MIBI scintigraphy, a large high-uptake mass was seen in the left parathyroid gland, as well as high-uptake lesions throughout the skeleton, which were less numerous than those seen by 18-FDG PET/CT. Ultrasonography of the neck visualized a mass consistent with an adenoma in the left parathyroid gland. Brown tumors are bone lesions whose diagnosis should be considered in patients with clinical and laboratory evidence of hyperparathyroidism, once a malignant disease is ruled out. Our case report suggests that 18-FDG PET/CT may be more sensitive than whole-body 99mTc-MIBI scintigraphy in detecting brown tumors.

Effect of Vestibulectomy for Intractable Vulvodynia

Study ObjectiveTo assess the effectiveness of vestibulectomy in treating vulvodynia for patients with inadequate response to vulvar care guidelines and medical management. DesignRetrospective case series (Canadian Task Force classification II-2). PatientsAll patients who underwent a vestibulectomy from 2004 to 2013 for vulvodynia. InterventionsAll patients in this study underwent a vestibulectomy. Measurements and Main ResultsIn this study we analyzed 31 patients' overall reported pain scores and Q-tip test scores before and after vestibulectomy. The efficacy of vestibulectomy on reduction of pain was then analyzed after surgical management. There was no significant difference in pain scores from initial visit compared with the last visit before vestibulectomy after vulvar care guidelines and medical management were initiated (p = .48–.94). However, mean subjective pain scores before and after vestibulectomy decreased by 67% (p < .001). Q-tip testing showed reductions of pain by 63% (p < .001) and 73% (p < .001) at the right and left Bartholin gland areas, respectively. There was approximately a 60% decrease of pain scored around the bilateral periurethral areas (p < .05). ConclusionsVestibulectomy is an effective treatment for vulvodynia. For those with intractable pain, vestibulectomy is an appropriate next step after unsuccessful medical treatment. The surgery leads to a significant decrease in patients' pain scores, nearly eliminating it in most cases.

The study of normal parathyroid echogenicity

Background: Some of the normal parathyroid can be shown on an ultrasound image. To our knowledge, however, either high or low echoic level of the normal parathyroid has been described without the confirmation of an experiment. Therefore, the echogenicity of the normal parathyroid was studied using intraoperative ultrasound. Materials and methods: Between October 2015 and January 2016, the parathyroid was examined in thyroidectomy procedures of 16 contiguous patients with thyroidal disease using an intraoperative array 8 – 18 MHz probe sheathed with a sterilized covering. There were 12 female and 4 male patients with an age range of 29 – 74 years old (mean, 47 ± 15). After one thyroid lobe or whole thyroid gland was removed, the parathyroid was found out by the surgeon. Then the parathyroid was scanned directly and through frontally-padded muscle of the neck, respectively. Results: The pathology results were thyroid papillary carcinoma (n = 11), thyroid medullary carcinoma (n = 2), thyroid adenoma (n = 1), retrosternal nodular goiter (n = 1), and thyroid nodular goiter (n = 1). Totally, twenty-five parathyroids were scanned in operation, including 8 right superior, 6 right inferior, 6 left superior, and 5 left inferior glands. All the parathyroids were visualized as hyperechoic structures, being homogeneous in texture (n = 22, 88%) and oval (n = 20, 80%), round (n = 3, 12%), or strip-like (n = 2, 8%) in shape. The length, width, and thickness averaged 6.8 ± 2.9 mm (range, 4 – 18 mm), 4.3 ± 1.6 mm (range, 3 – 10 mm), and 3.5 ± 1.3 mm (range, 1 – 7 mm). Conclusion: The normal parathyroid was confirmed to have a hyperechoic echogenicity, with most of them being homogenous and round-shaped, and measuring an average size of 6.8 × 4.3 × 3.5 mm through intraoperative ultrasound.