Non-functioning Mass Research Articles

Accelerated Wound Healing of Tetrahedral-Framework Nucleic Acid Nanozymes with High Penetration and Antioxidant Capacity

The wound repair process usually leads to a non-functioning mass of fibrotic tissue because of the oxidative imbalance of deep tissue layers. However, how to improve the penetration of active ingredients into deeper layers and regulate oxidative imbalances to create a regenerative microenvironment still remains a challenge. In this study, we designed a novel tetrahedral-framework nucleic acid (tFNA) nanozyme that could penetrate the skin/mucosa barrier as deep as 450 μm within 24 h. We also demonstrated the protective role of tFNAs on the mitochondrial structural and functional integrity and inhibition of reactive oxygen species production to repair oxidative imbalances through ERK1/2-Nrf2-HO-1 during repair processes. It was found that the proliferative state and the migration ability of postburn cells in vitro were accelerated, and the early closure of wounds in vivo was significantly promoted. This study therefore provides a promising strategy to efficiently regulate the oxidative imbalances in the deep layers of the skin during wound healing.

The effect of mass functionality on laparoscopic adrenalectomy outcomes.

This study aimed to determine the effect of adrenal mass functionality and different hormone subtypes synthesized by the adrenal masses on laparoscopic adrenalectomy (LA) outcomes. The study included 298 patients, 154 of whom were diagnosed with nonfunctional masses. In the functional group, 33, 62, and 59 patients had Conn syndrome, Cushing's syndrome, and pheochromocytoma, respectively. The variables were analyzed between the functional and nonfunctional groups and then compared among functional masses through subgroup analysis. The incidence of diabetes mellitus, hypertension, and obesity, blood loss, and length of hospital stay (LOH) were significantly higher in the functional group than in the nonfunctional group. In the subgroup analysis, patients with pheochromocytoma had significantly lower body mass index but significantly higher mass size, blood loss, and LOH than the other two groups. A positive correlation was found between mass size and blood loss in patients with pheochromocytoma (p ≤ 0.001, r = 0.761). However, no significant difference in complications was found among the groups. In this study, patients with functional adrenal masses had higher comorbidity rates and American Society of Anesthesiologists scores. Moreover, blood loss and LOH were longer on patients with functional adrenal masses who underwent LA. Mass size, blood loss, and LOH in patients with pheochromocytoma were significantly longer than those in patients with other functional adrenal masses. Thus, mass functionality did not increase the complications.

Bilateral Pulmonary Sequestration – A Rare Entity

Abstract Bronchopulmonary sequestration (BPS) is a congenital anomaly within the spectrum of abnormalities that can affect the normal development of airways, lung parenchyma, and vasculature. It accounts for up to 6.4% of all congenital pulmonary malformations. Sequestrated lung is a nonfunctioning mass of lung tissue that lacks communication with the tracheobronchial tree and is supplied by systemic arterial circulation. Pulmonary sequestration is usually a unilateral disease, bilateral pulmonary sequestration is a rare entity. Herein we present the case of a 26year old female, evaluated for cough with expectoration, hemoptysis and loss of weight, whose radiology suggestive of bilateral bronchopulmonary sequestration.

Adrenal incidentaloma: Do patients with apparently nonfunctioning mass or autonomous cortisol secretion have similar or different clinical and metabolic features?

Although there is growing evidence associating nonfunctioning adrenal incidentalomas (NFAI) with cardiovascular risk factors, there are limited data whether NFAI and autonomous cortisol secretion (ACS) groups have similar or different clinical and metabolic features. The aim of this study is to compare cardiometabolic clinic parameters among patients with ACS and NFAI, as well as controls. Cross-sectional study. Eighty nine NFAI, 58 ACS and 64 controls were evaluated. Diagnosis of NFAI (1 mg dexamethasone suppression test [1 mg-DST] ≤50 nmol/L [≤1.8 μg/dl]) and ACS (1 mg-DST > 50 nmol/L [> 1.8 μg/dl]) was established according to current guidelines. The control group was selected based on a normal adrenal imaging exam. There were no differences between groups regarding age, gender, ethnicity, menopause or body mass index. Patients with adrenal incidentaloma presented higher frequency of hypertension (74.1 vs. 57.8%; p = .02), resistant hypertension (45.4 vs. 9.4%; p < .001), dyslipidemia (80.1 vs. 63.9%; p = .01), as well as metabolic syndrome (84.2 vs. 61.7%; p = .001) compared to the controls, respectively. NFAI and ACS patients presented similar frequency of arterial hypertension (70.8 vs. 79.3%) and resistant hypertension (41.3 vs. 51.1%), dyslipidemia (79.3 vs. 81.5%) and metabolic syndrome (83.3 vs. 85.7%); also, levels of HbA1c were similar between the groups. Binary logistic regression showed that NFAI (p = .004) and ACS (p = .001) were independent predictors for resistant hypertension (p = .003); also, ACS was an independent predictor for metabolic syndrome (p = .04). NFAI and ACS presented a higher frequency of cardiometabolic morbidities in comparison with individuals with normal adrenal glands. Additionally, we demonstrated that both ACS and NFAI groups have similar cardiometabolic conditions.

СИНДРОМ АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИИ ПРИ ФЕОХРОМОЦИТОМЕ И ГОРМОНАЛЬНО-НЕАКТИВНОЙ АДРЕНОКОРТИКАЛЬНОЙ АДЕНОМЕ НАДПОЧЕЧНИКА

Introduction. The syndrome of arterial hypertension (AH) can be in patients with functioning and non-functioning masses of the adrenal glands which requires a thorough examination to exclude secon¬dary AH of origin. Aim. Identification of clinical, laboratory and radiological features of the AH syndrome in pheochromocytoma (PCC) and adrenocortical adrenal adenoma (incidentaloma). Materials and methods. A retrospective analysis of the clinic, biochemical, hormonal, radiological methods of examination was carried out in 15 patients referred for surgical treatment with a diagnosis of pheochromocytoma. During the postoperative histological examination of the removed masses of the adrenal glands, the diagnosis of PCC was confirmed in 8 out of 15 patients, in 7 patients instead of PCC, adrenocortical adenoma of was diagnosed. Results. Comparative analysis of the results of clinical, laboratory and radiological examination of patients with PCC and non-functioning adrenocortical adenoma with arterial hypertension syndrome showed that arterial hypertension syndrome in PCC has the following features: a crisis course of hypertension with its characteristic symptoms (headache, tremor, profuse sweating, palpitations), passing without treatment with the development of severe weakness after the crisis. Patients with PCC, compared with patients with adrenocortical adenoma, had a lower body mass, high levels of metanephrine, and on computed tomography (CT), the tumors were larger with high contrast uptake in the unenhanced and delayed phases. The reasons for the overdiagnosis of PCC in patients with adrenocortical adenoma in the presence of hypertension were: underestimation of clinical manifestations and an increase in the level of normetanephrine in daily urine, as well as a slight increase in the unenhanced density of contrast uptake on CT in 2 of 7 patients.

Preoperative differentiation of hypophysitis and pituitary adenomas using a novel clinicoradiologic scoring system

Hypophysitis can clinically and radiologically mimic other nonfunctioning masses of the sella turcica, complicating preoperative diagnosis. While sellar masses may be treated surgically, hypophysitis is often treated medically, so differentiating between them facilitates optimal management. The objective of our study was to develop a scoring system for the preoperative diagnosis of hypophysitis. A thorough literature review identified published hypophysitis cases, which were compared to a retrospective group of non-functioning pituitary adenomas (NFA) from our institution. A preoperative hypophysitis scoring system was developed and internally validated. Fifty-six pathologically confirmed hypophysitis cases were identified in the literature. After excluding individual cases with missing values, 18 hypophysitis cases were compared to an age- and sex-matched control group of 56 NFAs. Diabetes insipidus (DI) (p < 0.001), infundibular thickening (p < 0.001), absence of cavernous sinus invasion (CSI) (p < 0.001), relation to pregnancy (p = 0.002), and absence of visual symptoms (p = 0.007) were significantly associated with hypophysitis. Stepwise logistic regression identified DI and infundibular thickening as positive predictors of hypophysitis. CSI and visual symptoms were negative predictors. A 6-point hypophysitis-risk scoring system was derived: + 2 for DI, + 2 for absence of CSI, + 1 for infundibular thickening, + 1 for absence of visual symptoms. Scores ≥ 3 supported a diagnosis of hypophysitis (AUC 0.96, sensitivity 100%, specificity 75%). The scoring system identified 100% of hypophysitis cases at our institution with an estimated 24.7% false-positive rate. The proposed scoring system may aid preoperative diagnosis of hypophysitis, preventing unnecessary surgery in these patients.

A LUNG WITHIN A LUNG? A CASE REPORT OF MASSIVE HEMOPTYSIS SECONDARY TO PULMONARY SEQUESTRATION

TOPIC: Lung Pathology TYPE: Medical Student/Resident Case Reports INTRODUCTION: Bronchopulmonary sequestration (BPS), is defined as a non-functional mass of lung tissue with systemic arterial blood supply, but without normal tracheobronchial communication. BPS often presents in adulthood with recurrent pulmonary infections and even fatal hemoptysis. We present a case of a 53-year-old African American male with large volume hemoptysis while hiking in upstate New York, who was found to have right lower lobe intralobar pulmonary sequestration. CASE PRESENTATION: A 53-year-old African American male with a past medical history of hypertension, hyperlipidemia, and diabetes mellitus presented with a subacute cough for one month and one episode of large volume hemoptysis while hiking. Review of systems was negative for fever, chills, chest pain, pleurisy, history of tuberculosis, weight loss, and anticoagulation use. He admitted to recreational marajuana use, but denied smoking cigarettes. Initially he was tachypneic, saturating 91% on room air, but hemodynamically stable. Computed tomography angiography (CTA) revealed right lower lobe intralobar pulmonary sequestration with internal locules of air suggesting superimposed infection. Flexible bronchoscopy revealed fresh blood in the right mainstem and lower lobe. Thoracotomy was followed by a lower lobectomy, which confirmed the diagnosis as it demonstrated an aberrant arterial supply from the descending thoracic aorta. There was no envelopment of pleura around the lung fed by the large pulsatile artery. DISCUSSION: Pulmonary airway malformations are the most common type of congenital abnormalities of the lower respiratory tract, diagnosed 1 in 10,000 to 35,000 live births [1]. An intralobar sequestration (IS) is located in a normal lobe and an extralobar sequestration (ES) is outside, with both having their own visceral pleura. Hybrid lesions are most common and have features of both. ES presents early with associated congenital malformations, whereas IS presents later with hemoptysis and recurrent pulmonary infections [2]. BPS can appear as other pathologies on CT such as a mass lesion, cyst, cavity lesion and localized emphysema [3,4]. Lobectomy should be prompt to prevent complications, such as fatal hemoptysis [5]. Shorter recovery times have been noted with video-assisted thoracoscopic surgery (VATS) [6,7]. Postoperative complications include empyema, hemoptysis, prolonged air leak, and fistula formation. Berna et al described their surgical approach in 25 patients in 2011, and all patients were doing well at long-term follow-up [7]. CONCLUSIONS: BPS can be fatal despite its rarity and innocent presentation. Radiographic ambiguity and nonspecific symptoms may delay appropriate management. It is imperative to include BPS on the initial query when managing hemoptysis. In the era of COVID-19, where hemoptysis may herald a deadly disease, understanding the broad differential of hemoptysis expedites appropriate management. REFERENCE #1: [1] Durell J, Thakkar H, Gould S, Fowler D, Lakhoo K. Pathology of asymptomatic, prenatally diagnosed cystic lung malformations. J Pediatr Surg. 2016;51(2):231-235. doi:10.1016/j.jpedsurg.2015.10.061 REFERENCE #2: [2] Van Raemdonck D, De Boeck K, Devlieger H, et al. Pulmonary sequestration: a comparison between pediatric and adult patients. Eur J Cardiothorac Surg. 2001;19(4):388-395. doi:10.1016/s1010-7940(01)00603-0 REFERENCE #3: [3] Wei Y, Li F. Pulmonary sequestration: a retrospective analysis of 2625 cases in China. Eur J Cardiothorac Surg. 2011;40(1):e39-e42. doi:10.1016/j.ejcts.2011.01.080[4] Qi W, Zhao J, Shi G, Yang F. Intralobar pulmonary sequestration displayed as localized emphysema on computed tomography image. J Cardiothorac Surg. 2017;12(1):83. Published 2017 Sep 8. doi:10.1186/s13019-017-0646-9[5] Rubin EM, Garcia H, Horowitz MD, Guerra JJ Jr. Fatal massive hemoptysis secondary to intralobar sequestration. Chest. 1994 Sep;106(3):954-5. doi: 10.1378/chest.106.3.954. PMID: 8082388.[6] Sun X, Xiao Y. Pulmonary sequestration in adult patients: a retrospective study. Eur J Cardiothorac Surg. 2015;48(2):279-282. doi:10.1093/ejcts/ezu397[7] Polaczek, M., Baranska, I., Szolkowska, M., Zych, J., Rudzinski, P., Szopinski, J., Orlowski, T., & Roszkowski-Sliz, K. (2017). Clinical presentation and characteristics of 25 adult cases of pulmonary sequestration. Journal of thoracic disease, 9(3), 762–767. https://doi.org/10.21037/jtd.2017.03.107 DISCLOSURES: No relevant relationships by Christian Castaneda, source=Web Response no disclosure on file for Rammohan Gumpeni; No relevant relationships by Sophia Ji, source=Web Response No relevant relationships by Parmjyot Singh, source=Web Response No relevant relationships by Anthony Smith, source=Web Response

Pulmonary sequestration presenting as a massive haemoptysis in adult: A case report.

IntroductionPulmonary sequestration is a rare congenital lung malformation characterized by non-functioning mass of pulmonary tissue that lacks normal communication with bronchial tree and receives one or more aberrant systemic arterial supply. It usually presents in children with recurrent chest infections. It is uncommon in adult and remains asymptomatic or present with recurrent chest infections, rarely with more severe symptoms like a massive haemoptysis as in seen in our case.Case presentationA 22-year-old male presented with a chief complain of multiple episodes of massive haemoptysis. After evaluation with chest x-ray, CT chest and angiogram, he was diagnosed to have intralobar pulmonary sequestration. He underwent successful thoracotomy and left lower lobectomy. He is asymptomatic after one year of follow up.DiscussionPulmonary sequestration is rare in adult and can present with various symptoms like chest pain, cough, sputum production, recurrent infection and rarely haemoptysis. Intralobar sequestration of left lower lobe is the most common as seen in our case. The diagnosis can be made by Computed Tomogram chest with angiogram. Surgical intervention is the definitive curative treatment. Post-operative outcome is excellent with early patient satisfaction and promising outcome in long term follow-up.ConclusionBronchopulmonary sequestration can rarely present in adults presenting with massive haemoptysis. CT chest is the best modality for diagnosis. Early surgical intervention is definitive treatment with good long term outcome.

Spontaneous rupture of adrenal myelolipoma as a cause of acute flank pain: A case report

BACKGROUNDAdrenal myelolipoma is a rare, benign, non-functioning mass that occurs in the adrenal gland. It is composed of an admixture of hematopoietic elements and mature adipose tissue, similar to bone marrow. Even at large sizes, adrenal myelolipomas are usually asymptomatic and often incidentally found by ultrasonography or computed tomography (CT) scan. This paper describes an unusual case of adrenal myelolipoma presenting as flank pain.CASE SUMMARYA 50-year-old male with severe right flank pain underwent a CT scan revealing a huge mass extending into the suprarenal space. The mass showed a fat component with retroperitoneal hemorrhage. The tumor was treated laparoscopically, and pathologic examination revealed features of myelolipoma originating from the adrenal gland.CONCLUSIONAdrenal myelolipomas are generally asymptomatic and can be treated conservatively. However, rupture and hemorrhage of the tumor can cause symptoms requiring surgical removal.

Adrenalektomi Yapılan Hastalarda Klinik Endikasyon ve Cerrahi Yöntemlerin Değerlendirilmesi

Aim: The aim of this study was to evaluate the clinical surgical indications, surgical method selection criteria, and histopathological results of patients who were operated on with the diagnosis of adrenal mass in our general surgery clinic.&#x0D; Material and method: A retrospective analysis was made of the data retrieved from the hospital database of patients who underwent surgery for adrenal mass in our general surgery clinic between January 2016 and January 2021. The data examined included demographic characteristics, American Anesthesiologists Association (ASA) score, preoperative clinical diagnosis, surgical technique, perioperative complications, duration of hospital stay, and histopathological results. &#x0D; Results: A total of 16 patients underwent surgery for a diagnosis of adrenal mass in the specified study period. The patients comprised 13 (81.25%) females and 3 (18.75%) males with a mean age of 50.31 ± 15.06 years, and mean ASA score of 1.87 ± 0.61. Surgery was performed by open adrenalectomy (OA) in 3 (18.75%) cases and laparoscopic transperitoneal lateral adrenalectomy (LTLA) in 13 (81.25%) cases. The preoperative clinical diagnosis was functional tumour in 10 (62.5%) patients and non-functional mass in 6 (37.5%).&#x0D; Conclusion: Although adrenal gland tumors are extremely rare, a multidisciplinary approach is very important at the stages of diagnosis, surgical method selection, and postoperative follow-up. Surgeons should select the surgical method in which they are most experienced and trained, to be able to obtain the best results considering the risk factors.

Hormonally Active Adrenal tumors; Challenges and Outcomes for Different Surgical Approaches.

Objective:The aim of this study is to compare the intraoperative and short-term outcomes of different surgical approaches for hormone active and non-functional adrenal masses.Methods:The data of 206 patients who underwent adrenal gland surgery in our clinic between 2012 and 2020 were retrospectively analyzed. Pre-operative outpatient clinic records of the patients, imaging methods, laboratory results and surgery records, operation time (OT), amount of bleeding, duration of hospital stay, and complications were evaluated. Patients were divided into two groups as those with non-functional mass (n=80) and those with hormoneactive mass (n=126).Results:The median age of the patients was 52 (range 19–83) and 77.2% of them were female. Tumor size was larger in hormone active group (p=0.311), and the difference was more pronounced in the pheochromocytoma subgroup (p=0.088). The rate of transition to open surgery was similar in both groups (0.959), and no conversion to laparoscopy or conventional open surgery was performed in robotic cases. The duration of surgery (p=0.669), mean amount of blood loss (p=0.834), and mean hospital stay (p=0.195) were also similar between the two groups. Intraoperative and post-operative complications were similar between two groups (p=0.573 and p=0.415, respectively). Considering the subgroup analysis of the patients in hormone active group; the duration of hospital stay was longer in patients with Cushing syndrome (p=0.001), while there was no difference in OT and estimated blood loss between patients who were operated for Conn, Cushing, and pheochromocytoma (p=0.086 and p=0.099; respectively).Conclusion:Surgical results of hormone active adrenal masses were found to be similar to non-functional masses. Although the hormonal condition of the mass does not change the difficulty level of the surgical procedure, it may be recommended that the robotic approach be preferred to facilitate manipulation in these masses.

Pitfalls and differential diagnosis on adrenal lesions: current concepts in CT/MR imaging: a narrative review

The purpose of this pictorial essay is to review the imaging findings of adrenal lesions. Adrenal lesions could be divided into functioning or non-functioning masses, primary or metastatic, and benign or malignant. Imaging techniques have undergone significant advances in recent years. The most significant objective of adrenal imaging is represented by the detection and, when possible, characterization of adrenal lesions in order to direct patient management correctly. The detection and management of adrenal lesions is based on cross-sectional imaging obtained with non-contrast CT (tumour density), contrast-enhanced CT including delayed washout (either absolute percentage washout or relative percentage one) and finally with MR chemical shift analysis (loss of signal intensity between in-phase and out-of-phase images including both qualitative and quantitative estimates of signal loss). The small incidental adrenal nodules are benign, in most of cases; some tumors such as lipid-rich adenoma and myelolipoma have characteristic features that can be diagnosed accurately in CT. On contrary, if the presenting contrast-enhanced CT shows an adrenal mass with uncertain or malignant morphologic features, particularly in patients with a known history of malignancy, further evaluations should be considered. The most significative implications for radiologists are represented by how to assess risk of malignancy on imaging and what follow-up to indicate if an adrenal incidentaloma is not surgically removed.

CRITICAL PRESENTATION OF A BRONCHOPULMONARY SEQUESTRATION IN ADULTHOOD

SESSION TITLE: Medical Student/Resident Genetic and Developmental Disorders Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Congenital pulmonary anomalies are typically found at birth due to neonatal symptoms or imaging. Bronchopulmonary sequestrations (BPS) are rare, congenital, nonfunctioning masses of pulmonary tissue that lacks airway communication to the main bronchial tree and are supplied by systemic circulation [1]. Although most of these patients are identified at birth, some can live into adulthood without knowledge. In this case, we will discuss the rare appearance and complications of BPS in adult medicine and the steps for curative treatment. CASE PRESENTATION: A 28-year-old healthy female presented with sudden onset hematemesis and hemoptysis. On arrival, she was in hypovolemic shock with systolic blood pressure in the 50s. Patient received aggressive fluid resuscitation. Hemoglobin was stable despite blood loss. CT chest showed a 16 x 9cm bronchopulmonary sequestration in the right base. Patient was emergently intubated and underwent bronchoscopy showing normal mucosa without evidence of active bleed. A second bronchoscopy was performed to place a bronchial blocker to prevent further suspected bleeding into the right lower lung. Cardiothoracic surgery recommended transfer to University Hospital. After transfer, patient underwent repeat bronchoscopy to reposition the bronchial balloon. Interventional radiology embolized the right bronchial artery and two segmental branch arteries from the right inferior phrenic artery, all supplying the BPS. Thoracic surgery delayed resection due to severe aspiration pneumonitis. Patient was discharged and completed a course of antibiotics. She later underwent right muscle sparing thoracotomy with total resection of the BPS and therapeutic right lower lobe wedge resection (Figure 1). She gradually recovered inpatient and was discharged. She followed up with thoracic surgery without any symptoms. DISCUSSION: Although a rare disorder (1 in 10-35,000 live births), BPS typically presents as an incidental finding in a neonate. In adulthood, diagnosis is made through CT angiography of the chest showing systemic circulation supplying an aberrant lung tissue. Definitive diagnosis is made after resection of the tissue [1]. Treatment involves elective surgery in symptomatic patients to remove the BPS with or without partial lobectomy or wedge resection, such as in this case. In asymptomatic patients, risk assessment is evaluated. Patients with large lesions > 20% of the thorax or with characteristics of pleuropulmonary blastoma should have resection [1]. Low risk asymptomatic patients can be monitored via chest x-ray and CT chest. Patients may, however, still choose to proceed with elective surgery to prevent future complications that may cause the surgery to become urgent. CONCLUSIONS: If detected early, removal of BPS can prevent critical events. Rare, undetected BPS can suddenly appear in adulthood requiring stabilization prior to removal as curative treatment. Reference #1: Oermann, Christopher M, et al. “Bronchopulmonary Sequestration.” UpToDate, 2020, www.uptodate.com/contents/bronchopulmonary-sequestration?search=pulmonary%2Bcongenital%2Banomalies&topicRef=6346&source=related_link DISCLOSURES: No relevant relationships by Kalpan Desai, source=Web Response No relevant relationships by Vishal Jivan, source=Web Response No relevant relationships by Jeremy Renz, source=Web Response

Clinical Evaluation on Non-Functional Invasive Hypophysis Adenomas

Background&#x0D; There are ongoing studies to predetermine non-functional invasive pituitary adenomas which may show aggressive behavior. Our aim is to discuss whether there is a relationship between the immunohistochemical presence of GH, FSH, LH, PRL, ACTH, TSH and their aggressive clinical course in non-functional pituitary adenomas.&#x0D; Materials and Methods &#x0D; In this study, we evaluated retrospectively the files of the patients who were diagnosed with thesellar or parasellar tumor in our endocrinology clinic between the years of 2004-2014.The patients were divided into two groups as non-invasive pituitary adenomas and non-functional invasive pituitary adenomas. The immunohistochemical staining characteristics were compared between the two groups.&#x0D; Results &#x0D; In this study, we scanned the data of 70 patients who were followed for non-functional sellar or parasellar mass. 47.1% of the patients were female and 52.9% of the patients were male.39 patients had a non-functional pituitary adenoma.The rate of non-functional invasive adenoma was found to be 20.5%. There was a significant relationship between the immunohistochemical positivity of GH, FSH, LH andaggressive behavior of non-functional invasive adenomas. There was no a significant relationship between the immunohistochemicalpositivityof PRL, ACTH, TSH and aggressive behavior of non-functional invasive adenomas.&#x0D; Conclusion &#x0D; We found silent GH and gonadotropin adenomas as non-functional aggressive pituitary adenoma. More aggressive treatment and close clinical monitoring should be performed because atypical pituitary adenomas are characterized by invasive growth and aggressive clinical course.

MON-206 Diagnosis of Non-Functional Masses in Adrenal Gland Topography - Experience of a Tertiary Health Center

Introduction: Masses in adrenal topography are diagnosed frequently due to the increase in radiological imaging in clinical practice. Adrenal incidentalomas occur between 4% and 10% of the patients above 50 years undergoing abdominal imaging, and the majority are benign pathologies. Objective: To analyze the characteristics of the masses located in adrenal gland topography not originating from the adrenal gland. Methods: We retrospectively assessed patients from our tertiary hospital who underwent surgical treatment for masses in adrenal gland topography between 2006 and 2018. All patients had hormonal evaluations, according to the European and American Societies of Endocrinology guidelines. Two expert radiologists reviewed all images. Forty-six patients were included in the study, and the surgical specimens were analyzed by the same experienced pathologist. Patients with confirmed adrenocortical carcinoma (ACC) were excluded from this cohort. Results: Thirty-two (69.6%) patients were female. The median age was 49.5 years old (range 18-82yo). Abdominal or lumbar pain was the most frequent reason for medical investigation (43.5%). Adrenal incidentalomas represented 38.4% of the cohort. None of these patients had any clinical signs of adrenal hyperfunction, nor hormonal alteration. Twenty-four patients (52.17%) presented a mass on the left side, and only two cases presented bilateral adrenal masses. The median size was 8.6cm (1.3-18cm). The mean of Hounsfield Units (HU) on a non-contrasted CT was 25HU (0-50HU). Several etiologies were found: 8 cases (18%) of ganglioneuroma; 6 cases (13,5%) of adrenal cysts; 4 cases (9%) of leiomyosarcoma and adrenal hemorrhage; 3 cases (6.5%) of infectious disease; 2 cases (4.5%) of lymphangioma, schwannoma, and sarcoma. We also found single cases of renal cell carcinoma, poorly differentiated small cell neuroendocrine carcinoma, hepatocellular carcinoma, high grade dedifferentiated liposarcoma, epithelioid neoplasia, epithelial neoplasia with neuroendocrine differentiation, malignant peripheral nerve sheath tumor of the adrenal gland, poorly differentiated neuroblastoma, high grade lymphoma, myelolipoma, acute splenitis, arteriovenous malformation, and prostate cancer metastasis. Discussion and Conclusion: Ganglioneuroma was the most frequent diagnosis in adrenal incidentalomas in our cohort. In general, these conventional radiological exams could not differentiate lesions originated in the adrenal glands from lesions of other origins. In this large cohort, we could identify non-adrenal origin in approximately 45% of the patients with masses in the adrenal topography.

Exosome loaded alginate hydrogel promotes tissue regeneration in full-thickness skin wounds: An in vivo study.

Wound healing is known as one of the most complicated biological processes for injured skin caused by surgical, trauma, burns, or diabetic diseases, which causes a nonfunctioning mass of fibrotic tissue. Recent reports have suggested that exosomes (EXOs) secreted by this type of stem cells may contribute to their paracrine effect. In this study, the EXOs were isolated from the supernatant of cultured adipose-derived stem cells (ADSCs) via ultracentrifugation and filtration. The EXO loaded in the alginate-based hydrogel was used as a bioactive scaffold to preserve the EXO in the wound site in the animal model. The physical and biochemical properties of EXO loaded Alg hydrogel were characterized and results proved that fabricated structure was biodegradable and biocompatible. This bioactive wound dressing technique has significantly improved wound closure, collagen synthesis, and vessel formation in the wound area. Results offer a new viewpoint and a cell-free therapeutic strategy, for wound healing through the application of the composite structure of EXO encapsulated in alginate hydrogel.

Une séquestration pulmonaire particulière

Bronchopulmonary sequestration is a rare congenital abnormality characterized by the presence of a non-functioning mass of lung tissue which receives an aberrant arterial supply from systemic circulation. We describe the case of a 30-year-old man who presented with recurrent episodes of mild hemoptysis. CT angiography revealed a right inferior lobar sequestration supplied by three systemic arteries. The patient underwent thoracotomy with right lower lobectomy and section-ligature of the three abnormal vessels. This case highlights the radiological features as well as the intraoperative appearances of this rare anomaly.

Sequestro pulmonar e tratamento endovascular: um relato de caso

Pulmonary sequestration is a congenital anomaly defined as a nonfunctioning mass of lung parenchyma. Presence of an independent pleural envelope classifies it as intralobar, accounting for approximately 75% of the cases, while absence classifies cases as extralobar, accounting for the remaining 25%. Diagnosis is made through radiography and confirmed by computed tomography, magnetic resonance, or angiography. The traditional treatment is open surgical repair, but endovascular techniques have been used, with good results. We report the case of a 29-year-old-woman presenting with recurrent pneumonia for 5 years. A CT scan of the chest revealed poor vascular formation in the lower region of the right lung. The pulmonary sequestration was treated by embolization of the anomalous branch.

The hidden disease; bronchopulmonary sequestration as retrocardiac mass: a case report

Background: Bronchopulmonary sequestration, simply called as pulmonary sequestration, is a relatively rare congenital anomaly with few reports of initial diagnosis occurring during adulthood. It consists of a nonfunctioning mass of lung tissue that lacks normal communication with the tracheobronchial tree and that receives its arterial blood supply from the systemic circulation. Case Presentation: We report two cases with bronchopulmonary sequestration and a short review of the clinical/radiologic features of bronchopulmonary sequestration. Conclusion: Look carefully at the retrocardiac area of chest radiography in adults for the definition of unexpected lesions. It can be bronchopulmonary sequestrations. It can be diagnosed easily with a feeding artery by an aberrant systemic artery which usually arises from the aorta.

Long-term survival with stereotactic radiotherapy for imaging-diagnosed pituitary tumors in dogs.

Published studies on the use of stereotactic radiotherapy for dogs with pituitary tumors are limited. This retrospective observational study describes results of stereotactic radiotherapy for 45 dogs with imaging-diagnosed pituitary tumors. All dogs were treated at a single hospital during the period of December 2009-2015. The stereotactic radiotherapy was delivered in one 15 Gray (Gy) fraction or in three 8 Gy fractions. At the time of analysis, 41 dogs were deceased. Four were alive and censored from all survival analyses; one dog received 8 Gy every other day and was removed from protocol analyses. The median overall survival from first treatment was 311 days (95% confidence interval 226-410 days [range 1-2134 days]). Thirty-two dogs received 15 Gy (median overall survival 311 days; 95% confidence interval [range 221-427 days]), and 12 received 24 Gy on three consecutive days (median overall survival 245 days, 95% confidence interval [range 2-626 days]). Twenty-nine dogs had hyperadrenocorticism (median overall survival 245 days), while 16 had nonfunctional masses (median overall survival 626 days). Clinical improvement was reported in 37/45 cases. Presumptive signs of acute adverse effects within 4 months of stereotactic radiotherapy were noted in 10/45, and most had improvement spontaneously or with steroids. Late effects versus tumor progression were not discernable, but posttreatment blindness (2), hypernatremia (2), and progressive neurological signs (31) were reported. There was no statistical difference in median overall survival for different protocols. Patients with nonfunctional masses had longer median overall survival than those with hyperadrenocorticism (P=0.0003). Survival outcomes with stereotactic radiotherapy were shorter than those previously reported with definitive radiation, especially for dogs with hyperadrenocorticism.