Oxyphil Cells Research Articles

Relationship between parathyroid oxyphil cell proportion and clinical characteristics of patients with chronic kidney disease.

Parathyroid glands consist of chief cells and oxyphil cells. The parathyroid oxyphil cell proportion increased dramatically in patients with chronic kidney disease (CKD). The importance of the oxyphil cell in the treatment of secondary hyperparathyroidism (SHPT) has been enhanced in recent years. The aim of this study was to explore the possible relationship between parathyroid oxyphil cell proportion and clinical features of patients with CKD. From December 2010 to December 2018, 78 consecutive patients with CKD 5 who underwent parathyroidectomy (PTX) were reviewed. None of the patients had used Cinacalcet. Patients were divided into two groups according to their parathyroid oxyphil cell proportion. The mean parathyroid oxyphil cell proportion of all the patients was obtained. Group 1 consisted of 37 patients, the parathyroid oxyphil cell proportion of whom was more than or equal to mean proportion. Group 2 consisted of 41 patients, the parathyroid oxyphil cell proportion of whom was less than mean proportion. The demographic and biochemical data of the two groups were compared. Preoperative parathyroid hormone (PTH) and total weight of removed parathyroid glands in the patients of group 1were less than those in group 2. There was no difference between the two groups in terms of preoperative calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), age and dialysis years. The parathyroid oxyphil cell proportion was associated with preoperative PTH and total weight of removed parathyroid glands in the patients with CKD. Patients with more parathyroid oxyphil proportion had lower preoperative PTH level and smaller total weight of the removed parathyroid glands.

Analysis of clinical features of 40 cases with asthma-chronic obstructive pulmonary overlap syndrome

Objective To analyze the clinical characteristics of patients with asthma-chronic obstructive pulmonary overlap syndrome (ACOS). Methods From January 2015 to December 2017, 40 patients with ACOS, 40 patients with asthma and 40 patients with chronic obstructive pulmonary disease(COPD) in Zhoushan Hospital were collected.The general information, laboratory test indicators, lung function test indicators and FEV1 mutation after bronchodilator test were compared among the three groups. Results There were statistically significant differences in age[(45.36±5.27) vs. (54.45±4.69) vs. (67.57±5.18), F=9.334, P=0.004], the proportion of smoking patients (92.50% vs. 75.00% vs. 60.00%, χ2=11.550, P=0.003), and the proportion of family history of asthma (7.50% vs. 20.00% vs. 30.00%, χ2=6.562, P=0.038) among the patients with ACOS, asthma and COPD.The percentage of eosinophils in peripheral blood [(8.46±0.94)% vs. (6.13±0.78)% vs. (3.75±0.45)%, F=11.626, P=0.001] and the serum IgE levels [(353.41±45.74)IU/mL vs. (252.65±30.45)IU/mL vs. (155.26±22.77)IU/mL, F=7.605, P=0.001] were decreased in turn, the differences were statistically significant.The FEV1/FVC% and FEV1% pred in the ACOS group were lower than those in the asthma group [(54.26±6.86)% vs. (72.43±8.52)%, t=10.506, P=0.001 and (50.35±6.22)% vs. (62.60±7.52)%, t=7.939, P=0.001], however, there were no significant differences compared with the COPD group[(54.26±6.86)% vs. (53.88±7.25)%, t=0.241, P=0.810 and (50.35±6.22)% vs. (50.56±6.46)%, t=0.148, P=0.883]. The proportion of small airway dysfunction in the ACOS group was higher than that in the asthma group (82.50% vs. 57.50%, χ2=5.952, P=0.015), however, there was no statistically significant difference compared with COPD group(82.50% vs. 85.00%, χ2=0.092, P=0.762). The RV/TLC% in the ACOS group was higher than that in the asthma group [(46.71±5.31)% vs. (32.46±4.52)%, t=12.924, P=0.001], however, there was no statistically significant difference compared with the COPD group [(46.71±5.31)% vs. (46.92±5.75)%, t=0.170, P=0.866]. The DLCO% in the ACOS group was lower than that in the asthma group [(64.37±4.66)% vs (82.62±4.53)%, t=17.760, P=0.001], but higher than that of the COPD group [(64.37±4.66)% vs. (51.25±4.35)%, t=13.017, P=0.001]. After bronchodilator test, the FEV1 mutation rate of the ACOS group was higher than that of the COPD group [(20.86±2.05)% vs. (6.52±0.55)%, t=42.730, P=0.001], but there was no statistically significant difference compared with the asthma group [(20.86±2.05)% vs. (21.13±2.14)%, t=0.576, P=0.566]. Conclusion Compared with asthma patients, the age of ACOS patients is older, the percentage of peripheral blood eosinophils and the level of serum IgE are lower, the pulmonary ventilation function is lower, the airway dysfunction is more significant, the residual volume is more significant, the lung diffuse function is lower, acidic granulocyte airway inflammation is mild.But compared with patients with COPD, the age of ACOS patients is younger, the percentage of peripheral blood eosinophils and serum IgE levels are higher, the lung diffuse function is higher, and acidic granulocyte airway inflammation is heavier. Key words: Asthma; Pulmonary disease, chronic obstructive; Oxyphil cells; Immunoglobulin E; Respiratory function tests

Electrolyte disorders after endoscopic transnasal neurosurgical interventions

Background: Disorders of water and electrolyte balance, hyper- and hyponatremia, are common postoperative complications of transsphenoidal neurosurgical interventions and are found in up to 30–40% of cases. At the same time, delayed hyponatremia is the main cause of repeated hospitalizations of patients, and the risk factors/pathogenetic mechanisms responsible for the development of postoperative hyponatremia have not been fully investigated.
 Aim: To determine the frequency of water-electrolyte disturbances and to identify predictors of dysnatriemia states in patients after transnasal adenomectomy.
 Materials and methods: A retrospective single-site study included an analysis of electronic medical records of patients who underwent transnasal neurosurgical interventions for benign tumors of the pituitary gland (n = 416). The diagnostic and prognostic factors for the development of postoperative water-electrolyte disorders were evaluated.
 Results: The prevalence of hyponatremia in the total group of patients was 7.2%, and for hypernatremia it was 3 times higher – 24.3%, with these indicators being kept stable through the years of surgery (p > 0.05; χ2 with the Yeats correction). 66 (16%) of the operated patients, the sodium level in the early (0–5 day) and 157 (38%) patients in the later (6+ day) postoperative period was not determined, which may underestimate the identification of the most dangerous delayed postoperative hyponatremia. When analyzing the main clinical and laboratory characteristics of patients with hypo-, normo- and hypernatremia, no statistically significant differences were found between the parameters characterizing natremia, the osmolality of blood and urine, the frequency of determining blood sodium in different time intervals of the postoperative period. Complications of the main diagnosis (diabetes mellitus, coronary heart disease and arterial hypertension), selected parameters of pathological examination (identification of neurohypophysis cells, adenohypophysis, oxyphilic, basophilic or chromophobic cells, as well as other structures that are not part of the pituitary gland) and the operation protocol (bleeding, coagulation of sellar structures, liquorrhea, excision of the pituitary gland), did not differ between groups. In the hypernatremia group, the tumor volume in quantitative representation was lower than in the normo- and hyponatremia groups (1.0 ml vs. 1.5 and 1.5 ml, respectively). The number of neurosurgical interventions performed in a patient did not differ between the study groups.
 Conclusions: After transnasal adenomectomy, hypo- and hypernatremia occur in 7.2% and 24.3%, respectively, and do not depend on the presence of complications of the underlying disease, the parameters of the pathomorphological protocol, the appearance of postoperative hypopituitarism or the course of the operation itself. For the timely detection of disorders of water and electrolyte metabolism, the implementation of blood sodium testing in the early and late (6+ day) postoperative period is necessary in management of patients after transnasal adenomectomy.

The clinical significance of diagnosis and therapy in patients with adult bronchial asthma by fractional exhaled nitric oxide levels

Objective To evaluate the sensitivity and specificity of exhaled nitric oxide in the diagnosis and therapy of bronchial asthma. Methods From January 2016 to December 2017, 87 patients diagnosed with bronchial asthma in Luoyang Central Hospital Affiliated to Zhengzhou University were selected as asthma group , and 40 healthy people were selected as healthy control group at the same term.The levels of FeNO, FEV1/pred, peripheral blood EOS count, ACT score, percentage of sputum EOS were measured. Results The positive rate of FeNO was 56.3%(49/87) in the asthma group, which in the healthy control group was 5.0%(2/47). The fractional exhaled nitric oxide level of reexamined patients before treatment [(70.9±53.6)ppb] was higher than that after treatment[(12.2±8.7)ppb], and the difference was statistically significant(t=4.323, P=0.001). The fractional exhaled nitric oxide level in the asthma group [(42.4±42.5)ppb] was higher than that in the healthy control group [(9.4±5.8)ppb], and the difference between the two groups was statistically significant(t=2.871, P=0.001). The fractional exhaled nitric oxide level was positively correlated with peripheral blood EOS count (r=0.376, P=0.000) and ACT score (r=0.361, P=0.001), but had no correlation with FEV1/pred (r=-0.111, P=0.306) and sputum EOS (r=-0.036, P=0.805). Conclusion The measurement of fractional exhaled nitric oxide levels has an important clinical significance in the diagnosis of bronchial asthma.And it has a guiding significance for the evaluation of the therapeutic effect of bronchial asthma. Key words: Asthma; Nitric oxide; Respiratory function tests; Oxyphil cells; Granulocytes; Glucocorticoids; Adult

Buccal oncocytoma: Report of a case and literature review

IntroductionMore common in major salivary glands, oncocytomas are very rare tumors. They commonly occur in the parotid gland and are painless slow growing predominantly benign tumors. The term “oncocytoma” was introduced by Jaffe to designate those tumors of the salivary glands that consist predominantly of oncocytic cells lining the salivary ducts (1) Similalry, Meza- Chavez had proposed the name “oxyphilic granular cell adenoma. (2) Oncocytomas are extremely rare, benign and slow growing in nature. Here we present a rare case of buccal oncocytoma which is to our knowledge the 19th case of intraoral minor salivary gland tumor and the 7th reported case of buccal oncocytoma.Case presentationHere we present an exceedingly rare case of buccal oncocytoma in a 14 years boy who presented to the department of ENT with right buccal swelling for 6 months. He was posed the diagnosis of buccal cyst after cytological examination supported by CT scan. He then underwent an excisional biopsy where the final diagnosis was made as Buccal Oncocytoma.ConclusionsThough very rare in the picture, conditions like salivary gland oncocytomas still are reported on and off in the literature. The treatment of which is complete surgical excision.

Parathyroid glands: the normal development, anatomy and histological structure

Parathyroid glands (PG) are endocrine glands, which are the most important humoral regulators of calcium and phosphorus metabolism in the body. They were first described by an Englishman Richard Owen in 1849. Most of patients have four PG – upper and lower. In 13% of cases there are more than four PG. The glands arise as diverticula from the endoderm of the third and fourth branchial pouches between the fifth and twelfth week of gestation. The IV branchial pouch forms the upper gland, and III pouch forms the inferior gland.
 The parathyroid hormone production has been demonstrated as early as 83/7 weeks gestational age. The formation, migration, differentiation and functioning of the PGs are determined by a number of genes and changes in them could lead to disfunction in these processes. The ectopic of PG is possible when migration violation (up to 22% of cases). The most common location of the ectopic PG is parenchyma of the thymus and thyroid gland. Each PG is richly vascularized and it is surrounded by a thin connective tissue. In adults, there are two types of parenchymal cells: the chief cells (active and inactive forms) and the oxyphil cells. During the life, the ratio of types of parenchymal cells and their activity have been changing, as well as the characteristics of the stroma.

SUN-506 An Interesting Case Of Low-Grade Parathyroid Carcinoma

Background: Parathyroid Carcinoma (PC) is a rare form of malignancy and accounts for < 1% of cases of primary Hyperparathyroidism (PHT). It is challenging to diagnose PC due to lack of specific clinical features and biochemical markers. Pathological diagnosis can be troublesome as well, causing a delay in the ideal surgical treatment. Clinical Case: A 39 year old male with history of HTN, recurrent kidney stones, asthma and drug abuse was involuntarily admitted to the hospital by his fiancé after a domestic fight. Initial labs were significant for Calcium 13.2 mg/dl (N 8.8-10.5 mg/dl), Phosphorus 2.8mg/dl (N 2.5-4.5 mg/dl), Magnesium 1.2 mg/dl (N 1.8-2.4 mg/dl), BUN 24 mg/dl (N 6-22mg/dl), Creatinine 2 mg/dl (N 0.8-1.4 mg/dl), CPK 2550 u/l (32-230 u/l). Due to the physical assault, CT Brain and cervical spine were obtained which showed multiple calcified discs and ligaments along with hyperdense vertebral bodies and salt and pepper appearance of the cranial bones. A 2.7 x 2.3 x 4.5 cm mass adjacent to the posterior aspect of the left thyroid lobe concerning for possible parathyroid adenoma or thyroid neoplasm was also reported. Patient was treated with IV fluids and further investigation revealed iPTH 194 pg/ml (N 15-65 pg/ml), ca 12.7 mg/dl, Vit D(OH)25 - 21 ng/ml. Thyroid US and NM Parathyroid imaging confirmed a large 6 x 2.5 x 2.3 cm left superior parathyroid.The patient underwent parathyroidectomy, intraoperatively PTH dropped from 233 to 64 pg/ml. Kidney function and calcium normalized after the surgery. The patient was screened for MEN due to hyperparathyroidism and resistant hypertension. Gastrin, calcitonin, catecholamines were all within the normal range. During the surgery, a very large gland was noted without any local invasion. Gross pathologic examination of the specimen showed a markedly enlarged, fragmented and hemorrhagic parathyroid (12.6 gm). Histologically, tumor demonstrated uniform oxyphil cells with focal cellular atypia and low mitotic rate, divided by thick fibrous bands. No definitive vascular invasion was seen, however, peripheral nerve entrapment was noted. Fragmentation of the specimen with limited representation of the tumor stroma interface precluded accurate evaluation of capsular invasion and made this a difficult case to diagnose. The specimen was sent to Johns Hopkins for further evaluation. An immunostain for parafibromin demonstrated abnormal loss of nuclear expression, a finding that is 95% specific for parathyroid carcinoma. Based on the combination of these atypical features, the loss of parafibromin staining, entrapment of peripheral nerve, and the markedly enlarged parathyroid, the lesion were best regarded as a low-grade parathyroid carcinoma. Conclusion: PC is often a difficult pre-operative diagnosis and the patients are subjected to recurrent surgeries. Our patient underwent left thyroid lobectomy after the pathological confirmation of PC.

Цитологічні особливості багаторазово метастазуючих тиреоїдних папілярних карцином

Мета — комплексне цитологічне та імуноцитохімічне дослідження тиреоцитів пунктатів поопераційних реґіонарних метастазів папілярних тиреоїдних карцином із багаторазовим метастазуванням і порівняльний аналіз цитологічних характеристик первинних і повторних поопераційних метастазів у кожного пацієнта. Матеріал і методи. Цитоморфологічні та імуноцитохімічні дослідження з використанням моноклональних антитіл проти тиреоїдної пероксидази, тиреоглобуліну, антигену Кі‑67 проводили на матеріалі тонкоголкових аспіраційних пункційних біопсій 26 метастазів, виявлених у поопераційний період (після проведення тиреоїдектомії та радіойодтерапії), отриманих від 12 хворих на папілярний тиреоїдний рак із багаторазовим метастазуванням. Результати. За результатами дослідження фенотипових характеристик тиреоцитів пунктатів метастазів рецидивуючих папілярних карцином щитоподібної залози з повторним метастазуванням виявлено зміни цитологічних та імуноцитохімічних характеристик тиреоцитів у пунктатах повторних метастазів порівняно з такими первинних метастазів. Показано вірогідне зниження експресії тиреоїдної пероксидази та тиреоглобуліну та появу фенотипової гетерогенності популяції тиреоцитів (світлі клітини, клітини з макулами, оксифільні клітини) повторних метастазів порівняно з первинними. Висновок. У клітинах метастазів рецидивуючих папілярних карцином із повторним метастазуванням виявлено втрату ознак диференціації — вірогідне зниження експресії тиреоїдної пероксидази та тиреоглобуліну та появу фенотипової гетерогенності популяції тиреоцитів.

Autofluorescence in Parathyroidectomy: Signal Intensity Correlates with Serum Calcium and Parathyroid Hormone but Routine Clinical Use is Not Justified

BackgroundThe inability to identify the pathological gland at surgery results in failure to cure hyperparathyroidism in 2–5%. The poorly understood characteristic of parathyroid tissue to manifest autofluorescence (AF) under near-infrared (NIR) light has been promoted as an intraoperative adjunct in parathyroid surgery. This study sought to explore potential clinical correlates for AF and assess the clinical utility of AF in parathyroid surgery.MethodsConsecutive patients undergoing parathyroid surgery for primary and renal disease were included. NIR imaging was used intraoperatively and the degree of AF of parathyroid glands graded by the operating surgeon. Variables assessed for correlation with AF were: pre-operative serum calcium and PTH, SestaMIBI positivity, gland weight and histological composition.ResultsNinety-six patients underwent parathyroidectomy over an 8-month period: 49 bilateral explorations, 41 unilateral and 6 focussed lateral approaches: 284 potentially ‘visualisable’ glands in total. Two hundred and fifty-seven glands (90.5%) were visualised with NIR. Correlation was found between the degree of fluorescence and pre-operative serum calcium and PTH, but not between gland weight and SestaMIBI positivity. In those with renal hyperparathyroidism, a predominance of oxyphil cells correlated with increased AF.ConclusionAutofluorescence intensity correlates with serum calcium, PTH and gland composition. Further refinements would be required for this information to be of value in a clinical setting. Improvements allowing NIR to visualise the additional 9.5% of parathyroids and overcome the variation in signal intensity due to depth of access are required for the routine adoption of this technology. At present, its routine use in a clinical setting cannot be justified.

Relationship between parathyroid gland scintigraphy and its histopathology, oxyphil cell content and volume: a retrospective study.

Mechanisms that are responsible for positive 99mTc-MIBI uptake in parathyroid glands are not clearly understood, some authors suggest there is a correlation between 99mTc MIBI accumulation and oxyphil cell content or parathyroid gland volume. The aim of our work was to assess the relationship between the pathological structure of parathyroids, their volume, oxyphil cell content and parathyroid 99mTc-MIBI retention. A total of 62 hyperfunctioning parathyroid glands in 46 patients were retrospectively analyzed. Preoperative 99mTc-MIBI scintigraphy was performed according to the double-phase and subtraction protocol. After surgery all glands were evaluated histologically, oxyphil cell content was assessed and volume of each excised gland was calculated. Scintigraphy was positive in 41 of 62 parathyroid glands (66%). The median volume of positive glands was larger than that of negative glands (1.33 ml vs 0.7 ml, p = 0.015). Of the parathyroid lesions, there were 14 (22.6%) cases of nodular hyperplasia, 23 (37.1%) cases of diffuse hyperplasia, and 25 (40.3%) cases of adenomas. A high (≥ 25%) oxyphil cell content was found in 16 glands (25.8%) and a low ( < 25%) oxyphil cell content in 46 (74.2%) glands. Histopathology of parathyroid glands was related to the scintigraphy result (p = 0.002), but not to the 99mTc-MIBI uptake pattern (p = 0.868). The overall result of scintigraphy was not related to the oxyphil cell content (p = 0.797). 99mTc-MIBI uptake pattern wasn't related to the oxyphil cell content (p = 0.833). In general, parathyroid lesions with low oxyphil cell content were larger than parathyroid glands with high oxyphil cell content (1.33 ml vs 0.5 ml, respectively; p = 0.01). The median volume of parathyroids containing a high number of oxyphil cells and having a prolonged 99mTc-MIBI retention was larger than those without prolonged 99mTc-MIBI retention (1.62 ml vs 0.3 ml, respectively; p = 0.008). The median volume of parathyroids with low oxyphil cells content and showing prolonged 99mTc-MIBI retention was larger than those without prolonged 99mTc-MIBI retention (1.95 ml vs 1.07 ml, respectively; p = 0.014). Our findings suggest that a positive scintigraphy result depends on parathyroid histopathology and gland volume and does not depend on the presence of oxyphil cells. Prolonged 99mTc-retention is not related to the parathyroid gland histopathology and the presence of oxyphil cells but to the gland volume.

The Emerging Role of Nutritional Vitamin D in Secondary Hyperparathyroidism in CKD.

In chronic kidney disease (CKD), hyperphosphatemia induces fibroblast growth factor-23 (FGF-23) expression that disturbs renal 1,25-dihydroxy vitamin D (1,25D) synthesis; thereby increasing parathyroid hormone (PTH) production. FGF-23 acts on the parathyroid gland (PTG) to increase 1α-hydroxylase activity and results in increase intra-gland 1,25D production that attenuates PTH secretion efficiently if sufficient 25D are available. Interesting, calcimimetics can further increase PTG 1α-hydroxylase activity that emphasizes the demand for nutritional vitamin D (NVD) under high PTH status. In addition, the changes in hydroxylase enzyme activity highlight the greater parathyroid 25-hydroxyvitmain D (25D) requirement in secondary hyperparathyroidism (SHPT); the higher proportion of oxyphil cells as hyperplastic parathyroid progression; lower cytosolic vitamin D binding protein (DBP) content in the oxyphil cell; and calcitriol promote vitamin D degradation are all possible reasons supports nutritional vitamin D (NVD; e.g., Cholecalciferol) supplement is crucial in SHPT. Clinically, NVD can effectively restore serum 25D concentration and prevent the further increase in PTH level. Therefore, NVD might have the benefit of alleviating the development of SHPT in early CKD and further lowering PTH in moderate to severe SHPT in dialysis patients.

Parathyroid Imaging by 18F-Fluorocholine PET/CT in Patients With Primary Hyperparathyroidism and Inconclusive Conventional Methods: Clinico-Pathological Correlations

(18)F-fluorocholine positron emission tomography/computed tomography (FCH) was performed after inconclusive neck ultrasound and (99)Tc-sestaMIBI SPECT (MIBI) scintigraphy in patients with primary hyperparathyroidism (PHPT) to localize abnormal parathyroid glands before surgery. The results were retrospectively evaluated and compared to postoperative histopathological findings. 13 patients with PHPT were enrolled (mean age 64.3 years, preoperative calcium 2.74 mmol/l and parathyroid hormone 114.6 ng/l). FCH localized hyperfunctioning parathyroid glands in 12 patients of 13 (per patient sensitivity 92 % and positive predictive value (PPV) 100 %). Fourteen parathyroid lesions (11 adenomas, 3 hyperplastic glands) were resected with a mean size of 11.9 mm (per lesion sensitivity 93 % and PPV 81 %). Four adenomas and one hyperplastic gland were composed of only chief cells, whereas five lesions contained both chief and oxyphil cells. In three patients an exclusively oxyphil adenoma was found, surprisingly with negative MIBI scintigraphy in spite of a high mitochondria content in the oxyphil parathyroid cells. 12 of 13 patients had thyroid disease. In our limited study sample, FCH correctly identified parathyroid adenomas and/or hyperplastic glands in 92 % of patients with previously inconclusive conventional imaging. Unlike MIBI, FCH successfully localized small, hyperplastic and multiple hyperfunctioning parathyroid glands, irrespective of their histopathological composition.

Re-Evaluation of 162 Malignant Thyroid Nodules that were Interpreted as Benign Based on Ultrasound Findings.

PurposeThe goal of this study was to estimate the risk of malignant thyroid nodules being interpreted as benign based on ultrasound findings and to clarify the pathological features of these malignant nodules.Materials and Methods We retrospectively re-evaluated ultrasound and pathological findings for 162 malignant thyroid nodules that were initially interpreted as benign based on ultrasound findings at Kuma Hospital between April 2012 and June 2015. ResultsThe incidences of malignancy among “benign” thyroid nodules were 0.5% overall and 6.2% among resected nodules. In addition, 82.7% of thyroid nodules that were originally judged to have low or very low suspicion patterns were subsequently re-categorized as having high or intermediate suspicion patterns. The incidences of irregular margins (63.6%) and low echogenicity (36.4%) were higher than those of punctate microcalcification (17.9%) and the taller-than-wide shape (20.4%). Among microcarcinomas, the incidences were 65.7% for irregular margins and 51.4% for low echogenicity. Rim calcification with small extrusive soft tissue components and extrathyroidal extensions were not observed. After re-evaluation, 40.0% of papillary thyroid carcinomas remained benign based on their variants, such as the encapsulated, follicular, macrofollicular, and oxyphilic cell variants.ConclusionWe conclude that more careful observation, especially for lesions with irregular margins and low echogenicity, can help improve the diagnostic accuracy of thyroid ultrasonography. Furthermore, greater care may decrease the incidence of malignancy among thyroid nodules with low or very low suspicion patterns. Some variants of papillary thyroid carcinoma can have benign ultrasound findings.

An Easy and Effective Method to Locate Renal Vein During Retroperitoneal Laparoscopic Radical Nephrectomy: Single-Center Experience.

BackgroundThere are few studies that address how to quickly locate the renal vein after processing the renal artery during retroperitoneal laparoscopic radical nephrectomy (RLRN) for renal cell carcinoma (RCC). This study aimed to evaluate the feasibility of an easy and effective method to locate the renal vein in RLRN.Material/MethodsBetween September 2016 and October 2017, a total of 44 consecutive cases of RLRN were performed. All the surgeries used the proposed study method to locate the renal vein, in which surgeons located the renal artery following the medial arcuate ligament on the posterior abdominal wall, then the surgeon directly searched for the renal vein caudally relative to renal artery when performing left nephrectomy, but cranially when performing right nephrectomy.ResultsAmong the 44 enrolled RLRN patients, there were 28 left nephrectomies and 16 right nephrectomies. We found the renal vein in most cases successfully by our proposed method. The renal vein was located caudally relative to the renal artery in 27 cases of the left kidney (96.4%), and was located cranially in 14 cases of the right kidney (87.5%). The mean operative time was 135.0±27.8 minutes. No intraoperative complications occurred. Postoperative complications (fever) developed in 5 patients. Pathological examination revealed: clear cell carcinoma in 34 cases (77.3%), chromophobe renal cell carcinoma (RCC) in 5 cases (11.4%), papillary RCC in 3 cases (6.8%), multilocular cystic RCC in 1 case (2.3%), and oxyphil cell adenoma in 1 case (2.3%).ConclusionsOur proposed method to search for the renal vein might be a safe and feasible procedure to accelerate the process of handling the renal pedicle and of great practical significance in RLRN surgery.

Are oxyphil cells responsible for the ineffectiveness of cinacalcet hydrochloride in haemodialysis patients?

Parathyroid glands consist primarily of chief cells. In some cases, the proportion of parathyroid oxyphil cells increases in patients with chronic kidney disease. We describe a case of secondary hyperparathyroidism (SHPT) in a patient treated with haemodialysis who initially received large doses of vitamin D and calcium (Ca) supplements, as well as high doses of cinacalcet hydrochloride (C-HCl), but without any effect on parathyroid hormone levels. Following a successful parathyroidectomy, histopathological examination revealed that two of the parathyroid glands consisted of 40% of oxyphil cells. Oxyphil cells have significantly more Ca-sensing receptors (CaSRs) than chief cells, suggesting that CaSRs are involved in the transdifferentiation of chief cells to oxyphil cells. C-HCl treatment leads to a significant increase in parathyroid oxyphil cell content. This case suggests that C-HCl may induce specific phenotypic alterations in hyperplastic parathyroid glands in patients with severe SHPT.

Complementary role of parathormone washout test to 99mTc-MIBI parathyroid scintigraphy and histopathologic analysis of cell types in parathyroid adenomas.

Parathyroid scintigraphy (PS) can be negative or equivocal (N/E) in a considerable number of cases with highly suspicious clinical findings and biochemical results for parathyroid adenoma (PA). The aims of this study were to investigate the complementary role of parathormone washout test (PWT) to PS in patients with primary hyperparathyroidism (PHPT) and evaluate histopathologic aspects of PAs in comparison with PS results. Thirty-eight patients with PHPT referred for PS were included in the study. Seventeen patients had both scintigraphic and ultrasonographic findings concordant with PA (Group A). Twenty-one patients having N/E PS, but suspected lesions for PA on ultrasonography (US) formed Group B. PWT was performed for all patients and they underwent the surgical intervention. An adenoma was removed in all patients and the histopathologic cell characteristics were established. The tumor size on US was larger in those patients whose adenomas were seen on the PS (P<.001). The percentages of chief (or principal), oxyphilic and clear cells in PAs were not statistically different between the groups. Serum parathormone level and PWT were not statistically significant between Group A and Group B (P=.095 and P=.04, respectively). Although there is not a definitive threshold value, the sensitivity of PS increases with lesion size. While chief cell and oxyphilic cell content of PAs tend to deplete in N/E PS, clear cell rate increases substantially. Combining PS with both US and PWT increases the sensitivity of detection and localization of PAs.

Comparative Histopathologic Analysis of "Radiogenic" and "Sporadic" Papillary Thyroid Carcinoma: Patients Born Before and After the Chernobyl Accident.

The issue of whether radiation-induced thyroid cancer is pathologically different from sporadic remains not fully answered. This study compared structural characteristics and invasive features of papillary thyroid carcinoma (PTC) in two age-matched groups: patients who were children (≤4 years old) at the time of the Chernobyl accident and who lived in three regions of Ukraine most contaminated by radioactive iodine 131I ("radiogenic" cancer), and those who lived in the same regions but who were born after 1987 and were not exposed to 131I ("sporadic" cancer). Further, the histopathologic features of PTC were analyzed in relation to age and individual 131I thyroid dose. The study included 301 radiogenic and 194 sporadic PTCs. According to age at surgery, patients were subdivided into children (≤14 years old), adolescents (15-18 years old), and adults (19-28 years old). Statistical analyses included univariate tests and multivariable logistic regression within and across the age subgroups. Analyses of morphological features related to 131I doses were conducted among exposed patients on categorical and continuous scales controlling for sex and age. Among children, radiogenic PTC displayed a significantly higher frequency of tumors with a dominant solid growth pattern, intrathyroidal spread, extrathyroidal extension, lymphatic/vascular invasion, and distant metastases. Exposed adolescents more frequently displayed extrathyroidal extension, lymphatic/vascular invasion, and distant metastases. Exposed adults more frequently had intrathyroidal spread and extrathyroidal extension. The frequency of PTC with dominant papillary pattern and oxyphilic cell metaplasia was significantly lower in radiogenic compared to sporadic tumors for all age groups. Manifestations of tumor aggressiveness were most frequent in children compared to adolescents and adults regardless of etiology. Radiogenic PTC is less likely to demonstrate a dominant papillary growth pattern and more likely to display more aggressive tumor behavior than sporadic PTC. Histopathologic tumor aggressiveness declines with patient age in both radiogenic and sporadic cases.

Alterations of the MT-ATP8 Gene and 9-bp Deletion in Vietnamese Patients with Breast Cancer

Alterations of the MT-ATP8 Gene and 9-bp Deletion in Vietnamese Patients with Breast Cancer

Comparative proteomic analysis of chief and oxyphil cell nodules in refractory uremic hyperparathyroidism by iTRAQ coupled LC-MS/MS

SHPT is one of the most common complications of CKD-MBD. Recent studies indicate that oxyphil cell proliferation is related to SHPT progression, while not inhibited by current treatments. The aim of this study was to analyze the correlation between oxyphil cell and clinical indicators in SHPT, further explore the protein expression differences of oxyphil cell. Among 33 MHD patients, 84.8% patients have one or more oxyphil dominant glands and the overall oxyphil cells proportion was 39.5 ± 16.3%. Univariate correlation and multivariable linear regression model showed that oral calcitriol dosage and treatment duration were independently correlated to oxyphil cell ratio. Proteomic study showed that mitochondrial protein, protein synthesis, and cell cycle regulation were significantly altered in oxyphil cell nodules. DBP was downregulated in oxyphil nodules on protein level, which may contribute to calcitriol resistance by reducing vitamin D transport. Through KEGG and PPI network analysis, Wnt signaling, TGF-β, ubiquitin mediated proteolysis and cell cycle pathways were significantly enriched in oxyphil cell nodules. Among which, MIF-CUL1 axis was significantly increased. These results suggest that the limitations of vitamin D in SHPT treatment is closely related to oxyphil cell and may be attributed to the dysregulation of vitamin D transport and ubiquitin regulation of oxyphil cell. SignificanceSecondary hyperparathyroidism in end stage renal patients is one of the major challenges nephrology field faces. Emerging data indicate that oxyphil cell may participate in the pathophysiology of secondary hyperparathyroidism, while both calcimimetics and vitamin D receptor activators treatments are underperformed in controlling oxyphil cell proliferation. In the present study, we validated that the proliferation of oxyphil cells is associated with calcitriol treatment, and discovered that oxyphil cell nodules were significantly different from chief cells nodules in protein expression of mitochondria, protein synthesis and cell cycle regulation. It is noteworthy that DBP was downregulated in oxyphil nodules on protein level and may therefore participate in the resistance of calcitriol therapy by reducing the vitamin D transport capacity. Wnt signaling, TGF-β, ubiquitin mediated proteolysis and cell cycle pathways were significantly enriched in oxyphil cell nodules, among which, MIF-CUL1 axis may play an important role in the regulation of oxyphil proliferation and calcitriol resistance through ubiquitin mediated proteolysis. These results suggest that calcitriol treatment has limitations in oxyphil cell predominant SHPT, which may be attributed to the dysregulation of vitamin D transport and ubiquitin regulation of oxyphil cell, and the influence of microenvironment in uremia status may be the underlying reason.

Histological and histochemical studies of parathyroid gland in one-humped camel (&lt;i&gt;Camelus dromedarus&lt;/i&gt;)

Thirty one-humped camels were grouped into three: juvenile (Group A), adult (Group B), and old ages (Group C), were used for the study. The camel parathyroid gland tissues were obtained from camels slaughtered at the Kano Metropolitan abattoir. The glands were prepared for standard histological study using haematoxylin and eosin (H and E) stains for light microscopy. For histochemical studies, Periodic Acid Schiff (PAS) special stain was used to demonstrate glycogen and glycoprotein. The results showed that the parathyroid glands are surrounded by a thin capsule of connective tissue. They have abundant stroma of connective tissue, with large smooth muscles all over. The tissue of the parathyroid gland consists of clusters of principal or chief cells. There are two different functional stages of the principal cell. The light principal cell has a large, pale nucleus and pale cytoplasm (described as inactive). The dark principal cell is a smaller cell, with a small, dark nucleus and a dark cytoplasm (active cell). The presence of oxyphil cells was observed. Histochemical studies showed that the tissue of the parathyroid gland in one-humped camel reacted negatively to the Periodic Acid Schiff (PAS) stain. The parathyroid gland consisted of densely packed chief cells (light and dark cells), oxyphil cells, and abundance of adipose cells in the adult male and female. These cells were absent in the younger group, which is generally identical to what is found, specifically, in cows, goats, and in humans, which signifies that one-humped camel can be introduced as an experimental research animal model for human parathyroid gland, in understanding the etiology and possible solution to human parathyroid diseases and osteoporosis. The study of parthyroid gland will enhance the provision of basic and clinical information on endocrinology and related research fields, such as animal breeding and biotechnology in one humped camel.Keywords: Endocrinology, Histochemistry, Parathyroid gland, Principal (chief) cells, One-humped camel