BACKGROUND Cervical haemorrhage due to spontaneous rupture of a parathyroid adenoma is a rare complication that may cause life-threatening acute airway compromise.CASE SUMMARY A 64-year-old woman was admitted to the h...BACKGROUND Cervical haemorrhage due to spontaneous rupture of a parathyroid adenoma is a rare complication that may cause life-threatening acute airway compromise.CASE SUMMARY A 64-year-old woman was admitted to the hospital 1 day after the onset of right neck enlargement, local tenderness, head-turning difficulty, pharyngeal pain, and mild dyspnoea. Repeat routine blood testing showed a rapid decrease in the haemoglobin concentration, indicating active bleeding. Enhanced computed tomography images showed neck haemorrhage and a ruptured right parathyroid adenoma. The plan was to perform emergency neck exploration, haemorrhage removal, and right inferior parathyroidectomy under general anaesthesia. The patient was administered 50 mg of intravenous propofol, and the glottis was successfully visualised on video laryngoscopy. However, after the administration of a muscle relaxant, the glottis was no longer visible and the patient had a difficult airway that prevented mask ventilation and endotracheal intubation. Fortunately, an experienced anaesthesiologist successfully intubated the patient under video laryngoscopy after an emergency laryngeal mask placement. Postoperative pathology showed a parathyroid adenoma with marked bleeding and cystic changes. The patient recovered well without complications.CONCLUSION Airway management is very important in patients with cervical haemorrhage. After the administration of muscle relaxants, the loss of oropharyngeal support can cause acute airway obstruction.Therefore, muscle relaxants should be administered with caution. Anaesthesiologists should pay careful attention to airway management and have alternative airway devices and tracheotomy equipment available.展开更多
We present a case report of a parathyroid adenoma, which presented as a giant cystic neck mass while providing thorough reviews of the pathophysiology of parathyroid adenomas and the differential diagnosis for large, ...We present a case report of a parathyroid adenoma, which presented as a giant cystic neck mass while providing thorough reviews of the pathophysiology of parathyroid adenomas and the differential diagnosis for large, cystic neck masses in adults. A 72 year old female presented to a tertiary academic medical center with a complicated past medical history and was found to have an asymptomatic central neck mass which measured 10.5 × 7.7 × 4.1 cm on ultrasound and extended from the retropharyngeal space with mass effect on the hypopharynx, esophagus, trachea, and right carotid space structures as well as the superior mediastinum. She had elevated calcium and parathyroid hormone (PTH) levels. She underwent surgical excision of this mass and had an uneventful postoperative period. Large cystic neck masses generate a wide differential diagnosis. In adults, it is important to consider the rare possibility of parathyroid adenoma, especially in patients who may not be able to communicate vague symptoms of hypercalcemia. This particular parathyroid adenoma is several orders of magnitude larger than an average parathyroid adenoma and its massive size served as a distraction for the proper diagnosis as large, cystic neck masses in adults are to be considered cancer until proven otherwise.展开更多
BACKGROUND Parathyroid adenoma is a benign parathyroid tumor,with serum parathyroid hormone and calcium ion concentrations as the typical basis for diagnosis.Its clinical manifestations are complex and changeable;thus...BACKGROUND Parathyroid adenoma is a benign parathyroid tumor,with serum parathyroid hormone and calcium ion concentrations as the typical basis for diagnosis.Its clinical manifestations are complex and changeable;thus it is easily missed or misdiagnosed.Approximately 85%of patients with parathyroid adenoma develop primary hyperparathyroidism,and abnormalities in bones,kidneys and other organs can occur.Brown tumors are rare.CASE SUMMARY We report a rare case of fibrocystic osteitis associated with a parathyroid adenoma,which was discovered by chance due to a rib tumor.Abnormally elevated serum parathyroid hormone and calcium ion were found before surgery.We suspected primary hyperparathyroidism,and color Doppler ultrasound suggested the presence of a thyroid mass.With informed consent by the patient and her family,we first removed the rib tumor,and one week later,resection of the parathyroid adenoma and thyroid mass was performed on both sides,and the patient recovered well after surgery.CONCLUSION In the case of parathyroid adenoma combined with brown tumor,the bone cyst will gradually decrease in size with time without treatment.If not,surgery should be performed as soon as possible.展开更多
BACKGROUND There is a common pathologic relationship between parathyroid adenoma and thyroid cancer,but this relationship is infrequent in pregnant patients with primary hyperparathyroidism(PHPT).CASE SUMMARY A 27-yea...BACKGROUND There is a common pathologic relationship between parathyroid adenoma and thyroid cancer,but this relationship is infrequent in pregnant patients with primary hyperparathyroidism(PHPT).CASE SUMMARY A 27-year-old gravida 1 woman was transferred to our hospital at 16 wk of pregnancy.She was diagnosed with parathyroidoma,papillary carcinoma of the thyroid and thyroid adenoma and was managed surgically.Both the mother and the newborn were stable after a right inferior parathyroidectomy and total thyroidectomy.The healthy infant was delivered at the 40th week of pregnancy.The mother had no evidence of recurrence over three years of follow-up.CONCLUSION Awareness of concomitant PHPT and thyroid diseases may help in managing patients with a history of hypercalcemia.展开更多
BACKGROUND Parathyroid adenoma(PA) sometimes recurs after surgery,how to improve the surgical success rate of PA is the key to the treatment of this disease.AIM To investigate the clinical features,diagnosis,and surgi...BACKGROUND Parathyroid adenoma(PA) sometimes recurs after surgery,how to improve the surgical success rate of PA is the key to the treatment of this disease.AIM To investigate the clinical features,diagnosis,and surgical treatment of patients with PA.METHODS Patients who were pathologically confirmed with PA and had undergone surgery for the first time between January 2010 and December 2017 at the Beijing Shijitan Hospital affiliated to Capital Medical University were included in the study.The clinical features,localization diagnosis,and surgical treatment of these patients were analyzed.RESULTS Of the 140 patients,32 were male and 108 were female;132 cases had one adenoma,and 8 had two adenomas.In addition,114 cases had clinical symptoms,among which 51,28,23,8,and 4 had urinary system,skeletal system,digestive system,neuromuscular system,and neuropsychiatric symptoms,respectively,while 26 cases had no obvious symptoms.The median level of preoperative parathyroid hormone(PTH) was 201.0 pg/m L.The positive detection rate of technetium-99m sestamibi(Tc-99m MIBI) single-photon emission computed tomography/computed tomography(SPECT/CT),ultrasound examination,and the combined use of Tc-99m MIBI SPECT/CT and ultrasound examination was 92.9%,85.5%,and 96.4%,respectively.Open surgery was performed in all patients,and PTH was monitored during surgery.The success rate of surgery was 98.6%.After surgery,21 cases developed hypocalcemia,1 case developed temporary hoarseness,and 19 cases had transient hypoparathyroidism but there was no permanent hypoparathyroidism,postoperative hemorrhage,or hematoma in the surgical area.CONCLUSION For patients with clinically unexplained skeletal system,urinary system,and neuropsychiatric symptoms,the possibility of PA should be considered.Imaging examinations such as ultrasound and Tc-99m MIBI SPECT/CT could be integrated before surgery to obtain accurate localization diagnosis.Precise preoperative localization,intraoperative PTH monitoring,and delicate surgery to protect the integrity of the PA capsule ensure a minimally invasive and successful surgery.展开更多
<strong>Objective:</strong> To compare the clinical efficacy and safety of ultrasound-guided microwave ablation with surgery for the treatment of primary parathyroid adenoma. <strong>Methods:</str...<strong>Objective:</strong> To compare the clinical efficacy and safety of ultrasound-guided microwave ablation with surgery for the treatment of primary parathyroid adenoma. <strong>Methods:</strong> The clinical data of patients with primary parathyroid adenoma admitted to the First Hospital of Yangtze University from January 2010 to May 2020 were retrospectively analyzed, and they were divided into 43 cases in the microwave ablation group (MWA) and 39 cases in the surgical procedure group (SR) according to the different treatment methods. The surgical condition, postoperative complications, and changes in serum parathyroid hormone (PTH) and serum calcium and phosphorus levels were analyzed in both groups. <strong>Results:</strong> The hospital stay and operation time of patients in the microwave ablation group were shorter than those in the surgical group, and the intraoperative bleeding was significantly less than that in the surgical group (P < 0.05);the serum parathyroid hormone (PTH), blood calcium and blood phosphorus levels of patients in both groups were significantly lower than those before treatment (P < 0.05) after surgery of 1, 3 and 6 months respectively, and the differences between groups were not statistically significant (P > 0.05). There was no statistically significant difference in the incidence of postoperative complications between the two groups (P > 0.05). <strong>Conclusion: </strong>Microwave ablation can achieve the same therapeutic effect as surgery. It is a safe and feasible clinical technique worthy of clinical promotion with its short hospitalization time, less bleeding and less trauma.展开更多
Primary hyperparathyroidism(PHPT) is rare during pregnancy. A case of twin pregnancy with three simultaneous parathyroid adenomas at the same time has not been reported. Multiple parathyroid lesions are difficult to d...Primary hyperparathyroidism(PHPT) is rare during pregnancy. A case of twin pregnancy with three simultaneous parathyroid adenomas at the same time has not been reported. Multiple parathyroid lesions are difficult to diagnose, as pregnant women who insist upon continuing a pregnancy are not able to undergo 99mTc-sestamibi scintigraphy, so cases of PHPT are easily unobserved and often can have serious consequences for the patient and the fetus. Therefore, we reported a case of a 28-year-old woman mid-pregnancy with twins, who had hypercalcemia and was eventually diagnosed with twin pregnancy with PHPT due to a triple parathyroid adenoma, had good pregnancy outcomes after undergoing surgery in mid-pregnancy. Twin pregnancy with PHPT due to a triple parathyroid adenoma, as presented in this case, is very rare and surgery in mid-pregnancy is demonstrated here as safe. Intraoperative parathormone monitoring was and remains key to a successful operation.展开更多
Introduction: In 85% of patients, the cause of Primary Hyperparathyroidism (PHPT) is an adenoma. Parathyroid adenoma localization is usually simple. 96% of localizations prior to surgery are achieved with ultrasound a...Introduction: In 85% of patients, the cause of Primary Hyperparathyroidism (PHPT) is an adenoma. Parathyroid adenoma localization is usually simple. 96% of localizations prior to surgery are achieved with ultrasound and scintigraphy combination. Difficulties can appear. If the gland is not located in a cervical position and has no uptake in scintigraphy but there is high suspition of an adenoma causing the PHPT, some extra tests should be considered. Case Report: We present a case of giant cystic mediastinal adenoma, a quite rare condition, which was diagnosed as a thyroid colloid cyst by ultrasound, and was not localized by scintigraphy. We report the CT scan and the magnetic resonance imaging (MRI) images that show the tumour. It was surgically resected by a cervical approach. After the excision, the patient recovered normal levels of Calcium and Parathormone (PTH). Conclusion: We review literature about cystic and mediastinal adenomas and diagnostic methods when the standard ones do not give an accurate localization diagnosis.展开更多
Introduction: Mediastinal parathyroid adenoma localization is a rare entity. We report a case of excision by manubriotomy of intrathymic parathyroid adenoma detected by Computed Tomography scan of the chest and neck a...Introduction: Mediastinal parathyroid adenoma localization is a rare entity. We report a case of excision by manubriotomy of intrathymic parathyroid adenoma detected by Computed Tomography scan of the chest and neck and confirmed by Technetium-99 m-sestamibi scan (99 mTc-MIBI). Case Presentation: A 68 years old woman with history of hypercalcaemia, PTH elevation and operation for pathological fracture of the left femur 7 days before was presented to our service. The patient underwent manubriotomy and the adenoma was found within the right lobe of the thymus gland. Conclusion: The Technetium-99 m-sestamibi scan evaluation can be useful in the preoperative localization of ectopic parathyroid adenomas. The surgical approach by manubriotomy is privileged when the ectopic adenoma is in the upper part of anterior mediastinum.展开更多
Parathyroid adenoma classically presents symptoms of hypercalcaemia. Here, we present a case of a rare presentation of a parathyroid adenoma in a young male patient with a pathological fracture.
BACKGROUND No studies have yet been conducted on changes in microcirculatory hemody-namics of colorectal adenomas in vivo under endoscopy.The microcirculation of the colorectal adenoma could be observed in vivo by a n...BACKGROUND No studies have yet been conducted on changes in microcirculatory hemody-namics of colorectal adenomas in vivo under endoscopy.The microcirculation of the colorectal adenoma could be observed in vivo by a novel high-resolution magnification endoscopy with blue laser imaging(BLI),thus providing a new insight into the microcirculation of early colon tumors.AIM To observe the superficial microcirculation of colorectal adenomas using the novel magnifying colonoscope with BLI and quantitatively analyzed the changes in hemodynamic parameters.METHODS From October 2019 to January 2020,11 patients were screened for colon adenomas with the novel high-resolution magnification endoscope with BLI.Video images were recorded and processed with Adobe Premiere,Adobe Photoshop and Image-pro Plus software.Four microcirculation parameters:Microcirculation vessel density(MVD),mean vessel width(MVW)with width standard deviation(WSD),and blood flow velocity(BFV),were calculated for adenomas and the surrounding normal mucosa.RESULTS A total of 16 adenomas were identified.Compared with the normal surrounding mucosa,the superficial vessel density in the adenomas was decreased(MVD:0.95±0.18 vs 1.17±0.28μm/μm2,P<0.05).MVW(5.11±1.19 vs 4.16±0.76μm,P<0.05)and WSD(11.94±3.44 vs 9.04±3.74,P<0.05)were both increased.BFV slowed in the adenomas(709.74±213.28 vs 1256.51±383.31μm/s,P<0.05).CONCLUSION The novel high-resolution magnification endoscope with BLI can be used for in vivo study of adenoma superficial microcirculation.Superficial vessel density was decreased,more irregular,with slower blood flow.展开更多
BACKGROUND The incidence and mortality of colorectal cancer(CRC)are among the highest in the world,and its occurrence and development are closely related to tumor neovascularization.When the balance between pigment ep...BACKGROUND The incidence and mortality of colorectal cancer(CRC)are among the highest in the world,and its occurrence and development are closely related to tumor neovascularization.When the balance between pigment epithelium-derived factors(PEDF)that inhibit angiogenesis and vascular endothelial growth factors(VEGF)that stimulate angiogenesis is broken,angiogenesis is out of control,resulting in tumor development.Therefore,it is very necessary to find more therapeutic targets for CRC for early intervention and later treatment.AIM To investigate the expression and significance of PEDF,VEGF,and CD31-stained microvessel density values(CD31-MVD)in normal colorectal mucosa,adenoma,and CRC.METHODS In this case-control study,we collected archived wax blocks of specimens from the Digestive Endoscopy Center and the General Surgery Department of Chengdu Second People's Hospital from April 2022 to October 2022.Fifty cases of specimen wax blocks were selected as normal intestinal mucosa confirmed by electronic colonoscopy and concurrent biopsy(normal control group),50 cases of specimen wax blocks were selected as colorectal adenoma confirmed by electronic colonoscopy and pathological biopsy(adenoma group),and 50 cases of specimen wax blocks were selected as CRC confirmed by postoperative pathological biopsy after inpatient operation of general surgery(CRC group).An immunohistochemical staining experiment was carried out to detect PEDF and VEGF expression in three groups of specimens,analyze their differences,study the relationship between the two and clinicopathological factors in CRC group,record CD31-MVD in the three groups,and analyze the correlation of PEDF,VEGF,and CD31-MVD in the colorectal adenoma group and the CRC group.The F test or adjusted F test is used to analyze measurement data statistically.Kruskal-Wallis rank sum test was used between groups for ranked data.The chi-square test,adjusted chi-square test,or Fisher's exact test were used to compare the rates between groups.All differences between groups were compared using the Bonferroni method for multiple comparisons.Spearman correlation analysis was used to test the correlation of the data.The test level(α)was 0.05,and a two-sided P<0.05 was considered statistically significant.RESULTS The positive expression rate and expression intensity of PEDF were gradually decreased in the normal control group,adenoma group,and CRC group(100%vs 78%vs 50%,χ^(2)=34.430,P<0.001;++~++vs+~++vs-~+,H=94.059,P<0.001),while VEGF increased gradually(0%vs 68%vs 96%,χ^(2)=98.35,P<0.001;-vs-~+vs++~+++,H=107.734,P<0.001).In the CRC group,the positive expression rate of PEDF decreased with the increase of differen-tiation degree,invasion depth,lymph node metastasis,distant metastasis,and TNM stage(χ^(2)=20.513,4.160,5.128,6.349,5.128,P<0.05);the high expression rate of VEGF was the opposite(χ^(2)=10.317,13.134,17.643,21.844,17.643,P<0.05).In the colorectal adenoma group,the expression intensity of PEDF correlated negatively with CD31-MVD(r=-0.601,P<0.001),whereas VEGF was not significantly different(r=0.258,P=0.07).In the CRC group,the expression intensity of PEDF correlated negatively with the expression intensity of CD31-MVD and VEGF(r=-0.297,P<0.05;r=-0.548,P<0.05),while VEGF expression intensity was positively related to CD31-MVD(r=0.421,P=0.002).CONCLUSION It is possible that PEDF can be used as a new treatment and prevention target for CRC by upregulating the expression of PEDF while inhibiting the expression of VEGF.展开更多
Background: The simultaneous presence of a pituitary adenoma and a meningioma is a rare and underreported condition. The randomly encountered cases need to be reported to further allow our understanding of this collis...Background: The simultaneous presence of a pituitary adenoma and a meningioma is a rare and underreported condition. The randomly encountered cases need to be reported to further allow our understanding of this collision tumors that are still not understood nor fully described. Patients and Method: We report a case of coexisting nonfunctioning pituitary adenoma and a left temporal lobe meningioma revealed by a 1-year history of progressive vision loss and occasional headaches in a 56-year-old woman. Her clinical condition worsened in the last 5 months with ptosis, cavernous sinus syndrome, and ophthalmoplegia of the right eye without papilledema. There was an improvement in the visual symptoms after subtotal resection of both lesions through a right frontotemporal craniotomy. Histology confirmed a collision tumor. The patient was referred for adjuvant treatment with gamma knife radiosurgery. He was doing well and back to his usual duties 6 months later. Conclusion: A gross total or subtotal resection with adjuvant therapy is the gold standard for the surgical management of collision tumors for a favorable patient outcome.展开更多
Background: As the half-life of intact parathyroid hormone (iPTH) is very low, it reflects parathyroid insufficiency within minutes to hours after total thyroidectomy. Therefore, iPTH level assessment in the postopera...Background: As the half-life of intact parathyroid hormone (iPTH) is very low, it reflects parathyroid insufficiency within minutes to hours after total thyroidectomy. Therefore, iPTH level assessment in the postoperative period can be used to predict the development of hypocalcaemia. The optimal time point to measure serum iPTH is important for the accurate prediction of hypocalcaemia. Aim: This paper aims to evaluate the ability of iPTH as an early predictive marker of hypocalcaemia and determine which time iPTH is more able to predict postoperative hypocalcaemia. Method: This prospective observational study was conducted in the Department of Otolaryngology-Head & Neck Surgery, BSMMU, Dhaka, from July 2020 to December 2021, with 67 patients who underwent total thyroidectomy. iPTH levels were measured on the day before the operation and at 1 hour, 4 hours, and 24 hours after the operation. S.calcium levels were measured on the day before the operation and 1<sup>st</sup> postoperative day. All the data were compiled and sorted properly and were analyzed statistically. Results: Postoperative hypocalcaemia developed in 18 cases, with an incidence of 26.9%. Pearson correlation showed a significant correlation between postoperative iPTH at 1 hr, 4 h, and 24 hr with 1st postoperative calcium value. The Receiver operating characteristic (ROC) curve was processed for the postoperative iPTH at 1 hr, 4 h, and 24 hr. The sensitivity, specificity, cut-off value, and mean AUC found 93.9%, 94.4%, ≤14.0, 0.988;95.9%, 94.4%, ≤09.5, 0.993 and 91.8%, 94.4%, ≤11.0, 0.993 respectively. Conclusion: iPTH can be used as an early predictor of post-thy-roidectomy hypocalcaemia. 4 hr iPTH showed more sensitivity and specificity for a cut-off value near the laboratory reference range.展开更多
BACKGROUND Parathyroid carcinoma(PC)is a rare,slow-growing malignant tumor and a rare cause of primary hyperfunctioning of the parathyroid,with a highly variable clinical course,depending on the aggressiveness of the ...BACKGROUND Parathyroid carcinoma(PC)is a rare,slow-growing malignant tumor and a rare cause of primary hyperfunctioning of the parathyroid,with a highly variable clinical course,depending on the aggressiveness of the individual tumor and the degree of hypercalcemia.CASE SUMMARY The aim of this report is to summarize the diagnosis and treatment of three cases of PC and to review and conclude aspects regarding the three collected cases with reference to other relevant cases to explore the value of ultrasound in the diagnosis of PC.All three patients had hypercalcemia,consisting of a high serum calcium level and a high level of parathyroid hormone that was>2-fold(even>30-fold)of the normal upper limit.The ultrasonographic findings of the parathyroid gland showed that the glands were all>30 mm,and the internal echo was uneven.All patients underwent surgery.PC in three cases was confirmed by routine histopathology and immunohistochemistry.CONCLUSION As clinical signs and laboratory results are nonspecific,it is difficult to diagnose PC preoperatively,so imaging examinations are often needed.展开更多
The goal of parathyroid imaging in hyperparathyroidism is not diagnosis,rather it is the localization of the cause of hyperparathyroidism for planning the best therapeutic approach.Hence,the role of imaging to accurat...The goal of parathyroid imaging in hyperparathyroidism is not diagnosis,rather it is the localization of the cause of hyperparathyroidism for planning the best therapeutic approach.Hence,the role of imaging to accurately and precisely localize the abnormal parathyroid tissue is more important than ever to facilitate minimally invasive parathyroidectomy over bilateral neck exploration.The common causes include solitary parathyroid adenoma,multiple parathyroid adenomas,parathyroid hyperplasia and parathyroid carcinoma.It is highly imperative for the radiologist to be cautious of the mimics of parathyroid lesions like thyroid nodules and lymph nodes and be able to differentiate them on imaging.The various imaging modalities available include high resolution ultrasound of the neck,nuclear imaging studies,four-dimensional computed tomography(4D CT)and magnetic resonance imaging.Contrast enhanced ultrasound is a novel technique which has been recently added to the armam-entarium to differentiate between parathyroid adenomas and its mimics.Through this review article we wish to review the imaging features of parathyroid lesions on various imaging modalities and present an algorithm to guide their radiological differentiation from mimics.展开更多
BACKGROUND Pituitary apoplexy represents one of the most serious,life threatening endocrine emergencies that requires immediate management.Gonadotropin-releasing hormone agonist(GnRHa)can induce pituitary apoplexy in ...BACKGROUND Pituitary apoplexy represents one of the most serious,life threatening endocrine emergencies that requires immediate management.Gonadotropin-releasing hormone agonist(GnRHa)can induce pituitary apoplexy in those patients who have insidious pituitary adenoma coincidentally.CASE SUMMARY A 46-year-old woman,with a history of hypertension and menorrhagia was transferred to our hospital from a secondary care hospital after complaints of headache and vomiting,with loss of consciousness 5 min after an injection of GnRHa.The drug was prescribed by her gynecologist due to the presence of uterine myomas.The clinical neurological examination revealed right cranial nerve III palsy,ptosis and movement limitation of the right eye.Our first clinical consideration was a pituitary apoplexy.Blood hormonal analysis revealed mild hyperprolactinemia and high follicle stimulating hormone level;PTH and calcium was high with glomerular filtration rate mildly to moderately decrease.A computed tomography scan,revealed an enlarged pituitary gland(3.5 cm)impinging upon the optic chiasm with bone involvement of the sella.Following contrast media administration,the lesion showed homogeneous enhancement with high-density focus that suggests hemorrhagic infarction of the tumor.Transsphenoidal endoscopic surgery was perfomed and adenomatous tissue was removed.Immunohistochemistry was positive for luteinizing hormone(LH)and follicular-stimulating hormone(FSH).A solid hypoechoic nodule(14 mm x 13 mm x 16 mm)was found in the caudal portion of the right thyroid lobe after a parathyroid ultrasound.A genetic test of Multiple Endocrine Neoplasia type 1(MEN1)was negative.A right lower parathyroidectomy was performed and the pathologic study showed the presence of an encapsulated parathyroid carcinoma of 1.5 cm.A MEN type 4 genetic test was performed result was negative.CONCLUSION This case demonstrates an uncommon complication of GnRH agonist therapy in the setting of a pituitary macroadenoma and the casual finding of parathyroid carcinoma.It also highlights the importance of suspecting the presence of a multiple endocrine neoplasia syndrome and to carry out relevant genetic studies.展开更多
Pleomorphic adenoma(PA)is the most common benign tumour in the salivary gland and has high morphological complexity.However,the origin and intratumoral heterogeneity of PA are largely unknown.Here,we constructed a com...Pleomorphic adenoma(PA)is the most common benign tumour in the salivary gland and has high morphological complexity.However,the origin and intratumoral heterogeneity of PA are largely unknown.Here,we constructed a comprehensive atlas of PA at single-cell resolution and showed that PA exhibited five tumour subpopulations,three recapitulating the epithelial states of the normal parotid gland,and two PA-specific epithelial cell(PASE)populations unique to tumours.Then,six subgroups of PASE cells were identified,which varied in epithelium,bone,immune,metabolism,stemness and cell cycle signatures.Moreover,we revealed that CD36+myoepithelial cells were the tumour-initiating cells(TICs)in PA,and were dominated by the PI3K-AKT pathway.Targeting the PI3K-AKT pathway significantly inhibited CD36+myoepithelial cell-derived tumour spheres and the growth of PA organoids.Our results provide new insights into the diversity and origin of PA,offering an important clinical implication for targeting the PI3K-AKT signalling pathway in PA treatment.展开更多
基金Supported by Key Clinical Projects of Peking University Third Hospital,No. BYSYZD2021013Beijing Haidian District Innovation and transformation project,No. HDCXZHZB2021202。
文摘BACKGROUND Cervical haemorrhage due to spontaneous rupture of a parathyroid adenoma is a rare complication that may cause life-threatening acute airway compromise.CASE SUMMARY A 64-year-old woman was admitted to the hospital 1 day after the onset of right neck enlargement, local tenderness, head-turning difficulty, pharyngeal pain, and mild dyspnoea. Repeat routine blood testing showed a rapid decrease in the haemoglobin concentration, indicating active bleeding. Enhanced computed tomography images showed neck haemorrhage and a ruptured right parathyroid adenoma. The plan was to perform emergency neck exploration, haemorrhage removal, and right inferior parathyroidectomy under general anaesthesia. The patient was administered 50 mg of intravenous propofol, and the glottis was successfully visualised on video laryngoscopy. However, after the administration of a muscle relaxant, the glottis was no longer visible and the patient had a difficult airway that prevented mask ventilation and endotracheal intubation. Fortunately, an experienced anaesthesiologist successfully intubated the patient under video laryngoscopy after an emergency laryngeal mask placement. Postoperative pathology showed a parathyroid adenoma with marked bleeding and cystic changes. The patient recovered well without complications.CONCLUSION Airway management is very important in patients with cervical haemorrhage. After the administration of muscle relaxants, the loss of oropharyngeal support can cause acute airway obstruction.Therefore, muscle relaxants should be administered with caution. Anaesthesiologists should pay careful attention to airway management and have alternative airway devices and tracheotomy equipment available.
文摘We present a case report of a parathyroid adenoma, which presented as a giant cystic neck mass while providing thorough reviews of the pathophysiology of parathyroid adenomas and the differential diagnosis for large, cystic neck masses in adults. A 72 year old female presented to a tertiary academic medical center with a complicated past medical history and was found to have an asymptomatic central neck mass which measured 10.5 × 7.7 × 4.1 cm on ultrasound and extended from the retropharyngeal space with mass effect on the hypopharynx, esophagus, trachea, and right carotid space structures as well as the superior mediastinum. She had elevated calcium and parathyroid hormone (PTH) levels. She underwent surgical excision of this mass and had an uneventful postoperative period. Large cystic neck masses generate a wide differential diagnosis. In adults, it is important to consider the rare possibility of parathyroid adenoma, especially in patients who may not be able to communicate vague symptoms of hypercalcemia. This particular parathyroid adenoma is several orders of magnitude larger than an average parathyroid adenoma and its massive size served as a distraction for the proper diagnosis as large, cystic neck masses in adults are to be considered cancer until proven otherwise.
文摘BACKGROUND Parathyroid adenoma is a benign parathyroid tumor,with serum parathyroid hormone and calcium ion concentrations as the typical basis for diagnosis.Its clinical manifestations are complex and changeable;thus it is easily missed or misdiagnosed.Approximately 85%of patients with parathyroid adenoma develop primary hyperparathyroidism,and abnormalities in bones,kidneys and other organs can occur.Brown tumors are rare.CASE SUMMARY We report a rare case of fibrocystic osteitis associated with a parathyroid adenoma,which was discovered by chance due to a rib tumor.Abnormally elevated serum parathyroid hormone and calcium ion were found before surgery.We suspected primary hyperparathyroidism,and color Doppler ultrasound suggested the presence of a thyroid mass.With informed consent by the patient and her family,we first removed the rib tumor,and one week later,resection of the parathyroid adenoma and thyroid mass was performed on both sides,and the patient recovered well after surgery.CONCLUSION In the case of parathyroid adenoma combined with brown tumor,the bone cyst will gradually decrease in size with time without treatment.If not,surgery should be performed as soon as possible.
文摘BACKGROUND There is a common pathologic relationship between parathyroid adenoma and thyroid cancer,but this relationship is infrequent in pregnant patients with primary hyperparathyroidism(PHPT).CASE SUMMARY A 27-year-old gravida 1 woman was transferred to our hospital at 16 wk of pregnancy.She was diagnosed with parathyroidoma,papillary carcinoma of the thyroid and thyroid adenoma and was managed surgically.Both the mother and the newborn were stable after a right inferior parathyroidectomy and total thyroidectomy.The healthy infant was delivered at the 40th week of pregnancy.The mother had no evidence of recurrence over three years of follow-up.CONCLUSION Awareness of concomitant PHPT and thyroid diseases may help in managing patients with a history of hypercalcemia.
文摘BACKGROUND Parathyroid adenoma(PA) sometimes recurs after surgery,how to improve the surgical success rate of PA is the key to the treatment of this disease.AIM To investigate the clinical features,diagnosis,and surgical treatment of patients with PA.METHODS Patients who were pathologically confirmed with PA and had undergone surgery for the first time between January 2010 and December 2017 at the Beijing Shijitan Hospital affiliated to Capital Medical University were included in the study.The clinical features,localization diagnosis,and surgical treatment of these patients were analyzed.RESULTS Of the 140 patients,32 were male and 108 were female;132 cases had one adenoma,and 8 had two adenomas.In addition,114 cases had clinical symptoms,among which 51,28,23,8,and 4 had urinary system,skeletal system,digestive system,neuromuscular system,and neuropsychiatric symptoms,respectively,while 26 cases had no obvious symptoms.The median level of preoperative parathyroid hormone(PTH) was 201.0 pg/m L.The positive detection rate of technetium-99m sestamibi(Tc-99m MIBI) single-photon emission computed tomography/computed tomography(SPECT/CT),ultrasound examination,and the combined use of Tc-99m MIBI SPECT/CT and ultrasound examination was 92.9%,85.5%,and 96.4%,respectively.Open surgery was performed in all patients,and PTH was monitored during surgery.The success rate of surgery was 98.6%.After surgery,21 cases developed hypocalcemia,1 case developed temporary hoarseness,and 19 cases had transient hypoparathyroidism but there was no permanent hypoparathyroidism,postoperative hemorrhage,or hematoma in the surgical area.CONCLUSION For patients with clinically unexplained skeletal system,urinary system,and neuropsychiatric symptoms,the possibility of PA should be considered.Imaging examinations such as ultrasound and Tc-99m MIBI SPECT/CT could be integrated before surgery to obtain accurate localization diagnosis.Precise preoperative localization,intraoperative PTH monitoring,and delicate surgery to protect the integrity of the PA capsule ensure a minimally invasive and successful surgery.
文摘<strong>Objective:</strong> To compare the clinical efficacy and safety of ultrasound-guided microwave ablation with surgery for the treatment of primary parathyroid adenoma. <strong>Methods:</strong> The clinical data of patients with primary parathyroid adenoma admitted to the First Hospital of Yangtze University from January 2010 to May 2020 were retrospectively analyzed, and they were divided into 43 cases in the microwave ablation group (MWA) and 39 cases in the surgical procedure group (SR) according to the different treatment methods. The surgical condition, postoperative complications, and changes in serum parathyroid hormone (PTH) and serum calcium and phosphorus levels were analyzed in both groups. <strong>Results:</strong> The hospital stay and operation time of patients in the microwave ablation group were shorter than those in the surgical group, and the intraoperative bleeding was significantly less than that in the surgical group (P < 0.05);the serum parathyroid hormone (PTH), blood calcium and blood phosphorus levels of patients in both groups were significantly lower than those before treatment (P < 0.05) after surgery of 1, 3 and 6 months respectively, and the differences between groups were not statistically significant (P > 0.05). There was no statistically significant difference in the incidence of postoperative complications between the two groups (P > 0.05). <strong>Conclusion: </strong>Microwave ablation can achieve the same therapeutic effect as surgery. It is a safe and feasible clinical technique worthy of clinical promotion with its short hospitalization time, less bleeding and less trauma.
基金Supported by the Key Project of Scientific and Technological Innovation in Hangzhou,NO.20131813A08the Key Project of Medical Scientific and Technology Program in Hangzhou,NO.2013Z04+1 种基金the Traditional Chinese Medical Science Research Program of Zhejiang Province,NO.2018239534the Applied Research Project of Commonweal Technology in Zhejiang Province,NO.2017C33180
文摘Primary hyperparathyroidism(PHPT) is rare during pregnancy. A case of twin pregnancy with three simultaneous parathyroid adenomas at the same time has not been reported. Multiple parathyroid lesions are difficult to diagnose, as pregnant women who insist upon continuing a pregnancy are not able to undergo 99mTc-sestamibi scintigraphy, so cases of PHPT are easily unobserved and often can have serious consequences for the patient and the fetus. Therefore, we reported a case of a 28-year-old woman mid-pregnancy with twins, who had hypercalcemia and was eventually diagnosed with twin pregnancy with PHPT due to a triple parathyroid adenoma, had good pregnancy outcomes after undergoing surgery in mid-pregnancy. Twin pregnancy with PHPT due to a triple parathyroid adenoma, as presented in this case, is very rare and surgery in mid-pregnancy is demonstrated here as safe. Intraoperative parathormone monitoring was and remains key to a successful operation.
文摘Introduction: In 85% of patients, the cause of Primary Hyperparathyroidism (PHPT) is an adenoma. Parathyroid adenoma localization is usually simple. 96% of localizations prior to surgery are achieved with ultrasound and scintigraphy combination. Difficulties can appear. If the gland is not located in a cervical position and has no uptake in scintigraphy but there is high suspition of an adenoma causing the PHPT, some extra tests should be considered. Case Report: We present a case of giant cystic mediastinal adenoma, a quite rare condition, which was diagnosed as a thyroid colloid cyst by ultrasound, and was not localized by scintigraphy. We report the CT scan and the magnetic resonance imaging (MRI) images that show the tumour. It was surgically resected by a cervical approach. After the excision, the patient recovered normal levels of Calcium and Parathormone (PTH). Conclusion: We review literature about cystic and mediastinal adenomas and diagnostic methods when the standard ones do not give an accurate localization diagnosis.
文摘Introduction: Mediastinal parathyroid adenoma localization is a rare entity. We report a case of excision by manubriotomy of intrathymic parathyroid adenoma detected by Computed Tomography scan of the chest and neck and confirmed by Technetium-99 m-sestamibi scan (99 mTc-MIBI). Case Presentation: A 68 years old woman with history of hypercalcaemia, PTH elevation and operation for pathological fracture of the left femur 7 days before was presented to our service. The patient underwent manubriotomy and the adenoma was found within the right lobe of the thymus gland. Conclusion: The Technetium-99 m-sestamibi scan evaluation can be useful in the preoperative localization of ectopic parathyroid adenomas. The surgical approach by manubriotomy is privileged when the ectopic adenoma is in the upper part of anterior mediastinum.
文摘Parathyroid adenoma classically presents symptoms of hypercalcaemia. Here, we present a case of a rare presentation of a parathyroid adenoma in a young male patient with a pathological fracture.
基金This study was approved by the Medical Ethics Committee of Beijing Tsinghua Changgung Hospital(20002-0-02).
文摘BACKGROUND No studies have yet been conducted on changes in microcirculatory hemody-namics of colorectal adenomas in vivo under endoscopy.The microcirculation of the colorectal adenoma could be observed in vivo by a novel high-resolution magnification endoscopy with blue laser imaging(BLI),thus providing a new insight into the microcirculation of early colon tumors.AIM To observe the superficial microcirculation of colorectal adenomas using the novel magnifying colonoscope with BLI and quantitatively analyzed the changes in hemodynamic parameters.METHODS From October 2019 to January 2020,11 patients were screened for colon adenomas with the novel high-resolution magnification endoscope with BLI.Video images were recorded and processed with Adobe Premiere,Adobe Photoshop and Image-pro Plus software.Four microcirculation parameters:Microcirculation vessel density(MVD),mean vessel width(MVW)with width standard deviation(WSD),and blood flow velocity(BFV),were calculated for adenomas and the surrounding normal mucosa.RESULTS A total of 16 adenomas were identified.Compared with the normal surrounding mucosa,the superficial vessel density in the adenomas was decreased(MVD:0.95±0.18 vs 1.17±0.28μm/μm2,P<0.05).MVW(5.11±1.19 vs 4.16±0.76μm,P<0.05)and WSD(11.94±3.44 vs 9.04±3.74,P<0.05)were both increased.BFV slowed in the adenomas(709.74±213.28 vs 1256.51±383.31μm/s,P<0.05).CONCLUSION The novel high-resolution magnification endoscope with BLI can be used for in vivo study of adenoma superficial microcirculation.Superficial vessel density was decreased,more irregular,with slower blood flow.
基金The study was approved by the Ethics Committee of the Second People's Hospital of Chengdu.
文摘BACKGROUND The incidence and mortality of colorectal cancer(CRC)are among the highest in the world,and its occurrence and development are closely related to tumor neovascularization.When the balance between pigment epithelium-derived factors(PEDF)that inhibit angiogenesis and vascular endothelial growth factors(VEGF)that stimulate angiogenesis is broken,angiogenesis is out of control,resulting in tumor development.Therefore,it is very necessary to find more therapeutic targets for CRC for early intervention and later treatment.AIM To investigate the expression and significance of PEDF,VEGF,and CD31-stained microvessel density values(CD31-MVD)in normal colorectal mucosa,adenoma,and CRC.METHODS In this case-control study,we collected archived wax blocks of specimens from the Digestive Endoscopy Center and the General Surgery Department of Chengdu Second People's Hospital from April 2022 to October 2022.Fifty cases of specimen wax blocks were selected as normal intestinal mucosa confirmed by electronic colonoscopy and concurrent biopsy(normal control group),50 cases of specimen wax blocks were selected as colorectal adenoma confirmed by electronic colonoscopy and pathological biopsy(adenoma group),and 50 cases of specimen wax blocks were selected as CRC confirmed by postoperative pathological biopsy after inpatient operation of general surgery(CRC group).An immunohistochemical staining experiment was carried out to detect PEDF and VEGF expression in three groups of specimens,analyze their differences,study the relationship between the two and clinicopathological factors in CRC group,record CD31-MVD in the three groups,and analyze the correlation of PEDF,VEGF,and CD31-MVD in the colorectal adenoma group and the CRC group.The F test or adjusted F test is used to analyze measurement data statistically.Kruskal-Wallis rank sum test was used between groups for ranked data.The chi-square test,adjusted chi-square test,or Fisher's exact test were used to compare the rates between groups.All differences between groups were compared using the Bonferroni method for multiple comparisons.Spearman correlation analysis was used to test the correlation of the data.The test level(α)was 0.05,and a two-sided P<0.05 was considered statistically significant.RESULTS The positive expression rate and expression intensity of PEDF were gradually decreased in the normal control group,adenoma group,and CRC group(100%vs 78%vs 50%,χ^(2)=34.430,P<0.001;++~++vs+~++vs-~+,H=94.059,P<0.001),while VEGF increased gradually(0%vs 68%vs 96%,χ^(2)=98.35,P<0.001;-vs-~+vs++~+++,H=107.734,P<0.001).In the CRC group,the positive expression rate of PEDF decreased with the increase of differen-tiation degree,invasion depth,lymph node metastasis,distant metastasis,and TNM stage(χ^(2)=20.513,4.160,5.128,6.349,5.128,P<0.05);the high expression rate of VEGF was the opposite(χ^(2)=10.317,13.134,17.643,21.844,17.643,P<0.05).In the colorectal adenoma group,the expression intensity of PEDF correlated negatively with CD31-MVD(r=-0.601,P<0.001),whereas VEGF was not significantly different(r=0.258,P=0.07).In the CRC group,the expression intensity of PEDF correlated negatively with the expression intensity of CD31-MVD and VEGF(r=-0.297,P<0.05;r=-0.548,P<0.05),while VEGF expression intensity was positively related to CD31-MVD(r=0.421,P=0.002).CONCLUSION It is possible that PEDF can be used as a new treatment and prevention target for CRC by upregulating the expression of PEDF while inhibiting the expression of VEGF.
文摘Background: The simultaneous presence of a pituitary adenoma and a meningioma is a rare and underreported condition. The randomly encountered cases need to be reported to further allow our understanding of this collision tumors that are still not understood nor fully described. Patients and Method: We report a case of coexisting nonfunctioning pituitary adenoma and a left temporal lobe meningioma revealed by a 1-year history of progressive vision loss and occasional headaches in a 56-year-old woman. Her clinical condition worsened in the last 5 months with ptosis, cavernous sinus syndrome, and ophthalmoplegia of the right eye without papilledema. There was an improvement in the visual symptoms after subtotal resection of both lesions through a right frontotemporal craniotomy. Histology confirmed a collision tumor. The patient was referred for adjuvant treatment with gamma knife radiosurgery. He was doing well and back to his usual duties 6 months later. Conclusion: A gross total or subtotal resection with adjuvant therapy is the gold standard for the surgical management of collision tumors for a favorable patient outcome.
文摘Background: As the half-life of intact parathyroid hormone (iPTH) is very low, it reflects parathyroid insufficiency within minutes to hours after total thyroidectomy. Therefore, iPTH level assessment in the postoperative period can be used to predict the development of hypocalcaemia. The optimal time point to measure serum iPTH is important for the accurate prediction of hypocalcaemia. Aim: This paper aims to evaluate the ability of iPTH as an early predictive marker of hypocalcaemia and determine which time iPTH is more able to predict postoperative hypocalcaemia. Method: This prospective observational study was conducted in the Department of Otolaryngology-Head & Neck Surgery, BSMMU, Dhaka, from July 2020 to December 2021, with 67 patients who underwent total thyroidectomy. iPTH levels were measured on the day before the operation and at 1 hour, 4 hours, and 24 hours after the operation. S.calcium levels were measured on the day before the operation and 1<sup>st</sup> postoperative day. All the data were compiled and sorted properly and were analyzed statistically. Results: Postoperative hypocalcaemia developed in 18 cases, with an incidence of 26.9%. Pearson correlation showed a significant correlation between postoperative iPTH at 1 hr, 4 h, and 24 hr with 1st postoperative calcium value. The Receiver operating characteristic (ROC) curve was processed for the postoperative iPTH at 1 hr, 4 h, and 24 hr. The sensitivity, specificity, cut-off value, and mean AUC found 93.9%, 94.4%, ≤14.0, 0.988;95.9%, 94.4%, ≤09.5, 0.993 and 91.8%, 94.4%, ≤11.0, 0.993 respectively. Conclusion: iPTH can be used as an early predictor of post-thy-roidectomy hypocalcaemia. 4 hr iPTH showed more sensitivity and specificity for a cut-off value near the laboratory reference range.
文摘BACKGROUND Parathyroid carcinoma(PC)is a rare,slow-growing malignant tumor and a rare cause of primary hyperfunctioning of the parathyroid,with a highly variable clinical course,depending on the aggressiveness of the individual tumor and the degree of hypercalcemia.CASE SUMMARY The aim of this report is to summarize the diagnosis and treatment of three cases of PC and to review and conclude aspects regarding the three collected cases with reference to other relevant cases to explore the value of ultrasound in the diagnosis of PC.All three patients had hypercalcemia,consisting of a high serum calcium level and a high level of parathyroid hormone that was>2-fold(even>30-fold)of the normal upper limit.The ultrasonographic findings of the parathyroid gland showed that the glands were all>30 mm,and the internal echo was uneven.All patients underwent surgery.PC in three cases was confirmed by routine histopathology and immunohistochemistry.CONCLUSION As clinical signs and laboratory results are nonspecific,it is difficult to diagnose PC preoperatively,so imaging examinations are often needed.
文摘The goal of parathyroid imaging in hyperparathyroidism is not diagnosis,rather it is the localization of the cause of hyperparathyroidism for planning the best therapeutic approach.Hence,the role of imaging to accurately and precisely localize the abnormal parathyroid tissue is more important than ever to facilitate minimally invasive parathyroidectomy over bilateral neck exploration.The common causes include solitary parathyroid adenoma,multiple parathyroid adenomas,parathyroid hyperplasia and parathyroid carcinoma.It is highly imperative for the radiologist to be cautious of the mimics of parathyroid lesions like thyroid nodules and lymph nodes and be able to differentiate them on imaging.The various imaging modalities available include high resolution ultrasound of the neck,nuclear imaging studies,four-dimensional computed tomography(4D CT)and magnetic resonance imaging.Contrast enhanced ultrasound is a novel technique which has been recently added to the armam-entarium to differentiate between parathyroid adenomas and its mimics.Through this review article we wish to review the imaging features of parathyroid lesions on various imaging modalities and present an algorithm to guide their radiological differentiation from mimics.
基金Supported by FIS del Instituto de Salud Carlos Ⅲ(FEDER from E.U.),Spain,No.PI13/00322 and PI16/00884
文摘BACKGROUND Pituitary apoplexy represents one of the most serious,life threatening endocrine emergencies that requires immediate management.Gonadotropin-releasing hormone agonist(GnRHa)can induce pituitary apoplexy in those patients who have insidious pituitary adenoma coincidentally.CASE SUMMARY A 46-year-old woman,with a history of hypertension and menorrhagia was transferred to our hospital from a secondary care hospital after complaints of headache and vomiting,with loss of consciousness 5 min after an injection of GnRHa.The drug was prescribed by her gynecologist due to the presence of uterine myomas.The clinical neurological examination revealed right cranial nerve III palsy,ptosis and movement limitation of the right eye.Our first clinical consideration was a pituitary apoplexy.Blood hormonal analysis revealed mild hyperprolactinemia and high follicle stimulating hormone level;PTH and calcium was high with glomerular filtration rate mildly to moderately decrease.A computed tomography scan,revealed an enlarged pituitary gland(3.5 cm)impinging upon the optic chiasm with bone involvement of the sella.Following contrast media administration,the lesion showed homogeneous enhancement with high-density focus that suggests hemorrhagic infarction of the tumor.Transsphenoidal endoscopic surgery was perfomed and adenomatous tissue was removed.Immunohistochemistry was positive for luteinizing hormone(LH)and follicular-stimulating hormone(FSH).A solid hypoechoic nodule(14 mm x 13 mm x 16 mm)was found in the caudal portion of the right thyroid lobe after a parathyroid ultrasound.A genetic test of Multiple Endocrine Neoplasia type 1(MEN1)was negative.A right lower parathyroidectomy was performed and the pathologic study showed the presence of an encapsulated parathyroid carcinoma of 1.5 cm.A MEN type 4 genetic test was performed result was negative.CONCLUSION This case demonstrates an uncommon complication of GnRH agonist therapy in the setting of a pituitary macroadenoma and the casual finding of parathyroid carcinoma.It also highlights the importance of suspecting the presence of a multiple endocrine neoplasia syndrome and to carry out relevant genetic studies.
基金supported by the National Natural Science Foundation of China(82141112,82073265)Guangdong Financial Fund for High-Caliber Hospital Construction(174-2018-XMZC-0001-03-0125/D-14)to C.W.
文摘Pleomorphic adenoma(PA)is the most common benign tumour in the salivary gland and has high morphological complexity.However,the origin and intratumoral heterogeneity of PA are largely unknown.Here,we constructed a comprehensive atlas of PA at single-cell resolution and showed that PA exhibited five tumour subpopulations,three recapitulating the epithelial states of the normal parotid gland,and two PA-specific epithelial cell(PASE)populations unique to tumours.Then,six subgroups of PASE cells were identified,which varied in epithelium,bone,immune,metabolism,stemness and cell cycle signatures.Moreover,we revealed that CD36+myoepithelial cells were the tumour-initiating cells(TICs)in PA,and were dominated by the PI3K-AKT pathway.Targeting the PI3K-AKT pathway significantly inhibited CD36+myoepithelial cell-derived tumour spheres and the growth of PA organoids.Our results provide new insights into the diversity and origin of PA,offering an important clinical implication for targeting the PI3K-AKT signalling pathway in PA treatment.
