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Query: UMLS:C0001430 (adenoma)
 21,222 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Although several classic anatomic studies describing the number, location, size, and weight of normal parathyroid glands have been reported, as detailed description of the parathyroid glands in a large series of patients with primary hyperparathyroidism has not been available. Drawings were made of the exact locations of each of the normal and enlarged parathyroid glands identified, immediately following neck explorations in all patients with primary hyperparathyroidism during a 4-year period (1977 to 1981). The enlarged glands were also measured and weighed after excision. The records of 273 patients were reviewed. Single gland enlargement (adenoma) was found in 218 patients (80%). Hyperplasia of all identified parathyroid glands was found in 42 patients (15%). Two adenomas (at least two other glands grossly and microscopically normal) were found in seven patients (2.6%). Seven patients (2.6%) with biochemical evidence of the disease had only normal glands at neck exploration. Adenomas in ectopic locations were frequent. However, their locations, with few exceptions, were predictable. The larger an adenoma, the more likely it was to be ectopic. Right superior gland adenomas (mean size 2.6 cm) were ectopic in 39%. Left superior glands (mean size 2.62 cm) were ectopic in 36%. No superior parathyroid adenomas were intrathyroidal. five of 223 (2%) adenomas were entirely surrounded by thyroid parenchyma in the lower pole. Nearly all inferior gland adenomas within the thymus could be readily excised through the cervical incision. In the seven cases in which only normal parathyroids were identified, no fewer than three glands wer proven in each. Three patients have had subsequent mediastinal exploration and excision of an adenoma. This failure rate of cervical exploration (4%) is attributed to mediastinal adenomas, and a second adenoma, and incorrect diagnosis. An awareness of the frequency of ectopic adenomas and their usual locations is of considerable benefit to the surgeon. Identification of the normal glands is of great importance as the search for a specific missing gland (adenoma) can be conducted in a logical sequence based on anatomic and embryologic knowledge of the parathyroids.
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PMID:The anatomy of primary hyperparathyroidism. 713 2

A total of 44 cases of pancreatic lesions, including hyperplasia (six) cases, adenoma (mucinous cystadenomas [eight] and intraductal papillary adenoma [eight]), noninvasive intraductal papillary tumors (five), and invasive ductal carcinomas (17) were investigated possibly to establish a diagnostic marker. We examined the type of mucin secreted and immunoreactivities of antibodies to ras-p21 and c-erB-2 oncogene products. A significant decrease in the amount of mucin was found in invasive lesions, and this was associated with a shift toward production of neutral mucins and especially sialomucins. Hyperplasia and adenoma, in contrast, demonstrated a predominance of neutral mucin. The sulfated mucins found in normal epithelium were only very weakly stained in any of the tumor types. Thirty-three percent of non-invasive intraductal papillary tumors and 88% of invasive ductal adenocarcinomas demonstrated strong binding of the ras-p21 antibody. In contrast no obvious differences in expression of c-erbB-2 were evident between the groups. In conclusion, a combined mucin histochemical/immunohistochemical approach may facilitate accurate diagnosis.
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PMID:A mucous histochemical and immunohistochemical study of precancerous and neoplastic lesions in the human pancreas. 810 2

The ultrasound examination of superficial organs began with the application of the breast and thyroid. After the development of the high resolution real-time echography, this method has also been used for the examination of the salivary gland, parathyroid and lymph nodes, and it has become an indispensable diagnostic equipment, owing to low price, high diagnostic accuracy rate, short examination time and no invasiveness. Recently, colour Doppler equipment has developed and it has altered the reliability of ultrasound. [Breast]. The real-time method brought about the evaluation of compressibility and mobility by the dynamic test, and the interruption of the borderline of the mammary gland was added to the diagnostic criteria for breast cancer. Colour Doppler imaging will become a useful method to diagnose tumours, by evaluating the vascularity, blood flow volume or flow velocity. For nonpalpable tumours, ultrasonically guided aspiration cytology and biopsy were devised and they showed good results. [Thyroid]. Thyroid echography, together with aspiration cytology, became an integral part of the diagnostic method for thyroid cancer, and the necessity of the X-ray of the thyroid has decreased. The accuracy rate for papillary carcinoma recorded more than 80%. In the screening, the detection rate of carcinoma is now 1%. The differential diagnosis between carcinoma and adenoma, which both have a follicular pattern, is a problem yet to be solved. [Parathyroid]. Hyperplasia and adenoma of the parathyroid show hypoechoic and hypervascular area. In addition, the salivary gland and lymph nodes can also be evaluated with echography.
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PMID:[Current status of ultrasound examination of the superficial organs (breast and thyroid)]. 835 5

Neck exploration due to suspicion of primary hyperparathyroidism (pHPT) was performed in 309 instances (298 patients) during a 17 year period, in 44 instances (14%) as a second operation after former goitre surgery or surgery for pHPT. Adenomas were found in 247 patients (83%), 12 patients had double adenomas and one triple adenoma. Hyperplasia was registered in 34 patients (11%) and three had parathyroid cancer. Median weight of adenomas was 1200 mg and hyperplasia 1500 mg. In 14 patients only normal glands were identified. In six of these 14 patients the diagnosis was later withdrawn. In 276 out of 292 patients with pHPT normocalcaemia was established, 16 patients remained hypercalcaemic. Success-rate concerning verification of pHPT was therefore 97% (284 out of 292) and concerning attainment of normocalcaemia 95% (276 out of 292). There was one perioperative death due to myocardial infarction. Four patients had transient unilateral recurrent nerve injury. In one patient with parathyroid cancer vocal cord paralysis was permanent. Follow-up after at least one year revealed normocalcaemia in 91% of the patients, hypercalcaemia in 7% and hypocalcaemia in 2%. Twenty percent of the patients had died 0-12 years, median 2.8 years postoperatively. Death was related to the degree of hyperparathyroidism evaluated by weight of abnormal parathyroid tissue.
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PMID:[Surgical treatment of primary hyperparathyroidism]. 992 95

Primary hyperaldosteronism (adrenal adenoma and idiopathic hyperplasia) is a disorder with hypertension, hypokalemia, elevated serum aldosterone and suppressed plasma renin activity. Hyperplasia is managed medically whereas adenomas are treated surgically. Selective adrenal venous catheterization and aldosterone measurement is a useful tool in making the distinction in 95% of cases. We report a case of bilateral idiopathic hyperplasia of the adrenal glands adequately treated with medications for 6 years followed by worsening. Selective catheterization was consistent with a right sided adenoma. Surgical removal of the right adrenal gland alleviated her symptoms. Pathological examination showed focal nodular hyperplasia. We propose that in the course of the disease the focal hyperplastic nodule became autonomous and behaved like an adenoma. Monitoring of patients with adrenal hyperplasia for recurrence of symptoms is prudent as surgery is beneficial in patients who develop an autonomous nodule.
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PMID:Idiopathic hyperplasia of the adrenal gland behaving like an aldosterone producing adenoma. 907 69

Conventional treatment for BPH in recent decades has been transurethral resection of the prostate (TURP) or open prostatectomy, depending on adenoma volume. As TURP is a surgical treatment associated with high morbidity, a certain failure rate and mortality, urologists have been looking for other alternative treatments that are safer and at least as effective. Prostatic tissue ablation is one of the preferred alternative BPH treatments today and can be achieved with laser or with TURAPY--Transurethral Ablation Prostatectomy. This new treatment based on thermeablation of the prostate has been introduced recently by Direx Medical Systems. The treatment is administered with a transurethral Folley-like electrode delivering temperatures in the range of 80 degrees C. TURAPY causes extensive ablation of the tissue around the prostatic urethra, without the complications of a surgical procedure. Twenty two men, age 76 to 92 years (mean 79) with symptomatic Benign Prostatic Hyperplasia (BPH) and suprapubuc urinary fistulas were treated with the computer controlled radio frequency device TURAPY as day cases under local anaesthesia. In 1, 5-2 months after the procedure urination was restored, urinary fistulas healed.
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PMID:High temperature radiofrequency transurethral ablation of the prostate (TURAPY). 938 60

In 1983 a large family with MEN-1 (designated Tasman 1) was identified in Tasmania. Kindred screening and case follow-up over the subsequent 15 years has yielded data on over 160 MEN-1-affected patients. Hyperparathyroidism is present in over 60% of gene carriers by age 20 years and 95% by age 30 years. Hyperplasia is the characteristic pathological finding. Kaplan-Meier analysis indicates hyperparathyroidism recurs in the majority of patients despite near-total parathyroidectomy. Gastrinoma, 'nonfunctioning' pancreatic adenoma and insulinoma occur in up to 60, 50 and 10% of patients, respectively. Metastatic gastroenteropancreatic (GEP) tumours develop in up to 35% of family members, being frequent in some branches of Tasman 1, whilst rare in others. Pituitary disease developed in 19% of patients. Prolactinoma and 'nonfunctioning' adenoma account for 76 and 24%, respectively, of pituitary abnormalities. Prolactinomas exhibit clustering within branches of the Tasman 1 kindred. Adrenal adenomas occur in 36% of patients. The majority of adrenal lesions are benign and nonsecretory and develop in association with pancreatic neoplasia. Carcinoid tumours are uncommon but important malignancies. Malignant thymic carcinoid occurs in male patients, whereas bronchial carcinoid occurs predominantly in women. Prior to recognition of MEN-1 in Tasman 1, complications of hyperparathyroidism and malignancy accounted for the majority of patient mortality. Since commencement of prospective screening, malignant GEP tumours and cardiovascular disease have become the most prevalent causes of death amongst MEN-1-affected patients.
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PMID:Expression of the MEN-1 gene in a large kindred with multiple endocrine neoplasia type 1. 968 44

The files were studied of 300 patients operated for primary hyperparathyroidism for the first time. Their median age was 60 years. The female/male ratio was 3/1, but in the younger patients males and females were about equally present. Preoperatively, one third was considered as asymptomatic with respect to hyperparathyroidism. In this subgroup the hypercalcemia was detected coincidentally and the mean parathyroid hormone level was lower than in the others. Another third of the patients had nephrolithiasis, they were on the average younger and there were more males. Finally one third showed other symptoms as gastrointestinal disease, bone disease or general malaise. Intraoperatively, we found a solitary adenoma in 90% of the cases, a double adenoma in 5% (on each side of the neck in half of the cases) and hyperplasia in 4%. The adenomas had a tendency to occur more often in the upper parathyroid glands, but the difference was not important enough to influence the surgical technique. Hyperplasia patients were, on the average, younger and double adenoma patients older. The female/male ratio was 1/1 for hyperplasia and 15/1 for double adenoma.
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PMID:Pre- and intra-operative findings in primary hyperparathyroidism. 1144 71

Prostate Specific Antigen (PSA) is the most important marker of prostate diseases actually available. The aim of this study was to evaluate the relations between aging, PSA and prostatic volume's increase, and whether these relations justify the adoption of different normality ranges of PSA in the elderly. We considered 285 patients aged over 60 years (mean age 69.01 years), with Benign Prostatic Hyperplasia (BPH) and absence of malignant prostatic disease, prostatic phlogosis and absuntion of drugs that can influence the PSA's levels in the serum. Patients underwent PSA, digital rectal exploration and transrectal ultrasonography, with determination of the three prostatic diameters, of the prostatic volume by the ellipsoid formula and of the maximum adenoma diameter; PSA was determined in all patients and PSA free in those with total PSA > 4 ng/ml; the PSA density was calculated. We found that age does not correlate with PSA and is poorly correlated with prostatic volume (p < 0.05); on the contrary, PSA values are strongly related with prostatic volume and maximum diameter of adenoma (p < 0.01). Mean free PSA value was 16.3 +/- 5.99%, and most of patients had values in the so-called grey zone of discrimination between benignity and malignity. We conclude that in elderly patients with volume. These results suggest the possibility to consider as indicative of benignity also total PSA values between 4 and 10 ng/ml, when they are associated with a significative prostatic volume's increase and with free PSA greater than 10%.
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PMID:[PSA/volume ratio in prostatic disease in the elderly]. 1169 3

To compare the pituitary pathology of gigantism to that of acromegaly, 19 surgically resected lesions were studied from 10 males and 9 females, ages 13-49 (mean, 19 yr) with excessive height (>/=95th percentile), onset of disease prior to puberty, elevated growth hormone (GH) levels despite glucose suppression, and a pathologically confirmed GH-producing pituitary mass. One patient had MEN-I. The lesions included 18 adenomas and 1 case of pure hyperplasia. The median, mean, and range of serum GH and prolactin (PRL) levels were 64, 235, 5-1000 ng/mL and 47, 146, 29-770 ng/mL, respectively. Of the 8 adenoma specimens accompanied by nontumoral pituitary (i.e., tissue wherein the presence of hyperplasia was assessable), 3 (37%) demonstrated both. Of the 18 tumors, 78% were macroadenomas and 22% were grossly invasive; their immunophenotypes included GH (5%), GH and PRL (19%), and GHPRL and a glycoprotein hormone, usually TSH and/or a-subunit (76%). Of the 10 adenoma-containing lesions subject to electron microscopy (EM), 2 consisted of GH cells alone; 2 of mammosomatotroph (MS) cells alone; 1 of GH and MS cells; 1 of GH and PRL cells; 2 of GH, PRL, and MS cells; 1 of GH, PRL, and glycoprotein cells; and 1 was a subtype 3 adenoma. Ultrastructurally, GH cells and/or MS cells predominated in these lesions. Immuno-EM of one CH and PRL cell and of one GH-PR-MS tumor showed GH and PRL to be present not only in single cells but within the same granules. Nine of 12 adenoma-associated lesions subject to combined in situ hybridization (ISH) and immunostaining showed double labeling for PRL (or GH) mRNA and for GH (or PRL), respectively, features indicating MS differentiation. In the 4 lesions exhibiting hyperplasia, either alone (1) or in association with adenoma (3), EM showed MS cells in 3, and immuno-EM as well as combined immunohistochemistry and ISH showed double labeling for GH and PRL in both of the 2 cases studied. In summary, although in terms of their tinctorial characteristics and tumor size, the lesions of giants resemble those of acromegalics, those of the former are less often invasive and glycoprotein hormone containing, and more often contain ultrastructurally distinctive MS cells. The high frequency of adenoma with hyperplasia (37%) and the occurrence of hyperplasia alone (6%) is of particular notice since this finding is rare in patients with acromegaly. Hyperplasia is, however, seen in ectopic GH-releasing hormone production and the McCune-Albright syndrome. We conclude that the presence of MS is not rare in the pituitary lesions of patients with gigantism. Their presence may be a reflection of either hypothalamic dysfunction or of an intrinsic abnormality of pituitary cells,
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PMID:The Pituitary in Gigantism. 1211 38


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