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

Most of the hypophyseal adenomas can be removed by extracranial operation techniques. The ENT specialist prepares the approach to the pituitary gland while the neurosurgeon will resect the adenoma after having given the indication for this procedure. In this paper special attention is called to one of the extracranial techniques i.e. the sublabial-transseptal-transsphenoidal approach in hypophysectomy. It seems to be more advantageous than the other because the pituitary gland can be exactly removed oppositely. By that way the damage of the sinus, the carotid artery or the optic nerve can be avoided. The possibility of perforation of the nasal septum, deformation of the nose or atrophic rhinitis is of small importance especially if the otorhinologist will prepare the extracranial part of the operation. Moreover the neurosurgeon meets with a great and clear operation area because the anterior wall of the sella turcica can be resected extremely. Besides further advantages discussed in the paper the transseptal-transsphenoidal approach is rather simple, distinct and shortens the operation time.
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PMID:[The transseptal-transsphenoidal approach to the pituitary gland--a common problem of otorhinolaryngology and neurosurgery (author's transl)]. 54 67

In March 1989, ultrasonography revealed a hepatic mass in a 40 year old nulliparous woman who was then referred to the University of Southern California--Los Angeles (UCLA) Liver Unit. She exhibited no symptoms of a liver condition. From 19-28 years old, she took the combined oral contraceptive (OC) Ovulen 21 for irregular menses. After a brief period of taking Ortho Novum 1/80, she took Demulen 1/35-24 between ages 28-34. Her physician diagnoses endometriosis at 34. He stopped OC therapy and prescribed the progestin Norlutate. She had no history of hepatitis, toxin exposure, and previous liver disease. Further no one in her family had had liver disease or neoplasms. Computer tomography identified a 6.5 cm x 3.5 cm mass in the right lobe of the liver which matched a cold defect on a liver scan using technetium Tc 99m sulfur colloid. The mass selectively took up gallium. Arteriography revealed the mass to be a vascular tumor, but it did not exhibit a typical vascular pattern of an adenoma or the neovascularity of hepatocellular carcinoma. Physicians at UCLA used peritoneoscopy to take percutaneous needle biopsies of the right lobe which confirmed a hepatic adenoma. they then removed the right lobe of the liver. The remaining part of the liver was normal. Histologic examinations of the removed section showed features of a well differentiated hepatocellular carcinoma. Further tumor cells had invaded normal hepatic parenchyma. The physicians believed that hepatic adenoma was in the process of transforming into hepatocellular carcinoma in this patient. They thought that long term OC use, and possibly long term progestin use, may have contributed to the formation of the liver neoplasms. They emphasized the need for a pilot study to develop guidelines on surveillance ultrasonography of women taking OCs over a long period.
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PMID:Hepatocellular carcinoma coexisting with hepatic adenoma. Incidental discovery after long-term oral contraceptive use. 166 98

Clinical and laboratory evidence of an association of oral contraceptive (OC) use with the subsequent development of benign and malignant hepatobiliary neoplasia is growing. The authors present a case in which an adenoma within a large, multicentric anaplastic spindle cell carcinoma occurred in a woman with a long history of OC use. The patient, a 38-year-old gravida 2, para 2, was diagnosed following low-grade fevers and right upper quadrant pain. A partial hepatectomy was performed with no complications; however, a follow-up examination 2 months later revealed widespread intra-abdominal tumor recurrence histologically identical to the original tumor. Immunostaining for alpha 1 antitrypsin and keratin was strongly positive in tumor cells, indicating a biliary derivation. Electron microscopy indicated an epithelial derivation as well, including the presence of intracellular lumens, intermediary filaments, and numerous intercellular junctions. Estrogen and progesterone receptors were negative in the tumor. The tritiated thymidine labeling index was 5.05%, with an estimated potential doubling time of 11 days. This woman had no history of hepatitis, no family or personal history of neoplasms, and no known hepatotoxin exposure. The only medication used by the patient was Norlestrin, an OC containing 1 mg norethindrone and 50 mcg ethinyl estradiol that she had taken continuously for the past 8 years.
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PMID:Hepatic adenoma within a spindle cell carcinoma in a woman with a long history of oral contraceptives. 243 48

Unlike the proven causal association between oral contraceptive (OC) use and hepatic cell adenoma, the link between OCs and hepatocellular carcinoma remains speculative. The case history of a 53-year-old US woman suggests, however, that hepatic cell adenomas may transform into hepatocellular carcinoma. The patient, who had used Ovral continuously since 1966, presented in 1985 with vague abdominal pain and a palpable right upper quadrant mass. Computed tomography revealed a 12 x 8 cm mass in the right hepatic lobe and 2 small lesions in the left lobe. Serum alpha-fetoprotein and ferritin levels were normal and tests for hepatitis B were negative. A needle biopsy of the right lobe mass indicated benign hepatic adenoma. OC use was discontinued and the patient was examined at bimonthly intervals. Although she continued to report vague pain, there were no significant changes in radiologic findings or levels of alpha-fetoprotein over the next 18 months. At the 18-month follow-up visit, the alpha-fetoprotein level showed an increase to 227 mcg/L and had risen to 2300 mcg/L by the 30-month follow-up visit. At this time, computed tomography showed slight enlargement of the right lobe mass and inhomogeneity, while biopsy revealed sclerosing hepatocellular carcinoma. This is the 3rd case reported in the literature in which there is evidence of a transformation of hepatic cell adenomas into hepatocellular carcinoma in longterm OC users. Thus, the premalignant potential of hepatic cell carcinomas in OC users should be considered by physicians who follow such cases.
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PMID:Transformation of hepatic cell adenoma to hepatocellular carcinoma due to oral contraceptive use. 253 93

Several studies have been reported suggesting a relationship between pharyngeal obstruction due to ENT pathology and the sleep apnea syndrome (SAS). To determine the incidence of pathological ENT findings that may present symptoms similar to SAS, we performed ENT examination, fiberoptic nasopharyngoscopy, rhinomanometry and partial audiometry and electronystagmography in 431 patients who had undergone polysomnography for clinically suspected SAS. 336 patients were referred for ENT examination; 95 patients had some kind of ENT disease and therapy before polysomnography. In the first group 31% showed one or more pathological ENT finding (ears 9%, nasopharynx 2%, nose 19%, oropharynx 5%, larynx 5%, neck 1%); 10.5% had pathology in two regions and 0.7% in three regions. An ENT operation was indicated in 23%, usually for nasal obstruction. ENT findings included chronic otitis media, adenoids, enlargement of lingual tonsil and vocal cord pathology, but no patient had a malignant tumor or severe pharyngeal obstruction. We conclude that severe anatomical abnormalities or dysplastic syndromes are rare; only 2 SAS patients had acromegaly due to hypophyseal adenoma and 1 patient without SAS had craniofacial dysplasia. However, ENT examination frequently revealed severe nasal obstruction due to septal deviation, polyposis or adenoids. These findings emphasize the need for ENT examination and therapy before application of CPAP (continuous positive air pressure) therapy.
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PMID:[How frequent are pathologic ENT findings in patients with obstructive sleep apnea syndrome?]. 260 43

An obese 28-year old woman presented at the Royal Victoria Hospital on February 23, 1978 because of upper abdominal pain of 2 days duration. The patient had previously given birth 10 years ago and had since been taking an oral contraceptive (OC) containing 0.25 mg d-norgestrel and 0.05 mg ethinyl estradiol (Ovral). She had iron deficiency anemia at age 12, smoked 3 packs of cigarettes/week, rarely consumed alcoholic beverages and was not under any medication. Physical and laboratory examinations revealed a large liver tumor. Angiography and needle biopsy confirmed the diagnosis of hepatocellular adenoma (HCA). Resection was not indicated because of the size of the tumor. OCs were discontinued. Tubal ligation was performed 2 months later as the patient desired no further pregnancies. Complete regression of the tumor over a 12-month period was confirmed by subsequent scintiscans. This case shows that even large HCAs can regress completely with no therapy other than OC withdrawal, confirming the suggestions of others that simple observation after OC withdrawal may be preferable to resection in minimally symptomatic HCAs. A frequent histologic finding both in OC-associated HCA and in normal liver surrounding HCAs is marked sinusoidal dilatation, which suggests a general effect of estrogen therapy. Further studies should be done to determine the mechanisms by which OCs produce these changes and to define their clinical importance. The role of radionuclide imaging techniques, percutaneous liver biopsy, and angiography in the diagnosis of HCAs are very briefly described.
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PMID:Complete regression of hepatocellular adenoma after withdrawal of oral contraceptives. 627 17

The long term effects of the oral contraceptive, Norlestrin, were evaluated in sexually mature female rhesus (Macaca mulatta) monkeys over a 10 year period. Norlestrin, a combination of norethindrone acetate and ethinylestradiol (50:1) was given orally on a continuous cyclic regimen of 21 d of dosing followed by 7 d without treatment. Groups of 16 monkeys each received the drug at dose levels of 0.05, 0.51, and 2.55 mg/kg representing multiples of 1, 10, and 50 times the human dose, respectively. A comparable group of 16 animals remained untreated and served as controls. Selected clinical and laboratory parameters were monitored throughout the study and all animals were necropsied and evaluated for gross and histopathologic changes. All dose levels were well tolerated and survival was not affected. There were no consistent treatment-related alterations in coagulation or other clinical laboratory parameters. Ophthalmologically, macular pigmentary anomalies were observed in all groups. Treatment-associated pathologic findings, representing exaggerated pharmacological responses with superimposed senile changes, including ovarian and uterine atrophy and dilatation of acini and ducts in the mammary gland. Periodic vaginal cytologic examination and mammary gland palpation did not demonstrate drug related changes. A small number of neoplasms was seen in all groups and a granulosa cell carcinoma of the ovary occurred in a control animal. The benign tumors consisted of three cutaneous papillomas: one in a low dose and one in a high dose animal, a uterine leiomyoma in one high dose animal, and a pancreatic duct adenoma in one low dose animal. The results of this study indicate that Norlestrin had no significant toxic manifestations or tumorigenic potential when administered on a cyclic regimen to female rhesus monkeys at levels up to 50 times the human dose for ten yr.
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PMID:Ten-year oral toxicity study with Norlestrin in rhesus monkeys. 716 36

Pleomorphic adenoma (P.A.), the most common tumor of the salivary gland, demonstrates a peculiar clinicopathological behaviour for numerous reasons: the high recurrence rate following primary surgery (up to 50%), the appearance of malignancy (2-9%), the reported number of distant metastases histologically identical to the primary P.A. From among 71 cases of benign parotid tumors treated from Nov. 89 to Nov. 92 in the ENT Department of "Regina Elena", the National Cancer Institute in Rome, six particular cases showed multiple force of P.A. recurring after primary surgery performed from 3 to 32 years previously and are object of discussion in this study. All of these six cases had multiple recurrences, usually manifest as nodular clusters in the parotid area, while in three cases appeared as well a recurrence in the soft tissue of the neck, far removed from the parotid space, with no involvement of neck nodes as was revealed through histological examination following neck dissection. A hypothetical mechanism of diffusion is discussed. The Authors agree with the opinion which holds the surgeon's inability to successfully eradicate primary tumors responsible for the high frequency of recurrences. The surgical technique of "enucleation" is, in fact, inadequate in P.A. excision owing the high risk of mishandling or rupturing the tumor capsule with a consequent seeding of the tumor onto the surgical bed. Lateral lobectomy, with identification of the facial nerve, or total conservative parotidectomy (for deep lobe adenoma) are correct techniques in treating primary P.A.. The Authors also discuss management of recurrent P.A. in relation to facial nerve involvement. Preservation of the seventh nerve with eventual post-operative radiation should be considered an alternative to nerve sacrifice in selected cases of recurrent pleomorphic adenoma.
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PMID:[The recurrent multifocal pleomorphic adenoma]. 813 96

Even today, a wide variety of techniques are performed in parotid pleomorphic adenoma surgery, ranging from enucleation to total parotidectomy. This study reports the results of our experiences. Among a total of 587 surgically treated parotid lesions at the Homburg/Saar University ENT Department from 1968 through 1991, 205 were parotid pleomorphic adenomas. Among these, 166 patients received primary surgery at our department. Twenty-one enucleations led to 3 recurrent tumors (14%), while 108 superficial parotidectomies had 3 recurrences (2.8%). Fifteen extended superficial parotidectomies also produced 3 recurrences (20%) and 22 total parotidectomies had one recurrent case (4.5%). The overall recurrence rate was 6%, but increased to 8.3% in 5 years, 9.5% in 10 years and 12.5% in 15 years follow-up. The "true" overall recurrence rate after 10 years was estimated to be between 9.5 and 20% and that for lateral parotidectomies between 4.4 and 13%. Patients younger than 30 years of age at the time of primary surgery developed a tumor recurrence in 17% of all cases. The overall recurrence rate following secondary surgery was 13%. Clinical findings and surgical techniques for resections of pleomorphic adenomas and their recurrences are discussed. Segmental parotidectomy is the preferred treatment, but may have to be changed locally to enucleation in some cases in order to preserve the facial nerve.
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PMID:[Pleomorphic parotid adenomas and their recurrence]. 815 Jun 70

The high-resolution appearance of enlarged parathyroid glands is well known. Thus, real-time gray-scale US alone fails to provide, in ENT surgery, adequate sensitivity and specificity rates to differentiate between parathyroid glands, hypoechoic thyroid adenomas and other hypoechoic neck masses. Since parathyroid tissue, in both normal and enlarged glands, is hypervascular, color-Doppler US is used as a sort of non-invasive angiography to identify parathyroid glands. The combined use of B-mode and color-Doppler US allows the vascular features of thyroid masses to be satisfactorily demonstrated, with easy differentiation between enlarged parathyroid glands, featuring diffuse internal vascularization, and thyroid adenomas characterized by rounded peripheral vessels and also lymph nodes and cysts exhibiting different vascular patterns. We studied 25 patients with clinical and biochemical signs of hyperparathyroidism (19 primary and 6 secondary) submitted to surgery in the last 20 months. Every patient was scanned with both B-mode and color-Doppler US. At surgery, 19 parathyroid adenomas were found--16 of them correctly identified preoperatively with color-Doppler US and 3 false negatives (retrotracheal glands). Moreover, 1 false positive was observed due to a small Plummer's adenoma misdiagnosed as an intrathyroid parathyroid adenoma: both lesions had the same vascular pattern on US images. Sensitivity was 84.5% and specificity 93.7%. In secondary HPT patients, 23 hyperplastic glands were found at surgery--21 of them correctly identified preoperatively by color-Doppler US, with 2 false negatives. No false positive was found. Sensitivity was 87.5% and specificity 100%. Sensitivity does not differ very much from what reported in literature. Specificity is clearly increased by the use of color-Doppler US. The possible source of error represented by Plummer's adenomas lead us to investigate pulsed Doppler capabilities in differentiating Plummer's adenomas from PT glands, since color-Doppler findings were similar in the two conditions. Peak velocities recorded with both color and pulsed Doppler showed velocity to range 6 to 40 cm/s in parathyroid glands (mean +/- SD: 14.6 +/- 11.7) and 38 to 120 cm/s in thyrotoxic nodules (mean +/- SD: 78.4 +/- 23). The statistical analysis of the results showed a highly significant difference between the two groups of velocities. Peak velocities as recorded in the main, vessels of the parathyroid glands with color and pulsed Doppler were correlated with the activity of the parathyroid glands.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Clinical applications of color-Doppler: the parathyroid glands]. 833 86


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