Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The purpose of this study was to determine the patterns of iodine-131 6 beta-iodomethylnorcholesterol (NP-59) imaging and the correlation with computed tomography (CT)-guided adrenal biopsy and follow-up in patients with bilateral adrenal masses. To this end we investigated a consecutive sample of 29 euadrenal patients with bilateral adrenal masses discovered on CT for reasons other than suspected adrenal disease. Adrenal scintigraphy was performed using 1 mCi of NP-59 injected intravenously, with gamma camera imaging 5-7 days later. In 13 of the 29 patients bilateral adrenal masses were the result of metastatic involvement from lung carcinoma (5), lymphoma (3), adrenocarcinoma of the colon (3), squamous cell carcinoma of the larynx (1), and anaplastic carcinoma of unknown primary (1). Among these cases the NP-59 scan demonstrated either bilaterally absent tracer accumulation (in eight, all with bilateral metastases proven by CT-guided biopsy or progression on follow-up CT) or marked asymmetry of adrenocortical NP-59 uptake (in five). Biopsy of the adrenal demonstrating the least NP-59 uptake documented malignant involvement of that gland in five of five patients. In two patients an adenoma was found simultaneously in one adrenal with a contralateral malignant adrenal mass. In each of these cases, the adenoma demonstrated the greatest NP-59 uptake. In 16 patients diagnosis of adenoma was made on the basis of (a) CT-guided adrenal biopsy of the gland with the greatest NP-59 uptake of the pair (n = 4), or (b) adrenalectomy (n = 2), or (c) absence of change in the size of the adrenal mass on follow-up CT scanning performed 6 months to 3 years later (n = 10).(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Scintigraphy of incidentally discovered bilateral adrenal masses. 760 61

The authors review their experience with magnetic resonance imaging (MRI) of the adrenal gland and discuss the appearance of adrenal diseases where MRI is clinically useful. A basic description of some of the newer pulse sequences is provided. Fat-suppressed MRI is advantageous because of reduction of cardiac and respiratory motion induced artifacts, accentuation of small differences in tissue contrast, and elimination of chemical shift artifacts. These advantages far outweigh the disadvantages of inhomogeneity of fat suppression and the fewer slices obtained per acquisition. Chemical shift imaging is used to differentiate benign from malignant adrenal diseases based on a gradient echo phase cycling technique. Detailed descriptions of MRI findings in adrenal pheochromocytomas, hemorrhage, cysts, adenomas, myelolipomas, and metastases are provided. Most pheochromocytomas appear markedly hyperintense to the liver on T2-weighted images. However, this appearance is not specific as adrenal metastases and adrenal adenomas may occasionally produce a similar appearance. In addition, pheochromocytomas may occasionally be isointense or hypointense to the liver on T2-weighted images. Differentiation of adrenal metastases from adrenal adenomas with MRI is problematic using signal intensity ratios (33% overlap) or T2 calculations. The future of discriminating between adrenal metastases and adenomas may rest with chemical shift MRI, which uses in- and out-of-phase gradient echo pulse sequences for differentiation. This approach relies on the fact that adrenal adenomas contain fat, while adrenal metastases do not. The reported accuracy of chemical shift imaging in differentiating between adrenal adenomas and adrenal metastases ranges from 96 to 100%. An algorithmic approach to differentiating benign from malignant adrenal diseases is presented that relies on an initial noncontrast CT with CT attenuation values obtained from the adrenal mass. If CT attenuation values are less than zero, the mass is characterized as benign. If the mass remains indeterminate after CT, chemical shift MR is performed. If the mass remains indeterminate after MR, biopsy is required.
 ...
PMID:Magnetic resonance imaging of the adrenal gland. 761 77

A 45-year-old man presented with gynecomastia, hypertension and a large left adrenal mass. Further evaluation revealed elevated serum concentrations of estrogen, estrone sulfate, androstenedione, dehydroepiandrosterone, dehydroepiandrosterone sulfate, deoxycorticosterone, and aldosterone and increased 24-hour urinary 17-ketosteroid and free cortisol excretion. Removal of a 10 kg adrenocortical carcinoma led to normalization of the hormone concentrations and partial resolution of the gynecomastia. There was no clinical evidence of metastases. Incubation of tumor slices demonstrated that the tumor had an active aromatase and sulfotransferase. We estimated that about half the serum estrone arose from peripheral conversion of androstenedione. Feminizing adrenocortical carcinomas are rare and this case is unusual given the lack of clinical metastases and the probable dual source of estrogen from tumor as well as from the peripheral conversion of tumor-derived androgens.
 ...
PMID:Feminization as a result of both peripheral conversion of androgens and direct estrogen production from an adrenocortical carcinoma. 793 Mar 80

To evaluate the diagnostic contribution of adrenal scintigraphy with 75-Se-selenomethylcholesterol in adrenal masses, 42 patients have been studied. All of them had a solid adrenal mass discovered on computed tomography (seven bilateral). None of the patients showed any symptoms or clinical signs that might indicate the existence of adrenal dysfunction. Twenty-nine of them had known extra-adrenal primary malignant disease. Forty-nine adrenal tumours were detected with an average size of 3.29 cm (range 1.5-12 cm). Eighteen lesions showed increased uptake of radiocholesterol on the side of the adrenal mass, all of which were either proven to be benign, or behaved in a benign fashion. Twelve lesions showed normal uptake (10 in the benign group and one lung carcinoma metastasis), all but one (2.5 cm) being smaller than 2 cm. Decreased uptake was observed in 20 lesions (15 metastases, two nonfunctional adrenal carcinomas, one myelolipoma and two tuberculous infectious lesions). Adrenocortical scintigraphy provides functional information about adrenal masses and is useful in differentiating between benign and malignant lesions.
 ...
PMID:Differential diagnosis of solid adrenal masses using adrenocortical scintigraphy. 795 47

The role of adrenal scintigraphy in the noninvasive characterization of silent adrenal masses was investigated in 40 patients. The mass had been detected by US or CT performed in the evaluation of non-malignant extra-adrenal diseases (25 cases) or during staging or follow-up of a malignant extra-adrenal neoplasm (15 cases). In all cases radio-cholesterol scintigraphy (74 MBq i.v. of 131I-6 beta-iodomethylnorcholesterol in 19 cases; 11 MBq i.v. of 75Se-6 beta-selenomethylnorcholesterol in 21 cases) was performed; in 7 cases also 131I-MIBG scan (18.5-37 MBq i.v.) was carried out. When compared with CT data, radiocholesterol scintigraphy (standard or after suppression with dexamethasone) showed: concordant uptake (increased uptake of radiocholesterol on the side of the adrenal mass) in 24/26 patients with adrenal cortical adenoma; discordant uptake (absent or decreased uptake on the side of the adrenal mass) in 12 patients: 5 with adrenal metastases and 7 with non-adenomatous benign space-occupying lesions (2 ganglioneuromas, 1 post-traumatic hemorrhagic lesion, 3 adrenal cysts, 1 myelolipoma); indeterminate uptake (symmetric bilateral uptake) in 4 patients: 2 with a small adenoma, 1 with adrenal metastasis and 1 with a "false incidentaloma" (hepatic regenerative nodule). The results confirm the utility of radiocholesterol scintigraphy in demonstrating the benignity of adrenal lesions (particularly in identifying adrenocortical adenomas) and assess its place among the procedures used to characterize silent adrenal masses. The possible use of MIBG scintigraphy is also discussed.
 ...
PMID:[Contribution of nuclear medicine to the diagnosis of silent adrenal masses]. 814 73

A 60-year-old female patient presenting with anemia was found to have a left-sided renal tumor and a contralateral adrenal mass of 2 cm in diameter. Imaging studies for metastases were negative. Nephrectomy along with contralateral adrenalectomy was performed and histology disclosed renal cell carcinoma stage pT3a pNO G2 with solitary contralateral adrenal metastasis. In a survey of the literature, 24 previous cases of renal cancer with solitary contralateral adrenal metastasis were identified. The most probable biological pathway to explain this peculiar metastatic pattern is transpulmonal passage of circulating cancer cells and seeding in the adrenal gland on the basis of a particular susceptibility of adrenal tissue to circulating renal cancer cells. The case illustrates that surgery of solitary metastases from renal cell carcinoma may be beneficial to the patient. The case further highlights the caution that is required diagnostically in the interpretation of incidentally found adrenal masses when other malignancies are present.
 ...
PMID:Contralateral adrenal metastasis in renal cell cancer. 873 61

One in seventy randomly selected individuals is supposed to host an adrenal mass. The increasing number of incidentally detected adrenocortical adenomas requires the effective and reliable evaluation of dignity. So far this has been determined through a difficult multi-parametric analysis. Since MHC class II antigens are expressed in the normal adrenal cortex with a restriction to the zona reticularis, we examined 28 adrenocortical incidentalomas, 10 adenomas, 13 cortical carcinomas, 2 metastases, 10 controls as well as the adrenocortical carcinoma cell line NCI-H295 immunohistochemically for the expression of HLA class II antigens. We showed, that the majority of the adenomas still express class II antigens, whereas the expression is abrogated in all carcinomas examined. Our results indicate, that the detection of HLA class II positive tumour cells excludes malignancy. Therefore, MHC class II antigens may serve as a novel tumour marker in the evaluation of dignity in adrenocortical tumours. These findings could change the strategy for the assessment of adrenal masses.
 ...
PMID:MHC class II expression--a new tool to assess dignity in adrenocortical tumours. 895 65

Both CT and MRI have achieved high accuracy in the investigation of patients suspected of having adrenal pathology. The choice of technique will depend on several factors discussed in the review. The advent of spiral CT has allowed the examination to be tailored to demonstrating the adrenal with very high spatial resolution and it remains the most widely used initial technique. This review concentrates on new techniques for evaluating the incidentally discovered adrenal mass and differentiating between adrenal adenomas and metastases.
 ...
PMID:State-of-the-art CT and MRI of the adrenal gland. 922 96

We experienced that two lung cancer patients who had been considered to be potentially resectable were preoperatively pointed out enlarged adrenal glands. Therapeutically, discrimination between benign and malignant adrenal mass lesion is an important problem. Case 1: After a 3 course neoadjuvant chemotherapy, a 50-year-old man had a left adrenalectomy, which revealed non-functional adenoma. One month later, a left lower lobectomy for T3N2 adenocarcinoma was performed. Case 2: A 64-year-old man had a right upper lobectomy for T2N0 adenocarcinoma, firstly. Two months later, a left adrenalectomy was done because a rapid growth and lumbago, which revealed metastatic adenocarcinoma originating from the lung. The patient died of brain and stomach metastases 4 months postoperatively.
 ...
PMID:[Primary lung cancer with solitary adrenal tumor]. 1031 37

Primary neoplasms of the adrenal cortex are rare in children and differ significantly in epidemiology, clinical characteristics, and biologic features from their counterparts in adults. In children, the inclusive term adrenocortical neoplasm is applied because adrenal adenoma and adrenal carcinoma may be difficult to distinguish histopathologically. Pediatric adrenocortical neoplasms typically occur before 5 years of age, affect young girls more commonly than boys, and are associated with hemihypertrophy and Beckwith-Wiedemann and Li-Fraumeni syndromes. Most children with an adrenocortical neoplasm present with signs and symptoms of endocrine abnormality, including virilization and Cushing syndrome. Cross-sectional imaging studies typically demonstrate a large, circumscribed, predominantly solid suprarenal mass with variable heterogeneity due to hemorrhage and necrosis. Calcification is not uncommon. Local invasion and metastases to the lungs, liver, and regional lymph nodes may be present at diagnosis. When friable tumor thrombus extends into the inferior vena cava, it poses a high risk of pulmonary embolization. The finding of increased retroperitoneal fat due to hypercortisolism on computed tomographic and magnetic resonance images of children with an adrenal mass favors the diagnosis of adrenocortical neoplasm. Surgical resection is the mainstay of therapy, with chemotherapy used for patients with metastases or persistent elevated hormone levels following surgery. Patients younger than 5 years with aggressive adrenocortical neoplasms fare better than older children.
 ...
PMID:Adrenocortical neoplasms in children: radiologic-pathologic correlation. 1046 5


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>