Incidentally discovered adrenal tumors: endocrine and scintigraphic correlates.

Abstract Hormonal and morphological data were investigated in 202 consecutive patients with adrenal incidentalomas (171 unilateral and 31 bilateral) in an attempt to assess subclinical hyperfunction or malignancy. In addition to the classical evaluation, scintiscan was carried out in a large number of these patients. In unilateral incidentalomas, 83% showed normal hormonal function, whereas 17% had biochemical signs of adrenal overactivity (hyperaldosteronism in 3, hypercortisolism in 17, medullary hyperfunction in 9). [75Se]Methylnorcholesterol scintigraphy depicted malignant, space-occupying lesions as decreased or absent radiotracer uptake by the mass, and cortical adenomas as increased or normal uptake. In cortical adenomas a relationship between radiocholesterol uptake and degree of functional autonomy was demonstrated. [123I]Metaiodobenzilguanidine scintiscan visualized 7 of 8 pheochromocytomas. In bilateral incidentalomas, abnormal adrenal function was more frequent, accounting for 29% of cases (hyperaldosteronism in 3, hypercortisolism in 3, adrenal insufficiency in 2, and congenital adrenal hyperplasia in 1). Malignant lesions were not scintigraphically visualized. [75Se]Methylnorcholesterol scan also provided functional information in the case of a cortisol-secreting adenoma and an aldosteronoma with a concomitant contralateral nonhypersecreting adenoma, showing the greatest uptake in the hyperfunctioning adenomas. In both unilateral and bilateral lesions, endocrine testing failed to differentiate benign from malignant tumors. Although hormonal assessment is mandatory to clarify the functional patterns, only morphofunctional examination by scintiscan seems to provide more data about the likelihood of malignancy

Incidentally discovered adrenal tumors: endocrine and scintigraphic correlates.

Abstract Hormonal and morphological data were investigated in 202 consecutive patients with adrenal incidentalomas (171 unilateral and 31 bilateral) in an attempt to assess subclinical hyperfunction or malignancy. In addition to the classical evaluation, scintiscan was carried out in a large number of these patients. In unilateral incidentalomas, 83% showed normal hormonal function, whereas 17% had biochemical signs of adrenal overactivity (hyperaldosteronism in 3, hypercortisolism in 17, medullary hyperfunction in 9). [75Se]Methylnorcholesterol scintigraphy depicted malignant, space-occupying lesions as decreased or absent radiotracer uptake by the mass, and cortical adenomas as increased or normal uptake. In cortical adenomas a relationship between radiocholesterol uptake and degree of functional autonomy was demonstrated. [123I]Metaiodobenzilguanidine scintiscan visualized 7 of 8 pheochromocytomas. In bilateral incidentalomas, abnormal adrenal function was more frequent, accounting for 29% of cases (hyperaldosteronism in 3, hypercortisolism in 3, adrenal insufficiency in 2, and congenital adrenal hyperplasia in 1). Malignant lesions were not scintigraphically visualized. [75Se]Methylnorcholesterol scan also provided functional information in the case of a cortisol-secreting adenoma and an aldosteronoma with a concomitant contralateral nonhypersecreting adenoma, showing the greatest uptake in the hyperfunctioning adenomas. In both unilateral and bilateral lesions, endocrine testing failed to differentiate benign from malignant tumors. Although hormonal assessment is mandatory to clarify the functional patterns, only morphofunctional examination by scintiscan seems to provide more data about the likelihood of malignancy

Evaluación de la fuerza de asimiento palmar y calidad de vida de niños con cáncer sometidos a la quimioterapia con vincristina

Introdução: Com a quimioterapia, os pacientes podem apresentar diversas alterações; entre elas, polineuropatia e mudança na qualidade de vida, tanto à criança como aos familiares. Objetivo: Avaliar a força de preensão palmar e a qualidade de vida de crianças e adolescentes com câncer submetidos à quimioterapia com vincristina. Método: Trata-se de um estudo, no qual os pacientes responderam aos questionários de anamnese e PedsQLTM 3.0 Câncer Module, em três momentos diferentes do tratamento. Um dos seus responsáveis foi convidado a responder ao mesmo questionário. A força de preensão palmar foi aferida por meio de um dinamômetro, nos mesmos momentos. Resultados: A amostra foi composta por sete pacientes com mediana 7 (5-15 anos); com predomínio de meninas, residentes em Porto Alegre, RS, e diagnóstico prevalente de leucemia linfoide aguda, internados na primeira semana após o diagnóstico de câncer. A força de preensão palmar apresentou redução significativa para ambos os membros (p=0,018, membro superior direito; p=0,030, membro superior esquerdo). Apesar de não apresentar resultado significativo, na maioria dos domínios do questionário de qualidade de vida, ocorreu declínio nas respostas, principalmente nas dos pais. Conclusão: A quimioterapia com vincristina reduz a força muscular periférica em pacientes com câncer, nos 30 primeiros dias. Em relação à qualidade de vida, não foi apresentada diferença significativa. Porém, dentro dos domínios, pôde-se perceber algumas alterações. Sendo assim, fica clara a importância do acompanhamento contínuo da fisioterapia junto a uma equipe preparada para esses pacientes e seus familiares.Introduction: With chemotherapy, patients may have several changes. Among them: polyneuropathy and change in the quality of life, both the children and the family. Objective: To evaluate the handgrip’s power and the life quality in these children and teens with cancer undergoing to chemotherapy with vincristine. Method: This is a study in which patients responded the questionaries of anamnsis and PedsQLTM 3.0 Cancer Module in three different moments of the treatment. One of your responsible was invited to answer separately the same questionarie. The handgrip’s power was measured by dynamometer, in the same moments. Results: The sample was composed for seven patients with average 7 (5-15 years); The most of them were girls, residing in Porto Alegre-RS, with a prevalent diagnostic of Acute Lymphoid Leukemia and who were hospitalized in the first week after the diagnosis of cancer. The handgrip’s strength show significant reduction for all of the limbs (p=0,0018, right upper limb; p=0,0030, left upper limb). Although of not show significant results, in most areas of the questionnaire of quality of life ocurred decline in the answers, mainly in the parents awnsers. Conclusion: The chemotherapy with vincristine, decrease in the peripheral muscle strength in the patients with cancer, in the first 30 days. In relationship of quality of life, there was no significant diference, however we could perceive some trends. Therefore, it is clear the importance of the continuous monitoring of physiotherapy with a team prepared for these patients and their families.Introducción: Con la quimioterapia, los pacientes pueden presentar varias modificaciones. Entre ellas: polineuropatía y cambio en la calidad de vida, tanto del niño y de los familiares. Objetivo: Evaluar la fuerza de asimiento palmar y la calidad de vida de niños y adolescentes con cáncer sometidos a la quimioterapia con vincristina. Método: Se trata de un estudio, en el cual los pacientes respondieron a los cuestionarios de Anamnesis y PedsQLT M 3.0 Cáncer Module, en tres momentos diferentes del tratamiento. Uno de sus responsables fue invitado a responder el mismo cuestionario. La fuerza de asimiento palmar fue evaluada por medio de un dinamómetro, en los mismos momentos. Resultados: La muestra fue compuesta por siete pacientes con mediana 7 (5-15 años); teniendo más niñas, residentes en Porto Alegre- RS, con diagnóstico prevalente de leucemia linfoide aguda y que estaban internadas en la primera semana después del diagnóstico de câncer. La fuerza de asimiento palmar presentó una reducción significativa para ambos miembros (p=0,018, miembro superior derecho, p=0,030, miembro superior izquierdo). A pesar de no presentar resultados significativos, en la mayoría de los dominios del cuestionario de calidad de vida ocurrió declinación en las respuestas, principalmente en la respuesta de los padres. Conclusión: La quimioterapia con vincristina reduce la fuerza muscular periférica en pacientes con cáncer, en los 30 primeros días. En cuanto a la calidad de vida, no se presentó una diferencia significativa. Sin embargo, dentro de los dominios se pode percibir algunos cambios. Por lo tanto, queda claro la importancia del acompañamiento continuo de la fisioterapia junto a un equipo preparado para esos pacientes y sus familiares

Metastatic Adrenal PEComa: Case Report and Short Review of the Literature

PEComa has become a widely accepted entity, and increased recognition has led to descriptions of this tumor in a wide variety of anatomic sites, including the adrenal gland. PEComa (perivascular epithelioid cell tumor) is a mesenchymal tumor composed of perivascular cells, and the most frequent sites of PEComas are the uterus and retroperitoneum. The incidence is <1 per 1,000,000 people. We report a case of adrenal metastatic PEComa in a 63-year-old man discovered by a spontaneous hematoma of the rectus abdominis. In our case, PEComa of the adrenal gland was a significant diagnostic dilemma as the morphologic and immunophenotypic features of this neoplasm may easily be confused with those of other more commonly encountered lesions

Prognostic value of myocardial perfusion scintigraphy in elderly patients with hypertension: a 10-year follow-up analysis

The aim of the study was to assess the role of myocardial perfusion scintigraphy (MPS) in the prediction of future cardiac events in elderly hypertensive patients and to investigate if its prognostic value is maintained during a 10-year follow-up period.A total of 229 consecutive patients a parts per thousand yen 65 years old (range 65-88 years) with arterial hypertension, who were referred to our institution for stress/rest Tc-99m-sestamibi MPS between January 2000 and November 2001, were followed up for 10-12 years. Cardiac death, myocardial infarction and a coronary revascularization procedure were considered as events. Survival curves were computed by the Kaplan-Meier method. A stepwise Cox proportional hazards analysis was used to identify predictors of events.Follow-up was completed in 221 (96.5 %) patients; 26 patients experienced cardiac death, 29 myocardial infarction and 51 coronary revascularization. Annual event rates for cardiac death, cardiac death/myocardial infarction and cardiac death/myocardial infarction/coronary revascularization were, respectively, 0, 0.2 and 0.4 % for patients with a normal scan and 1.5, 3.0 and 5.3 % after an abnormal MPS. Event-free survival was significantly different according to extent and severity of perfusion defects (all p < 0.01). An increase in global chi-square in predicting cardiac events occurred when MPS data were added to pre-scan information (from 47.28 to 88.87; p < 0.001).MPS provides incremental prognostic information for the prediction of cardiac events in elderly patients with hypertension. Subjects with a normal scan have an excellent 10-year outcome, and the risk of experiencing a cardiac event increases with extension and severity of stress perfusion defect

Role of radiomic analysis of [18F]fluoromethylcholine PET/CT in predicting biochemical recurrence in a cohort of intermediate and high risk prostate cancer patients at initial staging

AimTo study the feasibility of radiomic analysis of baseline [F-18]fluoromethylcholine positron emission tomography/computed tomography (PET/CT) for the prediction of biochemical recurrence (BCR) in a cohort of intermediate and high-risk prostate cancer (PCa) patients.Material and methodsSeventy-four patients were prospectively collected. We analyzed three prostate gland (PG) segmentations (i.e., PG(whole): whole PG; PG(41%): prostate having standardized uptake value - SUV > 0.41*SUVmax; PG(2.5): prostate having SUV > 2.5) together with three SUV discretization steps (i.e., 0.2, 0.4, and 0.6). For each segmentation/discretization step, we trained a logistic regression model to predict BCR using radiomic and/or clinical features.ResultsThe median baseline prostate-specific antigen was 11 ng/mL, the Gleason score was > 7 for 54% of patients, and the clinical stage was T1/T2 for 89% and T3 for 9% of patients. The baseline clinical model achieved an area under the receiver operating characteristic curve (AUC) of 0.73. Performances improved when clinical data were combined with radiomic features, in particular for PG(2.5) and 0.4 discretization, for which the median test AUC was 0.78.ConclusionRadiomics reinforces clinical parameters in predicting BCR in intermediate and high-risk PCa patients. These first data strongly encourage further investigations on the use of radiomic analysis to identify patients at risk of BCR