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Ebbehoj A, Stochholm K, Jacobsen SF, Trolle C, Jepsen P, Robaczyk MG, Rasmussen ÅK, Feldt-Rasmussen U, Thomsen RW, Søndergaard E, Poulsen PL. Incidence and Clinical Presentation of Pheochromocytoma and Sympathetic Paraganglioma: A Population-based Study. J Clin Endocrinol Metab 2021; 106:e2251-e2261. [PMID: 33479747 DOI: 10.1210/clinem/dgaa965] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Indexed: 12/17/2022]
Abstract
CONTEXT Pheochromocytoma and sympathetic paraganglioma (PPGL) are rare catecholamine-secreting tumors but recent studies suggest increasing incidence. Traditionally, PPGL are described to present with paroxysmal symptoms and hypertension, but existing data on clinical presentation of PPGL come from referral centers. OBJECTIVE We aimed to describe time trends in clinical presentation and incidence of PPGL in a population-based study. METHODS We conducted a nationwide retrospective cohort study of a previously validated cohort of 567 patients diagnosed with PPGL in Denmark 1977-2015. We collected clinical data from medical records of a geographic subcohort of 192 patients. We calculated age-standardized incidence rates (SIRs) and prevalence for the nationwide cohort and descriptive statistics on presentation for the subset with clinical data. RESULTS SIRs increased from 1.4 (95% CI 0.2-2.5) per million person-years in 1977 to 6.6 (95% CI 4.4-8.7) per million person-years in 2015, corresponding to a 4.8-fold increase. The increase was mainly due to incidentally found tumors that were less than 4 cm and diagnosed in patients older than 50 years with no or limited paroxysmal symptoms of catecholamine excess. On December 31, 2015, prevalence of PPGL was 64.4 (CI 95% 57.7-71.2) per million inhabitants. Of 192 patients with clinical data, 171 (89.1%) had unilateral pheochromocytoma, while unilateral paraganglioma (n = 13, 6.8%) and multifocal PPGL (n = 8, 4.2%) were rare. CONCLUSION Incidence of PPGL has increased 4.8-fold from 1977 to 2015 due to a "new" group of older patients presenting with smaller incidentally found PPGL tumors and few or no paroxysmal symptoms.
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Affiliation(s)
- Andreas Ebbehoj
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kirstine Stochholm
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Christian Trolle
- Diagnostic Center, Regional Hospital Silkeborg, Silkeborg, Denmark
| | - Peter Jepsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Åse Krogh Rasmussen
- Department of Endocrinology and Metabolism, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Esben Søndergaard
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Per Løgstrup Poulsen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
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Abstract
RATIONALE Ectopic pheochromocytoma is a special type of pheochromocytoma which occurs outside the adrenal gland. The most common symptoms of ectopic pheochromocytoma are palpitations, headaches, profuse sweating, and hypertension. In clinical practice, diagnosis of ectopic pheochromocytoma remains difficult. PATIENT CONCERNS The patient was a 43-year-old female who was admitted to our hospital with the chief complaint of upper abdominal discomfort for 1 week. Computed tomography demonstrated a neoplasm in the head of pancreas. The patient also had history of hypertension and type-2 diabetes. DIAGNOSIS According to the postoperative pathological examination, the lesion was mainly composed of chromaffin cells. Immunohistochemical staining revealed that the tumor expressed chromogranin A, NSE, and synaptophysin. Based on these findings, this mass was diagnosed as benign ectopic pheochromocytoma (paraganglioma). INTERVENTIONS Surgical resection operation was carried out and the patient's blood pressure was monitored continuously. Vasopressor or anti-hypertensive drugs were used according to circumstances. OUTCOMES The patient recovered well and was discharged from hospital with normal blood pressure. LESSONS This report reminds us to pay close attention to the likelihood of ectopic pheochromocytoma and other low-incidence diseases. Physicians and imaging clinicians should explore all clinical possibilities to avoid missed diagnosis or misdiagnosis of ectopic pheochromocytoma and take effective treatment measures to maximize patient benefits.
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Donatini G, Kraimps JL, Caillard C, Mirallie E, Pierre F, De Calan L, Hamy A, Larin O, Tovkay O, Cherenko S. Pheochromocytoma diagnosed during pregnancy: lessons learned from a series of ten patients. Surg Endosc 2018; 32:3890-3900. [PMID: 29488089 DOI: 10.1007/s00464-018-6128-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 02/23/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Pheochromocytoma (PHEO) in pregnancy is a life-threatening condition. Its management is challenging with regards to the timing and type of surgery. METHODS A retrospective review of the management of ten patients diagnosed with pheochromocytoma during pregnancy was performed. Data were collected on the initial diagnostic workup, symptoms, treatment, and follow-up. RESULTS PHEO was diagnosed in ten patients who were between the 10th and the 29th weeks of pregnancy. Six patients had none to mild symptoms, while four had complications of paroxysmal hypertension. Imaging investigations consisted of MRI, CT scan and ultrasounds. All had urinary metanephrines, measured as part of their workup. Three patients had MEN 2A, one VHL syndrome, one suspected SDH mutation. All patients were treated either with α/β blockers or calcium channel blockers to stabilize their clinical conditions. Seven patients underwent a laparoscopic adrenalectomy before delivery. Three out of these seven patients had a bilateral PHEO and underwent a unilateral adrenalectomy of the larger tumor during pregnancy, followed by a planned cesarean section and a subsequent contralateral adrenalectomy within a few months after delivery. Three patients had emergency surgery for maternal or fetal complications, with C-section followed by concomitant or delayed adrenalectomy. All newborns from the group of planned surgery were healthy, while two out three newborns within the emergency surgery group died shortly after delivery secondary to cardiac and pulmonary complications. CONCLUSIONS PHEO in pregnancy is a rare condition. Maternal and fetal prognosis improved over the last decades, but still lethal consequences may be present if misdiagnosed or mistreated. A thorough multidisciplinary team approach should be tailored on an individual basis to better manage the pathology. Unilateral adrenalectomy in a pregnant patient with bilateral PHEO may be an option to avoid the risk of adrenal insufficiency after bilateral adrenalectomy.
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Affiliation(s)
- G Donatini
- Department of General and Endocrine Surgery, CHU Poitiers, 2 Rue de la Miletrie, 86021, Poitiers, France.
| | - J L Kraimps
- Department of General and Endocrine Surgery, CHU Poitiers, 2 Rue de la Miletrie, 86021, Poitiers, France
| | - C Caillard
- Department of General and Endocrine Surgery, CHU Nantes, Nantes, France
| | - E Mirallie
- Department of General and Endocrine Surgery, CHU Nantes, Nantes, France
| | - F Pierre
- Department of Obstetrics and Gynaecology, CHU Poitiers, Poitiers, France
| | - Loïc De Calan
- Department of General and Endocrine Surgery, CHU Tours, Tours, France
| | - A Hamy
- Department of General and Endocrine Surgery, CHU Angers, Angers, France
| | - O Larin
- Department of Endocrine Surgery, Ukrainian Scientific and Practical Center for Endocrine Surgery of Public Health Ministry of Ukraine, Kiev, Ukraine
| | - O Tovkay
- Department of Endocrine Surgery, Ukrainian Scientific and Practical Center for Endocrine Surgery of Public Health Ministry of Ukraine, Kiev, Ukraine
| | - S Cherenko
- Department of Endocrine Surgery, Ukrainian Scientific and Practical Center for Endocrine Surgery of Public Health Ministry of Ukraine, Kiev, Ukraine
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Song M, Sun K, Xia T, Zhou L, Li Y, Sun Z, Zhang Y, Zhang X, Sun R, Chen B, Tan Q. Malignant pheochromocytoma in the anterior mediastinum with sternal invasion: a case report. J Thorac Dis 2017; 9:E202-E209. [PMID: 28449504 DOI: 10.21037/jtd.2017.02.71] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Pheochromocytomas are catecholamine-producing neuroendocrine tumors that usually occur in the adrenal medulla or sympathetic paraganglia. Anterior mediastinum involvement with pheochromocytoma is rare and may not present with typical symptoms. Its clinical manifestation may be unclear and a high index of suspicion is required for accurate diagnosis. We report a rare case of pheochromocytoma of the anterior mediastinum in a 51-year-old female. A painful hard mass on the sternum was the only clinical manifestation. Imageological examination indicated that there might be a malignant mass on the anterior mediastinum and thoracic wall. The patient accepted surgical curettage and thoracic wall reconstruction. Based on pathological results and WHO definition, the final diagnosis was malignant pheochromocytoma. After six months follow-up, the patient had no recurrence or any symptom. Malignant pheochromocytoma in the anterior mediastinum invading the sternum is rare. A local painful mass may be the only clinical manifestation without special laboratory results. Surgery remains as the first choice for these patients. For this rare case, 3D reconstruction by special software may be a good method to realize individualized treatment. The final decision of the diagnosis should be based on pathological results, past medical history and WHO definition. Long-term follow-up is necessary, while other suspicious lesions should also be given sufficient attention.
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Affiliation(s)
- Mingzhi Song
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China.,Department of Orthopaedics, The Third Affiliated Hospital of Dalian Medical University, Dalian 116200, China
| | - Kebin Sun
- College of Information Engineering, Dalian University, Dalian 116622, China
| | - Tian Xia
- Department of Thoracic Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Lei Zhou
- Department of Thoracic Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Yangyang Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Zhe Sun
- Department of Thoracic Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Yuchi Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Xianbin Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Ran Sun
- Department of Nursing, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China.,Operation Room, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Bo Chen
- Department of Nuclear Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Qingwei Tan
- Department of Thoracic Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
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Navarrete A, Almenara R, Momblán D, Lacy A. Laparoscopic resection of a paraganglioma in the organ of Zuckerkandl 123I-metaiodobenzylguanidine guided by gamma probe. Cir Esp 2016; 95:239-241. [PMID: 27890387 DOI: 10.1016/j.ciresp.2016.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/26/2016] [Accepted: 10/03/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Andrés Navarrete
- Departamento de Cirugía Gastrointestinal, Hospital Clínic, Barcelona, España; Departamento de Cirugía, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile; Departamento de Cirugía, Hospital Militar, Santiago, Chile.
| | - Raúl Almenara
- Departamento de Cirugía Gastrointestinal, Hospital Clínic, Barcelona, España
| | - Dulce Momblán
- Departamento de Cirugía Gastrointestinal, Hospital Clínic, Barcelona, España
| | - Antonio Lacy
- Departamento de Cirugía Gastrointestinal, Hospital Clínic, Barcelona, España
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Salgaonkar H, Behera RR, Sharma PC, Chadha M, Katara AN, Bhandarkar DS. Laparoscopic resection of a large paraganglioma arising in the organ of Zuckerkandl: Report of a case and review of the literature. J Minim Access Surg 2016; 12:378-81. [PMID: 27251804 PMCID: PMC5022524 DOI: 10.4103/0972-9941.169990] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Paragangliomas are catecholamine-secreting neuroendocrine tumours arising from chromaffin tissue at extra-adrenal sites. The commonest site for a paraganglioma is the organ of Zuckerkandl. Traditional treatment of paraganglioma of organ of Zuckerkandl (POZ) involves open surgical resection, and only a few cases of laparoscopic approach to this pathology have been reported. We report the successful laparoscopic resection of a large POZ in a 22-year-old woman and review the previous cases reporting a laparoscopic approach to this rare tumour.
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Affiliation(s)
| | - Ramya Ranjan Behera
- Department of Minimal Access Surgery, Hinduja Hospital, Mumbai, Maharashtra, India
| | | | - Manoj Chadha
- Department of Endocrinology, Hinduja Hospital, Mumbai, Maharashtra, India
| | - Avinash N Katara
- Department of Minimal Access Surgery, Hinduja Hospital, Mumbai, Maharashtra, India
| | - Deepraj S Bhandarkar
- Department of Minimal Access Surgery, Hinduja Hospital, Mumbai, Maharashtra, India
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Yang M, Ding H, Cai M, He YA, Cai Y, Zeng Y, Tian BL. Pheochromocytoma of the pancreas: A report of three cases and a literature review. Oncol Lett 2016; 12:959-962. [PMID: 27446377 DOI: 10.3892/ol.2016.4721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 12/11/2015] [Indexed: 02/05/2023] Open
Abstract
Pheochromocytoma is primarily derived from the adrenal medulla. The majority of extra-adrenal pheochromocytoma cases occur in the superior para-aortic region and para-adrenal area. However, pheochromocytoma originating from the pancreas is rare. The present study reports the cases of three patients who had no history of hypertension but were post-operatively diagnosed with pheochromocytoma located in the pancreas. Of the three patients, two were admitted to hospital due to abdominal pain, and imaging examinations revealed a soft-tissue lesion in the head of pancreas. Local resection of the pancreatic tumor was successfully performed and a diagnosis of pheochromocytoma derived from the pancreas was subsequently made by pathologists. The third patient was admitted to hospital for surgical treatment due to the identification of a continuously growing lesion in the tail of pancreas during physical examinations. Distal resection of the pancreas was stopped during surgery when the patient's blood pressure and heart rate suddenly increased to 180/110 mmHg and 140 beats/min, respectively. Due to a marked rise in noradrenaline and adrenaline levels in the blood subsequent to surgery, the patient was diagnosed with pancreatic pheochromocytoma. The present study additionally reviewed the associated literature concerning pheochromocytoma in order to improve the understanding of this rare clinical phenomenon. The aim of the present study is to highlight to surgeons that although patients may not present with typical clinical manifestations due to the non-functional status of the tumor, undiagnosed pheochromocytoma of the pancreas should be considered when surgeons observe an unexpected hypertensive crisis during pancreatic tumor surgery.
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Affiliation(s)
- Min Yang
- Department of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Hui Ding
- Department of Hepatobiliary Surgery, People's Hospital of Jiangyou, Mianyang, Sichuan 621700, P.R. China
| | - Min Cai
- Department of Hepatobiliary Surgery, People's Hospital of Jiangyou, Mianyang, Sichuan 621700, P.R. China
| | - Yan-An He
- Department of Hepatobiliary Surgery, People's Hospital of Jiangyou, Mianyang, Sichuan 621700, P.R. China
| | - Yu Cai
- Department of Hepatobiliary Surgery, People's Hospital of Jiangyou, Mianyang, Sichuan 621700, P.R. China
| | - Yong Zeng
- Department of Hepatobiliary Surgery, People's Hospital of Jiangyou, Mianyang, Sichuan 621700, P.R. China
| | - Bo-Le Tian
- Department of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, P.R. China
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8
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Leon-Ariza DS, Leon-Ariza JS, Leon-Sarmiento FE. "Unclassical" Combination of Smell Dysfunction, Altered Abdominal Nociception and Human Hypertension Associated "Classical" Adrenal-Augmentation. J Med Cases 2015; 6:527-533. [PMID: 26688704 DOI: 10.14740/jmc2330w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
We report a 33-year-old female patient, who arrived to the emergency ward with an abdominal pain that suddenly started 10 days before admission. Simultaneously, the patient developed sudden arterial hypertension and smell disturbances. Conventional medical treatment for pain and arterial hypertension was effortless. Laboratory tests ruled out pancreatitis. Metanephrines in her urine were also normal. A dual-phase intravenous contrast computed tomography of the abdomen showed a large mass within left adrenal gland. Adrenocortical adenoma was diagnosed. The mass was not hypervascularized but positive for synaptophysin and chromogranin A. Importantly, these proteins are heavily involved with acetylcholine metabolism. The triad of olfactory disorders, pain and arterial hypertension normalized after surgically extracting the adrenal mass. To our knowledge, this medical case is the first reported patient exhibiting immediate recovery of such unclassical triad of local and remote findings. The function and dysfunction of key nanocholinergic pathways involved with smell, blood pressure and nociception would explain the pathophysiology of this unique medical case.
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Affiliation(s)
- Daniel S Leon-Ariza
- Faculty of Health Sciences, Universidad de Santander - UDES, Bucaramanga, Colombia ; Mediciencias Research Group, Unicolciencias/Universidad Nacional, Bogota, Colombia
| | - Juan S Leon-Ariza
- Mediciencias Research Group, Unicolciencias/Universidad Nacional, Bogota, Colombia ; Faculty of Medicine, Universidad de La Sabana, Chia, Colombia
| | - Fidias E Leon-Sarmiento
- Smell & Taste Center, Department of Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, PA, USA
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9
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Abstract
Abstract
Background
Phaeochromocytoma in pregnancy is a rare and potentially dangerous situation for mother and fetus. This review aimed to assess current mortality rates and how medical and surgical management affect these.
Methods
Articles in English published between 2000 and 2011 were obtained from a MEDLINE search. Eligible publications presented women diagnosed with phaeochromocytoma in the antenatal or immediate postnatal period, and reported management and outcomes.
Results
A total of 135 reports were identified. After applying inclusion criteria, 77 pregnancies involving 78 fetuses were analysed. Fetal and maternal mortality rates were 17 per cent (13 of 78) and 8 per cent (6 of 77) respectively. Better outcomes were achieved when the diagnosis of phaeochromocytoma was made in the antenatal period than when it was made during labour or immediately postpartum (survival of both mother and fetus(es) in 48 of 56 versus 12 of 21 respectively; P = 0·012). When the diagnosis was made before 23 weeks' gestation, there was no difference in outcomes when phaeochromocytoma surgery was carried out in the second trimester, compared with when it was postponed to the third trimester or after delivery (fetal death 2 of 18 versus 2 of 8 respectively; P = 0·563).
Conclusion
This review, although limited by the rarity of the condition and level of available evidence, demonstrated that survival rates are improved if the diagnosis of phaeochromocytoma can be established antenatally. With diagnosis before 23 weeks' gestation, no definite advantage of proceeding with tumour removal during the second trimester could be demonstrated.
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Affiliation(s)
- M A Biggar
- Department of Endocrine Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- Department of Surgery, Middlemore Hospital, Counties Manukau District Health Board, Otahuhu, Auckland, New Zealand
| | - T W J Lennard
- Department of Endocrine Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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Schaefer IM, Gunawan B, Füzesi L, Blech M, Frasunek J, Loertzer H. Chromosomal imbalances in urinary bladder paraganglioma. CANCER GENETICS AND CYTOGENETICS 2010; 203:341-4. [PMID: 21156256 DOI: 10.1016/j.cancergencyto.2010.07.131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 07/13/2010] [Accepted: 07/25/2010] [Indexed: 10/18/2022]
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Affiliation(s)
- R Hardy
- School of Surgical and Reproductive Sciences, Newcastle University, and Department of Endocrine Surgery, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK
| | - T W J Lennard
- School of Surgical and Reproductive Sciences, Newcastle University, and Department of Endocrine Surgery, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK
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Goldsby RE, Fitzgerald PA. Meta[131I]iodobenzylguanidine therapy for patients with metastatic and unresectable pheochromocytoma and paraganglioma. Nucl Med Biol 2008. [DOI: 10.1016/j.nucmedbio.2008.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sadow PM, Rumilla KM, Erickson LA, Lloyd RV. Stathmin expression in pheochromocytomas, paragangliomas, and in other endocrine tumors. Endocr Pathol 2008; 19:97-103. [PMID: 18461287 DOI: 10.1007/s12022-008-9028-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Pheochromocytomas are neuroendocrine tumors confined to the adrenal glands, and malignant pheochromocytomas can spread to various sites including the liver, lung, and bones. Paragangliomas occur in numerous locations in the body, so assessment of metastatic disease is more challenging, as patients with familial syndromes often have multiple, possibly independent paragangliomas. The most reliable criterion for malignancy in pheochromocytomas and paragangliomas is metastatic disease. Because there are few immunohistochemical markers that are useful in the diagnosis of malignancy in pheochromocytomas and paragangliomas before they metastasize, more markers are needed to characterize these tumors. Stathmin is a widely expressed 17-kDa cytoplasmic, microtubule destabilizing and sequestering phosphoprotein that is important in cell motility and cancer cell metastasis. It is upregulated in various malignancies. We examined stathmin expression in tissues from patients with pheochromocytomas (n = 48), malignant pheochromocytomas (n = 28), paragangliomas (n = 42), and malignant paragangliomas (n = 21) by immunohistochemistry using tissue microarrays (TMA) with a polyclonal antibody against stathmin. A series of other endocrine tissues and tumors (n = 70) were also examined for stathmin expression. Stathmin was more highly expressed in pheochromocytomas compared to normal adrenals, a finding confirmed by Western blot. There was higher expression of stathmin by immunohistochemical staining in malignant pheochromocytomas compared to pheochromocytomas without metastasis when analyzed by maximal staining (p = 0.012). Stathmin was present in a wide variety of endocrine tumors and was most highly expressed in rapidly proliferating tumors including anaplastic thyroid carcinomas, Merkel cell carcinomas of the skin and small cell carcinomas of the lung. These results show that stathmin is expressed at higher levels in more rapidly proliferating endocrine tumors. However, it is probably not useful as a stand-alone marker to determine malignancy in pheochromocytomas for individual tumors.
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Affiliation(s)
- Peter M Sadow
- Department of Pathology, Brigham and Women's Hospital, Boston, MA 02115, USA
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