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Borkowska A, Olszewska A, Skarzynska W, Marciniak M, Skrzeszewski M, Kieda C, Was H. High Hemin Concentration Induces Escape from Senescence of Normoxic and Hypoxic Colon Cancer Cells. Cancers (Basel) 2022; 14:cancers14194793. [PMID: 36230727 PMCID: PMC9564005 DOI: 10.3390/cancers14194793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 11/23/2022] Open
Abstract
Simple Summary High red-meat consumption as well as bleeding or bruising can promote oxidative stress and, in consequence, cancer development. However, the mechanism of that phenomenon is not understood. The induction of therapy-induced senescence (TIS) might also be induced by oxidative stress. Recently, TIS cells, despite their inhibited proliferation potential, have been identified as one of the sources of tumor re-growth. Here, with the use of molecular analyses, we found that oxidative stress, promoted by high doses of hemin or H2O2, can trigger TIS escape and cell re-population. It is closely related to the activity of antioxidative enzymes, especially heme oxygenase-1. Hypoxia might accelerate these effects. Therefore, we propose that the prevention of excessive oxidative stress could be a potential target in senolytic therapies. Abstract Hemoglobin from either red meat or bowel bleeding may promote oxidative stress and increase the risk of colorectal cancer (CRC). Additionally, solid cancers or their metastases may be present with localized bruising. Escape from therapy-induced senescence (TIS) might be one of the mechanisms of tumor re-growth. Therefore, we sought to study whether hemin can cause escape from TIS in CRC. To induce senescence, human colon cancer cells were exposed to a chemotherapeutic agent irinotecan (IRINO). Cells treated with IRINO exhibited common hallmarks of TIS. To mimic bleeding, colon cancer cells were additionally treated with hemin. High hemin concentration activated heme oxygenase-1 (HO-1), induced escape from TIS and epithelial-to-mesenchymal transition, and augmented progeny production. The effect was even stronger in hypoxic conditions. Similar results were obtained when TIS cells were treated with another prooxidant agent, H2O2. Silencing of antioxidative enzymes such as catalase (CAT) or glutathione peroxidase-1 (GPx-1) maintained colon cancer cells in a senescent state. Our study demonstrates that a high hemin concentration combined with an increased activity of antioxidative enzymes, especially HO-1, leads to escape from the senescence of colon cancer cells. Therefore, our observations could be used in targeted anti-cancer therapy.
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Affiliation(s)
- Agata Borkowska
- Laboratory of Molecular Oncology and Innovative Therapies, Military Institute of Medicine, Szaserow 128 Street, 04-141 Warsaw, Poland
- Postgraduate School of Molecular Medicine, Medical University of Warsaw, Zwirki i Wigury 61 Street, 02-091 Warsaw, Poland
| | - Aleksandra Olszewska
- Laboratory of Molecular Oncology and Innovative Therapies, Military Institute of Medicine, Szaserow 128 Street, 04-141 Warsaw, Poland
- Postgraduate School of Molecular Medicine, Medical University of Warsaw, Zwirki i Wigury 61 Street, 02-091 Warsaw, Poland
| | - Weronika Skarzynska
- Laboratory of Molecular Oncology and Innovative Therapies, Military Institute of Medicine, Szaserow 128 Street, 04-141 Warsaw, Poland
| | - Marta Marciniak
- Laboratory of Molecular Oncology and Innovative Therapies, Military Institute of Medicine, Szaserow 128 Street, 04-141 Warsaw, Poland
| | - Maciej Skrzeszewski
- Laboratory of Molecular Oncology and Innovative Therapies, Military Institute of Medicine, Szaserow 128 Street, 04-141 Warsaw, Poland
- Doctoral School of Translational Medicine, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland
| | - Claudine Kieda
- Laboratory of Molecular Oncology and Innovative Therapies, Military Institute of Medicine, Szaserow 128 Street, 04-141 Warsaw, Poland
- Centre for Molecular Biophysics, UPR CNRS 4301, CEDEX 2, 45071 Orléans, France
| | - Halina Was
- Laboratory of Molecular Oncology and Innovative Therapies, Military Institute of Medicine, Szaserow 128 Street, 04-141 Warsaw, Poland
- Correspondence:
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Familiari M, Di Santo D, Galli A, Danè G, Giordano L, Mellone R, Bussi M. Spontaneous extracapsular parathyroid adenoma hemorrhage: when surgery is required? Endocrine 2022; 75:575-582. [PMID: 34554413 DOI: 10.1007/s12020-021-02876-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 09/12/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Spontaneous bleeding is a rare but serious complication of parathyroid adenomas and few cases were reported in the literature. Clinical manifestations and treatment may vary but sometimes an immediate surgery is required. In other cases a conservative approach can be preferred based on clinical stability and patients' conditions. The purpose of this work is to describe our case and to carry out a review of the current literature on this topic. METHODS We reported a case of a parathyroid adenoma hemorrhage in an elderly patient describing its management. Moreover, a literature review of 57 cases was carried out, with the aim of collecting data about the most involved parathyroid gland and identifying the most correct management based on clinical manifestations and chosen treatments. RESULTS The patients had an age between 29 and 81 years (mean 56.9 ± 16.4 years). Forty-four patients were females (77.2%), whereas 12 were males (21.8%). Based on clinical severity, age, comorbidities and calcemic status, three possible scenarios were identified, each with a recommended management. CONCLUSIONS In parathyroid adenoma hemorrhages a careful clinical assessment is crucial to identify emergency conditions requiring immediate intubation, tracheostomy or neck exploration. Elderlies and comorbid patients have a higher risk of perioperative complications and indication for surgery should be evaluated case by case: whenever feasible, a conservative approach should be preferred in these subjects, especially in those with a stable course and without hypercalcemia-related symptoms.
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Affiliation(s)
- Marco Familiari
- Department of Otolaryngology-Head and Neck Surgery, Scientific Institute of Hospitalization and Care San Raffaele Hospital, Vita-Salute University, Milan, Italy.
| | - Davide Di Santo
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, via Manzoni 56 Rozzano, 20089, Milan, Italy
| | - Andrea Galli
- Department of Otolaryngology-Head and Neck Surgery, Scientific Institute of Hospitalization and Care San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Giulia Danè
- Department of Otolaryngology-Head and Neck Surgery, Scientific Institute of Hospitalization and Care San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Leone Giordano
- Department of Otolaryngology-Head and Neck Surgery, Scientific Institute of Hospitalization and Care San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Renata Mellone
- Department of Radiology, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Mario Bussi
- Department of Otolaryngology-Head and Neck Surgery, Scientific Institute of Hospitalization and Care San Raffaele Hospital, Vita-Salute University, Milan, Italy
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3
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Porta L, Ghezzi R, Cadonici AC, Dalino Ciaramella P, Martes C, Basile A, Bellone A. An unusual case of neck hematoma and hypercalcemia. Emer Care J 2021. [DOI: 10.4081/ecj.2021.9548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
One of the most frequent cause of hypercalcemia is primary hyperparathyroidism, which can lead to systemic involvement and life-threatening conditions. We described a rare case of a parathyroid adenoma rupture with consequent bleeding and respiratory airway compression. An 84-year-old man presented to the emergency department complaining neck swelling and related dysphagia. A computer tomography of the neck revealed an extensive left lateral hematoma, and a neck ultrasonography evidenced a hemorrhagic parathyroid adenoma, later confirmed by a 99 mTc-MIBI scintigraphy. To date only 40 cases of ruptured parathyroid adenomas have been described in literature, however due to the possibility of massive bleeding and compression of the airways this diagnosis should always be ruled out. The rupture of a parathyroid adenoma is a rare, but possibly life-threatening event due to airways compression and hemodynamic instability. Testing for hypercalcemia and hyperparathyroidism is mandatory to obtain a correct diagnosis.
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Zammit M, Siau R, Panarese A. Importance of serum calcium in spontaneous neck haematoma. BMJ Case Rep 2020; 13:13/9/e237267. [PMID: 32895253 DOI: 10.1136/bcr-2020-237267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present an unusual case of spontaneous cervical haemorrhage secondary to extra-capsular bleeding from a parathyroid adenoma. Signs and symptoms on presentation included sore throat, dysphagia and anterior chest ecchymosis. While CT confirmed active cervical haemorrhage, elevated serum calcium and parathyroid hormone raised suspicion of possible parathyroid pathology. This case report and literature review highlight the diagnostic value of serum calcium in presentations of acute spontaneous neck haematoma. This should be considered especially in the acute phase, where imaging may not identify the source of haemorrhage. Initial observation and deferred surgery is the treatment of choice, with emergency operative management reserved for respiratory distress and worsening compressive symptoms.
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Affiliation(s)
- Matthew Zammit
- ENT, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
| | - Richard Siau
- ENT, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
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Torimitsu S, Makino Y, Yamaguchi R, Chiba F, Tsuneya S, Iwase H. Fatal Spontaneous Retropharyngeal Hematoma with Airway Obstruction in the Setting of Treatment with Dipyridamole. J Forensic Sci 2019; 65:987-990. [PMID: 31658383 DOI: 10.1111/1556-4029.14226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/04/2019] [Accepted: 10/09/2019] [Indexed: 12/01/2022]
Abstract
We report a fatal case of airway obstruction caused by spontaneous retropharyngeal hematoma (RH) in the setting of treatment with dipyridamole. A 90-year-old woman presented with cervical swelling, neck and chest ecchymoses, and complaints of dyspnea. She suffered cardiopulmonary arrest in the ambulance, and her death was confirmed after transportation to the hospital. The major finding of postmortem computed tomography (PMCT) prior to autopsy was widening of the prevertebral soft tissue. The results of the autopsy indicated that the cause of death was mechanical asphyxia, secondary to pharyngeal and laryngeal compression caused by the RH. There were no evident injuries, medical interventions, or particular diseases, suggesting the spontaneous cause of the RH. To the best of our knowledge, this is the first report of a fatal case secondary to spontaneous RH that was revealed through PMCT imaging.
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Affiliation(s)
- Suguru Torimitsu
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Yohsuke Makino
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Rutsuko Yamaguchi
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Fumiko Chiba
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Shigeki Tsuneya
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Hirotaro Iwase
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Education and Research Center of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
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Abstract
Emergencies in endocrine surgery are rare. Acute neck hematoma may result from recent surgery or spontaneous as with ruptured thyroidal cyst, thyroidal vessel, or parathyroid adenoma. We are reporting a case of acute neck hematoma caused by a ruptured of parathyroid adenoma, which required urgent surgical intervention.
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Affiliation(s)
- Doaa Alfraidy
- Department of Surgery, King Khalid University HospitalKing Saud UniversityRiyadhSaudi Arabia
| | - Hadeel Helmi
- Department of Surgery, King Khalid University HospitalKing Saud UniversityRiyadhSaudi Arabia
| | - Maha Alamodi Alghamdi
- Department of Surgery, King Khalid University HospitalKing Saud UniversityRiyadhSaudi Arabia
- King Khalid UniversityAbhaSaudi Arabia
| | - Areej Bokhari
- Department of Surgery, King Khalid University HospitalKing Saud UniversityRiyadhSaudi Arabia
| | - Abdulaziz Alsaif
- Department of Surgery, King Khalid University HospitalKing Saud UniversityRiyadhSaudi Arabia
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7
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Hu Y, Cui M, Xia Y, Su Z, Zhang X, Liao Q, Jiang Y, Zhao Y. The Clinical Features of Cystic Parathyroid Adenoma in Chinese Population: A Single-Center Experience. Int J Endocrinol 2018; 2018:3745239. [PMID: 30123260 PMCID: PMC6079486 DOI: 10.1155/2018/3745239] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 06/21/2018] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Cystic parathyroid adenoma is a rare cause of primary hyperparathyroidism, but its preoperative diagnosis and management remain inconclusive. METHOD We retrospectively identified patients with cystic parathyroid adenomas who underwent surgery at Peking Union Medical College Hospital. RESULTS Patients with cystic parathyroid adenomas had higher serum intact parathyroid hormone and calcium levels, larger maximum tumor diameter, and lower serum inorganic phosphorus level than did those with solid adenomas. Patients with cystic adenomas were predominantly male, and hypercalcemic crisis and atypical adenomas were common. The accuracy of preoperative localization methodologies was lower in patients with cystic adenomas than in patients with solid adenomas. US-guided fine-needle aspiration was performed in 11 patients. In all patients, the iPTH level in cystic fluid was much higher than that in serum. No sign of recurrence was observed after a median follow-up of 39 months. CONCLUSIONS Cystic parathyroid adenomas may not be as rare as previously reported. FNA may be a safe and feasible localization methodology for patients with inconclusive preoperative localization methodologies. Close follow-up is necessary for patients with cystic parathyroid adenomas, which account for a substantial proportion of atypical adenoma cases.
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Affiliation(s)
- Ya Hu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Ming Cui
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Yu Xia
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Zhe Su
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Xiang Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Quan Liao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Yuxin Jiang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Yupei Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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8
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Shinomiya H, Otsuki N, Takahara SI, Yasui R, Sawada N, Komatsu H, Fujio H, Fujiwara H, Nibu KI. Parathyroid adenoma causing spontaneous cervical hematoma: two case reports. BMC Res Notes 2015; 8:726. [PMID: 26610856 PMCID: PMC4661989 DOI: 10.1186/s13104-015-1611-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 10/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although spontaneous rupture of a cervical parathyroid adenoma with extracapsular hemorrhage is rare, it may cause cervical and mediastinal hematoma, leading to potentially fatal consequences. CASE PRESENTATION The first case was a 76-year-old Asian female who presented with pharyngeal discomfort and anterior chest ecchymosis. Endoscopic investigation showed submucosal hemorrhage in the pharynx and larynx. The second case was a 62-year-old Asian male who presented with anterior chest ecchymosis and suspected of a ruptured blood vessel. Both cases were diagnosed parathyroid adenoma with extracapsular bleeding by hypercalcemia, high levels of intact parathyroid hormone and presence of a nodule behind the thyroid. Both cases were treated with excision of tumor 7 months after initial presentation. After surgery, serum calcium and parathyroid hormone levels had decreased to normal level in both cases. CONCLUSION Extracapsular bleeding of a parathyroid adenoma should be considered in the differential diagnosis of non-traumatic neck hematoma.
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Affiliation(s)
- Hitomi Shinomiya
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 6500017, Japan.
| | - Naoki Otsuki
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 6500017, Japan.
| | - Shin-Ichi Takahara
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 6500017, Japan.
| | - Rie Yasui
- Department of Otorhinolaryngology, Kakogawa West City Hospital, Kakogawa, Japan.
| | - Naoki Sawada
- Department of Otolaryngology, Nishi-Kobe Medical Center, Kobe, Japan.
| | - Hirokazu Komatsu
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 6500017, Japan.
| | - Hisami Fujio
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 6500017, Japan.
| | - Hajime Fujiwara
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 6500017, Japan.
| | - Ken-Ichi Nibu
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 6500017, Japan.
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Ghasemi-Rad M, Lesha E, Abkhiz S, Mohammadi A. PRIMARY HYPERPARATHYROIDISM: COMPARING BETWEEN SOLID AND CYSTIC ADENOMAS AND THE EFFICACY OF ULTRASOUND AND SINGLE-PHOTON EMISSION COMPUTED TOMOGRAPHY IN THEIR DIAGNOSIS. Endocr Pract 2015; 21:1277-81. [PMID: 26307898 DOI: 10.4158/ep15789.or] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Primary hyperparathyroidism (PHPT) is a disorder that results from abnormal functioning of the parathyroid glands. The purpose of this study was to compare cystic and solid adenomas by analyzing different variables associated with PHPT and parathyroid adenomas (age, calcium, phosphorus, and parathyroid hormone [PTH] levels, adenoma volume) while comparing the efficacy of ultrasound and single-photon emission computed tomography in differentiating between both types of adenoma. METHODS From 152 patients diagnosed with PHPT between January 2013 and 2014, only 109 patients who had positive ultrasonographic findings for single parathyroid adenoma were included in the study. RESULTS A total of 26 patients had cystic adenomas and 83 patients had solid adenomas. Sestamibi (MIBI) was negative in 50% of the cystic adenoma group and 27.7% of the solid adenoma group, with an overall technetium-MIBI efficacy of 67%. Age, phosphorus level, and adenoma volume were significantly higher in patients with cystic adenomas (P = .001, P = .02, and P = .02, respectively), whereas calcium and PTH levels were significantly higher in patients with solid adenomas (P = .02, P = .038, respectively). MIBI had a significant correlation with PTH levels (P = .031) and adenoma volume (P = .05) only in patients with solid adenomas. No significant correlation was found between sex and type of parathyroid adenoma. CONCLUSION The current study is the first to compare age, PTH levels, and adenoma volume between cystic and solid adenoma patients, providing more information for the poorly understood pathology of cystic adenomas. Our findings showed that age and calcium and PTH levels are significantly higher in patients with solid adenomas, whereas adenoma volume and phosphorus levels are significantly higher in patients with cystic adenomas.
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Abstract
We report a case of lethal acute aortic dissection revealed by a large ecchymotic area at the root of the neck; the subject was an 86-year-old man who died suddenly in his hospital room. His medical history included ischemic heart disease with pacemaker implantation and an aortic surgical prosthesis. Forensic autopsy showed a major subcutaneous hemorrhage in the neck and large left pleural and pericardial adhesions secondary to thoracic surgery. The cause of death was an acute aortic dissection. Large adhesions led to an extensive mediastinal hemorrhage, spreading to the subcutaneous tissues of the neck. This case report highlights the difficulties in differentiating between traumatic and pseudo-bruising during a death scene investigation. The etiologies of pseudo-bruising are reviewed.
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Affiliation(s)
- Anne-Sophie Advenier
- Department of Forensic Medicine and Pathology, Raymond Poincaré Hospital, AP-HP, Versailles Saint-Quentin University, Garches, France
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Yoshimura N, Mukaida H, Mimura T, Iwata K, Amioka A, Hirabayashi N, Takiyama W. A case of an acute cervicomediastinal hematoma secondary to the spontaneous rupture of a parathyroid adenoma. Ann Thorac Cardiovasc Surg 2013; 20 Suppl:816-20. [PMID: 23445790 DOI: 10.5761/atcs.cr.12.02060] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We herein report the case of a patient with an acute cervicomediastinal hematoma secondary to the spontaneous rupture of a parathyroid adenoma. A 47-year-old female presented with swelling and pain in the neck. She had no history of trauma or of having undergone any medical or odontological procedures. An ultrasound examination revealed the presence of an obscure mass located behind the right lobe of the thyroid gland. A computed tomography scan showed the presence of a low-density lesion extending from the retropharynx to the mediastinum, a high-density lesion located behind the right lobe of the thyroid gland and a right pleural effusion. Because the patient's neck swelling and anemia gradually worsened, she underwent emergency surgery. The neck was found to be swollen due to a hematoma; however, no abscesses were detected in the operative field.Thoracoscopy of the right chest showed no active bleeding. The fragmented mass was histopathologically diagnosed as a parathyroid adenoma with acute hemorrhage, which is quite rare. Our experience suggests that, in patients with severe cervicomediastinal hematomas without any trauma or trigger, a diagnosis of spontaneous rupture of a parathyroid gland lesion should be considered.
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Affiliation(s)
- Noriko Yoshimura
- Department of Surgery, Hiroshima City Asa Hospital, Hiroshima, Japan
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12
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Cohen O, Yehuda M, Adi M, Lahav Y, Halperin D. Spontaneous Neck Hematoma in a Patient with Fibromuscular Dysplasia: A Case Report and a Review of the Literature. Case Rep Otolaryngol 2013; 2013:1-4. [PMID: 24191215 PMCID: PMC3804144 DOI: 10.1155/2013/352830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 09/02/2013] [Indexed: 11/17/2022] Open
Abstract
Background. Fibromuscular dysplasia (FMD) is a vascular disease that may present as aneurysms in the cervical arteries. Spontaneous neck hematoma is a rare life threatening medical condition. This is the first report of neck hematoma in a patient with FMD.Methods and Results. We present a case of a 69-year-old woman, with diagnosed cervical FMD and a 3-day history of sore throat and neck pain, who presented with enlarging neck hematoma. No active bleeding was noticed on CT angiography, airway was not compromised, and patient was managed conservatively. Next day, invasive angiography was performed, and no bleeding vessel was demonstrated. Patient has improved and was discharged after 5 days of hospitalization. We have discussed the different etiology of this condition, focusing on systemic vascular diseases.Conclusion. Complaint of neck pain in a patient with a FMD should raise suspicion for possible neck hematoma. Conversely, spontaneous neck hematoma without clear etiology should raise suspicion for a systemic vascular disease.
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Merante-Boschin I, Fassan M, Pelizzo MR, Ide EC, Rugge M. Neck emergency due to parathyroid adenoma bleeding: a case report. J Med Case Rep 2009; 3:7404. [PMID: 19830200 PMCID: PMC2726549 DOI: 10.1186/1752-1947-3-7404] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Accepted: 01/22/2009] [Indexed: 11/24/2022] Open
Abstract
Introduction The spontaneous rupture of a parathyroid adenoma accompanied by extracapsular hemorrhage is a rare, potentially fatal, condition and is a cervicomediastinal surgical emergency. Case presentation This report describes an atypical two-step spontaneous rupture of an asymptomatic parathyroid adenoma in a 56-year-old Caucasian woman who presented with a painful mass in the right side of her neck. Conclusion Based on this case report and similar cases reported in the medical literature, a diagnosis of extracapsular parathyroid hemorrhage should be considered when a non-traumatic sudden neck swelling coexists with hypercalcemia and regional ecchymosis.
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Abstract
Mediastinal hematomas are the end result of numerous conditions ranging from the deadly traumatic aortic injury to the common changes after open heart surgery. The location of the hematoma, its relation with the surrounding structures, the clinical history, and associated findings can help narrow the differential diagnosis. Contrast-enhanced computed tomography is the imaging modality of choice because of its accessibility, noninvasiveness, rapid acquisition, and ability to evaluate the entire thorax at once.
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15
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Shim WS, Kim IK, Yoo SD, Kim DH. Non-functional parathyroid adenoma presenting as a massive cervical hematoma: a case report. Clin Exp Otorhinolaryngol 2008; 1:46-8. [PMID: 19434262 DOI: 10.3342/ceo.2008.1.1.46] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2008] [Accepted: 03/15/2008] [Indexed: 11/08/2022] Open
Abstract
Parathyroid adenoma usually manifests with symptoms related to hypercalcemia, such as urinary stone and bone fracture. It may also present with asymptomatic hypercalcemia. However, spontaneous cervical hematoma may occur very rarely as a result of extracapsular hemorrhage of a cervical parathyroid adenoma causing acute painful cervical swelling, bruising, dyspnea, hoarseness and dysphagia. We report a 44-year-old woman who manifested as a spontaneous cervical hematoma without any clinical evidence of hyperparathyroidism.
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Abstract
Spontaneous retropharyngeal hemorrhage from a cervical parathyroid adenoma is a rare complication of primary hyperparathyroidism. Because of its rarity, it has seldom been documented in the radiologic or ENT literature. Patients may present with a variety of manifestations, ranging from dysphagia to dysphonia to life-threatening dyspnea or hemorrhage. Awareness of a possible thyroid or parathyroid etiology may expedite treatment and prevent unnecessary interventions. We present a case of spontaneous retropharyngeal hemorrhage in which the “sentinel clot” sign enabled us to identify the lesion of origin.
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Affiliation(s)
- George Koulouris
- From the Department of Radiology, The Alfred Hospital, Victoria, Australia
| | - Marcus Pianta
- From the Department of Radiology, The Alfred Hospital, Victoria, Australia
| | - Stephen Stuckey
- Department of Radiology, Princess Alexandra Hospital, Brisbane, Australia
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Abstract
BACKGROUND In a minority of patients, primary hyperparathyroidism spontaneously remits either by autoinfarction or by hemorrhage into or around the adenoma. We describe a case of autoparathyroidectomy occurring in a 63-year-old man 9 years after three parathyroid glands were removed during a total thyroidectomy. This case is compared with 50 previously reported cases of autoparathyriodectomy, and a meta-analysis is performed. METHODS Case report, literature review, and meta-analysis were done using statistical software (SigmaStat 2.0, SPSS, Chicago). RESULTS Fifty cases of autoparathyroidectomy were summarized according to the three etiologies. The greatest biochemical aberration was found in the acute intracapsular hemorrhage group, with [Ca(++)] falling from a mean 15.1 mg/dL to 8.9 mg/dL. The average drop in parathyroid hormone was 69% across all groups, comparing favorably to surgical resection. CONCLUSIONS Autoparathyroidectomy is a rare but described outcome of unoperated primary hyperparathyroidism that may delay or supplant operative management.
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Affiliation(s)
- Christopher T Wootten
- Department of Otolaryngology, Vanderbilt University, 1215 21st Avenue South, Nashville, Tennessee 37232, USA.
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Abstract
OBJECTIVE To describe a rare clinical presentation of necrosis of a parathyroid adenoma, manifesting as fever of unknown origin. METHODS We present a case report, including detailed clinical and laboratory data, of a patient with previously undiagnosed primary hyperparathyroidism in whom necrosis of a parathyroid adenoma developed during a psychiatric admission for depression. RESULTS A 40-year-old woman was admitted with severe depression. During her hospitalization, she was found to have osteitis fibrosa cystica, pathologic fractures of her left femur, and primary hyperparathyroidism. Shortly after her admission, spontaneous necrosis of her parathyroid adenoma developed, in association with high-grade fever, acute hypercalcemic crisis, neck pain, hypophonia, and shortness of breath. Findings on extensive evaluation of the fever remained unremarkable, with persistent high-grade temperatures that resolved postoperatively. CONCLUSION Spontaneous necrosis of a parathyroid adenoma is a rare but well-documented complication of primary hyperparathyroidism. Fever, a previously undocumented associated finding, might be a part of the clinical syndrome of this complication.
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Affiliation(s)
- Lubna M Zuberi
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
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Affiliation(s)
- Cara M Connolly
- Department of Plastic Surgery, Morriston Hospital, Swansea, UK
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Shundo Y, Nogimura H, Kita Y, Neyatani H, Kobayashi R, Sugimura H. Spontaneous parathyroid adenoma hemorrhage. Jpn J Thorac Cardiovasc Surg 2002; 50:391-4. [PMID: 12382409 DOI: 10.1007/bf02913192] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report a case of spontaneous parathyroid adenoma hemorrhage. A 50-year-old man with a sore throat, and swelling and ecchymosis of the entire anterior neck was found in cervical and chest computed tomography revealed to have a low-density area extending from the parapharyngeal region to below the carina, Suspecting descending necrotizing mediastinitis secondary to a peritonsillar abscess, we conducted mediastinal and cervical drainage, but found no abscess. No evidence was found, either, in bacteriological culture of sputum and pleural effusion. After the hematoma disappeared, cervical ultrasonography indicated parathyroid adenoma. Serum calcium was marginally increased, indicating that serum calcium should be determined if cervical or mediastinal hematoma develops without an obvious cause.
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Affiliation(s)
- Yasumasa Shundo
- Department of Thoracic Surgery, Fujieda General Hospital, 4-1-11 Surugadai, Fujieda, Shizuoka 426-8677, Japan
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