Multiple endocrine adenomatosis-I and II

The Histopathological Patterns of Ovarian Neoplasms in Different Age Groups: A Retrospective Study in a Tertiary Care Center

Objectives Ovarian cancer is one of the most prevalent neoplasms worldwide and it affects women of all ages. This study aimed to identify the common histopathological patterns of ovarian cancer among different age groups in the western region of Saudi Arabia. Methods This was a retrospective study that reviewed all ovarian specimens diagnosed as "ovarian tumors" by the Pathology Department from January 2016 to December 2020 at King Abdulaziz University Hospital, Saudi Arabia. The frequencies of ovarian neoplasm subtypes and their frequencies in different age groups were calculated. Results Out of 565 ovarian specimens studied, 63.2% were ovarian neoplasms while 36.8% were non-neoplastic functional cysts. Benign neoplasms 64.4% were more common than borderline 6.2% and malignant ones 29.4% in all age groups, except above the age of 60. Collectively as a category, surface epithelial neoplasms were the most common (59.4%). However, germ cell tumor in the form of mature cystic teratoma was the most common benign neoplasm 33.9% and the most common malignant was serous cystadenocarcinoma (40%). Conclusion Documenting new trends of histopathological patterns of ovarian neoplasms helps to detect variation among different age groups and to understand probable predisposing factors. This study found that the percentage of ovarian malignancy has increased over the years in the western region of Saudi Arabia. This signifies the need to increase awareness in order to achieve timely diagnosis and management.

Highlights from endocrine surgical history

Endocrine surgery includes excision of diseased or sometimes normal endocrine glands and occasionally the transplantation of endocrine tissues. Male castration was performed for social reasons in prehistoric times, and thyroid operations were described during the twelfth century. Until the end of the nineteenth century most operations were undertaken to relieve the local effects of pathologic enlargement of the thyroid, ovaries, pituitary, and adrenals; and with the development of anesthesia, antisepsis, and effective hemostasis, thyroidectomy for benign, nontoxic goiter was perfected. Thyroid deficiency followed total thyroidectomy, and thyroid replacement therapy was developed. Toxic goiter was sometimes relieved by partial thyroidectomy. After the discovery of hormones early this century, knowledge of endocrinology increased, and many syndromes of hormonal excess were described. Surgeons began to operate to relieve them. Results improved with mastery of surgical technique, especially for operations on the thyroid, parathyroids, and pituitary; with the development of methods for diagnosis of syndromes and the localization of lesions; with teamwork; and with the use of hormones, drugs, and radiotherapy as alternative or additional forms of therapy before, during, and after operation. Notable advances followed adequate resection of thyroid tissue and the use of iodine and antithyroid drugs before operation for toxic goiter. The use of cortisone rendered adrenalectomy safe for the relief of cancer of the breast and prostate and of Cushing's syndrome. For about 40 years increasing numbers of surgeons have specialized in endocrine surgery as a discipline within general surgery, and results of treatment have improved greatly.

The solitary thyroid nodule: diagnosis and management of malignant disease

While few solitary thyroid nodules are carcinomatous, it is essential to identify and preferentially select those that are for surgery. Clinical, biochemical, serologic, radiographic, scintigraphic, sonographic, biopsy, and even therapeutic evaluation may be necessary to choose those patients with the greatest probability of malignancy. The benefits and limitations of each diagnostic modality are discussed, and the importance of fine-needle aspiration is stressed. After the operative confirmation of malignancy, the prognosis in any given case depends on 1) the histologic type of the neoplasm, 2) its size and extent, 3) the presence of angioinvasiveness, 4) the tendency toward multicentricity of the lesion, 5) the age and sex of the patient, and 6) whether distant metastases are present. These factors influence the extent of surgery required for well-differentiated carcinomas. Meticulous dissection and preservation of the recurrent laryngeal nerves and the parathyroid glands along with their blood supply are important if total thyroidectomy for papillary carcinoma is to be employed with an acceptable operative morbidity to optimize survival. The value of the adjunctive use of thyroid hormone and radioactive iodine is also discussed. Finally, the clinical behaviors and treatments of undifferentiated carcinomas, sarcomas, lymphomas, and neoplasms metastatic to the thyroid gland are reviewed.

Insulinoma: diagnosis, surgical management and long-term follow-up. Review of 41 cases

The clinical features, diagnosis and surgical considerations in 41 patients with insulinoma treated at Columbia-Presbyterian Medical Center are presented along with a review of the literature. One hundred percent of patients surviving surgery for benign functional beta cell tumors were cured of hypoglycemia. A detailed long-term follow-up study in the majority of patients after surgical cure documented a statistically significant incidence of neuropsychiatric aberration, adult-onset diabetes mellitus and peptic ulcer disease. Patients who have undergone surgery for endogenous hyperinsulinism should be followed up carefully for the development of these disorders, and their overall prognosis should be considered cautiously.

Phaeochromocytomas in 72 patients: clinical and diagnostic features, treatment and long term results

Phaeochromocytomas were diagnosed in 72 patients in Hammersmith, Belfast and Newcastle between 1955 and 1976. Fourteen were found unexpectedly at autopsy while 58 were diagnosed in life. Associated lesions included neurofibromatosis (7 patients), medullary carcinoma of the thyroid (3), renal artery stenosis (2) and cerebellar haemangioblastoma (1). The clinical features were similar to those reported by others. Hypertension was found in all but one of the patients and was sustained only in 17 per cent, paroxysmal only in 48 per cent and sustained with superadded paroxysms in 33 per cent. Hypertension was significantly greater in the women than in the men.

Diagnosis was confirmed chemically in all patients and urinary vanylmandelic acid (VMA) was elevated in all but one. Tumours were localized correctly by various radiographic techniques and by selective venous sampling in over 80 per cent of patients. The tumours were in adrenals in 59 patients (bilateral in 6) and at extra-adrenal, intra-abdominal sites in 13.

The tumours were removed surgically from those in whom they were diagnosed in life. Before 1967 3 of 17 patients died after operation (18 per cent). Since then patients have been prepared with alpha blockade and have received infusions of plasma, blood or dextran after removal of the tumours. One of 41 patients so treated has died after operation (2 per cent). Phaeochromocytomas were diagnosed and treated in pregnancy in 4 patients, all of whom survived. Two of the fetuses died.

Five tumours diagnosed in life were malignant and 2 recurred (40 per cent). Fifty-three were benign and 2 of these recurred locally (4 per cent).

All but 2 patients (who could not be traced) were followed completely from 1 to 20 years after operation and 3 died during this period. Two-thirds of the patients were alive after 10 years.

Paroxysmal hypertension was abolished by operation, but sustained hypertension often persisted and required drug therapy.

It is concluded that at least one-third of phaeochromocytomas are not diagnosed in life and that a high index of suspicion is required to bring them to light. If they are diagnosed and treated by present methods, the prognosis is good.

Carcinoma of the Thyroid Gland, adenoma of the Adrenal Cortex and Peptic Ulcer: An Unreported Association

A 39-year-old man, operated on for duodenal ulcer, was found to have a papillary carcinoma of the thyroid, an aldosterone-producing adenoma of the adrenal cortex, and a recurrence of a peptic ulcer. The probable coincidental occurrence of these diseases in this patient is suggested. Nevertheless, careful investigation of the other endocrine glands in patients with endocrine tumors is recommended.