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Carr NJ, Bibeau F, Bradley RF, Dartigues P, Feakins RM, Geisinger KR, Gui X, Isaac S, Milione M, Misdraji J, Pai RK, Rodriguez-Justo M, Sobin LH, van Velthuysen MLF, Yantiss RK. The histopathological classification, diagnosis and differential diagnosis of mucinous appendiceal neoplasms, appendiceal adenocarcinomas and pseudomyxoma peritonei. Histopathology 2017; 71:847-858. [PMID: 28746986 DOI: 10.1111/his.13324] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [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: 12/11/2022]
Abstract
The vermiform appendix is the primary site of several distinctive benign and malignant neoplasms. Some can produce the clinical syndrome of pseudomyxoma peritonei (PMP). A consensus on their terminology was reached by an international panel of pathologists and clinicians working under the auspices of the Peritoneal Surface Oncology Group International (PSOGI), and this review discusses the application of the PSOGI classification to routine reporting. We discuss diagnosis and differential diagnosis together with implications for patient management, covering low-grade appendiceal mucinous neoplasms, high-grade appendiceal mucinous neoplasms, serrated polyps, adenomas and adenocarcinomas. We do not cover goblet cell tumours or neuroendocrine neoplasms in this paper.
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Affiliation(s)
- Norman J Carr
- Department of Pathology, Peritoneal Malignancy Institute, Basingstoke, UK
| | - Frederic Bibeau
- Service d'Anatomie et Cytologie Pathologiques, Université de Caen-Normandie, Caen, France
| | | | - Peggy Dartigues
- Département de Biologie et de Pathologie Médicales, Institut Gustave Roussy, Villejuif, France
| | - Roger M Feakins
- Department of Histopathology, Royal London Hospital, London, UK
| | - Kim R Geisinger
- Department of Pathology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Xianyong Gui
- University of Calgary and Calgary Laboratory Services, Calgary, Canada
| | - Sylvie Isaac
- Service d'Anatomie Pathologique, RENAPE, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Massimo Milione
- First Division of Pathology, Department of Pathology and Laboratory Medicine, IRCCS Foundation National Cancer Institute, Milan, Italy
| | - Joseph Misdraji
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Reetesh K Pai
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Leslie H Sobin
- Frederick National Laboratory for Cancer Research, National Cancer Institute, Rockville, MD, USA
| | | | - Rhonda K Yantiss
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
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2
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Asner DM, Bradley RF, de Viveiros L, Doe PJ, Fernandes JL, Fertl M, Finn EC, Formaggio JA, Furse D, Jones AM, Kofron JN, LaRoque BH, Leber M, McBride EL, Miller ML, Mohanmurthy P, Monreal B, Oblath NS, Robertson RGH, Rosenberg LJ, Rybka G, Rysewyk D, Sternberg MG, Tedeschi JR, Thümmler T, VanDevender BA, Woods NL. Single-Electron Detection and Spectroscopy via Relativistic Cyclotron Radiation. Phys Rev Lett 2015; 114:162501. [PMID: 25955048 DOI: 10.1103/physrevlett.114.162501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Indexed: 06/04/2023]
Abstract
It has been understood since 1897 that accelerating charges must emit electromagnetic radiation. Although first derived in 1904, cyclotron radiation from a single electron orbiting in a magnetic field has never been observed directly. We demonstrate single-electron detection in a novel radio-frequency spectrometer. The relativistic shift in the cyclotron frequency permits a precise electron energy measurement. Precise beta electron spectroscopy from gaseous radiation sources is a key technique in modern efforts to measure the neutrino mass via the tritium decay end point, and this work demonstrates a fundamentally new approach to precision beta spectroscopy for future neutrino mass experiments.
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Affiliation(s)
- D M Asner
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - R F Bradley
- National Radio Astronomy Observatory, Charlottesville, Virginia 22903, USA
| | - L de Viveiros
- Department of Physics, University of California, Santa Barbara, California 93106, USA
| | - P J Doe
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - J L Fernandes
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - M Fertl
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - E C Finn
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - J A Formaggio
- Laboratory for Nuclear Science, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - D Furse
- Laboratory for Nuclear Science, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - A M Jones
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - J N Kofron
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - B H LaRoque
- Department of Physics, University of California, Santa Barbara, California 93106, USA
| | - M Leber
- Department of Physics, University of California, Santa Barbara, California 93106, USA
| | - E L McBride
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - M L Miller
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - P Mohanmurthy
- Laboratory for Nuclear Science, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - B Monreal
- Department of Physics, University of California, Santa Barbara, California 93106, USA
| | - N S Oblath
- Laboratory for Nuclear Science, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - R G H Robertson
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - L J Rosenberg
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - G Rybka
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - D Rysewyk
- Laboratory for Nuclear Science, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - M G Sternberg
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - J R Tedeschi
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - T Thümmler
- Institut für Kernphysik, Karlsruher Institut für Technologie, 76021 Karlsruhe, Germany
| | - B A VanDevender
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - N L Woods
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
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3
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Koh S, Bradley RF, French SW, Farmer DG, Cortina G. Congenital visceral myopathy with a predominantly hypertrophic pattern treated by multivisceral transplantation. Hum Pathol 2008; 39:970-4. [PMID: 18329691 DOI: 10.1016/j.humpath.2007.10.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Revised: 09/26/2007] [Accepted: 10/08/2007] [Indexed: 12/20/2022]
Abstract
Chronic intestinal pseudoobstruction due to visceral myopathy may cause intestinal failure. The anatomical pathology of visceral myopathy is dominated by an atrophic muscularis propria. We present a case that is overwhelmingly dominated by a hypertrophic muscularis propria. The hypertrophic pattern was documented from ages 2 to 28 years. Most descriptions of visceral myopathy focus on the atrophic pattern of injury to the muscularis propria, typified by vacuolar degeneration of myocytes, loss of muscle fibers, and frequently with a honeycomb pattern of fibrosis. Hypertrophic changes can be observed in visceral myopathy, but the hypertrophy typically represents only a minor feature, typically limited to the internal layer of the muscularis propria. In our patient, the observed muscular hypertrophy differed from most descriptions because it (a) was the dominant pattern of injury and (b) involved both layers of muscularis propria rather than just the inner circular layer. The patient had intestinal failure and the complications induced cirrhosis, eventually treated by multivisceral transplantation to correct the intestinal failure and cirrhosis.
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Affiliation(s)
- Stephen Koh
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, CA 90095, USA
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Abstract
Hepatic lymphangiomatosis is a rare disease characterized by an abnormal lymphatic proliferation involving the liver alone, liver and spleen, or multiple organs. Hepatic lymphangiomatosis becomes symptomatic secondary to compression or replacement of the normal parenchyma, which can lead to liver failure. Resection and orthotopic liver transplantation (OLT) can be used as treatment for this disease. We herein describe a 42-year-old female who had undergone successful OLT for hepatic lymphangiomatosis with recurrent disease detected 19 yr later in the transplanted liver. This is, to our knowledge, the first described case of recurrent hepatic lymphangiomatosis after OLT. In conclusion, we discuss the clinical, radiologic, pathologic, and immunohistochemical findings and review other reported cases of hepatic lymphangiomatosis that have undergone OLT.
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Affiliation(s)
- Seong H Ra
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA 90095-1732, USA
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Geisinger KR, Levine EA, Shen P, Bradley RF. Pleuropulmonary involvement in pseudomyxoma peritonei: morphologic assessment and literature review. Am J Clin Pathol 2007; 127:135-43. [PMID: 17145619 DOI: 10.1309/601k2l2t7cr5u7g1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Intrathoracic spread in patients with pseudomyxoma peritonei (PP) is rare. We reviewed 101 patients uniformly treated at our institution for PP of appendiceal origin. In that study, we suggested mucinous carcinoma peritonei (MCP) as the pathologic terminology for all cases of PP. Four patients had pathologically documented pleuropulmonary involvement. We subsequently examined another patient with pleural invasion. Of 5 patients, 3 had low-grade histologic features in the peritoneum; these showed variably proliferative, bland-appearing neoplastic cells arising from low-grade appendiceal mucinous neoplasms. In 2 cases, 1 or more pulmonary parenchymal metastases of low histologic grade developed. The lack of pleural involvement argued against transdiaphragmatic tumor extension. The third patient with low-grade MCP had direct extension through the left diaphragm involving the left pleural and pericardial spaces without pulmonary parenchymal involvement. In the 2 patients with high-grade MCP, right-sided pleural effusions developed. Neither patient had documented injury to the diaphragm. Pleural cytologic examination revealed high-grade adenocarcinoma cells singly, in small clusters, and in large spheres. The smear backgrounds contained wispy mucin. None of the 5 patients developed thoracic lymph nodal metastases. Although rare, mucinous neoplasms from PP may involve the thorax.
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Affiliation(s)
- Kim R Geisinger
- Department of Pathology, Wake Forest University School of Medicine and the North Carolina Baptist Hospital, Winston-Salem, NC 27157-1072, USA
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6
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Bradley RF, Stewart JH, Russell GB, Levine EA, Geisinger KR. Pseudomyxoma peritonei of appendiceal origin: a clinicopathologic analysis of 101 patients uniformly treated at a single institution, with literature review. Am J Surg Pathol 2006; 30:551-9. [PMID: 16699309 DOI: 10.1097/01.pas.0000202039.74837.7d] [Citation(s) in RCA: 270] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Pseudomyxoma peritonei is a clinical term for gelatinous ascites, usually secondary to an appendiceal tumor. The pathologic classification of pseudomyxoma peritonei and its associated appendiceal tumors has been plagued with controversy and confusing terminology. In an effort to clarify this, we reviewed the pathology of 101 patients, all treated at our institution from 1993 to 2005, with pseudomyxoma peritonei of appendiceal origin. All patients were uniformly treated with our standardized protocol. This is the largest pathologic series solely devoted to appendiceal neoplasia with gelatinous ascites. The cases were assigned, according to previously published criteria, to the categories of disseminated peritoneal adenomucinosis (DPAM), peritoneal mucinous carcinomatosis (PMCA), or PMCA with intermediate (well differentiated) features (PMCA-I), with the exception that any case with a signet-ring cell component was considered as PMCA and not PMCA-I. By histologic category, 58 patients had DPAM, 23 were PMCA, and 20 were PMCA-I.One-year, 3-year, and 5-year survival outcomes were not significantly different between DPAM and PMCA-I. DPAM and PMCA-I also exhibited a roughly equal incidence of parenchymal (beyond the serosa) organ invasion. Survival outcomes were significantly worse for PMCA, compared with PMCA-I and DPAM. After reviewing our data and the literature, mucinous carcinoma peritonei-low grade was applied to the low-grade histology of pseudomyxoma peritonei, including those cases referred to by some as DPAM in the same category as PMCA-I. Cases that are moderately differentiated to poorly differentiated are classified as mucinous carcinoma peritonei-high grade.
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Affiliation(s)
- Robert F Bradley
- Department of Pathology, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston Salem, NC 27157, USA.
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7
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Abstract
Focal nodular hyperplasia (FNH) is a common benign liver tumor that is often confused with hepatic adenoma. Despite the benign course of both lesions, hepatic adenomas are associated with rupture and bleeding, and suggested management often includes prophylactic surgical resection. FNH lesions are thought to not rupture or bleed, and traditional management does not include resection. We report the case of a woman with FNH who presented with intraperitoneal hemorrhage after the rupture of a FNH lesion. Only six previous documented cases of hemoperitoneum associated with FNH have ever been reported. This report reviews all previously recorded cases of FNH lesions that have resulted in intraperitoneal hemorrhage. We suggest that although FNH is a benign lesion and intervention is typically unnecessary, the potential for rupture requiring surgical resection should always be considered.
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Affiliation(s)
- Mario P. Demarco
- From the Surgical Oncology Service, Departments of General Surgery and Pathology, Wake Forest University, Winston-Salem, North Carolina
| | - Perry Shen
- From the Surgical Oncology Service, Departments of General Surgery and Pathology, Wake Forest University, Winston-Salem, North Carolina
| | - Robert F. Bradley
- From the Surgical Oncology Service, Departments of General Surgery and Pathology, Wake Forest University, Winston-Salem, North Carolina
| | - Edward A. Levine
- From the Surgical Oncology Service, Departments of General Surgery and Pathology, Wake Forest University, Winston-Salem, North Carolina
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8
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Demarco MP, Shen P, Bradley RF, Levine EA. Intraperitoneal hemorrhage in a patient with hepatic focal nodular hyperplasia. Am Surg 2006; 72:555-9. [PMID: 16808214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Focal nodular hyperplasia (FNH) is a common benign liver tumor that is often confused with hepatic adenoma. Despite the benign course of both lesions, hepatic adenomas are associated with rupture and bleeding, and suggested management often includes prophylactic surgical resection. FNH lesions are thought to not rupture or bleed, and traditional management does not include resection. We report the case of a woman with FNH who presented with intraperitoneal hemorrhage after the rupture of a FNH lesion. Only six previous documented cases of hemoperitoneum associated with FNH have ever been reported. This report reviews all previously recorded cases of FNH lesions that have resulted in intraperitoneal hemorrhage. We suggest that although FNH is a benign lesion and intervention is typically unnecessary, the potential for rupture requiring surgical resection should always be considered.
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Affiliation(s)
- Mario P Demarco
- Surgical Oncology Service, Department of General Surgery, Wake Forest University, Winston-Salem, North Carolina 27157, USA
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9
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Stewart JH, Shen P, Russell GB, Bradley RF, Hundley JC, Loggie BL, Geisinger KR, Levine EA. Appendiceal neoplasms with peritoneal dissemination: outcomes after cytoreductive surgery and intraperitoneal hyperthermic chemotherapy. Ann Surg Oncol 2006; 13:624-34. [PMID: 16538401 DOI: 10.1007/s10434-006-9708-2] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2005] [Accepted: 08/16/2005] [Indexed: 12/12/2022]
Abstract
BACKGROUND Appendiceal neoplasms frequently present with peritoneal dissemination (PD) and have a clinical course marked by bowel obstruction and subsequent death. Few data have correlated outcome with appendiceal histology after cytoreductive surgery and intraperitoneal hyperthermic chemotherapy (IPHC). We have reviewed our experience with cytoreductive surgery and IPHC for PD from the appendix. METHODS A total of 110 cases of PD from proven appendiceal neoplasms treated with IPHC were identified from a prospectively managed database. Tumor samples were classified on pathologic review as disseminated peritoneal adenomucinosis (n = 55), peritoneal mucinous carcinomatosis (PMCA) with intermediate features (n = 18), PMCA (n = 29), or high-grade nonmucinous lesions (n = 8). A retrospective review was performed with long-term survival as the primary outcome measure. RESULTS A total of 116 IPHCs were performed on 110 patients for appendiceal PD between 1993 and 2004. The 1-, 3-, and 5-year survival rates for all cases were 79.9% +/- 4.1%, 59.0% +/- 5.7%, and 53.4% +/- 6.5%, respectively. When stratified by histology, disseminated peritoneal adenomucinosis and intermediate tumors had better 3-year survival rates (77% +/- 7% and 81% +/- 10%) than PMCA and high-grade nonmucinous lesions (35% +/- 10% and 15% +/- 14%; P = .0032 for test of differences between groups). Age at presentation (P = .0134), performance status (P < .0001), time between diagnosis and IPHC (P = .0011), resection status (P = .0044), and length of hyperthermic chemoperfusion (P = .0193) were independently associated with survival. CONCLUSIONS The data show that long-term survival is anticipated in most patients who are treated with cytoreduction and IPHC for appendiceal PD. The findings presented herein underscore the important prognostic characteristics that predict outcome after IPHC in patients with PD. In all, this work establishes a framework for the consideration of IPHC in future trials for appendiceal PD.
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Affiliation(s)
- John H Stewart
- Department of General Surgery, Surgical Oncology Service, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157, USA
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Duffy L, Sikivie P, Tanner DB, Asztalos S, Hagmann C, Kinion D, Rosenberg LJ, van Bibber K, Yu D, Bradley RF. Results of a search for cold flows of dark matter axions. Phys Rev Lett 2005; 95:091304. [PMID: 16197206 DOI: 10.1103/physrevlett.95.091304] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2005] [Indexed: 05/04/2023]
Abstract
Theoretical arguments predict that the distribution of cold dark matter in spiral galaxies has peaks in velocity space associated with nonthermalized flows of dark matter particles. We searched for the corresponding peaks in the spectrum of microwave photons from axion to photon conversion in a cavity detector for dark matter axions. We found none and place limits on the density of any local flow of axions as a function of the flow velocity dispersion over the axion mass range 1.98 to 2.17 microeV.
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Affiliation(s)
- L Duffy
- Physics Department, University of Florida, Gainesville, FL 32611, USA
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Hundley JC, Albertson DA, Bradley RF, Levine EA. Resection of Pulmonary Metastasis from Parathyroid Carcinoma. Am Surg 2003. [DOI: 10.1177/000313480306900909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The management of metastasis from parathyroid carcinoma (PC) is an unusual challenge. Systemic therapy has minimal effect on the course of the disease and its associated hypercalcemia. Resection of isolated pulmonary metastases is an attractive option in the setting of recurrent hypercalcemia. We report a case of a patient who underwent resection of multiple functional PC pulmonary metastases almost 20 years after the original neck resection. The patient originally presented in 1982 with what was thought to be hyperparathyroidism secondary to a parathyroid adenoma. Surgical exploration revealed the presence of a well differentiated PC. The patient was transiently normocalcemic, but underwent surgical exploration in 1993 and 1996 for recurrent PC in the neck. The patient again improved, but presented in 2001 with diffuse arthralgia, fatigue, malaise, weight loss, and decreased appetite. She was found to have a serum calcium of 12.7 mg/dL and an intact parathyroid hormone of 1542 pmol/L. Computed tomography identified the presence of two right-sided and two left-sided pulmonary masses. Sternotomy with bilateral pulmonary metastectomy was performed. Functional PC metastasis was confirmed on pathological examination. One year following metastectomy the patient is hypocalcemic, requiring oral calcium and vitamin D supplementation. Functional pulmonary metastasis from PC is a rare cause of hypercalcemia. Complete resection of isolated pulmonary metastases can provide effective palliation with long-term survival.
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Affiliation(s)
- Jonathan C. Hundley
- From the Departments of Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - David A. Albertson
- From the Departments of Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - Robert F. Bradley
- Departments of Pathology, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - Edward A. Levine
- From the Departments of Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
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12
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Hundley JC, Albertson DA, Bradley RF, Levine EA. Resection of pulmonary metastasis from parathyroid carcinoma. Am Surg 2003; 69:779-83. [PMID: 14509326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
The management of metastasis from parathyroid carcinoma (PC) is an unusual challenge. Systemic therapy has minimal effect on the course of the disease and its associated hypercalcemia. Resection of isolated pulmonary metastases is an attractive option in the setting of recurrent hypercalcemia. We report a case of a patient who underwent resection of multiple functional PC pulmonary metastases almost 20 years after the original neck resection. The patient originally presented in 1982 with what was thought to be hyperparathyroidism secondary to a parathyroid adenoma. Surgical exploration revealed the presence of a well differentiated PC. The patient was transiently normocalcemic, but underwent surgical exploration in 1993 and 1996 for recurrent PC in the neck. The patient again improved, but presented in 2001 with diffuse arthralgia, fatigue, malaise, weight loss, and decreased appetite. She was found to have a serum calcium of 12.7 mg/dL and an intact parathyroid hormone of 1542 pmol/L. Computed tomography identified the presence of two right-sided and two left-sided pulmonary masses. Sternotomy with bilateral pulmonary metastectomy was performed. Functional PC metastasis was confirmed on pathological examination. One year following metastectomy the patient is hypocalcemic, requiring oral calcium and vitamin D supplementation. Functional pulmonary metastasis from PC is a rare cause of hypercalcemia. Complete resection of isolated pulmonary metastases can provide effective palliation with long-term survival.
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Affiliation(s)
- Jonathan C Hundley
- Departments of Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina 27157, USA
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13
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Krolewski AS, Kosinski EJ, Warram JH, Leland OS, Busick EJ, Asmal AC, Rand LI, Christlieb AR, Bradley RF, Kahn CR. Magnitude and determinants of coronary artery disease in juvenile-onset, insulin-dependent diabetes mellitus. Am J Cardiol 1987; 59:750-5. [PMID: 3825934 DOI: 10.1016/0002-9149(87)91086-1] [Citation(s) in RCA: 475] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The risk of premature coronary artery disease (CAD) and its determinants were investigated in a cohort of 292 patients with juvenile-onset, insulin-dependent diabetes mellitus (IDDM) who were followed for 20 to 40 years. Although patients with juvenile-onset IDDM had an extremely high risk of premature CAD, the earliest deaths due to CAD did not occur until late in the third decade of life. After age 30 years, the mortality rate due to CAD increased rapidly, equally in men and women, and particularly among persons with renal complications. By age 55 years the cumulative mortality rate due to CAD was 35 +/- 5%. This was far higher than the corresponding rate for nondiabetic persons in the Framingham Heart Study, 8% for men and 4% for women. Angina and acute nonfatal myocardial infarction followed a similar pattern, as did asymptomatic CAD detected by stress test, so that their combined prevalence rate was 33% among survivors aged 45 to 59 years. Age at onset of IDDM and the presence of eye complications did not contribute to risk of premature CAD. This pattern suggests that juvenile-onset diabetes and its renal complications are modifiers of the natural history of atherosclerosis in that although they profoundly accelerate progression of early atherosclerotic lesions to very severe CAD, they may not contribute to initiation of atherosclerosis.
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14
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Christlieb AR, Warram JH, Królewski AS, Busick EJ, Ganda OP, Asmal AC, Soeldner JS, Bradley RF. Hypertension: the major risk factor in juvenile-onset insulin-dependent diabetics. Diabetes 1981; 30:90-6. [PMID: 7297776 DOI: 10.2337/diab.30.2.s90] [Citation(s) in RCA: 121] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The prevalence of hypertension in various age groups of diabetics and its role as a risk factor in juvenileonset insulin-dependent diabetics followed for 40 yr after diagnosis was evaluated. The results show clearly that hypertension is more prevalent in diabetics of any age after age 24 yr than in the general population.
In this type of diabetes, although death due to renal disease occurs earlier than that due to coronary heart disease, both causes of death are significantly related to hypertension. Those patients with an onset of diabetes 13 yr of age or younger can expect to live longer following the diagnosis of diabetes mellitus than those with an onset after 13 yr of age, perhaps because hypertension appears at about the same age in both groups. Case/control analysis of the data shows that survivors have significantly less hypertension than those dying of renal or cardiac disease. Furthermore, the close temporal relationship between the onset of hypertension and the onset of proteinuria in patients with either renal or coronary deaths suggests that the hypertension in these patients is renal in origin.
Two other risk factors, smoking and serum lipids, were evaluated in this population. From the data thus far accumulated, neither smoking nor lipids appear to influence mortality significantly. We conclude that hypertension is the major additive risk factor for mortality in juvenile-onset insulin-dependent diabetics.
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15
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D'Elia JA, Weinrauch LA, Healy RW, Libertino JA, Bradley RF, Leland OS. Myocardial dysfunction without coronary artery disease in diabetic renal failure. Am J Cardiol 1979; 43:193-9. [PMID: 153711 DOI: 10.1016/s0002-9149(79)80004-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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16
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Weinrauch LA, Healy RW, Leland OS, Goldstein HH, Libertino JA, Takacs FJ, Bradley RF, Gleason RE, D'Elia JA. Decreased insulin requirement in acute renal failure in diabetic nephropathy. Arch Intern Med 1978; 138:399-402. [PMID: 629634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Twelve of 13 diabetics with azotemic nephropathy experienced exacerbation of renal failure and decreased insulin requirement after coronary angiography utilizing radiographic contrast material. The single patient who did not develop acute renal failure had no evidence of decreased insulin requirement. Eleven of 12 patients had decreased insulin requirement: mean decrement in insulin dose, 40%; mean decrement in fasting blood glucose level, 33%; mean decrement in peak blood glucose level, 42%. The 12th patient underwent peritoneal dialysis against hypertonic glucose without need of an increased insulin dose. Eight of 11 patients experienced a total of 19 insulin reactions; one patient was hypoglycemic continuously, despite infusion of glucose and discontinuation of insulin. The decrement of insulin requirement was not proportional to the rise in either serum creatinine or potassium concentrations. We suggest that when acute renal failure occurs in diabetics, decreased insulin requirement should be anticipated and the insulin dose lowered.
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Tan MH, Graham CA, Bradley RF, Gleason RE, Soeldner JS. The effects of long-term therapy with oral hypoglycemic agents on the oral glucose tolerance test dynamics in male chemical diabetics. Diabetes 1977; 26:561-70. [PMID: 324835 DOI: 10.2337/diab.26.6.561] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [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: 12/14/2022]
Abstract
The effect of fixed doses of oral hypoglycemic agents and placebo (diet alone) on the blood glucose, serum insulin, triglyceride, and cholesterol responses during oral glucose tolerance tests done annually for up to four years' follow-up was studied, in a double-blind manner, in five groups of mild male chemical diabetics. The drugs used were chlorpropamide (100 mg. O.D.), tolbutamide (500 mg. b.i.d.), phenformin (50 mg. O.D.), acetohexamide (250 mg. O.D.), and placebo. Each subject was given an individualized diet aimed at attaining and maintaining ideal weight. Comparison by chi-square analysis between the placebo group and each of the drug groups showed (a) no significant differences with regard to the number of subjects with normal glucose tolerance in each of the tests and (b) no change in the insulin secretion dynamics. Comparison between the initial test and each of the subsequent tests within each group showed (a) a greater number of subjects with normal glucose tolerance in the first follow-up test in the chlorpropamide group only, (b) no change in the insulin secretion dynamics except in the chlorpropamide group, where there was an increased insulin/glucose ratio in the first follow-up test, and (c) no change in the fasting serum triglyceride and cholesterol levels.
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Abstract
From a list of all patients seen at the Joslin Clinic in a recent 6-month period, a random sample of 965 was selected for record review by a clinic assistant. A house physician specializing in diabetes then verified and adjusted the assistant's work as necessary. The data were analyzed both by simple cross-classification and by fitting a multiple logistic risk function. As often reported previously, we found a strong positive association between retinopathy and duration of diabetes. One of our findings which has not been so clearly reported in earlier papers is that the positive association between retinopathy and age is limited to the group with diabetes of less than 10 years' duration. We also found sex differences in retinopathy prevalence which were not large enough to rule out attributing them to chance.
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Bradley RF, Dolger H, Forsham PH, Seltzer H. "Settling the UGDP controversy"? JAMA 1975; 232:813-7. [PMID: 1091759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Draskoczy SP, Leland OS, Bradley RF. Aorto-coronary bypass in the diabetic patient. Kidney Int Suppl 1974:37-40. [PMID: 4549516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Abstract
A boy died in diabetic acidosis at the age of nine, after seven years of known diabetes. At necropsy there was diffuse glomerulosclerosis by light microscopy, evidenced by diffuse mesangial thickening of the peripheral glomeru-lar loops and irregular thickening of the capillary basement membrane of the glomeruli. Glomerulosclerosis is a rare finding in a person of this age as revealed in a review of the literature.
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Munichoodappa CS, Rees SB, Bradley RF, Balodimos MC, Boden G. Bragg peak proton beam irradiation of the pituitary gland for proliferative diabetic retinopathy. Ann Intern Med 1971; 74:491-8. [PMID: 5551157 DOI: 10.7326/0003-4819-74-4-491] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Plevin SN, Balodimos MC, Bradley RF. Perinephric abscess in diabetic patients. J Urol 1970; 103:538-43. [PMID: 5443834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Affiliation(s)
- Sanford N. Plevin
- From the Joslin Diabetes Foundation, Inc., the New England Deaconess Hospital and the Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Marios C. Balodimos
- From the Joslin Diabetes Foundation, Inc., the New England Deaconess Hospital and the Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Robert F. Bradley
- From the Joslin Diabetes Foundation, Inc., the New England Deaconess Hospital and the Department of Medicine, Harvard Medical School, Boston, Massachusetts
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