scholarly journals Clinical and laboratory characteristics and results of treatment of patients with ACTH-producing neuroendocrine tumors of various localization

2021 ◽  
Vol 93 (10) ◽  
pp. 1171-1178
Author(s):  
Olga O. Golounina ◽  
Zhanna E. Belaya ◽  
Liudmila Ya. Rozhinskaya ◽  
Evgeniya I. Marova ◽  
Michail Yu. Pikunov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Fatal Outcome ◽  
Distant Metastases ◽  
Multiple Organ ◽  
Ectopic Acth Syndrome ◽  
Ectopic Acth ◽  
Results Of Treatment ◽  
Single Center Study ◽  
Pancreatic Net

Aim. To study the clinical, biochemical characteristics, treatment results and follow-up of patients with ectopic ACTH syndrome EAS (ACTH adrenocorticotropic hormone ). Materials and methods. A retrospective, observational, single-center study of 130 patients with EAS. Demographic information of patients, medical history, results of laboratory and instrumental investigations at the pre- and postoperative stages and follow-up of EAS were analyzed. Results. The mean age at the diagnosis ranged from 12 to 74 years (Me 40 years [28; 54]). The duration of the disease from the onset of symptoms to the verification of the diagnosis varied from 2 to 168 months (Me 17.5 months [7; 46]). Eighty-one (62,3%) patients had bronchopulmonary NET, 9 thymic carcinoid, 7 pancreatic NET, 5 pheochromocytoma, 1 cecum NET, 1 appendix carcinoid tumor, 1 medullary thyroid cancer and 25 (19.2%) had an occult source of ACTH. The median follow-up period of patients was 27 months [9.75; 61.0] with a maximum follow-up of 372 months. Currently, primary tumor was removed in 82 (63.1%) patients, bilateral adrenalectomy was performed in 23 (18%) patients, in 16 of them there was an occult source of ACTH-producing NET and in 7 patients in order to control hypercortisolism after non-successful surgical treatment. Regional and distant metastases were revealed in 25 (19.2%) patients. At the time of the last observation 59 (72%) patients were exhibited a full recovery, 12 (14.6%) had relapse of the disease and 26 (20%) died from multiple organ failure (n=18), pulmonary embolism (n=4), surgical complications (n=2), disseminated intravascular coagulation syndrome (n=1) or COVID-19 (n=1). Conclusion. In our cohort of patients bronchopulmonary NET are the most frequent cause of EAS (62.3%). Surgical treatment leads to remission of hypercortisolism in 72% cases; the proportion of relapse (14.6%) and fatal outcome (20%) remains frequent in EAS.

scholarly journals The role of 68Ga-DOTA derivatives PET-CT in patients with ectopic ACTH syndrome

2020 ◽  
Vol 9 (4) ◽  
pp. 337-345
Author(s):  
Filippo Ceccato ◽  
Diego Cecchin ◽  
Michele Gregianin ◽  
Giacomo Ricci ◽  
Cristina Campi ◽  
...  
Keyword(s):  
Small Cell Lung Carcinoma ◽  
Ectopic Acth Syndrome ◽  
Ectopic Acth ◽  
Cell Lung Carcinoma ◽  
Ectopic Acth Secretion ◽  
Bronchial Carcinoids ◽  
Pet Ct ◽  
Pancreatic Net ◽  
Acth Secreting

Introduction and aim Ectopic ACTH secretion (EAS) is mostly secondary to thoracic/abdominal neuroendocrine tumours (NETs) or small cell-lung carcinoma (SCLC). We studied the diagnostic accuracy of CT with 68Ga-Dota derivatives (68Ga-SSTR) PET in localizing ACTH-secreting tumor in patients with EAS. Materials and methods 68Ga-SSTR-PET/CT was performed and compared with the nearest enhanced CT in 18 cases (16 primary and 2 recurrent neoplasms). Unspecific, indeterminate and false-positive uptakes were assessed using conventional imaging, follow-up or histology. Results We diagnosed 13 thoracic (9 primary and 2 recurrent bronchial carcinoids, 2 SCLCs) and 1 abdominal (pancreatic NET) tumors. Eight ACTH-secreting tumors were promptly identified at EAS diagnosis (’overt’, four pulmonary carcinoids with two recurrences and two SCLC); six EAS have been discovered during the subsequent follow-up (’covert’, five bronchial carcinoids and one pancreatic NET). At the time of EAS diagnosis, imaging was able to correctly detect the ACTH-secreting tumour in 8/18 cases (6 new diagnosis and 2 recurrences). During the follow-up, six out of initially ten ‘occult’ cases became ‘covert’. At last available follow-up, CT and 68Ga-SSTR-PET/CT were able to diagnose 11/18 and 12/18 ACTH-secreting tumours, respectively (11/14 and 12/14 considering only overt and covert cases, respectively). Four cases have never been localized by conventional or nuclear imaging (’occult EAS’), despite an average follow-up of 5 years. Conclusion The 68Ga-SSTR-PET/CT is useful in localizing EAS, especially to enhance positive prediction of the suggestive CT lesions and to detect occult neoplasms.

scholarly journals Treatment of Injuries of the Lumbar Spine

2019 ◽  
Vol 5 (12) ◽  
pp. 156-162
Author(s):  
M. Sabyraliev
Keyword(s):  
Surgical Treatment ◽  
Lumbar Spine ◽  
Spinal Canal ◽  
Thoracolumbar Spine ◽  
Spinal Injuries ◽  
Long Term Results ◽  
Results Of Treatment ◽  
Post Traumatic

Surgical treatment of patients with spinal injuries, accompanied by traumatic stenosis of the spinal canal, is an urgent and discussed problem of modern vertebrology. Surgical treatment of 111 patients with various injuries of the thoracolumbar spine was performed. In 40 patients, post-traumatic stenosis was eliminated using ligamentotaxis using transpedicular osteosynthesis. The immediate results of treatment were followed up in all patients: good results were obtained in 33 (82.5%) cases; satisfactory — in 6 (15.0%), unsatisfactory — in 1 (2.5%). Long-term results with a follow-up of more than 1 year were followed up in 27 (67.5%) patients; good results were obtained in 20 (74.0%), satisfactory in 7 (25.0%).

ANALYSIS OF THE RESULTS OF SURGICAL TREATMENT OF PRIMARY TRIGEMINAL NEURALGIA USING LASER DESTRUCTION OF THE SENSITIVE ROOT IN ELDERLY AND SENILE PATIENTS

2021 ◽  
pp. 1122-1129
Author(s):  
В. А. Бывальцев ◽  
А. А. Калинин ◽  
А. К. Оконешникова ◽  
А. В. Егоров ◽  
В. Ю. Голобородько ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Adverse Effects ◽  
Trigeminal Neuralgia ◽  
Preoperative Pain ◽  
Results Of Treatment ◽  
Sf 36 ◽  
Trigeminal Root ◽  
Perioperative Complication ◽  
Primary Trigeminal Neuralgia

Цель исследования - анализ результатов хирургического лечения первичной невралгии тройничного нерва при использовании лазерной деструкции чувствительного корешка у пациентов пожилого и старческого возраста. Проспективно изучены результаты лечения 25 пациентов старше 65 лет с устойчивой к консервативному лечению тригеминальной болью, которым была проведена лазерная деструкция чувствительного корешка тройничного нерва (970 нм, частота 9 Гц и мощность 3 Вт в суммарной дозе 100 Дж) в период 2018-2019 гг. Средний катамнез наблюдения составил 12 мес. В результате установлено значительное снижение интенсивности болевых ощущений по шкале лицевой боли с 87 (83,5; 91,5) до 15,5 (12,5; 18,5) мм ( р =0,002) в отдаленном периоде. В среднем через 12 мес после операции выявлено значимое увеличение показателей физического и психологического компонентов здоровья по опроснику SF-36 ( p =0,02 и p =0,01 соответственно). В катамнезе по шкале Macnab отмечены преимущественно отличные ( n =23; 92 %) и хорошие ( n =2; 8 %) результаты лечения. Зарегистрировано одно (4 %) периоперационное осложнение и два (8 %) неблагоприятных последствия анестезиологического пособия. Таким образом, применение лазерной денервации чувствительного корешка при первичной невралгии тройничного нерва у пациентов пожилого и старческого возраста позволяет значительно снизить уровень дооперационного болевого синдрома и улучшить качество жизни при низком риске формирования неблагоприятных последствий. The aim of the study was to analyze the results of surgical treatment of primary trigeminal neuralgia using laser destruction of the sensitive root in elderly and senile patients. The results of treatment of 25 patients older than 65 years with conservative treatment-resistant trigeminal pain who underwent laser destruction of the sensitive trigeminal root (970 nm, 9 Hz and 3 W power in a total dose of 100 J) in the period from 2018-2019 were prospectively studied. The average follow-up was 12 months. As a result, a significant decrease in the intensity of pain on the scale of facial pain was found from 87 (83,5; 91,5) mm to 15,5 (12,5; 18,5) mm ( p =0,002) in the long-term period. On average, 12 months after the operation, a significant improvement in the indicators of the physical and psychological components of health was revealed on the SF-36 questionnaire ( p =0,02 and p =0,01, respectively). In the follow-up on the Macnab scale, predominantly excellent ( n =23; 92 %) and good ( n =2; 8 %) treatment results were noted. Registered 1 (4 %) perioperative complication and 2 (8 %) adverse effects of anesthesiology benefits. Thus, the use of laser denervation of the sensitive root in primary trigeminal neuralgia in elderly and senile patients can significantly reduce the level of preoperative pain and improve the quality of life, with low risks of adverse effects.

Different Therapeutic Approaches and Outcome in the Treatment of Pterygium

1998 ◽  
Vol 8 (3) ◽  
pp. 148-152 ◽  
Author(s):  
C. H. Karabatsas ◽  
G. W. Marsh ◽  
A. M. Cook ◽  
S. D. Cook
Keyword(s):  
Surgical Treatment ◽  
Surgical Techniques ◽  
Surgical Excision ◽  
Lamellar Keratoplasty ◽  
Therapeutic Approaches ◽  
Therapeutic Modalities ◽  
Results Of Treatment ◽  
One Year

Purpose This study was initiated to investigate the role of different therapeutic modalities in the outcome of the surgical treatment of pterygium. Methods The results of treatment of pterygia with a variety of surgical techniques were studied in 56 eyes (49 patients) operated on at Bristol Eye Hospital during a period of five years. The surgical techniques included simple excision; bare sclera; conjunctival autograft; sliding conjunctival flap; lamellar keratoplasty and penetrating keratoplasty. Twelve eyes received additional beta irradiation in a fractionated total dose of 40 Gys. Results The incidence of recurrence was 23.2% for the 43 treated primary pterygia, and 23% for the 13 recurrent pterygia. All recurrences occurred between 2.5 and 11 months postoperatively. None of the 11 cases where additional beta irradiation was used showed any recurrence or other complication within the study period. In the recurrent pterygia group, the cases treated with a combination of surgical excision and beta irradiation, showed significantly lower recurrence rate (p<0.001) compared to those cases treated with surgical excision alone. Conclusions Beta irradiation as a complement to surgical treatment of pterygium, is successful in treating high risk cases such as reoperations, whereas for the majority of primary pterygia surgical excision alone is adequate. Additionally, follow up of one year will reveal any recurrences.

scholarly journals An atypical case of ectopic ACTH syndrome in an adolescent boy

2020 ◽  
Vol 2020 (3) ◽  
Author(s):  
Shreya Sharma ◽  
Rajesh Joshi
Keyword(s):  
Abdominal Pain ◽  
Adrenocorticotropic Hormone ◽  
Neuroendocrine Tumours ◽  
Ectopic Acth Syndrome ◽  
Ectopic Acth ◽  
Atypical Case ◽  
Intermittent Abdominal Pain ◽  
Pancreatic Net ◽  
Pancreatic Neuroendocrine Tumours ◽  
Ectopic Adrenocorticotropic Hormone

Abstract Ectopic adrenocorticotropic hormone (ACTH) syndrome (EAS) is exceedingly rare in children and scarcely reported. Pancreatic neuroendocrine tumours (NETs) can rarely lead to secretion of ectopic ACTH. A 14-year-old boy presented with hyperpigmentation, hypertension and intermittent abdominal pain, and was diagnosed with endogenous hypercortisolism. An incidental pancreatic mass discovered on routine ultrasonogram (USG) revealed the source of ACTH. He underwent successful excision of the mass with resolution of hypercortisolism. The histopathology revealed a Pancreatic NET and immunohistochemistry was positive for ACTH stain.

Intraductal carcinoma of the breast: results of treatment with excisional biopsy and irradiation.

1985 ◽  
Vol 3 (10) ◽  
pp. 1339-1343 ◽  
Author(s):  
A Recht ◽  
B S Danoff ◽  
L J Solin ◽  
S Schnitt ◽  
J Connolly ◽  
...  
Keyword(s):  
Nipple Discharge ◽  
Distant Metastases ◽  
Excisional Biopsy ◽  
Intraductal Carcinoma ◽  
Carcinoma Of The Breast ◽  
Palpable Mass ◽  
Results Of Treatment ◽  
Number Of Patients ◽  
Boost Dose

Between 1976 and 1983, 40 women with intraductal carcinoma of the breast without invasion underwent excisional biopsy and irradiation as an alternative to mastectomy. The median age was 53 years (range, 28 to 77 years) and the median follow-up time since initiation of radiation was 44 months (range, 14 to 97 months). Twenty-seven patients presented with a palpable mass; in 13 patients the tumor was detected only by mammography. A limited axillary dissection was performed in 13 patients, and all lymph nodes removed were negative. Treatment was administered to the breast and adjacent chest wall to a dose of 4,600 to 5,000 rad, with 26 patients also receiving a boost dose of 1,000 to 2,000 rad to the site of the primary. Four patients have developed a recurrence in the treated breast, at 17, 19, 35, and 63 months after the beginning of radiation therapy. The 5-year actuarial rate of local recurrence is 10%. Three of the recurrences were in those four patients who presented with a nipple discharge and a central primary. In two cases, the recurrence consisted of only intraductal carcinoma; in the other two, both intraductal and invasive cancer were found. All four patients with recurrence underwent mastectomy and are well without evidence of distant metastases at 1, 12, 15, and 15 months since mastectomy. Cosmetic results were excellent. No patient has developed distant metastases. Since the number of patients treated is small and the period of follow-up is short, one must be cautious in the interpretation of these results. Nonetheless, the treatment of intraductal carcinoma of the breast by excision and irradiation appears to give acceptable local control and excellent survival when suitable precautions of patient selection and evaluation are taken.

scholarly journals Cushing's syndrome associated with a nested stromal epithelial tumor of the liver: hormonal, immunohistochemical, and molecular studies

2009 ◽  
Vol 161 (5) ◽  
pp. 805-810 ◽  
Author(s):  
Anne Rod ◽  
Manuela Voicu ◽  
Laurence Chiche ◽  
Céline Bazille ◽  
Hervé Mittre ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Malignant Tumors ◽  
Cushing's Syndrome ◽  
Good Prognosis ◽  
University Hospital ◽  
Ectopic Acth Syndrome ◽  
Epithelial Tumor ◽  
Ectopic Acth ◽  
Normal Human

ContextEctopic ACTH syndrome (EAS) is principally associated with aggressive malignant tumors but also with neuroendocrine tumors of good prognosis. Recently, rare nonhepatocytic nested stromal and epithelial tumors (NSET) were characterized by their possible association with Cushing's syndrome of which biochemical and physiopathological features were still incompletely studied.ObjectiveTo describe the clinical and hormonal characteristics of an EAS originating from a liver NSET and further understand the mechanism of cortisol overproduction.Design and settingThis is a clinical case report from the Endocrinology Department of Caen University Hospital, France.Patient and interventionA 17-year-old female patient was found to have a large liver NSET with mild Cushingoid clinical features and intense biological hypercortisolism but moderate ACTH secretion. Resection of the tumor was curative with a 30-month follow-up.ResultsThe epithelial component of the tumor coexpressed ACTH mildly, corticotropin-releasing hormone (CRH) strongly, and 11β-hydroxysteroid dehydrogenase at a level comparable with normal human hepatocytes.ConclusionsLiver NSET is a new cause of EAS, which may evoke hypercortisolism by multiple biochemical pathways.

scholarly journals LAPAROSCOPIC ADRENALECTOMY IN SURGICAL TREATMENT OF ADRENANOCORTICAL CARCINOMA

2019 ◽  
Vol 21 (1) ◽  
pp. 75-78
Author(s):  
A V Krivosheev ◽  
T A Britvin ◽  
M E Beloshitsky
Keyword(s):  
Surgical Treatment ◽  
Laparoscopic Adrenalectomy ◽  
Distant Metastases ◽  
Long Term Results ◽  
R0 Resection ◽  
Morphological Examination ◽  
Number Of Patients ◽  
Immunohistochemical Studies

Relevance of research: аdrenalectomy remains the only method of potentially radical treatment of adrenocortical carcinoma (AСС), and the complete resection is considered one of the leading factors in the prognosis of disease. The question of the possibility and feasibility of using video- endoscopic technologies in the treatment of patients with ACC is still being discussed. Objective: the purpose of our study was to evaluate the effectiveness of laparoscopic adrenalectomy in the treatment of ACC patients. Material and methods: the study is based on the analysis of the results of diagnostics and surgical treatment of 12 patients who underwent laparoscopic adrenalectomy and verified ACC during histological and immunohistochemical studies. Results: stage I were verified (according to the ENSAT) in 4 cases, in 4 - II stage, and in 4 - III stage. The median of tumor size was 4.9 cm. Intraoperative and postoperative complications did not occur. In all cases, the R0-resection was confirmed by morphological examination. The median patient follow-up was 71 months (1; 141), during this period 11 patients were alive, 1 patient, who had surgery in stage III died of disease progression (distant metastases) 49 months after surgery. During the follow-up period tumor recurrence did not occur. Overall 5-year survival was 75% (95% CI; 30-95%). Conclusion: despite the small number of patients included in this study, satisfactory immediate results (absence of complications, R0-resection) and long-term results allow us to consider video- endoscopic surgery as an effective treatment for patients with ACC.

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