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Management of infertility and long-term follow-up in women with follicle-stimulating hormone-secreting Adenoma

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Chinese Medical Journal 2021年第1期134卷 101-103页

作者： Yun Ren Jie-Jing Wang Li-Na Wang Ying Wang Jie Qiao Xiu-Mei Zhen Hong-Bin Chi Rong Li Center for Reproductive Medicine Department of Obstetrics and GynecologyPeking University Third HospitalBeijing 100191China

Follicle-stimulating hormone(FSH)-secreting Adenoma(FSHoma)is a relatively uncommon type of gonadotroph Adenoma.[1]The characteristics of this disease in women in the reproductive age include enlarged ovaries with multiple cysts,normal to elevated serum estradiol levels,elevated FSH levels,reduced luteinizing hormone(LH)levels,causally induced menstrual disorder,infertility,and ovarian hyperstimulation.The tumor is always immuno-positive for FSH and sometimes immunopositive for LH and prolactin(PRL).

关键词： Adenoma stimulating elevated

Duodenal intussusception secondary to ampullary Adenoma: A case report

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World Journal of Clinical Cases 2019年第14期7卷 1857-1864页

作者： Masaaki Hirata Yoshiharu Shirakata Kenya Yamanaka Department of Surgery Hyogo Prefectural Amagasaki General Medical CenterAmagasakiHyogo 660-0892Japan

BACKGROUND Because the duodenum is fixed onto the retroperitoneum, duodenal intussusception is usually impossible except in cases of malrotational abnormality. Although cases of duodenal intussusception without malrotational abnormalities have been reported, it is unclear whether they constitute true intussusception or simple mucosal prolapse. CASE SUMMARY A 66-year-old woman presented with whole-body edema and malaise. Blood analysis indicated severe anemia and cholestasis. Endoscopic examination revealed a pedunculate polyp on the second part of the duodenum that migrated distally with mucosal elongation. Computed tomography showed duodenal intussusception. A tumor as the lead point and retroperitoneal structure, including the head of the pancreas and fat, invaginated beyond the duodenojejunal flexure. She was diagnosed with ampullary Adenoma caused repeated intussusception that reduced spontaneously and underwent pancreaticoduodenectomy. Laparotomy showed tumor prolapse beyond the duodenojejunal flexure without intussusception. There was no evidence of malrotational abnormality. She was discharged with no complications. CONCLUSION We report true duodenal intussusception without malrotational abnormality. This phenomenon was also associated with mucosal prolapse.

关键词： Duodenal intussusception Mucosal prolapse Ampullary Adenoma Case report

Multi-parameter ultrasound based on the logistic regression model in the differential diagnosis of hepatocellular Adenoma and focal nodular hyperplasia

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World Journal of Gastrointestinal Oncology 2019年第12期11卷 1193-1205页

作者： Meng Wu Ru-Hai Zhou Feng Xu Xian-Peng Li Ping Zhao Rui Yuan Yu-Peng Lan Wei-Xia Zhou Department of Ultrasound Yinzhou Hospital Affiliated to Ningbo University School of MedicineNingbo 315000Zhejiang ProvinceChina Department of Gastroenterology Yinzhou Hospital Affiliated to Ningbo University School of MedicineNingbo 315000Zhejiang ProvinceChina

BACKGROUND Focal nodular hyperplasia(FNH)has very low potential risk,and a tendency to spontaneously resolve.Hepatocellular Adenoma(HCA)has a certain malignant tendency,and its prognosis is significantly different from FNH.Accurate identification of HCA and FNH is critical for clinical treatment.AIM To analyze the value of multi-parameter ultrasound index based on logistic regression for the differential diagnosis of HCA and FNH.METHODS Thirty-one patients with HCA were included in the HCA group.Fifty patients with FNH were included in the FNH group.The clinical data were collected and recorded in the two groups.Conventional ultrasound,shear wave elastography,and contrast-enhanced ultrasound were performed,and the lesion location,lesion echo,Young’s modulus(YM)value,YM ratio,and changes of time intense curve(TIC)were recorded.Multivariate logistic regression analysis was used to screen the indicators that can be used for the differential diagnosis of HCA and FNH.A ROC curve was established for the potential indicators to analyze the accuracy of the differential diagnosis of HCA and FNH.The value of the combined indicators for distinguishing HCA and FNH were explored.RESULTS Multivariate logistic regression analysis showed that lesion echo(P=0.000),YM value(P=0.000)and TIC decreasing slope(P=0.000)were the potential indicators identifying HCA and FNH.In the ROC curve analysis,the accuracy of the YM value distinguishing HCA and FNH was the highest(AUC=0.891),which was significantly higher than the AUC of the lesion echo and the TIC decreasing slope(P<0.05).The accuracy of the combined diagnosis was the highest(AUC=0.938),which was significantly higher than the AUC of the indicators diagnosing HCA individually(P<0.05).This sensitivity was 91.23%,and the specificity was 83.33%.CONCLUSION The combination of lesion echo,YM value and TIC decreasing slope can accurately differentiate between HCA and FNH.

关键词： Hepatocellular Adenoma Focal nodular hyperplasia Ultrasound Logistic regression

Malignant transformation of hepatocellular Adenoma in a young female patient after ovulation induction fertility treatment:A case report

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World Journal of Gastrointestinal Surgery 2019年第4期11卷 229-236页

作者： Juan Glinka Rodrigo Sanchez Clariá Eugenia Fratanoni Juan Spina Eduardo Mullen Victoria Ardiles Oscar Mazza Juan Pekolj Martín de Santiba?es Eduardo de Santiba?es Department of General Surgery Hepatobilio-pancreatic Unit Hospital Italiano de Buenos Aires Department of Radiology Hospital Italiano de Buenos Aires Department of Surgical Pathology Hospital Italiano de Buenos Aires

BACKGROUND Hepatocellular Adenoma(HCA) is a rare benign liver tumor usually affecting young women with a history of prolonged use of hormonal contraception.Although the majority is asymptomatic, a low proportion may have significant complications such as bleeding or malignancy. Despite responding to the hormonal stimulus, the desire for pregnancy in patients with small HCA is not contraindicated. However, through this work we demonstrate that intensive hormonal therapies such as those used in the treatment of infertility can trigger serious complications CASE SUMMARY A 33-year-old female with a 10-year history of oral contraceptive use was diagnosed with a hepatic tumor as an incidental finding in an abdominal ultrasound. The patient showed no symptoms and physical examination was unremarkable. Laboratory functional tests were within normal limits and tests for serum tumor markers were negative. An abdominal magnetic resonance imaging(MRI) was performed, showing a 30 mm × 29 mm focal lesion in segment VI of the liver compatible with HCA or Focal Nodular Hyperplasia with atypical behavior. After a total of six years of follow-up, the patient underwent ovulation induction treatment for infertility. On a following MRI, a suspected malignancy was warned and hence, surgery was decided. The surgical specimen revealed malignant transformation of HCA towards trabecular hepatocarcinoma with dedifferentiated areas. There was non-evidence of tumor recurrence after three years of clinical and imaging follow-up.,CONCLUSION HCAs can be malignant regardless its size and low-risk appearance on MRI when an ovultation induction therapy is indicated.

关键词： Hepatocellular Adenoma Malignant transformation Focal liver lesion Adenoma Ovulation induction Case report

Hepatocellular Adenoma: An unsolved diagnostic enigma

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World Journal of Gastroenterology 2019年第20期25卷 2442-2449页

作者： Matteo Renzulli Alfredo Clemente Francesco Tovoli Salvatore Cappabianca Luigi Bolondi Rita Golfieri Radiology Unit Department of ExperimentalDiagnostic and Speciality MedicineSant’Orsola HospitalUniversity of BolognaBologna 40138Italy Radiology and Radiotherapy Unit Department of Precision MedicineUniversity of Campania "L. Vanvitelli"Naples 80138Italy Unit of Internal Medicine Department of Medical and Surgical SciencesUniversity of BolognaBologna 40138Italy

Hepatocellular Adenoma (HCA) is a rare benign liver tumour associated with the use of oral contraceptives or other steroid medications which occurs predominantly in young and middle-aged women. Unlike other benign liver tumours, an HCA may be complicated by bleeding and malignant transformation. HCAs have been divided into four subtypes based on molecular and pathological features: hepatocyte nuclear factor 1α-mutated HCA, inflammatory HCA,β-catenin-mutated HCA, and unclassified HCA.β-cateninmutated HCA has the highest risk of haemorrhage or malignant transformation. In the latest upgrade of the guidelines regarding the management of benign liver tumours published in 2016 by the European Association for the Study of the Liver, magnetic resonance imaging (MRI) was recognized to be superior to all other imaging modalities in detecting HCAs and in being able to subtype HCAs up to 80%, with positive identification of 1α-mutated HCA or inflammatory HCA achievable with > 90% specificity. This review analyzed the imaging features of HCA using MRI with hepato-specific contrast agents, focusing on the limitations in the HCA characterization.

关键词： Hepatocellular Adenoma Magnetic resonance imaging Hepato-specific contrast media Liver neoplasm Gadolinium-ethoxybenzyl-diethylenetriaminepentaacetic acid

Effective chemotherapy for submandibular gland carcinoma ex pleomorphic Adenoma with lung metastasis after radiotherapy: A case report

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World Journal of Clinical Cases 2019年第6期7卷 792-797页

作者： Zhi-Yuan Chen Yu Zhang Yan Tu Wei Zhao Mei Li Cancer Center West China HospitalSichuan University Oncology Department the Second People’s Hospital of Yunnan Province Radiology Department Yunnan Tumor Hospital Pathology Department West China HospitalSichuan University Department of Head & Neck Cancer Cancer CenterWest China HospitalSichuan University

BACKGROUND Only a few cases of carcinoma ex pleomorphic Adenoma arising in the submandibular gland have ever been reported,all with a poor prognosis. The standard treatment for salivary gland carcinoma ex pleomorphic Adenoma is surgical resection combined with postoperative radiotherapy,but the necessity of chemotherapy as well as the most appropriate treatment regimen for patients with distant metastasis after radiotherapy remains controversial.CASE SUMMARY This report presents the case of a 73-year-old woman who suffered submandibular gland carcinoma ex pleomorphic Adenoma. She accepted surgery to remove the mass; she was found to have lung metastasis after radiotherapy.Her condition was controlled by chemotherapy with liposomal doxorubicin plus cisplatin.CONCLUSION The positive clinical outcome in the patient reveals that this chemotherapy regimen may be an alternative treatment for such a condition.

关键词： Malignant pleomorphic Adenoma Salivary gland tumors Chemotherapy Carcinoma ex pleomorphic Adenoma Case report

Radiological aspects of giant hepatocellular Adenoma of the left liver: A case report

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World Journal of Clinical Cases 2019年第23期7卷 4111-4118页

作者： Li-Ping Zheng Chun-Dong Hu Jing Wang Xu-Jian Chen Yi-Yu Shen Department of General Surgery The Second Affiliated Hospital of Jiaxing University

BACKGROUND Hepatocellular Adenoma(HCA)is very rare and has a high misdiagnosis rate through clinical and imaging examinations.We report a case of giant HCA of the left liver in a young woman that was diagnosed by medical imaging and pathology.CASE SUMMARY A 21-year-old woman was admitted to our department for a giant hepatic tumor measuring 22 cm×20 cm×10 cm that completely replaced the left hepatic lobe.Her laboratory data only suggested mildly elevated liver function parameters and C-reactive protein levels.A computed tomography(CT)scan showed mixed density in the tumor.Magnetic resonance imaging(MRI)of the tumor revealed a heterogeneous hypointensity on T1-weighed MR images and heterogeneous hyperintensity on T2-weighed MR images.On dynamic contrast CT and MRI scans,the tumor presented marked enhancement and the subcapsular feeding arteries were clearly visible in the arterial phase,with persistent enhancement in the portal and delayed phases.Moreover,the tumor capsule was especially prominent on T1-weighted MR images and showed marked enhancement in the delayed phase.Based on these imaging manifestations,the tumor was initially considered to be an HCA.Subsequently,the tumor was completely resected and pathologically diagnosed as an HCA.CONCLUSION HCA is an extremely rare hepatic tumor.Preoperative misdiagnoses were common not only due to the absence of special clinical manifestations and laboratory examination findings,but also due to the clinicians’lack of practical diagnostic experience and vigilance in identifying HCA on medical images.Our case highlights the importance of the combination of contrast-enhanced CT and MRI in the preoperative diagnosis of HCA.

关键词： Hepatocellular Adenoma Computed tomography Magnetic resonance imaging Case report Differential diagnosis Pathology

Adenoma and advanced neoplasia detection rates increase from 45 years of age

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World Journal of Gastroenterology 2019年第4期25卷 447-456页

作者： David Karsenti Gaelle Tharsis Pascal Burtin Franck Venezia Gilles Tordjman Agnès Gillet Joelle Samama Karine Nahon-Uzan Philippe Cattan Maryan Cavicchi Digestive Endoscopy Unit Clinique Paris-Bercy Digestive Endoscopy Unit Institut Gustave Roussy

BACKGROUND Colonoscopy is considered a valid primary screening tool for colorectal cancer(CRC). The decreasing risk of CRC observed in patients undergoing colonoscopy is correlated with the Adenoma detection rate(ADR). Due to the fact that screening programs usually start from the age of 50, very few data are available on the risk of Adenoma between 40 and 49 years. However, the incidence of CRC is increasing in young populations and it is not uncommon in routine practice to detect Adenomas or even advanced neoplasia during colonoscopy in patients under 50 years.AIM To compare the ADR and advanced neoplasia detection rate(ANDR) according to age in a large series of patients during routine colonoscopy.METHODS All consecutive patients who were scheduled for colonoscopy were included.Exclusion criteria were as follows: patients scheduled for partial colonoscopy or interventional colonoscopy(for stent insertion or stenosis dilation).Colonoscopies were performed in our unit by a team of 30 gastroenterologists in2016. We determined the ADR and ANDR in each age group in the whole population and in the population with an average risk of CRC(excluding patients with personal or family history of advanced Adenoma or cancer).RESULTS6027 colonoscopies were performed in patients with a median age of 57 years(range, 15-96). The ADR and ANDR were 28.6% and 9.7%, respectively, in the whole population. When comparing patients aged 40-44(n = 382) and 45-49 years (n = 515), a strong increase in all parameters from 45 years was observed, with the ADR rising from 9.7% in patients aged 40-44 to 21.2% between 45 and 49(P <0.001) and the ANDR increasing from 3.1% in patients aged 40-44 to 6.4% in those aged 45-49 years(P < 0.03). With regard to patients aged 50-54(n = 849), a statistically significant increase in the ADR and ANDR was not observed between patients aged 45-49 and those aged 50-54 years. In the population with an average risk of CRC, the ADR and ANDR were still significantly higher in patients aged 45-49 compared with those

关键词： Colorectal cancer Screening Adenoma detection rate Colonoscopy Cohort study

Immunohistochemical features of carcinoma ex pleomorphic Adenoma and pleomorphic Adenoma in the lacrimal gland

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International Journal of Ophthalmology(English edition) 2019年第8期12卷 1238-1242页

作者： Ping Zhang Li-Juan Tang Huan-Huan Gao Wen-Xin Zhang Jian-Xian Lin Hua-Sheng Yang Department of Ocular Pathology State Key Laboratory ofOphthalmologyZhongshan Ophthalmic CenterSun Yat-senUniversityGuangzhou510060Guangdong ProvinceChina Department of Orbital Disease and Oncology State KeyLaboratory of OphthalmologyZhongshan Ophthalmic CenterSun Yat-sen UniversityGuangzhou510060GuangdongProvinceChina

AIM: To investigate C-myc, Ki-67, pan-cytokeratin, and vimentin immunohistochemical features of carcinoma ex pleomorphic Adenoma(Ca-ex-PA) and pleomorphic Adenoma(PA) in the lacrimal gland in order to find some clues in the differential diagnosis between them.METHODS: We reviewed microscopic slides and clinical records of 64 cases of PA and 15 cases of Ca-ex-PA in the lacrimal gland. Immunohistochemical antibodies for C-myc, Ki-67, pan-cytokeratin, and vimentin were employed.RESULTS: Median age of PA was 43.2 y(from 21 to 75). The 35 patients(54.7%) were male and 29 patients(45.3%) were female. For the PAs, the average positivity of C-myc was 4.6%;the average proliferation index of Ki-67 was 3.2%;pan-cytokeratin was positive in ductal cells, and vimentin was positive in myoepithelial cells. Median age of Ca-ex-PA was 54.3 y(from 26 to 76). There were 7 male patients(46.7%) and 8 female patients(53.3%). Among 15 Ca-ex-PAs, there were 6 myoepithelial carcinomas, 4 adenocarcinomas, 3 epithelial-myoepithelial carcinomas, and 2 squamous cell carcinomas. For the Ca-ex-PAs, the average positivity of C-myc was 36.4%;the average proliferation index of Ki-67 was 29.2%;pan-cytokeratin was positive in all cases, and vimentin was positive in myoepithelial carcinomas.CONCLUSION: PA has a lower positivity of C-myc and Ki-67, while Ca-ex-PA had a higher positivity of these two biomarkers. These four biomarkers as a set could provide valuable clues in the differential diagnosis between Ca-exPA and PA. Our results indicate that the activation of C-myc could play an important role in the pathogenesis of Ca-exPA and PA.

关键词： carcinoma ex pleomorphic Adenoma pleomorphic Adenoma C-myc immunohistochemistry