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Pal N, Banu HN, Chakraborty M, Jain N, Maiti PK. Current perspective of adrenal histoplasmosis in India: A prospective study in a tertiary care hospital, Eastern India. Indian J Med Microbiol 2022; 43:90-95. [PMID: 36272878 DOI: 10.1016/j.ijmmb.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/22/2022] [Accepted: 10/03/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Adrenal histoplasmosis (AH) is an uncommon form of disseminated histoplasmosis caused by the dimorphic fungus Histoplasma capsulatum. Though, India is considered to be a non-endemic area for histoplasmosis, a high rise of AH cases is reported currently from various parts of India. Our study aimed to evaluate the current perspective of adrenal histoplasmosis in India by reviewing its clinical course, differential diagnosis, treatment, and mortality of our eleven confirmed cases of AH along with the review of authentic reported AH cases from India. MATERIAL &METHOD Clinical materials were taken from radiologically suspected all 15 cases either with unilateral or bilateral adrenal enlargement, referred between 2018 and 2020 for microbiological investigations. Fungal stain and fungal culture along with other tests for possible differential diagnosis with AH were conducted. RESULT Out of fifteen incidentaloma detected by radio-imaging, eleven cases of AH had been diagnosed in our hospital with yield of Rhodotorula spp. in one mimicking case. Nine of them were male (82%) and all were HIV nonreactive, which corroborates with the literature review. All of them had nonspecific clinical presentation of chronic abdominal pain, fever, weight loss, and anorexia. Four developed primary adrenal insufficiency, which are similar to the literature review (41%). On treatment with itraconazole and/or amphotericin B, all patients survived except one lost in follow-up. CONCLUSION Male preponderance and non-compromised immune status are two special characteristics of most AH though reasons are ill understood. So, mycological investigations are to be done for every such case.
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Affiliation(s)
- Nupur Pal
- Department of Microbiology, Institute of Post-Graduate Medical Education & Research, 244 AJC Bose Road, Kolkata 700020, India.
| | - Hossain Najma Banu
- Department of Microbiology, Institute of Post-Graduate Medical Education & Research, 244 AJC Bose Road, Kolkata 700020, India
| | - Mohana Chakraborty
- Department of Microbiology, Institute of Post-Graduate Medical Education & Research, 244 AJC Bose Road, Kolkata 700020, India
| | - Namrata Jain
- Department of Microbiology, Institute of Post-Graduate Medical Education & Research, 244 AJC Bose Road, Kolkata 700020, India
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Teng Q, Fan B, Wang Y, Wen S, Wang H, Liu T, Wang L. Primary adrenal tuberculosis infection in patients with Behcet's disease presenting as isolated adrenal metastasis by 18F-FDG PET/CT: a rare case report and literature review. Gland Surg 2021; 10:3431-3442. [PMID: 35070903 PMCID: PMC8749099 DOI: 10.21037/gs-21-511] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/05/2021] [Indexed: 07/30/2023]
Abstract
Primary adrenal tuberculosis (TB) is a rare type of extrapulmonary tuberculosis (EPTB). A pathological biopsy is usually required to make a definite diagnosis due to nonspecific symptoms. Antituberculous chemotherapy is the main treatment regimen, and cortisol replacement therapy should be added when adrenal insufficiency is involved. Here, we present a 59-year-old man who had recurrence of oral and genital aphthosis for 3 years and was diagnosed with Behcet's disease (BD), which was cured by thalidomide. After 10 days of admission, the patient had sudden abdominal pain in the right upper quadrant with high fever and was diagnosed with acute cholecystitis attack, which was treated by percutaneous transhepatic gallbladder drainage (PTGBD). Further contrast-enhanced CT showed a right adrenal mass with a diameter of 2.0 cm, and PET-CT indicated intense 18F-fluorodeoxyglucose (18F-FDG) uptake in the right adrenal mass with a maximum standardized uptake value (SUVmax) of 15.2. As a metastatic adrenal mass was suspected, the patient underwent retroperitoneal laparoscopic adrenalectomy. Histopathological and immunohistochemical analysis revealed primary adrenal TB. After routine anti-tuberculosis treatment with isoniazid, rifampin, pyrazinamide and ethambutol for six months, the patient was cured and discharged. In summary, primary unilateral adrenal TB without adrenal insufficiency is difficult to diagnose only on the basis of clinical manifestations and examinations. Further studies are needed to develop an easier and more accurate diagnostic examination.
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Affiliation(s)
- Qiliang Teng
- Department of Urology, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Bo Fan
- Department of Urology, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yutong Wang
- First Clinical College, Dalian Medical University, Dalian, China
| | - Shuang Wen
- Department of Pathology, Dalian Friendship Hospital, Dalian, China
| | - Honglong Wang
- Department of Pathology, Dalian Friendship Hospital, Dalian, China
| | - Tianqing Liu
- Department of Pathology, Dalian Friendship Hospital, Dalian, China
| | - Liang Wang
- Department of Urology, Second Affiliated Hospital of Dalian Medical University, Dalian, China
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An extensive study for binary characterisation of adrenal tumours. Med Biol Eng Comput 2018; 57:849-862. [DOI: 10.1007/s11517-018-1923-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 10/25/2018] [Indexed: 12/21/2022]
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4
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Bender K, Waldie AM, Asogan M, Figtree MC, Sywak MS. Fungal granuloma: a case report of a rare cause for isolated adrenal incidentaloma. ANZ J Surg 2018; 89:E525-E526. [PMID: 30347491 DOI: 10.1111/ans.14856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/03/2018] [Accepted: 08/10/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Kyle Bender
- Department of Endocrine Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Anna M Waldie
- Department of Endocrine Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Mrudhula Asogan
- Department of Microbiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Melanie C Figtree
- Department of Microbiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Mark S Sywak
- Department of Endocrine Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Koyuncu H, Ceylan R, Erdogan H, Sivri M. A novel pipeline for adrenal tumour segmentation. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2018; 159:77-86. [PMID: 29650321 DOI: 10.1016/j.cmpb.2018.01.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 12/17/2017] [Accepted: 01/24/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Adrenal tumours occur on adrenal glands surrounded by organs and osteoid. These tumours can be categorized as either functional, non-functional, malign, or benign. Depending on their appearance in the abdomen, adrenal tumours can arise from one adrenal gland (unilateral) or from both adrenal glands (bilateral) and can connect with other organs, including the liver, spleen, pancreas, etc. This connection phenomenon constitutes the most important handicap against adrenal tumour segmentation. Size change, variety of shape, diverse location, and low contrast (similar grey values between the various tissues) are other disadvantages compounding segmentation difficulty. Few studies have considered adrenal tumour segmentation, and no significant improvement has been achieved for unilateral, bilateral, adherent, or noncohesive tumour segmentation. There is also no recognised segmentation pipeline or method for adrenal tumours including different shape, size, or location information. METHODS This study proposes an adrenal tumour segmentation (ATUS) pipeline designed to eliminate the above disadvantages for adrenal tumour segmentation. ATUS incorporates a number of image methods, including contrast limited adaptive histogram equalization, split and merge based on quadtree decomposition, mean shift segmentation, large grey level eliminator, and region growing. RESULTS Performance assessment of ATUS was realised on 32 arterial and portal phase computed tomography images using six metrics: dice, jaccard, sensitivity, specificity, accuracy, and structural similarity index. ATUS achieved remarkable segmentation performance, and was not affected by the discussed handicaps, on particularly adherence to other organs, with success rates of 83.06%, 71.44%, 86.44%, 99.66%, 99.43%, and 98.51% for the metrics, respectively, for images including sufficient contrast uptake. CONCLUSIONS The proposed ATUS system realises detailed adrenal tumour segmentation, and avoids known disadvantages preventing accurate segmentation.
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Affiliation(s)
- Hasan Koyuncu
- Selçuk University, Electrical & Electronics Engineering Department, Konya, Turkey.
| | - Rahime Ceylan
- Selçuk University, Electrical & Electronics Engineering Department, Konya, Turkey.
| | - Hasan Erdogan
- University of Health Sciences, Konya Training and Research Hospital, Radiology Clinic, Konya, Turkey
| | - Mesut Sivri
- University of Health Sciences, Ankara Child Health and Disease Hematology Oncology Training and Research Hospital, Radiology Clinic, Ankara, Turkey
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What, where and why: exploring fluorodeoxyglucose-PET's ability to localise and differentiate infection from cancer. Curr Opin Infect Dis 2018; 30:552-564. [PMID: 28922285 DOI: 10.1097/qco.0000000000000405] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW To review the utility of FDG-PET imaging in detecting the cause of fever and infection in patients with cancer. RECENT FINDINGS FDG-PET has been shown to have high sensitivity and accuracy for causes of neutropenic fever, leading to higher diagnostic certainty in this group. Recent advances in pathogen-specific labelling in PET to identify Aspergillus spp. and Yersinia spp. infections in mice, as well as differentiating between Gram-positive, Gram-negative and mycobacterial infections are promising. SUMMARY Patients with cancer are vulnerable to infection and fever, and the causes of these are frequently unclear using conventional diagnostic methods leading to high morbidity and mortality, length of stay and costs of care. FDG-PET/CT, with its unique complementary functional and anatomical information as well as its whole-body imaging capability, has demonstrated use in detecting occult infection in immunocompromised patients, including invasive fungal and occult bacterial infections, as well as defining extent of infection. By demonstrating disease resolution following treatment and allowing earlier cessation of therapy, FDG-PET acts as a key tool for antimicrobial and antifungal stewardship. Limitations include at times poor differentiation between infection, malignancy and sterile inflammation, however, exciting new technologies specific to infectious pathogens may help alleviate that issue. Further prospective randomised research is needed to explore these benefits in a nonbiased fashion.
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Gajendra S, Jha B, Sahni T, Goel S, Raina V, Sachdev R. Disseminated Histoplasmosis in an Immunocompetent Host Presenting as Pancytopenia with Bilateral Adrenal Masses. Turk J Haematol 2017; 32:191-2. [PMID: 26316495 PMCID: PMC4451493 DOI: 10.4274/tjh.2014.0084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
| | | | | | | | | | - Ritesh Sachdev
- Medanta The Medicity Hospital, Clinic of Pathology and Laboratory Medicine, Haryana, India E-mail: Phone: 09811836806
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9
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Kalathoorakath RR, Sharma A, Sood A, Nahar U, Gorla AKR, Mittal BR. 18F-FDG PET/CT imaging and PET-guided biopsy in evaluation and treatment decision in adrenal histoplasmosis. BJR Case Rep 2016; 2:20150451. [PMID: 30459990 PMCID: PMC6243334 DOI: 10.1259/bjrcr.20150451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 02/08/2016] [Accepted: 02/10/2016] [Indexed: 11/28/2022] Open
Abstract
Histoplasmosis is a rare opportunistic fungal infection. It is commonly seen in immunocompromised individuals from endemic areas. Adrenal glands are frequently involved in the disseminated disease. Here, we present the case of a retropositive patient with constitutional symptoms, where whole-body positron emission tomography/CT scan revealed intense 18F-fludeoxyglucose uptake in bulky adrenal glands, and subsequent positron emission tomography-guided biopsy helped in establishing the diagnosis of adrenal histoplasmosis.
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Affiliation(s)
| | - Aman Sharma
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Ashwani Sood
- Department of Nuclear Medicine, PGIMER, Chandigarh, India
| | - Uma Nahar
- Department of Histopathology, PGIMER, Chandigarh, India
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Altinmakas E, Guo M, Kundu UR, Habra MA, Ng C. Computed tomography and 18F-fluorodeoxyglucose positron emission tomography/computed tomography findings in adrenal candidiasis and histoplasmosis: two cases. Clin Imaging 2015; 39:1115-8. [DOI: 10.1016/j.clinimag.2015.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 06/19/2015] [Accepted: 07/06/2015] [Indexed: 12/16/2022]
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Kandathil A, Wong KK, Wale DJ, Zatelli MC, Maffione AM, Gross MD, Rubello D. Metabolic and anatomic characteristics of benign and malignant adrenal masses on positron emission tomography/computed tomography: a review of literature. Endocrine 2015; 49:6-26. [PMID: 25273320 DOI: 10.1007/s12020-014-0440-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 09/25/2014] [Indexed: 12/12/2022]
Abstract
PET/CT with (18)F-fluorodeoxyglucose (FDG) or using different radiocompounds has proven accuracy for detection of adrenal metastases in patients undergoing cancer staging. It can assist the diagnostic work-up in oncology patients by identifying distant metastases to the adrenal(s) and defining oligometastatic disease that may benefit from targeted intervention. In patients with incidentally discovered adrenal nodules, so-called adrenal "incidentaloma" FDG PET/CT is emerging as a useful test to distinguish benign from malignant etiology. Current published evidence suggests a role for FDG PET/CT in assessing the malignant potential of an adrenal lesion that has been 'indeterminately' categorized with unenhanced CT, adrenal protocol contrast-enhanced CT, or chemical-shift MRI. FDG PET/CT could be used to stratify patients with higher risk of malignancy for surgical intervention, while recommending surveillance for adrenal masses with low malignant potential. There are caveats for interpretation of the metabolic activity of an adrenal nodule on PET/CT that may lead to false-positive and false-negative interpretation. Adrenal lesions represent a wide spectrum of etiologies, and the typical appearances on PET/CT are still being described, therefore our goal was to summarize the current diagnostic strategies for evaluation of adrenal lesions and present metabolic and anatomic appearances of common and uncommon adrenal lesions. In spite of the emerging role of PET/CT to differentiate benign from malignant adrenal mass, especially in difficult cases, it should be emphasized that PET/CT is not needed for most patients and that many diagnostic problems can be resolved by CT and/or MR imaging.
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Affiliation(s)
- Asha Kandathil
- Nuclear Medicine/Radiology Department, University of Michigan Hospital, Ann Arbor, MI, 48109, USA
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18F-FDG PET as a monitoring tool to assess treatment response in bilateral adrenal histoplasmosis. Clin Nucl Med 2014; 39:576-8. [PMID: 24662660 DOI: 10.1097/rlu.0000000000000400] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 60-year-old woman with clinical and biochemical features suggestive of adrenal insufficiency was found to have bilateral adrenal masses on CT scan and was subjected to F-FDG PET scan. The scan showed hypermetabolic mediastinal nodes in addition to intense tracer uptake in bilateral adrenal masses. CT-guided adrenal biopsy grew Histoplasma capsulatum on Sabouraud dextrose agar culture. A second F-FDG PET scan after 6 months of appropriate antifungal therapy showed a significant decrease in intensity of uptake consistent with the clinical outcome.
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14
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Kathuria S, Capoor MR, Yadav S, Singh A, Ramesh V. Disseminated histoplasmosis in an apparently immunocompetent individual from north India: a case report and review. Med Mycol 2013; 51:774-8. [DOI: 10.3109/13693786.2013.777166] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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15
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Tsai YJ, Lin YH, Hsu CH, Yeh SD. 18F-fluorodeoxyglucose positron emission tomography for the initial evaluation and monitoring of therapeutic response in bilateral adrenal histoplasmosis. Clin Imaging 2013; 37:791-3. [DOI: 10.1016/j.clinimag.2013.02.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 01/31/2013] [Accepted: 02/28/2013] [Indexed: 11/24/2022]
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Gailey MP, Klutts JS, Jensen CS. Fine-needle aspiration of histoplasmosis in the era of endoscopic ultrasound and endobronchial ultrasound. Cancer Cytopathol 2013; 121:508-17. [DOI: 10.1002/cncy.21298] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 03/19/2013] [Accepted: 03/19/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Michael P. Gailey
- Department of Pathology; University of Iowa Hospitals and Clinics; Iowa City Iowa
| | - J. Stacey Klutts
- Department of Pathology; University of Iowa Hospitals and Clinics; Iowa City Iowa
| | - Chris S. Jensen
- Department of Pathology; University of Iowa Hospitals and Clinics; Iowa City Iowa
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Troh E, Doukoure B, Diomande M, Kouacou-Lohoues M, N’Dah K, Abouna A. Histoplasmose surrénalienne chez un sujet immunocompétent. À propos d’une observation à Abidjan en Côte d’Ivoire. J Mycol Med 2010. [DOI: 10.1016/j.mycmed.2010.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Rappo U, Beitler J, Faulhaber J, Firoz B, Henning J, Thomas K, Maslow M, Goldfarb D, Horowitz H. Expanding the horizons of histoplasmosis: disseminated histoplasmosis in a renal transplant patient after a trip to Bangladesh. Transpl Infect Dis 2010; 12:155-60. [DOI: 10.1111/j.1399-3062.2009.00466.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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PET/CT incidental detection of bilateral adrenal myelolipomas in a patient with a huge maxillary sinus carcinoma. Clin Nucl Med 2010; 35:132-3. [PMID: 20090469 DOI: 10.1097/rlu.0b013e3181c7c007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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