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Lasolle H, Teulade M, Lapras V, Vasiljevic A, Borson-Chazot F, Jouanneau E, Raverot G. Postoperative remission of non-invasive lactotroph pituitary tumor: a single-center experience. Ann Endocrinol (Paris) 2021; 83:1-8. [PMID: 34871604 DOI: 10.1016/j.ando.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Dopaminergic agonists (DA) are the first-line treatment in lactotroph pituitary tumor but treatment usually needs to be life-long. After surgical transphenoid resection, remission rates range from 60% to 90%, with low morbidity. OBJECTIVE The objective was to evaluate outcome of surgical treatment of selected non-invasive prolactinoma, and to identify factors associated with long-term remission. METHOD Early postoperative (3 months) and last follow-up data for non-invasive lactotroph tumors operated on in intention-to-cure in our center, between 2008 and 2017 were retrospectively reviewed: prolactin (PRL) level, DA treatment, pituitary function, and MRI data. Remission was defined as PRL plasma level below the upper limit of normal without DA treatment. RESULTS Fifty-three of the 60 patients (32 of the 33 microadenomas) were in remission at 3 months and 46 (28/33 microadenomas) at last follow-up 22.7 months (range, 1.1-126.5 months) after surgery. Five-year recurrence-free survival was 77.5% [65.8-91.2]. Male gender, larger tumor size at diagnosis and before surgery and higher plasma PRL level at diagnosis were all significantly associated with lower remission rates on univariate analysis. Transient diabetes insipidus and hyponatremia occurred in 2 and 5 patients respectively. One case of isolated thyrotroph insufficiency was observed. During follow-up, 13 women became pregnant (12 spontaneously). CONCLUSION This cohort confirmed the high remission rate of lactotroph tumors after surgery in a selected population, with limited morbidity, and conserved pituitary function in almost all cases.
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Affiliation(s)
- Hélène Lasolle
- Fédération d'Endocrinologie, Centre de Référence Maladies Rares Hypophysaires (HYPO) Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France; Université Lyon 1, Lyon, France; INSERM U1052, CNRS UMR5286, Cancer Research Center of Lyon, F-69372 Lyon, France
| | - Marie Teulade
- Fédération d'Endocrinologie, Centre de Référence Maladies Rares Hypophysaires (HYPO) Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France; Université Lyon 1, Lyon, France; INSERM U1052, CNRS UMR5286, Cancer Research Center of Lyon, F-69372 Lyon, France
| | - Véronique Lapras
- Service d'imagerie médicale et interventionnelle, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Alexandre Vasiljevic
- Université Lyon 1, Lyon, France; INSERM U1052, CNRS UMR5286, Cancer Research Center of Lyon, F-69372 Lyon, France; Centre de Pathologie Est, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Françoise Borson-Chazot
- Fédération d'Endocrinologie, Centre de Référence Maladies Rares Hypophysaires (HYPO) Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France; Université Lyon 1, Lyon, France
| | - Emmanuel Jouanneau
- Université Lyon 1, Lyon, France; INSERM U1052, CNRS UMR5286, Cancer Research Center of Lyon, F-69372 Lyon, France; Service de Neurochirurgie, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Gérald Raverot
- Fédération d'Endocrinologie, Centre de Référence Maladies Rares Hypophysaires (HYPO) Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France; Université Lyon 1, Lyon, France; INSERM U1052, CNRS UMR5286, Cancer Research Center of Lyon, F-69372 Lyon, France.
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Ravella L, Lopez J, Descotes F, Giai J, Lapras V, Denier ML, Borson-Chazot F, Lifante JC, Decaussin-Petrucci M. Cytological features and nuclear scores: Diagnostic tools in preoperative fine needle aspiration of indeterminate thyroid nodules with RAS or BRAF K601E mutations? Cytopathology 2020; 32:37-44. [PMID: 32803788 DOI: 10.1111/cyt.12904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/05/2020] [Accepted: 08/11/2020] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The cytological diagnosis of follicular-patterned thyroid lesions is challenging, especially since the World Health Organisation classification has recognised non-invasive follicular thyroid neoplasm with papillary-like features. These entities are often classified as indeterminate on cytology. Molecular testing has been proposed to help classify indeterminate nodules. RAS and K601E BRAF mutations are mostly encountered in follicular-patterned lesions, but their diagnostic value is not well established. Nuclear scores have also been proposed to help classify indeterminate lesions. OBJECTIVE To investigate the correlation between cytological features and histology and to assess nuclear scores in a series of indeterminate RAS or BRAF K601E positive thyroid nodules. METHODS The cytological parameters of 69 indeterminate RAS or BRAF K601E-positive thyroid nodules were evaluated. The Strickland and Maletta scores and a new nuclear score were assessed. Diagnosis of malignant, benign or indolent neoplasms was confirmed in each case by histology. Malignant and indolent nodules were considered surgical nodules, and adenomas non-surgical nodule. RESULTS Surgical nodules were associated with the presence of ground glass nuclei (P = .001), grooves (P < .001) or irregular nuclear membranes (P = .01) on cytology. Nuclear scores were more often ≥2 in surgical nodules compared to benign ones (P < .001), with high sensitivity, but a low negative predictive value. CONCLUSIONS Analysis of nuclear features is useful to distinguish non-surgical from surgical nodules in indeterminate FNAs. Although nuclear scores are not ideal rule-out tests for indeterminate RAS or BRAF K601E positive nodules, they seem useful to screen non-molecular tested or non-mutated indeterminate FNAs. This work shows that meticulous analysis of nuclear features on cytological specimens can be useful to distinguish non-surgical nodules (adenoma) from surgical nodules in indeterminate FNAs. Although nuclear scores are not rule-out tests for indeterminate RAS or BRAF K601E positive nodules, they are useful in screening non-molecular tested or non-mutated indeterminate FNAs for surgery.
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Affiliation(s)
- Lucie Ravella
- Centre de Biologie et Pathologie Sud, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Jonathan Lopez
- Biochemistry and Molecular Biology Department, Centre Hospitalier Lyon Sud, Pierre Bénite, France.,Team EMT and Cancer Cell Plasticity, Cancer Research Center of Lyon, Lyon 1 University, Villeurbanne, France
| | - Françoise Descotes
- Biochemistry and Molecular Biology Department, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Joris Giai
- CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Véronique Lapras
- Radiology Department, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Marie-Laure Denier
- Radiology Department, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Françoise Borson-Chazot
- Endocrinology Department, Groupement Hospitalier Est, Bron, France.,Faculté de Médecine Lyon Est, Universite Claude Bernard Lyon 1, Lyon, France
| | - Jean-Christophe Lifante
- Endocrine Surgery Department, Centre Hospitalier Lyon Sud, France.,Faculté de Médecine Lyon Sud, Universite, Oullins, France
| | - Myriam Decaussin-Petrucci
- Centre de Biologie et Pathologie Sud, Centre Hospitalier Lyon Sud, Pierre Bénite, France.,INSERM1052, CNRS5286, Cancer Research Center of Lyon, Lyon 1 University, Villeurbanne, France
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Castellnou S, Vasiljevic A, Lapras V, Raverot V, Alix E, Borson-Chazot F, Jouanneau E, Raverot G, Lasolle H. SST5 expression and USP8 mutation in functioning and silent corticotroph pituitary tumors. Endocr Connect 2020; 9:EC-20-0035.R1. [PMID: 32101529 PMCID: PMC7077525 DOI: 10.1530/ec-20-0035] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 02/25/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Somatostatin receptor type 5 (SST5) is inconsistently expressed by corticotroph tumors, with higher expression found in corticotropinomas having ubiquitin-specific protease 8 (USP8) mutations. Aims were to study the correlation between characteristics of corticotropinomas and SST5 expression/USP8 mutation status and to describe the response to pasireotide in 5 patients. DESIGN Retrospective cohort study. METHODS Clinico-biochemical, radiological and pathological data of 62 patients, operated for a functioning or silent corticotropinoma between 2013 and 2017, were collected. SST5 expression was measured by immunohistochemistry (clone UMB-4, Abcam, IRS>1 being considered positive) and Sanger sequencing was performed on 50 tumors to screen for USP8 mutations. RESULTS SST5 expression was positive in 26/62 pituitary tumors. A moderate or strong IRS was found in 15/58 corticotropinomas and in 13/35 functioning corticotropinomas. Among functioning tumors, those expressing SST5 were more frequent in women (22/24 vs 9/15, P=0.04) and had a lower grade (P=0.04) compared to others. USP8 mutations were identified in 13/50 pituitary tumors and were more frequent in functioning compared to silent tumors (11/30 vs 2/20, P=0.05). SST5 expression was more frequent in USP8mut vs USP8wt tumors (10/11 vs 7/19, P=0.007). Among treated patients, normal urinary free cortisol levels were obtained in 3 patients (IRS 0, 2, 6) while a 4-fold decrease was observed in one patient (IRS 4). CONCLUSION SST5 expression appears to be associated with functioning, USP8mut and lower grade corticotropinomas. A correlation between SST5 expression or USP8mut and response to pasireotide remains to be confirmed.
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Affiliation(s)
- Solène Castellnou
- Service d’Endocrinologie, Centre de Référence des Maladies Rares de l’Hypophyse HYPO, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
- Université Lyon 1, Villeurbanne, France
| | - Alexandre Vasiljevic
- Université Lyon 1, Villeurbanne, France
- Centre de Biologie et Pathologie Est, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
- INSERM U1052, CNRS, UMR5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
| | - Véronique Lapras
- Service de Radiologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Véronique Raverot
- Laboratoire d’Hormonologie, Centre de Biologie et Pathologie Est, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Eudeline Alix
- Département de Cytogénétique, Centre de Biologie et Pathologie Est, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Françoise Borson-Chazot
- Service d’Endocrinologie, Centre de Référence des Maladies Rares de l’Hypophyse HYPO, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
- Université Lyon 1, Villeurbanne, France
| | - Emmanuel Jouanneau
- Université Lyon 1, Villeurbanne, France
- INSERM U1052, CNRS, UMR5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
- Service de Neurochirurgie, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Gérald Raverot
- Service d’Endocrinologie, Centre de Référence des Maladies Rares de l’Hypophyse HYPO, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
- Université Lyon 1, Villeurbanne, France
- INSERM U1052, CNRS, UMR5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
| | - Hélène Lasolle
- Service d’Endocrinologie, Centre de Référence des Maladies Rares de l’Hypophyse HYPO, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
- Université Lyon 1, Villeurbanne, France
- INSERM U1052, CNRS, UMR5286, Centre de Recherche en Cancérologie de Lyon, Lyon, France
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Buchy M, Lapras V, Rabilloud M, Vasiljevic A, Borson-Chazot F, Jouanneau E, Raverot G. Predicting early post-operative remission in pituitary adenomas: evaluation of the modified knosp classification. Pituitary 2019; 22:467-475. [PMID: 31286328 DOI: 10.1007/s11102-019-00976-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE Cavernous sinus invasion by pituitary adenomas is an important prognostic factor for evaluating the possibilities of complete remission and to guide patient management. A widely used Magnetic Resonance Imaging grading system, suggested by Knosp in 1993, has recently been revised by the same group. The aims of our study were to apply this revised grading system to our surgical series, to determine its association with surgical outcomes, gross-total resection (GTR) and endocrinological remission (ER), paying particular attention to grades 3A and 3B, which represent the novelty of this revised classification. METHODS We included consecutive patients who underwent endoscopic endonasal surgery for a macroadenoma from September 2012 to December 2016. MRI images were reviewed and classified according to the revised Knosp classification. Surgical reports indicated the intra-operative CS invasion. GTR and ER were evaluated on 3-months post-operative MRI and endocrine evaluation. RESULTS 254 patients were included in this study. We found a total rate of cavernous sinus invasion of 18.4%. Different outcomes were observed for each grade, with an increased rate of cavernous sinus invasion with each grade. Per-operative rates of invasion were 61.5 and 78.6% in grades 3A and 3B respectively. GTR was negatively correlated with the grade, while rates were 55.8% and 30.0% for grades 3A and 3B respectively. CONCLUSION The revised Knosp radiological classification contributes to the prediction of surgical outcomes and early ER in pituitary adenomas. To manage, as precisely as possible, the risk of early recurrence in pituitary adenomas, clinicians should also consider other recognized prognostic factors, such as the proliferative status of the tumor.
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Affiliation(s)
- Marie Buchy
- Fédération d'Endocrinologie, Centre de Référence Maladies Rares hypophysaires, Groupement Hospitalier Est, Hospices Civils de Lyon, 69677, Bron, France
- Service d'Endocrinologie, Diabète, Nutrition, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310, Pierre-Bénite, France
- Université Lyon 1, 69100, Villeurbanne, France
| | - Véronique Lapras
- Service de Radiologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Muriel Rabilloud
- Université Lyon 1, 69100, Villeurbanne, France
- Hospices Civils de Lyon, Service de Biostatistiques et Bio-informatique, 69003, Lyon, France
- CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe de Biostatistiques-Santé, 69100, Villeurbanne, France
| | - Alexandre Vasiljevic
- Université Lyon 1, 69100, Villeurbanne, France
- INSERM U1052, CNRS, UMR5286; Cancer Research Center of Lyon, 69372, Lyon, France
- Centre de Pathologie Est, Groupement Hospitalier Est, Hospices Civils de Lyon, 69677, Bron, France
| | - Françoise Borson-Chazot
- Fédération d'Endocrinologie, Centre de Référence Maladies Rares hypophysaires, Groupement Hospitalier Est, Hospices Civils de Lyon, 69677, Bron, France
- Université Lyon 1, 69100, Villeurbanne, France
| | - Emmanuel Jouanneau
- Université Lyon 1, 69100, Villeurbanne, France
- INSERM U1052, CNRS, UMR5286; Cancer Research Center of Lyon, 69372, Lyon, France
- Service de Neurochirurgie, Groupement Hospitalier Est, Hospices Civils de Lyon, 69677, Bron, France
| | - Gérald Raverot
- Fédération d'Endocrinologie, Centre de Référence Maladies Rares hypophysaires, Groupement Hospitalier Est, Hospices Civils de Lyon, 69677, Bron, France.
- Université Lyon 1, 69100, Villeurbanne, France.
- INSERM U1052, CNRS, UMR5286; Cancer Research Center of Lyon, 69372, Lyon, France.
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5
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Borson-Chazot F, Dantony E, Illouz F, Lopez J, Niccoli P, Wassermann J, Do Cao C, Leboulleux S, Klein M, Tabarin A, Eberle MC, Benisvy D, de la Fouchardière C, Bournaud C, Lasolle H, Delahaye A, Rabilloud M, Lapras V, Decaussin-Petrucci M, Schlumberger M. Effect of Buparlisib, a Pan-Class I PI3K Inhibitor, in Refractory Follicular and Poorly Differentiated Thyroid Cancer. Thyroid 2018; 28:1174-1179. [PMID: 30105951 DOI: 10.1089/thy.2017.0663] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Dysregulation of the phosphatidylinositol 3-kinase (PI3K) pathway is frequent in advanced follicular (FTC) and poorly differentiated thyroid (PDTC) carcinomas and has been implicated in oncogenesis and tumor progression. This study investigated the efficacy and safety of buparlisib, a pan-PI3K inhibitor in radioiodine refractory FTC and PDTC. METHODS The primary endpoint of this open-label, multicenter, phase 2 pilot study was progression-free survival (PFS) at 6 months. The sample size was determined considering that a PFS ≤50% at 6 months would denote an absence of benefits (null hypothesis). Secondary endpoints were objective response rate, PFS at 12 months, overall survival at 6 and 12 months, and safety based on the frequency and severity of adverse events (AEs). RESULTS Forty-three patients (19M/24 F; median age: 67 years) with metastatic, radioiodine refractory, progressive disease received buparlisib, 100 mg, daily. Histology was PDTC in 25 (58%), FTC in 17 (40%), and Hürthle cell carcinoma in 1 (2%). RAS mutation was found in 44% (12/27) and activation of the PI3K pathway in 35% (8/23) of tested tumors. The probability of PFS was 41.7% [95% confidence interval (CI) 7.7-55.5] at 6 months and 20.9% [CI 0-35.7] at 12 months, lower than the 50% expected PFS. At 6 months, 25.6% patients had stable disease, 48.8% were progressive and 25.6% had stopped treatment due to AE. The response to therapy was not influenced by age, sex, histology, or genetic alterations. The overall survivals at 6 and 12 months were 85.9% [CI 76-97] and 78.7 % [CI 67-92], respectively. The mean tumor growth rate decreased from 3.78 mm/month [CI 2.61-4.95] before treatment to 0.8 mm/month [CI -0.2-1.88] during treatment (p < 0.02). Severe grade 3-4 AEs occurred in 27 patients (63%), including hepatitis (25%), hyperglycemia (21%), mood disorders (12%), and skin toxicity (12%), with favorable outcome after temporary or permanent treatment discontinuation or dose reduction. CONCLUSIONS Buparlisib did not result in significant efficacy in advanced FTC and PDTC. However, the decrease in tumor growth rate may suggest incomplete inhibition of oncogenic pathways and/or escape mechanisms. This should lead to evaluate combined therapy associating inhibitors of both the PI3K and mitogen-activated protein kinase pathways.
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Affiliation(s)
- Francoise Borson-Chazot
- 1 Fédération d'Endocrinologie, Hospices Civils de Lyon, Université Claude Bernard Lyon 1 , Lyon, France
| | - Emmanuelle Dantony
- 2 Service de Biostatistique-Bioinformatique, Hospices Civils de Lyon, Université Lyon 1 , Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Frederic Illouz
- 3 Service d'Endocrinologie, Centre de Référence de la Thyroïde et des Récepteurs Hormonaux , Centre Hospitalier Universitaire d'Angers, France
| | - Jonathan Lopez
- 4 Service de Biochimie et Biologie moléculaire, Centre Hospitalier Lyon-Sud , Hospices Civils de Lyon, Université Lyon 1, France
| | - Patricia Niccoli
- 5 Departement d'Oncologie Médicale, Institut Paoli Calmette , Marseille, France
| | - Johanna Wassermann
- 6 Département d'oncologie Médicale, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Sorbonne , Paris, France
| | - Christine Do Cao
- 7 Service d'Endocrinologie, Centre Hospitalier Regional et Universitaire Lille , France
| | - Sophie Leboulleux
- 8 Service de Médecine Nucléaire et de Cancérologie Endocrinienne, Institut Gustave Roussy , Villejuif et Université Paris Saclay, France
| | - Marc Klein
- 9 Service d'Endocrinologie, Centre Hospitalier Universitaire et Université de Nancy , France
| | - Antoine Tabarin
- 10 Service d'Endocrinologie, Centre Hospitalier Universitaire et Université de Bordeaux , France
| | - Marie-Claude Eberle
- 11 Service de Médecine Nucléaire, Institut du Cancer de Montpellier , France
| | - Danielle Benisvy
- 12 Service de Médecine Nucléaire, Centre Antoine Lacassagne , Nice, France
| | | | - Claire Bournaud
- 14 Centre de Médecine Nucléaire, Groupement Hospitalier Est , Hospices Civils de Lyon, France
| | - Helene Lasolle
- 1 Fédération d'Endocrinologie, Hospices Civils de Lyon, Université Claude Bernard Lyon 1 , Lyon, France
| | - Armelle Delahaye
- 1 Fédération d'Endocrinologie, Hospices Civils de Lyon, Université Claude Bernard Lyon 1 , Lyon, France
| | - Muriel Rabilloud
- 2 Service de Biostatistique-Bioinformatique, Hospices Civils de Lyon, Université Lyon 1 , Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Véronique Lapras
- 15 Service de Radiologie, Centre Hospitalier Lyon-Sud , Hospices Civils de Lyon, France
| | - Myriam Decaussin-Petrucci
- 16 Service d'Anatomie et Cytologie Pathologiques, Groupement Hospitalier Lyon Sud , Hospices Civils de Lyon, et Université Lyon 1, France
| | - Martin Schlumberger
- 8 Service de Médecine Nucléaire et de Cancérologie Endocrinienne, Institut Gustave Roussy , Villejuif et Université Paris Saclay, France
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Decaussin-Petrucci M, Descotes F, Depaepe L, Lapras V, Denier ML, Borson-Chazot F, Lifante JC, Lopez J. Molecular testing of BRAF, RAS and TERT on thyroid FNAs with indeterminate cytology improves diagnostic accuracy. Cytopathology 2017; 28:482-487. [PMID: 29094776 DOI: 10.1111/cyt.12493] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Liquid-based (LB)-FNA is widely recognized as a reliable diagnostic method to evaluate thyroid nodules. However, up to 30% of LB-FNA remain indeterminate according to the Bethesda system. Use of molecular biomarkers has been recommended to improve its pathological accuracy but implementation of these tests in clinical practice may be difficult. Here, we evaluated feasibility and performance of molecular profiling in routine practice by testing LB-FNA for BRAF, N/HRAS and TERT mutations. METHODS We studied a large prospective cohort of 326 cases, including 61 atypia of undetermined significance, 124 follicular neoplasms, 72 suspicious for malignancy and 69 malignant cases. Diagnosis of malignancy was confirmed by histology on paired surgical specimen. RESULTS Mutated LB-FNAs were significantly associated with malignancy regardless of the cytological classification. Overall sensitivity was 60% and specificity 89%. Importantly, in atypia of undetermined significance and follicular neoplasm patients undergoing surgery according to the Bethesda guidelines, negative predictive values were 85.4% and 90% respectively. TERT promoter mutation was rare but very specific for malignancy (5.5%) suggesting that it could be of interest in patients with indeterminate cytology. CONCLUSIONS Mutation profiling can be successfully performed on thyroid LB-FNA without any dedicated sample in a pathology laboratory. It is an easy way to improve diagnostic accuracy of routine LB-FNA and may help to better select patients for surgery and to avoid unnecessary thyroidectomies.
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Affiliation(s)
- M Decaussin-Petrucci
- Pathology department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France.,Cancer Research Center of Lyon, INSERM1052 CNRS5286, Université de Lyon, Lyon, France
| | - F Descotes
- Biochemistry and molecular biology department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - L Depaepe
- Pathology department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - V Lapras
- Radiology department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - M-L Denier
- Radiology department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - F Borson-Chazot
- Endocrinology department, Groupement hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - J-C Lifante
- Endocrine surgery department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - J Lopez
- Biochemistry and molecular biology department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France.,Cancer Research Center of Lyon, INSERM1052 CNRS5286, Université de Lyon, Lyon, France
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7
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Lasolle H, Riche B, Decaussin-Petrucci M, Dantony E, Lapras V, Cornu C, Lachuer J, Peix JL, Lifante JC, Capraru OM, Selmi-Ruby S, Rousset B, Borson-Chazot F, Roy P. Predicting thyroid nodule malignancy at several prevalence values with a combined Bethesda-molecular test. Transl Res 2017; 188:58-66.e1. [PMID: 28797549 DOI: 10.1016/j.trsl.2017.07.005] [Citation(s) in RCA: 3] [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: 03/06/2017] [Revised: 07/06/2017] [Accepted: 07/18/2017] [Indexed: 01/21/2023]
Abstract
Investigation of thyroid nodules using fine-needle aspiration cytology (FNAC) gives indeterminate results in up to 30% of samples using the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). We present a combined Bethesda-molecular predictor of nodule malignancy to improve the accuracy of the preoperative diagnosis of thyroid nodules. To detect a molecular signature of thyroid nodule malignancy, a molecular test was performed on FNACs from 128 thyroid nodules from prospectively included patients, collected in a tertiary center. The test relied on a transcriptomic array of 20 genes selected from a previous study. An optimal set of seven genes was identified using a logistic regression model. Comparison between the combined predictor (TBSRTC + molecular) and TBSRTC alone used the area under the ROC curve (AUC). Performance of the combined predictor was calculated according to various malignancy prevalence values and benefit-to-harm ratios (B/Hr) (favoring sensitivity or specificity). In our population (36% malignancy prevalence) and with a B/Hr of 1, the combined predictor achieved 95% specificity and 76% sensitivity. The AUC was 93.5%; higher than that of TBSRTC (P = 0.004). Among indeterminate nodules (30% malignancy prevalence), sensitivity and specificity were 52.2% and 96.2%, respectively, with a B/Hr of 1, or 95.7% and 64.2% with a B/Hr of 4 (favoring sensitivity), allowing avoidance of 64% of unnecessary surgeries at the cost of only one false-positive result. In conclusion, this predictor could improve the detection of thyroid nodule malignancy, taking into account malignancy prevalence and B/Hr, and reduce the number of unnecessary thyroidectomies.
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Affiliation(s)
- Hélène Lasolle
- Fédération d'Endocrinologie, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France; Université Lyon 1, Lyon, France; Service de Biostatistique, Hospices Civils de Lyon, Lyon, France; CNRS UMR5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France.
| | - Benjamin Riche
- Université Lyon 1, Lyon, France; Service de Biostatistique, Hospices Civils de Lyon, Lyon, France; CNRS UMR5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Myriam Decaussin-Petrucci
- Université Lyon 1, Lyon, France; Service d'anatomie-pathologique, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Emmanuelle Dantony
- Université Lyon 1, Lyon, France; Service de Biostatistique, Hospices Civils de Lyon, Lyon, France; CNRS UMR5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Véronique Lapras
- Service de Radiologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Catherine Cornu
- Université Lyon 1, Lyon, France; INSERM, CIC1407, Bron, France; Service de Pharmacologie Clinique, Hospices Civils de Lyon, Bron, France
| | - Joël Lachuer
- Université Lyon 1, Lyon, France; Centre de Recherche en Cancérologie de Lyon, INSERM, U 1052, Lyon, France; ProfileXpert, SFR santé Lyon Est, UMS 3453 CNRS - US7 INSERM, Lyon, France
| | - Jean-Louis Peix
- Université Lyon 1, Lyon, France; Service de Chirurgie Digestive et Endocrinienne, Hôpital Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Jean-Christophe Lifante
- Université Lyon 1, Lyon, France; Service de Chirurgie Digestive et Endocrinienne, Hôpital Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Oana-Maria Capraru
- Fédération d'Endocrinologie, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France; Centre de Recherche en Cancérologie de Lyon, INSERM, U 1052, Lyon, France; University of Medicine and Pharmacy, Tirgu Mures, Romania
| | - Samia Selmi-Ruby
- Université Lyon 1, Lyon, France; Centre de Recherche en Cancérologie de Lyon, INSERM, U 1052, Lyon, France
| | - Bernard Rousset
- Université Lyon 1, Lyon, France; Centre de Recherche en Cancérologie de Lyon, INSERM, U 1052, Lyon, France
| | - Françoise Borson-Chazot
- Fédération d'Endocrinologie, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France; Université Lyon 1, Lyon, France; Centre de Recherche en Cancérologie de Lyon, INSERM, U 1052, Lyon, France
| | - Pascal Roy
- Université Lyon 1, Lyon, France; Service de Biostatistique, Hospices Civils de Lyon, Lyon, France; CNRS UMR5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
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Marchand L, Nozières C, Walter T, Descotes F, Decaussin-Petrucci M, Joly MO, Lapras V, Bournaud C, Borson-Chazot F. Combination chemotherapy with 5-fluorouracil and dacarbazine in advanced medullary thyroid cancer, a possible alternative? Acta Oncol 2016; 55:1064-6. [PMID: 27173015 DOI: 10.3109/0284186x.2016.1157264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Lucien Marchand
- Department of Endocrinology, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France
| | - Cécile Nozières
- Department of Endocrinology, Centre Hospitalier de Vienne, Vienne, France
| | - Thomas Walter
- Department of Oncology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
- Lyon 1 University, CRCL INSERM U1052
| | - Françoise Descotes
- Department of Biochemistry, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre Bénite, France
| | - Myriam Decaussin-Petrucci
- Department of Pathology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre Bénite, France
| | - Marie-Odile Joly
- Department of Central Anatomy and Pathological Cytology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
- Lyon 1 University, CRCL INSERM U1052
| | - Véronique Lapras
- Department of Radiology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre Bénite, France
| | - Claire Bournaud
- Department of Nuclear Medicine, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France
| | - Françoise Borson-Chazot
- Department of Endocrinology, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France
- Lyon 1 University, CRCL INSERM U1052
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9
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Potorac I, Petrossians P, Daly AF, Schillo F, Ben Slama C, Nagi S, Sahnoun M, Brue T, Girard N, Chanson P, Nasser G, Caron P, Bonneville F, Raverot G, Lapras V, Cotton F, Delemer B, Higel B, Boulin A, Gaillard S, Luca F, Goichot B, Dietemann JL, Beckers A, Bonneville JF. Pituitary MRI characteristics in 297 acromegaly patients based on T2-weighted sequences. Endocr Relat Cancer 2015; 22:169-77. [PMID: 25556181 DOI: 10.1530/erc-14-0305] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Responses of GH-secreting adenomas to multimodal management of acromegaly vary widely between patients. Understanding the behavioral patterns of GH-secreting adenomas by identifying factors predictive of their evolution is a research priority. The aim of this study was to clarify the relationship between the T2-weighted adenoma signal on diagnostic magnetic resonance imaging (MRI) in acromegaly and clinical and biological features at diagnosis. An international, multicenter, retrospective analysis was performed using a large population of 297 acromegalic patients recently diagnosed with available diagnostic MRI evaluations. The study was conducted at ten endocrine tertiary referral centers. Clinical and biochemical characteristics, and MRI signal findings were evaluated. T2-hypointense adenomas represented 52.9% of the series, were smaller than their T2-hyperintense and isointense counterparts (P<0.0001), were associated with higher IGF1 levels (P=0.0001), invaded the cavernous sinus less frequently (P=0.0002), and rarely caused optic chiasm compression (P<0.0001). Acromegalic men tended to be younger at diagnosis than women (P=0.067) and presented higher IGF1 values (P=0.01). Although in total, adenomas had a predominantly inferior extension in 45.8% of cases, in men this was more frequent (P<0.0001), whereas in women optic chiasm compression of macroadenomas occurred more often (P=0.0067). Most adenomas (45.1%) measured between 11 and 20 mm in maximal diameter and bigger adenomas were diagnosed at younger ages (P=0.0001). The T2-weighted signal differentiates GH-secreting adenomas into subgroups with particular behaviors. This raises the question of whether the T2-weighted signal could represent a factor in the classification of acromegalic patients in future studies.
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Affiliation(s)
- Iulia Potorac
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, BelgiumDepartment of EndocrinologyCHU Besançon, Besançon, FranceDepartments of EndocrinologyNeuroradiologySchool of Medicine, Tunis University, Tunis, TunisiaDepartments of EndocrinologyNeuroradiologyCHU Marseille, Marseille, FranceDepartments of EndocrinologyNeuroradiologyCHU Bicêtre, Le Kremlin-Bicêtre, FranceDepartments of EndocrinologyNeuroradiologyCHU Toulouse, Toulouse, FranceDepartments of EndocrinologyRadiologyHospices Civils de Lyon, Lyon, FranceDepartments of EndocrinologyNeuroradiologyCHU Reims, Reims, FranceDepartments of NeuroradiologyNeurosurgeryCH Foch, Suresnes, FranceDepartments of EndocrinologyNeuroradiologyCHU Strasbourg, Strasbourg, France
| | - Patrick Petrossians
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, BelgiumDepartment of EndocrinologyCHU Besançon, Besançon, FranceDepartments of EndocrinologyNeuroradiologySchool of Medicine, Tunis University, Tunis, TunisiaDepartments of EndocrinologyNeuroradiologyCHU Marseille, Marseille, FranceDepartments of EndocrinologyNeuroradiologyCHU Bicêtre, Le Kremlin-Bicêtre, FranceDepartments of EndocrinologyNeuroradiologyCHU Toulouse, Toulouse, FranceDepartments of EndocrinologyRadiologyHospices Civils de Lyon, Lyon, FranceDepartments of EndocrinologyNeuroradiologyCHU Reims, Reims, FranceDepartments of NeuroradiologyNeurosurgeryCH Foch, Suresnes, FranceDepartments of EndocrinologyNeuroradiologyCHU Strasbourg, Strasbourg, France
| | - Adrian F Daly
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, BelgiumDepartment of EndocrinologyCHU Besançon, Besançon, FranceDepartments of EndocrinologyNeuroradiologySchool of Medicine, Tunis University, Tunis, TunisiaDepartments of EndocrinologyNeuroradiologyCHU Marseille, Marseille, FranceDepartments of EndocrinologyNeuroradiologyCHU Bicêtre, Le Kremlin-Bicêtre, FranceDepartments of EndocrinologyNeuroradiologyCHU Toulouse, Toulouse, FranceDepartments of EndocrinologyRadiologyHospices Civils de Lyon, Lyon, FranceDepartments of EndocrinologyNeuroradiologyCHU Reims, Reims, FranceDepartments of NeuroradiologyNeurosurgeryCH Foch, Suresnes, FranceDepartments of EndocrinologyNeuroradiologyCHU Strasbourg, Strasbourg, France
| | - Franck Schillo
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, BelgiumDepartment of EndocrinologyCHU Besançon, Besançon, FranceDepartments of EndocrinologyNeuroradiologySchool of Medicine, Tunis University, Tunis, TunisiaDepartments of EndocrinologyNeuroradiologyCHU Marseille, Marseille, FranceDepartments of EndocrinologyNeuroradiologyCHU Bicêtre, Le Kremlin-Bicêtre, FranceDepartments of EndocrinologyNeuroradiologyCHU Toulouse, Toulouse, FranceDepartments of EndocrinologyRadiologyHospices Civils de Lyon, Lyon, FranceDepartments of EndocrinologyNeuroradiologyCHU Reims, Reims, FranceDepartments of NeuroradiologyNeurosurgeryCH Foch, Suresnes, FranceDepartments of EndocrinologyNeuroradiologyCHU Strasbourg, Strasbourg, France
| | - Claude Ben Slama
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, BelgiumDepartment of EndocrinologyCHU Besançon, Besançon, FranceDepartments of EndocrinologyNeuroradiologySchool of Medicine, Tunis University, Tunis, TunisiaDepartments of EndocrinologyNeuroradiologyCHU Marseille, Marseille, FranceDepartments of EndocrinologyNeuroradiologyCHU Bicêtre, Le Kremlin-Bicêtre, FranceDepartments of EndocrinologyNeuroradiologyCHU Toulouse, Toulouse, FranceDepartments of EndocrinologyRadiologyHospices Civils de Lyon, Lyon, FranceDepartments of EndocrinologyNeuroradiologyCHU Reims, Reims, FranceDepartments of NeuroradiologyNeurosurgeryCH Foch, Suresnes, FranceDepartments of EndocrinologyNeuroradiologyCHU Strasbourg, Strasbourg, France
| | - Sonia Nagi
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, BelgiumDepartment of EndocrinologyCHU Besançon, Besançon, FranceDepartments of EndocrinologyNeuroradiologySchool of Medicine, Tunis University, Tunis, TunisiaDepartments of EndocrinologyNeuroradiologyCHU Marseille, Marseille, FranceDepartments of EndocrinologyNeuroradiologyCHU Bicêtre, Le Kremlin-Bicêtre, FranceDepartments of EndocrinologyNeuroradiologyCHU Toulouse, Toulouse, FranceDepartments of EndocrinologyRadiologyHospices Civils de Lyon, Lyon, FranceDepartments of EndocrinologyNeuroradiologyCHU Reims, Reims, FranceDepartments of NeuroradiologyNeurosurgeryCH Foch, Suresnes, FranceDepartments of EndocrinologyNeuroradiologyCHU Strasbourg, Strasbourg, France
| | - Mouna Sahnoun
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, BelgiumDepartment of EndocrinologyCHU Besançon, Besançon, FranceDepartments of EndocrinologyNeuroradiologySchool of Medicine, Tunis University, Tunis, TunisiaDepartments of EndocrinologyNeuroradiologyCHU Marseille, Marseille, FranceDepartments of EndocrinologyNeuroradiologyCHU Bicêtre, Le Kremlin-Bicêtre, FranceDepartments of EndocrinologyNeuroradiologyCHU Toulouse, Toulouse, FranceDepartments of EndocrinologyRadiologyHospices Civils de Lyon, Lyon, FranceDepartments of EndocrinologyNeuroradiologyCHU Reims, Reims, FranceDepartments of NeuroradiologyNeurosurgeryCH Foch, Suresnes, FranceDepartments of EndocrinologyNeuroradiologyCHU Strasbourg, Strasbourg, France
| | - Thierry Brue
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, BelgiumDepartment of EndocrinologyCHU Besançon, Besançon, FranceDepartments of EndocrinologyNeuroradiologySchool of Medicine, Tunis University, Tunis, TunisiaDepartments of EndocrinologyNeuroradiologyCHU Marseille, Marseille, FranceDepartments of EndocrinologyNeuroradiologyCHU Bicêtre, Le Kremlin-Bicêtre, FranceDepartments of EndocrinologyNeuroradiologyCHU Toulouse, Toulouse, FranceDepartments of EndocrinologyRadiologyHospices Civils de Lyon, Lyon, FranceDepartments of EndocrinologyNeuroradiologyCHU Reims, Reims, FranceDepartments of NeuroradiologyNeurosurgeryCH Foch, Suresnes, FranceDepartments of EndocrinologyNeuroradiologyCHU Strasbourg, Strasbourg, France
| | - Nadine Girard
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, BelgiumDepartment of EndocrinologyCHU Besançon, Besançon, FranceDepartments of EndocrinologyNeuroradiologySchool of Medicine, Tunis University, Tunis, TunisiaDepartments of EndocrinologyNeuroradiologyCHU Marseille, Marseille, FranceDepartments of EndocrinologyNeuroradiologyCHU Bicêtre, Le Kremlin-Bicêtre, FranceDepartments of EndocrinologyNeuroradiologyCHU Toulouse, Toulouse, FranceDepartments of EndocrinologyRadiologyHospices Civils de Lyon, Lyon, FranceDepartments of EndocrinologyNeuroradiologyCHU Reims, Reims, FranceDepartments of NeuroradiologyNeurosurgeryCH Foch, Suresnes, FranceDepartments of EndocrinologyNeuroradiologyCHU Strasbourg, Strasbourg, France
| | - Philippe Chanson
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, BelgiumDepartment of EndocrinologyCHU Besançon, Besançon, FranceDepartments of EndocrinologyNeuroradiologySchool of Medicine, Tunis University, Tunis, TunisiaDepartments of EndocrinologyNeuroradiologyCHU Marseille, Marseille, FranceDepartments of EndocrinologyNeuroradiologyCHU Bicêtre, Le Kremlin-Bicêtre, FranceDepartments of EndocrinologyNeuroradiologyCHU Toulouse, Toulouse, FranceDepartments of EndocrinologyRadiologyHospices Civils de Lyon, Lyon, FranceDepartments of EndocrinologyNeuroradiologyCHU Reims, Reims, FranceDepartments of NeuroradiologyNeurosurgeryCH Foch, Suresnes, FranceDepartments of EndocrinologyNeuroradiologyCHU Strasbourg, Strasbourg, France
| | - Ghaidaa Nasser
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, BelgiumDepartment of EndocrinologyCHU Besançon, Besançon, FranceDepartments of EndocrinologyNeuroradiologySchool of Medicine, Tunis University, Tunis, TunisiaDepartments of EndocrinologyNeuroradiologyCHU Marseille, Marseille, FranceDepartments of EndocrinologyNeuroradiologyCHU Bicêtre, Le Kremlin-Bicêtre, FranceDepartments of EndocrinologyNeuroradiologyCHU Toulouse, Toulouse, FranceDepartments of EndocrinologyRadiologyHospices Civils de Lyon, Lyon, FranceDepartments of EndocrinologyNeuroradiologyCHU Reims, Reims, FranceDepartments of NeuroradiologyNeurosurgeryCH Foch, Suresnes, FranceDepartments of EndocrinologyNeuroradiologyCHU Strasbourg, Strasbourg, France
| | - Philippe Caron
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, BelgiumDepartment of EndocrinologyCHU Besançon, Besançon, FranceDepartments of EndocrinologyNeuroradiologySchool of Medicine, Tunis University, Tunis, TunisiaDepartments of EndocrinologyNeuroradiologyCHU Marseille, Marseille, FranceDepartments of EndocrinologyNeuroradiologyCHU Bicêtre, Le Kremlin-Bicêtre, FranceDepartments of EndocrinologyNeuroradiologyCHU Toulouse, Toulouse, FranceDepartments of EndocrinologyRadiologyHospices Civils de Lyon, Lyon, FranceDepartments of EndocrinologyNeuroradiologyCHU Reims, Reims, FranceDepartments of NeuroradiologyNeurosurgeryCH Foch, Suresnes, FranceDepartments of EndocrinologyNeuroradiologyCHU Strasbourg, Strasbourg, France
| | - Fabrice Bonneville
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, BelgiumDepartment of EndocrinologyCHU Besançon, Besançon, FranceDepartments of EndocrinologyNeuroradiologySchool of Medicine, Tunis University, Tunis, TunisiaDepartments of EndocrinologyNeuroradiologyCHU Marseille, Marseille, FranceDepartments of EndocrinologyNeuroradiologyCHU Bicêtre, Le Kremlin-Bicêtre, FranceDepartments of EndocrinologyNeuroradiologyCHU Toulouse, Toulouse, FranceDepartments of EndocrinologyRadiologyHospices Civils de Lyon, Lyon, FranceDepartments of EndocrinologyNeuroradiologyCHU Reims, Reims, FranceDepartments of NeuroradiologyNeurosurgeryCH Foch, Suresnes, FranceDepartments of EndocrinologyNeuroradiologyCHU Strasbourg, Strasbourg, France
| | - Gérald Raverot
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, BelgiumDepartment of EndocrinologyCHU Besançon, Besançon, FranceDepartments of EndocrinologyNeuroradiologySchool of Medicine, Tunis University, Tunis, TunisiaDepartments of EndocrinologyNeuroradiologyCHU Marseille, Marseille, FranceDepartments of EndocrinologyNeuroradiologyCHU Bicêtre, Le Kremlin-Bicêtre, FranceDepartments of EndocrinologyNeuroradiologyCHU Toulouse, Toulouse, FranceDepartments of EndocrinologyRadiologyHospices Civils de Lyon, Lyon, FranceDepartments of EndocrinologyNeuroradiologyCHU Reims, Reims, FranceDepartments of NeuroradiologyNeurosurgeryCH Foch, Suresnes, FranceDepartments of EndocrinologyNeuroradiologyCHU Strasbourg, Strasbourg, France
| | - Véronique Lapras
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, BelgiumDepartment of EndocrinologyCHU Besançon, Besançon, FranceDepartments of EndocrinologyNeuroradiologySchool of Medicine, Tunis University, Tunis, TunisiaDepartments of EndocrinologyNeuroradiologyCHU Marseille, Marseille, FranceDepartments of EndocrinologyNeuroradiologyCHU Bicêtre, Le Kremlin-Bicêtre, FranceDepartments of EndocrinologyNeuroradiologyCHU Toulouse, Toulouse, FranceDepartments of EndocrinologyRadiologyHospices Civils de Lyon, Lyon, FranceDepartments of EndocrinologyNeuroradiologyCHU Reims, Reims, FranceDepartments of NeuroradiologyNeurosurgeryCH Foch, Suresnes, FranceDepartments of EndocrinologyNeuroradiologyCHU Strasbourg, Strasbourg, France
| | - François Cotton
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, BelgiumDepartment of EndocrinologyCHU Besançon, Besançon, FranceDepartments of EndocrinologyNeuroradiologySchool of Medicine, Tunis University, Tunis, TunisiaDepartments of EndocrinologyNeuroradiologyCHU Marseille, Marseille, FranceDepartments of EndocrinologyNeuroradiologyCHU Bicêtre, Le Kremlin-Bicêtre, FranceDepartments of EndocrinologyNeuroradiologyCHU Toulouse, Toulouse, FranceDepartments of EndocrinologyRadiologyHospices Civils de Lyon, Lyon, FranceDepartments of EndocrinologyNeuroradiologyCHU Reims, Reims, FranceDepartments of NeuroradiologyNeurosurgeryCH Foch, Suresnes, FranceDepartments of EndocrinologyNeuroradiologyCHU Strasbourg, Strasbourg, France
| | - Brigitte Delemer
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, BelgiumDepartment of EndocrinologyCHU Besançon, Besançon, FranceDepartments of EndocrinologyNeuroradiologySchool of Medicine, Tunis University, Tunis, TunisiaDepartments of EndocrinologyNeuroradiologyCHU Marseille, Marseille, FranceDepartments of EndocrinologyNeuroradiologyCHU Bicêtre, Le Kremlin-Bicêtre, FranceDepartments of EndocrinologyNeuroradiologyCHU Toulouse, Toulouse, FranceDepartments of EndocrinologyRadiologyHospices Civils de Lyon, Lyon, FranceDepartments of EndocrinologyNeuroradiologyCHU Reims, Reims, FranceDepartments of NeuroradiologyNeurosurgeryCH Foch, Suresnes, FranceDepartments of EndocrinologyNeuroradiologyCHU Strasbourg, Strasbourg, France
| | - Brigitte Higel
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, BelgiumDepartment of EndocrinologyCHU Besançon, Besançon, FranceDepartments of EndocrinologyNeuroradiologySchool of Medicine, Tunis University, Tunis, TunisiaDepartments of EndocrinologyNeuroradiologyCHU Marseille, Marseille, FranceDepartments of EndocrinologyNeuroradiologyCHU Bicêtre, Le Kremlin-Bicêtre, FranceDepartments of EndocrinologyNeuroradiologyCHU Toulouse, Toulouse, FranceDepartments of EndocrinologyRadiologyHospices Civils de Lyon, Lyon, FranceDepartments of EndocrinologyNeuroradiologyCHU Reims, Reims, FranceDepartments of NeuroradiologyNeurosurgeryCH Foch, Suresnes, FranceDepartments of EndocrinologyNeuroradiologyCHU Strasbourg, Strasbourg, France
| | - Anne Boulin
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, BelgiumDepartment of EndocrinologyCHU Besançon, Besançon, FranceDepartments of EndocrinologyNeuroradiologySchool of Medicine, Tunis University, Tunis, TunisiaDepartments of EndocrinologyNeuroradiologyCHU Marseille, Marseille, FranceDepartments of EndocrinologyNeuroradiologyCHU Bicêtre, Le Kremlin-Bicêtre, FranceDepartments of EndocrinologyNeuroradiologyCHU Toulouse, Toulouse, FranceDepartments of EndocrinologyRadiologyHospices Civils de Lyon, Lyon, FranceDepartments of EndocrinologyNeuroradiologyCHU Reims, Reims, FranceDepartments of NeuroradiologyNeurosurgeryCH Foch, Suresnes, FranceDepartments of EndocrinologyNeuroradiologyCHU Strasbourg, Strasbourg, France
| | - Stéphan Gaillard
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, BelgiumDepartment of EndocrinologyCHU Besançon, Besançon, FranceDepartments of EndocrinologyNeuroradiologySchool of Medicine, Tunis University, Tunis, TunisiaDepartments of EndocrinologyNeuroradiologyCHU Marseille, Marseille, FranceDepartments of EndocrinologyNeuroradiologyCHU Bicêtre, Le Kremlin-Bicêtre, FranceDepartments of EndocrinologyNeuroradiologyCHU Toulouse, Toulouse, FranceDepartments of EndocrinologyRadiologyHospices Civils de Lyon, Lyon, FranceDepartments of EndocrinologyNeuroradiologyCHU Reims, Reims, FranceDepartments of NeuroradiologyNeurosurgeryCH Foch, Suresnes, FranceDepartments of EndocrinologyNeuroradiologyCHU Strasbourg, Strasbourg, France
| | - Florina Luca
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, BelgiumDepartment of EndocrinologyCHU Besançon, Besançon, FranceDepartments of EndocrinologyNeuroradiologySchool of Medicine, Tunis University, Tunis, TunisiaDepartments of EndocrinologyNeuroradiologyCHU Marseille, Marseille, FranceDepartments of EndocrinologyNeuroradiologyCHU Bicêtre, Le Kremlin-Bicêtre, FranceDepartments of EndocrinologyNeuroradiologyCHU Toulouse, Toulouse, FranceDepartments of EndocrinologyRadiologyHospices Civils de Lyon, Lyon, FranceDepartments of EndocrinologyNeuroradiologyCHU Reims, Reims, FranceDepartments of NeuroradiologyNeurosurgeryCH Foch, Suresnes, FranceDepartments of EndocrinologyNeuroradiologyCHU Strasbourg, Strasbourg, France
| | - Bernard Goichot
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, BelgiumDepartment of EndocrinologyCHU Besançon, Besançon, FranceDepartments of EndocrinologyNeuroradiologySchool of Medicine, Tunis University, Tunis, TunisiaDepartments of EndocrinologyNeuroradiologyCHU Marseille, Marseille, FranceDepartments of EndocrinologyNeuroradiologyCHU Bicêtre, Le Kremlin-Bicêtre, FranceDepartments of EndocrinologyNeuroradiologyCHU Toulouse, Toulouse, FranceDepartments of EndocrinologyRadiologyHospices Civils de Lyon, Lyon, FranceDepartments of EndocrinologyNeuroradiologyCHU Reims, Reims, FranceDepartments of NeuroradiologyNeurosurgeryCH Foch, Suresnes, FranceDepartments of EndocrinologyNeuroradiologyCHU Strasbourg, Strasbourg, France
| | - Jean-Louis Dietemann
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, BelgiumDepartment of EndocrinologyCHU Besançon, Besançon, FranceDepartments of EndocrinologyNeuroradiologySchool of Medicine, Tunis University, Tunis, TunisiaDepartments of EndocrinologyNeuroradiologyCHU Marseille, Marseille, FranceDepartments of EndocrinologyNeuroradiologyCHU Bicêtre, Le Kremlin-Bicêtre, FranceDepartments of EndocrinologyNeuroradiologyCHU Toulouse, Toulouse, FranceDepartments of EndocrinologyRadiologyHospices Civils de Lyon, Lyon, FranceDepartments of EndocrinologyNeuroradiologyCHU Reims, Reims, FranceDepartments of NeuroradiologyNeurosurgeryCH Foch, Suresnes, FranceDepartments of EndocrinologyNeuroradiologyCHU Strasbourg, Strasbourg, France
| | - Albert Beckers
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, BelgiumDepartment of EndocrinologyCHU Besançon, Besançon, FranceDepartments of EndocrinologyNeuroradiologySchool of Medicine, Tunis University, Tunis, TunisiaDepartments of EndocrinologyNeuroradiologyCHU Marseille, Marseille, FranceDepartments of EndocrinologyNeuroradiologyCHU Bicêtre, Le Kremlin-Bicêtre, FranceDepartments of EndocrinologyNeuroradiologyCHU Toulouse, Toulouse, FranceDepartments of EndocrinologyRadiologyHospices Civils de Lyon, Lyon, FranceDepartments of EndocrinologyNeuroradiologyCHU Reims, Reims, FranceDepartments of NeuroradiologyNeurosurgeryCH Foch, Suresnes, FranceDepartments of EndocrinologyNeuroradiologyCHU Strasbourg, Strasbourg, France
| | - Jean-François Bonneville
- Department of EndocrinologyCentre Hospitalier Universitaire de Liège, Université de Liège, Domaine Universitaire du Sart Tilman, 4000 Liège, BelgiumDepartment of EndocrinologyCHU Besançon, Besançon, FranceDepartments of EndocrinologyNeuroradiologySchool of Medicine, Tunis University, Tunis, TunisiaDepartments of EndocrinologyNeuroradiologyCHU Marseille, Marseille, FranceDepartments of EndocrinologyNeuroradiologyCHU Bicêtre, Le Kremlin-Bicêtre, FranceDepartments of EndocrinologyNeuroradiologyCHU Toulouse, Toulouse, FranceDepartments of EndocrinologyRadiologyHospices Civils de Lyon, Lyon, FranceDepartments of EndocrinologyNeuroradiologyCHU Reims, Reims, FranceDepartments of NeuroradiologyNeurosurgeryCH Foch, Suresnes, FranceDepartments of EndocrinologyNeuroradiologyCHU Strasbourg, Strasbourg, France
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Potorac I, Petrossians P, Schillo F, slama CB, Nagi S, Sahnoun M, Brue T, Girard N, Chanson P, Nasser G, Caron P, Bonneville F, Raverot G, Lapras V, Cotton F, Delemer B, Higel B, Boulin A, Gaillard S, Goichot B, Dietemann JL, Kreutz J, Tshibanda L, Beckers A, Bonneville JF. Corrélations significatives de l’aspect en IRM Haute Résolution des adénomes hypophysaires à GH avant traitement. Annales d'Endocrinologie 2013. [DOI: 10.1016/j.ando.2013.07.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Trouillas J, Roy P, Sturm N, Dantony E, Cortet-Rudelli C, Viennet G, Bonneville JF, Assaker R, Auger C, Brue T, Cornelius A, Dufour H, Jouanneau E, François P, Galland F, Mougel F, Chapuis F, Villeneuve L, Maurage CA, Figarella-Branger D, Raverot G, Barlier A, Bernier M, Bonnet F, Borson-Chazot F, Brassier G, Caulet-Maugendre S, Chabre O, Chanson P, Cottier JF, Delemer B, Delgrange E, Di Tommaso L, Eimer S, Gaillard S, Jan M, Girard JJ, Lapras V, Loiseau H, Passagia JG, Patey M, Penfornis A, Poirier JY, Perrin G, Tabarin A. A new prognostic clinicopathological classification of pituitary adenomas: a multicentric case-control study of 410 patients with 8 years post-operative follow-up. Acta Neuropathol 2013; 126:123-35. [PMID: 23400299 DOI: 10.1007/s00401-013-1084-y] [Citation(s) in RCA: 311] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 01/07/2013] [Accepted: 01/17/2013] [Indexed: 01/03/2023]
Abstract
Pituitary adenomas are currently classified by histological, immunocytochemical and numerous ultrastructural characteristics lacking unequivocal prognostic correlations. We investigated the prognostic value of a new clinicopathological classification with grades based on invasion and proliferation. This retrospective multicentric case-control study comprised 410 patients who had surgery for a pituitary tumour with long-term follow-up. Using pituitary magnetic resonance imaging for diagnosis of cavernous or sphenoid sinus invasion, immunocytochemistry, markers of the cell cycle (Ki-67, mitoses) and p53, tumours were classified according to size (micro, macro and giant), type (PRL, GH, FSH/LH, ACTH and TSH) and grade (grade 1a: non-invasive, 1b: non-invasive and proliferative, 2a: invasive, 2b: invasive and proliferative, and 3: metastatic). The association between patient status at 8-year follow-up and age, sex, and classification was evaluated by two multivariate analyses assessing disease- or recurrence/progression-free status. At 8 years after surgery, 195 patients were disease-free (controls) and 215 patients were not (cases). In 125 of the cases the tumours had recurred or progressed. Analyses of disease-free and recurrence/progression-free status revealed the significant prognostic value (p < 0.001; p < 0.05) of age, tumour type, and grade across all tumour types and for each tumour type. Invasive and proliferative tumours (grade 2b) had a poor prognosis with an increased probability of tumour persistence or progression of 25- or 12-fold, respectively, as compared to non-invasive tumours (grade 1a). This new, easy to use clinicopathological classification of pituitary endocrine tumours has demonstrated its prognostic worth by strongly predicting the probability of post-operative complete remission or tumour progression and so could help clinicians choose the best post-operative therapy.
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Bournaud C, Charrié A, Nozières C, Chikh K, Lapras V, Denier ML, Paulin C, Decaussin-Petrucci M, Peix JL, Lifante JC, Cornu C, Giraud C, Orgiazzi J, Borson-Chazot F. Thyroglobulin measurement in fine-needle aspirates of lymph nodes in patients with differentiated thyroid cancer: a simple definition of the threshold value, with emphasis on potential pitfalls of the method. Clin Chem Lab Med 2010; 48:1171-7. [DOI: 10.1515/cclm.2010.220] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
OBJECTIVE An unusual case of a patient with Löfgren syndrome peritoneal involvement by sarcoidosis. PATIENT AND METHODS A 36-year-old woman presented with Löfgren syndrome and an increase in liver enzyme levels. An abdominal CT scan showed multiple nodules on the peritoneum mimicking peritoneal carcinomatosis. Laparoscopy was conducted with biopsy of the peritoneal nodules. RESULTS Biopsy specimens from the peritoneum, liver, and bronchi showed noncaseating granulomas, and the search for tuberculosis was negative. Clinical and biological features resolved within 6 months, without therapy with steroids, while a thoracic CT scan as well as an abdominal CT scan showed no change. CONCLUSION To our knowledge, this is the first reported case of peritoneal sarcoidosis associated with Löfgren syndrome. A longer follow-up will, however, be required to assess the chronicity of the disease.
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Affiliation(s)
- Laure Bourdillon
- Department of Internal Medicine, Hôtel Dieu, 69288 Lyon Cedex 02, France
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Dalle S, Paulin C, Lapras V, Balme B, Ronger-Savle S, Thomas L. Fine-needle aspiration biopsy with ultrasound guidance in patients with malignant melanoma and palpable lymph nodes. Br J Dermatol 2007; 155:552-6. [PMID: 16911280 DOI: 10.1111/j.1365-2133.2006.07361.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [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: 11/29/2022]
Abstract
BACKGROUND Recurrence after treatment of stage I-II melanoma involves regional lymph nodes in about 50% of patients. A reliable method is needed to evaluate lymph node status (metastatic or not) in the case of palpable lymph nodes. OBJECTIVES To evaluate the efficiency of fine-needle aspiration biopsy (FNAB) in examining clinically detected suspicious lymph node in patients followed up after surgical removal of stage I-II melanoma. PATIENTS AND METHODS One hundred and twenty FNABs were performed in 67 patients with a suspicious node in an open study conducted in a French melanoma regional referral centre, Hôpital de l'Hôtel-Dieu. Cytodiagnosis was classified as positive, negative, inadequate or inconclusive. Sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios were calculated after final histopathological evaluation. RESULTS Fifty-eight of 120 FNABs were positive (48%), 50 of 120 (42%) were negative, four of 120 (3%) were inconclusive and eight of 120 (7%) were inadequate. Among the 108 FNABs in which a definitive diagnosis could be given, sensitivity was 98.2% [95% confidence interval (CI) 90.7-99.9] and specificity was 96.1% (95% CI 86.8-98.9). CONCLUSIONS FNAB under ultrasound guidance is an efficient tool to discriminate better between cases in which surgical treatment of the lymph node basin should be performed and patients who should return for follow-up. Surgical treatment appears to be required in cases of positive FNAB or in inconclusive cases.
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Affiliation(s)
- S Dalle
- Service de Radiologie, Hôpital de l'Hôtel-Dieu, 1 Place de l'Hôpital, 69288 Lyon Cedex 02, France.
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Sève P, Lanier-Gachon E, Garbit V, Stankovic K, Lapras V, Broussolle C. [A cruralgia of unusual cause]. Rev Med Interne 2006; 28:120-1. [PMID: 16919853 DOI: 10.1016/j.revmed.2006.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2006] [Accepted: 07/03/2006] [Indexed: 11/27/2022]
Affiliation(s)
- P Sève
- Service de médecine interne, Hôtel-Dieu, 1, place de l'Hôpital, 69288 Lyon cedex 02, France.
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Tetreau R, Beziat C, Marion D, Gouillat C, Lapras V, Bancel B. [Capillary hemangioma of the spleen on conventional and contrast-enhanced US]. J Radiol 2006; 87:575-7. [PMID: 16733417 DOI: 10.1016/s0221-0363(06)74042-2] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
We report a case of splenic vascular neoplasm in a 75 year old asymptomatic woman. CT and enhanced sonography were not consistent with a typical hemangioma. Splenectomy was finally realised and pathologic exam showed a capillary hemangioma with thrombosis. The imaging appearance of splenic hemangiomas may be complex because of splenic topography, size and complicating features. The differentiation of these lesions from malignant disease may not be possible.
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Affiliation(s)
- R Tetreau
- Service de Radiologie, Hôtel Dieu, Lyon.
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Sève P, Bui-Xuan C, David G, Stankovic K, Lapras V, Broussolle C. [An aortic abnormality]. Rev Med Interne 2005; 27:66-7. [PMID: 15923064 DOI: 10.1016/j.revmed.2005.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2005] [Accepted: 04/11/2005] [Indexed: 10/25/2022]
Affiliation(s)
- P Sève
- Service de médecine interne, Hôtel-Dieu, 1, place de l'hôpital, 69288 Lyon cedex 02, France
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Abstract
AIM OF THE STUDY Primary hyperparathyroidism usually affects elderly patients. Juvenile primary hyperparathyroidism is rare, and raises diagnostic and prognostic problems. The aim of this retrospective study on 24 patients is to establish clinical, histological, and therapeutic features of juvenile primary hyperparathyroidism. PATIENTS AND METHODS From 1986 to 2001, 673 patients were treated for primary hyperparathyroidism in our department. Twenty four patients were younger than 30 years old (3.5%). There were 14 women and 10 men. Mean age was 23 year (14-30). Clinical manifestations, pathologics findings and postoperative results were studied. RESULTS Sixteen patients presented a sporadic form of primary hyperparathyroidism with a single adenoma. Clinical manifestations were renal symptoms in 11 cases and acute hypercalcemia syndrome in 2 cases. Seven patients had a NEM I syndrome: parathyroid lesions were 6 hyperplasia and one adenoma. A 27 years old woman presented a recurrent familial isolated hyperparathyroidism. She was operated on 10 years before and at reoperation parathyroid carcinoma was found. Nineteen patients were cured after a post operative follow up ranging from 3 to 168 months. One patient had an asymptomatic hypercalcemia recurrence. Two patients presented permanent hypoparathyroidism treated with calcitriol and calcium. CONCLUSION Sporadic forms represent majority of cases of juvenile hyperparathyroidism. Renal manifestations are usual. Nevertheless, multiple endocrine neoplasia type 1 has to be evocated.
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Affiliation(s)
- O Monneuse
- Service de chirurgie, hôpital de l'Antiquaille, 69321 Lyon, France
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Bernard S, Touzet S, Personne I, Lapras V, Bondon PJ, Berthezène F, Moulin P. Association between microsomal triglyceride transfer protein gene polymorphism and the biological features of liver steatosis in patients with type II diabetes. Diabetologia 2000; 43:995-9. [PMID: 10990076 DOI: 10.1007/s001250051481] [Citation(s) in RCA: 114] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIMS/HYPOTHESIS Non-alcoholic steatohepatitis is frequent in Type II (non-insulin-dependent) diabetes mellitus and can lead to fibrosis and cirrhosis. The interindividual variability in the occurrence of nonalcoholic steatohepatitis suggests, however, a genetic modulation. Microsomal triglyceride transfer protein (MTP) is necessary for the assembly and secretion of VLDL and when the protein is not functional, such as in abetalipoproteinaemia, a steatohepatitis occurs. We therefore assessed the association between a functional polymorphism in the promoter region of MTP gene (-493 G/T) and the biological features of steatohepatitis in Type II diabetic patients. METHODS We studied 271 patients with Type II diabetes. Determination of -493 G/T polymorphism was made by PCR-RFLP. Increased liver enzymes were used as surrogates of liver steatosis and alanine aminotransferase concentration was the outcome variable for the multivariate analysis. Liver ultrasonography was available for a subgroup of patients with newly diagnosed diabetes. RESULTS The proportion of patients with increased alanine aminotransferase was higher in GG than in GT and TT subgroups (23%, 11% and 6%, respectively, p = 0.01). Additionally, patients with high alanine aminotransferase concentrations were more likely to be young (p = 0.01), male (p = 0.001), obese (p = 0.04) and have low HDL-cholesterol (p = 0.01). In multivariate analysis, the MTP genotype was independently associated with alanine aminotransferase concentration (p = 0.0023) as well as sex and body mass index but not HDL-cholesterol. CONCLUSION/INTERPRETATION The -493 G/T MTP gene polymorphism is associated with biological surrogates of steatohepatitis in patients with Type II diabetes. The G allele which is responsible for a decrease in MTP gene transcription is prone to increase the intrahepatic triglycerides content, conferring by this a genetic susceptibility for steatohepatitis.
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Affiliation(s)
- S Bernard
- Department of Endocrinology and Nutrition, Cardiovascular Hospital Louis-Pradel, Bron, France
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Peix JL, el Khazen M, Mancini F, Binet A, Berger N, Lapras V. [Surgery for primary hyperparathyroidism in 1998. Apropos of 66 patients and 3 methods of approach]. Ann Chir 2000; 125:346-52. [PMID: 10900736 DOI: 10.1016/s0003-3944(00)00207-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
STUDY AIM The aim of this prospective study was to assess the advantages and disadvantages of cervicotomy, selective lateral approach and video-assisted surgery in the treatment of primary hyperparathyroidism (HPT 1). PATIENTS AND METHODS During 1998, 66 patients were operated on for HPT 1 in the same center. There were 48 women and 18 men (mean age: 58 years, range: 21-84), familial HPT 1 or MEN1 excluded. The interventions were performed via classical cervicotomy (n = 32), via selective lateral approach (n = 8) and were video-assisted (n = 25). A mediastinal adenoma was removed via cervicotomy and another one via left thoracoscopy. The procedure was associated with intraoperative parathormone (PTH) quick-assay. Calcium testing was controlled before leaving the hospital and 2 months later. RESULTS A double adenoma and 65 single adenomas were confirmed by pathological report. Circulating PTH levels, 20 minutes after removal of the adenoma, always decreased significantly. In video-assisted procedures, there were 11 conversions to open cervicotomy (44%) and morbidity consisted of one case of laryngeal nerve paralysis. At the end of the study, all patients except one had a normal calcium level. CONCLUSION Video-assisted parathyroidectomy is feasible but requires a preoperative localisation of the adenoma and intraoperative PTH quick-assay. Its main benefit in cervical adenoma is to reduce the scar and in mediastinal adenoma to avoid sternotomy. With the elective approach, results are similar to those of video-assisted surgery and the procedure is much easier to perform. Classical cervicotomy is still the best option in case of previous cervicotomy, of simultaneous thyroidectomy, of negative preoperative imaging and in elderly patients less concerned about cosmetic benefit.
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Affiliation(s)
- J L Peix
- Service de chirurgie, hôpital de l'Antiquaille, Lyon, France
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Peix JL, Van Box Som P, Claeys K, Lapras V. [Excision of a parathyroid adenoma of the aorto-pulmonary window under thoracoscopy]. Presse Med 1996; 25:494-6. [PMID: 8685109] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES Neck exploration is usually required in all cases of primary hyperparathyroidism. Without a precise localization preoperatively cervicotomy may be unsuccessful, especially in case of an ectopic adenoma. CASE REPORT A patient with primary hyperparathyroidism due to a solitary adenoma localized in the middle mediastinum was identified on preoperative computed tomography and technetium-99m-sestamibi radionuclide scan. The tumor was successfully removed at thoracoscopy without neck exploration. DISCUSSION Preoperative localization of primary hyperparathyroid tumors is not indicated in all patients. In some selected cases (acute hypercalcemia, reoperation, serious illness) prior neck exploration would be useful in guiding the surgeon.
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Affiliation(s)
- J L Peix
- Service de Chirurgie, Hôpital de l'Antiquaille, Lyon
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Dupuis J, Bodnar D, Sturtz F, Broussolle E, Exbrayat C, Lapras V, Chazot G. [Reversible retroperitoneal fibrosis after prolonged treatment with bromocriptine: apropos of 2 cases]. Rev Med Interne 1990; 11:183. [PMID: 2399383 DOI: 10.1016/s0248-8663(05)82228-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Lapras V, Pelle-Francoz D, Maillet PJ, Pinet A. [Ultrasonic diagnosis in scrotal pathology. Apropos of 137 tests]. J Radiol 1986; 67:127-33. [PMID: 3519955] [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: 01/06/2023]
Abstract
Ultrasound imaging of scrotum in 137 patients detected 31 inflammatory lesions of epididymis or testis, 8 tumors, 23 cystic lesions, 21 hydroceles and 19 other affections. Medical or surgical treatment was instituted in 63% of patients, the other 37% failing to attend. Therapy was effective in 90.5% of cases (100% of fluid lesions, 80.6% of inflammatory lesions and 87.5% of tumors). Ultrasound imaging appears to be an excellent complement to clinical examination, when findings are insufficient or when examination is difficult because of severe pain, allowing identification of the fluid or solid nature of a lesion. It is also of specific value for diagnosis of subclinical tumors, surveillance of patients at risk and detailed investigation of inflammatory lesions.
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