Expression of Glucose Metabolism-Related Proteins in Adrenal Neoplasms

<b><i>Purpose:</i></b> The aim of this study was to investigate the expression patterns of glucose metabolism-related proteins and their clinicopathologic implications in adrenal cortical neoplasms (ACN) and pheochromocytoma (PCC). <b><i>Methods:</i></b> Immunohistochemical staining was performed to evaluate glucose metabolism-related proteins (GLUT1, CAIX, hexokinase II, G6PDH, PHGDH, and SHMT1) in 132 ACN cases (115 adrenal cortical adenoma [ACA] and 17 adrenal cortical carcinoma [ACC]) and 189 PCC cases. <b><i>Results:</i></b> Expression levels of GLUT1 in tumor cells ([T]; <i>p</i> &#x3c; 0.001), GLUT1 in stromal cells ([S]; <i>p</i> &#x3c; 0.001), G6PDH (<i>p</i> &#x3c; 0.001), and SHMT1 (<i>p</i> = 0.002) were higher in ACN than in PCC. GLUT1 (T; <i>p</i> = 0.045) and PHGDH (<i>p</i> = 0.043) levels were higher in ACC than in ACA. In a univariate analysis of ACN, GLUT1 (T; <i>p</i> = 0.017), CAIX (S; <i>p</i> = 0.003), and PHGDH (<i>p</i> = 0.009) levels were correlated with a shorter overall survival (OS). GLUT1 (T; <i>p</i> = 0.001) and PHGDH (<i>p</i> &#x3c; 0.001) were related to a shorter OS in PCC. GLUT1 (T) positivity (<i>p</i> = 0.043) in ACN predicted a poor OS in a multivariate Cox analysis. In PCC, high GAPP score (<i>p</i> = 0.026), GLUT1 (T; <i>p</i> = 0.002), and PHGDH (<i>p</i> &#x3c; 0.001) were independent prognostic factors for poor OS. <b><i>Conclusions:</i></b> The adrenal gland tumors ACN and PCC had different expression patterns of glucose metabolism-related proteins (GLUT1, G6PDH, and SHMT1), with higher expression levels in ACN than in PCC. GLUT1 and PHGDH were significant prognostic factors in these adrenal neoplasms.

Modern possibilities of the urine steroid profile testing applying for the adrenocortical cancer diagnosis

BACKGROUND: X-ray diagnostics methods are important in detection of adrenal neoplasms malignant nature. The sensitivity and specificity of these methods are high enough. However the hormonal tests are also necessary to make an accurate clinical diagnosis with the high diagnostic efficiency of modern X-ray methods for adrenal tumors diagnosing. The urine steroid profile violations are detected with the adrenal glands various pathologies (primary hyperaldosteronism, hypercorticism, congenital hyperplasia of the adrenal cortex and adrenocortical cancer). Urine steroid profile tests in patients with diagnosed adrenal neoplasms are intended primarily to confirm or refute the adrenocortical cancer risk. At the same time in the medical community to date there are a number of disagreements accumulated regarding the accuracy and significance of the urine steroid profile tests. AIMS: The study aims to determine the urine steroid profile determination accuracy limits for the adrenocortical cancer diagnosis. MATERIALS AND METHODS: In total 62 samples were tested for urine steroid profile by gas chromatography-mass spectrometry. 58 patients had morphologically confirmed adrenal neoplasms. The study was blind prospective. To increase the study accuracy the 30 patients with adrenocortical adenomas (n = 17) and adrenocortical cancer (n = 13) were selected out of 58 tested persons. The sensitivity, specificity and accuracy of the urine steroid profile were determined in order to assess information content of such method for the adrenocortical carcinoma diagnosis. RESULTS: The possibilities of the urine steroid profile determining for the adrenocortical cancer diagnosis are estimated. The method sensitivity was 46.2%, specificity and accuracy were 70.6% and 60% respectively. The most reliable of adrenocortical cancer markers were tetrahydro-11-deoxycortisol and dehydroepiandrosterone (38.5% of cases) increasing concentrations. CONCLUSIONS: The present study demonstrates relatively low diagnostic efficacy of the urine steroid profile as a primary diagnostic method for adrenocortical cancer determining. This is especially evident in comparison with X-ray diagnostic methods. The technique interpretation is complex and accessible only to specialists with extremely high qualifications. Such fact complicates the distribution and widespread use in clinical practice of this testing method. At the same time the urine steroid profile determination in the future (after additional study) may be apply as an auxiliary diagnostic method which in some cases determines the treatment tactics for patients undergoing adrenocortical cancer adrenalectomy treatment.KEYWORDS: dPheochromocytoma; intraoperative hemodynamic instability; laparoscopic adrenalectomy; Endovascular embolization of preoperative; сase report.

Experience in endoscopic treatment of patients with adrenal neoplasms

Objective: To summarize the experience of endoscopic surgical treatment of patients with adrenal neoplasms.Methods: The results of treatment of 80 patients (64 women and 16 men) with adrenal neoplasm were retrospectively analyzed in Medical Center, Far Eastern Federal University, from 2014 to 2019.Results: Andrenalectomies were performed via three accesses: laparoscopic (49 cases), retroperitoneoscopic (22 cases) and laparoscopy-assisted (6 cases). Three cases required conversion. 70 benign and 10 malignant neoplasms were removed. Complications, including one death, developed in four cases.Conclusions: Minimally invasive andrenalectomy is safer and more preferable than open surgery due to reduced duration of hospital stay, decreased rate of complications, degree of pain syndrome, extent of blood loss and need for opioid analgesics.

PRACTICAL ASPECTS OF LAPAROSCOPIC ADRENALECTOMY IN CHILDREN WITH BENIGN ADRENAL TUMORS

Introduction. Despite of almost 30-year world experience in mini-invasive adrenalectomy in non-oncologic pediatric patients, this issue remains not fully understood and systematized in the domestic literature. Material and methods. Our work is based on 67 laparoscopic adrenalectomies performed in 65 patients, aged from 3 months to 17 years, with predominantly benign neoplasms. Despite of a thorough preoperative examination of each patient, we met malignant neoplasms in 7 cases: 4 - adrenocortical cancer and 3 - neuroblastomas (further they were treated by oncologists). Location of the neoplasms was as follows: right-sided - 31, left-sided - 26, bilateral - 8 (6 patients out of them had bilateral simultaneous removal). Average size of the removed formations was 4.65 ± 1.29 cm (maximum 12 cm). Results and discussion. The vast majority of detected adrenal neoplasms are removed. Exceptions may be neoplasms less than 4 cm in diameter with the native density less than 10 HU by computed tomography; however, they should be actively monitored by specialists. If a malignant process is suspected, patients should be examined more thoroughly and should be treated in specialized hospitals. Nowadays, a minimally invasive and safe surgical treatment of neoplasms in the adrenal glands depends on the experience and trainings of surgeons and anesthesiologists, as well as on the equipment in the operating room. A key to the successful treatment of patients with benign adrenal neoplasms is a specific attention to curative peculiarities in such patients as well as an adequate sequence of actions during laparoscopic adrenalectomy in its main stage, namely, ligation of the central adrenal vein.