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Christopher R McHenry

Publications and source records attributed to Christopher R McHenry.

At least 19 recordsLinked to original sources
PubMed2006

When fine-needle aspiration biopsy cannot exclude papillary thyroid cancer: a therapeutic dilemma.

HYPOTHESIS: Clinical or cytologic factors predictive of malignancy can be identified and incorporated into a treatment algorithm for patients with a fine-needle aspiration biopsy (FNAB) specimen interpreted as "suspicious for" papillary thyroid cancer (PTC). DESIGN: Retrospective review of a prospectively maintained database. SETTING: University-affiliated tertiary care hospital. PATIENTS: Seven hundred thirty-eight patients with nodular thyroid disease evaluated between 1990 and 2004. INTERVENTIONS: Patients with an FNAB specimen suspicious for PTC were identified. The frequency of carcinoma was determined. Clinical features were reviewed. The FNAB specimens suspicious for PTC were examined in a blinded fashion to determine if specific cytologic features were important in distinguishing benign vs malignant disease. MAIN OUTCOME MEASURES: The presence of specific clinical and cytologic features was correlated with the incidence of carcinoma. A secondary outcome measure was to determine the value of frozen section examination in establishing the extent of thyroidectomy. RESULTS: Forty-five patients (7%) had an FNAB specimen suspicious for PTC; 18 (40%) of these patients had carcinoma. Prominent nuclear inclusions and/or grooves, papillary formations, and the absence of colloid were features associated with PTC (P<.05). No clinical features reliably identified malignant disease. Frozen section examination results altered treatment in 15 (56%) of 27 patients. CONCLUSIONS: An FNAB specimen suspicious for PTC is associated with a 40% incidence of carcinoma. Extensive nuclear inclusions and/or grooves, papillary formations, and the absence of colloid are predictive of carcinoma. Rare intranuclear inclusions and/or grooves alone in an otherwise benign-appearing specimen are uniformly associated with benign disease. Frozen section examination is of value in determining the extent of thyroidectomy.

Adenocarcinoma↗
PubMed2006

Incidence and location of ectopic abnormal parathyroid glands.

BACKGROUND: Ectopic parathyroid glands are a cause for failed parathyroid exploration. METHODS: Patients with hyperparathyroidism and ectopic parathyroid glands were identified from a parathyroid database. Laboratory data, gland weights, and surgical outcomes were obtained. The locations of the ectopic glands were correlated with results of technetium-99m-sestamibi imaging. RESULTS: Of 231 patients operated on for hyperparathyroidism, 37 (16%) had ectopic parathyroid glands. Ectopic inferior glands (N = 23 [62%]) were intrathymic, n = 7 (30%); anterosuperior mediastinal, n = 5 (22%); intrathyroidal, n = 5 (22%); within the thyrothymic ligament, n = 4 (17%); and submandibular, n = 2 (9%). Ectopic superior glands (N = 14 [38%]) were in the tracheoesophageal groove, n = 6 (43%); retroesophageal, n = 3 (22%); posterosuperior mediastinal, n = 2 (14%); intrathyroidal, n = 1 (7%); in the carotid sheath, n = 1 (7%); and paraesophageal, n = 1 (7%). Sestamibi scans were true-positive in 81%, identifying 13 of 16 retrosternal glands, and false-negative in 19%. CONCLUSIONS: A 16% incidence of ectopic parathyroid glands and a 100% positive predictive value of sestamibi scintigraphy underscore the importance of sestamibi imaging in patients with primary hyperparathyroidism.

Choristoma↗
PubMed2006

Follicular and Hürthle cell carcinoma of the thyroid gland.

Follicular and Hürthle cell carcinoma of the thyroid gland are uncommon tumors that are genotypically similar. Current and future diagnostic adjuncts, treatment, and postoperative follow-up for patients with follicular and Hürthle cell cancer are outlined. Risk factors for recurrence and mortality and the reported outcomes of treatment of follicular and Hürthle cell carcinoma are reviewed.

Adenoma↗
PubMed2006

Islet cell tumors.

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Adrenocorticotropic Hormone↗
PubMed2005

Parathyroid carcinoma.

Parathyroid carcinoma is an uncommon malignancy. It accounts for less than 1% of cases of primary hyperparathyroidism (HPT). It is manifested by severe hypercalcemia and up to 50% of patients will have concomitant kidney or bone disease. The etiology of parathyroid carcinoma is unknown, however, the recently discovered HRPT2 gene, a tumor suppressor gene encoding for the protein parafibromin, has been implicated in the pathogenesis. Identification of inactivating germ-line mutations in HRPT2 has significant implications for diagnosis and management. This article summarizes the genetic aspects of parathyroid carcinoma, reviews its clinical manifestations, and outlines the principles of surgical therapy, the indications for adjuvant therapy, and the use of bisphosphonate and calcimimetic agents for management of hypercalcemia.

Carcinoma↗
PubMed2005

Fine-needle aspiration biopsy specimen with a predominance of Hürthle cells: a dilemma in the management of nodular thyroid disease.

BACKGROUND: A fine-needle aspiration biopsy (FNAB) specimen of a thyroid nodule with a predominance of Hürthle cells usually is indicative of a Hürthle cell neoplasm, but it also may occur with nonneoplastic disease. METHODS: A prospective nodular thyroid disease database was used to identify patients with a FNAB specimen consisting of a predominance of Hürthle cells. Clinical factors were investigated and FNAB specimens were examined in a blinded fashion by a single cytopathologist to determine if there were specific factors that could be used to distinguish nonneoplastic from neoplastic disease. RESULTS: Of the 738 patients with nodular thyroid disease, 622 had a FNAB specimen. The FNAB specimen was interpreted as consistent with a Hürthle cell neoplasm in 45 (7%) patients, 7 (16%) with carcinoma, 21 (47%) with adenoma, 12 (27%) with adenomatous hyperplasia, and 5 (11%) with thyroiditis. Extensive cellularity and absent colloid were associated with neoplastic disease (P < .05). No cytologic feature reliably excluded neoplastic disease (P > .05). No significant differences in age (x +/- SD) (51 +/- 17 vs 54 +/- 17 y), sex (female/male ratio, 6/1 vs 15/2), nodule size (3.9 +/- 1.9 vs 3.4 +/- 2.0 cm), weight of excised thyroid tissue (42 +/- 27 vs 33 +/- 30 g), or functional status of the thyroid gland was observed between patients with neoplastic (n = 28, 62%) versus nonneoplastic (n = 17, 38%) disease. CONCLUSIONS: Neoplastic disease accounts for two thirds of the pathology in patients with a predominance of Hürthle cells on FNAB specimen and neither clinical nor cytologic features reliably exclude Hürthle cell adenoma or carcinoma. As a result, thyroidectomy is recommended for all patients with a thyroid nodule and a predominance of Hürthle cells on FNAB specimen.

Adenoma, Oxyphilic↗
PubMed2004

Giant insulinoma: case report and review of the literature.

An insulinoma is a rare pancreatic endocrine tumor that is typically sporadic, solitary, and less than 2 cm in diameter. Fewer than 5% of insulinomas are larger than 3 cm. Ninety percent or more of all insulinomas are benign. Larger tumors are more likely to be malignant. We report a case of a giant pedunculated insulinoma, measuring 9 cm in diameter and weighing 100 g, with amyloid deposits accounting for 70% of the tumor volume. At the time of operation, no local invasion or metastatic disease was identified. On pathological evaluation, the tumor was classified as an insulinoma of uncertain biological behavior. In addition to describing the clinical presentation and operative findings, criteria for determining malignancy are outlined, a detailed pathological description is presented, and the 2000 World Health Organization Classification for Pancreatic Endocrine Neoplasms is reviewed.

Aged↗
PubMed2004

Post-parathyroidectomy hypocalcemia: incidence, risk factors, and management.

The purpose of this study was to evaluate the incidence and severity of hypocalcemia after parathyroidectomy and delineate its risk factors. Data was retrieved from a prospective database. Patients with postoperative hypocalcemia were identified and risk factors were investigated including primary versus renal hyperparathyroidism (HPT), preoperative calcium, parathyroid hormone (PTH) and alkaline phosphatase levels, gland weight, pathology, extent of surgery, and reoperative surgery. Of the 162 patients who underwent parathyroidectomy, 84 (52%) were hypocalcemic postoperatively: 55 (42%) of 132 patients with primary and 29 (97%) of 30 patients with renal HPT (P = 0.0001). Patients with renal HPT had more profound hypocalcemia with a mean +/- SD calcium of 7.34 mg/dL +/- 1.07 versus 7.76 mg/dL +/- 0.59 for patients with primary HPT (P < 0.05). Symptoms were present in 28 (51%) of 55 patients with primary and 13 (45%) of 29 patients with renal HPT. Only three (2%) patients with primary compared to 29 (97%) with renal HPT were treated with intravenous calcium. The average length of stay for hypocalcemic patients was 0.7 days for primary HPT versus 4.7 days for renal HPT (P < 0.0005). Patients with primary HPT who underwent subtotal parathyroidectomy had significantly lower postoperative calcium levels (7.95 mg/dL +/- 0.64) than patients who had a single or double adenoma removed (8.49 mg/dL +/- 0.79) (P = 0.036). No other factor was predictive of postoperative hypocalcemia. Patients with renal HPT develop profound postoperative hypocalcemia requiring intravenous calcium and vitamin D therapy. Hypocalcemia in patients with primary HPT develop less severe hypocalcemia that is amenable to outpatient oral calcium therapy and should be routinely initiated following subtotal parathyroidectomy.

Calcium↗
PubMed2004

Complications and sequelae of thyroidectomy and an analysis of surgeon experience and outcome.

Theodor Kocher is credited with refining the technique of thyroidectomy and reducing the incidence of postoperative hemorrhage. He also recognized the importance of preservation of the parathyroid glands. His accomplishments led to a reduction in surgical mortality, from 50% to less than 4.5%. Additional improvements in technique have reduced the mortality rate to near zero. Morbidity, however, remains a concern for surgeons who perform thyroid surgery. Complications and sequelae of thyroid surgery are reviewed, including recurrent and superior laryngeal nerve injury, temporary hypocalcemia, permanent hypoparathyroidism, thyroid storm, bleeding, wound infection, and hypothyroidism. The association between the volume of thyroidectomies performed by a surgeon and outcome is also discussed in this chapter.

Clinical Competence↗
PubMed2004

Unrecognized foreign body ingestion: an unusual cause for abdominal pain in a healthy adult.

An unusual case of a unrecognized foreign body ingestion in a healthy, reliable adult patient is reported. A diagnosis of a foreign body perforation of the stomach was made on computed tomographic imaging of the abdomen that was obtained for evaluation of unremitting pain. This case emphasizes the importance of considering foreign body ingestion in the differential diagnosis for abdominal pain of unknown etiology.

Abdominal Pain↗
PubMed2003

Adenomatoid tumor of the adrenal gland with micronodular adrenal cortical hyperplasia.

We report a case of an adenomatoid tumor (AT) of an adrenal gland with micronodular adrenal cortical hyperplasia (ACH). A 51-year-old man was found to have newly developed hypertension with clinical evidence of primary aldosteronism. A computerized tomogram of the abdomen revealed a solitary mass in the right adrenal gland. He underwent a right adrenalectomy for a presumptive clinical diagnosis of a solitary aldosterone-producing adrenal cortical adenoma. On histopathologic examination, the adrenal gland demonstrated an AT, diagnosed by the characteristic histological features, immunohistochemical stain results, and electron microscopic findings. The surrounding adrenal cortex showed multiple small hyperplastic cortical nodules. After the adrenalectomy, the patient's blood pressure normalized. Primary AT of the adrenal gland coexisting with micronodular ACH associated with hypertension has not been previously reported.

Adrenal Cortex Neoplasms↗
PubMed2003

The false negative technetium-99m-sestamibi scan in patients with primary hyperparathyroidism: correlation with clinical factors and operative findings.

False negative (FN) results limit the efficacy of technetium-99m-sestamibi scanning for parathyroid localization. We determined the incidence of FN results and attempted to correlate it with clinical and operative findings. One hundred forty-six patients underwent parathyroidectomy; 89 had primary hyperparathyroidism (76 single adenoma and 13 multiglandular disease) and underwent sestamibi scanning. The false negative rate was 22 per cent with an overall sensitivity of 77 per cent and a positive predictive value of 99 per cent. Patients with single adenomas were more likely to have a true positive scan than those with multiglandular disease [83% vs 38%; odds ratio (OR) = 7.754, 95% confidence interval (CI) = 2.184-27.524; P < or = 0.0001]. Inferior adenomas (90% vs 59%; OR = 6.261, 95% CI = 2.037-19.243; P < or = 0.0001) and larger adenomas (1422.3 +/- 1576.2 vs 474.6 +/- 193.2 g; P < or = 0.0001) were more likely to be detected by sestamibi imaging. Patients with normal preoperative calcium levels were more likely to have an FN sestamibi scan. Sestamibi parathyroid imaging is limited by a 22 per cent FN rate and is less accurate for detecting abnormal parathyroid tissue in patients with small adenomas, multiglandular disease, superior adenomas, or preoperative normocalcemia.

Adenoma↗
PubMed2003

The clinical significance of an isofunctioning thyroid nodule.

The management of an "isofunctioning" thyroid nodule--defined by radioiodine uptake equivalent to normal thyroid tissue--is often a dilemma. Our goal was to determine the percentage of thyroid nodules that were isofunctioning and the frequency with which carcinoma occurred in an isofunctioning nodule. Patients referred for evaluation of a thyroid nodule from 1990 to 2002 were reviewed and those with an iodine-123 thyroid scintiscan were identified. Nodule size, serum thyrotropin, fine-needle aspiration biopsy, pathology, and follow-up were determined for patients with an isofunctioning, hypofunctioning, or hyperfunctioning thyroid nodule. Of the 562 patients with a thyroid nodule 273 (49%) had a thyroid scan. Nodules were hypofunctioning in 232 (85%), isofunctioning in 29 (11%), and hyperfunctioning in 12 (4%) patients. Mean nodule size and serum thyrotropin level were respectively 2.49 +/- 0.23 cm and 1.73 +/- 0.26 microIU/mL for isofunctioning, 2.47 +/- 0.31 cm and 0.83 +/- 0.21 microIU/mL for hyperfunctioning, and 3.94 +/- 0.13 cm and 1.86 +/- 0.28 pIU/mL for hypofunctioning nodules. Seventeen patients with an isofunctioning nodule underwent thyroidectomy and 12 patients were followed for a mean 27 months without an increase in nodule size. No patient with a hyperfunctioning nodule, six patients (21%) with an isofunctioning nodule, and 44 patients (19%) with a hypofunctioning nodule had a carcinoma. We conclude that the risk of malignancy in an isofunctioning nodule is similar to that of a hypofunctioning nodule and therefore the management should be based on routine fine-needle aspiration biopsy.

Algorithms↗
PubMed2002

Persistent parathyroid hormone elevation following curative parathyroidectomy for primary hyperparathyroidism.

BACKGROUND: Persistent elevation of parathyroid hormone (PTH) levels following parathyroidectomy may indicate residual abnormal parathyroid tissue. OBJECTIVE: To determine the clinical significance and risk factors for persistent PTH elevation following curative parathyroidectomy. METHODS: A prospective study of consecutive patients with primary hyperparathyroidism who had resolution of hypercalcemia following parathyroidectomy. Patients with low or normal serum calcium and increased PTH levels postoperatively were identified, and serial calcium and PTH levels and clinical course were monitored. A multivariate analysis was performed to identify features associated with an elevated postoperative PTH level. RESULTS: Of 85 patients with resolution of hypercalcemia following parathyroidectomy, postoperative PTH levels were elevated in 23 (27%) (mean, 99 pg/mL; range, 70-194 pg/mL) and normal in 62 (mean, 30 pg/mL; range, 3-65 pg/mL) (P<.001). No significant differences in preoperative or postoperative calcium or preoperative PTH levels were found between groups. Among patients with persistent PTH elevation, 18 had adenoma and 5 had multiglandular disease, compared with 52 with adenoma and 10 with multiglandular disease in patients with normal postoperative PTH levels (P>.05). Multivariate analysis demonstrated that black race and musculoskeletal symptoms were associated with an elevated postoperative PTH level (P =.01. After an average 16-month follow-up, PTH levels normalized in 13 patients, decreased in 5, and were unchanged in 2. Three patients were lost to follow-up. CONCLUSIONS: Persistent PTH elevation occurs in 27% of patients following curative parathyroidectomy and is usually a transient phenomenon more common in patients with musculoskeletal symptoms and of the black race. It is not a manifestation of persistent disease but is most likely a secondary response to bone remineralization.

Adult↗