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Venous sampling: its role in localization of endocrine tumours.

Despite recent instrumentation advancement in morphologic imaging, venous sampling remains a sensitive physiological investigation for functional localization of hormonal hypersecretion. The test requires technical expertise and reliable laboratory support, and should be selectively applied to address individual clinical problems in coordination with other imaging modalities. Depending on the venous anatomy, sampling may achieve regional localization or lateralization of the endocrine tumour. Adrenal venous sampling serves to lateralize functioning tumour, and to differentiate it from hyperplasia. Inferior petrosal sinus sampling confirms pituitary Cushing's disease and lateralizes the adenoma. Systemic venous sampling identifies the site of ectopic hormonal secretion. In the localization of pancreatic islet cell tumours, the test is further enhanced by sampling after intraarterial injection of hormonal secretagogue. The experience of venous sampling in a regional referral hospital is discussed, including the patient selection, its technical details, pitfalls and effectiveness in achieving tumour localization for patient management.

Adrenal Gland Neoplasms↗

Studies on tyrosine hydroxylase in neuroblastoma in relation to urinary levels of catecholamine metabolites.

Tyrosine hydroxylase (TH) activity has been determined in 22 neuroblastoma tumors from 15 patients, in 1 pheochromocytoma, 20 adrenal glands, 10 other tumors and organs, and 4 specimens of sera. The enzyme activity was found only in the neural crest tumors and adrenal glands, but the levels were too low to be detected in the other tumors and in normal liver and kidney tissues. The average specific activity (mean +/- SE) of TH in 23 neural crest tumors was 0.559 +/- 0.101; in 20 adrenal glands was 0.418 +/- 0.124 nmol/mg protein/minute. In 13 patients with neuroblastoma and 1 patient with pheochromocytoma, both TH levels in the primary tumors and urinary excretion of vanillylmandelic acid (VMA) and homovanillic acid (HVA) were studied. The urinary excretion of VMA by 10 of 13 neuroblastoma patients and by the patient with pheochromocytoma was significantly to markedly elevated above normal levels; excretion of HVA by 12 of 13 neuroblastoma patients was similarly elevated. These results indicate that tyrosine hydroxylase, an enzyme specifically located in the adrenal medulla and monoaminergic neurons, is also present in neuroblastoma, a malignant tumor of similar embryologic origin, and in pheochromocytoma. Not only can TH activity in these tumors be demonstrated in vitro, but the elevated urinary excretion of VMA and/or HVA by the majority of patients with these tumors also indicates TH activity of the tumors in vivo.

Adolescent↗

Pheochromocytoma and paraganglioma: comparison of MR imaging with CT and I-131 MIBG scintigraphy.

To ascertain the magnetic resonance (MR) imaging characteristics of pheochromocytomas and paragangliomas and to compare MR with computed tomography (CT) and iodine-131 metaiodobenzylguanidine (I-131 MIBG), 19 patients (18 with pheochromocytomas, one with a paraganglioma) were studied. The 18 patients with pheochromocytomas had had positive findings with I-131 MIBG scintigraphy. Abdominal pheochromocytomas were generally hypointense compared with normal liver on T1-weighted MR images and extremely hyperintense on T2-weighted MR images. MR imaging was preferable to CT in the evaluation of primary pheochromocytomas due to superior tissue characterization, particularly in the patient with hypertension and borderline catecholamine levels. For patients with recurrent or metastatic disease, the data suggest that I-131 MIBG scintigraphy is the examination of choice.

3-Iodobenzylguanidine↗

CT diagnosis of adrenal abnormalities in patients with primary non-adrenal malignancies.

Fifty-seven patients with primary non-adrenal malignancy were found to have unsuspected adrenal abnormality on CT. In 33, comparison of histopathologic findings and/or the patients' hospital course or follow-up lead to the diagnosis of adrenal metastases (23), benign non-functioning adenomas (7), metastasis with hyperplasia (1), benign hyperplasia (1), and fatty infiltration (1). The analysis of CT findings indicated that: I) A heterogeneous adrenal mass showing contrast enhancement was always metastatic, II) Nonfunctioning adenomas were always 3 cm or smaller in diameter, III) Bilateral adrenal masses and growth of adrenal mass on follow-up CT or regression on treatment indicated metastases, and IV) metastatic disease could not be excluded purely on the basis of the size of the adrenal mass.

Adrenal Gland Neoplasms↗

Fine-needle aspiration biopsy of the adrenal glands: A ten-year experience.

We report on our experience in FNA biopsy of the adrenal gland: 177 biopsies performed in the last 10 years. Cytologic diagnoses were divided into four groups: nondiagnostic aspirates (28%), primary adrenal lesions (13%), metastatic neoplasms (33%), and negative cases with known extra-adrenal malignancies (25%). Among diagnostic smears and excluding the latter group, the procedure was 100% specific for malignancy, and 98% of the lesions were correctly diagnosed. There were no known false-positive or false-negative samples. Quality of diagnosis improves with careful smearing (avoids artifacts) and immediate evaluation (raises adequacy rates) by the pathologist. Although the primary or secondary nature of most adrenal masses is readily apparent, it is essential to correlate the clinical, laboratory, and cytologic findings to reach the correct diagnosis. Furthermore, we believe that the primary site of many adrenal metastases must be defined on the basis of clinical data. Diagn. Cytopathol. 1999;21:92-97.

Adolescent↗