Este estimat că un procent important, de până la 90%, din pacienţii cu insuficienţa renală cronică dezvoltă hiperparatiroidism secundar (HPS). Cu toate că boala prezintă multiple manifestări, cea mai importantă caracteristică patologică, din punctul de vedere al mortalităţii crescute, e reprezentată de calcificările ectopice arteriale, miocardice şi valvulare cardiace. Acestea sunt progresive şi conduc la hipertensiune arterială, hipertrofie ventriculară stângă, blocuri atrio-ventriculare, angină pectorală şi infarct miocardic. Aşadar riscul evenimentelor cardio-vasculare este mult crescut. Eşecul terapiei medicamentoase în a stăpâni progresia bolii reprezintă o indicaţie pentru paratiroidectomie. In HPS sunt afectate toate glandele paratiroide, de aici necesitatea de a decela intraoperator 4 glande, prin explorare cervicală bilaterală. Totuşi, având în vedere posibilitatea unor localizări ectopice a acestor glande cât şi eventualitatea unora supranumerare, este de dorit a avea preoperator o hartă imagistică cât mai exactă, evitând astfel riscul recurenţei postoperatorii. Investigaţiile imagistice disponibile sunt reprezentate de ecografia regiunii cervicale, scintigrafia paratiroidiană şi de cele de linia a doua-examinare CT sau RMN. Dacă în hiperparatiroidismul primar, unde există un singur adenom paratiroidian (sau două), rezultatele imagistice preoperatorii sunt satisfăcătoare, în HPS există destule cazuri în care imagistica nu evidenţiază toate cele patru glande paratiroide. Cuvinte cheie: paratiroide, hiperparatiroidism secundar, insuficienţa renală cronică, scintigrafie
Background and Objectives: Parathyroid cancer is a very rare endocrine tumor, especially in patients with secondary hyperparathyroidism due to end stage renal disease failure. This pathology is difficult to diagnose preoperatively because it has nonspecific clinical manifestations and paraclinical aspects. Our study of the literature identified 34 reported cases of parathyroid carcinoma over the last 40 years in patients undergoing dialysis. We present our experience as illustrative of the features of clinical presentation and histopathological findings of parathyroid carcinoma and assess its management considering the recent relevant literature. Materials and Methods: From January 2012 to November 2022, 650 patients with secondary hyperparathyroidism undergoing dialysis were treated at our academic Department of General Surgery and only two cases of parathyroid carcinoma were diagnosed on histopathological examination. Results: All patients presented with symptomatic hypercalcemia, with no clinical or imaging suspicion of malignant disease and were surgically treated by total parathyroidectomy. Histopathological examination revealed morphologic aspects of parathyroid carcinoma in two cases and immunostaining of Ki-67 was performed for diagnostic confirmation. Postoperative follow-up showed no signs of recurrence and no oncological adjuvant treatment or surgical reinterventions were needed. Conclusions: Parathyroid neoplasia is a particularly rare disease, that remains a challenge when it comes to diagnosis and proper management. Surgical approach is the only valid treatment to remove the malignant tissue and thus improve the patient’s prognosis. Medical and oncologic treatment may be beneficial to control hypercalcemia in case of tumor recurrence.
The CD34 protein was identified almost four decades ago as a biomarker for hematopoietic stem cell progenitors. CD34 expression of these stem cells has been exploited for therapeutic purposes in various hematological disorders. In the last few decades, studies have revealed the presence of CD34 expression on other types of cells with non-hematopoietic origins, such as interstitial cells, endothelial cells, fibrocytes, and muscle satellite cells. Furthermore, CD34 expression may also be found on a variety of cancer stem cells. Nowadays, the molecular functions of this protein have been involved in a variety of cellular functions, such as enhancing proliferation and blocking cell differentiation, enhanced lymphocyte adhesion, and cell morphogenesis. Although a complete understanding of this transmembrane protein, including its developmental origins, its stem cell connections, and other functions, is yet to be achieved. In this paper, we aimed to carry out a systematic analysis of the structure, functions, and relationship with cancer stem cells of CD34 based on the literature overview.
The interstitial cells of Cajal (ICC) represent a particular network formed by some peculiar cells that were first described by the great neuroanatomist, S. Ramon y Cajal. Nowadays, the ICC have become a fascinating topic for scientists, arousing their curiosity; as a result, there is a vast number of published articles related to the ICC. Today, everybody widely accepts that the ICC represent the pacemaker of the gastrointestinal tract and are highly probable to be the origin cells for gastrointestinal tumors (GISTs). Recently, Cajal-like cells (ICLC) were described, which are found in different organs but with an as yet unknown physiological role that needs further study. New information regarding intestinal development indicates that the ICC (fibroblast-like and muscle-like) and intestinal muscle cells have the same common embryonic cells, thereby presenting the same cellular ultrastructure. Nowadays, there is a vast quantity of information that proves the connection of the ICC and GISTs. Both of them are known to present c-kit expression and the same ultrastructural cell features, which includes minimal myoid differentiation that is noticed in GISTs, therefore, supporting the hypothesis that GISTs are ICC-related tumors. In this review, we have tried to highlight the origin and distribution of Cajal interstitial cells based on their ultrastructural features as well as their relationship with gastrointestinal stromal tumors.
Hiperparatiroidismul secundar de cauză renală (sHPT) afectează într-o măsură mai mică sau mai mare, la toţi pacienţii cu boală cronică de rinichii. Această patologia este severă întrucât survine la un pacient tarat, la care boala cronică de rinichi se asociază frecvent cu multiple comorbidităţi severe, astfel mortalitatea este mai mare faţă de populaţia generală. Eşecul conduitei medicale reprezintă o indicaţie pentru efectuarea tratamentului chirurgical. Recurenţa bolii, în hiperparatiroidismul secundar de cauză renală, după tratamentul chirurgical prin paratioridectomie totală cu autotransplant sau paratiroidectomie subtotală poate reprezenta o provocare datorită hiperplazierii ţesutului restant sau hiperplazierea autogrefelor. Scopul acestui studiu retrospectiv a fost de a evidenţia factorii de risc pentru apariţia hiperplaziei glandulare în cazul pacienţilor cu hiperparatiroidism secundar de cauză renală şi de a determina standardizarea tratamentulul chirurgical pentru hiperparatiroidismul secundar în vederea minimizării ratelor de recidivă. Astfel, pacienţii cu sHPT ar putea fi scutiţi de administrarea prelungită şi continuă a medicamentelor, care ar provoca hipoparatiroidism intolerabil odată cu intervenţia chirurgicală extensivă (19). Evaluare dimensiunii paratiroidiene poate sugera prezenţa hiperplaziei nodulare contribuind la efectuarea unei paratiroidectomii timpurii şi totodată la alegerea tratamentului chirurgical optim pentru pacienţii sHPT. Intrucât rezistenţa la terapia medicală este dată de prezenţa hiperplaziei nodulare unii
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