The adrenal glands are paired endocrine organs located above the kidneys that are comprised of an outer cortex and inner medulla. The cortex secretes mineralocorticoids, glucocorticoids, and sex hormones. The medulla secretes catecholamines. Common non-neoplastic diseases include Cushing's syndrome, hyperaldosteronism, and adrenal insufficiency. Adrenal cortical tumors include adenomas, which can be functional or non-functional, and rare carcinomas. Pheochromocytomas arise from the medulla and secrete catecholamines, causing hypertension. Neuroblastomas are rare tumors seen in young children that often metastasize.
Adrenal tumor, classification, management - easy explanationSwatilekha Das
Adrenal tumor- topic for B.Sc Nursing Students, GNM Students
definition
classification
clinical manifestations
treatment
easy explanation for nursing students
Adrenal tumor, classification, management - easy explanationSwatilekha Das
Adrenal tumor- topic for B.Sc Nursing Students, GNM Students
definition
classification
clinical manifestations
treatment
easy explanation for nursing students
SHORT TALK ABOUT DIFFERENTIAL DIAGNOSIS ABOUT ADRENAL MASS LESION DDX, COMMON AND LESS COMMON CAUSES WITH CLUES TO DIAGNOSIS AND SOME EXAMPLES
HOPPING YOU LIKE IT
DR HISHAM ALKHATIB
CONSULTANT RADIOLOGIST
SHORT TALK ABOUT DIFFERENTIAL DIAGNOSIS ABOUT ADRENAL MASS LESION DDX, COMMON AND LESS COMMON CAUSES WITH CLUES TO DIAGNOSIS AND SOME EXAMPLES
HOPPING YOU LIKE IT
DR HISHAM ALKHATIB
CONSULTANT RADIOLOGIST
Disease of older males.
The Philadelphia chromosome - BCR-ABL gene and it’s Tyrosine kinase protein – central to the pathogenesis.
Occurs in 3 phases
Imatinib has revolutionized the management
Dr Andrew Stewart, Consultant Haematologist, The Royal Gwent Hospital
Dr Chris Jenkins, Consultant Haematologist, University Hospital of the North Midlands
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
4. Histology
• Two distinctive parts : 1. Cortex. 2. Medulla
1. Cortex:
• Mesodermal origin
• Three distinct layers: Glomerulosa: Mineralocorticoids
Fasciculata : Glucocorticoids
Reticularis : Sex hormones
2. Medulla:
• Neuroectodermal in origin (neural crest)
• Secrete catecholamines: Epinephrine and norepinephrine
5. 1. Glomerulosa: well-outlined cells
aggregated into small clusters
and short trabeculae
2. Fasciculata: broad band made up
of large cells with distinct
membranes arranged in two cell-
wide cords. Cytoplasm is
vacuolated/clear
3. Reticularis: haphazard
arrangement of cells with
granular cytoplasm. Lipofuscin
may be present
6. • Chromaffin cells: arranged in small nests
and cords separated by prominent
vasculature; large polygonal cells with
poorly outlined borders, abundant
granular and usually basophilic cytoplasm;
takes up chromium salts
Sustentacular cells: supporting cells, spindle
cells at periphery of nests of chromaffin cells;
associated with rich vasculature; S100+,
difficult to identify with routine staining.
19. Cortical Nodules
• 7% of those over 70 years
• Spherical, unencapsulated, usually multiple
• Microscopic to grossly apparent
• Usually < 3 mm
• Majority are non-functional
• They increase in number with age, but not associated with
hypertension, diabetes, or cardiovascular disease – ‘incidentalomas’
• Found in up to 53% of adrenal glands at autopsy
• D/D: Nodules of true cortical hyperplasia, cortical adenomas
• IHC: Cytochrome P450
20. Congenital adrenal hyperplasia
• Inborn error of metabolism
• Mutation of CYP21 gene on chromosome 6
• Majority of cases of ‘adrenogenital syndrome’ develop within the
first year of life
• Basic defect: absence of the enzyme 21-hydroxylase
• Clinical picture is usually that of a pure virilizing syndrome
• Deficiency of 11β-hydroxylase: virilization and hypertension
• Hyperplasia of zona reticularis
21.
22. Adrenal cortical adenoma
• Solitary, well circumscribed, nodule,
capsulated/ uncapsulated
• Upto 2.5 cm, 50 g
• Non-functional or functional
• Cushing syndrome and hyperaldosteronism
• Cortex adjacent to the non-functional
adenomas is normal where as that adjacent
to a functional adenoma is atrophic
• Cut surface – yellowish to yellowish brown
• No areas of hemorrhage and necrosis
23. Adrenal cortical adenoma
• Microscopically, Predominantly lipid-
laden cells resembling ZF, arranged in
an alveolar pattern interspersed with
short cords
• Focal groups of compact cells may be
seen
• Mitotic activity is rare
• In patients with Conn's syndrome,
there may be cells resembling ZG and
others showing mixed features of ZG
and ZF—‘hybrid’ cells
• Compact cells often predominate in
tumors associated with virilization
24. Variants of cortical adenomas
1. Black adenoma: dark brown to black
color because of the presence of
pigment, thought to represent either
lipofuscin or neuromelanin.
Alterations of lipid metabolism
induced by the abnormal
mitochondria present in the cells of
these lesions. Mostly non –
functional
2. Adenoma with foci of myelipoma:
myo-lipomatous component with
areas of small hemorrhagic foci
25. Variants of cortical adenomas
3. Adrenocortical Oncocytoma: tumor
cells studded with mitochondria,
mostly benign, peculiar cytoplasmic
crystalline inclusions may be seen
4. Myxoid adrenocortical neoplasms:
prominent myxoid features
5. Lipoadenoma : abundant mature
adipose tissue
6. Sarcomatoid carcinoma
7. Adenosquamous carcinoma
26. Adrenal cortical carcinoma
• Rare, 0.5 and 2 per million
• Aggressive tumor, median survival of 15
months
• Over half show local invasion or metastases
at the time of presentation
• Functioning tumors account for 24% and 74%
of cases
• Cushing’s syndrome, virilization
• Large tumors, 3 – 40 cm, 50 gm
• Uncapsulated, invasion into the capsule if
present
• Cut surface, lobulations with fibrous bands
and areas of necrosis and hemorrhage
• Invasion of major veins is a frequent finding,
often leads to total occlusion, thrombosis,
and embolism
27. Adrenal cortical carcinoma
• Microscopically,
• Less ordered structure than in
adenomas
• Trabecular and diffuse
patterns are common
• Nuclear pleomorphism seen
• Mitoses, including atypical
forms, often present
• Capsular and vascular invasion
can often be identified
28. Histologic diagnosis of malignancy
• Weiss criteria:
09 Histological features are assessed and the presence of 03 or
more indicates malignant potential
• Modified Weiss index:
Omits histological features that had poor inter-observer
correlation and incorporates the others into a weighted score
• Ki-67 index: greater than 5% is seen only in carcinoma
29. • A Weiss score of ≥6 was associated with poorer disease-free interval and overall
survival
30. 03 major criteria and 04 minor criteria have been proposed and tumors are defined as malignant, of uncertain
malignant potential or benign, based on the presence or absence of these criteria
31. Molecular aspects of adrenal cortical tumors
• Adrenal cortical tumors associated with various familial diseases
• Beckwith–Wiedemann syndrome: linked to the 11p15 locus with paternal
disomy and overexpression of IGF-2
*Exomphalos - Macroglossia – Gigantism
• Li–Fraumeni syndrome: germline mutations in the TP53 tumor suppressor
gene on 17q13.1
*Sarcoma, Cancers of the breast, brain and adrenal glands
• Multiple endocrine neoplasia type 1 syndrome (MEN1): mutations in the
MEN1 gene on 11q13
*Neoplastic lesions in pituitary, parathyroid gland and pancreas
• Familial adenomatous polyposis: APC gene defects on chromosome 5
32. Molecular aspects of adrenal cortical tumors
• The most common abnormality in carcinoma is overexpression of IGF-2,
reported in about 90% of cases, located at 11p15
• Loss of the maternal allele and duplication of the paternal allele
• Wnt/β-catenin pathway: hyperplasias, adenoma, and carcinomas
33. Immunohistochemistry
• Majority of cortical tumors will be positive for inhibin-α and Melan A
• Chromogranin: negative in cortical tumors and almost always positive in
Pheochromocytoma
• Synaptophysin : positive in both cortical tumors and pheochromocytoma
• Cytokeratins: strongly expressed by cortical tumors
35. Pheochromocytoma
• Neoplasms composed of chromaffin cells,
• Synthesize and release catecholamines
• Cause of surgically correctable hypertension
• “Rule of 10s”
• Ten percent of pheochromocytomas are extra-adrenal
• Ten percent of sporadic adrenal pheochromocytomas are bilateral
• Ten percent of adrenal pheochromocytomas are biologically malignant
• Ten percent of adrenal pheochromocytomas are not associated with
hypertension
• Associated with increased activity of HIF 1-α and enhanced growth factor
receptor pathway signaling (e.g. RET, NF1)
38. Pheochromocytoma
• Clinical features:
1. Increase catecholamine release
2. Hypertension, young, often refractory to treatment
3. Paroxysmal, with relatively normal blood pressure between surges
4. Classical triad of symptoms includes headache, diaphoresis and palpitations
or tachycardia
5. Less commonly anxiety, tremulousness, pain in the chest or abdomen,
weakness or weight loss
6. Severe constipation or pseudo-obstruction may occur because
catecholamines may inhibit peristalsis
7. May occasionally secrete other hormones, such as calcitonin, ACTH,
parathyroid hormone or somatostatin
39. Pheochromocytoma
• Morphology:
1. Range from small, circumscribed lesions
to large hemorrhagic masses weighing
kilograms
2. Larger tumors are well demarcated by
either connective tissue or compressed
cortical or medullary tissue
3. Average weight of 100gm
4. Richly vascularized fibrous trabeculae within
the tumor produce a lobular pattern
5. Cut surfaces of smaller
pheochromocytomas are yellow-tan.
Larger lesions tend to be hemorrhagic,
necrotic, and cystic and typically
efface the adrenal gland
6. Incubation of fresh tissue with a potassium
dichromate solution gives the tumor a
dark brown color due to oxidation of stored
catecholamines, thus the term chromaffin
40. Pheochromocytoma
• Microscopy:
1. Tumors are composed of clusters of
polygonal chromaffin cells or chief cells
that are surrounded by supporting
sustentacular cells, creating small nests
or alveoli (zellballen) that are supplied by
a rich vascular network
2. Uncommonly, the dominant cell type is a
spindle or small cell
3. The cytoplasm has a finely granular
appearance, best demonstrated with
silver stains, due to the presence of
granules containing catecholamines
4. Nuclei are usually round to ovoid,
with a stippled “salt and pepper”
chromatin that is characteristic of
neuroendocrine tumors
5. IHC: Chromogranin and synaptophysin for
the chief cells where as S-100 for
sustentacular cells
41. Neuroblastoma
• Seen in young children
• 80% are detected in those under
the age of 4 years, and the
median age at diagnosis is 21
months
• Can exhibit familial incidence;
Beckwith– Wiedemann syndrome,
Hirschsprung disease,
neurofibromatosis
• Morphology:
• Usually large, soft, gray, and
relatively well circumscribed;
areas of hemorrhage, necrosis,
and calcification are often
present
42. Neuroblastoma
• Microscopically:
• Pattern of growth is vaguely nodular
• Incomplete fibrous septa
• Calcification may be a prominent
feature
• Necrosis is a constant feature
• Tumor cells are small and regular, with
round, deeply staining nuclei slightly
larger than lymphocytes
• Little cytoplasm, and cytoplasmic
outlines are poorly defined
• Homer Wright rosettes are present in
1/3rd cases; they are characterized by
collections of tumor cells around a
central area filled with a fibrillary
material
• Bizarre giant tumor cells
43. Ganglioneuroma
• Benign tumors, seen in older age
group
• Most common neoplasm of the
sympathetic nervous system in adults
• Rarely found in the adrenal gland
• Grossly,
• Large, encapsulated masses of firm
consistency with a homogeneous,
solid, grayish white cut surface
having a focally edematous
appearance
• Microscopically,
• Overall appearance resembles that
of a neurofibroma, presence of
numerous collections of abnormal
but fully mature ganglion cells,
often having more than one nucleus
44. # Union for International Cancer Control
## European Network for the Study of Adrenal Tumors
** Adjacent organs include kidney, diaphragm, great vessels, pancreas, and liver