Lars-Eric Tisell

Hyperparathyroidism in persons treated with x-rays for tuberculous cervical adenitis

Follow‐up examinations of one hundred persons treated with x‐rays for tuberculous adenitis between 1930 and 1946 have been carried out to determine if there is an increased incidence of hyperparathyroidism (HPT) after radiation exposure. Neck explorations were done in patients with hypercalcemia and signs and symptoms compatible with HPT. Individuals with thyroid masses were also operated upon when examination of fine needle specimens gave suspicions of malignancy. Eleven subjects were found to have developed parathyroid adenoma or hyperplasia. Four other individuals have hypercalcaemia but are asymptomatic. The mean absorbed dose in the parthyroid glands varied between 75 and 2,200 rads. Six individuals received more than 1,200 rads; four of them later developed HPT, while no HPT occurred below a dose of 300 rads. The high incidence of HPT among patients who had been heavily exposed to radiation suggests a cause and effect relationship between radiation treatment and development of HPT. Cancer 40:846–854, 1977.

Metastasizing gastric epithelioid leiomyosarcomas (leiomyoblastomas) in young individuals with long‐term survival

Results. Four patients with metastasizing epithelioid leiomyosarcoma of the stomach, three females and one male (15, 20, 22, and 25 years of age, respectively), are reported. Two patients had recurrent tumors in the gastric remnant. Liver metastases occurred in all patients, three of whom had lymph node metastases; two had peritoneal metastases. The patients are alive at 17,19, 27 and 48 years after the diagnosis was made and 17‐27 years after the first demonstration of metastases. One woman had multiple chondromatous hamartomas of the lung. Operations were performed when the patients had symptoms and during periods of no symptoms, as directed by the second‐look principle. One patient had 10 operations. None of the patients received adjuvant therapy. All three women have given birth to healthy children after metastases were diagnosed. Three of the primary tumors were large (10‐20 cm) and multinodular, features that have been associated with unfavorable prognosis. The four primary tumors had a similar light microscopic appearance, characterized by moderate cell and nuclear pleo‐morphism and low mitotic activity, 0.03‐0.1/mm2. Ultra‐structurally, a network of intermediate filaments was found within the cytoplasm of the tumor cells corresponding to the immunohistochemical positivity for vi‐mentin. The immunohistochemical findings (negative im‐munoreaction for desmin and alpha smooth‐muscle ac‐tin) and the ultrastructural analysis produced no evidence of the production of smooth‐muscle cell myofi‐laments. However, there were tumor cells with an abundance of mitochondria and a paucity of filaments, features that may be characteristic of epithelioid leiomyo‐matous tumors. In addition, immunohistochemical negativity for cytokeratins, epithelial membrane antigen, S‐100 protein, neuron‐specific enolase, and chromo‐granin militate against an epithelial or neuroectodermal cell differentiation.

Incidence of hypoparathyroidism after radical surgery for thyroid carcinoma and autotransplantation of parathyroid glands.

Ninety-seven consecutive patients had radical surgery for thyroid carcinoma. Eighty-six of these had one or more parathyroids implanted into muscle tissue. At follow-up, ninety-one patients were normocalcemic without substitution, fifteen of those with only implanted glands. The results show that radical surgery can be performed with a low incidence of hypoparathyroidism, provided the parathyroids are carefully searched for and liberally implanted.

Recurrent and metastasizing gastric leiomyoblastoma (epithelioid leiomyosarcoma) associated with multiple pulmonary chondro-hamartomas: long survival of a patient treated with repeated operations.

A 15‐year‐old girl was operated for gastric leiomyoblastoma (epithelioid leiomysocarcoma) with metastasis to a regional lymph node. She has subsequently been operated on twice: once for local recurrence and metastases 9 years after her initial operation and once for an intraabdominal lymph node metastasis. Now, 13 years after her first operation for gastric leiomyoblastoma she is free from symptoms and signs of disease. Preoperative angiography was helpful in diagnosing the recurrence and planning the second operation. Our observations speak in favor of surgical treatment of recurrent and metastasizing gastric leiomyoblastoma. This patient was also operated for multiple pulmonary chondro‐hamartomas, primarily suspected to be metastases. Coincidence of gastric leiomyoblastoma and pulmonary chondro‐hamartoma does not seem to be due to chance alone.

Latent hypoparathyroidism in patients with autotransplanted parathyroid glands.

Eighteen patients had undergone radical surgery for thyroid carcinoma. In all of them four parathyroid glands had been verified by frozen-section biopsy and removed. Thereafter two, three or four glands wereautotransplanted into muscle tissue. At least 1 year after the operation the patients underwent a calcium deprivation test. Before the test they all had normal serum calcium values without treatment. During the test seven patients remained normocalcemic, seven became hypocalcemic, and four had occasional low serum calcium values. After the test all were normocalcemic again. Patients with only autotransplanted parathyroid glands left after surgery should be tested for latent hypoparathyroidism.

Autotransplantation of fresh diseased parathyroid tissue in primary and radiation-induced hyperparathyroidism

Thirty-five patients with primary or radiation-induced hyperparathyroidism underwent autotransplantation with fresh diseased parathyroid tissue. Due to previous neck surgery (34 percent), concomitant thyroid surgery (66 percent), and a high proportion of multiglandular parathyroid disease (43 percent), all patients ran a high risk of becoming hypoparathyroid, At follow-up , a mean of 28 months after operation, 32 patients had normal parathyroid function, 2 had hyper- and 1 had hypoparathyroid function. The amount of tissue used for transplantation was individually chosen by relating the serum calcium level to the total parathyroid mass. In patients with water-clear cell hyperplasia and thus low endocrine activity on a weight basis, large grafts were needed, whereas less than 120 mg was used in most other cases. In two of our three failures we did not follow these tactics. Our results show that autografting fresh diseased parathyroid tissue can minimize the occurrence of postoperative hypoparathyroidism in patients at high risk of this complication. In no case has recurrent or progressive hypercalcemia developed.