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Primary hyperparathyroidism (PHPT) is characterized by hypercalcemia due to inappropriate parathyroid hormone (PTH) secretion mostly caused by a single adenoma. Clinical manifestations vary and include bone loss (osteopenia, osteoporosis), kidney stones, asthenia and psychiatric disorders. In 80 % of cases PHPT is asymptomatic. Secondary causes of elevated PTH such as renal insufficiency and/or vitamin D deficiency should be excluded, and 24-hour calciuria should be measured to rule out familial hyocalciuric hypercalcemia. Surgery requires radiological tests: a cervical ultrasound to exclude concomitant thyroid pathology and a functional examination (Sestamibi scintigraphy or F-choline PET scan). Management should be discussed in a multidisciplinary team. Treatment is surgical and can also be offered to asymptomatic patients.

Since 2015 operations performed in the field of endocrine surgery have been entered into the European registry EUROCRINE®. The aim of this analysis was a description of the current healthcare situation for adrenal surgery in a homogeneous healthcare environment corresponding to the German-speaking countries-or to the presence of the working group on surgical endocrinology (CAEK) of the German society for general and visceral surgery (DGAV)-and to assess the adherence to current international treatment guidelines. An analysis of the preoperative diagnostics, the applied operative techniques and the underlying histological entities was carried out for all operations on adrenal glands in Germany, Switzerland and Austria, which were registered in EUROCRINE® from 2015 to 2019. In the total of 21 participating hospitals from the German-speaking EUROCRINE® countries, 658 operations on adrenal glands were performed. In 90% of cases unilateral adrenalectomy was performed, in 3% bilateral adrenalectomy and in 7% other resection procedures. In 41% the main histological diagnosis was an adrenocortical adenoma. In 15% malignant entities were detected on final histology, including 6% adrenocortical carcinoma (ACC) and 8% metastases to the adrenal glands. 23% of the operations were performed for pheochromocytoma. This entity was primarily resected using minimally invasive approaches (82%), whereas minimally invasive techniques were applied in 28% for ACC and in 66% for metastases to the adrenal glands. Surprisingly, following adrenocortical adenoma and pheochromocytoma, the third most common histological entity was metastasis of different extra-adrenal primary tumors to the adrenal gland. Of the operations for ACC 28% were scheduled for minimally invasive techniques, but conversion to open surgery was necessary in 20%. The analysis revealed discrepancies between treatment reality and international guideline recommendations that raise questions, which will be addressed by an updated version of the EUROCRINE® module for the documentation of adrenal surgery.

Complications following lung transplantation may impede allograft function and threaten patient survival. The five main complications after lung transplantation are primary graft dysfunction, post-surgical complications, alloimmune responses, infections, and malignancy. Primary graft dysfunction, a transient ischemic/reperfusion injury, appears as a pulmonary edema in almost every patient during the first three days post-surgery. Post-surgical dysfunction could be depicted on computed tomography (CT), such as bronchial anastomosis dehiscence, bronchial stenosis and bronchomalacia, pulmonary artery stenosis, and size mismatch. Alloimmune responses represent acute rejection or chronic lung allograft dysfunction (CLAD). CLAD has three different forms (bronchiolitis obliterans syndrome, restrictive allograft syndrome, acute fibrinoid organizing pneumonia) that could be differentiated on CT. Infections are different depending on their time of occurrence. The first post-operative month is mostly associated with bacterial and fungal pathogens. From the second to sixth months, viral pneumonias and fungal and parasitic opportunistic infections are more frequent. Different patterns according to the type of infection exist on CT. Malignancy should be depicted and corresponded principally to post-transplantation lymphoproliferative disease (PTLD). In this review, we describe specific CT signs of these five main lung transplantation complications and their time of occurrence to improve diagnosis, follow-up, medical management, and to correlate these findings with pathology results. KEY POINTS: • The five main complications are primary graft dysfunction, surgical, alloimmune, infectious, and malignancy complications. • CT identifies anomalies in the setting of unspecific symptoms of lung transplantation complications. • Knowledge of the specific CT signs can allow a prompt diagnosis. • CT signs maximize the yield of bronchoscopy, transbronchial biopsy, and bronchoalveolar lavage. • Radiopathological correlation helps to understand CT signs after lung transplantation complications.

The objective was the evaluation of the conservative treatment in the management of the unilateral adrenal gland hemorrhage (UAGH). By retrospective study, we analysed the files of 11 patients of UAGH medically treated between January 1994 and December 2003. The UAGH has been diagnosed by imaging then the adrenal gland corticosteroid and medulla have been explored by lab test. 10 patients had haematoma at the right side. The symptom was marking by a sudden acute abdominal pain. Bybiological plan, all the lesions were non secreting. All the patients have been followed-up for one year at least and all became asymptomatic. 50% of the size of the masses regressed after the first 6 months on CT scan control. The morphology permits by the follow-up the elimination of silent tumour. L’objectif de l’étude était d’évaluer le traitement conservateur dans la prise en charge de l’hématome surrénalien unilatéral (HSU). Par une étude rétrospective, nous avons étudié les dossiers de 11 patientstraités médicalement entre janvier 1994 et décembre 2003 pour un HSU. L’HSU était diagnostiqué par des examens d’imagerie puis des dosages biologiques ont permis d’explorer la corticosurrénale et lamédullosurrénale. 10 patients avaient un hématome à droite. La symptomatologie était marquée par la survenue brutale d’une douleur abdominale. Au plan biologique toutes les lésions étaient nonsécrétantes. Le suivi était d’au moins une année et tous les patients sont devenus asymptomatiques. On notait une régression de 50% de la taille au scanner de l’HSU au terme des 6 premiers mois. L’imagerie permet avec le suivi d’éliminer une tumeur sous jacente.

BACKGROUND: The small cell variant of medullary thyroid carcinoma (SCV-MTC) is a very unusual tumor that carries a poor prognosis. This tumor type closely resembles small cell pulmonary neuroendocrine carcinoma or lymphoma. CASE: A 43-year-old woman had a palpable mass on the right side of her neck. A fine needle aspiration biopsy (FNAB) revealed a hypercellular lesion composed mainly of isolated, small, round cells with salt-and-pepper chromatin interspersed with inconspicuous deposits of fluffy acellular material. A diagnosis of "malignant tumor, consistent with small cell carcinoma, metastasis not excluded" was rendered during the on-site rapid cytologic examination. Immunostaining showed a few isolated cells reactive for calcitonin, intense and diffuse immunoreactivity for carcinoembryonic antigen, dotlike positivity for chromogranin and cytokeratin, and negativity for thyroglobulin. Congo-red staining was positive in the acellular deposit, consistent with SCV-MTC. Subsequent total thyroidectomy confirmed this diagnosis. CONCLUSION: The wide range of cytomorphologic features of MTC can be misleading on FNAB and can be a diagnostic challenge. Congo-red staining and immunoreactivity for calcitonin can be negative in this variant. Consequently, salt-and-pepper chromatin, Congo-red staining and a panel of antibodies comprising calcitonin, carcinoembryonic antigen, chromogranin, cytokeratin, leukocyte common antigen and thyroglobulin are mandatory for the correct diagnosis.