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International Journal of Surgery Case... Aug 2023Neuroendocrine tumors most frequently originate from the gastrointestinal tract (GIT). Their presentation in tissues other than the GIT and pancreas is usually due to...
INTRODUCTION AND IMPORTANCE
Neuroendocrine tumors most frequently originate from the gastrointestinal tract (GIT). Their presentation in tissues other than the GIT and pancreas is usually due to metastatic involvement from lesions at these sites. There have been a few cases of neuroendocrine tumors identified in tissues such as the mesentery and peritoneum, without identification of a primary lesion supporting their origin as metastasis.
CASE PRESENTATION
We present the case of a patient with abdominal pain, in whom a primary mesenteric neuroendocrine tumor was identified. The patient completed one year of follow-up without identification of an additional lesion. Case Reported in line with the SCARE criteria.
CLINICAL DISCUSSION
This is a rare condition with few reports in the literature, without significant changes in its classification or management.
CONCLUSION
The search for a primary lesion and follow-up are essential to characterize the presence of primary mesenteric neuroendocrine tumors.
PubMed: 37506529
DOI: 10.1016/j.ijscr.2023.108517 -
FASEB Journal : Official Publication of... Jul 2023Leucine-rich repeat containing 8A (LRRC8A) volume regulated anion channels (VRACs) are activated by inflammatory and pro-contractile stimuli including tumor necrosis...
Leucine-rich repeat containing 8A (LRRC8A) volume regulated anion channels (VRACs) are activated by inflammatory and pro-contractile stimuli including tumor necrosis factor alpha (TNFα), angiotensin II and stretch. LRRC8A associates with NADPH oxidase 1 (Nox1) and supports extracellular superoxide production. We tested the hypothesis that VRACs modulate TNFα signaling and vasomotor function in mice lacking LRRC8A exclusively in vascular smooth muscle cells (VSMCs, Sm22α-Cre, Knockout). Knockout (KO) mesenteric vessels contracted normally but relaxation to acetylcholine (ACh) and sodium nitroprusside (SNP) was enhanced compared to wild type (WT). Forty-eight hours of ex vivo exposure to TNFα (10 ng/mL) enhanced contraction to norepinephrine (NE) and markedly impaired dilation to ACh and SNP in WT but not KO vessels. VRAC blockade (carbenoxolone, CBX, 100 μM, 20 min) enhanced dilation of control rings and restored impaired dilation following TNFα exposure. Myogenic tone was absent in KO rings. LRRC8A immunoprecipitation followed by mass spectroscopy identified 33 proteins that interacted with LRRC8A. Among them, the myosin phosphatase rho-interacting protein (MPRIP) links RhoA, MYPT1 and actin. LRRC8A-MPRIP co-localization was confirmed by confocal imaging of tagged proteins, Proximity Ligation Assays, and IP/western blots. siLRRC8A or CBX treatment decreased RhoA activity in VSMCs, and MYPT1 phosphorylation was reduced in KO mesenteries suggesting that reduced ROCK activity contributes to enhanced relaxation. MPRIP was a target of redox modification, becoming oxidized (sulfenylated) after TNFα exposure. Interaction of LRRC8A with MPRIP may allow redox regulation of the cytoskeleton by linking Nox1 activation to impaired vasodilation. This identifies VRACs as potential targets for treatment or prevention of vascular disease.
Topics: Animals; Mice; Acetylcholine; Anions; Membrane Proteins; Mice, Knockout; Myosin-Light-Chain Phosphatase; Signal Transduction; Tumor Necrosis Factor-alpha; Muscle, Smooth, Vascular
PubMed: 37310356
DOI: 10.1096/fj.202300561R -
NPJ Regenerative Medicine Jan 2024Mesenchymal stem cells (MSCs) are novel therapeutics for the treatment of Crohn's disease. However, their mechanism of action is unclear, especially in disease-relevant...
Mesenchymal stem cells (MSCs) are novel therapeutics for the treatment of Crohn's disease. However, their mechanism of action is unclear, especially in disease-relevant chronic models of inflammation. Thus, we used SAMP-1/YitFc (SAMP), a chronic and spontaneous murine model of small intestinal inflammation, to study the therapeutic effects and mechanism of action of human bone marrow-derived MSCs (hMSC). hMSC dose-dependently inhibited naïve T lymphocyte proliferation via prostaglandin E (PGE) secretion and reprogrammed macrophages to an anti-inflammatory phenotype. We found that the hMSCs promoted mucosal healing and immunologic response early after administration in SAMP when live hMSCs are present (until day 9) and resulted in a complete response characterized by mucosal, histological, immunologic, and radiological healing by day 28 when no live hMSCs are present. hMSCs mediate their effect via modulation of T cells and macrophages in the mesentery and mesenteric lymph nodes (mLN). Sc-RNAseq confirmed the anti-inflammatory phenotype of macrophages and identified macrophage efferocytosis of apoptotic hMSCs as a mechanism that explains their long-term efficacy. Taken together, our findings show that hMSCs result in healing and tissue regeneration in a chronic model of small intestinal inflammation and despite being short-lived, exert long-term effects via sustained anti-inflammatory programming of macrophages via efferocytosis.
PubMed: 38245543
DOI: 10.1038/s41536-024-00347-1 -
Korean Journal of Clinical Oncology Dec 2023Distant metastases of well-differentiated thyroid cancers (WDTCs) to bone and lungs are well known, while intra-abdominal, mesenteric metastases are very rare. Herein,...
Distant metastases of well-differentiated thyroid cancers (WDTCs) to bone and lungs are well known, while intra-abdominal, mesenteric metastases are very rare. Herein, we report a case of intra-abdominal, mesenteric metastasis of WDTC. A 62-year-old man underwent thyroid lobectomy for follicular thyroid cancer. One year later, lung metastasis was observed. The patient simultaneously underwent lung wedge resection and complete thyroidectomy. Eleven years later, serum thyroglobulin level was elevated. On the work-up study, a metastatic lesion in the lungs and a mass in the mesentery were identified. Two lesions of the lung and mesentery were surgically resected. The mass in the mesentery was pathologically diagnosed as metastatic WDTC.
PubMed: 38229494
DOI: 10.14216/kjco.23015 -
BJS Open Jul 2023A central lymphadenectomy in right-sided colon cancer involves dissection along the superior mesenteric axis, but the extent is debated due to a lack of consensus and... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
A central lymphadenectomy in right-sided colon cancer involves dissection along the superior mesenteric axis, but the extent is debated due to a lack of consensus and the fear of major complications. This randomized controlled trial compared the rate of postoperative morbidity in patients undergoing laparoscopic versus open right-sided colectomy with central lymphadenectomy.
METHODS
This open, prospective, randomized controlled trial compared patients operated on with open and laparoscopic right-sided colectomy (cStages I-III) with a central lymphadenectomy at two Norwegian institutions between October 2016 and December 2021. Dissections were conducted along the superior mesenteric vein in the laparoscopic group, and along the left anterior border of the superior mesenteric artery in the open group, both according to complete mesocolic excision principles. Surgery was standardized and performed by three experienced surgeons for each study group. The primary outcome of interest was to measure postoperative 30-day complications (Clavien-Dindo ≥ grade II).
RESULTS
Of 273 eligible patients, 135 were randomized and 128 analysed (63 operated on with open and 65 using laparoscopic procedures). Postoperative complications occurred in 42.8 per cent of the patients treated with open and 38.4 per cent of the patients treated using laparoscopic surgery, P = 0.372. The incidence of Clavien-Dindo grade IIIb complications was 7.9 per cent in the open versus 4.6 per cent in the laparoscopic group, P = 0.341. There were no grade IV or V complications, and no re-operations due to anastomotic leakages. There was no significant difference in the mean(s.e.m.) number of removed lymph nodes (open versus laparoscopic respectively: 31.9(1.8) versus 29.3(1.3); P = 0.235).
CONCLUSION
There was no significant difference in complications between the two groups. Standardized oncologic right-sided colectomy with central lymphadenectomy along the mesenterial root was performed safely, both open and laparoscopic, with incidence of major complications ranging between 4.6 and 7.9 per cent and no re-operations for anastomotic leakage. Radicality in terms of lymphadenectomy was comparable between the two groups.Registration number: NCT03776591 (http://www.clinicaltrials.gov).
Topics: Humans; Prospective Studies; Colonic Neoplasms; Lymph Node Excision; Laparoscopy; Colectomy; Anastomotic Leak
PubMed: 37643373
DOI: 10.1093/bjsopen/zrad074 -
Advanced Science (Weinheim,... Jun 2024The construction of bioartificial livers, such as liver organoids, offers significant promise for disease modeling, drug development, and regenerative medicine. However,...
The construction of bioartificial livers, such as liver organoids, offers significant promise for disease modeling, drug development, and regenerative medicine. However, existing methods for generating liver organoids have limitations, including lengthy and complex processes (taking 6-8 weeks or longer), safety concerns associated with pluripotency, limited functionality of pluripotent stem cell-derived hepatocytes, and small, highly variable sizes (typically ≈50-500 µm in diameter). Prolonged culture also leads to the formation of necrotic cores, further restricting size and function. In this study, a straightforward and time-efficient approach is developed for creating rapid self-assembly mini-livers (RSALs) within 12 h. Additionally, primary hepatocytes are significantly expanded in vitro for use as seeding cells. RSALs exhibit consistent larger sizes (5.5 mm in diameter), improved cell viability (99%), and enhanced liver functionality. Notably, RSALs are functionally vascularized within 2 weeks post-transplantation into the mesentery of mice. These authentic hepatocyte-based RSALs effectively protect mice from 90%-hepatectomy-induced liver failure, demonstrating the potential of bioartificial liver-based therapy.
Topics: Animals; Mice; Hepatectomy; Liver Failure; Hepatocytes; Disease Models, Animal; Liver, Artificial; Liver; Organoids; Male; Mice, Inbred C57BL
PubMed: 38493495
DOI: 10.1002/advs.202309166 -
European Radiology Experimental Sep 2023Creeping fat is a pathological feature of small bowel Crohn's disease (CD), with literature suggesting that bowel resection with extended mesenteric resection is related...
BACKGROUND
Creeping fat is a pathological feature of small bowel Crohn's disease (CD), with literature suggesting that bowel resection with extended mesenteric resection is related to less postoperative recurrences. Conventional imaging is unable to accurately quantify the disease involvement (i.e., fibrosis) of creeping fat. Quantification of disease involvement could be useful in decision-making for additional extended mesenteric resection. We investigated the feasibility of magnetic resonance elastography (MRE) of the mesentery and if MRE is capable to detect fibrotic disease involvement of mesentery in active CD.
METHODS
Multifrequency MRE yielded spatial stiffness (shear wave speed, SWS, |G*|) and fluidity maps (φ). Viscoelastic properties of seven CD patients' mesentery were compared to age- and sex-matched healthy volunteers (HV) (Mann-Whitney U-test). Within CD patients, the affected and "presumably" unaffected mesentery were compared (Wilcoxon-signed rank test). Repeatability was tested in 15 HVs (Bland-Altman analysis, coefficient of variation [CoV]). Spearman rank correlations were used to investigate the relation between microscopically scored amount of mesenteric fibrosis and viscoelastic parameters.
RESULTS
SWS, |G*|, and φ of affected mesentery in CD were higher compared to HV (p = 0.017, p = 0.001, p = 0.017). Strong correlations were found between percentage of area of mesenteric fibrosis and SWS and |G*| (p < 0.010). No differences were found within CD between affected and presumably unaffected mesentery. Repeatability of SWS showed 95% limits of agreement of (-0.09, 0.13 m/s) and within-subject CoV of 5.3%.
CONCLUSION
MRE may have the potential to measure fibrotic disease involvement of the mesentery in CD, possibly guiding clinical decision-making with respect to extended mesenteric resection.
TRIAL REGISTRATION
Dutch trial register, NL9105 , registered 7 December 2020.
RELEVANCE STATEMENT
MRE may have the potential to measure the amount of mesenteric fibrosis of the affected mesenteric fat in active Crohn's disease, giving more insight into disease progression and could potentially play a role in clinical decision-making for extended mesenteric resection.
KEY POINTS
• MRE of the mesentery in patients with active CD is feasible. • Fluidity and stiffness of the mesentery increase in active CD, while stiffness correlates with the histopathological amount of mesenteric fibrosis. • MRE provides biomarkers to quantify mesenteric disease activity in active CD.
Topics: Humans; Crohn Disease; Cross-Sectional Studies; Elasticity Imaging Techniques; Fibrosis; Mesentery; Prospective Studies; Male; Female
PubMed: 37718360
DOI: 10.1186/s41747-023-00366-5 -
Journal of Clinical Medicine Feb 2024Mesenteric ischemia is a challenging condition characterized by insufficient blood perfusion to the mesentery and, consequently, intestinal tissues that continues to... (Review)
Review
UNLABELLED
Mesenteric ischemia is a challenging condition characterized by insufficient blood perfusion to the mesentery and, consequently, intestinal tissues that continues to perplex clinicians. Despite its low prevalence, the condition's variable clinical presentation and elusive radiographic diagnosis can delay life-saving interventions in the acute setting and deteriorate the quality of life of patients when left undiagnosed or misdiagnosed.
PURPOSE
Review and summarize recent diagnostic updates and emergent intervention strategies for acute and chronic mesenteric ischemia.
METHODS
A narrative review of all relevant studies from January 2022 through September 2023.
RESULTS
A total of 11 studies from MEDLINE, supplemented with 44 studies from Google Scholar, were included in the review.
CONCLUSIONS
Both acute and chronic mesenteric ischemia propose diagnostic and therapeutic challenges for interventionalists. Computed tomographic angiography remains the diagnostic modality of choice for both. Open surgical intervention remains the gold standard for acute mesenteric ischemia, while endovascular techniques are preferred for chronic mesenteric ischemia.
PubMed: 38592672
DOI: 10.3390/jcm13051217