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Internal Medicine (Tokyo, Japan) Feb 2020A 72-year-old man was followed as an outpatient at our hospital for 6 years after surgery for small cell carcinoma of left adrenal gland origin. Follow-up abdominal...
A 72-year-old man was followed as an outpatient at our hospital for 6 years after surgery for small cell carcinoma of left adrenal gland origin. Follow-up abdominal computed tomography showed a 6-cm mass in the left lower mesentery. The patient underwent open laparotomy. The histological diagnosis was sclerosing mesenteritis. The previous specimens of the left adrenal mass were then re-examined with a microscope, and panniculitis was found around the small cell carcinoma. Both lesions were histologically similar to IgG4-related disease (RD), but they did not completely meet the diagnostic criteria of IgG4-RD clinically or histologically.
Topics: Adult; Aged; Aged, 80 and over; Child; Diagnosis, Differential; Female; Humans; Immunoglobulin G4-Related Disease; Laparotomy; Male; Mesentery; Middle Aged; Molecular Mimicry; Panniculitis, Peritoneal; Tomography, X-Ray Computed
PubMed: 31708540
DOI: 10.2169/internalmedicine.3221-19 -
Euroasian Journal of... 2022To briefly discuss the imaging features of different types of intra-abdominal fat necrosis. (Review)
Review
AIM
To briefly discuss the imaging features of different types of intra-abdominal fat necrosis.
BACKGROUND
Trauma and ischemic insult may result in intra-abdominal fat necrosis. Fat necrosis may present with acute abdomen, clinically simulating with other etiologies, such as acute diverticulitis and acute appendicitis.
MAIN BODY
Imaging plays a crucial role in making the exact diagnosis and differentiating it from other pathologies that may require surgical intervention. Computed tomography (CT) is the most commonly used imaging modality. A small fat attenuation lesion with a hyperattenuating rim in contact with the ventral surface of the sigmoid colon indicates epiploic appendagitis while a larger fat-attenuation lesion on the right side of the abdomen in between the colon and anterior abdominal wall indicates omental infarction. Fat stranding at the root of the mesentery with fat ring sign represents inflammatory mesenteric panniculitis while retractile or sclerosing mesenteritis appears as a fibrotic spiculated mass with or without calcification, mimicking mesenteric carcinoid. In patients with acute pancreatitis, the amount of inflamed fat correlates with clinical severity and outcome.
CONCLUSIONS
Familiarity with the imaging features of different types of intraabdominal fat necrosis helps in establishing an accurate diagnosis, thus avoiding unnecessary intervention.
HOW TO CITE THIS ARTICLE
Patel RK, Mittal S, Singh S. Imaging of Mischievous Intra-abdominal Fat Presenting with Abdominal Pain: A Pictorial Review. Euroasian J Hepato-Gastroenterol 2022;12(1):45-49.
PubMed: 35990862
DOI: 10.5005/jp-journals-10018-1355 -
Children (Basel, Switzerland) Apr 2022Erythema nodosum (EN) is the most frequent form of panniculitis in children. We performed a literature review analyzing studies on pediatric EN published from 1990 to... (Review)
Review
Erythema nodosum (EN) is the most frequent form of panniculitis in children. We performed a literature review analyzing studies on pediatric EN published from 1990 to February 2022. EN is rare in pediatric age. It can be primary/idiopathic in 23-55% cases, or secondary in 47-77% cases. Secondary EN is related to a wide variety of conditions including infectious diseases, autoimmune disorders, malignancy, drugs, vaccinations, and pregnancy. The diagnosis of EN is clinical, based on the acute appearance of painful and red nodules localized to lower limbs, bilaterally distributed. If EN is diagnosed, basic work-up should include inflammatory markers, serum aminotransferases, lactate dehydrogenase, creatinine, protein electrophoresis, immunoglobulins, testing for streptococcal infection, and a tuberculin skin test. Based on the medical history and associated manifestations, further laboratory and radiological exams should be performed. The prognosis of EN is excellent, with spontaneous resolution in most patients within 2-6 weeks. Treatment, if needed, is addressed to the underlying condition. Despite being a rare manifestation in children, EN can be isolated or the first manifestation of a systemic or infectious condition. EN diagnosis is clinical, and a high index of suspicion is needed to perform investigations for the underlying disorders.
PubMed: 35455555
DOI: 10.3390/children9040511 -
BMJ Open Ophthalmology 2020To investigate the incidence, clinicopathological characteristics and survival of ocular adnexal lymphoma (OAL) in the paediatric population.
OBJECTIVE
To investigate the incidence, clinicopathological characteristics and survival of ocular adnexal lymphoma (OAL) in the paediatric population.
METHODS AND ANALYSIS
In this retrospective case series, the Surveillance, Epidemiology and End Results database was accessed to identify individuals with OAL ≤18 years of age, diagnosed between 1973 and 2015. OAL located in the eyelid, conjunctiva, lacrimal apparatus and orbit were included. Main outcome measures were the age-adjusted incidence rates (IRs) per 1 000 000 population at risk (calculated for the period 2000-2015) and descriptive statistics of demographic and clinicopathological features.
RESULTS
The IR of paediatric OAL was 0.12 (95% CI 0.08 to 0.16) per 1 000 000. Males (0.15; 95% CI 0.10 to 0.22) and blacks (0.24; 95% CI 0.13 to 0.42) had a higher tendency for OAL development. A total of 55 tumours in 54 children were identified. The majority were localised (78.4%), conjunctival (49.1%) lymphomas. Extranodal marginal zone lymphoma (EMZL, 45.5%, n=25) was the most frequent subtype, followed by diffuse large B-cell lymphoma (DLBCL, 9.1%, n=5), B lymphoblastic lymphoma (7.3%, n=4), follicular lymphoma (5.5%, n=3), Burkitt lymphoma (5.5%, n=3), anaplastic large cell lymphoma (ALCL, 3.6%, n=2), small lymphocytic lymphoma (1.8%, n=1), diffuse large B-cell lymphoma, immunoblastic (1.8%, n=1) and panniculitis-like T-cell lymphoma (1.8%, n=1). Localised, low-grade, conjunctival lymphomas were frequently treated with complete excision with or without radiation, while high-grade and distant tumours usually received chemotherapy. Only 29.1% of paediatric OAL cases were treated with radiation. Three out of five (60%) patients with DLBCL died of lymphoma at a median follow-up of 21 (range 10-86) months, and 1 out of 2 (50%) patients with ALCL died of lymphoma at 23 months from diagnosis.
CONCLUSION
OAL in the paediatric population is rare. The majority of OAL are EMZL and are characterised by excellent prognosis. The histological subtype was found to be the main predictor of outcome with cancer-specific deaths observed in patients with DLBCL and ALCL.
PubMed: 32596505
DOI: 10.1136/bmjophth-2020-000483 -
Modern Pathology : An Official Journal... Jan 2020The following discussion deals with three emerging infection diseases that any dermatopathologist working in the northern hemisphere can come across. The first subject... (Review)
Review
The following discussion deals with three emerging infection diseases that any dermatopathologist working in the northern hemisphere can come across. The first subject to be dealt with is gnathostomiasis. This parasitic disease is produced by the third larvarial stage of the parasite that in most patients is associated with the ingestion of raw fish. Epidemiologically, it is most commonly seen in South East Asia, Japan, China, and the American continent, mainly in Mexico, Ecuador, and Peru. Nowadays, the disease is also seen in travelers living in the developed countries who recently came back from visiting endemic countries. The disease produces a pattern of migratory panniculitis or dermatitis with infiltration of eosinophils in tissue. The requirements for making the diagnosis are provided, including clinical forms, common histological findings on skin biopsy as well as the use of ancillary testing. Buruli ulcer, a prevalent mycobacterial infection in Africa, is described from the clinical and histopathological point of view. The disease has been described occasionally in Central and South America as well as in developed countries such as Australia and Japan; Buruli ulcer has also been described in travelers returning from endemic areas. Clinically, the disease is characterized by large, painless ulcerations with undermined borders. Systemic symptoms are usually absent. Classical histological findings include a particular type of fat necrosis and the presence of abundant acid fast bacilli in tissue. Such findings should raise the possibility of this disease, with the purpose of early therapeutically intervention. Lastly, the infection by free living ameba Balamuthia mandrillaris, an emerging condition seen in the US and Peru, is extensively discussed. Special attention is given to clinical and histological characteristics, as well as to the clues for early diagnosis and the tools available for confirmation.
Topics: Amebiasis; Balamuthia mandrillaris; Biopsy; Buruli Ulcer; Communicable Diseases, Emerging; Diagnosis, Differential; Gnathostomiasis; Host-Parasite Interactions; Humans; Predictive Value of Tests; Skin; Skin Diseases
PubMed: 31685961
DOI: 10.1038/s41379-019-0399-1 -
Clinical Nephrology. Case Studies 2023We present two atypical cases of calciphylaxis presenting with ocular ischemic pathology - both without the hallmark cutaneous manifestations - to raise awareness of...
PURPOSE
We present two atypical cases of calciphylaxis presenting with ocular ischemic pathology - both without the hallmark cutaneous manifestations - to raise awareness of this rare yet highly disabling condition.
OBSERVATIONS
We report two cases of ophthalmic calciphylaxis presenting as (1) anterior ischemic optic neuropathy (AION) and cilioretinal artery occlusion in a 76-year-old woman with pre-dialysis kidney failure, and (2) AION with contralateral central retinal artery occlusion (CRAO) in a 44-year-old man on hemodialysis.
CONCLUSION AND IMPORTANCE
These cases highlight the need for judicious clinical suspicion of calciphylaxis in patients with kidney failure, presenting with microvascular ischemic ophthalmic pathology such as AION or CRAO. Confirmation with temporal artery biopsy is essential to direct targeted individualized multi-disciplinary treatment of calciphylaxis and avoid unnecessary steroid exposure in cases masquerading as giant cell arteritis (GCA).
PubMed: 38169875
DOI: 10.5414/CNCS111088 -
Iranian Journal of Medical Sciences Mar 2024
Topics: Humans; Panniculitis, Peritoneal; Tomography, X-Ray Computed
PubMed: 38584652
DOI: 10.30476/IJMS.2023.98397.3074 -
Clinical Case Reports Jun 2022Here, a case of Sputnik-V vaccine-induced panniculitis was reported. The patient developed erythema, induration, and local tenderness at the injection site after...
Here, a case of Sputnik-V vaccine-induced panniculitis was reported. The patient developed erythema, induration, and local tenderness at the injection site after 13 days of the injection. Ultra-sonography imaging showed inflammation in subcutaneous layers including fat tissue compatible with panniculitis. She received ibuprofen and warm compress, and all symptoms resolved.
PubMed: 35662784
DOI: 10.1002/ccr3.5923 -
International Journal of Molecular... Jun 2020Adipose tissue is an active endocrine and immune organ that controls systemic immunometabolism via multiple pathways. Diverse immune cell populations reside in adipose... (Review)
Review
Adipose tissue is an active endocrine and immune organ that controls systemic immunometabolism via multiple pathways. Diverse immune cell populations reside in adipose tissue, and their composition and immune responses vary with nutritional and environmental conditions. Adipose tissue dysfunction, characterized by sterile low-grade chronic inflammation and excessive immune cell infiltration, is a hallmark of obesity, as well as an important link to cardiometabolic diseases. Amongst the pro-inflammatory factors secreted by the dysfunctional adipose tissue, interleukin (IL)-1β, induced by the NLR family pyrin domain-containing 3 (NLRP3) inflammasome, not only impairs peripheral insulin sensitivity, but it also interferes with the endocrine and immune functions of adipose tissue in a paracrine manner. Human studies indicated that NLRP3 activity in adipose tissues positively correlates with obesity and its metabolic complications, and treatment with the IL-1β antibody improves glycaemia control in type 2 diabetic patients. In mouse models, genetic or pharmacological inhibition of NLRP3 activation pathways or IL-1β prevents adipose tissue dysfunction, including inflammation, fibrosis, defective lipid handling and adipogenesis, which in turn alleviates obesity and its related metabolic disorders. In this review, we summarize both the negative and positive regulators of NLRP3 inflammasome activation, and its pathophysiological consequences on immunometabolism. We also discuss the potential therapeutic approaches to targeting adipose tissue inflammasome for the treatment of obesity and its related metabolic disorders.
Topics: Adipokines; Adipose Tissue; Animals; Autophagy; Diabetes Mellitus, Type 2; Humans; Inflammasomes; Insulin Resistance; Lipid Metabolism; Lipopolysaccharides; Metabolic Diseases; Mice; NLR Family, Pyrin Domain-Containing 3 Protein; Obesity; Panniculitis
PubMed: 32545355
DOI: 10.3390/ijms21114184 -
Archives of Plastic Surgery Jul 2022Lupus panniculitis (LP) often presents with tender nodules and intermittent ulcers that then heal with scarring and lipoatrophy. The current mainstay of treatment is...
Lupus panniculitis (LP) often presents with tender nodules and intermittent ulcers that then heal with scarring and lipoatrophy. The current mainstay of treatment is medical treatment. Research regarding the treatment of lipoatrophy from LP with autologous fat grafting is limited. We would like to share our experience in this rare case, which was treated with autologous fat transfer. A 48-year-old female presented with erythematous plaque, tender nodules, and ulcers following by a depression of the lesion at the left temporal area. The patient also had indurated erythematous plaque at her left cheek. Both lesions were aggravated by sunlight exposure. After several investigations, she was diagnosed as LP with secondary lipoatrophy and tumid lupus erythematosus at her left temporal and left cheek, respectively. She received antimalarial drug and topical steroids. The patient underwent two sessions of autologous fat transfer. She was satisfied with the volume and contour improvement in the scar following the injection of 8 and 3.7 mL of fat. Furthermore, the patient reported the remission of tender nodules and ulcers since the first fat graft injection. In conclusion, the autologous fat transfer is a simple and effective treatment for lipoatrophy and scar secondary to LP with promising results.
PubMed: 35919548
DOI: 10.1055/s-0042-1751024