Asunto(s)
Inmunoglobulina G/metabolismo , Paniculitis Peritoneal/diagnóstico por imagen , Paniculitis Peritoneal/metabolismo , Biopsia con Aguja , Diagnóstico Diferencial , Endoscopía del Sistema Digestivo , Glucocorticoides/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Paniculitis Peritoneal/tratamiento farmacológico , Prednisolona/uso terapéutico , Tomografía Computarizada por Rayos X , Ultrasonografía IntervencionalRESUMEN
RATIONALE: Mesenteric panniculitis (MP) is a rare disease with abdominal and systemic symptoms and is characterized by nonspecific inflammation, fat necrosis, and fibrosis in mesenteric fat. Active inflammatory responses may increase levels of prostaglandin E-major urinary metabolite (PGE-MUM), which was reported to reflect the disease activity of ulcerative colitis and chronic fibrosing interstitial pneumonia. We recently experienced a case with elevated PGE-MUM at the time of diagnosis of MP and we investigated the potential of PGE-MUM as a biomarker. PATIENT CONCERN: In this report we described 2 active mesenteric panniculitis patients with high PGE-MUM levels. DIAGNOSES: Mesenteric panniculitis INTERVENTIONS:: Both MP patients were measured the levels of PGE-MUM. OUTCOMES: Both MP patients exhibited high levels of PGE-MUM before treatment. In one, the levels were sensitively correlated with clinical symptoms and serological markers on steroids. LESSONS: The study observations suggest the potential of PGE-MUM to reflect the disease activity of MP. To verify its use, more findings based on clinical studies should be accumulated.
Asunto(s)
Corticoesteroides/uso terapéutico , Paniculitis Peritoneal/tratamiento farmacológico , Paniculitis Peritoneal/metabolismo , Prostaglandinas E/metabolismo , Anciano , Biomarcadores/metabolismo , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Paniculitis Peritoneal/orina , Medición de Riesgo , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , UrinálisisRESUMEN
Guanylin (Gn), a bioactive peptide, and its receptor, guanylyl cyclase-C (GC-C), are primarily present in the intestine and maintain homeostasis in body fluids. Recently, rats whose macrophages overexpress Gn and GC-C were found to be resistant to diet-induced obesity. Considering that obesity is strongly related to a chronic inflammatory state in white adipose tissues, it is possible that Gn-GC-C macrophages contribute to the regulation of inflammation. In the present study, we investigated the inflammatory state of mesenteric fat in rats transgenic for both Gn and GC-C (double-transgenic [dTg] rats) by evaluating the levels of cyclic guanosine monophosphate (cGMP), a second messenger of Gn-GC-C, cGMP-dependent protein kinase (PKG), and phosphorylated vasodilator-stimulated phosphoprotein (VASP), a target protein of PKG. The levels of cGMP in dTg rats was higher than in WT rats fed the same diet. Although there were no significant differences in levels of PKG and phosphorylated VASP between WT and dTg rats fed a standard diet (STD), these levels in dTg rats fed a high fat diet (HFD) were markedly increased compared with levels in HFD WT rats. Furthermore, mRNA levels of proinflammatory factors in mesenteric fat were lower in HFD dTg rats than in HFD WT rats and were similar to levels in STD WT and dTg rats. These results indicate that the Gn-GC-C system in macrophages regulates the cGMP-PKG-VASP pathway and controls obesity through the downregulation of proinflammatory factors.
Asunto(s)
GMP Cíclico/metabolismo , Hormonas Gastrointestinales/metabolismo , Grasa Intraabdominal/metabolismo , Macrófagos Peritoneales/metabolismo , Péptidos Natriuréticos/metabolismo , Paniculitis Peritoneal/metabolismo , Receptores Acoplados a la Guanilato-Ciclasa/agonistas , Receptores de Péptidos/agonistas , Sistemas de Mensajero Secundario , Animales , Moléculas de Adhesión Celular/metabolismo , Proteínas Quinasas Dependientes de GMP Cíclico/metabolismo , Dieta Alta en Grasa/efectos adversos , Hormonas Gastrointestinales/genética , Inmunohistoquímica , Mediadores de Inflamación/metabolismo , Grasa Intraabdominal/enzimología , Grasa Intraabdominal/inmunología , Grasa Intraabdominal/patología , Macrófagos Peritoneales/enzimología , Macrófagos Peritoneales/inmunología , Macrófagos Peritoneales/patología , Masculino , Proteínas de Microfilamentos/metabolismo , Péptidos Natriuréticos/genética , Obesidad/etiología , Obesidad/inmunología , Obesidad/metabolismo , Obesidad/patología , Paniculitis Peritoneal/etiología , Paniculitis Peritoneal/inmunología , Paniculitis Peritoneal/patología , Fosfoproteínas/metabolismo , Fosforilación , Procesamiento Proteico-Postraduccional , Distribución Aleatoria , Ratas , Ratas Transgénicas , Receptores de Enterotoxina , Receptores Acoplados a la Guanilato-Ciclasa/genética , Receptores Acoplados a la Guanilato-Ciclasa/metabolismo , Receptores de Péptidos/genética , Receptores de Péptidos/metabolismoRESUMEN
In 1924, mesenteric panniculitis was first described in the medical literature by Jura et al. as 'retractile mesenteritis.' It represents a spectrum of disease processes characterized by degeneration, inflammation and scarring of the adipose tissue of the mesentery. The clinical presentations vary according to the stage of the disease and they include abdominal pain, weight loss, nausea and vomiting. Computed tomography findings are usually diagnostic. The gross findings include thickening of the mesentery, mass lesions and adhesion to the surrounding organs. Histologically, there is a chronic inflammatory process involving the adipose tissue with fat necrosis, inflammation and fibrosis. Herein, the authors address the clinicopathological features, course, treatment and pathogenetic mechanisms of mesenteric panniculitis.
Asunto(s)
Tejido Adiposo , Paniculitis Peritoneal , Tejido Adiposo/diagnóstico por imagen , Tejido Adiposo/metabolismo , Tejido Adiposo/patología , Animales , Biopsia , Diagnóstico por Imagen/métodos , Humanos , Mesenterio , Paniculitis Peritoneal/diagnóstico , Paniculitis Peritoneal/epidemiología , Paniculitis Peritoneal/metabolismo , Paniculitis Peritoneal/terapia , Valor Predictivo de las Pruebas , Radiografía , Factores de Riesgo , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
AIM: To assess the metabolic behavior of mesenteric panniculitis (MP), possible manifestation patterns in ¹8F-FDG PET/CT imaging and to discover if it is a reliable diagnostic method to differentiate tumor disease from inflammatory condition in this context. MATERIAL AND METHODS: A total of 2,666 PET/CT scans were evaluated prospectively from April 2012 to August 2013. Thirty patients were included (37 scans) with radiological signs of MP. There were 8 women and 22 men, aged between 39 and 81 years, in the sample. According to the ¹8F-FDG uptake in the mesenteric lesions, expressed as SUVmax, patients were classified into two different groups: Group A consisted of 10 patients with increased uptake, SUVmax ≥ 2 or greater than the activity found in the surrounding healthy mesenteric tissue, and Group B (20 patients) SUVmax <2 or indistinguishable from healthy tissue. RESULTS: No signs of mesenteric tumour involvement were demonstrated during a mean follow up of 13 months (false positives) in 80% of the Group A patients (mean SUVmax 7.11). Signs of the presence of tumor were only demonstrated in two patients of Group A (SUVmax 7.57 and 9.46) with a positive predictive value of 49.79%. All Group B patients were confirmed to be free of mesenteric involvement. CONCLUSIONS: The presence of radiological signs of suggestive of MP, increase in glycidic metabolism, even intense and focal in these lesions, which may not exclude the possibility of an ongoing tumour process, would have a high likelihood of being indicative of intense inflammatory activity.
Asunto(s)
Radioisótopos de Flúor/farmacocinética , Fluorodesoxiglucosa F18/farmacocinética , Metástasis Linfática/diagnóstico por imagen , Mesenterio/diagnóstico por imagen , Paniculitis Peritoneal/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Radiofármacos/farmacocinética , Adulto , Anciano , Anciano de 80 o más Años , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Paniculitis Peritoneal/metabolismo , Estudios ProspectivosRESUMEN
Sclerosing mesenteritis is a rare inflammatory and fibrosing disorder of unknown etiology, while IgG4-related disease (IgG4-RD) consists of mass-forming, fibroinflammatory lesions characterized by high serum IgG4 levels and tissue infiltration of many IgG4-positive plasma cells; obliterative phlebitis is common. This report describes a case of sclerosing mesenteritis that was considered a manifestation of IgG4-RD. A 53-year-old man underwent right hemicolectomy because of an ileocecal mass that did not improve with conservative therapy. The ill-defined fibroinflammatory lesion extended in the mesentery with storiform fibrosis, obliterative phlebitis, and infiltration of many IgG4-positive plasma cells. The ratio of IgG4-positive/IgG-positive cells was 64%, and the ratio of forkhead box protein 3 (FOXP3)-positive/CD4-positive cells was elevated (13%). It is likely that at least some cases of sclerosing mesenteritis are a manifestation of IgG4-RD. It is important to investigate this relationship because steroid therapy may benefit such cases.