1
|
Liu T, Basseri S, Mussari B, DaBreo D, SenGupta S, Villalobos D, Awad S. Generalized lymphatic anomalies and review of the current management landscape: a case report and review of the literature. J Med Case Rep 2021; 15:398. [PMID: 34372919 PMCID: PMC8353871 DOI: 10.1186/s13256-021-02953-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 06/09/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Generalized lymphatic anomaly previously known as diffuse systemic lymphangiomatosis is a rare multisystem congenital disease arising from the lymphatic system, and it is characterized by abnormal proliferation of the lymphatic channels in osseous and extraosseous tissues. It typically affects children or young adults. Although it is benign, it can be misdiagnosed as malignancy because of its diffuse and debilitating nature depending on the site of involvement. Due to its rarity, diagnosis is often delayed, leading to potential significant morbidity or mortality if vital organs are involved. Furthermore, its potential for multiorgan involvement with no curative treatment makes its management challenging. CASE PRESENTATION We describe a case of a 35-year-old Caucasian female, who presented with epigastric pain and was subsequently extensively investigated at multiple tertiary centers by numerous specialists for query malignancy and metabolic bone disorder following incidental computed tomography imaging findings of multiple osteolytic lesions in the axial skeleton, and low-attenuating lesions in the axilla, spleen, and mediastinum. The diagnosis was confirmed with an axillary excisional biopsy. She was clinically stable with no end organ damage. She was monitored conservatively. CONCLUSIONS The case illustrates the importance of increased awareness among clinicians for this rare congenital disease to enable earlier diagnosis and to avoid unnecessary invasive investigations. Furthermore, this case highlights the potential need for multiple biopsies of affected sites to confirm diagnosis. We also discuss the emergence of interferon therapy, chemotherapy, immunosuppression, and immunotherapy as medical management for this condition.
Collapse
Affiliation(s)
- Tao Liu
- Department of Medicine, Queen's University, C3-008, 166 Brock Street, Kingston, ON, K7L 5G2, Canada.
| | - Sana Basseri
- Department of Radiology, Queen's University, Kingston, ON, Canada
| | - Ben Mussari
- Department of Radiology, Queen's University, Kingston, ON, Canada
| | - Dominique DaBreo
- Department of Radiology, Queen's University, Kingston, ON, Canada
| | - Sandip SenGupta
- Department of Pathology, Queen's University, Kingston, ON, Canada
| | | | - Sara Awad
- Department of Medicine, Queen's University, C3-008, 166 Brock Street, Kingston, ON, K7L 5G2, Canada
| |
Collapse
|
2
|
Abstract
BACKGROUND Dyshidrotic pemphigoid (DP) is a rare variant of bullous pemphigoid (BP) that affects the hands and feet and may resemble an acute vesicular eczema. While it can remain confined to hands and feet, spread that involves the entire body is described. BP and DP are associated with autoantibodies directed against hemidesmosomal proteins BP180 (collagen XVII) and BP230 (dystonin), which are transmembrane and intracellular proteins in the basement membrane zone, respectively. CASE SUMMARY We present a case of DP in a 78-year-old woman who was diagnosed based on histopathologic and immunofluorescence findings and subsequently successfully treated. CONCLUSION DP is an unusual form of localized BP. While the pathogenesis is still unclear, it may involve differential expression of BP antigens in the cutaneous basement membrane of the hands and feet. The clinical presentation is a diagnostic challenge, and skin biopsies with immunofluorescence studies are required for diagnosis.
Collapse
Affiliation(s)
- Sana Basseri
- 1 Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Thai Yen Ly
- 1 Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.,2 Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, NS, Canada
| | - Peter R Hull
- 1 Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.,3 Department of Medicine, Division of Clinical Dermatology and Cutaneous Science, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
3
|
Connors J, Basseri S, Grant A, Giffin N, Mahdi G, Noble A, Rashid M, Otley A, Van Limbergen J. Exclusive Enteral Nutrition Therapy in Paediatric Crohn's Disease Results in Long-term Avoidance of Corticosteroids: Results of a Propensity-score Matched Cohort Analysis. J Crohns Colitis 2017; 11:1063-1070. [PMID: 28575325 PMCID: PMC5881686 DOI: 10.1093/ecco-jcc/jjx060] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 05/25/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Exclusive enteral nutrition [EEN] is recommended as a first-line induction therapy for paediatric Crohn's disease [CD] although corticosteroids [CS] are still used commonly. Our aim was to compare short- and long-term disease outcomes of paediatric CD patients initially managed with either EEN or CS. METHODS Medical records of newly diagnosed paediatric CD patients treated with EEN or CS as induction therapy were retrospectively reviewed. To minimise selection bias inherent in observational cohort studies, propensity analysis was carried out. Data on anthropometrics, medical history, and presenting phenotype were collected at time of diagnosis [baseline]; outcomes of interest, including medication use, hospitalisation, surgical procedures, and disease progression were assessed up to 6 years following diagnosis. RESULTS Of 127 patients reviewed, a total of 111 propensity-score matched CD patients receiving EEN [n = 76] or CS [n = 35] were analysed. By 4-12 weeks of induction therapy, 86.6% of EEN-treated patients achieved remission (Paediatric Crohn's Disease Activity Index [PCDAI] ≤ 7.5) compared with 58.1% of patients in the CS-treated group [p < 0.01]. Choice of EEN over CS for induction was associated with avoidance of corticosteroids over a 6-year follow-up period. Analysis of long-term linear growth, hospitalisation, need for biologic therapy, or surgical intervention did not reveal any significant differences. CONCLUSIONS These findings suggest that EEN induction therapy is more effective in achieving early remission and is associated with long-term steroid avoidance without increased use of biologics or need for surgery.
Collapse
Affiliation(s)
- Jessica Connors
- Division of Gastroenterology, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Sana Basseri
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Amy Grant
- Division of Gastroenterology, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Nick Giffin
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Gamal Mahdi
- Division of Gastroenterology, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Angela Noble
- Division of Gastroenterology, IWK Health Centre, Halifax, Nova Scotia, Canada,Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mohsin Rashid
- Division of Gastroenterology, IWK Health Centre, Halifax, Nova Scotia, Canada,Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anthony Otley
- Division of Gastroenterology, IWK Health Centre, Halifax, Nova Scotia, Canada,Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Johan Van Limbergen
- Division of Gastroenterology, IWK Health Centre, Halifax, Nova Scotia, Canada,Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada,Corresponding author: Johan Van Limbergen, MD, PhD, Division of Pediatric Gastroenterology & Nutrition, Department of Pediatrics, IWK Health Centre, Dalhousie University, 5850/5980 University Avenue, Halifax, Nova Scotia B3K 6R8, Canada. Tel.: [902] 470–8746/8225; fax: [902] 470–7249;
| |
Collapse
|
4
|
Basseri S, Lightfoot CB. Balloon-occluded retrograde transvenous obliteration for treatment of bleeding gastric varices: case report and review of literature. Radiol Case Rep 2016; 11:365-369. [PMID: 27920863 PMCID: PMC5128388 DOI: 10.1016/j.radcr.2016.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 09/12/2016] [Accepted: 09/15/2016] [Indexed: 02/07/2023] Open
Abstract
Gastric variceal bleeding is a major complication of portal hypertension and is associated with high morbidity and mortality. While esophageal varices are more common, gastric varices are often more challenging to treat. Balloon-Occluded Retrograde Transvenous Obliteration is an interventional procedure whereby the portosystemic gastrorenal shunt is accessed via the left renal vein and the gastric varix outflow tract obliterated using direct sclerotherapy. Herein, we present a case of a 68-year-old female patient with cirrhosis who presented with bleeding gastric varices and successfully treated. This case highlights the procedural steps and the importance of detailed knowledge of the patient's portosystemic anatomy for determining suitability for balloon-occluded retrograde transvenous obliteration of gastric varices.
Collapse
Affiliation(s)
- Sana Basseri
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Christopher B Lightfoot
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada; Department of Radiology, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
5
|
Basseri S, Lhoták Š, Fullerton MD, Palanivel R, Jiang H, Lynn EG, Ford RJ, Maclean KN, Steinberg GR, Austin RC. Loss of TDAG51 results in mature-onset obesity, hepatic steatosis, and insulin resistance by regulating lipogenesis. Diabetes 2013; 62:158-69. [PMID: 22961087 PMCID: PMC3526025 DOI: 10.2337/db12-0256] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Regulation of energy metabolism is critical for the prevention of obesity, diabetes, and hepatic steatosis. Here, we report an important role for the pleckstrin homology-related domain family member, T-cell death-associated gene 51 (TDAG51), in the regulation of energy metabolism. TDAG51 expression was examined during adipocyte differentiation. Adipogenic potential of preadipocytes with knockdown or absence of TDAG51 was assessed. Weight gain, insulin sensitivity, metabolic rate, and liver lipid content were also compared between TDAG51-deficient (TDAG51(-/-)) and wild-type mice. In addition to its relatively high expression in liver, TDAG51 was also present in white adipose tissue (WAT). TDAG51 was downregulated during adipogenesis, and TDAG51(-/-) preadipocytes exhibited greater lipogenic potential. TDAG51(-/-) mice fed a chow diet exhibited greater body and WAT mass, had reduced energy expenditure, displayed mature-onset insulin resistance (IR), and were predisposed to hepatic steatosis. TDAG51(-/-) mice had increased hepatic triglycerides and SREBP-1 target gene expression. Furthermore, TDAG51 expression was inversely correlated with fatty liver in multiple mouse models of hepatic steatosis. Taken together, our findings suggest that TDAG51 is involved in energy homeostasis at least in part by regulating lipogenesis in liver and WAT, and hence, may constitute a novel therapeutic target for the treatment of obesity and IR.
Collapse
Affiliation(s)
- Sana Basseri
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Hamilton Centre for Kidney Research, St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Šárka Lhoták
- Hamilton Centre for Kidney Research, St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Morgan D. Fullerton
- Division of Endocrinology and Metabolism, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Rengasamy Palanivel
- Division of Endocrinology and Metabolism, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Hua Jiang
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Edward G. Lynn
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Hamilton Centre for Kidney Research, St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Rebecca J. Ford
- Division of Endocrinology and Metabolism, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kenneth N. Maclean
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Gregory R. Steinberg
- Division of Endocrinology and Metabolism, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Richard C. Austin
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Hamilton Centre for Kidney Research, St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
- Corresponding author: Richard C. Austin,
| |
Collapse
|
6
|
Dickhout JG, Lhoták Š, Hilditch BA, Basseri S, Colgan SM, Lynn EG, Carlisle RE, Zhou J, Sood SK, Ingram AJ, Austin RC. Induction of the unfolded protein response after monocyte to macrophage differentiation augments cell survival in early atherosclerotic lesions. FASEB J 2010; 25:576-89. [PMID: 20966213 DOI: 10.1096/fj.10-159319] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Endoplasmic reticulum (ER) stress causes macrophage cell death within advanced atherosclerotic lesions, thereby contributing to necrotic core formation and increasing the risk of atherothrombotic disease. However, unlike in advanced lesions, the appearance of dead/apoptotic macrophages in early lesions is less prominent. Given that activation of the unfolded protein response (UPR) is detected in early lesion-resident macrophages and can enhance cell survival against ER stress, we investigated whether UPR activation occurs after monocyte to macrophage differentiation and confers a cytoprotective advantage to the macrophage. Human peripheral blood monocytes were treated with monocyte colony-stimulating factor to induce macrophage differentiation, as assessed by changes in ultrastructure and scavenger receptor expression. UPR markers, including GRP78, GRP94, and spliced XBP-1, were induced after macrophage differentiation and occurred after a significant increase in de novo protein synthesis. UPR activation after differentiation reduced macrophage cell death by ER stress-inducing agents. Further, GRP78 overexpression in macrophages was sufficient to reduce ER stress-induced cell death. Consistent with these in vitro findings, UPR activation was observed in viable lesion-resident macrophages from human carotid arteries and from the aortas of apoE(-/-) mice. However, no evidence of apoptosis was observed in early lesion-resident macrophages from the aortas of apoE(-/-) mice. Thus, our findings that UPR activation occurs during macrophage differentiation and is cytoprotective against ER stress-inducing agents suggest an important cellular mechanism for macrophage survival within early atherosclerotic lesions.
Collapse
Affiliation(s)
- Jeffrey G Dickhout
- Division of Nephrology, McMaster University and St. Joseph's Healthcare Hamilton, 50 Charlton Ave. East, Hamilton, ON, Canada L8N 4A6
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Basseri S, Lhoták S, Sharma AM, Austin RC. The chemical chaperone 4-phenylbutyrate inhibits adipogenesis by modulating the unfolded protein response. J Lipid Res 2010; 50:2486-501. [PMID: 19461119 DOI: 10.1194/jlr.m900216-jlr200] [Citation(s) in RCA: 179] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Recent studies have shown a link between obesity and endoplasmic reticulum (ER) stress. Perturbations in ER homeostasis cause ER stress and activation of the unfolded protein response (UPR). Adipocyte differentiation contributes to weight gain, and we have shown that markers of ER stress/UPR activation, including GRP78, phospho-eIF2, and spliced XBP1, are upregulated during adipogenesis. Given these findings, the objective of this study was to determine whether attenuation of UPR activation by the chemical chaperone 4-phenylbutyrate (4-PBA) inhibits adipogenesis. Exposure of 3T3-L1 preadipocytes to 4-PBA in the presence of differentiation media decreased expression of ER stress markers. Concomitant with the suppression of UPR activation, 4-PBA resulted in attenuation of adipogenesis as measured by lipid accumulation and adiponectin secretion. Consistent with these in vitro findings, female C57BL/6 mice fed a high-fat diet supplemented with 4-PBA showed a significant reduction in weight gain and had reduced fat pad mass, as compared with the high-fat diet alone group. Furthermore, 4-PBA supplementation decreased GRP78 expression in the adipose tissue and lowered plasma triglyceride, glucose, leptin, and adiponectin levels without altering food intake. Taken together, these results suggest that UPR activation contributes to adipogenesis and that blocking its activation with 4-PBA prevents adipocyte differentiation and weight gain in mice.
Collapse
Affiliation(s)
- Sana Basseri
- Department of Medicine, McMaster University, St. Joseph's Healthcare Hamilton and the Henderson Research Centre, Hamilton, Ontario, L8N 4A6, Canada
| | | | | | | |
Collapse
|
8
|
|
9
|
Dickhout JG, Basseri S, Austin RC. Macrophage Function and Its Impact on Atherosclerotic Lesion Composition, Progression, and Stability. Arterioscler Thromb Vasc Biol 2008; 28:1413-5. [DOI: 10.1161/atvbaha.108.169144] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jeffrey G. Dickhout
- From the Department of Medicine, McMaster University, St. Joseph’s Hospital and the Henderson Research Centre, Hamilton, Ontario, Canada
| | - Sana Basseri
- From the Department of Medicine, McMaster University, St. Joseph’s Hospital and the Henderson Research Centre, Hamilton, Ontario, Canada
| | - Richard C. Austin
- From the Department of Medicine, McMaster University, St. Joseph’s Hospital and the Henderson Research Centre, Hamilton, Ontario, Canada
| |
Collapse
|
10
|
Affiliation(s)
| | | | | | | | | | | | - Richard C. Austin
- Pathology and Molecular Medicine/Henderson Research CenterMcMaster UniversityHamiltonCanada
| |
Collapse
|