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Lungu M, Oprea VD, Stoleriu G, Ionescu AM, Zaharia AL, Croitoru A, Stan B, Niculet E. Madelung's Disease Evolving to Liposarcoma: An Uncommon Encounter. Life (Basel) 2024; 14:521. [PMID: 38672791 PMCID: PMC11051324 DOI: 10.3390/life14040521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/11/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Background: Madelung's disease-known also as Benign Symmetric Adenolipomatosis (BSA) or Multiple Symmetric Lipomatosis (MSL), is a rare subcutaneous tissue disease characterized by the proliferation of non-encapsulated fat tissue with mature adipocytes. Patients develop symmetrical fatty deposits of varying sizes, (located particularly around the neck, shoulders, upper and middle back, arms, abdomen, and thighs), having clinical, esthetic, and psychiatric repercussions. (2) Methods: We report a case diagnosed with BSA upon admission to the Neurological and Internal Medicine Departments of the Emergency Clinical Hospital of Galati. (3) Results: This patient developed compressive phenomena and liposarcoma with liver metastasis, followed by death shortly after hospital presentation. The histopathology examination confirmed right latero-cervical liposarcoma and round cell hepatic metastasis. The specific metabolic ethiopathogenic mechanism has not been elucidated, but the adipocytes of BSA are different from normal cells in proliferation, hormonal regulation, and mitochondrial activity; a rare mitochondrial gene mutation, together with other interacting genetic or non-genetic factors, have been considered in recent studies. A thorough literature search identified only three cases reporting malignant tumors in BSA patients. (4) Conclusions: The goal of our paper is to present this rare case in the oncogenic synergism of two tumors. In the management of this BSA disorder, possible malignant transformation should be considered, although only scarce evidence was found supporting this.
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Affiliation(s)
- Mihaiela Lungu
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania (A.L.Z.); (A.C.)
- “St. Ap. Andrei” Clinical County Emergency Hospital, 800579 Galati, Romania
| | - Violeta Diana Oprea
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania (A.L.Z.); (A.C.)
- “St. Ap. Andrei” Clinical County Emergency Hospital, 800579 Galati, Romania
| | - Gabriela Stoleriu
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania (A.L.Z.); (A.C.)
- “St. Spiridon” Clinical Emergency County Hospital Iasi, 700111 Iasi, Romania
| | - Ana-Maria Ionescu
- Faculty of Medicine and Pharmacy, Ovidius University of Constanța, 900470 Constanța, Romania;
| | - Andrei Lucian Zaharia
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania (A.L.Z.); (A.C.)
- “St. Ap. Andrei” Clinical County Emergency Hospital, 800579 Galati, Romania
| | - Ana Croitoru
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania (A.L.Z.); (A.C.)
- “St. Ap. Andrei” Clinical County Emergency Hospital, 800579 Galati, Romania
| | - Bianca Stan
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania (A.L.Z.); (A.C.)
- “St. Ap. Andrei” Clinical County Emergency Hospital, 800579 Galati, Romania
| | - Elena Niculet
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800008 Galati, Romania (A.L.Z.); (A.C.)
- “St. Ap. Andrei” Clinical County Emergency Hospital, 800579 Galati, Romania
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Zaharia AL, Tutunaru D, Oprea VD, Tănase CE, Croitoru A, Stan B, Voinescu DC, Ionescu AM, Coadǎ CA, Lungu M. Thrombomodulin Serum Levels-A Predictable Biomarker for the Acute Onset of Ischemic Stroke. Curr Issues Mol Biol 2024; 46:677-688. [PMID: 38248346 PMCID: PMC10813863 DOI: 10.3390/cimb46010044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/07/2024] [Accepted: 01/10/2024] [Indexed: 01/23/2024] Open
Abstract
The early diagnosis of acute ischemic stroke (AIS) can be challenging in cases presenting with a scarcity of clinical signs, normal cerebral imaging in early stages and a lack of specific serum markers. Thrombomodulin has been shown to be associated with cerebrovascular ischemic events and can be considered an important biomarker for the acute onset of ischemic stroke. In our study, we compared the serum levels of thrombomodulin (sTM) between a relevant patient group of 70 AIS patients and a control group of patients without AIS admitted into the neurology department between June 2022 and May 2023. sTM levels were measured at 24 h and 48 h after patients' admissions into the hospital. There was a significant difference between the two groups (AIS: 23.2 ± 9.17 ng/mL vs. controls: 3.64 ± 1.72 ng/mL; p-value < 0.001). sTM values were correlated with the score of neurological deficits, with gender and dyslipidemia. The association of sTM values with the acute onset of AIS as an end point was significant, which allows rapid therapeutic interventions, even in the absence of a well-defined clinical syndrome (AUC = 0.99). Reanalysis of the patients after propensity score matching increased the power of sTM as a biomarker (AUC = 1). sTM represents a potentially useful biomarker to diagnose the onset of an AIS, even in scarce clinical presentations, which makes thrombomodulin a valuable indicator for early treatment initiation.
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Affiliation(s)
- Andrei-Lucian Zaharia
- “St. Apostle Andrei” Clinical Emergency County Hospital Galati, 800578 Galati, Romania; (A.-L.Z.); (A.C.); (B.S.); (D.C.V.); (M.L.)
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800216 Galati, Romania;
| | - Dana Tutunaru
- “St. Apostle Andrei” Clinical Emergency County Hospital Galati, 800578 Galati, Romania; (A.-L.Z.); (A.C.); (B.S.); (D.C.V.); (M.L.)
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800216 Galati, Romania;
| | - Violeta Diana Oprea
- “St. Apostle Andrei” Clinical Emergency County Hospital Galati, 800578 Galati, Romania; (A.-L.Z.); (A.C.); (B.S.); (D.C.V.); (M.L.)
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800216 Galati, Romania;
| | - Claudiu Elisei Tănase
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800216 Galati, Romania;
- “St. Joan” Pediatric Clinical Emergency Hospital Galati, 800487 Galati, Romania
| | - Ana Croitoru
- “St. Apostle Andrei” Clinical Emergency County Hospital Galati, 800578 Galati, Romania; (A.-L.Z.); (A.C.); (B.S.); (D.C.V.); (M.L.)
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800216 Galati, Romania;
| | - Bianca Stan
- “St. Apostle Andrei” Clinical Emergency County Hospital Galati, 800578 Galati, Romania; (A.-L.Z.); (A.C.); (B.S.); (D.C.V.); (M.L.)
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800216 Galati, Romania;
| | - Doina Carina Voinescu
- “St. Apostle Andrei” Clinical Emergency County Hospital Galati, 800578 Galati, Romania; (A.-L.Z.); (A.C.); (B.S.); (D.C.V.); (M.L.)
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800216 Galati, Romania;
| | - Ana-Maria Ionescu
- Faculty of Medicine and Pharmacy, Ovidius University of Constanța, 900470 Constanța, Romania;
| | - Camelia Alexandra Coadǎ
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Mihaiela Lungu
- “St. Apostle Andrei” Clinical Emergency County Hospital Galati, 800578 Galati, Romania; (A.-L.Z.); (A.C.); (B.S.); (D.C.V.); (M.L.)
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University of Galati, 800216 Galati, Romania;
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Lungu M, Oprea VD, Zaharia AL, Stan B, Rebegea L, Mocanu DI, Elkan EM, Niculet E, Croitoru A. Stroke-Associating Acute Limb Ischemia Due to the Rupture of a Hydatid Cyst. Curr Issues Mol Biol 2023; 45:2597-2608. [PMID: 36975540 PMCID: PMC10047644 DOI: 10.3390/cimb45030170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/18/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023] Open
Abstract
(1) Background: Hydatidosis, or human cystic echinococcosis, is a zoonotic disease. Endemic in some areas, recently it has an increasing incidence in wider regions, determined by population migration. Clinical features depend on the localization and level of infection: asymptomatic or with signs related to hypersensitivity, organic functional deficiencies, expanding mass effects, cyst infection and sudden death. In rare cases, the rupture of a hydatid cyst causes emboli formation by the residual laminated membrane. (2) Methods: We performed an extensive literature review, starting from the case of a 25-year-old patient presenting with neurologic symptoms relevant for acute stroke, associating right upper limb ischemia. (3) Results: Imaging investigations revealed the source of the emboli as the rupture of a hydatid cyst, the patient presenting multiple pericardial and mediastinal localizations. Cerebral imaging confirmed an acute left occipital ischemic lesion, with complete recovery of the neurological deficit after therapy, while surgery for acute brachial artery ischemia had a favorable postoperative evolution. Specific anthelmintic therapy was initiated. An extensive literature review using available databases revealed the scarcity of data on embolism as a consequence of cyst rupture, highlighting the significant risk of clinicians overlooking this possible etiology. (4) Conclusions: An associated allergic reaction should raise the hypothesis of a hydatid cyst rupture as a cause of any level acute ischemic lesion.
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Affiliation(s)
- Mihaela Lungu
- "St. Apostle Andrei" Clinical Emergency County Hospital Galati, 800578 Galati, Romania
- Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Galati, 800216 Galati, Romania
| | - Violeta Diana Oprea
- "St. Apostle Andrei" Clinical Emergency County Hospital Galati, 800578 Galati, Romania
- Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Galati, 800216 Galati, Romania
| | - Andrei Lucian Zaharia
- "St. Apostle Andrei" Clinical Emergency County Hospital Galati, 800578 Galati, Romania
- Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Galati, 800216 Galati, Romania
| | - Bianca Stan
- "St. Apostle Andrei" Clinical Emergency County Hospital Galati, 800578 Galati, Romania
- Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Galati, 800216 Galati, Romania
| | - Laura Rebegea
- "St. Apostle Andrei" Clinical Emergency County Hospital Galati, 800578 Galati, Romania
- Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Galati, 800216 Galati, Romania
| | - Dan Iulian Mocanu
- "St. Apostle Andrei" Clinical Emergency County Hospital Galati, 800578 Galati, Romania
- Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Galati, 800216 Galati, Romania
| | - Eva Maria Elkan
- Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Galati, 800216 Galati, Romania
- "St. Joan" Pediatric Clinical Emergency Hospital Galati, 800487 Galati, Romania
| | - Elena Niculet
- "St. Apostle Andrei" Clinical Emergency County Hospital Galati, 800578 Galati, Romania
- Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Galati, 800216 Galati, Romania
| | - Ana Croitoru
- "St. Apostle Andrei" Clinical Emergency County Hospital Galati, 800578 Galati, Romania
- Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Galati, 800216 Galati, Romania
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Chung YFA, Tay KH, Stan B, Htoo AMM, Thng CH, Chow PKH, Ooi LLPJ, Lau TN. Percutaneous drainage of liver abscess complicated by hepato-venous fistula. Singapore Med J 2003; 44:299-301. [PMID: 14560862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Severe systemic sepsis after percutaneous drainage of liver abscess is rare. We report two cases of hepato-venous fistulas between hepatic abscesses and hepatic/portal veins documented on abscessography during percutaneous drainage of liver abscesses, which resulted in severe sepsis and a stormy post drainage clinical course. Liver abscesses can rupture into the portal and hepatic veins causing worsening of systemic sepsis especially when they are in close proximity to each other. During percutaneous drainage, care must also be taken to avoid overinjection of the abscess, which can worsen the fistula. The ensuing sepsis is severe and requires aggressive intensive medical care and ventilatory support to tide the patient over the septic episode.
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Affiliation(s)
- Y F A Chung
- Department of General Surgery, Singapore General Hospital, Outram Road, Singapore 169608.
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