Case report of Leser-Trelat sign as sequela of an atypical inflammatory process.

BACKGROUND: Leser-Trelat sign is a rare paraneoplastic syndrome in which one main characteristic presented is an eruption of multiple seborrheic keratoses around different areas of the body. This syndrome has been associated with multiple gastrointestinal malignancies, especially adenocarcinoma of stomach and colon. CASE REPORT: We report a 70-year-old male who presented to the surgery clinic complaining of a persistent lower abdominal pain for the past 2 months. The pain was associated with weight loss and the gradual appearance of multiple seborrheic keratoses in his body. The patient was admitted to the hospital for further evaluation, a CT scan shows an 8.1 × 5.2 cm mass in the mid mesentery and laboratories shows anemia and positive fecal occult blood. The patient was scheduled for an exploratory laparotomy. During the surgery, a large mass was found arising from the ascending colon with invasion into the adjacent sigmoid colon. The mass was sent to pathology and shows a foreign body granuloma. In addition to the surgery, the patient undergoes an endoscopic evaluation to rule out a malignancy from the upper gastrointestinal system, no masses or lesions were found. CONCLUSION: This is the first case reported, as far as our knowledge, of a foreign body granuloma in the association of Leser-Trelat sign. Foreign body granulomas are associated with multiple cellular signaling and this could be the source of the association of the Leser-Trelat sign. Further evaluation is needed to have a better understanding of the association between the Leser-Trelat sign and the formation of a foreign body granuloma.

Decreased lipid metabolism but increased FA biosynthesis are coupled with changes in liver microRNAs in obese subjects with NAFLD.

BACKGROUND/OBJECTIVE: Many controversies regarding the association of liver miRNAs with obesity and nonalcoholic fatty liver diseases (NAFLD) call for additional validations. This study sought to investigate variations in genes and hepatic miRNAs in a sample of obese patients with or without NAFLD and human hepatocytes (HH). SUBJECTS/METHODS: A total of 60 non-consecutive obese women following bariatric surgery were recruited. Subjects were classified as NAFLD (n=17), borderline (n=24) and controls (n=19) with normal enzymatic profile, liver histology and ultrasound assessments. Profiling of 744 miRNAs was performed in 8 obese women with no sign of hepatic disease and 11 NAFLD patients. Additional validation and expression of genes related to de novo fatty acid (FA) biosynthesis, uptake, transport and ß-oxidation; glucose metabolism, and inflammation was tested in the extended sample. Induction of NAFLD-related genes and miRNAs was examined in HepG2 cells and primary HH treated with palmitic acid (PA), a combination of palmitate and oleic acid, or high glucose, and insulin (HG) mimicking insulin resistance in NAFLD. RESULTS: In the discovery sample, 14 miRNAs were associated with NAFLD. Analyses in the extended sample confirmed decreased miR-139-5p, miR-30b-5p, miR-122-5p and miR-422a, and increased miR-146b-5p in obese subjects with NAFLD. Multiple linear regression analyses disclosed that NAFLD contributed independently to explain miR-139-5p (P=0.005), miR-30b-5p (P=0.005), miR-122-5p (P=0.021), miR-422a (P=0.007) and miR-146a (P=0.033) expression variance after controlling for confounders. Decreased miR-122-5p in liver was associated with impaired FA usage. Expression of inflammatory and macrophage-related genes was opposite to decreased miR-30b-5p, miR-139-5p and miR-422a, whereas increased miR-146b-5p was associated with FABP4 and decreased glucose metabolism and FA mobilization. In partial agreement, PA (but not HG) led to decreased miR-139-5p, miR-30b-5p, miR-422a and miR-146a in vitro, in parallel with increased lipogenesis and FA transport, decreased glucose metabolism and diminished FA oxidation. CONCLUSION: This study confirms decreased liver glucose and lipid metabolism but increased FA biosynthesis coupled with changes in five unique miRNAs in obese patients with NAFLD.