RESUMEN
Breast fat necrosis (BFN) is usually a benign inflammatory response to breast trauma. However, an extremely rare cause of fat necrosis is calciphylaxis, a calcification of small- and medium-sized arteries causing thrombosis and ischemia. It is classified into (A) uremic (B) nonuremic-induced calciphylaxis. Calciphylaxis has been reported to be encountered in different parts of the body. However, to the best of our knowledge there is only one case in the English literature of BFN 2ry to warfarin-induced calciphylaxis. We report a 65-year-old female, known case of atrial fibrillation on warfarin, presented with a left breast mass of 4-month duration. The mass was painful and progressively enlarging. Examination of the left breast showed 7 × 4 cm mass, spanning from 10-2 o'clock, free from surrounding structures, with preserved overlying skin. However, the mass was not visualized on mammogram. Ultrasound showed a left breast lobulated hypoechoic mass containing a hyperechoic component. Biopsy showed fat necrosis. After 1 month, she presented with ulceration of the overlying skin. After wide local excision, histopathology demonstrated a calciphylaxis-induced fat necrosis. Considering the patient's background, the diagnosis was BFN secondary to warfarin-induced calciphylaxis. Hence, the warfarin was shifted to Rivaroxaban, 6 months follow-up showed no evidence of recurrence. In conclusion, the rarity of nonuremic calciphylaxis is reflected on the delay of diagnosis in some of the reported cases and the lack of grading system used to guide the management of such difficult wounds. However, keeping a high index of suspicion is important whenever such wounds are encountered with presence of risk factors other than end-stage kidney disease.
Asunto(s)
Neoplasias de la Mama , Calcifilaxia , Necrosis Grasa , Anciano , Neoplasias de la Mama/tratamiento farmacológico , Calcifilaxia/inducido químicamente , Calcifilaxia/diagnóstico , Necrosis Grasa/inducido químicamente , Necrosis Grasa/diagnóstico por imagen , Femenino , Humanos , Necrosis , Recurrencia Local de Neoplasia , Warfarina/efectos adversosRESUMEN
A 59-year-old woman with history of metastatic melanoma, currently on nivolumab, presents for a restaging FDG PET/CT scan. New subcutaneous hypermetabolic foci are seen in bilateral lower extremities, suggestive of recurrent melanoma. She is referred for percutaneous image-guided biopsy for definitive diagnosis of progressive disease. Ultrasound shows the subcutaneous foci to be hyperechoic (fat density), and biopsy of the right thigh nodule shows fat necrosis with no evidence of tumor. Fat necrosis, an immune-related adverse event, can be FDG-avid and mimic malignancy on PET/CT scan.
Asunto(s)
Necrosis Grasa/inducido químicamente , Necrosis Grasa/inmunología , Fluorodesoxiglucosa F18/metabolismo , Nivolumab/efectos adversos , Grasa Subcutánea/patología , Necrosis Grasa/diagnóstico por imagen , Necrosis Grasa/patología , Femenino , Humanos , Biopsia Guiada por Imagen , Melanoma/tratamiento farmacológico , Persona de Mediana Edad , Tomografía Computarizada por Tomografía de Emisión de Positrones , Neoplasias Cutáneas/tratamiento farmacológico , Grasa Subcutánea/efectos de los fármacos , Melanoma Cutáneo MalignoAsunto(s)
Astrocitoma/tratamiento farmacológico , Neoplasias Encefálicas/tratamiento farmacológico , Necrosis Grasa/patología , MAP Quinasa Quinasa 1/antagonistas & inhibidores , Terapia Molecular Dirigida/efectos adversos , Inhibidores de Proteínas Quinasas/efectos adversos , Proteínas Proto-Oncogénicas B-raf/antagonistas & inhibidores , Adolescente , Astrocitoma/metabolismo , Astrocitoma/patología , Neoplasias Encefálicas/metabolismo , Neoplasias Encefálicas/patología , Necrosis Grasa/inducido químicamente , Humanos , Masculino , Mutación , PronósticoRESUMEN
Acute lipolysis of visceral fat or circulating triglycerides may worsen acute pancreatitis (AP)-associated local and systemic injury. The pancreas expresses pancreatic triacylglycerol lipase (PNLIP), pancreatic lipase-related protein 2 (PNLIPRP2), and carboxyl ester lipase (CEL), which may leak into the visceral fat or systemic circulation during pancreatitis. We, thus, aimed to determine the pancreatic lipase(s) regulating lipotoxicity during AP. For this AP, associated fat necrosis was analyzed using Western blot analysis. Bile acid (using liquid chromatography-tandem mass spectrometry) and fatty acid (using gas chromatography) concentrations were measured in human fat necrosis. The fat necrosis milieu was simulated in vitro using glyceryl trilinoleate because linoleic acid is increased in fat necrosis. Bile acid requirements to effectively hydrolyze glyceryl trilinoleate were studied using exogenous or overexpressed lipases. The renal cell line (HEK 293) was used to study lipotoxic injury. Because dual pancreatic lipase knockouts are lethal, exocrine parotid acini lacking lipases were used to verify the results. PNLIP, PNLIPRP2, and CEL were increased in fat necrosis. Although PNLIP and PNLIPRP2 were equipotent in inducing lipolysis and lipotoxic injury, CEL required bile acid concentrations higher than in human fat necrosis. The high bile acid requirements for effective lipolysis make CEL an unlikely mediator of lipotoxic injury in AP. It remains to be explored whether PNLIP or PNLIPRP2 worsens AP severity in vivo.
Asunto(s)
Necrosis Grasa/enzimología , Grasa Intraabdominal/enzimología , Lipasa/metabolismo , Pancreatitis/enzimología , Animales , Necrosis Grasa/inducido químicamente , Necrosis Grasa/genética , Necrosis Grasa/patología , Técnicas de Silenciamiento del Gen , Células HEK293 , Humanos , Grasa Intraabdominal/patología , Ácido Linoleico/toxicidad , Lipasa/genética , Masculino , Ratones , Pancreatitis/inducido químicamente , Pancreatitis/genética , Pancreatitis/patologíaAsunto(s)
Adyuvantes Inmunológicos/efectos adversos , Necrosis Grasa/inducido químicamente , Interferon beta-1b/efectos adversos , Esclerosis Múltiple Recurrente-Remitente/tratamiento farmacológico , Adyuvantes Inmunológicos/uso terapéutico , Adulto , Necrosis Grasa/diagnóstico , Femenino , Humanos , Interferon beta-1b/uso terapéuticoAsunto(s)
Absceso/inducido químicamente , Apomorfina/efectos adversos , Agonistas de Dopamina/efectos adversos , Necrosis Grasa/inducido químicamente , Absceso/complicaciones , Apomorfina/uso terapéutico , Agonistas de Dopamina/uso terapéutico , Necrosis Grasa/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Enfermedad de Parkinson/tratamiento farmacológico , Tejido SubcutáneoAsunto(s)
Antineoplásicos/efectos adversos , Axitinib/efectos adversos , Carcinoma de Células Renales/tratamiento farmacológico , Necrosis Grasa/inducido químicamente , Neoplasias Renales/tratamiento farmacológico , Sirolimus/análogos & derivados , Grasa Subcutánea/efectos de los fármacos , Anciano , Brazo , Humanos , Masculino , Sirolimus/efectos adversosRESUMEN
Regorafenib is a second-generation multikinase inhibitor that is approved for the treatment of metastatic colon cancer and advanced gastrointestinal stromal tumors. Hand-foot skin reaction, alopecia, and oral mucositis are well-established side effects of this medication. Herein, we discuss a 60-year-old woman who developed a lobular and septal granulomatous panniculitis after six months of therapy with regorafenib. Biopsy demonstrated focal lobular and septal granulomatous inflammation admixed with septal fibrosis and lobular lymphohistiocytic infiltrate associated with fat necrosis. To our knowledge, regorafenib-induced panniculitis has not been previously described. Increased awareness of this presentation can facilitate more timely diagnosis and treatment.
Asunto(s)
Antineoplásicos/efectos adversos , Neoplasias Gastrointestinales/patología , Tumores del Estroma Gastrointestinal/tratamiento farmacológico , Dermatosis de la Pierna/inducido químicamente , Paniculitis/inducido químicamente , Neoplasias Peritoneales/tratamiento farmacológico , Compuestos de Fenilurea/efectos adversos , Piridinas/efectos adversos , Necrosis Grasa/inducido químicamente , Necrosis Grasa/patología , Femenino , Tumores del Estroma Gastrointestinal/secundario , Humanos , Dermatosis de la Pierna/patología , Persona de Mediana Edad , Paniculitis/patología , Neoplasias Peritoneales/secundario , Piel/patologíaRESUMEN
Mujer de 59 años de edad, la cual cuenta con antecedente de aplicación de material oleoso en los glúteos hace 11 años; posteriormente hace 18 meses comienza con cuadro de poliartritis aditivas simétricas, así como afección en las vías aéreas superior e inferior, sin evidencia de alteración por granulomatosis con poliangitis (Wegener). Presenta en suero autoanticuerpos, y se toma biopsia de piel donde se observa granuloma por cuerpo extraño. Se concluye con síndrome autoinmune/inflamatorio inducido por adyuvante, en el que la afección pulmonar es una manifestación atípica en la presentación inicial de la enfermedad (AU)
A 59-year-old female with a history of injection of an oily material in the buttocks 11 years ago. She developed symmetric additive polyarthritis as well as superior and inferior airways involvement. There was no evidence of granulomatosis with polyangiitis (Wegener). She had several serum autoantibodies and a skin biopsy showed a foreign body granuloma. The diagnosis of adjuvant induced autoimmune/inflammatory syndrome was made. The pulmonary involvement was an atypical manifestation at the onset of disease (AU)
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Enfermedades Autoinmunes/inducido químicamente , Enfermedades Autoinmunes/complicaciones , Granulomatosis Linfomatoide/inducido químicamente , Granulomatosis Linfomatoide/complicaciones , Artritis/complicaciones , Artritis/fisiopatología , Adyuvantes Farmacéuticos/efectos adversos , Prednisona/uso terapéutico , Factor Reumatoide , Poliangitis Microscópica/inducido químicamente , Poliangitis Microscópica/complicaciones , Biopsia , Necrosis Grasa/inducido químicamente , Necrosis Grasa/complicaciones , Cuerpos Extraños/inducido químicamente , Cuerpos Extraños/complicacionesAsunto(s)
Anticoagulantes/efectos adversos , Calcifilaxia/inducido químicamente , Enfermedades de la Piel/inducido químicamente , Warfarina/efectos adversos , Desbridamiento , Progresión de la Enfermedad , Necrosis Grasa/inducido químicamente , Necrosis Grasa/cirugía , Femenino , Humanos , Persona de Mediana Edad , Enfermedades de la Piel/patologíaRESUMEN
BACKGROUND: Fat necrosis is one of the most common complications following free flap breast reconstruction. Although a minor complication, fat necrosis can compromise esthetic results and confuse with cancer recurrence. Perfusion-related factors and post-operative radiotherapy are the known risks. However, the influence of adjuvant chemotherapy on fat necrosis prevalence remains unknown. METHODS: Our initial experience of 88 consecutive breast reconstructions with free abdominal flaps was reviewed. The prevalence of fat necrosis was recorded and the risk factors were analyzed using univariate and multivariate logistic regression models. RESULTS: The overall prevalence of fat necrosis was 36.4% in this series. In a multivariate logistic regression model, adjuvant chemotherapy significantly increased the risk of fat necrosis. The relative risk was 4.762 (95% confidence interval (CI), 1.767-12.831; p = 0.002). There was no evidence of a specific chemotherapeutic agent causing fat necrosis. The first cycle of adjuvant chemotherapy was frequently delivered earlier in patients with fat necrosis than those without fat necrosis, although this tendency was not statistically significant. CONCLUSIONS: Our initial experience with free flap breast reconstruction seems to suggest that chemotherapy may increase the risk of fat necrosis following immediate breast reconstruction. Patients should be fully informed, and the initiation of post-operative chemotherapy may be adjusted accordingly.
Asunto(s)
Músculos Abdominales/trasplante , Antineoplásicos/efectos adversos , Neoplasias de la Mama/cirugía , Necrosis Grasa/inducido químicamente , Colgajos Tisulares Libres/efectos adversos , Mamoplastia/efectos adversos , Pared Abdominal/cirugía , Adulto , Mama/cirugía , Quimioterapia Adyuvante/efectos adversos , Necrosis Grasa/etiología , Femenino , Colgajos Tisulares Libres/irrigación sanguínea , Colgajos Tisulares Libres/patología , Humanos , Mamoplastia/métodos , Persona de Mediana Edad , Factores de RiesgoAsunto(s)
Carcinoma Hepatocelular/terapia , Quimioembolización Terapéutica/efectos adversos , Doxorrubicina/efectos adversos , Necrosis Grasa/inducido químicamente , Neoplasias Hepáticas/terapia , Grasa Subcutánea/patología , Anciano , Biopsia con Aguja , Carcinoma Hepatocelular/patología , Quimioembolización Terapéutica/métodos , Doxorrubicina/administración & dosificación , Portadores de Fármacos , Necrosis Grasa/patología , Necrosis Grasa/cirugía , Estudios de Seguimiento , Arteria Hepática/diagnóstico por imagen , Humanos , Inmunohistoquímica , Neoplasias Hepáticas/patología , Angiografía por Resonancia Magnética/métodos , Masculino , Monitoreo Fisiológico/métodos , Estadificación de Neoplasias , Radiografía , Medición de Riesgo , Ombligo/patología , Ombligo/cirugíaRESUMEN
Nicolau Syndrome (NS) is a rare but severe localized adverse reaction at the site of intramuscular drug injection. The typical presentation is intense pain around the injection site soon after injection, followed by erythema, purplish network discolouration of the skin, haemorrhagic patch, and finally tissue necrosis. Here in, we report a 9 years old boy, the third Nicolau Syndrome (NS) reported from Iran after a single intramuscular injection of penicillin.
Asunto(s)
Erupciones por Medicamentos/etiología , Necrosis Grasa/inducido químicamente , Músculo Esquelético/patología , Penicilinas/efectos adversos , Piel/patología , Niño , Diagnóstico Diferencial , Erupciones por Medicamentos/diagnóstico , Necrosis Grasa/patología , Humanos , Inyecciones Intramusculares/efectos adversos , Imagen por Resonancia Magnética , Masculino , Penicilinas/administración & dosificación , SíndromeAsunto(s)
Trastornos Relacionados con Cocaína/complicaciones , Cocaína/efectos adversos , Fascia/efectos de los fármacos , Necrosis Grasa/inducido químicamente , Grasa Subcutánea/efectos de los fármacos , Vasoconstrictores/efectos adversos , Cocaína/administración & dosificación , Fascia/patología , Humanos , Drogas Ilícitas/efectos adversos , Inyecciones Intravenosas , Masculino , Persona de Mediana Edad , Necrosis/inducido químicamente , Grasa Subcutánea/patología , Vasoconstrictores/administración & dosificaciónAsunto(s)
Neoplasias de la Mama/secundario , Colorantes/efectos adversos , Necrosis Grasa/inducido químicamente , Biopsia del Ganglio Linfático Centinela/métodos , Colorantes/administración & dosificación , Necrosis Grasa/patología , Femenino , Humanos , Inyecciones , Metástasis Linfática , Persona de Mediana EdadRESUMEN
HYPOTHESIS: Methylene blue and isosulfan blue perform similarly in the sentinel node procedure. DESIGN: Retrospective medical record review. SETTING: County hospital with surgical residency. PATIENTS: A total of 194 patients underwent the sentinel node procedure. INTERVENTION: Sentinel node procedure with methylene blue or isosulfan blue. MAIN OUTCOME MEASURES: The identification rate, number of sentinel nodes identified, clinicopathologic variables, adverse effects, and complications were compared between the 2 groups. RESULTS: The sentinel node identification rate was similar between the 2 groups (99.1% with methylene blue and 100.0% with isosulfan blue). Slightly more sentinel nodes were identified using methylene blue (mean, 2.7 vs 2.1; P = .03). No allergic reactions were seen. Significantly more patients experienced a change in pulse oximetry readings, a wider range of pulse oximetry reduction, and a greater mean decrease in pulse oximetry readings with isosulfan blue than with methylene blue. No skin complications were seen in either group. A palpable mass occurred at the site of methylene blue injection in 8.2% of patients. CONCLUSIONS: The sentinel node identification rate was similar with methylene blue and with isosulfan blue. Methylene blue has significant advantages with respect to product cost, absence of anaphylactic reactions, and lack of interference with pulse oximetry. However, awareness is necessary of the possibility of injection site mass after methylene blue injection.
Asunto(s)
Neoplasias de la Mama/secundario , Necrosis Grasa/inducido químicamente , Azul de Metileno/efectos adversos , Colorantes de Rosanilina , Biopsia del Ganglio Linfático Centinela/métodos , Colorantes/administración & dosificación , Necrosis Grasa/patología , Femenino , Humanos , Inyecciones , Metástasis Linfática , Azul de Metileno/administración & dosificación , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Colorantes de Rosanilina/administración & dosificaciónRESUMEN
OBJECTIVE: Somatostatin analogues are the most commonly used drugs for treatment of acromegaly. Known side effects include gastrointestinal reactions, cholelithiasis, effects on glucose metabolism, and mild reactions at injection sites. We report a patient who developed fat and skin necroses after injections of a depot somatostatin analogue. SUBJECT: A woman with active acromegaly was given deep subcutaneous injections of an extended release formulation of lanreotide at alternate sides of the buttocks on three occasions over a ten week period. The regimen was then discontinued due to gastrointestinal complaints. One month later indurated subcutaneous nodules appeared at both sites. After another two months, the patient presented 10×10 cm lesions on the buttocks, with central erythematous zones and, at the site of two injections, a necrotic 5×3 cm ulcer. There were no signs of infection or systemic diseases. MRI revealed bilateral fat necroses. A month later, an ulcer developed at the second site. The ulcers were managed conservatively until clear demarcations were obtained, where after surgical revisions were performed. Eight months after the last injection, the wounds could be closed. CONCLUSION: The fat and skin necroses represent a side-effect not previously described after deep subcutaneous injections. Possibly, the patient had an exceptional susceptibility to develop an inflammatory, foreign-body like reaction that hypothetically was aggravated by a sustained anti-angiogenic effect of the compound.