Introduction and importance Littoral cell angioma is a rare solid spleen tumor with uncertain malignant potential. It is usually asymptomatic; therefore, its diagnosis is usually incidental. There are approximately 150 cases reported in the medical literature, but none of them in the Hispanic population. Case presentation We present a case of a 54-year-old woman who presented to our clinic with nonspecific abdominal pain. Imaging studies show a splenic mass with littoral cell angioma characteristics. The patient underwent an open splenectomy with subsequent histopathologic and immunohistochemical studies that confirmed the presence of a littoral cell angioma of a diameter of 8 × 4.5 × 3.5 cm. The patient was discharged after an uneventful postoperative recovery and was referred to the outpatient clinic for follow up. Clinical discussion This case report highlights the close relationship between the littoral cell angioma, neoplasias, and autoimmune diseases. Even though LCA has a good prognosis, there is still the possibility of malignant transformation, especially when the spleen weighs 1500 g; our patient's sample pointed towards a benign pathology. LCA has a positive IHC for endothelial and histiocyte tissues. The IHC results of our patient were positive for CD34 + and CD68 + , confirming the LCA diagnosis. Conclusion Within red pulp spleen tumors, LCA should be highly considered as a differential diagnosis in all types of populations. In the case of a confirmed LCA, routine screening for neoplasias and autoimmune diseases should be performed.
Purpose: The effect of high altitude ( ≥ 1500 m) and its potential association with mortality by COVID-19 remains controversial. We assessed the effect of high altitude on the survival/discharge of COVID-19 patients requiring intensive care unit (ICU) admission for mechanical ventilation compared to individuals treated at sea level. Methods: A retrospective cohort multi-center study of consecutive adults patients with a positive RT-PCR test for COVID-19 who were mechanically ventilated between March and November 2020. Data were collected from two sea-level hospitals and four high-altitude hospitals in Ecuador. The primary outcome was ICU and hospital survival/discharge. Survival analysis was conducted using semi-parametric Cox proportional hazards models. Results: Of the study population (n = 670), 35.2% were female with a mean age of 58.3 ± 12.6 years. On admission, high-altitude patients were more likely to be younger (57.2 vs. 60.5 years old), presented with less comorbidities such as hypertension (25.9% vs. 54.9% with p-value <.001) and diabetes mellitus (20.5% vs. 37.2% with p-value <.001), less probability of having a capillary refill time > 3 sec (13.7% vs. 30.1%, p-value <.001), and less severity-of-illness condition (APACHE II score, 17.5 ± 8.1 vs. 20 ± 8.2, p < .01). After adjusting for key confounders high altitude is associated with significant higher probabilities of ICU survival/discharge (HR: 1.74 [95% CI: 1.46-2.08]) and hospital survival/discharge (HR: 1.35 [95% CI: 1.18-1.55]) than patients treated at sea level. Conclusions: Patients treated at high altitude at any time point during the study period were 74% more likely to experience ICU survival/discharge and 35% more likely to experience hospital survival/discharge than to the sea-level group. Possible reasons for these findings are genetic and physiological adaptations due to exposure to chronic hypoxia.
Background The number of Hansen's disease cases in Latin America and the Caribbean has decreased in the last decade; nevertheless, the region is still struggling with infections caused by Mycobacterium leprae. This is a case report that portrays the diagnostic and management challenges associated with atypical uveitic glaucoma that is due to Hansen's disease. Case presentation A 62-year-old female was referred with a 2-year history of anterior uveitis of unknown etiology and ocular hypertension. Past medical history and general physical examination were unremarkable. Upon ocular examination, her best-corrected visual acuity (BCVA) was 20/25 in the OD and 20/60 in the OS. Tonometry showed intraocular pressures (IOPs) of 29 mmHg and 22 mmHg in her right and left eyes, respectively. The slit-lamp examination showed clinical signs of bilateral granulomatous anterior uveitis and cataracts; gonioscopy revealed open angles with some peripheral anterior synechiae for both eyes. Fundus examination and glaucoma tests revealed mild glaucomatous damage in the right eye. Given the presentation of uveitis, the respective questionnaire was completed by internal medicine and rheumatology. Four months later, after bilateral cataract surgery, the patient developed skin plaques on the face, neck, upper back, and extremities, which were biopsied and identified as positive for tuberculoid leprosy. Conclusion This is the first case report in Ecuador of atypical glaucoma triggered by infectious uveitis produced by Mycobacterium leprae . We describe a female patient's clinical presentation with several ocular signs of leprosy and other nonspecific and rarely seen symptoms. Uveitis is a condition that often requires a multidisciplinary team of ophthalmologists and clinicians because of the possible manifestation of an underlying systemic disease, creating a challenge for all the medical personnel involved in the management of the case.
Unchecked hyperadiposity causes systemic metabolic perturbations and subclinical chronic inflammation, promoting hormone receptor positive (HR+) breast cancer. Murine models of high-fat diet-induced obesity have shown alterations in proteins involved in fatty acid binding and mitochondrial beta-oxidation, including enoyl-CoA hydratase short chain 1 (ECHS1), which promote increased uptake of fatty acids by primary tumor cells. This creates a metabolic tug of war between tumor and immune cells in the tumor microenvironment, thereby depriving cytotoxic immune cells of the metabolic reprogramming for anti-tumor functionality. Nonetheless, metabolic gene expression changes in breast tumor microenvironment of obese individuals remain elusive. We hypothesize that increased expression of ECHS1 leads to immune dysregulation in breast tumor microenvironment and increases risk of cancer progression. Proteomic and genomic expression and survival characteristics of ECHS1 in invasive breast cancer was explored in The Cancer Genome Atlas (TCGA) and the Clinical Proteomic Tumor Analysis Consortium. We the modeled the effects of ECHS1 expression on immune infiltration in the tumor microenvironment using a regression framework. We also performed single cell RNA sequencing analysis for differential expression of ECHS1 in various human breast cells. Additionally, expression level of ECHS1 was validated in silico in adipose tissue to elucidate increased immune dysregulation and risk of progression of breast carcinoma in obese individuals. We found a significantly increased expression of ECHS1 at both RNA and protein levels in HR+ breast cancer (p<0.001 for both), compared to Herceptin 2 receptor-positive or triple negative breast cancer. High expression of ECHS1 in female breast cancer is also associated with significantly decreased survival based on the TCGA data. Further, we found a significantly negative correlation of CD8+ T cells, neutrophils, and macrophages, and a significantly positive correlation of regulatory T cells with ECHS1 expression in the breast tumor microenvironment. We discovered increased expression of ECHS1 in luminal epithelial cells compared to myoepithelial cells based on single cell RNA sequencing. Lastly, high expression of ECHS1 protein expression based on immunohistochemistry was confirmed in human adipocytes. Collectively, our observations support the hypothesis that preferential uptake of free fatty acid through increased expression of ECHS1 in HR+ breast cancer impairs cytotoxic and anti-tumor effects of CD8+ T cells in the tumor microenvironment. Immune dysregulation is further amplified in obese individuals given increased levels of adipose cells and higher ECHS1 expression. Altogether, ECHS1 is a putative biomarker and potential therapeutic target as its downregulation may improve survival in obese patients with HR+ breast cancer. Citation Format: Tina Bharani, Divyansh Agarwal, Estefania Roldan-Vasquez, Jessalyn Ubellacker, Ted A. James. ECHS1 mediates metabolic disruption in hormone receptor-positive breast tumor microenvironment [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1270.
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