An unusual case of primary adenocarcinoma occurring in the inguinal region of an elderly woman is reported. It appeared to have arisen from the mesothelium of the canal of Nuck. It recurred and involved one inguinal lymph node three years after the diagnosis and seven years after the initial appearance of the mass. The absence of associated peritoneal tumor distinguishes this case from other reported primary malignant neoplasms of the hernial sac.

Celiac disease (CD) is a systemic autoimmune disease, which is triggered by gluten intake in genetically susceptible individuals. The most important serological markers used for CD diagnosis are test based on immunoglobulin (Ig) A isotype, being the determination of tissue anti-transglutaminase IgA (tTG) 2 the marker of choice for diagnosis. Selective IgA deficiency (SIgAD) is more prevalent in CD patients than in the general population, making the serologically diagnosis of the diseasedifficult. In the present descriptive observational study, 74 adult patients with a confirmed CD diagnosis were included and anti-tTG2 IgA was determined by using ELISA assay in order to detect those patients with undetermined or negative levels, which could present SIgAD. The total IgA level was determined in these patients and the mean concentration was 237.8 ± 100.6 mg/dL. In a female patient, total IgA was less than 7 mg/dL, with normal IgG and IgM levels, characteristic of SIgAD. Thus, the calculated frequency of SIgAD was 1.35% of the CD study population. In conclusion, this work is a first approach to describe the frequency of SIgAD in CD patients of the country and reaffirms the importance of including total IgA determination in the case of conducting IgA-based serological tests specific for CD.

Introduction: Celiac disease (CD) is an autoimmune enteropathy triggered by gluten ingestion in genetically susceptible individuals. In CD, activation of the immune response causes damage of the intestinal mucosa, and a gluten-free diet (GFD) is the only available therapy. Intestinal damage can lead to an increase in the circulation of components of bacteria from the intestinal lumen, such as lipopolysaccharide (LPS). Soluble CD14 (sCD14) and lipopolysaccharide-binding protein (LBP) participate in the recognition of LPS, and their levels are altered in different pathologies. In the present study, the circulating levels of sCD14 and LBP from untreated CD patients were evaluated and compared to CD patients on a GFD and controls.Material and methods: In total seventy-two adult patients with CD, twenty-three untreated CD patients and forty-nine on a GFD were included. In addition, fifty-five healthy individuals were included as controls. Additionally, the effect of LPS on sCD14 production by both normal and inflamed intestinal tissue culture was explored.Results: Serum levels of sCD14 were found to be significantly increased in untreated CD patients compared to patients on a GFD and controls. In addition, we found that LPS induced the production of sCD14 by biopsies of intestinal tissue from untreated CD patients. Conclusions:The data from this study show that circulating levels of sCD14 are increased in the untreated CD patients compared to patients on a GFD. Our data show that LPS induces the production of sCD14 by the intestinal tissue from untreated CD patients.

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Fecha de envío 19/10/21 Fecha de aprobación 01/12/21 Palabras claves enfermedad celíaca, dieta, libre de gluten, inflamación, citoquinas, interferón gamma. ResumenIntroducción: La enfermedad celíaca (EC) es una enteropatía crónica autoinmune, con inflamación principal a nivel del intestino delgado, gatillada por la exposición al gluten de la dieta en individuos genéticamente susceptibles. Las citoquinas inflamatorias se encuentran implicadas en la patogénesis de la EC, entre ellas una citoquina relevante es el interferón gamma (IFN-γ). Los niveles de esta citoquina se encuentran alterados en la EC y se relaciona con daños a la mucosa intestinal. La dieta libre de gluten (DLG) es el único tratamiento efectivo para la EC. Objetivo: Determinar el efecto de una DLG sobre los niveles circulantes de IFN-γ en pacientes adultos paraguayos con EC. métodos: Se incluyeron 40 pacientes con EC, de los cuales 20 no presentaban DLG debido a su diagnóstico reciente y 20 presentaban una DLG. Además, se incluyeron 15 sujetos controles aparentemente sanos. Resultados: Los pacientes con EC sin DLG presentaron niveles séricos de IFN-γ aumentados respecto al grupo control. Contrariamente, los pacientes con DLG no presentaron diferencias en los niveles de la citoquina al comparar con el grupo control. Conclusión: Los niveles séricos de la citoquina pro-inflamatoria IFN-γ se encontraron elevados en los pacientes adultos con EC sin una DLG en comparación a individuos controles, lo cual aporta información sobre el proceso inflamatorio presente en este grupo de pacientes. Effect of gluten-free diet on interferon gamma (IFN-γ) levels in patients with celiac