ABSTRACT
The role of interferon ß-1b (IFNß-1b), used for multiple sclerosis (MS) therapy, in cancer occurrence is uncertain. There is evidence supporting the role of human herpesvirus 4 [Epstein-Barr virus (EBV)] in thyroid cancer and MS. Simultaneous occurrence of papillary and medullary carcinomas is rare, and its association with MS in a young woman raises questions. A 46-year-old female patient was diagnosed with relapsing-remitting multiple sclerosis in 2008. In 2018, cervical MRI detected a thyroid nodule with right cervical adenopathy. Her thyroid function was normal, but increased calcitonin levels were found (70.53 pg/ml; normal value: <9.82 pg/ml). EBV serology tested positive. Paraclinical studies ruled out multiple endocrine neoplasia syndrome. Whole thyroid resection with whole cervical lymph node dissection was performed. To our knowledge, this is the first case that describes an association between MS and thyroid collision tumors. Histological examination ascertained both papillary and medullary thyroid cancer. After surgery, the calcitonin level normalized, and the patient received a therapeutic dose of iodine-131. IFNß-1b therapy was discontinued. The coexistence of thyroid cancers in MS patients could be explained by immune-mediated inflammation. Although EBV is not the only agent responsible for the development of MS or thyroid cancers, it could be considered a contributory factor in our case. Further research on EBV involvement in the occurrence of simultaneous immune pathologies in various organs is needed to confirm these data.
ABSTRACT
Although hypercoagulable states are most often associated with venous thromboses, arterial thromboses are reported in protein C, protein S, antithrombin deficient patients and in those with factor V Leiden, components of hereditary thrombophilia. Because these arterial thromboses (peripheral artery disease, myocardial infarction, and cerebral infarction) mostly affect young persons, aged below 45 years, it is important to test and treat these thrombophilic defects. Because the relation thrombophilia--arterial thromboses is still under debate, due to conflicting data, this article is a review of studies published in literature regarding the implication of the above-mentioned thrombophilic defects in cerebral infarcts.
Subject(s)
Antithrombin III Deficiency/complications , Brain Ischemia/blood , Brain Ischemia/etiology , Factor V/genetics , Protein C Deficiency/complications , Protein S Deficiency/complications , Stroke/blood , Stroke/etiology , Antithrombin III Deficiency/blood , Antithrombin III Deficiency/genetics , Blood Coagulation Disorders, Inherited/blood , Blood Coagulation Disorders, Inherited/complications , Blood Coagulation Disorders, Inherited/genetics , Brain Ischemia/genetics , Female , Humans , Male , Point Mutation , Pregnancy , Protein C Deficiency/blood , Protein C Deficiency/genetics , Protein S Deficiency/blood , Protein S Deficiency/genetics , Risk Factors , Stroke/genetics , Thrombophilia/blood , Thrombophilia/complications , Thrombophilia/geneticsABSTRACT
Deficiencies of natural anticoagulants protein C, protein S, antithrombin and activated protein C resistance are components of inherited thrombophilia. Inherited thrombophilia was defined as a genetically determined tendency towards venous thromboembolism, which characteristically occurs in young patients (before 40 to 45 years old), without apparent causes, and tend to recur. There have been many debates about the implication of these defects in arterial thromboses (peripheral artery disease, myocardial infarction, cerebral infarction) in the recent years. The screening for thrombophilia is recommended for young patients with spontaneous thromboses, arterial infarctions, family history of thromboses, personal history of recurrent abortions, with thrombosis of venous dural sinuses or strokes or myocardial infarctions, in patients with venous thrombosis in unusual sites, because the diagnosis of such a disease leads to a treatment that is lifesaving [1,2].
