Heterotopic bone formation with extramedullary haematopoiesis in a thyroid nodule.

The presence of mature bone and bone marrow in the thyroid gland is an exceedingly rare occurrence. Extramedullary haematopoiesis (EMH) and heterotopic bone formation (HBF) should be suspected when cytology of thyroid nodules reveals evidence of megakaryocytes or bone marrow fat, respectively. The cause of these abnormalities has not been fully elucidated, but the role of bone morphogenic factors (BMPs) in their pathogenesis has been suggested. Both EMH and HBF can be seen in both benign and malignant primary thyroid conditions, and although they have not been definitively associated with significant pathology, it is recommended that extension studies be considered in the event of these findings to rule out concomitant haematological conditions.

Multiple myeloma and light-chain amyloidosis: a rare presentation

ABSTRACT Introduction: Primary systemic amyloidosis is part of the spectrum of plasma cell neoplasms, in which immunoglobulin light chains are deposited in multiple organs. However, myopathic involvement along with respiratory failure and associated multiple myeloma is a rare condition. Clinical case: This paper presents the case of a patient with systemic light chain amyloidosis who was admitted due to myopathy with respiratory failure and adynamic ileus that required intensive care. Infiltration in skin and digestive tract was confirmed by histology. The patient presented with concomitant multiple myeloma with lytic bone lesions and myeloma kidney. The patient responded well to the CyBorD scheme (cyclophosphamide, bortezomib, dexamethasone), renal function was recovered and skin lesions decreased. However, gastrointestinal and myopathic involvement was difficult to manage, requiring ventilatory support and parenteral nutrition. Discussion: Clinicians may oversee this pathology, leading to advanced stages of the disease. Currently, new chemotherapy agents and autologous transplantation may increase the survival of these patients. Conclusion: AL amyloidosis has a wide spectrum of manifestations and should be considered in differentials to reach an early diagnosis and make it treatable.

RESUMEN Introducción. La amiloidosis sistémica primaria hace parte del espectro de neoplasias de células plasmáticas, donde las cadenas livianas de inmunoglobulina se depositan en múltiples órganos. El compromiso miopático con falla respiratoria y mieloma múltiple asociado es poco frecuente. Caso clínico. Se presenta el caso de un paciente con amiloidosis sistémica de cadenas livianas (AL) quien ingresó por miopatía con falla respiratoria e íleo adinámico, por lo que se llevó a la unidad de cuidados intensivos. Por histología se confirmó infiltración en piel y tracto digestivo y concomitantemente se presentó mieloma múltiple con lesiones óseas líticas y riñón de mieloma. El paciente tuvo buena respuesta al esquema CyBorD (ciclofosfamida, bortezomib, dexametasona), recuperó su función renal y tuvo disminución de las lesiones en piel. Sin embargo, el compromiso gastrointestinal y miopático fue difícil de manejar y se requirió soporte ventilatorio y nutrición parenteral. Discusión. El clínico puede pasar por alto esta patología, por lo que es probable llegar a fases avanzadas de la enfermedad. En la actualidad, con nuevos agentes de quimioterapia y trasplante autólogo, se puede aumentar la sobrevida de estos pacientes. Conclusión. La amiloidosis AL tiene un amplio espectro de manifestaciones y debe considerarse en los diagnósticos diferenciales a fin de hacer un diagnóstico precoz y hacerla una condición tratable.

Maternal serum omentin-1 profile is similar in humans and in the rat animal model.

Omentin-1 is an adipocytokine with anti-inflammatory activity that has been associated with different metabolic disorders. The aim of this study is to investigate the serum profiles of omentin-1 throughout human and rat pregnancy. Serum omentin-1 levels were determined by ELISA in a prospective cohort study of healthy pregnant women (n=40) during the three trimesters of pregnancy and in twenty healthy non-pregnant women during the follicular and luteal phase of the menstrual cycle. In addition, serum omentin-1 levels were measured in rats during different periods of pregnancy (gestational days 8, 12, 16, 19, and 21) and in an age-matched control (virgin) group of rats (n=12rats/group). Finally, immunohistochemistry was used to demonstrate the presence of omentin-1 protein in human and rat placenta. Omentin-1 immunoreactivity was detected in cytotrophoblasts, syncytiotrophoblasts, sparse Hofbauer cells, and endothelial cells of the stem villi of human placenta. Additionally, it was detected in the labyrinthine trophoblast and yolk sac layer of the rat placenta. Human and rat serum omentin-1 levels were significantly lower in the late gestational period when compared with the non-pregnant women and virgin rats (p<0.05). Serum omentin-1 changes were not significant throughout the gestation in both species (p>0.05). Human serum omentin-1 levels have an inverse relationship with triglyceride levels during pregnancy. Our findings have not determined the exact role of omentin-1 during pregnancy, concerning the metabolic control of triglycerides and other energy sources. Whether omentin-1 decrease implies a regulatory function is still not clear. Further studies are needed to address this issue and determine the role of omentin-1 in metabolic adaptations during normal human and rat pregnancy.