Bolesti brucha patria medzi pomerne časté symptómy u adolescentov. Príčiny, ktoré sa podieľajú na bolestiach brucha, sú pestré a tým aj diferenciálna diagnostika je pomerne rozsiahla a zložitá. To súvisí pravdepodobne s tým, že brucho zaberá pomerne veľkú oblasť, obsahuje množstvo orgánov, štruktúr, systémov vrátane lymfatických uzlín, ktoré generalizovane reagujú na infekciu, či nádorové ochorenia. V našej kazuistike opisujeme prípad 17-ročného pacienta s náhlymi bolesťami brucha, chudnutím, vracaním a ikterom. V rámci diferenciálnej diagnostiky sa realizovali laboratórne a zobrazovacie vyšetrenia so zameraním na pankreas a hepatobiliárny trakt, kde sa zobrazila zväčšená hlava a chvost pankreasu, peripankreatická lymfadenopatia s vedľajším nálezom drobných ložísk na obličkách. V úvode sa suponovala skôr hereditárna pankreatitída a pseudotumory na obličkách, vzhľadom na vek pacienta bol menej pravdepodobný tumor pankreasu a metastázy. Definitívna diagnóza bola stanovená odberom bioptických vzoriek pankreasu pomocou endosonografického vyšetrenia. Histologický a cytologický nález preukázal prítomnosť lymfocytárnych blastických buniek, charakteru CD20+ B-NHL, konštatovaný difúzny veľkobunkový B-lymfóm pankreasu (DLBCL – diffuse large B cell lymphoma). Staging ochorenia nepreukázal inflitráciu malígnych buniek v kostnej dreni a centrálnej nervovej sústave. Promptne stanovená diagnóza a podaná príslušná onkologická liečba (chemoterapia v kombinácii s monoklonálnou protilátkou) zabezpečila pacientovi návrat do každodenného života a je nevyhnutným predpokladom priaznivej prognózy pacienta.
Abdominal pain is a relatively common symptom in adolescents. The causes that contribute to abdominal pain are varied and the differential diagnosis is therefore rather extensive and complex. This is probably related to the fact that the abdomen extends over a relatively large area containing numerous organs, structures, and systems, including the lymph nodes which respond to infection or cancer in a generalized way. In our case report we present the case of a 17-year-old patient with sudden abdominal pain, weight loss, vomiting and jaundice. Laboratory and imaging examinations were performed, focusing on the pancreas and the hepatobiliary tract and showing an enlarged head and tail of the pancreas, peripancreatic lymphadenopathy with a secondary finding of small lesions on the kidneys. Firstly, we suspected hereditary pancreatitis and pseudotumors in the kidney, while pancreatic tumor and metastases were considered less likely, given the patient’s age. The definitive diagnosis was established by collecting biopsy samples from the pancreas via endosonographic examination. Histological and cytological findings showed the presence of lymphocyte blast cells of the CD20 + B-NHL nature, diagnosed as diffuse large B cell lymphoma (DLBCL). Staging of the disease showed no infiltration of malignant cells in the bone marrow and central nervous system. The prompt diagnosis and administration of appropriate oncological treatment (chemotherapy in combination with a monoclonal antibody) ensured the patient’s return to daily life and they were a necessary prerequisite for a favorable prognosis of the patient.
- MeSH
- bolesti břicha etiologie MeSH
- difúzní velkobuněčný B-lymfom * diagnóza patologie terapie MeSH
- lidé MeSH
- mladiství MeSH
- nádory slinivky břišní * diagnóza terapie MeSH
- pankreas diagnostické zobrazování patologie MeSH
- PET/CT metody MeSH
- protokoly antitumorózní kombinované chemoterapie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
It is well known that smoking is the risk factor in the development and clinical course of Crohn s disease (CD), but on the other hand, smoking is a protective factor against ulcerative colitis (UC). The pathways that are influenced by smoking in CD and UC are poorly understood. The aim of our study was to analyse the influence of smoking on the mRNA expression of cytokines in mucosa in patients with CD and UC. We performed a cross-sectional study. The cohort consisted of 86 IBD patients (48 CD patients and 38 UC patients) and took place at the IBD Centre at the University Hospital Bratislava-Ružinov. We took the demographic and clinical data of each patient, including information about their smoking habits. We performed a colonoscopy on each patient and took biopsies from both inflamed and non-inflamed sigma (CD, UC) and terminal ileum (CD). mRNA was extracted from mucosal biopsy samples for each cytokine and was normalized to a housekeeping gene (GAPDH). Finally, we compared the mRNA expression of target cytokines in the mucosa of smokers and non-smokers in IBD patients. Smokers with Crohn s disease have a significantly higher mRNA expression of pro-inflammatory cytokine TNF ? (p=0.003) in inflamed mucosa in sigma compared with non-smokers. In smokers with ulcerative colitis, we observed significantly higher mRNA expression of anti-inflammatory cytokine IL 10 (p=0.022) in non-inflamed mucosa of sigma. Similarly, smokers with UC have a significantly decreased mRNA expression of cytokine TLR 2 (p=0.024) and CCR1 (p=0.049) in non-inflamed mucosa of sigma. Based on our results, smoking has a positive influence on cessation and the clinical course of UC due to the stimulation of anti-inflammatory cytokine IL 10 in mucosa. On the other hand, smokers with CD have a higher expression of pro-inflammatory cytokine TNF ?, which could be associated with a worsening of the disease and response to therapy.
- MeSH
- Crohnova nemoc metabolismus MeSH
- cytokiny metabolismus MeSH
- dospělí MeSH
- kouření tabáku metabolismus MeSH
- lidé středního věku MeSH
- lidé MeSH
- messenger RNA metabolismus MeSH
- mladý dospělý MeSH
- průřezové studie MeSH
- senioři MeSH
- střevní sliznice metabolismus MeSH
- ulcerózní kolitida metabolismus MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
