Despite the increased incidence of tuberculosis related to human immunodeficiency virus (HIV) in recent decades, pancreatic tuberculosis has rarely been described. We report a case of pancreatic tuberculosis in a 39-y...Despite the increased incidence of tuberculosis related to human immunodeficiency virus (HIV) in recent decades, pancreatic tuberculosis has rarely been described. We report a case of pancreatic tuberculosis in a 39-year- old African man who presented with progressive dysphagia, vomiting, weight loss and productive cough, accompanied by localized epigastric pain and one episode of melena. HIV-1 testing was positive and lymphocyte subset profile showed CD4 count of 9/mm3. Abdominal computed tomography (CT) scan with contrast revealed a cystic mass in the body of the pancreas, significant portal and retroperitoneal cystic adenopathy, and multiple cystic lesions in the spleen and liver. CT guided cyst aspiration and node biopsy detected Mycobacterium tuberculosis. The patient responded well on antituberculosis and antiretroviral therapy. Tuberculosis rarely involves the pancreas, probably due to the presence of pancreatic enzymes which interfere with the seeding of Mycobacterium tuberculosis. Pancreatic tuberculosis is considered to be the result of dissemination of the infection from nearby lymphatic nodes. Endoscopic ultrasound or CT guided fine needle aspiration for cytology is the recommended diagnostic technique. Although the prognosis is good with anti-tuberculosis treatment, it could be fatal without correct diagnosis and treatment. The clinician’s high index of suspicion of pancreatic tuberculosis and application of FNAB to obtain pathological evidence are extremely important to a correct diagnosis, especially in young HIV positive patients.展开更多
PTEN, a negative regulator of the phosphatidylinositol-3-kinase/AKT pathway, is an important modulator of insulin signaling. To determine the metabolic function of pancreatic Pten, we generated pancreas-specific Pten ...PTEN, a negative regulator of the phosphatidylinositol-3-kinase/AKT pathway, is an important modulator of insulin signaling. To determine the metabolic function of pancreatic Pten, we generated pancreas-specific Pten knockout （PPKO） mice. PPKO mice had enlarged pancreas and elevated proliferation of acinar cells. They also exhibited hypoglycemia, hypoinsulinemia, and altered amino metabolism. Notably, PPKO mice showed delayed onset of streptozotocin （STZ）-induced diabetes and sex-biased resistance to high-fat-diet （HFD）-induced diabetes. To investigate the mechanism for the resistance to HFD-induced hyperglycemia in PPKO mice, we evaluated AKT phosphorylation in major insulin-responsive tissues： the liver, muscle, and fat. We found that Pten loss in the pancreas causes the elevation of AKT signaling in the liver. The phosphorylation of AKT and its downstream substrate GSK3β was increased in the liver of PPKO mice, while PTEN level was decreased without detectable excision of Pten allele in the liver of PPKO mice. Proteomics analysis revealed dramatically decreased level of 78-kDa glucose-regulated protein （GRP78） in the liver of PPKO mice, which may also contribute to the lower blood glucose level of PPKO mice fed with HFD. Together, our findings reveal a novel response in the liver to pancreatic defect in metabolic regulation, adding a new dimension to understanding diabetes resistance.展开更多
Pancreatic tuberculosis (TB) is a relatively rare disease that can mimic carcinoma,lymphoma,cystic neoplasia,retroperitoneal tumors,pancreatitis or pseudocysts.Here,I report the case of a 31-year-old immigrant Burmese...Pancreatic tuberculosis (TB) is a relatively rare disease that can mimic carcinoma,lymphoma,cystic neoplasia,retroperitoneal tumors,pancreatitis or pseudocysts.Here,I report the case of a 31-year-old immigrant Burmese woman who exhibited epigastralgia,fever,weight loss and an epigastric mass.The patient was diagnosed with pancreatic TB and acquired immunodeficiency syndrome,and was treated with antituberculous drugs and percutaneous catheter drainage without a laparotomy.The clinical presentation,radiographic investigation and management of pancreatic TB are summarized in this paper to emphasize the importance of considering this rare disease in the differential diagnosis of pancreatic masses concomitant with human immunodeficiency virus infection.I also emphasize the need for both histopathological and microbiological diagnosis via fineneedle aspiration.展开更多
文摘Despite the increased incidence of tuberculosis related to human immunodeficiency virus (HIV) in recent decades, pancreatic tuberculosis has rarely been described. We report a case of pancreatic tuberculosis in a 39-year- old African man who presented with progressive dysphagia, vomiting, weight loss and productive cough, accompanied by localized epigastric pain and one episode of melena. HIV-1 testing was positive and lymphocyte subset profile showed CD4 count of 9/mm3. Abdominal computed tomography (CT) scan with contrast revealed a cystic mass in the body of the pancreas, significant portal and retroperitoneal cystic adenopathy, and multiple cystic lesions in the spleen and liver. CT guided cyst aspiration and node biopsy detected Mycobacterium tuberculosis. The patient responded well on antituberculosis and antiretroviral therapy. Tuberculosis rarely involves the pancreas, probably due to the presence of pancreatic enzymes which interfere with the seeding of Mycobacterium tuberculosis. Pancreatic tuberculosis is considered to be the result of dissemination of the infection from nearby lymphatic nodes. Endoscopic ultrasound or CT guided fine needle aspiration for cytology is the recommended diagnostic technique. Although the prognosis is good with anti-tuberculosis treatment, it could be fatal without correct diagnosis and treatment. The clinician’s high index of suspicion of pancreatic tuberculosis and application of FNAB to obtain pathological evidence are extremely important to a correct diagnosis, especially in young HIV positive patients.
基金This research was supported by grants from the Ministry of Ed- ucation （705001）, National Basic Research Program of China （973 Program 2009CB941200）, National Natural Science Foundation of China （30830061 and 30421004）, and a 111 project to H Deng. We thank Dr Tak Wah Mak （University of Alberta, Canada） for kindly providing the Ptern mice, Dr Guoqiang Gu （Vanderbilt University, USA） for kindly providing the plasmid of Pdxl-Cre, and Dr C Wright （Vanderbilt University, USA） for the PDX1 antibody. We thank the Model Animal Research Center of Nanjing University for B6 129-Gt（ROSA）26Sor tm/Sho/J mice and the Research Center for Proteome Analysis for proteomics analysis. We thank Dr Matt Stremlau, Dr Hui Zhang, Jun Cai, Han Qin, Jian Li, Yan Shi, Haisheng Zhou, and Fei Ye for their critical reading of the manu- script. We also thank Wei Jiang, Yushan Guo, Jie Yang, Chengyan Wang, Hui Zhang, and other colleagues in our laboratory for providing technical assistance and advice during the experiments.
文摘PTEN, a negative regulator of the phosphatidylinositol-3-kinase/AKT pathway, is an important modulator of insulin signaling. To determine the metabolic function of pancreatic Pten, we generated pancreas-specific Pten knockout （PPKO） mice. PPKO mice had enlarged pancreas and elevated proliferation of acinar cells. They also exhibited hypoglycemia, hypoinsulinemia, and altered amino metabolism. Notably, PPKO mice showed delayed onset of streptozotocin （STZ）-induced diabetes and sex-biased resistance to high-fat-diet （HFD）-induced diabetes. To investigate the mechanism for the resistance to HFD-induced hyperglycemia in PPKO mice, we evaluated AKT phosphorylation in major insulin-responsive tissues： the liver, muscle, and fat. We found that Pten loss in the pancreas causes the elevation of AKT signaling in the liver. The phosphorylation of AKT and its downstream substrate GSK3β was increased in the liver of PPKO mice, while PTEN level was decreased without detectable excision of Pten allele in the liver of PPKO mice. Proteomics analysis revealed dramatically decreased level of 78-kDa glucose-regulated protein （GRP78） in the liver of PPKO mice, which may also contribute to the lower blood glucose level of PPKO mice fed with HFD. Together, our findings reveal a novel response in the liver to pancreatic defect in metabolic regulation, adding a new dimension to understanding diabetes resistance.
文摘Pancreatic tuberculosis (TB) is a relatively rare disease that can mimic carcinoma,lymphoma,cystic neoplasia,retroperitoneal tumors,pancreatitis or pseudocysts.Here,I report the case of a 31-year-old immigrant Burmese woman who exhibited epigastralgia,fever,weight loss and an epigastric mass.The patient was diagnosed with pancreatic TB and acquired immunodeficiency syndrome,and was treated with antituberculous drugs and percutaneous catheter drainage without a laparotomy.The clinical presentation,radiographic investigation and management of pancreatic TB are summarized in this paper to emphasize the importance of considering this rare disease in the differential diagnosis of pancreatic masses concomitant with human immunodeficiency virus infection.I also emphasize the need for both histopathological and microbiological diagnosis via fineneedle aspiration.
