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Local recurrence was reduced considerably due to the introduction of neoadjuvant chemoradiotherapy as treatment for locally advanced rectal cancer. However, certain proportions of patients would experience local recurrence inevitably; the lateral pelvic lymph node is the primary site of rectal cancer recurrence even after administering neoadjuvant chemoradiotherapy. It remains unknown whether lateral pelvic lymph node metastasis is considered as a locoregional disease or a distant metastasis. Although the oncologic stance of lateral pelvic lymph node metastasis is controversial, there is increasing research interest in evaluating the conditional benefit of lateral pelvic lymph node dissection in a subgroup of patients. Researchers reported an improvement in local control in patients with clinically suspected lateral pelvic lymph node metastasis before/or after neoadjuvant chemoradiotherapy who underwent lateral pelvic lymph node dissection. However, there is no clear consensus regarding the indication, diagnostic method, and extent of lateral pelvic lymph node dissection.
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Bone marrow adipose tissue (BMAT) increases with aging and once disregarded as a passive marrow space filler. However, accumulating evidence suggests that BMAT is an active modulator of bone, hematopoiesis, and metabolism. Characterization of BMAT in molecular and cellular levels identified that it is distinct from white or brown adipose tissue. This review summarizes current knowledge on changes of BMAT under physiological and pathophysiological conditions of bone and marrow. Expansion of BMAT is closely linked with increased fracture risk, therefore regulation of BMAT can be considered as a novel therapeutic approach to enhance bone strength. Regarding hematopoiesis, increase in BMAT is negatively associated with the marrow function, but it is indispensable for maintaining myelopoiesis in acute myeloid leukemia. In addition, BMAT expansion is paradoxically identified in obesity as well as anorexia nervosa. It is considered that BMAT performs a different function in different nutritional states. Future studies would involve more detailed research about regulatory factors of BMAT and its functions in health and diseases. Enhancing our understanding about BMAT would open a new avenue for combating BMAT-related diseases.
, Min Young Lee, You Won Choi, Hae Young Choi, Ji Yeon Byun Pancreatic panniculitis is a rare skin complication in which subcutaneous fat necrosis occurs in association with pancreatic disorders, most commonly acute or chronic pancreatitis. Erythematous subcutaneous nodules develop on the legs and spontaneously ulcerate or exude an oily substance. A 32-year-old Korean female patient presented with a 2-week-history of tender nodules with erythematous crusts on her left shin. She had a history of alcoholic liver cirrhosis and, 5 weeks earlier, had been diagnosed with acute pancreatitis. The histopathologic findings from a skin biopsy were consistent with lobular panniculitis, without signs of vasculitis, and diffuse fat necrosis. Basophilic calcium deposits were present in the dermis and subcutaneous fat. These findings were suggestive of pancreatic panniculitis. The skin lesion had a chronic course corresponding to repeated exacerbations of the patient’s pancreatitis. Thus, in the differential diagnosis of subcutaneous nodules, clinicians should consider pancreatic panniculitis as a cutaneous manifestation of pancreatic disease.
, Soon Sup Chung, Ryung-Ah Lee Citations
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