Prolonged infective SARS-CoV-2 omicron variant shedding in a patient with diffuse large B cell lymphoma successfully cleared after three courses of remdesivir.

We report a case of prolonged shedding of the infective SARS-CoV-2 omicron variant BA.1.1.2 in a 79-year-old male patient with diffuse large B-cell lymphoma, after receiving chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP). The patient was admitted to our hospital in late March 2022 for the sixth course of R-CHOP chemotherapy. Initially, the patient tested negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using an in-hospital loop-mediated amplification assay with a nasopharyngeal swab, both on the day of admission and three days later. However, the patient developed fever and was diagnosed with coronavirus disease (COVID-19) six days after admission and was suspected to have contracted the infection in the ward. Viral shedding continued for more than three months, with confirmed viral infectivity. As compared to the original Wuhan-Hu-1/2019 strain, amino acid substitutions including S36 N in non-structural protein (NSP)2, S148P, S1265del and L1266I in NSP3, G105D in NSP4, G496S, A831V, or V987F in spike protein, and I45T in open-reading frame (ORF)9b were randomly detected in isolated viruses. Although the patient had received two doses of the BNT162b2 vaccine approximately six months earlier and the third dose on day 127 after the infection, both serum anti-spike and anti-nuclear protein IgG and IgM tests were negative at day 92, 114, and 149 after the infection. The patient finally cleared the virus after the third course of remdesivir and did not have further recurrence.

Inflammatory Hepatocellular Adenoma with Elevated Serum Protein Induced by Vitamin K Absence/Antagonist-II in Adult Males.

Two men (24 and 34 years of age) with a single hypervascular liver tumor were admitted to our hospital. The tumors were diagnosed as hepatocellular adenoma (HCA) by an ultrasound-guided biopsy and classified as inflammatory type by immunohistochemical staining. Considering the risk of malignant transformation, they underwent surgical resection. Although the serum levels of protein induced by vitamin K absence/antagonist-II (PIVKA-II) were slightly elevated, they normalized after the resection. The diagnosis of HCA including malignant transformation is often difficult by image findings alone. Careful immunohistochemical examinations are very useful for the diagnosis and classification of subgroups, including malignant transformation. In addition, we proved that HCA without malignant transformation expresses PIVKA-II.

[A case of complete response after neoadjuvant chemotherapy for advanced esophageal cancer with low-dose FP therapy].

The patient was a 58-year-old man complaining of vomit and body-weight loss of 10 kg with advanced lower thoraco-abdominal esophageal cancer, which was 9 cm in length and with a maximum diameter of 5.5 cm on thoracic CT examination. Moderately differentiated squamous cell carcinoma diagnosed by pre-operative endoscopic biopsy. Low-dose FP therapy (continuous 5-FU div of 500 mg/day with intermittent CDDP div of 5 mg/day) was performed during 4 weeks as neoadjuvant chemotherapy. The side effect was little, and the tumor size was remarkably reduced. A histological complete response was diagnosed with no carcinoma cells evident in the resected specimen. The patient is alive and healthy with no relapse of the carcinoma 30 months after operation. We are first planning neoadjuvant chemotherapy, and then considering the additional radiotherapy after estimating the effect of chemotherapy. Low-dose FP therapy with low-dose cisplatin as a modulator does not show much side effect and is useful for esophageal cancer. We consider that the chemotherapy is more effective preoperatively than postoperatively because it preserves the feeding vessels for transporting the medicine to the focus of the disease.

A case of annular pancreas in a male adult.

Annular pancreas is a rare congenital anomaly, which consists of a ring of pancreatic tissue partially or completely encircling the descending portion of the duodenum. We reported a case of symptomatic annular pancreas in a 40 year old man admitted to our hospital complaining of abdominal pain, nausea and vomiting without body weight loss in January 2000. The patient underwent laparoscopic cholecystectomy for acalculous cholecystitis in September 1996. Initially, he was diagnosed with duodenal stenosis due to a duodenal ulcer scar, but laboratory data showed no abnormalities. His symptoms did not improve with medication or endoscopic balloon dilatation. Duodenograpy revealed a narrow segment with a smooth mucosal surface in the 2nd portion of the duodenal loop in the duodenum, and a computed tomography (CT) scan demonstrated a thickened pancreas head around this narrow segment. We were therefore able to diagnose annular pancreas. A duodeno-duodenostomy was performed in March 2000. The patient's postoperative course was uneventful, and he was discharged from our hospital on the 19th postoperative day. Although define diagnosis of annular pancreas is frequently made at laparotomy, the development of a recurrent imaging modality might assist in the preoperative diagnosis.