Endoscopic Treatment of Solitary Colonic Ganglioneuroma.

Ganglioneuromas (GNs) in adults are uncommon clinical entities, especially in the colon. Patients with GNs without multiple endocrine neoplasia or neurofibromatosis-I are normally asymptomatic; however, GNs can present with abdominal pain, weight loss, bleeding, and anemia, depending on the size and location. Here, we present a case of solitary colonic GN treated with endoscopic mucosal resection. A 40-year-old Japanese outpatient with a positive fecal occult blood test visited our hospital. We performed diagnostic colonoscopy, which revealed a polyp of 15-mm diameter in the ascending colon. Electromagnetic resonance imaging was performed, and the histological examination revealed benign polypoid spindle-cell proliferation, ganglion cells, and thick nerve bundles, which was positive for S-100 protein immunoreactivity consistent with GN.

Pathological Findings in Male Patients With Anti-N-methyl-d-Aspartate Receptor Encephalitis.

Anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis is the most common type of autoimmune encephalitis. The disease predominantly affects women (1:5-1:10), with only 3 reports of autopsy findings in women being published to date. The present study reports findings from the first autopsy performed on a man with anti-NMDAR encephalitis. The patient had some scattered lesions in the limbic system with neuronal loss, gliosis, and microglial activation. The temporal and frontal cortices showed additional patchy demyelination. T-lymphocyte infiltration was detectable in the fusiform gyrus lesion. These findings were partly similar to those reported in female patients. Although clinical differences based on the sex of the patient are reported for this disease, the observed pathological similarities potentially help to establish common therapeutic strategies for all patients. Severe testicular damage was additionally observed in the male patient in this study. Biopsy-proven severe testicular damage was also confirmed in another, previously fertile man who became azoospermic. Moreover, serum follicle-stimulating hormone levels, which often increased in response to disturbed spermatogenesis, were elevated, and testosterone/luteinizing hormone ratio reflecting Leydig cell function was low in all 5 male patients in this study. Overall, these findings suggest similar brain pathology in patients of both sexes and severe testicular damage in male patients.

Unusual Case of Cardiac Amyloidosis Preceded by a Twenty-year History of Dilated Cardiomyopathy and Heart Failure.

Amyloidosis is a well-known but uncommon disease, and the physician must maintain a high index of suspicion in order to make a timely diagnosis. The expected survival of patients with cardiac amyloidosis is generally poor. In particular, survival has been reported to be 4-12 months for patients with amyloid light-chain amyloidosis with congestive heart failure. We herein report a rare case of cardiac amyloidosis in which the patient presented with cardiac hypertrophy after a 20-year history of dilated cardiomyopathy and heart failure.

Primary leiomyosarcoma of the colon.

Primary leiomyosarcomas of the gastrointestinal (GI) tract are extremely rare and highly aggressive neoplasms, and only a small number of true cases have been reported since the concept of GI stromal tumors was established. Here, we report a case of a primary leiomyosarcoma of the transverse colon. A 46-year-old Japanese male with a large mass in the right upper abdomen was admitted to our hospital. Computed tomography and magnetic resonance imaging revealed long segments of wall thickening of the transverse colon with large consecutive tumors measuring 12 cm in diameter. A projecting irregular mass with marked mucosal necrosis was found on colonoscopy. Pathological examination revealed a spindle cell tumor growing circumferentially and transmurally to replace the muscularis propria in the transverse colon. The spindle cells were positive for smooth muscle actin, and negative for KIT, CD34, DOG-1, and S-100 protein. The patient has shown repeat recurrence in spite of sufficient surgical excision being promptly performed.

[Cyst of the tunica albuginea testis : a case report].

This report concerns a case of cyst of the tunica albuginea testis in a 74-year-old man, who presented with a painful swelling of right scrotal contents. Magnetic resonance imaging (MRI) and ultrasonography revealed a cystic mass on the surface of the right testicle. We performed resection of the cystic wall. The histological findings indicated cyst of the tunica albuginea testis. In this series, we collected 30 cases in the Japanese literature.

[Granulocyte-colony stimulating factor-producing urothelial carcinoma of the renal pelvis : a case report].

A 43-year-old woman was referred to our hospital for fever, general fatigue and left flank abdominal pain during the last two weeks. A blood test showed severe inflammation, and computed tomography (CT) study of the abdomen with intravenous contrast revealed swelling and irregular enhancement in the upper left kidney. Initially, we diagnosed it as xanthogranulomatous pyelonephritis and treated it with antibiotics. A percutaneous renal biopsy was performed because the white blood cell count remained elevated after the treatment. Histopathologic examination revealed a carcinoma. Therefore, we performed left nephroureterectomy. The diagnosis was high grade urothelial carcinoma of the renal pelvis, and it stained positive by immunohistochemical staining using anti-granulocyte-colony stimulating factor (G-CSF). The serum G-CSF level was also elevated on the same day. The patient received chemotherapy but, died 9 months after surgery. A G-CSF-producing urothelial carcinoma of the renal pelvis is known to have a poor prognosis in the Japanese literature. It is important to closely monitor a G-CSF producing tumor, when a patient shows severe inflammation, but no infection.

Details of treatment-related difficulties in men with anti-N-methyl-D-aspartate receptor encephalitis.

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) antibody-associated encephalitis is an immunologic disease characterized by a female preponderance. Males are infrequently affected. The clinical symptoms of affected boys as well as girls have been summarized, and they have some clinical features distinct from those of adults. However, the characteristics of men have been described in only a few reports. We describe in detail four men with anti-NMDAR encephalitis who presented with several clinical features that complicated disease management and recovery, including venous thrombosis, bilateral hippocampal involvement, hypersexuality, and joint contracture. We also report the first detailed clinical information about a male patient who died of this disease. In addition, we summarize the clinical characteristics of five patients previously reported by others.