Lymphangitis carcinomatosa from gallbladder cancer.

A 61-year-old woman was admitted to our hospital with productive cough and fever. Computed tomography images revealed ground glass opacities in both lung fields, and a space-occupying lesion in the gallbladder. Transbronchial lung biopsy revealed a poorly differentiated adenocarcinoma with invasion of the lymph ducts; accordingly, a diagnosis of lymphangitis carcinomatosa was made. We could not administer chemotherapy due to poor performance status, and the patient died of respiratory failure 30 days after admission. Owing to pathological autopsy findings of poorly differentiated adenocarcinoma in the gallbladder, we diagnosed this as a rare case of gallbladder cancer presenting with lymphangitis carcinomatosa.

[A CASE OF PROBABLE LATE-ONSET SYSTEMIC LUPUS ERYTHEMATOSUS WHERE THE INITIAL MANIFESTATION WAS A UNILATERAL PLEURAL EFFUSION].

A 74-year-old man developed with left pleural effusion and was suspected of benign asbestos pleural effusion and tuberculous pleurisy. Because of elevation of ADA level in the pleural effusion, diagnostic treatment for tuberculous pleurisy by anti-tuberculosis drugs was performed. However, right pleural effusion, cutaneous/mucosal lesions, leukocytopenia, and fever elevation occurred. The pathology of skin biopsy was consistent with systemic lupus erythematosus (SLE). Since clinical findings did not improve even after discontinuation of all drugs, he received steroid therapy was started and clinical findings improved. He was suspected of late-onset SLE. In conclusion, lupus pleurisy should also be differentiated when pleural effusion is seen in older. Late-onset SLE and drug-induced lupus should be carefully differentiated based on the clinical course.

[A CASE OF SUMMER-TYPE HYPERSENSITIVITY PNEUMONITIS DURING IMMUNOSUPPRESSIVE TREATMENT FOR SYSTEMIC SCLEROSIS].

A 70-year-old woman undergoing long-term treatment for systemic scleroderma and secondary Sjögren syndrome developed fever during tapering of steroids. Chest CT showed centrilobular granular shadow and ground glass opacities. The pathology of transbronchial lung biopsy and the findings of bronchoalveolar lavage fluid were consistent with hypersensitivity pneumonitis and positive for anti-Trichosporon asahii antibody. Because her symptoms and imaging findings improved after house cleaning, she was diagnosed with summertype hypersensitivity pneumonitis. When lung lesions are found in patients with collagen disease, it is necessary to distinguish various diseases. In particular, allergic diseases can be difficult to diagnose by steroid therapy. In order to make an accurate diagnosis, medical history and image interpretation should be performed carefully and histologically searched as much as possible.

The STOP-Bang Test Is Useful for Predicting the Severity of Obstructive Sleep Apnea.

INTRODUCTION: The STOP-Bang test was used to detect patients at high risk of obstructive sleep apnea (OSA). We evaluated the usefulness of the STOP-Bang test for predicting the severity of OSA in Japanese patients. METHODS: We retrospectively evaluated the patients who performed full polysomnography at the Mihara Medical Association Hospital. We evaluated the correlation between the STOP-Bang score and the apnea hypopnea index (AHI) using Spearman's rank correlation analysis. We then used multivariate analyses to examine the independent risk factor for severe OSA (AHI ≥ 30/hr). RESULTS: One hundred seven patients were diagnosed as no (n = 5), mild (n = 17), moderate (n = 30), and severe (n = 55) OSA. The median age was 67 years old (range: 35-84), and 73 of the 107 patients were males. The correlation coefficient between the STOP-Bang score and AHI was 0.701 (P < 0.001). A STOP-Bang score ≥ 5 had sensitivity of 80.0% and specificity of 76.9% for detecting severe OSA. A STOP-Bang score ≥ 5 and BMI ≥ 30 kg/m2 were the independent risk factor for severe OSA. CONCLUSIONS: The STOP-Bang score correlates with AHI and is useful for predicting OSA severity. Polysomnography should be performed actively for the patients with high STOP-Bang scores.

[Development of Pulmonary Pleomorphic Carcinoma after Treatment for Infectious Bulla].

A 54-year-old man with a history of smoking developed infectious bullae at the apex of his left lung and underwent long-term antimicrobial treatment. The bullae gradually reduced in size along with a slight left pleural thickening. Left back pain relapsed after a year, and CT revealed a rapid increase in pleural thickening. Left upper lobectomy led to the diagnosis of pulmonary polymorphic carcinoma. Chronic inflammation due to infection could contribute to carcinogenesis; therefore, post-inflammatory changes should be carefully followed-up.

[A Case of Lung Cancer Discovered Due to Unresponsive Course of Corticosteroids for Rheumatoid-Associated Interstitial Lung Disease].

A 76-year-old female was followed up for rheumatoid arthritis-associated interstitial lung disease(RA-ILD). Consolidation and ground-glass opacities were observed in the right lung. When the corticosteroid was restarted due to a relapse of RA-ILD, most of the shadows disappeared. However, ground-glass nodules remained in the apex of the right lung. Thoracoscopic segmentectomy was performed, and lung cancer was diagnosed. Patients with rheumatoid arthritis suffer from complications such as RA-ILD, drug-induced pneumonia, pulmonary infections, and malignancies. A careful assessment of treatment response should be made in case of a differential diagnosis.

[A Case of Small Cell Lung Cancer Diagnosed with Metastasis-Induced Acute Pancreatitis].

A 56-year-old man was admitted to our hospital for management of acute epigastric abdominal pain and elevation of pancreatic enzymes. The CT scan revealed enlargement ofthe pancreatic body as well as the lung tumor ofthe right hilar and superior mediastinum. Therefore, bronchoscopy was performed and a diagnosis of small cell lung cancer with metastasisinduced acute pancreatitis(MIAP)was made. Prompt improvement in pancreatic findings was observed following chemotherapy. MIAP, which is a rare complication of lung cancer may affect the prognosis and quality of life of the patients; therefore, rapid diagnosis and appropriate treatment are important.