[A case of primary lung adenocarcinoma accompanied by Ewing's sarcoma successfully treated with ifosfamide].

We report a patient with primary lung adenocarcinoma who had Ewing's sarcoma and was successfully treated with ifosfamide. A 56-year-old Japanese man was referred to the Orthopedic Department of our hospital with a complaint of pain on his hip, ischuria, and dyschezia (vesicorectal disorder). MRI showed a mass in the sacrum. Open biopsy revealed Ewing's sarcoma (T2N0M0G4, Stage II B). Chest CT to screen showed an abnormal shadow in the left pulmonary lower lobe (S10). Bronchoscopic examination revealed primary lung adenocarcinoma(cT2N0M0, Stage I B). Because of a severe hip pain, treatment for Ewing's sarcoma by high-dose ifosfamide (day 1: 4 g/m2/day --> day 2-7: 2 g/m2/day: total 14 g/m2) was given in one course before lung surgery. The lung adenocarcinoma became small, the reduction ratio of the tumor was 26.5% and the tumor changed into a cavity. No serious adverse effect was observed.

[A case of MPO-ANCA-related vasculitis with chronic alveolar hemorrhage].

It has been reported that alveolar hemorrhage caused by ANCA-associated vasculitis occurs in the seriously acute stage. However, we report a rare case of chronic alveolar hemorrhage in a 26-year-old woman who had been on maintenance hemodialysis because of rapidly progressive glomerulonephritis (RPGN) since the age of 17. On a regular checkup at her clinic, chest radiographs revealed diffuse micronodular opacities in both lung fields when she was 22 years of age, and anemia was identified at 24. Before the patient was referred to our hospital, the shadows on the radiographs remained almost unchanged, whereas the anemia, for reasons unknown, slowly deteriorated. She was referred to our hospital because of micronodular opacities detected on a chest radiogram in an annual health check at the age of 26. She was asymptomatic, but her laboratory data showed a normochromic anemia (hemoglobin 6.3 g/dl), and the serum level of MPO-ANCA was 195 EU. Bronchoalveolar lavage at bronchoscopy macroscopically revealed bloody fluids containing hemosiderin-laden macrophages. Histological examination of the biopsy specimen by video-assisted thoracoscopic lung biopsy revealed pauci-immune pulmonary capillaritis and alveolar hemorrhage. She was diagnosed as having MPO-ANCA-related vasculitis, especially microscopic polyangiitis preceding RPGN, and the clinical course suggesting alveolar hemorrhage was progressing slowly. The diagnosis was therefore "chronic alveolar hemorrhage". We emphasize that it is necessary to consider alveolar hemorrhage when a patient who has been on maintenance hemodialysis for RPGN has a combination of anemia and diffuse micronodular opacities, even if the condition is not accompanied with any respiratory symptoms.