[A case of mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN) diagnosed by re-biopsy of the enlarged primary tumor during chemotherapy for gastric adenocarcinoma].

Gastric mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN) is an extremely rare form of gastric neoplasm, and its prognosis is often poor. This is a case report wherein the primary site increased during chemotherapy against gastric adenocarcinoma and was diagnosed with gastric MiNEN after total gastrectomy. A 71-year-old man was diagnosed with gastric adenocarcinoma complicated with liver and para-aortic lymph node metastasis. Chemotherapy with S-1, oxaliplatin, and trastuzumab was initiated. Although the size of metastatic lesions was reduced after six courses of treatment, a part of the primary site of gastric tumor rapidly. Pathological rebiopsy of the primary site suggested a neuroendocrine carcinoma, and he was finally diagnosed with gastric MiNEN after total gastrectomy. Thus, second-line chemotherapy was then initiated showing good response. We herein report a case of MiNEN with a rare diagnostic process.

[Rhabdomyolysis associated with long-term treatment of esomeprazole].

Proton pump inhibitors (PPIs) have been widely used in the treatment of gastroesophageal reflux disease and peptic ulcer disease. Although they have a potent acid suppressive effect and excellent efficacy in acid-related diseases, PPI-induced rhabdomyolysis has been reported. Here, we report the case of a patient with reflux esophagitis who developed rhabdomyolysis after esomeprazole treatment. A 67-year-old man with reflux esophagitis who had started esomeprazole treatment for the preceding 10 months complained of back and limb fatigue and myalgia. His serum creatinine kinase (CK) level was markedly elevated, and CK isozyme exhibited an MM pattern. He was diagnosed with rhabdomyolysis induced by esomeprazole. The cessation of esomeprazole rapidly improved his symptoms, and the serum CK level was normalized within 16 days. PPI-induced rhabdomyolysis is a rare complication. In most cases, PPI-induced rhabdomyolysis occurs within 3 months after starting PPIs. However, rhabdomyolysis occurred at 10 months after starting esomeprazole treatment in our patient. Early diagnosis of PPI-induced rhabdomyolysis is required even in long-term PPI users.

Protein-losing Enteropathy Complicated with Primary Intestinal Follicular Lymphoma.

Protein-losing enteropathy (PLE) is a rare syndrome characterized by hypoproteinemia due to gastrointestinal (GI) protein loss. Primary intestinal follicular lymphoma (PIFL), a specific variant of follicular lymphoma with essential only GI involvement, has not been reported as an etiology of PLE. We herein report a case of PLE complicated with PIFL that was successfully treated with rituximab, resulting in rapid improvement of PLE and a complete response of PIFL. Macroscopic findings of ulcerative lesions with diffuse involvement, which were precisely described by capsule and double-balloon enteroscopy at the diagnosis, also improved following the treatment. This case provides a clue suggesting factors that promote PLE in PIFL.

Vanishing Tumor in a Liver Graft from a Hepatitis B Virus Surface Antigen-Positive Donor.

We report a case of vanishing tumor considered as inflammatory pseudotumor (IPT) found in the liver after living donor liver transplantation (LDLT) from a hepatitis B virus surface antigen-positive donor. The radiological findings were similar to those of hepatocellular carcinoma (HCC). However, the tumor disappeared completely within several months and was suggested to have been an IPT. IPT is known to be associated with biliary duct operation or biliary infection, and it can show various enhancement patterns in radiological studies, sometimes resembling HCC. It should be considered in the differential diagnosis of a liver tumor in patients with LDLT.