Detailed clinical course of a patient with rapidly progressing sarcomatoid pleural mesothelioma without p16 deletion with systemic haematogenous metastasis to soft tissues.

Sarcomatoid mesothelioma is difficult to differentiate from other mesotheliomas. Here, we describe the case of a man in his early 80s with sarcomatoid mesothelioma and a history of asbestos exposure. He initially presented with right-sided chest pain and was examined. Right-sided pleural effusion was detected; therefore, he was hospitalised. Based on the observed pleural effusion and biopsy result, the presence of a malignant tumour was excluded; hence, he was diagnosed with benign asbestos pleurisy. He subsequently developed left-sided pleural effusion, masses and lung nodules, and died 9.5 months after the initial examination. A definitive diagnosis of sarcomatoid mesothelioma with rapid systemic progression was established after detailed investigations using autopsy specimens. This rare case of mesothelioma-without p16 deletion (detected using fluorescence in situ hybridisation)-presented differently from the usual sarcomatoid mesothelioma.

A patient with epithelioid pleural mesothelioma (Myxoid variant) who survived for a long period without treatment.

Pleural mesothelioma is a disease with a very poor prognosis. Here, we report a mesothelioma patient who survived for 5 years and a half. As a result of the autopsy, the tumor was diagnosed as a myxoid variant, which is internationally proposed as a histological subtype of epithelioid mesothelioma with a relatively favorable prognosis. Since patients with this disease are expected to survive for a long period even without treatment, careful determination of the therapeutic approach is considered necessary. This report is considered to be the first of a myxoid variant epithelioid pleural mesothelioma in Japan.

Retrospective investigation on diagnostic process for benign asbestos pleural effusion (BAPE) using checklist.

OBJECTIVES: In Japan, benign asbestos pleural effusion (BAPE) has been eligible for industrial accident compensation since 2003 as an asbestos-related disease despite the lack of good criteria. We compiled a criteria into a checklist of essential items and for excluding other diseases inducing pleural effusion as a diagnosis process. METHOD: Thoracentesis was performed in order to confirm the presence of pleural effusion at the initial diagnosis, and 105 suspected BAPE patients were retrospectively examined. We complied a checklist comprising the following diagnostic items: (a) occupational asbestos exposure; (b) confirmation of exudate of pleural effusion; (c) exclusion of pleural effusion with malignant tumors based on negative results of CEA and hyaluronic acid, and cytology of pleural effusion; (d) exclusion of rheumatic, bacterial, and tuberculous pleuritis; (d) radiological findings for exclusion of malignancies; and (e) histopathological findings based on thoracoscopy that exclude malignancies (when thoracoscopy was not performed, there was confirmation that no malignancies were present during 3-month follow-up observation). Cases that satisfied all items were defined as BAPE. RESULTS: Among the 105 suspected cases, there were five cases that had no occupational asbestos exposure; six cases in which transudate of on pleural effusion; one case each of rheumatoid pleuritis and tuberculous pleuritis; and five cases of pleural mesothelioma based on chest radiography and histopathological findings within 3 months after initial diagnosis. Therefore, we excluded 18 cases from the 105 candidates and determined 87 cases of BAPE. CONCLUSION: We consider that six items described above are suitable for diagnosing BAPE.

Clinical Investigation of Benign Asbestos Pleural Effusion.

There is no detailed information about benign asbestos pleural effusion (BAPE). The aim of the study was to clarify the clinical features of BAPE. The criteria of enrolled patients were as follows: (1) history of asbestos exposure; (2) presence of pleural effusion determined by chest X-ray, CT, and thoracentesis; and (3) the absence of other causes of effusion. Clinical information was retrospectively analysed and the radiological images were reviewed. There were 110 BAPE patients between 1991 and 2012. All were males and the median age at diagnosis was 74 years. The median duration of asbestos exposure and period of latency for disease onset of BAPE were 31 and 48 years, respectively. Mean values of hyaluronic acid, adenosine deaminase, and carcinoembryonic antigen in the pleural fluid were 39,840 ng/mL, 23.9 IU/L, and 1.8 ng/mL, respectively. Pleural plaques were detected in 98 cases (89.1%). Asbestosis was present in 6 (5.5%) cases, rounded atelectasis was detected in 41 (37.3%) cases, and diffuse pleural thickening (DPT) was detected in 30 (27.3%) cases. One case developed lung cancer (LC) before and after BAPE. None of the cases developed malignant pleural mesothelioma (MPM) during the follow-up.

Clinical study of asbestos-related lung cancer in Japan with special reference to occupational history.

A total of 152 patients with asbestos-related lung cancer recognized by the criteria of Japanese compensation law for asbestos-related diseases were examined and compared with 431 patients with non-asbestos-related lung cancer. Male comprised 96% of patients. Ages ranged from 50 to 91 years with a median of 72 years. Eighty-nine percent were smokers or ex-smokers. Almost all patients had occupational histories of asbestos exposure. The median duration of asbestos exposure was 31 years and the median latency period was 47 years. Thirty-four percent of patients exhibited asbestosis and 81% exhibited pleural plaques by radiography. Regarding asbestos particles in the lung for 73 operated or autopsied patients, 62% had more than 5,000 particles per gram. On the other hand, 100% of non-asbestos-related lung cancer patients had <5000 particles per gram with a median of 554 particles. The number of asbestos bodies in the lung, male gender, absence of symptoms, smoking index, and early stage of cancer were significantly much more than those of non-asbestos-related lung cancer. In this study, a diagnosis of asbestos-related lung cancer was made in 34% of patients by asbestosis, in 62% by presence of both pleural plaques and more than 10 years' occupational asbestos exposure, and in 4% by more than 5000 asbestos particles per gram of lung tissue. Occupational histories, duration of asbestos exposure, and pleural plaques are common categories for the recognition of asbestos-related lung cancer in Japan.

The effectiveness of gefitinib on spinal metastases of lung cancer - report of two cases -.

Lung cancer has a high mortality rate and is often diagnosed at the metastatic stage. Recently, gefitinib, a molecule target therapeutic drug, has offered a new approach for patients with non-small-cell lung cancer (NSCLC). This report describes the effects of gefitinib on bone metastases in two patients with NSCLC. The pain induced by a bone metastasis was relieved after the administration of gefitinib. Furthermore, the radiographs and CT findings showed sclerotic changes that matched those of the metastatic bone tumor after gefitinib administration in both patients. It is believed that gefitinib inhibited tumor cell proliferation and induced normal bone formation. In patients with NSCLC, gefitinib may be effective in the treatment of bone metastases.

[A case of eosinophilic cellulitis (Wells' syndrome)].

A 67-year-old man sustained a minor injury on the right hand after touching a potted plant. Several days later, he noted erythema and marked swelling on the right hand and forearm. The same lesions developed on the left hand and forearm. He also had pruritic erythema on the neck, trunk, and thighs. The initial clinical diagnosis was bacterial cellulitis and contact dermatitis. However, oral antibiotic and topical steroid therapy were not effective. Laboratory investigations revealed peripheral blood eosinophilia, elevated serum IgE level, and positive antinuclear antibody. Histopathological examination of a skin biopsy specimen showed an excessive infiltration of eosinophils and flame figures in the dermis. We diagnosed this case as eosinophilic cellulitis (Wells' syndrome). The skin lesions responded rapidly to the systemic oral steroid therapy. There has been no recurrence of eruption in 1 year of follow-up. The condition of the disease was correlated to peripheral blood eosinophil counts, and serum eosinophil cationic protein levels. However, serum interleukin-5 levels were within normal limits.

Intestinal obstruction in autosomal dominant polycystic kidney disease.

A 42-year-old woman with autosomal dominant polycystic kidney disease (ADPKD) was admitted to our hospital on April 29, 1999, with complaints of abdominal pain. A diagnosis of intestinal obstruction was reached on the basis of clinical findings and X-ray evidence. A computed tomography scan of the abdomen showed massively enlarged kidneys, especially the right kidney, which seemed to compress the small intestine. The patient underwent percutaneous aspiration of the largest cysts on the surface of the right kidney. The symptoms, in this rare case of intestinal obstruction by an enlarged kidney in ADPKD, were alleviated the day after the aspiration procedure.