A Case Report of Primary Unresectable Hilar Cholangiocarcinoma Causing Colonic Obstruction Due to Peritoneal Dissemination.

Although surgical resection is the only available treatment to achieve long-term survival in biliary tract cancer, many cases are often identified at an advanced stage at the time of diagnosis. Radiotherapy may be an alternative option to prolong survival in cases with locally advanced unresectable disease. While there are some reports of long-term survival after radiotherapy for unresectable biliary tract cancer, it is rare that clinical symptoms are exhibited by peritoneal dissemination more than 8 years after radiotherapy and that resection can be performed. Our case was a 55-year-old female who had visited with a complaint of jaundice and was diagnosed with primary unresectable hilar cholangiocarcinoma. She received definitve chemoradiotherapy, and repeated receiving maintenance chemotherapy thereafter until clinical manifestation. During follow-up, she was diagnosed with stenosis of the sigmoid colon, which was attributed to peritoneal dissemination of cholangiocarcinoma. We herein report a rare case of primary unresectable hilar cholangiocarcinoma after chemoradiotherapy which was followed by chemotherapy that was controlled for more than 8 years but eventually caused colonic obstruction attributed to peritoneal dissemination.

[A Case of Ascending Colon Cancer with Skull Metastasis].

A 55-year-old woman became aware of a tumor on the left side of the head in July, 2020 and was referred to our hospital in September because of its rapid growth. A head CT showed a neoplastic lesion of the skull. A CT from the neck to the pelvis revealed an ascending colon tumor and multiple lesions in the liver, which was suspected as metastasis. A colonoscopy also showed a type 2 like lesion in the ascending colon, and a biopsy showed adenocarcinoma. A pedunculated polyp had been pointed out in the ascending colon at another hospital four years previously, and the pathological result was an adenoma, but endoscopic mucosal resection was not performed. It is considered that the adenoma became advanced colon cancer with metastasis through the mechanism of multistage carcinogenesis. Metastatic lesions of the ascending colon cancer was suspected with regard to the skull lesion. In addition to the rapid growth, surgical removal was desirable from the viewpoint of cosmetology, and surgery was performed in November. The postoperative pathological diagnosis was a metastatic skull tumor derived from ascending colon cancer. The diagnosis was Stage IVb according to the Japanese Classification of Colorectal, Appendiceal, and Anal Carcinoma (9th Edition). Although chemotherapy was started after surgery, the metastatic liver cancer increased rapidly and the patient passed away in April, 2021.

Pulmonary computed tomography findings of visceral larva migrans caused by Ascaris suum.

OBJECTIVE: To retrospectively evaluate the computed tomography (CT) findings of pulmonary involvement in patients with visceral larva migrans caused by Ascaris suum. METHODS: Institutional review board approval was obtained, and informed consent was waived. Chest CT scans obtained between January 1994 and November 2005 in 32 patients infected with A. suum were retrospectively evaluated by 3 chest radiologists. In 4 patients who underwent surgical or transbronchial biopsy, comparisons of the CT images with the actual specimens were performed. RESULTS: On CT scans, abnormal findings were seen in 28 patients. The most common abnormality consisted of nodules (n = 19) in which the majority had a halo of ground-glass attenuation (n = 17), followed by ground-glass attenuation (n = 18), and interlobular septal thickening (n = 14). These abnormalities were predominantly seen in the peripheral lung (n = 25). Of the 7 patients who underwent follow-up CT scans, nodules (n = 6) and ground-glass attenuation (n = 5) had migrated in 4 patients. Pathologically, these findings corresponded to marked eosinophilic infiltration into the interstitium. CONCLUSIONS: These CT findings are considered to be suggestive of thoracic involvement in patients with visceral larva migrans caused by A. suum.

Bronchiolitis obliterans organizing pneumonia after bone marrow transplantation: association with human leukocyte antigens.

UNLABELLED: This is the first study reporting the relationship between the development of bronchiolitis obliterans organizing pneumonia (BOOP) and human leukocyte antigen (HLA) in patients with bone marrow transplantation (BMT). The HLA B35 was significantly higher in patients with BOOP than in patients without BOOP after BMT (P = 0.0069). The HLA B35 is important as a host factor for the generation of BOOP after BMT. OBJECTIVE: To assess the relationship between the development of BOOP after BMT and HLA. METHODS: We retrospectively reviewed clinical features and chest computed tomographic scans in 64 patients who underwent allogeneic BMT between March 1990 and September 2004, and evaluated the relationship between HLA and development of BOOP. RESULTS: Development of BOOP was between days 22 and 347 (mean, 114 days). The common computed tomographic findings consisted of patchy consolidation in subpleural and/or peribronchovascular distributions. Frequency of HLA B35 in patients with BOOP development after BMT was significantly higher than in patients without BOOP after BMT (P = 0.0069). There were no significant relationships between the others of this antigen and BOOP development. CONCLUSIONS: Our results suggested that HLA B35 is an important host factor for the generation of BOOP after BMT.

Pulmonary CT findings in 320 carriers of human T-lymphotropic virus type 1.

PURPOSE: To retrospectively evaluate pulmonary computed tomographic (CT) findings in human T-lymphotropic virus type 1 (HTLV-1) carriers, who were characterized by means of polyclonal integration of proviral DNA. MATERIALS AND METHODS: Institutional review board approval was obtained, and informed consent was waived. Chest CT scans obtained between January 1996 and October 2004 in 320 (154 men, 166 women; age range, 31-86 years; mean, 64 years) patients with HTLV-1 were retrospectively evaluated by three chest radiologists. Parenchymal abnormalities (ground-glass opacity, consolidation, centrilobular nodules, thickening of bronchovascular bundles, interlobular septal thickening, and bronchiectasis) were evaluated, along with enlarged lymph nodes and pleural effusion. In 58 patients who underwent surgical biopsy or transbronchial biopsy, comparison of CT images with the actual specimens was performed by a pathologist and three chest radiologists. RESULTS: On CT scans, abnormal findings were seen in 98 (30.1%) patients and consisted of centrilobular nodules (n = 95), thickening of bronchovascular bundles (n = 55), ground-glass opacity (n = 51), bronchiectasis (n = 50), interlobular septal thickening (n = 28), and consolidation (n = 5). These abnormalities were predominantly seen in the peripheral lung parenchyma (n = 70). Pathologically, these findings corresponded to lymphocytic infiltration along respiratory bronchioles and bronchovascular bundles. Pleural effusion and enlarged lymph nodes were found in two and five patients, respectively. CONCLUSION: CT findings in patients with HTLV-1 consisted mainly of centrilobular nodules, ground-glass opacity, and thickening of the bronchovascular bundles in the peripheral lung. These CT findings are considered suggestive of thoracic involvement in patients with HTLV-1.