Silicosis, then microscopic polyangiitis-antineutrophil cytoplasmic antibodies-associated vasculitis may be work-related disease in patients with silicosis.

A 74-year-old man with silicosis was admitted to the hospital because of prolonged fever. After referral to internal medicine for persistent fever and renal dysfunction, workup revealed antineutrophil cytoplasmic antibodies (ANCA) positivity. He was diagnosed with microscopic polyangiitis (MPA). After treatment with immunosuppressive therapy, his condition improved. Herein, we discuss silica exposure and the risk of ANCA-associated vasculitis (AAV), particularly in terms of work-related diseases. Silica exposure is a notorious risk factor for developing AAV, which is potentially lethal when not identified. When we see a silicosis patient with new-onset prolonged fever and generalized fatigue, AAV should be taken into consideration. This case report provides beneficial information to reliably assess patients at high risk of developing AAV in primary care settings.

A multicenter survey of enteroscopy for the diagnosis of intestinal follicular lymphoma.

The importance of enteroscopy examinations to investigate the entire length of the small intestines has been emphasized in follicular lymphoma patients with intestinal involvement. The aim of the present study was to determine the current state of enteroscopy examinations, including the performance rate, and the prevalence of small intestinal lesions in a patient population in Japan. A retrospective multicenter survey of 17 institutions collected the case information of 110 follicular lymphoma patients with gastrointestinal involvement. The results of the enteroscopy examinations were reviewed, and in order to identify potential factors affecting the performance rate of enteroscopy, patient gender, age at lymphoma diagnosis, histopathological grade, clinical stage, the date of the initial diagnosis and the annual volume of enteroscopy at the institution were compared between the patients who underwent one or more enteroscopy procedures and the patients who did not undergo enteroscopy. A total of 34 patients (30.9%) underwent enteroscopy, and 24 of these (70.6%) presented with involvement in the jejunum and/or ileum. It was found that more patients diagnosed in recent years and more patients treated at an ultra-high volume institution (≥101 enteroscopy examinations/year) underwent an enteroscopy. In conclusion, although the prevalence of small intestinal lesions was high (70.6%) in the follicular lymphoma patients presenting with intestinal involvement, the performance rate of enteroscopy was only 30.9%, and thus the majority of the patients have not undergone enteroscopy examinations. Further investigation is required to define the clinical significance of enteroscopy at the initial diagnostic work-up and during the follow-up period of these patients.

Virtual ultrasonography-assisted percutaneous ablation of hepatocellular carcinoma.

Recent advances in multi-detector row computed tomography have enabled the synthesis of high-quality multiplanar reconstruction images. With this technique, arbitrary sectional images resembling conventional ultrasonography (US) images, i.e. virtual US images, can easily be created. We describe 3 cases of small hepatocellular carcinoma poorly visualized with US in which US-guided percutaneous ablation was safely and successfully performed with the assistance of the virtual US system. No local recurrence was found after a mean follow-up of 17 months. Percutaneous ablation using the virtual US system is a promising method for treating hepatocellular carcinoma poorly visualized with US.

Dermatomyositis associated with hepatocellular carcinoma in an elderly female patient with hepatitis C virus-related liver cirrhosis.

A 79-year-old female patient with hepatitis C virus-related liver cirrhosis was diagnosed as having hepatocellular carcinoma (HCC) with a diameter of 2.0 cm. She refused therapy for HCC. Nine months after the diagnosis, she developed dermatomyositis when the HCC enlarged to a diameter of 6.0 cm. She underwent therapy for dermatomyositis, and then transcatheter arterial chemoembolization for HCC. Although the manifestations of dermatomyositis improved and entire tumor necrosis was achieved, she died of pneumonia 2 mo after the treatment of HCC. HCC and/or chronic hepatitis C virus infection might be involved in the pathogenesis of dermatomyositis.

TT virus-positive hepatocellular carcinoma arising from non-cirrhotic liver in an elderly man.

A 43-mm hepatic tumor was incidentally detected by computed tomography in a 72-year-old man. Liver function test results were normal. Serum hepatitis B, C and G viruses were negative, while serum TT virus was positive. Autoantibodies were negative. The patient had no history of alcohol consumption. The tumor was found to be a moderately differentiated hepatocellular carcinoma (HCC) from a resected specimen. Neither lobular inflammation nor fibrosis was observed in the surrounding liver. Intrahepatic hepatitis B virus was not detected. This is a case of non-B, non-C HCC positive for only TT virus arising from a non-cirrhotic liver.