Development of primary central nervous system lymphoma associated with human immunodeficiency virus and JC virus infection.

We report here a case of a 37-year-old man with human immunodeficiency virus (HIV) infection followed by JC virus (JCV) infection and primary central nervous system lymphoma (PCNSL). The patient had been infected with HIV type 1 due to blood products for hemophilia A during infancy. He had progression of nervous symptoms and was diagnosed with progressive multifocal leukoencephalopathy (PML) clinically at the age of 36, when his CD4-positive lymphocyte counts ranged between 350 and 450/µl. Oral mefloquine, intravenous methylprednisolone pulse therapy, and intravenous immunoglobulin were not effective for the PML, and the patient entered a vegetative state. Brain biopsy revealed JCV infection without pathological findings of PML. Eight months after the clinical diagnosis of PML, he developed respiratory failure and brain magnetic resonance imaging revealed a mass lesion in the brain stem. The patient died 19 months after the diagnosis of PML. Autopsy findings were compatible with PCNSL. EBV-encoded small RNA-1-positive cells were not detected. We present a case of JCV-positive PCNSL with HIV infection complicated with clinical PML.

Granular cell tumor of the urethra.

A 38-year-old woman was referred for urethral tumor treatment. Needle biopsy of the tumor was performed. Histologically, the tumor was composed of large polygonal cells with eosinophilic and periodic acid-Schiff (PAS)-positive granular cytoplasm, indistinct cell margins and small round central nuclei. Immunohistochemical staining for S100 protein, vimentin, and neuron-specific enolase (NSE) was positive, indicating that it was a granular cell tumor. Excision of the tumor including the urethra and appendicovesicostomy using the Mitrofanoff principle were performed. There has been no tumor recurrence in the 8 months after the operation.