A case of simultaneous occurrence of hepatitis and pancreatitis during the combination immunochemotherapy for non-small cell lung carcinoma.

Immune checkpoint inhibitors (ICIs) improved the prognosis of patients with advanced lung cancers. The combination therapy of cytotoxic drugs and ICI is approved as first-line chemotherapy in non-small-cell lung cancer (NSCLC) and extensive disease small-cell lung cancer (ED-SCLC). It has been reported various immune-related adverse events (irAEs). We herein report a 65-year-old man with NSCLC who developed hepatitis and pancreatitis simultaneously during the combination immunochemotherapy. In the treatment of hepatitis and pancreatitis, the clinical course was different. In this report, the importance of accurate diagnosis through detailed examination and treatment priority depending on the severity of the symptoms is indicated.

Primary synovial sarcoma of the left heart with large amount of necrotic tissue.

We present a case of primary synovial sarcoma arising from the left heart, an extremely rare occurrence, with a large amount of necrotic tissue, which suggested a poor prognosis. After incomplete tumor resection, chemotherapy and radiation therapy were performed; however, PET/CT findings at 26 months after the operation revealed local recurrence. Although we performed two additional operations following chemotherapy, the patient died from local recurrence at 36 months after the initial operation. In this case of synovial sarcoma arising from the left heart, even though aggressive multimodality therapy was performed, the prognosis was still poor.

A case of relapsing encephalitis positive for gamma aminobutyric acid (GABA)A receptor antibody associated with Type B3 thymoma.

A 87-year-old female presented with subacute progression of cognitive decline. Fluid-attenuated inversion recovery images of brain MRI showed multifocal high-intensity lesions. Thoracic CT image revealed the presence of thymoma, and serum autoantibody screening showed positivity for anti-gamma aminobutyric acid (GABA)A receptor antibody. Histopathological analysis confirmed type B3 thymoma after thymectomy. The patient received both plasmapheresis and intravenous methylprednisolone therapy, and showed remarkable amelioration of clinical symptoms and MRI abnormal high intensity. However, after 2 month from the clinical recovery, the patient showed recurrence of brain lesions and intravenous methylprednisolone monotherapy was performed. Continuation of oral steroid therapy was required to maintain the quienscent state of inflammation within the central nervous system. Anti-GABAA receptor antibody is a recently discovered novel autoantibody associated with autoimmue encephalitis. Due to the limited number of literature reported, clinical course and therapeutic response of GABAA receptor antibody encephalitis remains elusive. Here we reported a rare case of GABAA receptor antibody encephalitis with type B3 thymoma. Clinical, radiological and therapeutic courses described in our report highlight the importance of immunotherapy for treatment of the disease.

[A Case of Hereditary Medullary Thyroid Cancer (MEN2A/FMTC) Diagnosed at the Time of Recurrence].

We report a 42-year-old man with hereditary medullary thyroid cancer (multiple endocrine neoplasia, MEN2A/familial medullary thyroid carcinoma, FMTC), which was diagnosed at the time of tumor recurrence. He had a past history of a left thyroidectomy with neck dissection 7 years previously. A RET gene analysis revealed a point mutation (codon 618), and we diagnosed him as having hereditary medullary thyroid cancer. We resected the recurrent tumor in the right thyroid lobe together with performing a right lateral and central neck dissection. A RET gene analysis should be performed for patients with medullary thyroid cancer. When a RET gene mutation is present, a total thyroidectomy must be performed for the medullary thyroid cancer.

[A Case of Perirenal Inflammatory Liposarcoma].

A 65-year-old man had been hospitalized for examination of melena at a separate facility. Computed tomography (CT) showed left renal mass and he was referred to our hospital. Magnetic resonance imaging (MRI) revealed a tumor without adipose components in the perirenal space. Preoperative diagnosis was retroperitoneal malignant tumor. Tumor excision and left nephrectomy were performed. Pathologic evaluation revealed inflammatory liposarcoma. He has been followed up for 10 months with no additional treatment and no evidence of local recurrence was seen.

Endoglin expression in upper urinary tract urothelial carcinoma is associated with intravesical recurrence after radical nephroureterectomy.

OBJECTIVES: To evaluate the expression and prognostic significance of endoglin in patients with upper urinary tract urothelial carcinoma. METHODS: zArchival formalin-fixed and paraffin-embedded tissues from 99 cases of primary upper urinary tract urothelial carcinomas treated with nephroureterectomy were retrieved. Tissue microarrays were constructed with triplicate tumor samples and paired non-neoplastic urothelium. Tissue microarrays were analyzed using immunohistochemistry for endoglin, and the associations between clinicopathological parameters and outcome were studied. RESULTS: Endoglin expression was significantly higher in the endothelium of upper urinary tract urothelial carcinomas than in paired benign urothelium (P < 0.001). Endoglin expression was not associated with pathological T stage or tumor grade, and it was not associated with increased hazard ratios for cancer-specific mortality, tumor recurrence in the lymph node or distant metastasis. However, expression of endoglin was significantly associated with intravesical recurrence, when adjusting for other relevant clinicopathological variables (P = 0.015). CONCLUSIONS: Endoglin is overexpressed in the endothelium of upper urinary tract urothelial carcinomas when compared with normal urothelium, and this overexpression seems to be associated with a higher risk of intravesical recurrence. Therefore, endoglin could be a biomarker for the prediction of intravesical recurrence, as well as a potential therapeutic target.

A rare case of spontaneous necrosis of primary renal cell carcinoma.

A 42-year-old woman was referred to our hospital with a chief complaint of asymptomatic gross hematuria. Computed tomography revealed a 4-cm tumour in the left kidney and radical nephrectomy was performed. Microscopically, the tumour was completely necrotic and consisted of nests of cells with abundant cytoplasm and large nuclei. Immunohistochemical analysis indicated complete infarction of the chromophobe renal cell carcinoma. Two years after surgery, the patient remained recurrence-free.

Two cases of plasmacytoid variant of urothelial carcinoma of urinary bladder: systemic chemotherapy might be of benefit.

We report two cases of the plasmacytoid variant of urothelial carcinoma of urinary bladder in which systemic chemotherapy was effective. In the first case, a 76-year-old man presented with dysphasia. Magnetic resonance imaging (MRI) and computed tomography revealed a brain tumor and a bladder tumor. Resection of the brain tumor and transurethral resection of the bladder tumor were performed. The pathological diagnosis was plasmacytoid variant of urothelial carcinoma of urinary bladder with brain metastasis (pT1N0M1). Three cycles of adjuvant MVAC (methotrexate, vinblastine, adriamycin, and cisplatin) chemotherapy were performed. He has no evidence of recurrence 96 months after resection of brain metastasis. In the second case, a 76-year-old man presented with hematuria. MRI revealed a bladder tumor with abdominal wall invasion, and a transurethral biopsy was performed. The pathological diagnosis was plasmacytoid variant of urothelial carcinoma of urinary bladder (cT4bN0M0). After three cycles of neoadjuvant GC (gemcitabine and cisplatin) chemotherapy, MRI demonstrated a complete response. Radical cystectomy was performed, and the pathological diagnosis was pT0pN0. Although there was no evidence of recurrence 9 months after radical cystectomy, he died from other causes. Our two cases suggest that systemic chemotherapy might be effective for the plasmacytoid variant of urothelial carcinoma.

[Retrospective analysis of immediate cause of death in lung cancer-two case reports of lung cancer deaths due to bowel necrosis].

The immediate cause of death of 313 patients who died of lung cancer during 5 years in this center was analyzed. The specific, immediate causes of the 313 deaths were respiratory failure 34. 8%, pneumonia 19. 0%, cachexia 12. 0%, and brain metastasis 8. 3%. Digestive organ disease deaths were 7. 0%(22 patients), being the 5th-ranking immediate cause of death. Of these 22 cases, hepatic insufficiency death by liver metastasis was in 10 out of 22 cases, and gastrointestinal bleeding was in 8 cases. Two patients died of intestinal tract necrosis, but the direct causal relationship between the cause of death and the tumor was unconfirmed from the autopsy result. However, we speculated that an elderly, tumor-bearing condition combined with chemotherapy led to prolonged immobility, a poor nutritional state, and rapid weight loss, which could be influential on the bowel necrosis.

An autopsy-proven case of myeloperoxidase-antineutrophil cytoplasmic antibody-positive polyarteritis nodosa with acute renal failure and alveolar hemorrhage.

An 80-year-old woman positive for myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) was admitted with a 3-month history of fever, general malaise, and weight loss, after unsuccessful treatment with antibiotics. Upon admission, her fever persisted, and there was concomitant deterioration of renal function without active urine sediments. Furthermore, she developed hemoptysis, and chest computed tomography (CT) scan revealed bilateral diffuse alveolar hemorrhage. Although a renal biopsy was not performed because of her dementia, we initially suspected microscopic polyangiitis (MPA) on the basis of her clinical course. Because of her poor general condition, she was administered a low dose of prednisolone. Although her fever subsided, she suffered from intractable alveolar hemorrhage and eventually died from respiratory failure. During the autopsy, fibrinoid necrosis was restricted to medium-sized arteries, including the arcuate arteries of the kidneys and the bronchial arteries, without necrotizing crescentic glomerulonephritis and alveolar capillaritis. Therefore, polyarteritis nodosa (PAN) was diagnosed. It is important to distinguish between MPA and PAN because they can lead to life-threatening complications, and their treatment strategies and prognosis are different. When a patient presents with MPO-ANCA, alveolar hemorrhage, and acute renal failure with little evidence of glomerulonephritis, a differential diagnosis of PAN should be made; however, it is difficult to do so without pathological findings. Therefore, pathological examination should be carried out whenever possible.

Porous gelatin particles for uterine artery embolization: an experimental study of intra-arterial distribution, uterine necrosis, and inflammation in a porcine model.

PURPOSE: We evaluated the location of porous gelatin particles (GP; Gelpart; Nippon Kayaku/Astellas, Tokyo, Japan) within the arterial vasculature and their acute effects on uterine necrosis and inflammation after uterine artery embolization (UAE) in swine. MATERIALS AND METHODS: Adult nonpregnant pigs (n = 6) were allocated to either 1- (n = 3) or 2-mm GP (n = 3). Superselective and bilateral embolization of the uterine arteries was performed. All animals were killed 1 week after UAE. Macroscopic and microscopic findings, including the level of arterial occlusion and their effect on uterine necrosis and inflammation, were analyzed. RESULTS: All UAE procedures were completed without severe complications. The macroscopic necrosis was seen in two animals in the 2-mm group with an extent of <50%. The location of the occluded arteries did not differ significantly between groups. The median diameters of the occluded arteries were 449 microm (95% confidence interval [CI] 417-538 microm) in the 1-mm GP group and 484 microm (95% CI 370-560 microm) in the 2-mm GP group. As for microscopic necrosis, no statistically significant difference was observed. The qualitative inflammatory reaction was significantly greater in the 2-mm GP group than in the 1-mm group (p < 0.001). CONCLUSIONS: Both 1- and 2-mm GP occluded the arteries relevant to the target diameter for UAE in porcine uterus, presumably due to the plastic deformity. Both sizes of GP were associated with limited areas of necrosis; however, evaluation of inflammatory reaction was preliminary. Further study with adequate evaluation of inflammatory reactions is suggested.

Well-differentiated papillary mesothelioma with invasion to the chest wall.

Well-differentiated papillary mesothelioma (WDPM) is an uncommon tumor with a papillary architecture, bland cytologic features, a tendency toward superficial spread without invasion, and good prognosis with prolonged survival. WDPM occurs primarily in the peritoneum of women, but also rarely in the pleura. We here report a case of 48-year-old woman who developed WDPM in the pleura with no history of asbestos exposure. Tumors were multifocal and widespread with a velvety appearance on the surface of parietal and visceral pleurae resected by extrapleural pneumonectomy (EPP). Tumors showed papillary structures with fibrovascular cores and lined by epithelioid cells. Immunohistochemically, these epithelioid tumor cells were positive for epithelial membrane antigen (EMA), a marker of malignant mesothelioma, with more than 50% positive for p53. Tumor cells microinvaded into subpleural parenchyma of the lung and minimally spread to adipose tissues of the mediastinal lesion. In addition, tumor cells invaded into the chest wall with a trabecular or glandular architecture. Based on these findings, this case is pathologically considered as WDPM of the pleura with malignant potential.