A Case of Synchronous Lung Squamous Cell Carcinoma and Diffuse Large B-cell Lymphoma / 대한내과학회지

A 65-year-old male was referred to our hospital for evaluation of a right pleural effusion. Thoracic computed tomography (CT) revealed a huge central mass with right hilar and subcarinal lymph node conglomerates. An endobronchial mass was incidentally found in the right upper lobe bronchus, and endobronchial ultrasound-guided transbronchial needle biopsy of the mediastinal lymph nodes was thus also performed at the time of bronchoscopy. The two biopsies revealed squamous cell carcinoma and diffuse large B-cell lymphoma (DLBCL), respectively. As the pathology of the mediastinal lymph nodes was unknown, the lung cancer could not be accurately staged. Thus, we treated the DLBCL; follow-up positron emission tomography/CT after two cycles of chemotherapy showed that the conglomerate mass had disappeared but the right upper lobe lesion remained. Lung cancer staging thus became more accurate and radical treatment could be considered. To the best of our knowledge, this is the first report of a co-existing squamous cell carcinoma of the lung and DLBCL of the intrapulmonary lymph nodes.

Multiple Hepatic Metastasis and Lymphatic Metastasis of Solid Pseudopapillary Neoplasm of Pancreas

Solid pseudo-papillary neoplasm (SPN) of pancreas is a rare epithelial neoplasm of pancreas with a low malignant potential, occurs most commonly in young females. Here, we report a rare case of woman who has severe hepatomegaly due to multiple hepatic metastases of SPN of pancreas. At the time of diagnosis, a SPN was detected at only pancreas and there was no evidence of metastasis. So, she received subtotal pancreatectomy and total splenectomy. After 2 years of follow up, multiple small hepatic metastases were presented. In spite of three times of radiofrequency ablation, the burden of hepatic metastasis has increased continuously and multiple intra-abdominal lymph nodes metastases were detected, and ascites and peripheral edema occurred. However, because of benign feature of SPN and extremely rare incidence of recurrence and metastasis, there is no specific treatment guideline for metastatic SPN. Through multidisciplinary care service, we planned to do radiotherapy followed by a transarterial chemoembolization (TACE). But the patient could not have a scheduled radiation therapy due to deterioration of liver function. So changing the strategy of treatment, followed by TACEs were done alone. Although the size of SPN is not reduced, the extent of SPN and complication of SPN (ascites, peripheral edema, abdominal pain and so on) are being controlled.

A case of generalized argyria presenting with muscle weakness

BACKGROUND: Argyria is a rare irreversible cutaneous pigmentation disorder caused by prolonged exposure to silver. Herein, we report a case of generalized argyria that developed after chronic ingestion of soluble silver-nano particles and presented with muscle weakness. CASE PRESENTATION: A 74-year-old woman visited our emergency room, complaining of fever and mental deterioration. She was diagnosed with acute pyelonephritis and recovered after antibiotic therapy. At presentation, diffuse slate gray-bluish pigmented patches were noticed on her face and nails. Two months prior to visiting our hospital, she was diagnosed with inflammatory myopathy and given steroid therapy at another hospital. We performed a nerve conduction study that revealed polyneuropathy. In skin biopsies from pigmented areas of the forehead and nose, the histopathologic results showed brown-black granules in basement membranes of sweat gland epithelia, which are diagnostic findings of argyria. We reviewed pathology slides obtained from the left thigh muscles and found markedly degenerated myofibers with disorganization of myofibrils without inflammatory reactions, consistent with unspecified myopathy, rather than inflammatory myopathy. The patient was diagnosed with generalized argyria with polyneuropathy and myopathy and transferred to a rehabilitation institution after being tapered off of steroids. CONCLUSIONS: Clinicians should be aware of clinical manifestations of argyria and consider it in differential diagnosis when they examine patients who present with skin pigmentation and muscle weakness.