Abstract : The antineutrophil cytoplasmic antibody （ANCA）-associated vasculitis was approved for treatment with the complement C5a receptor inhibitor, Avacopan, in September 2021.　However, experience with its use in microscopic polyangiitis （MPA）, which is the most common form of ANCA-associated vasculitis in Japan and presents with rapid progressive glomerulonephritis （RPGN）, is limited.　 There are few reports in the literature regarding the use of Avacopan to treat MPA with a clinical presentation of RPGN.　We treated three MPA patients with RPGN using a combination of Avacopan and Prednisolone.　In all cases, renal function, urinary findings, and inflammatory response improved during the one to three-month observation period from the start of treatment.　The clinical results suggest that treatment with Avacopan helped improve MPA-induced RPGN in these patients after a short observation period.　Nonetheless, long-term follow-up is required to confirm the maintenance rates of disease remission and the incidence of adverse events.

Abstract : In this case report, we present a rare case of mesonephric adenocarcinoma of the cervix that recurred with pulmonary metastases six years after initial treatment.　At first presentation, the patient was a 69-year-old woman, gravida 3 para 2.　She presented to a clinic with a chief complaint of lower back pain.　She was referred to our hospital because she had an enlarged uterus, cervical cytology showed no abnormalities and endometrial cytology was positive.　Transvaginal ultrasound revealed a substantial cervical mass measuring 4 cm, and a biopsy from this site suggested mesonephric adenocarcinoma.　A radical hysterectomy and bilateral adnexectomy were performed, and histopathology confirmed the presence of mesonephric adenocarcinoma with extension from the cervix to the vaginal wall and invasion of the right parametrium.　The final clinical stage was stage IIB mesonephric adenocarcinoma of the cervix, and concurrent chemoradiotherapy was given as adjuvant therapy.　Six years after surgery for cervical cancer, lesions in the left lung field and elevated CA19-9 were observed.　 Partial resection of the upper lobe of the left lung revealed a recurrence of mesonephric adenocarcinoma.　 18 months later, an enlarged mass was found in the right lung field and a diagnosis of recurrent mesonephric adenocarcinoma was made.　After three courses of CPT-11 chemotherapy, the mass in the right lung field shrank and the patient is currently alive with a performance status of 0, 108 months after surgery for cervical cancer.　Mesonephric adenocarcinoma of the cervix is a rare and challenging disease to diagnose preoperatively due to its embryological features.　The presence of a solid lesion on the cervix, even in the absence of abnormal cervical cytology, should raise suspicion for this disease.　Long-term follow-up is crucial as recurrence can occur several years after surgery.

Abstract : A 72-year-old man underwent laparoscopic low anterior resection for rectal cancer.　Pathological examination revealed pT3（SS）, pN2b, M0, pStageIIIc, and rectal cancer with microsatellite instability-high （MSI-High）.　After that, pembrolizumab was started due to multiple pulmonary metastases.　On the 4th day after the 11th course of administration, he noticed anorexia, abdominal pain and headache.　Blood tests and computed tomography （CT） showed no intestinal disease.　On the other hand, blood glucose level was as high as 334 mg/dL and HbA1c was 7.1%, indicating impaired glucose tolerance, which had not been noted before.　He was admitted for detailed examination and treat-ment, but hyperglycemia persisted thereafter.　Based on the presence of urinary ketone bodies and a marked decrease in insulin secretion, we diagnosed him with acute-onset type 1 diabetes mellitus as immune-related adverse events （irAE） caused by pembrolizumab.　The patient was discharged on the 16th hospital day after prompt initiation of adequate fluid infusion and insulin therapy without aggravation.　After discharge, he has been treated with pembrolizumab while continuing multiple daily injections insulin therapy.　IrAEs can occur in any organ of the body.　Type 1 diabetes mellitus is known to be one of the rare cases, with an onset frequency of 0.7%, and it may lead to type 1 diabetes mellitus, so prompt diagnosis and treatment are important.　We experienced a case of MSI-High rectal cancer who developed acute-onset type 1 diabetes mellitus while receiving pembrolizumab.　When a sudden rise in blood glucose level and gastrointestinal symptoms are observed during the use of immune checkpoint inhibitors （ICI）, it is important to suspect this disease and to promptly diagnose and start treatment.