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Masataka Yokode, Eiji Ikeda, Yugo Matsui, Sena Iwamura, Sakae Mikami, ...
2018Volume 57Issue 20 Pages
2945-2949
Published: October 15, 2018
Released on J-STAGE: October 15, 2018
Advance online publication: June 06, 2018
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A 90-year-old man was referred to our hospital because of a positive fecal occult blood test. Colonoscopy revealed a lesion with multiple nodules covered with abundant mucus at the hepatic flexure. Computed tomography showed a dilated appendix attached distally to the hepatic flexure. Right hemicolectomy was performed, and the pathological examination revealed a mucinous appendiceal adenocarcinoma infiltrating the hepatic flexure without pseudomyxoma peritonei. The patient is doing well without recurrence 12 months postoperatively. Extraperitoneal drainage of the malignant ascites caused by the fistula may allow for an early diagnosis, while also making it possible to successfully resect the lesion, thus resulting in a favorable outcome.
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Kimitoshi Kubo, Noriko Kimura, Katsuhiro Mabe, Yusuke Nishimura, Motot ...
2018Volume 57Issue 20 Pages
2951-2955
Published: October 15, 2018
Released on J-STAGE: October 15, 2018
Advance online publication: May 18, 2018
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The endoscopic and pathological features of early gastric mixed adenoneuroendocrine carcinoma (MANEC), as well as its carcinogenesis, remain largely unclear. Screening esophagogastroduodenoscopy was performed on an 80-year-old man, revealing 3 superficial elevated lesions. Endoscopic submucosal dissection (ESD) was performed, and the patient was diagnosed with intramucosal gastric cancer comprising mixed adenocarcinoma and neuroendocrine tumor, well-differentiated adenocarcinoma and well-differentiated adenocarcinoma, with negative margins. To our knowledge, this is the first report describing the endoscopic and pathological findings of synchronous triple gastric cancer incorporating mixed adenocarcinoma and neuroendocrine tumor completely resected with ESD.
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Yoon Suk Lee, Nam-Hoon Kim, Jun Hyuk Son, Jung Wook Kim, Won Ki Bae, K ...
2018Volume 57Issue 20 Pages
2957-2962
Published: October 15, 2018
Released on J-STAGE: October 15, 2018
Advance online publication: March 09, 2018
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Autoimmune pancreatitis (AIP) is a distinct subtype of pancreatitis, which is classified into type 1 and 2 based on the clinicopathological features. According to the international consensus diagnostic criteria, pancreas resection or core biopsy specimens are recommended to make an accurate histological evaluation. However, the usefulness of endoscopic ultrasonography (EUS) guided fine needle aspiration (FNA) for histological evaluation has also been reported. Furthermore, the simultaneous presentation of type 2 AIP and Crohn's disease (CD) is very rare, especially in the Asian population. Therefore, we herein report a case of type 2 AIP with CD, which was diagnosed using EUS guided FNA with a 22-gauge needle.
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Taiji Okada, Kaori Mogi, Akihiro Endo, Hiroyuki Yoshitomi, Teiji Oda, ...
2018Volume 57Issue 20 Pages
2963-2968
Published: October 15, 2018
Released on J-STAGE: October 15, 2018
Advance online publication: May 18, 2018
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Traumatic tricuspid regurgitation (TR) is a rare cardiovascular complication in chest trauma. Changes in the left ventricle (LV) function after operation are unclear. A 61-year-old woman who had been involved in a traffic accident 1 month earlier presented with exertional dyspnea. Transthoracic echocardiography (TTE) showed severe tricuspid regurgitation (TR) accompanied by LV dysfunction due to anterior leaflet prolapse with papillary muscle rupture. After tricuspid plasty, the LV function improved, as evidenced by TTE and speckle tracking echocardiography. In conclusion, the early diagnosis of traumatic TR is important, and early surgical intervention might be effective for achieving ventricular function improvement.
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Kentaro Arakawa, Toshikazu Gondo, Kensuke Matsushita, Hideo Himeno, Ka ...
2018Volume 57Issue 20 Pages
2969-2973
Published: October 15, 2018
Released on J-STAGE: October 15, 2018
Advance online publication: June 06, 2018
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A 62-year-old woman with takotsubo cardiomyopathy (TCM) accompanied by cardiogenic shock due to the obstruction of left ventricular outflow tract (LVOT) and massive mitral regurgitation (MR) was admitted to the emergency department. After successful treatment with intensive care, dobutamine stress-echocardiography was performed, which reproduced a dynamic LVOT gradient, severe MR and cardiogenic shock. A histological examination obtained from the right ventricular septum demonstrated hypertrophied and bizarre myocytes, with myocyte disarray. Besides TCM, a diagnosis of preexisting hypertrophic cardiomyopathy with latent obstruction was made. She was discharged with medical therapy including a beta-blocker, which would not be routinely employed in the treatment of a patient with TCM.
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Ryo Koda, Ryo Itoh, Masafumi Tsuchida, Kazumasa Ohashi, Noriaki Iino, ...
2018Volume 57Issue 20 Pages
2975-2980
Published: October 15, 2018
Released on J-STAGE: October 15, 2018
Advance online publication: June 06, 2018
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Legionella pneumonia is occasionally accompanied by renal complications; however, the cause of this remains unknown. We herein report a 70-year-old Japanese man with Legionella pneumonia who presented with hyponatremia, hypophosphatemia, and hypouricemia. The levels of urinary β2-microglobulin and N-acetyl-β-D-glucosaminidase were remarkably high, indicating severe renal tubular damage. The presence of glycosuria and aminoaciduria as well as increased fractional excretion of uric acid and decreased tubular reabsorption of phosphate indicated that the patient's condition was complicated with Fanconi syndrome. After antimicrobial therapy, the electrolyte abnormalities and renal tubular damage were completely resolved.
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Yuko Asato, Toshiaki Kamitani, Kuniyuki Ootsuka, Mizuki Kuramochi, Koz ...
2018Volume 57Issue 20 Pages
2981-2986
Published: October 15, 2018
Released on J-STAGE: October 15, 2018
Advance online publication: May 18, 2018
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We herein report the case of a 76-year old man with aquaporin-4-Immunoglobulin-G (AQP4-IgG)-positive neuromyelitis optica spectrum disorder (NMOSD), in whom transient interstitial pulmonary lesions developed at the early stage of the disease. Chest X-ray showed multiple infiltrative shadows in both upper lung fields, and computed tomography revealed abnormal shadows distributed randomly in the lungs. Surgical lung biopsy showed features of unclassifiable interstitial pneumonia, characterized by various types of air-space organization, which resulted in obscure lung structure. This is the first report to describe the pathological findings of interstitial pneumonia, which may represent a rare extra-central nervous system complication of NMOSD.
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Kazuo Suzuki, Takahiro Yanagimura, Kazumasa Ohashi, Hiroshi Kagamu, To ...
2018Volume 57Issue 20 Pages
2987-2990
Published: October 15, 2018
Released on J-STAGE: October 15, 2018
Advance online publication: May 18, 2018
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A 65-year-old man was diagnosed with advanced non-small, non-squamous lung cancer. He was treated with chemotherapy containing bevacizumab as well as cisplatin and pemetrexed. After 2 courses of treatment, computed tomography revealed that his abdominal aortic artery was almost occluded by a thrombus; however, he had no ischemic symptoms. Heparin infusion and warfarin reduced the size of the arterial thrombus and the patient was subsequently treated with chemotherapy without bevacizumab. No thrombotic events occurred during the subsequent treatment. We later noticed a small organized abdominal arterial clot and calcification on a computed tomography scan taken before bevacizumab treatment. Atherosclerotic changes should be evaluated before the administration of bevacizumab.
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Yuji Uehara, Hajime Kasai, Takahiro Nakajima, Nobuhiro Tanabe, Koichir ...
2018Volume 57Issue 20 Pages
2991-2994
Published: October 15, 2018
Released on J-STAGE: October 15, 2018
Advance online publication: June 06, 2018
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Progressive fibrobullous changes in the residual lobes are sometimes observed after lobectomy. Aspergillus osteomyelitis is an uncommon infection that rarely occurs sternally. A 70-year-old man who had undergone lobectomy 12 years earlier was admitted to our hospital for chest pain. He was diagnosed with Aspergillus sternomyelitis based on sternal bone culture after an ultrasound-guided percutaneous needle biopsy. The fibrosis and right residual lung apex volume loss had gradually progressed over 12 years, and therefore, chronic pulmonary aspergillosis (CPA) with direct invasion sternal from the CPA was considered. Aspergillus sternomyelitis can develop from CPA as a late complication of lobectomy.
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Shinya Daitoku, Tomomi Aoyagi, Shinichiro Takao, Seiya Tada, Mika Kuro ...
2018Volume 57Issue 20 Pages
2995-2999
Published: October 15, 2018
Released on J-STAGE: October 15, 2018
Advance online publication: May 18, 2018
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Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening syndrome that occurs as a complication in many clinical settings. Malignancy-associated HLH develops in patients with hematopoietic neoplasms, particularly in those with lymphoma, and its development in those with myelodysplastic syndrome (MDS) is uncommon. We herein report a case of HLH in a patient with low-risk MDS that was successfully treated with azacitidine. The prevalence of immune abnormalities among MDS patients and the immune effects of azacitidine have recently been elucidated, suggesting that MDS-associated HLH occurs as a result of immune impairment, and azacitidine improves this condition by restoring the immune system.
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Masao Hagihara, Toru Mese, Shin Ohara, Jian Hua, Shiro Ide, Morihiro I ...
2018Volume 57Issue 20 Pages
3001-3005
Published: October 15, 2018
Released on J-STAGE: October 15, 2018
Advance online publication: May 18, 2018
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We herein report a rare case of methotrexate (MTX)-associated intravascular large B-cell lymphoma (IVLBCL) in a man with rheumatoid arthritis. Two episodes of a fever of unknown origin accompanied by elevated levels of serum lactate dehydrogenase and the soluble interleukin-2 receptor occurred within a year, so the patient was suspected of having an MTX-associated lymphoproliferative disorder. His clinical symptoms resolved after the cessation of MTX. However, after treatment with iguratimod, another disease-modified anti-rheumatic drug, markedly similar symptoms recurred, and random skin biopsies resulted in a diagnosis of IVLBCL. The patient received a rituximab-containing chemotherapy and achieved complete remission.
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Masanori Kurihara, Takuya Sasaki, Hiroyuki Ishiura, Shoji Tsuji
2018Volume 57Issue 20 Pages
3007-3010
Published: October 15, 2018
Released on J-STAGE: October 15, 2018
Advance online publication: May 18, 2018
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Cardiac 123I-metaiodobenzylguanidine (MIBG) scintigraphy is a promising biomarker for dementia with Lewy bodies (DLB). However, we experienced a patient with cognitive decline, parkinsonism, and a decreased MIBG uptake who turned out to have HIV dementia. Normal dopamine transporter single-photon emission computed tomography reduced the possibility of comorbid Lewy body pathology causing the patient' s parkinsonism. The decreased MIBG uptake was most likely due to postganglionic sympathetic nerve denervation, which can also be caused by HIV. This case further emphasizes the importance of excluding other causes of autonomic neuropathy, including HIV infection, before interpreting MIBG scans.
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Yuka Ebihara, Hitoshi Mochizuki, Nobuyuki Ishii, Ikuko Mizuta, Kazutak ...
2018Volume 57Issue 20 Pages
3011-3014
Published: October 15, 2018
Released on J-STAGE: October 15, 2018
Advance online publication: May 18, 2018
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A 50-year-old man with a family history of stroke and depression slowly developed brain lesions. Magnetic resonance imaging revealed hyperintense lesions in the diffuse white matter, external capsules, and temporal poles on T2-weighted imaging. A heterozygous mutation c.3879C>G in exon 24 of the NOTCH3 gene (p.Cys1293Trp) was detected, confirming a diagnosis of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Exon 24 mutations are rather rare and this represents the first Japanese case of CADASIL.
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Haruka Takeshige, Sachiko Nakayama, Kenya Nishioka, Yuanzhe Li, Yumiko ...
2018Volume 57Issue 20 Pages
3015-3019
Published: October 15, 2018
Released on J-STAGE: October 15, 2018
Advance online publication: June 06, 2018
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Supplementary material
We herein report two patients harboring the mutation N279K in microtubule-associated protein tau (MAPT), who showed parkinsonism with a disease duration within three years from the onset, evaluated by dopamine transporter (DAT) [123I]N-ω-fluoroprophyl-2β-carbomethoxy-3β-(4-iodophenyl) tropane single-photon emission computed tomography. We performed a quantification analysis, comparing five age- and severity-matched PD patients and six normal controls. The patients with the N279K mutation showed a more marked reduction in their DAT densities, especially in the caudate nucleus and anterior putamen, than the others. An early marked reduction in the DAT densities in the caudate nucleus and anterior putamen may be an early biomarker of patients with MAPT mutations.
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Keiko Ohnari, Kazumasa Okada, Osamu Higuchi, Hidenori Matsuo, Hiroaki ...
2018Volume 57Issue 20 Pages
3021-3024
Published: October 15, 2018
Released on J-STAGE: October 15, 2018
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An 82-year-old woman developed neck weakness and dysarthria with antibodies against acetylcholine receptor (AChR) and low-density lipoprotein receptor-related protein 4 (LRP4). Myasthenia gravis (MG) was diagnosed by edrophonium and repetitive nerve stimulation tests. Her symptoms resolved completely by immunotherapy. One year later, she presented with muscle weakness and bulbar palsy accompanied by atrophy and fasciculation. Her tendon reflexes were brisk, and Babinski's sign was positive. She was diagnosed with probable amyotrophic lateral sclerosis (ALS). Immunotherapy did not improve her symptoms, and she ultimately died of respiratory failure. MG and ALS may share a pathophysiology, including anti-LRP4 antibodies at the neuromuscular junction.
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Yuya Fujita, Shoichi Fukui, Midori Ishida, Yushiro Endo, Sosuke Tsuji, ...
2018Volume 57Issue 20 Pages
3025-3028
Published: October 15, 2018
Released on J-STAGE: October 15, 2018
Advance online publication: May 18, 2018
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A 70-year-old Japanese woman presented to our hospital with gait disturbance and cognitive dysfunction. Since she had arthritis, lymphopenia, hypocomplementemia, and anti-nuclear and anti-double-stranded DNA antibodies, she was diagnosed with systemic lupus erythematosus (SLE). T2-weighted magnetic resonance imaging revealed bilateral hyperintensities in the putamen. Based on her cognitive impairment, muscle rigidity, and high levels of interleukin-6 in the cerebrospinal fluid, we believed she had developed a complication of a neuropsychiatric disease and administered corticosteroids and intravenous cyclophosphamide therapy. Her cognitive function fully recovered, and her gait disturbance improved. Attending to cognitive impairment in elderly SLE patients is necessary.
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Rika Tanaka, Yasuhiro Shimojima, Hideaki Moteki, Dai Kishida, Ken-ichi ...
2018Volume 57Issue 20 Pages
3029-3033
Published: October 15, 2018
Released on J-STAGE: October 15, 2018
Advance online publication: May 18, 2018
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We herein report a case of otitis media with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (OMAAV) induced by propylthiouracil (PTU). A 30-year-old Japanese woman with Graves' disease, who was treated with PTU, reported with otitis media with sensorineural hearing loss bilaterally and trigeminal neuralgia on the left side, as well as elevated serum levels of myeloperoxidase-ANCA. Prior treatment with antibiotics was ineffective even after tympanostomy. However, clinical remission was immediately achieved after initiating prednisolone together with PTU withdrawal. These findings suggest that PTU therapy induces localized otological involvement as the concept of OMAAV.
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Keiko Koshiba, Sei Muraoka, Toshihiro Nanki, Satoru Komatsumoto
2018Volume 57Issue 20 Pages
3035-3040
Published: October 15, 2018
Released on J-STAGE: October 15, 2018
Advance online publication: June 06, 2018
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We report the findings of an 18-year-old boy with immunoglobulin A vasculitis (IgAV) complicated with bowel perforation and nephritis. He presented with abdominal pain, arthralgia and palpable purpura. Massive proteinuria developed during his clinical course. The patient was treated successfully using combination therapy of glucocorticoid (GC), cyclosporine (CYA) and factor XIII (F XIII) replacement. A standard treatment strategy for severe IgAV patients has not been established due to its rarity. Combination therapy using GC, CYA and F XIII replacement should be considered for severe IgAV patients.
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Koichi Miyashita, Shun Matsuura, Kenichi Tajima, Shogo Tajima, Ami Ao ...
2018Volume 57Issue 20 Pages
3041-3045
Published: October 15, 2018
Released on J-STAGE: October 15, 2018
Advance online publication: May 18, 2018
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A 63-year-old woman presented with a fever, eruption, and sterile pyuria. A cystoscopic examination revealed submucosal nodular lesions in the trigone of the bladder, and a biopsy specimen showed epithelioid cell granulomas in the lamina propria of the bladder. Mycobacterium avium grew in the urine culture. Other organ involvement, such as the lungs, spleen, bones, muscles, and pelvic lymph nodes, was observed on radiological examinations, and M. avium was isolated from some organ lesions. Interferon-γ-neutralizing autoantibodies were detected in the patient's serum. Therefore, the patient was diagnosed with disseminated M. avium infection, which was resolved with antimycobacterial treatment.
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Ryutaro Furukawa, Hirokuni Homma, Tomohiro Inoue, Hajime Horiuchi, Kaz ...
2018Volume 57Issue 20 Pages
3047-3050
Published: October 15, 2018
Released on J-STAGE: October 15, 2018
Advance online publication: May 18, 2018
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Temozolomide, a key drug in the treatment of malignant glioma, can cause profound lymphopenia and various opportunistic infectious diseases. A 79-year-old woman with anaplastic oligodendroglioma developed a fever and gross hematuria after 8 weeks of standard radiotherapy with concomitant temozolomide treatment. A cytomegalovirus (CMV) antigen test for pp65 antigenemia was positive (137 cells per 75,800 leukocytes), and the findings from a urine cytology test were consistent with CMV-induced hemorrhagic cystitis. She was treated with ganciclovir, and her condition improved. CMV monitoring is needed when patients develop symptoms related to opportunistic infections during temozolomide treatment for malignant glioma.
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Hidekazu Tanaka, Ken Kamata, Mamoru Takenaka, Masatoshi Kudo
2018Volume 57Issue 20 Pages
3051-3052
Published: October 15, 2018
Released on J-STAGE: October 15, 2018
Advance online publication: May 18, 2018
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Taijyu Satoh, Akio Fukui, Shigehiko Katoh, Motoyuki Matsui
2018Volume 57Issue 20 Pages
3053-3054
Published: October 15, 2018
Released on J-STAGE: October 15, 2018
Advance online publication: May 18, 2018
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Nobuyuki Takasu, Hiromichi Seki
2018Volume 57Issue 20 Pages
3055-3056
Published: October 15, 2018
Released on J-STAGE: October 15, 2018
Advance online publication: May 18, 2018
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Tomohiro Yabushita, Kazuyuki Ueno, Satoshi Yoshioka, Takayuki Ishikawa
2018Volume 57Issue 20 Pages
3057-3058
Published: October 15, 2018
Released on J-STAGE: October 15, 2018
Advance online publication: June 06, 2018
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Suzuna Sugi, Shinjiro Kaieda, Ken-ichi Irie, Hiroaki Ida
2018Volume 57Issue 20 Pages
3059
Published: October 15, 2018
Released on J-STAGE: October 15, 2018
Advance online publication: May 18, 2018
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Ryohei Ono, Izumi Kitagawa, Hiroshi Osafune
2018Volume 57Issue 20 Pages
3061-3062
Published: October 15, 2018
Released on J-STAGE: October 15, 2018
Advance online publication: May 18, 2018
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Shotaro Haji, Futoshi Eto, Tsuyoshi Torii
2018Volume 57Issue 20 Pages
3063-3064
Published: October 15, 2018
Released on J-STAGE: October 15, 2018
Advance online publication: May 18, 2018
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