We report a case of granulocyte-colony stimulating factor producing gastric cancer with multiple liver metastases. A 68-year-old woman who complained of epigastralgia visited our hospital. Upper gastrointestinal endoscopic examination revealed a type-2 gastric cancer. The laboratory data at admission indicated leukocytosis (35900/μl) and a high level of serum granulocyte-colony stimulating factor (61pg/mg). Granulocyte-colony stimulating factor producing gastric cancer was diagnosed by immunohistochemistry of biopsy specimen. Since we detected multiple liver metastases, chemotherapy was performed. Granulocyte-colony stimulating factor-producing gastric cancer is relatively rare and we summarize previous reports.
A 23-year-old woman was admitted in NovemberC 2002, complaining pain of the left side and buttock. She had ulcerative colitis when she was 16 and received medical treatment. Based on physical examination and findings of magnetic resonance imaging and bone scintigrapy, as sacroiliitis complicated by ulcerative colitis. was diagnosed Reports on sacroiliitis and ankylosing spondylitis complicated by inflammatory bowel diseases (IBD) are relatively rare in Japan, whereas they are common complications of IBD in Western countries. The efficacy of steroids on pain relief of sacroiliitis and ankylosing spondylitis is unclear.
We report a case of severe ulcerative colitis complicated with primary diabetes mellitus that was effectively treated with oral tacrolimus. A 36-year-old man suffered his first attack of ulcerative colitis. Because it was difficult to control the patient's diabetes, we instituted tacrolimus and azathioprine without a corticosteroid regimen as the initial treatment. Within two weeks, the ulcerative colitis activity went into remission and the patient's diabetes did not worsen.
A 42-year-old woman who complained of epigastralgia was referred to our hospital because of an abdominal mass found by ultrasonography. CT and MRI scans revealed that the abdominal mass, 4 cm in diameter, located on the left side of the right kidney. Gastroduodenoscopy detected a deep ulcerative lesion covered with a yellowish coat in the second portion of duodenum. A sonolucent area at the bottom of the ulcerative lesion seemed to expend to the abdominal mass on ultrasonic endoscopy. Tuberculosis was one possible differential diagnosis. Pathological examination including Ziehl-Neelsen staining using biopsy specimens taken from the bottom of the ulcerative lesion did not show tuberculosis infection. However, polymerase chain reaction analysis using the biopsy specimens revealed that gene expression of tuberculosis was positive. We determined that tuberculous lymphadenitis penetrated the duodenum forming an ulcerative lesion in the duodenum. The administration of anti-tubercular medicine for 6 months male the abdominal mass disappeare and the duodenal ulcerative lesion formed an ulcer scar. We report here a case of tuberculous lymphadenitis penetrating the duodenum which was successfully treated by conservative therapy without surgical treatment.
A 72-year-old woman with multilocular liver cysts was admitted. This lesions seemed to be an alveolar hydatid disease. Two methods of Western blotting were used for serologic diagnosis. One method recognizes antigens of crude extracts of Echinococcus multilocularis (EM). The other method recognizes a purified antigen (Em18) of EM. Her serum only reacted with the former method and never reacted with Em18 antigen. Eighteen months after first admissionC she had an operation. The resected specimen was diagnosed with simple cysts. Western blotting using Em18 antigen could greatly facilitate the differential diagnosis of simple liver cyst and alveolar hydatid disease.
We encountered 4 cases of hepatic peribiliary cysts (HPBC) in our hospital. Two were asymptomatic, one was complicated by a choledocholithiasis, and one by cholangitis and sepsis. Based on a review of the 38 cases of HPBC clinically diagnosed in Japan, the main problem associated with this disease seemed incorrect preoperative diagnosis leading to an unnecessary hepatectomy. Another problem was concomitant cholangitis, which tended to recur and in some cases needed aggressive treatment using drainage.