Nine cases of mantle cell lymphoma with gastrointestinal involvement were retrospectively reviewed, and their clinical features, including the involved organs, macroscopic forms, treatment methods, and prognoses were evaluated. The involved organs in the gastrointestinal tract were the stomach in 5 cases, the duodenum in 4, the ileum in 5, the cecum in 1, the colon in 4, and the rectum in 2. The macroscopic form of the gastric involvement varied, and included the protruding type in 3 cases, the ulcerated type in one, and the superficial type in one. On the other hand, the macroscopic form of the intestinal involvement from the duodenum to the rectum was mostly of the multiple lymphomatous polyposis type, which was observed in 6 cases. A hyper CVAD/MA regimen and high-dose chemotherapy with autologous peripheral blood stem cell transplantation was performed in 5 cases. All of these 5 cases continue to show a complete response.
A 54-year-old woman brought by ambulance had a lower abdominal mass and cough. Bilateral pleural effusion was revealed by X-ray and CT. An abdominal CT and MRI disclosed bilateral ovarian tumors which were considered to be metastatic tumors. GI endoscopy disclosed IIc-like advanced gastric cancer on the posterior wall of the stomach. Distal gastrectomy, total hysterectomy and bilateral adnexectomy were carried out. Gastric cancer was pathologically diagnosed as signet-ring cell carcinoma. Ovarian tumors had a similar histology, which suggested metastasis from gastric cancer. Since bilateral pleural effusion completely vanished after the ovarian resection, we concluded that this case coincided with pseudo-Meigs' syndrome. Pseudo-Meigs' syndrome of metastatic ovarian tumor from gastric cancer is very rare, only 3 cases having been reported in Japan.
We describe a 42-year-old-man with HIV infection who developed ulcerative colitis. Ulcerative colitis was diagnosed on the basis of clinical symptoms, and the findings of colonoscopy, pathology and culture. Although remission of ulcerative colitis was induced by PSL and SASP, HIV infection progressed. Treatment with highly active antiretroviral therapy (HAART) was started. HIV viral load decreased to less than 50copies/ml and CD4 counts increased to over 400/μl. After discontinuance of PSL and SASP, he is still in good condition. This is the first report of HIV infection associated with ulcerative colitis in Japan. A relationship between immune disorder in advanced HIV infection and inflammatory bowel disease was suggested. Ulcerative colitis might be an important complication in HIV infection.
A 29-year-old man was admitted with abdominal pain. Peritonitis symptoms appeared on the day after of hospitalization and emeregency surgery was performed. A Meckel diverticulum adhered to the mesenterium of the sigmoid colon which was strangulated for a length of 30cm. Additionally, a second Meckel diverticulum was present on the oral side of the first one. The length of these were 3cm and 5cm, and the longer one caused the strangulation. The letter diverticulum contained a crab shell about 2cm in size, which was considered to be the cause of adhesion. Our search of the literature revealed only one report of two Meckel diverticula. This type of our case is extremely rare.
A 77-year-old man was admitted to our hospital with abdominal pain and ascites. He had an occupational history of working with asbestos. Abdominal CT showed multiple nodular lesions with enhancement by contrast medium in the cavity. Platelet counts, CRP and serum IL-6 level were increased. Biopsied materials obtained by laparoscopy showed oval cells with rich cytoplasm growing in an epithelial pattern. To clarify the characteristics of the cells, immunohistochemistry was performed. Calretinin and CK5/6 were positive, and CEA, S-100 protein, c-kit and CD34 were negative, result in confirmation of a diagnosis of malignant mesothelioma. Because IL-6, IL-6 receptor and VEGF were expressed markedly, the patient received chemotherapy for IL-6 suppression. During the treatment, thrombocytosis imploved satisfactorily.
A 58-year-old man was brought to our hospital with left upper abdominal pain which suddenly appeared on the previous evening. An abdominal CT scan showed localized retention of ascites, a slightly high density mass under the left upper abdominal wall, with a high density area detected within the mass, which was suggestive of leakage of contrast medium from peripheral branches of the omental artery. From these findings intraperitoneal hemorrhage caused by bleeding from the greater omentum was suspected. Angiographic examination of the abdomen indicated extravasation of contrast medium from blood vessels of the right gastroepiploic artery. Transarterial embolization was carried out and permanent hemostasis was achieved. Injury, anticoagulant, neoplasms, varix, torsion of the omentum, and segmental arterial mediolysis (SAM) etc have been reported as causes of omental bleeding, but none of these were found in our case. We diagnosed the present case as idiopathic omental bleeding.
Case 1) A 35-year-old man was admitted to our hospital for detailed examination of a 50-mm pancreas head tumor with surrounding lymph node swelling detected on medical checkup images. Ultrasound-guided lymph node biopsy specimens gave a diagnosis of a nonfunctioning pancreatic neuroendocrine cancer, and adjuvant systemic chemotherapy was given after surgical resection of the tumor. Case 2) A 52-year-old man was admitted to our hospital for detailed examination of an 18-mm pancreas head tumor detected by medical checkup FDG-PET images. Imaging tests gave a diagnosis of a nonfunctioning pancreatic neuroendocrine tumor. He underwent surgical resection, and the tumor was diagnosed as benign pathologically. Both cases showed FDG-PET accumulation in the tumors irrespective of their malignant or benign nature. Increased prevalence of FDG-PET checkup may increase the diagnosis of pancreatic neuroendocrine tumor in asymptomatic subjects.
We report a case of a 35-year-old patient with acute pancreatitis after administration of ceftriaxone. She was given ceftriaxone (2g/day) for 9 days because of diverticulitis of the colon. She was admitted to our hospital again because of epigastralgia 12 days after the first administration of ceftriaxone. Laboratory examination showed markedly elevated serum amylase, and CT scan demonstrated findings consistent with acute pancreatitis, in addition to sludge in the common bile duct and gall bladder, which was not identified before the administration of ceftriaxone. We should be aware of the fact that administration of ceftriaxone sometimes results in the formation of biliary sludge and can cause severe adverse events such as cholecystitis and pancreatitis, not only in children, but also in adult patients.