Rinsho Ketsueki
Online ISSN : 1882-0824
Print ISSN : 0485-1439
ISSN-L : 0485-1439
Volume 42, Issue 7
Displaying 1-10 of 10 articles from this issue
  • Hiroyuki FUJITA, Hideyuki KOHARAZAWA, Hiroko NISHIDA, Soichiro TERADA, ...
    2001 Volume 42 Issue 7 Pages 537-542
    Published: 2001
    Released on J-STAGE: July 28, 2009
    JOURNAL RESTRICTED ACCESS
    A 45-year-old woman was admitted to our hospital in August, 1999. Laboratory data showed a white blood cell count of 5,050/μl with 78% abnormal lymphocytes, hemoglobin 6.8 g/dl, platelets 4.8×104l, and soluble IL-2 receptor 97,600/ml. The abnormal cells were characterized by a hairy appearance under phase contrast microscopy, and showed strong tartrate-resistant acid phosphatase activity. Immunophenotype analysis revealed that these cells were positive for CD11c, CD19 and CD25, and negative for CD5. Bone marrow biopsy showed diffuse proliferation of hairy cells with moderate myelofibrosis. We diagnosed the patient as having European-American-type hairy cell leukemia. Pentostatin was administered at a dose of 5 mg/m2 weekly. After twelve doses, the peripheral blood data returned to the normal range with no hairy cells in the blood or bone marrow, although slight splenomegaly remained. The patient underwent splenectomy in December of the same year, and we were unable to find any hairy cells by histological and immunohistochemical examination. Although most patients with hairy cell leukemia in Japan have the Japanese variant, and the European-American type is rare, pentostatin is as effective as it is for European and American patients.
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  • Shuji NAKADA, Tetsuaki SEKIKAWA, Shinobu TAKAHARA, Yasunori YAMAZAKI, ...
    2001 Volume 42 Issue 7 Pages 543-548
    Published: 2001
    Released on J-STAGE: July 28, 2009
    JOURNAL RESTRICTED ACCESS
    We describe a patient with myelodysplastic syndrome (MDS) who developed disseminated infection due to nontuberculous mycobacteria (NTM). A 64-year-old man was admitted because of persistent fever that had been unresponsive to antibiotics. Bone marrow aspiration specimens showed myelodysplasia (RA), but the origin of the fever was unclear. Cytopenia worsened to a level that required transfusion of red blood cells and platelets. Repeated bone marrow examination revealed hypoplasia with hemophagocytosis. Several weeks later, photochromogenic NTM was isolated from bone marrow specimens, sputum and broncho-alveolar lavage (BAL) fluid which had been obtained on admission. Antituberculosis treatment with clarithromycin markedly improved the patient's general condition and hematological abnormalities. Three months after resolution of the NTM infection, the peripheral blood monocyte count increased, the fever recurred, and the patient suddenly died of myocardial infarction. Disseminated infection with NTM has gained attention as a frequent complication of AIDS, and NTM can also be one of the pathogens causing disseminated infection in patients with MDS. In the present case, infection with mycobacteria that normally would have been digested by macrophages and would not have caused disseminated infection in a healthy individual, was probably related to the clinical features including high fever, severe pancytopenia and hemophagocytosis.
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  • Shoichi DOI, Setsuko EDAMURA, Hiroshi AKASAKA, Masayo KAWAMURA, Nobuyo ...
    2001 Volume 42 Issue 7 Pages 549-553
    Published: 2001
    Released on J-STAGE: July 28, 2009
    JOURNAL RESTRICTED ACCESS
    We describe a complete cytogenetic response to interferon-α in a patient with chronic myelogenous leukemia undergoing chronic hemodialysis. Although IFN-α therapy has been applied to patients with chronic hepatitis C receiving hemodialysis, the pharmacokinetics of IFN-α in patients with poor renal function still remain unclear. In the present patient, the serum IFN-α concentration remained high even 48 hours after injection (42.9 IU/ml), and IFN-α was almost completely removed by hemodialysis (<6 UI/ml). The patient was treated with IFN-α (3×106 IU, three times a week), and cytogenetic disappearance (0%) of the Ph-positive clone was confirmed 31 months after the start of therapy. Recombinant human erythropoietin (Epo) was used to treat anemia due to renal failure and IFN-α therapy. The anemia was controllable with Epo, and no adverse effect was observed.
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  • Masatoshi KANNO, Shinobu NAKAMURA, Daisuke DANNO, Chika UOTANI, Takeha ...
    2001 Volume 42 Issue 7 Pages 554-558
    Published: 2001
    Released on J-STAGE: July 28, 2009
    JOURNAL RESTRICTED ACCESS
    A 71-year-old woman with an 8-year history of IgG-κ type multiple myeloma was admitted because of severe lumbago and bone destruction. Her serum IgG level was elevated to 5,565 mg/dl at admission. Despite treatment with doxorubicin, vincristine, dexamethasone, melphalan and interferon-α, the response was transient. Nine months later, multiple skin nodules appeared on her chest, abdominal wall and right thigh accompanied by elevation of the serum IgG level. Response to combination chemotherapy with cyclophosphamide, ranimustine, vincristine and prednisolone was also transient. The skin tumors on the bilateral thighs, especially on the left side, acquired chemotherapy resistance and gradually enlarged. Although the serum IgG level was maintained by chemotherapy within the range 1,790∼2,676 mg/dl, the skin tumors on the left thigh had spread very rapidly and appeared “rock-like”. The enlarged tumors caused necrosis with erosions and oozing hemorrhage. A skin biopsy from the tumors on the left thigh showed plasmacytoma in which infiltration of large anaplastic plasma cells was observed. The patient died of sepsis 8 months after the skin tumors initially developed. This is a very rare case of multiple myeloma in which multiple large plasmacytomas of the skin developed and grew aggressively at the terminal stage after a long-term indolent course.
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  • Yoshiharu IGARASHI, Tomohiro HAYASHI, Shinji SATO, Takeo KATO
    2001 Volume 42 Issue 7 Pages 559-564
    Published: 2001
    Released on J-STAGE: July 28, 2009
    JOURNAL RESTRICTED ACCESS
    A 77-year-old woman was referred to our hospital because of leukocytosis and leukoblastosis in September 1999. She was healthy except for hypertension, and no abnormal findings in the peripheral blood had been observed up to December 1998. Physical examination revealed neither hepatosplenomegaly nor superficial lymphadenopathy. A bone marrow film showed massive proliferation of blast cells (87.8%), some of which contained coarse basophilic granules (38.6%). The cells were negative for peroxidase and esterase (α-naphtyl butyrate and ASD-chloroacetate) staining, but the granules showed metachromasia upon toluidine blue staining. As immunophenotypic analysis of the cells showed double positive for CD13/CD19 but negativity for CD33, this case did not meet the diagnostic criteria for biphenotypic acute leukemia. Chromosome and gene analyses showed positivity for the Ph1 chromosome with minor bcr/abl chimeric mRNA. A homogenate of the peripheral mononuclear cells demonstrated a high concentration of histamine. Electron microscopy analysis confirmed that some of the blast cells contained dense granules, which closely resembled “immature basophil granules” morphologically. These results suggested that the blast cells showed basophilic differentiation. As the clinical course and peripheral blood fingdings were different from blastic crisis of chronic myelogenous leukemia (CML) and CML with minor bcr/abl chimeric mRNA, the present case was diagnosed as “multiphenotypic acute leukemia”, a type of acute basophilic leukemia classified by Duchayne.
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  • Miyuki HAYAMA, Nozomi NIITSU, Jun-ichi TAMARU, Masaaki HIGASHIHARA
    2001 Volume 42 Issue 7 Pages 565-570
    Published: 2001
    Released on J-STAGE: July 28, 2009
    JOURNAL RESTRICTED ACCESS
    Primary vaginal non-Hodgkin's lymphomas (NHL) are rare, and are clinically difficult to differentiate from inflammatory diseases or vaginal cancer. Here, we present such a case in a 74-year-old woman complaining of fever and difficulty with urination. Pelvic examination revealed a tumor involving most of the vaginal wall, and pelvic MRI demonstrated vaginal wall thickening. A biopsy of this lesion confirmed NHL (diffuse large B-cell lymphoma), and the patient was admitted. Abdominal CT and MRI detected a vaginal tumor, and Ga scintigraphy confirmed accumulation in the pelvis, but no abnormalities were seen in other areas. Therefore, the patient was diagnosed as having NHL at clinical stage IB with low-intermediate risk (international prognosis index) (LDH 1,309 IU/L). The patient underwent three courses of CHOP therapy followed by radiotherapy, and complete remission was achieved. Primary vaginal NHL often affects women younger than 50 years of age, and abnormal hemorrhage is the initial symptom in many cases. There have been a number of reports of long-term survival following appropriate early chemotherapy and radiation therapy, suggesting that early diagnosis and treatment based on vaginal biopsy findings greatly influence the prognosis.
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