Rinsho Ketsueki
Online ISSN : 1882-0824
Print ISSN : 0485-1439
ISSN-L : 0485-1439
Volume 44, Issue 11
Displaying 1-11 of 11 articles from this issue
  • Yasufumi MASAKI, Dong Ling LI, Kumiko SHIMOYAMA, Takanori KAWANAMI, To ...
    2003 Volume 44 Issue 11 Pages 1074-1079
    Published: 2003
    Released on J-STAGE: July 28, 2009
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    We report an unusual case of the ‘reverse’ variant of follicular lymphoma in which the nodules had central parts that stained dark and cuffs that stained pale. Because diagnosis was difficult relying only on formalin-fixed histopathology, we examined the cell surface markers and karyotype. The patient, a 65-year-old man, presented with multiple lymphadenopathy, low-grade fever, night sweats, anorexia, dry cough and sense of chest oppression. Cell surface marker analysis showed that pathologic lymphocytes were positive for CD10, CD19, CD20, HLA-DR, IgM/IgD and kappa, and t(14;18)(q32;q21) was detected by karyotypic analysis. The ‘reverse’ variant of follicular lymphoma, clinical stage IVB was diagnosed. the rearrangement band was detected with PCR-based clonality analysis in not only the immunoglobulin heavy chain gene but also the T cell receptor γ chain gene, thus confirming monoclonal proliferation of both B cells and T cells.
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  • Yasuhiro MOCHIDUKI, Shingo MURAMOTO
    2003 Volume 44 Issue 11 Pages 1080-1084
    Published: 2003
    Released on J-STAGE: July 28, 2009
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    A 15-year-old male with refractory anemia in myelodysplastic syndrome underwent peripheral blood stem cell transplantation from his two-loci-mismatched haploidentical mother. The conditioning regimen was comprised of cyclophosphamide, busulfan, and fludarabine. Non-T-cell-depleted peripheral blood stem cells were infused with graft-versus-host disease (GVHD) prophylaxis consisting of tacrolimus and short-course methotrexate. Engraftment was confirmed on day 18, and complete chimera on day 29. Although the patient developed grade II acute GVHD following the transplantation, it responded rapidly to steroid administration. The subsequent course was uneventful, and he remains well in complete remission in 26 months after transplant. This successful experience suggests that maternal hematopoietic stem cell transplant for children, in specific immune tolerance based on the presence of microchimerism and compatibility of minor histocompatibility antigens between mother and child, may have given rise to the favorable preventing effect against severe GVHD.
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  • Kazuteru OHASHI, Michiaki MIKOSHIBA, Yuji TANAKA, Yoshiki OKUYAMA, Kiy ...
    2003 Volume 44 Issue 11 Pages 1085-1089
    Published: 2003
    Released on J-STAGE: July 28, 2009
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    The case of a 32-year-old female with relapsed myelodysplastic syndrome (MDS) after second course of allogeneic transplantation is described. The peripheral blood stem cell transplantation was performed as early as 3 months after the initial bone marrow transplantation because of rejection and relapse; however, the patient again relapsed 2 months later. Immediate discontinuation of cyclosporine resulted in the progression of pancytopenia and the development of high fever, liver dysfunction and skin eruption. The patient was then treated with dexamethasone, which successfully stabilized these symptoms. After these clinical events, a dramatic hematological response was obtained; the blast rate was reduced from 10.6 to 0% in bone marrow aspiration, and pancytopenia was restored to normal levels. Moreover, fluorescence in situ hybridization analyses with X and Y chromosome-specific probes revealed that hematopoietic precursor cells were predominantly of donor origin. The patient subsequently received donor lymphocyte infusion (DLI) from the original donor. Currently, 2 years after DLI, the patient continues to be in remission.
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  • Noriko DOKI, Yasuyuki SAITO, Nahoko HATSUMI, Hiroyuki IRISAWA, Tohru S ...
    2003 Volume 44 Issue 11 Pages 1090-1094
    Published: 2003
    Released on J-STAGE: July 28, 2009
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    A-36-year-old male diagnosed with acute myelogenous leukemia (AML, M2) failed to achieve a complete remission after having undergone two courses of induction chemotherapy (idarubicin hydrochloride+cytarabine, high-dose cytarabine), and moreover, his cerebrospinal fluid (CSF) then revealed abnormal blasts. Dosages of 30 mg of methotrexate, 80 mg of cytarabine, and 40 mg of prednisolone acetate were given via lumbar puncture, and following this treatment, the leukemic cells were no longer detectable in his CSF. As a prophylaxis for meningeal leukemia relapse, he continued to receive intrathecal chemotherapy (methotrexate, prednisolone acetate) twice a week, and later he underwent reinduction therapy (second high-dose cytarabine). He displayed mental disorientation on the thirty-seventh day after he had been given a high-dose of cytarabine (araC). Up to the thirty-seventh day, he had also been given a total of 135 mg of intrathecal methotrexate. On the thirty-ninth day he fell into a coma, and his brain computed tomography (CT) demonstrated low density areas in the white matter, in addition to edema. These findings were compatible with leukoencephalopathy. With the administration of glycerin and methylprednisolone, his condition, however, began to reverse, and by the fifty-third day his brain edema had subsided and his mental condition had improved. On the ninetieth day he began to walk without assistance, and after the third course of re-induction chemotherapy, he achieved complete remission. He is currently doing well.
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  • Nobu AKIYAMA, Hiroyuki OHTAKE, Akira OHWADA, Kohichi KAJIWARA, Miyuki ...
    2003 Volume 44 Issue 11 Pages 1095-1100
    Published: 2003
    Released on J-STAGE: July 28, 2009
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    A-51-year-old woman with a sixteen-year history of mixed connective tissue disease was admitted to the Kitasato University Hospital because of hypogastric pain in September 1999. Colonofiberscopy and computed tomography in the abdomen demonstrated thickening of the intestinal wall with a hemorrhagic ulcer in the terminal ileum. The histopathologic findings of the lesion revealed diffuse infiltration of atypical T-lymphocytes. The titers of anti-HTLV-I antibody and serum soluble IL-2 receptor were elevated. The diagnosis of adult T-cell leukemia/lymphoma (ATLL) infiltrating the terminal ileum was made. Combination chemotherapy including VEPA-M was undertaken, and resulted in a partial response. ATLL became refractory about June 2000. Flaccid paralysis, dysesthesia in the left lower limb and bladder-bowel disturbance emerged in a few days, July 2000. T2-weighed MRCT images demonstrated that a lesion with a high intensity signal was present in the spinal cord around Th 7. Flower-like cells were detected in the cerebrospinal fluid. Infiltration of ATLL into the thoracic cord was diagnosed. Administration of intrathecal methotrexate and prednisolone, systemic dexamethasone and local irradiation of 30 Gy improved the paralysis and the abnormal MRCT findings. Rehabilitation restored the patient's ability to walk.
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  • Hiroyuki ISHIDA, Kanako MORI, Takao YOSHIHARA, Noriko SHIN, Akira MORI ...
    2003 Volume 44 Issue 11 Pages 1101-1106
    Published: 2003
    Released on J-STAGE: July 28, 2009
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    An 11-year-old boy with acute lymphoblastic leukemia received unrelated cord blood transplantation at the second remission. Because of early graft failure, he was given a second non-T-cell depleted bone marrow transplant from his HLA 2 loci (HLA-A and -DRB1)-mismatched mother 36 days after the first transplantation. Feto-maternal microchimerism was verified before transplantation. The second transplantation was performed with fludarabine/melphalan as a conditioning regimen, and tacrolimus/short-course methotrexate as graft-versus-host disease (GVHD) prophylaxis. Engraftment was prompt with a recovery of neutrophils (>0.5x109/l) by day +10, reticulocytes (>1%) by day +17 and platelets (>50x109/l) by day +18. Mild regimen-related toxicities (grade I gastrointestinal, grade II hepatic) were observed and acute GVHD was grade I (skin: stage 2). No severe complication was noted. At 6 months post-transplantation, he had no chronic GVHD or leukemia relapse. This experience indicates the future feasibility of a back-up non-T-cell depleted transplantation from HLA 2 loci-mismatched and feto-maternal microchimerism-positive mothers in cases with primary graft failure.
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  • Takahiko NAKANE, Takahisa YAMANE, Hisako SHIBATA, Yasutaka AOYAMA, Tar ...
    2003 Volume 44 Issue 11 Pages 1107-1109
    Published: 2003
    Released on J-STAGE: July 28, 2009
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    A 56-year-old woman noticed soreness and swelling in the right nipple. Two weeks later, she noticed a mass in the outer lower region of the right areolar area, which was excised and the pathology of which was consistent with diffuse large B cell lymphoma (DLBCL). She was admitted when the right nipple mass was noted to be increasing, and was diagnosed as having stage I lymphoma. Her nipple mass was excised, and the pathology was consistent with DLBCL. CHOP therapy was administered three times and she was judged as having complete remission. Malignant lymphoma accounts for 0.15-0.17% of primary breast malignancies. Though the nipple and areolar area seem to be a rare primary site, this should be recognized as a sentinel zone for malignant lymphoma.
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  • Kazuhiro MAKI, Fumihiko NAKAMURA, Hisako GUNJI, Yukihiro ARAI, Kinuko ...
    2003 Volume 44 Issue 11 Pages 1110-1112
    Published: 2003
    Released on J-STAGE: July 28, 2009
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    21-year-old male was diagnosed as having acute lymphoblastic leukemia (ALL) in March 2001. Standard G-banding analysis revealed normal karyotype. He achieved complete remission after the first course of induction therapy and underwent allogeneic PBSCT in August 2001. However, leukemic cells appeared in the peripheral blood demonstrating complex chromosomal abnormalities with Philadelphia chromosome (Ph1) and expressing minor BCR/ABL transcripts. We thus retrospectively examined the bone marrow sample at presentation with both interphase FISH and RT-PCR methods. Surprisingly, almost all leukemic blasts at presentation turned out to possess the minor type of BCR/ABL fusion gene. In spite of the second allogeneic PBSCT, the patient died of pneumonia and graft-versus-host disease in the liver in September 2002. This case is rare in that cytogenetic analysis failed to detect Ph1 due to leukemic cells dormancy. The application of both FISH and RT-PCR studies would appear to be essential to avoid overlooking Ph1-positive ALL.
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  • Tomoko KIKUCHI, Akira MIYATA, Soichiro FUJII, Takeshi KIKUCHI
    2003 Volume 44 Issue 11 Pages 1113-1116
    Published: 2003
    Released on J-STAGE: July 28, 2009
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    We describe a patient with acute myelogenous leukemia (AML) who was complicated with severe tumor lysis syndrome (TLS) after a single day of chemotherapy; a previously unreported occurrence. A 48-year-old man was admitted because of fever and bleeding tendency, and was diagnosed as having AML: M1. His white blood cell count (WBC) was 66,300/μl with 96% myeloblasts. Chemotherapy with idarubicin and cytarabine was started. On the second day of the therapy, he developed acute renal failure (ARF) and deterioration of disseminated intravascular coagulation (DIC) with a marked reduction in his WBC (8500/μl). Immediately after a diagnosis of tumor lysis syndrome (TLS), the following chemotherapy was discontinued. Hemodiafiltration and hemofiltration were initiated to treat the ARF, concomitant with anticoagulant and antifibrinolysis therapy for the DIC. Chemotherapy with daunorubicin and cytarabine was resumed on the 12th day, recognizing a regrowth of leukemic cells. Thereafter a complete remission was achieved without recurrence of the TLS.
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  • Yuko NAKAMURA, Yukihiro ARAI, Hisako GUNJI, Honoka ARAI, Fumihiko NAKA ...
    2003 Volume 44 Issue 11 Pages 1117-1119
    Published: 2003
    Released on J-STAGE: July 28, 2009
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    A 26-year-old woman was diagnosed as having autoimmune hemolytic anemia in September 2002. Her eosinophil count was already high (2,190/μl) at that time. She received prednisolone therapy with a good response and was released from the treatment in April 2003. Eosinophil numbers were within the normal range under the prednisolone administration. However, they began to increase after its completion. No underlying causes for the eosinophilia were evident. When the eosinophil count reached 5,474/μl, the patient developed massive pleural effusion as well as palpebral swelling and myalgia, leading to a diagnosis of hypereosinophilic syndrome. Re-administration of prednisolone resulted in the disappearance of these symptoms and eosinophilia. Her eosinophils seemed to have reactivated after cessation of the prednisolone therapy and infiltrated into her organs.
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