Rinsho Ketsueki
Online ISSN : 1882-0824
Print ISSN : 0485-1439
ISSN-L : 0485-1439
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Volume 50, Issue 5
Displaying 1-15 of 15 articles from this issue
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Picture in Clinical Hematology No.37
Feature articles: Advances in basic and clinical researches on cancer immunology
The 70th Annual Meeting of the Japanese Society of Hematology
Symposium 4
Case Reports
  • Extranodal CD20-positive peripheral T-cell lymphoma presenting with adrenal and testicular masses
    Masanori MAKITA, Ichiro MURAKAMI, Takanori YOSHIOKA, Hisaaki TANAKA, K ...
    2009 Volume 50 Issue 5 Pages 413-418
    Published: 2009
    Released on J-STAGE: May 30, 2009
    DOIhttps://doi.org/10.11406/rinketsu.50.413
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    We report a case of extranodal CD20-positive peripheral T-cell lymphoma (PTCL). A 59-year-old man was admitted because of a right testicular mass in April 2006. CT scan revealed bilateral adrenal masses and he underwent right orchiectomy. The enlarged testis showed diffuse infiltration of large CD20-positive lymphocytes with slight CD3-positive cells. These cells were negative for CD10 and showed a high MIB-1 index. The pathological diagnosis was diffuse large B-cell lymphoma. He received R-CHOP, but developed brain involvement. He received whole brain radiotherapy following high-dose methotrexate, but he died of disease progression in August 2007. At autopsy, lymphoma cells were definitely positive for CD3 and negative for CD20. Monoclonal TCR gamma gene rearrangement was detected in the brain specimen without IgH rearrangement by PCR. The testicular tumor also showed the same clonal bands. Immunohistochemical re-evaluation of the testis showed CD20+, CD79a-, PAX5-, MUM1-, CD3 p+, CD5 p+, CD4-, CD8-, CD7 p+, granzyme B+, and TIA1+. Based on the clinical course and immunohistology, we finally diagnosed this case as extranodal PTCL-nos (not otherwise specified) with aberrant CD20 expression, which is extremely rare. The detection of gene rearrangement, plural immunohistochemical markers and knowledge of the possibility of CD20+ PTCL-nos are necessary for such cases.
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  • Endoscopic biliary drainage for choledocholithiasis in a patient with aplastic anemia before hematological engraftment after allogeneic transplantation
    Kohei OKADA, Satoshi HASHINO, Mutsumi TAKAHATA, Masahiro ONOZAWA, Kaor ...
    2009 Volume 50 Issue 5 Pages 419-423
    Published: 2009
    Released on J-STAGE: May 30, 2009
    DOIhttps://doi.org/10.11406/rinketsu.50.419
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    A 30-year-old man was diagnosed with severe aplastic anemia in 1997. He received mPSL pulse therapy and was treated with ATG and cyclosporine, resulting in remission and exacerbation; however, his pancytopenia gradually progressed and transfusions were required. He was referred to our hospital for further treatment by allogeneic bone marrow transplantation (allo-BMT). Before allo-BMT, he suffered febrile neutropenia. His white blood cell count was <100/μl despite daily administration of G-CSF. Although we detected asymptomatic stones in his gallbladder (GB) and common bile duct (CBD) by a screening test before allo-BMT, we decided to remove the stones after BMT because of his severe neutropenia. He underwent allo-BMT from an HLA-matched unrelated donor after conditioning with a reduced-intensity regimen. On day 9 after BMT, he developed acute obstructive suppurative cholangitis. Germ-free care was transiently stopped and endoscopic biliary drainage (EBD) was performed for the stones in the common bile duct. Engraftment of WBC was confirmed on day 24, and the stones were removed using endoscopic sphincterotomy on day 57 after confirmation of platelet recovery. We could perform EBD safely before hematological engraftment. A strategy for the management of asymptomatic stones of the GB and CBD has not yet been established. The possibility of removing stones before BMT should therefore be considered. Consideration should also be given to the possibility of improving acute obstructive suppurative cholangitis by EBD and antibiotics before hematological engraftment in such cases when stones cannot be removed before BMT.
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  • Pure red cell aplasia accompanied by autoimmune hemolytic anemia in a patient with type A viral hepatitis
    Hiromi KOISO, Satsuki KOBAYASHI, Kazue UEKI, Tetsuya HAMADA, Norifumi ...
    2009 Volume 50 Issue 5 Pages 424-429
    Published: 2009
    Released on J-STAGE: May 30, 2009
    DOIhttps://doi.org/10.11406/rinketsu.50.424
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    A rare case of acute hepatitis A associated with autoimmune hemolytic anemia (AIHA) and pure red cell aplasia (PRCA) is reported. A 55-year-old woman consulted a doctor because of common cold-like symptoms and she was referred to our hospital in January 2007. Laboratory findings showed a marked elevation of serum transaminase and total bilirubin levels (AST 9,605 IU/l, ALT 5,546 IU/l and T-bil 4.14 mg/dl), and prolonged prothrombin time, findings which suggested the risk of progression to fulminant hepatitis, and she was treated with plasmapheresis and hemodialysis filtration on the first and second hospital days. She was diagnosed with severe acute hepatitis A based on the elevation of serum IgM anti-hepatitis A virus. On the 20th hospital day, her hemoglobin level began to decrease in spite of improving transaminase levels without any signs of gastrointestinal bleeding. Bilirubin and LDH elevation, haptoglobin decline and a positive direct Coombs test were detected and these findings indicated AIHA complication; however, the reticulocyte count decreased and bone marrow showed marked erythroid hypoplasia so the co-existence of PRCA was diagnosed. After oral prednisolone administration (1 mg/kg/day), her hemolytic anemia rapidly improved.
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  • Allogeneic hematopoietic stem cell transplantation after surgical resection of pulmonary aspergillosis in 5 patients with acute leukemia
    Kenji MOTOHASHI, Satomi ITO, Maki HAGIHARA, Rika SAKAI, Masatsugu TANA ...
    2009 Volume 50 Issue 5 Pages 430-434
    Published: 2009
    Released on J-STAGE: May 30, 2009
    DOIhttps://doi.org/10.11406/rinketsu.50.430
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    We report five patients with acute leukemia who underwent allogeneic hematopoietic stem cell transplantation (HSCT) following surgical resection of pulmonary aspergillosis. The patients were three men and two women with a median age of 40 (range, 32∼60). The diagnosis, based on CT imaging, Aspergillus antigen, culture, and histopathology of resected lung specimens, included two proven and three possible pulmonary aspergillosis. Median duration from surgery to HSCT was 2.5 months (range, 1.0∼20). Pre-transplant restrictive-type lung dysfunction was observed in four patients. Antifungal prophylaxis after HSCT was attempted with voriconazole in three patients, amphotericin-B in one patient, and micafungin in one patient. No patients experienced a relapse of pulmonary aspergillosis, although three patients died after HSCT. The causes of death included leukemia relapse in two and hemophagocytic syndrome in one. These results suggest that pre-transplant surgical resection with post-transplant prophylactic antifungal agents seems to be an effective strategy to prevent the relapse of pulmonary aspergillosis in patients with residual disease in the lung before allogeneic HSCT.
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