Rinsho Ketsueki
Online ISSN : 1882-0824
Print ISSN : 0485-1439
ISSN-L : 0485-1439
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Volume 55, Issue 3
Displaying 1-14 of 14 articles from this issue
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Picture in Clinical Hematology
The 75th Annual Meeting of the Japanese Society of Hematology
Asian Joint Symposium
Symposium 1 (JSH-ASH Joint Symposium)
Review
Case Reports
  • Methotrexate-related lymphomatoid granulomatosis successfully treated with discontinuation of methotrexate and radiotherapy to brain
    Tomohiro YAMAKAWA, Mitsutoshi KUROSAWA, Masakatsu YONEZUMI, Sachiko SU ...
    2014 Volume 55 Issue 3 Pages 321-326
    Published: 2014
    Released on J-STAGE: March 29, 2014
    DOIhttps://doi.org/10.11406/rinketsu.55.321
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    A 70-year-old woman with rheumatoid arthritis treated with methotrexate (MTX) complained of right arm weakness. On CT and MRI, tumors were found in the right frontal lobe, bilateral lungs, and left renal parenchyma. She was diagnosed as having lymphomatoid granulomatosis (LYG) grade 2 on thoracoscopic biopsy of the left lung. We discontinued MTX and treated a mass lesion in the right frontal lobe with stereotactic radiotherapy. As a result, the tumors showed a gradual reduction in size, and the patient achieved complete remission. LYG is a rare lymphoproliferative disorder, and has various clinical characteristics. We describe herein a patient with LYG grade 2 with cerebral, pulmonary, and renal lesions, who has maintained a complete remission for six months, to date, after treatment.
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  • Efficacy of chemotherapy combined with bortezomib for two cases of relapsed/refractory acute lymphoblastic leukemia
    Dai KEINO, Ryo OHYAMA, Tomoko ASHIKAGA, Mizuho MORIMOTO, Atsuki YAMASH ...
    2014 Volume 55 Issue 3 Pages 327-333
    Published: 2014
    Released on J-STAGE: March 29, 2014
    DOIhttps://doi.org/10.11406/rinketsu.55.327
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    Bortezomib (BZM), a proteasome inhibitor, was recently reported to be effective against acute lymphoblastic leukemia (ALL). We report two cases of relapsed/refractory ALL, who were treated with BZM (1.3 mg/m2/dose, 2 doses/week for 2 weeks) in combination with vincristine, doxorubicin, dexamethasone, and L-asparaginase (L-ASP). The first patient was a 16-year-old girl who developed a bone marrow relapse 8 months after the initial diagnosis during consolidation chemotherapy. She received BZM-combined chemotherapy without L-ASP considering her previous history of an allergic reaction to L-ASP. The BZM-combined regimen was discontinued due to interstitial pneumonia development on day 13, and the interstitial pneumonia was successfully treated with steroid pulse therapy. Although her elevated serum LDH transiently normalized on day 16, blasts in peripheral blood did not disappear, and she died of leukemia without achieving remission. The second patient was a 17-year-old girl who developed a third bone marrow relapse after cord blood transplantation. She was given the same BZM combined regimen. Although the BZM-combined regimen was discontinued due to acute pancreatitis development on day 12, complete remission without platelet recovery was confirmed on day 62. Our experience suggests not only the effectiveness of BZM-combined chemotherapy but also the importance of controlling its toxicities when administered as a salvage therapy for advanced ALL patients.
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  • Primary systemic AL amyloidosis with remarkable calcification in the spleen
    Kiyotaka UCHIYAMA, Nobuhiro TSUKADA, Kanji MIYAZAKI, Yu ABE, Rieko SEK ...
    2014 Volume 55 Issue 3 Pages 334-339
    Published: 2014
    Released on J-STAGE: March 29, 2014
    DOIhttps://doi.org/10.11406/rinketsu.55.334
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    We report a 50-year-old female patient with diffuse and rapidly progressing splenic calcification. She had developed nephrotic syndrome and been diagnosed with renal amyloid light-chain amyloidosis in 2010. Although she had been given melphalan and dexamethasone therapy and high-dose melphalan followed by autologous blood stem-cell transplantation, her renal function worsened and hemodialysis was started in May 2011. Since November 2011, splenic calcification, probably associated with amyloidosis, had progressed, and diffuse calcification was observed throughout the splenic area in September 2012. During the same period, the patient was hospitalized for thrombocytopenia. Although splenic dysfunction due to calcification was suspected to be the cause of thrombocytopenia, the association between the two could not be established. The platelet count rose with an improvement in hepatic congestion due to reinforced fluid removal during dialysis.
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  • Mucosa-associated lymphoid tissue lymphoma of the larynx
    Jian HUA, Yasunobu IWAKI, Morihiro INOUE, Yoichiro TAKIGUCHI, Yasunori ...
    2014 Volume 55 Issue 3 Pages 340-344
    Published: 2014
    Released on J-STAGE: March 29, 2014
    DOIhttps://doi.org/10.11406/rinketsu.55.340
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    A 63-year-old female suffering from hepatitis C virus infection and manic depression was admitted with a 4-month history of hoarseness. Endoscopic examination revealed the presence of a neoplasm with a smooth surface in the left supraglottic region extending to the left false vocal cord. Based on the histological findings, together with the results of systemic evaluation, the patient was diagnosed as having a mucosa-associated lymphoid tissue (MALT) lymphoma in clinical stage IE, according to the Ann Arbor classification. After one month of follow-up, the patient presented with involvement of multiple subcutaneous regions in the left neck area, etc. Biopsies revealed the same type of lymphoma as that in the supraglottis. The disease was considered to have progressed to clinical stage IV. Six courses of R-CVP (rituximab, cyclophosphamide, vincristine and prednisolone) treatment resulted in complete remission of all lesions. Primary MALT lymphoma in the larynx is extremely rare. Since the first description by Diebold et al in 1990, only 43 cases have been reported. Among these reported cases, only 7 (16%) with progressive stages were described. The R-CVP regimen appears to be effective for the treatment of progressive primary MALT lymphoma of the larynx. Furthermore, hepatitis C virus infection is thought to be closely associated with the aggressive malignant process and subcutaneous dissemination.
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  • Copper deficiency anemia morphologically mimicking myelodysplastic syndrome
    Taku KIKUCHI, Takehiko MORI, Takayuki SHIMIZU, Shinya MORITA, Hidaka K ...
    2014 Volume 55 Issue 3 Pages 345-349
    Published: 2014
    Released on J-STAGE: March 29, 2014
    DOIhttps://doi.org/10.11406/rinketsu.55.345
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    A 64-year-old man underwent kidney transplantation for progressive chronic renal failure which had developed 8 years after allogeneic bone marrow transplantation for acute myeloid leukemia. Because of post-operative complications, he had been placed on intravenous hyperalimentation. Three months after the transplantation, anemia rapidly progressed (hemoglobin, 7.9 g/dl). The proportion of reticulocytes was 0.2%, but white blood cell and platelet counts remained within normal ranges. Serum iron, vitamin B12, and folate levels were normal. Bone marrow examination showed the presence of ringed sideroblasts and cytoplasmic vacuoles in a fraction of erythroid cells. Megakaryocytes were adequate in number with normal morphology. Although the findings were consistent with refractory anemia with ringed sideroblasts according to the WHO classification, cytoplasmic vacuolations were also observed in myeloid cells, suggesting copper deficiency. Indeed, serum copper and ceruloplasmin levels were found to be low (33 μg/dl and 11 mg/dl, respectively), and oral copper supplementation at a daily dose of 1 mg was initiated. There was a prompt increase in reticulocytes, and the hemoglobin level was normalized within one month, in response to this regimen. In progressive anemia cases with ringed sideroblasts in the bone marrow, copper deficiency should be considered in the differential diagnosis.
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  • Efficacy of rituximab for a variant type of multicentric Castleman's disease termed the TAFRO syndrome
    Takayuki OZAWA, Satoru KOSUGI, Maiko KITO, Mayu ONISHI, Toru KIDA, Soi ...
    2014 Volume 55 Issue 3 Pages 350-355
    Published: 2014
    Released on J-STAGE: March 29, 2014
    DOIhttps://doi.org/10.11406/rinketsu.55.350
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    A 48-year-old woman was hospitalized because of severe thrombocytopenia, leg edema, and fever. Intravenous immunoglobulin therapy was administered, but no efficacy was obtained. Her bone marrow was dry-tap, and fibrosis was found in the biopsy specimens. A positron emission tomographic study showed FDG-avid lymphadenopathy and hepatomegaly. Biopsy specimens of axillary lymph nodes showed Castleman's disease-like findings. Since she then developed severe proteinuria and massive pleural effusion, steroid therapy was started, providing temporary relief of symptoms other than the thrombocytopenia. However, rapid worsening of her general condition prompted us to attempt rituximab as salvage therapy. The pleural effusion, edema, and proteinuria disappeared soon after starting rituximab administration. Platelet counts also normalized and fibrosis of the bone marrow showed amelioration. Recently, a variant of multicentric Castleman's disease, termed the TAFRO syndrome, has been proposed, and our patient's features fit the diagnosis of this syndrome. Rituximab might be considered as a therapeutic option in such cases.
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  • Cytomegalovirus mononucleosis complicated with peripheral facial palsy
    Taichi HIRANO, Takahiro TSUJI, Hiroshi YAMASAKI, Hiroyuki TSUDA
    2014 Volume 55 Issue 3 Pages 356-359
    Published: 2014
    Released on J-STAGE: March 29, 2014
    DOIhttps://doi.org/10.11406/rinketsu.55.356
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    A 36-year-old woman was admitted to our hospital for further examination of an acute febrile illness with liver dysfunction. A peripheral blood smear displayed atypical lymphocytes. Cytomegalovirus (CMV) mononucleosis was diagnosed based on the detection of CMV-specific IgM and conventional CMV pp65 antigen. The physical examination on admission revealed signs of lower motor neuron right facial palsy. There were no significant cerebrospinal fluid findings, nor were there other neurological abnormalities. After receiving a short-course of oral corticosteroids, the patient gradually recovered from the facial paralysis. A one-month follow-up examination indicated that she had fully recovered neurologically, showing disappearance of CMV-DNA and a significant increase in the anti-CMV IgG titer. To our knowledge, there has been only one previous report describing CMV as the cause of an isolated facial palsy combined with CMV mononucleosis.
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  • Polycythemia vera developed after a major molecular response to imatinib mesylate treatment in a patient with chronic myelogenous leukemia
    Wataru JOMEN, Hiroyuki KURODA, [in Japanese], Teppei MATSUNO, Masan ...
    2014 Volume 55 Issue 3 Pages 360-365
    Published: 2014
    Released on J-STAGE: March 29, 2014
    DOIhttps://doi.org/10.11406/rinketsu.55.360
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    A 68-year-old man complained of dizziness and was referred to our hospital by his primary physician for evaluation of an elevated leukocyte count. In April 2002, soon after the chronic phase of chronic myeloid leukemia had been diagnosed, he was treated with imatinib. In March 2010, imatinib treatment was completed and the BCR/ABL fusion gene had become undetectable by real time quantitative PCR. Subsequently, leukocyte counts and the hematocrit gradually rose. In August 2012, a bone marrow aspirate showed hypercellular marrow with marked erythroid hyperplasia and the presence of the JAK2 gene V617F mutation. He was diagnosed with polycythemia vera. Phlebotomy and chemotherapy were started in addition to imatinib administration. Shortly thereafter complete blood counts returned to normal levels.
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