We herein present four cases of bone marrow (BM)-based B-cell neoplasms, which had non-IgM class M-proteins and carried the MYD88^L265P mutation. Patients were in their fifties to eighties and were all male. Their presenting symptoms as well as routine laboratory test values were variable, and none had osteolytic bone lesions, renal insufficiency, or hypercalcemia or any signs or symptoms indicative of hyperviscosity. M-proteins in the serum of each case were IgG-κ and small amounts of IgM-κ in 1, IgG-κ in 2, and light chain λ only in 1, and Bence Jones protein was detected in the urine of 3. BM showed hypercellularity with the infiltration of 22.4-93.9% mature lymphocytes and cells with the plasmacytoid/plasma cell appearance were found in 2. Flow cytometry showed that neoplastic cells were uniformly positive for CD19, CD20, and CD22 and negative for CD5 and CD23. Increased numbers of mast cells were detected in 2 cases, while Dutcher bodies were observed in a few plasma cells in 1. We developed two polymerase chain reaction (PCR)-based tests to detect the MYD88^L265P mutation and obtained PCR products indicative of the mutation in all four cases. Each patient was treated with rituximab alone or in combination with fludarabine or bendamustine, or bortezomib and dexamethasone. Although each case was formerly diagnosed with variable diseases, the presence of the MYD88^L265P mutation indicated that all 4 cases were reliably classified into the category of lymphoplasmacytic lymphoma.

After adopting laparoscopic surgery for endometrial cancer soon after the procedure was approved in 2014, we have treated obese women. We report three severely obese women with endometrial cancer who underwent laparoscopic surgery. Case 1 was a 52-year-old, G3P0 woman whose height was 158 cm, body weight was 105 kg, and BMI was 42.0 kg/m² . She was diagnosed preoperatively with atypical endometrial hyperplasia or endometrial cancer IA (FIGO staging) and grade 1 endometrioid adenocarcinoma. Laparoscopic total hysterectomy and salpingo-oophorectomy were performed. The operation time was 277 minutes and intraoperative blood loss was 20 mL. She was discharged on the 4th postoperative day. Case 2 was a 31-year-old, G3P0 woman (height, 163 cm; body weight, 130 kg; BMI, 48.9 kg/m² ) who was diagnosed preoperatively with endometrial cancer IA and grade 1 endometrioid adenocarcinoma. Laparoscopic total hysterectomy and salpingo-oophorectomy, in addition to partial omentectomy and dissection of pelvic lymph nodes, were performed. The operation time was 463 minutes and intraoperative blood loss was 50 mL. She was discharged on the 6th postoperative day. Case 3 was a 56-year-old, G3P0 woman (height, 157 cm; body weight, 128 kg; BMI, 51.9 kg/m² ) who was diagnosed preoperatively with endometrial cancer IA and grade 2 endometrioid adenocarcinoma. She underwent laparoscopic total hysterectomy, salpingo-oophorectomy, and partial omentectomy. The operation time was 354 minutes and intraoperative blood loss was 50 mL. She was discharged on the 8th postoperative day. Although the duration of surgery for these three women was prolonged, compared with the mean time for laparoscopic surgery for endometrial cancer at our institution, their courses were uneventful and there were no major intraoperative or postoperative complications. This report suggests that laparoscopic surgery may be applicable for severely obese women with endometrial cancer; however, as there are difficulties with exposure, manipulation of instruments, extraction of the surgical specimens, and port closure, further technical improvement is required to shorten the duration of the surgical procedure.

Unilateral twin tubal pregnancy is rare. We report the first case of the preoperative diagnosis of unilateral twin tubal pregnancy by enhanced magnetic resonance imaging. A 31-year-old female visited our hospital because she became pregnant after ovulation induction by clomiphene at her previous clinic. A small amount of bleeding from the external uterine cervix was observed at the initial visit. Transvaginal ultrasonography revealed a fetal sac near the right fallopian tube, but it was not detected in the uterus. Two gestational-like structures were noted in the right fallopian tube on enhanced magnetic resonance imaging, and she was diagnosed with right twin tubal pregnancy. Laparoscopic right fallopian tube resection was performed after the diagnosis. Two masses were found in the right fallopian tube. Enhanced magnetic resonance imaging was useful for the diagnosis of unilateral twin tubal pregnancy.