A 73-year-old woman was hospitalized due to cough and weight loss. Chest radiograph revealed a right pleural effusion. The pleural effusion was exudative, predominantly consisting of lymphocytes. Cytological examination of pleural effusion revealed no malignant cells. As adenosine deaminase levels in of pleural effusion were elevated（50.1 IU/l），we suspected that the patient had tuberculous pleurisy and initiated anti-tuberculosis therapy, however the pleural effusion did not resolve. Subsequently, high levels of serum soluble interleukin-2 receptor（3030 IU/l）were observed. Chest computed tomography（CT）revealed a mass in the lower lobe of the right lung, suggesting malignant lymphoma. Thoracoscopy was then performed under general anesthesia; granular nodules on the parietal pleura and a fist-sized tumor in the visceral pleura were observed. Histopathological examination established the diagnosis of diffuse large B-cell lymphoma consisting of CD20-positive cells. Positron emission tomography-CT revealed 2-［18F］fluoro-2-deoxy-D-glucose accumulation in the mediastinal lymph nodes, right pleura, and the mass on the right lower lobe, with no obvious accumulation in other organs. We diagnosed primary pleural malignant lymphoma and achieved complete remission after treatment with R-CHOP. No recurrence has been observed for more than 2 years.

【Introduction】There are few reports on cell-free and concentrated reinfusion therapy for pleural effusion, compared to those for ascites. We report here a case in which long-term home care became possible after cell-free and concentrated reinfusion therapy with placement of an intrathoracic catheter subcutaneous port system for refractory pleural effusion found during the course of lung cancer.【Case】A 62-year-old woman with recurrence of primary lung cancer was referred to our department. She had respiratory distress and cough due to the right pleural effusion. Symptoms were relieved with drainage of pleural effusion by thoracentesis. After hospital discharge, the frequency of required right pleural effusion drainage increased, but the patient expressed a strong desire for home care. Therefore, after placement of an intrathoracic port, home care was begun, and she underwent cell-free and concentrated reinfusion therapy for pleural effusion for 6 months at a nearby hospital as an outpatient. During the teratment, she could keep her activities and quality of life.【Conclusion】This case suggests that cell-free and concentrated reinfusion therapy for pleural effusion with placement of an intrathoracic port can contribute to maintenance and improvement of activities of daily living and quality of life in patients with refractory pleural effusion.

We herein report two cases of neuroendocrine ductal carcinoma in situ of the breast with some reference to literature.

In both of two cases, wide excision of the tumor was performed and breast irradiation was done after surgery. Our 2 cases were slightly different from typical characteristic findings of NE-DCIS. NE-DCIS often has benign cytological findings and is easily misdiagnosed as papilloma by needle or mammotome biopsy. Our 2 cases also were not diagnosed as malignancy, not even by frozen section diagnosis during surgery. NE-DCIS is often involved in cases like our case 2 with papillary lesion, we have to perform wide excision actively without observing pointlessly or repeating needle biopsy. Although it is often difficult to definitely diagnose NE-DCIS by needle biopsy, careful evaluation of cell morphology and immunohisto/cytochemical studies enable an accurate diagnosis.

NE-DCIS is a relatively rare entity. We must further accumulate clinical cases to study the therapeutic methods and the prognosis of the disease.

A 78-year-old man underwent distal partial gastrectomy and Billroth I reconstruction for early gastric cancer in May 1995, then was followed up by us. In March 2005, he was found in upper gastrointestinal endoscopy to have an elevated Isp lesion of the duodenum. Histological examination of biopsy specimens showed on inflammatory polyp and no malignancy. After one year of observation, the lesion became a IIa+IIc lesion in upper gastrointestinal endoscopy. Biopsy specimens showed group V and suspected signet-ring cell carcinoma. After further examination, we conducted partial resection of the duodenum. Macroscopically, the 8×6 mm tumor appeared to be a IIa+IIc lesion located in the second portion of the duodenum. The histological diagnosis was signet-ring cell carcinoma, within the membrane, ly0 and v0. The surgical margin was negative. We conducted curative surgery. He is alive without recurrence almost 10years after the operation. Billroth I reconstruction enabled us to diagnose duodenal cancer early in this case.