ABSTRACT
Etanercept is a soluble receptor fusion protein that inhibits tumor necrosis factor-alpha(TNF-alpha). The receptor is used widely in the treatment of ankylosing spondylitis, rheumatoid arthritis, sarcoidosis and other indications. For sarcoidosis, it potentially suppresses granuloma formation with TNF-alpha blocking. On the other hand, recent studies have suggested that paradoxical sarcoidosis can be induced by TNF-alpha antagonists in some cases. A 42-year-old woman, who was treated with etanercept due to ankylosing spondylitis for 5 years, was admitted because of right suprahilar lymphadenopathy on chest radiography. Chest computed tomography revealed an enlargement of supraclavicular, paratracheal, mediastinal lymph nodes. She was diagnosed with sarcoidosis on the supraclavicular lymph node biopsy, which was non-caseating epithelioid cell granuloma and excluded from similar diseases. She was treated for sarcoidosis with prednisolone instead of etanercept.
Subject(s)
Adult , Female , Humans , Arthritis, Rheumatoid , Biopsy , Epithelioid Cells , Granuloma , Hand , Immunoglobulin G , Lymph Nodes , Lymphatic Diseases , Necrosis , Prednisolone , Receptors, Tumor Necrosis Factor , Sarcoidosis , Spondylitis, Ankylosing , Thorax , Tumor Necrosis Factor-alpha , EtanerceptABSTRACT
The simultaneous occurrence of primary gastric lymphoma and adenocarcinoma is rarely reported. We here report a case of synchronous double primary tumor of advanced gastric cancer and diffuse large B cell lymphoma. A 65-year-old woman underwent an esophagogastroduodenoscopy for the evaluation of abdominal discomfort of two months' duration. The endoscopic examination showed an ulcerating tumor in the gastric antrum and thickened folds in the fundus and the microscopic examination revealed an adenocarcinoma in the antrum and a diffuse large B-cell lymphoma in the fundus. She has had total gastrectomy and CHOP chemotherapy with rituximab. Since the cases of synchronous double primary gastric tumors have been increased on the recent medical advances, when a gastric tumor is detected for the endoscopic examination, an endoscopist has to make every endeavor not to miss another tumor in the stomach.
Subject(s)
Aged , Female , Humans , Adenocarcinoma/diagnosis , Antibodies, Monoclonal, Murine-Derived/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Cyclophosphamide/therapeutic use , Doxorubicin/therapeutic use , Endoscopy, Digestive System , Gastrectomy , Lymphoma, Large B-Cell, Diffuse/diagnosis , Neoplasms, Multiple Primary/diagnosis , Prednisone/therapeutic use , Stomach Neoplasms/diagnosis , Tomography, X-Ray Computed , Vincristine/therapeutic useABSTRACT
Takayasu arteritis is a nonspecific granulomatous inflammatory arteriopathy of unknown cause that results in occlusive obliteration and less commonly aneurysmal degeneration of large and medium-sized elastic arteries. The diagnosis of Takayasu arteritis and the assessment of its progression and extent remain challenging, especially in patients presenting with a constellation of non-specific symptoms and laboratory tests. The standard diagnostic procedures include biopsy, arteriography, sonography, and magnetic resonance angiography. However, these procedures are invasive or largely operator-dependent, and document only morphological changes such as stenosis, occlusion and aneurysmal transformation which mainly occur in late stages of the disease. On the other hand, Positron-emission tomography is an operator-independent, non-invasive metabolic imaging modality which plays a major role in diagnosis of nonspecific inflammatory diseases. We report a case in which Positron-emission tomography was applied to the detection of Takayasu arteritis and assessment of its disease progression.
Subject(s)
Humans , Aneurysm , Angiography , Arteries , Biopsy , Constriction, Pathologic , Disease Progression , Hand , Magnetic Resonance Angiography , Positron-Emission Tomography , Takayasu ArteritisABSTRACT
Kikuchi's disease and hemophagocytic lymphohistiocytosis (HLH) present different clinical characteristics, especially in prognosis, although both diseases have the clinical similarity in initial presentations. Kikuchi's disease usually has a self-limiting clinical course, but HLH can be fatal. Accordingly, it is important that the differential diagnoses and decision as to initial treatment be made as soon as possible, at the time of clinical presentation. In the case of Kikuchi's disease accompanied with HLH, the decision concerning initial treatment can be very difficult, because these cases have been rarely reported and the prognosis is unpredictable. We report a case of a 21-year-old female diagnosed with Kikuchi's disease accompanied with HLH. Treatment involved steroid therapy, as for treatment of HLH. Recovery was complete. Kikuchi's disease with HLH can be completely treated with more aggressive therapy than used for Kikuchi's disease alone.