[Case of intravascular lymphoma diagnosed by transbronchial lung biopsy, with transient spontaneous remission].

A 70-year-old man visited hospital because of intermittent fever (about 38 degrees C) and night sweat. He had a history of smoking of 1 pack a day for 35 years. He had no abnormal findings on physical examination, but had abnormal laboratory findings, including elevated C-reactive protein, lactate dehydrogenase and soluble interleukin-2 receptor levels. Although malignant lymphoma was suspected, his symptoms and laboratory findings resolved spontaneously. However, intermittent fever and night sweat reoccurred 19 months after his first presentation, and he visited our hospital with dyspnea the following month. On physical examination, he had no abnormal findings. A chest radiograph showed no abnormal findings, but chest and abdominal CT images revealed diffuse ground-glass opacities in both lung fields, and splenomegaly. Transbronchial lung biopsy (TBLB) confirmed a diagnosis of intravascular large B-cell lymphoma. Spontaneous remission is rare in aggressive lymphomas, including intravascular lymphomas (IVL). We report a case of IVL, with symptoms which resolved spontaneously, and reoccurred 19 months later with diffuse interstitial shadows on chest CT images, and in which a diagnosis of IVL was confirmed by TBLB.

[An autopsy case of chronic empyema-associated angiosarcoma that presented with a rapidly growing chest wall mass].

A 76-year-old woman with chronic tuberculous empyema presented with bloody sputa and anorexia in April 2005. Chest X-ray and CT scan showed no obvious change compared with previous films. She complained of a left chest pain in June 2005, and chest CT scan showed a tumor shadow enhanced heterogeneously on the left chest wall and chronic empyema. After admission, the chest wall mass grew rapidly. Neither CT- nor sonographically guided biopsy yielded a definitive diagnosis. Dynamic MRI showed a high signal intensity unlike hematoma. She died of respiratory failure 2 months after the onset of her chest pain. Autopsy revealed angiosarcoma. We should always keep in mind the early diagnosis of malignant tumor and tuberculosis in patients presenting with a chest wall mass and constitutional symptoms during follow-up of chronic tuberculous empyema.

[Prolonged survival of gefitinib treatment in patients with advanced and previously treated non-small cell lung cancer].

The purpose of this study was to evaluate the survival outcome in patients with advanced and previously treated non-small cell lung cancer given gefitinib (GEF) at our institution. We reviewed the clinical records of 70 Japanese patients,among whom 33 received several chemotherapy treatment modalities including GEF monotherapy (GEF group), and the other 37 were given several chemotherapy treatment modalities without GEF monotherapy (non-GEF group). The median survival time (MST) after second-line chemotherapy in the GEF group was 527 days with 1-year and 2-year survival rates of 59% and 26%, respectively. The MST in the non-GEF group was 175 days with 1-year and 2-year survival rates of 21% and 16%, respectively. Overall survival after second-line chemotherapy in the GEF group was significantly longer than in the non-GEF group (hazard ratio 1.93; 95% confidence interval 1.15-3.53, p=0.014). In our limited clinical experience, chemotherapy treatment including GEF monotherapy appeared to have longer survival than non-GEF treatment.

[Understanding of pneumococcal vaccination in patients with chronic respiratory diseases].

Pneumococcal vaccination is still rare in Japan. To evaluate understanding concerning the vaccination, we employed a questionnaire answered by patients aged over 60 with chronic respiratory diseases from August to October 2002. Only 286 (18%) of the 1595 patients already knew of the existence of the vaccine, and 999 (64%) patients wanted to be vaccinated. That season, 717 (43%) patients were actually vaccinated. Patients with chronic respiratory failure, those who had contracted pulmonary infections in the previous year, those over 70 year-old, and male patients tended to be vaccinated. Although elderly and high-risk patients are recommended to be vaccinated, the pneumococcal vaccination rates in those patients was low. Campaigns for vaccination are needed.

[A case of cT0N2M0 small cell lung cancer with Lambert-Eaton myasthenic syndrome].

We encountered a very rare case of cT0N2M0 small cell lung cancer (SCLC) with Lambert-Eaton myasthenic syndrome (LEMS). A 69-year-old man with a complaint of muscle weakness was admitted to our hospital. Although his chest radiograph on admission showed no abnormal findings, CT scanning detected a mediastinal lymphadenopathy. Also, 2-[18F]-2-fluorodeoxy-D-glucose position emission tomography (FDG-PET) revealed increased accumulation in the same portion in the mediastinum. A diagnosis of LEMS was made from the distinctive electromyogram (EMG) findings (waning and waxing phenomenon in response to low-and high-frequency repetitive stimulation, respectively) in combination with the increased serum level of a P/Q-type anti-voltage-gated calcium channel (VGCC) antibody. Subsequent histopathological diagnosis by mediastinoscopic resection of a paraaortic lymph node was small cell carcinoma. No distant metastasis was detected by MRI of the brain, abdominal CT scan or an FDG-PET. Eight courses of chemotherapy (carboplatin + etoposide) with radiotherapy of the mediastinum (for a total dose of 45 Gy) was performed. A decreased serum level of P/Q-type anti-VGCC antibody titers followed by marked improvement of neurological dysfunction (muscle weakness, gait disturbance and scanning speech) and of an EMG finding (a loss of waning phenomenon) was observed. A close relationship between reduction of the antibody titers and improvement of neurological symptoms after the therapy was noticed. It was suggested that monitoring the level of a P/Q-type anti-VGCC antibody titer in the serum is important for evaluating the efficacy of chemotherapy for LEMS associated with SCLC.

[A case of intrapulmonary teratoma presenting with expectoration of white hair and cheese-like material].

A 41-year-old man presented with expectoration of white hair and cheese-like material. The chest radiograph showed a round shadow adjacent to the right hilum. Bronchofiberscopy revealed strands of white hair and an obstruction consisting of sebaceous material in the right B3b bronchus. Right upper lobectomy was performed. Histological examination confirmed the diagnosis of intrapulmonary mature teratoma. This characteristic clinical presentation and the bronchofiberscopic findings may have been specific for the diagnosis of teratoma in this case.

[Effect of glycyrrhizin on anti-tuberculosis drug-induced hepatitis].

In cases in which hepatotoxicity developed during anti-tuberculosis chemotherapy, the rapid recovery of liver function is essential for the completion of the anti-tuberculosis chemotherapy protocol. Glycyrrhizin (Stronger Neo-Minophagen C: SNMC) is widely used in Japan for the treatment of patients with drug eruption or chronic hepatitis. However, a consensus on the clinical effects of glycyrrhizin for the treatment of anti-tuberculosis drug-induced hepatitis has not yet been reached. We studied 24 cases who showed abnormal liver function test results while undergoing anti-tuberculosis chemotherapy and who were treated with or without glycyrrhizin. We then compared recovery periods of liver function among both groups. The time required for liver function normalization in the patients who received glycyrrhizin (SNMC, 40 ml daily, intravenously) was 15.1 +/- 4.5 days and the time required for normalization in the non-glycyrrhizin group was 15.2 +/- 5.2 days. The difference was not significant and the fact indicated that glycyrrhizin is not useful for the treatment of anti-tuberculosis drug-induced hepatitis.