[A case of co-existent disseminated Mycobacterium avium infection and non-Hodgkin's lymphoma].

A 76-year-old man was admitted to our hospital with dyspnea. Chest CT revealed bronchial stenosis caused by mediastinal lymphadenopathy. An FDG-PET scan showed increased FDG uptake in the mediastinal lymph nodes, lumbar vertebrae and left ilium. Neither the first biopsy specimen from the left ilium nor the endobronchial lesion showed malignant cells, but both were positive on acid-fast bacillus staining. Genetic testing found the Mycobacterium avium (MAC) gene. Therefore, we diagnosed disseminated MAC infection, and started antibiotic therapy. However, he did not respond to the therapy, and his bronchial stenosis worsened. We performed a biopsy of the newly-appearing supraclavicular lymph node, and of the left ilium again, and confirmed a new diagnosis; diffuse large B cell lymphoma, coexistent with disseminated MAC infection. This case suggests not only the simultaneous occurrence of disseminated MAC infection and diffuse large B cell lymphoma, but also the coexistence of both diseases within the same organs, and that there may be some relationship between the two diseases.

[Estimation of preoperative induction chemoradiotherapy effectiveness for non small-cell lung cancer].

We have performed the clinical evaluations of preoperative induction chemoradiotherapy (CRTx) for 25 patients with non small-cell lung cancer (male: 19, female: 6, mean age: 66.4-year-old). The clinical stages of these patients were IIA: 1, IIB: 7, IIIA: 14, and IIIB: 3, respectively. In the histological type of lung cancer, there were 12 patients of adenocarcinoma, 7 of squamous cell carcinoma, 1 of adenosquamous carcinoma, 1 of anaplastic carcinoma, and 4 of large cell carcinoma. We applied two courses of regimen as the pre-operative chemotherapy (CDDP+DOC or CBDCA+PTX). Twenty-four patients received radiotherapy as the concurrent radiotherapy (44 Gy: 22 patients, 60 Gy: 2 patients). Among the 25 patients, 16 patients accomplished both chemotherapies, and the effects of the treatment were as follows: CR; none, PR; 15, SD; 9, respectively. And the other patient was not an evaluable case due to atelectasis. Histopathological effects (Ef) were Ef-3: 3, Ef-2: 11, Ef-1: 7, Ef-0: 1 and Ef was not evaluable in 3 cases. Post operative pathological findings showed that 14 patients were down staged. There were no operative mortality associated with the operation, and no serious morbidity case was observed. Eighteen patients were survived and 1 patient was survived with tumor metastases. Only one patient died of recurrence in the upper mediastinal lymph nodes, 3 patients died of the brain metastases, one died of hepatic metastasis, and one died of cryptogenic sudden death. As a result, there was no serious operative morbidity observed in the course of this CRTx. We therefore recommend that induction chemoradiotherapy as a beneficial pre-operative treatment.

[A case of lung cancer producing granulocyte colony-stimulating factor with a significantly high uptake in the bones observed by a FDG-PET scan].

A 57-year-old man complaining of right shoulder pain was admitted. Chest enhanced CT scanning showed a mass shadow in the right upper lobe with chest wall invasion. The laboratory data on admission showed marked leukocytosis. A CT-guided lung biopsy was performed, and a histological examination of the biopsy specimen showed a spindle cell type pleomorphic carcinoma. Immunohistochemistry staining using an anti-granulocyte colony-stimulating factor (G-CSF) monoclonal antibody demonstrated many tumor cells containing G-CSF as well as an increased level of serum G-CSF. The diagnosis was determined to be lung cancer producing G-CSF. FDG-PET scanning showed a significantly high uptake in the right upper field and the bones throughout the body. After chemoradiation therapy, the patient underwent a right upper lobectomy with a chest wall resection. Since then, the leukocytosis and the high level of serum G-CSF normalized and the high uptake in the bones disappeared in the FDG-PET scan.