An Adult Case of Herpes Simplex Virus-associated Granulomatous Encephalitis.

Brain granuloma occurs under certain conditions. Herpes simplex virus (HSV) causes granulomatous encephalitis in children; however, it has been rarely reported in adults. A 74-year-old man with a history of herpes simplex encephalitis suffered recurrent seizures. Brain magnetic resonance imaging revealed a mass lesion and resection was performed. A polymerase chain reaction using a brain biopsy specimen was positive for HSV DNA; thus, the patient was diagnosed with HSV-associated granulomatous encephalitis. After administering acyclovir, the patient showed improvement. HSV can cause granulomatous encephalitis in adults, and acyclovir can be used for its treatment.

[A Case of Small Cell Carcinoma of the Esophagus with Complete Response to Chemoradiotherapy in an Elderly Patient].

Small cell carcinoma of the esophagus is a rare malignancy with a perceived poor prognosis. We report a case of long-term survival using chemoradiotherapy. An 80-year-old man visited our hospital complaining of hiccup. Endoscopic examination showed type 2 lesions in the lower esophagus with a pathological diagnosis of small cell carcinoma. Based on the diagnosis of cStage Ⅲ disease and the patient's age, chemoradiotherapy comprising 3 courses of CDDP and CPT-11 and 45 Gy of irradiation was administered. After treatment completion, the therapeutic effect was evaluated as a complete response through CT, PET-CT, and endoscopic examination. No recurrence has been identified more than 5 years after achieving the complete response.

Infectious mononucleosis lymphoadenitis showing histologic findings indistinguishable from toxoplasma lymphadenitis. A report of three cases.

Lymph node lesions in infectious mononucleosis (IM) show a marked histologic diversity. We report here three cases of IM lymphadenitis with histologic findings indistinguishable from those of toxoplasmic lymphadenitis. The histologic findings of the three cases presented here showed a histologic triad of toxoplasmic lymphadenitis, including (i) numerous lymphoid follicles with hyperplastic germinal centers; (ii) small clusters or single epithelioid histiocytes; and (iii) multiple foci of monocytoid B-cells. Moreover, all three lesions contained isolated or small clusters of epithelioid histiocytes within the hyperplastic germinal centers and the periphery of lymphoid follicles, which are the most specific histologic findings of toxoplasmic lymphadenitis. However, serologic findings confirmed EBV infection in all three cases. On in situ hybridization, numerous Epstein-Barr virus (EBV)-encoded small RNA (EBER)-positive cells were demonstrated in the germinal center, as well as in interfollicular areas in all three cases. Toxoplasmosis gondii infection was excluded in at least one case, based on serologic findings. Polymerase chain reaction analysis also demonstrated that there was no T. gondii DNA in the remaining two cases. Two of our three cases showed atypical clinical presentations, including an absence of atypical lymphocytosis in peripheral blood in two cases, age more than 30 years, and an absence of systemic symptoms in one case. It appears that previous descriptions emphasize the differential diagnostic problems between IM lymphadenitis and malignant lymphomas. However, from a therapeutic perspective, it is important to discriminate IM lymphadenitis from toxoplasmic lymphadenitis particularly in patients showing atypical clinical features.

Rapid enlargement of a mediastinal mass: thymoma hemorrhage into a thymic cyst.

A 52-year-old man was admitted to Matsudo City Hospital because of an anterior mediastinal mass. One month prior, when he suddenly suffered chest pain, computed tomography (CT) showed a 4 x 3 cm mass in the chest. On admission, the symptom disappeared. However, chest CT revealed rapid enlargement of the mass to 10 x 6 cm. Based on the CT findings, we suspected a tumor. Therefore, we performed a thymothymectomy. The mass, measuring 12 x 8 x 6 cm, contained a solid tumor and a fluid-filled cyst. Pathology showed a thymoma and a multilocular thymic cyst. We speculated that hemorrhage from the thymoma spread into the multilocular thymic cyst and enlarged the mass.

Primary splenic diffuse large B-cell lymphoma manifesting in red pulp.

We evaluated six cases of diffuse large B-cell lymphoma (DLBCL) involving the red pulp of the spleen. All had B symptoms and an aggressive clinical course. The lymphoma cells proliferated diffusely and non-cohesively in the cords of the red pulp. The lymphoma involved the bone marrow in four of the five patients and the liver in all four of the patients examined. However, lymph node (LN) involvement was rare at presentation, and systemic LN involvement was not observed even in the terminal phase. The lymphoma cells infiltrated the intrasinusoidal/intravascular and interstitial spaces of the involved tissues and were detected in the peripheral blood in two of the six patients. CD5-expressing lymphoma cells were detected in four of the five patients examined. Because these cases had some unique clinical features and occurred in distinct splenic sites, we proposed that primary splenic DLBCL manifesting in red pulp is a distinct clinicopathological entity.

Large mediastinal cyst of an ectopic thyroid with small nodules diagnosed as papillary carcinoma.

A 49-year-old man was admitted to hospital for investigation of a mediastinal shadow seen on a chest radiograph. Chest completed tomography revealed a mediastinal mass of 65 x 55mm. At surgery, the mass was found to be contained within the upper mediastinum and adherent to the vertebrae, esophagus, trachea, and superior vena cava. We therefore selected sequential approaches using a lateral incision for the thoracotomy and a modified transmanubrial approach. The lateral incision enabled detachment of the adhesion between the mass and the posterior to median mediastinum, and the modified transmanubrial approach was useful for separating the mass from the upper to anterior mediastinum. The mass had no connection to the cervical thyroid gland. Histological examination revealed a large mediastinal cyst of an ectopic thyroid with small nodules diagnosed as papillary carcinoma. There was no recurrence 14 months after surgery.

The effects of water-soluble cyclodextrins on the histological integrity of the rat nasal mucosa.

The aim of this study was to investigate the effect of highly water-soluble cyclodextrins (CDs) on the histological integrity of the nasal mucosa. In order to evaluate their effects, the in vivo single and repeated nasal exposure studies were performed using male Wistar rats. The rat nasal cavity was excised after an application of various CD solutions at different times. The morphological appearances of the rat nasal mucosae were analyzed with the light microscopic and the scanning electron microscopic studies. By utilizing 5-min exposure of each CD solution to the nasal mucosa, no tissue damage was visible for 1.5% w/v beta-CD and 5 and 20% w/v hydroxypropyl beta-CD (HP beta-CD), and the effects were quite similar to controls. However, using 20% w/v randomly methylated beta-CD (RM beta-CD) showed severe damage on the integrity of nasal mucosa. The severity was similar to 1% w/v polyoxyethylene-9-lauryl ether or l% w/v sodium deoxycholate. Meanwhile, 30 or 60 min exposure to 10% w/v HP beta-CD or RM beta-CD resulted in no obvious mucosal damage. In addition, in vivo repeated dosing of RM beta-CD did not show any toxicity up to 20% w/v. These results suggest that at least, less than 10% w/v CD solutions do not induce gross tissue damage and can keep the histological integrity of the nasal mucosa.