Assessment of cognitive function and sleep-wake rhythms in community-dwelling older adults.

Disruption of the circadian rhythm and sleep-wake cycles is a consequence of aging and is associated with the cognitive decline and many neurodegenerative conditions. We investigated the bedtime, wake-up time, sleep timing (midpoint between bedtime and wake-up time), and sleep timing standard deviation (SD) using the actigraphy among 80 consecutive volunteers aged ≥ 60 years. Global cognitive function and executive function of detailed cognitive domains were evaluated using the mini-mental state examination (MMSE) and Wisconsin card sorting test (WCST) and subjective daytime sleepiness was assessed using the Epworth Sleepiness Scale (ESS). The category achievement (CA), total errors (TE), perseverative errors of Nelson (PEN), non-perseverative errors (NPE), and difficulties in maintaining set (DMS) on the WCST were significantly correlated with sleep timing SD (CA: r = - 0.276, p = 0.013, TE: r = 0.311, p = 0.005, PEN: r = 0.241, p = 0.032, NPE: r = 0.250, p = 0.025, DMS: r = 0.235, p = 0.036), but not with the MMSE score. Multiple regression analyses with the stepwise forward selection method including age, ESS score, bedtime, sleep timing, and sleep timing SD, revealed that the ESS score, and sleep timing SD were significant factors related to CA on the WCST (ESS score: ß = - 0.322, p = 0.004; sleep timing SD: ß = - 0.250, p = 0.022). Assessment of sleep-wake rhythms, daytime sleepiness, and cognitive function using the MMSE and WCST is valuable for the prediction of cognitive decline in the geriatric population.

Association of sleep-wake rhythm and sleep quality with endothelial function in young adults.

Objective: The environment in modern society could disturb the sleep-wake rhythm. We aimed to study the association of sleep-wake rhythm with endothelial function and sleep quality. Material and Methods: Thirty-one healthy university students (mean age: 20.4±1.8 years) were enrolled. The endothelial function was evaluated with the percent endothelium-dependent flow-mediated dilation of the brachial artery [%FMD: (maximum diameter - baseline diameter)/baseline diameter x 100] using the high-resolution ultrasonography. We also measured the total sleep time (TST), sleep effciency, and the standard deviation (SD) of sleep timing (midpoint between bedtime and wake-up time) using the actigraphy. The irregular sleep-wake rhythm was defined as having the shift of bedtime or wake-up time for two hours or longer. Results: The %FMD and sleep efficiency were significantly lower in the irregular group than regular group (%FMD: 6.1±2.4 vs. 10.9±2.3, p<0.001, sleep effciency: 92.2±5.8 vs. 95.9±2.8%, p=0.027), whereas there was no significant difference in %FMD between the two groups of TST <6 hours and TST ≥6 hours. The %FMD was significantly correlated with SD of sleep timing (r=-0.481, p=0.006). Multiple regression analyses, including age, sex, TST, sleep effciency, and SD of sleep timing revealed that the SD of sleep timing was a significant factor associated with %FMD (ß=-0.454, p=0.017). Conclusion: Our findings suggest that the irregular sleep-wake rhythm and poor sleep quality could have adverse effects on endothelial function in young adults.

Effects of long sleep time and irregular sleep-wake rhythm on cognitive function in older people.

Sleep disturbances and cognitive decline are common in older adults. We aimed to investigate the effects of the total sleep time (TST) and sleep-wake rhythm on executive function and working memory in older adults. In 63 older participants, we measured the TST, wake after sleep onset (WASO), and sleep timing (midpoint between bedtime and wake-up time) using actigraphy. Executive function was evaluated with the trail making test B (TMT-B) and Wisconsin card sorting test (WCST). The number of back task (N-back task) was used to measure working memory. Participants with a TST ≥ 8 h had a significantly lower percentage of correct answers (% correct) on the 1-back task than those with a TST < 8 h. The % correct on the 1-back task was significantly correlated with the TST, WASO, and sleep timing. Multiple regression analyses revealed that the TST and sleep timing were significant factors of the % correct on the 1-back task. The TMT-B score was significantly correlated with the sleep timing. Category achievement on the WCST was significantly correlated with the standard deviation of the sleep timing. Therefore, a long sleep time and an irregular sleep-wake rhythm could have adverse effects on executive function and working memory in older people.

Morphology of the Ulnar Insertion of the Triangular Fibrocartilage Complex and Related Osseous Landmarks.

PURPOSE: In triangular fibrocartilage complex (TFCC) injuries, a foveal tear of the radioulnar ligament often requires surgery. Previous studies have suggested that surgeons should attach the TFCC to the center of the fovea. The TFCC and its insertion points are small structures, and few studies have reported details of the foveal insertion. This study aimed to clarify the morphology of the ulnar insertion of the TFCC and related osseous landmarks with 3-dimensional imaging. METHODS: This study used 26 formalin-fixed cadavers. At the ulna, the TFCC was inserted from the fovea to the middle part of the ulnar styloid. After gross observation of the TFCC, the ulnar insertion was outlined using a 1.0-mm drill. We then created 3-dimensional images of the ulna using computed tomography and marked (with software) an outline of the foveal insertion of the TFCC. We measured the area and the long and short diameters of the TFCC insertion. RESULTS: The area of the TFCC insertion was 34 mm2 and positively correlated with the height of the ulnar styloid and the area of the ulnar head. The TFCC's highest point was 58% of the ulnar styloid height. The center of the TFCC insertion was 1.3 mm ulnar and 0.6 mm dorsal from the lowest point of the ulnar surface. CONCLUSIONS: The center of the TFCC insertion was slightly ulnar of the lowest point of the ulnar surface. This study revealed the center, the area, and the osseous relation of the ulnar insertion of the TFCC. CLINICAL RELEVANCE: When surgeons repair a TFCC foveal tear, they can find the anatomical center of the ulnar insertion efficiently and easily based on its osseous relationship.

Sleep fragmentation and working memory in healthy adults.

INTRODUCTION: Sleep is essential for performing cognitive function in humans. We have hypothesized that sleep fragmentation compared to sleep efficiency may have a negative impact on the working memory. MATERIAL AND METHODS: Twenty-eight healthy adults (18 males and 10 females; mean age 27.8±15.5 years) were enrolled in this study. We measured the total sleep time (TST), sleep efficiency, %stage wakefulness (W), %stage rapid eye movement (REM), %stage N1, %stage N2, %stage N3, wake after sleep onset (WASO), and arousal index using polysomnography. Working memory, executive function, and sustained attention of three domains of cognitive function were evaluated with the number of back task (N-back task), Wisconsin card sorting test (WCST), and continuous performance test-identical pairs (CPT-IP), respectively. RESULTS: The percentage of correct answers on the 2-back task was significantly correlated with %stage REM, %stage N1, and %stage N2 (%stage REM: r=0.505, p=0.006; %stage N1: r=-0.637, p<0.001; %stage N2: r=0.670, p<0.001), and multiple regression analysis including the stepwise forward selection method revealed that %stage N2 was the most significant factor (%stage N2: ß=0.670, p<0.001). The percentage of correct answers on the 2-back task was also significantly correlated with TST, sleep efficiency, WASO, and arousal index (TST: r=0.492, p=0.008; sleep efficiency: r=0.622, p<0.001; WASO: r=-0.721, p<0.001; arousal index: r=-0.656, p<0.001), and WASO was the significant factor (ß=-2.086, p=0.007). The WCST category achievement and CPT-IP d-prime score were correlated with none of the sleep variables. CONCLUSION: Increased WASO and a decrease in %stage N2 were associated with worse working memory.

Patient characteristics affecting accurate detection of sleep apnea using a bed sheet-type portable monitor.

PURPOSE: Although performed inside a laboratory, attended polysomnography (PSG) has long been the gold standard for the diagnosis of sleep apnea. However, high costs and long wait times have led to the development of home-based portable monitoring devices. A bed sheet-shaped device called SD102 (Suzuken Co., Nagoya, Japan) has been developed, and its accuracy in evaluating sleep apnea is becoming evident. The purpose of this study was to confirm the accuracy of SD102 in evaluating sleep apnea and to investigate patient characteristics that may contribute to inaccurate test results in patients with suspected obstructive sleep apnea (OSA). METHODS: One hundred and eighty-nine patients simultaneously underwent PSG and portable monitoring by using a home sleep apnea testing (HSAT) device. A blinded, experienced technologist using the American Academy of Sleep Medicine criteria versions 2.1 and 2.3 scored the PSG data and HSAT device data, respectively. RESULTS: The respiratory event index (REI) by HSAT significantly correlated with the apnea-hypopnea index (AHI) by PSG (r = 0.974, p < 0.001). HSAT sensitivity, specificity, and positive and negative predictive values of 0.99, 0.83, 0.95, and 0.97, respectively. Body mass index and arousal index were significantly associated with the difference between REI from SD102 HSAT and AHI from PSG. CONCLUSIONS: This study demonstrates the good agreement between REI and AHI in patients with suspected OSA and suggests that understanding the limitations of different testing methods may help in the accurate detection of OSA.

Clinical profiles of late-onset psychiatric patients exhibiting incidental REM sleep without atonia.

Rapid eye movement (REM) sleep without atonia (RWA), which is a hallmark of REM sleep behavior disorder (RBD) on polysomnography (PSG), may represent specific characteristics of prodromal Parkinson's disease (PD)/dementia with Lewy bodies (DLB), even when dream-enactment behavior is absent. We investigated the clinical profiles associated with PD/DLB in late-onset psychiatric patients exhibiting incidental RWA. Among patients who underwent PSG in our psychiatric ward, eight with incidental RWA, nine with idiopathic RBD, and seven with PD or DLB who had preceding RBD were included. Clinical variables, including the percentage of RWA in the total REM sleep (%RWA), were compared among the three groups. The frequency of depressive disorders as a primary psychiatric diagnosis and antidepressant usage were significantly higher in the incidental RWA group than in the other groups. There were no differences in the prevalence of supportive features of DLB among the three groups. The median %RWA was significantly lower in the incidental RWA group than in the other groups. Although the cardiac 123I-metaiodobenzylguanidine uptake was significantly higher in the incidental RWA group compared with the other groups, the groups showed overlap in the specific binding ratios on dopamine transporter imaging. All patients in the three groups exhibited cingulate island sign ratios on brain perfusion single-photon emission computed tomography within a threshold of 0.281, which is the optimal cut-off value for a diagnosis of DLB. In this series, late-onset psychiatric patients with incidental RWA partially shared common clinical profiles with idiopathic RBD and PD/DLB.

Early diagnosis of Lewy body disease in patients with late-onset psychiatric disorders using clinical history of rapid eye movement sleep behavior disorder and [123 I]-metaiodobenzylguanidine cardiac scintigraphy.

AIM: Rapid eye movement sleep behavior disorder (RBD) and psychiatric symptoms often antedate the clinical diagnosis of Parkinson's disease or dementia with Lewy bodies. The purpose of this study was to investigate RBD and its relevance to Lewy body disease (LBD) in patients with late-onset psychiatric disorders. METHODS: Study subjects included 19 patients with late-onset psychiatric disorders who exhibited REM sleep without atonia (RWA), which is a hallmark of RBD on polysomnography, at our psychiatric ward. Clinical profiles and radiological findings by cardiac [123 I]-metaiodobenzylguanidine ([123 I]-MIBG) scintigraphy and imaging for the dopamine transporter (DAT) were compared between patients with and without RBD symptoms. The correlations between the percentage of RWA in the total rapid eye movement sleep (%RWA) and radiological findings were also investigated. RESULTS: Nine patients reported RBD symptoms only on specific questioning, but clinical profiles, including the prevalence of antipsychotropic usage, did not differ when compared to the remaining 10 patients without RBD (incidental RWA group). The median %RWA was significantly higher in the definite RBD group than in the incidental RWA group. Although the cardiac [123 I]-MIBG uptake was significantly lower in the definite RBD group than in the incidental RWA group, there was overlap in the specific binding ratio on DAT scan. CONCLUSION: The severity of %RWA was highly correlated with the value of cardiac [123 I]-MIBG uptake, but not with specific binding ratio on DAT scan. Clinical history of RBD and cardiac [123 I]-MIBG scintigraphy are helpful for an early differential diagnosis of LBD from late-onset psychiatric disorders, even before parkinsonism or dementia appears.

Rapid eye movement sleep without atonia may help diagnose Lewy body disease in middle-aged and older patients with somatic symptom disorder.

BACKGROUND: Lewy body disease (LBD), including Parkinson's disease (PD) and dementia with Lewy bodies (DLB), is defined pathologically as degeneration in the central and peripheral nervous system associated with Lewy bodies. Somatic symptom disorder often predates the clinical diagnosis of PD and DLB. It is crucial to make an initial diagnosis of LBD in patients with psychiatric symptoms because administering psychotropic drugs often causes or exacerbates extrapyramidal signs. Given the close association between rapid eye movement (REM) sleep behaviour disorder and LBD, REM sleep without atonia on polysomnography may help to diagnose LBD in middle-aged and older patients with somatic symptom disorder. METHODS: We reviewed the clinical profiles of five patients with an initial diagnosis of somatic symptom disorder who exhibited REM sleep without atonia on polysomnography. There were three men and two women, with a mean age of 68.4 years (range: 55.0-78.0 years). The mean Mini-Mental State Examination score was 26 (range: 22-30). RESULTS: Only two patients had a clinical history of dream-enacting behaviour and fulfilled the clinical criteria for REM sleep behaviour disorder, but clinical conditions in the other three patients corresponded to subclinical REM sleep behaviour disorder. Final clinical diagnoses were made as probable DLB in three patients; two patients did not meet the clinical criteria for PD or DLB. Neurological examinations revealed mild extrapyramidal signs in these two patients, and their scores on the motor component of the Unified Parkinson's Disease Rating Scale were 8 and 5 points, and their Mini-Mental State Examination scores were 30 points. Neither patient exhibited dream-enacting behaviour, but both had constipation. Cardiac 123 I-metaiodobenzylguanidine scintigraphy revealed mild increased washout rates. DISCUSSION: REM sleep without atonia may provide an opportunity to identify LBD in patients with somatic symptom disorder, even before they fulfil the clinical criteria for PD or DLB. Continued follow-up will be needed to determine whether these psychiatric patients are in the prodromal stage of PD or DLB.

REM sleep without atonia in middle-aged and older psychiatric patients and Lewy body disease: a case series.

OBJECTIVE: Rapid eye movement (REM) sleep behavior disorder (RBD) is commonly associated with Lewy body disease, narcolepsy, or depression. In contrast, the relationship between REM sleep without atonia (RWA), which is a hallmark of RBD on polysomnography, and clinical characteristics remains unclear. The purpose of this study is to investigate the clinical features of psychiatric patients exhibiting RWA and its relevance to Lewy body disease. METHODS: Of 55 consecutive patients who underwent polysomnography at the psychiatric ward, 25 patients with sleep apnea syndrome were excluded, and 12 patients exhibiting RWA were identified. The clinical profiles were compared between the groups with and without RWA. RESULTS: The mean age and the frequency of neurocognitive disorders were significantly higher in 12 patients with RWA than in 18 without. Only five of the 12 patients exhibiting RWA had episodes of dream-enactment behavior, and fulfilled the clinical criteria for RBD. Two young patients were diagnosed with narcolepsy, while the other middle-aged and older patients fulfilled the clinical criteria for Parkinson's disease (n = 1), dementia with Lewy bodies (n = 4), idiopathic RBD (n = 2), and major depressive disorder (MDD) (n = 3). The patients with MDD exhibited constipation and/or olfactory dysfunction. Moreover, neuroimaging examinations in the patients with MDD revealed isolated occipital hypoperfusion in three patients and mild dopamine transporter deficit in one patient. CONCLUSIONS: Rapid eye movement sleep without atonia itself may be associated with specific clinical profiles, even when dream-enactment behavior is absent. Continued follow-up of the patients with MDD exhibiting RWA is warranted to determine if they represent the prodromal Parkinson's disease/dementia with Lewy bodies. Copyright © 2016 John Wiley & Sons, Ltd.

Poor sleep quality impairs cognitive performance in older adults.

The prevalence of insomnia increases with age. Short sleep duration is associated with deficits in cognitive performance. We hypothesized that short sleep duration and sleep quality influence cognitive performance in older adults. The study included 78 adults aged 60 years and over (72.2 ± 5.9 years). Total sleep time and sleep efficiency (total sleep time/time in bed × 100) were calculated using actigraphy. We evaluated cognitive performance with the continuous performance test-identical pairs and the number-back test. Sleep apnea was evaluated overnight with a portable home monitoring system. The accuracy of the 0-back test significantly decreased in participants with total sleep time less than 5 h compared with those with total sleep time greater than 7 h, but there was no significant difference in continuous performance test-identical pairs between the two groups. Participants with sleep efficiency <85% showed a significant decrease in 0- and 1-back test accuracy compared with those with sleep efficiency ≥85%. There were no significant differences in the accuracy of number-back tests and continuous performance test-identical pairs between apnea-hypopnea index ≥15 h(-1) and apnea-hypopnea index <15 h(-1) groups, or among lowest SpO2  ≥ 90%, lowest 80-90%, and lowest SpO2  < 80% groups. Age, total sleep time and sleep efficiency were significantly correlated with accuracy on the 0-back test. Age and sleep efficiency were significantly correlated with accuracy on the 1-back test. Multiple regression analysis revealed that total sleep time was independently correlated with accuracy on the 0-back test, while age was independently correlated with accuracy on the 1-back test. Our findings suggest that sleep duration and sleep quality may play a role in cognitive performance in older adults.

Magnifying endoscopy for intestinal follicular lymphoma is helpful for prompt diagnosis.

The representative endoscopic features of primary intestinal follicular lymphoma are well known as small whitish polypoid nodules, but a magnified view has only been described in a few case reports. Herein, we report a case with intestinal follicular lymphoma in which magnifying endoscopy with narrow band imaging was helpful for prompt diagnosis. A 57-year-old Japanese woman underwent surveillance esophagogastroduodenoscopy. The endoscopic examination revealed confluent whitish granules in the duodenum, distinct from the nodules or polyps that are typical findings of intestinal follicular lymphoma. Magnifying endoscopy visualized whitish enlarged villi, and narrow band imaging emphasized an elongated and coiled vascular pattern. Based on these features, intestinal follicular lymphoma was highly suspected, and subsequent histological study confirmed the diagnosis. This case demonstrates that magnifying endoscopy with narrow band imaging was useful for the detection and prompt diagnosis of intestinal follicular lymphoma. The pathological features of intestinal follicular lymphoma are also discussed.

Comparison of oxygen desaturation patterns in children and adults with sleep-disordered breathing.

PURPOSE: Although the number of apnea-hypopnea episodes per hour apnea-hypopnea index (AHI) is typically used to evaluate sleep-disordered breathing (SDB) in adults, it does not provide an accurate characterization of SDB in children. We investigated differences in SDB patterns in children and adults to evaluate SDB severity in children. MATERIALS AND METHODS: Fifteen adults (mean age, 45.3 ± 8.4 years) and 15 children (mean age, 6.7 ± 3.9 years) with adenotonsillar hypertrophy underwent standard polysomnography. The change of oxygen saturation (ΔSpO2) was defined as the difference between baseline SpO2 during stable nighttime breathing and the lowest SpO2 accompanied by an apnea-hypopnea event. The number of apnea-hypopnea episodes was determined using two different criteria to define an episode (criterion 1: cessation of airflow for at least 10s; criterion 2: cessation of airflow for at least two consecutive breaths). RESULTS: Mean ΔSpO2 accompanied by obstructive apneas lasting ≤10 s was significantly greater in children than in adults, although there was no significant difference in the duration of apnea-hypopnea episodes. The slope of the regression line between ΔSpO2 and apnea-hypopnea duration in children was greater than in adults (P<0.005). AHI in children was higher when calculated using criterion 2 compared to criterion 1 (10.9 ± 9.4 vs. 6.5 ± 4.9/h, P=0.003). CONCLUSIONS: ΔSpO2 is a good indicator of SDB severity in children, and should therefore be considered in the diagnosis and treatment of pediatric SDB along with AHI.

Increased eosinophilic cationic protein in nasal fluid in hospitalized wheezy infants with RSV infection.

BACKGROUND: Respiratory syncytial virus (RSV) is a major respiratory pathogen which causes bronchiolitis with dyspnea and wheezing in children less than 2 years old. RSV bronchiolitis in infancy severe enough to cause hospitalization might be a risk factor for allergic sensitization and bronchial asthma in future. However, the pathophysiology behind this development has not been clearly characterized. To evaluate the existence of airway inflammation and characteristic of RSV bronchiolitis, we analyzed and compared the concentrations of eosinophilic cationic protein (ECP) in nasal fluid and plasma. METHODS: From 69 infants (aged <2 years) hospitalized for possible lower respiratory tract infections including RSV infection, we collected nasal fluid and plasma and determined the ECP concentrations. RESULTS: ECP concentrations in nasal fluid were significantly higher in patients with wheezing and/or bronchial rales than in patients without them (1733 ± 660 ng/mL vs 680 ± 450 ng/mL, p = 0.018), and those of the respiratory syncitial virus-infected group were significantly higher than those of the uninfected group (p = 0.04). Meanwhile, there was no significant difference in plasma ECP levels between patients with wheezing and patients without wheezing, and no significant difference between RSV-infected and other pathogen-infected patients. There were significant correlations between nasal fluid ECP concentrations and both neutrophil and eosinophil counts in the peripheral blood. CONCLUSIONS: Nasal fluid ECP concentrations are increased in infants with lower respiratory infections including RSV infection accompanied with wheezing. ECP probably originates from neutrophils as well as eosinophils migrated into airways. The monitoring of ECP concentration in nasal fluid may be useful for evaluating leukocyte (including eosinophils and neutrophils)-mediated airway inflammation during infancy and its severity.

Composite paraganglioma-ganglioneuroma in the retroperitoneum.

BACKGROUND: Paragangliomas occur most commonly in head and neck region and much less frequently, they are found in the retroperitoneum. Composite paraganglioma-ganglioneuroma of the retroperitoneum is very rare. CASE PRESENTATION: We present an unusual case of retroperitoneal composite paraganglioma-ganglioneuroma discovered on computed tomography in a 63-year-old female patient. Routine hematological examination and biochemical tests were within normal limits. Plasma adrenaline was 0.042 ng/ml, plasma noradrenaline 0.341 ng/ml, and plasma dopamine <0.01 ng/ml. An abdominal contrast-enhanced CT scan and magnetic resonance imaging revealed a 6.5 cm heterogeneous retroperitoneal mass with a cystic component. The retroperitoneal tumor accumulated (131)I-Metaiodobenzylguanidine ((131)I-MIBG) 48 hours after radioisotope injection. Under the diagnosis of paraganglioma in the retroperitoneum, the patient underwent surgery. The resected tumor (6.5 x 5 x 3 cm) was solid and easily removed en bloc. The cut surface of the tumor and histology revealed two different components in the tumor: paraganglioma centrally and ganglioneuroma on the periphery. She remains disease-free 18 months after surgery. CONCLUSION: This case reminds us that neuroendocrine tumor should be included in the differential diagnosis of a retroperitoneal mass although composite paraganglioma-ganglioneuroma in the retroperitoneum is very rare.

[A case of liposarcoma of the ascending colon mesenterium].

We encountered a rare case of liposarcoma of the ascending colon mesenterium. A 53-year-old man visited our hospital because of a mass, 12x8cm in diameter, in the right upper abdomen. On computed tomography (CT), the tumor showed irregular density with a smooth surface and was enhanced irregularly. A part of the tumor protruded into the colon in the upper portion of the ascending colon. The tumor was surgically resected by right hemicolectomy. Histological diagnosis of the tumor was well-differentiated liposarcoma, sclerosing variant. Radiological findings seemed to reflect the pathological findings well.

Spontaneous regression of an invasive thymoma.

Although there are many reports of spontaneous regression of noninvasive thymoma, there are no reports of spontaneous regression of an invasive thymoma. Moreover, the mechanism of the spontaneous regression is still unknown. The present case concerns a 47-year-old man who presented with chest pain. Computed tomography (CT) showed a large anterior mediastinal mass with left pleural effusion that occluded the innominate vein. The tissue obtained by video-assisted thoracic surgery suggested a diagnosis of invasive thymic carcinoma. One month later CT showed prominent regression of the tumor, and the tumor was completely resected. On pathology, the diagnosis was thymoma type B3.

Treatment of primary melanoma of the lung monitored by 5-S-cysteinyldopa levels.

Malignant melanoma originating outside the skin is very rare, whereas primary malignant melanoma of the lung is extremely rare. 5-S-Cysteinyldopa (5-S-CD), a melanin metabolite, has been reported to be a prognostic marker for cutaneous malignant melanoma. This is the first report in the English language literature dealing with primary malignant melanoma of the lung using serum 5-S-Cysteinyldopa levels to monitor the effects of surgery and chemotherapy.

Asymptomatic colonic metastases from primary squamous cell carcinoma of the lung with a positive fecal occult blood test.

We describe a 74-year-old man with a colonic metastatic squamous cell carcinoma (SCC) from the lung. His chest X-ray revealed an abnormal shadow in the right upper lobe. Computed tomography (CT) of the chest demonstrated a large lung tumor in the right upper lobe obstructing the right upper bronchus. Bronchoscopy revealed an easy-bleeding tumor in the right upper bronchus that was diagnosed as poorly differentiated squamous cell lung carcinoma. He underwent colonoscopy because he had a positive fecal occult blood test. Colonoscopy revealed a large protruding lesion with central ulceration in the descending colon. Histological examination of the biopsy specimen obtained from the colonic lesion revealed SCC. The lesion was diagnosed as metastatic colonic SCC. He had no abdominal symptoms. He underwent chemotherapy with an infusion of cisplatin 130 mg i.v. day 1, and docetaxel hydrate 100 mg i.v. day 1, repeated every 4 wk, followed by 4 courses of chemotherapy. The primary lesion shrank by less than 10% and was judged to be "Partial Response" (PR) after 3 courses of treatment. The patient still lived 23 wk after the diagnosis of metastatic colonic SCC. Colonic metastasis of primary SCC of the lung is rare.