Neurosarcoidosis Presenting with Obstructive Hydrocephalus Successfully Treated with Endoscopic Third Ventriculostomy.

A 58-year-old Japanese woman complained of unstable gait and dizziness lasting for a month. She had been diagnosed histologically with pulmonary and cutaneous sarcoidosis and attended outpatient clinics for routine checkups. Head computed tomography and magnetic resonance imaging (MRI) indicated obstructive hydrocephalus caused by a contrast-enhanced lesion in the cerebral aqueduct. The patient underwent endoscopic third ventriculostomy and a biopsy of the lesion, leading to the diagnosis of neurosarcoidosis. This was a rare case of neurosarcoidosis presenting with obstructive hydrocephalus that was treated with endoscopic third ventriculostomy and diagnosed histologically via an intraoperative biopsy.

[A case of jejunal neuroendocrine carcinoma complicated with dermatomyositis].

A 65-year-old woman who had been diagnosed with dermatomyositis presented to the hospital with a small bowel mass. She had tested positive for fecal occult blood test and anemia at a medical checkup;therefore, computerized tomography (CT) was performed at the previous hospital and it had revealed thickening of the intestinal wall. Abdominal contrast-enhanced CT, single-balloon assisted enteroscopy, and biopsy led to a diagnosis of poorly differentiated jejunal adenocarcinoma. The patient underwent laparoscopic segmental resection of the jejunum with dissection of mesenteric lymph nodes. A histological examination revealed that the tumor was neuroendocrine carcinoma (NEC), large-cell type of the jejunum, pT3, pN0, sM0, and pStage IIA. Immunohistochemically, the NEC component was positive for chromogranin A and negative for neural cell adhesion molecule and synaptophysin. The MIB-1 index was 60%. Four courses of postoperative chemotherapy using cisplatin and etoposide were administered. The patient is currently doing well without any recurrence or metastasis. To the best of the author's knowledge, this is the first report of dermatomyositis associated with primary jejunal NEC.

[A Case of Rectum-Infiltrating Prostate Cancer Mimicking Prostate-Infiltrating Rectal Cancer].

A 71-year-old man was admitted to the department of general surgery at our hospital due to constipation. A large bowel endoscopic examination revealed a stenosis of the rectum near the anus. The pathological diagnosis of the biopsy was poorly differentiated adenocarcinoma. After a computed tomography/magnetic resonance imaging examination, rectal cancer infiltrating the prostate was the diagnosis. External beam radiation therapy and chemotherapy were performed. After those neoadjuvant therapies, an abdominoperineal resection of the rectum (Miles) and a retropubic radical prostatectomy were performed. The final pathological diagnosis was prostate cancer infiltrating the rectum. Prostate cancer infiltrating the rectum is rare because of the Denonvillier's fascia barrier. However, it is difficult to distinguish prostate cancer infiltrating the rectum from rectal cancer infiltrating the prostate. Thus, when we see rectal cancer infiltrating the prostate, prostate cancer infiltrating the rectum should be suspected, serum prostate specific antigen (PSA) level should be determined, and PSA immunostaining should be performed.

Metastatic pulmonary malignant melanoma showing a ring-shaped and halo signs.

Classically, metastatic tumours are solid, multiple, well-circumscribed, and rarely cavitary. This rare case of metastatic pulmonary malignant melanoma showed a ring-shaped ground-glass opacity and then the halo sign, depending on the disease progression.

Acute pancreatitis-onset carcinoma in situ of the pancreas with focal fat replacement diagnosed using serial pancreatic-juice aspiration cytologic examination (SPACE).

A 59-year-old woman was admitted for acute pancreatitis. Abdominal computed tomography and magnetic resonance imaging revealed a swollen pancreatic parenchyma with dilatation of the main pancreatic duct (MPD) of the pancreas tail, which was separated from the normal pancreas body side by a locally atrophic part of the pancreas. Magnetic resonance cholangiopancreatography showed MPD stricture in the pancreas tail with dilatation of the upstream MPD. Endoscopic ultrasonography revealed that the MPD stricture of the pancreas tail was surrounded by a blurred and hypoechoic area. Endoscopic retrograde cholangiopancreatography was performed for serial pancreatic-juice aspiration cytologic examination (SPACE). The result indicated adenocarcinoma. Distal pancreatectomy was performed, and the histopathological examination showed high-grade PanIN (carcinoma in situ of the pancreatic duct) of the pancreas tail with atrophy and fibrosis of the pancreatic parenchyma, and local fat replacement adjacent to the lesion. The final histopathological diagnosis was carcinoma in situ of the pancreatic duct of the pancreas tail. Acute pancreatitis and local fatty change of the pancreatic parenchyma with MPD stricture are important clinical manifestations of pancreatic carcinoma in situ (PCIS) and performing SPACE in cases of MPD stricture without a recognizable mass is preferable for a diagnosis of PCIS.

[Middle mediastinal schwannoma originating from the intrathoracic vagal nerve with difficulty in swallowing; report of a case].

A 41-year-old male complaining of difficulty in swallowing was referred to our hospital. Chest computed tomography( CT) demonstrated 34×25×36 mm tumors in the subcarinal region. Gadolinium( Gd)-diethylenetriamine pentaacetic acid( DTPA) enhanced magnetic resonance imaging (MRI) showed the tumor with the target appearance sign, i.e., signal intensity of the mass was low on T1-weighted MRI, and the center of the mass was enhanced by Gd-DTPA. A neurogenic tumor was suspected on radiological findings. Resection of the tumor by video-assisted thoracoscopic surgery was performed. The tumor was found to originate from the left vagus nerve by operative findings and was diagnosed as schwannoma by pathological examination.

[Bilateral pulmonary metastases from hepatocellular carcinoma successfully treated by surgical resection and stereotactic radiotherapy; report of a case].

We report a case of 68-year-old-man with pulmonary metastases from hepatocellular carcinoma (HCC). Following right hepatic lobectomy in January 2005, 4 pulmonary metastases in the right lung were detected by chest computed tomography (CT) in September 2007. As chemotherapy was not effective, surgical resection (right upper lobectomy, partial resection of middle and lower lobe ) was performed. Secondary metastases in the left lung was detected in March 2008, and stereotactic radiotherapy was performed considering the site of tumor location and poor pulmonary function. Two years after radiotherapy, the patient is alive without recurrence.

Development of a new disintegration method for orally disintegrating tablets.

Recently, the focus has been on the importance of assessing the oral disintegrative properties of orally disintegrating tablets (ODTs). In particular, in the development stages and the quality control field of ODT products, a physical assessment method which easily measures oral disintegrative properties is desired. For this reason, we developed a new disintegration test method (Kyoto-model disintegration method or KYO method), which is useful to predict the oral disintegrative properties of an ODT easily, and examined the availability of the method. In the KYO method, ODT samples were classified in terms of their water permeability, and a moderate water volume was decided. Subsequently, the disintegrative properties were assessed with the newly proposed method. For 25 commercial prescription ODTs used as samples, a good correlation was shown between the results of a human sensory test by five healthy male volunteers and the results using the KYO method. Furthermore, the KYO method could evaluate time-dependent changes in ODT samples. On the other hand, no correlation was observed between the Japanese Pharmacopeia disintegration test and the human sensory test. These results suggested that the KYO method reflected the disintegration nature of the ODTs in the oral cavity, and could easily be applied to development stages and the quality control field of ODT products.

[Granular cell tumor in the mediastinum; report of a case].

Granular cell tumor is found in various organs but is rare in the mediastinum. We report a case of 21-year-old woman with a granular cell tumor in the left upper mediastinum. Chest computed tomography (CT) showed a 30 x 20 mm well circumscribed tumor in the left upper mediastinum. Tumor resection was performed. It was found that the tumor involved the sympathetic nerve. Histopathologically, the tumor consisted of cells with eosinophilic granules and diagnosed as a granular cell tumor.

Determination of indapamide in human serum using 96-well solid-phase extraction and high-performance liquid chromatography-tandem mass spectrometry (LC-MS/MS).

A sensitive and specific method using high-performance liquid chromatography (LC)-electrospray tandem mass spectrometry (ESI-MS/MS) for the determination of indapamide in human serum was developed and validated. Indapamide and an internal standard (4-diethylaminobenzoic acid) were isolated from serum samples by solid-phase extraction (SPE) with Oasis HLB 96-well plates and determined by LC-MS/MS in multiple reaction monitoring (MRM) mode. The calibration curve of serum indapamide was linear in the range of 0.2-20 ng/ml with a correlation coefficient of 0.9999. The repeatability, intermediate precisions, and accuracies at 0.2, 5, and 20 ng/ml in serum were less than 15%. The absolute recoveries of indapamide and the internal standard were 79.4-81.5% and 87.5%, respectively, and the low limit of quantitation of serum indapamide was 0.2 ng/mL. The analytical method was applied to a bioequivalence study of KYD-041 (1 mg as film-coated tablets, test formulations) and Natrix Tab.1 (1 mg as sugar-coated tablets, reference formulation). The 90% confidence interval of the ratios (test formulation/reference formulation) for log(Cmax) and log(AUCt) were in the range log(0.80)-log(1.25), which supports the conclusion that KYD-041 is bioequivalent to Natrix Tab.1 with respect to the rate and extent of indapamide absorption.

Primary low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT)-type of the liver in a patient with hepatitis C virus infection.

We report a case of primary low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT)-type of the liver presenting as a solitary mass in a patient with hepatitis C virus infection. A 73-year-old male was referred to our hospital because of a solitary mass in the liver, which was identified by ultrasonography during a routine follow-up study for his hepatitis C virus carrier status. A fine-needle biopsy was performed and the mass was diagnosed as non-Hodgkin's lymphoma. A detailed investigation showed no evidence of lymphoma in other sites. Left lateral segmentectomy was performed. Histologic examination showed diffuse, monotonous infiltration of centrocyte-like cells that are CD 19(+), CD 20(+), sIgM-lambda(+), CD 3(-), CD 5(-), CD 10(-). The patient received no adjuvant chemotherapy and is alive and disease free 34 months after surgery.

[Renal pelvic cancer representing G-CSF production and hypercalcemia simultaneously: a case report].

A 73-year-old man was admitted to the hospital complaining of gross hematuria and left flank pain. Abdominal ultrasonography and computed tomography revealed a left renal tumor with extracapsular extension. Laboratory data showed marked leukocytosis of 121,000/mm3 and hypercalcemia of 12.3 mg/dl without any findings of inflammatory disease or bone metastasis. Enzyme immunoassay of the serum demonstrated a high level of granulocyte colony-stimulating factor (250 pg/ml) and parathyroid hormone-related protein (1,069 pmol/l). Pathological diagnosis of needle biopsy specimen of the primary tumor was transitional cell carcinoma which was suspected to have originated from renal pelvis. Immunohistochemical examination with anti-granulocyte colony-stimulating factor monoclonal antibody demonstrated granulocyte colony-stimulating factor production in cancer cells. The patient underwent a course of systemic chemotherapy, but died two months after diagnosis. To our knowledge, this is the first report of renal pelvic cancer representing granulocyte colony-stimulating factor production and hypercalcemia simultaneously.

[Sarcomatoid carcinoma of the renal pelvis: a case report].

A 65-year-old man visited our hospital with the complaint of left hypochondrial pain. Since he had left giant hydronephrosis due to ureteral stone, we performed left nephrectomy. Unexpectedly, macroscopic examination of the resected kidney revealed multiple yellowish nodules located in the renal pelvis and calyces. Histopathologically the nodules consisted of two pattern of malignancy, transitional cell carcinoma and spindle sarcomatous tumor. Immunohistochemical examination showed that spindle cells were stained positive for cytokeratin, and the final diagnosis was sarcomatoid carcinoma of left renal pelvis. Postoperatively, the patient underwent two courses of adjuvant chemotherapy, but metastases to retroperitoneal lymph nodes were noted two months after operation. He died of the disease eight months postoperatively.