[Human herpesvirus 8-unrelated primary effusion lymphoma-like lymphoma that developed during myelodysplastic syndrome].

Primary effusion lymphoma (PEL) is a large B-cell lymphoma that only proliferates proliferating effusion in the body cavity. It is associated with human herpesvirus 8 (HHV8).HHV8 negative effusion lymphoma, which is different from PEL in many ways, has also been reported and is referred to as HHV8-unrelated PEL-like lymphoma. This lymphoma is very rare and its clinical characteristics have not been fully clarified.A 79-year-old male developed HHV8-negative primary effusion lymphoma during treatment for myelodysplastic syndrome.Abdominal computed tomography revealed abdominal effusion, but did not show any evidence of a tumor mass or lymph node enlargement. A cytological analysis of his pleural effusion revealed atypical lymphoid cells that were negative for CD10, and positive for CD19 and CD20. Corticosteroids were administered to treat the abdominal effusion; however, the patient died of an exacerbation of lymphoma on the 20th day after the initiation of corticosteroid therapy. We herein report the case of an HIV seronegative elderly patient with HHV8-unrelated PEL-like lymphoma.

[A methotrexate-associated lympholiferative disorder patient with gastrointestinal perforation].

A 70-year-old woman was diagnosed with chronic rheumatoid arthritis and treated with methotrexate and prednisolone. She visited our hospital to determine the cause of her continuous fatigue and fever for the past three weeks. She consumed no food orally and was provided antibiotics because free air was found on computed tomography (CT). Intraperitoneal small lymphadenopathy and swelling of both adrenal glands was also found on CT, and MTX-associated lymphoproliferative disorder (MTX-LPD) was suspected. Am adrenal gland biopsy showed diffuse large B-cell lymphoma (DLBCL) associated with MTX-LPD. The causes of gastrointestinal perforation with collagen diseases have been reported to be functional gastrointestinal disorders with collagen diseases like amyloidosis, gastrointestinal infections in immunocompromised patients, and side effects of medication, such as steroids or NSAIDs and MTX. MTX-LPD is an uncommon side effect of methotrexate. To ensure its appropriate diagnosis and treatment, it is important to improve the degree of recognition of MTX-LPD, and a prompt response is needed.

Totally implantable central venous device-associated blood stream infection in elderly malignant disease patients.

AIM: We investigated the rate of bloodstream infections in elderly malignant disease patients whose totally implantable central venous device (CV ports) had been removed for any reason at our hospital. METHODS: We evaluated 22 elderly malignant disease patients who had had their CV ports removed for any reason between May 2014 to April 2015. RESULTS: The patients were 12 males and 10 females between 62 and 86 years of age with a median age of 75.5 years. The catheter tip cultures were positive in 6 out of 22 cases (27.3%). Gram-positive cocci were detected in 5 cases, and gram-positive bacilli were detected in 1 case. Five of these 6 cases (83%) found to have positive catheter tip cultures were cultured at the time of death. In addition, 5 of the 13 catheters removed at the time of death resulted in positive culture results (38%). The positive culture ratio correlated well with the ratio of death and the age in cases of hematopoietic tumors. CONCLUSION: In cancer patients, the CV port is frequently used for the delivery of anti-cancer medicines. However, CV port infections are underestimated and typically not recognized in a timely manner. Patients suspected of having a CV port infection should be closely observed and the catheter removed immediately. However, it is very difficult to decide to discontinue a CV port, since its removal may render patients more susceptible to blood stream infections due to their poor general health and old age. CV port use should be considered in such cases to prevent future blood stream infections.