Primary T-cell lymphoma associated with tubulovillous adenoma of the rectum: report of a case.

We report what to our knowledge is the first documented case of "peripheral T-cell lymphoma-not otherwise specified" (PTCL-NOS) associated with a rectal adenoma. Colorectal lymphomas are relatively uncommon, but colorectal T-cell lymphomas are extremely rare. The patient was a 92-year-old woman, referred to our hospital for investigation of anal bleeding. Rectal examination revealed a 3-cm pedunculated polypoid mass 5 cm above the anal verge. We performed a transanal local excision, and histopathological examination revealed a tubulovillous adenoma, with the diffuse proliferation of large lymphoid cells mainly discernible in the mucus membrane lamina propria, with infiltration to the submucosal layer. Immunohistochemical examination of the lymphoid cells revealed positive staining for CD3, weak staining for CD4 and CD8, and negative staining for CD5, CD10, CD20, CD56, CD79a, TIA-1, and Granzyme B. The tumor was diagnosed as PTCL-NOS associated with rectal tubulovillous adenoma. The patient died 28 days after surgery, most probably of progression of the PTCL-NOS.

Positron emission tomography with 18F-fluoro-2-deoxyglucose for the detection of recurrent ovarian cancer.

BACKGROUND: Recurrent ovarian cancer is refractory and resistant to treatment in most patients, and no effective treatment for it has been established. Starting a treatment when tumors still consist of micro foci may contribute to improvement of prognosis. Therefore, the early diagnosis of relapse is important. METHODS: Among patients with epithelial ovarian cancer in whom initial treatment achieved remission between April 1998 and December 2003, those patients in whom the cancer-related antigen (CA)125 level was increased during the subsequent follow-up period, or those who showed abnormal computed tomography (CT)/magnetic resonance imaging (MRI) findings despite normal CA125 levels, were examined by 18F-fluoro-2-deoxyglucose - positron emission tomography (FDG-PET). We compared the rates of accurate diagnosis of recurrence achieved using CT/MRI, CA125, and FDG-PET in patients with a definitive diagnosis of relapse. RESULTS: We investigated 29 patients with epithelial ovarian cancer. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of FDG-PET were 84.6% (22/26), 100% (3/3), 100% (22/22), 42.9% (3/7), and 86.2% (25/29), respectively. These values were higher than the corresponding values obtained using CT/MRI or CA125 levels. CONCLUSION: FDG-PET may be very useful for identifying sites of recurrent ovarian cancer, although this procedure had a low NPV because of the high rate of false-negative findings for micro or cystic lesions.

Diverticulitis causing a high serum level of carbohydrate antigen 19-9: report of a case.

We report herein a rare case of diverticulitis causing a high serum level of carbohydrate antigen (CA) 19-9. A 52-year-old man was admitted to our hospital with lower abdominal pain. Laboratory data showed evidence of inflammation and a high serum level of CA 19-9 (370 U/ml). Computed tomography demonstrated thickening of the wall of the sigmoid colon. He was diagnosed as having diverticulitis of the sigmoid colon and was treated with antibiotics. Although his symptoms improved, the presence of a malignancy such as colorectal cancer could not be completely ruled out because of the persistently high serum level of CA 19-9. A laparotomy was performed and the sigmoid colon was found to be adherent to the bladder. Under a diagnosis of diverticulitis, a sigmoidectomy was performed. Pathological examination revealed diverticulitis of the sigmoid colon, but there was no evidence of malignancy in the resected specimen. The serum CA 19-9 level decreased to normal postoperatively and immunohistochemical staining revealed CA 19-9 antigen in the cytoplasm of the diverticular epithelium. Therefore, a possible explanation for the high level of this tumor marker was diverticulitis of the sigmoid colon.