Norio Takayashiki

Collagenous sprue diagnosed by double balloon endoscopy

Double balloon endoscopy (DBE) is useful for diagnosing many intestinal diseases and for endoscopic procedures. We report a case of chronic diarrhea in a 58‐year‐old Japanese man. He was initially suspected to have malabsorption syndrome. DBE showed reduction of folds, scalloping, mucosal nodularity and granularity. Pathological examinations of biopsies from the jejunum showed severe villous atrophy with subepithelial collagen bands. These findings led to the final diagnosis of collagenous sprue (CS). With1 month of total parenteral nutrition followed by a low‐gluten diet, his symptoms gradually improved. CS has never been reported before in Japan. DBE is useful for making a diagnosis of CS, and may be considered for patients who are suffering from diarrhea of unknown cause.

Spontaneous regression of FDG/PET positive lung adenocarcinoma in an elderly man

Spontaneous cancer regression, either partial or complete, is a rare phenomenon, particularly in patients with lung cancer. The present paper is the case report of an elderly lung cancer patient aged 80 who exhibited spontaneous regression of the primary lesion, without receiving any treatment. Spontaneous regression commenced two years after obtaining pathological specimens by transbronchial biopsy from the pulmonary lesion. It is interesting that the tumor lesion had a strong uptake (standardized uptake value max: 26.3) in ¹⁸fluorodeoxyglucose positron-emission tomography before biopsy and that the regression occurred after a long interval after the biopsy, and that the regression developed in an elderly man. It is unknown why spontaneous regression was observed in this case and what kind of mechanism was involved in the phenomenon. Even in the elderly, as observed in our case, spontaneous regression can occur. The patient should be closely followed up to monitor the clinical course of such an unusual phenomenon.

Nodular Metastatic Lung Tumor from Thyroid Carcinoma

Pulmonary metastases from thyroid cancer usually present with a micronodular or miliary pattern throughout both lungs; pulmonary metastasis with nodules measuring 10 mm in diameter is very rare. We herein present a 74-year-old woman with a history of papillary thyroid cancer treated surgically 17 years previously who presented with pulmonary metastatic nodules measuring 15 mm in diameter on chest radiography. If a pulmonary nodule or nodules are encountered in a patient with a history of thyroid cancer, though very rare, the possibility that it is a metastasis must be borne in mind.

Mediastinal Mass in a Patient with IgG4-Related Disease

Introduction: IgG4-related disease is now considered to result from an imbalance in the regulatory immune system, and it is diagnosed on the basis of clinical and histopathologic evidence such as the presence of lymphoplasmacytic infiltrates, especially increased IgG4-positive plasma cells and fibrotic sclerosing tissue. Case report: We report herein a 45-year-old male patient with mediastinal mass with IgG4-related disease. IgG4-related disease can involve any organ but the most frequently involved sites include pancreato-hepatobiliary tract, salivary glands, and kidneys, generally manifesting as a mass in one or more sites mimicking a neoplasia. In the thoracic region, IgG4-related disease manifests as interstitial lung disease and fibrosing mediastinitis. Mediastinal lesion in our patient was quite resemble to mediastinal tumor derived from anterior mediastinum. This is the first case with mediastinal mass in a patient with this disease. Conclusion: Although very rare, we should rule out this disease as differential diagnosis in patients with anterior homogeneous density mediastinal mass simulating mediastinal tumor.

Ossification and increased bone mineral density with zoledronic acid in a patient with lung adenocarcinoma: A case report

Cases of ossification and increased bone mineral density (BMD) at sites of bone metastasis following zoledronic acid (ZA) treatment have not been reported. The current study presents the case of a 65-year-old patient with lung adenocarcinoma and bone metastases in the lumbar vertebrae and femurs. Ossification and an increase in BMD at the metastatic sites was achieved following treatment with ZA and irradiation of the bone metastatic sites. The patient was able to maintain a normal lifestyle for over two years, despite the bone metastases. Therefore, as treatment with ZA was demonstrated to improve patient quality of life, physicians should consider this treatment strategy, particularly for the treatment of metastasis in weight-bearing bones.

Cerebellar metastasis with the cavity of both components of lung adenosquamous cell carcinoma

66 The 2 components of the surgically resected tu‐ mor were precisely separated by manual microdis‐ section under microscope to avoid contamination of each sample by different components. An epi‐ dermal growth factor receptor (EGFR) exon 19 de‐ letion, but not the T790M mutation, was identified in both components. Thereafter, the patient devel‐ oped several small cavitary metastases (<10 mm in size) in both lungs (FIGURE 1B). She was admin‐ istered EGFR ‐tyrosine kinase inhibitors and cy‐ totoxic chemotherapies (gefitinib for 23 months; 4 cycles of carboplatin, pemetrexed, and bevaci‐ zumab; 15 cycles of pemetrexed and bevacizumab for 15 months; afatinib for 13 months; and 17 cy‐ cles of docetaxel and bevacizumab for 15 months), A 72 ‐year ‐old woman with no history of smok‐ ing presented to our hospital with dizziness for the past 3 weeks. Nine years earlier, she had he‐ moptysis, and a large tumor in the left lung was revealed by chest computed tomography (FIGURE 1A). The patient underwent a lobectomy of the left lower lung and mediastinal lymph node dissection. The resected tumor consisted of the components of adenocarcinoma as well as squamous cell carcinoma, each comprising more than 10% of the tumor. The final pathological di‐ agnosis was lung adenosquamous cell carcino‐ ma, and the tumor was staged as pT3bN1M1a according to the TNM classification. CLINICAL IMAGE

A case of microscopic, multiple sclerosing pneumocytoma: Multiple sclerosing pneumocytoma

Sclerosing pneumocytoma is a rare tumor of the lung, commonly affecting middle‐aged women, and is mostly isolated. Although this tumor is thought to be derived from primitive respiratory epithelial cells, the characteristics of the precursor cells are still unknown. A 19‐year‐old woman presented with multiple nodules in the right lung. Partial resection of the right middle lobe was performed, and seven sclerosing pneumocytomas, including four that were microscopic, were detected. The latter showed a simple papillary pattern, and three of them consisted of only round cell‐like cells (single population). Interestingly, these round cell‐like cells were positive for both p63 and TTF‐1, but totally negative for SP‐A. On the other hand, the tumor cells of the other four sclerosing pneumocytomas showing a papillary pattern with a dual population, were diffusely positive for TTF‐1 and focally positive for SP‐A (only in surface cells), but negative or very focally positive for p63. It has been reported that p63‐positive stem cell‐like cells are present in the distal airway and have potential to differentiate into type II pneumocytes. The immunohistochemical features of these multiple microscopic lesions suggest that the p63‐TTF‐1 double‐positive cells are candidate precursor cells of sclerosing pneumocytoma.

Chronic expanding hematoma in the chest: A case report

Chronic expanding hematoma (CEH) is a rare disease that is usually present as a large solitary pulmonary nodule. CEHs are slow growing, but processes underlying their development remain unknown. The present study herein reports the case of a 76-year-old male patient with CEH and discusses a number of CEH cases published in the literature. The majority of these previously described patients were Asians. The CEH in the present case was not a successfully resected one, but the patients clinical course provided information concerning the natural history of the disease. During the clinical course, the patient underwent several chest computed tomography scans. For the present case report, the doubling time and volume change of the mass was calculated, which revealed that the lesion had an inconstant growth rate and that its onset was between 8.2-11.0 years before the patient succumbed to this disease. Accumulation of knowledge about this rare disease will help to elucidate it further.

Lipoma adjacent to scapula in an elderly

An 81-year-old man complained a soft mass in right back, which was noticed a week ago. He had been diagnosed as having chronic obstructive pulmonary disease seven years previously and treated with longacting muscarinic antagonistat our hospital. On physical examination, an egg-sized soft mass was palpable in right back. It seemed to be fixed to the underlying structure or overlying skin. A chest CT scan showed a 5 x 5 cm homogenous low density mass, which had the same density as fat, adjacent to right scapula (Figure 1). The lesion was completely removed surgically and it was diagnosed as lipoma pathologically. Retrospectively, not only low attenuation area in both lungs but also the tumor was observed in a chest CT scan taken 6 years previously (Figure 2).

Duodenal and pancreas metastasis from lung cancer

A 56-year-old man was referred to our hospital due to an ill-defined mass, which was diagnosed as having lung adenocarcinoma pathologically, in the left lower lobe of the lung with ipsilateral mediastinal lymph nodes (Figure 1). The patient was treated with platinum-based chemotherapy for 5 months. The patient was readmitted with the two weeks history of epigastric pain. He also complained of anorexia, lethargy, and weight loss of 4 kilograms over past four months. Epigastric pain was not dull in nature, aggravated by food in take, and it had increased in intensity over two weeks, for which he was taking oxycodone/acetaminophen, but minimal pain relief. The patient had 10-year history of systemic lupus erythematosus, which has been treated with prednisolone. He was ex-smoker with one pack a day for 20 years. On physical examination, he was found in fair general condition, but his vitals were stable. On abdominal examination, there was mild epigastric tenderness without any rigidity, guarding, orrebound tenderness. The rest of systemic examination was unremarkable. Complete blood count (CBC) showed hemoglobin 12.0 gm/dL, white blood cells (WBC) 8200/microL; and platelets 336.000/microL. Liver and renal function tests were within normal limits. Fecal occult blood (FOB) test was found negative. Upper gastrointestinal endoscopy revealed a tumorous lesion at the opposite site of papilla of Vater (Figure 2). Pathological specimen from the duodenal lesion showed adenocarcinoma and immuno histochemical staining for thyroid transcription factor-1 positive cells (Figure 3A: Hematoxylin-Eosin staining, Figure 3B: thyroid transcription factor-1: TTF-1). These findings strongly supported the diagnosis of metastatic adenocarcinoma of the lung origin. Computed tomography (CT) of abdomen showed ill-defined mass measuring 3.2×3.0 cm in Duodenal and pancreas metastasis from lung cancer doi • 10.5578/tt.24112 Tuberk Toraks 2017;65(2):165-168 Geliş Tarihi/Received: 08.03.2016 • Kabul Ediliş Tarihi/Accepted: 19.06.2016