Takashi Misaki

A unique subtype of diffuse large B-cell lymphoma primarily involving the bone marrow, spleen, and liver, defined by fluorodeoxyglucose-positron emission tomography combined with computed tomography

Abstract We describe 10 cases of diffuse large B-cell lymphoma (DLBCL) confined to the bone marrow (BM), spleen, and liver, as evidenced by the uniformly increased uptake of fluorodeoxyglucose (FDG) on positron emission tomography combined with computed tomography (PET/CT). Ages ranged from 56 to 87. All, but one patient presented with ‘B’ symptoms, a poor performance status, and hepatosplenomegaly. All patients showed cytopenia and elevated lactate dehydrogenase levels and were classified into the high-risk category of the International Prognostic Index scoring. BM infiltration was diffuse, interstitial/intrasinusoidal, or mixed, and all showed the nongerminal center B immunophenotype. Five patients had a rearrangement involving 3q27/BCL6, while six had increased copies of MYC, BCL2, or BCL6. All patients were initially treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone, leading to complete responses in six out of eight evaluable patients. We propose BM, spleen, and liver-type DLBCL, which is defined by the findings of FDG-PET/CT.

Chylopericardium Caused by Non-small Cell Lung Cancer: A Rare Complication of Superior Vena Cava Syndrome

CASE REPORT A previously healthy, 77-year-old Japanese man was presented with a 2-week history of worsening dyspnea. At presentation, he was in respiratory distress and orthopneic. Blood pressure was 154/80 mmHg without paradoxical pulses, respiratory rate was 16 per minute, and the oxygen saturation was 97% with supplemental oxygen (3 L) by nasal cannula. The face and upper extremities were edematous. Computed tomography of the chest and echocardiography showed moderate amounts of pericardial effusion but no signs of tamponade (Figure 1A). Chylous effusion of 500 mL was drained by pericardiocentesis, and dyspnea was relieved. Analysis of the pericardial effusion revealed total protein at 5.2 g/dL, total cholesterol 212 mg/dL, and triglyceride 806 mg/dL. There were no malignant cells and no bacterial or mycobacterial growth. The pericardial draining tube was removed without chemical pericardiodesis. Primary adenocarcinoma of the lung and SVC syndrome were diagnosed (Figure 1B). The TMN classification was cT3N3M0 Stage3B. Pedal lymphatic scintigraphy using Tc-human serum albumin revealed tracer accumulation in the mediastinal lymph nodes but not in the pericardial cavity (Figure 2). The patient selected best supportive care at diagnosis. During the 4 weeks after the drainage, his dyspnea recurred. Chest radiograph showed cardiomegaly and bilateral pleural effusion (Figure 3A). Echocardiography revealed the reaccumulation of pericardial effusion but not so much as to require drainage again. Dexamethasone was started at 2 mg/d because of appetite loss and malaise. After 2 weeks of corticosteroid therapy, dyspnea and facial edema improved. Cardiomegaly decreased and bilateral pleural effusion was resolved (Figure 3B). Echocardiography demonstrated a decrease in pericardial effusion. The patient continued dexamethasone without a marked increase in pericardial effusion for 8

Current abstracts of the articles published in The Japanese Journal of Nuclear Medicine

Sympathetic nerve system is activated as a compensatory mechanism in heart failure. However, excessive activation of sympathetic nerve system deteriorates disease state. Sympathetic nerve system can be suppressed with N-type Ca 2+ channel blocker. An antihypertensive drug, cilnidipine, is a dual L/N-type Ca 2+ channel blocker. We studies usefulness of cilnidipine in treating with chronic heart failure with 123I-MIBG myocardial scintigraphy. We enrolled 24 patients with stable chronic heart failure. Twelve patients were treated with ACE-inhibitors, diuretics and cardiotonics (control group), and the other 12 patients were treated with ACE-inhibitors, diuretics, cardiotonics and cilnidipine (cilnidipine group). We examined blood pressure, heart rate, norepinephrine level, brain natriuretic peptide (BNP) level, cardiothoracic ratio on chest X-ray, ejection fraction of left ventricle on two-dimensional echocardiography, count rate of heart to mediastinum (H/M) and washout rate (WOR) on 123I-MIBG myocardial scintigraphy before and six months after medication. Symptom was improved in 8 patients in the control group and 10 patients in the cilnidipine group after medication. And another parameters were also improved in the both groups after medication. However the degree of change in blood pressure (mmHg) was 21.2 _+ 8.0 in the cilnidipine group and 10.8 _+ 9.1 in the control group, that in heart rate (/min) was 24.1 +_ 6.8 and 16.2 _ 11.0, that in BNP level (pg/m/) was 65.2 _ 12.0 and 42.8 _ 11.1, that in H/M was 0.30 _ 0.08 and 0.19 _+ 0.09, that in WOR was 19.4 _ 5.6 and 12.2 _ 7.0, respectively. And the degree of these changes were larger in the cilnidipine group (p < 0.05). These findings suggested that cilnidipine, a dual L/N-type Ca 2+ channel blocker, might be useful in treating with chronic heart failure.