Yoichi Watahiki

Inflammatory pseudotumour-like follicular dendritic cell tumour of the spleen

We describe an unusual case of a 73-year-old woman presenting with a solitary splenic mass 8 cm in diameter and an elevation of serum soluble interleukin-2 receptor level. The preoperative diagnosis was primary malignant lymphoma of the spleen. Splenectomy was conducted. Histological analysis confirmed an inflammatory pseudotumour-like follicular dendritic cell tumour that showed different clinicopathological features from those of the classic follicular dendritic cell tumour. Only 33 cases of inflammatory pseudotumour-like follicular dendritic cell tumour have so far been reported. We discuss the incidence, presentation and management of this rare disease.

Primary non-Hodgkin's lymphoma in the dorsolumbar muscles

Abstract We report a case of primary soft tissue lymphoma with pulmonary involvement in a 57-year-old man, successfully treated with surgery and chemotherapy. The patient presented with a giant mass (16 × 20 cm) in the left dorsolumbar region. Computed tomography (CT) demonstrated a right-sided pulmonary tumor, in addition to the giant tumor in the left dorsolumbar muscles. On an incisonal biopsy, the left dorsolumbar muscle tumor was suspected to be a sarcoma, and en-bloc resection was therefore performed. During surgery, four left pulmonary tumors that had not been observed on CT were found and surgically resected. The patient was finally diagnosed with soft tissue non-Hodgkins B cell lymphoma with pulmonary involvement. After postoperative chemotherapy, the right pulmonary nodule disappeared. The patient was well and had no evidence of disease 22 months after surgery. To the best of our knowledge, primary soft tissue lymphoma is extremely rare.

Fatal fulminant herpes simplex hepatitis following surgery in an adult

We present a case of a healthy 72-year-old man with herpes simplex hepatitis (HSVH) development soon after ordinary surgery for biliary stones. A sudden onset of hepatitis associated with high fever and leukopenia emerged on postoperative day 5, followed by a rapid and lethal course (died on day 9), despite an acyclovir therapy on day 8. Postmortem liver biopsy revealed positive immunostaining for herpes simplex virus (HSV) type-1. The serum tests (available after the death) were negative for anti-HSV immunogloblulins, but positive for HSV DNA. A review of 15 cases of postsurgical HSVH along with 42 cases of non-surgical HSH showed that (1): A wide spectrum of surgical procedures was involved; and (2): High mortality (87%) associated with lower rates of ante-mortem diagnosis (20%) and acyclovir treatment (20%). Due to the difficulty in diagnosis and lethal nature, an early clinical suspension and prompt empirical anti-viral intervention are imperative for postsurgical hepatitis with undetermined etiology, characterized by fever and leucopenia.

A Case of Colonic Perforation Complicated with Acute Pancreatitis.

急性膵炎における合併症として大腸穿孔をともなうことはまれである. われわれは急性膵炎が原因と考えられた横行結腸穿孔例を経験し手術によりこれを救命しえたので報告する. 症例は48歳の男性で, 発熱と全身倦怠感を認め検査のため入院となった. 腹部超音波検査, CT検査にて後腹膜膿瘍を疑い, 注腸造影検査を施行したところ横行結腸において腸管外への造影剤の漏出が認められたため, 後腹膜膿瘍および大腸穿孔と診断し緊急手術を行った. 開腹すると後腹膜は膨隆し切開にて多量の膿の排出を認め, 横行結腸に穿孔を認めた. 術式は横行結腸, 下行結腸切除と人工肛門造設ならびに後腹膜ドレナージを行った. 切除した大腸の穿孔部位の炎症所見は漿膜側において顕著で組織学的にpericolitisおよびmarginal arteryの血栓を認め, 急性膵炎による虚血性変化が大腸穿孔の原因と考えられた.