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Matsuo M.,Japan Community Health Care Organization Kyushu Hospital | Tuneyoshi M.,Kyushu University | Mine M.,The Mutual
Diagnostic Pathology | Year: 2016

Background: Primary mucinous carcinoma of the thyroid gland is a rare disease; only 6 cases of primary mucinous carcinoma of the thyroid have been previously reported. Primary mucinous carcinoma of the thyroid gland with incomplete tumor resection tends to be associated with a poor prognosis, resulting in death within a few months. An early and appropriate diagnosis may contribute to improvement in patient prognosis; however, it is extremely difficult to diagnose primary mucinous carcinoma of the thyroid. We present the seventh reported case of primary mucinous carcinoma in the thyroid gland; moreover, rhabdoid cells were detected, which, to our knowledge, is a novel finding. Case presentation: An 81-year-old Japanese woman was initially diagnosed with a poorly differentiated thyroid carcinoma, and she underwent a hemithyroidectomy. Pathological examination revealed the presence of abundant mucus and agglomeration of large atypical cells. Rhabdoid cells were also seen scattered among the tumor cells. Immunostaining was performed for various markers, and on the basis of these results, we diagnosed the lesion as primary mucinous carcinoma with rhabdoid cells in the thyroid gland. Ten months after surgery, recurrence was noted in the paratracheal lymph nodes; therefore, total resection of the residual thyroid gland and paratracheal lymphadenectomy with thyroid-stimulating hormone suppression were performed. The patient is currently alive and disease-free. Conclusions: The current case is of interest not only because of the rare histological findings, but also because the patient achieved long-term survival following diagnosis of a mucinous carcinoma. We believe this report will be helpful for diagnosing future cases of mucinous carcinoma of the thyroid. © 2016 The Author(s).

Fujisawa K.,Japan Community Health Care Organization Kyushu Hospital
Journal of Japanese Society of Gastroenterology | Year: 2015

A woman in her 80s was admitted to our hospital on account of jaundice, abnormal liver function tests, and leukocytosis. She was diagnosed with adult T-cell leukemia on the basis of the presence of anti-human T-cell leukemia virus type I (HTLV-I) and the results of flow cytometric analysis of peripheral blood. She also showed lung consolidation and cavitation, and a sputum smear and culture revealed cryptococcal infection. Therefore, she was diagnosed with pulmonary cryptococcosis. However, the cause of the abnormal liver function tests and jaundice remained unclear, and the patient subsequently died. On autopsy, multiple granulomas were observed throughout the liver, consistent with cryptococcal bodies. Herein we report this rare case of hepatic cryptococcosis with predominant hepatobiliary complaints.

Noshiro H.,Saga University | Kai K.,Saga University | Yoda Y.,Saga University | Kono H.,Saga University | Uchiyama A.,Japan Community Health Care Organization Kyushu Hospital
Esophagus | Year: 2016

Background: Ultrasonic activated devices (USADs) may produce inadvertent injuries due to heat or shock waves. However, thermal injury and shock waves are considered to be avoidable if these devices are used appropriately. Methods: Utilizing a porcine model, we examined the relationship between the occurrence of tissue damage around the iliac artery and sciatic nerve and the usage of an USAD. Thereafter, we prospectively determined the clinical outcomes following the usage of the USAD during dissection along the recurrent laryngeal nerves (RLN) in 114 consecutive patients who underwent thoracoscopic esophageal surgery. Results: The temperatures measured in the pig iliac artery and sciatic nerve more than 2 mm from the activating blade (at a power setting of 70 %, within 2 s) did not increase to 42 °C. In a subsequent clinical series using the short activating technique according to the findings of in vivo experiments, scheduled laryngoscopic studies showed the rate of vocal cord palsy after esophagectomy to be 39 %, which was more sensitive than the substantial presence of hoarseness (28 %). Conclusions: Adverse effects by using the USAD on the nerves may be avoidable if the activation of the current using an USAD is conducted within 2 s at positions more than 2 mm from the nerves. This short activation technique using the USAD is therefore considered to be safe and feasible for lymph node dissection along the RLNs during thoracoscopic esophagectomy, although the apparent reasons for postoperative dysfunction in the vocal cords remain unclear. © 2016 The Japan Esophageal Society and Springer Japan

Hiyamuta H.,Kyushu University | Yamada S.,Kyushu University | Matsukuma Y.,Kyushu University | Tsuchimoto A.,Kyushu University | And 8 more authors.
Internal Medicine | Year: 2016

A 70-year-old woman was admitted to our hospital because of fatigue and renal dysfunction and was diagnosed with light chain deposition disease (LCDD) with multiple organ involvement (kidney, thyroid gland, heart and eyes). After chemotherapy with bortezomib, cyclophosphamide and dexamethasone, hepatobiliary enzyme levels increased abruptly. A liver biopsy showed light chain deposition in Disse spaces. After two years of treatment with bortezomib, melphalan and prednisone (VMP) administered at shorter intervals relative to regular cycles, the patient showed a hematological and organ response. This case indicates that a relatively low dose intensity VMP regimen is preferable for elderly patients with LCDD with multiple organ involvement. © 2016 The Japanese Society of Internal Medicine.

Yoshimoto G.,Kyushu University | Ogawa R.,Japan Community Health Care Organization Kyushu Hospital | Aoki K.,Japan Community Health Care Organization Kyushu Hospital | Higuchi M.,JR Kyushu Hospital | And 8 more authors.
Annals of Hematology | Year: 2015

The introduction of reduced-intensity conditioning (RIC) regimens has made possible allogeneic hematopoietic cell transplantation (allo-HCT) in older patients with acute myeloid leukemia (AML). However, the optimal timing of allo-HCT in these patients and its relative risks and benefits when compared with chemotherapies have not been determined. This retrospective study by the Fukuoka Blood and Marrow Transplant Group compared RIC allo-HSCT with non-transplant therapies, the choice based on donor availability, in AML patients in their first complete remission (CR1). The prognostic value of various patient characteristics and disease-specific variables were investigated in 299 patients aged ≥60 years with AML in CR1. Among the 107 patients aged 60–65 years, 54 of whom received allo-HCT and 53 of whom continued chemotherapies; allo-HCT, adverse-risk group, and hematopoietic cell transplantation-comorbidity index were significant predictors of survival outcomes. Among 192 patients aged ≥66 years deemed ineligible for allo-HCT, relapse and Karnofsky performance status after induction therapy were significant predictors of survival outcomes. Findings from this study may facilitate a new standard of care for older AML patients in CR1 who are considered candidates for allo-HCT. © 2015, Springer-Verlag Berlin Heidelberg.

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