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Matsunaga T.,Nagasaki Medical Center | Izumi Y.,Nagasaki Medical Center | Iwanaga N.,Nagasaki Medical Center | Kawahara C.,Nagasaki Medical Center | And 5 more authors.
Tohoku Journal of Experimental Medicine

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome is characterized by symmetrical synovitis predominantly involving the wrists, and is associated with marked pitting edema of the dorsum of the hands. Although the etiology of RS3PE syndrome is still unknown, several putative associations with malignancies and hematological disorders have been reported. Myelodysplastic syndrome (MDS) is characterized by infective hematopoiesis with possible transformation to leukemia; however, an association between RS3PE syndrome and MDS has been rarely reported. Here, we describe a 67-year-old man with MDS with refractory anemia who developed RS3PE syndrome 3 months after the diagnosis of MDS. The patient presented with polyarthritis with pitting edema at the dorsum of the hands, the elevated serum levels of C-reactive protein and a proinflammatory cytokine, interleukin-6, and the elevated plasma levels of vascular endothelial growth factor (VEGF). VEGF has been shown to be involved in the pathogenesis of RS3PE syndrome. Treatment with low doses of corticosteroids resulted in the regression of polyarthritis and pitting edema of the dorsum of the hands, as well as a reduction in the elevated levels of plasma VEGF. Partial resolution of refractory anemia was also observed with steroid therapy. In summary, RS3PE syndrome developed shortly after MDS was identified in this patient. The sequence of clinical events suggests that MDS-mediated immunological abnormalities including inflammatory cytokine induction may be responsible for the association between MDS and RS3PE syndrome. Patients with RS3PE syndrome should be screened for hematological disorders that promote proinflammatory mediators. © 2015 Tohoku University Medical Press. Source

Migita K.,Clinical Research Center | Miyashita T.,Clinical Research Center | Mizuno A.,Clinical Research Center | Jiuchi Y.,Clinical Research Center | And 6 more authors.
Modern Rheumatology

We describe herein a patient who presented with immunoglobulin G4-related disease (IgG4-RD) involving the testis and prostate as well as the submandibular glands. Massive infiltration of IgG4-expressing plasma cells was observed in testis and prostate tissues. Serum concentrations of B cell activating factor belonging to the tumor necrosis factor family (BAFF) were elevated in parallel with serum IgG4 concentrations, and infiltration of BAFF-receptor (BAFF-R)-expressing B cells and BAFF-expressing lymphoid cells was observed around the ectopic lymphoid foci in the affected urogenital tissues. To date, testicular involvement in a patient diagnosed with IgG4-RD had not been reported, making this the first reported case of IgG4-related epididymo-orchitis. These findings suggest that the immune mechanism underlying ectopic lymphoneogenesis in IgG4-RD may involve enhanced BAFF/BAFF-R interactions among lymphoid cells. © 2013 Japan College of Rheumatology. Source

Hakariya T.,Nagasaki University | Obata S.,Nagasaki Prefecture Shimabara Hospital | Igawa T.,Nagasaki University | Sakai H.,Nagasaki University
Anticancer Research

Aim: We examined the feasibility of local intensity-modulated radiation therapy (IMRT) with pelvic irradiation using the simultaneous integrated boost (SIB) technique to treat patients with castration-resistant prostate cancer (CRPC) after several lines of hormonal therapy. Patients and Methods: Data from 10 consecutive patients with CRPC treated with SIB-IMRT between November 2001 and September 2009 were analyzed retrospectively. Results: A decline in prostate-specific antigen (PSA) level was observed in all cases after SIB-IMRT. Biochemical progression-free survival at 5 years was 70% with a median follow-up of 33.5 months after SIB-IMRT. All patients completed SIB-IMRT without delay due to acute toxicity. The PSA nadir after first-line hormonal therapy, the PSA before SIB-IMRT, the PSA doubling time before SIB-IMRT and the PSA nadir after SIB-IMRT were significant factors for biochemical progression after SIB-IMRT. Conclusion: SIB-IMRT for patients with CRPC is feasible and has a satisfactory effect in terms of disease control. © 2014, International Institute of Anticancer Research. All rights reserved. Source

Tajiri H.,Nagasaki Prefecture Shimabara Hospital
Nihon Hoshasen Gijutsu Gakkai zasshi

Almost all mammary lesions are detected by a mammography and an ultrasound. However, a small part of lesions cannot be shown by only a magnetic resonance imaging (MRI). MRI-guided vacuum-assisted breast biopsy is a very useful means for the pathological diagnosis of these lesions. We performed MRI-guided vacuum-assisted breast biopsy to 4 patients with the lesions seen only by MRI. Biopsies were safely and easily performed using biopsy software (syngo BreVis). These biopsied specimens resulted cancer in 1, adenoma in 1 and benign lesions in 2. With an increase of the opportunity of MRI for the mammary lesions, we expect these lesions become increasingly large. We believe that MRI-guided vacuum-assisted breast biopsy will be an important diagnostic modality. Source

Matsumoto M.,Nagasaki University | Abe K.,Nagasaki University | Baba H.,Nagasaki University | Kinoshita N.,Nagasaki University | And 4 more authors.
Clinical Neuropathology

Paragangliomas of the cauda equina are very rare. Preoperatively, they are usually diagnosed as schwannoma. We report 2 cases that exhibited unusual histopathologic structure as well as a typical Zellballen pattern with a highly vascular stroma. The unusual features included papillary, ribboning, and pseudorosette patterns, ganglion cell nests, and melanin pigment. Pathological diagnosis of paraganglioma may be especially difficult when such unusual histopathological features are seen. Correct histopathological diagnosis is important as paraganglioma has a better prognosis than other tumors included in the differential diagnosis for this location. © 2012 Dustri-Verlag Dr. K. Feistle. Source

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