We herein present our experience with a case involving a 17-year-old Japanese boy suffering from acute myocarditis after his second coronavirus disease-2019 (COVID-19) messenger RNA (mRNA) vaccine shot. The patients had a history of myocarditis associated with Campylobacter jejuni 3 years prior. This has been the first-ever documented case of myocarditis associated with COVID-19 mRNA vaccination in a patient with a history of myocarditis. We present a series of images and blood biomarkers for different types of myocarditis that developed in this single patient.

Localization of ectopic cyclic Cushing's syndrome, which causes life-threatening complications, is challenging. A 70-year-old woman showed cyclic hypokalemia and hyperglycemia and was diagnosed with cyclic ectopic Cushing's syndrome. Although somatostatin-receptor scintigraphy failed to localize the responsible tumor, fluorodeoxyglucose-positron emission tomography (FDG-PET) showed the uptake of tracer in a lung tumor. Lobectomy resulted in remission. The resected adrenocorticotropic hormone (ACTH)-producing neuroendocrine tumor had Ki-67<2% and negative staining for somatostatin receptors. This is the first case assessed both radiological findings and pathological findings in cyclic ectopic Cushing's syndrome. Subsequent FDG-PET is recommended if somatostatin-receptor scintigraphy is negative.

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Background Primary angiosarcoma of the breast is very rare, accounting for 0.05% of all malignant breast tumors. It has very high malignant potential and poor prognosis, though due to the rarity of the disease, there is no established treatment. We report this case along with a literature review. Case presentation We report the case of a 30-year-old Asian woman who was diagnosed with bilateral primary angiosarcoma of the breast while breastfeeding. After surgery, she underwent radiation therapy, chemotherapy, and hepatic arterial infusion chemotherapy for local recurrence of liver metastases, but these were ineffective, and she required several arterial embolization procedures for intratumoral bleeding and rupture of liver metastases. Conclusions Angiosarcoma has a poor prognosis due to a high rate of local recurrence and distant metastasis. Although there is no established evidence for radiotherapy or chemotherapy, multimodality treatment may be necessary because of the high malignancy and rapid progression of the disease.

Background: Preoperative differential diagnosis between atypical lipomatous tumor (ALT)/well-differentiated liposarcoma (WDLS) and lipoma is important to determine the appropriate resection margin. However, since their radiological and histopathological findings are similar, it may be difficult to make a differential diagnosis. In this study, we evaluated the diagnostic accuracies of clinical, radiological, and histopathological examinations for diagnosing ALT/WDLS and developed a new combined scoring system.Methods: Eighty-nine ALT/WDLS and 56 lipomas were included and their clinical characteristics, magnetic resonance imaging (MRI) findings, histological findings by hematoxylin and eosin (HE) staining were investigated, and compared between ALT/WDLS and lipoma. Then, univariate analyses and multivariate logistic regression analyses were performed for the findings, and a combined scoring system consisted of predictive factors of ALT/WDLS was developed. Results: The univariate and multivariate logistic regression analyses revealed that tumor location (lower extremity), deep site, and size (>11cm), thick septa (>2mm), enhancement of septa or nodular lesions on MRI, and lipoblasts in HE staining were significantly different for the diagnosis of ALT/WDLS. Based on the six predictive factors, we developed a combined scoring system (total 0–16 points, the cutoff was 9 points). The mean score of ALT/WDLS was significantly higher than lipoma (11.9 vs. 5.6, p<0.0001). The area under the curve was 0.945, and sensitivity was 87.6% and specificity was 91.1% by the receiver operating characteristics curve.Conclusions: We developed a new combined scoring system based on comprehensive examinations that excluded examination which requires special equipment and reagents such as fluorescence in situ hybridization (FISH), and this can be used in many medical institutions. The diagnostic accuracy of ALT/WDLS was high and it may be useful for preoperative diagnosis and surgical plan.