Abstract. The current study presents the case of a 66-year-old male presenting with fever and chest pain. Chest enhanced computed tomography scanning revealed a mass shadow in the right upper lobe with chest wall invasion. 18-Fluorodeoxyglucose-positron emission tomography (FDG-PET) identified the localized uptake of the mass lesion in the right upper lobe, in addition to diffuse uptake by the bone marrow. The laboratory data on admission revealed marked leukocytosis and an elevated C-reactive protein level (CRP). Serum concentrations of granulocyte colony-stimulating factor (G-CSF) and interleukin 6 were increased. Based on a clinical diagnosis of non-small cell lung cancer (c-T3N0M0 stage IIB), the patient underwent right upper lobectomy with chest wall resection. The histological examination showed a pulmonary pleomorphic carcinoma. Immunohistochemical analysis of the resected tumor tissues revealed positive staining for G-CSF. The patient's high-grade fever, leukocytosis, and elevated CRP level rapidly subsided following the resection. This confirmed that the tumor was a G-CSF-producing pulmonary pleomorphic carcinoma. Five months after the resection, the diffuse FDG uptake in the bone marrow was absent, even with the presence of a small pulmonary metastasis and marginal serum G-CSF elevation. Diffuse FDG uptake in bone marrow induced by G-CSF producing pleomorphic carcinoma must be taken into consideration, in order for it not to be misinterpreted as diffuse bone marrow metastases or hematologic malignancy. IntroductionThere have been several previous studies reporting that various cytokines, including granulocyte colony-stimulating factor (G-CSF) and interleukin 6 (IL-6), are produced by lung carcinomas, particularly pleomorphic carcinomas previously diagnosed as large cell carcinomas (1-7). G-CSF production by cancer cells has been associated with the rapid progression of the disease and with the poor prognosis.Pleomorphic carcinoma of lung was first classified in 1999 by the World Health Organization as a subset of sarcomatoid carcinoma. This type of tumor is rare, accounting for 2-3% of all cancer cases in a previous surgical series, but for <1% in epidemiological studies (8). Pleomorphic carcinoma is a poorly-differentiated non-small cell lung carcinoma, which may consist of a squamous cell carcinoma, adenocarcinoma or undifferentiated non-small cell carcinoma that contains ≥10% spindle and/or giant cells or a carcinoma consisting only of spindle and giant cells. Pleomorphic carcinoma of the lung has been reported to have aggressive clinical course with a poor response to chemotherapy and radiotherapy (8). The prognosis is significantly poorer than that of most other subsets of non-small cell lung cancer, even in early-stage disease.G-CSF causes hyper metabolic uptake of bone marrow in positron emission tomography (PET) using F-18-fluorodeoxyglucose (FDG) (9,10). The current case encountered diffuse FDG uptake in the bone marrow by G-CSF-producing pleomorphic carcinoma prior to the tumor resection, and...
Aneurysms within renal angiomyolipomas (AML) may rupture into the tumor or pararenal space. Transcatheter arterial embolization is the first-choice treatment to control bleeding. Here, we describe the use of coil embolization in two cases of spontaneous intratumoral hemorrhage with the hemodynamic characteristics of renal arteriovenous (AV) fistula in renal AML. In case 1, renal angiography showed several intratumoral aneurysms, one of which had ruptured into the tumor, resulting in the formation of an intratumoral hematoma. Blood flow within the hematoma was rapid and the blood was immediately returned to the systemic circulation through the left renal vein. In case 2, renal angiography showed that the rupture of an intratumoral aneurysm of a tumor-feeding artery had resulted in formation of an intratumoral hematoma and direct renal vein communication. No extratumoral hemorrhage was observed in either case. The hemodynamics of both hematomas resembled those of a high-flow renal AV fistula. The ruptured aneurysms were embolized with detachable and pushable coils (case 1) or pushable coils only (case 2). To our knowledge, this is the first report of successful embolization of AV fistula-like intratumoral hemorrhage in renal AML.
Histological changes of liver biopsy specimens were compared with functioning liver cell mass estimated by an index, ICG capacity, and with plasma levels of various proteins, in 85 patients with liver diseases. IGC capacity was inversely proportional to the degrees of liver cell degeneration and lymphocyte infiltration in the portal tracts and parenchyma, in contrast to plasma disappearance rate of ICG (K), which was inversely proportional to the degrees of portal tract fibrosis and bridge formation. Among the plasma proteins synthesized in the liver, the plasma levels of prealbumin, and alpha1-acid glycoprotein showed the tendencies to decrease with the increase in the degrees of liver cell degeneration. The levels of ceruloplasmin, haptoglobin beta1A/C and transferrin were proportional to the degree of the degeneration. Plasma albumin had no correlation to any histological change. The plasma levels of gamma-globulin and IgG were both proportional to the degrees of portal tract fibrosis and bridge formation. IgM also paralleled to the degree of the fibrosis. The level of IgA was inversely proportional to the degree of liver cell swelling. It was concluded that quantitative estimations of some histological changes in the liver are valuable for the estimations of liver function and the grade of the diseases of the liver.
Computed tomography-guided needle biopsy (CT-GNB) has a high diagnostic yield for lung cancer but higher complication rates compared to those of other biopsy modalities. We sought to clarify in which thoracic lesions we could achieve a quick pathological diagnosis using CT-GNB, considering the risks and benefits. We retrospectively enrolled 110 patients who underwent CT-GNB and 547 patients who underwent transbronchial biopsy (TBB) for parenchymal lung lesions in clinical practice. The diagnostic rates of CT-GNB and TBB were 87.3% and 75.3%. After failed diagnosis with other biopsy modalities, 92.3% of patients were finally diagnosed using CT-GNB and 65.8% using TBB. In cases with a negative bronchial sign, there was a statistically higher diagnostic rate with CT-GNB than with TBB (p < 0.001: 89.4% vs. 0%). Complication rates were higher with CT-GNB (50.9%) than with TBB (16.3%). However, there were lower rates of complications in cases with inhomogeneous tumors, subpleural lesions, and when more than 15 mm of the punctured needle length was within the target. We conclude that CT-GNB is an effective biopsy modality with a high diagnostic rate that is especially recommended when the bronchus sign is negative. It can be safely performed if risk factors for complications are taken into account.
It was shown that the reduction of tertiary benzylic hydroxy group of (2R,3S,4R,5S)-3,5-bis(4-benzyloxy-3-methoxyphenyl)-2,4-dimethyltetrahydro-3-furanol 17, followed by the intramolecular Friedel-Crafts reaction gave exclusively indane with (7S,7'S,8R,8'R)-2,7'-cyclo-7,8'-neolignan structure 18 along with (7S,7'R,8S,8'R)-7,8'-epoxy-8,7'-neolignan...
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