A review of the literature of 2,155 reported patients with primary carcinoma of the pancreas, revealed 110 cases or 5% to have skeletal metastasis by radiographic or autopsy study. A study conducted over a 2 year period disclosed that 1 case of skeletal metastasis was detected by bone scanning in 16 patients with pancreatic carcinoma. This indicates a minimum skeletal metastasis rate of 6%. We feel these percentages are low and can be further defined by the more routine employment of the bone scan to evaluate patients with carcinoma of the pancreas. The true figure may be much higher, perhaps as high as 20%.
BACKGROUNDImmunosuppression is effective in treating a number of diseases, but adverse effects such as bone marrow suppression, infection, and oncogenesis are of concern. Methotrexate is a key immunosuppressant used to treat rheumatoid arthritis. Although it is effective for many patients, various side effects have been reported, one of the most serious being methotrexate-related lymphoproliferative disorder. While this may occur in various organs, liver involvement is rare. Information on these liver lesions, including clinical characteristics, course, and imaging studies, has not been summarized to date.CASE SUMMARYWe present a case of 70-year-old woman presented with a 2-wk history of fever and abdominal pain. She had had rheumatoid arthritis for 5 years and was being treated with medication including methotrexate. Contrast-enhanced computed tomography revealed multiple low density tumors in the liver and the histological analyses showed significant proliferation of lymphocytes in masses that were positive on immunohistochemical staining for CD3, CD4, CD8, and CD79a but negative for CD20 and CD56. Staining for Epstein-Barr virus-encoded RNA was negative. And based on these findings, the liver tumors were diagnosed as Methotrexate-related lymphoproliferative disorders. A time-dependent disappearance of the liver tumors after stopping methotrexate supported the diagnoses.CONCLUSIONThe information obtained from our case and a review of 9 additional cases reported thus far assist physicians who may face the challenge of diagnosing and managing this disorder.
We describe a case of Multicentric Reticulohistiocytosis (MR), followed-up for 26 years after diagnosis, which required numerous surgeries involving revision. A 36-year-old woman visited our institution because of distal interphalangeal joint (DIPJ) pain, deformity of the bilateral little fingers, and papulo-nodular cutaneous lesions on both hands. Between 1995 to 2003 arthrodesis of the bilateral thumb, index, middle, ring and little DIPJs were essential. After that, several re-surgeries were needed because of backout of temporary K-wires at the time of follow-up. Furthermore, we performed arthroplasty of the bilateral index, middle, ring proximal interphalangeal (PIP), left thumb metacarpophalangeal joints (MPJs), and right knee joint in 2007 to 2014. Similar, left total knee arthroplasty (TKA) and bilateral total hip arthroplasty (THA) were performed in 2013 to 2016. Postoperative four years after right TKA, aseptic loosening of the tibia and patellar component was gradually recognized. Therefore, we performed revision TKA using long-stemmed augments on the tibial component. The patellar components were removed and we performed patelloplasty only because the height of the remaining patella was thin. The patient was able to walk without a t-cane one year postoperatively. During consecutive follow-up, we experienced some of complications such as the backout of temporary K-wires or nonunion and bone absorption after arthrodesis, and experienced early aseptic loosening after arthroplasty. Therefore, additional surgeries included reinternal fixation or revision arthroplasty were necessary. Postoperatively, surgeons must carefully consider specific bone absorption around the prosthesis or joint in this rare disease.
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