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Pharyngeal metastasis following living-donor liver transplantation for hepatocellular carcinoma: a case report and literature review.
Tohyama, T, Sakamoto, K, Tamura, K, Nakamura, T, Watanabe, J, Wakisaka, H, Takada, Y
World journal of surgical oncology. 2020;(1):109
Abstract
BACKGROUND The most common sites of recurrence after liver transplantation for hepatocellular carcinoma (HCC) have been reported to be the liver, lung, bone, and adrenal glands, but there have also been many reports of cases of multiple recurrence. The prognosis after recurrence is poor, with reported median survival after recurrence of HCC ranging from 9 to 19 months. Here, we report a case of long-term survival after recurrence of pharyngeal metastasis following living-donor liver transplantation (LDLT) for HCC within the Milan criteria, by resection of the metastatic region and cervical lymph node dissection. CASE PRESENTATION A 47-year-old man with a Model End-stage Liver Disease (MELD) score of 11 underwent LDLT for HCC within the Milan criteria for liver cirrhosis associated with hepatitis B virus infection, with his 48-year-old elder brother as the living donor. One year and 10 months after liver transplantation, he visited a nearby hospital with a chief complaint of discomfort on swallowing. A pedunculated polyp was found in the hypopharynx, and biopsy revealed HCC metastasis. We performed pharyngeal polypectomy. Two years later, cervical lymph node metastasis appeared, and neck lymph node dissection was performed. Although recurrence subsequently occurred three times in the grafted liver, the patient is still alive 12 years and 10 months after recurrence of pharyngeal metastasis. He is now a tumor-free outpatient taking sorafenib. CONCLUSION It is necessary to recognize that the nasopharyngeal region is a potential site of HCC metastasis. Prognostic improvement can be expected with close follow-up, early detection, and multidisciplinary treatment, including radical resection.
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Dystrophic calcinosis with both a huge calcified mass in the cervical spine and calcification in the chest wall in a patient with rheumatoid overlap syndrome.
Nakamura, T, Hirakawa, K, Takaoka, H, Iyama, K
Clinical rheumatology. 2016;(5):1403-9
Abstract
Dystrophic calcinosis in soft tissue occurs in damaged or devitalized tissues in the presence of normal calcium and phosphorous metabolism. It is often noted in subcutaneous tissues in patients with collagen vascular diseases and may involve a relatively localized area or be widespread. A 74-year-old Japanese woman with an overlap of rheumatoid arthritis, Sjögren's syndrome, and systemic sclerosis developed a huge tumor-like mass at the atlanto-axial vertebral joint region that caused severe cervical pain and difficulty in activities of daily living. She also had subcutaneous dystrophic calcification in the soft tissue of the chest wall. Calcinosis associated with systemic sclerosis is a well-recognized phenomenon, but a destructive paraspinal tumor in the cervical spine associated with overlap syndrome is extremely unique. Because calcinosis in spinal locations can be complicated by neurological involvement, patients with progressive symptoms may require surgical intervention. Surgical resection and biological therapy improved this patient's life and activities of daily living. Calcinosis is common in the conditions reviewed here, and different agents have been used for treatment. However, calcinosis management is poorly organized and lacks an accepted classification, systematic studies, and clinical therapeutic trials. The association of calcinosis and collagen vascular diseases is clinically and etiologically important. Although a combination of calcinosis and rheumatoid overlap syndrome is rare, various collagen vascular diseases may occur simultaneously. A perceptive diagnostic approach toward these diseases is critical, and early diagnosis and treatment are needed to prevent dystrophic calcinosis.
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Acute hemicerebellitis in a young adult: a case report and literature review.
Suzuki, K, Nakamura, T, Numao, A, Fujita, H, Komagamine, T, Nagashima, T, Asakawa, Y, Watanabe, Y, Takekawa, H, Hirata, K
Journal of the neurological sciences. 2014;(1-2):364-7
Abstract
Acute hemicerebellitis, marked by headache with or without cerebellar signs, is a rare clinical entity involving a unilateral cerebellar hemisphere. The pathogenesis of acute hemicerebellitis remains unclear, and the disease rarely occurs in adults. Here, we report an 18-year-old woman who presented with a lack of coordination of the right hand and leg lasting longer than one week, following a pulsatile headache. A neurological examination disclosed ocular dysmetria, right-sided limb ataxia and slight truncal ataxia. Cerebrospinal fluid analysis showed mononuclear pleocytosis. The serology and autoimmune studies were unremarkable. Brain magnetic resonance imaging (MRI) revealed a focal signal change in the right cerebellar hemisphere and vermis. Acute hemicerebellitis was diagnosed, and the patient was treated with intravenous methylprednisolone sodium succinate and acyclovir. Subsequently, the headache resolved, and the cerebellar signs were markedly improved. Twenty days after admission, she became asymptomatic and brain MRI showed resolution of cerebellar hyperintensity on the right side. In conclusion, we identified only 6 additional patients with adult-onset acute hemicerebellitis from previous reports, highlighting the importance of recognizing this rare clinical entity. Its clinical outcome is usually favorable, but in the acute phase, attention should be directed toward clinical symptoms that are suggestive of increased intracranial pressure.
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[Primary yolk sac tumor in the cerebellar vermis. Case report].
Nakamura, T, Kanamori, M, Sonoda, Y, Watanabe, M, Kumabe, T, Tominaga, T
No shinkei geka. Neurological surgery. 2009;(2):173-7
Abstract
A 2-year-old boy presented with gait disturbance and limb ataxia. T1-weighted magnetic resonance (MR) imaging with gadolinium-diethylenetriaminepenta-acetic acid administration showed a heterogeneously enhanced mass lesion with a cystic component in the cerebellar vermis. The minimum apparent diffusion coefficient value of the lesion was 1.96 x 10(-3) mm2/sec, and 1H-MR spectroscopy showed elevated choline and lipid peaks, and decreased N-acetyl aspartate peak. The tumor was totally resected, and the histological diagnosis was yolk sac tumor. Consistent with this diagnosis, a-fetoprotein levels in the serum and cerebrospinal fluid were 7094 ng/m/ and 22.3 ng/m/, respectively. 18F-fluorodeoxyglucose-positron emission tomography, and thoracic, abdominal, and pelvic computed tomography showed no abnormal lesions, excluding the possibility of metastatic yolk sac tumor from an extracranial lesion. The patient received chemotherapy consisting of ifosfamide, cisplatin, and etoposide, and had not relapsed at 6 months after resection. Germ cell tumors rarely develop in the posterior fossa. This case suggests that yolk sac tumor could develop in the cerebellar vermis.
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Urticarial reaction caused by ethanol.
Nakagawa, Y, Sumikawa, Y, Nakamura, T, Itami, S, Katayama, I, Aoki, T
Allergology international : official journal of the Japanese Society of Allergology. 2006;(4):411-4
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Abstract
BACKGROUND We report a case of an urticarial reaction after drinking alcohol beverages. The patient was a 47-year-old man suffering urticarial and anaphylactoid reaction to alcohol for two years. These reactions were observed at every alcohol beverages intake. CASE SUMMARY We performed a prick test with diluted ethanol, alcohol beverages and their metabolites (acetaldehyde, acetic acid). Only acetic acid showed a positive result. Oral challenge test with diluted-ethanol caused pruritus and swelling of his lips. An oral challenge test with 8% diluted Shochu (Japanese distilled alcohol from rice or wheat) caused wheals on his upper back. DISCUSSION Only acetic acid, a metabolite of alcohol, induced a positive prick test in the patient with alcohol-induced urticaria. This result was not observed in normal volunteers. An oral challenge test with diluted-alcohol or Shochu showed a positive wheal reaction in a dose dependent-manner which suggests that urticaria seen in this patient might be induced by alcohol-intolerance. However possible allergic reaction to acetaldehyde could not be excluded.