LETTER TO THE EDITOR : A Rare Case of Annular Pustular Psoriasis Associated with Pemphigus Foliaceus

( Kenichi Kato ),( Takaaki Hanafusa ),( Ken Igawa ),( Motohiro Tatsumi ),( Yuji Takahashi ),( Takashi Yamanaka ),( Ichiro Katayama ) 대한피부과학회 2014 Annals of Dermatology Vol.26 No.2

Poster Session : PS 0339 ; Hematology : Study of Multiple Neoplasms Including Hematological Malignancies and Lung Cancer

( Daisuke Nagase ),( Susumu Ishihara ),( Akiko Sakai ),( Motohiro Kato ),( Yasunobu Kuraishi ),( Kazuho Arai ),( Haruka Izumi ),( Kazuhiko Natori ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: It is a well-known fact that the prevalence of malignancy increases year by year. In addition, other malignancies may be found in the systemic screening before treatment or after several therapy during observation. Malignant lymphoma is often the most number of patients. We reviewed the complication with lung cancer that was a poor prognosis. We look for possibility of the prognosis improvement by determining a characteristic. Methods: In 290 cases multiple cancer including hematological malignancy in our department, we examined 20 cases that including lung cancer & malignant lymphoma. Reviewed the following is gender, age, outbreak style, strategy of therapy, clinical income, and overall survival. Diagnostic criteria of multiple cancer is according to Warren&Gates. It was distinguish synchronous and metachronous that synchronous double cancer diagnosed interval of 6 months. Results: The subjects were 20 patients, median age was 70 years. Synchronous cancer was found in 5 patients and metachronous in 15 patients. Malignant lymphoma was non-Hodgkin`s lymphoma in 11 patients, Hodgkin`s lymphomain 2 patients and lymphoma- stage mycosis fungoides in 1patient. Acute myelogeneous leukemia 3 cases, myelodysplastic syndrome 3 cases. All of the patients with ML underwent chemotherapy (CTx) and 8 and 4 of them achieved completeand partial remission, respectively, while 2cases had progressive disease. In 20 cases with LC, operation (Ope) alone was conducted in 6 cases, Ope+ adjuvant therapy in 3 cases, radiation therapy (RTx) in 1case, RTx + CTx in 1case, and CTx alone in 7 cases, non therapy 2 cases. The median survival was 11 months. Conclusions: For metachronous type, there is chance to fi nd second cancer, if they observed long time. I think that we must understand he has or will have another cancer. Prognosis improvement of the advanced lung cancer is expected.

Poster Session : PS 0328 ; Hematology : Metachronous Double Cancer Included B-Cell Chronic Lymphocytic Leukemia and Pancreatic Cancer That Diagnosed After Progression of Diabetes

( Kazuhiko Natori ),( Daisuke Nagase ),( Susumu Ishihara ),( Akiko Sakai ),( Motohiro Kato ),( Yasunobu Kuraishi ),( Kazuho Arai ),( Haruka Izumi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Among the gastrointestinal cancers, pancreatic cancer has the poorest prognosis. It is important to diagnose patients when the pancreatic cancer is still operable, which remains the only effective procedure. The initial manifestations of pancreatic cancer include abnormal glucose tolerance and onset of diabetes. Methods: We experienced a patient with B-cell chronic lymphocytic leukemia (B-CLL) who was diagnosed with pancreatic cancer after progression of diabetes. Results: A 74-year-old man was diagnosed with B-cell chronic lymphocytic leukemia and was followed up at our outpatient department. In March 2011, he suffered from deterioration of diabetes (HgbA1c: 7. 6%) and underwent detailed examination. After examination, patient was diagnosed with Stage IV pancreatic cancer and is treated with gemcitabine monotherapy. Conclusions: The incidence of diabetes and abnormal glucose tolerance complicated with pancreatic cancer is relatively high. It has been shown that diabetes correlates positively with the risk of onset of pancreatic cancer. However, it has also been demonstrated that diabetes is the result rather than the risk factor of pancreatic cancer onset. Although abnormal glucose tolerance and diabetes onset are important as the initial manifestations of pancreatic cancer. It is necessary to diagnose patients in the early stage of pancreatic cancer, when it is still operable. In comparison with the conventional risk factors of smoking and diabetes, a family history of pancreatic cancer and various hereditary syndromes are much superior risk factors. Patients with pancreatic cancer who have at least 2 fi rst-degree relatives are considered to have familial pancreatic cancer.

Poster Session : PS 0330 ; Hematology : Experience of Chemotherapy of Malignant Lymphoma in More Than 90 Years

( Kazuhiko Natori ),( Susumu Ishihara ),( Daisuke Nagase ),( Yukitoshi Toyoda ),( Akiko Sakai ),( Motohiro Kato ),( Yasunobu Kuraishi ),( Kazuho Arai ),( Haruka Izumi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Chemotherapy of the elderly person was common practice. Clinical outcome is force to equal an adult. However, a patient 90 years or older has a high risk of chemotherapy. We report our experience with two patients of malignant lymphoma 90 years or older. Methods: In periods from 2003 to 2013, patients whom malignant lymphoma was diagnosed in our hospital, we extracted a case 90 years or older. We reviewed gender, clinical stage, chemotherapy, dosage, clinical outcome, and prognosis. Results: Case 1: 91-year-old male, fi rst manifestation was systemic lymphadenopathy, Sufferings from dyspnea, he became the hospitalization. Pleural effusion was revealed, after lymph node biopsy, he was diagnosed non-Hodgkin`s lymphoma diffuse large B cell (NHL DLBCL). We performed chemotherapy by his strong wish. After 3 course of R-CHOP (dosage 50%), he achieved partial remission and was able to return to the house. He died after a diagnosis in 13 months. Case 2: 90-year-old female, fi rst manifestation was dysfunction of artifi cial denture, she had a checkup in dentistry. At the time dentist discovered a mass lesion and performed biopsy. Diagnosis was NHL DLBCL, and she was referred and had performed chemotherapy our hospital. After 6 course of R-CHOP (dosage 65%), she achieved complete remission and he still alive. Conclusions: It is got enough cinical outcome from even a case 90 years or older bychemotherapy. However, drug reduction criteria are not established that are indispensable for safe chemot

Poster Session : PS 0338 ; Hematology : The Multiple Neoplasms Consist of Colon Cancer and Hematological Malignancy

( Kazuhiko Natori ),( Susumu Ishihara ),( Daisuke Nagase ),( Yukitoshi Toyoda ),( Akiko Shibuya ),( Motohiro Kato ),( Yasunobu Kuraishi ),( Kazuho Arai ),( Haruka Izumi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Colon cancer accounts for number of cases, a superior of the cause of death like gastric cancer, lung cancer. Wereport aggregates the multiple neoplasms including hematological malignancy and colon cancer. Methods: In the case that hematologic malignancy was diagnosed in our hospital by 1988 from 2013, The multiple cancer including colon cancer and the hematologic malignancy was 45 cases. So we reviewed and reported. Results: All cases are 45 cases, including female 14 cases, male 31cases, synchronous type 15 cases, metechronous type 30 cases. Multiple neoplasms consist of double cancer 33 cases, triple cancer 11 cases, quadrop cancer 1case. The median interval period in double cancer is 58 months. Hematological malignancy consist of non-Hodgkin`s lymphoma 24 cases, Hodgkin`s lymphoma 1 case, myelodysplastic syndrome 6 cases, chronic myelogeneou leukemia 3 cases, multiple myeloma 5 cases, macroglobrinemia 2 cases, acute lymphoblastic leukemia 3 cases, acute myelogeneous leukemia 2 case. Chronic lymphocytic leukemia 1 case. The sites of colon cancer studied 41 cases and results were that ascending colon 7cases, transverous colon 3cases, descending colon 2cases, sigmoid colon 9cases, rectum 8 cases. In a double cancer, 12 cases were preceding colon cancer and 9 cases were preceding hematological malignancy, an interval of the colon cancer precedence cases, the median time was 83M, hematological malignancy precedence cases was 42M. Median survival time is 15M, about cause of death, 21 cases still alive and 24 cases are dead. In 24 cases, hematological malignancy 17 cases, colon cancer 7 cases. Conclusions: In the case of hematological malignancy precedence case, 4 of 9 colon cancer occurred within three years. We should take attention about incidence of other malignancies, particularly those that occur from gastrointestinal tract and serious observation about distant metastasis site, such as liver and lung.

Poster Session : PS 0336 ; Hematology : Hodgkin`s Lymphoma in Our Hospital

( Kazuhiko Natori ),( Daisuke Nagase ),( Susumu Ishihara ),( Akiko Sakai ),( Motohiro Kato ),( Yasunobu Kuraishi ),( Kazuho Arai ),( Haruka Izumi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: In Japan, ML is hematological malignancies with much number of cases. non-Hodgkin`s lymphoma(NHL) is more than 90%. There is extremely little number of patients Hodgkin`s lymphoma(HL). In Europe, the rarion between NHL and HL, is almost half and half. So we paid attention to HL and examined. Methods: We intended for patient which ML was diagnosed in our hospital from January 2003 to December, 2012. We studied and reported 38 cases about age, gender, pathological fi ndings, therapy, median survival time, 5 years survival rate. Survival was measured from the diagnosis of multiple cancer to time of death or last contact. Results: All cases were 38 cases, gender ration was male 23 cases, female 16 cases. Median age was 45 years, pathological fi ndings, L-D 1 case, L-P 1 case, L-R 6 cases, MC 15 cases, PHL 1 case, NS 14 cases. About clinical stage, I was 5 cases, II was 15 cases, III was 10 cases, IV was 7 cases. Adult patients were 25 cases, elderly patients were 13 cases. About therapy, more than 65 years old that assumed Bleomycine skipped. ABVD therapy performed 26 cases, ABVD therapy + RTx 1 case, AVD therapy 8 cases, C-MOPP therapy 3 cases. Median survival time was 84 months, and 5 years survival rate was 79. 6%. About age, less than 60 years group did not reach median survival time, median survival time of more than 60 years group was 76 months. There is no signifi cant difference between 2 group. 29 cases were survivor and death cases were 9 cases. Cause of death, 8 cases due to original disease, 1 case another reason( because of lung cancer). Conclusions: HL is good prognosis disease in hematological malignancies, but in more than 60 years patients, there is many problem.

Poster Session:PS 0224 ; Gastroenterology : HBV Infection Screening for Malignant Lymphoma

( Kazuhiko Natori ),( Susumu Ishihara ),( Daisuke Nagase ),( Akiko Sakai ),( Motohiro Kato ),( Yasunobu Kuraishi ),( Kazuho Arai ),( Haruka Izumi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Malignant lymphoma(ML) is the ninth place cause of death in Japan and chemotherapy(CTx) is fi rst choice. Side effect of CTx, rituximab, reactivation of the Hepatitis B type virous(HBV) is serious problem. We reviewed the situation of the HBV infection check of patients that was performed CTx. Methods: We intended for patient which ML was diagnosed in our hospital from January 2003 to December, 2012. The pretreatment HBV check factor is hepatitis B surface antigen(HBsAg), hepatitis B surface antibody(anti-HBs), antihepatitis B core antibody(anti-HBc). When either anti-HBs or anti-HBc is positive, we measure viral amount by HBV-DNA Taqman. In the case of HBV check is imcomplete, additional HBV check followed as much as possible. We reviewed positive rate of HBsAg, anti-HBs, anti-HBc. Also we investigated HBV reactivation rate of R+CTx. Results: All cases were 446 cases, about type of malignant lymphoma, Hodgkin`s lymphoma(HL) 39 cases, non-Hodgkin`s lymphoma(NHL) 401 cases, Adult T cell Lymphoma( ATL) 6 cases. Among 446 patients, 411 cases received CTx or CTx+radiation therapy(RTx). HBsAg was examined in all cases, anti-HBs, anti-HBc was 351 cases, 261 cases respectively. The case searched three factors before CTx was 150 cases. 30 cases were searched HBV-DNA Taqman that indicated anti-HBs and/or anti-HBc were positive. In theses cases, treatment needed situation were 5 cases. These 5 cases treated by entecavir and after 2 weeks, CTx performed. The case that already given an antiviral drug with HBsAg positive for treatment was 4 cases. 107 cases were searched anti-HBs, anti-HBc or either after CTx. 2 cases was revealed to have needed the administration of antiviral drug. HBV reactivation rate was 0%. Conclusions: Only 2 cases needed therapy for HBV infection that were revealed after CTx. We do check in all cases and try for safe chemotherapy especially rituximab including regimen.

Poster Session : PS 0335 ; Hematology : Study of Non-Hodgkin`s Lymphoma Diffuse Large B Cell Cases That are Treated without Rituximab

( Kazuhiko Natori ),( Daisuke Nagase ),( Susumu Ishihara ),( Akiko Sakai ),( Motohiro Kato ),( Yasunobu Kuraishi ),( Kazuho Arai ),( Haruka Izumi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: The strategy of non-Hodgkin`s lymphoma changed dramatiscally, especially in B cell type by rituximab. The pathological fi ndings which showed immunochemical stain CD20 positive cases, rituximab is effective agent about. Some cases did not treat without rituximab several reasons. Methods: From 2003 to 2012, 9 years, we intended for 446 patients whom malignant lymphoma was diagnosed in detail by histopathology. Clinical stage is determinded by Ann Aobor classifi cation. We investigate the cases who do not treat without rituximab about the reason, age, clinical stage, therapy and prognosis. Results: All cases are 69 cases, about gender, male 42 cases, female 27 cases, median age is 71 years ranged 22-89 years. Perfomance Status at diagnosis, 0 grade 20 cases, 1grade 17 cases, 2grade 4 cases, 3grade 10 cases, 4grade 18 cases. About clinical stage by Ann Aobor classifi cation, I is 14 cases that included L-I(Lugano classifi cation), II is 5 cases, III is 9 cases, IV is 41 cases. Strategy of therapy, best supporting care 17 cases, aim to cure 42 case, palliative 11 cases. The reason without rituximab, bestsupporting care 18 cases, another standard therapy 13 cases, CD20 negative 3 cases, Hepatitis B virus active infection 6 cases, Hepatitis C virus active infection 2 cases, palliative therapy 12 cases, infusion reaction 9 cases, much tumor burden 2 cases, avoiding gastrointestinal perforation 2 cases, leukemic state 1 case. Median survival time is 12 months ranged 1-111 months. Conclusions: Rituximab is remarkably improved prognosis about non-Hodgkin`s lymphoma.

Poster Session : PS 0333 ; Hematology : Multiple Neoplasms Including Malignant Lymphoma

( Kazuhiko Natori ),( Daisuke Nagase ),( Susumu Ishihara ),( Akiko Sakai ),( Yukitoshiq Toyoda ),( Motohiro Kato ),( Yasunobu Kuraishi ),( Kazuho Arai ),( Haruka Izumi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: The clinical outcome of the malignant lymphoma improved and longterm survivor increased. In addition, the improvement of the examination technology and available PET/CT, screening ability rose, multiple neoplasms increased drastically last decade. We reviewed multiple neoplasms including the ML which accounted for a major ratio in hematological malignancies. Methods: We were approved privacy policy by the Ethical Review Board. Between January 1988 and December 2013, we reviewed multiple neoplasms including hematological malignancies. The diagnosis of the multiple neoplasms depends on a criteria of Warren & Gates. The defi nition of metachronous type and synchronous type is 6 months interval. Results: During the studied period, 285 cases became the subject of the examination. The multiple neoplasms including the ML was 161 cases in that. Median age was 70 years, male/female ratio was 101/60, double neoplasms were 135 cases, triple neoplasms 24 cases, quadple neoplasms 2 cases. The type of multiple neoplasms, metachrounaous type, synchronous type, were 120 cases, 41 cases respectively. In metachronous double type, all cases were102, and median time of interval was 59 months. The Consist of malignant neoplasms, gastric cancer 39 cases, colon cancer 26 cases, lung cancer 24 cases, hepatocellular carcinoma 13 cases, breast cancer 13 cases, prostate carcinoma 10 cases, and 18 kind of diagnosis 64 cases. On the other hand, kind of malignant lymphoma, Hodgkin`s lymphoma 7 cases, non-Hodgkin`s lymphoma 153 cases, adult T cell lymphoma 1 case. Median overall survival time was 33 months. About double neoplasms, median overall survival time between metachronous and synchronous type, there is signifi cance difference. Conclusions: In metachronous double type, all cases were102, 41 cases out of 102 cases were diagnosed within 5 years. We can discover metachronous multiple neoplasms by serial observations of fi ve years from an initial diagnosis.

Poster Session : PS 0332 ; Hematology : Malignant Lymphoma That Diagnosed from Gastric Biopsy

( Kazuhiko Natori ),( Daisuke Nagase ),( Susumu Ishihara ),( Yukitoshi Toyoda ),( Sakai ),( Motohiro Kato ),( Yasunobu Kuraishi ),( Kazuho Arai ),( Haruka Izumi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Primary malignant gastrointestinal lymphoma accounts for 1-4% of malignant gastrointestinal tumors. Herein, we report the results of our study on 32 patients diagnosed from biopsy of stomach. Methods: From 2003 to 2012, we intended for 466 patients whom malignant lymphoma. 32 patients were selected. All patients were followed up until death or untile December 2013. Survival was measured from the diagnosis of multiple cancer to time of death or last contact. Results: All cases are 32 cases, gender male 16 cases, female 16 cases. Median age is 68 years, performance status is grade 0 20 cases, grade 1 7 cases, 2 grade 1 case, 3 grade 1 case, grade4 3 cases. Pathological fi ndings, 31 cases are non-Hodgkin`s lymphoma, 1 case is adult T cell lymphoma. Immnochemical stain fi ndings, diffuse laerge B cell type 21 cases, MALT lymphoma 8 cases, T cell lymphoma 1 cases, unknown 1 case. Clinical stage by Ann aobor classifi cation, stage IV is 13 cases, and Lugno classifi cation, L-I 17 cases, L-II-1 1 case, L-II-2 1 case. About therapy, CHOP or CHO therapy 3 cases(because of HBV active infection), rituximab +CHOP therapy 15 cases, Radiation therapy 4 cases, CHOP therapy after radiation therapy 2 cases, CHOP therapy after total gastrectomy 2 cases Eradication alone 1 case, chemotherapy ( CHOP therapy ) after eradication 1 case. Median survival time is not reached, 5 years survival rate is 66. 7%. At last December 2013, surviver is 23 cases, dead is 9 cases. Conclusions: The benefits of surgical treatment include decreased tumor amount by resection of local and regional lymph nodes, and more accurate diagnosis of the disease stage. However, we consider that the disadvantages of the majority of the recent therapies can be avoided by performing endoscopic examination and improving diagnostic imaging.