Aortic Valve Papillary Fibroelastoma Associated with Acute Cerebral Infarction: A Case Report

An 80-year-old woman with a history of congestive heart failure, atrial fibrillation, and hypertension was transferred to our institution with hematemesis. Her drug regimen included 2 mg warfarin potassium/day to prevent thromboembolic events. Transthoracic echocardiography (TTE) performed at 78 years of age revealed a mass attached to the noncoronary cusp and a cardiac tumor was suspected. The patient declined surgery and was meticulously followed up with periodic TTE. Upper gastroendoscopy revealed a gastric ulcer with an exposed blood vessel; anticoagulant therapy was ceased. On day 15 of admission, acute cerebral infarction occurred. Heparin sodium and warfarin potassium were administered rapidly, and her symptoms improved. TTE revealed no alteration of the mobile, string-like mass attached to the noncoronary cusp. Cardiac tumor was considered the cause of cerebral infarction, and the patient consented to surgical therapy. Pathological examination of the resected tumor suggested papillary fibroelastoma (PFE). Although no guidelines exist for PFE management, a mobile, cardiac tumor necessitates surgical resection to prevent thromboembolic events, even when small in size

Gastric Endocrine Cell Carcinoma Coexistent with Adenocarcinoma

A 69-year-old female presented to our institution with epigastralgia and abdominal distension. Upper gastrointestinal series revealed a 5 cm ulcerative lesion with irregular margins and elevated distinct borders from the angle to the pyloric ring. Gastroendoscopy revealed a Borrmann type 2 tumor. Several biopsied specimens revealed proliferation of small and heterogeneous cancer cells with rich chromatin and fibrous septum with rich vessels at connective tissues, which was confirmed as gastric endocrine cell carcinoma (ECC) on immunostaining with chromogranin and synaptophysin. Furthermore, other specimens revealed atypical cells forming glandular structures, which were confirmed as well-differentiated tubular adenocarcinomas. Distal gastrectomy with D2 lymph node dissection and Billroth I reconstruction was performed. Pathological examination of the gross specimen revealed that adenocarcinoma comprised <10% of all cancer cells. Close analysis of ECC revealed a mixture of small and large cells. According to the WHO 2010 classification of gastrointestinal neuroendocrine tumors, this gastric tumor was diagnosed as neuroendocrine carcinoma. The patient was administered adjuvant chemotherapy with cisplatin and etoposide. One year following surgery, follow-up abdominal CT revealed multiple liver metastases. The patient received the best supportive care but eventually died 18 months after surgery. Here we present this case of gastric ECC coexistent with adenocarcinoma

Primary Hepatic Lymphoma Is Difficult to Discriminate from a Liver Abscess

An 82-year-old woman presented with a high-grade fever of 40°C and was admitted to our institution for intensive examination and treatment. Noncontrast abdominal computed tomography (CT) revealed low-density masses at segments 5 and 8, suggestive of a liver abscess. On further examination, a contrast-enhanced abdominal CT showed a 30×30 mm mass with an enhanced margin at segment 8 in the arterial phase; the contrast agents were washed out in the venous phase. In addition, a 63×52 mm mass with a density lower than that of liver parenchyma was observed at segment 8 in the portal phase. On the basis of these findings, either a liver abscess or hepatocellular carcinoma was suspected. To confirm the diagnosis, a fine needle biopsy was scheduled. Histopathological analysis of the biopsied specimens confirmed the diagnosis of diffuse large B-cell lymphoma. Chemotherapy was not indicated owing to the patient’s age and poor performance status; thus, best supportive care was planned. On day 22 after admission, the patient died of pneumonia. We experienced a case of PHL that was difficult to discriminate from a liver abscess. Imaging alone is insufficient to diagnose PHL; therefore, fine needle biopsy is recommended for a definitive diagnosis

A Case of Squamous Cell Carcinoma of the Lung That Produced Granulocyte Colony-Stimulating Factor and Interleukin-6

A 77-year-old woman visited our institution complaining of general fatigue. Chest radiography revealed masses in the upper and middle lung fields. Pathological findings for an endoscopic biopsy specimen revealed squamous cell carcinoma. High-grade fever developed and blood analyses revealed sustained elevated white blood cell count and C-reactive protein levels. Cytokine production by tumor cells was suspected; both serum granulocyte colony-stimulating factor (117 pg/mL; normal: <57.5 pg/mL) and interleukin-6 (83.5 pg/mL; normal: <2.41 pg/mL) levels were high. Immunohistochemical examination of biopsy specimens showed positive staining with antigranulocyte colony-stimulating factor and anti-interleukin-6 monoclonal antibodies. Diagnosis of a tumor that produced granulocyte colony-stimulating factor and interleukin-6 was established. The patient was administered best supportive therapy since she was not eligible for surgical treatment because of her poor respiratory function. She died from interstitial pneumonia exacerbation two months after this diagnosis. We present a female with squamous cell carcinoma of the lung that produced granulocyte colony-stimulating factor and interleukin-6