Hautgeschwulste durch Lungendistoma (Paragonimus westermani)

Zwei 7 jahrige Kinder nahmen ungekochte Flussigkeit von Potamon dehaanii zu sich, eine Volksrnedizin gegen Keuchhusten. Einige Monate darauf bemerkten sie blutige Sputa und nicht entzundliche Geschwulste an den Lenden oder der Bauchseite. In den Tumoren wurde je ein Lungendistoma entdeckt. Dieser Parasit kann daher manchmal in die Subkutis oder in die tiefe Kutisschicht einwandern. Zum Schlusse Inochten wir Herrn Prof. Tanabe vom pathologischen Institut dieser Universitat unsern warmsten Dank aussprechen dafur, dass er die Struktur der Parasiten eingehend untersuchte. </p

Osimertinib Did Not Respond to a Pulmonary Adenocarcinoma with Triple Mutations of Epidermal Growth Factor Receptor, G719S, T790M and S768I

Uncommon epidermal growth factor receptor (EGFR) gene mutations include G719S, T790M and S768I. T790M gatekeeper mutation is the most frequent mechanism of acquired drug resistance to first- and second-generation EGFR-tyrosine kinase inhibitors (TKIs). Osimertinib is a specific EGFR-TKI to overcome T790M resistance mutation. However, owing to a new drug and a rare mutation type, it remains unknown whether osimertinib is effective for acquired S768I. Herein, we reported a 76 year-old woman with pulmonary adenocarcinoma, which had acquired EGFR mutations of S768I and T790M in addition to original G719S after long gefitinib treatment. These mutations were detected in biopsy specimen of liver metastases. During two months of osimertinib, multiple liver metastases progressively enlarged. This case suggested that acquired S768I mutation might be resistant to osimeritinib, despite of co-occurrence of T790M

Lambert-Eaton Myasthenic Syndrome Caused by Nivolumab in a Patient with Squamous Cell Lung Cancer

Lambert-Eaton myasthenic syndrome (LEMS) is a representative paraneoplastic neurological syndrome. Recently, nivolumab, an anti-programmed cell death 1 inhibitor, has been approved for advanced non-small-cell lung cancer. Careful attention should be paid to immune-related adverse events (irAEs), including neurotoxicity. We herein report a 73-year-old woman with LEMS that occurred during nivolumab treatment for pulmonary squamous cell carcinoma. After the 20th week of nivolumab, she experienced various neurological symptoms such as ptosis, lower limb weakness, and photophobia. Findings from a nerve conduction study and a positive anti-P/Q-type voltage-gated calcium channel antibody made a diagnosis of LEMS. Pyridostigmine and 3,4-diaminopyridine temporarily improved her symptoms. This was the first case of LEMS as a neurological irAE. LEMS should be considered as a possible neurological irAE

Association of Pain History and Current Pain With Sagittal Spinal Alignment and Muscle Stiffness and Muscle Mass of the Back Muscles in Middle-aged and Elderly Women

[Study Design] A cross-sectional study. [Objective] To investigate the association of low back pain history (LBPH) and LBP with sagittal spinal alignment, stiffness assessed using ultrasonic shear wave elastography, and mass of the back muscle in community-dwelling middle-aged and elderly women. [Summary of Background Data] The association of LBPH and LBP with sagittal spinal alignment, stiffness, and mass of the back muscles remains unclear in middle-aged and elderly women. [Participants and Methods] The study comprised 19 asymptomatic middle-aged and elderly women [control (CTR) group], 16 middle-aged and elderly women with LBPH (LBPH group), and 23 middle-aged and elderly women with LBP (LBP group). Sagittal spinal alignment in the standing and prone positions (kyphosis angle in the thoracic spine, lordosis angle in the lumbar spine, and anterior inclination angle in the sacrum) was measured using a Spinal Mouse. The stiffness of the back muscles (lumbar erector spinae and multifidus) in the prone position was measured using ultrasonic shear wave elastography. The mass of the back muscles (thoracic and lumbar erector spinae, lumbar multifidus, and quadratus lumborum) was also measured. [Results] Multiple logistic regression analysis with a forward selection method showed that the stiffness of the lumbar multifidus muscle was a significant and independent factor of LBPH. The stiffness of the lumbar multifidus muscle was significantly higher in the LBPH group than in the CTR group. Multiple logistic regression analysis also indicated that lumbar lordosis angle in the standing position was a significant and independent factor of LBP. The lumbar lordosis angle was significantly smaller in the LBP group than in the CTR group. [Conclusions] Our results suggest that LBPH is associated with increased stiffness of the lumbar multifidus muscle in the prone position, and that LBP is associated with the decreased lumbar lordosis in the standing position in community-dwelling middle-aged and elderly women

Successful Dasatinib Treatment of Epidermal Growth Factor Receptor-Mutant Lung Adenocarcinoma and BCR-ABL1-Positive Chronic Myeloid Leukemia: A Case Report

Dasatinib, a second-generation BCR-ABL1 tyrosine kinase inhibitor (TKI), inhibits multiple kinase pathways and is a promising anti-tumor agent for various solid tumors, including lung cancer. Herein, we report a patient with coexisting epidermal growth factor receptor (EGFR)-mutant lung adenocarcinoma and BCR-ABL1-positive chronic myeloid leukemia (CML). The patient received afatinib for a postoperative intrapulmonary recurrence of lung adenocarcinoma harboring EGFR exon 19 deletion. Tumor reduction was achieved with afatinib; however, dose reduction was required because of grade 2 diarrhea and skin toxicity. The reduced dose maintained a partial response. Thirty-one months after introduction of afatinib, he was diagnosed as having BCR-ABL1-positive CML and nilotinib was added to his treatment regimen. However, the combination of nilotinib and afatinib aggravated his diarrhea, prompting discontinuation of afatinib. Because nilotinib does not have sufficient anti-tumor efficacy for CML, dasatinib was substituted for nilotinib. Thirty-five months after introduction of dasatinib, bosutinib was substituted for dasatinib because of uncontrollable pleural effusions. Dasatinib achieved 31- and 35-month progression-free survivals for CML and EGFR-mutant lung adenocarcinoma, respectively. Dasatinib is thus a therapeutic option for coexisting EGFR-mutant lung adenocarcinoma and BCR-ABL1-positive CML when TKI combination therapy is contraindicated by severe adverse events. In our patient, adding nilotinib to afatinib led to severe diarrhea. When administering TKI combination therapy, drug-drug interactions should be considered