Discrepancy between magnetic resonance imaging and cranial nerve neuropathies associated with the involvement of diffuse large B-cell lymphoma（DLBL）.

An 83-year-old female developed diffuse large B-cell lymphoma（DLBL） of the left nasal cavity. Complete remission was achieved after two courses of Rituximab and CHOP（R-CHOP） . During the fourth course of R-CHOP, sensory disturbance and palsy of the left face developed. Left trigeminal nerve swelling was observed in magnetic resonance imaging（MRI） followed by double vision in the left eye, and MRI revealed swelling of both trigeminal nerves but not of the abducens nerve. Although the swelling of the trigeminal nerves and the double vision subside after administration of prednisolone, the palsy of the left face persisted. Two months after the fourth course of R-CHOP, symptoms of the palsy of the left face progressed and palsy of the right face, double vision, and palsy of the left facialis nerve developed. Then,blepharoptosis of the right eye developed and palsy of the right oculomotorius nerve was observed. MRI showed the presence of trigeminal nerve and oculomotorius nerve swelling but no swelling of the other cranial nerves. Furthermore, skin eruption developed around the left eye.Cytology of this lesion revealed the invasion of lymphoma cells

Dosimetric comparison between dual-isocentric dynamic conformal arc therapy and mono-isocentric volumetric-modulated arc therapy for two large brain metastases

Mono-isocentric volumetric-modulated arc therapy (VMAT) can be used to treat multiple brain metastases. It remains unknown whether mono-isocentric VMAT can improve the dose distribution compared with dual-isocentric dynamic conformal arc therapy (DCAT), especially for two brain metastases. We compared the dose distribution between dual-isocentric DCAT and mono-isocentric VMAT for two large brain metastases, and analyzed the relationship between the distance between the two targets and the difference in dose distribution. A total of 19 patients, each with two large brain metastases, were enrolled. The dose prescribed for each planning target volume (PTV) was 28 Gy in five fractions (D99.8 = 100%). We created new indices derived from conformity indices suggested by the Radiation Therapy Oncology Group (RTOG; mRTOG-CI) and Paddick et al. (mIP-CI), using the dosimetric parameters of the sum of the two PTVs. The median PTV was 5.05 cm³ (range, 2.10–28.47). VMAT significantly improved mRTOG-CI and mIP-CI compared with DCAT. In all cases, VMAT was able to improve mRTOG-CI and mIP-CI compared with DCAT. Whereas the normal brain volume receiving 5 Gy was similar between the two modalities, the normal brain receiving 10, 12, 15, 20, 25 and 28 Gy (V₁₀-V₂₈) was significantly smaller in VMAT. The mean beam-on times were 213.3 s and 121.9 s in DCAT and VMAT, respectively (P < 0.001). Mono-isocentric VMAT improved the target conformity and reduced the beam-on time and V₁₀-V₂₈ of the normal brain for not only two close metastases but also two distant metastases. Mono-isocentric VMAT seems to be a promising treatment technique for two large brain metastases

Cytogenetic analysis in a multiple myeloma patient who developed myelomatous pleural effusion and plasma cell leukemia

We report on a patient with multiple myeloma who developed myelomatous pleural effusion and plasma cell leukemia. After the fourth course of chemotherapy, pleural effusion developed, and plasma cells were observed in peripheral blood after the sixth course of chemotherapy. Homozygous loss of chromosome 16 and monosomy X developed before the fourth course of chemotherapy. In this case, such cytogenetic abnormalities may be related to the myelomatous effusion and leukemic changes in multiple myelomas

Osimertinib-Associated Toxic Epidermal Necrolysis in a Lung Cancer Patient Harboring an EGFR Mutation—A Case Report and a Review of the Literature

Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are life-threatening dermatologic adverse events in the same category, caused by a delayed-type drug hypersensitivity reaction. Although skin toxicity is common during treatment with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs), osimertinib-associated TEN is quite rare&mdash;thus far, only one report has been published from China. We report a case of an 80-year-old Japanese woman with lung adenocarcinoma harboring an EGFR-sensitizing mutation who was treated with osimertinib as the first-line treatment. Forty-six days after osimertinib induction, diffuse erythematous rash rapidly spread over the patient&rsquo;s trunk along with vesicles and purpuric macules; furthermore, she developed targetoid erythema on the face. Despite osimertinib discontinuation and corticosteroid treatment, diffuse erythema with Nikolsky&rsquo;s sign, general epidermal detachment, erosion and loose blisters developed over her entire body including the face. Based on her symptoms, TEN was diagnosed and thus, intravenous immunoglobulin was immediately administered for 4 days. The treatment ameliorated TEN-associated skin toxicity and caused epithelialization. Reports on osimertinib-associated SJS/TEN are scarce and only one report each on SJS and TEN from China is available. This is the first report of osimertinib-associated TEN from Japan. Cases of EGFR-TKI-associated SJS/TEN have been reported predominantly from Asian countries, suggesting ethnicity and genetic linkage play a role in the underlying mechanism

Cytogenetic analysis in a multiple myeloma patient who developed myelomatous pleural effusion and plasma cell leukemia

We report on a patient with multiple myeloma who developed myelomatous pleural effusion and plasma cell leukemia. After the fourth course of chemotherapy, pleural effusion developed, and plasma cells were observed in peripheral blood after the sixth course of chemotherapy. Homozygous loss of chromosome 16 and monosomy X developed before the fourth course of chemotherapy. In this case, such cytogenetic abnormalities may be related to the myelomatous effusion and leukemic changes in multiple myelomas

Geometric Control of Nuclearity in Copper(I)/Dioxygen Chemistry

Copper­(I) complexes supported by a series of N₃-tridentate ligands bearing a rigid cyclic diamine framework such as 1,5-diazacyclooctane (<b>L8</b>, eight-membered ring), 1,4-diazacycloheptane (<b>L7</b>, seven-membered ring), or 1,4-diazacyclohexane (<b>L6</b>, six-membered ring) with a common 2-(2-pyridyl)­ethyl side arm were synthesized and their reactivity toward O₂ were compared. The copper­(I) complex of <b>L8</b> preferentially provided a mononuclear copper­(II) end-on superoxide complex <b>S</b> as reported previously [Itoh, S., et al.<i> J. Am. Chem. Soc.</i> <b>2009</b>, 131, 2788–2789], whereas a copper­(I) complex of <b>L7</b> gave a bis­(μ-oxido)­dicopper­(III) complex <b>O</b> at a low temperature (−85 °C) in acetone. On the other hand, no such active-oxygen complex was detected in the oxygenation reaction of the copper­(I) complex of <b>L6</b> under the same conditions. In addition, O₂-reactivity of the copper­(I) complex supported by an acyclic version of the tridentate ligand (<b>LA</b>, PyCH₂CH₂N­(CH₃)­CH₂CH₂CH₂N­(CH₃)₂; Py = 2-pyridyl) was examined to obtain a mixture of a (μ–η²:η²-peroxido)­dicopper­(II) complex ^<b>S</b><b>P</b> and a bis­(μ-oxido)­dicopper­(III) complex <b>O</b>. Careful inspection of the crystal structures of copper­(I) and copper­(II) complexes and the redox potentials of copper­(I) complexes has revealed important geometric effects of the supporting ligands on controlling nuclearity of the generated copper active-oxygen complexes

Redox Properties of a Mononuclear Copper(II)-Superoxide Complex

Redox properties of a mononuclear copper­(II) superoxide complex, (L)­Cu^II–OO^•, supported by a tridentate ligand (L = 1-(2-phenethyl)-5-[2-(2-pyridyl)­ethyl]-1,5-diazacyclooctane) have been examined as a model compound of the putative reactive intermediate of peptidylglycine α-hydroxylating monooxygenase (PHM) and dopamine β-monooxygenase (DβM) (Kunishita et al. <i>J. Am. Chem. Soc.</i> <b>2009</b>, <i>131</i>, 2788–2789; <i>Inorg. Chem.</i> <b>2012</b>, <i>51</i>, 9465–9480). On the basis of the reactivity toward a series of one-electron reductants, the reduction potential of (L)­Cu^II–OO^• was estimated to be 0.19 ± 0.07 V vs SCE in acetone at 298 K (cf. Tahsini et al.<i> Chem.Eur. J.</i> <b>2012</b>, <i>18</i>, 1084–1093). In the reaction of TEMPO-H (2,2,6,6-tetramethylpiperidine-<i>N</i>-hydroxide), a simple HAT (hydrogen atom transfer) reaction took place to give the corresponding hydroperoxide complex LCu^II–OOH, whereas the reaction with phenol derivatives (^XArOH) gave the corresponding phenolate adducts, LCu^II–O^XAr, presumably via an acid–base reaction between the superoxide ligand and the phenols. The reaction of (L)­Cu^II–OO^• with a series of triphenylphosphine derivatives gave the corresponding triphenylphosphine oxides via an electrophilic ionic substitution mechanism with a Hammett ρ value as −4.3, whereas the reaction with thioanisole (sulfide) only gave a copper­(I) complex. These reactivities of (L)­Cu^II–OO^• are different from those of a similar end-on superoxide copper­(II) complex supported by a tetradentate TMG₃tren ligand (1,1,1-Tris­{2-[<i>N</i>^<i>2</i>-(1,1,3,3-tetramethylguanidino)]­ethyl}­amine (Maiti et al.<i> Angew. Chem., Int. Ed.</i> <b>2008</b>, <i>47</i>, 82–85)