Inflammatory pseudotumors of the kidney and the lung presenting as immunoglobulin G4-related disease: a case report

<p>Abstract</p> <p>Introduction</p> <p>It has been reported that immunoglobulin G4-related systemic disease can spread to nearly every organ, and often presents as an inflammatory mass or masses at those sites. In the kidney, this disease is often diagnosed after a radical or partial nephrectomy following the discovery of an inflammatory mass which is often suspected to be a malignant tumor. Here, we present a rare case of inflammatory pseudotumors of the kidney and the lung presenting as immunoglobulin G4-related disease, which were diagnosed by computed tomography-guided biopsies.</p> <p>Case presentation</p> <p>A 54-year-old Japanese man was referred to our hospital with suspected bilateral renal cancer, multiple lung metastases and autoimmune pancreatitis. His serum immunoglobulin G4 level was high. We used computed tomography-guided biopsies and histopathological examinations of the biopsied specimens to diagnose the tumors as immunoglobulin G4-related bilateral renal and lung inflammatory pseudotumors. Our patient was treated with oral prednisolone, and after one month of treatment, contrast-enhanced computed tomography demonstrated a general improvement, as noted by a reduction in size of the masses.</p> <p>Conclusion</p> <p>Renal masses that are formed due to immunoglobulin G4-related disease require comprehensive diagnosis to prevent unnecessary surgical resections from being performed. Further consideration should be paid to immunoglobulin G4-related diseases in the future.</p

Lactate dehydrogenase(LDH)は前立腺癌骨転移症例の予後予測因子である

We analyzed clinical data to identify prognostic indicators in prostate cancer patients with bone metastasis. The subjects were 60 patients with bone metastasis out of 165 patients diagnosed with prostate cancer at our clinic over 6 years from January 1998 to December 2003. The age at the initial diagnosis was 61 to 91 (mean: 73.7 +/- 7.5) years old. The following items were considered to be possible prognostic indicators: T (type) classification, N (node) classification, Gleason score, prostate specific antigen (PSA) value before therapy, disease grade, alkaline phosphatase (ALP), lactate dehydrogenase (LDH), serum calcium (Ca), hemoglobin (Hgb), and platelet count (Plt). The 5-year overall survival rate was 45.7% in the 60 patients. Univariate analysis showed statistically significant differences in N (1), Gleason score 7 + 8/Gleason score 9 + 10, and LDH level (p = 0.0053, 0.0261, and 0.0049, respectively). Multivariate Cox proportional hazard analysis of these three items showed a statistically significant difference in LDH level and Gleason score 9 +/- 10 (p = 0.0167 and 0.0371). LDH was suggested to be an excellent prognostic indicator, because of its objectivity and convenience of measurement, in prostate cancer patients with bone metastasis.目的:どのような前立腺癌骨転移症例が内分泌療法抵抗性へと移行し, 予後不良な転帰をたどるのであるか, 詳細は明らかにされていない。今回, われわれは前立腺癌骨転移症例に対し, 各種臨床データにおける予後予測因子としての可能性を検討した。対象と方法:1998年1月から2003年12月までの6年間に当院において前立腺癌と診断された165例中, 骨転移を有する60例を対象とした。初診時年齢は61～91歳(平均73.7±7.5歳)であった。検討項目としては, T classification, N classification, Gleason score(GS), 治療前prostate specific antigen(PSA)値, extent of disease grade, alkaline phosphatase(ALP), lactate dehydrogenase(LDH), 血清calcium(Ca), hemoglobin(Hgb), platelet(Plt)とした。結果:60例の5-year overall survival rateは45.7%であった。単変量解析にて統計学的に有意差が認められた項目は, N(1), GS7+8とGS9+10, LDH異常値であった(p=0.0053, p=0.0261, p=0.0049)。これら3群のmultivariate Cox proportional hazard analysisではLDH異常値とGS9+10で統計学的有意差が認められた(p=0.0167, p=0.0371)。結論:LDHは, その客観性および簡便性から, 前立腺癌骨転移症例に対し有力な予後予測因子であると考えられた。(著者抄録

Retrospective study comparing six - and twelve-core prostate biopsy in detection of prostate cancer

OBJECTIVE: We compared the safety and efficacy of the 12-core biopsy with those of the conventional systematic 6-core biopsy with PSA levels between 4.1 and 20.0 ng/mL. MATERIALS AND METHODS: This study included 428 patients who underwent a 6-core biopsy and 128 patients who underwent a 12-core biopsy. Biopsies were performed transrectally under ultrasound guidance. The 12-core biopsy scheme involved obtaining 6 far lateral cores. RESULTS: For patients with PSA level between 4.1 and 10.1 ng/mL, 47 of the 265 patients who underwent 6-core biopsy and 32 of the 91 patients who underwent a12-core biopsy were diagnosed with prostate cancer (p = 0.0006). Among the patients with a PSA level between 10.1 and 20.0 ng/mL, 48 of 163 patients who underwent the 6-core biopsy and 16 of 37 patients who underwent the 12-core biopsy were diagnosed with prostate cancer (p = 0.0606). Three of the 95 patients who were diagnosed with prostate cancer through the 6-core biopsy and 12 of the 48 patients who were diagnosed through the 12-core biopsy had cancer located in the anterior apex. The 12-core biopsy increased the diagnostic rate in the apex (p = 0.001). No statistically significant differences were found in incidence of complications. CONCLUSION: We concluded that the 12-core biopsy is a safe and more effective procedure for increasing the diagnostic rate of prostate cancer than the 6-core biopsy in patients with PSA level between 4.1 and 10.0 ng/mL, and the most useful anatomical area to be added was found to be cores from the anterior apex