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A 74-year-old male with lung squamous cell carcinoma who was treated with the anti PD-1 antibody nivolumab developed frequent diarrhea four months after initiating treatment. However, his condition did not improve despite prednisolone at 20mg. Endoscopic examination revealed loss of vascular pattern, erosions, and mucosal friability, resembling ulcerative colitis. Colonoscopy revealed punch-out ulcers in the affected mucosa. Therefore, he was definitively diagnosed with severe colitis caused by immune checkpoint inhibitor treatment and cytomegalovirus colitis. Nivolumab was discontinued, and he was treated with 60mg prednisolone and ganciclovir. Although his colitis improved, he developed pneumonia and died thereafter. This case highlights adverse events that are associated with immune checkpoint inhibitors which should be treated properly.

A 66-year-old woman was admitted to our hospital with heartburn and liver dysfunction. She was diagnosed with advanced gastric cancer. After the initiation of chemotherapy with trastuzumab, capecitabine, and cisplatin, she developed hyponatremia and renal failure with renal salt-wasting syndrome (RSWS). She recovered from these conditions after infusion of hypertonic saline. A diagnosis of RSWS should be considered in patients with hyponatremia who receive cisplatin-based chemotherapy.

A 75-year-old man was admitted to our hospital because of right hypochondralgia. Computed tomography (CT) revealed a large tumor in the right lobe of the liver. Ultrasonography (US) showed vessels in the tumor. Needle biopsy specimens showed malignant lymphoma (Diffuse large B cell lymphoma). Ga scintigraphy and FDG-PET did not demonstrate other lesions and the definitive diagnosis was primary malignant lymphoma of the liver. CHOP with Rituximab therapy (R-CHOP therapy) was performed. After 8 courses of therapy the FDG-PET results were negative and we considered complete remission. We describe a case of primary malignant lymphoma of the liver treated successfully by R-CHOP therapy.

A 72-year-old man with diabetes mellitus and hypertension was admitted for further examination and therapy of diabetes. In order to evaluate his pancreas, abdominal computed tomography (CT) was performed, showing a space-occupying lesion (SOL) in the pancreatic uncus. He did not show any symptoms related to the pancreas or gastro intestinal tract. Three-dimensional CT (3D-CT) indicated that the SOL was not a solid tumor but a vessel fistula, fed by the superior mesenteric artery and the gastro duodenal artery, drained by the superior mesenteric vein. Abdominal angiography also showed its peculiar vessel structure, confirming arterio-venous (A-V) malformation in the pancreas. Pancreatic A-V malformation is a rare condition but should not be forgotten in the differential diagnosis of pancreatic SOL. Our case showed the advantages of 3D-CT with its low invasiveness and convenience for the diagnosis of A-V malformation in the pancreas.