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A 66-year-old man was diagnosed with symptomatic IgG-λ multiple myeloma based on the presence of anemia, thrombocytopenia, renal dysfunction, and a tumor on the right sixth rib. Bone marrow aspiration yielded a dry tap and biopsy revealed myelofibrosis grade 2. Partial response was achieved with Bd (bortezomib and dexamethasone) and VRd (bortezomib, lenalidomide, and dexamethasone). The patient received autologous stem cell transplantation, but the myeloma relapsed 3 months later, and liver tumors developed as well. DKd (daratumumab, carfilzomib, and dexamethasone) was administered, but the patient died due to disease progression. Autopsy revealed multiple extramedullary lesions in the liver, spleen, gallbladder, adrenal glands, kidneys, and multiple lymph nodes, as well as ascites.

A 72-year-old woman presented with generalized lymphadenopathies and plasmacytosis accompanied by polyclonal hypergammopathy. 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) showed FDG accumulation in the systemic lymph nodes, spleen, and multiple bones. Human immunodeficiency virus antibody was negative. Lymph node histologic findings showed a monotonous population of plasma cells with a starry-sky appearance. The cells were positive for CD19, λ, and Epstein-Barr virus-encoded RNA, and negative for CD20 and CD56. The MIB-1 index was 80%. A diagnosis of plasmablastic lymphoma with plasmacytosis and polyclonal hypergammopathy was made, and complete metabolic response was achieved after six cycles of dose-adjusted-EPOCH therapy (etoposide, prednisolone, vincristine, cyclophosphamide, and doxorubicin).

A 72-year-old man underwent hemodialysis because of end-stage renal failure. The patient often suffered acute pancreatitis and was diagnosed with main duct type intraductal papillary mucinous neoplasm(IPMN). Moreover, skin erythema with pain occurred and was treated as cellulitis using antibiotics; however, the skin lesions did not improve. Skin pathological findings indicated subcutaneous nodular fat necrosis due to pancreatitis. Subtotal stomach-preserving pancreaticoduodenectomy was performed, and the skin erythema with pain symptoms were relieved. The final diagnoses were ampullary carcinoma and intraductal papillary mucinous adenoma(IPMA). We experienced a rare case of subcutaneous nodular fat necrosis due to IPMN.

A 54-year-old male patient, who presented with multiple lymphadenopathies, bilateral leg edema, and oscheohydrocele, was diagnosed with diffuse large B-cell lymphoma (DLBCL) stage IVB. His lymphadenopathies disappeared after six courses of R-CHOP therapy, which consist of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone); however, right hypopyon and partly remaining testicular soft tissue masses with fluorodeoxyglucose accumulation were observed. Lymphoma cell infiltration was observed in the aqueous humor of the right anterior chamber and testis, which indicates DLBCL progression. Hypopyon disappeared after the first course of intrathecal chemotherapy combined with R-HDMA therapy, which consists of rituximab and high-dose methotrexate/cytarabine, but recurred in the third course. The patient then underwent busulfan and thiotepa (BuTT) therapy followed by autologous peripheral blood stem cell transplantation (auto-PBSCT) after four courses of R-HDMA therapy. Hypopyon promptly disappeared after BuTT therapy and no hypopyon recurrence was observed 9 months after auto-PBSCT. Therefore, BuTT therapy is effective for hypopyon associated with refractory DLBCL.

Two cases of human herpesvirus 8 (HHV8)-negative effusion-based lymphoma (EBL) involving unilateral pleural effusion that regressed only after drainage are reported. Cases 1 and 2 were 91- and 81-year-old men with right and left pleural effusion, respectively. No chemotherapy was administered to either patient because of their advanced age and the presence of cardiac comorbidities. They completely recovered after effusion drainage alone without relapse till the last observation. Thus, this study suggests that some patients with HHV8-negative EBL can be safely managed with effusion drainage alone.

The patient was a 63-year-old male. The upper esophagogastroduodenoscopy for anemia found a type 2 tumor at the greater curvature of the gastric angular region, which was revealed as a low-differentiated adenocarcinoma by biopsy. The abdominal CT showed a total of 10 metastases of 11-27 mm in size at the bilateral hepatic lobes. T3(SS)N0M1H1P0 and cStage Ⅳ of gastric cancer was diagnosed. SP therapy was performed for 1 year: the size of gastric primary focus reduced, and a metastatic lesion of 7 mm in size was found only at S1. We performed a gastrectomy of the pylorus side and hepatic S1 radiofrequency ablation. Postoperatively, S-1 single therapy has continued, and the patient has survived to date for 2 years without any recurrence. Although the prognosis of a simultaneous multiple liver metastasis from gastric cancer tends to be poor, our multidisciplinary approach resulted in a favorable prognosis.

The need to remove palliative primary tumors in the incurable Stage Ⅳ colorectal cancer patients remains debatable. Here, we describe the case of a 62-year-old man diagnosed with rectal cancer(cT3N2bM1b, cStage Ⅳb)with both primary tumor and metastatic lesions that were unresectable. Systemic chemotherapy was administered with 5-fluorouracil, Leucovorin, and oxaliplatin(FOLFOX)or FOLFOX with bevacizumab(BEV). After 12 months of treatment, CT scan revealed that both the primary tumor and metastases had shrunk significantly, leading to the conclusion that the primary tumor was resectable. Subsequently, laparoscopic abdominoperineal resection was performed. The patient was discharged 21 days postoperatively, and chemotherapy(FOLFOX plus BEV)was reintroduced 24 days after discharge. The patient was alive 25 months after the first consultation. Palliative primary tumor resection involves risks of operative complications and tumor progression owing to the absence of chemotherapy; however, some recent evidence has shown that primary tumor resection was associated with better prognosis and could be a good option on an individual patient basis. Further studies are required to establish the optimal strategy for patients with Stage Ⅳ colorectal cancer.

Thrombocytopenia is a relatively common complication in pregnancy, with a reported frequency of 7%-11%. The causes of this condition are diverse, although the most common etiology is gestational thrombocytopenia (GT) (70%-80%), followed by HELLP syndrome and immune thrombocytopenia (ITP). To investigate the clinical features of thrombocytopenia during pregnancy, we conducted a retrospective analysis of 69 women at our center with 91 pregnancies in which the platelet count was below 100×10 9 /l. There were 38 cases in women with a prior diagnosis of thrombocytopenic diseases such as ITP or an inherited platelet disorder. In the remaining 53 cases, a diagnosis could be made only after delivery. We analyzed the disease course, maternal and perinatal characteristics, platelet count fluctuations, and pregnancy outcomes. The final diagnosis was GT in 38, ITP in 14, and other causes in 1. To distinguish between GT and ITP is not always feasible and can sometimes only be performed based on postpartum changes in the platelet count. In pregnant women with thrombocytopenia, careful follow-up of platelet count fluctuations after delivery is crucial to distinguish ITP from GT.

Tramcet is a mixture of tramadol and acetaminophen. Acetaminophen poisoning may be caused by excessive intake of Tramcet. A 17-year-old female took excessive quantity of Tramcet before noon. She reported it herself in the emergency room. Her main complaint was nausea and dizziness. Acetaminophen may cause liver damage with dose-dependent manner. Because there was a possibility of acetaminophen poisoning, we started oral acetylcysteine. She was discharged from hospital 5 days later without side effects of acetylecysteine and liver damage.

A 28-year-old man complained of pain in the oral mucosa and pharynx in March 2011, and then developed fever and generalized swelling of the cheek. In March 2012, a gum biopsy led to a diagnosis of extranodal natural killer/T-cell lymphoma (ENKL). (18)F-FDG-PET revealed significant uptake in the mouth, tonsils, jawbone, shoulder blade, humerus, ilium, femur, and spleen. After two courses of the SMILE (dexamethasone, methotrexate (MTX), ifosfamide, L-asparaginase, etoposide) regimen, the response was stable disease. However, a high-dose MTX/cytarabine (MA) regimen was effective. After three courses of the MA regimen, a partial response was achieved. Then, allogeneic bone marrow transplantation from an unrelated donor was performed. At 10 months after transplantation, there was no sign of recurrence. Although the optimal treatment for ENKL refractory to the SMILE regimen has yet to be established, our case suggests the MA regimen to be a potentially effective treatment option.

We treated a patient with recurrent ovarian cancer with cancerous peritonitis by weekly paclitaxel (w-TXL) therapy (65 mg/m2). Abdominocentesis was not performed to eliminate ascites, in order to maintain higher quality of life (QOL), and critical adverse reaction was not seen for 12 months. We measured the TXL concentration in blood plasma and ascites after TXL infusion by HPLC method. The TXL titer in plasma was 427 ng/ml after infusion, 23 ng/ml after 24 hours and under 10 ng/ml after 48 hours. The TXL titer in ascites was 41 ng/ml after infusion, 37 ng/ml after 6 hours, 18 ng/ml after 12 hours, 10 ng/ml after 24 hours and under 10 ng/ml after 48 hours. TXL transportation from blood to ascites was good. This result suggested that intravenous infusion of TXL was effective for cancerous peritonitis treatment.

It is well known that neuropathy, myelopathy, and arthropathy are specific adverse effects induced by paclitaxel administration. Parkinson's disease is neural degenerative disease, and the influence of paclitaxel administration on patients with Parkinson's disease is unknown. We have successfully treated an ovarian cancer patient with Parkinson's disease by paclitaxel/CBDCA combined chemotherapy after surgery. The patient was a 57-year-old woman with solid and cystic ovarian tumor. Among the tumor markers CA125, CA19-9, and SLX, only SLX was elevated. We operated and made a pathological diagnosis of the ovarian tumor as clear cell adenocarcinoma (FIGO stage Ic). After surgery, the patient was treated with paclitaxel (260 mg [175 mg/m2]) and CBDCA (600 mg [AUC = 5]) combined chemotherapy for 5 courses. Her status is complete remission. During chemotherapy, she had felt the decreased efficacy of her Parkinson's disease medication. We could continue chemotherapy by increasing the dose of the Parkinson's drug. There is only one case report on the influence of paclitaxel on Parkinson's disease, in which the course was similar to the present case.

Ceftriaxone was used in single intravenously dose of 1 g to treat 20 men with gonorrhoea caused by penicillinase-producing Neisseria gonorrhoeae (PPNG) and non-PPNG. Of 14 patients followed up, 13 (92.9%) were cured. Cure rates for PPNG infections and non-PPNG infections were 100% and 90.9% respectively. No side effect was observed except 1 case of vomiting out of 20 cases. It is concluded that this drug is safe and effective in treating both PPNG and non-PPNG infections.

The serum levels of CA 15-3, Carcinoembryonic antigen (CEA) and SCC-Ag were determined in 30 patients with squamous cell carcinoma of the lung. The patients were classified into 2 groups, a peripheral type and a central type, according to bronchoscopic findings. The obtained results were as follows: serum-CA 15-3 and serum-CEA were significantly elevated in patients with peripheral type, and serum-SCC-Ag was elevated in both types of squamous cell carcinoma.