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Introduction: Laparoscopic cholecystectomy is a standard procedure for treating cholescytitis, but severe inflammation may cause complications. Our previous study showed that the apparent diffusion coefficient (ADC) values could predict difficult surgery. In the present study, relevance of ADC values in grading the severity of cholecystitis was pathologically investigated. Methods: We retrospectively analyzed a total of 50 patients who underwent laparoscopic cholecystectomy or laparotomic cholecystectomy/choledocholithotomy. The degree of inflammation in the neck of the gall bladder was pathologically graded into three tiers (grade 1, mild; grade 2, moderate; grade 3, severe), and ulceration, lymphoid follicle formation, and wall thickness of the gallbladder neck were recorded. All factors were statistically compared with the measured ADC values. Results: The ADC value was significantly lower in the severe inflammation group (grade 3) than in the weak inflammation group (grades 1 and 2) (1.93 ± 0.22 vs 2.38 ± 0.67, respectively; P =.02). Ulceration and wall thickness in the gallbladder neck were significantly correlated with ADC values (P =.04 and.006, respectively), and lymphoid follicle formation was marginally correlated with ADC values (P =.06). The diagnostic utility of the ADC values decreased as the interval between imaging and cholecystectomy increased. [Correction added on 19 October 2022, after first online publication: [On the first sentence of the Results section, (grades 2 and 3) for weak inflammation group has been changed to (grades 1 and 2).] Conclusion: ADC values were inversely associated with the pathologic intensity of cholecystitis. We recommend that the ADC value be measured before surgery, so that the procedure can be accordingly planned. [ABSTRACT FROM AUTHOR]

A case of so-called inflammatory pseudotumor (IPT), occurring in the spleen of a 77-year-old woman, is reported. The spleen contained a well-circumscribed mass with central hemorrhage and necrosis. Histologically, spindle cells were dispersed in a background of abundant inflammatory cells, predominantly lymphocytes and plasma cells. The cells possessed enlarged, sometimes twisted or irregularly folded, nuclei that contained vesicular chromatin, and small but distinct, centrally located nucleoli. Immunohistochemically, the spindle cells were diffusely positive for vimentin, and focally positive for follicular dendritic cell (FDC) markers (Ber-MAC-DRC for CD35 and CNA.42). The Epstein–Barr virus (EBV) was exclusively detected in the spindle cells by in situ hybridization analysis. The cells also expressed the latent membrane protein-1 (LMP-1) of EBV, and polymerase chain reaction (PCR) analysis revealed that the LMP-1 gene had a 30-bp deletion and three point mutations, although their significance remains controversial. Inflammatory pseudotumor is a descriptive term that encompasses several different entities, and recent investigations have revealed the existence of neoplastic entities among IPT. One of the neoplastic IPT, recently designated ‘IPT-like FDC tumor’, is characterized by proliferation of EBV-positive FDC and commonly occurs in the liver and spleen. Because such tumors are capable of recurrence and metastasis, it is important to consider the possibility of an IPT-like FDC tumor when making a diagnosis of a hepatic/splenic IPT-like lesion. [ABSTRACT FROM AUTHOR]

A 74-year-old man with malignant pleural effusion due to recurrent gastric cancer underwent a failed pleurodesis. He subsequently underwent subcutaneous implantable pleural port implantation surgery followed by outpatient chemotherapy for 1 month. His disease progressed and he was unable to go to the hospital. He requested home care, so a nurse practitioner visited his home and drained the pleural effusion from the subcutaneous implantable pleural port. About 3 weeks after starting home care, he died at home. Pleurodesis is a common treatment for malignant pleural effusion; however, if a patient does not respond, long-term hospitalization is required due to manage port drainage. The subcutaneous implantable pleural port may aid provision of effective home care.

We report the case of a 47-year-old woman with Stage VI gastric cancer accompanied by p2 grade dissemination which responded to chemotherapy using TS-1. Treatment of the patient with daily oral administration of 80 mg TS-1 for 2 cycles resulted in partial regression in the size of the primary lesion. Side effects were only seen after administration of 1 month, as mild pigmentation easily controlled by white vaseline ointment. After 6 cycles of administration, the effect on the gastric mucosal lesion decreased, and the wall thickness and stenosis of the antrum were increased. The patient has been administered 10 cycles of chemotherapy with no myelosupression, and maintains a good quality of life.