Primary malignant mediastinal germ cell tumors (GCTs) are rare pediatric tumors that have a poorer prognosis than GCTs occurring elsewhere in the body. Due to their rarity and aggressiveness, they are often locally advanced and unresectable at diagnosis, and currently, there is no standard optimal treatment approach. Herein, we present a rare case of pediatric anterior mediastinal yolk sac tumor (YST) diagnosed as pathological complete response (CR) to chemotherapy but prematurely required pulmonary metastasectomy of mixed GCT consisting of seminoma and YST. Testicular GCTs can relapse as tumors of subtypes that are pathologically different from the primary tumor, each having distinct pathogenesis, treatment modality, and prognosis; however, this phenomenon is seldom reported in mediastinal GCTs. This report reviewed the discordance of histological composition between primary and metastatic tumors. When treating mediastinal nonseminomatous GCTs, the possibility of early recurrence should be considered, even if the primary tumor is completely resected and diagnosed as pathological CR to chemotherapy.
OBJECTIVE:A common cause of shoulder joint pain in this population is subacromial impingement, often associated with increased thoracic kyphosis. However, the association between thoracic kyphosis angle and shoulder joint pain in competitive swimmers remains uncertain. The aim of this study was to investigate factors associated with shoulder joint pain in male competitive swimmers, considering both previously reported variables and the thoracic kyphosis angle. DESIGN:Cross-sectional observational study. SETTING:Poolside at the participants' school. PARTICIPANTS:A total of 64 male university and adult swimmers participated. INDEPENDENT VARIABLES:Participants were divided into Group P (with shoulder joint pain) and Group N (without shoulder joint pain). MAIN OUTCOME MEASURES:Measurements included external and internal rotation range of motion (ROM) at 90 degrees shoulder abduction (Abd90°ER and Abd90°IR), internal rotation ROM at 90 degrees shoulder flexion (Flex90°IR), scapular dyskinesis (SD) test, shoulder rotation width, lumbar locked rotation, and thoracic kyphosis angle. The significance level was set at <5%. RESULTS:Four variables exhibited significant differences between groups: Abd90°IR (median, 95% confidence interval [CI]): Group P, 66.0 degrees [57.7 degrees-68.5 degrees] versus Group N, 76.0 degrees [69.5 degrees-78.0 degrees]; Flex90°IR (median [95% CI]): Group P, 16.0 degrees [8.4 degrees-17.0 degrees] versus Group N, 25.0 degrees [23.1 degrees-27.1 degrees]; thoracic kyphosis angle (median [95% CI]): Group P, 23.1 degrees [20.4 degrees-25.9 degrees] versus Group N, 19.4 degrees [17.6 degrees-21.1 degrees]; and SD (positive test result in 15 of 27 patients in Group P vs 11 of 37 in Group N). CONCLUSIONS:Shoulder joint pain in competitive swimmers may be associated with an increased thoracic kyphosis angle during upper limb elevation, SD, and reduced shoulder ROM.
Treatment selection for patients with polycythemia vera (PV) is based on patient age and history of thrombosis. The standard treatment is low-dose aspirin and phlebotomy, with cytoreductive therapy added for high-risk PV. Clinical trials in patients with PV have shown that ropeginterferon alfa-2b (ropeg-IFN) treatment is safe, efficacious, and reduces JAK2 V617F allele burden. As PV mainly affects individuals aged 60 years and older, incidence estimates have been increasing. Here we report 3 cases of elderly patients treated with ropeg-IFN who experienced no serious adverse events. All 3 patients achieved and maintained complete hematologic response with reduced JAK2 V617F allele burden. Ropeg-IFN is an effective and safe therapy for elderly patients with PV that also improves quality of life.
A 62-year-old man presented with neurological symptoms, and head computed tomography revealed multiple brain metastases. Subsequent evaluation identified a 30-mm Type 2 ulcerative lesion in the lower gastric body, diagnosed as moderately differentiated tubular adenocarcinoma. In addition, numerous small, patchy white lesions with a large "white globe appearance (WGA)-like" appearance were observed endoscopically throughout the stomach. Histological analysis confirmed lymphatic invasion of adenocarcinoma in these areas. These findings suggest that a large WGA-like appearance may reflect lymphatic dissemination and could serve as endoscopic markers for evaluating tumor invasion depth and metastatic potential in gastric cancer.
The sequential occurrence of two or more types of lymphomas is rare, particularly when they involve different cell lineages. We herein report a rare case of the sequential development of T-cell lymphoproliferative disorder (LPD) after treatment with rituximab for follicular lymphoma (FL). Although the efficacy and safety of rituximab have been established, the immunosuppressive effects of rituximab-containing therapy and the development of iatrogenic LPD/lymphoma, which is typically related to Epstein-Barr virus (EBV), need to be considered. EBV may infect T lymphocytes and manifest as hemophagocytic lymphohistiocytosis (HLH). Disease progression from HLH to clonal T-cell LPD has been reported in a high percentage of HLH patients. We herein report the clinical effects of HLH-2004 and CHOP in an elderly patient who developed EBV-positive T-cell LPD with HLH after treatment with rituximab for FL. An awareness of its clinical symptoms, bone marrow examination, and monitoring of the EBV load may help to discriminate EBV-positive T-cell LPD from the recurrence of FL or histologic transformation, and facilitate the timely initiation of life-saving therapies.
