Adult T-cell leukaemia/lymphoma (ATLL) is a haematological malignancy caused by infection with human T-cell leukaemia virus type 1 (HTLV-1). ATLL arising in the oral and maxillofacial region is extremely rare. We report a rare case of asymptomatic mandibular involvement and present a brief literature review of previously reported oral ATLL cases. A 72-year-old man presented with a cutaneous mass on the thigh. Whole-body 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT), performed for systemic evaluation, revealed intense uptake in the anterior mandibular body, although no intraoral symptoms or swelling were observed. CT demonstrated trabecular bone densification, while MRI showed bone marrow signal alteration with diffusion restriction. Biopsy revealed infiltration of atypical lymphocytes. Immunohistochemistry demonstrated positivity for T-cell markers, and DNA Southern blot analysis confirmed monoclonal integration of HTLV-1, leading to a definitive diagnosis of ATLL. The patient achieved transient complete remission with chemotherapy and electron beam therapy but died 15 months after onset. ATLL involving the jaw is extremely rare and lacks characteristic imaging features. This is the first report of asymptomatic ATLL of the mandible detected during systemic evaluation by 18F-FDG-PET/CT. In the present case, PET/CT contributed to the detection of a clinically occult mandibular lesion, whereas CT and MRI also demonstrated abnormal findings. A review of previously reported oral ATLL cases further supports the rarity of mandibular involvement. 18F-FDG PET/CT is useful as an adjunctive modality for detecting latent mandibular lesions in ATLL, and biopsy is recommended when abnormal uptake is observed, even in asymptomatic cases.
Background: Uniportal thoracoscopic surgery has gained popularity as a minimally invasive approach for anatomical lung resection. While outcomes from high-volume centers have been reported, evidence describing nationwide real-world practice across institutions with varying experience is scarce. This study aimed to evaluate the current status and perioperative outcomes of uniportal thoracoscopic anatomical pulmonary resections in Japan. Methods: We conducted a multicenter retrospective study under the Japanese Uniportal Video-assisted Thoracoscopic Surgery Interest Group. Patients with primary lung cancer who underwent uniportal thoracoscopic lobectomy or segmentectomy in Japan between April 2018 and March 2023 were included. Clinical information was collected from participating institutions, and patient characteristics, operative variables, and perioperative outcomes were evaluated. The primary outcome was the incidence of procedurerelated complications, with secondary outcomes including operative time and other perioperative parameters. Results: A total of 3,546 patients were analyzed, comprising 2,780 lobectomies and 766 segmentectomies. The proportion of segmentectomies gradually increased during the study period. In the lobectomy group, the median operative time was 170 min, with prolonged air leak in 7.6% and significant vessel injury in 3.4%. In the segmentectomy group, the median operative time was 154 min, with prolonged air leak in 4.6% and significant vessel injury in 3.5%. Thirty-day mortality was 0.3% in both groups, and conversion to multiport or thoracotomy occurred in 1.8-3.6% of cases. Conclusions: This nationwide analysis indicates that uniportal thoracoscopic anatomical pulmonary resection is performed safely in Japan, with perioperative outcomes comparable to those reported internationally. Although operative times were slightly longer than those in single-institution series, complication rates remained low, indicating that uniportal thoracoscopic anatomical pulmonary resection is being conducted with acceptable perioperative outcomes in real-world practice.
BACKGROUND:In moyamoya disease, fragile collateral networks such as periventricular anastomoses are associated with an increased risk of hemorrhage, particularly in the posterior circulation. Peripheral aneurysms arising from these vessels are rare, and those involving the artery of Percheron are exceptionally uncommon. OBSERVATIONS:A 55-year-old patient with a history of thalamic hemorrhage presented with headache and impaired consciousness. CT revealed a right thalamic hemorrhage with intraventricular extension and acute hydrocephalus. Emergency ventricular drainage was performed. Subsequent angiography identified a ruptured peripheral aneurysm arising from the artery of Percheron originating from the left P1 segment, along with right-dominant moyamoya vascular architecture. The aneurysm was successfully treated with N-butyl cyanoacrylate embolization to prevent rebleeding. Due to insufficient clearance of intraventricular hematoma, endoscopic evacuation was performed. The patient experienced no rebleeding, and follow-up angiography confirmed durable obliteration of the aneurysm. LESSONS:Peripheral aneurysms arising from the artery of Percheron in moyamoya disease are extremely rare but should be considered in cases of deep hemorrhage with intraventricular extension. Prompt endovascular embolization using liquid embolic agents, combined with endoscopic hematoma evacuation, may provide an effective and minimally invasive treatment strategy. https://thejns.org/doi/10.3171/CASE26356.
Background Primary small intestinal lymphoma (PSIL) is a rare disease, and its clinical characteristics and prognostic factors remain insufficiently defined because of limited large-scale data. Methods We conducted a nationwide multicenter retrospective study of 686 patients diagnosed with PSIL between January 2008 and December 2017 at 44 institutions in Japan. Clinical characteristics, histological subtypes, and overall survival were analyzed. Results B-cell lymphoma was the predominant immunophenotype (n = 623, 91%), whereas T-cell lymphoma was uncommon (n = 50, 7%). Diffuse large B-cell lymphoma (DLBCL) was the most frequent histological subtype (n = 330, 48%), followed by follicular lymphoma (FL) (n = 224, 33%). Compared with other B-cell lymphomas, FL was more common in women and more frequently involved the jejunum (P < 0.001). The 5-year overall survival rate was significantly higher in patients with B-cell lymphoma than in those with T-cell lymphoma (81% vs. 23%, P < 0.001). Multivariate Cox regression analysis identified age > 60 years and T-cell lymphoma as independent adverse prognostic factors, whereas FL was an independent predictor of favorable overall survival. Conclusions This nationwide multicenter analysis delineates the clinicopathological features and survival outcomes of PSIL in Japan. FL represents the second most common subtype after DLBCL and is associated with a favorable prognosis among PSIL subtypes.
Background : Accurate absorbed dose-to-water determination in radiotherapy requires electrometers calibrated by a primary standards laboratory (PSL). Recent studies have suggested that electrometers of the same model may exhibit sufficiently similar sensitivity characteristics to allow the use of a common electrometer calibration coefficient for quality-control purposes. However, the effect of this approach on absorbed dose-to-water uncertainty has not been quantitatively evaluated. Purpose : To evaluate the uncertainty contribution associated with the use of a common electrometer calibration coefficient and to assess its influence on absorbed dose-to-water determination. Methods A multicenter study was conducted involving 12 radiotherapy facilities and 24 combinations of linear accelerators, ionization chambers, and electrometers. All electrometers possessed valid PSL-issued calibration coefficients. Absorbed dose-to-water values were calculated using both the PSL calibration coefficient ( k elec ) and a common electrometer coefficient ( k elec,user ). Dose monitor unit values and uncertainty budgets were compared for 6-MV and 10-MV photon beams. Uncertainty analysis was performed according to the Guide to the Expression of Uncertainty in Measurement (GUM). Results : Only small differences were observed between dose monitor unit values calculated using ( k elec ) and ( k elec,user ). The user-dependent uncertainty increased from 0.17% to 0.23% ( k = 1), corresponding to an increase of approximately 0.06 percentage points. However, this contribution remained substantially smaller than the dominant uncertainty sources in reference dosimetry. Consequently, the combined standard uncertainty and expanded uncertainty of absorbed dose-to-water determination remained unchanged. Conclusion : The uncertainty contribution associated with the common electrometer calibration coefficient was small and had no meaningful influence on the overall uncertainty budget of absorbed dose-to-water determination. These findings support the use of a common coefficient for electrometer sensitivity verification and quality-control applications within a given electrometer type. Although periodic PSL calibration remains essential for maintaining traceability, common-coefficient-based verification may provide a useful complementary approach for routine electrometer quality assurance.
