Accurate clinical staging is important in diffuse large B-cell lymphoma (DLBCL) to adapt to optimal therapy. Splenic involvement of DLBCL has been recently more detectable with the advancement of a diagnostic scan by 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT). Our clinical question is whether splenic involvement was adequately diagnosed by FDG-PET/CT imaging. This retrospective study aimed to determine the optimal index for evaluating splenic involvement in patients with DLBCL. Patients with newly diagnosed DLBCL who were examined with FDG-PET/CT at diagnosis and the end of induction chemotherapy (EOI) was enrolled. The splenic involvement with the splenic FDG uptake value higher than that of the liver at diagnosis or with the decrease of splenic uptake at EOI by visual evaluation was evaluated as positive. The calculative evaluation of splenic involvement, based on the data of standardized uptake value (SUV) of the spleen, used maximum SUV (SUVmax), mean SUV (SUVmean), spleen total lesion glycolysis (spleen TLG), and spleen length. A change in each index following induction chemotherapy was expressed as an index. Receiver operating characteristic analysis was used to set the cutoff value for each index. This study included 52 patients. Spleen TLG (0.904) showed the best accuracy, followed by SUVmax (0.885) and SUVmean (0.885), among the 5 indexes for splenic involvement at diagnosis. Splenic involvement was predicted with a higher accuracy level (0.923) when selecting the cases with values higher than the cutoff level on both spleen TLG and SUVmax. The decision at EOI was more suitable by selecting both positive cases of ∆ TLG and ∆ SUVmax. Obtaining both the positive spleen TLG and SUVmax is recommended at diagnosis to predict splenic involvement. The assessment by ∆ spleen TLG and ∆ SUVmax seems to be optimal.

We herein report a unique case of aortic rupture due to co-localization of aortic intimal myofibroblastic sarcoma (IMFS) and urothelial carcinoma (UC). A 76-year-old man who was being followed up after surgery for UC 5 years earlier developed aortic rupture and underwent emergency surgery. Intraoperatively, a tumorous mass on the luminal side of the aortic arch was found near the rupture. A histopathological analysis of the mass revealed aortic IMFS. Furthermore, co-localization of IMFS and UC cells was found near the rupture. The fragility of the aortic wall due to co-localization of IMFS and UC was believed to contribute to the aortic rupture.

魚骨により消化管穿孔をきたすことがあると知られているが，魚骨の迷入により肝膿瘍をきたした症例は稀である．症例は，74歳の男性．発熱，呼吸苦を主訴に救急受診した．2週間前に魚骨を飲み込んだ自覚があった．腹部CT検査，腹部超音波検査で肝内に魚骨を疑う異物および肝膿瘍を認めた．ショックを伴う全身状態の悪化を認めたため，緊急で経皮的膿瘍ドレナージ術を施行した．翌日に開腹肝内異物除去術，膿瘍ドレナージ術を施行した．術中超音波検査で膿瘍内に音響陰影を伴う線状高エコーを認めた．膿瘍ドレナージを行ったところ，肝内に完全に埋没した魚骨を認め，摘出した．消化管の穿孔・穿通部位は明らかではなかった．術後21日目に軽快退院した．魚骨の迷入により肝膿瘍をきたした稀な症例を経験した．保存的加療やPTADのみでは再燃・増悪例も報告されており，全身状態が安定した状態で，可及的速やかに魚骨の除去を検討すべきである．