Silicone lymphadenopathy with concomitant malignant lymphoma

Six cases of axillary lymphadenopathy induced by silicone elastomer following silastic finger joint arthroplasty have been reported; 2 cases had associated malignant lymphoma. This is the 3rd reported case of malignant lymphoma with concomitant silicone lymphadenopathy discovered 8 years after insertion of silastic finger joint arthroplasty for longstanding rheumatoid arthritis. Histology revealed a partially replaced reactive lymph node with immunoblastic lymphoma. Both sides contained single and clusters of multinucleated giant cells with silastic particles, as well as formed asteroid bodies. Malignant lymphoma is associated with rheumatoid disease, but to date, silicone particles have not been linked to malignant lymphoma.     

A case of multiple esophageal carcinomas concomitant with achalasia

A 51-year-old man had been diagnosed with esophageal achalasia 26 years previously; however, regular medical examination was not performed. He presented to the hospital for severe back pain and increased dysphagia during the past 7 months. Endoscopic examination showed the presence of multiple primary carcinoma of the esophagus with achalasia. An esophagogram showed sigmoid-type achalasia with grade III dilatation. Subtotal esophagectomy with mediastinal and abdominal lymphadenectomy was performed. Histopathological examination showed three squamous cell carcinomas at pStage IVB, including pT3 and pM1b. Furthermore, all the three lesions located in the large, slightly iodine-stained area showed hyperplasia with inflammatory cells. Although adjuvant chemotherapy was administered, the patient died of recurrence on the right chest wall and in the stomach, liver, and left iliac bone at 23 months after operation. A patient with esophageal achalasia should be carefully followed up by endoscopy with iodine staining.     

A case of hemophagocytic syndrome with multiple myeloma]

A case with multiple myeloma complicated with hemophagocytic syndrome (HS) is presented. Because pancytopenia, liver dysfunction and increase of mature histiocytes in the bone marrow appeared rapidly a diagnosis of HS was made. The patient died of multiple organ failure, despite steroid therapy. Autopsy revealed marked invasion of hemophagocytic histiocytes not only into the bone marrow but also into many other organs such as the liver, lymph nodes and kidneys. HS is a histiocyte proliferative disorders, which is likely to be seen in immunocompromised hosts, but there is no previous report about HS and multiple myeloma.     

Hyaline-vascular type Castleman's disease with concomitant malignant B-cell lymphoma.

This case report describes a patient with localized hyaline-vascular (H-V) type Castleman's disease with concomitant malignant B-cell lymphoma. Malignant lymphoma has been described in association with multicentric type Castleman's disease, but not in association with the localized H-V type. Evidence for a relation between the two lesions in this patient by means of histologic, flow-cytometric, cytogenetic and gene rearrangement studies was not found.     

A multiple myeloma case presenting with bilateral pleural involvement

Pleural effusion is a relatively infrequent finding in multiple myeloma (MM) and malign effusions due to myelomatous effusion is seen very rarely. In this article we reported a case with bilateral myelomatous effusion. Myelomatous etiology was detected by demonstrating gammopathy in pleural fluid protein electrophoresis and demonstrating abundant number of atypical plasma cells in pleural fluid cytology. Pleural fluids due to MM are usually seen in IgA type of MM's, IgG on the surface of CD-138 positive cell was demonstrated in flow cytometric study of the pleural fluid of the reported case. In conclusion we mentioned that a patient who does not have diagnosis of MM before may present with pleural involvement, the involvement may be bilateral and flow cytometry can be used in diagnosis.     

A case of bone marrow mastocytosis associated with multiple myeloma

 Mastocytosis is a term used for a spectrum of disorders characterized by abnormal growth and accumulation of mast cells. The cutaneous variants of the disease have to be distinguished from systemic mastocytosis (SM), in which at least one extracutaneous organ is involved. In contrast to cutaneous mastocytosis, SM is often associated with another hematologic neoplasm. In most cases clonal myeloid malignancies such as a myeloproliferative or myelodysplastic syndrome occur. In a few cases of SM, however, clonal lymphoid disorders have been described. We here report on a case of SM associated with multiple myeloma. At first presentation, the 48-year old female patient showed monoclonal IgGλ gammopathy and bone marrow (BM) mastocytosis, but no BM plasma cell infiltrates. Eight years later, the patient presented with BM mastocytosis and overt multiple myeloma. The co-existence of myeloma and mastocytosis was demonstrable by staining serial BM sections with antibodies against mast cell tryptase, CD68R, and the plasma cell marker VS38c. Interphase FISH analysis of BM sections revealed a numeric gain of chromosome 5 and chromosome 7 in the plasma cells but not in the mast cell infiltrates, thereby confirming the presence of two different neoplastic cell populations. To our knowledge, this is the first report describing the co-existence of multiple myeloma and mastocytosis.     

A rare case of multiple myeloma initially presenting with pseudoachalasia

Pseudoachalasia is a rare clinical entity with clinical, radiographic, and manometric features often indistinguishable from achalasia. Primary adenocarcinomas arising at the gastroesophageal junction or a tumor of the distal esophagus are the most frequent causes of pseudoachalasia. Rarely, processes other than esophagogastric cancers including chronic idiopathic intestinal pseudo-obstruction, amyloidosis, sarcoidosis, Chagas' disease, vagotomy, antireflux surgery, pancreatic pseudocysts, von Recklinghausen's neuroinomatosis, gastrointestinal stromal tumor, and other malignancies and rare genetic syndromes, may lead to the development of pseudoachalasia. Secondary achalasia is extremely rare, with less than 100 cases reported in the literature so far. Gastrointestinal manifestations in primary or secondary amyloidosis include abdominal pain, diarrhea, constipation, malabsorption, obstruction, motility disturbance, intestinal infarction, perforation, and hemorrhage; however, gastrointestinal tract involvement is asymptomatic in most instances. We present here a rare case of multiple myeloma initially presenting with dysphagia because of esophageal amyloidosis and manometric findings typical of achalasia.     

伴mott细胞增多非分泌型多发性骨髓瘤1例

病例:女,64岁。因反复右背疼痛1年,加重伴右肩痛20d于2006年8月入院。患者于入院前1年无明显诱因感右背疼痛,活动后加剧,症状反复发作,20d前加重伴右肩疼痛,手臂不能上举,药物治疗效果不明显,疼痛不向手臂及