Here, we present the case of a 74-year-old Japanese man with segmental intestinal necrosis, which developed after treatment with pulsed methylprednisolone for mononeuritis multiplex. The patient was weakly positive fo...Here, we present the case of a 74-year-old Japanese man with segmental intestinal necrosis, which developed after treatment with pulsed methylprednisolone for mononeuritis multiplex. The patient was weakly positive for myeloperoxidase (MPO)-anti-neutrophil cytoplasmic antibody (ANCA). Computed tomography and surgical findings were compatible with nonocclusive mesenteric ischemia (NOMI). He underwent small intestinal resection by emergency surgery and an intestinal fistula was made. Pathologically, necrotizing vasculitis with fibrinoid necrosis was present in medium to small-sized arteries, which was equivalent to Arkin's classification Ⅱ-Ⅳ. Most of the arteries had fibrous intimal thickening, which was considered to obstruct the arteries and thus cause segmental intestinal necrosis. A diagnosis of polyarteritis nodosa (PAN) was made, and intravenous cyclophosphamide pulse therapy was added to the therapeutic regimen. This patient was successfully treated with these multidisciplinary therapies and his stoma was finally closed. This is a very rare and indicative case of PAN weakly positive for MPO-ANCA and clinically mimicking NOMI, which occurred even after treatment with pulsed methylprednisolone.展开更多
Aim:To investigate whether tumor cells in a lymph node(LN)can invade from the marginal sinus into extranodal veins via vessel branches that communicate with intranodal veins and whether this can be a starting point fo...Aim:To investigate whether tumor cells in a lymph node(LN)can invade from the marginal sinus into extranodal veins via vessel branches that communicate with intranodal veins and whether this can be a starting point for hematogenous metastasis at the early stage of LN metastasis.Methods:Vascular and lymphatic networks of LNs in MXH10/Mo-lpr/lpr mice were investigated using three-dimensional micro-computed tomography and histological methods.Flow in the blood vessel networks of LNs was investigated by fluorescence microscopy.Tumor cells were injected into the subiliac LNs of MXH10/Mo-lpr/lpr mice to induce metastasis to the proper axillary LNs.Tumor development in the proper axillary LN was detected using an in vivo bioluminescence imaging system.A two-dimensional image of the proper axillary LN microvasculature was reconstructed using a contrast-enhanced high-frequency ultrasound system.Results:Extranodal veins communicated with intranodal veins via branches that penetrated the capsule,and blood flowed from intranodal veins to extranodal veins.Tumor cells that had metastasized to the marginal sinus invaded these communicating veins to develop hematogenous metastases.Conclusion:Metastatic LNs that would be considered by clinical imaging to be stage N0 can be a starting point for hematogenous metastasis.The study findings highlight the need for the development of novel techniques for the diagnosis and treatment of early-stage LN metastasis,i.e.,when standard diagnostic imaging might incorrectly classify the LN as stage N0.展开更多
文摘Here, we present the case of a 74-year-old Japanese man with segmental intestinal necrosis, which developed after treatment with pulsed methylprednisolone for mononeuritis multiplex. The patient was weakly positive for myeloperoxidase (MPO)-anti-neutrophil cytoplasmic antibody (ANCA). Computed tomography and surgical findings were compatible with nonocclusive mesenteric ischemia (NOMI). He underwent small intestinal resection by emergency surgery and an intestinal fistula was made. Pathologically, necrotizing vasculitis with fibrinoid necrosis was present in medium to small-sized arteries, which was equivalent to Arkin's classification Ⅱ-Ⅳ. Most of the arteries had fibrous intimal thickening, which was considered to obstruct the arteries and thus cause segmental intestinal necrosis. A diagnosis of polyarteritis nodosa (PAN) was made, and intravenous cyclophosphamide pulse therapy was added to the therapeutic regimen. This patient was successfully treated with these multidisciplinary therapies and his stoma was finally closed. This is a very rare and indicative case of PAN weakly positive for MPO-ANCA and clinically mimicking NOMI, which occurred even after treatment with pulsed methylprednisolone.
基金The study was supported by JSPS KAKENHI[17K20077(TK)and 17H00865(TK)].
文摘Aim:To investigate whether tumor cells in a lymph node(LN)can invade from the marginal sinus into extranodal veins via vessel branches that communicate with intranodal veins and whether this can be a starting point for hematogenous metastasis at the early stage of LN metastasis.Methods:Vascular and lymphatic networks of LNs in MXH10/Mo-lpr/lpr mice were investigated using three-dimensional micro-computed tomography and histological methods.Flow in the blood vessel networks of LNs was investigated by fluorescence microscopy.Tumor cells were injected into the subiliac LNs of MXH10/Mo-lpr/lpr mice to induce metastasis to the proper axillary LNs.Tumor development in the proper axillary LN was detected using an in vivo bioluminescence imaging system.A two-dimensional image of the proper axillary LN microvasculature was reconstructed using a contrast-enhanced high-frequency ultrasound system.Results:Extranodal veins communicated with intranodal veins via branches that penetrated the capsule,and blood flowed from intranodal veins to extranodal veins.Tumor cells that had metastasized to the marginal sinus invaded these communicating veins to develop hematogenous metastases.Conclusion:Metastatic LNs that would be considered by clinical imaging to be stage N0 can be a starting point for hematogenous metastasis.The study findings highlight the need for the development of novel techniques for the diagnosis and treatment of early-stage LN metastasis,i.e.,when standard diagnostic imaging might incorrectly classify the LN as stage N0.
