Search

Human T-cell leukemia virus type I (HTLV-1) infection and adult T-cell leukemia-lymphoma (ATL) have been shown to cause immunodeficiency. However, only a few cases have been reported on the development of Epstein-Barr virus positive-diffuse large B-cell lymphoma (EBV-DLBCL) in HTLV-1 carriers or in patients with ATL. Here we report a case of a female HTLV-1 carrier who developed cytomegalovirus (CMV) retinitis. During the CMV retinitis treatment, she developed a liver tumor. The diagnosis of composite ATL and EBV-DLBCL was made by tumor biopsy. The patient also suffered from pulmonary cryptococcosis and invasive pulmonary aspergillosis at the time of chemotherapy initiation. She had repeated CMV antigenemia and bacterial sepsis during the course of chemotherapy, and she died of bacterial sepsis. HTLV-1 carriers who are complicated with opportunistic infections should be carefully observed not only for ATL development but also for the development of EBV-DLBCL and associated infectious complications.

A 70-year-old man was given a diagnosis of advanced type 3 gastric cancer and underwent surgery. In addition to total gastrectomy and D2 lymph node resection, partial liver resection was performed due to detection of a solitary liver metastasis which was initially overlooked on preoperative CT. Histopathologically, the tumor was diagnosed as gastric adenosquamous carcinoma (Int, INFβ, pT2 (ss), H1, ly1, v2 (mp), EVG, n (-), pPM (-), pDM (-)). Three metastasic lesions appeared in the liver on abdominal CT scan performed 3 months after the operation. The patient underwent adjuvant chemotherapy with S-1. Since enlargement of the liver metastases was observed following 2 courses of treatment, the patient received combination chemotherapy of irinotecan and cisplatin. Of 3 metastatic lesions, 1 disappeared and 2 decreased to less than 2 cm in diameter after 8 courses of 2nd line treatment. Radiofrequency ablation (RFA) was successfully performed to treat the remaining liver metastases. The patient has been free of recurrence for 41 months.

We report a case of sclerosing cholangitis caused by oral chemotherapy with S-1. A 79-year-old woman with a history of hypertension presented with epigastric discomfort. Upper gastrointestinal endoscopy revealed advanced gastric cancer in the gastric antrum and abdominal computed tomography showed multiple lymph node metastasis. The patient underwent chemotherapy with S-1. Since 2 months later, blood chemistry analysis showed liver dysfunction and hyperbilirubinemia, and chemotherapy was discontinued. Endoscopic retrograde cholangiopancreatography revealed stenosis of the bile duct at the hepatic hilum. There was no evidence of tumor in the liver. We diagnosed chemotherapy-induced sclerosing cholangitis (CISC) caused by S-1. Although treatment with ursodeoxycholic acid and corticosteroids was temporarily effective, she eventually died of CISC and gastric cancer. To the best of our knowledge, this is the first case report of CISC caused by S-1. We present this rare condition with a review of the literature.