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Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been reported to be useful not only for the diagnosis of lymph node metastasis of lung cancer but also for benign diseases. We retrospectively analyzed the results of patients with tuberculous lymphadenitis (TL) who had undergone EBUS-TBNA between November 2010 and January 2016. EBUS-TBNA was performed in 427 cases during that period. Six cases were finally diagnosed as TL. The punctured lymph node was 8 lesions. Pathological findings consistent with TL were obtained in all 6 cases (100%), and the tissue specimens were positive in Ziehl-Neelsen staining in 3 of the 6 cases (50%). In all 6 cases, the acid-fast bacteria (AFB) smear test of the needle rinse fluid was negative, 2 cases were positive for AFB culture (33.3%), and 2 cases were positive for Mycobacterium tuberculosis (MTB)-PCR test (33.3%). In this study, the positive rate of mycobacterial culture and the MTB-PCR test of the needle rinse fluid was low, though the concordance rate of pathological findings with TL was high (100%). The results suggest that EBUS-TBNA should be carefully evaluated in patients with TL, considering the low positive rate of mycobacterial culture and MTB-PCR test in the needle rinse fluid.

Autologous peripheral blood stem cell transplantation (auto-PBSCT) is considered the standard therapy for younger patients with multiple myeloma, however, survival curve doesn't reach plateau. On the other hand, allogeneic reduced-intensity stem cell transplantation (RIST) with graft-versus-myeloma (GVM) effects is expected to be the curable therapy. We had three cases received RIST (one case as a salvage therapy for relapse after tandem auto-PBSCT, and two cases as an intentional RIST after achieving partial response by auto-PBSCT). All of three cases relapsing or progressing after RIST showed disease type of plasmacytoma without plasma cells in the bone marrow. That may be because conditioning regimen doesn't include total body irradiation, or GVM is ineffective in plasmacytoma, but effective in bone marrow. Here, we report clinical course of these three cases with some consideration.

A 50-year-old man noticed a mass in the right cervical region and presented to our hospital. He underwent biopsy of a cervical lymph node, which revealed non-Hodgkin's lymphoma (diffuse large B cell, lymphoblastic type) histologically. He was treated with chemotherapy (CHOP) and radiation, and achieved complete remission. Two months later, he was admitted because of distal pain and extensive numbness of the lower limb as well as weakness of the left leg. Lumbar MRI showed an area of abnormal intensity in the cauda equina. Cytological examination of cerebrospinal fluid showed class V (lymphoma cells), so he was diagnosed as having recurrent malignant lymphoma of the spinal cord. He was treated with intrathecal chemotherapy and irradiation. After the treatment the mass in the cauda equina disappeared and the neurological symptoms in his legs resolved. It is rare for malignant lymphoma to recur in the spinal cord, particularly the cauda equina. It is well known that cauda equina syndrome can be caused by vertebral lesions and primary spinal cord tumors, but it is also necessary to keep malignant lymphoma of the cauda equina in mind.

A 72-year-old female patient, hospitalized for parkinsonism, suffered cardiopulmonary arrest without any certain causes. The patient was successfully resuscitated and her life was sustained by artificial ventilator for 100 days. All brainstem reflexes were absent, and flat electroencephalogram and no response of brainstem auditory evoked potentials were confirmed twice with an interval of over 6 hours. Flexion of the arm induced reflex rectus abdominis muscle contraction, resembling expiratory movement. Muscle stretch reflexes on rectus abdominis were hyperactive. The expiration-like movement appeared in an apnea test seven minutes after a cessation of artificial ventilation. Electrical stimuli on femoral nerve induced complex action potentials with a 70.2 +/- 6.9 msec latency and 300 msec duration in rectus abdominis muscle, which were similar to the spino-bulbo-spinal reflex. Single photon emission tomography showed only slight cerebral cortical blood flow. The expiration-like movements observed in this case suggest a relationship not only with the spinal cord reflex but also with polysynaptic reflexes to reticular formation in the medulla oblongata.

Magnetic resonance imaging (MRI) is useful for detecting spinal cord lesions in multiple sclerosis (MS). In this study, we have examined MRI for 14 patients (26 cases) with clinically definite MS and investigated the correlations between neurological and MRI findings before and after high-dose corticosteroid therapy (pulse therapy). High signal intensity areas on T2-weighted images (T2WI) were found in 25 of 26 cases. In 22 cases spinal level of clinically suspected lesions were involved in these high intensity areas. T1-weighted images (T1WI) after intravenous gadolinium with diethylenetriamine pentaacetic acid (Gd-DTPA) were also obtained and in 12 of 17 cases before pulse therapy, the symptoms and enhancement of lesions correlated well. The symptoms regressed in all cases after pulse therapy, and high-intensity areas in T2WI became less distinct. Gd-DTPA enhanced areas disappeared in 6 cases and became smaller in 3 of 12 cases. Additional pulse therapy in 3 cases effectively diminished the enhanced areas in these cases. In one patient who had repeated pulse therapy, MRI showed no enhancement. In two other patients who continued on decreased steroid dose had relapses, pulse therapy was therefore started again, providing a good recovery both clinically and radiologically. The changes of MRI findings and clinical course suggest that the pathological changes in spinal MS may be caused not only by demyelination but also by parenchymal edema. Clinical and MRI concordance was significantly better with Gd-DTPA enhanced T1WI than the high-intensity areas in T2WI. Contrast enhancement gives more information about disease activity and the reaction to therapy.