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A 70-year-old woman with rheumatoid arthritis treated with methotrexate (MTX) complained of right arm weakness. On CT and MRI, tumors were found in the right frontal lobe, bilateral lungs, and left renal parenchyma. She was diagnosed as having lymphomatoid granulomatosis (LYG) grade 2 on thoracoscopic biopsy of the left lung. We discontinued MTX and treated a mass lesion in the right frontal lobe with stereotactic radiotherapy. As a result, the tumors showed a gradual reduction in size, and the patient achieved complete remission. LYG is a rare lymphoproliferative disorder, and has various clinical characteristics. We describe herein a patient with LYG grade 2 with cerebral, pulmonary, and renal lesions, who has maintained a complete remission for six months, to date, after treatment.

A 76-year-old woman presented with vaginal bleeding and discharge in September 2009. She was admitted to our hospital because a tumor of 5 cm in diameter was found in the vagina in a nearby clinic. She was diagnosed with primary vaginal diffuse large B-cell lymphoma (DLBCL) on biopsy of the tumor because CT, MRI and FDG-PET showed no area of lymphomatous involvement other than the vagina and direct involvement into the bladder. She achieved complete response (CR) after chemotherapy followed by localized radiation therapy, but she had a relapse in the central nervous system (CNS) two months after CR. A study of 57 reported cases of primary vaginal lymphoma suggested that the most common histologic type was DLBCL, and most of patients were in a localized stage and responded well to combination of chemotherapy and radiation therapy. To date, two cases of primary vaginal lymphoma with a relapse in the CNS have been reported. We presumed that direct involvement into the bladder of vaginal lymphoma contributed to the relapse in the CNS in this case.

A 44-year-old man was referred to Hakodate Chuo Hospital because of progressive fatigue in April 2001, and was diagnosed as having adult T-cell leukemia (ATL; acute type). Complete remission was not obtained even with the application of multiple anti-leukemic agents including CHOP-V-MMV. The patient received an allogeneic bone marrow transplant from his HLA-identical, HTLV-I antibody-negative sibling donor in June 2002. The conditioning regimen consisted of cyclophosphamide, etoposide and total body irradiation. Cyclosporine A and a short course of methotrexate were given as prophylaxis for graft-versus-host disease (GVHD). Engraftment was achieved on day 16, while ATL cells were detected in the peripheral blood throughout the transplantation. ATL cells were also detected in bone marrow on day 20. Withdrawal of the immunosuppressant induced the eradication of the residual ATL cells in the peripheral blood on day 24 and in the bone marrow on day 40. Grade III of acute GVHD developed in the bowel on day 40, which lasted for over 5 months and was gradually resolved by administration of prednisolone and tacrolimus. The patient remains in complete remission 23 months after the transplantation. The clinical consequence of our case clearly shows that a graft-versus-leukemia (GVL) effect combined with graft-versus-host disease (GVHD) plays a curative role even in an early phase after bone marrow transplantation for patients with adult T-cell leukemia.

A 60-year-old woman was admitted to our hospital to receive treatment for relapse of biphenotypic leukemia 4 years after her initial presentation. Bone marrow examination revealed 53.5% lymphoblasts, which were classified as ALL-L2 with a normal karyotype. Lymphoblast surface markers were positive for cells of both B-cell and myeloid lineage. Immunoglobulin heavy chain and T-cell receptor gene rearrangements were investigated with PCR. Clonal rearrangement of TCR delta V delta 2-D delta 3 was detected. The same clonal rearrangement of TCR delta was found using frozen initial leukemic cells. Rather than secondary leukemia, the patient's leukemia was confirmed as relapse of the initial clone. Detection of the clonal rearrangement was also useful as a patient-specific marker for minimal residual disease.