Internal medicine
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Hepatic undifferentiated pleomorphic sarcoma (UPS) is a rare malignant mesenchymal tumor with unclear cancer-related genetic mutations. In a 60-year-old Japanese woman with a rapidly growing, inoperable hepatic UPS, a genetic mutation analysis revealed KRAS and TP53 mutations. Despite initiating hepatic arterial infusion chemotherapy, the tumor continued to grow, and the patient's poor performance status complicated the transition to a phase I KRAS mutation drug trial, leading to death eight months after the symptom onset. A timely genetic mutation analysis may facilitate effective treatment transitions in hepatic UPS despite the lack of established treatments.
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We herein report a rare case of duodenal adenocarcinoma with a rapidly progressive course. Esophagogastroduodenoscopy revealed Brunner's gland hyperplasia in the bulbs of the duodenum three years prior to this presentation. Two years earlier, gastric foveolar metaplasia had been observed in the bulbs. ⋯ At this time, the lesion had markedly increased in size, and the duodenum was circumferentially stenotic due to the mass. Pathologically, he was diagnosed with duodenal adenocarcinoma with a gastric-dominant immunophenotype and he died two months later. Although extremely rare, we should keep in mind that duodenal tumors with a gastric phenotype may sometimes progress rapidly within a short period of time.
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Helicobacter pylori eradication is effective for the regression of gastric hyperplastic polyps (GHPs). We report a case which demonstrated an enlargement of GHPs after H. pylori eradication. ⋯ Gastric colonization with Helicobacter heilmannii s.s. was observed after H. pylori eradication, thus suggesting the involvement of non-H. pylori Helicobacter species (NHPHs) infection for the enlargement of GHPs, in addition to the proliferative effects of PPI use on the gastric epithelium. Screening for NHPHs may be necessary in dog lovers to avoid paradoxical responses to H. pylori eradication.
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We herein report a case of IgG4-related autoimmune hepatitis (AIH) in a patient with a history of type 1 autoimmune pancreatitis. A 56-year-old man presented with fatigue and jaundice at our hospital. ⋯ Based on the diagnosis of IgG4-related AIH, prednisolone treatment was initiated, which led to the rapid resolution of liver dysfunction and jaundice. An accurate diagnosis of IgG4-related AIH is crucial to prevent secondary manifestations.