Internal medicine
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An 80-year-old woman presented with a 30-mm protruding lesion-like submucosal tumor with a central depression located at the anterior wall of the upper gastric body. The depressed area had a well-demarcated margin, while the other area was covered by a non-neoplastic mucosa. A biopsy specimen revealed neuroendocrine carcinoma. ⋯ In addition, a hypoechoic zone was observed on the margin of the mass. Distal gastrectomy was performed. The final diagnosis was a mixed neuroendocrine-non-neuroendocrine neoplasm arising from the heterotopic gastric gland.
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The relationship between anti-neutrophil cytoplasmic antibody (ANCA) titer levels and relapse risk in patients with ANCA-associated vasculitis (AAV) following clinical remission remains controversial. We herein report a case showing ectopic relapse of AAV in the pituitary with no ANCA elevation after renal remission. Magnetic resonance imaging revealed an enlarged pituitary gland. ⋯ We diagnosed this case as relapse of AAV in the pituitary. One month after rituximab therapy, the pituitary gland volume had decreased. The intensification of therapy due to the possibility of vasculitis relapse may facilitate better control of AAV.
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A 77-year-old woman was admitted to our hospital with severe ongoing chest pain. Electrocardiography showed ST-segment elevation in the inferior leads and tall R waves in leads V1-2. Posterior-inferior myocardial infarction was diagnosed. ⋯ She underwent percutaneous coronary intervention (PCI). Despite difficulty navigating the long and tortuous LAD, we successfully performed reperfusion of the wrap-around LAD. CAG post-PCI showed the posterior descending artery arising from the LAD, described as hyperdominant LAD.