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Ampullary Neuroendocrine Carcinoma Presenting with Clinically Confirmed Endogenous Hyperinsulinemic Hypoglycemia. 壶腹神经内分泌癌表现为临床证实的内源性高胰岛素性低血糖。
IF 1.1
Internal medicine (Tokyo, Japan) Pub Date : 2026-10-15 DOI: 10.2169/internalmedicine.7605-26
Mika Ito, Eiki Ishisaka, Yoshiro Kashii, Yuno Goto, Yukimatsu Yoshio, Waka Sakai, Tomoki Kameyama, Masakiyo Sasahara, Tomoko Norose, Nobuyuki Ohike
{"title":"Ampullary Neuroendocrine Carcinoma Presenting with Clinically Confirmed Endogenous Hyperinsulinemic Hypoglycemia.","authors":"Mika Ito, Eiki Ishisaka, Yoshiro Kashii, Yuno Goto, Yukimatsu Yoshio, Waka Sakai, Tomoki Kameyama, Masakiyo Sasahara, Tomoko Norose, Nobuyuki Ohike","doi":"10.2169/internalmedicine.7605-26","DOIUrl":"https://doi.org/10.2169/internalmedicine.7605-26","url":null,"abstract":"<p><p>A 65-year-old man without diabetes presented with fasting hypoglycemia. During a fasting test, plasma glucose decreased to 46 mg/dL with inappropriately elevated insulin (11.1 μU/mL) and C-peptide (8.7 ng/mL) levels, confirming endogenous hyperinsulinemic hypoglycemia. Imaging revealed a tumor of the ampulla of Vater with multiple liver metastases but no pancreatic lesions. An endoscopic biopsy revealed poorly differentiated small cell-type NEC with a Ki-67 index >90% and complete loss of RB1 expression. Despite negative insulin immunostaining, dynamic endocrine testing confirmed endogenous hyperinsulinemic hypoglycemia. These findings were clinically consistent with ectopic insulin secretion from the NEC, although pathological confirmation was not obtained in this case. This case highlights the importance of integrating physiological, radiological, and pathological findings when evaluating suspected ectopic insulin secretion.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Facial Plethora: An Overlooked Clue to Superior Vena Cava Syndrome. 面部过多：上腔静脉综合征的一个被忽视的线索。
IF 1.1
Internal medicine (Tokyo, Japan) Pub Date : 2026-10-15 DOI: 10.2169/internalmedicine.7640-26
Satoshi Hayano, Naoki Tani, Yuki Toyama, Masayuki Kashima
{"title":"Facial Plethora: An Overlooked Clue to Superior Vena Cava Syndrome.","authors":"Satoshi Hayano, Naoki Tani, Yuki Toyama, Masayuki Kashima","doi":"10.2169/internalmedicine.7640-26","DOIUrl":"https://doi.org/10.2169/internalmedicine.7640-26","url":null,"abstract":"","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Bloomy Rind Sign in Leptomeningeal Carcinomatosis Associated with EGFR-Mutated Lung Adenocarcinoma. 与egfr突变的肺腺癌相关的薄脑膜癌的Bloomy Rind征象。
IF 1.1
Internal medicine (Tokyo, Japan) Pub Date : 2026-10-15 DOI: 10.2169/internalmedicine.7924-26
Makoto Hibino, Chiharu Samata, Hikari Higa, Shigehiro Watanabe, Riko Kamada, Shunichi Tobe, Kazunari Maeda, Shigeto Horiuchi, Tetsuri Kondo
{"title":"Bloomy Rind Sign in Leptomeningeal Carcinomatosis Associated with EGFR-Mutated Lung Adenocarcinoma.","authors":"Makoto Hibino, Chiharu Samata, Hikari Higa, Shigehiro Watanabe, Riko Kamada, Shunichi Tobe, Kazunari Maeda, Shigeto Horiuchi, Tetsuri Kondo","doi":"10.2169/internalmedicine.7924-26","DOIUrl":"https://doi.org/10.2169/internalmedicine.7924-26","url":null,"abstract":"<p><p>We report two cases of leptomeningeal carcinomatosis (LMC) associated with EGFR exon 19 deletion lung adenocarcinoma, in which the \"bloomy rind sign\" on magnetic resonance imaging (MRI) provided supportive radiological evidence. In Case 1, the progression of MRI findings paralleled rising cerebrospinal fluid (CSF) carcinoembryonic antigen levels, exceeding serum concentrations despite persistently negative cytology. In Case 2, the sign appeared with recurrent intracranial hypertension and positive CSF cytology results. Despite treatment, both patients deteriorated in their condition. These cases suggest that the bloomy rind sign may raise suspicion of LMC despite unrevealing cytology; in Case 1, serial CSF CEA changes paralleled the clinical course of the patient.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Embolic Ischemic Stroke Associated with Maintenance Intravenous Immunoglobulin Therapy. 栓塞性缺血性脑卒中与维持静脉注射免疫球蛋白治疗相关。
IF 1.1
Internal medicine (Tokyo, Japan) Pub Date : 2026-10-15 Epub Date: 2026-02-24 DOI: 10.2169/internalmedicine.6976-25
Ryoji Miyano, Yu Yoshida, Kazuki Fujita, Yuka Hayashi, Yoshio Sakiyama
{"title":"Embolic Ischemic Stroke Associated with Maintenance Intravenous Immunoglobulin Therapy.","authors":"Ryoji Miyano, Yu Yoshida, Kazuki Fujita, Yuka Hayashi, Yoshio Sakiyama","doi":"10.2169/internalmedicine.6976-25","DOIUrl":"10.2169/internalmedicine.6976-25","url":null,"abstract":"<p><p>We describe the case of a 51-year-old man who experienced an embolic ischemic stroke during long-term maintenance of intravenous immunoglobulin (IVIG) therapy for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). At 43 years of age, he was diagnosed with CIDP and had tolerated IVIG well. Immediately after completing the 112th infusion, he exhibited acute right-hand clumsiness. Brain magnetic resonance imaging revealed an acute embolic infarction, and neither risk factors for ischemic stroke nor alternative embolic sources were identified. Although IVIG is generally considered safe, this case highlights that embolic stroke may occur even in relatively younger, low-risk patients during uneventful maintenance IVIG therapy, warranting continued vigilance.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":"2758-2762"},"PeriodicalIF":1.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147278144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Giant Intrasellar Aneurysm Presenting with Hypopituitarism. 巨大鞍内动脉瘤表现为垂体功能减退。
IF 1.1
Internal medicine (Tokyo, Japan) Pub Date : 2026-10-15 Epub Date: 2026-03-03 DOI: 10.2169/internalmedicine.6720-25
Kiichiro Oryu, Yuji Kato, Akira Uchino, Takeshi Hayashi
{"title":"Giant Intrasellar Aneurysm Presenting with Hypopituitarism.","authors":"Kiichiro Oryu, Yuji Kato, Akira Uchino, Takeshi Hayashi","doi":"10.2169/internalmedicine.6720-25","DOIUrl":"10.2169/internalmedicine.6720-25","url":null,"abstract":"","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":"2780-2781"},"PeriodicalIF":1.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147358510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Combined Hepatocellular-cholangiocarcinoma Patient Treated with Durvalumab Plus Gemcitabine and Cisplatin. 杜伐单抗联合吉西他滨和顺铂治疗肝细胞胆管癌1例
IF 1.1
Internal medicine (Tokyo, Japan) Pub Date : 2026-10-15 Epub Date: 2026-03-17 DOI: 10.2169/internalmedicine.6512-25
Daisuke Kobayashi, Manabu Hayashi, Yosuke Takahata, Masashi Fujita, Naoto Abe, Tatsuro Sugaya, Kazuki Akaike, Kentaro Sato, Hiroshi Shimizu, Hiroyuki Asama, Kazumichi Abe, Yasuyuki Kobayashi, Yuko Hashimoto, Takuto Hikichi, Hiromasa Ohira
{"title":"Combined Hepatocellular-cholangiocarcinoma Patient Treated with Durvalumab Plus Gemcitabine and Cisplatin.","authors":"Daisuke Kobayashi, Manabu Hayashi, Yosuke Takahata, Masashi Fujita, Naoto Abe, Tatsuro Sugaya, Kazuki Akaike, Kentaro Sato, Hiroshi Shimizu, Hiroyuki Asama, Kazumichi Abe, Yasuyuki Kobayashi, Yuko Hashimoto, Takuto Hikichi, Hiromasa Ohira","doi":"10.2169/internalmedicine.6512-25","DOIUrl":"10.2169/internalmedicine.6512-25","url":null,"abstract":"<p><p>A 55-year-old man with lower abdominal pain and diarrhea was referred to our hospital. Computed tomography (CT) revealed a hypovascular liver tumor, lymph node/bone metastases, and peritoneal dissemination. Based on a histological analysis of lymph node metastasis, he was diagnosed with combined hepatocellular-cholangiocarcinoma (cHCC-CCA) and received durvalumab plus gemcitabine and cisplatin (Dur/GC). After treatment, the patient developed grade 2 diarrhea and grade 3 thrombocytopenia. CT after one course of Dur/GC demonstrated tumor shrinkage and expanded peritoneal dissemination, suggesting the need for further studies on the efficacy and safety of this therapy for unresectable cHCC-CCA.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":"2685-2689"},"PeriodicalIF":1.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147483029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Challenges Associated with the Diagnosis and Treatment for Aplastic Anemia Concurrent with Lymphoplasmacytic Lymphoma/Waldenström's Macroglobulinemia. 再生障碍性贫血并发淋巴浆细胞性淋巴瘤/Waldenström巨球蛋白血症的诊断和治疗的挑战。
IF 1.1
Internal medicine (Tokyo, Japan) Pub Date : 2026-10-15 Epub Date: 2026-03-10 DOI: 10.2169/internalmedicine.7151-26
Naohiro Sekiguchi
{"title":"The Challenges Associated with the Diagnosis and Treatment for Aplastic Anemia Concurrent with Lymphoplasmacytic Lymphoma/Waldenström's Macroglobulinemia.","authors":"Naohiro Sekiguchi","doi":"10.2169/internalmedicine.7151-26","DOIUrl":"10.2169/internalmedicine.7151-26","url":null,"abstract":"","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":"2650-2651"},"PeriodicalIF":1.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147439018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
If Becker Muscular Dystrophy Initially Manifests with Heart Disease and Rhabdomyolysis, Neurological Work-up Is Imperative. 如果贝克肌萎缩症最初表现为心脏病和横纹肌溶解，神经系统检查是必要的。
IF 1.1
Internal medicine (Tokyo, Japan) Pub Date : 2026-10-15 Epub Date: 2026-03-03 DOI: 10.2169/internalmedicine.7023-25
Josef Finsterer
{"title":"If Becker Muscular Dystrophy Initially Manifests with Heart Disease and Rhabdomyolysis, Neurological Work-up Is Imperative.","authors":"Josef Finsterer","doi":"10.2169/internalmedicine.7023-25","DOIUrl":"10.2169/internalmedicine.7023-25","url":null,"abstract":"","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":"2784"},"PeriodicalIF":1.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147358570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Severe Transfusion-refractory Cytopenia Mimicking Bone Marrow Failure in a Patient Living with HIV after Antiretroviral Therapy Interruption. HIV患者在抗逆转录病毒治疗中断后的严重输血难治性细胞减少模拟骨髓衰竭。
IF 1.1
Internal medicine (Tokyo, Japan) Pub Date : 2026-10-15 Epub Date: 2026-03-03 DOI: 10.2169/internalmedicine.7009-25
Shuichi Okaya, Hiroshi Ito, Tomoya Shiba, Yoko Kurihara, Keiichiro Hattori, Mayu Inoue, Dongmei Ma, Satoru Kawano, Nobutake Shimojo
{"title":"Severe Transfusion-refractory Cytopenia Mimicking Bone Marrow Failure in a Patient Living with HIV after Antiretroviral Therapy Interruption.","authors":"Shuichi Okaya, Hiroshi Ito, Tomoya Shiba, Yoko Kurihara, Keiichiro Hattori, Mayu Inoue, Dongmei Ma, Satoru Kawano, Nobutake Shimojo","doi":"10.2169/internalmedicine.7009-25","DOIUrl":"10.2169/internalmedicine.7009-25","url":null,"abstract":"<p><p>Severe thrombocytopenia is a frequent but diagnostically challenging complication in people living with human immunodeficiency virus (HIV) (PLWH). We report the case of a 43-year-old woman with HIV who developed life-threatening hematochezia and profound thrombocytopenia after the interruption of antiretroviral therapy. Although bone marrow aspiration showed hypocellular fatty marrow, preserved leukocyte counts and the overall clinical context supported immune thrombocytopenia (ITP) secondary to uncontrolled HIV replication. Treatment with intravenous immunoglobulin and high-dose corticosteroids led to independent transfusion and platelet recovery. Helicobacter pylori infection was identified and eradicated. This case highlights the fact that hypocellular marrow findings mimicking bone marrow failure do not exclude ITP in PLWH.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":"2773-2777"},"PeriodicalIF":1.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147358426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A Transfusion-transmitted Chronic Hepatitis E Virus Infection after Allogeneic Bone Marrow Transplantation with Viral Clearance Following Immunosuppression Tapering. 输血传播的慢性戊型肝炎病毒感染异体骨髓移植后病毒清除免疫抑制逐渐减少。
IF 1.1
Internal medicine (Tokyo, Japan) Pub Date : 2026-10-15 Epub Date: 2026-03-03 DOI: 10.2169/internalmedicine.6903-25
Keijiro Sato, Hiroko Kazumoto, Ami Tanaka, Hidekatsu Sakata, Shunya Sunohara, Shintaro Kazama, Hiroko Kaiume, Hiromitsu Mori, Toshimitsu Ueki
{"title":"A Transfusion-transmitted Chronic Hepatitis E Virus Infection after Allogeneic Bone Marrow Transplantation with Viral Clearance Following Immunosuppression Tapering.","authors":"Keijiro Sato, Hiroko Kazumoto, Ami Tanaka, Hidekatsu Sakata, Shunya Sunohara, Shintaro Kazama, Hiroko Kaiume, Hiromitsu Mori, Toshimitsu Ueki","doi":"10.2169/internalmedicine.6903-25","DOIUrl":"10.2169/internalmedicine.6903-25","url":null,"abstract":"<p><p>A hepatitis E virus (HEV) infection is typically self-limiting in immunocompetent individuals, but it may cause chronic persistent or fulminant hepatitis in immunocompromised hosts. We report the case of a 62-year-old woman with myelofibrosis who developed chronic hepatitis E due to transfusion-transmitted HEV genotype 3 infection after allogeneic bone marrow transplantation, which was confirmed by positivity for anti-HEV IgA and HEV RNA, as well as the viral RNA sequence identity between the transfusion donor and recipient. Liver dysfunction appeared two months after transfusion and worsened despite tacrolimus escalation for suspected graft-versus-host disease, but it resolved after tacrolimus tapering alone. Although foodborne transmission is common, transfusion and other unidentified sources can also cause an HEV infection. An HEV should be considered when a patient shows posttransplant liver dysfunction.</p>","PeriodicalId":520650,"journal":{"name":"Internal medicine (Tokyo, Japan)","volume":" ","pages":"2680-2684"},"PeriodicalIF":1.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147358529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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