The Clinical and Hormonal Characteristics of Primary Adrenal Lymphomas: The Necessity of Early Detection of Adrenal Insufficiency

Objective To analyze the clinical and endocrine characteristics of patients with primary adrenal lymphoma. Patients We retrospectively reviewed the cases of five patients with primary adrenal lymphoma who were treated in our hospital between April 2004 and March 2015. We investigated the characteristics of the clinical and pathological findings, treatment, prognosis and complications of adrenal insufficiency. Results Adrenal insufficiency, which was confirmed by the laboratory data at the initial presentation, was observed in two cases. One case was complicated by relative adrenal insufficiency during a course of chemotherapy. The plasma adrenaline and urinary adrenaline levels were decreased in four cases and three cases, respectively. Diffusion MRI was radiologically diagnostic. In all of the cases, the patients were pathologically diagnosed with diffuse large-B cell lymphoma and were treated with rituximab and CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone)-like chemotherapy. Two patients received central nervous system prophylaxis with high-dose methotrexate. Four of the patients survived and one patient died during the follow-up period. Conclusion The early detection of adrenal insufficiency and the administration of an appropriate dose of hydrocortisone are necessary during the course of chemotherapy as well as at the initial manifestation. The exclusion of adrenal dysfunction prior to invasive diagnostic procedures, such as CT-guided needle biopsy, is also critical.

Single-channel 3.84 Tbit/s, 64 QAM coherent Nyquist pulse transmission over 150 km with a spectral efficiency of 10.6 bit/s/Hz

We report a polarization-multiplexed 320 Gbaud, 64 QAM coherent Nyquist pulse transmission with a frequency-stabilized mode-locked laser and a modified digital back-propagation method for pulse transmission. Using a combination consisting of a mode-locked laser and a pulse shaper, we obtained a Nyquist pulse with a high OSNR of 51 dB. We achieved error free operation under a back-to-back condition with the OSNR improvement. By developing a new digital back-propagation method for pulse propagation, we achieved a bit error rate below the 7% forward error correction limit of 2x10^-3 for all the tributaries of the OTDM signal data after a 150 km transmission. As a result, single-channel 3.84 Tbit/s data were successfully transmitted over 150 km with a spectral efficiency of 10.6 bit/s/Hz.