Cytomegalovirus (CMV) antigenaemia for rapid diagnosis and monitoring of CMV-associated disease after bone marrow transplantation

A technique for the rapid detection of cytomegalovirus (CMV) antigen-positive blood leucocytes (CMV antigenaemia) was evaluated in 15 marrow transplant patients as a means of diagnosis and for monitoring CMV-associated disease. CMV antigenaemia was determined by direct immunoperoxidase staining of leucocytes with a peroxidase-labelled monoclonal antibody, HRP-C7, which binds an immediate-early antigen of human CMV. CMV antigenaemia occurred in 7/15 marrow transplant patients (47%) and was initially detected between 4 and 6 weeks after transplantation. CMV-associated diseases developed in 3/15 patients (20%). All patients with CMV-associated disease had a relatively large number of CMV antigen-positive leucocytes, exceeding 10 per 50,000 white blood cells (WBCs). In the remaining 12 patients, CMV antigen-positive leucocytes were less than 10 per 50,000 WBCs or were undetectable. CMV-associated disease did not develop in these patients during the period of monitoring. CMV antigen-positive leucocytes were detected more frequently in patients who developed acute graft-versus-host disease (GVHD) or haemorrhagic cystitis than in those without such complications. CMV antigens were detectable from 1 to 4 weeks before the onset of CMV-associated disease which allowed initiation of ganciclovir treatment at an early stage. The degree of CMV antigenaemia paralleled the clinical symptoms and signs, higher degrees of antigenaemia being associated with more significant disease. Thus, the detection of CMV antigen-positive blood leucocytes is useful for the diagnosis and monitoring of CMV-associated disease following bone marrow transplantation.

Elevated platelet-associated IgG in SLE patients due to anti-platelet autoantibody: differentiation between autoantibodies and immune complexes by ether elution

The level of platelet-associated IgG (PAIgG) is reported to be elevated in patients with systemic lupus erythematosus (SLE). However, the nature of PAIgG is unclear. We have investigated whether the PAIgG of SLE consists of anti-platelet autoantibodies or immune complexes (IC). The PAIgG values measured by flow cytometry were elevated in 11/25 patients with SLE. 3/6 SLE patients with thrombocytopenia had a high level of PAIgG (the mean fluorescence intensity > 10). We used an ether elution technique to determine whether elevated PAIgG consists of anti-platelet antibodies or IC. Preliminary experiments showed that the eluates prepared from platelets sensitized with anti-HPA-4a antibody reacted with normal platelets, while the eluates prepared from platelets sensitized with heat-aggregated IgG or model IC failed to react with normal platelets. These results indicate that the reactivity of eluates can distinguish between platelet-bound antibody and IC. We applied this technique to analysis of the PAIgG of SLE platelets. The eluates from SLE platelets (the mean fluorescence intensity > 10) reacted with normal platelets, indicating that the PAIgG of SLE platelets has the nature of antiplatelet autoantibodies. Furthermore, we investigated the target antigens which bind PAIgGs of SLE, using the direct immunoprecipitation procedure and modified antigen capture ELISA (MACE). Both methods identified GPIIb/IIIa as the target antigens. We conclude that the ether elution technique can distinguish between anti-platelet antibodies and IC, and that the PAIgGs of SLE with a high PAIgG value and thrombocytopenia have the nature of anti-platelet autoantibodies.

Natural antibody against Thomsen-Friedenreich antigen in sera of patients with carcinomas and infectious diseases

The levels of natural antibody against Thomsen-Friedenreich (TF) antigen in sera of patients with various cancers and infectious diseases were examined by an enzyme-linked immunosorbent assay (ELISA) and compared with those of healthy donors. The levels of antibody against TF antigen in sera of patients with adenocarcinomas such as gastric, pancreatic and colorectal cancers were lower than those of patients with hepatoma, pyelonephritis and pneumonia. These findings may reflect the expression of TF-antigen in adenocarcinoma tissues.

[The incidence of atherosclerotic lesions of the carotid artery in people of one community]

Carotid sonography were conducted in people of one community (122 males and 243 females) in 1990 and 1991. The intima-media thickness (IMT) in the main trunk and bifurcation-bulb areas of bilateral carotid arteries were measured in 122 males. IMTs of four areas increased with aging. In all cases, the average IMT of the right main trunk was 0.8 +/- 0.1 mm (mean +/- SD) and those of the remaining three areas were 0.9 +/- 0.2 mm. The IMT of the right bifurcation area in males aged 75 years or older was the thickest; i.e., 1.1 +/- 0.3 mm. Therefore, atherosclerotic lesions (AL) were defined as an IMT of 1.5 mm or more. The incidence of AL increased along with aging both in males and females. In those who were less than 65 years old, the incidence in males was 12.8% (10/78) and that in females was 9.0% (12/134). In those who were 65 years old or older, the incidence in males was 31.8% (14/44) and that in females was 26.9% (29/109). The incidence of AL tended to increase rapidly from 65 years of age in both males and females. Moreover, the incidence of AL in bilateral carotid arteries increased along with aging as well. Since IMT, the incidence of AL and that of AL in bilateral carotid arteries increased with aging, we considered that these parameters could be used as indices of the degree of general atherosclerosis.

[Clinical pharmacology and efficacy of S-1108]

We studied the pharmacokinetics of a new cephem antibiotic, S-1108, in patients with impaired kidney functions. Serum and urinary levels of S-1006 were determined after oral administration of S-1108 at 150 mg to 9 patients with renal dysfunction. In patients with severe renal impairment, high serum levels were maintained over long periods of time. Urinary excretion rates of S-1006 were lower as degrees of kidney failure were severer. S-1108 was administered to treat 27 patients with respiratory tract infections, and its clinical efficacy and safety were evaluated. The clinical efficacies were good in 26 patients, but poor in 1, yielding an efficacy rate of 96.3%. As to adverse reactions; diarrhea was observed in one case. Laboratory tests revealed elevated GOT and GPT in 1, and elevated gamma-GTP in another. These abnormalities, however, were slight and no severe side effects were caused by the drug.

[A case of modified maze operation for atrial fibrillation accompanied by mitral stenosis]

A 45-year-old man suffering from mitral stenosis and atrial fibrillation underwent a mitral commissurotomy and received a modified maze operation. In order to preserve the sinus node artery, we used a new incision line differing from that of Cox and introduced a cryosurgery. After the operation, atrial fibrillation disappeared. The atrial kick was also clearly observed by the echocardiogram. We think that combined operations have advantage both to cure atrial fibrillation and to deal with the mitral valve easily.

Urinary protein C inhibitor binding region in the B beta-chain of human fibrinogen

The urinary protein C inhibitor (PCI) binding region in the B beta-chain of human fibrinogen was examined by ligand blotting, reverse-phase HPLC and amino acid sequencing. The B beta-chain, isolated from reduced and pyridylethylated fibrinogen, was digested with staphylococcal V8 protease to yield eight peptides consisting of 10, 12, 13, 13.5, 14, 16, 17 and 18 kDa bands and the cleaved peptides were ligand-blotted. The 12 kDa band bound to urinary PCI. Moreover, the digested B beta-chain was isolated by reverse-HPLC and the elution peak showing positive binding to urinary PCI was sequenced. The N-terminal amino acid sequence was A V S Q T, which corresponds to Ala106-Thr110 in the B beta-chain. Judging from the M(r) of this peptide (12 kDa), it comprises the region from Ala106 to Glu192-Glu210 which are partly located in the D-region. It is concluded that the urinary PCI-binding region to the B beta-chain resides in the sequence of Ala110 to Glu192-Glu210.

Pulmonary hypertension as a fatal complication of extrahepatic portal hypertension

Pulmonary hypertension is an uncommon complication of portal hypertension seen in cirrhotic as well as noncirrhotic patients. We report a 10-year-old girl who presented with extrahepatic portal hypertension and pulmonary hypertension in the absence of intrinsic liver disease. Further investigations revealed high serum concentrations of prostaglandin F2 alpha, thromboxane B2 in the inferior vena cava, and angiotensin I in the inferior vena cava and right ventricle. The increased levels of these vasoconstrictive substances strongly suggest that the possible mechanism for the pulmonary hypertension in such patients with extrahepatic portal hypertension include shunting of vasoactive agents from the splanchnic circulation to the pulmonary vascular bed.

[Helicobacter pylori infection in gastric cancer]

The relationship between Helicobacter pylori (H. pylori) infection and gastric cancer becomes the topics in the world, since some reports thereon in 1991. The purpose of this study was to know the prevalence of H. pylori infection in many patients with gastric cancer. We examined the H. pylori IgG antibody in 507 patients with gastric cancer resected surgically in our hospital from 1989 to 1991, retrospectively. For the test of H. pylori IgG antibody, HM-CAP EIA kit (Italy, ENTERIC PRODUCTS Co.) was used. The overall detection rate of H. pylori IgG antibody was 75% (378/507). H. pylori infection was significant significantly frequent in early cancer (80%, 231/288) than advanced cancer (67%, 147/219). But, the other clinicopathological features such as sex, age, histological type, location and the degree of intestinal metaplasia were not significantly correlated with H. pylori infection. To evaluate the risk of H. pylori infection for gastric cancer, we are going to plan a matched-pair case-control study.

Cyclosporine combined with methylprednisolone or methotrexate in prophylaxis of moderate to severe acute graft-versus-host disease

To evaluate the efficacy of cyclosporine (CYA) regimens in preventing moderate to severe acute graft-versus-host disease (GVHD), 25 patients received immunosuppressive therapy consisting of either CYA and methylprednisolone or CYA and methotrexate (MTX) and the incidence and severity of acute GVHD was compared. These patients had leukemia or myelodysplastic syndrome (MDS) and received bone marrow transplants (BMT) from genotypically HLA-identical siblings. The incidence of grade I-IV acute GVHD in patients on the CYA/methylprednisolone regimen was 64% (7 of 11) compared with 50% (7 of 14) in those on the CYA/MTX regimen. Five of 11 patients with the CYA/methylprednisolone regimen developed moderate to severe acute GVHD (grade II-IV), fatal in 3 cases. No patient on the CYA/MTX regimen developed moderate to severe acute GVHD. Engraftment was faster in the CYA/methylprednisolone group than in the CYA/MTX group. The incidence of toxicity observed soon after BMT was comparable between groups. The CYA/MTX regimen may be superior to the CYA/methylprednisolone regimen for preventing moderate to severe acute GVHD.

[Cytomegalovirus antigenemia in the differential diagnosis of pulmonary infiltrates after allogeneic bone marrow transplantation]

For the differential diagnosis of pulmonary infiltrates after bone marrow transplantation, cytomegalovirus (CMV) antigenemia was evaluated in 9 episodes of pneumonia which developed in 7 allogeneic marrow transplant patients between 9 and 495 days after transplant. The diagnosis of lung infiltration was made based on clinical findings including histological, cytological or microbiological examinations using bronchoalveolar lavage fluid specimens, sputum or lung tissue. The CMV antigen-positive leukocytes were detected with a direct immunoperoxidase technique using a peroxidase-labeled monoclonal antibody (HRP-C7) against CMV immediate early antigen. The episodes included 2 CMV pneumonias, 1 pneumocystis carinii pneumonia, 1 adenovirus pneumonia, 1 bacterial pneumonia, 1 bacterial and fungal pneumonia, 2 idiopathic pneumonias and 1 capillary leak syndrome associated with hyper acute GVHD. The CMV antigenemia became positive only in two patients with CMV pneumonia and the number of CMV antigen-positive leukocytes exceeded 10 per 50000 WBCs. The CMV antigenemia test required only 24 hours to obtain results. These observations suggest that the detection of CMV antigenemia is of great value in the differential diagnosis of pulmonary infiltrates in marrow transplant patients.

A synthetic peptide which specifically inhibits heat-treated interleukin-8 binding and chemotaxis for neutrophils

Interleukin-8 (IL-8) is a peptide which is secreted by stimulated human monocytes and which is chemotactic for human neutrophils. We synthesized three overlapping peptides spanning the amino-terminal region of the IL-8 sequence. None of the peptides retained the chemotactic activity of the native molecule. One of the peptides, IL-8(3-25), inhibited the neutrophil chemotactic activity of recombinant IL-8 (rIL-8) which had been preheated to 40 degrees C but did not reduce neutrophil chemokinesis, or the chemotactic activity of unheated rIL-8, FMLP, C5a or LTB4. Interleukin-8 exhibited similar binding kinetics and chemotaxis for neutrophils regardless of whether it had been pretreated at 40 degrees C. In addition, IL-8(3-25) was also able to decrease the binding of preheated IL-8 to neutrophils. IL-8(3-25), which can self-associate, binds directly to receptors on the neutrophil. The data suggest that heat-treated, but not untreated, IL-8 causes the IL-8(3-25) multimers to disaggregate, allowing the monomeric peptide to directly bind to the IL-8 receptor and thus inhibiting IL-8/receptor binding.

[NEO-MACOP-B chemotherapy for the treatment of advanced-stage aggressive non-Hodgkin's lymphoma]

We conducted a new chemotherapy, NEO-MAC OP-B (addition of etoposide and mitoxantrone to MACOP-B with half dose of methotrexate and half administration of doxorubicin), to reduce severe mucositis, which is a major toxic effect of MACOP-B, and to increase its effect with etoposide and mitoxantrone as new non-cross resistant drugs. Between Jan. 1989 and Mar. 1993, 12 patients with previously untreated advanced aggressive non-Hodgkin's lymphoma (NHL), 2 patients with adult T cell lymphoma, and 3 patients with relapsed NHL, were treated with NEO-MACOP-B. After termination of NEO-MACOP-B therapy, 83.3% of 12 patients with previously untreated NHL were in complete remission (CR). After median follow-up of 22 months, Kaplan-Meier estimates showed that overall survival of 12 previously untreated patients was 71.4%, and relapse-free survival of complete responder was 83.3%. Toxic effects on all 17 patients were moderate with a lower incidence of severe mucositis (only one patient with relatively severe stomatitis, WHO Grade 3). No treatment related deaths were observed. Thus, NEO-MACOP-B is an effective and safe treatment for advanced stage aggressive NHL.

Evaluation of leukaemic contamination in peripheral blood stem cell harvests by reverse transcriptase polymerase chain reaction

A major issue in autologous blood stem cell transplantation (ABSCT) for leukaemia is whether peripheral blood stem cell (PBSC) harvests are less contaminated with leukaemic cells than bone marrow mononuclear cells (BMMNC). We compared leukaemic contamination in PBSC harvests and BMMNC, obtained simultaneously, by using reverse transcriptase polymerase chain reaction (RT-PCR) of leukaemia-specific chimaeric messenger RNA (mRNA), in three patients with Philadelphia chromosome (Ph)-positive acute lymphoblastic leukaemia (ALL), one with Ph-positive acute myelogenous leukaemia (AML), and two with acute promyelocytic leukaemia (APL). Our two-step PCR method employed 'nested primers' in the second step and can detect one leukaemic blast diluted into 10(6) HL-60 cells. In three of four patients with Ph-positive ALL and AML we detected leukaemic contamination in both PBSC harvests and BMMNC. In the remaining patient with ALL, both PBSC harvests and BMMNC were PCR-negative. Both PBSC harvests and BMMNC from one patient with APL were PCR-positive. In contrast, PBSC harvests from another patient with APL, whose BMMNC could not be obtained because of bone marrow necrosis, were PCR-positive after the first course of consolidation chemotherapy, but became PCR-negative after the second course. The present study does not support the hypothesis that PBSC harvests are less contaminated by leukaemic cells than BMMNC, but suggests that PBSC harvests are contaminated when BMMNC are contaminated.

[Milk of calcium renal stone in a patient with ureteral tumor: a case report]

We report a case of milk of calcium renal stone within a calyceal diverticulum in the patient with left ureteral tumor. The patient was a 77-year-old-man with the chief complaint of asymptomatic microscopic hematuria. A plain film revealed round opaque calcific densities in the left kidney in the supine position and a dense crescent-shaped shadow with a horizontal border in the upright position. An intravenous pyelography showed left hydronephrosis and calculi within a calyceal diverticulum. Computed tomography in the supine position revealed layering of the calcifications in cystic lesion of the left kidney accompanied by left hydronephrosis due to a soft mass in the left ureter and a right renal cyst. Retrograde pyelography revealed a filling defect of the middle portion of the left ureter. Under the diagnosis of milk of calcium renal stone and left ureteral tumor, left total nephroureterectomy and partial cystectomy was performed. Pathological findings indicated transitional epithelium of the diverticulum wall and grade 1 transitional cell carcinoma of the left ureteral tumor.

Expression of the differentiated phenotype of chondrocytes in newly synthesized acetabulum

Human cartilaginous cells produce two types of proteoglycan monomers (PGI and PGII) distinguishable by their molecular size in density gradient centrifugation under dissociative conditions. In order to determine whether connective tissues on the sliding surface of the acetabulum on an endoprosthesis are able to differentiate into cartilaginous tissue, we made histological and biochemical analysis of the incorporation of 35S and the distribution of the molecular size of proteoglycans produced. Histologically, dense collagen fibers were observed both on weight-bearing and non-weight-bearing surfaces, but there was little evidence of cartilaginous metaplasia. Biochemical analysis, however, demonstrated that incorporation of 35S in newly synthesized glycosaminoglycan (GAG) was higher than that in non-cartilaginous tissues, suggesting that cartilaginous differentiation of mesenchymal tissues had occurred.

Effects of extracorporeal circulation on blood ketone body ratio reflecting hepatic energy metabolism during cardiac operation

To examine the effects of extracorporeal circulation using an artificial heart and lung machine on hepatic energy metabolism in patients with cardiac operation using hypothermia, the arterial blood ketone body ratio (AKBR) reflecting the hepatic mitochondrial redox state was determined in 12 patients who had undergone cardiac operation using extracorporeal circulation from March to August 1991. Changes in AKBR were compared with those before and after extracorporeal circulation. AKBR decreased significantly after the beginning of extracorporeal circulation (p < 0.001) and remained at a lower level throughout extracorporeal circulation. On termination of extracorporeal circulation, the initial level was immediately resumed. The extent of decrease in ketone body ratio at ten minutes before termination of extracorporeal circulation was correlated with short term postoperative hepatic insufficiency. The patients whose ratio decreased below 0.4 showed increased levels in glutamic-pyruvic transaminase at the end of the first and second week after operation. Changes in AKBR were significantly associated with those in blood pressure (r = 0.433; p < 0.005) and body temperature (r = 0.472; p < 0.005). It was concluded that blood pressure and body temperature influence the blood ketone body ratio during extracorporeal circulation.

Antishock effect of U-67,590A, methylprednisolone suleptanate, associated with restoration of lowered vascular reactivity in endotoxemic rats

We wished to investigate the modulating effects of a glucocorticoid on mortality and sustained hypotension in endotoxemic rats in conjunction with in vitro study of responses of isolated aorta to KCl, norepinephrine (NE), and acetylcholine (ACh). Endotoxemia was induced by intravenous (i.v.) bolus injection of 50 mg/kg Escherichia coli endotoxin in rats, resulting in high mortality. Pretreatment with U-67,590A, methylprednisolone suleptanate, at a dose of 9 mg/kg resulted in 100% survival; the survival rate of saline-treated controls was 21%. Isolated rat aorta that had been treated with endotoxin for 4 h showed decreases in contractile responses to KCl and NE and in relaxing response to ACh. Similar attenuation of contractile responsiveness was observed in endothelium-denuded preparations. Addition of endotoxin to the in vitro tissue bath did not inhibit the responses in a 4-h period. Pretreatment with U-67,590A inhibited the late gradual decrease in blood pressure (BP) but not the early hypotensive response to endotoxin. The responses to KCl or NE of aorta isolated 4 h after the endotoxin injection remained suppressed in U-67,590A-treated rats but were restored in 24 h. These results suggest that endotoxemia impairs the endothelium moderately, but this does not account for either reduced reactivity of vascular smooth muscle to vasoconstrictor agents or the sustained hypotension. The steroid inhibits endotoxemia-induced mortality and sustained hypotension.

[Newly developed blocking balloon catheter for PTA of internal carotid artery]

We have developed a new blocking balloon system for percutaneous transluminal angioplasty (PTA) of the internal carotid artery (ICA). A latex balloon (BALT) is attached on the top of a Superselector infusion-type catheter (TORAY) which is used as a blocking balloon catheter. It can be navigated into the distal part of the ICA under torque control as well as flow control by withdrawing the core wire. Our PTA procedure is as follows, 1) insert the sheath catheter 8-9 F in size, 2) insert the PTA balloon catheter (Accent balloon, Cook) with a blocking balloon catheter through the sheath catheter, 3) navigate the blocking balloon into the distal part of the ICA, 4) introduce the PTA balloon to the stenotic portion after occlusion of the distal ICA by the blocking balloon, 5) PTA, 6) wash the lumen of the ICA with saline, 7) deflate the blocking balloon and withdraw the system. We performed PTA for 5 ICA lesions in 4 cases and got successful dilatations for all of them without complications. Our blocking balloon system is useful for performing the PTA of the ICA safely.

Cushing's disease: evaluation of mineralocorticoid-induced hypertension

A patient (32-year-old female) with Cushing's syndrome due to pituitary adenoma and hypertension with hypokalemia is reviewed. Endocrinological studies demonstrated low plasma renin activity, low plasma aldosterone concentration and high plasma deoxycorticosterone concentration. Blood pressure response to exogenous angiotensin II was enhanced. After the withdrawal of cortisol replacement following surgery, her abnormal endocrinological findings, hypertension and serum potassium level returned to normal and her blood pressure response to exogenous angiotensin II was reduced. These results suggest that in this case deoxycorticosterone might have contributed to the development and maintenance of her hypertension accompanied with hypokalemia.

[Surgery for thoracic aortic aneurysm by retrograde total body perfusion and deep hypothermia]

We performed retrograde total body perfusion and deep hypothermia for DeBakey III aortic dissection and aneurysm of the distal arch. We could operate with only posterolateral skin incision using a long venous cannula, which is originally a part of percutaneous cardiopulmonary support (PCPS). The duration of retrograde total body perfusion was 31-101 minutes, the perfusion volume 0.6-1.4 L/min, the central venous pressure 5-16 mmHg. All five cases were successfully operated. As a postoperative cerebral accident, one case showed transient dysfunction. There was no postoperative liver and renal dysfunction. The perfusion volume was maintained in 2.5-3.0 L/min during ventricular fibrillation, which is occurred in cooling and rewarming process. So, this long venous cannula worked well to assist circulation. We think retrograde total body perfusion is a useful assisting device for DeBakey III aortic dissection and aneurysm of the distal arch.

Involvement of the proteasome and antizyme in ornithine decarboxylase degradation by a reticulocyte lysate

Ornithine decarboxylase (ODC) degradation in a freshly prepared reticulocyte lysate was examined. Immunodepletion of proteasomes from the reticulocyte lysate resulted in almost complete loss of ODC degradation. In contrast with the previously reported degradation in extracts of hepatoma tissue-culture (HTC) and Chinese-hamster ovary (CHO) cells or that by the purified 26 S proteasome, efficient degradation of ODC was observed in the lysate without exogenous antizyme, an ODC protein inhibitor induced by polyamines, owing to the presence of a significant amount of antizyme in the lysate. The degradation of ODC in the lysate was strongly suppressed on inactivation of antizyme in the lysate with antizyme inhibitor, a protein which binds to the antizyme and releases ODC from the ODC-antizyme complex. Thus the main pathway for ODC degradation in a reticulocyte lysate was essentially the same as that characterized previously in extracts of HTC and CHO cells, namely an ATP- and antizyme-dependent 26 S proteasome-catalysed pathway that is presumed to be responsible for ODC degradation in whole cells.

[Subacute subdural hematoma--reexamination of mechanism by CT and MRI findings]

We have already reported about the importance of establishing the concept of subacute subdural hematoma. But the mechanism by which this disease develops has not as yet been elucidated fully. In one case of subacute subdural hematoma, we were able to perform CT and MRI over time and obtained findings which were of use in studying the mechanism of development. The case was a 56-year-old male. He developed with seizure. CT on admission revealed acute subdural hematoma and subarachnoid hemorrhage. But neurological deficits were absent. So he was treated conservatively. On the 16th hospital day there appeared seizure, anisocoria and an increase in the mass sign due to subdural hematoma was noted on CT, so a diagnosis of subacute subdural hematoma was made. Cerebrospinal fluid was considered accountable for the increase in the mass sign judging from the findings of CT and MRI each performed over time. It was surmised that subdural effusion developed concurrently in the subacute stage. Three conditions, namely, presence of (1) arachnoid tear, (2) clots, (3) no intracranial hypertension are considered important as the mechanism by which subacute subdural hematoma develops.

[A case of thymoma showing extensive necrosis]

A 44-year-old man was admitted with fever elevation and dyspnea. Chest X-ray and CT examination indicated a 6 x 4 cm anterior mediastinal tumor, pleural effusion and pericardial effusion. Blood examination showed no inflammation findings. Gallium scintigraphy indicated no uptake at the tumor. He underwent resection of the tumor. Postoperative pathohistological examination showed most part of the tumor fell into necrosis. And remained part of the tumor showed a figure of predominantly mixed type thymoma. Thymoma showing extensive necrosis is rare.