Abdominal aortic aneurysm and cystic kidneys are both common diseases that have been increasingly detected due to the development of medical screening instruments, such as computed tomography and ultrasonography. We occasionally intraoperatively encounter abdominal aortic aneurysms accompanying cystic renal lesions. However, there have been extremely few reports about abdominal aortic aneurysms complicated by cystic renal disease. Large renal cysts or polycystic kidneys are at risk of rupture or intraoperative hemorrhage, and can hinder the surgical treatment of abdominal aortic aneurysm. Therefore, there is a significant need for surgeons to be able to preoperatively determine the potential of an interruption of the procedure, for example, due to a cystic lesion. In this paper, we report a case of a 77-year-old man with abdominal aortic aneurysm who complained of abdominal fullness due to the presence of large cystic lesions in both kidneys. Preoperatively we aspirated 1, 550ml percutaneously from bilateral renal cysts under ultrasonographic guidance, but did not instill sclerosing agents, such as ethanol. Three days after the percutaneous aspiration, surgical treatment of the abdominal aortic aneurysm (5.2cm in diameter), the left common iliac arterial aneurysm and the right common iliac arterial aneurysm (3.0 and 2.6cm in diameter) was performed through a median abdominal incision with a retroperitoneal approach. The arterial prosthesis used was a Y-shaped woven double velour vascular graft. The postoperative course was uneventful and the patient was discharged 14 days after the vascular reconstruction procedure. Our experience suggests that percutaneous aspiration of large renal cysts that might hinder the surgical procedure for abdominal aortic aneurysm is useful.

This report presents the case of a patient demonstrating multicentric Castleman's disease (MCD) with a lung lesion that was successfully treated with an anti-interleukin-6 receptor antibody, tocilizumab in combination with corticosteroid and tacrolimus. A 43-yr-old female with abnormal shadows on a chest X-ray was referred to the hospital for further examination. She was diagnosed as having MCD based on the characteristic pathology of inguinal lymph node, lung lesions, laboratory data, and undifferentiated arthritis. Corticosteroid and rituximab therapy did not fully ameliorate the symptoms; thus, the therapeutic regimen was changed to include tocilizumab, oral corticosteroid and tacrolimus. This regimen resulted in clinical remission and the dose of tocilizumab and corticosteroid could be tapered. Tocilizumab in combination with corticosteroid and tacrolimus may therefore be a beneficial treatment regimen for lung lesions associated with MCD.
Adrenal Cortex Hormones/therapeutic use ; Adult ; Antibodies, Monoclonal/*therapeutic use ; Drug Therapy, Combination ; Female ; Giant Lymph Node Hyperplasia/*diagnosis/drug therapy/radiography ; Humans ; Immunosuppressive Agents/therapeutic use ; Lung Diseases, Interstitial/*drug therapy/pathology ; Lymph Nodes/pathology ; Receptors, Interleukin-6/antagonists & inhibitors ; Tacrolimus/therapeutic use ; Tomography, X-Ray Computed