- [Show abstract] [Hide abstract] ABSTRACT: A 72-year-old man was admitted with obstructive jaundice. Computed tomography revealed a 4cm tumor with multiple cystic components obstructing the common bile duct. Endoscopic ultrasonography, endoscopic retrograde cholangiopancreatography and intraductal ultrasonography demonstrated the tumor, which derived from the lower bile duct, grew into the bile duct lumen. Peroral cholangioscopy revealed distended tumor vessels on the surface of the tumor. Signet ring cell carcinoma of the bile duct was diagnosed by biopsy. The patient died 3 months after the first hospital admission despite chemotherapy.
- [Show abstract] [Hide abstract] ABSTRACT: To investigate the influence of human immunodeficiency virus (HIV) infection on the clinical course of amebic colitis, we retrospectively examined a consecutive series of nineteen patients diagnosed as having amebic colitis in our hospital from 2005 until 2009. Colonoscopy revealed more wide-ranging erosions or ulcers in HIV infected patients than in HIV uninfected patients, and HIV infected patients also suffered from cytomegalovirus colitis at a higher rate. This study suggests that examination and selection of treatment considering HIV infection and cytomegalovirus colitis as complications are important in clinical practice for amebic colitis.
- [Show abstract] [Hide abstract] ABSTRACT: We experienced a case of acute hepatic failure caused by infiltration of leukemic cells to the liver in 40 years old male with acute myelogenous leukemia (FAB: M5b). Plasma exchange and hemodiafiltration were performed for five days since the 4th hospitalized day when encepharopathy was appeared. However, he died on 11th day. Ultrasound Doppler imaging showed high resistant index of hepatic artery and high velocity of portal flow on the 4th, 6th and 9th hospitalized day. Coagulation necrosis of hepatic cells and infiltration of leukemic cells to the portal tract were observed by hepatic biopsy performed on the 3rd hospitalized day. An arteriole in the portal tract changed very narrow, and the cavity of that cannot be seen histologically. It was considered that the decreased perfusion of hepatic arterial flow was related to the cause of acute hepatic failure and bad progress of the disease closely in this case.
- [Show abstract] [Hide abstract] ABSTRACT: A 30-year-old woman developed severe liver dysfunction 1 year after bone marrow transplantation (BMT) from an HLA-identical sibling donor for B lymphoblastic leukemia (B-ALL) during the tapering of cyclosporin A. The histologic picture resembled autoimmune hepatitis (AIH), although neither autoantibody nor hypergammaglobulinemia was detected. She entered hepatic coma, and underwent living donor liver transplantation from the same donor on day 421 after BMT. She is well 18 months after the procedure, showing normal liver function and hematopoiesis. AIH-like hepatic graft-versus-host disease (GVHD) has not been documented. This patient is the second case of living donor liver transplantation for hepatic GVHD from the same donor.
- [Show abstract] [Hide abstract] ABSTRACT: We experienced a case of fulminate hepatitis of 54 years old male by hepatitis virus type B. Increased portal blood flow signal (maximum velocity: 46.3 cm/s) and no arterial blood flow signal were observed by ultrasound Doppler imaging. Histopathological examination of necropsy liver specimen showed massive necrosis. No obstructive finding such as thrombosis was observed in vessels of portal tracts. The number of arterioles observed per portal tract (n = 20) was 1.6 ± 0.9 (0-4). The ratio of arteriolar diameter for that of portal venules was 0.18 ± 0.20 (0.03-0.72). The number of arterioles was fewer, and arteriolar diameter relative to portal venules was smaller than normal in previous report. These histlogical findings were suggested to reflect the peculiar hemodynamics observed by ultrasound Doppler imaging.
- [Show abstract] [Hide abstract] ABSTRACT: A 77-year-old man, who underwent segmental pancreatectomy for intraductal papillary mucinous adenoma in 2001, was referred to our hospital with complaints of hematemesis and melena on January, 2004. Emergency upper gastrointestinal endoscopy showed a pulsating submucosal protrusion in the duodenal bulb, which was identified as a gastroduodenal arterial aneurysm measuring 1.5cm on abdominal CT imaging. Transcatheter arterial embolization of the aneurysm with metallic coils was successfully performed. Periodically repeated endoscopic examination has revealed the coils protruding into the duodenal lumen without any serious complication.
- [Show abstract] [Hide abstract] ABSTRACT: A 66-year-old man was admitted to our hospital because of body weight loss and jaundice. Abdominal CT showed a solid tumor in the head of the pancreas, measuring 8 cm. Endoscopic retrograde pancreatography (ERP) revealed pancreatic duct blockage due to the bulging tumor into the main pancreatic duct. Endoscopic biopsy from the surface of the exposed mass at the site of the papilla of Vater obtained only necrotic tissue. Endoscopic ultrasound-guided fine needle aspiration biopsy (EUS-FNAB) revealed acinar cell carcinoma (ACC). Pyrolus-preserving pancreaticoduodenectomy was performed. Histological findings showed a bulging tumor occupying the main and accessory pancreatic ducts. This from of spreading of ACC is very rare, and only two cases have been reported previously. In this case, EUS-FNA was very useful for the preoperative diagonosis.
- [Show abstract] [Hide abstract] ABSTRACT: It has been shown during the last decade that certain types of colorectal neoplasms; small depressed lesions with or without a slight marginal elevation, tend to progress more rapidly compared with ordinary polypoid adenomas. Depressed colorectal lesions are believed, at least in Japan, to play an important role in colorectal carcinogenesis. Ten years ago they were considered extremely rare, but nowadays more and more similar cases are found not only in the Orient but also in Europe. [Objective] To clarify the characteristics of depressed colorectal lesions and to find the keys to detect them. [Materials] During the period from April 1996 to September 1997, 1712 cases of total colonoscopy were performed by 9 examiners in our institute. The examinees presented with symptoms and/or signs such as bloody stool, fecal occult blood, or polyps detected by barium enema study. Some of them underwent the colonoscopy as a regular follow-up after polypectomy or colectomy. [Results] Out of all the cases, 1116 cases were shown to have polyps or cancers amounting to 2048 lesions, which were divided into five groups; submucosal tumors such as leiomyoma (the number was 16), obvious advanced cancers (81), so-called laterally spreading tumors or large flat adenomas (49), protruded polyps or small flat adenomas (1887), and small depressed lesions (15). The frequency of the depressed lesions were higher than the general belief. The respective rates of severe dysplasia (which is considered as carcinoma in situ in Japan) in protruded polyps, laterally spreading tumors and depressed lesions were 2.6%, 20.4%, and 33.3%. The rates of invasive cancer were 0.16%, 12.2%, and 46.7%, respectively. The sizes of the depressed lesions ranged from 3mm to 20mm, the number of depressed carcinomas less than 10mm in diameter being six. Thirteen of the depressed lesions were associated by large polyps (including three colon cancers) which were considered causing the symptoms and signs leading to the colonoscopic examination. Each colonoscopist's detection rate of depressed lesions was not necessarily in proportion to the number of examinations performed. Twelve cases were detected by one colonoscopist who were trained in a leading center of colonoscopy in Japan and who used a zoom colonoscope and dye spraying. [Conclusion] Depressed lesions of colorectum are more malignant than protruded polyps. They usually do not present any specific symptoms or signs but tend to be associated with large polyps or cancers. They can be detected only by the eyes of the examiners who are familiar with such lesions.