[Show abstract][Hide abstract] ABSTRACT: Mesenteric panniculitis (MP) is a benign fibroinflammatory process characterized by the presence of fat necrosis, chronic inflammation and fibrosis in the mesentery. Although various causal factors, such as malignancy, chronic inflammatory conditions and autoimmune processes, have been identified, the precise etiology remains unknown. We herein report a rare case of MP accompanying Sjögren's syndrome in which a mass lesion and intestinal stenosis were observed simultaneously. This condition led to ileus, which was effectively treated using prednisolone.
[Show abstract][Hide abstract] ABSTRACT: A 64-year-old Helicobacter pylori infection-naïve woman was found to have a small (≤ 10 mm) depression on the anterior wall of the upper gastric body. On white light endoscopy, the lesion appeared to be inconspicuous, whitish with dilated vessels. 0.2% indigo carmine chromoendoscopy enable better visualization of the depression. On narrow band imaging with magnification, the microsurface structure of the surrounding mucosa was absent and a network of tortuous microvessels were observed within the depressed area. Endoscopic ultrasonography indicated that the tumor was confined to the mucosa. The lesion was removed by endoscopic submucosal dissection. Histological finding of the resected specimen revealed that carcinomatous tubules existed in the deep part of the lamina propria with minimal (300 μm) submucosal invasion which were covered with the atrophic non-neoplastic foveolar epithelium. The tumor was diffusely positive for MUC6 and pepsinogen-I, while it was negative for MUC5AC and H+/K+-ATPase. A diagnosis of early stage gastric adenocarcinoma of fundic gland type (chief cell predominant type) was made.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: The appropriateness of endoscopic resection in patients with T1 colorectal carcinomas is unclear. Highly precise predictors of lymph node metastasis are required to optimize the outcomes of treatments for T1 colorectal carcinomas. OBJECTIVE: The purpose of this work was to identify predictors of lymph node metastasis by examining the clinicopathologic significance of immunophenotypes found in T1 colorectal carcinomas. DESIGN: This was a retrospective study. SETTINGS: The study was conducted at a university hospital. PATIENTS: Included were 265 patients with T1 colorectal carcinoma who underwent radical surgery. INTERVENTIONS: Patients with T1 colorectal carcinoma were managed. MAIN OUTCOME MEASURES: Immunophenotypes were associated with various clinicopathologic parameters, and CD10 expression was strongly associated with lymph node metastasis. RESULTS: The levels of MUC2, MUC5AC, and CD10 expression were individually significantly associated with tumor location, growth pattern, histologic type, invasive potential, and metastatic potential. The incidence of lymph node metastasis was significantly associated with each of the 5 following parameters: depth of submucosal invasion (p = 0.005), tumor budding (p < 0.001), lymphatic invasion (p < 0.001), MUC2 expression (p = 0.006), and CD10 expression (p < 0.001). Multivariate analysis showed that CD10 expression (OR, 9.2 [95% CI, 2.5-39.8]; p = 0.001) and lymphatic invasion (OR, 6.3 [95% CI, 2.5-17.7]; p < 0.001) were independently associated with lymph node metastasis. LIMITATIONS: This study was limited by its small sample size, intraobserver variation attributed to immunohistochemical staining, and potential selection bias because surgically resected specimens were collected instead of endoscopically resected specimens. CONCLUSIONS: We suggest that CD10 expression is closely associated with lymph node metastasis in T1 colorectal carcinoma.
No preview · Article · Aug 2014 · Diseases of the Colon & Rectum
[Show abstract][Hide abstract] ABSTRACT: A 58-year-old woman complaining of hematochezia was diagnosed with rectal cancer (RS, 2, cSS, N1, H0, P0). A laparo-scopic-assisted anterior resection was performed. The hard adhesion between the rectal wall and the uterus indicated that the rectal tumor directly invaded the uterus. After proximal lymph node dissection, open surgery was performed. By intraoperative enteroscopy, we recognized that the main tumor was located distal from the adhesion. Intraoperative histological examination revealed no malignancy, and the ad-hesion was diagnosed as endometriosis. We therefore report a case of rectal endometriosis for which intraoperative histo-logical examination and enteroscopy allowed for the preser-vation of the uterus. We also include a literature review.
Preview · Article · Jan 2014 · Nihon Gekakei Rengo Gakkaishi (Journal of Japanese College of Surgeons)
[Show abstract][Hide abstract] ABSTRACT: The patient was a 40-year-old man who had suffered from Crohn's disease (CD) for 19 years and developed an intractable perianal fistula and two strictures in the small bowel. Dilatation of the two strictures using double-balloon endoscopy did not improve the subileus symptoms. An anal canal adenocarcinoma was also detected using double-balloon endoscopy. The ileum and rectoperianal area were partially resected, and a precise immunohistochemical pathologic assessment revealed that all three lesions were fistula-associated adenocarcinomas. Accumulating endoscopic findings of CD-associated cancer and precise pathologic diagnostic findings will help to establish a suitable surveillance method.
No preview · Article · Feb 2013 · Internal Medicine
[Show abstract][Hide abstract] ABSTRACT: Background
There are currently no universally accepted indications and criteria for additional gastrectomy after endoscopic resection of submucosally invasive cancer. The purpose of the present study was to establish accurate indications and criteria for such additional gastrectomy on the basis of lymph node metastasis risk.
We investigated 130 submucosally invasive gastric cancers and analyzed the pathological risk factors for lymph node metastasis. The tumors were evaluated for pathological factors in the area of invasion, and factors were compared between the cases with lymph node metastasis and those without.
Univariate logistic regression analysis showed that tumor minor axis length, depth of invasion, histological classification of the area of submucosal invasion, absence of lymphoid infiltration, ulceration or scar in the lesion, and lymphatic and venous invasion are statistically significant risk factors for lymph node metastasis. Multivariate logistic regression analysis showed that the absence of lymphoid infiltration and the presence of lymphatic invasion are statistically significant as risk factors for lymph node metastasis.
We present a scoring system on the basis of the pathological criteria tested in this study. Our findings enable more accurate identification of patients who should undergo additional gastrectomy after endoscopic resection.
[Show abstract][Hide abstract] ABSTRACT: Yersinia enterocolitica (YE) infection is a rare cause of intestinal intussusception, especially in adults. We herein, report a case of adult intussusception due to YE enterocolitis. A 24-year-old woman was admitted because of severe abdominal pain. She was clinically diagnosed with ileocolic intussusception on the basis of the findings of computed tomography (CT) and a gastrografin enema. Manual surgical reduction was sufficient to alleviate the intussusception. A histological examination of the lymph nodes around the ileocecum excluded lymphoma. Serological testing revealed that the cause of the intussusception was a YE infection. The patient's postoperative course was good and no recurrence was seen during the follow-up.
No preview · Article · Sep 2012 · Internal Medicine
[Show abstract][Hide abstract] ABSTRACT: A 50-year-old male was hospitalized for further investigations after clinical features suggestive of hepatic dysfunction were detected. Ultrasonography, magnetic resonance cholangiopancreatography, and multidetector computed tomography revealed biliary dilation and enhancement of a tumor in the distal common bile duct. Duodenoscopy revealed pale mucosa with granules and nodules over the entire circumference of the descending 2nd portion. The ampulla of Vater was located in the center of the lesions, and adenocarcinoma was detected on biopsy. Percutaneous transhepatic cholangioscopy was performed following percutaneous transhepatic cholangiodrainage, and polyp-like elevated lesions were observed extruding from the papillary portion into the biliary lumen. Papillary carcinoma was diagnosed and pancreatoduodenectomy was performed. Histopathological findings revealed a well-differentiated adenocarcinoma with partial invasion of the tissue surrounding the sphincter of Oddi in the ampulla of Vater alone and superficial spread across the lower bile duct, pancreatic duct, and duodenum. We report a case of carcinoma of the ampulla of Vater without deep invasion that showed superficial spread over the entire circumference of the descending portion of the duodenum and distal bile duct.
No preview · Article · Sep 2012 · Gastroenterological Endoscopy
[Show abstract][Hide abstract] ABSTRACT: The prognostic factor(s) of carcinoma of the ampulla of Vater were analyzed retrospectively and the significance of lymphadenectomy around the superior mesenteric artery and para-aortic region on the clinical outcome was evaluated.
From 1985 to 2008, 34 carcinomas of the ampulla of Vater patients who underwent pancreaticoduodenectomy with curative intent were analyzed with respect to tumor extent, operation method and prognosis.
Overall 5-year survival was 52.6%. On multivariate analysis, lymph node metastasis, pancreatic invasion, venous invasion, perineural invasion and lymphadenectomy around the superior mesenteric artery were the significant prognostic factors. However, the dissection of para-aortic lymph nodes had no substantial survival benefit. Compared with the duodenal cancer, the prognosis for carcinoma of the ampulla of Vater was significantly worse although no differences in clinicopathological characteristics of patients were observed.
Lymph node metastasis, pancreatic invasion, venous invasion, perineural invasion, and lymphadenectomy around the superior mesenteric artery are important prognostic factors. Pylorus-preserving pancreaticoduodenectomy, with lymphadenectomy around the superior mesenteric artery without dissection of para-aortic lymph nodes is recommended as optimal surgery. Though the treatment results were worse than that of duodenal cancer, curative operation should be performed, regardless of site of origin.
No preview · Article · Jul 2012 · Hepato-gastroenterology
[Show abstract][Hide abstract] ABSTRACT: Collagenous colitis (CC) is a well-known cause of chronic non-bloody diarrhea, especially in elderly women. CC is characterized histopathologically by an increase in the thickness of the subepithelial collagen layer to at least 10 μm, epithelial damage, and chronic inflammation of the lamina propria. Generally, the colonic mucosa in CC is macroscopically normal, although minor, non-specific abnormalities may be found. Due to the recent advancement of endoscopic and diagnostic technologies, however, microscopic mucosal abnormalities and specific longitudinal linear lacerations of the mucosa characteristic of CC have been identified. The association of CC with non-steroidal anti-inflammatory drugs and proton pump inhibitors has also been reported. Since definitive diagnosis of CC has to rely on pathologically documented collagen bands and mononuclear infiltration, the efficiency and precision of colonic biopsy need to be improved. Of the 29 CC patients that we have encountered at our institution, it was in 15 of 29 cases that the endoscopic finding that we performed a biopsy on was apparent. Our comparison of the endoscopic and histopathological findings of CC in the 15 patients showed that the mucosa frequently appeared coarse and nodular on the surface of the mucosa, which was also significantly thicker in collagen bands, demonstrating a strong correlation between collagen band formation and CC. Also, the coarse and nodular surface of the mucosa was most frequently seen affecting the proximal colon. The results suggest that endoscopic observation and biopsy of the proximal colon, where a coarse and nodular surface of the mucosa is often found, may be useful for confirmation of the diagnosis in patients with suspected CC.
[Show abstract][Hide abstract] ABSTRACT: "Japanese clinical guidelines for autoimmune pancreatitis" advised to carefully differentiate between two conditions: autoimmune pancreatitis (AIP) and associated sclerosing cholangitis (SC), and pancreatobiliary malignancy.
We report a series of three cases for which differential diagnosis of pancreatobiliary carcinoma from AIP and associated SC was crucial.
Three patients presented with biliary stenosis secondary to pancreatic swelling or mass lesion, followed by further examinations: Case 1 was first diagnosed as having tumor-forming pancreatitis associated with AIP but eventually proven to be pancreatic head carcinoma; case 2 was operated for suspected bile duct cancer combined with AIP and associated cholangitis, and early cancer was found in the resected specimen; case 3 was operated on for presumed cholangiocarcinoma combined with AIP-associated SC, but no malignancy was found.
Current series of cases would raise an alert on diagnosis of AIP and associated SC, and pancreatobiliary malignancy should be carefully excluded by any means. Surgical intervention would be required in selected cases of this clinical entity.
No preview · Article · Dec 2011 · Journal of Gastrointestinal Cancer
[Show abstract][Hide abstract] ABSTRACT: A 76-year-old woman with sudden epigastric pain and vomiting was admitted to our hospital. Gastrointestinal endoscopy revealed that a cord like mucosa involving several streaks in the gastric fornix was incarcerated in the duodenal bulb. Abdominal computed tomography scans visualized a tumor 5 cm in diameter in the duodenal bulb. The tumor was diagnosed as a gastrointestinal stromal tumor (GIST) arising from the gastric fornix after preoperative manually-assisted endoscopic reduction of the impaction was successful. A partial gastrectomy was performed via a small incision. Pathologically, the 5-cm-diameter tumor was a GIST and immunostaining revealed it was positive for KIT and CD34, and negative for desmin and SlOO protein. The patient's postoperative course was uneventful. She has shown no signs of recurrence up till the time of writing. We report herein on a case of GIST of the gastric fornix presenting with ball valve syndrome.
No preview · Article · Sep 2011 · Gastroenterological Endoscopy
[Show abstract][Hide abstract] ABSTRACT: Small bowel adenocarcinoma is a relatively uncommon neoplasm that accounts for approximately 0.3% to 2.4% of digestive cancers. In comparison with carcinomas of the other areas of the gastrointestinal tract, the prognosis for small bowel adenocarcinoma is generally worse. The prognostic factors of small bowel adenocarcinoma were analyzed retrospectively, and the significance of operative procedure, lymphadenectomy, and adjuvant chemotherapy was evaluated.
From 1990 to 2009, 30 patients with small bowel adenocarcinoma who underwent surgery at Osaka Medical College Hospital were analyzed with respect to tumor extent, operation method, and prognosis.
Overall 5-year survival was 52.5%, and the median survival time was 27.0 months. On univariate and multivariate analyses, the location (duodenum vs. jejunum and ileum), size (greater or less than 70 mm), and tumor, nodes, and metastasis (TNM) stage (stage 0 + I + II vs. III + IV) of the tumor were the significant prognostic factors. No differences in survival and recurrence rates were observed between patients undergoing pancreaticoduodenectomy and those undergoing partial resection, between those undergoing mural lymphadenectomy and those undergoing extended lymphadenectomy, or between those with and without adjuvant chemotherapy. The combination of surgery and adjuvant chemotherapy did not control recurrence or improve the prognosis.
In small bowel adenocarcinoma, location, size, and TNM stage of the tumors were the independent prognostic factors after curative resections. Partial resection with mural lymphadenectomy may be recommended as optimal surgery for small bowel adenocarcinoma.
No preview · Article · May 2011 · Journal of Gastrointestinal Cancer
[Show abstract][Hide abstract] ABSTRACT: Since actinomycosis sometimes causes an abdominal tumor which mimics malignancy, treatment strategy varies from case to case. We herein report two cases which were treated with a combination of antibiotics and surgical intervention. Both patients presented with an intra-abdominal tumor lesion mimicking malignant disease after an appendectomy for acute appendicitis. Case 1 received surgical extirpation of the abdominal tumor in the liver and kidney twice since the clinical diagnosis of actinomycosis was not made. In contrast, case 2 was successfully treated by a combination of antibiotics and laparoscopic surgery following the experience of case 1. When a high probability diagnosis can be made, a laparoscopic approach is a useful and effective option to treat this condition.
[Show abstract][Hide abstract] ABSTRACT: We report a resected case of effective treatment with S-1+CPT-11 combination chemotherapy for advanced gastric cancer. The patient was a 65-year-old man who had a type 3 gastric cancer from the middle body of the stomach to the angle. An abdominal CT scan demonstrated bulky lymph node metastasis (cType 3, T3, N2, M0, cStage IIIb), which was then treated with S-1+CPT-11 (S-1 80 mg/m2 day 1-21, CPT-11 80 mg/m2 day 1, 15/5 weeksx2 courses)as neoadjuvant chemotherapy. After 2 courses of chemotherapy, the primary lesion and regional metastatic lymph nodes were reduced by CT (cType 3, T2, N2, M0, cStage IIIa). Total gastrectomy with D3 nodal dissection was performed. The histological diagnosis was pT2 (ss), pN0, sH0, pCY0, sP0, sM0, tub2, INF beta, ly0, v1, n0, stage I b, Cur A, and the histological effect of the main tumor was judged to be Grade 1b. He was treated by S-1 after surgery. The patient has been in good health without a recurrence for 3 years after surgery. This case suggests that neoadjuvant chemotherapy with S-1+CPT-11 is a potential regimen for advanced gastric cancer.
No preview · Article · Jul 2010 · Gan to kagaku ryoho. Cancer & chemotherapy
[Show abstract][Hide abstract] ABSTRACT: The patient was a 60-year-old male. The upper esophago-gastro-duodenoscopy was performed for screening purposes. At the esophagogastric junction, a depressed erythematous lesion was found with a diameter of 15 mm. The histopathological diagnosis by biopsy was well -differentiated adenocarcinoma taken with all examination, we valuated the depth of invasion was in the mucosal layer, therefore, ESD was performed. With consideration for esophageal intramucosal invasion, we performed resection with an approximately more than 6 mm margin around the lesion. The histopathological diagnosis indicated that the lesion had subepithelial spread at the oral side of the esophagus. The oral surgical margin was positive and submucosal invasion was observed. Thus, additional resection was performed. Superficial Barrett's adenocarcinoma often spreads submucosal layer, and it is often difficult to diagnose its extent. We report here a case of Barrett's adenocarcinoma with intramucosal spread extending beyond 1 cm.
No preview · Article · Mar 2010 · Gastroenterological Endoscopy
[Show abstract][Hide abstract] ABSTRACT: Heterotopic pancreatic cancer in the duodenum is a very rare disease. Only twelve cases have been reported worldwide to date. We report a rare case of malignant transformation of heterotopic pancreas (Heinrich type III) in the duodenum with long-term survival of the patient, and review the 12 cases in the literature.
A 75-year-old Japanese man was admitted to our hospital complaining of nausea and vomiting. Endoscopy and upper gastrointestinal contrast study showed marked duodenal stenosis. A pylorus-preserving pancreaticoduodenectomy was performed. Histopathological examination of the surgically resected specimen showed malignant transformation of heterotopic pancreas (Heinrich type III) in the duodenum. The postoperative course was uneventful, and the patient was discharged from the hospital on postoperative day 30. He is well and shows no signs of recurrence at the time of writing, six years after the surgery.
Adenocarcinoma arising within the heterotopic pancreas appears to be rare. It is difficult to obtain a correct diagnosis preoperatively. The management of heterotopic pancreas depends on the presence or absence of symptoms. If the patient is asymptomatic or benign, conservative treatment with regular follow-up is recommended. When the patient is symptomatic or there is a suspicion of malignancy, surgical management with intra-operative frozen section diagnosis is indicated.
Full-text · Article · Feb 2010 · Journal of Medical Case Reports
[Show abstract][Hide abstract] ABSTRACT: Detection of early gastric tube cancers (GTCs) has increased with more detailed surveillance endoscopy using indigo carmine dye following esophagectomy. This retrospective study clarified the clinicopathological features and application of endoscopic submucosal dissection (ESD) for GTCs. Data collected for eight GTCs treated by ESD included clinical and pathological features and outcomes following ESD. Overall, eight GTCs were identified in seven (6.3 %) of 112 patients who underwent esophagectomy and gastric tube reconstruction. Almost all lesions were macroscopically type 0-IIa with mucosal to submucosal invasion, and seven GTCs were successfully resected en bloc by ESD. Submucosal invasion to > 500 microm was observed in one case with associated delayed perforation that was treated conservatively. No local recurrences of GTCs were observed. Detailed surveillance endoscopy using indigo carmine dye appears useful for diagnosing early-stage GTC. Furthermore ESD represents a feasible alternative to conventional endoscopic mucosal resection as a minimally invasive therapy for early-stage GTC.