Search

A 72-year-old man had undergone uncomplicated endoscopic submucosal dissection (ESD) with en bloc resection of a localized 20-mm IIc lesion in the anterior wall of the gastric angle. Twenty-eight days later, he was re-admitted with epigastric pain of one-week duration. Contrast-enhanced computed tomography (CT) revealed a 60-mm mass bordered by viscera; repeat endoscopy confirmed a smooth elevated submucosal tumor at the greater curvature on the oral side of the post-ESD ulcer. We diagnosed him with a perigastric abscess as a complication of ESD and performed endoscopic ultrasound-guided drainage. Subsequently, the symptoms and blood inflammatory parameters improved, and follow-up CT showed the disappearance of the abscess.

Background and study aims Despite the information regarding extravasation from contrast-enhanced computed tomography (CECT), the detectability of the target diverticulum by colonoscopy remains unsatisfactory in colonic diverticular bleeding (CDB). The lack of common signs recognizable on CT and endoscopic images makes it difficult to set a region of interest; however, this can be overcome with the “step-clipping” method, a strategic marking technique for revealing the target. We aimed to investigate the clinical performance of the step-clipping method in patients with CDB. Patients and methods Eighty-seven patients diagnosed with CDB with extravasation using CECT who underwent colonoscopy between August 2007 and February 2020 were included. Patients were divided into two categories: the traditional group (those who underwent colonoscopy from August 2007 to May 2017, n = 54) and the step-clipping group (those who underwent colonoscopy from June 2017 to February 2020, n = 33). Results The detection rate for the responsible diverticulum was significantly higher in the step-clipping group than in the traditional group (94 % vs 63 %; P = .0013). The step-clipping group had a shorter average search time during colonoscopy (9.6 vs 40.5 minutes; P Conclusions Colonoscopy using the step-clipping method can improve the detectability of the target lesion within a shorter time, thus leading to lower re-bleeding rates and earlier hospital discharge.

症例は71歳，女性．右乳房A>C領域に拍動を有する鶉卵大の腫瘤を触知した．超音波検査で血管と思われる無エコー域を血栓と思われる低エコー域が層状に被包する脈瘤を認め，ドプラ超音波で無エコー域内に明瞭な血流と拍動を認めた．造影CT検査で腫瘤への流入血管は内胸動脈と外側胸動脈の分枝と確認した．乳腺仮性動脈瘤の診断で摘出術を施行した．摘出標本では比較的太い血管を器質化した血栓が層状に被包する腫瘤であった．病理検査で内膜および中膜が破綻した血管とそれを被包する血栓と結合織を認め，乳腺仮性動脈瘤と診断した．乳腺仮性動脈瘤は本邦報告例のない極めて稀な疾患で，文献的考察を加え報告する．

Plummer-Vinson症候群は嚥下障害，鉄欠乏性貧血および舌炎を主徴とする症候群で，下咽頭癌や頸部食道癌との合併が多いとされる．今回われわれは，Plummer-Vinson症候群に発症した胃癌の1例を経験したので報告する．症例は62歳，男性．30年前より貧血，嚥下困難を自覚．最近になって嚥下困難が増悪したため来院．血液検査にて鉄欠乏性貧血を認めた．上部消化管精査にて食道入口部に膜様狭窄（食道web）を認めた．また胃体部大彎にI型腫瘍を認め，組織学的に胃癌と診断された．Plummer-Vinson症候群に発症した胃癌の診断で根治的胃亜全摘術を施行した．病理組織学的に乳頭腺癌であった．現在再発兆候無く，鉄剤の内服にて貧血および嚥下困難は認めていない．今回，Plummer-Vinson症候群と胃癌との明確な関連性は指摘できなかったが，本症候群の患者に対しては，胃癌の発症も念頭に置いた診療が必要と考えられた．

Tubular carcinoma of the breast is a rare type of breast carinoma which has characteristic histologic findings, especially pure type tubular carcinoma in that lymp node metastases rarely occur and the prognosis is good. We report a case of resected pure type tubular carcinoma of the breast with lymph node metastasis. A 55-year-old woman was referred to the hospital because of a tumor formation at her left breast. The tumor shadow with spicula was identified by a mammogram, but the tumor could not be diagnosed as malignancy by an aspiration cytology. By an excisional biopsy, the tumor was diagnosed as tubular carcinoma. The patient underwent a mastectomy with lymph nodes dissection. Postoperative histological findings revealed pure type tubular carcinoma with axillary lymph node metastasis. Since lymph node metastasis is detected in a pure type tubular carcinoma like in this case, tubular carcinoma should be dealt with the same manner as other invasive carcinomas of the breast are treated.