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Bronchogenic cyst is very difficult to diagnose preoperatively. We report two cases of bronchogenic cyst of the esophagus diagnosed and treated by thoracoscopic resection or endoscopic mucosal incision. Thoracoscopic resection was performed to diagnose and treat case 1, while in case 2, histological diagnosis was obtained with an endoscopic mucosal incision. On endoscopic ultrasonography, the lesion characteristically demonstrated two components consisting of an anechoic and homogeneous echoic pattern. Although it is very rare for bronchogenic cyst to be complicated by malignancy, histological diagnosis is necessary. If tumor localization is in the esophageal wall and the safety of a mucosal incision can be confirmed, endoscopic incision is a good alternative that allows less invasive diagnosis and treatment than surgery or thoracoscopy.

We report on a case of an 80-year-old male with autopsy-confirmed biliary cystadenocarcinoma. The tumor's growth was followed up for five years. CT findings on first admission revealed that the cyst walls of the tumor were smooth. However, a CT taken four years later showed large cysts with irregular walls which were growing invasively and expanding beyond the liver. The patient died of liver dysfunction caused by obstructive jaundice due to the liver tumor, and an autopsy was performed. Histologic examination of the autopsy material revealed a multilocular tumor that was identified as being a biliary cystadenocarcinoma and microscopic lung metastases were seen. The character of the multilocular cyst with septations covered by papillary proliferation of atypical columnar epithelium and many remaining portions with low grade dysplasia led us to suspect the tumor was derived from a cystadenoma.

The early stage of colorectal cancer is divided into two morphological types polypoid and superficial. What percentage of advanced cancer is derived from the polypoid or superficial type is a matter of concern. The ratio of superficial variety among of ulcerated cancers was studied using those 2 cm or less in diameter, which often retain mucosal cancer. The existence of horizontal growing mucosal cancer at the marginal area of ulcerated cancer is a hallmark showing the lesion being of superficial origin. Eight (57 %) out of the 14 cases of ulcerated cancer, 2 cm or less, had this finding. This suggests that more than half of smaller colorectal cancers are of superficial origin. A zig-zag pattern (ZZP) was evident in 3 cases of superficial origin. No cases in the nonsuperficial group had the ZZP. The existence of circumferential ZZP during colonoscopic observation indicates that the cancer is of superficial origin.

The expression of oncogene products and growth factors (epidermal growth factor, transforming growth factor-β, erb B-2, ras p 21, and c- myc ) in gallbladder cancer and chronic cholecystitis was measured by immunohistochemical staining on paraffin-embedded serial sections. Expression of these products was graded according to staining intensity in an area of positively stained cells. This study reports the detection of oncogene products and growth factors in cholecystitis as well as in early and late gallbladder cancer. The multiexpression of oncogene products and growth factors was greater for both gallbladder cancer groups as compared with the cholecystitis group. The percentage of epidermal growth factor positivity diminished with increased proportion of interstitial tissue and, conversely, the percentage of transforming growth factor positivity increased with increased proportion of interstitial tissue. The proportion of ras positivity was significantly greater in both early and advanced cholecystic cancer as compared with cholecystitis, but also was considerable even for cholecystitis. These results suggest that various oncogenes may have significant roles in gallbladder cancer and that collagen synthesis is reduced by epidermal growth factor and enhanced by transforming growth factor-β.

Sixty-nine hyperplastic polyps over 6mm in diameter were studied with respect to their size and location. Of these polyps, 47% in the rectum, 35% in the right colon, and 80% in the left colon were pedunculated. In other words, polyps with stalks were prevalent in the left colon. Horizontally growing tumors like hyperplastic polyps tended to be pedunculated depending on their location.

Serum sialic acid was measured to evaluate the activity of Crohn's disease. The sialic acid levels of patients with Crohn's disease in remission (CRP 0.0 mg/dl) were significantly higher than those of healthy subjects and postoperative patients with Crohn's disease. In patients in remission, serum sialic acid was significantly correlated with hemoglobin, hematocrit, platelet, and rapid turnover protein. Correlations with platelet, retinol-binding protein, and prealbumin were especially strong. From these findings, it was concluded that serum sialic acid level provides a useful index of the activity of Crohn's disease.

We report that the penetrating type of early gastric cancer (PEN) is a specific type of early gastric cancer and that the poorly differentiated PEN type could be considered an initial lesion of linitis plastica-type cancer. We performed an immunohistochemical study to clarify the role of growth factors (epidermal growth factor [EGF] and transforming growth factor-beta [TGF-beta]) in the PEN type of early gastric cancer. The results indicated that the PEN type of early gastric cancer has a high growth capacity. Moreover, it was suggested that EGF was involved in its specific infiltrative growth and that both EGF and TGF-beta were involved in its specific scirrhous growth. From these findings, it was assumed that the immunohistochemical staining of EGF and TGF-beta in endoscopic biopsy specimens was useful for the diagnosis of the PEN type of gastric cancer and also for the diagnosis of the initial lesion of linitis plastica-type gastric cancer.

The estrogen receptor was studied in a total of 42 cases of gastric carcinoma which included 14 cases of the penetrating type of early gastric carcinoma (PEN), 14 cases of the common type of early gastric carcinomas (EA) and 14 cases of the advanced gastric carcinomas (AD). An immunohistochemical study using the anti-ER-D5 antibody revealed that the detection of estrogen receptor-positive tumor cells was significantly higher in the PEN group and in the AD group than in the EA group. Moreover, the incidence of estrogen receptor immunoreactivity in infiltrative and scirrhous PENs was significantly higher than that in non-infiltrative and non-scirrhous PENs. These results suggests that the estrogen receptor may play an important role in infiltrative proliferation and scirrhous growth in the PENs. Furthermore, the results indicated that ER immunostaining procedures applied to endoscopic biopsy specimens could be useful for the endoscopic diagnosis of PEN-type early gastric cancer.

We studied a 57-year-old man who was diagnosed as having giant rugae at a mass-screening for gastric cancer. He was examined endoscopically for check-up purposes. In addition to giant rugal folds which occurred throughout the entire fundus and body of the stomach, a type IIc lesion was noted in the posterior lower wall of the gastric body. A biopsy revealed signet ring cell carcinoma. A total gastrectomy was performed. A resected specimen was serially sectioned and underwent histopathological examination; hypertrophy and cystic elongation of the gastric glands indicative of so-called giant hypertrophic gastritis was seen. The histological type of the type IIc lesion was undifferentiated adenocarcinoma with the signet ring cells being confined to the mucosal layer. This patient had a rare case of Menetrier's disease complicated by intramucosal carcinoma.

大腸腺腫,腺腫内癌,sm癌,進行癌,平坦陥凹型癌,計51例における癌遣伝子産物(ras, c-myc, erbB-2),および増殖因子(EGF, TGF-β)の発現をパラフィン包埋材料の連続切片を用いて免疫組織化学染色により検討した,rasを除く遺伝子産物は腺腫群では低値を示し,浸潤傾向とともに高値を示した.進行癌周囲正常粘膜ではras, erbB-2が高値を示した.癌周囲異型粘膜の染色濃度には癌の病理学的形態による特異的な所見はなかった.sm浸潤部では進行癌が他群に比較して高値を示した.腫瘍性病変の各群とも癌遺伝子産物は重複して陽性を示した.またいずれの群においても浸潤を伴うものではこの部で非浸潤部と比較して重複陽性例が多かった.以上より大腸癌における発癌には複数の癌遺伝子の活性化が関与していることが示唆された.

Specific types of early gastric cancer were investigated in accordance with the cancer surface area and the degree of penetration by means of quantitative measurements of the surface area of early gastric cancer using the interactive image analysis system. The results indicated a significant correlation between the surface area and the penetration depth in ordinary early gastric cancer. However these correlations were not observed in both well and poorly differentiated adenocarcinoma cases of the so-called PEN and SUPER types, which showed a significant specificity when compared with ordinary early gastric cancer. The PEN and SUPER types of early gastric cancer also exhibited various clinicopathological characteristics, and it was suggested that the poorly differentiated PEN type might be the initial lesion of a linitis plastica type gastric cancer. Examination of the conditions of the mucosa surrounding the cancer revealed a difference between the PEN and the SUPER types, and this suggested that the environment at the site of a cancer growth influences the type of growth and the spread of early gastric cancer.

大腸sm癌の予後と臨床病理学的特徴よリポリペクトミー後の追加腸切除の必要性について検討した.過去18年間に当センターで経験した大腸sm癌のうち126症例127病変(手術例71症例)を対象とした.(1)有茎性sm癌は手術症例でリンパ節転移を認めず,ポリペクトミー後手術例でも癌遺残はなく,ポリペクトミー単独の症例でも再発は認められなかった.(2)無茎性(広基性,表面型)sm癌はsm 2以上でリンパ節転移を認めた.従って粘膜下層にわずかに浸潤しているものsm 1(約300μ)以外はリンパ節転移の可能性があるため追加切除が必要である.

Colonoscopic characteristics of aphthoid ulcers in amebiasis, Crohn's disease, and tuberculosis were evaluated. Multiple aphthoid ulcers were featured in 14 out of 15 cases of amebiasis, 7 out of 74 cases of Crohn's disease, and 5 out of 24 cases of tuberculosis. Aphthoid ulcers of amebiasis were often confined to the rectum and lower sigmoid colon, being characterized by marginal elevation and erythema. Crohn's aphthoid ulcers lacked the red halo in all but one case. No verrucous elevations were observed. The intervening mucosa appeared intact in all cases. Aphthoid ulcers of intestinal tuberculosis were oval or lozenge-shaped. They were surrounded by a marginal red halo in 4 cases (80%), however, the red halos found in tuberculosis patients were milder than those of patients with amebiasis. Aphthoid ulcers of Crohn's disease and tuberculosis showed a tendency to be arranged in a specific direction. Crohn's ulcers were arranged in a longitudinal fashion, whereas tuberculous ulcers were arranged in a circular fashion. Ulcers of amebiasis were arranged entirely at random. Biopsy from aphthoid ulcers of amebiasis showed parasites in 64%, whereas cytological studies were positive in 93% of cases.

We examined differences in the degree of differentiation in intramucosal and submucosal areas of involvement in early colorectal adenocarcinomas of 131 patients and compared these findings with tumor morphology. In addition, K-ras and p53 protein expression was determined in cases where poorly differentiated adenocarcinoma was detected in the submucosa. We identified 6 patients with both intramucosal differentiated (well-to-moderately differentiated) adenocarcinoma and submucosal poorly differentiated adenocarcinoma (MwSp). The morphological tumor type was superficial in all MwSp cases. The observed MwSp adenocarcinomas had a significantly higher frequency of lymphatic invasion than the more common superficial type of adenocarcinoma. Genetic analysis of these MwSp lesions was carried out using the polymerase chain reaction-restriction fragment-length polymorphism (PCR-RFLP) method to detect the presence of K-ras codon 12 point mutations, and an immunologic staining technique was used to identify the presence of p53 protein overexpression. The K-ras mutation rate was 33.3%, and the p53 overexpression rate was 66.7% for the MwSp adenocarcinomas. Our findings suggest that the rapidly reduced histologic differentiation observed in some of these superficial colorectal adenocarcinomas may play a role in their higher degree of invasiveness.

We describe a 23-year-old man with protein-losing enteropathy, iron deficiency anemia, and recurrent gastrointestinal bleeding. The patient eventually developed disseminated intravascular coagulation, portal vein thrombosis, and extensive small bowel infarction. The autopsy showed multiple telangiectases in the intestines, mesentery, liver, gallbladder, renal pelves, and diaphragm. In addition, lymphangiectases were found in the retroperitoneal space, intestines, and liver. These lesions appeared to have been the cause of the gastrointestinal bleeding and the protein-losing enteropathy. The case most likely represents Osler-Weber-Rendu disease without the usual manifestations in the skin and oral-nasal cavities.

Thirty-seven diminutive flat depressed neoplastic lesions of the colon, smaller than 5 mm, were detected by contrast chromoscopy using an indigo carmine capsule and subsequently removed by endoscopic mucosal resection. We investigated the endoscopic, macroscopic, and histologic characteristics of these lesions and also evaluated the usefulness of chromoscopy and the magnifying endoscope for detecting this type of lesion. The lesions were classified into two types according to the measured height of the histologic sections: 28 lesions were truly flat depressed and the remaining 9 lesions were flat elevated. Of the 37 lesions, 18 were adenomas with mild atypia, 14 with moderate atypia, and 5 with severe atypia. The flat depressed lesions included 12 with mild atypia, 11 with moderate atypia, and 5 with severe atypia. No invasive carcinoma was present in either type, and no adenoma with severe atypia was identified in any of the flat elevated lesions. The overall rate of severe atypia was 13.5%; the rate of severe atypia for the flat depressed type was 17.9%, which is approximately 14-fold greater than that of ordinary diminutive polypoid adenomas (1.3%). The detection of these lesions was facilitated by the use of indigo carmine dye, which clearly demonstrated the mucosal irregularities. The frequency of detection of these lesions was increased four to five times with a magnifying endoscope, as occurred in nearly 10% of all of the patients examined. These data suggest that the finding of endoscopically minute flat depressed neoplastic lesions is not at all uncommon when examination is meticulously performed. Furthermore, these lesions, especially the truly flat depressed type, have a high rate of severe atypia despite their small size and should be carefully treated. To detect and treat this type of lesion, meticulous colonoscopic examinations, aided by chromoscopy and a magnifying colonoscope, may be warranted

We examined the p53 protein and human papilloma virus (HPV) by immunohistochemistry and DNA ploidy by cytofluorometry in paraffin-embedded esophageal carcinoma tissue specimens. Sixty-one patients with superficial esophageal carcinoma were operated on between 1983 and 1991 without any prior treatment. Immunostaining of the anti-p53 protein antibody (CM1) was positive in 32 carcinomas (52%). Patients with p53-positive tumors had a poorer outcome than those with p53-negative tumors (P

Ras gene mutations occur relatively early during colorectal tumor development and have been observed in 40-50% of malignant colorectal tumors. Advances in endoscopic techniques have made it possible to detect small, flat colorectal tumors that could not be detected by standard examinations. To determine whether ras gene mutations are also involved in the genesis of small, flat colorectal tumors, we examined ras point mutations in 34 cases of small polypoid or flat elevated colorectal tumors (32 adenomas, 2 carcinomas) and in 26 cases of small, flat colorectal tumors (13 adenomas, 13 carcinomas) by means of the polymerase chain reaction (PCR) and dot-blot hybridization. Ras gene point mutations were observed in 16 of the 34 tumors of the former type (47%), but in none of the 26 tumors of the latter type, even though the grade of dysplasia was severe in the flat tumors. Our results suggest that different genetic pathways for tumor progression may exist for polypoid and for flat colorectal carcinomas. © Wiley-Liss, Inc.

A man was admitted to our hospital because of intestinal reddish bleeding. Colonic varices were found at the cecum by colonoscopy. Angiography of the superior mesenteric artery showed that blood vessels were scant from the end of the ileum to the ascending colon. An operative view revealed the varices, but there was no trace of the ileocecal vein. This case, presenting a deficit of the ileocecal vein, indicated that the blood flow could not return via the ileocecal vein, and therefore there was an outflow through the varices to the surrounding intestine or abdominal veins. Such a case is probably unrepresented in the literature because it was caused by the total deficiency of the ileocecal vein and it was in the right colon.

Leiomyoblastoma has been regarded as a neoplasm of smooth muscle origin. With recent progress in immunohistostaining techniques, many clinicopathological discrepancies have been pointed out about the origin of leiomyoblastoma. It has been claimed that gastrointestinal non-epithelial tumors should be regarded as stromal tumors in order to study their origin. In the present study, we performed various forms of immunohistostaining in seven cases of leiomyoblastoma to determine their origin. One case expressed desmine and muscle specific actin and was considered to be derived from smooth muscle. Four neoplasms expressed S-100 protein (two cases were also NSE positive) and were thought to be derived from the nerve. Two cases were of unknown derivation. These results suggest that the cells of leiomyoblastoma may arise from a primitive to totipotential cell of neural lineages that may anomalously express smooth muscle filaments.

Endoscopic appearance of the gastrointestinal tract of a patient with severe hemorrhagic enteric graft-vs.-host disease (GVHD) is presented. A 29-year-old man with chronic myelogenous leukemia suffered from severe enteric GVHD after allogeneic bone marrow transplantation. Endoscopy showed hemorrhagic ulceration of the upper jejunum, terminal ileum, and colon at the onset of melena. Sections of biopsies were compatible with acute GVHD. Repeat endoscopy showed gradual healing of the lesions after steroid pulse and antilymphocyte globulin therapy, but the patient died of cytomegalovirus pneumonitis 14 months later. Autopsy revealed submucosal fibrosis of the small intestine and colon.

There have been only a few reports of squamous cell metaplasia 4 or squamous cell carcinoma1,2.5,6 of the colon associated with ulcerative colitis. We encountered a patient with squamous cell metaplasia and long-standing ulcerative colitis. The lesion was noted endoscopically as a pinkish white area with a clearly demarcated border. Lugol stain and biopsies demonstrated the lesion to be composed of squamous epithelium.

A case is reported in which a colonic hemangioma was successfully removed endoscopically. The authors recommend that the colonoscopist be skilled and use the technique only for polypoid lesions

潰瘍性大腸炎(以下UCと略す)の結腸全摘術後小腸再燃の報告は,欧米ではよく報告されているが,本邦では未だその報告をみない.われわれは,UCにて結腸全摘術後,回腸に再燃を思わせる炎症性変化を来した興味ある2症例を経験したので報告する.

A case of Peutz-Jeghers syndrome in which one colonic polyp showed many foci of glandular dysplasia is reported. Peutz-Jeghers polyps are considered to be hamartomatous, and their malignant potential has been considered doubtful. This case is valuable because foci of glandular dysplasia existed within hyperplastic glands. Glands of Peutz-Jeghers polyps are proliferative in nature, and therefore it is not surprising that there are areas of glandular dysplasia and of cancerous change.

Esophageal lesions are rarely seen in patients with intestinal Behçet's disease. Three patients with esophageal lesions (dissection of esophageal mucosa, esophageal ulcer, esophageal varices) were observed among 15 patients with intestinal Behçet's disease or non-specific simple ulcer (1974-1984). Two-thirds of these fifteen patients had fully developed or suspected Behçet's disease, and one-third had no symptoms typical of Behçet's disease. They are classified as non-specific simple ulcer. The average age of the 15 patients was 43 years, all patients but one were male. The recurrence rate after surgical treatment was 70%, that of medical treatment was 90%.

A case of progressive systemic sclerosis associated with colonic involvement is described. Barium-enema examination revealed segmental involvement. Colonoscopic examination of the whole range of the involved colon revealed wide-mouthed diverticula with interspersed rigid areas and numerous ulcerations. These colonoscopic findings appeared to be distinct from those associated with tuberculosis and Crohn's disease.

A large juvenile polyp in the ascending colon of a 5-year-old boy was successfully polypectomized . The boy often had rectal bleeding, and anemia was known. Transection was necessary to prevent bleeding and anemia.

Colitis cystica profunda is a benign condition that has been confused with carcinoma. This rarely recognized condition is characterized by submucosal cysts. Macroscopically, the ulcerated character of the mass suggests carcinoma. Microscopically, attenuation of the innocuous-appearing cyst linings may give the false impression of a mucus-secreting carcinoma. A case of colitis cystica profunda in which the macroscopic appearance was so suggestive of malignancy that operation was carried out is reported.

A case of esophageal Crohn's disease is described. Crohn's lesion was observed in the lower esophagus, and sarcoid-like granulomas were found in the biopsied specimen. A clinical consideration of this phenomenon is presented.

Five hundred eighty-two patients with colorectal adenomas or early cancers were polypectomized from 1974 to 1985. In 100 patients, total colonoscopy was performed more than twice after the initial polypectomies. These patients were divided into three groups: group A patients underwent total colonoscopy at 1-year intervals; group B patients underwent total colonoscopy at 2-year intervals, group C patients underwent total colonoscopy at 3-year or more than 3-year intervals. The frequency and location of newly developed adenomas were investigated. The detection rate for new adenomas was 13% in group A and 50% in group B; thus, there was a significant difference between group A and group B (P less than 0.01). The transverse colon is the only segment where the topological proportion of newly developed adenomas increased in comparison with that of index adenomas (P less than 0.05). The detection rate for new adenomas was significantly higher in patients who had carcinoma in situ at the time of initial polypectomy (P less than 0.05). Questionnaires about colonoscopy and colonic adenomas were therefore mailed to the patients who were lost to follow-up after the polypectomy.

A case with diagnosis of benign cystic teratoma penetrating the rectal wall is presented. Teratoma of the rectum, primary or secondary, is not familiar and diagnosis is difficult. However, it is rather easy when teeth are found on x-ray or by colonoscopy. Even in such instances the origin of the tumor is usually obscure before operation.

A 43-year-old Japanese woman with asynchronous onset of ulcerative colitis and aortitis syndrome (Takayasu’s arteritis) is reported. The possible relationship between the two disorders is discussed.

These Japanese experts describe in helpful detail their technic for negotiating by colonoscopy the twists and turns of the bowel in order to obtain biopsy specimens from the terminal ileum. Granular ileal mucosa, reflecting lymphoid hyperplasia, is common in younger patients but probably represents an abnormality in older adults.