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A 70-year-old man was diagnosed with coronavirus disease 2019 (COVID-19) pneumonia. Twenty-six days after admission, he experienced hematemesis despite improvement in his respiratory symptoms. Contrast-enhanced computed tomography revealed edematous stomach wall thickening with neither ischemic findings in the gastric wall nor obstruction of the gastric artery. Emergent esophagogastroduodenoscopy showed diffuse dark-red mucosa accompanied by multiple easy-bleeding, irregularly shaped ulcers throughout almost the whole stomach without active bleeding or visible vessels. The clinical course, including the endoscopic findings, progressed favorably with conservative treatment. COVID-19 pneumonia can present with acute gastric mucosal lesion, which may be induced by microvascular thrombosis due to COVID-19-related coagulopathy.

A 69-year-old man was referred to our department with acute hepatitis. He had been newly treated with benidipine hydrochloride for two months. His blood test results were as follows: aspartate aminotransferase, 1,614 IU/L; alanine aminotransferase, 1,091 IU/L and anti-smooth muscle antibody, ×80. Needle liver biopsy specimen showed interface hepatitis with mainly lymphocytic infiltration and bridging fibrosis in the periportal area. Immunohistochemistry revealed lymphocytic infiltration positive for IgG4. We diagnosed him with IgG4-related AIH with an etiology that was suspected of being drug-induced. Oral prednisolone was started and then tapered after achieving biochemical remission. Hepatitis recurred after the cessation of steroids; however, remission was achieved with ursodeoxycholic acid.

A 78-year-old man underwent endoscopic submucosal dissection (ESD) of early gastric cancer (EGC) (type 0-IIa) in the anterior wall of the antrum. En bloc resection was achieved. The histopathological examination revealed very well-differentiated tubular adenocarcinoma (tub1) of 30 × 22 mm in size, confined to the mucosa. No lymphovascular invasion or ulceration was observed, and there was no undifferentiated-type component and the margins were tumor-free. Therefore, this lesion fulfilled the eCuraA criteria. Two years after ESD, esophagogastroduodenoscopy revealed an irregular, slightly-depressed lesion within the post-ESD scar. Tubular adenocarcinoma was suspected based on histopathological examination of a biopsy specimen. The tumor was resected by ESD. A histopathological examination revealed well-differentiated tubular adenocarcinoma (tub1) of 6 × 4 mm in size, confined to the mucosa. No lymphovascular invasion was detected and the margins were tumor-free. These findings indicated a curative resection. Recurrence following a curative ESD of an intramucosal differentiated-type EGC which fulfilled the eCuraA criteria is rare. Careful endoscopic observation using magnifying narrow band imaging (NBI) is needed after ESD, even when curative resection is achieved.

A 74-year-old woman was admitted to our hospital with upper abdominal pain and bloody vomiting. An abdominal aneurysm compressed the third portion of the duodenum and the second portion of duodenum was distended with thickened walls as in superior mesenteric artery syndrome. Endoscopic examination showed an edematous mucosa with hemorrhagic erosions, shallow longitudinal ulcers, and star-shaped ulcers in the duodenum. We diagnosed this case as ischemic duodenitis associated with superior mesenteric artery syndrome caused by compression by an abdominal aortic aneurysm. The symptoms improved on treatment with bowel rest, total parenteral nutrition and administration of a proton pump inhibitor. We present here a rare case of ischemic duodenitis and summarize the previous medical literature on the disease.

Enoki Y, Katoh G, Okabe H & Yanagisawa A (2010) Histopathology56, 384–394 Clinicopathological features and CD57 expression in renal cell carcinoma in acquired cystic disease of the kidneys: with special emphasis on a relation to the duration of haemodialysis, the degree of calcium oxalate deposition, histological type, and possible tumorigenesis Aims: Acquired cystic disease of the kidney (ACDK) in patients undergoing haemodialysis is known to develop into renal cell carcinoma (RCC), but its pathogenesis remains unclear. The aims were to analyse the histological findings of ACDK-RCC and to determine its histogenesis. Methods and results: Twenty-nine RCCs in 23 patients with ACDK were classified into three groups according to the duration of haemodialysis and were analysed for histological type, calcium oxalate (Oxa) deposition, and cyst and atypical cyst (AC) formation. Histologically, 21 tumours were ACDK-RCC and eight were clear cell carcinoma (CCC). The ratio of ACDK-RCC and the numbers of cysts and ACs increased as the duration of haemodialysis was prolonged. The degrees of intratumoral Oxa deposition and cyst and AC formation of ACDK-RCCs were higher than those of CCCs (Oxa, P = 0.028; cyst, P

Pulmonary hypertension is known to develop in patients with connective tissue diseases. We report a case with systemic lupus erythematosus, in which the natural course of pulmonary hypertension due to systemic lupus erythematosus was observed. This female patient was diagnosed with systemic lupus erythematosus at 24 years of age, but had refused to take steroids or immunosuppressants. A diagnosis of pulmonary hypertension due to systemic lupus erythematosus was made at 42 years old; the pulmonary artery increased in size over a decade. At 59 years old, the patient was transferred to the emergency department of our hospital in a state of shock, at which time chest computed tomography showed a pulmonary artery aneurysm of 82 mm. She died hours after admission, with no response to cardiopulmonary resuscitation. Autopsy showed an enlarged right ventricle and pulmonary alveolar hemorrhage with the formation of a plexiform lesion, accompanied by thrombi, in the branches of the pulmonary artery.

症例は25歳の女性で, 下腹部痛, 嘔吐, 発熱を主訴に近医を受診し急性虫垂炎の診断で当院に紹介された. 約1か月間インドに旅行しており帰国直後であった. 来院時下腹部全体に激しい自発痛および圧痛を認めた. 腹部CTと超音波検査で臍方向に向かう腫大した虫垂を認め, 急性虫垂炎と診断し虫垂切除術を施行, 8.5×2.5cmのフランクフルトソーセージ様に発赤腫大した虫垂を認めた. 術後再度腹痛と下痢, 白い膿状の便汁を認め, 39℃台の発熱も続いたため精査を行い腹部CTで上行結腸の著明な壁肥厚, 大腸内視鏡で白苔付着を伴い多発し散在する類円形のびらんと深掘れの潰瘍を認めた. その後, 大腸生検組織および虫垂切除組織から栄養型アメーバが検出されたため, アメーバ性大腸炎と診断しメトロニダゾールの内服を開始した.開始後より解熱し症状も消失した. 海外渡航歴があり急性虫垂炎の症状のある患者では赤痢アメーバなども念頭において原因の検索を行わなくてはいけないと考えられた.

高分化型脂肪肉腫の亜分類である脱分化型は,高分化型脂肪肉腫の5%以下と稀な組織型である.今回われわれは,後腹膜に発生した巨大な脱分化型脂肪肉腫に対して,手術切除を行った症例を経験したので報告する.症例は58歳,女性. 2004年腰痛にて近医受診し,腹部エコーにて右側腹部に巨大な腫瘤を指摘される.穿刺吸引細胞診にて間葉系悪性腫瘍との診断を得たため,手術切除を施行した.腫瘍は12×16×8.5cm, 1,120gの充実性の腫瘍であったが高度の中心性壊死を示していた.組織所見では,高分化型脂肪肉腫の部分と短紡錘型細胞が目立ち,悪性線維性組織球腫様所見を呈した充実部分とが認められ,脱分化型脂肪肉腫と診断した.脱分化型脂肪肉腫は,他の組織型に比べて予後不良である.治療の第一選択は他の脂肪肉腫と同じく,外科切除となる.化学療法・放射線療法などの補助療法の有効性は定まったものはない.

Radial MRI findings and pathological changes were comparatively examined in the acetabular labrum of 11 hips of 11 patients, who underwent total hip arthroplasty for osteoarthritis due to acetabular dysplasia. Diffuse high signal pattern on the radial MR images corresponded to histological degeneration of the labrum. High signal pattern which was equivalent to the synovial fluid, showed an intralabral tear. In the obscure areas of MR images, severe impairment of the labrum such as rupture, detachment, and displacement were found.

Poorly differentiated neuroendocrine cell carcinomas of the gallbladder are rare and patients with such tumors have a poor prognosis. We describe a 64-year-old male with a large cell neuroendocrine carcinoma of the gallbladder and multiple lymph node metastases. Diagnostic excisional biopsy of the left axillary lymph nodes revealed atypical cells with predominantly large-sized round-to-oval nuclei, proliferating in a solid and focal nesting pattern. The tumor cells were positive for synaptophysin and chromogranin A, and strongly positive for Ki-67, leading to a diagnosis of poorly differentiated neuroendocrine cell carcinoma of the gallbladder, of large cell type. Using (18)F-fluorodeoxy glucose-positron emission tomography/computed tomography to determine the origin of these tumors, we observed the accumulation of (18)F-fluorodeoxy glucose in multiple large lymph nodes, a small part of the liver and the fundus of the gallbladder. Computed tomography-guided aspiration of the gallbladder showed the same pleomorphic tumor cells as the lymph nodes. The patient was diagnosed with a large cell neuroendocrine carcinoma of the gallbladder, only ∼25 mm in diameter. Combination chemotherapy with cisplatin and docetaxel, the regimen used for non-small cell lung carcinomas, and probably large cell lung carcinomas, resulted in the disappearance of the lymph node metastases and a marked improvement in the performance status for ∼22 months. The poor prognosis of patients with these aggressive tumors may be improved by the use of minimally invasive diagnostic procedures and combined systemic chemotherapy as soon as possible.

A 45-year-old man was first treated for lymph node metastases of colon cancer with FOLFIRI. After 13 courses, the lymph node metastases worsened, and he was treated with mFOLFOX6 plus bevacizumab as the second-line chemotherapy. After 8 courses, his anorexia and anemia became increasingly troublesome. We diagnosed this as the direct invasion of lymph node metastases to the gastric wall. As the third-line chemotherapy, cetuximab monotherapy was applied. The gastric ulcer lesion then began healing as a scar. In our progressive case, cetuximab monotherapy was effective as a third-line treatment.

Peritoneal mesothelioma presents difficulty in early diagnosis and establishment of standard treatment. We report a case of malignant peritoneal mesothelioma treated effectively with cisplatin and gemcitabine. A 53-year-old man, presenting with abdominal fullness and massive ascites was first admitted to our hospital in April, 2006. Although we conducted upper gastrointestinal endoscopy, total colonoscopy, chest-abdominal computed tomography, and FDG-PET, suspected with disseminated metastasis of cancer, we could not detect the original cancer lesion. Then, a diagnostic laparoscopy revealed many gray-colored nodules diffusely in the peritoneum. The peritoneal biopsy demonstrated that tumor cells grow papillarly and show a strongly positive image for calretinin, but a negative image for Ber-EP4. Therefore, we have diagnosed this case as a malignant peritoneal mesothelioma. Treatment with cisplatin 60 mg/m² and intraperitoneal instillation of mitomycin C 10 mg/m² were not so effective. Then, cisplatin 60 mg/m² and gemcitabine 1,000 mg/m² were administered biweekly. The tumor marker decreased remarkably and the massive ascites disappeared. Therefore, the chemotherapy could be done on an outpatient basis.

A 64-year-old man was admitted to our hospital with anal pain on evacuation. MRI revealed a large rectal submucosal tumor, more than 6 cm in diameter. Fine needle histological diagnosis indicated GIST with moderate risk. The patient was treated with imatinib mesylate in order to preserve the anus. The anal pain and tumor size decreased. Trans-anal local excision was performed. This case suggests that imatinib mesylate can make it possible to treat large rectal GIST cases by preserving anus, if neoadjuvant chemotherapy can be effective.

Although giant cell arteritis (GCA), clinically designated as temporal arteritis, is recognized as a systemic disease, the breast may be the primary organ in which it is manifested. GCA of the breast is a rare disease that mainly occurs in postmenoposal elderly women. It manifests as nodules or pain in the breast, with or without tenderness, and is associated with significant constitutional symptoms that resemble those of polymyalgia rheumatica (PMR). These symptoms can be treated with or without prednisone therapy and can improve without the development of organ dysfunction. The clinical manifestations can often be recognized only by retrospective analysis after excisional biopsy. GCA of the breast occasionally mimics carcinoma, and its initial manifestations may be similar to those of other forms of vasculitis involving the breast, such as polyarteritis nodosa and Wegener granulomatosis. Biopsy is indispensable for establishing a definitive diagnosis. Thus far, the findings of imaging procedures, such as mammography and ultrasonography, for patients with mammary GCA have not been reported in detail, and no distinctive findings associated with this condition have been identified. Considering this and the fact that spontaneous remission may occur in some cases, mammary GCA probably often goes undiagnosed or may be misdiagnosed as an ordinary mammary disease. GCA of the breast should be considered as a potential diagnosis in the case of elderly women presenting with PMR-like symptoms and tenderness, lumps, or pain in the breast. We report a case of GCA affecting the breast and review previous reports on this condition in an attempt to summarize the features that distinguish this disease from other vascular diseases of the breast.