One hundred fifty nine surgically resected cases of colorectal carcinoma associated with submu.cosal invasion(sm cancer)were clinicopathologically reviewed in order to idelltify risk factors associated with hepatic and lymphnodal rnetastases. All tumors were classified as those with or those without hepatic or lymphnodal metastases or both. Metastatic involvement was seell in 12 cases(7.5%). Seven factors were compared between the two groups:1. the mode of growth(polypoid or no:npolypoid);2. the degree of submucosal invasion(sm 1, 2, and 3 by the depth of invasion, and smla and smlb by the volume of the carcinoma componeht);3. histologic differentiation(well, moderately or poorly-differentiated); 4. the presence or absence of bud-1ike structures in submucosal invasion ; 5. the presence or absence of lymphatic permeations in the colorectal wall, 6. the presen.ce or absence of venous invasion; and 7. macroscopic feture. On multivariate analysis of these seven factors, the only variable cansidered on the basis of a logistic model in stepwise variable selections was the presence of lymphatic permeation. In addition, histologic differentiation and the degree of submucosal invasion were statistically significant as risk factors. Collsequently, the mQst significant risk factors for metastasis in sm cancers were marked lymphatic permeation, submucosal invasion deeper than smlb, and poor histologic differentiatioll. These results suggest that the histologic evaluation of these risk factors in endoscopically resected specimens is important for decision, whether endoscoplc resectloll or surgical segmental resection should be performed.

View full abstract

Irreguiariy dilated vessels ire the bile duct mucosa arc characteristic findings of carcinoma observed by percutaneous transhepatic cholangioscopy. The cholangial vascu -tar pattern has subjectively self-similar structure which suggests that these structures play have fractal elements and that the fractal dimension. may be a usefu.l morphometric discriminant. To quantify the cholangial vascu.lar pattern, Fractal analysis was performed. The fractal dirnensions of irnages from videoendoscopic color pictures of 8 regions vascular dilatation and 7 regions of fine distinct vascular patterns were measured by a box-counting method using a microcompu.ter-based on image analysis system All examined vascular patterns were shown to have a fractal structure within the range of scales examined. The fractal dimension of vascular dilatation and fine vascular patterens were 1.48±0.05 and L31±0.08, respectivelly (p<0.05). The fractal dimensions of the vascular pattern is corresponded to structual complexity of vascular pattern. This study shows that cholangial vascular patterns have a fractal structure and that fractal dimension is a useful morphometric discriminant for cholangial vascular pattern.

View full abstract

We successfully performed endoscopic mucosal resection using a cap-fitted panendoscope(EMRC)for a rare case of esophageal lipoma. The patient was a 65-year-old female.Upper gastrointestinal endoscopy revealed a sessile submucosal tumor in the lower esophagus, 10mm in size. The subrnucosal tumor was resected with the overlying mucosa by EMRC. Pathological diagnosis was a lipoma of the esophagus. Esophageal lipoma has been reported in only 37 cases in Japan. We reported the usefulness of EMRC and reviewed the cases of the lipoma of the esophagus in the Japanese literature.

View full abstract

A 17-year-old female visited our department with a complaint of epigastric pain. The initial gastroscopy discloSed two polypoid lesions on the anterior wall of the fundus of the stomach. A histological examination of biopsied specirnens revealed well differerltiated adenocarcinoma at the top of the both gastric polyps. After repeated endoscopic biopsy, we concluded it as malignant transformation of gastric polyp. At the third cndoscopic examination for the purpose of mucosal resection, we could not identify any gastric lesions on the same site. Therefore, it was considered that the tumor was completely removed by the second endoscopic biopsy so that mucosal resection was not perforlned. Thereafter, endoseopie examinations carried out every 3 months for one year revealed no reeurrent lesions.

View full abstract

A 44-year-old man was diagnosed as haying inoperable malignant gastric outlet stenosis. VLTe tried endoscopic insertion of a self-expandable metallic stmt (EMS) as palliative treatment. We could insert EMS by the method of bringing an endoscope (Olympus JF IT-20)fixed EMS on the top into the stenotic lesion. After implantation, the patient was able to take a regular diet. EMS way placed in patients with malignant gastric outlet stenosis, effectively improving his QOL, but has not come into wide use because of difficulty of the inserting technique. Our method is considerably easy and we think that it should be utilized more positively.

View full abstract

We report an infancy case of gastric ulcer with Helicobacter pyloril(H.pylori)infection. An one-year and two-month old baby was admitted to ou.r hospital complaining of hematQemesis and tarry stooL Urgent endoscopy revealed the active gastric ulcer at angulus.H. pyloril infection of the patient was definLed as positive by the culture, histology, rapid urease test, and 13C-urea breath test, but as negative by the serological examination. Her father was diagnosed as positive H.pylori infection, but mother's finding was negative. After she was treated with proton pump inhibitor, amoxicillin, and clarithromycin, H.pylori was successfully eradicated. In this case, H.pylor infection may have played an important role in gastric ulcer formatio:n because she had had no inducible factor for ulcer except H.pylori infection. PCR(polymerase chain reaction)-RFLP(Restriction Fragment Length Polymorphism)method suggested the identification of two strains between the patient and her father. Zhus the transmission could be through the oral routs from her father under the condition that he often gave the food to the patient by mouth to mouth direetly. this was extrerriely rare ease, revealing possible pathogenesis of gastrie ulcer anal transmission route of H.pylori of infants.

View full abstract

A 60-year-old female was admitted toour hospital becauseof hematemesis and tarry st stool UpPer GI series(Figure 2-a, 2-b)and endoscopy(Figure 1)revealed a glant pedunculated polyp 5cm in diameteron the anteriorof duodenal capolt was too large to withdrew the resected speicemen vii pyloric ring by single polypectomy. So piecemeal plypectomy was performed using a vinyl snare for the prevention against the hemorrhageo Two thirdsof the polyp was removed by the procedure. There was noaccldeht such as a hemorrhage and a perforation. Histology was a Brunner's gland adenoma(Figure 4-a, 4 -b), The sizeof the remaining tumor was diminished a week lateroIt is suggested that the piecemeal Polypectomy using the vinyl snare will be safe and effective in patients with a giant duodellal polyp more than 3cm in diameter.

View full abstract

We report a case of advanced calanic carcinnma mimicking submucasal tumor (SMT) . A 62-year-old man was referred to our hospital because of positive fecal occult blood. Colonoscopy revealed a sigmoid lesion resembling SMT 10mm in diameter with small depression an the tap of the tumor. We resected the tumor after submucosal saline injection. The patient underwent sigmoidectomy because microscopic examination of the tumor revealed poorly differentiated adenocarcinoma invasing the cut end of specimen . Microscopical examination of resected colonic specimen revealed that residual tumor was consisted of poorly differenciated adenocarcinoma 5mm in diameter . The depth of invasion was classified as musclaris propria 1(mpl)with no lymphatic, no venous nor lymphnodal invasion.

View full abstract

A 57-year-old marl in shock state was admitted to our hospital because of sudden onset of abdominal pain, nausea and vomitting. Severe metabolic acidosis, hypoxia, and hypovolemia were observed on admission. The patient was diag:nosed to have nonoco culusive mesenteric infarction(NOMI). Therefore, we resected the necrotic segment of the small intestine. During the operation, endoscopic observation of intestinal rnucosa was useful to decide the resection margins. Intraoperative endoscopy is helpful for assesment of intestinal viability and decision making in patients with mesenteric ischernia.

View full abstract

A 70 year old man with alcoholic liver cirrhosis was admitted becauseof massive hematemesis. End oscopy revealed no.varices but gastric polyp in the fornix as a causeof hematemesis. Histological analysis demonstrated hyperplastic polyp with small artery which could be the causeof bleeding. Accompanying liver cirrhosis was seemed to aggravate the tendencyof bleeding from gastric polypo. Bleeding from gastric polyp has been reported tobe rare as a causeof upper gastrointestinal bleedingbut when compllcated with hemorrhagic diathesis such as liver cirrhosis, we must pay attention togastrlc polyp as a cause of gastric bleeding.

View full abstract

We applied self-expandable metallic stents(EndoCoil)in two patients with unresectable pancreatic carcinoma causing obstructive jaundice due to involvement of the lower bile duct. Clinical improvement was had been achieved in both patients with no stmt dysfunction until death(9 and 11 months). This type of metallic stent has several advantages, i. e., its wide caliber(24F)after deployment, prevention of tumor ingrowth by the coilstructure, and removability. This new stmt is considered to be effective for lower bile duct stenosis.

View full abstract

A 63-year-old female was admitted to our hospital for the evaluation of diabetesmellitus. LTS showed a cystic lesion with several small nodules in the pancreatic body andCT demonstrated a faintly enhanced lesion of the pancreatic body. ERCP revealed adiffuse dilatation of main pancreatic duct(MPD)and a filling defect lesion in the inferiorside of MPD in the pancreatic body. EUS revealed a high-echoic mass in MPD adjacentto cystic lesion of the pancreatic body. POPS showed a polypoid lesion growing to alrnostobstruct its lumen of the pancreatic body. Most of the surface of the polyp was smooth withred spots. IDUS of thepolypoid lesion revealed a homogeneous, high-echoic lesio in thepancreatic body. Distal pancreatectomy and splenectomy were carried out. Histologically, the polypoid tumor was composed of a markedly proliferating tu.bular adenoma with lowgrade atypia. It was generally krlown that intraductal neoplasms of the pancreas wascommonly composed of papillary structure. Therefore this appeared to be a rare case, which had an intraductal tubular adenoma proliferating like a Y-III polyp.

View full abstract