The aim of this study was to investigate whether a disturbance in balance between cellproliferation and apoptosis might underlie colorectal neoplastic development or shape. Atotal of 8 colorectal adenornas and 51 early colorectal carcinomas(9 0f depressed typecancer and 42 of polypoid type cancer)were selected for this study. Apoptotic cells weredetected using the terminal deoxynucleotidyltransferase-mediated dUTP nick-end labelingassay(TUNEL assay). bcl-2, and p53 expression were analyzed using the immunoperoxidase technique. The association between apoptotic rates(Apoptosis labeling index;ALI)and bcl-2 and p53 expression was examined. The results were as follows; 1) ALI were not correlated between depressed type and polypoid type in earXy color-ectal cancer. This result suggests that the shapes of early colorectal cancer are notaffected by apoptotic rates. 2) ALI versus p53 averexpression demonstrated a inversecorrelation. ALI in adenoma had significantly higher khan in early colorectal cancer.Adenomas are affected by p53-dependent apoptosis which occur in normal colorectalepithelium. 3)We detected cytaplasmic bci-2 expression in l of 8 (12.5%)depressed type.This rate was significantly lower than in adenoma and polypaid type.

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A 54-year-old man showed esophageal and gastric polyposis, multiple colon polyps, braves disease, lipoma and renal cell carcinoma. He had neither facial trichilemmomasIlor oral papillomatosis that characterize Cowden disease(CD). However, in accordancewith the criteria he ws diagnosed as CD by seeing esophageal and gastric polyposis onupper gastrointestinal endoseopy. Although it had heen reported that there is a loss ofheterozygosity(LOH)in chrom.osome 10q23 in CD, we could rlot detect it in this case. Ourreport shows that gastrointestinal endoscopy has advantages of detecting gastrointestirlalpolyposis and obtaining biopsy specimens for genetic study in CD.

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A 84-year-old woman was admitted to our hospital with complaints of dysphagia. Theoperation on her achalasia of esophagus was undergone by fundic patch method at theother hospital in 1977. In 1991, she visited to our hospital for the first time because of hematemesis, on thatoccasion, esophageal divertieulum and the reflux esophagitis were pointed out. Then shehad been followed up at our hospital with diagnoses of esophageal diverticulum and refluxesophagitis. Recently, dysphagia came to be serious and advanced gradually. Finally shebecame an impossible ingestion in December 195, so she was admitted to our hospital. Double-contrast radiography of the esophagus showed a large mass lesion Tike atumor, which obstructed the esophageal tract. Endoscopy demonstrated a tumor-like masslesion with black-brown tone surface located in the diverticulum of the lower esophagus. It existed as clinging to the esophageal wall, we removed it by the basket-type forceps.The mass was 6 cm in diameter and looked like a disk of the mushroom. The histopath-ological observation revealed the mass was fungous congeries. For the formalin-fixation, we were able to do neither culture nor the judgment of fungus any longer. After removalof the fungous congeries, she became to be able to eat orally. This paper presents a case of the esophageal mycosis complicated With the obstructionof the lower esophagus by the fungous congeries, because of its rarity in the literature.

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A forty-year-old female v as admitted for a close evaluation of multiple elevatedlesions in the stornach which was pointed out by a mass screening examination in September 1994. Laboratory tests were within normal limits except for a marked elevation of theserum gastrin level over 3000pg/ml. Gastric parietal cell autoantibodies were negative, andthere was no sign of pernicious anemia. Gastrointestinal endoscopy demonstrated multipleelevated lesions with reddness in the fundic gland mucosa. Biopsied specimens revealedcarcinoid tissue positive for Grimelius stain. The gastric acid secretion evaluated by Congo-Red stain and by 24 hour pH monitoring in the stomach demonstated achlorhydria.Surgical resection was performed in February 195, with a preoperative diagnosis ofmultiple gastric carcinoids with type A gastritis. Postoperative microscopic examinationof the stomach reveahd marked atrophy of the fundic gland and submucosal extension ofthe tumor, but no metastasis to lymph nodes and other organs. Many endocrine cellmicronests(ECM)and carcinoid cells were observed diffusely in the deep submucosal layerof the fundic lesion. The serum gastrin level returned to normal seven days after operation.

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A 70 year-old woman with multiple hyperplastic polyps of stomach had been followedup by endascopically for 1$years. In 1994, endoscopic examination revealed two polyps among multiple polyps: a whitish semipedunculated polyp 8 rnm in diameter on the anterior wall of the cflrpus and a pedunculated polyp 15 mm in diameter on the greater curvature of the corpus. Biopsy specimens were not taken from the former, but taken from the latter which was and diagnosed as hyperplastic polyp histologically. However, in May 1997, the farmer changed to advanced paarly differentiated adenocarcinama and the latter increased in size which was histologically focal cancer with hyperplastic polyp. This case was quite interesting in considering adequate follow-up of patient with multiple hyperplastic polyps and malignant transformation of hyperplastic polyps.

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A 68-year-old female was admitted to our hospital suffering from massive tarry stooldue to upper gastrointestinal bleeding on January 7, 1998. Her marked thrombocytopeniawas accompanied with bleeding symptoms such as epistaxis, hematuria and cutaneouseccymosis. Subsequent examinations including bone marrow study indicated the diagnosisof idiopathic thrombocytopenic purpura(ITP). Although frequ.ent transfusions of bloodand platelets were required because of prolonged severe bleeding of the gastrointestinaltract, the treatment with corticosteroids resulted in a gradual increase in the platelet countfollowed by the improvement of bleeding symptoms. She recovered from life-threteninggastrointestinal hemorrhage, and vvas discharged from our hospital on the 153rd hospitalday. An endoscopic examination an the second hospital day showed diffuseiy scatterednumerous petechiae in the gastric body and fornix, and two hrisky hemorrhaging pointsnear the gastric angulus, which proved to be two minute ulcers on the 14th hospital dayafter hemostasis. The subsequent endoscopy on the 28th hospital day demonstrated severallongitudinal hemorrhagic striae in the gastric body and fornix instead of previouslyobserved numerous petechiae. Two hemorrhagic ulcers became red scars and white scarson the 56th and 84th hospital day, respectively;all of the hemorrhagic lesions throughoutthe stomach were completely disappeared. Though gastrointestinal bleeding is one ofcommon clinical manifestations in patients with ITP especially in the elderly, endoscopicexaminations are rarely performed during the course of hemorrhagic episode. Vie reportpeculiar endoscopic findings which were nOt preveously mentioned in a clinical course ofpatient with ITP complicated by massive bleeding in the upper gastrointestinal tract.

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A 56-year-old man was admitted to our hospital with chief complaints of upperabdominal pain and fever having leukocytosis and elevation of CRP level. Upper gastrointestinal endoscopic examination revealed a foreign body resembled to a fish bonepenetrating the anterior wall of the antrum of the stomach. The fish bone was pulled outendoscopically, then, clinical symptoms and signs were improved. There had been reportedll cases of penetration of the stomach by a fish bone in Japan. Mast of them were followedby peritonitis or abscess in peritoneal cavity, and were surgically operated. Only 2 casesincluding our case (second case reported), were cured by endoscopic treatment.

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A 63-year-old man who underwent Billroth II gastrectamy due tc gastric ulcer 29years ago was fotiowed up by upper gastrointestinal endoscopy. The first endoscopicexamination 8 years and 7 months ago showed a protruding lesion along the gastrojejunostomy site of remnant stomach. The sessile poiypoid protrusion was reddish anddivided into areae gastricae by network of wide grooves. Histological examination ofbiopsy specimens from the lesion revealed hypertrophy of foveolar epithelium and cysticdilatation of gland. On the basis of these findings he was diagnosed as gastritis cysticapolypesa and foliowed up with endasccpy. Early stump cancer on the greater curvaturewas detected by repeated endoscopy. The structure of gastritis cystica poiyposa wasmostly destroyed by cancerous tissue.

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This case report described a 54-year old woman with multiple small erosions and elevated lesions in the proximal descending duodenum diagnosed histopathologically as low-grade mucosa-associated lymphoid tissue lymphoma (MALToma). She was infected with helicobacter pylori, and we atternpted to eradicate. H. pylori with quadruple therapyconsisting of omeprazole, bismuth subnitrate, amoxicillin and metronidazole. Cure of theinfection was proved one and three months after the end of therapy by culture, histology and urea breath test. The lesions, however, remained unchanged during five months follow-up after the therapy. Thus the surgical procedure of partial duodenectomy was performed. The histologic study of the resected specimen revealed that infiltration of centracyte-like cells was limited to the submucosa. Although there are a few reports on regression of duodenal MALToma after eradication of H. pylori, anti-H. pylori therapy was not effective for our patient.

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A 73 year-old male visited our hospital with a chief complaint of body weight loss(7kg/6 months)and was diagnosed as lung cancer in the right middle lobe (stage 1), and early colonic cancer(ECC)in the sigmoid colon. ECC exhibited an unusual shape as superficial depressed type cancer (type IIc)located on the stalk and the base of pedunculated polyp cancer(type Ip). Pathological examination of the resected colonic specimen revealed welldifferentiated type, low-grade cancer with submucosal invasion. Polypoid and depressed parts of the cancer showed the exact same pathoiogicai findings without apparent border, and no differences were found in a pattern of K-ras gene mutation and p53 protein expression. combined shape of ECC is extremely rare, and the authors reviewed the literature.

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A 49-year-old man underwent an operation on a diagnosis of appendicitis. After theappendectomy, the patient had a diagnosis of acute terminal ileitis, because the resectedappendix was macroscopically normal and the edematous serosa of the terminal ileum wasobserved during the operation. one month after the appendectomy, the patient began tosuffer from watery diarrhea. Colonoscopy revealed erosions and reddish mucosa diffuselyfrom the rectum to the sigmoid colon, and normal vascular mucosa from the descendingcolon to the cecum. Interestingly, past-appendectomied area of the cecum vvas elevatedlike a suhmucosal tumor, and redness and tiny erosions were seen in the residual mucosaafter appendectomy. Pathological findings of the biopsy specimens taken from the post-appendectomy residual mucosa showed severe infiltration of inflammatory cell. Recently, it is generally accepted that slipped lesion of the appendiceal orifice is common inulcerative colitis. our case showed that skipped lesion was also involved in the postappendectomy residual mucosa. It may be important to observe the bottom of the cecurnclosely, even if patients With ulcerative colitis arc after appendectomy.

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