Mucosa-associated lymphoid tissue (MALT) lymphoma is now regarded as a distinct disease entity and listed under the name of extranodal marginal zone B-cell lymphoma of MALT type in the coming WHO classification. The anatomical sites of this tumor mostly prefer to the gastrointestinal tract. In recent years, a correct diagnosis is more often made by the endoscopic examination and biopsy, and closely associated with the therapeutic strategies. However, the issues surrounding the endoscopic appearances and histological evaluation of this tumor remain. Endoscopic appearances of gastric MALT lymphoma varied among the cases, and were described under many terms of multiple erosions, ulcers, cobblestone mucosa, discolored mucosa. lesions resembling early gastric cancer, submucosal tumors, and enlarged folds, etc. Combination of some of them was often observed in the individual lesions. After cure of Helicobacter pylori, most of these appearances gradually changed to that of atrophic mucosa. Notably, the cases with submucosal tumors usually showed a poor response, which was clearly contrasted with those of the other appearances. Endoscopic appearances of colonic MALT lymphoma appeared to be unified as single or multiple protrusions in many cases, indicating that the lymphoma was mainly situated at the submucosal tissue. Histological evaluation on the effect of eradication treatment has not been consented yet, the issue of which might be focused on the interpretation of grade 3 of Wotherspoon's score. The diagnostic term of MALT lymphoma should be used only for the low-grade tumor originally described as 'low-grade B-cell lymphoma of MALT type'. On the constellation of endoscopic, histopathological and genetic findings, gastric MALT lymphomas can be pragmatically classified into three types (MALT A, B, and C) in terms of their response to H. pylori. This may be clinically relevant for deciding the appropriate mode of treatment of MALT lymphomas.

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We detected 142 cases of colorectal cancer by screening colonoscopy for the past 15 years, and compared cases detected by non initial endoscopy with those detected by initial endoscopy. The rate of proximal cancers was relatively higher in the non initial group and it was thus demonstrated that complete colonoscopy was important. Since the rate of smaller and earlier cancers which could be endoscopically resected was also higher, it is suggested that undergoing screening colonoscopy once in several years improve quality of life of candidates, if false-negative ratio could be low level. 8 cases (24.2%) of the non initial group underwent surgical operation because of deeper invasion of cancer ; 5 cases were superficial type cancer, 2 cases were invasive cancer in the hepatic flexure and splenic flexure and some of them were revealed by barium enema, not by colonoscopy. These results suggest that careful observation and supplementation by barium enema, if necessary, are inevitable to reduce the false-negative ratio.

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We report a case of bezoar associated with gastric ulcer, which was treated endoscopically using electrohydraulic lithotripsy. A 57-year-old woman was admitted to the hospital due to epigastric pain. Upper Gastro-intestinal endoscopy and X-ray examination revealed gastric bezoar 5 x 8.2cm a in size, and a stage A2 gastric ulcer at the angulus. Gastric bezoar was removed using electrohydraulic lithotripsy. Analytical study of the sumples detected tanin. Therefore, the patient was diagnosed to have a persimon bezoar. The gastric ulcer healed within one month after the treatment. Although only three cases of bezoar successfully treated by endoscopic electrohydraulic lithotripsy have been reported, this technique may be useful to treat bezoars with hard shell.

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A 70-year-old woman who had been suffered from diabetes mellitus visited our hospital with chief complaints of anorexia, loss of weight, alopecia, onychotrophia and pigmentation. In this case, endoscopic findings of upper GI tract had been normal a year ago. However, on admission, serum total protein concentration was 5.2 g/dl, and in her stomach and colon, extensive polyposis were revealed by endoscopic examinations. These characteristic manifestations suggested the diagnosis of Cronkhite-Canada syndrome. Prednisolone and tranexamic acid were administered. Alopecia, onychotrophia, pigmentation and hypoproteinemia and polyposis were dramatically improved within 5 months.

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This case report described primary gastric mucosa-associated lymphoid tissue (MALT) lymphoma with epithelial signet-ring cell and it was difficult to make a diagnosis whether they represented an associated carcinoma. A 50-year-old man presented in October 1997 with mucosal irregularity on the anterior wall and greater curvature at the level of the angles of the stomach. The endoscopic biopsies showed a suspicion of lymphoid infiltrates. Repeat endoscopic biopsy specimens of irregular mucosa on the anterior wall in March 1998 showed epithelial signet-ring cell associated with lymphoid infiltration on light microscopy, suggesting gastric signet-ring cell carcinoma. The diagnosis of signet-ring cell carcinoma was proposed and the patient underwent partial gastrectomy in April 1998. Based on the histologic, immuno-histochemical analyses of the resected specimen, a diagnosis of low-grade B-cell MALT lymphoma with epithelial clusters of signet-ring cell was made. Follow-up biopsies of the gastric remnant performed in 1998 and 1999 were negative for tumor cells. Our case showed that signet-ring cell occurring in gastric MALT lymphomas represent a foveolar lymphoepith-elial lesion in which the epithelial cells' reaction to infiltrating lymphocytes results in a signet-ring cell appearance.

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A 66-year-old man was introduced to this hospital for further examination and treatment of polyp of the colon. Colonoscopy was performed a total of 3 times at about 1 month intervals, and an Is type polyp of about 4 mm with flat surface and distorted shape accompanied by rubor and elevation in the surrounding area was observed. Endoscopic mucosal resection was performed, and poorly dif f erenciated adenocarcinoma mixed with moderatery dif f erenciated adenocarcinoma in surface layer was found in the mucosal layer. Although the tumor did not pass through the muscular layer of the mucosa, it infiltrated into the submucosal lymphatic vessel, and therefore, an additional operation was conducted. Vascular invasion spread to lymphatic vessels in the surrounding adipose tissue. The illness was diagnosed as poorly differenciated adenocarcinoma ss ly (3) v(1) lymphnode metastasis N3.

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A 91-year-old female was admitted to our hospital with complaints of abdominal pain and hematochezia. Colonoscopy demonstrated circumfereintially edematous mucosa which extended from the sigmoid colon to the cecum. Under a tentative diagnosis of ishcemic colitis, we conservetively treated the patient. However, she died of disseminated intravascular coagulation 11 days later. Autopsy findings revealed ischemic changes involving the ileum and the entire colon. Of interest, the autopsy could confirm the absence of the inferior mesentric artery. The extensive ischemic intestinnal lesion of our case seems to have owed to the decrease of blood flow in the superior mesentric artery.

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A 64-year-old man was admitted with complaints of abdominal pain and bloody diarrhea. He had past illness including irritable bowel syndrome and multiple diverticula of the sigmoid colon. He was diagnosed as transient ischemic colitis in the sigmoid and descending colon. Ten and sixteen months later, he had similar symptoms and was diagnosed as the same diagnosis. Abdominal angiography showed normal inferior mesenteric artery and vein. Barium enema showed excessively developed haustra and multiple diverticula in the sigmoid and descending colon. Ischemic colitis with three episodes of attack complicated with irritable bowel syndrome is rare.

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A 66-year-old woman visited her home doctor because of a positive fecal occult blood test. Colonoscopy revealed a Ips polyp in the ascending colon, and a diagnosis of moderately differentiated adenocarcinoma was made according to the results of the biopsy. The patient was admitted to our hospital for surgery. Double contrasted colonography did not reveal the polypoid lesion in the ascending colon. Colonoscopy revealed a depressed lesion with fold convergence in the ascending colon. Laparo-assisted ileocecal resection was perf omed. Histological findings of the resected specimen revealed no cancer cells. This is a very rare case of a polypoid cancer of the colon showing spontaneous dislodgment during the clinical course.

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A 84 year old female was admitted our hospital for the treatment of obstructive jaundice.Since US showed dilatation and stones of CBD, PTCD was performed. The cholangiographyshowed stenosis of lower CBD and delay of bile excretion. Hepatobiliary scintigraphy showedalso delay of bile excretion. PTCS showed no malignant lesion and recurrent impaction ofduodenal papilla in CBD. These data suggested that obstructive jaundice was caused bypapillary dusfunction and recurrent impaction of duodenal papilla in CBD. Therefore PTCS-papillotomy was performed. After that she has been doing. well, and now no cholangjtis areobserbed.

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