From 1968 to August, 1977, 10 cases of colorectal non-epithelial tumors were experienced at our institute. They included two cases of leiomyomas, four cases of lipomas, and a case of benign lymphoma, pneumastosis cystoides and two cases of endometriosis.
Leiomyomas, which located in the rectum, were diagnosed preoperatively by means of rectal biopsies.
Three of four cases of lipomas, which located in the transverse colon, were examined endoscopically. Although the characteristic endoscopic appearances of the lipomas are said to be smooth, soft and pliable consistency with normal overlying mucosa, two of three cases showed shallow ulceration and reddness over the mass, that resulted in macroscopic resemblance to adenomatous polyps. When the lower half of the mass was smooth with shallow irregular ulceration on the upper half, endoscopic diagnosis of lipoma rather than adenomatous polyp was suggested. Endoscopic diagnosis of lipomas were difficult without careful observation. One of the lipomas was successfully removed via the colonoscope. The endos-copic removal may be very useful for diagnosis and treatment in selected cases of the nonepithelial tumors.

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Non-epithelial tumors of the large bowel causing manifest clinical symptoms have been sporadically reported in surgical literatures, on the contrary, scarecely any systemic autopsy studies on these lesions have been done, especially in our country.
The authors have studied 1, 130 cases, consecutively autopsied in Tokyo Metropolitan Geriatric Hospital, putting stresses upon non-epithelial benign tumors of the large bowel.
1) 50 cases in total were observed. They were all small and trivial to be responsible for the cases of any patient's death.
2) Lipomas were the most common non-epithelial tumor, 35 cases out of 1, 130 cases (3.1%) bearing 45 lipomas in total. All lipomas were in the submucosa, measuring less than 2cm in diameter. In 6 cases, the lesion was multiple, 2 to 5 in number.
3) Other lesions were polypoid lymphangiectasis (6), leiomyoma (5), hemangioma (2) and fibroma (2).
4) Problems of benign lymphoid polyp and lipohyperplasia of the ileocecal valve were also discussed.

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Non-epithelial tumors of the gastrointestinal tracts are very rare. Its incidence is about 1-5% of the all neoplasmas of the gastrointestinal tract. Benign non-epithelial tumors in the small intestine are occupied about 60% of all benign tumors. But there is very low frequency in the stomach, colon and rectum. The incidence of the malignant non-epithelial tumors (sarcoma) is very rare, 1-2% of all malignant tumors in stomach and large intestine. However, in the small intestine, it is showed to be over 40% in sarcoma. Of all benign non-epithelial tumors, histologically leiomyoma and benign lipoma are very common. Most of sarcoma are malignant lymphoma and leiomyosarcoma, and other tumors are very rare.
It is very important to differentiate leiomyosarcoma from neurogenic sarcoma. Almost cases which were previously reported as neurogenic tumor, especially neurinoma or neurogenic sarcoma of the gastrointestinal tract, are probably leiomyosarcoma and leiomyoma. In this paper we emphasized the importance of histological differential diagnosis between leiomyosa-rcoma and neurogenic tumors in the gastrointestinal tract. And we reported a case of solitary neurogenic sarcoma of the small intestine.
Recently, lymphoid-plasmacytic disorders associated with appearance of a unique serum and urinary protein, which is Fc-fragment of the counterpart of the heavy chain of Ig-G, are known as heavy chain disease. We have experienced a case of heavy chain disease, which was involved the gastrointestinal tract. We cannot find any reports of heavy chain disease involving the gastrointestinal tract. Histologically heavy chain disease features (reticulum cell sarcoma like and Hodgkin desease like) but malignant lymphoma, and remarkable plasma cell infiltration was noted. This feature is very characteristic of this disease. Ig-A heavy chain disease (α-chain disease) arises from small intestine. The characteristical histoligical findings is diffuse plasma cell infiltration and clinically associated with malabsorption.

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Rectal bleeding is the most frequent symptom of hemangioma of the colon. Bleeding from cavernous hemangiomas may be precipitous and brisk or slowly oozing and only discovered as the cause of iron deficiency anemia. The presence of multiple phleboliths and a filling defect on barium enema is highly suggestive of a cavernous hemangioma. Although the diagnosis may be confirmed by selective arteriography, the final decision rests on gross and histologic demonstration of vascular malformations in the excised specimen, especially if the lesion is very small.
Complete surgical resection of the involved segment of the colon, when possible, is the treatment of choice.

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Neurofibroma of the large intestine is very rare. None of the cases could not be found in these ten years in Japanese literature. It reveals no symptomes in early stage but later occur bleeding, anemia, abdominal pain and other symptomes. Roentogenogram and endoscopy are usually rather difficult to dignose it correctly. It is definitely diagnosed only by histological examination. Differential diagnosis between neurofibroma and other neurogenic or myogenic tumors is sometimes difficult. Alcian blue, Azan and Masson stain are used effectively in these cases. Electron microscopy is also useful to differentiate neurofibroma from Schwannoma. Surgical excision is the treatment of choice. Prognosis of the excision is good. Malignant change rarely occurs in a solitary neurofibroma. 10-20% of the neurofibroma associated with neurofibromatosis (von Recklinghausen) become malignant.
A case of the cecal neurofibroma of 57-year-old male was also reported in this paper.

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Case report : The patient was a 30 year old male with the complaint of anal bleeding of 7 days duration about 3 months prior to the admission. Digital rectal examination revealed a hard, smooth, not-tender submucosal mass in the anterior aspect of the rectum. Physical examination was otherwise entirely negative. Complete excision of the tumor was carried out. The tumor mass measured 1 × 1 × 1.5 cm. Histological diagnosis was leiomyosarcoma in low grade malignacy. No signs of local recurrence or distant metastasis were found at the time of this report, a year after the operation.
Review of the literature : Forty five cases of leiomyosarcoma of the rectum were found in the Japanese medical literature. The incidence was most frequent in the 5th decade.
The majority of the tumors ranged from hen's egg to man's fist in size. The smallest one was 1 × 1 × 1.5 cm that we reported.
Common symptoms were rectal bleeding and difficult defecation. As to the treatment, size and malignant grade should be considered. Abdominoperineal resection of the rectum was performed in many cases, but a complete local excision of the small lesion with low grade malignancy may be justified, provided careful long-term follow up is possible.

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CF-LB3 is the latest instrument with the purpose getting more complete observation and reaching into more proximal part. Widened visual field and increased vending mechanism of the tip have made the center of the lumen more easily and blind areas where located around the acute angle of the segment or behind the semilunar fold more deminished. Furthermore, 2 kinds of rigidity in the tube of instrument such as softer part of 50 cm from the tip and remaining harder part have made the followability more increased, the walkingstick phenomenon more decreased, and discomfort from the patient more diminished. Therefore, the withdrawal and straightening have become one of more important technic in this instrument, because the tip is easily introduced into the proximal part without utilizing the rebound from the bowel wall due to the muscle tone or another neighbouring organs.
Again, harder part of the tube was useful to decreased the S-loop formation on the instrument. Success rate into the cecum using CF-LB3+stiffening tube was 95.8% in 189 examinations. CF-MB3 is medium length with same mechanism as CF-LB3. Polypectomy is also possible as previous instrument CF-LB2.

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Villous adenoma of the colon is comparatively rare in Japan. But this disease has some clinical importance, because of its high incidence of malignant change, serum electrolyte in-balance and so on.
In this paper, we would like to present a case of villous adenoma of the sigmoid colon diagnosed by endoscope. The patient is 35 year-old female, complaining of mucous stools.
Its usual colonoscopic picture shows whitish, soft, fragile and papillary tumor, and using magnifying colonoscope, CF-MB2-M type (Olympus), the minute findings of its surface can be easily observed up to each crypt surface, showing irregularly arranged surface resembling to convolution of the brain. These findings are quite different from those of colonic cancer and/or other adenomas of the colon.

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