Purpose: Lymphatic invasion is an important predictor for lymph node (LN) metastasis in colorectal cancer. However, it is difficult to identify vessels precisely by the current ways of stain. The purpose of this study is to make it clear the significance of lymphatic invasion as a predictor of LN metastasis by using LYVE-1 immunohistochemistry as an indicator of lymphatic vessels to evaluate the utility of lymphatic invasion the significance of lymphatic invasion.
Objects and Methods: The immunostain by LYVE-1 was carried out to 58 cases with colorectal cancer showing submucosal invasion including 17 cases with LN metastasis.
Result: According to the univariate logistic regression analysis, four factors were regarded as the predictive factors on LN metastasis: the tumordifferentiation (p=0.003), the depth of submucosal invasion of the primary tumor (p=0.011), budding (p=0.005), and lymphatic invasion by LYVE-1 immunohistochemistry (p=0.0003). On the other hand, according to the multivariate logistic regression analysis, only the lymphatic invasion was a predictor on LN metastasis.
Conclusion: The result of this study indicates the important of lymphatic invasion and the utility of the LYVE-1 immunohistochemistry.

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We treated 452 cases of internal hemorrhoids (IH) only with aluminum potassium sulfate tannic acid (ALTA) from April 2005 until December 2006 at Kunimoto Hospital. Of these, we retreated 16 cases, consisting of 6 relapsed IH cases and 10 cases with remaining external hemorrhoids (EH) that were not injected with ALTA. The causes of IH recurrence were insufficient dosage of ALTA (4 cases), inaccuracy in site of injection (1 case), and unknown etiology (1 case). Our experience suggests that the full-dose of ALTA required to induce a reduction of IH should be injected at the precise site, and that patients with EH are not indicated for ALTA. Therefore, in cases which comply strictly with the above criteria, we consider that treatment with ALTA could be a curative treatment for IH comparable to operation involving ligation and excision (LE).

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This study analyzed the characteristics and outcome of salvage procedures in 30 pouch related complications (PRC) after restorative proctocorectomy with ileal pouch anal anastomosis (IPAA) for ulcerative colitis (UC). Mean age at the development of PRC was 33.0 years. The mean time between the first IPAA and the onset of PRC was 2.2 years. As complaints of PRC, perineal discharge, melena, anal pain and low back pain occurred in 21, 9, 7, and 4 patients respectively. The pattern of PRC included refractory perianal fistula in 14, pelvic abscess in 13, anastomotic stenosis in 2, and sphincter damage in 1. The 30 PRC patients received a mean of 2.7 (range, 1-7) salvage procedures, of whom 25 required temporary diverting ileostomy. Sixteen patients received seton drainage 24 times. Seven patients received re-do IPAA, 2 of whom ultimately underwent closure of ileostomy. Six patients underwent pouch excision.
There were 4 patients who had been diagnosed with indeterminate colitis or Crohn's disease and PRC during the course of the salvage strategies. Although the course of PRC after IPAA varies, it is often possible to salvage the pouch by an appropriate strategy.

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A carcinoid tumor occurring in the alimentary canal is rare in Japan. We reviewed cases of carcinoid tumor occurring in the appendix in our hospital clinicopathologically.
Materials and Method: We performed an examination of clinical observations, exitus and pathological study for cases diagnosed as appendiceal carcinoid tumor between 1996 and 2005.
Results: Alimentary canal carcinoid tumor was diagnosed in 74 cases during the period: 12 cases in the stomach, 4 cases in the small intestinum, 52 cases in the rectum and 6 cases in the appendix. As for the appendiceal carcinoid tumor cases, the average age was 40.3 years old and all were females. The tumor was found during operation for acute appendicitis (5 cases) and during operation for intestinal disease (one case). The pathological invasion depth of the tumor in the five cases was ss and that of the one case was mp. The malignant potential was low because MIB-index was lower than 1% in all cases. As for the treatment of the tumor, four cases had only an appendectomy and the other two cases had a secondary major operation. Lymph node metastases were not found in the three cases which underwent ileocaecal resection with lymph node dissection. There has been no recurrence in any of the cases.
Conclusion: Appendiceal carcinoid tumor appeared in 8% of alimentary canal carcinoid tumors. These cases were mostly diagnosed during acute appendicitis. Most of the appendiceal carcinoid tumors were not malignant and the outcome was good.

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Patients with ischemic colitis are usually treated conservatively; however, those who develop gangrene as a result require surgical intervention. The causes of gangrenous ischemic colitis have not yet been clearly identified, although much evidence has been accumulated to suggest that vessel disease and intestinal injury are closely involved.
We encountered three cases of gangrenous ischemic colitis and investigated the differences in the clinicopathologic characteristics between our cases and cases with non-occlusive mesenteric ischemia (NOMI). The areas affected by ischemic damage in our cases were limited to the left side of the colon. Colectomy was performed at 30, 70, and 60 hours after onset in each case. The bowel infarction was suspected to be precipitated by trauma and colonic bacteria in the first case, atherosclerotic disease of the arteries supplying the bowel with constipation and bacteria in the second case and chronic segmental colitis with constipation in the third case.
In the cases with NOMI, the mesenteric perfusion may be compromised because of vessel spasm in hemodynamically unstable patients, such as heart disease. Useful diagnostic criteria for gangrenous ischemic colitis need to be established to devise appropriate strategies for therapy, and to determine the survival rates and quality of life of these patients.

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A 60-year-old woman with bloody stool and narrow feces visited our hospital. The colonoscopy and barium enema revealed two elevated lesions of the rectum, one in the lower rectum (Rb) and one in the upper rectum (Ra). Biopsy specimens suggested that both lesions were squamous cell carcinoma. The Rb tumor was a 2cm type-2, and the Ra tumor was about a 6cm type-1. We performed resection by abdominoperineal resection in August 2005. Histological examination of the specimen of Rb revealed poorly differentiated squamous cell carcinoma: mp, ly2, v2. Histological examination of the Ra specimen revealed similarity to Rb tumor and suggested that the origin of Ra tumor was submucosal. We suggest that squamous cell carcinoma of the lower rectum was the primary carcinoma and that squamous cell carcinoma of the upper rectum at 70mm distant from the cancer of Rb was intramural metastasis from Rb. We report this rare case with lower rectal squamous cell carcinoma (Rb-P) with simultaneous intramural metastasis.

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We report a case of polyarteritis nodosa with stenosis of the sigmoid colon. A 60-year-old man was admitted to the hospital complaining of abdominal pain and high fever. Although he received medical treatment, his symptoms did not improve. Barium enema and colonoscopy revealed severe stenosis and mucosal redness of the sigmoid colon. Abdominal CT scan showed splenic artery aneurysms and small hepatic artery aneurysms. Celiac and right renal arteriography showed small multiple aneurysms. Moreover, inferior mesenteric arteriography showed occlusion of the sigmoidal arteries and aneurysms of branches of the left colic and the superior rectal artery. From the results, stenosis of the sigmoid colon was diagnosed preoperatively and an operation was performed. During the operation, contraction of the sigmoid colon, thickening of the mesocolon and adhesion of the ileum to the sigmoid colon were found. Although ischemic change of the serosa of the colorectum was not recognized, the left colon measuring 23cm in length was resected while assessing the circulation with a laser flowmeter. His postoperative course was uneventful. We diagnosed polyarteritis nodosa from the findings of the pathologic specimens. Although the gastrointestinal tract is frequently involved in polyarteritis nodosa, it is relatively rare to involve the colorectum. We retrospectively reviewed 22 cases with polyarteritis nodosa involving the colorectum in the Japanese literature.

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We report a case of villous tumor of the rectum with electrolyte depletion syndrome. The patient was a 72-year-old man who complained of diarrhea and vomiting, and was transferred to our institution from a nearby hospital for examination and therapy. On laboratory data at admission, renal dysfunction and dehydration (BUN 80.9mg/dl, Cr 2.6mg/dl, Na 121mEq/l, Cl 87mEq/dl, K 2.1mEq/dl) were found. A colonoscopy revealed a villous tumor with mucus in the rectum and pathological examination of the biopsy specimen revealed well differentiated adenocarcinoma in the villous tumor. After admission, renal dysfunction and electrolyte depletion were improved by saline containing potassium chloride, so we performed abdomino-perineal resection. In the resected specimen, the size of the tumor was 8×14cm, and the histopathological diagnosis was an adenocarcinoma invading mucosa in the tubulo-villous adenoma. After the operation, there have been no recurrences of the dehydration and electrolyte depletion.

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We report the diagnostic usefulness of MRI in combination with conventional endoscopy and barium enema examination in a case of endometriosis of the sigmoid colon. The patient was a 39-year-old woman. Barium enema showed transverse ridging. Endoscopy showed a granular mucosa on the lesion unilaterally, with a reddened, eroded surface surrounded by a small elevation. Biopsy revealed only nonspecific inflammatory cell infiltration. Endoscopic ultrasound at 12 MHz showed a metallic-appearing, hyperechoic lesion. T1-weighted MRI demonstrated high signal intensity suggestive of hemorrhage in the thickened colonic wall corresponding to the lesion, with no gadolinium enhancement. These findings excluded neoplastic lesions, and led to a diagnosis of endometriosis of the sigmoid colon. Hormone therapy reduced clinical symptoms including abdominal pain. After explaing the limitations of conservative treatment and the risk of malignant transformation, informed consent was obtained, and the patient has been carefully followed up.

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