A 63-year-old Japanese woman was diagnosed with duodenal follicular lymphoma. The initial esophagogastroduodenoscopic examination with magnifying observation revealed opaque white spots and enlarged whitish villi. Nine months later, esophagogastroduodenoscopy showed that the size of the lymphoma lesion decreased, and only opaque white spots were visible. The histological analysis of biopsy samples obtained during the initial endoscopy examination showed both neoplastic follicles and an inter-follicular infiltration of lymphoma cells, whereas the biopsy samples obtained at the endoscopy performed 9 months later showed only neoplastic follicle formation. These results suggest that the magnifying endoscopic features may reflect the underlying pathological mechanisms : enlarged whitish villi are probably due to lymphoma cell infiltration in the inter-follicular area, and opaque white spots are probably caused by neoplastic follicle formation.
The patient was a 46-year old Japanese female who had undergone wide excision of the iliac bone and hip transposition at our institute's orthopedics department 2 years earlier. She presented with a growing incisional hernia and was transferred to our gastroenterological surgery department for surgical treatment. We planned a mesh repair for the incisional hernia, which protruded over the right iliac bone. The dimensions of the abdominal defect were 15×9 cm, and we used prolene mesh to repair the defect. The mesh was fixed at the inner part of the iliac bone, folded back at the iliac horn and fixed to the abdominal oblique muscles. The postoperative course was smooth, and recurrence was not seen at 3.5 years after the operation. An incisional hernia as seen in this patient's case is very rare, but we found that the underlay technique and prolene mesh were very useful for the three-dimensional hernia repair.