A 75-year-old man was admitted to our hospital with the chief complaint of a choking feeling around the esophagus. Laboratory examinations revealed eosinophilia, and high levels of serum immunoglobulin (Ig) E. A computed tomography scan (CT) showed wall thickening of the esophagus and terminal ileum, and ascites around the liver. An endoscopic examination revealed mild mucosal edema in the esophagus, stomach, and small intestine. Biopsy specimens showed diffuse eosinophilic infiltration in the mucosa. We therefore diagnosed eosinophilic gastroenteritis. Oral prednisolone relieved clinical conditions and the CT image improved. This case was considered valuable, because there have been few reports of eosinophilic esophagitis in Japan.
A 69-year-old man was admitted to our hospital with nausea and vomiting. Gastric endoscopy revealed advanced gastric cancer in the upper body of the stomach. Serum AFP increased to 254 ng/ml, but abdominal CT showed no liver metastasis. Total gastrectomy was performed and histologic examination revealed poorly differentiated adenocarcinoma, and positive immunohistochemical staining for AFP and HCG. He was discharged without complications at postoperative day 19. However, he was admitted again with severe headache 3 days later. Brain CT showed a high density mass in the cerebellum. Tumorectomy was performed, and brain metastasis from the gastric cancer was confirmed pathologically.
An 84-year-old man was admitted to our hospital because of anemia and occult blood. A huge abdominal mass (12 cm on diameter) was palpable in his right upper abdomen. Colonoscopy showed Type 3-like tumor with a large ulcer in the transverse colon, and the biopsy specimen indicated moderately differentiated adenocarcinoma. The tumor had progressed far beyond the colonic wall to form a huge mass with the direct invasion into the stomach. We diagnosed this case as extramural growth type colon cancer, and he underwent a partial colectomy and sub-total gastrectomy and he has no recurrence for 11 months after the operation. Colorectal cancer presenting extramural growth is rare. We studied related factors causing such rare growth types according to summaries of the 27 cases reported in Japan and we also studied the strongly positive immunohistochemical activity of E-cadherin, a cell adhesion molecule, in this case.
A 62-year-old man was admitted to our hospital because of elevated serum CEA and CA19-9. Colonoscopy disclosed a submucosal tumor (SMT) in the ascending colon. CT showed a tumor with partial calcification, 40×30 mm in size. FDG-PET showed no abnormal uptake in the tumor. During a follow-up three months later, colonoscopy showed an ulcer on the upper surface of the SMT, and pathological findings of the biopsy specimen disclosed mucinous adenocarcinoma. Right hemicolectomy was performed. Pathological findings of the resected specimen showed mucinous adenocarcinoma invading the subserosa with heterotopic ossification of the same site as the calcification on CT.
A 28-year-old woman with ascites was admitted to our hospital. We diagnosed peritonitis carcinomatosa caused by colon cancer complicated by ulcerative colitis. We performed peritoneal tap and infusion of mitomycin C, and administered 5-fluorouracil. Her clinical status gradually worsened, and she died 5 months later. At autopsy, the histological examination showed many mucinous adenocarcinoma and signet ring cell carcinoma with dysplasia. There were also some areas of squamous cell carcinoma with squamous metaplasia and dysplasia far from rectum. Squamous cell carcinoma and adenosquamous cell carcinoma of the colon are rare complications of ulecerative colitis. We reported this case as an addition to the literature on the subject.
We report two cases of patients with hepatocellular carcinoma (HCC) that developed in cryptogenic cirrhosis suggestive of nonalcoholic steatohepatitis (NASH) as background liver disease. Case 1 was a 68-year-old woman, and case 2 was a 46-year-old man. They were admitted to our department for evaluation and treatment of HCC. The causes of the underlying liver disease were not determined from blood tests. However, histological analysis of non-tumor tissues of the liver revealed cirrhosis with few fat droplets. Both patients had undergone liver biopsy 26 years before the treatment of HCC. Histological review of the biopsy specimens revealed NASH (case 1) and fatty liver (case 2), respectively. It was suggested that these cases progressed from NASH and fatty liver, respectively, to NASH-related cirrhosis (so called burned-out NASH), eventually, developing HCC. These findings suggest that substantial number of burned-out NASH cases may be included in those with cryptogenic cirrhosis. These two patients are indicative cases that may reveal the long-term natural course of fatty liver and NASH.
A 57-year-old man presented with chief complaints of right hypochondrial pain and fever. Laboratory tests revealed severe inflammatory reactions. Abdominal ultrasonography disclosed a mass with non-homogeneous internal echoes suggesting hepatic abscess. Percutaneous liver biopsy revealed a lump of actinomycetes, allowing a diagnosis of hepatic actinomycosis. The abscess disappeared following long-term treatment with penicillin antibiotics. Actinomycosis developing primarily in the liver is very rare. This condition needs to be distinguished from tumorous lesions of the liver, including malignancy. It seems noteworthy that the diagnosis of this condition was possible on the basis of percutaneous liver biopsy.
A 74-year-old woman visited our hospital for a health checkup, and liver dysfunction and cholangiectasis were detected. Further examinations revealed a protruding lesion spreading diffusely from the upper to the lower extra-hepatic bile duct. On a diagnosis of extra-hepatic bile duct cancer, the patient underwent pancreato-duodenectomy with preservation of the pyloric ring. Small papillary denticulate lesions, forming papillary adenocarcinoma, was scattered over a flat granular lesion of atypical hyperplasia. This morphological pattern is rare, and suggests that the cancer cells may have derived from atypical hyperplastic epithelium.