We describe four patients with acute esophageal necrosis who were admitted to hospital due to upper gastrointestinal bleeding. "Black esophagus" is endoscopically defined as diffuse dark pigmentation of the esophageal wall. The underlying conditions were ketoacidosis in three of the patients and diabetes mellitus in two. Three patients responded well to empirical supportive therapy and one patient died of coexisting illness rather than the esophageal status. Acute esophageal necrosis is a rare entity that should be considered in the differential diagnosis of upper gastrointestinal bleeding.
A man in his thirties with epigastric pain was referred to our hospital for detailed examinations. Abdominal computed tomography showed an abdominal cystic lesion with a longest dimension of 7cm, located behind the stomach. Endoscopic ultrasonography through the stomach showed a cystic lesion and the wall of the lesion revealed continuity to the proper muscle layer of the gastric wall. Therefore, gastric duplication was suspected and the cystic lesion was resected because of the possibility of malignancy and also for a definitive diagnosis. The cystic lesion consisted of columnar ciliated epithelium, seromucous glands, smooth muscle and cartilage and was diagnosed as a bronchogenic cyst. Bronchogenic cysts are sometimes encountered in the thoracic or mediastinal area, but abdominal bronchogenic cysts, such as the present case, are extremely rare.
A 60-year-old man presented with diarrhea and weight loss. Colonoscopy revealed multiple reddish polypoid lesions throughout the gastrointestinal tract and was diagnosed as Cronkhite-Canada syndrome (CCS). Prednisolone therapy caused regression of polyps. Some of them were suspected to be early colon cancers and adenomas. We endoscopically performed mucosal resection for 15 polyps after prednisolone therapy. Histological examination of one of polyps showed invasion of the submucosal layer and colon resection was performed. This case suggests that diagnosis and treatment are important in polyps of CCS.
We performed abdomino-perineal resection of the rectum and partial resection of a vagina in a 78-year-old woman on a diagnosis of anal canal basaloid carcinoma with vaginal invasion. We did not perform specific adjuvant therapy pre- or postoperatively, but no recurrence appeared for 5 years. Anal canal basaloid carcinoma is a comparatively rare disorder, and the prognosis is relatively good. It seemed that determination of the indication of postoperative adjuvant therapy will require the accumulation of future further cases and enough appearance with operative methods in the treatment of anal canal basaloid carcinoma.
A 64-year-old man who had been given a diagnosis of idiopathic chronic cold agglutinin disease in a medical clinic suffered from Raynaud's phenomenon and acrocyanosis in winter. He was admitted to our hospital with unbearable abdominal pain. Blood tests showed liver dysfunction with jaundice and severe acidosis. Abdominal angiogram and contrast-enhanced CT revealed superior mesenteric artery occlusion. These findings suggest that thrombosis due to cold agglutinin disease could be the cause of superior mesenteric artery occlusion.
A 27-year-old man was admitted to our hospital for evaluation and treatment of liver dysfunction with jaundice and hepatosplenomegaly. The patient had severe photosensitivity from childhood. Upper gastrointestinal endoscopy revealed mild esophageal varices. The clinical manifestations, analyses of the urine and blood for porphyrins and skin biopsy led us to a diagnosis of erythropoietic protoporphyria. Because of acute deterioration of liver function, living donor liver transplantation was performed. The resected liver revealed cirrhosis. We report a rare case of erythropoietic protoporphyria with severe liver dysfunction and present a review of the literature.
A 64-year-old man complained of pain in his left humerus. A histopathological examination of biopsy specimens taken from the lesion revealed a hepatocellular carcinoma. No primary hepatic lesion was revealed in a subsequent examination performed at this time. Enhanced computed tomography examination of the abdomen 14months later, showed a nodular lesion, approximately 15mm in diameter, therefore a partial hepatectomy was performed. The lesion was histopathologically diagnosed as a moderately-poorly differentiated hepatocellular carcinoma. The inability to identify the primary hepatocellular carcinoma is quite rare, and the present case may be the first report of the discovery of the primary hepatocellular cancer after the diagnosis of a secondary lesion.
A 64-year-old male visited our hospital complaining of epigastric pain, and was diagnosed as esophageal cancer with multiple liver metastases. Histological examinations revealed squamous cell carcinoma. He had serious liver dysfunctions and his general conditions were severe, expressed as 3 of the performance status. He was treated using radiotherapy and chemotherapy with low-dose nedaplatin and 5-fluorouracil after the fully sufficient informed consent was taken. As for adverse events, Grade 2 of thrombocytopenia was only observed. Liver tumors responded to anticancer drug treatment immediately, and liver functions were almost normalized. The chemotherapy using low-dose nedaplatin and 5-FU combined with the radiotherapy was feasible and effective to patients with poor conditions.