We examined the clinicopathological features of metastatic gastric tumor, using 9 tumors of 8 patients. Histological diagnosis with all biopsy specimens were adenocarcinoma. Most of the metastatic sites were located in the middle or upper gastric corpus. Endoscopic features of the lesion showed a submucosal tumor-like (5 cases) and primary gastric cancer-like (3 cases) appearance. Immunohistochemical staining of cytokeratins, TTF-1, surfactant protein, ER, or MGB1 identified the primary site; 6 in the lung and 2 in the breast. One case was diagnosed based on the EGFR mutation analysis. In conclusion, immunohistochemical staining and molecular method are useful tools to distinguish metastatic gastric tumor from primary gastric cancer.
A man in his fifties had a medical checkup. Mucosal papillomatosis in his oral cavity and palmoplantar keratosis were observed. Esophagogastroduodenoscopy revealed multiple polypoid lesions both in the esophagus and stomach. In addition, colonoscopy showed schwannoma in the rectum. He underwent an operation for adenomatous goiter. At first his typical esophageal multiple polypoid lesion was a diagnostic cue to Cowden disease (CD). Other clinical findings convinced us that he was suffering from CD. He was, then, diagnosed as CD according to the criteria of International Cowden Consortium although he had no family medical history suspicious of CD. Interestingly, genetic testing revealed that the patient had a germline mutation in exon5 of PTEN on chromosome 10. It was a point mutation of C to T transition at codon130, resulting in nonsense mutation (CGA→TGA). A close follow-up, especially cancer surveillance, is necessary for him since CD is associated with a high risk of developing malignant disease. It is noted that the typical esophageal features can be a diagnostic cue to CD, as shown in the present case.
We report 3 cases with unusual complications of gastric outlet obstruction caused by a gastrostomy tube balloon. All cases developed vomiting, and 2 cases were accompanied by hematemesis. Gastric ulcer was observed in 1 case, aspiration pneumonia was observed in 2 cases, and pancreatitis was observed in 1 case. This condition improved rapidly by correction of the position of the balloon in all cases. In patient vomiting during management for gastrostomy we need to consider migration of the gastrostomy tube balloon. Careful management of the gastrostomy tube balloon is important.
A 70-year-old man was given a diagnosis of advanced type 3 gastric cancer and underwent surgery. In addition to total gastrectomy and D2 lymph node resection, partial liver resection was performed due to detection of a solitary liver metastasis which was initially overlooked on preoperative CT. Histopathologically, the tumor was diagnosed as gastric adenosquamous carcinoma (Int, INFβ, pT2 (ss), H1, ly1, v2 (mp), EVG, n (-), pPM (-), pDM (-)). Three metastasic lesions appeared in the liver on abdominal CT scan performed 3 months after the operation. The patient underwent adjuvant chemotherapy with S-1. Since enlargement of the liver metastases was observed following 2 courses of treatment, the patient received combination chemotherapy of irinotecan and cisplatin. Of 3 metastatic lesions, 1 disappeared and 2 decreased to less than 2cm in diameter after 8 courses of 2nd line treatment. Radiofrequency ablation (RFA) was successfully performed to treat the remaining liver metastases. The patient has been free of recurrence for 41 months.
Computed tomography colonography (CTC) was performed in 5 patients with pneumatosis cystoides intestinalis (PCI). The virtual colonoscopy view of CTC as well as total colonoscopy (TCS) findings showed polypoid lesions in the colon, and multiplanar reconstruction images of the colon revealed in the polypoid lesions of the colon. We confirmed the diagnosis of PCI in all cases. CTC also detected the PCI lesions in the subserosa of the colonic wall which were not detected by TCS. Accurate evaluation of the extent of PCI involvement was obtained by CT air-contrast enema images. CTC is useful for detection of PCI lesions, assessment of the exact site and final diagnosis for PCI.
A woman in her seventies was admitted because of general fatigue and liver dysfunction (ALT 2565IU/l). She was diabetic and, 2 months ago, began eating kikuimo (Jerusalem artichoke) containing inulin, which is thought to decrease blood sugar level. Although tests showed no evidence of acute infection of HAV, HBV, HCV, EBV and CMV, a drug-induced lymphocyte stimulation test using kikuimo extract was positive. She was first diagnosed with drug-induced liver injury according to the Japanese diagnostic criteria for the disease. After a non-eventful recovery, her serum was found to be positive for hepatitis E-antibody and RNA (genotype 3), indicating recent, autochthonous infection of HEV. The patient might have been misdiagnosed with drug-induced liver injury unless the serum test for HEV had been performed. We believe that HEV screening is mandatory for accurate diagnosis of hepatitis E and drug-induced liver injury.
A 50-year-old man with a history of alcohol intake exceeding 80g/day was admitted because of severe liver dysfunction and high fever. A rapid increase of transaminase with remittent high fever was observed several days after admission. Abdominal CT scan demonstrated a 22×20mm mass in segment 8, highly suggestive of hepatocellular carcinoma. However, because the etiology of the liver dysfunction was still unknown, we performed a liver biopsy on the sixth day. Histological examination of the liver specimen showed marked granulocyte infiltration, Mallory bodies, and hepatocyte ballooning, all consistent with alcoholic hepatitis. We made a final diagnosis of alcoholic hepatitis and successfully treated him with corticosteroids. This case suggests that a liver biopsy has diagnostic value in alcoholic hepatitis, especially in cases in which the diagnosis is uncertain.
A 62-year-old man was admitted with dyspnea. Computed tomography (CT) revealed left massive pleural effusion and a cystic lesion in the posterior mediastinal compartment extending to the pancreatic head via the esophageal hiatus. The pleural effusion had a high amylase content. Based on these findings, we diagnosed mediastinal pancreatic pseudocyst accompanied by pancreatic pleural effusion. We treated him with CT-guided puncture and endoscopic pancreatic drainage. Endoscopic pancreatic treatment is possible for pancreatic pseudocysts.