Nippon Shokakibyo Gakkai Zasshi
Online ISSN : 1349-7693
Print ISSN : 0446-6586
Volume 112 , Issue 11
Showing 1-11 articles out of 11 articles from the selected issue
Review article
Monthly report; Intestinal flora and digestive disease
Case report
  • Sayaka OGAWA, Youichi MIYAOKA, Aya FUJIWARA, Kousuke TSUKANO, Satoshi ...
    2015 Volume 112 Issue 11 Pages 1982-1990
    Published: November 05, 2015
    Released: November 05, 2015
    JOURNALS FREE ACCESS
    A man in his 40s was referred to our hospital with abdominal pain. A gastric submucosal tumor (SMT) was diagnosed nine years previously, but the patient was lost to follow-up. Upon our evaluation, the SMT had enlarged, as demonstrated by esophagogastroduodenoscopy and abdominal computed tomography. Endoscopic ultrasonography revealed a hypoechoic and isoechoic mosaic mass, which primarily occupied the third and fourth layers of the gastric wall. Aspiration cytodiagnosis was performed, the results of which led to a suspicion of adenocarcinoma arising from gastric ectopic pancreas. Next, we conducted segmental gastrectomy. Pathological examination showed adiponecrosis, a pancreatic stone, chronic inflammatory cell infiltration, and fibrosis. Thus, the patient was diagnosed with chronic pancreatitis occurring in a gastric aberrant pancreas.
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  • Yosuke MINODA, Soichi ITABA, Toyoma KAKU, Kosuke MAKIHARA, Junko MATSU ...
    2015 Volume 112 Issue 11 Pages 1991-1997
    Published: November 05, 2015
    Released: November 05, 2015
    JOURNALS FREE ACCESS
    An 85-year-old woman with anemia underwent colonoscopy, which revealed a 25-mm submucosal tumor with ulceration in the lower rectum. Histological examination of a biopsy showed that the lesion was a gastrointestinal stromal tumor (GIST). Subsequent esophagogastroduodenoscopy revealed a submucosal tumor in the duodenum, and examination of a biopsy obtained by endoscopic ultrasound-guided fine-needle aspiration also confirmed that this lesion was a GIST. The rectal lesion was surgically resected to control bleeding and was confirmed as a GIST histologically. Simultaneous development of GISTs in the rectum and duodenum is extremely rare.
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  • Hideaki TANIGUCHI, Koutaro SHIBAGAKI, Daisuke GOTO, Eiichi KAKEHI
    2015 Volume 112 Issue 11 Pages 1998-2004
    Published: November 05, 2015
    Released: November 05, 2015
    JOURNALS FREE ACCESS
    An 80-year-old woman with a history of chronic hepatitis B was referred to our hospital because of upper gastrointestinal bleeding of unknown origin. Dynamic computed tomography revealed liver cirrhosis and hepatofugal collateral vessels around the duodenum. Emergency esophagogastroduodenoscopy showed duodenal varices with an erosive spot, highly suggestive of a variceal rupture site. We immediately performed endoscopic clipping of the ruptured site to achieve temporary hemostasis. Ten days later, elective balloon-occluded retrograde transvenous obliteration (B-RTO) was performed to prevent recurrence. We describe a successfully treated case of duodenal variceal rupture managed by combination therapy with endoscopic clipping and B-RTO.
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  • Hiroyuki ISHIBASHI, Yosho FUKITA, Michifumi TOYOMIZU, Tsutoshi ASAKI, ...
    2015 Volume 112 Issue 11 Pages 2005-2013
    Published: November 05, 2015
    Released: November 05, 2015
    JOURNALS FREE ACCESS
    We report the case of an 88-year-old woman with localized intestinal obstruction caused by a midgut neuroendocrine tumor (NET) without endocrine symptoms. She was referred to our hospital for lower abdominal pain. Abdominal enhanced computed tomography revealed a thickened wall in the terminal ileum with dilated small bowel and multiple hepatic metastases upstream. Although the presenting symptoms resolved with short-term fasting and defecation, we performed further investigation. Colonoscopy confirmed the presence of submucosal tumors in the terminal ileum with a yellow-discolored surface but without ulceration or erosion. Magnifying endoscopy with narrow-band imaging clearly showed extended and dilated vessels, with the existing vessels maintained under the epithelium. Biopsies from these lesions were immunohistochemically positive for all neuroendocrine markers, and the Ki-67 index was 10%. Therefore, the patient was diagnosed with NET, and she underwent laparoscopic surgery to relieve the intestinal obstruction. Pathological examination of the resected specimen confirmed grade 2 NET with intramural metastasis and dissemination. After follow-up for a month, octreotide long-acting repeatable therapy was initiated and the patient was free of symptoms at the 6-month follow-up. This is the first report of midgut NET observed by magnifying endoscopy with narrow-band imaging.
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  • Takaomi OKAWA, Hiromi NOGAMI, Eiji KADOTA
    2015 Volume 112 Issue 11 Pages 2014-2023
    Published: November 05, 2015
    Released: November 05, 2015
    JOURNALS FREE ACCESS
    A 68-year-old man presented to our hospital requesting an operation for an anal prolapse. However, because of appetite loss and general malaise, we performed screening gastroscopy that revealed a huge ulcerative lesion in the greater curvature of the middle stomach. Biopsy showed a solid tumor with marked dyskaryosis that was positive for synaptophysin on immunohistochemical staining. Abdominal computed tomography revealed a tumor measuring larger than 20cm in diameter in the greater curvature of the stomach and two hepatic metastases. A preoperative diagnosis of neuroendocrine cell carcinoma (NEC) was made and the patient underwent surgery. The lesion displayed extraluminal growth and directly infiltrated the ileum and colon. We therefore performed distal gastrectomy with combined resection of the gallbladder, ileum, transverse colon, and sigmoid colon. However, despite transcatheter arterial chemoembolization for the liver metastases, the patient died 1 year 2 months after the initial surgery. Gastric NECs are rare and have poor outcomes, being associated with rapid progression of lymph node and liver metastases. Moreover, they rarely show extraluminal growth or invasion to other organs. We present a report of this case along with a review of the literature.
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  • Yutaka AKIMOTO, Koichiro TSUTSUMI, Hironari KATO, Hidenori HATA, Hiroy ...
    2015 Volume 112 Issue 11 Pages 2024-2034
    Published: November 05, 2015
    Released: November 05, 2015
    JOURNALS FREE ACCESS
    A 52-year-old woman was admitted to our hospital with right upper quadrant pain with gallbladder wall thickening and multiple liver tumors. Endoscopic ultrasound-guided biopsy revealed small cell carcinomas of both the gallbladder and liver. After 10 cycles of chemotherapy with etoposide and cisplatin, marked shrinkage of the tumors was evident on computed tomography. The patient subsequently underwent hepatectomy and resection of the extrahepatic bile duct and gallbladder with curative intent. Although no viable tumor cells were found in the resected specimens, we confirmed phagocytosis of tumor cells killed by chemotherapy in the resected liver specimen. Therefore, we suspected that the patient had primary small cell carcinoma of the liver that had been successfully treated. This is a rare case of primary small cell carcinoma of the liver that showed pathological complete response to chemotherapy with etoposide and cisplatin.
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