Nippon Shokakibyo Gakkai Zasshi
Online ISSN : 1349-7693
Print ISSN : 0446-6586
Volume 114, Issue 2
Displaying 1-10 of 10 articles from this issue
Review article
Monthly report; Laparoscopic and endoscopic cooperative surgery
Original article
  • Satoko UMEDA, Hiroshi SERIZAWA, Taku KOBAYASHI, Takahiko TOYONAGA, Eik ...
    2017 Volume 114 Issue 2 Pages 230-237
    Published: February 05, 2017
    Released on J-STAGE: February 05, 2017
    JOURNAL FREE ACCESS

    The clinical and pathological features of human intestinal spirochetosis (HIS) are not well known. Here we report 55 patients with HIS who were diagnosed at our institution during the past 5 years. Seven patients presented with symptoms such as abdominal pain or diarrhea, while the others were incidentally diagnosed during screening colonoscopy. Most patients had non-specific endoscopic findings, including intestinal edema or erosion. The diagnosis of HIS was histologically confirmed via hematoxylin and eosin staining, periodic acid-Schiff staining, and/or immunohistochemistry using anti-Treponema pallidum antibody. Among the 55 patients, five were diagnosed with diseases other than HIS (amoebic colitis, three;ulcerative colitis, one). Sixteen patients were treated with either amoxicillin or metronidazole;only metronidazole proved to be effective. The clinical significance of asymptomatic HIS remains unknown. Some case reports suggest a risk for increased severity in patients with immunodeficiency and/or sexually transmitted diseases. Therefore, aggressive treatment for HIS should be considered, particularly in high-risk patients.

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Case report
  • Masafumi HASHIGUCHI, Tsutomu TAMAI, Yuuichiro NASU, Fumisato SASAKI, M ...
    2017 Volume 114 Issue 2 Pages 238-247
    Published: February 05, 2017
    Released on J-STAGE: February 05, 2017
    JOURNAL FREE ACCESS

    A 77-year-old man underwent endoscopic submucosal dissection (ESD) of a type 0-IIc tumor located in the cardiac part of the stomach. The pathological diagnosis of the tumor was poorly differentiated tubular adenocarcinoma with submucosal invasion depth;therefore, radical gastrectomy was also performed. After 1 year and 10 months, liver metastasis was detected because of which partial liver resection was performed. The pathological diagnosis of the tumor was neuroendocrine carcinoma (NEC). The pathology of the ESD specimen was re-examined, and a diagnosis of gastric NEC was made;furthermore, the liver tumor was regarded as metachronous metastasis. Despite the radical excision of the stage IA tumor, metastasis occurred. Chemotherapy with S-1 alone was successfully performed after the liver resection while considering the advanced age of the patient. Follow-up revealed no signs of recurrence at 1 year and 4 months after the treatment, indicating that the S-1 therapy may be considered for treating NEC in elderly and medically compromised patients owing to its mild side effects.

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  • Eriko YAMAGUCHI, Tsutomu IWASA, Eikichi IHARA, Yosuke TOMITA, Akira AS ...
    2017 Volume 114 Issue 2 Pages 248-255
    Published: February 05, 2017
    Released on J-STAGE: February 05, 2017
    JOURNAL FREE ACCESS

    A man in his 60s was referred to our institution for the evaluation of a gastric neuroendocrine tumor (G-NET) located in the fornix and that measured 13mm in size. Blood test results revealed hypergastrinemia (up to 3376pg/ml). Additional tests, including esophagogastroduodenoscopy, computed tomography, and intragastric pH monitoring, indicated that hypergastrinemia was not associated with type A autoimmune gastritis or gastrinoma. The patient was positive for the immunoglobulin G antibody against Helicobacter pylori, suggesting type B chronic atrophic gastritis as the cause for the condition. This report describes a rare case of G-NET with hypergastrinemia following type B chronic atrophic gastritis. Evaluation of similar cases is necessary to determine if H. pylori-associated chronic atrophic gastritis is frequently associated with G-NET.

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  • Rieko NAKATA, Hirokazu KADOYA, Naoki SUGIMURA, Takayuki KATSUNO, Kazuk ...
    2017 Volume 114 Issue 2 Pages 256-263
    Published: February 05, 2017
    Released on J-STAGE: February 05, 2017
    JOURNAL FREE ACCESS

    A 35-year-old woman, who was an HBV carrier, complained of fever for 2 weeks, and thus, she was admitted in our hospital. Both serum AFP and PIVKA-II levels were abnormally high, and an abdominal enhanced CT revealed the presence of multiple masses in both lobes of the liver. She was diagnosed with hepatocellular carcinoma (T4, N0, M0, and Vp4) and was treated with transcatheter arterial infusion chemotherapy. On the 4th day of her illness, her serum glucose level was 26mg/dl. Glucose infusion and intravenous hyperalimentation were not effective, and she experienced repeated hypoglycemic attacks. Based on the low levels of both insulin (0.4μU/ml) and insulin-like growth factor (IGF)-I (14ng/ml), we made a diagnosis of non-islet cell tumor hypoglycemia associated with hepatocellular carcinoma. The patient was orally administered prednisolone at a dose of 20mg/day. On the 49th day of illness, the hepatocellular carcinoma ruptured, and 2 days later, she died because of hemorrhage shock. Postmortem immunohistochemical staining for IGF-II was positive in the tumor cells of the liver. Furthermore, Western immunoblotting revealed the presence of high-molecular-weight form of IGF-II in the serum of the patient.

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  • Jun UNNO, Takehiro AKAHANE, Kenichiro NAKAGAWA, Keiichiro HIRAMOTO, Ya ...
    2017 Volume 114 Issue 2 Pages 264-273
    Published: February 05, 2017
    Released on J-STAGE: February 05, 2017
    JOURNAL FREE ACCESS

    A 74-year-old man underwent regular follow-up observations after being diagnosed with gallbladder adenomyomatosis based on findings, such as the thickening of the wall of the gallbladder fundus and the presence of intramural cysts. Over the course of 3 years, a papillary tumor located on the thickened wall of the gallbladder had increased in size and extended into the lumen. Consequently, the patient was diagnosed with gallbladder cancer and underwent extended cholecystectomy. The histological diagnosis was intracystic papillary neoplasm (ICPN) of the gallbladder. Although several Rokitansky-Aschoff sinuses that had increased in size because of tumor progression were observed, no adenomyomatosis of the gallbladder was detected. ICPN, a recently identified disease, is not widely known to present with imaging findings similar to adenomyomatosis. The primary treatment of ICPN is radical resection, whereas adenomyomatosis is generally conservatively managed with regular follow-up observations. As the treatment strategies for these two diseases greatly differ, differential diagnosis must be carefully performed.

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  • Takahiro URATA, Michiko NAGAMINE, Naotaka KUGIYAMA, Kana NODA, Ryo ICH ...
    2017 Volume 114 Issue 2 Pages 274-282
    Published: February 05, 2017
    Released on J-STAGE: February 05, 2017
    JOURNAL FREE ACCESS

    A 65-year-old female presented with an elevated lesion that was identified in the gallbladder fundus via abdominal ultrasound during a medical checkup. The tumor was a pedunculated lesion, measuring 30mm in diameter, that exhibited a blood flow pattern with gradual dense staining throughout the equilibrium phase on the abdominal contrast computed tomography and a high signal intensity on T2-weighted magnetic resonance imaging. Histopathological findings revealed the proliferation of poorly differentiated adenocarcinoma, including signet ring cells, throughout the tumor along with the formation of a mucous lake. The patient was consequently diagnosed with poorly differentiated mucinous carcinoma of the gallbladder.

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