Nippon Shokakibyo Gakkai Zasshi
Online ISSN : 1349-7693
Print ISSN : 0446-6586
Volume 116 , Issue 8
Showing 1-10 articles out of 10 articles from the selected issue
Monthly report (General review article); Recent advancement in sclerosing cholangitis -Primary and IgG4-related sclerosing cholangitis-
Monthly report (Review article); Recent advancement in sclerosing cholangitis -Primary and IgG4-related sclerosing cholangitis-
Case report
  • Takafumi MIE, Takashi OHTA, Takayuki IWAMOTO, Rui MIZUMOTO, Yuki ARIMO ...
    2019 Volume 116 Issue 8 Pages 654-659
    Published: August 10, 2019
    Released: August 09, 2019
    JOURNALS RESTRICTED ACCESS

    A 42-year-old female developed type 1 diabetes mellitus at the age of 16 years and received insulin therapy. Esophagogastroduodenoscopy revealed an atrophic change localized in the gastric body and a small, protruding gastric lesion. Biopsy revealed that this lesion was gastric neuroendocrine tumor. Hence, the patient underwent en bloc resection by endoscopic submucosal resection with a ligation device. As the patient presented both autoimmune gastritis and type 1 diabetes mellitus, she was diagnosed with type 4 autoimmune polyendocrine syndrome. We report this case considering that only few cases of gastric neuroendocrine tumor with autoimmune gastritis (type A gastritis) complicated with autoimmune polyendocrine syndrome have been reported till date.

    Download PDF (991K)
  • Kazunori ADACHI, Naotaka OGASAWARA, Yasuhiro TAMURA, Shinya IZAWA, Yas ...
    2019 Volume 116 Issue 8 Pages 660-667
    Published: August 10, 2019
    Released: August 09, 2019
    JOURNALS RESTRICTED ACCESS

    An 82-year-old man with abdominal pain was admitted to our hospital. Laboratory tests revealed the following:white blood cells, 14300/μl;serum hemoglobin level, 12.9g/dl;serum C-reactive protein level, 0.38mg/dl;and negative anti-Helicobacter pylori immunoglobulin G test. Abdominal computed tomography revealed a tumor in the appendix along with multiple swollen lymph nodes. Colonoscopy revealed a submucosal tumor (SMT) of approximately 30mm in diameter with central ulceration. However, a tumor tissue specimen could not be obtained for biopsy;thus, the tumor could not be diagnosed. In esophagogastroduodenoscopy, abnormalities or gastric mucosal atrophy was not observed. A rapid urease test yielded negative results. Hence, endoscopic ultrasound-guided fine needle aspiration for the SMT was recommended;however, the patient preferred to undergo a definitive surgery to establish exact diagnosis. Therefore, right hemicolectomy and lymph node dissection (D3) were performed. Histopathologically, the resected tumor specimen showed atypical lymphocytes. Additionally, immunohistochemical evaluation demonstrated positive staining of the tumor cells for CD20 and BCL2 and negative staining for CD34, CD4, CD10, and BCL6. The tumor was finally diagnosed as a stage II2 mucosa-associated lymphoid tissue lymphoma (Lugano classification). Postoperatively, the patient received chemotherapy with four cycles of rituximab based on his age and activities of daily living.

    Download PDF (2526K)
  • Yuko MIURA, Fumihiko IWAMOTO, Yasuaki ISHIDA, Toru KUNO, Keisuke TANAK ...
    2019 Volume 116 Issue 8 Pages 668-675
    Published: August 10, 2019
    Released: August 09, 2019
    JOURNALS RESTRICTED ACCESS

    Eosinophilic gastroenteritis is a rare disease that causes various abdominal symptoms that result from the infiltration of eosinophils in the digestive tract. However, this condition has been poorly explored, and the treatment criteria and prognosis after treatment are still unclear. A 20-year-old man with a refractory duodenal ulcer had been undergoing treatment since 14 years of age at another hospital. He was admitted to our hospital with abdominal pain and anemia (hemoglobin:6.3g/dL). His blood test showed elevated serum immunoglobulin E levels, considering that he was allergic to many foods. Furthermore, endoscopic biopsy detected the occurrence of eosinophilic gastroenteritis with gastritis, duodenal ulcer, and colitis. We treated him by avoiding allergenic foods and prescribing antihistamine and vonoprazan;however, duodenal ulcer and gastrointestinal tract inflammation did not show improvement. Thus, he was diagnosed with wide-ranging and refractory eosinophilic gastroenteritis and treated with 40mg/day of steroids. After 2 months, he recovered from gastritis and duodenal ulcer, and his eosinophil level decreased, as assessed using endoscopic biopsy. Eosinophilic gastroenteritis is poorly investigated, and its treatment standards have not yet been determined. Nonetheless, steroid treatment is often applied in severe cases.

    Download PDF (1439K)
  • Yuki HIROSE, Akiyoshi KINOSHITA, Ayako ISHII, Utako ISHIMOTO, Keiko SH ...
    2019 Volume 116 Issue 8 Pages 676-684
    Published: August 10, 2019
    Released: August 09, 2019
    JOURNALS RESTRICTED ACCESS

    A 42-year-old woman was referred to our hospital for the treatment of pyloric stenosis. Esophagogastroduodenoscopy (EGD) and computed tomography (CT) revealed the presence of type 4 advanced gastric cancer with bladder metastasis and peritoneal dissemination. Biopsy specimen examination revealed poorly differentiated adenocarcinoma with signet ring cell carcinoma. Thus, two cycles of chemotherapy with 5-fluorouracil, leucovorin, and oxaliplatin were administered. Subsequently, the gastric lesion and bladder metastasis reduced as detected using EGD and CT. Consequently, she achieved adequate oral intake. After changing the regimen to tegafur/gimeracil/oteracil and oxaliplatin, she was discharged. Currently, she continues to receive chemotherapy.

    Download PDF (1123K)
  • Masayuki UENO, Naoyuki NISHIMURA, Yuichi SHIMODATE, Akira DOI, Hirokaz ...
    2019 Volume 116 Issue 8 Pages 685-689
    Published: August 10, 2019
    Released: August 09, 2019
    JOURNALS RESTRICTED ACCESS

    Here, we report the case of an 82-year-old woman with sclerosing mesenteritis diagnosed using needle biopsy under the guidance of computed tomography (CT) and ultrasound (US). The patient manifested appetite loss, weight loss, and epigastric pain. CT of the abdomen and pelvis revealed increased density of the mesentery adjacent to the small bowel along with enlarged lymph nodes. Hence, we suspected sclerosing mesenteritis but also considered malignancies, such as lymphoma. We then performed CT- and US-guided needle biopsy with coaxial technique. We inserted an introducer needle by verifying its location using CT and extracted multiple specimens using a finer needle that passed through the introducer without incident. The collected specimens were adequate and histological diagnosis revealed sclerosing mesenteritis. We treated the patient with corticosteroids, and her symptoms and radiographic findings improved. Thus, the coaxial technique was a useful and minimally invasive tool for the diagnosis of sclerosing mesenteritis.

    Download PDF (1005K)
feedback
Top