Daisuke Norimura

MAGNIFYING ENDOSCOPIC OBSERVATION WITH NARROW BAND IMAGING FOR SPECIALIZED INTESTINAL METAPLASIA IN BARRETT'S ESOPHAGUS WITH SPECIAL REFERENCE TO LIGHT BLUE CRESTS

Aim:  Barretts esophagus (BE) with specialized intestinal metaplasia (SIM) is at high risk of esophageal adenocarcinoma. Magnified endoscopy with narrow band imaging (ME‐NBI) can be useful for detecting this condition. In addition to pit patterns, light blue crests (LBC), blue‐whitish patchy areas on the metaplastic epithelia of the stomach, can predict SIM in BE under ME‐NBI observation.

Education and Imaging. Gastrointestinal: gastric mucosa-associated lymphoid tissue (MALT) lymphoma observed by magnifying endoscopy with narrow band imaging.

Mucosa-associated lymphoid tissue (MALT) lymphoma derived from the B-lymphocytes, rarely occurs in the gastrointestinal (GI) tract. The commonest site of occurrence is the stomach. Narrow band imaging (NBI) with magnifying endoscopy can identify MALT lymphoma and there have been several reports and case series on this. We presently report a 79-year-old man who underwent GI endoscopy as part of a health checkup. Conventional endoscopy showed a depressed reddish lesion in the posterior wall of the mid-gastric body (Figure 1A). Chromoendoscopy with indigo carmine identified this to be a depressed lesion. (Figure 1B) Magnifying endoscopy with NBI showed a cleare demarcation line of this depressed lesion (Figure 1C, arrows), and revealed an loss of the normal epithelium and abnormal micro-vessels that did not have the typical tree-branching calibre changes around white round lesions (Figure 1D). Endoscopic biopsy specimens taken from the lesion showed a diffuse proliferation of abnormal lymphoid cells within the mucosa (low-power histology—not shown). High-power histology showed a diffuse proliferation of small centrocyte-like cells and lymphoepithelial lesions. Immunohistochemical analysis was positive for CD20 but negative for CD3. He was diagnosed as having gastric MALT lymphoma. The positron-emission tomography/computed tomography showed only gastric uptake and no other extra-nodal disease. Based on the histopathological findings, a diagnosis of gastric MALT lymphoma (high-grade) was made, and combination-chemotherapy with pirarubicin hydrochloride, cyclophosphamide, vincristine sulfate and rituximab was started.

Primary gastric follicular lymphoma manifesting as a submucosal tumor-like lesion

Follicular lymphoma occurs rarely in the gastrointestinal (GI) tract. Although previous studies have reported cases of follicular lymphoma in the GI tract by using advanced endoscopic imaging, gastric follicular lymphoma presenting as a submucosal tumor (SMT)-like lesion is rarely described.We report a case of primary follicular lymphoma which was resected by endoscopic submucosal dissection (ESD). A 69-year-old woman underwent gastrointestinal health check-up. Upper GI endoscopy revealed a SMT-like lesion with bridging folds in the greater curvature of the stomach (Fig. 1). Magnified endoscopy with narrow band imaging (ME-NBI) showed a nominal change of microsurface structures and microvessels. Endoscopic ultrasonography (EUS) showed the hypoechoic lesion with a lattice-work structure in the mucosal and submucosal layer (Fig. 2a). Histopathology of endoscopic biopsy specimens taken from the lesions showed atypical lymphoid cells, but no neoplastic changes. Abdominal computed tomography (CT) and colonoscopy showed no abnormalities. As EUS indicated that the tumor was localized within the submucosal layer and histopathology from the lesions showed atypical lymphoid cells, ESD was carried out for accurate histopathlogical diagnosis and en bloc resection. En bloc resection was completed without complications. Endoscopic horizontal margin was negative. The resected specimen revealed a dome-shaped tumor measuring 18 mm ¥ 14 mm ¥ 10 mm (Fig. 2b). Microscopic examination showed the follicular structures consisting of medium-sized abnormal lymphoid cells with dense nuclei. Neoplastic cells infiltrated into the submucosal layer, but the vertical margin was negative. Immunohistochemical analysis revealed that the neoplastic cells were positive for CD20 and Bcl-2, but negative for CD3, and hence, she was diagnosed as having gastric follicular lymphoma. We report a rare case of gastric follicular lymphoma manifesting as a SMT. In this case, the accurate diagnosis was difficult by various endoscopic modalities such as EUS and ME-NBI; therefore, ESD was carried out for diagnostic and therapeutic purpose. The exact diagnosis was due to acquisition of sufficient tissue by ESD procedure. We believe that ESD should be considered as one of the minimally invasive diagnostic methods in gastric malignant lymphoma.

Gastrointestinal: Gastric mucosa-associated lymphoid tissue (MALT) lymphoma observed by magnifying endoscopy with narrow band imaging

Mucosa-associated lymphoid tissue (MALT) lymphoma derived from the B-lymphocytes, rarely occurs in the gastrointestinal (GI) tract. The commonest site of occurrence is the stomach. Narrow band imaging (NBI) with magnifying endoscopy can identify MALT lymphoma and there have been several reports and case series on this. We presently report a 79-year-old man who underwent GI endoscopy as part of a health checkup. Conventional endoscopy showed a depressed reddish lesion in the posterior wall of the mid-gastric body (Figure 1A). Chromoendoscopy with indigo carmine identified this to be a depressed lesion. (Figure 1B) Magnifying endoscopy with NBI showed a cleare demarcation line of this depressed lesion (Figure 1C, arrows), and revealed an loss of the normal epithelium and abnormal micro-vessels that did not have the typical tree-branching calibre changes around white round lesions (Figure 1D). Endoscopic biopsy specimens taken from the lesion showed a diffuse proliferation of abnormal lymphoid cells within the mucosa (low-power histology—not shown). High-power histology showed a diffuse proliferation of small centrocyte-like cells and lymphoepithelial lesions. Immunohistochemical analysis was positive for CD20 but negative for CD3. He was diagnosed as having gastric MALT lymphoma. The positron-emission tomography/computed tomography showed only gastric uptake and no other extra-nodal disease. Based on the histopathological findings, a diagnosis of gastric MALT lymphoma (high-grade) was made, and combination-chemotherapy with pirarubicin hydrochloride, cyclophosphamide, vincristine sulfate and rituximab was started.

Gastrointestinal: Gastric mucosa-associated lymphoid tissue (MALT) lymphoma observed by magnifying endoscopy with narrow band imaging: Education and Imaging

Mucosa-associated lymphoid tissue (MALT) lymphoma derived from the B-lymphocytes, rarely occurs in the gastrointestinal (GI) tract. The commonest site of occurrence is the stomach. Narrow band imaging (NBI) with magnifying endoscopy can identify MALT lymphoma and there have been several reports and case series on this. We presently report a 79-year-old man who underwent GI endoscopy as part of a health checkup. Conventional endoscopy showed a depressed reddish lesion in the posterior wall of the mid-gastric body (Figure 1A). Chromoendoscopy with indigo carmine identified this to be a depressed lesion. (Figure 1B) Magnifying endoscopy with NBI showed a cleare demarcation line of this depressed lesion (Figure 1C, arrows), and revealed an loss of the normal epithelium and abnormal micro-vessels that did not have the typical tree-branching calibre changes around white round lesions (Figure 1D). Endoscopic biopsy specimens taken from the lesion showed a diffuse proliferation of abnormal lymphoid cells within the mucosa (low-power histology—not shown). High-power histology showed a diffuse proliferation of small centrocyte-like cells and lymphoepithelial lesions. Immunohistochemical analysis was positive for CD20 but negative for CD3. He was diagnosed as having gastric MALT lymphoma. The positron-emission tomography/computed tomography showed only gastric uptake and no other extra-nodal disease. Based on the histopathological findings, a diagnosis of gastric MALT lymphoma (high-grade) was made, and combination-chemotherapy with pirarubicin hydrochloride, cyclophosphamide, vincristine sulfate and rituximab was started.

Analysis of the tumor color patterns of early esophageal cancer using an autofluorescence imaging video endoscopy.

Background: Using a novel autofluorescence imaging video (AFI) endoscopy system, early esophageal cancers (EECs) appeared purple or brown in green background. However, the factors associated with these color patterns remain unraveled. The aims of this study were to classify the AFI color patterns of EECs and to investigate the correlation between the color patterns and clinicopathologic features of EECs. Patients: From April 2008 to April 2010, 32 patients with 42 EECs who underwent endoscopic submucosal dissection at the Nagasaki University Hospital were enrolled in this study. They consisted of 25 men and 7 women, with the mean age of 64.7 years old (range, 52 to 82 y). Methods: With AFI endoscopy, we classified 2 color patters in EECs into purple in green patterns (P in G) and brown with purple dots in green patterns (BP in G), and we assessed the association with clinicopathologic factors. These factors included tumor morphology, location, size, histologic depth of invasion, and histologic lymphatic and vessel permeations. Results: The color patterns of EECs were classified into 2 groups: purple in green patterns (P in G) (14%) and brown with purple dots in green patterns (BP in G) (86%). Univariate analysis revealed that only macroscopic type was associated with the EECs color pattern. Conclusions: This study revealed the association of AFI color patterns with clinicopathologic factors of EECs. Recognition of the color patterns in AFI images might be useful for the detections and diagnosis of EECs as one of the new endoscopic modalities.

Intestinal mantle cell lymphoma observed by double-balloon endoscopy with Fuji Intelligent Chromo Endoscopy.

Title Intestinal mantle cell lymphoma observed by double-balloon endoscopy with Fuji Intelligent Chromo Endoscopy. Author(s) Norimura, Daisuke; Isomoto, Hajime; Niino, Daisuke; Akazawa, Yuko; Yamaguchi, Naoyuki; Ohnita, Ken; Shikuwa, Saburo; Takeshima, Fuminao; Nakao, Kazuhiko Citation Endoscopy, 43(2), pp.E26-E27; 2011 Issue Date 2011-03 URL http://hdl.handle.net/10069/27389 Right