Fukuji Mochizuki

The point mutation of c-Ki-ras at codon 12 in carcinoma of the pancreatic head region and in intraductal mucin-hypersecreting neoplasm of the pancreas

SummaryIn order to clarify whether the detection of a point mutation in the c-Ki-ras gene at codon 12 in tumor tissues can assist in predicting the tumor’s biological grade of malignancy, two types of tumors were investigated; one was called “carcinoma in the pancreatic head region,” and the other was intraductal mucin-hypersecreting neoplasm of the pancreas (IMHN). Dot hybridization and a modified PCR technique developed by Haliassos et al. were employed. Among 16 cases of tumors in the pancreatic head region, the point mutation was detected with a high frequency only in pancreatic ductal cell carcinomas (five out of six cases, 83.3%), but was not detected in extrahepatic bile duct carcinomas (0/5) or in ampullary carcinomas (0/5). In pancreatic ductal cell carcinomas, no relation was found between the occurrence of the point mutation and the histological type of the tumor. Among 20 cases of IMHNs, the point mutation was found in 11 cases (55%). No relation was found between the occurrence of the mutation and the size of IMHNs. However, as the grade of cell atypia increased, the frequency of the mutation tended to become higher. These results suggest that detection of this point mutation might be useful for distinguishing pancreatic ductal cell carcinoma from those of other origins in the pancreatic head region, and for the determination of the histopathological grade of malignancy in IMHNs.

Analysis of the Layer Structure of the Gallbladder Wall Delineated by Endoscopic Ultrasound Using the Pinning Method

Abstract: The gallbladder is a suitable target of endoscopic ultrasound (EUS). However, the interpretation of the layer structure of the gallbladder wall delineated by EUS is still controversial. To confirm the relationship between the layers demonstrated by EUS and the histological structure, we performed a study using the pinning method. In most slices, the gallbladder wall was demonstrated to be a two‐or three‐layer structure, consisting of a low echoic layer, sometimes with an overlying hyperechoic layer, and a high echoic layer from the mucosal side. The slices were pierced with pins at random depths. Among the twelve pin echoes demonstrated in the low echoic layer, four were located in the muscularis propria, two in the border between the muscularis propria and the subserosa, three in the fibrous layer of the upper portion of the subserosa, and three in the adipose layer of the lower portion of the subserosa. The three sites where the pin echoes were seen at the border between the low echoic and high echoic layers were located in the fibrous layer, the border between the fibrous layer and the adipose layer, and in the adipose layer, respectively. The twelve sites at which pin echoes were observed in the high echoic layer were confirmed to be in the adipose layer. These results indicate that the inner hypoechoic layer includes not only the muscularis propria but also the fibrous layer of the subserosa. This should be kept in mind when assessing the depth of invasion of a gallbladder carcinoma.

Pancreatoscopy for Mucus Producing Pancreatic Tumor

Abstract: The mucus producing tumor of the pancreas (MPT) is now drawing attention because of its characteristic clinical features. It is characterized by abundant secretion of mucin into the cystic cavity or the main pancreatic duct and relatively benign biological behavior. In this paper, endoscopic characteristics of MPT and the role of pancreatoscopy in the diagnosis of this entity are discussed. Eight cases of MPT with various histological backgrounds were examined with pancreatoscopy. Six cases underwent peroral pancreatoscopy and intraoperative pancreatoscopy was performed in four cases. The endoscopic findings of MPT are summarized as follows: 1) Granular change of the epithelium of the pancreatic duct. 2) Papillary tumor with dilatation of capillary vessles on its surface. 3) Irregularity or detachment of the epithelium of the pancreatic duct. The findings mentioned above in 1), 2) and 3) were obtained in three cases, two cases, and two cases, respectively. Except in one case, the border of the lesion with the neighboring normal mucosa was well identified.

Endoscopic Mucosal Resection (EMR) of Early Gastric Cancer : Usefulness of Aspiration EMR Using a Cap-fitted Scope

Abstract: We conducted this study to clarify the effectiveness of aspiration endoscopic mucosal resection (EMR) using a cap‐fitted scope for early gastric cancer in the C and M regions of the stomach. EMR was performed in 111 early gastric cancer patients with 123 lesions in the C and M regions. The patients were divided into three groups. The EMR‐1CS group consisted of patients who had undergone EMR with a one‐channeled scope, the EMR‐2CS group those who had received EMR in which a two‐channeled scope was utilized. The EMRC group consisted of patients who had undergone aspiration EMR with a cap‐fitted scope.

Foreign Bodies in the Bile Duct After Laparoscopic Cholecystectomy

Abstract: A 57‐year‐old man who had undergone laparoscopic cholecystectomy three years previously was referred to our department for evaluation of foreign bodies in his abdomen. Endoscopic retrograde cholangiopancreatography revealed that the foreign bodies existed in the bile duct, and they were considered to be clips used during the laparoscopic cholecystectomy. Endoscopic sphincterotomy and removal of the foreign bodies with a Dormia basket were successfully performed. Migration of clips into the bile duct should be kept in mind as a possible late complication of laparoscopic cholecystectomy. Endoscopic sphincterotomy is a feasible treatment of choice.

A Case of Postsurgical Pancreatic Pseudocyst Treated by Endoscopic Cystogastrostomy

Pancreatic pseudocyst after pancreatic surgery is a relatively rare condition and conservative therapy is the common treatment of choice. When symptoms persist or complications follow, however, surgical treatment is considered. There have been reports on endoscopic cystoenterostomy since the early 1980s. We herein describe a case of postsurgical pancreatic pseudocyst treated successfully by endoscopic cystogastrostomy. A nineteen‐year‐old female showing left hypochondralgia and back pain with elevation of her serum amylase level, who had undergone enucleation of a solid cystic tumor in the body of the pancreas, was referred to our department. She was diagnosed as having a pseudocyst of the pancreas 5.8×4.5 cm in size at the site of enucleation by US and CT. Endoscopic retrograde pancreatography and endoscopic ultrasonography performed simultaneously revealed obstruction of the main pancreatic duct and a cystic change in the body‐tail of the pancreas just behind the gastric wall of the upper body. An extrinsic compression was seen in the posterior wall of the upper body of the stomach endoscopically. An incision was made using a sphincterotome. A pigtail stent, 7.2 Fr in size, was placed to keep the patency of the fistula, which was removed one and a half months later. Her symptoms showed great improvement immediately after the procedure. Follow‐up CT demonstrated no recurrence of the pseudocyst.

Diagnosis of the Depth of Advanced Gastric Cancer Invasion by Endoscopic Ultrasonography

Preoperative endoscopic ultrasonography (EUS) was performed in 272 patients with advanced gastric cancer who underwent gastrectomy between December 1986 and December 1993. We divided the subjects into two groups: group A consisted of patients whose stomachs were filled with water for the EUS examination (water‐filling method: 1986.12–1992. 10) and group B of patients in whom EUS was performed with the water‐filled balloon compression method (balloon‐compression method) in addition to the water‐filling method (1992.11–1993. 12). A comparative study of EUS diagnostic efficacy, as regards the depth of invasion, was made between group A and group B. The following results were obtained:

Endoscopic Biliary Drainage without Endoscopic Sphincterotomy

Endoscopic biliary drainage (EBD) is usually performed after endoscopic sphincterotomy (EST). In some patients, however, EBD without EST, so‐called nonEST‐EBD, is also effective.

Observations on benign gastric ulcer simulating gastric carcinoma

SummaryWe have re-evaluated over-diagnosed cases which were first diagnosed, pre-operatively, as gastric cancer yet later confirmed as benign lesion (excavated lesion, in particular) in the post-operative histological examination of resected stomachs. We have experienced a total number of 1,358 cases which, being detected through mass survey, were diagnosed as cancer and, consequently, operated upon. On the other hand, 61 benign cases were misdiagnosed as cancer, 28 cases being protruded lesions and 33 cases excavated lesions. Among the misdiagnosed cases of excavated lesions, 27 cases were gastric ulcers or their scars, the remaining 6 cases being gastritis or gastric erosion. In 22 out of 33 cases of misdiagnosis, the wrong diagnosis was made by relying solely upon X-ray and endoscopy. Even after the addition of cytology, there were still 9 cases of misdiagnosis. Since, however, biopsy was introduced, there have been only 2 cases of wrong diagnosis. We may safely say that through these findings the absolute necessity of biopsy for the attainment of an accurate diagnosis of early gastric cancer has been sufficiently attested.

APPLICATION OF MAGNIFYING ENDOSOCPY AND ENDOSCOPIC ULTRASONOGRAPHY TO COLORECTAL NEOPLASTIC LESIONS

to 20 MHz, and 20 MHz probes are commonly used. The probes can scan both linearly and radially, and a combination of these methods is used for 3-D image reconstruction by image processing. Olympus sells a radially scanning dedicated endoscope, model CF-UMQ 230, with two frequencies: 7.5 MHz and 12 MHz or 7.5 MHz and 20 MHz, and the frequency choice can be made by a one-touch function. Because this endoscope has a frequency of 7.5 MHz, it can scan highly protruded lesions and organs adjacent to the colon. However, because the scope is thick, there is still room for improvement in its maneuverability.