Hidenaga Uesugi

Hepatoid adenocarcinoma in Barrett’s esophagus associated with achalasia: First case report

We report an unusual hepatoid adenocarcinoma in Barrett’s esophagus with achalasia, which developed in a 44‐year‐old Japanese woman. The patient received an esophago‐gastrectomy after diagnosis of the tumor and achalasia at the lower esophagus, 4 months before her death due to multiple metastatic tumors of the liver. The main granular tumor removed surgically was a hepatoid adenocarcinoma, mainly composed of clear cancer cells (α‐1 antitrypsin, albumin and α‐fetoprotein positive), with elements of choriocarcinoma and tubular adenocarcinoma. Non‐neoplastic specialized columnar epithelium was present extensively near the oral side of the tumor edge in the esophagus, indicating Barrett’s esophagus. This unusual tumor was therefore considered to have originated in Barrett’s esophagus. The gastroesophageal reflux was presumed to have occurred for a long period, as there was a well‐preserved fundic gland in the stomach and a history of frequent vomiting from the patient’s youth, accounting for the appearance of achalasia.

A Study on Myogenic Tumors of the Upper Gastrointestinal Tract by Endoscopic Ultrasonography—With Special Reference to the Differential Diagnosis of Benign and Malignant Lesions

Seventy‐six myogenic tumors (60 leimyomas, 3 leiomyoblastomas, 13 leiomyosarcomas) surgically resected from the upper gastrointestinal tract were studied histopathologically to define the characteristics of benign and malignant tumors. Twenty‐nine of these lesions (22 leiomyomas, 3 leiomyoblastomas, 4 leiomyosarcomas) were additionally studied by EUS before resection to investigate the relationship between EUS and histopathological findings and establish a scoring system enabling the differentiation of malignant from benign lesions. The results indicated that coagulative necrosis and bleeding were principally responsible for the heterogeneous internal echo of tumors. Anechoic areas corresponded to colliquative necrosis or cystic degeneration. Five EUS findings of prime importance in identifying malignant myogenic tumors were found to be: (1) a tumor diameter of ±3.0 cm, (2) nodular shape, (3) an ulceration depth of ± 5 mm, (4) a heterogeneous internal echo, and (5) the presence of an anechoic area. Each of these five parameters was assigned a score of 1 Point, and lesions with a total score of 3 or more were evaluated as being malignant. The sensitivity and specificity of our scoring system for myogenic tumors were respectively 100% and 73% in the 29 cases studied by EUS and 100% and 80% for all 76 tumors studied histopathologically.

Case Report: Distinctive Diffuse Duodenitis Associated with Ulcerative Colitis

There are numerous and varied complicat ions in the natural course of ulcerative colitis, and the extracolonic manifestations of this disease have been described in many reviews and case reports (1± 3). Wellknown bowel complications include toxic megacolon (4, 5), colitis cystica profunda (6), backwash ileitis (7, 8), and postcolectomy pouchitis (9, 10). The extension of pathologi cal changes of ulcerative colitis in a retrograde manner through the ileocecal valve into the ileum, responsible for backwash ileitis, only reaches a short distance into the ileum, and the upper small intestine, particularly the duodenum, is not affected (7). We report here a surgical case of diffuse ulcerative duodeniti s accompanying ulcerative colitis without backwash ileitis and discuss its pathogenesis.

A case of adenocarcinoma of the small intestine in a Japanese patient with Crohn disease: a report with immunohistochemical and oncogenic analyses.

We report a rare case of Crohn disease accompanied by a small-bowel carcinoma that developed in a 54-year-old Japanese man. The ulcerating tumor, which histologically proved to be a poorly differentiated adenocarcinoma and dysplasia surrounding the carcinoma, was located in the diseased ileum. The Ki-67 immunoreactive epithelial cells were increased in regenerative mucosa as compared with values for normal mucosa. The Ki-67- and p53-positive cells were increased in dysplasia and carcinoma as compared with values for regenerative or normal mucosa. In contrast, the p21(WAF1/CIP1) immunoreactive cells were decreased in this order. Intense DCC (deleted in colorectal cancer) expression was constantly shown among normal, regenerative, dysplastic and cancerous tissues. No bcl-2 expression and c-Ki-ras mutations were apparent. In conclusion, enhanced epithelial cell proliferation, p53 overexpression, and decrease of p21(WAF1/CIP1) expression may predispose the small-bowel mucosa to dysplasia and carcinoma development in Crohn disease.

Different expression of Bcl‐2 protein in gastric adenomas and carcinomas

In order to cast light on the possible role of bcl‐2 protein (Bcl‐2) expression In gastric tumorigenesis, 33 cases of gastric adenomas and carcinomas originating from the same stomachs were immunohistocnemically investigated for Bcl‐2 protein (Bcl‐2) expression, accumulation of p53 protein and cell proliferation as determined by the KI‐67 labeling index (LI). Bcl‐2 expression was detected in 24/33 (72.7%) adenomas and in 6/33 (18.2%) carcinomas, the difference being statistically significant (P=0.0O01). Only 4 of 33 (12.1%) cases exhibited expression in both adenoma and carcinoma lesions in the same stomachs. ImmunoreactMty was decreased in areas of cellular and structural atypia in adenoma lesions (P<0.008), and appeared to be positively linked to the tumor progression and the degree of differentatlon in carcinomas, although It did not reach statistical significance. Accumulation of p53 protein was rare In the adenomas but was found in 15/33 (45.5%) of carcinoma lesions, with a significant dissociation from Bcl‐2 immunoreactivity. No apparent relation between Ki‐67 U and either adenoma grading or carcinoma typing was noted, although average KI‐67 LI of the highest labeling areas in carcinomas was statistically higher than in adenomas (P=0.0001). These results indicate that the regulation of Bcl‐2 expression may differ between gastric adenomas and carcinomas, may be correlated with tumor dlfferentiathre features. In addition, p53 accumulation may play an Important role in the onset of malignancy.

An aggressive desmoid tumor in a patient with familial adenomatous polyposis: immunohistochemical findings.

A case of an aggressive desmoid tumor in a patient with familial adenomatous polyposis is described. The lesion rapidly enlarged with compression of adjacent structures including the ureter and small bowel, and the patient died because of small bowel perforation and hydronephrosis 3 years after detection of small desmoid tumors at the time of a prophylactic coloproctectomy for a colon carcinoma. Immunohistochemically, proliferating cell nuclear antigen (PCNA), p21WAF1/CIP1 and cathepsin D indices, but not the bcl-2 index, which were defined as the numbers of immunoreactive tumor cells per 1000 tumor cells, increased in line with tumor progression. The tumor did not show staining for collagen IV, but was characterized by intense staining for basic fibroblast growth factor (bFGF). Accordingly, tumor aggression was related to increases in both cell proliferation and protease activity, as well as an enhanced expression of bFGF. In addition, the desmoid tumor showed deregulation between PCNA and p21WAF1/CIP1 because the normal inverse relation between these two was not apparent.

Brief Case ReportsAn aggressive desmoid tumor in a patient with familial adenomatous polyposis: immunohistochemical findings

A case of an aggressive desmoid tumor in a patient with familial adenomatous polyposis is described. The lesion rapidlyenlarged with compression of adjacent structures including the ureter and small bowel, and the patient died because of small bowel perforation and hydronephrosis 3 years after detection of small desmoid tumors at the time of a prophylactic coloproctectomy for a colon carcinoma. Immunohistochemically, proliferating cell nuclear antigen (PCNA), p21WAF1/CIP1 and cathepsin D indices, but not the bcl-2 index, which were defined as the numbers of immunoreactive tumor cells per 1000 tumor cells, increased in line with tumor progression. The tumor did not show staining for collagen IV, but was characterized by intense staining for basic fibroblast growth factor (bFGF). Accordingly, tumor aggression was related to increases in both cell proliferation and protease activity, as well as an enhanced expression of bFGF. In addition, the desmoid tumor showed deregulation between PCNA and p21WAF1/CIP1 because the normal inverse relation between these two was not apparent.

A case of common bile duct adenoma diagnosed by exfoliative cytology of bile juice.

術前に, 胆汁の細胞診で, 総胆管に発生した管状腺腫と診断された73歳, 女性の1例を経験したので報告する.術後5年の経過をとっているが, 良好である.本腫瘍の細胞学的および病理組織学的な所見を報告したい.腺腫の腫瘍細胞は大型で, 核・細胞質比が増大し, 核クロマチンは増量しているが細胞異型は少ない.大型腫瘍細胞で, ほぼ均一の大きさを呈する異型細胞所見は胆汁中の腺腫細胞の細胞診断に重要な所見である.