Katsuo Yamazaki

Anal Endosonography in the Diagnosis and Management of Perianal Endometriosis: Report of a Case

We report a rare case of perianal endometriosis, diagnosed in a 39-year-old woman who presented with a several-day history of a painful mass in the perineum. Perianal examination showed redness and swelling in the right anterior direction. A soft tumor was palpated, but there was no evidence of an episiotomy scar, or of fistula orifices. An anal endosonography in the right anterior direction revealed a sharply defined lesion, 17 × 14 mm in diameter, with high echoic enhancement at its center. The lesion was located along the edge of the external anal sphincter but did not involve it. Based on these endosonographic findings, the tumor was not considered to be an abscess or fistula. We detected its location, and judged it possible to enucleate the tumor under local anesthesia without injuring the anal sphincter. The operation was performed uneventfully and a histological diagnosis of endometriosis was confirmed. Using anal endosonography, we were able to determine the exact anatomic relationship of the lesion in the internal and external sphincter, which substantially influenced the diagnosis and operative procedures.

Development of hepatocellular carcinoma following treatment with6-mercaptopurine for ulcerative colitis: investigation of chromosomal aberration by comparative genomic hybridization

In a 64-year-old man who had been treated with prednisolone (PSL) and 6-mercaptopurine (6MP) for a long period, for ulcerative colitis (UC), hepatocellular carcinoma (HCC) was detected incidentally. The UC was in remission with these medications. After he had been taking these medications for about 8 years, HCC was detected by computed tomography (CT), done for the evaluation of an other disease. Blood chemistry examination results were normal, except that the protein induced by vitamin K antagonist (PIVKA)-II level was 7940 AU/ml. We performed resection of liver segment V. With comparative genomic hybridization, chromosomal aberrations were recognized; these were gains of 1q, 3ptel-21, 8p12, and 22q11.23–22q13.1. Generally, HCC is associated with hepatitis virus infection in most cases, but in this patient, the HCC was not related to hepatitis C virus (HCV) or HBV. It is presumed that this case was related to the immunosuppressive therapy for UC and was associated with the gains of 1q, 3p, and 8p.