Koichi Satoh

Primary gastric lymphoma with spontaneous perforation: report of a case.

Abstract Primary gastric lymphoma with spontaneous perforation is rare. We report herein the case of a 53-year-old-man who was admitted to our hospital with severe epigastralgia. Emergency endoscopic examination showed a perforated gastric tumor in the lower body of the greater curvature, and a distal subtotal gastrectomy with lymph node dissection was performed. The resected tumor measured 10.0 × 8.0 cm and was associated with an area of ulceration, 8.0 × 6.0 cm in size, and perforation, 1.0 × 0.5 cm in size. Pathological examination confirmed a diagnosis of B-cell malignant lymphoma of the diffuse, medium-sized cell type. According to the Ann Arbor and Naqvi classifications, the lymphoma was stage II and stage III, respectively. Postoperative adjuvant chemotherapy comprising cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) was given. The patient is currently well with no signs of recurrence, 2 years 4 months after his operation.

A case of pancreatic serous cystadenoma with obstructive jaundice

A 62‐year‐old man with precordial pain and fever consulted a local practitioner. Blood tests revealed jaundice. Acute cholecystitis was diagnosed on ultrasonographic examination, and percutaneous transluminal gall‐bladder drainage was performed. The patient was referred to the Department of Surgery for operation. Imaging studies performed via a drain disclosed compression and stenosis of the lower portion of the common bile duct. A computed tomographic scan showed a multilocular nodule‐like low‐density area measuring 2.0 × 2.0 cm in diameter at the head of the pancreas. Endoscopic retrograde cholangiopancreatography disclosed compression and stenosis of the main pancreatic duct at the head of the pancreas. Angiographic examination revealed encasement of the intrapancreatic branch of the posterior pancreatic arcade, located in the same area as the compression stenosis of the bile duct. The results of imaging studies suggested cancer of the head of the pancreas, and a pancreatoduodenectomy was performed. The resected specimen included a mass measuring 3.5 × 2.7 × 1.7 cm, which was located at the head of the pancreas. On examination of a cut section, the mass was found to consist of small multilocular cysts. The cysts invaded the intrapancreatic bile duct. The histopathological diagnosis was serous cystadenoma.

A CASE OF GROOVE PANCREATITIS WITH DUODENAL STENOSIS

A 58‐year‐old man presented with a 2‐month history of nausea and vomiting. Blood levels of hepatic enzymes and pancreatitis markers were slightly elevated. Hypotonic duodenographic and endoscopic examinations revealed stenosis encircling the descending duodenum. A computed tomography (CT) scan showed inflammatory changes in the head of the pancreas and thickening of the duodenal wall. Magnetic resonance cholangiography demonstrated stenosis of the intrapancreatic segment of the common bile duct and diffuse dilatation of the main pancreatic duct, without irregularity. At laparotomy, microscopic examination of a needle biopsy specimen of the head of pancreas revealed no evidence of malignancy. Distal gastrectomy with Billroth II anastomosis was performed. Microscopically, fibrous thickening of the duodenal wall, serositis and hyperplasia of Brunners glands were found. The presence of duodenal stenosis due to segmental pancreatitis, referred to as groove pancreatitis, was confirmed. The elevated blood levels of pancreatitis markers returned to the normal range 8 months after the operation. Ultrasonic echography and abdominal CT also revealed a marked reduction in dilatation of the extrahepatic bile duct and the main pancreatic duct. In patients suspected of having pancreatic carcinoma or regional pancreatitis, groove pancreatitis should be included in the differential diagnosis.

PRIMARY GASTRIC LYMPHOMA WITH ARTERIAL BLEEDING

We experienced a case of primary gastric lymphoma with arterial bleeding. The case was an 88‐year‐old‐man who was admitted to our hospital with hematemesis. Gastroduodenal endoscopy revealed a gastric ulcerating tumor with arterial bleeding in the posterior wall of the angular gastric region, and a distal subtotal gastrectomy with lymph node dissection was performed. The resected tumor measured 7.0 × 3.0 cm in size with a blood vessel visible in the bottom of the ulcer. Pathologic examination confirmed a diagnosis of B‐cell malignant lymphoma of the diffuse large cell type. Metastasis was detected in nos 3 and 5 lymph nodes. According to the Ann Arbor and Naquvi classifications, the lymphoma was stage IIE and II, respectively. One year and 10 months after the operation, a computed tomography scan revealed a few swollen lymph nodes around the abdominal aorta. Recurrence of lymphoma was confirmed and chemotherapy comprising cyclophosphamide, doxorubin, vincristine and predonisolone was given at half the ordinary adult dose.

Extensive hemorrhagic erosive gastritis associated with acute pancreatitis successfully treated with a somatostatin analog

In massive hemorrhage from acute gastric mucosal lesions, it is occasionally difficult to control the bleeding with nonsurgical therapy. We used the somatostatin analog, octreotide, which suppresses gastric and pancreatic function, to treat severe hemorrhagic erosive gastritis in a patient with acute pancreatitis. A 22-year-old man presented with epigastralgia and melena. Blood levels of pancreatitis markers were elevated. Computed tomography revealed diffuse enlargement of the pancreas, without fluid collection around the organ. An endoscopic examination showed extensive hemorrhagic erosions over almost the whole gastric mucosa. We diagnosed extensive hemorrhagic erosive gastritis with acute pancreatitis. A protease inhibitor (nafamostat mesilate 50 mg/day) and an H2 receptor antagonist (famotidine 40 mg/day) were administered by injection for 6 days; the patients serum and urine amylase levels fell, but the gastric erosions with hemorrhage were not attenuated. Octreotide was given subcutaneously, at a daily dose of 100 μg for 5 days, without famotidine administration. His melena disappeared, and the gastric erosions were markedly decreased. Administration of the somatostatin analog, octreotide, proved to be effective treatment in a patient with severe hemorrhagic erosive gastritis associated with acute pancreatitis.

Establishment of a simple detection system for blood group ABO-specific transferase activity in DNA-transfected cells

A/B-transferase is a glycosyltransferase that transfers a sugar substrate onto H-antigen resulting in the synthesis of glycoproteins and glycolipids termed A/B-antigens. The ABO blood group (ABO) gene encoding A/B-transferase possesses numerous polymorphisms affecting the specificity and/or activity of the enzyme. The relationship between genotype and phenotype is very complicated, except for those of some critical polymorphisms. In order to establish a system for evaluating the effect of each polymorphism on the transferase function, an A- or B-transferase cDNA expressing vector was introduced into HeLa cells, a cell line that do not possess endogenous A/B-transferase activity. We successfully detected substrate-specific transferase activity in the cells and in the culture medium. Furthermore, in three different assays, each corresponding A- or B-antigen was detected in the transfectants with high sensitivity. Accordingly, the present study demonstrates a possibility that A/B-transferase variants may be characterized by using this method.

A Case of Leiomyosarcoma with a Cartilaginous Matrix

Abstract: Leiomyosarcomas with a cartilaginous matrix are extremely rare. A 72‐year‐old man presented with a mass approximately the size of a hens egg, on the posterior wall of the lesser curvature of the stomach, near the esophagogastric junction. On endoscopic ultrasonography, the size of the tumor was estimated to be 30X20 mm. On histopathological exmination of sections of the lesion stained with hematoxylin and eosin, the tumor was found to be composed of densely packed spindle cells with mitotic figures. A hyaline‐like matrix was seen at the center of the tumor. This matrix contained cells with vacuoles around the nuclei. On immunohistochemical staining, the tumor cells stained positively for vimentin and desmin. The cartilaginous portion of the tumor was positive for S‐100 protein. We describe herein our experience and discuss similar cases reported in the literature.