Masaaki Matsukawa

RARE GASTRIC CALCIFYING FIBROUS PSEUDOTUMOR REMOVED BY ENDOSCOPIC SUBMUCOSAL DISSECTION

We report a case of a calcifying fibrous pseudotumor of the stomach that we resected using endoscopic submucosal dissection (ESD). A 61‐year‐old male with a gastric submucosal tumor was admitted to our hospital for treatment. By upper gastrointestinal tract endoscopy, a smooth‐surfaced submucosal tumor measuring 2 cm in diameter was observed in the anterior wall of the middle body of the stomach. By endoscopic ultrasonography, a mass was observed in the stomach submucosa; the mass had a well‐defined boundary. Internally, the mass was heterogeneous and hypoechoic; high spots were scattered throughout the mass. Continuity between the mass and the muscularis mucosae and muscularis propria was not observed. Strongly suspecting that this mass was a gastrointestinal stromal tumor arising from the stomach, we resected the mass by ESD for total biopsy. Histopathologically, the mass consisted of proliferation of eosinophilic collagen fibers with plasma cell infiltration and lymphoid follicle proliferation. Calcification was also observed in some parts of the mass. Thus, the mass was identified as calcifying fibrous pseudotumor. Calcifying fibrous pseudotumor of the stomach is extremely rare and its histogenesis remains unclear; however, its morphology became distinct by comparing endoscopic/radiological and histopathological findings.

Effectiveness of doxifluridine (5-DFUR)/docetaxel against advanced/recurrent gastric cancer showing resistance to various anticancer drug regimens

Abstract.A 58-year-old man was diagnosed as having type 3 gastric cancer (poorly differentiated adenocarcinoma). He underwent total gastrectomy with splenectomy, as well as D3 dissection, and received postoperative chemotherapy combining oral uracil and futrafur (UFT) with cisplatin (CDDP), but results showed recurrence of multiple abdominal lymph node metastases around the aorta. He therefore received various anticancer drug regimens (irinotecan [CPT-11]/CDDP; 1 M tegafur-0.4 M gimeracil-1 M oteracil potassium [TS-1], methotrexate (MTX)/5-fluorouracil); however, final results showed growth of lymph node metastasis and simultaneous worsening of his general condition. The patient then received combined administration of doxifluridine (5′-DFUR)/docetaxel (5′-DFUR, 1000 mg/body [666.7 mg/m2], given by consecutive daily administration, orally, for days 1–14; and docetaxel, 80 mg/body [60 mg/m2], on day 8, by venous drip, every 3 weeks). Three courses of this regimen resulted in approximately 90% reduction of the abdominal lymph node size, disappearance of the right cervical lymph node metastasis, reductions of the levels of two tumor markers (carcinoembryonic antigen [CEA] and carbohydrate antigen [CA]19-9), and improvement of his general condition. In total, seven courses of the regimen were carried out. The patient died on day 298 after starting this combined regimen and showed a response period of 126 days. The primary toxicity identified was neutropenia (grade 4), as well as other low-grade (grade 1, 2) hematological and nonhematological toxicities. In the field of gastric cancer treatment, especially for patients showing multiple resistance to anticancer drugs, an effective therapy is critically needed.

CASE OF A MINUTE SESSILE LESION OF THE SIGMOID COLON WITH MASSIVE CANCER INVOLVEMENT IN THE SUBMUCOSAL LAYER

A 53‐year‐old man was referred to our hospital because of the appearance of a positive fecal occult immunological reaction. We found a domed lesion 0.4 cm in diameter in the sigmoid colon. Bleeding spots were observed on the surface of the lesion on endoscopy. We performed endoscopic mucosal resection of the lesion, which was found to contain well‐differentiated adeno‐carcinoma and cancer cells infiltrating to the cut‐end of resected specimen. Laparoscopy‐assisted sigmoidectomy was then performed with dissection of the lymph nodes. The dissected lesion was diagnosed as adenocarcinoma with moderate fibrosis and massive cancerous involvement. The patient died of recurrent cancer 3 years after the operation. In the minute sessile lesion, bleeding spots on the surface may suggest invasive cancer with massive cancer involvement within the submucosal layer.

Radiological Findings of Minute and Small Depressed Colorectal Neoplasm

We are required to detect colorectal cancer at the early stage in order to improve its prognosis. Minute cancers are an early cancer and are detected as a depressed lesion. We could demonstrate small and minute depressive cancers(4 lesions) and adenomas(6 lesions) emploing a new preparation of barium enema. This preparation consists of bisacodyl 15mg, massive isotonic citrated magnesium solution (25m 1/b.w. kg), cysapride 15mg and a low-fat, low-residue meal. Ten depressed lesions (3 lesions ranging between 1 cm and 0.6 cm, 7 lesions of less than 0.6 cm) were demonstrated by double contrast method. Findings of those depressed lesions were demonstrated as a radiolucent area around a faint barium fleck.