Masayoshi Ide

Carcinoid of the esophagus located in lamina propria

Abstract: We report a carcinoid tumor in the mucosal layer of the esophagus of a 63-year-old man. Barium X-ray and endoscopy indicated the tumor to be a polypoid lesion in the lower esophagus.Endoscopic ultrasonography (EUS) demonstrated the lesion to be a sharply demarcated hyperechoic tumor in the mucosal layer. Biopsy yielded a diagnosis carcinoid of the esophagus. In the resected specimen of the esophagus, the tumor was 11 mm in longest dimension with a shallow depression on it smooth surface. Histologically, the tumor was located in the mucosal layer, as shown by EUS, and was composed of small round cells which were positive for argyrophil, but not argentaffine. Carcinoid tumor of the esophagus found at an early stage, and localized in the lamina propria layer, is very rare. The present case is the second report in Japan.

A Case of Choledochocele Associated with Carcinoma of the Pancreas

A‐59‐year old woman was admitted with lumbago and back pain. An abdominal ultrasonography and abdominal computed tomography demonstrated a tumor of the body of the pancreas and multiple space occupying lesions in the liver. Endoscopic retrograde chorangiopancreatography revealed a 11 mm cystic dilatation of the terminal portion of the common bile duct protruding into the duodenal lumen and an obstruction of the pancreatic duct in the body portion. Celiac artery angiography showed an irregularity in the wall of the splenic artery. In line with these findings, the patient was diagnosed as suffering from choledochocele associated with carcinoma of the pancreas. As she already had multiple metastatic liver tumors, her treatment was limited to amelioration of her symptoms. Increasing stenosis of the common bile duct, however, required endoscopic sphinctomy and endoscopic retrograde biliary drainage. Type 3 Choledochocele of Alonso‐Lejs classification is very rare, and only a few cases have been reported in association with malignant bile duct tumors. We believe this case to be the first one in our country linked with carcinoma of the pancreas.

A case of the pathogenesis of choledochocele in relaion to dysfunction of the sphincter of Oddi

SummaryA 47-year-old woman was admitted for evaluation of pain in the right upper quadrant of the abdomen. Seventeen years previously, she had undergone cholecystectomy for cholelithiasis. Endoscopic retrograde cholangiopancreatography (ERCP) showed a cystic dilatation of the terminal portion of the common bile duct (CBD) protruding into the duodenal lumen and delaying the drainage of contrast medium. In this patient the CBD and the pancreatic duct had separate openings into the duodenum, so the relaitonship of the CBD to the pancreatic duct appeared to be unimportant in the formation of the cyst. Repeated changes in the radius of the cyst suggested dysfunction of the ampullary component of the sphincter of Oddi, with maintenance of normal function of the common duct component. The pathogenesis of the choledochocele in this patient is discussed in relation to dysfunction of the sphincter of Oddi. In addition, 2 criteria for the diagnosis of choledochocele by ERCP are proposed: [1] cystic dilatation of the terminal portion of the CBD protruding into the duodenal lumen, arrd [2] absence of the narrow segment of the CBD.