Masuho Haraguchi

Clinical and endoscopic features of adult T-cell leukemia/lymphoma with duodenal involvement.

We describe three cases of adult T-cell leukemia/lymphoma (ATLL) with duodenal involvement and provide a review of the literature. The first case, a 74-year-old woman with acute subtype of ATLL, had multiple polypoid lesions from the bulbus extending into the descending portion of the duodenum. The second case, a 70-year-old man with lymphoma subtype of ATLL, had a polypoid tumor in the descending portion of the duodenum and multiple protruded lesions in the small and large intestines. The third case, a 67-year-old man with lymphoma subtype of ATLL, had a flat-elevated lesion in the descending portion of the duodenum, as well as a gastric ulcerated lesion. Biopsies from these lesions showed mucosal invasion of ATLL cells in each case. All patients received combination chemotherapy, which was successful in the first and third cases, accompanied by the disappearance of gastroduodenal lesions.

Helicobacter pylori infection in patients with gastric involvement by adult T‐cell leukemia/lymphoma

Gastrointestinal involvement is seen frequently in patients with adult T‐cell leukemia/lymphoma (ATLL). The authors previously showed a relatively low prevalence of Helicobacter pylori infection in individuals with human T‐cell lymphotropic virus 1 (HTLV‐1) infection, including patients with ATLL; however, the correlation between H. pylori infection and ATLL gastric involvement has not been investigated.

Jejunal Perforation in a Patient with Adult T-Cell Leukemia

We present a case of adult T-cell leukemia (ATL) with jejunal perforation at the site of intestinal involvement by ATL. A 39-year-old woman presented with sudden-onset abdominal pain. Physical examination showed generalized severe abdominal tenderness and intraabdominal free air was seen on radiographic examination. Under a diagnosis of peritonitis due to intestinal perforation, an emergency operation was performed. A pinhole-like perforation was found in the jejunum 80 cm distal to Treitzs ligament, and the patient underwent partial resection of the affected jejunum. Microscopic examination revealed diffuse infiltration of abnormal lymphocytes into the entire wall of the jejunum and mesenteric lymph nodes. A diagnosis of ATL was confirmed by the presence of antibody to human T-lymphotropic virus type 1 (HTLV-1) in the serum, a positive result for T-cell markers and the HTLV-1 proviral genome in the mononuclear cells in the specimens. The final diagnosis was thus lymphoma subtype of ATL. Combination chemotherapy was repeated until the patient died 14 months postoperatively. Emergent surgery followed by intense chemotherapy might improve survival in patients with ATL and perforated intestine.

Changes in Colonoscopic Findings in Longstanding Ulcerative Colitis

Abstract: A total of 44 patients with long‐standing ulcerative colitis were studied to elucidate changes over time in colonoscopic and histological inflammatory activity. More than two years of symptomatic remission without melena or bloody diarrhea was achieved in 63.6% (28/44). All patients underwent total colonoscopic examinations. Compared with findings of the previously involved area, 70.5% (31/44) showed a reduction or disappearance of the inflammatory area on endoscopic and histological examinations; however, the rectal inflammation disappeared in 31.8% (14/44) of patients. Moreover, it became apparent that the remaining active inflammatory area tended to show discontinuous spread with patchy inflammatory foci. Thus, the mucosal inflammation in long‐standing ulcerative colitis may be characterized by a reduction in both extent and degree.