Miki Adachi

Neuroendocrine carcinoma of the stomach: a case study.

Gastric neuroendocrine carcinomas are rare and have a poor prognosis, and the diagnostic criteria for this disease have recently changed. We herein report a case of sporadic gastric neuroendocrine carcinoma. A 75-year-old man was referred to our hospital with epigastric pain. Endoscopic examination revealed a localized ulcerative lesion (diameter, 4 cm) at the upper stomach. The diagnosis on biopsy was neuroendocrine carcinoma. Total gastrectomy with D2 lymphadenectomy, splenectomy, and cholecystectomy was performed. Pathologically, the tumor infiltrated the subserosal layer, and 6/49 lymph nodes were involved. The tumor was uniform in shape and arranged in a rosette-like structure to form solid nests, with medium-sized, round-to-cuboid-shaped tumor cells and intense mitosis 46/10 HPF. It was positive for synaptophysin and chromogranin A, and the Ki-67 labeling index was 70–80%. The diagnosis of neuroendocrine carcinoma was made according to the WHO 2010 criteria. The patient was followed up for three years without recurrence.

Clinicopathologic Features of Flat Adenoma of the Large Bowel

One hundred and twenty-three “flat adenomas” in 98 patients were collected from the polypectomy and surgically resected specimens, and colonoscopic & histologic characteristics were described. They consisted 9.5% of ordinary polypoid adenomas removed colonoscopically and tended to situate more evenly in the colon than ordinary polypoid adenomas although the commonest site was in the left colon and the rectum. More than 90% of them were under 1cm in diameter and 15% of them showed severe atypia. The importance of recognizing the presence of these small “flat adenomas” as a new precursor of colonic carcinoma was stressed.

A Case of Localized Primary Sclerosing Cholangitis.

症例は68歳の男性. 黄疸を主訴に入院. 経皮経肝胆嚢造影にて, 総肝管に限局した狭窄像を認めたため, 胆管癌を疑い開腹手術を施行した. 手術時上部胆管に限局した狭窄部を含めた肝外胆管切除, 胆嚢摘出術, 肝管空腸吻合術を施行した. 病理組織学的に, 狭窄部には悪性所見を認めず, 胆管周囲の繊維化と著明な慢性炎症浸潤を認め, 限局型の原発性硬化性胆管炎(primary sclerosing cholangitis; PSC) と診断された. 術後8か月を経過した現在, 再発の兆候もなく健在である.過去の文献的考察をふまえ, 本症例のような限局型PSCは, びまん型で予後不良な定型的PSCとは, 明らかにその臨床像と経過が異なっており, 同一疾患として扱うことの妥当性について, 今後検討を加えるべきと考えられた.