Mitsuyuki Matsumoto

Plexiform leiomyoma of the esophagus: A peculiar gross variant simulating plexiform neurofibroma

A plexiform variant of leiomyoma of the esophagus in a 51-year-old woman is reported. The patient was diagnosed with a tumor of the esophagus in an X-ray mass survey of the upper gastrointestinal tract. She was referred to the Ryukyu University Hospital for further examination. She appeared healthy with no complaints. Upper gastrointestinal series revealed an oval, well-defined filling defect in the lower esophagus just above the esophagogastric junction. Endoscopy revealed an undulating bulge covered with normal esophageal mucosa. Endoscopic ultrasonography showed a sharply demarcated hypoechoic mural tumor with internal linear pattern, with no evidence of penetration into the surrounding tissue. These findings were evaluated as consistent with a leiomyoma. Removing the tumor by enucleation was easily accomplished. Unexpectedly, on gross inspection, the tumor was a plexiform type, mimicking a plexiform neurofibroma. Light and electron microscopic examination and immunohistochemistry of the tumor tissue confirmed leiomyoma. Since the enucleation of the tumor, the patient has been free of recurrence and symptoms for 1.5 years at the time of this report.

Recurrent hemorrhaging from stomal ulcers following a side to side longitudinal pancreaticojejunostomy for chronic pancreatitis: report of a case.

SummaryGastrointestinal (GI) hemorrhaging secondary to stomal ulcers following a pancreaticojejunostomy for chronic pancreatitis is a rare postoperative condition that has not hitherto been reported in the literature. A 25-yr-old Japanese female was referred to Ryukyu University Hospital with GI hemorrhaging of unknown origin. She had undergone a modified Puestow procedure (Partington procedure) for chronic pancreatitis with pancreatolithiasis and an associated dilatation of the main pancreatic duct at 19 yr of age. A technetium-99m blood-flow scan demonstrated the pooling of radionuclides in the area of the jejunal loop, which was highly suggestive of bleeding into the jejunum. Over the next day, she demonstrated persistent melena. At exploratory laparotomy, the anastomotic jejunal loop was filled with clotted blood. Operative endoscopy through an incision of the jejunal loop in close proximity to the anastomosis showed oozing blood from the anastomotic jejunal mucosa. Following a resection of the affected anastomotic segment of the jejunum, a side to side longitudinal pancreaticojejunostomy was again performed on this patient. The resected jejunum showed pathologically pseudopolyp-like edema, congestion, and an ulceration of the stomal mucosa. The patient showed a good postoperative course and has been doing well for the past 8 yr since reoperation.

Colon Cancer in Pregnancy: Report of a Case and Review of the Literature

A 37-year-old pregnant Japanese woman presented with right upper quadrant pain and pitting edema of the lower extremity. She had become pregnant via intrauterine insemination after a long history of i

Flat-Elevated (de novo) Carcinoma of the Sigmoid Colon with a Pedunculated Muscularis propria Mimicking a Polypoid Carcinoma

A small flat-elevated carcinoma with a pedunculated muscularis propria mimicking an early polypoid carcinoma in a 67-year-old woman is reported. The patient was referred with a diagnosis of polypoid carcinoma of the sigmoid colon. Barium enema revealed an angular polypoid tumor, and endoscopy showed a sessile, plateau-like tumor with a central depression. Endoscopic ultrasonography showed a semilunar tumor with penetration into the muscularis propria, which showed a tent-like elevation. In July 1994, sigmoidectomy with lymph node dissection was performed. Macroscopically, the tumor was 2 cm in size and plateau-like with a depression. Microscopically, the tumor exhibited a plateau-like lesion with an ulcerative change on the surface. The section through the mid-portion of the tumor showed a stalk-like elevation of the inner circular muscle layer with carcinoma infiltration. The lymph nodes were involved by carcinoma. The tumor was a well-differentiated adenocarcinoma with invasion of the muscularis propria and positive regional lymph node metastasis (stage IIIb). The postoperative course was uneventful, and the patient is free of recurrence one year after surgery. This pedunculated stalklike formation of the muscle layer with invasive foci may be produced by peristalsis similar to that of the stalk of polyps.