Norihiro Hanabata

Microvessel morphology and vascular endothelial growth factor expression in human colonic carcinoma with or without metastasis.

We quantified microvessel morphology and vascular endothelial growth factor (VEGF) expression in human colonic carcinoma with or without metastasis. The cancerous growth and the noncancerous section of surgical specimens from 36 patients with colorectal carcinoma (14 without metastasis and 22 with metastasis) were studied. Tissue slices immunostained with CD34 were processed for microvessel counts (per mm2), the mean diameter of microvessels (μm), and the mean spatial direction of microvessels (degree), defined by the angle between the longitudinal axis of microvessels and the direction perpendicular to the surface of the mucosa. Tissue slices immunostained with anti-VEGF antibody were processed for total epithelial cell counts (per mm2), VEGF-positive cell counts (per mm2), and VEGF-positive ratio (%). Carcinoma without metastasis had significantly larger microvessel counts (213 ± 77, p < 0.01), larger microvessel diameter (7.99 ± 1.77, p < 0.05), and larger spatial direction (47.2 ± 8.3, p < 0.01) than normal tissue (144 ± 49 for microvessel counts; 7.03 ± 0.90 for microvessel diameter; 39.5 ± 6.6 for spatial direction). Compared with carcinoma without metastasis, carcinoma with metastasis had a significantly larger microvessel diameter (9.75 ± 2.65, p < 0.03) and lower microvessel counts (180 ± 92, p = 0.51). Carcinoma without metastasis had a significantly larger VEGF-positive cell count (1276 ± 805, p < 0.05) and larger VEGF-positive ratio (53.6 ± 39.3, p < 0.05) than normal tissue (571 ± 553 for VEGF-positive cell counts; 24.6 ± 23.2 for VEGF-positive ratio). Carcinoma with metastasis had a significantly lower total cell count (1443 ± 237, p < 0.001) and lower VEGF-positive cell count (716 ± 463, p < 0.05) than carcinoma without metastasis. With tumor progression, microvessel diameter significantly increased and microvessel counts decreased, which can be in part explained by VEGF expression. The microvessel diameter seems to be the dominant parameter responsible for cancer cell intravasation as the first step of metastasis.

MORPHOMETRY FOR MICROVESSELS IN EARLY GASTRIC CANCER BY NARROW BAND IMAGING-EQUIPPED MAGNIFYING ENDOSCOPY

Background and Aim:  Microvascular architecture is a variable characterizing early gastric cancer (EGC) against the background. The aims of the present study were to measure morphological variables of the microvessels and to compare the variables between EGC and the background.

Vascular endothelial growth factor expression and microvessel parameters of colonic mucosa correlate with sensitivity to steroid in patients with ulcerative colitis

Objective Vascular endothelial growth factor (VEGF) expression and microvessel parameters have not yet been quantified in the colonic mucosa of ulcerative colitis (UC). The aim of this study was to correlate the parameters with clinical responsiveness to steroid therapy. Material and methods Colorectal biopsy specimens from 39 UC patients with high sensitivity to steroid (H-UC), 9 UC patients with low sensitivity to steroid (L-UC) and 6 normal controls (NC) were examined. Methods Tissue sections were immunostained with anti-VEGF antibody for number of inflammatory cells (/mm2), VEGF-positive cell (/mm2) and VEGF-positive ratio (%), and with CD34 for microvessel counts (/mm2) and the mean microvessel diameter (μm). Results The H-UC group had a significantly larger total cell count (10,048±2751, p<0.0001) or VEGF-positive cells (2363±707, p<0.0001) than the NC group (7235±2088 or 1537±297, respectively) with no difference in VEGF-positive ratio (24.3±6.9 for H-UC versus 22.7±6.9 for NC). The L-UC group had a significantly lower VEGF-positive cell count (1420±701, p<0.0005) or VEGF-positive ratio (11.6±5.5, p<0.0005) than the H-UC group, whereas microvessel counts were almost constant regardless of the subject groups (345±7 0 for NC versus 346±99 for H-UC versus 349±114 for L-UC). Significant increases in microvessel diameter were seen when comparing NC (6.68±0.60) with H-UC (7.83±1.09, p<0.0001) and H-UC with L-UC (9.05±1.70, p<0.03). Out of the five parameters, VEGF-positive ratio and microvessel diameter had a predictive value for L-UC with an 88.9% sensitivity and 88.9% specificity. Conclusions L-UC was characterized either as VEGF underexpression or enlarged microvessel. The disruption of the healing process or disturbance of microcirculation may be involved in low sensitivity to steroid therapy in UC.

Influence of endoscopic submucosal dissection on serum levels of pepsinogens in patients with early gastric cancer

Background:  The serum levels of pepsinogens (PG) have been considered to be a useful marker for assessing the risk of metachronous gastric cancer in patients who undergo endoscopic submucosal dissection. However, the influence of endoscopic submucosal dissection (ESD) on serum levels of PG has not yet been examined. The aim of this study was to examine whether the level of PG after ESD can be used to predict the risk of metachronous cancer.

Successful adalimumab treatment and usefulness of capsule endoscopy for gut inflammation concomitant with ankylosing spondylitis

Abstract Here we describe a 20-year-old man with ankylosing spondylitis and gut inflammation, who was successfully treated with adalimumab. Capsule endoscopy and ileocolonoscopy showed multiple erosions and aphthoid ulcers in the ileum and the ileocecal valve. Immunohistochemical analysis of the terminal ileum demonstrated that the number of IL-23p19 expressing macrophages was increased. Adalimumab was administered, and his back pain and abdominal symptoms improved. Adalimumab might be an effective treatment for gut inflammation related to ankylosing spondylitis.

Capsule Endoscopy for Differentiating Early Crohn's Disease from Behçet'sDisease

Objective: Crohns disease (CD) and Behcets disease (BD) are two major causes of inflammatory lesions in the small bowel. For detecting such lesions, the most sensitive exam is small-bowel capsule endoscopy (CE), an imaging modality suitable for evaluating lesions of the small intestine, with a relatively low rate of capsule retention. However, few reports have employed CE to compare the small-bowel inflammation in early CD with that in early BD. Thus, the aim of our study was to obtain a systematic characterization of small-bowel lesions in early CD and BD by using CE. Methods: This retrospective single-center study included 22 patients with early CD and 16 patients with early BD. The patients underwent small-bowel CE for detection and characterization of small-bowel lesions. After reviewing the CE findings in each patient, we assessed the small-bowel mucosal inflammation using the Lewis score, an inflammatory biomarker (C-reactive protein), and the disease activity index. The CE findings (number, distribution, and shape of lesions), Lewis score, disease activity index, and C-reactive protein levels were compared between the groups of CD and BD patients. Results: Small-bowel lesions were observed in 90.9% of CD patients, and in 68.7% of BD patients. Regarding distribution, CD patients exhibited multiple concentrated ulcers, which were more severe distally, while BD patients mostly exhibited solitary ulcers. Regarding shape, linear and longitudinal ulcers were observed, respectively, in 68.2% and 50% of CD patients; however, no such ulcers were observed in BD patients. C-reactive protein levels and disease activity indices were poorly correlated with Lewis score for both diseases. Capsule retention during CE did not occur in any patient included in this study. Conclusion: CE is a valuable tool to assess the mucosal inflammation of the small bowel in early CD and BD. Greater mucosal inflammation in the distal small bowel, and presence of linear and longitudinal ulcers may be the key findings for the differential diagnosis of small-bowel inflammation between early CD and BD

Computer-Aided Estimation for the Risk of Development of Gastric Cancer by Image Processing

The aim of this study was to establish a computer-aided estimating system for determining the risk of development of gastric cancer, achieved by image processing on an ordinary endoscopic picture. Digital endoscopic pictures of the background gastric mucosa in 26 Helicobacter pylori (H. pylori) positive patients with early intestinal type gastric cancer and age-gender-matched H. pylori positive subjects without cancer were used. The pictures were processed for 15 pictorial parameters. Out of the 15 pictorial parameters, 3 parameters were found to characterize the background gastric mucosa with gastric cancer against that without. Based on the Bayes decision theory, the computer-aided estimating system has been established. Sensitivity, specificity, positive predictive value and negative predictive value of the Bayes classifier were found to be 0.64, 0.64, 0.65 and 0.63, respectively. This method may permit an effective selection of the high risk population of gastric cancer needing follow-up endoscopy.