Takashi Kogure

Superficial esophageal carcinoma. Radiological findings in double-contrast studies.

Most cases of superficial esophageal cancer have been reported in Japan and China. Radiological findings in 11 patients (13 lesions) are described. Superficial spreading cancer is difficult to detect despite widespread mucosal involvement. Double-contrast technique is essential, both to detect lesions and to demonstrate their extent. An irregular, rigid wall, mucosal abnormalities such as barium pooling and coating, and protrusions of various sizes and shapes are diagnostic features.

What are longitudinal vessels? Endoscopic observation and clinical significance of longitudinal vessels in the lower esophagus

We have reviewed articles on the longitudinal vessels observed in the lower esophagus. In our previous study, we observed longitudinal (palisading) vessels through the mucosal epithelium in 884 (98%) of 905 consecutive endoscopic examinations of the lower esophagus, whereas in 20 examinations (2%) they could not be observed because of inflammation. The lengths of the longitudinal vessels were within the range of 2 to 3 cm in 90% of investigations. “Indentation” (notch or narrowing) compatible with the esophageal hiatus was observed in the transitional zone between the tubal esophagus and saccular stomach by both radiographic (as an indentation) and endoscopic (as a narrowing; we used the term indentation in this article) examinations. In cases without hiatal hernia, the indentation coincided with the esophagogastric junction (EGJ). We examined endoscopically the relationships among the locations of the indentation, squamocolumnar junction, and the longitudinal vessels. In no patients did we observe longitudinal vessels through the gastric mucosa beyond the indentation. Therefore, observation of longitudinal vessels through the mucosal epithelium was an indicator that the mucosa was located within the esophagus. However, in 21% of the 884 observations, columnar-lined mucosa was seen continuously from the gastric mucosa proximally beyond the indentation, and longitudinal vessels were observed through this columnar-lined mucosa. Because the longitudinal vessels were peculiar to the esophageal mucosa, we could assume that this columnar-lined mucosa was located within the esophagus and was Barretts mucosa, although very short. Therefore, Barretts mucosa can be precisely diagnosed endoscopically by using the longitudinal vessels as diagnostic markers. The Japan Esophageal Society has authorized the endoscopic definition that the lower ends of the longitudinal vessels mark the limit of the EGJ.

The spreading of radiolabelled fatty suppository bases in the human rectum

The purpose of this study was to develop a radiolabelling method for assessing the spreading of fatty suppository bases (Witepsol H-5, W-35 and S-55), and to apply this technique to the evaluation of suppository disposition in the human rectum. 99mTc was bound chemically to the bases Witepsol H-5 and W-35, and mixed physically with Witepsol S-55. The spreading of each suppository base was monitored by gamma-scintigraphy following rectal administration. The mean radioactivity remaining at the inserted region 4 h after administration was 44.2% of total activity. The mean perpendicular maximum spreading distance from this region was 7.7 cm on the scintigram near to the sigmoid colon. Defecation was suggested to be a factor influencing the spread of suppository bases. However, there was no clear relationship between the type of suppository base used and the extent of its spread within the rectum.

Cinematographic study on the reconstructed esophagus

Therapeutic effects of irradiation on esophageal carcinoma were studied in 48 cases with serial endoscopic and bioptic observations. Histological findings were correlated with preoperative bioptic findings in 21 cases which were subjected to extirpation after irradiation. (I) Endoscopic findings--The appearance of the carcinomatous lesion can be divided into two basic types, superficial (ulcerative or tumorous) and submucosal (flat elevated and/or rigid stenotic). The course and effects of irradiation were different in each type, destructive of the surface and responsive in the former and little superficial change and resistent in the latter. Each lesion being intermingled with both types, observations of dominancy can give presumption of therapeutic effects. (2) Serial bioptic cytology; (3) Histological findings; (A) Therapeutic effects were evaluated in respect of total doses (X IOOOR) in I20 bioptic specimens with the following results: X I(0-2X), X 2(2-4) and granulation and nomal mucosa (4-8X). Histology of extirpated specimens, however, demonstrated less therapeutic effects (XI:9, X2:9, X3:3) in contrast with the bioptic findings. Carcinomatous ceils in the resected specimens remained dominantly in submucosa and muscularis propria, being barely detected in mucosa. In spite of apparent healing by endoscopic and bioptic evaluations, carcinomatous infiltrations should be suspected to remain in deeper layers under these conditions (advanced stage after preoperative irradiation. -Ca 5X). (B) Cellular atypism (CAT) was classified into 3 groups on the basis of charactristics in squamous carcinoma--Size of the cells, differentiations of cytoplasm and of nuclei, intercellular bridges and cancer pearl formation. Classification of structural atypism was mainly based on the layer structure in carcinomatous tissues. CAT of pre-irradiated bioptic tissues revealed the following ra te I : I I : I I I I :3 : I . Results of comparative studies in CAT of pre-irradiated bioptic tissues (CAT) and post-irradiated extirpated specimens (RCAT) were the following--CAT (RCAT) : I(I) II(II , I, 0), I II (III, II). These results were caused by disapperance of highly atypical cells and eosionphilic tendency in cytoplasm after irradiation and/or failure in bioptic diagnosis. In no case RCAT was more atypical than CAT. The relation between CAT of preirradiated biopsy and therapeutic effects of post-irradiated tissues was as follows--CAT I (X2.X3) and CAT II, I I I (XI--X3). Further observations were required in the respect of therapeutic effects.

Multicentric origin in squamous cell carcinoma of the esophagus

Multiple cancerous lesion is not infrequently noticed in the specimen of squamous cell carcinoma of the esophagus. However, the relationship between multicentric origin or separate nodule and intraepithelial carcinoma has not been completely discussed. One hundred and forty cases ofsquamous cell carcinoma of the esophagus have been examined. Intraepitherial carcinoma associated with carcinoma of the esophagus was noted in 31 cases (22.1%). Ten were continuous to the main tumor and 21 were interrupted from the main tumor. Among those 21, 10 were interrupted at the point close to the main tumor, 7 were wide and partly interrupted and 4 were distant from the main tumor. It is concluded that concomitant intraepithelial carcinoma which is very distant or interrupted from the main tumor, separate nodule with concomitant intraepithelial carcinoma or pseudosarcoma may be probable assumption of multiple primary independent cancer focuses. It shoudl be well recognized that other types of intramural cancerous lesion such as infiltration or embolic metastases from the main tumor are quite different from multiple primary independent cancer focuses which are closely related to the intraepithelial carcinoma concomitant with carcinoma of the esophagus.