Takayoshi Yamada

A case of early-stage gastric plasmacytoma.

Extramedullary plasmacytomas are rare, and mostly occur in the upper respiratory tract.1 Those in the gastrointestinal tract2 and stomach constitute approximately 10% and 5%, respectively, of all extramedullary plasmacytomas.2 In particular, cases of early-stage gastric plasmacytoma in which neoplastic cells are confined to the mucosa or submucosa have been extremely rare.3 We report here a case of an early stage, superficially spreading type of gastric plasmacytoma in which the endoscopic features changed after a few months’ interval. Helicobacter pylori were found histopathologically in biopsy specimens. As the mucosal lesion was markedly improved endoscopically, but histologically unchanged after H. pylori eradication, a subtotal gastrectomy was performed. The eradication of H. pylori may improve the endoscopic findings but not affect the histological findings of atypical plasma cell infiltration in gastric plasmacytoma. A 77-year-old man was referred to the medical clinic with nausea that had begun 2 months earlier. In an upper endoscopic study performed on July 7, 1999, irregular reddish mucosa with a shallow ulcer was detected in the anterior wall of the antrum (Fig. 1A). In biopsy specimens, plasmacytoma was suspected. The patient was then referred to our hospital for further evaluation of the gastric lesion, on August 5, 1999. Physical examination on admission showed no remarkable findings. Neither an abdominal mass nor peripheral lymph nodule swelling was noted. Urinalysis, blood analysis, proteinogram, and blood chemistry showed no unusual findings. Bence Jones’ protein was also not detectable in a concentrated urine sample. M protein was not detected. Serum immunoglobulin values were within normal limits. Letter to the editor

A CASE OF PYOGENIC GRANULOMA IN THE SIGMOID COLON TREATED WITH ARGON PLASMA COAGULATION

Pyogenic granuloma (PG) with hemorrhagic tendency, is often recognized in the oral mucosa and skin, but rare in the gastrointestinal tract. Only 20 cases have been reported in the gastric mucosa. There have been no reports of gastrointestinal PG treated by argon plasma coagulation (APC). We report here the first case of PG in the sigmoid colon treated by APC. The patient was a 64‐year‐old woman complaining of constipation who was referred to a university hospital of Kochi Medical School. She presented with easily bleeding mucosa, as revealed by a total colonoscopic study in the sigmoid colon. Magnifying colonoscopic examination showed two sessile small polyps in the sigmoid colon. Pathological examination of the biopsy specimens revealed pyogenic granuloma. We treated this lesion by endoscopic APC. No recurrence has been found as of 9 months after APC therapy.

Small cell carcinoma of the esophagus with metastasis to the brain: a case report

Small cell carcinoma of the esophagus is a rare disease with early systemic metastasis, and the prognosis remains poor. This present case (a 60-year-old Japanese man) was a small cell carcinoma at the lower third of the esophagus complicated by multiple liver and brain metastases. After the first chemotherapy, endoscopic study showed significant shrinkage of the primary esophageal tumor. About 4 months later, however, a primary tumor formed a deep ulceration, and a CT scan of the abdomen also showed further progression of the liver metastases. One year after starting the therapy, a disturbance in the patient’s right eyesight and awkward movement of his right hand occurred. Brain magnetic resonance imaging revealed several high-density areas compatible with metastasis. Gamma knife radiosurgery for metastatic brain tumors was carried out, and all tumors had shrunk. Unfortunately, the patient’s liver function deteriorated gradually because of the aggravation of liver metastases, and the patient died 1 year and 5 months from the time of diagnosis.