Takehiro Shimamoto

Ultrasonographic evaluation of the bowel wall in inflammatory bowel disease: Comparison of in vivo and in vitro studies

To assist in the evaluation of inflammatory changes of the affected bowel, we classified the transabdominal ultrasonographic findings into types A-C. We compared the in vivo and in vitro sonographic images to the histopathologic findings of resected specimens. A total of 22 bowel specimens (five normal, 12 with Crohns disease, five with ulcerative colitis) were examined sonographically with a 3.75-MHz curved and a 7.5-MHz linear array scanner; histologic examination of the same area of tissue was performed afterwards. These three examinations corresponded well to each other. Our classification scheme is useful in quantifying the severity of inflammatory changes in the affected bowel.

Usefulness of Nucleolar Organizer Region Staining in Gastric Myogenic Tumors: Correlation with Ploidy by DNA Flow Cytometry

A silver-staining technique to identify nucleolar organizer region-associated proteins (Ag-NOR) was applied to 55 gastric myogenic tumors. The mean numbers of Ag-NOR in the nucleus were: leiomyoma (30 cases), 2.0 +/- 0.6 (mean +/- SD); low-grade leiomyosarcoma (11 cases), 3.0 +/- 0.7; and high-grade leiomyosarcoma (14 cases), 3.9 +/- 0.7. The Ag-NOR counts were compared with DNA ploidy as determined by flow cytometry in 46 tumors. The Ag-NOR counts were significantly different in the aneuploid leiomyosarcomas (4.1 +/- 0.6: mean +/- SD) and diploid leiomyosarcomas (2.9 +/- 0.6: mean +/- SD). Thus, this parameter may serve as an objective histological discriminant for malignancy.

Gastric emptying and bezoars in Japanese : report of five cases

Bezoars are conglomerates of undigested material in the stomach. Previous reports have shown that a decrease in secretion of pepsin and gastric acid and a delay in gastric emptying might contribute to their formation. To clarify the pathogenesis of the formation of gastric bezoars, we studied gastric emptying in five patients who presented with a bezoar. In addition, gastric acid secretion was studied in three of the cases. Gastric emptying was not delayed in any case, and there was no trend toward a decrease in gastric acid secretion.The five patients were successfully treated by the endoscopic fragmentation and enzymatic dissolution of the benzoars. We conclude that, in Japanese, factors other than a delay in gastric emptying are the main contributors to bezoar formation.

Heterotopic pancreas diagnosed by endoscopic ultrasonography and endoscopic injection of ethanol to make a histologic diagnosis

A gastric submucosal tumor in a 56-year-old man was presumed to be heterotopic pancreas on the basis of endoscopy and endoscopic ultrasonography. To obtain a histologic diagnosis we injected ethanol at the tumor site to create an artificial ulcer. This facilitated the removal of endoscopic biopsy specimens from the submucosal layer so that histologic examination could confirm the presence of heterotopic pancreatic tissue.

Solitary pedunculated polypoid gastric gland heterotopia

SummaryA solitary pedunculated gastric polyp in the gastric fundus was removed from an asymptomatic 36-year-old woman with normal gastric acid secretion and a normal serum gastrin level. This lesion exhibited distinctive histological features including prominent proliferation of pseudopyloric glands, fundic glands, foveolar epithelium and a fibromuscular stroma. Moreover, its surface was entirely covered by a layer of normal gastric epithelium. Biopsies of the background mucosa taken from the gastric fundus revealed only mild superficial gastritis. A gastric gland heterotopia was diagnosed because of its unique morphology.

Unusual Manifestation of Malignant Lymphoma of the Esophagus

Primary malignant lymphoma of the esophagus is very rare. We encountered three cases of esophageal malignant lymphoma, showing unusual manifestations radiologically and endoscopically. In all cases, the upper gastrointestinal series showed smooth swelling of folds resembling varices. Esophagoscopy showed smooth and soft longitudinal protruding lesions. A computed tomographic scan showed marked thickening of the esophageal wall. These cases were diagnosed by endoscopic giant forceps biopsy specimens as small-cell, diffuse type malignant lymphoma. We report the unusual manifestation of malignant lymphoma characterized by marked thickening of the esophageal wall.

Strip Biopsy for the Diagnosis and Treatment of Superficial Esophageal Carcinoma and Esophageal Dysplasia

In order to establish a precise pathological diagnosis and to decide the correct approach for esophageal dysplasia or early esophageal cancer, it is desirable to obtain a full thickness mucosal and submucosal biopsy. Strip biopsy has proven to be effective for the treatment and for the diagnosis of flat or sessile lesions of the gastrointestinal tract [1–3]. In this study, we evaluate the efficacy of strip biopsy for the diagnosis and treatment of polypoid or flat lesions of the esophagus.

Natural History of Esophageal Squamous Cell Carcinoma, with Special Reference to Evaluation of Clinical Growth Rate by Tumor Volume Doubling Time

Esophageal carcinoma is a common malignancy with a poor prognosis, despite recent advances in treatment. We previously reported ten patients with rapidly growing squamous cell carcinomas of the esophagus, and showed that the rapid growth of this tumor explains both why it is seldom detected at an early stage and why prognosis is poor [1]. However, reports at variance with our findings have been published [2–4]. In particular, the selection of patients in our previous study may have presented a problem, particularly since the number was small. Moreover, to determine if tumor growth is actually rapid, it is necessary to evaluate tumor growth objectively by comparison with malignancies of other organs.