Teruhiko Sakamoto

A Case of Benign Schwannoma of the Transverse Colon with Granulation Tissue

Schwannomas occurring in the gastrointestinal tract are rare, and among them, schwannomas of the large intestine are extremely rare. In this paper, we report a case of a macroscopically atypical schwannoma of the transverse colon. The case is a female aged 67. Stool occult blood test was positive, and colonoscopy revealed a protruded lesion resembling a type 1 carcinoma measuring 4 cm with a reddish and uneven surface on the transverse colon. The surface was smooth and lobulated in observation with indigo carmine spray, and granulation tissue was revealed by biopsies. CT of the abdomen showed an irregular mass, and clinical examinations could not rule out malignancy. Therefore, partial transverse colectomy with peripheral lymph node dissection was performed. Histologically, proliferation of spindle cells was observed originating from the muscularis propria, and most of the upper part of the lesion was replaced by granulation tissue. In immunohistochemical staining, S-100 protein and NSE were positive while KIT, CD34, desmin and smooth muscle actin were negative, and the tumor was therefore diagnosed to be a schwannoma. In addition, since the MIB-1 labeling index was low and virtually no mitosis was observed, it was diagnosed as benign tumor.

Activation of mucosal phospholipase D in a rat model of colitis

Abstract Background and Aims: Phospholipase D (PLD) hydrolyzes phosphatidylcholine and produces lipid second messengers. Although cellular PLD has recently been recognized as an important signal‐transmitting enzyme, the role of PLD in pathophysiologic conditions is largely unknown. In particular, the regulation of PLD in intestinal inflammation has not been previously investigated. The aim of the present study was to elucidate the role of PLD in experimental colitis.

Beta-adrenoreceptor agonists for diffuse esophageal spasm

esophageal body for 20min after administration (Fig. 1) and concomitantly improved the dysphagia and chest pain. Because salbutamol sulfate has fewer adverse reactions, as well as a longer effect than trimetoquinol hydrochloride, and because oral administration was the most suitable application, we applied the oral administration of salbutamol to clinical use for diffuse esophageal spasm. Salbutamol sulfate (4mg in 4ml of tap water) given orally quickly resolved the patient’s complaints and permitted her to eat without difficulty, even during an attack. No adverse effect was observed. Agents used for the medical treatment of diffuse esophageal spasm include anticholinergics,1 nitrates,2 and calcium antagonists3 that are reported to relax contracting esophageal smooth muscles. Patients refractory to these medications require more hazardous therapy, including pneumatic dilatation and surgical myotomy, so an alternative medical agent has been sought. To our best knowledge, in regard to beta-adrenoreceptor agonists,4 there has been no report of their use in diffuse esophageal spasm. Although it has been reported that the stimulation of both beta-1 and beta-2 receptors significantly decreases esophageal motility,5 and stimulation of beta-3 receptors mediates the relaxation of esophageal smooth muscle,6,7 the prominent subtype involved in this relaxant effect in diffuse esophageal spasm remains to be determined. The clinical and manometric responses of our patient to betaadrenoreceptor agonists suggest that these agents may become a novel choice in the treatment of patients with diffuse esophageal spasm who show an unremarkable response to conventional medical therapies.

Endoscopic Diagnosis and Treatment for Colorectal Cancer

Colonoscopy plays an important role in the medical care of patients with colorectal cancer. It is generally used for both the diagnosis of different stages of colorectal cancer and the treatment of early colorectal cancer and its precursors. The recent progress in colonoscopy has been remarkable. Endoscopes with variable rigidity and small diameters provide efficient insertion to the cecum and result in lower distress for patients. Trained colonoscopists can insert endoscopes into the cecum within a few minutes, and it is not necessary to anesthetize patients without severe peritoneal adhesion. We can obtain good-quality pictures and special images to assist in diagnosis by using highvision endoscopes, magnifying endoscopes, dye spray, and narrow-band imaging (NBI). Determining whether a colorectal carcinoma can be curatively resected by endoscopic treatment or whether the carcinoma has a risk of lymph node metastasis is a very delicate and important task. In particular, the depth of cancer invasion is related to lymph node metastasis; therefore, endoscopic ultrasonography and the classification of pit patterns, capillary patterns via NBI, and the lesion-lifted condition are used to diagnose the depth of cancer invasion (Kato, 2001, Sano, 2008). Treatment for colorectal neoplastic lesions begins with hot biopsy and snare polypectomy, and recently, endoscopic submucosal resection (EMR), piecemeal EMR (EPMR), and endoscopic submucosal dissection (ESD) have become available for large and flat lesions of the colon and rectum. Early colorectal carcinoma is defined as a carcinoma within the submucosal layer that is not invading the muscularis propria. Carcinoma in situ (mucosal carcinoma) and carcinoma that slightly invades the submucosa and without risk factors for metastasis do not metastasize into lymph nodes or distant organs. Nonmetastatic carcinoma is cured by local resection with colonoscope. It is important to make an accurate diagnosis by endoscopy and to perform confident resection for pathological evaluation. In this chapter, we describe endoscopic diagnosis for colorectal carcinoma and differential diagnosis, and treatment options for early colorectal cancer without metastasis and for adenoma which is regarded as a precancerous condition. In addition, we briefly discuss risk factors for lymph node metastasis in early colorectal carcinoma.