Toshimi Umeno

COLONIC CANCER IN A PATIENT WITH PRIMARY SCLEROSING CHOLANGITIS AND LONG-STANDING ULCERATIVE COLITIS

A 27-year-old woman with a 9-year history of ulcerative colitis involving the entire colon was admitted to our hospital in August 1992 because of bloody stools and left lower abdominal pain. She had been treated with sulfasalazine since 1983 and the colitis had been clinically quiescent or mild for 7 years. She had also been diagnosed as having primary sclerosing cholangitis (PSC) 4 years prior to this admission, based on the clinical, laboratory, and cholangiographic findings. A barium enema and colonoscopy showed an irregular mass obstructing the bowel lumen in the distal portion of the descending colon. Biopsy specimens taken from the mass revealed moderately differentiated adenocarcinoma, and a subtotal colectomy was performed. Histologic examination of the mass lesion showed moderately differentiated adenocarcinoma invading the pericolic adipose tissue. She is currently alive 3 years after surgery. PSC has recently been reported as a risk factor for colonic neoplasia in patients with longstanding ulcerative colitis. In Japan, however, colorectal cancer associated with PSC and ulcerative colitis has rarely been reported. The present case suggests that the risk of colonic cancer is higher in patients with ulcerative colitis and PSC than in patients with ulcerative colitis alone.

Carcinoma of the gall-bladder associated with primary sclerosing cholangitis and ulcerative colitis

A 64‐year‐old Japanese male was admitted to Fukuoka University Hospital to undergo further examination for an elevated γ‐glutamyltransferase (γ‐GTP) level. Endoscopic retrograde cholangiography (ERC) showed dilatation of the intrahepatic bile duct and stenosis of the proximal portion of the common bile duct. No abnormality was found in the gall‐bladder. Since the fecal occult blood test was positive, sigmoidoscopy and a barium enema were performed. Sigmoidoscopy showed a hyperemic and hemorrhagic mucosa in the rectum, but a barium enema study did not show any abnormal findings in the entire colon. We diagnosed the patient to have primary sclerosing cholangitis (PSC) and ulcerative proctitis based on these radiological and endoscopic findings. Bloody stool and fever occurred 4 months after the first admission. The patient’s colitis extended to the entire colon. Because of the failure of corticosteroid therapy, a subtotal colectomy was performed. Given that a mass was intraoperatively palpable in the gall‐bladder, a cholecystectomy was simultaneously performed. In the whole resected colon, diffuse ulcerations and mucosal islands were found. Grossly, a flat polypoid lesion, measuring 2 cm in diameter, was found in the fundus of the resected gall‐bladder. Sections of this lesion in the gall‐bladder revealed cystic atypical glands and some atypical cell clusters invading the subserosa. The present case suggests that careful observations are needed for patients with ulcerative colitis who have an elevated γ‐GTP level even if the colitis is limited to the distal colon and the serum alkaline phosphatase level is normal.

Study of Lymphatic Flow in the Remnant Stomach by Endoscopical Injection of Activated Carbon Particles(CH40).

残胃の癌症例に微粒子活性炭CH40を術前経内視鏡的に残胃小轡に流入し, リンパ節の黒染の有無により残胃のリンパ流を検討した. 対象は14例で, 初回手術は良性疾患6例 (B-1法3例, B-2法3例). 悪性疾患8例 (B-1法5例, B-2法3例) であった. 初回良性例ではNo.1, 3, 7のリンパ節が黒染され左胃動脈経路が主体であったが, No.10, 11などの脾動脈経路のリンパ節も黒染されていた. 初回悪性例のR2郭清後では左胃動脈経路はみられず, 脾動脈経路, 左下横隔動脈経路が主体であったが, B-1法ではNo.12, 13への新生リンパ路がみられた. R3郭清後では既成リンパ路の遮断により, B-1法でNo.16のみ, B-2法では空腸間膜リンパ節のみの黒染例がみられ, いずれも新生リンパ路であった. 初回悪性例では残胃副リンパ路のリンパ流の増加および新生リンパ路がみられたが, R2とR3の郭清後では異なったリンパ流がみられた.

DUPLICATION OF THE STOMACH: A CASE REPORT AND A REVIEW OF LITERATURE

われわれは26歳男性で胃潰瘍にて胃部分切除を行い, 術後の標本検索にて胃と交通を有し管状の形態を示す副胃の合併例を経験したので報告した.副胃は胃前庭部前壁側から小弯側にかけて小鶏卵大程の大きさでみられたが, 管腔の粘膜は近位2/3は幽門部粘膜に被われ, 遠位1/3は十二指腸粘膜に被われている非常に稀有な症例であった.われわれの集計しえた本邦の副胃報告例は26例で文献的考察をおこなったが, 10歳以下の症例が11例を占めていた.好発部位は前庭部大弯側で, 形態的には嚢状のものが大多数であった.各臓器と交通を有するものは4例でそのうち3例は管状例であった.