Yasuhiko Nishiyama

Case Report: Distinctive Diffuse Duodenitis Associated with Ulcerative Colitis

There are numerous and varied complicat ions in the natural course of ulcerative colitis, and the extracolonic manifestations of this disease have been described in many reviews and case reports (1± 3). Wellknown bowel complications include toxic megacolon (4, 5), colitis cystica profunda (6), backwash ileitis (7, 8), and postcolectomy pouchitis (9, 10). The extension of pathologi cal changes of ulcerative colitis in a retrograde manner through the ileocecal valve into the ileum, responsible for backwash ileitis, only reaches a short distance into the ileum, and the upper small intestine, particularly the duodenum, is not affected (7). We report here a surgical case of diffuse ulcerative duodeniti s accompanying ulcerative colitis without backwash ileitis and discuss its pathogenesis.

Different apoptotic activity and p21WAF1/CIP1, but not p27Kip1, expression in serrated adenomas as compared with traditional adenomas and hyperplastic polyps of the colorectum

PurposeSerrated adenomas (SAs), which include a wide spectrum of lesions, can be broadly divided into two subtypes: type I, closely mimicking hyperplastic polyps (HPs), and type II, unequivocal adenomatous tumor. Our preliminary findings showed clinicopathologic differences between them. The present study was conducted to investigate apoptotic activity and expression of the cell cycle regulator proteins p21WAF1/CIP1 and p27Kip1 in type I and II SAs, as compared with traditional adenomas (TAs) and HPs.MethodsApoptotic activity was estimated in hematoxylin-eosin stained specimens, and p21WAF1/CIP1 or p27Kip1 immunoreactivity was determined in 62 SAs (19 type I and 43 type II), 50 TAs and 19 HPs. The numbers (percentages) of apoptotic or immunoreactive cells were counted per 1,000 epithelial cells in equally separated crypt zones (upper, middle, and lower thirds).ResultsThe apoptotic activity in the middle, but not the upper or lower crypt zone was higher in type II SAs (median 0.2%, interquartile range 0.1–0.5%) than in HPs (0.1%, 0.1–0.2%, P<0.01), whereas it was lower in type I SAs (0.2%, 0.1–0.3%) than in TAs (0.5%, 0.2–0.6%, P<0.001). P21WAF1/CIP1 expression in the lower crypt zone was higher in both type I and type II SAs (19.8%, 7.0–33.2% and 20.4%, 3.9–47.8%, P<0.0001) than in TAs (1.2%, 0.6–5.2%), and a similar tendency was also observed for the middle crypt zone. p27Kip1 expression did not vary among the groups.ConclusionsThe differences in apoptotic activity and p21WAF1/CIP1 expression between SAs and TAs or HPs indicate that SA should be considered as a distinct subtype of colorectal neoplasm. The two subtypes of SA do not differ in these parameters despite specific clinicopathological features.

Comparative Histologic Assessment of Proctocolectomy Specimens from Japanese and American Patients with Ulcerative Colitis with or Without Dysplasia

There have been no reports of histologic differences in ulcerative colitis (UC) between Japanese and American patients. We therefore compared histology in proctocolectomy resection specimens between Japanese patients with UC (19 cases with and 21 without dysplasia) at the Kitasato University East Hospital and American patients with UC (21 cases with and 24 without dysplasia) at the University of Washington Medical Center. In cases of UC with, but not without dysplasia, cryptitis (p = 0.010) and epithelial apoptosis (p < 0.001) in the nondysplastic mucosa were more frequently observed in Japanese than in American cases, whereas lamina propria fibrosis was more prominent in American counterparts (p = 0.008). In patients with UC with dysplasia, the duration of disease was significantly longer in American than in Japanese patients (median, 17 vs 14 years, respectively; p = 0.038). This might, in part, explain the histologic variation. Another possibility for the differences is that the preoperative medications may have differed in the populations.

A case of common bile duct adenoma diagnosed by exfoliative cytology of bile juice.

術前に, 胆汁の細胞診で, 総胆管に発生した管状腺腫と診断された73歳, 女性の1例を経験したので報告する.術後5年の経過をとっているが, 良好である.本腫瘍の細胞学的および病理組織学的な所見を報告したい.腺腫の腫瘍細胞は大型で, 核・細胞質比が増大し, 核クロマチンは増量しているが細胞異型は少ない.大型腫瘍細胞で, ほぼ均一の大きさを呈する異型細胞所見は胆汁中の腺腫細胞の細胞診断に重要な所見である.