Yojiro Sadamoto

Preoperative diagnosis and staging of gallbladder carcinoma by EUS

BACKGROUND EUS has recently been shown to be efficacious for the preoperative assessment of depth of invasion of gallbladder carcinoma. This study assessed the value of EUS for determining T stage (International Union Against Cancer). METHODS Preoperative EUS findings in 41 patients with gallbladder carcinoma were analyzed retrospectively. EUS images were classified according to the shape of the tumor and the adjacent gallbladder wall structure as follows: type A, pedunculated mass with preserved adjacent wall structures; type B, sessile and/or broad-based mass with a preserved outer hyperechoic layer of the gallbladder wall; type C, sessile and/or broad-based mass with a narrowed outer hyperechoic layer; type D, sessile and/or broad-based mass with a disrupted outer hyperechoic layer. EUS and histopathologic findings were compared, including the depth of invasion of the tumor in the resection specimen. RESULTS The 4 categories of EUS images of gallbladder carcinoma correlated with the histologic depth of invasion and T stage. Accuracies for the EUS classification as type A corresponding to pTis, type B to pT1, type C to pT2, and type D to pT3-4 were, respectively, 100%, 75.6%, 85.3%, and 92.7%. CONCLUSIONS Preoperative EUS imaging accurately depicts T stage of gallbladder carcinoma and allows for effective therapeutic decision making.

Pneumocystis pneumonia during combined therapy of infliximab, corticosteroid, and azathioprine in a patient with Crohn's disease

Pneumocystis pneumonia (PCP) is one of the most frequent and severe opportunistic infections in immunocompromised patients. In recognition of its genetic and functional distinctiveness, the organism that causes human PCP has now been designated Pneumocystis jiroveci [1]. The number of patients who are receiving chronic immunosuppressive medication or have an altered immune system and are thus at risk of PCP is increasing rapidly [2]. A recent report indicated that inflammatory disorders represent nearly 20% of the underlying diseases associated with PCP in HIV-negative patients [3]. Furthermore, patients

Steroid-induced osteonecrosis in refractory ulcerative colitis.

We report a case of steroid-induced osteonecrosis in a patient with refractory ulcerative colitis. A 31 year-old woman presented suffering from refractory ulcerative colitis. She had been treated by prednisolone for ten years. Sharp pain and swelling appeared suddenly in her right knee. Conventional radiography revealed neither osteoporosis nor a fracture. However, magnetic resonance imaging by T1-, T2 and T2*-weighted images revealed irregular heterogeneous areas of low- and high-intensity in her right femur and tibia. For a precise early diagnosis of osteonecrosis, bone magnetic resonance imaging was found to be an excellent diagnostic tool.

Pedunculated gastric carcinoma demonstrating a gastric foveolar phenotype

We report a case of gastric cancer complicated with very well differentiated adenocarcinoma containing signet ring cells. An endoscopic examination revealed a pedunculated polyp in the fornix of the stomach. A surgical operation was performed and the pathological findings showed very well differentiated adenocarcinoma mimicking gastric foveolae with a poorly differentiated component containing signet ring cells. This is the first case of pedunculated gastric cancer complicated with very well differentiated adenocarcinoma containing signet ring cells and also demonstrating a gastric foveolar phenotype.