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Hokama A, Kobashigawa C, Fujita J. Inflammatory myoglandular polyps of the rectum. Hong Kong Med J 2015; 21:84.e3-4. [PMID: 25686710 DOI: 10.12809/hkmj134189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Akira Hokama
- Department of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan (Currently at Department of Endoscopy, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan)
| | - Chiharu Kobashigawa
- Department of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan (Currently at Department of Endoscopy, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan)
| | - Jiro Fujita
- Department of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan
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Nahar S, Nakamoto M, Hokama A, Kobashigawa C, Kaida M, Kinjo T, Hirata T, Kinjo N, Saio M, Yoshimi N, Ohtsuki Y, Fujita J. Peritoneal Malignant Mesothelioma with Epithelioid Type, Demonstrating High Serum and Ascitic KL-6 Levels: Immunohistochemical Analyses. Rare Tumors 2015; 7:5947. [PMID: 26500734 PMCID: PMC4600996 DOI: 10.4081/rt.2015.5947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 06/14/2015] [Indexed: 11/22/2022] Open
Abstract
We report a case of KL-6 producing peritoneal malignant mesothelioma. A 56-year-old woman was referred to our hospital on November 2005 with severe abdominal distention. Peritoneal malignant mesothelioma with epithelioid type was diagnosed by clinical symptoms, laboratory investigations, imaging studies, and immunohistochemical examination of known tumor markers. In addition, high serum and ascitic KL-6 levels were observed and the immunostaining of the tumor for KL-6 was evident. We thus consider KL-6 to be a potential novel marker for peritoneal malignant mesothelioma with epithelioid type.
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Affiliation(s)
- Saifun Nahar
- Department of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus , Nishihnara, Japan
| | - Manabu Nakamoto
- Department of Endoscopy, University of the Ryukyus , Nishihnara, Japan
| | - Akira Hokama
- Department of Endoscopy, University of the Ryukyus , Nishihnara, Japan
| | | | - Masatoshi Kaida
- Department of Endoscopy, University of the Ryukyus , Nishihnara, Japan
| | - Tetsu Kinjo
- Department of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus , Nishihnara, Japan
| | - Tetsuo Hirata
- Department of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus , Nishihnara, Japan
| | - Nagisa Kinjo
- Department of Endoscopy, University of the Ryukyus , Nishihnara, Japan
| | - Masanao Saio
- Department of Pathology and Oncology, University of the Ryukyus , Nishihnara, Japan
| | - Naoki Yoshimi
- Department of Pathology and Oncology, University of the Ryukyus , Nishihnara, Japan
| | - Yuji Ohtsuki
- Division of Pathology, Matsuyama-shimin Hospital , Japan
| | - Jiro Fujita
- Department of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus , Nishihnara, Japan
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Hokama A, Uechi K, Takeshima E, Kobashigawa C, Iraha A, Kinjo T, Kishimoto K, Kinjo F, Fujita J. A fish bone perforation of the esophagus. Endoscopy 2014; 46 Suppl 1 UCTN:E216-7. [PMID: 24806364 DOI: 10.1055/s-0034-1364952] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Akira Hokama
- Department of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kayoko Uechi
- Department of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus, Okinawa, Japan
| | - Eriko Takeshima
- Department of Endoscopy, University of the Ryukyus, Okinawa, Japan
| | - Chiharu Kobashigawa
- Department of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus, Okinawa, Japan
| | - Atsushi Iraha
- Department of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus, Okinawa, Japan
| | - Tetsu Kinjo
- Department of Endoscopy, University of the Ryukyus, Okinawa, Japan
| | - Kazuto Kishimoto
- Department of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus, Okinawa, Japan
| | - Fukunori Kinjo
- Department of Endoscopy, University of the Ryukyus, Okinawa, Japan
| | - Jiro Fujita
- Department of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus, Okinawa, Japan
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Ohira T, Hokama A, Kinjo N, Nakamoto M, Kobashigawa C, Kise Y, Yamashiro S, Kinjo F, Kuniyoshi Y, Fujita J. Detection of active bleeding from gastric antral vascular ectasia by capsule endoscopy. World J Gastrointest Endosc 2013; 5:138-140. [PMID: 23515703 PMCID: PMC3600552 DOI: 10.4253/wjge.v5.i3.138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 10/29/2012] [Accepted: 01/07/2013] [Indexed: 02/05/2023] Open
Abstract
Gastric antral vascular ectasia (GAVE) has been recognized as one of the important causes of occult and obscure gastrointestinal bleeding. The diagnosis is typically made based on the characteristic endoscopic features, including longitudinal row of flat, reddish stripes radiating from the pylorus into the antrum that resemble the stripes on a watermelon. These appearances, however, can easily be misinterpreted as moderate to severe gastritis. Although it is believed that capsule endoscopy (CE) is not helpful for the study of the stomach with its large lumen, GAVE can be more likely to be detected at CE rather than conventional endoscopy. CE can be regarded as “physiologic” endoscopy, without the need for gastric inflation and subsequent compression of the vasculature. The blood flow of the ecstatic vessels may be diminished in an inflated stomach. Therefore, GAVE may be prominent in CE. We herein describe a case of active bleeding from GAVE detected by CE and would like to emphasize a possibility that CE can improve diagnostic yields for GAVE.
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Hokama A, Kishimoto K, Ihama Y, Kobashigawa C, Nakamoto M, Hirata T, Kinjo N, Higa F, Tateyama M, Kinjo F, Iseki K, Kato S, Fujita J. Endoscopic and radiographic features of gastrointestinal involvement in vasculitis. World J Gastrointest Endosc 2012; 4:50-6. [PMID: 22442741 PMCID: PMC3309893 DOI: 10.4253/wjge.v4.i3.50] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 11/04/2011] [Accepted: 03/01/2012] [Indexed: 02/05/2023] Open
Abstract
Vasculitis is an inflammation of vessel walls, followed by alteration of the blood flow and damage to the dependent organ. Vasculitis can cause local or diffuse pathologic changes in the gastrointestinal (GI) tract. The variety of GI lesions includes ulcer, submucosal edema, hemorrhage, paralytic ileus, mesenteric ischemia, bowel obstruction, and life-threatening perforation.The endoscopic and radiographic features of GI involvement in vasculitisare reviewed with the emphasis on small-vessel vasculitis by presenting our typical cases, including Churg-Strauss syndrome, Henoch-Schönlein purpura, systemic lupus erythematosus, and Behçet’s disease. Important endoscopic features are ischemic enterocolitis and ulcer. Characteristic computed tomographic findings include bowel wall thickening with the target sign and engorgement of mesenteric vessels with comb sign. Knowledge of endoscopic and radiographic GI manifestations can help make an early diagnosis and establish treatment strategy.
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Affiliation(s)
- Akira Hokama
- Akira Hokama, Kazuto Kishimoto, Yasushi Ihama, Tetsuo Hirata, Futoshi Higa, Masao Tateyama, Jiro Fujita, Department of Infectious, Respiratory and Digestive Medicine, Faculty of Medicine, University of the Ryukyus, Okinawa 903-0125, Japan
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Hokama A, Kishimoto K, Nakamoto M, Kobashigawa C, Hirata T, Kinjo N, Kinjo F, Kato S, Fujita J. Endoscopic and histopathological features of gastrointestinal amyloidosis. World J Gastrointest Endosc 2011; 3:157-61. [PMID: 21954412 PMCID: PMC3180620 DOI: 10.4253/wjge.v3.i8.157] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 07/18/2011] [Accepted: 08/06/2011] [Indexed: 02/05/2023] Open
Abstract
Amyloidosis is a rare disorder, characterized by the extracellular deposition of an abnormal fibrillar protein, which disrupts tissue structure and function. Amyloidosis can be acquired or hereditary, and systemic or localized to a single organ, such as the gastrointestinal (GI) tract. Clinical manifestations may vary from asymptomatic to fatal forms. Primary amyloidosis (monoclonal immunoglobulin light chains, AL) is the most common form of amyloidosis. AL amyloidosis has been associated with plasma cell dyscrasias, such as, multiple myeloma. Secondary amyloidosis is caused by the deposition of fragments of the circulating acute-phase reactant, serum amyloid A protein (SAA). Common causes of AA amyloidosis are chronic inflammatory disorders. Although GI symptoms are usually nonspecific, histopathological patterns of amyloid deposition are associated with clinical and endoscopic features. Amyloid deposition in the muscularis mucosae, submucosa, and muscularis propria has been dominant in AL amyloidosis, leading to polypoid protrusions and thickening of the valvulae conniventes, whereas granular amyloid deposition mainly in the propria mucosae has been related to AA amyloidosis, resulting in the fine granular appearance, mucosal friability, and erosions. As a result, AL amyloidosis usually presents with constipation, mechanical obstruction, or chronic intestinal pseudo-obstruction while AA amyloidosis presents with diarrhea and malabsorption Amyloidotic GI symptoms are mostly refractory and have a negative impact on quality of life and survival. Diagnosing GI amyloidosis requires high suspicion of evaluating endoscopists. Because of the absence of specific treatments for reducing the abundance of the amyloidogenic precursor protein, we should be aware of certain associations between patterns of amyloid deposition and clinical and endoscopic features.
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Affiliation(s)
- Akira Hokama
- Akira Hokama, Kazuto Kishimoto, Tetsuo Hirata, Jiro Fujita, Department of Infectious, Respiratory, and Digestive Medicine, Faculty of Medicine, University of the Ryukyus, Okinawa 903-0125, Japan
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Hokama A, Yamamoto YI, Taira K, Nakamura M, Kobashigawa C, Nakamoto M, Hirata T, Kinjo N, Kinjo F, Takahashi K, Fujita J. Esophagitis dissecans superficialis and autoimmune bullous dermatoses: A review. World J Gastrointest Endosc 2010; 2:252-6. [PMID: 21160615 PMCID: PMC2999143 DOI: 10.4253/wjge.v2.i7.252] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 06/23/2010] [Accepted: 06/30/2010] [Indexed: 02/05/2023] Open
Abstract
Esophagitis dissecans superficialis (EDS) is a rare and severe endoscopic finding characterized by sloughing of large fragments of esophageal mucosal lining. Although EDS has been reported in association with serious illnesses and certain medications, the pathophysiological association of autoimmune bullous dermatoses with EDS has gained remarkable attention. Among these dermatoses, pemphigus vulgaris and pemphigoid frequently present with various types of esophageal involvement including EDS. We review the pathophysiology and clinical features of this involvement with the presentation of our experiences. The importance of endoscopic evaluation of this entity is discussed.
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Affiliation(s)
- Akira Hokama
- Akira Hokama, Tetsuo Hirata, Jiro Fujita, Department of Infectious, Respiratory and Digestive Medicine, Faculty of Medicine, University of the Ryukyus, Okinawa 903-0125, Japan
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Hokama A, Nakamura M, Kobashigawa C, Chinen H, Kishimoto K, Nakamoto M, Hirata T, Kinjo N, Kinjo F, Samura H, Nishimaki T, Fujita J. Education and imaging. Gastrointestinal: Signs of pneumoperitoneum. J Gastroenterol Hepatol 2009; 24:497. [PMID: 19335789 DOI: 10.1111/j.1440-1746.2009.05835.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- A Hokama
- First Department of Internal Medicine, University of the Ryukyus, Okinawa, Japan
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Yogi T, Hokama A, Kinjo F, Tomiyama R, Koide M, Kishimoto K, Makishi T, Oshiro M, Miyagi S, Kobashigawa C, Takaki R, Nakayama T, Saito A. Whipple's disease: the first Japanese case diagnosed by electron microscopy and polymerase chain reaction. Intern Med 2004; 43:566-70. [PMID: 15335181 DOI: 10.2169/internalmedicine.43.566] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 52-year-old man presented with diarrhea and 20 kg weight loss in one year. Enteroscopy showed diffuse yellow-white shaggy mucosa in the duodenum and jejunum. Biopsies of the duodenal mucosa revealed massive infiltration within the lamina propria by foamy macrophages strongly positive for periodic acid-Schiff stain. Electron microscopy demonstrated numerous bacilli within macrophages of the lamina propria. Tropheryma whipplei DNA was detected by polymerase chain reaction. The definitive diagnosis of Whipple's disease was made. Antibiotic therapy dramatically improved his clinical picture. This is the first Japanese case with Whipple's disease diagnosed by electron microscopy and polymerase chain reaction.
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Affiliation(s)
- Tatsuji Yogi
- First Department of Internal Medicine, University of the Ryukyus, Nishihara, Okinawa
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