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Esaki M, Matsumoto T, Hizawa K, Aoyagi K, Mibu R, Iida M, Fujishima M. Intraoperative enteroscopy detects more lesions but is not predictive of postoperative recurrence in Crohn’s disease. Surg Endosc 2014; 15:455-9. [PMID: 11353960 DOI: 10.1007/s004640000174] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/1999] [Accepted: 12/16/1999] [Indexed: 01/01/2023]
Abstract
BACKGROUND The aim of this investigation was to elucidate the clinical value of intraoperative enteroscopy (IOE) for Crohn's disease, and to determine the value of IOE in predicting recurrent disease. METHODS In this study 27 patients requiring surgery were examined by both preoperative radiography and IOE. The findings obtained by these procedures in the remnant small intestine were compared. In 19 patients, the clinical course and colonoscopic or radiographic findings after surgery were analyzed. RESULTS Intestinal lesions were identified in 23 patients by IOE, and in 19 patients by radiography. Longitudinal ulcers were equivalently detected by IOE (63%) and radiography (56%), whereas small ulcers and inflammatory polyps were less frequently detected by radiography than by IOE (37% vs 74% and 19% vs 33%, respectively). Neither the presence nor the distribution of IOE findings was related to postoperative recurrence. CONCLUSIONS Whereas IOE demonstrates small intestinal lesions in detail, the procedure alone cannot predict postoperative recurrence in Crohn's disease.
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Affiliation(s)
- M Esaki
- Department of Internal Medicine II, Kyushu University Hospital, Maidashi 3-1-1, Fukuoka 812-8582, Japan.
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Affiliation(s)
- K Hizawa
- Department of Gastroenterology, Kyushu Central Hospital, Fukuoka, Japan
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Hizawa K, Takeya T, Yao T, Yamamoto H, Aomi H, Nakahara T, Matsumoto T, Iida M. Gastric inflammatory polyposis after long-term intermittent use of nonsteroidal anti-inflammatory drugs and histamine2-receptor antagonists. Endoscopy 2005; 37:685. [PMID: 16010622 DOI: 10.1055/s-2005-861425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- K Hizawa
- Dept. of Internal Medicine, Kyushu Central Hospital, Fukuoka, Japan.
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Matsumoto T, Esaki M, Hizawa K, Kurahara K, Hirakawa K, Yao T, Iida M. Accuracy of radiographic assessment for the diagnosis of invasion depth in small invasive colorectal cancer. Br J Radiol 2003; 76:611-6. [PMID: 14500275 DOI: 10.1259/bjr/63403347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Radiographic findings of 113 submucosally invasive colorectal cancers (CRCs) <or=20 mm were investigated by two observers to examine whether barium radiography is predictive of the invasion depth in small colorectal cancer. Smooth surface, central barium fleck, fold convergency and eccentric rigidity were chosen as the radiographic determinants. Predictive values of the determinants for deep submucosal invasion were compared between 45 CRCs <or=10 mm and 68 CRCs >10 mm. 47 CRCs had invaded the submucosa superficially while 66 CRCs had invaded deeply. The concordance rate in the assessment of radiology was 90.3% in smooth surface, 92.9% in central barium fleck, 90.3% in fold convergency and 79.6% in eccentric rigidity. Positive predictive value of central barium fleck for deep submucosal invasion was significantly higher in CRCs>10 mm than in those <or=10 mm (0.86 vs. 0.64, p=0.034). In contrast, negative predictive values of smooth surface (0.89 vs. 0.34, p<0.00001), central barium fleck (0.87 vs. 0.38, p=0.0002), fold convergency (0.64 vs. 0.33, p=0.0023) and eccentric rigidity (0.79 vs. 0.48, p=0.023) were significantly higher in CRCs <or=10 mm than in those >10 mm. These findings suggest that barium radiography is a procedure which can give useful information in prediction of invasion depth in CRCs <or=10 mm in size.
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Affiliation(s)
- T Matsumoto
- Departments of Medicine & Clinical Science and Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka 812-8582, Japan
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Abstract
Inflammatory myoglandular polyp is an uncommon benign colorectal polyp. We treated nine cases of histologically verified inflammatory myoglandular polyp. The polyps were identified as a pedunculated protrusion located in the distal part of the large intestine. On colonoscopy, eight polyps had a smooth, spherical, and hyperemic surface, accompanied by a patchy mucous exudate. Magnification endoscopy revealed a rugged surface composed of smooth nodules. These colonoscopic findings corresponded to hyperplastic glands with occasional cystic dilation and inflamed stroma with proliferation of smooth-muscle fibers. Inflammatory myoglandular polyp appears to be a distinctive clinical entity, with a unique appearance on colonoscopy.
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Affiliation(s)
- T Moriyama
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Abstract
We have encountered an unusual case of gastric carcinoid tumors. Gastroscopic examination of a 71-year-old male patient showed eight smooth protrusions at the greater curvature of the gastric body, some of which had central depressions. Endoscopic ultrasonography demonstrated that the largest tumor (2.6 cm in diameter) was located in the submucosal layer. The patient had a normal serum gastrin level and was negative for antiparietal cell antibody. The patient was also found to have a pituitary tumor, an adenomatous goiter, and bilateral Warthin's tumors of the parotid glands. Histological examination of the resected stomach identified 12 discrete carcinoid tumors. There was no evidence of atrophic gastritis or of endocrine cell micronests. No mutations of the MEN1 gene were found on genomic DNA analysis. Despite the multiplicity of carcinoid tumors, we diagnosed type 3 gastric carcinoid in this patient.
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Affiliation(s)
- T Moriyama
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka 812-8582, Japan.
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Hizawa K, Iwai K, Esaki M, Matsumoto T, Suekane H, Iida M. Is endoscopic ultrasonography indispensable in assessing the appropriateness of endoscopic resection for gastric cancer? Endoscopy 2002; 34:973-8. [PMID: 12471541 DOI: 10.1055/s-2002-35851] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.0] [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: 02/07/2023]
Abstract
BACKGROUND AND STUDY AIMS Endoscopic resection is increasingly being used in the treatment of early gastric cancer. The aim of the present study was to investigate the accuracy of pretherapeutic staging techniques for assessing the appropriateness of endoscopic resection. PATIENTS AND METHODS Both endoscopy and endosonography were carried out at our institution in the treatment of 234 early gastric cancers, with histological confirmation of malignancy following surgical resection (137 lesions) or endoscopic resection (97 lesions). The accuracy in detecting intramucosal cancer with each of the diagnostic procedures was assessed. RESULTS The accuracy rates for detecting intramucosal cancer using endoscopy and endosonography were calculated as 84 % (197 of 234) and 78 % (182 of 234), respectively. The accuracy tended to be lower in lesions located in the upper third of the stomach, in those measuring 2 cm or more in diameter, and in those with an undifferentiated histology with ulcer fibrosis. However, there were no significant differences in the accuracy rates between endoscopy and endosonography. Precise staging was achieved by endoscopy alone in 103 of 109 differentiated adenocarcinomas without ulcer fibrosis, where the lesions measured less than 2 cm in diameter. CONCLUSIONS Endoscopic resection is indicated in intramucosal gastric cancer lesions showing differentiated histology, no ulcer fibrosis and a diameter of less than 2 cm. EUS may additionally be used for further evaluation in these patients.
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Affiliation(s)
- K Hizawa
- Dept of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Hizawa K, Iwai K, Esaki M, Suekane H, Inuzuka S, Matsumoto T, Yao T, Iida M. Endosonographic features of Brunner's gland hamartomas which were subsequently resected endoscopically. Endoscopy 2002; 34:956-8. [PMID: 12471538 DOI: 10.1055/s-2002-35849] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [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: 12/10/2022]
Abstract
BACKGROUND AND STUDY AIMS Brunner's gland hamartomas are uncommon duodenal submucosal tumors. We aim to describe their morphological characteristics, with particular attention to the endosonographic features. PATIENTS AND METHODS We reviewed the radiological, endoscopic, endosonographic, and histological findings from six Brunner's gland hamartomas which were completely removed by endoscopic resection. RESULTS The lesions appeared as broad-based, sessile, or pedunculated submucosal tumors, measuring 0.7 to 2 cm in maximal diameter. Three lesions contained tiny dimple-like depressions on the surface; in one lesion these were only recognized following the use of an endoscopic dye-spraying technique. All the lesions could be safely removed by endoscopic resection after endosonographic confirmation of the layer origin within the submucosa. The internal echo structure of the tumors appeared to be solid echogenic in two, simple cystic in two, and multicystic in the remaining two lesions. In three lesions with an indistinct boundary, some stromal proliferation and solid Brunner's glands were recognized in an area extending from the mucosa to the submucosa. These endosonographic features corresponded to histological findings comprising stromal proliferation and various degrees of solid and cystic glandular Brunner's glands. CONCLUSIONS Brunner's gland hamartoma is characterized endosonographically by a heterogeneous solid and/or cystic mass within the submucosa.
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Affiliation(s)
- K Hizawa
- Dept of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Abstract
BACKGROUND Serrated adenoma is a precursor of colorectal cancer. AIM To clarify possible genotype-phenotype correlations of serrated adenomas in familial adenomatous polyposis (FAP). PATIENTS Eleven patients from eight families with FAP. METHODS We performed total colonoscopy with multiple biopsies in patients. Neoplasia with a serrated glandular structure was regarded as a serrated adenoma. In each patient, germline mutations of the APC gene were determined. Colonic phenotype was compared with germline mutations of the APC gene. RESULTS Serrated adenomas were found in three patients. These patients had macroscopic polyps <100 in number. Pedigrees with serrated adenomas had the truncating germline APC mutation at codon 161, 332, or 1556 while in the other pedigrees mutations were found between codons 554 and 1324. CONCLUSIONS In FAP, serrated adenoma may be a phenotype characteristic of the attenuated form.
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Affiliation(s)
- T Matsumoto
- Department of Endoscopic Diagnostics and Therapeutics, Kyushu University Hospital, Fukuoka, Japan.
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Affiliation(s)
- K Hizawa
- Department of Internal Medicine, Kyushu Central Hospital, Maidashi 3-1-1, Higashi-ku, Fukuoka 812-8582, Japan.
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Hizawa K, Sakamoto K, Nakahara T, Inuzuka S, Akagi K, Shimono R, Iwai K, Matsumoto T. Endosonographic demonstration of a giant fibrous polyp of the anus. Gastrointest Endosc 2001; 53:824-5. [PMID: 11375606 DOI: 10.1067/mge.2001.114956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- K Hizawa
- Department of Internal Medicine, Kyushu Central Hospital, Fukuoka, Japan
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Nakamura S, Matsumoto T, Suekane H, Takeshita M, Hizawa K, Kawasaki M, Yao T, Tsuneyoshi M, Iida M, Fujishima M. Predictive value of endoscopic ultrasonography for regression of gastric low grade and high grade MALT lymphomas after eradication of Helicobacter pylori. Gut 2001; 48:454-60. [PMID: 11247887 PMCID: PMC1728260 DOI: 10.1136/gut.48.4.454] [Citation(s) in RCA: 187] [Impact Index Per Article: 8.1] [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: 02/07/2023]
Abstract
BACKGROUND While a close association between gastric mucosa associated lymphoid tissue (MALT) lymphoma and Helicobacter pylori infection has been established, there are still cases which do not respond to H pylori eradication. AIMS To investigate the clinicopathological factors which may help predict the therapeutic efficacy of H pylori eradication in gastric MALT lymphoma. PATIENTS Forty one patients with gastric MALT lymphoma, including low and high grade lesions. METHODS After endosonographic staging was determined, H pylori was eradicated in all patients, and the subsequent gastric pathological course was then investigated. RESULTS Complete regression of MALT lymphoma was observed in 29(71%) patients, partial regression in five (12%), and no regression in seven (17%). Twenty six (93%) of 28 MALT lymphomas restricted to the mucosa but only three (23%) of 13 lymphomas which invaded the deep portion of the submucosa or beyond completely regressed. Kaplan-Meier analysis for the probability of complete regression of MALT lymphoma revealed a significant difference between tumours restricted to the mucosa and those invading the submucosa deeply or beyond (p<0.05). Neither the presence of a high grade component, perigastric lymphadenopathy, nor clinical staging prior to eradication correlated with the probability of lymphoma regression. CONCLUSIONS Assessment of deep submucosal invasion by endosonography is valuable for predicting the efficacy of H pylori eradication in gastric MALT lymphoma.
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Affiliation(s)
- S Nakamura
- Second Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
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Affiliation(s)
- N Okada
- Departments of Medicine and Clinical Science, Anatomic Pathology, Surgery and Oncology, Endoscopic Diagnosis and Therapeutics, Kyushu University Hospital, Fukuoka, Japan
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Hizawa K, Nakahara T, Yano Y, Inuzuka S, Akagi K, Matsumoto T. Effect of amoxicillin, clarithromycin, and rabeprazole, a new proton pump inhibitor, in eradication therapy for relapsing peptic ulcer diseases with Helicobacter pylori infection. J Clin Gastroenterol 2000; 31:338-9. [PMID: 11129280 DOI: 10.1097/00004836-200012000-00016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Abstract
In Crohn's disease (CD), aphthous lesions are regarded as possible precursors of typical intestinal involvement. To determine the natural course of intestinal lesions in CD of aphthous type, the clinical course of 10 patients was retrospectively investigated during a period ranging from 6 to 16 years after diagnosis. The criterion for inclusion was confirmed aphthous lesions within the gastrointestinal tract with histologically verified epithelioid granuloma. The degrees of aphthous lesions in the small intestine and the colon were graded by small bowel radiography, barium enema examination and colonoscopy. Five patients developed typical CD during a period ranging from 0.8-3.3 years. The site of involvement was the ileum in three patients, the colon in one patient and both the ileum and the colon in one patient. Typical small intestinal CD occurred in four of seven patients with marked aphthous lesions of the small intestine, whereas colonic CD occurred in two of eight patients with such aphthous lesions of the colon. These findings suggest that CD of aphthous type is not necessarily a precursor of clinically overt disease. This may especially be the case for colonic aphthous lesions.
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Affiliation(s)
- T Matsumoto
- Department of Endoscopic Diagnostics and Therapeutics, Kyushu University Hospital, Maidashi 3-1-1, Higashiku, Fukuoka, Japan
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Hizawa K, Matsumoto T, Kouzuki T, Suekane H, Esaki M, Fujishima M. Cystic submucosal tumors in the gastrointestinal tract: endosonographic findings and endoscopic removal. Endoscopy 2000; 32:712-4. [PMID: 10989996 DOI: 10.1055/s-2000-9025] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [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: 12/13/2022]
Abstract
BACKGROUND AND STUDY AIMS The aim of the present study was to describe the endosonographic findings in gastrointestinal cystic submucosal tumors. PATIENTS AND METHODS The endosonographic and clinicopathological findings in 51 patients with a confirmed diagnosis of cystic submucosal tumors were reviewed. RESULTS Endosonographically, cystic submucosal tumors were classified into simple cystic, multicystic, and solid cystic tumor types. The simple cystic tumor type was frequently identified in cysts, and rarely in Brunner's gland hamartomas or in heterotopic gastric mucosa. The multicystic tumor type was common in lymphangiomas, followed by gastric cystic malformations, hemangiomas, and Brunner's gland hamartomas. The solid cystic tumor type included duplication cysts, heterotopic gastric mucosa, heterotopic pancreas, myogenic tumors with advanced cystic degeneration, and gastric tuberculomas. Based on the endosonographic findings, 14 lesions were safely treated with endoscopic removal, using in particular the unroofing technique (cutting off the upper part of the tumors) in nine lesions. CONCLUSIONS Endosonography is a useful diagnostic modality for investigating cystic submucosal tumors.
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Affiliation(s)
- K Hizawa
- Second Dept. of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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Matsumoto T, Iida M, Nakamura S, Hizawa K, Yao T, Tsuneyoshi M, Fujishima M. Natural history of ampullary adenoma in familial adenomatous polyposis: reconfirmation of benign nature during extended surveillance. Am J Gastroenterol 2000; 95:1557-62. [PMID: 10894596 DOI: 10.1111/j.1572-0241.2000.02094.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.8] [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: 12/11/2022]
Abstract
OBJECTIVE Surgical or endoscopic papillectomy may be one of the therapeutic strategies for patients with familial adenomatous polyposis (FAP). To determine whether prophylactic papillectomy is necessary for FAP, we investigated the natural history of the ampullary adenoma in FAP. METHODS Eighteen subjects with FAP were surveyed by duodenoscopy with biopsy for >10 yr. Endoscopic appearance, histological findings, and immunohistochemical stainings for Ki-67 of ampulla were compared between initial and final endoscopic examinations. RESULTS The endoscopic grade in the ampulla remained unchanged in 16 subjects, whereas in two subjects an increase in the endoscopic grade was noted. In two subjects adenoma developed from an endoscopically and histologically normal ampulla. The histological grade of dysplasia increased in three of 12 subjects who initially had adenoma. The labeling index for Ki-67 was not different between initial and final examinations. CONCLUSIONS These data suggest that most ampullary adenoma of patients with FAP is static and that aggressive endoscopic or surgical removal is unnecessary for the adenoma.
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Affiliation(s)
- T Matsumoto
- Department of Endoscopic Diagnostics and Therapeutics, Kyushu University Hospital, Fukuoka, Japan
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Hizawa K, Kawasaki M, Yao T, Aoyagi K, Suekane H, Kawakubo K, Fujishima M. Endoscopic ultrasound features of protein-losing gastropathy with hypertrophic gastric folds. Endoscopy 2000; 32:394-7. [PMID: 10817179 DOI: 10.1055/s-2000-640] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [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: 12/10/2022]
Abstract
BACKGROUND AND STUDY AIMS We aim to clarify the endoscopic ultrasound (EUS) features of protein-losing gastropathy with hypertrophic gastric folds (PLGH), including Ménétrier's disease. PATIENTS AND METHODS We analyzed the EUS and histologic findings in five patients who underwent both endoscopic ultrasonography and endoscopic resection. RESULTS Histologically, we diagnosed one patient as having acute gastritis, three patients as having Ménétrier's disease, and the remaining patient as having hypertrophic lymphocytic gastritis (HLG). Helicobacter pylori was recognized in all but one patient. At EUS every patient was found to have giant gastric folds (13 to 20 mm in diameter), resulting from echogenic thickening of the mucosal layer with or without cystic components. Two patients who underwent eradication therapy of H. pylori showed both clinical and morphologic resolution. CONCLUSIONS Echogenic thickening of the mucosal layer may be a characteristic EUS feature of protein-losing gastropathy with hypertrophic gastric folds, and H. pylori may be one of the causative agents.
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Affiliation(s)
- K Hizawa
- Second Dept. of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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Abstract
A 74-year-old man was admitted to our hospital with frequent right flank pain. The multiple multilocular hepatic abscesses were revealed by computed tomography. Radiographs following a barium meal showed a linear filling defect in the ileum consistent with ascariasis. One day after treatment with pyrantel pamoate, an Ascaris was passed in the stool. The pyogenic hepatic abscesses gradually healed with both antibiotics and continuous drainage. After 2 months, he was discharged. In this case, the pyogenic hepatic abscesses were thus considered to have been caused by an inflammation which spread through the portal vein.
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Affiliation(s)
- H Ogata
- Second Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka
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Matsumoto T, Iida M, Nakamura S, Hizawa K, Mizuno M, Yao T, Tsuneyoshi M, Fujishima M. Depressed adenoma of the duodenum in patients with familial adenomatous polyposis: endoscopic and immunohistochemical features. Cancer 1999; 86:1414-20. [PMID: 10526267 DOI: 10.1002/(sici)1097-0142(19991015)86:8<1414::aid-cncr5>3.0.co;2-#] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Depressed neoplastic lesions of the colorectum have been specified in patients with familial adenomatous polyposis (FAP). The aim of this study was to characterize endoscopic, histologic, and immunohistochemical features of depressed adenoma of the duodenum in patients with FAP. METHODS Duodenoscopy was performed on 25 patients with FAP, and the neoplastic nonampullary lesions were classified as polypoid or depressed adenomas. The grade of dysplasia, the proliferative activity determined by Ki-67 labeling index (LI), and the grade of p53 expression were compared between polypoid and depressed neoplasia. RESULTS Ten subjects had depressed nonampullary adenoma, whereas polypoid adenoma was found in the remaining 15 subjects. Moderate dysplasia was more frequent in depressed adenoma than in polypoid adenoma (70% vs. 27%, P = 0.04). Whereas p53 expression was not different between the two adenoma groups, the LI was significantly higher in depressed adenoma than in polypoid adenoma (59.7 +/- 9.5 vs. 47.5 +/- 10.7, P < 0.01). CONCLUSIONS Depressed adenoma of the duodenum is a distinctive phenotype of duodenal neoplasm in patients with FAP. The high proliferative activity of depressed adenoma suggests that there may be a need to survey FAP patients with such lesions intensively.
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Affiliation(s)
- T Matsumoto
- Division of Gastroenterology, Department of Medicine, Kawasaki Medical School, Okayama, Japan
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21
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Koga H, Aoyagi K, Hizawa K, Iida M, Jo Y, Yao T, Oohata Y, Mibu R, Fujishima M. Rapidly and infiltratively growing Crohn's carcinoma of the small bowel: serial radiologic findings and a review of the literature. Clin Imaging 1999; 23:298-301. [PMID: 10665347 DOI: 10.1016/s0899-7071(99)00149-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
We carried out a retrospective evaluation of serial changes in the small bowel radiographs of a patient with small bowel cancer accompanied by long-standing Crohn's disease. During the 8 months before diagnosis, marked morphological changes were noted. A solitary and irregular protrusion, and rapidly growing stricture under careful medical management of the underlying disease may indicate the development of cancer.
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Affiliation(s)
- H Koga
- Second Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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Kurahara K, Aoyagi K, Hizawa K, Yao T, Iida M, Fujishima M. Spontaneous disappearance of a gastric lipoma after endoscopic biopsy: report of an unusual case. Endoscopy 1999; 31:S31. [PMID: 10376473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- K Kurahara
- Second Dept. of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
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23
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Hizawa K, Iida M, Mochizuki Y, Aoyagi K, Eguchi K, Fujishima M. Endoscopic appearance of isosporiasis. Endoscopy 1999; 31:S21. [PMID: 10344448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- K Hizawa
- Second Dept. of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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Affiliation(s)
- K Hizawa
- Second Department of Internal Medicine and Second Department of Pathology, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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25
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Joko T, Tanaka H, Hirakata H, Henzan H, Hizawa K, Hirakata E, Higashi H, Yonemasu H, Fujishima M. Phlegmonous gastritis in a haemodialysis patient with secondary amyloidosis. Nephrol Dial Transplant 1999; 14:196-8. [PMID: 10052508 DOI: 10.1093/ndt/14.1.196] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Joko
- The Second Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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Abstract
PURPOSE To describe the double-contrast radiographic features of lupus-associated enteropathy. MATERIALS AND METHODS Six patients with systemic lupus erythematosus involving the small bowel were assessed by double-contrast radiography of the duodenum and small intestine, with reference to clinical manifestations and jejunoscopic findings. RESULTS Lupus-associated enteropathy could be categorized into two types: acute onset enteritis in four patients and protein-losing enteropathy with hyperlipidaemia in two patients. The former group presented with irregular thickening and spiculation in the folds of the multiple segments of the duodenum to the terminal ileum, and they were frequently accompanied by thumbprinting, suggestive of ischaemic change. The latter group was characterized by mildly thickened folds with multiple submucosal nodules in the upper portion of the jejunum. In one patient from this group, jejunal biopsy demonstrated lymphangiectasia. Both groups were successfully treated by high-dose prednisolone. Follow-up radiography in the former group showed a complete improvement within 2-7 weeks, whereas radiographic abnormalities in the latter remained even after 2 months. CONCLUSIONS Lupus-associated enteropathy cases may be divisible into two types; an acute ischaemic enteritis type and a protein-losing enteropathy type, each presenting distinct radiographic features.
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Affiliation(s)
- K Hizawa
- Second Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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27
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Esaki M, Aoyagi K, Hizawa K, Nakamura S, Hirakawa K, Koga H, Yao T, Fujishima M. Multiple granular cell tumors of the esophagus removed endoscopically: a case report. Gastrointest Endosc 1998; 48:536-9. [PMID: 9831849 DOI: 10.1016/s0016-5107(98)70102-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- M Esaki
- Second Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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28
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Hizawa K, Iida M, Eguchi K, Aoyagi K, Tada S, Kuwano Y, Mochizuki Y, Fujishima M. Comparative features of double-contrast barium studies in patients with isosporiasis and strongyloidiasis. Clin Radiol 1998; 53:764-7. [PMID: 9817096 DOI: 10.1016/s0009-9260(98)80321-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To compare the gastrointestinal features of isosporiasis and strongyloidiasis. METHODS Two patients with isosporiasis and three patients with strongyloidiasis were assessed by double-contrast radiography of the duodenum and small intestine, with reference to histology of the duodenal biopsy specimens. RESULTS Both conditions affected the duodenum and the proximal jejunum, and showed similar radiographic changes as the diseases progressed. Thus, three patients with diarrhoea lasting 1 year or less showed only minimal or irregularly thickened mucosal folds, which seemed to result from mucosal inflammation. Two patients with long-standing disease periods (17 years and 30 years) presented a markedly granular mucosal appearance with effacement of the folds on radiography. These chronological differences in the radiographic features seemed to reflect the degree of villous atrophy. CONCLUSION Isosporiasis has similar radiographic features of strongyloidiasis.
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Affiliation(s)
- K Hizawa
- Second Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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29
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Yada S, Hizawa K, Aoyagi K, Hashizume M, Matsumoto T, Koga H, Fujishima M. Portal hypertensive gastropathy due to chronic portal vein occlusion in Crohn's disease. Am J Gastroenterol 1998; 93:1376-7. [PMID: 9707073 DOI: 10.1111/j.1572-0241.1998.424_e.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- S Yada
- Second Department of Internal Medicine, Kyushu University, Fukuoka, Japan
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30
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Furuse M, Aoyagi K, Esaki M, Shigemura T, Nakamura S, Hizawa K, Kozuki T, Yao T, Kimura Y, Fujishima M. Endoscopic appearance of primary appendiceal lymphoma. Gastrointest Endosc 1998; 48:86-7. [PMID: 9684675 DOI: 10.1016/s0016-5107(98)70139-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- M Furuse
- Second Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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31
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Hirakawa K, Aoyagi K, Yao T, Hizawa K, Kido H, Fujishima M. A case of pyogenic granuloma in the duodenum: successful treatment by endoscopic snare polypectomy. Gastrointest Endosc 1998; 47:538-40. [PMID: 9647384 DOI: 10.1016/s0016-5107(98)70260-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- K Hirakawa
- Second Department of Internal Medicine, Kyushu University, Fukuoka, Japan
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32
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Hasegawa T, Shimoda T, Hirohashi S, Hizawa K, Sano T. Collagenous fibroma (desmoplastic fibroblastoma): report of four cases and review of the literature. Arch Pathol Lab Med 1998; 122:455-60. [PMID: 9593348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Collagenous fibroma (desmoplastic fibroblastoma) is poorly recognized and may be mistaken for other benign or even malignant spindle-cell tumors of soft tissue because of the small number of reported cases. DESIGN Collagenous fibromas resected from four adult women were studied histologically and immunohistochemically. RESULTS The tumors were well-circumscribed firm masses, measuring from 1.0 to 13.8 cm (mean, 5.5 cm) across the greatest diameter, located in the subcutaneous or deep soft tissue of the shoulder, thigh, back, and neck. Each of the tumors was characterized by a paucicellular lesion with spindle- and stellate-shaped fibroblastic cells embedded in a hypovascular, densely fibrous stroma. Mitotic figures and necrosis were not identified. One tumor contained dystrophic calcification and metaplastic bone, and another included small foci of floretlike multinucleated giant cells. Although appearing well demarcated on gross examination, one tumor focally infiltrated the surrounding skeletal muscle and adipose tissue. On immunohistochemical examination, all of the tumors were diffusely positive for vimentin. One tumor showed focal staining for alpha-smooth muscle actin, and another was partially positive for desmin, a staining profile that is typical of myofibroblasts. No tumor recurred during the follow-up periods of 67 to 108 months (mean, 93 months). CONCLUSION Collagenous fibroma may be a distinctive fibrous soft-tissue tumor with benign biological behavior.
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Affiliation(s)
- T Hasegawa
- Pathology Division, National Cancer Center Research Institute and Hospital, Tokyo, Japan
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33
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Abstract
Primary liposarcoma of the stomach is rare and only seven cases have been described in the English literature. Here we report the eighth case, which occurred in a 68-year-old woman who presented with repeated tarry stools and hematemesis. Endoscopic examination revealed a large ulcerated submucosal mass at the gastric angle. The patient was treated by total gastrectomy. On microscopic examination, the tumor showed the features of a well differentiated sclerosing liposarcoma. Immunohistochemically, many spindle to stellate tumor cells were diffusely positive for vimentin and CD34. Positivity for S-100 protein was found in the adipocytic component, including lipoblasts, in addition to some spindle-shaped tumor cells. On ultrastructural examination, the spindle to stellate cells had features characteristic of fibroblasts. No recurrence or metastasis was seen during 13 months. Liposarcoma of the stomach has to be considered in the differential diagnosis with other submucosal lesions, such as gastric lipoma and gastrointestinal stromal tumor.
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Affiliation(s)
- K Seki
- Department of Pathology, Tokushima Municipal Hospital, Japan
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34
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Kanamoto K, Aoyagi K, Nakamura S, Hizawa K, Suekane H, Sakamoto K, Fujishima M. Simultaneous coexistence of early adenocarcinoma and low-grade MALT lymphoma of the stomach associated with Helicobacter pylori infection: a case report. Gastrointest Endosc 1998; 47:73-5. [PMID: 9468428 DOI: 10.1016/s0016-5107(98)70303-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
MESH Headings
- Adenocarcinoma/complications
- Adenocarcinoma/diagnosis
- Adenocarcinoma/pathology
- Adenocarcinoma/surgery
- Biopsy, Needle
- Diagnosis, Differential
- Endosonography
- Follow-Up Studies
- Gastrectomy
- Gastroscopy
- Helicobacter Infections/complications
- Helicobacter Infections/diagnosis
- Humans
- Lymphoma, B-Cell, Marginal Zone/complications
- Lymphoma, B-Cell, Marginal Zone/diagnosis
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, B-Cell, Marginal Zone/surgery
- Male
- Middle Aged
- Neoplasms, Multiple Primary/diagnosis
- Neoplasms, Multiple Primary/surgery
- Stomach Neoplasms/complications
- Stomach Neoplasms/diagnosis
- Stomach Neoplasms/pathology
- Stomach Neoplasms/surgery
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Affiliation(s)
- K Kanamoto
- Second Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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35
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Abstract
Mounting cytogenetic evidence indicates that synovial sarcomas, regardless of histological conformation, share the specific reciprocal chromosomal translocation t(X;18)(p11.2;q11.2). Application of dual-colour fluorescence in situ hybridization (FISH) on interphase nuclei isolated from archival paraffin-embedded material to identify the specific translocation is of diagnostic importance for pathological practice and retrospective study. Five cases of well-characterized biphasic synovial sarcomas, two monophasic fibrous synovial sarcomas, one embryonal rhabdomyosarcoma, one fibrosarcoma, and one malignant peripheral nerve sheath tumour were analysed. To visualize the translocated chromosomal fragments and their topographic relationships with centromeres of chromosomes X and 18, nuclei from each case were hybridized concurrently with chromosome X centromeric and chromosome 18 painting probes, and chromosome 18 centromeric and chromosome X painting probes, respectively. Six out of seven synovial sarcomas showed chromosomal alterations consistent with t(X;18). One biphasic synovial sarcoma had trisomy 18 and lacked the chromosomal translocation t(X;18). The other three spindle cell sarcomas and the normal control tissues showed the normal numerical and structural composition for chromosomes X and 18. It is indicated from the present study that when histological differential diagnosis is difficult, FISH would be a crucial aid in detecting a known specific chromosomal alteration and that dual-colour FISH is an efficient stable diagnostic tool for pathological research and daily diagnosis. The results also suggest that rare synovial sarcomas may lack the chromosomal translocation t(X;18). 1998 John Wiley & Sons, Ltd.
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Affiliation(s)
- P Yang
- First Department of Pathology, University of Tokushima School of Medicine, Japan
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36
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Hizawa K, Suekane H, Kawasaki M, Yao T, Aoyagi K, Fujishima M. Diffuse cystic malformation and neoplasia-associated cystic formation in the stomach. Endosonographic features and diagnosis of tumor depth. J Clin Gastroenterol 1997; 25:634-9. [PMID: 9451678 DOI: 10.1097/00004836-199712000-00017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [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: 02/06/2023]
Abstract
We have evaluated the endoscopic ultrasonography (EUS) features of cystic malformation of the stomach and the depth of associated neoplasia. We included 15 patients with multiple cystic components identified on EUS: 6 patients with multiple cysts restricted focally to gastric neoplasia and 9 patients with diffusely distributed cysts. We categorized the former findings as focal cystic malformation (FCM), and the latter as diffuse cystic malformation (DCM) of the stomach and reviewed the endosonographic features. Both FCM and DCM tended to show male preponderance and develop in older patients. Cystic changes in FCM extended from the neoplastic lesion to the submucosa regardless of the location in the stomach. Diffuse cystic malformation was located predominantly in the gastric body and mainly was shown as the thickened submucosa and/or deep mucosa with multiple cystic components. The boundary between the mucosal layer or the tumor echo and the submucosal layer was indistinct in eight patients, which led to a lower accuracy in EUS diagnosis of tumor depth. Diffuse cystic malformation has characteristic EUS features and occasionally is accompanied by gastric neoplasia. Endoscopic ultrasonography is inaccurate in determining tumor depth when multiple submucosal cysts are present.
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Affiliation(s)
- K Hizawa
- Second Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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37
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Hizawa K. [Facts and concepts in bone and soft tissue tumor pathology]. Nihon Seikeigeka Gakkai Zasshi 1997; 71:609-17. [PMID: 9430137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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38
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Kawasaki M, Hizawa K, Aoyagi K, Nakamura S, Fujishima M. Ménétrièr's disease associated with Helicobacter pylori infection: resolution of enlarged gastric folds and hypoproteinemia after antibacterial treatment. Am J Gastroenterol 1997; 92:1909-12. [PMID: 9382064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We herein report a case of a 46-yr-old female with Ménétrièr's disease associated with Helicobacter pylori (H. pylori) infection, in whom the appearance of enlarged gastric folds and hypoproteinemia were both successfully treated by antibacterial treatment. The patient had been treated with famotidine for 3 yr under a diagnosis of Ménétrièr's disease, which caused an increase in her serum protein concentration to a level at which she suffered no clinical problems; however, the concentration never reached a normal range, and the presence of enlarged gastric folds also remained unchanged. Because H. pylori colonization was detected in the stomach and was also retrospectively recognized in the initial histologic specimens, antibacterial treatment with omeprazole, clarithromycin, and metronidazole was thus attempted. As a result of the successful eradication of H. pylori, the enlarged gastric folds returned to normal and the serum protein concentration thus increased to a normal level after the treatment. The etiology of Ménétrièr's disease remains unknown; however, the above findings suggest that H. pylori infection may in some cases cause Ménétrièr's disease and should therefore be carefully treated in any patient with this condition.
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Affiliation(s)
- M Kawasaki
- Second Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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39
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Abstract
AIMS To clarify a clinical entity of juvenile polyposis of the stomach compared with generalised juvenile gastrointestinal polyposis. METHODS The clinicopathological features of juvenile polyposis dominantly involving the stomach at initial presentation were reviewed in 12 patients (three new patients and nine from the literature). These were compared with 29 cases of generalised juvenile gastrointestinal polyposis. RESULTS There were three men and nine women with juvenile polyposis of the stomach, aged 10-63 years. Hypoproteinaemia was present in nine patients, anaemia in seven, and a family history of intestinal polyposis in seven. No patient presented with a congenital abnormality. During the observation period, two patients developed colonic juvenile polyps. Gastric polyps invariably affected the antrum and extended to the fundus, eventually becoming more numerous, larger, and more pedunculated. Ten patients required gastrectomy for associated malignancy or uncontrolled protein losing gastropathy. Histological examinations of the resected specimens demonstrated neoplastic tissue arising from juvenile polyps in four of the 12 patients. Atypism in these mixed polyps varied from adenoma to well or moderately differentiated adenocarcinoma. CONCLUSIONS Juvenile polyposis of the stomach has malignant potential, and may be a separate entity from generalised juvenile gastrointestinal polyposis.
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Affiliation(s)
- K Hizawa
- Second Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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40
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Kawasaki M, Hizawa K, Aoyagi K, Kuroki F, Nakahara T, Sakamoto K, Iida M, Fujishima M. Ileitis caused by Henoch-Schönlein purpura. An endoscopic view of the terminal ileum. J Clin Gastroenterol 1997; 25:396-8. [PMID: 9412933 DOI: 10.1097/00004836-199707000-00026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- M Kawasaki
- Second Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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41
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Abstract
To clarify the clinical risk of desmoid tumors developing in familial adenomatous polyposis, we reviewed the cases of 49 Japanese patients diagnosed with familial adenomatous polyposis at our institute. In six patients who manifested desmoid tumors at a mean age of 31 years, we reviewed the clinical features and compared various phenotypic manifestations with those in the 43 patients without desmoid tumors. During the observation periods (mean, 6.5 years), two of six patients with desmoid tumors died because of the tumors, which measured > 10 cm in diameter at the initial diagnosis, whereas the remaining four patients with desmoid tumors < 5 cm did not experience complications. The patients with desmoid tumors tended to be women (5 of 6 vs. 17 of 43; p = 0.05) and more frequently had gastric fundic gland polyposis (5 of 6 vs. 17 of 43; p = 0.05) than did the patients without desmoid tumors. There were no apparent differences in other clinical manifestations, including the incidences of colonic polyposis, gastroduodenal adenomas, and extraintestinal tumors. Desmoid tumors can be serious complication in patients with familial adenomatous polyposis. There may be some association in the genesis of desmoid tumors and gastric fundic gland polyposis.
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Affiliation(s)
- K Hizawa
- Second Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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42
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Esaki M, Aoyagi K, Hizawa K, Fujishima M. Gastric leiomyosarcoma: detection on plain chest radiograph. AJR Am J Roentgenol 1997; 168:1624-5. [PMID: 9168752 DOI: 10.2214/ajr.168.6.9168752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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43
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Hizawa K, Ohta Y, Satou H, Aoyagi K, Eguchi K, Fujishima M. Endoscopic hydrostatic balloon dilation of ulcer-induced pyloric stenosis in rheumatoid arthritis and secondary amyloidosis. Surg Endosc 1997; 11:673-5. [PMID: 9171133 DOI: 10.1007/s004649900420] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We describe a 50-year-old Japanese woman with rheumatoid arthritis who presented with near-complete gastric outlet obstruction. The patient also suffered from secondary gastrointestinal and cardiac amyloidosis. Gastroscopy revealed multiple huge gastric antral ulcers in which amyloid deposits were identified on histologic examination. The ulcers became scars after treatment with omeprazole, which cause in severe pyloric stenosis. Endoscopic hydrostatic balloon dilation under fluoroscopic guidance was performed twice for 10 min. The pyloric outlet remained sufficiently patent 22 months later.
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Affiliation(s)
- K Hizawa
- Second Department of Internal Medicine, Faculty of Medicine, Kyushu University, Maidashi 3-1-1, Higashi-Ku, Fukuoka 812-82, Japan
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Abstract
This study was conducted to clarify the actual morbidity and clinicopathologic features of thyroid neoplasia in patients with familial adenomatous polyposis. We analyzed the clinical records of 49 Japanese patients with familial adenomatous polyposis diagnosed at our institute. Six of these patients had thyroid neoplasias (3 carcinomas, 2 adenomas, and 1 of unknown histology). Among 17 patients (11 men and 6 women) who had been examined by thyroid ultrasonography or in whom postmortem examination was performed; we categorized 6 patients with thyroid tumor as the TT group, and the remaining 11 without thyroid tumor as the NTT group. The clinical features of the two groups were compared. Thyroid neoplasia was detected by physical examination in 2.3% of 43 patients so examined and was detected in 25% of 8 patients examined by thyroid ultrasonography, and in 44% of the 9 patients subjected to postmortem examination. There were no significant differences between the TT and NTT groups in gender; age at first admission, colectomy, and last follow-up visit; number of colonic polyps; or in presence of colorectal cancers, gastroduodenal adenomas, gastric fundic gland polyposis, retinal pigmented lesions, or extraintestinal tumors. The thyroid gland is frequently affected in patients with familial adenomatous polyposis, but there may be no association between thyroid neoplasia and other clinical manifestations.
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Affiliation(s)
- K Hizawa
- Second Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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45
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Affiliation(s)
- M Kawasaki
- Second Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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46
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Yamamoto C, Aoyagi K, Suekane H, Iida M, Hizawa K, Kuwano Y, Nakamura S, Fujishima M. Carcinoid tumors of the duodenum: report of three cases treated by endoscopic resection. Endoscopy 1997; 29:218-21. [PMID: 9201476 DOI: 10.1055/s-2007-1004168] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [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: 02/04/2023]
Abstract
Three patients with small (less than 1 cm) duodenal carcinoid tumors are described, two of whom underwent endoscopic resection using simple snare polypectomy. In the third patient, a small tumor (5 mm) could no longer be found after initial biopsies on subsequent repeated endoscopic-bioptic follow-up. All three patients are free of local recurrence or systemic symptoms 2-14 years after the procedure.
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Affiliation(s)
- C Yamamoto
- Second Dept. of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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47
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Hasegawa T, Hirose T, Seki K, Hizawa K, Ishii S, Wakabayashi J. Histological and immunohistochemical diversities, and proliferative activity and grading in osteosarcomas. Cancer Detect Prev 1997; 21:280-7. [PMID: 9167046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
To examine the differentiation and proliferative activity of tumor cells, 30 osteosarcomas, including osteoblastic, chondroblastic, fibroblastic, malignant fibrous histiocytoma-like, telangiectatic, giant cell-rich low-grade central, and epithelioid types, were studied immunohistochemically. A variable number of tumor cells in all cases showed osteocalcin immunoreactivity. In four preparations of the frozen sections, osteoblastic, fibroblastic, and chondroblastic tumor cells were positive for bone-type alkaline phosphatase antibody 2D3. S-100 protein immunoreactivity was found not only in seven tumors of the chondroblastic type, but also in four of nine osteoblastic tumors and each of the low-grade central, giant cell-rich, and epithelioid types. A histiocytic marker, CD68, was negative for tumor cells in all cases. Some cells of 17 tumors were positive for desmin and/or alpha-smooth muscle actin; this was regarded as an indication of myofibroblastic differentiation. Tumor cells of the epithelioid type and those of two osteoblastic tumors expressed cytokeratin (CAM5.2) and epithelial membrane antigen. Proliferating-cell nuclear antigen (PCNA) reactivity was found in the cell nuclei of 22 tumors, most of which were high grade. Many cells in six high-grade tumors also showed the nuclear staining for p53 protein. Of these tumors, PCNA and p53 positivities tended to be more numerous in osteoblastic cells, atypical spindle-shaped, and bizarre giant cells than in well-developed chondroid cells. From these findings, osteosarcomas are concluded to be composed basically of osteoblastic cells, that are indispensable for diagnosis of osteosarcomas, with a variable number of chondroblastic, myofibroblastic, and, rarely, epithelioid cells, and this manifold cellular differentiation corresponds to the histological and clinical diversities. The osteoblastic, fibro- or myofibroblastic, and undifferentiated cells mainly participate in proliferation of osteosarcomas. The p53 gene alterations may play a part in the neoplastic transformation and proliferation of osteosarcomas.
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Affiliation(s)
- T Hasegawa
- First Department of Pathology, University of Tokushima School of Medicine, Japan
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48
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Inoue A, Hasegawa T, Ikata T, Hizawa K. Fibrosarcoma of the toe: a destructive lesion of the distal phalanx. Clin Orthop Relat Res 1996:239-44. [PMID: 8981902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A rare case of well differentiated fibrosarcoma occurring in the left second toe is described in a 12-year-old boy who presented with a destructive lesion that had almost totally destroyed the distal phalanx, except for the epiphysis. Amputated specimens showed microscopic evidence of proliferation of uniform spindle cells arranged in both fascicles and a characteristic herringbone pattern with a small number of mitotic figures. This tumor did not show any specific immunoreactivity except for vimentin and had basic ultrastructural characteristics of fibroblasts and myofibroblasts. The tumor was treated by amputation at the middle phalanx level and had not recurred 3 years later. From the presenting radiographic features, some benign neoplasms and reactive lesions were considered in the differential diagnosis. Only results from the pathologic examination were useful in reaching a correct diagnosis.
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Affiliation(s)
- A Inoue
- Department of Orthopedic Surgery, The University of Tokushima, School of Medicine, Japan
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49
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Affiliation(s)
- K Hizawa
- Second Dept. of Internal Medicine, Kyushu University, Fukuoka, Japan
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50
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Hizawa K. [On the histogenesis and classification of fibrous, lipomatous, fibrohistiocytic and related tumors of bone and soft tissues]. Nihon Seikeigeka Gakkai Zasshi 1996; 70:685-95. [PMID: 8934463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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