Malignant lymphoma of the stomach after chemotherapy for hepatocellular carcinoma

A rare case of malignant lymphoma of the stomach after treatment for hepatocellular carcinoma (HCC) is reported. A 72-year old man presented with a large mass on the right hypochondrium, which was diagnosed as HCC associated with chronic hepatitis C with cirrhosis. The inoperable tumor was treated conservatively with cisplatin, etoposide, carboplatin, and Lipiodol infused into the hepatic artery, together with transcatheter arterial embolization. The patient presented 38 months later with features suggestive of gastric ulceration. Endoscopy and histological examination of biopsy material confirmed the presence of malignant lymphoma of the stomach. He ultimately died as a result of hepatic failure. The clinical presentation suggests that gastric lymphoma was possibly related to the lymphotropic effect of hepatitis C virus (HCV) and exacerbated by intraarterial injection of the cytotoxic drugs.

Case report: hippocratic digital and Crohn's disease

A case of Hippocratic digital associated with secondary hypertrophic osteoarthropathy complicating Crohn's disease in a 29 year old Japanese male is reported. Hippocratic digital, or finger clubbing, complicating inflammatory bowel disease has been frequently reported in the Western hemisphere. However, its association with secondary hypertrophic osteoarthropathy has been very rarely found in that disease. In Japan, Hippocratic digital has not been described previously. With regard to the pathogenesis of Hippocratic digital and secondary hypertrophic osteoarthropathy, the theory that both entities belong to the same pathological spectrum and that megakaryocytes or platelet clumps may play the most important role, is discussed.

Carcinoma in gastric hyperplastic polyps. A phenotypic study

One-hundred twelve hyperplastic polyps were analyzed. The aim was to study their malignant transformation. Among them, four hyperplastic polyps harbored adenocarcinoma; two were from our own institution (1.8%). The majority were pedunculated and located in the antrum with an average of 14.5 mm in diameter. The four polyps bore well-differentiated adenocarcinoma. Dysplasia and intestinal metaplasia were detected in two and three polyps, respectively. The cancer and dysplastic foci shared the same type of neutral and acid mucosubstances. p53 oncoprotein was positive in three cancer foci and in the dysplastic areas, and nucleolar organizer region counts were higher in the cancer foci. In conclusion, hyperplastic polyps have malignant potential. Such possibility increases in polyps larger than 14.5 mm. In our cases, the carcinoma foci may have arisen from dysplastic areas. Once the neoplastic changes occur, the cancer cells proliferate and behave as other adenocarcinomas of the stomach.

Adult T-cell leukemia with multiple lymphomatous polyposis of the gastrointestinal tract

A rare case of adult T-cell leukemia (ATL) in which multiple lymphomatous polyposis (MLP) was revealed throughout the entire gastrointestinal tract is reported here. The polypectomy specimens taken from the rectum revealed infiltration of neoplastic T-cells, the integration of HTLV-1 proviral DNA, and increased CD4 (OKT4) and CD25 (IL-2R) cells. The analysis of surface markers of the lymphocytes from polypoid lesions may be useful for elucidating cell tropism and homing properties in the gastrointestinal tract. Although MLP has always been associated with B-cell lymphoma in the Western world, it is important for clinicians and pathologists to be aware that MLP may be caused by the infiltration of ATL cells.

Signet ring cell carcinoma in hyperplastic polyp

BACKGROUND

A polypectomy was performed on a 68-year-old woman who had three gastric hyperplastic polyps. A focal signet ring cell carcinoma was discovered in one of the polyps, which was 2.2 cm in diameter and was located in the antrum.

METHODS

To study the carcinoma's phenotype expression, special mucin histochemical stainings were performed.

RESULTS

The carcinoma infiltrated only into the mucosa. Intestinal metaplasia was scant. In the neoplasm neutral and foveolar mucin was predominant over acid mucin. The surrounding hyperplastic foveolar epithelium showed positivity for neutral mucin, and the intestinal metaplasia foci for acid mucin.

CONCLUSIONS

This neoplasm has a mixed composition of mucins and shares histochemical characteristics with the surrounding hyperplastic foveolar epithelium.

Differential mechanism of peptide YY and neuropeptide Y in inhibiting motility of guinea-pig colon

The effect of peptide YY on contractility, acetylcholine release and noradrenaline release was examined in the isolated guinea-pig colon, and findings were compared with those for neuropeptide Y. Peptide YY and neuropeptide Y inhibited the twitch contractions mediated by the stimulation of cholinergic neurons. Peptide YY, neuropeptide Y, [Leu31,Pro34]neuropeptide Y and neuropeptide Y-(13-36) inhibited the electrically stimulated release of acetylcholine. Neuropeptide Y, but not peptide YY, inhibited the high K(+)-stimulated tetrodotoxin-resistant release of acetylcholine, while the inhibitory effect of neuropeptide Y disappeared after treatment with yohimbine. Neuropeptide Y, but not peptide YY or neuropeptide Y analogues, evoked the release of noradrenaline. After desensitization to the effects of neuropeptide Y, peptide YY inhibited electrically stimulated acetylcholine release. Thus, peptide YY inhibits acetylcholine release through stimulation of a receptor, distinct from the site of action of neuropeptide Y, located on cholinergic neurons as well as the neuropeptide Y Y1 and Y2 receptors in the guinea-pig colon. Neuropeptide Y inhibits acetylcholine release due to the noradrenaline release mediated by stimulation of a receptor distinct from neuropeptide Y Y1 and Y2 receptors, located on adrenergic neurons.

DNA aneuploidy in a case of rectosigmoid adenocarcinoma complicated by ulcerative colitis

A case of Borrmann type IV colorectal adenocarcinoma detected as a complication of long-standing ulcerative colitis is reported. Barium enema and colonoscopy disclosed a stenotic area associated with a tumoral mass and a flat elevated lesion in the rectosigmoid region and a submucosal tumor-like lesion in the rectum. Total colectomy was performed and histological studies demonstrated a moderately differentiated adenocarcinoma accompanied by high- and low-grade dysplasia. DNA ploidy pattern analysis showed aneuploidy in the adenocarcinoma and high-grade dysplasia, but diploidy in the normal and atrophic mucosa and in low-grade dysplasia. DNA aneuploid content was associated with the presence of colorectal carcinoma complicating ulcerative colitis, indicating that DNA content studies should be included in screening programs to detect early colorectal carcinoma following this disease, as a complementary study to histological assessment.

Alterations of p53 and k-ras genes in human colorectal-cancer with ulcerative-colitis

Using polymerase chain reaction and single strand conformation polymorphism assay, we examined genetic alterations of p53 and K-ras genes in multiple lesions of colorectal cancers that developed in three patients with ulcerative colitis. p53 gene mutations were found in two lesions and a K-ms gene mutation at codon 12 was found only in one. Neither was found in non-cancerous lesions. The results indicate that mutation of both genes may not be so frequent among Japanese patients. They were found only in very few cancerous lesions of each patient. Therefore, it is possible that the oncogenic process in each lesion is a consequence of rather independent events. Our preliminary results suggest the potential usefulness of CD44 variant forms as markers for dysplastic and cancerous tissues in ulcerative colitis.

Goblet cell carcinoid of the appendix

A 47-year-old man was admitted with appendicitis, and appendectomy was performed. On microscopic examination of the resected specimen, the presence of goblet cell carcinoid in the tip of appendix was revealed. This tumor showed an aggressive nature with perineural and vascular invasion around the appendiceal serosa. The tumor was composed of two main cell populations: mucin-producing (goblet cell type) and silver-positive cells (endocrine differentiation). Additionally, a few cells were also positive for serotonin and lysozyme, but negative for gastrin and ACTH. These findings suggest that goblet cell carcinoid share some functional and histologic characteristics with carcinoid tumors and adenocarcinomas, although it is a distinct entity.

A case of inflammatory malignant fibrous histiocytoma of the colon

Primary malignant fibrous histiocytoma seldom occurs in the alimentary tract. This report documents a case in which a 50-year-old man presented with abdominal fullness and anorexia, together with inflammatory reactions such as fever, leukocytosis, an elevated erythrocyte sedimentation rate and positive CRP. Radiologic and endoscopic studies revealed a large mass in the ascending colon. The histology of the resected tumor revealed inflammatory malignant fibrous histiocytoma, a histologic subtype which is rare among not only soft tissue fibrous but also as gastrointestinal histiocytomas. The inflammatory reactions disappeared following resection of the tumor. Although we suspected that the tumor produced granulocyte colony-stimulating factor because of the slightly elevated serum level and the characteristics of the tumor histology, an immunohistochemical study failed to show the G-CSF production by the tumor cells.

Carcinoma of duodenal bulb arising from the Brunner's gland

A 75-year-old man was diagnosed as having a sessile tumor measuring 1.4 x 1.0 cm in size in the duodenal bulb after upper gastroduodenal series. The biopsy specimens revealed a proliferation of the adenomatous glands showing an acinar structure with papillary infolding; type III mucus, which is characteristic of Brunner's glands. Antral glands and mucus neck cells of the fundic glands were also observed in the adenomatous glands by concanavalin A staining. Thus, it was clear that the tumor had originated from the Brunner's glands. Three years and four months later, the sessile tumor had developed into a fungating ulcerated tumor via a polypoid form. The biopsy specimens revealed a papillary adenocarcinoma with foci of undifferentiated carcinoma. Retrospectively, the adenomatous glands in the biopsy taken from the sessile tumor should have been regarded as low grade carcinoma. Therefore, we propose that when a polyp or tumor shows an increase in size or change in macroscopic appearance, surgery should be considered.

Clinical course and magnifying endoscopic findings of fine lesions of the large intestinal mucosa in Crohn's disease

"Worm-eaten" appearance (WEA) is a fine lesion of Crohn's disease observed in apparently normal rectal mucosa by magnifying endoscopy. Magnifying endoscopy has now been performed following application of methylene blue on 37 occasions in 27 patients with Crohn's disease, and the occurrence of WEA was reviewed in relation to the duration and extent of disease. The frequency of WEA was 75% in patients with a history of less than five years and 77% in those who had had the disease for more than five years. In the active stage, the frequency was 85% and 100% respectively, and the degree of WEA also increased. The detection rate of granulomata in regions of WEA was 53% when the clinical history was less than five years and 33% when five years or more. In active disease, granulomata were found in 70% and 67% respectively. The large intestine other than the rectum was reviewed in eight patients with ileitis. WEA and granulomata were observed throughout the large intestine including the cecum, especially when the ileal disease was active.

Multiple carcinoids and endocrine cell micronests in type A gastritis. Their morphology, histogenesis, and natural history

Six cases of type A gastritis associated with multiple carcinoids and/or endocrine cell micronests (ECM) in the atrophic fundic mucosa were examined light microscopically, immunohistochemically, and ultrastructurally. The ECM and carcinoids were mainly composed of enterochromaffin-like (ECL) cells. The cells were hyperplastic only in the atrophic fundic glands and pseudopyloric glands, but not in the intestinal metaplastic gland. It is suggested that the development of both the ECM and the carcinoids is highly related to the atrophic change of the fundic mucosa and a trophic action of subsequently raised serum gastrin in type A gastritis and that the both lesions arise from the pseudopyloric glands or atrophic fundic glands. In addition, the definition of neoplastic ECM (microcarcinoid) of the stomach was made with comparative study on both the cases with ECM and multiple carcinoids and the cases with ECM alone.

Multiple carcinoids and endocrine cell micronests in type A gastritis. Their morphology, histogenesis, and natural history

Six cases of type A gastritis associated with multiple carcinoids and/or endocrine cell micronests (ECM) in the atrophic fundic mucosa were examined light microscopically, immunohistochemically, and ultrastructurally. The ECM and carcinoids were mainly composed of enterochromaffin-like (ECL) cells. The cells were hyperplastic only in the atrophic fundic glands and pseudopyloric glands, but not in the intestinal metaplastic gland. It is suggested that the development of both the ECM and the carcinoids is highly related to the atrophic change of the fundic mucosa and a trophic action of subsequently raised serum gastrin in type A gastritis and that the both lesions arise from the pseudopyloric glands or atrophic fundic glands. In addition, the definition of neoplastic ECM (microcarcinoid) of the stomach was made with comparative study on both the cases with ECM and multiple carcinoids and the cases with ECM alone.

[Multiple gastric carcinoids occurring in atrophic fundic mucosa]

A 49-year-old man with iron deficiency anemia and achlorhydria was found to have a carcinoid 7 X 4 mm in the upper corpus of the stomach. The subtotally resected stomach histologically revealed 20 carcinoids measuring 0.1-7 mm in largest diameter and numerous argyrophil cell micronests at the base of the severely atrophic fundic mucosa. Some of the lesions invaded down to the submucosa. The antral mucosa was mildly atrophic. All carcinoids and micronests were non-argentaffin and argyrophil, and negative upon immunoreaction with 12 kinds of peptides and amine.