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Minami R, Nakahodo J, Kikuyama M, Chiba K, Tabata H, Tachibana A, Kamisawa T. Endoscopic Nasopancreatic Drainage Contributes to Early Resolution of Postgastrectomy Gastropancreatic Fistula. Intern Med 2024; 63:487-491. [PMID: 37407450 PMCID: PMC10937146 DOI: 10.2169/internalmedicine.1500-22] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/07/2023] [Indexed: 07/07/2023] Open
Abstract
A 76-year-old man experienced abdominal pain 43 days after gastric cancer resection. Computed tomography revealed a gastric wall defect extending to the pancreas, and endoscopic retrograde pancreatography revealed a gastropancreatic fistula. Afterward, a nasopancreatic duct drainage tube was inserted. Seven days later, no leakage of the contrast medium from the duct was observed, and the patient was discharged 22 days after endoscopic nasopancreatic duct drainage. Endoscopic nasopancreatic duct drainage prevents pancreatic juice leakage and promotes gastric ulcer healing.
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Affiliation(s)
- Ryogo Minami
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Japan
| | - Jun Nakahodo
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Japan
| | - Masataka Kikuyama
- Department of Gastroenterology, Tokyo Women's Medical University, Japan
| | - Kazuro Chiba
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Japan
| | - Hiroki Tabata
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Japan
| | - Ayu Tachibana
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Japan
| | - Terumi Kamisawa
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Japan
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Kikuyama M. A Novel Diagnostic Imaging Method for the Early Detection of Pancreatic Cancer. Diagnostics (Basel) 2023; 13:2080. [PMID: 37370975 DOI: 10.3390/diagnostics13122080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) has an extremely poor prognosis, with a survival rate of less than 10% [...].
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Affiliation(s)
- Masataka Kikuyama
- Department of Gastroenterology, Tokyo Women's Medical University, 8-1 Shinjuku-ku, Tokyo 162-8666, Japan
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Kikuyama M, Nakahodo J, Honda G, Suzuki M, Horiguchi SI, Chiba K, Tabata H, Ome Y, Uemura SI, Kawamoto Y, Kamisawa T. Pancreatic duct epithelial malignancy suggested by large focal pancreatic parenchymal atrophy in cystic diseases of the pancreas. Pancreatology 2023:S1424-3903(23)00066-2. [PMID: 37003856 DOI: 10.1016/j.pan.2023.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/23/2023] [Accepted: 03/12/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND /Objectives: A cystic lesion is common in the pancreas. Focal pancreatic parenchymal atrophy (FPPA) has been reported as a sign of high-grade pancreatic intraepithelial neoplasia/carcinoma in situ (HGP/CIS). Some cystic lesions accompany FPPA. However, the relationship between a cystic lesion, FPPA, and the histopathological background of the pancreatic duct is unknown. METHODS We retrospectively evaluated the data of 98 patients with a cystic lesion who underwent serial pancreatic juice aspiration cytologic examination (SPACE) because of accompanying FPPA, increased size of the cystic lesion, and pancreatic duct stricture at the base. RESULTS The clinical diagnosis of a cystic lesion was intraductal papillary mucinous neoplasia (IPMN) and cysts in 72 (73.5%) and 26 (26.5%) patients, respectively. Ninety of the 98 patients (91.8%) had FPPA. Positive results (adenocarcinoma and suspicion) on SPACE were observed in 56 of all cases (57.1%), 48 of IPMN (66.7%), 8 of cysts (30.8%), and 54 of FPPA (59.3%), and were significantly associated with IPMN (p = 0.002) and the large FPPA (>269.79 mm2,p = 0.0001); moreover, these disorders are considerably related (p = 0.0003). Fifty patients (51.0%) with positive results on SPACE underwent surgery, with the histopathological diagnosis of epithelial malignancy in 42 patients (42.9%, 42/50, 84%). Many cystic lesions clinically diagnosed as IPMN were dilated branches covered by pancreatic intraepithelial neoplasia. CONCLUSIONS Positive results on SPACE were significantly associated with the clinical diagnosis of IPMN and the large FPPA. Moreover, these disorders are significantly related. Surgery owing to positive results could lead to the histopathological diagnosis of HGP/CIS.
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Affiliation(s)
- Masataka Kikuyama
- Department of Gastroenterology, Tokyo Women's Medical Hospital, Tokyo, Japan; Department of Gastroenterology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan.
| | - Jun Nakahodo
- Department of Gastroenterology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Goro Honda
- Department of Surgery, Tokyo Women's Medical Hospital, Tokyo, Japan
| | - Mizuka Suzuki
- Department of Radiology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | | | - Kazuro Chiba
- Department of Gastroenterology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Hiroki Tabata
- Department of Gastroenterology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Yusuke Ome
- Department of Surgery, Tokyo Women's Medical Hospital, Tokyo, Japan
| | | | - Yusuke Kawamoto
- Department of Surgery, Tokyo Women's Medical Hospital, Tokyo, Japan
| | - Terumi Kamisawa
- Department of Gastroenterology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
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Nakahodo J, Kikuyama M, Fukumura Y, Horiguchi SI, Chiba K, Tabata H, Suzuki M, Kamisawa T. Focal pancreatic parenchyma atrophy is a harbinger of pancreatic cancer and a clue to the intraductal spreading subtype. Pancreatology 2022; 22:1148-1158. [PMID: 36273992 DOI: 10.1016/j.pan.2022.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 09/14/2022] [Accepted: 10/11/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND/OBJECTIVES Radiological evidence of focal pancreatic parenchymal atrophy (FPPA) may presage early pancreatic ductal adenocarcinoma (PDAC) development. We aimed to clarify the incidence of FPPA and the clinicopathological features of PDAC with FPPA before diagnosis. METHODS Data on endoscopic ultrasound-guided fine-needle biopsies and surgical samples from 170 patients with pancreatic cancer histologically diagnosed between 2014 and 2019 were extracted from the pathology database of Komagome Hospital and Juntendo University hospital and retrospectively evaluated together with 51 patients without PDAC. RESULTS FPPA was identified in 47/170 (28%) patients before PDAC diagnosis and in 2/51 (4%) patients in the control group (P < 0.01). The median duration from FPPA detection to diagnosis was 35 (interquartile range [IQR]:16-63) months. In 24/47 (51%) patients with FPPA, the atrophic area resolved. The lesion was in the head and body/tail in 7/40 and 67/56 of the patients with (n = 47) and without FPPA (n = 123), respectively (P < 0.001). Histopathologically confirmed non-invasive lesions in the main pancreatic duct and a positive surgical margin in the resected specimens occurred in 53% vs. 21% (P = 0.078) and 29% vs. 3% (P = 0.001) of the groups, respectively. The PDAC patients with FPPA accompanied by a malignant pancreatic resection margin had high-grade pancreatic intraepithelial neoplasia. CONCLUSIONS FPPA occurred in 28% of the PDAC group at 35 months prediagnosis. The FPPA area resolved before PDAC onset. Benchmarking previous images of the pancreas with the focus on FPPA may enable prediction of PDAC. PDAC with FPPA involves widespread high-grade pancreatic intraepithelial neoplasia requiring a wide surgical margin for surgical excision.
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Affiliation(s)
- Jun Nakahodo
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Bunkyo-Ku, Tokyo, Japan; Department of Human Pathology, Juntendo University, Bunkyo-Ku, Tokyo, Japan; Pancreatic Cancer Research for Secure Salvage Young Investigators (PASSYON), Japan.
| | - Masataka Kikuyama
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Bunkyo-Ku, Tokyo, Japan; Department of Gastroenterology, Tokyo Women's Medical University Hospital, Shinjuku-Ku, Tokyo, Japan
| | - Yuki Fukumura
- Department of Human Pathology, Juntendo University, Bunkyo-Ku, Tokyo, Japan
| | - Shin-Ichiro Horiguchi
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Bunkyo-Ku, Tokyo, Japan
| | - Kazuro Chiba
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Bunkyo-Ku, Tokyo, Japan
| | - Hiroki Tabata
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Bunkyo-Ku, Tokyo, Japan
| | - Mizuka Suzuki
- Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Bunkyo-Ku, Tokyo, Japan
| | - Terumi Kamisawa
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Bunkyo-Ku, Tokyo, Japan
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Matsumura M, Honda G, Tani K, Nemoto S, Ome Y, Hayakawa S, Suzuki M, Horiguchi S, Kikuyama M, Seyama Y. The outcome of a multidisciplinary approach incorporating neoadjuvant chemoradiotherapy with
S1
for resectable pancreatic ductal adenocarcinoma. Ann Gastroenterol Surg 2022; 7:306-317. [PMID: 36998294 PMCID: PMC10043772 DOI: 10.1002/ags3.12624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/14/2022] [Indexed: 04/01/2023] Open
Abstract
Aim This study was performed to evaluate the efficacy of a multidisciplinary approach incorporating neoadjuvant chemoradiotherapy with S1 (S1-NACRT) for resectable pancreatic ductal adenocarcinoma. Methods The medical records of 132 patients who received S1-NACRT for resectable pancreatic ductal adenocarcinoma from 2010 to 2019 were reviewed. The S1-NACRT regimen consisted of S1 at a dose of 80-120 mg/body/day together with 1.8 Gy of radiation in 28 fractions. The patients were re-evaluated 4 weeks after S1-NACRT completion, and a pancreatectomy was then considered. Results Adverse events of S1-NACRT ≥grade 3 occurred in 22.7% of the patients, and 1.5% discontinued therapy. Of the 112 patients who underwent a pancreatectomy, 109 underwent R0 resection. Adjuvant chemotherapy with relative dose intensity ≥50% was administered to 74.1% of the patients who underwent resection. The median overall survival of all patients was 47 months, and the median overall survival and recurrence-free survival of patients who underwent resection was 71 and 32 months, respectively. According to the multivariate analyses of prognostic factors for overall survival in patients who underwent resection, negative margin status (hazard ratio: 0.182; P = 0.006) and relative dose intensity of adjuvant chemotherapy ≥50% (hazard ratio 0.294; P < 0.001) were independent prognostic factors of overall survival. Conclusions A multidisciplinary approach incorporating S1-NACRT for resectable pancreatic ductal adenocarcinoma demonstrated acceptable tolerability and good local control and resulted in comparable survival benefits.
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Affiliation(s)
- Masaru Matsumura
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalTokyoJapan
| | - Goro Honda
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalTokyoJapan
- Department of Surgery, Institute of GastroenterologyTokyo Women's Medical UniversityTokyoJapan
| | - Keigo Tani
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalTokyoJapan
| | - Satoshi Nemoto
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalTokyoJapan
| | - Yusuke Ome
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalTokyoJapan
- Department of Surgery, Institute of GastroenterologyTokyo Women's Medical UniversityTokyoJapan
| | - Sara Hayakawa
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalTokyoJapan
| | - Mizuka Suzuki
- Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalTokyoJapan
| | - Shin‐ichiro Horiguchi
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalTokyoJapan
| | - Masataka Kikuyama
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalTokyoJapan
| | - Yasuji Seyama
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalTokyoJapan
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Watanabe K, Kamisawa T, Chiba K, Kikuyama M, Nakahodo J, Igarashi Y. Gallbladder wall thickening in patients with IgG4-related diseases, with special emphasis on IgG4-related cholecystitis. Scand J Gastroenterol 2021; 56:1456-1461. [PMID: 34486468 DOI: 10.1080/00365521.2021.1971758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Gallbladder (GB) wall thickening sometimes occurs in patients with autoimmune pancreatitis (AIP), a condition for which the name, IgG4-related cholecystitis, was proposed. We examined the radiological findings of the GB in patients with IgG4-related diseases and clinical features of patients with GB wall thickening and presented a hypothesis of its pathogenesis. MATERIALS AND METHODS GB wall thickening was defined by thickness ≥ 4 mm. GB wall thickness was examined in 258 patients with IgG4-related disease. Clinical and imaging findings of 200 patients with AIP with and without GB wall thickening were then compared. RESULTS GB wall thickening was detected in 58 patients (29%) with AIP and two patients with isolated IgG4-related sclerosing cholangitis. In the 60 GBs examined, wall thickening was diffuse, with the walls possessing a smooth inner surface. No GB wall thickening was detected among the 56 patients with IgG4-related disease without AIP or IgG4-related sclerosing cholangitis. Bile duct stenosis was detected in 56 patients (97%) with AIP with GB wall thickening. Intraductal ultrasonography indicated cystic duct wall thickening connected to bile duct wall thickening in 11 of 14 (79%) patients with AIP or IgG4-related sclerosing cholangitis with GB wall thickening. Forty-eight patients in whom IgG4-related cholecystitis was diagnosed experienced resolution of the GB wall thickening after receiving steroid therapy. CONCLUSIONS Most cases of GB wall thickening in IgG4-related diseases are closely associated with IgG4-related sclerosing cholangitis and may be a manifestation of IgG4-related disease throughout the biliary tract, including the bile duct, cystic duct, and GB.
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Affiliation(s)
- Koji Watanabe
- Department of Internal Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, Tokyo, Japan
| | - Terumi Kamisawa
- Department of Internal Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Kazuro Chiba
- Department of Internal Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Masataka Kikuyama
- Department of Internal Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Jun Nakahodo
- Department of Internal Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Yoshinori Igarashi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, Tokyo, Japan
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Satoh T, Kikuyama M, Sasaki K, Ishiwatari H, Kawaguchi S, Sato J, Kaneko J, Matsubayashi H. Detectability on Plain CT is an Effective Discriminator between Carcinoma and Benign Disorder for a Polyp >10 mm in the Gallbladder. Diagnostics (Basel) 2021; 11:diagnostics11030388. [PMID: 33668755 PMCID: PMC7996218 DOI: 10.3390/diagnostics11030388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/06/2021] [Revised: 02/13/2021] [Accepted: 02/22/2021] [Indexed: 12/25/2022] Open
Abstract
An appropriate diagnosis is required to avoid unnecessary surgery for gallbladder cholesterol polyps (GChPs) and to appropriately treat pedunculated gallbladder carcinomas (GCs). Generally, polyps >10 mm are regarded as surgical candidates. We retrospectively evaluated plain and contrast-enhanced (CE) computed tomography (CT) findings and histopathological features of 11 early GCs and 10 GChPs sized 10–30 mm to differentiate between GC and GChP >10 mm and determine their histopathological background. Patient characteristics, including polyp size, did not significantly differ between groups. All GCs and GChPs were detected on CE-CT; GCs were detected more often than GChPs on plain CT (73% vs. 9%; p < 0.01). Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy for GCs were 73%, 90%, 89%, 75%, and 81%, respectively. On multivariate analysis, lesion detectability on plain CT was independently associated with GCs (odds ratio, 27.1; p = 0.044). Histopathologically, GChPs consisted of adipose tissue. Although larger vessel areas in GCs than in GChPs was not significant (52,737 μm2 vs. 31,906 μm2; p = 0.51), cell densities were significantly greater in GCs (0.015/μm2 vs. 0.0080/μm2; p < 0.01). Among GPs larger than 10 mm, plain CT could contribute to differentiating GCs from GChPs.
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Affiliation(s)
- Tatsunori Satoh
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka 411-8777, Japan; (H.I.); (J.S.); (J.K.); (H.M.)
- Correspondence: ; Tel.: +81-55-989-5222
| | - Masataka Kikuyama
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-0021, Japan;
| | - Keiko Sasaki
- Division of Pathology, Shizuoka Cancer Center, Shizuoka 411-8777, Japan;
| | - Hirotoshi Ishiwatari
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka 411-8777, Japan; (H.I.); (J.S.); (J.K.); (H.M.)
| | - Shinya Kawaguchi
- Department of Gastroenterology, Shizuoka General Hospital, Shizuoka 420-8527, Japan;
| | - Junya Sato
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka 411-8777, Japan; (H.I.); (J.S.); (J.K.); (H.M.)
| | - Junichi Kaneko
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka 411-8777, Japan; (H.I.); (J.S.); (J.K.); (H.M.)
| | - Hiroyuki Matsubayashi
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka 411-8777, Japan; (H.I.); (J.S.); (J.K.); (H.M.)
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Shimizuguchi R, Kikuyama M, Kamisawa T, Kuruma S, Chiba K. Acute obstructive suppurative pancreatic ductitis in pancreatic malignancies. Endosc Int Open 2020; 8:E1765-E1768. [PMID: 33269309 PMCID: PMC7671758 DOI: 10.1055/a-1268-7086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/03/2020] [Indexed: 10/26/2022] Open
Abstract
Background and study aims Acute obstructive suppurative pancreatic ductitis (AOSPD) is a suppurative pancreatic duct infection with main pancreatic duct (MPD) or accessory pancreatic duct obstruction in the absence of a pancreatic pseudocyst or necrosis, which is experienced usually in chronic pancreatitis. The diagnosis is confirmed by the finding of pancreatic duct obstruction on endoscopic retrograde cholangiopancreatography (ERCP) with evidence of infection, such as a positive pancreatic juice culture or drainage of purulent pancreatic juice. Patients and methods We studied five patients with pancreatic ductal adenocarcinoma (PDAC) and one with chronic myelogenous leukemia (CML), who suffered from AOSPD. Results Of the 281 PDAC and 39 CML patients who we treated in the past 2 years in our hospital, five with PDAC (1.8 %) and one with CML (2.6 %) experienced AOSPD. Each patient had fever, abdominal pain, and increased blood C-reactive protein. Pancreatography found that each patient had a MPD stricture and an upstream dilatation. Four had a disruption of the MPD in the upper stream of the stricture. Nasopancreatic drainage was successfully performed in all patients. Pancreatic juice culture was positive for Klebsiella pneumonia, Enterobacter agerogenes, or Enterococcus cloacae in four patients. Conclusion AOSPD should be considered in pancreatic malignancy with fever and abdominal pain. Prompt diagnosis of AOSPD could avoid shortening of survival of patients with an already poor prognosis by infection.
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Affiliation(s)
- Ryoko Shimizuguchi
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Masataka Kikuyama
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Terumi Kamisawa
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Sawako Kuruma
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Kazuro Chiba
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
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Nakahodo J, Kikuyama M, Nojiri S, Chiba K, Yoshimoto K, Kamisawa T, Horiguchi SI, Honda G. Focal parenchymal atrophy of pancreas: An important sign of underlying high-grade pancreatic intraepithelial neoplasia without invasive carcinoma, i.e., carcinoma in situ. Pancreatology 2020; 20:1689-1697. [PMID: 33039293 DOI: 10.1016/j.pan.2020.09.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Diagnosing high-grade intraepithelial neoplasia without invasion, traditionally referred to as carcinoma in situ (CIS), is essential for improving prognosis. We examined the imaging findings of patients with and without CIS to identify significant aspects for the diagnosis of CIS. METHODS Forty-six patients strongly suspected of early pancreatic cancer without nodule on imaging (CIS group, n = 27; non-malignant group, n = 19) were retrospectively evaluated according to ten factors of computed tomography/magnetic resonance imaging (CT/MRI), endoscopic ultrasonography (EUS), and endoscopic retrograde cholangiopancreatography (ERCP) using hierarchical cluster and univariate analyses. RESULTS Two clusters were formed by hierarchical cluster analysis. One cluster consisted of 83.3% CIS cases with similar image findings such as focal pancreatic parenchymal atrophy (FPPA) on CT/MRI, main pancreatic duct (MPD) stricture surrounded by hypoechoic areas on EUS, and MPD stricture with upstream MPD dilation on ERCP. On univariate analysis, the CIS and non-malignant groups had FPPA on CT/MRI in 15 (55.6%) and 3 (15.8%) cases (p = 0.013), and MPD stricture surrounded by hypoechoic areas on EUS in 20 (74.1%) and 4 (21.1%) cases (p = 0.001), respectively. MPD stricture surrounded by hypoechoic areas was observed in 80% (12/15) of CIS cases with FPPA on CT/MRI and correlated with FPPA. Moreover, FPPA and MPD stricture surrounded by hypoechoic areas had histopathologically observed fibrosis or fat replacement due to pancreatic parenchymal atrophy. CONCLUSIONS FPPA and MPD stricture surrounded by hypoechoic areas are significant findings for the diagnosis of CIS.
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Affiliation(s)
- Jun Nakahodo
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Bunkyo-Ku, Tokyo, Japan; Department of Human Pathology, Juntendo University, Bunkyo-Ku, Tokyo, Japan.
| | - Masataka Kikuyama
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Bunkyo-Ku, Tokyo, Japan
| | - Shuko Nojiri
- Department of Medical Technology Innovation Center, Juntendo University, Bunkyo-Ku, Tokyo, Japan
| | - Kazuro Chiba
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Bunkyo-Ku, Tokyo, Japan
| | - Kensuke Yoshimoto
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Bunkyo-Ku, Tokyo, Japan; Division of Gastroenterology and Hepatology, Department of Internal Medicine (Omori), School of Medicine, Faculty of Medicine, Toho University, Ota-ku, Tokyo, Japan
| | - Terumi Kamisawa
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Bunkyo-Ku, Tokyo, Japan
| | - Shin-Ichiro Horiguchi
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Bunkyo-Ku, Tokyo, Japan
| | - Goro Honda
- Department of Gastroenterological Surgery, New Tokyo Hospital, Matsudo, Chiba, Japan
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10
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Kuruma S, Kikuyama M, Chiba K, Yoshimoto K, Kamisawa T, Honda G, Horiguchi S, Nakahodo J. Carcinoma in situ of the pancreas with pancreatic duct stricture persistent for 4 years diagnosed by serial pancreatic juice aspiration cytologic examination (SPACE). Clin J Gastroenterol 2019; 13:443-447. [PMID: 31768883 DOI: 10.1007/s12328-019-01065-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 10/28/2019] [Indexed: 01/06/2023]
Abstract
Serial pancreatic juice aspiration cytologic examination (SPACE) by nasopancreatic tube placement can give us an opportunity to diagnose early-stage pancreatic cancer with higher sensitivity and specificity compared with conventional pancreatic cytology by one-time pancreatic juice aspiration or pancreatic duct brushing. We performed SPACE in a patient with persistent pancreatic duct stricture (PDS) with gradually advancing pancreatic parenchyma atrophy (PPA) in the pancreas tail. The result of SPACE was suggestive of pancreatic carcinoma, and distal pancreatectomy was performed. Histopathological examination of the resected specimen revealed carcinoma in situ of the pancreas. The present case could indicate that any PDS becomes a candidate for SPACE especially in a patient with PPA, although the PDS remains unchanged for a long period.
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Affiliation(s)
- Sawako Kuruma
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Komagome Hospital, Tokyo, Japan.
| | - Masataka Kikuyama
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Komagome Hospital, Tokyo, Japan
| | - Kazuro Chiba
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Komagome Hospital, Tokyo, Japan
| | - Kensuke Yoshimoto
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Komagome Hospital, Tokyo, Japan
| | - Terumi Kamisawa
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Komagome Hospital, Tokyo, Japan
| | - Goro Honda
- Department of Surgery, New Tokyo Hospital, Chiba, Japan
| | - Shinichiro Horiguchi
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Komagome Hospital, Tokyo, Japan
| | - Jun Nakahodo
- Department of Human Pathology, Juntendo University, Tokyo, Japan
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Yoshimoto K, Kamisawa T, Kikuyama M, Kuruma S, Chiba K, Igarashi Y. Classification of pancreaticobiliary maljunction and its clinical features in adults. J Hepatobiliary Pancreat Sci 2019; 26:541-547. [PMID: 31633314 DOI: 10.1002/jhbp.691] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND In pancreaticobiliary maljunction (PBM), reflux of pancreatic juice and bile produces various pathological conditions in the biliary tract and pancreas. Clinical features according to the classification of PBM by confluence between the distal bile duct and the main pancreatic duct proposed in 2015 were evaluated in children. METHODS Clinical features and complicating diseases according to the PBM classification were evaluated in 168 adult PBM patients. Patency of Santorini duct and associated biliary carcinomas were evaluated in 123 patients. RESULTS Similar to children, there were significant differences in age (P < 0.01) and type of common bile duct (P < 0.01) between the groups of the classification. Unlike in children, there was no significant difference in the incidence of abdominal pain and hyperamylasemia. There were 87 associated biliary carcinomas (79 gallbladder carcinomas and eight cholangiocarcinomas). PBM patients with a cudgel-type Santorini duct, which is greater than 2 mm in diameter, did not develop biliary carcinomas, compared to 61.1% of those with other types of Santorini duct (P < 0.01). CONCLUSIONS Clinical features according to the PBM classification in adults were different from those in children. Although biliary carcinomas were frequently seen in adult PBM patients, none of those with a cudgel-type Santorini duct developed biliary carcinoma.
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Affiliation(s)
- Kensuke Yoshimoto
- Department of Internal Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, Tokyo, Japan
| | - Terumi Kamisawa
- Department of Internal Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Masataka Kikuyama
- Department of Internal Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Sawako Kuruma
- Department of Internal Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Kazuro Chiba
- Department of Internal Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Yoshinori Igarashi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, Tokyo, Japan
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Matsubayashi H, Kiyozumi Y, Ishiwatari H, Uesaka K, Kikuyama M, Ono H. Surveillance of Individuals with a Family History of Pancreatic Cancer and Inherited Cancer Syndromes: A Strategy for Detecting Early Pancreatic Cancers. Diagnostics (Basel) 2019; 9:E169. [PMID: 31683730 PMCID: PMC6963266 DOI: 10.3390/diagnostics9040169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 10/13/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 12/13/2022] Open
Abstract
A family history of pancreatic cancer (PC) is a risk factor of PC, and risk levels increase as affected families grow in number and/or develop PC at younger ages. Familial pancreatic cancer (FPC) is defined as a client having at least two PC cases in a first degree relatives. In the narrow sense, FPC does not include some inherited cancer syndromes that are known to increase the risks of PC, such as Peutz-Jeghers syndrome (PJS), hereditary pancreatitis (HP), hereditary breast ovarian cancer syndrome (HBOC), and so on. FPC accounts for 5%-10% of total PC diagnoses and is marked by several features in genetic, epidemiological, and clinicopathological findings that are similar to or distinct from conventional PC. Recent advances in genetic medicine have led to an increased ability to identify germline variants of cancer-associated genes. To date, high-risk individuals (HRIs) in many developed countries, including FPC kindreds and inherited cancer syndromes, are screened clinically to detect and treat early-stage PC. This article highlights the concept of FPC and the most recent data on its detection.
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Affiliation(s)
- Hiroyuki Matsubayashi
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka 411-8777, Japan.
- Division of Genetic Medicine Promotion, Shizuoka Cancer Center, Shizuoka 411-8777, Japan.
| | - Yoshimi Kiyozumi
- Division of Genetic Medicine Promotion, Shizuoka Cancer Center, Shizuoka 411-8777, Japan.
| | | | - Katsuhiko Uesaka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka 411-8777, Japan.
| | - Masataka Kikuyama
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-0021, Japan.
| | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka 411-8777, Japan.
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13
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Kuruma S, Kamisawa T, Kikuyama M, Chiba K, Shimizuguchi R, Koizumi S, Tabata T. Clinical characteristics of autoimmune pancreatitis with IgG4 related kidney disease. Adv Med Sci 2019; 64:246-251. [PMID: 30826634 DOI: 10.1016/j.advms.2018.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 09/29/2018] [Accepted: 12/10/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE To clarify the clinical characteristics of autoimmune pancreatitis (AIP) in immunoglobulin (Ig)G4-related kidney disease (IgG4-RKD). PATIENTS AND METHODS A total of 92 patients with AIP were divided into an IgG4-RKD-positive group (RKD-P group, n = 13) and an IgG4-RKD-negative group (RKD-N group, n = 79) on the basis of the diagnostic criteria for IgG4-RKD. Clinical characteristics, including: age; sex; the presence of extrapancreatic lesions other than renal lesions, proteinuria, and hematuria; serum concentrations of IgG, IgG4, IgE, and creatinine; and urinary concentrations of liver-type fatty acid binding protein, α1-microglobulin, β2-microglobulin, and N-acetyl-β-d-glucosaminidase were compared between the RKD-P and RKD-N groups. The clinical course of the RKD-P group was also characterized. RESULTS The prevalence of extrapancreatic lesions other than renal lesions was significantly higher in the RKD-P group (84.6% vs 43.0%,p < 0.01). Serum creatinine (1.19 mg/dl versus 0.74 mg/dl, p < 0.05), urinary β2-microglobulin (6609.8 μg/l vs 265.8 μg/l, p < 0.05), and the prevalence of proteinuria (30.7% vs 7.6%, p < 0.05) were significantly higher in the RKD-P group. Nine out of thirteen patients in the RKD-P group had multiple low-density renal lesions on enhanced computed tomography, 3 patients had multiple high-intensity lesions on diffusion-weighted magnetic resonance images, and 1 patient had diffuse thickening of the renal wall, with a smooth intra-luminal surface. CONCLUSIONS Patients who had AIP with IgG4-RKD were more likely to have extrapancreatic lesions other than those in the kidney, and their serum creatinine and urinary β2-microglobulin concentrations were significantly higher than in those without IgG4-RKD.
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14
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Kuruma S, Kikuyama M, Kamisawa T, Chiba K. Hyper-dense fluid on plain computed tomography may reveal a ruptured aneurysm in patients with median arcuate ligament syndrome. Clin J Gastroenterol 2019; 12:473-478. [PMID: 30997671 DOI: 10.1007/s12328-019-00968-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 03/16/2019] [Indexed: 11/26/2022]
Abstract
Rupture of abdominal aneurysms associated with median arcuate ligament syndrome (MALS) is a serious condition and requires accurate diagnosis in a clinical setting. We examined three patients with this condition: two women aged 45 and 71 years, and a 61-year-old man. They complained of abdominal pain and had fluid collection around the duodenum. Plain computed tomography (CT) of the fluid collection revealed hyper density, which suggests the presence of blood. Moreover, contrast-enhanced CT revealed aneurysms in the pancreatic head area. Angiography revealed aneurysms of the branches of the gastroepiploic artery, which were treated by endovascular embolization in all patients. Thus, patients with abdominal pain and high-density fluid collection around the duodenum on plain CT may suffer from hemorrhage following rupture of MALS-associated aneurysms.
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Affiliation(s)
- Sawako Kuruma
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan.
| | - Masataka Kikuyama
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Terumi Kamisawa
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Kazuro Chiba
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
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15
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Kikuyama M, Kato M, Kaisaki S, Yao Y, Sakatani T. Analysis of the utility of 3D digital breast tomosynthesis. Breast 2019. [DOI: 10.1016/s0960-9776(19)30209-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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16
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Kanno A, Masamune A, Hanada K, Kikuyama M, Kitano M. Advances in Early Detection of Pancreatic Cancer. Diagnostics (Basel) 2019; 9:diagnostics9010018. [PMID: 30764550 PMCID: PMC6468351 DOI: 10.3390/diagnostics9010018] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 01/10/2019] [Revised: 01/24/2019] [Accepted: 01/28/2019] [Indexed: 12/12/2022] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is a lethal disease. PDAC is the fourth leading cause of death in the United States and Japan based on epidemiological data. Early detection of PDAC is very important to improve the prognosis of PDAC. Early detection of pancreatic ductal adenocarcinoma (PDAC) requires further examination after selecting cases with risk factors for the condition, such as family history, hereditary pancreatic carcinoma syndrome, intraductal papillary mucinous neoplasms, or chronic pancreatitis. The Japan Study Group on the Early Detection of Pancreatic Cancer has investigated and clarified the clinicopathological features for the early diagnosis of PDAC. In Japan, an algorithm for the early diagnosis of PDAC, which utilized the cooperation of local clinics and regional general hospitals, has been a breakthrough in the detection of early-stage PDAC. Further approaches for the early diagnosis of PDAC are warranted.
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Affiliation(s)
- Atsushi Kanno
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
- Japan Study Group on the Early Detection of Pancreatic Cancer (JEDPAC), Onomichi 722-8508, Japan.
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
| | - Keiji Hanada
- Japan Study Group on the Early Detection of Pancreatic Cancer (JEDPAC), Onomichi 722-8508, Japan.
- Department of Gastroenterology, JA Onomichi General Hospital, Onomichi 722-8508, Japan.
| | - Masataka Kikuyama
- Japan Study Group on the Early Detection of Pancreatic Cancer (JEDPAC), Onomichi 722-8508, Japan.
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Komagome Hospital, Tokyo 113-0021, Japan.
| | - Masayuki Kitano
- Japan Study Group on the Early Detection of Pancreatic Cancer (JEDPAC), Onomichi 722-8508, Japan.
- Department of Gastroenterology, Wakayama Medical University School of Medicine, Wakayama 641-0012, Japan.
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17
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Masui Y, Kikuyama M, Kawaguchi S, Kanemoto H. Hereditary Pancreatitis Showing Numerous Cysts with Pancreatic Cancer. Intern Med 2018; 57:3333-3334. [PMID: 29984748 PMCID: PMC6287986 DOI: 10.2169/internalmedicine.0938-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Yuichi Masui
- Department of Gastroenterology, Shizuoka General Hospital, Japan
| | - Masataka Kikuyama
- Department of Gastroenterology, Shizuoka General Hospital, Japan
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Komagome Hospital, Japan
| | - Shinya Kawaguchi
- Department of Gastroenterology, Shizuoka General Hospital, Japan
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18
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Abstract
Five patients complaining of severe pain due to severe post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) underwent nasopancreatic drainage (NPD) placement. Pain relief was achieved on the second, fourth, and fifth day in three, one, and one patients, respectively. Four patients underwent pancreatic juice culture; all were positive. Our results suggest that NPD can relieve severe PEP with severe pain. Bacteria-induced protease-activated receptor-2 activation may be associated with PEP.
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Affiliation(s)
- Shinya Kawaguchi
- Department of Gastroenterology, Shizuoka General Hospital, Japan
| | - Masataka Kikuyama
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Tatsunori Satoh
- Department of Gastroenterology, Shizuoka General Hospital, Japan
| | - Shuzo Terada
- Department of Gastroenterology, Shizuoka General Hospital, Japan
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19
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Shimizuguchi R, Kamisawa T, Endo Y, Kikuyama M, Kuruma S, Chiba K, Tabata T, Koizumi S. Hypothyroidism in patients with autoimmune pancreatitis. World J Gastrointest Pharmacol Ther 2018; 9:16-21. [PMID: 29736303 PMCID: PMC5937026 DOI: 10.4292/wjgpt.v9.i2.16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 12/24/2017] [Revised: 01/30/2018] [Accepted: 03/07/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To examine thyroid function and clinical features of hypothyroidism in autoimmune pancreatitis (AIP) patients.
METHODS We examined thyroid function in 77 patients with type 1 AIP (50 males, 27 females; median age 68 years, range 33-85) diagnosed according to the Japanese diagnostic criteria for AIP 2011. We compared clinical and serological findings between patients with and without various categories of hypothyroidism. The change in hypothyroidism after steroid therapy was also examined.
RESULTS Eight patients (10%) had hypothyroidism of 6 patients had subclinical hypothyroidism with a normal serum free thyroxine (FT4) and high thyroid stimulating hormone (TSH) level, and 2 patients had central hypothyroidism with low serum free triiodothyronine (FT3), FT4 and TSH levels. A significant goiter of the thyroid was not observed in any patient. There were no significant differences in age; male to female ratio; serum concentrations of IgG and IgG4-related disease (IgG4-RD); presence of anti-thyroglobulin antibody, antinuclear antigen or rheumatoid factor; or presence of extrapancreatic lesions between the 6 patients with subclinical hypothyroidism and patients with euthyroidism. After steroid therapy, both subclinical and central hypothyroidism improved with improvement of the AIP.
CONCLUSION Hypothyroidism was observed in 8 (10%) of 77 AIP patients and was subclinical in 6 patients and central in 2 patients. Further studies are necessary to clarify whether this subclinical hypothyroidism is another manifestation of IgG4-RD.
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Affiliation(s)
- Ryoko Shimizuguchi
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo 113-8677, Japan
| | - Terumi Kamisawa
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo 113-8677, Japan
| | - Yuka Endo
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo 113-8677, Japan
| | - Masataka Kikuyama
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo 113-8677, Japan
| | - Sawako Kuruma
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo 113-8677, Japan
| | - Kazuro Chiba
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo 113-8677, Japan
| | - Taku Tabata
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo 113-8677, Japan
| | - Satomi Koizumi
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo 113-8677, Japan
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20
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Shimizuguchi R, Kikuyama M, Kamisawa T, Kuruma S, Chiba K. Acute obstructive suppurative pancreatic ductitis (AOSPD) in pancreatic cancer treated by nasopancreatic drainage. Clin J Gastroenterol 2018; 11:315-319. [PMID: 29464657 DOI: 10.1007/s12328-018-0830-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 02/05/2018] [Indexed: 10/18/2022]
Abstract
An 80-year-old woman with pancreatic cancer was admitted with fever and abdominal pain. Blood examinations showed an elevated CRP level. On computed tomography (CT), a pancreatic tumor with a dilated upstream main pancreatic duct (MPD) was seen. Endoscopic retrograde cholangiopancreatography (ERCP) showed the strictured part of the MPD at the head of the pancreas with upstream dilatation. A nasopancreatic drainage tube was placed. Through the tube, purulent pancreatic juice was discharged and culture of the pancreatic juice grew Klebsiella pneumoniae. On the day after ERCP, the patient's condition and the laboratory results improved. The patient's disorder was diagnosed as acute obstructive suppurative pancreatitis with pancreatic cancer.
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Affiliation(s)
- Ryoko Shimizuguchi
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Masataka Kikuyama
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
| | - Terumi Kamisawa
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Sawako Kuruma
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Kazuro Chiba
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
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Kikuyama M, Kamisawa T, Kuruma S, Chiba K, Kawaguchi S, Terada S, Satoh T. Early Diagnosis to Improve the Poor Prognosis of Pancreatic Cancer. Cancers (Basel) 2018; 10:cancers10020048. [PMID: 29439461 PMCID: PMC5836080 DOI: 10.3390/cancers10020048] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 01/25/2018] [Accepted: 02/02/2018] [Indexed: 12/12/2022] Open
Abstract
Pancreatic cancer (PC) has a poor prognosis due to delayed diagnosis. Early diagnosis is the most important factor for improving prognosis. For early diagnosis of PC, patients with clinical manifestations suggestive of PC and high risk for developing PC need to be selected for examinations for PC. Signs suggestive of PC (e.g., symptoms, diabetes mellitus, acute pancreatitis, or abnormal results of blood examinations) should not be missed, and the details of risks for PC (e.g., familial history of PC, intraductal mucin producing neoplasm, chronic pancreatitis, hereditary pancreatitis, or life habit) should be understood. Multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) can be performed for diagnosing PC, but the diagnostic ability of these examinations for PC is limited. Endoscopic diagnostic procedures, such as endoscopic ultrasonography, including fine-needle aspiration, and endoscopic retrograde pancreatocholangiography, including Serial Pancreatic-juice Aspiration Cytologic Examination (SPACE), could be recommended for a detailed examination to diagnose pancreatic carcinoma earlier.
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Affiliation(s)
- Masataka Kikuyama
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan.
| | - Terumi Kamisawa
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan.
| | - Sawako Kuruma
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan.
| | - Kazuro Chiba
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan.
| | - Shinya Kawaguchi
- Department of Gastroenterology, Shizuoka General Hospital, Shizuoka 420-8527, Japan.
| | - Shuzo Terada
- Department of Gastroenterology, Shizuoka General Hospital, Shizuoka 420-8527, Japan.
| | - Tatsunori Satoh
- Department of Gastroenterology, Shizuoka General Hospital, Shizuoka 420-8527, Japan.
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22
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Kikuyama M, Shirane N, Kawaguchi S, Terada S, Mukai T, Sugimoto K. New 14-mm diameter Niti-S biliary uncovered metal stent for unresectable distal biliary malignant obstruction. World J Gastrointest Endosc 2018; 10:16-22. [PMID: 29375737 PMCID: PMC5768999 DOI: 10.4253/wjge.v10.i1.16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 07/04/2017] [Revised: 08/24/2017] [Accepted: 11/03/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate whether an uncovered self-expandable metal stent (UCSEMS) with a large diameter could prevent recurrent biliary obstruction (RBO).
METHODS Thirty-eight patients with malignant biliary obstruction underwent treatment with an UCSEMS with a 14-mm diameter (Niti-S 14). Retrospectively, we evaluated technical and functional success rate, RBO rate, time to RBO, survival time, and adverse events in these patients.
RESULTS Stent placement success and functional success were achieved in all patients. Two patients (5.3%) had RBO due to tumor ingrowth or overgrowth. The median time to RBO was 190 (range, 164-215) d. The median survival time was 120 (range, 18-502) d. The 6-mo non-RBO rate was 91%. Other adverse events other than RBO occurred as follows: Acute cholecystitis, post-ERCP pancreatitis, hemobilia, and fever without exacerbation of liver injury, and liver abscess in 4 (10.3%), 3 (7.9%), 2 (5.3%), 1 (2.6%), and 1 (2.6%), respectively. Migration of the stents was not observed.
CONCLUSION Niti-S 14 is considered to be a preferable metal stent because of a low rate of RBO with no migration.
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Affiliation(s)
- Masataka Kikuyama
- Department of Gastroenterology, Komagome Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-8677, Japan
| | - Naofumi Shirane
- Department of Gastroenterology, Komagome Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-8677, Japan
- Department of Gastroenterology, Shizuoka General Hospital, Shizuoka 432-8021, Japan
| | - Shinya Kawaguchi
- Department of Gastroenterology, Komagome Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-8677, Japan
| | - Shuzou Terada
- Department of Gastroenterology, Komagome Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-8677, Japan
| | - Tsuyoshi Mukai
- Department of Gastroenterology, Komagome Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-8677, Japan
- Department of Gastroenterology, Gifu Municipal Hospital, Gifu 500-8513, Japan
| | - Ken Sugimoto
- Department of Gastroenterology, Komagome Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-8677, Japan
- Department of Gastroenterology, Hamamatsu University School of Medicine, Shizuoka 113-8677, Japan
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23
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Kanno A, Masamune A, Hanada K, Maguchi H, Shimizu Y, Ueki T, Hasebe O, Ohtsuka T, Nakamura M, Takenaka M, Kitano M, Kikuyama M, Gabata T, Yoshida K, Sasaki T, Serikawa M, Furukawa T, Yanagisawa A, Shimosegawa T. Multicenter study of early pancreatic cancer in Japan. Pancreatology 2018; 18:61-67. [PMID: 29170051 DOI: 10.1016/j.pan.2017.11.007] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 10/21/2017] [Accepted: 11/16/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES The diagnosis of early-stage pancreatic ductal adenocarcinoma (PDAC) is still challenging. We conducted a multicenter study to clarify the clinical features of early-stage PDAC in Japan. METHODS We collected patients with stage 0 and stage I PDAC according to the sixth edition of the Japanese Classification of Pancreatic Carcinoma. We retrospectively analyzed the clinical profiles including opportunities for medical examination, imaging modalities and findings, methods of cytological diagnosis, and prognosis according to the stages at diagnosis. RESULTS Two hundred cases with Stage 0 and stage I PDAC were reported from 14 institutions, which accounted for approximately 0.7% and 3% of all PDAC cases, respectively. Overall, 20% of the early-stage PDAC cases were symptomatic. Indirect imaging findings such as dilatation of the main pancreatic duct were useful to detect early-stage PDAC. In particular, local fatty changes may be specific to early-stage PDAC. For preoperative pathologic diagnosis, cytology during endoscopic retrograde cholangiopancreatography was more commonly applied than endoscopic ultrasound fine-needle aspiration. Although the overall prognosis was favorable, new PDAC lesions developed in the remnant pancreas in 11.5% cases. CONCLUSIONS This multicenter study revealed several key points concerning the diagnosis and management of early-stage PDAC, including screening of asymptomatic cases, importance of indirect imaging findings, application of cytology during endoscopic retrograde cholangiopancreatography, and the risk of carcinogenesis in the remnant pancreas.
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Affiliation(s)
- Atsushi Kanno
- Division of Gastroenterology, Tohoku University, Graduate School of Medicine, Japan.
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University, Graduate School of Medicine, Japan
| | - Keiji Hanada
- Department of Gastroenterology, JA Onomichi General Hospital, Japan
| | | | - Yasuhiro Shimizu
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Japan
| | - Toshiharu Ueki
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Japan
| | - Osamu Hasebe
- Department of Gastroenterology, Nagano Municipal Hospital, Japan
| | - Takao Ohtsuka
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University, Faculty of Medicine, Japan
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University, School of Medicine, Japan
| | | | | | - Koji Yoshida
- Department of Interventional Bilio-Pancreatology, Kawasaki Medical School, Japan
| | - Tamito Sasaki
- Department of Gastroenterology, Hiroshima Prefectural Hospital, Japan
| | - Masahiro Serikawa
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Japan
| | - Toru Furukawa
- Institute for Integrated Medical Sciences, Tokyo Women's Medical University, Japan; Department of Histopathology, Tohoku University, Graduate School of Medicine, Japan
| | - Akio Yanagisawa
- Department of Pathology, Kyoto Prefectural University of Medicine, Japan
| | - Tooru Shimosegawa
- Division of Gastroenterology, Tohoku University, Graduate School of Medicine, Japan
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Satoh T, Kikuyama M, Kawaguchi S, Kanemoto H, Muro H, Hanada K. Acute pancreatitis-onset carcinoma in situ of the pancreas with focal fat replacement diagnosed using serial pancreatic-juice aspiration cytologic examination (SPACE). Clin J Gastroenterol 2017; 10:541-545. [PMID: 28986726 DOI: 10.1007/s12328-017-0776-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 09/01/2017] [Indexed: 12/11/2022]
Abstract
A 59-year-old woman was admitted for acute pancreatitis. Abdominal computed tomography and magnetic resonance imaging revealed a swollen pancreatic parenchyma with dilatation of the main pancreatic duct (MPD) of the pancreas tail, which was separated from the normal pancreas body side by a locally atrophic part of the pancreas. Magnetic resonance cholangiopancreatography showed MPD stricture in the pancreas tail with dilatation of the upstream MPD. Endoscopic ultrasonography revealed that the MPD stricture of the pancreas tail was surrounded by a blurred and hypoechoic area. Endoscopic retrograde cholangiopancreatography was performed for serial pancreatic-juice aspiration cytologic examination (SPACE). The result indicated adenocarcinoma. Distal pancreatectomy was performed, and the histopathological examination showed high-grade PanIN (carcinoma in situ of the pancreatic duct) of the pancreas tail with atrophy and fibrosis of the pancreatic parenchyma, and local fat replacement adjacent to the lesion. The final histopathological diagnosis was carcinoma in situ of the pancreatic duct of the pancreas tail. Acute pancreatitis and local fatty change of the pancreatic parenchyma with MPD stricture are important clinical manifestations of pancreatic carcinoma in situ (PCIS) and performing SPACE in cases of MPD stricture without a recognizable mass is preferable for a diagnosis of PCIS.
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Affiliation(s)
- Tatsunori Satoh
- Department of Gastroenterology, Shizuoka General Hospital, 4-27-1, Kita-ando, Aoiku, Shizuoka, 420-8527, Japan.
| | - Masataka Kikuyama
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Shinya Kawaguchi
- Department of Gastroenterology, Shizuoka General Hospital, 4-27-1, Kita-ando, Aoiku, Shizuoka, 420-8527, Japan
| | | | - Hiroyuki Muro
- Department of Pathology, Shizuoka General Hospital, Shizuoka, Japan
| | - Keiji Hanada
- Department of Gastroenterology, JA Onomichi General Hospital, Hiroshima, Japan
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Hanaoka M, Kammisawa T, Koizumi S, Kuruma S, Chiba K, Kikuyama M, Shirakura S, Sugimoto T, Hishima T. Clinical features of IgG4-related rhinosinusitis. Adv Med Sci 2017; 62:393-397. [PMID: 28575786 DOI: 10.1016/j.advms.2017.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 03/05/2017] [Accepted: 04/20/2017] [Indexed: 12/24/2022]
Abstract
PURPOSE IgG4-related disease is a systemic disease that affects various organs of the body. Aim of this study is to elucidate the clinical characteristics of IgG4-related rhinosinusitis. MATERIAL AND METHODS Clinical features, laboratory findings, radiological and endoscopic findings, associated disease, treatment and prognosis were retrospectively examined in 10 patients with IgG4-related rhinosinusitis. RESULTS The age was 59.1±11.3 years old and male-to-female ratio was 1:1. The chief nasal complaints were hyposmia (n=4), nasal obstruction (n=3), and nothing (n=3). Serum IgG4 levels were elevated in all patients and the value was 740.4±472.4mg/dl. Other IgG4-related diseases were associated in all 10 patients, including IgG4-related sialadenitis (n=6), IgG4-related dacryoadenitis (n=5), and autoimmune pancreatitis (n=5). Imaging findings on CT/MRI were obstruction of the way of elimination (n=10), thickening of the sinus mucous membrane (n=10), and fluid in the sinus (n=6). All of the cases had bilateral findings. Nasal endoscopic findings were chiefly deviated nasal septum (n=5), polyps (n=4), edema of the mucous membrane (n=3). Histologically, abundant infiltration of IgG4 positive plasma cell and lymphocyte and an elevated IgG4+/IgG+ cell ration was detected in all 8 patients and 5 patients, respectively. Endoscopic sinus surgery was performed in 8 patients. Eight patients were treated with steroid therapy for other associated IgG4-related diseases. Symptoms improved in all 6 patients after an initial treatment (endoscopic surgery (n=5) and steroids (n=1)), but one patient suffered relapse. CONCLUSIONS IgG4-related rhinosinusitis is a distinct entity of IgG4-related disease, and is associated in patients with multiple IgG4-related diseases.
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Affiliation(s)
- Machiko Hanaoka
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Terumi Kammisawa
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan.
| | - Satomi Koizumi
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Sawako Kuruma
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Kazuro Chiba
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Masataka Kikuyama
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Satoshi Shirakura
- Otorhinolaryngology-Head and Neck Tumor Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Taro Sugimoto
- Otorhinolaryngology-Head and Neck Tumor Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
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26
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Kikuyama M, Kunimata H, Oka T, Tachibana A. Clinicopathological analysis of mucinous carcinoma in breast cancer. Breast 2017. [DOI: 10.1016/s0960-9776(17)30146-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Kamisawa T, Kuruma S, Chiba K, Tabata T, Koizumi S, Kikuyama M. Biliary carcinogenesis in pancreaticobiliary maljunction. J Gastroenterol 2017; 52:158-163. [PMID: 27704265 DOI: 10.1007/s00535-016-1268-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 09/15/2016] [Indexed: 02/07/2023]
Abstract
Pancreaticobiliary maljunction (PBM) is a congenital malformation in which the pancreatic and bile ducts join anatomically outside the duodenal wall. Because of the excessive length of the common channel in PBM, sphincter action does not directly affect the pancreaticobiliary junction, which allows pancreatic juice to reflux into the biliary tract. According to the results of a nationwide survey, bile duct and gallbladder cancers were found in 6.9 and 13.4 % of adult patients with congenital biliary dilatation, respectively, and in 3.1 and 37.4 % of those with PBM without biliary dilatation, respectively. Biliary tract cancers develop about 15-20 years earlier in patients with PBM than in individuals without PBM; they sometimes develop as double cancers. Carcinogenesis is strongly associated with stasis of bile intermingled with refluxed pancreatic juice. Epithelial cells in the biliary tract of PBM patients are under constant attack from activated pancreatic enzymes, increased secondary bile acids, or other mutagens. This can result in hyperplastic change with increased cell proliferation activity, and in turn, oncogene and/or tumor suppressor gene mutations in the epithelia, leading to the biliary tract carcinogenesis. The carcinogenesis of biliary tract cancer accompanying PBM is considered to involve a hyperplasia-dysplasia-carcinoma sequence induced by chronic inflammation caused by the reflux of pancreatic juice into the biliary tract, which differs from the adenoma-carcinoma sequence or the de novo carcinogenesis associated with biliary tract cancers in the population without PBM. Patients with a relatively long common channel have a similar, albeit slightly lower, risk for gallbladder cancer compared with PBM patients.
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Affiliation(s)
- Terumi Kamisawa
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan.
| | - Sawako Kuruma
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Kazuro Chiba
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Taku Tabata
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Satomi Koizumi
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Masataka Kikuyama
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
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Yokoi Y, Kikuyama M. Reply to the letter regarding "early dual drainage combining transpapillary endotherapy and percutaneous catheter drainage in patients with pancreatic fistula associated with severe acute pancreatitis". Pancreatology 2017; 17:153-154. [PMID: 28089101 DOI: 10.1016/j.pan.2017.01.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 01/02/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Yoshihiro Yokoi
- Department of Surgery, Shinshiro Municipal Hospital, 32-1 Kitahata, Shinshiro, Aichi 441-1387, Japan.
| | - Masataka Kikuyama
- Department of Gastroenterology, Shizuoka General Hospital, 4-27-1 Kita-andoh, Aoi-ku, Shizuoka, Shizuoka 425-8527, Japan
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Matsubayashi H, Kishida Y, Iwai T, Murai K, Yoshida M, Imai K, Yamamoto Y, Kikuyama M, Ono H. Transpapillary biliary stenting is a risk factor for pancreatic stones in patients with autoimmune pancreatitis. Endosc Int Open 2016; 4:E912-7. [PMID: 27540582 PMCID: PMC4988851 DOI: 10.1055/s-0042-111201] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 06/13/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND AND STUDY AIM Pancreatic stones occasionally develop in autoimmune pancreatitis (AIP), often worsen endocrine and exocrine functions, and occasionally cause pain attacks. However, the risks of pancreatic stones in AIP have been poorly studied. The aim of this study was to analyze the risk factors associated with pancreatic stone formation in cases of AIP. PATIENTS AND METHODS In total, 50 patients with AIP (39 males, 11 females; mean age 64.0 years), followed up for at least a year, were analyzed for their demographic and clinical findings and pancreatic stone occurrence. RESULTS In total, 50 patients were followed up for an average of 59.7 (12 - 120) months, with steroid treatment in 44 patients (88 %); pancreatic stones occurred in 14 (28 %) patients after the diagnosis of AIP and endoscopic treatment was needed in one patient with pain attack. The pancreatic stones appeared only in patients with long follow-up period (P < 0.001, 83.9 months vs. 49.6 months), biliary stenting (odds ratio [OR]: 8.40, P = 0.010), relapse (OR: 6.20, P = 0.023), jaundice (OR: 5.40, P = 0.019), and swelling of the duodenal major papilla (OR: 4.67, P = 0.040). Biliary stenting was placed for an average of 9.9 months in 27 patients. Multivariate analysis revealed a significant association only with biliary stenting (P = 0.011). The stones appeared relatively earlier in patients with stones in the main pancreatic duct or Santorini duct (22.1 months) than in patients where pancreatic stones developed elsewhere (53.4 months) (P = 0.018). CONCLUSIONS The risk of pancreatic stone development should be taken into account when a biliary stent is placed in patients with AIP.
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Affiliation(s)
- Hiroyuki Matsubayashi
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan,Corresponding author Hiroyuki Matsubayashi, MD, PhD Division of EndoscopyShizuoka Cancer Center1007ShimonagakuboNagaizumiSuntogunShizuoka411-8777Japan+81-55-9895222
| | | | - Tomohiro Iwai
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Katsuyuki Murai
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Masao Yoshida
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kenichiro Imai
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yusuke Yamamoto
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Masataka Kikuyama
- Division of Gastroenterology, Shizuoka General Hospital, Shizuoka, Japan
| | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
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Yokoi Y, Kikuyama M, Kurokami T, Sato T. Early dual drainage combining transpapillary endotherapy and percutaneous catheter drainage in patients with pancreatic fistula associated with severe acute pancreatitis. Pancreatology 2016; 16:497-507. [PMID: 27053007 DOI: 10.1016/j.pan.2016.03.007] [Citation(s) in RCA: 18] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 01/28/2016] [Accepted: 03/06/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The development of pancreatic fistula (PF) associated with pancreatic necrosis is of great concern in the management of severe acute pancreatitis (SAP). We expected that early recognition and intervention of PF combined with percutaneous catheter drainage (PCD) for pancreatic infection may improve SAP outcomes. METHODS Fifteen consecutive patients with SAP were enrolled. Whenever feasible, fine-needle aspiration for fluid collection was performed to determine infection and amylase concentration. For infection and PF with amylase-rich fluid, PCD and transpapillary endotherapy (preferably naso-pancreatic drainage) were carried out as soon as possible. PCD was intensively managed by irrigating the sized-up and multiple large bore catheters. RESULTS Infected fluid collection and PF were both detected in 13 (86.7%) patients. Pancreatic duct (PD) disruption (n = 6) and organ failure (n = 5) occurred exclusively in patients with amylase-rich collection ≥10,000 U/L. The median timing of PCD and endotherapy was 15.5 and 16.5 days, respectively. No serious complications or mortality resulted from intervention procedures other than stent occlusion in one (6.7%) patient. Surgical intervention due to uncontrollable infection and visceral organ injury was avoided. Fistula closure was achieved in 12 (92.3%) of 13 PF patients with a median duration of 45 days. Disease-related mortality occurred in one (6.7%) patient. CONCLUSION Amylase-rich fluid collection ≥10,000 U/L may be an indication for further endoscopic investigation of PD disruption. Early dual drainage combining pancreatic endotherapy and PCD is feasible and safe, and may improve treatment outcome.
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Affiliation(s)
- Yoshihiro Yokoi
- Department of Surgery, Shinshiro Municipal Hospital, 32-1 Kitahata, Shinshiro, Aichi 441-1387, Japan.
| | - Masataka Kikuyama
- Department of Gastroenterology, Shizuoka General Hospital, 4-27-1 Kita-andoh, Aoi-ku, Shizuoka, Shizuoka 425-8527, Japan
| | - Takafumi Kurokami
- Department of Gastroenterology, Shizuoka General Hospital, 4-27-1 Kita-andoh, Aoi-ku, Shizuoka, Shizuoka 425-8527, Japan
| | - Tatsunori Sato
- Department of Gastroenterology, Shizuoka General Hospital, 4-27-1 Kita-andoh, Aoi-ku, Shizuoka, Shizuoka 425-8527, Japan
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31
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Kikuyama M, Aoyama H, Kyoden Y. Endoscopic ultrasonography-guided choledochojejunostomy: Novel method to treat a severely stenotic choledochojejunal anastomosis. Dig Endosc 2016; 28:221. [PMID: 26566896 DOI: 10.1111/den.12572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 12/13/2022]
Affiliation(s)
- Masataka Kikuyama
- Department of Gastroenterology, Shizuoka General Hospital, Shizuoka, Japan
| | - Haruna Aoyama
- Department of Gastroenterology, Shizuoka General Hospital, Shizuoka, Japan
| | - Yusuke Kyoden
- Department of Surgery, Shizuoka General Hospital, Shizuoka, Japan
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32
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Enokida K, Kikuyama M, Kurokami T, Shirane N, Aoyama H, Aoyama H, Sato T, Taki Y. [Endoscopic nasobiliary and nasopancreatic drainage contributing to healing of duodenal ulcer perforation: a case report]. Nihon Shokakibyo Gakkai Zasshi 2015; 112:1836-42. [PMID: 26440686 DOI: 10.11405/nisshoshi.112.1836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A 75-year-old man with vomiting and right abdominal pain was admitted to the Department of Surgery in our hospital. With a diagnosis of perforated duodenal ulcer, he was treated conservatively. On the day 8 of hospitalization, his general condition worsened and he underwent surgery. During operation, the perforated duodenal ulcer and paraduodenal fluid collection was observed, and percutaneous drainage was accordingly established. After this procedure, renal dysfunction was exacerbated and he was transferred to our department for endoscopic treatment. On day 28 of hospitalization, nasobiliary and nasopancreatic drainage was administered. Renal dysfunction gradually improved, and healing of the perforated duodenal ulcer was recognized on day 93. On day 112, the patient was discharged.
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Affiliation(s)
- Kohei Enokida
- Department of Gastroenterology, Shizuoka General Hospital
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33
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Yoshikawa T, Yamada T, Kurokami T, Sato S, Hazama H, Suzuki M, Arai K, Kikuyama M. [Three cases of enteroenteric intussusception examined by three-dimensional computed tomography enteroclysis]. Nihon Shokakibyo Gakkai Zasshi 2015; 112:508-14. [PMID: 25759225 DOI: 10.11405/nisshoshi.112.508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Three-dimensional computed tomography (3D CT) enteroclysis or virtual enteroscopy is a novel technique to explore the entire small bowel using a modified protocol of virtual colonoscopy by inflating the small bowel with air. In our hospital, the procedure is performed routinely for cases with suspected gross lesions. We performed 3D CT enteroclysis for three cases with enteroenteric intussusception bowel. The lesions associated with intussusception were identified, single-incision laparoscopic surgery was performed, and diagnoses of lipoma and Peutz-Jeghers polyp were made in two cases. 3D CT enteroclysis did not reveal any associated lesion in the third case. This was followed by an intraoperative exploration during gastrectomy for stomach cancer, but no intestinal lesion was found. A diagnosis of idiopathic intussusception and its spontaneous release was made, and no recurrence was observed during the follow-up period. 3D CT enteroclysis seems to be an appropriate modality for the evaluation of enteroenteric intussusception.
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Kikuyama M, Kunimata H, Oka T, Tachibana A. P250 Clinicopathological analysis of the p53 expression status in breast cancer. Breast 2015. [DOI: 10.1016/s0960-9776(15)70282-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Abstract
OBJECTIVE The aims of this study were to assess the incidence of pancreatic cancer and the contributing factors for the diagnosis of tumors in patients with acute pancreatitis and to gain insight into how patients with acute pancreatitis should be followed up. METHODS Using the electronic medical database of Shizuoka General Hospital, 177 patients admitted for acute pancreatitis in the past 6 years were evaluated retrospectively for pancreatic cancer. RESULTS Twelve patients (6.8%) were newly diagnosed with pancreatic cancer. During the first hospitalization, 5 patients (41.7%) with a detected pancreatic mass underwent surgical treatment: the final tumor stages were IA, IIA, and IIB in 1, 2, and 2 patients, respectively. In 7 patients (58.3%) without a detected pancreatic mass at the first admission, a pancreatic mass was recognized on follow-up computed tomography (CT) in 2 patients with main pancreatic duct (MPD) dilatation, and 1 patient with recurrent acute pancreatitis. The tumor stages were IA, IIA, and IA, respectively. Among the remaining 4 patients without follow-up, the tumor stage was IV. The patient gender, age, MPD dilatation, tumor marker, and serum amylase level were not significantly associated with pancreatic cancer. The detection of a pancreatic mass on CT led to the diagnosis of pancreatic cancer. CONCLUSION Acute pancreatitis should be considered as a possible diagnostic indicator of pancreatic cancer. Various factors associated with acute pancreatitis and pancreatic cancer were not predictive of a diagnosis of pancreatic cancer. Only the detection of a pancreatic mass led to the early diagnosis of pancreatic cancer. Patients hospitalized for acute pancreatitis should be followed up with a diagnostic imaging modality.
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Affiliation(s)
- Yuto Kimura
- Department of Gastroenterology, Kyoto University Hospital, Japan
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36
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Enokida K, Kikuyama M, Shirai T, Suzuki M. Tumor-like lesion of a hepatoduodenal ligament due to tuberculosis. Intern Med 2015; 54:1153-4. [PMID: 25948368 DOI: 10.2169/internalmedicine.54.3813] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kohei Enokida
- Department of Gastroenterology, Shizuoka General Hospital, Japan
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Kikuyama M, Akashi-Tanaka S, Hojo T, Kinoshita T, Ogawa T, Seto Y, Tsuda H. Utility of intraoperative frozen section examinations of surgical margins: implication of margin-exposed tumor component features on further surgical treatment. Jpn J Clin Oncol 2014; 45:19-25. [DOI: 10.1093/jjco/hyu158] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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38
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Yoshikawa T, Shirane H, Matsuda M, Suzuki N, Kurokami T, Taki Y, Arai K, Kikuyama M. [Virtual enteroscopy for the evaluation of stenosis in a case of chronic multiple ulcers of the small intestine]. Nihon Shokakibyo Gakkai Zasshi 2014; 111:756-764. [PMID: 24769465] [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: 06/03/2023]
Abstract
A 39-year-old female presented to our hospital with diarrhea, vomiting, anemia, and hypoalbuminemia. Virtual enteroscopy was performed to evaluate the small bowel; we found annular stenoses at 89, 100, 116, 147, and 154 cm from the ligament of Treitz. Small bowel resection was performed, and annular ulcers were confirmed at 58, 71, 90, 130, 138, 218, and 225 cm from the ligament of Treitz. Clinical records and pathological examination failed to determine the cause of these ulcers, and we diagnosed chronic multiple ulcers of the small intestine. Thus, we believe that virtual enteroscopy can be beneficial in preoperatively diagnosing multiple ulcers and stenoses in the small bowel.
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Kikuyama M, Nakamura K, Kurokami T. Alcoholic severe acute pancreatitis with positive culture of pancreatic juice treated by nasopancreatic drainage. Pancreatology 2014; 14:151-3. [PMID: 24854608 DOI: 10.1016/j.pan.2014.03.020] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 03/12/2014] [Accepted: 03/17/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Severe acute pancreatitis (SAP) is a serious disease associated with alcoholism and has a high mortality rate. Effective treatments have not been established. METHODS A 58-year-old man was admitted due to alcoholic SAP. Endoscopic retrograde cholangiopancreatography revealed pancreatic calculi at the pancreas head and a stricture in the pancreatic duct from the pancreas head to the body. Endoscopically, nasopancreatic drainage (NPD) was placed through the minor papilla to the pancreas tail beyond the stricture. RESULTS Pancreatic juice culture was positive for Streptococcus and Enterobacter. The day after NPD, upper abdominal pain was relieved. After changing NPD to a pancreatic stent, the patient was discharged on day 21 post-NPD. CONCLUSION Alcoholic SAP may reflect aggravation of chronic pancreatitis. The possibility of acute bacterial inflammation should be considered in all cases of chronic alcoholic pancreatitis who present with severe features of inflammation, even in the early stages of an attack. Treatment of this subset of cases by drainage could be of great importance and NPD may be the preferred method.
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Affiliation(s)
- Masataka Kikuyama
- Department of Gastroenterology, Shizuoka General Hospital, Shizuoka, Japan.
| | - Kazumasa Nakamura
- Department of Gastroenterology, Shizuoka General Hospital, Shizuoka, Japan
| | - Takafumi Kurokami
- Department of Gastroenterology, Shizuoka General Hospital, Shizuoka, Japan
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Kikuyama M, Ueda T. Endoscopic ultrasound-guided transjejunal puncture of the main pancreatic duct as an alternative treatment for strictured pancreatojejunal anastomosis. Pancreatology 2014; 14:107-8. [PMID: 24650963 DOI: 10.1016/j.pan.2014.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 01/10/2014] [Accepted: 02/02/2014] [Indexed: 12/11/2022]
Affiliation(s)
- Masataka Kikuyama
- Department of Gastroenterology, Shizuoka General Hospital, Shizuoka, Japan.
| | - Tatsuki Ueda
- Department of Gastroenterology, Kyoto University Hospital, Kyoto, Japan
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41
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Affiliation(s)
- Haruna Aoyama
- Department of Gastroenterology, Shizuoka General Hospital, Japan
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Yoshikawa T, Kurokami T, Kikuyama M. [Meckel's diverticulum detected by virtual enteroscopy in a patient with nonsteroidal anti-inflammatory drug-induced enteropathy]. Nihon Shokakibyo Gakkai Zasshi 2014; 111:69-73. [PMID: 24390260] [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: 06/03/2023]
Abstract
A 68-year-old female presented to our hospital with abdominal discomfort and obscure gastrointestinal bleeding. She had been prescribed aspirin for retinal venous occlusion. Video capsule endoscopy (VCE) revealed multiple erosions, annular ulcers, and bleeding, confirming a diagnosis of nonsteroidal anti-inflammatory drug (NSAID)-induced enteropathy. Virtual enteroscopy (VE) was performed to evaluate stenosis of the small intestine, during which a 5-cm long diverticulum was incidentally detected at a site 99cm from the ileocecal valve. On the basis of the location, size, and shape, a diagnosis of Meckel's diverticulum was made. Second look of the VCE images could not detect the Meckel's diverticulum. After the cessation of taking aspirin, the patient had no more abdominal symptoms, and we concluded NSAID-induced enteropathy was the cause of the symptoms. Meckel's diverticula are sometimes difficult to diagnose, but VE was able to depict the lesion clearly. Meckel's diverticulum is one of the best indications for VE.
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Matsusaki S, Kikuyama M, Kawakami H, Kubota K, Maguchi H. [Clinical features and CT findings in the differential diagnosis of IgG4-related sclerosing cholangitis and cholangiocarcinoma]. Nihon Shokakibyo Gakkai Zasshi 2013; 110:615-621. [PMID: 23558124] [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: 06/02/2023]
Abstract
To clarify the clinical features and CT findings of IgG4-related sclerosing cholangitis (IgG4-SC), we reviewed 16 cases of IgG4-SC and 10 cases of cholangiocarcinoma concerning patient background, treatment, outcomes and CT findings. The median age of IgG4-SC cases was 70 (range 54-79) years, and only 1 was a woman. Serum IgG4 level of all IgG4-SC patients were elevated and in 13 patients steroid therapy proved effective. The CT findings were analyzed with regard to the biliary strictures (symmetry, outer margin, inner margin), wall enhancement pattern and pancreas size. The CT findings of symmetric wall thickness and total scores were significantly higher in IgG4-SC than in cholangiocarcinoma. Although the small number of patients in this study is a limitation, the CT findings may help distinguish IgG4-SC from cholangiocarcinoma.
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Shiokawa M, Kodama Y, Yoshimura K, Kawanami C, Mimura J, Yamashita Y, Asada M, Kikuyama M, Okabe Y, Inokuma T, Ohana M, Kokuryu H, Takeda K, Tsuji Y, Minami R, Sakuma Y, Kuriyama K, Ota Y, Tanabe W, Maruno T, Kurita A, Sawai Y, Uza N, Watanabe T, Haga H, Chiba T. Risk of cancer in patients with autoimmune pancreatitis. Am J Gastroenterol 2013; 108:610-7. [PMID: 23318486 DOI: 10.1038/ajg.2012.465] [Citation(s) in RCA: 158] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Although simultaneous occurrences of autoimmune pancreatitis (AIP) and cancer are occasionally observed, it remains largely unknown whether cancer and AIP occur independently or these disorders are interrelated. The aim of this study was to examine the relationship between AIP and cancer. METHODS We conducted a multicenter, retrospective cohort study. One hundred and eight patients who met the Asian diagnostic criteria for AIP were included in the study. We calculated the proportion, standardized incidence ratio (SIR), relative risk, and time course of cancer development in patients with AIP. We also analyzed the clinicopathological characteristics of AIP patients with cancer in comparison with those without cancer. RESULTS Of the 108 AIP patients, 18 cancers were found in 15 patients (13.9%) during the median follow-up period of 3.3 years. The SIR of cancer was 2.7 (95% confidence interval (CI) 1.4-3.9), which was stratified into the first year (6.1 (95% CI 2.3-9.9)) and subsequent years (1.5 (95% CI 0.3-2.8)) after AIP diagnosis. Relative risk of cancer among AIP patients at the time of AIP diagnosis was 4.9 (95% CI 1.7-14.9). In six of eight patients whose cancer lesions could be assessed before corticosteroid therapy for AIP, abundant IgG4-positive plasma cell infiltration was observed in the cancer stroma. These six patients experienced no AIP relapse after successful cancer treatment. CONCLUSIONS Patients with AIP are at high risk of having various cancers. The highest risk for cancer in the first year after AIP diagnosis and absence of AIP relapse after successful treatment of the coexisting cancers suggest that AIP may develop as a paraneoplastic syndrome in some patients.
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Affiliation(s)
- Masahiro Shiokawa
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Affiliation(s)
- Masataka Kikuyama
- Department of GastroenterologyShizuoka General Hospital Shizuoka Japan
| | - Tatsuki Ueda
- Department of Second SurgerySchool of MedicineHamamatsu Medical University Shizuoka Japan
| | - Keisuke Inaba
- Department of Second SurgerySchool of MedicineHamamatsu Medical University Shizuoka Japan
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Inoue K, Sonobe M, Kawamura Y, Etoh T, Takagi M, Matsumura T, Kikuyama M, Kimura M, Minami S, Utsuki H, Yamazaki T, Suzuki T, Tsuji D, Hayashi H, Itoh K. Polymorphisms of the UDP-Glucuronosyl Transferase 1A Genes Are Associated with Adverse Events in Cancer Patients Receiving Irinotecan-Based Chemotherapy. TOHOKU J EXP MED 2013; 229:107-14. [DOI: 10.1620/tjem.229.107] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Kazuyuki Inoue
- Department of Clinical Pharmacology and Genetics, School of Pharmaceutical Sciences, University of Shizuoka
| | - Momoyo Sonobe
- Department of Clinical Pharmacology and Genetics, School of Pharmaceutical Sciences, University of Shizuoka
| | - Yukinori Kawamura
- Department of Clinical Pharmacology and Genetics, School of Pharmaceutical Sciences, University of Shizuoka
| | - Takashi Etoh
- Department of Respiratory Center, Shizuoka General Hospital
| | | | | | | | | | - Sato Minami
- Department of Pharmacy, Shizuoka General Hospital
| | | | | | | | - Daiki Tsuji
- Department of Clinical Pharmacology and Genetics, School of Pharmaceutical Sciences, University of Shizuoka
| | - Hideki Hayashi
- Department of Clinical Pharmacology and Genetics, School of Pharmaceutical Sciences, University of Shizuoka
| | - Kunihiko Itoh
- Department of Clinical Pharmacology and Genetics, School of Pharmaceutical Sciences, University of Shizuoka
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Affiliation(s)
- Masanori Matsuda
- Department of Gastroenterology, Shizuoka General Hospital, Japan
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Nagakura C, Kikuyama M, Matsumura K, Arai K. [Large serous cystic adenoma at the pancreas tail mimicking mucinous cystic neoplasm]. Nihon Shokakibyo Gakkai Zasshi 2012; 109:1230-1235. [PMID: 22790628] [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: 06/01/2023]
Abstract
A 62-year-old woman presented with left abdominal pain. A large and multi-cystic lesion at the pancreas tail was recognized on imaging examinations. MRI revealed low and high signal intensity on T1- and T2-weighted imaging, with focal and bright components in the nodule adjacent to the septum on T2-weighted imaging. Distal pancreatectomy was performed, and the cystic lesion was diagnosed as serous cystic adenoma with hemorrhage. The characters of serous cystic components on imaging examinations could help to distinguish the lesion from mucinous cystic neoplasm.
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Affiliation(s)
- Chisako Nagakura
- Department of Gastroenterology, Shizuoka General Hospital, Japan
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Morita T, Kikuyama M, Kurokami T, Nagakura C, Yoshida M, Ueda T, Shigetomo M, Suzuki N. [Large accessory spleen torsion with a distorted fascicular structure; a case report]. Nihon Shokakibyo Gakkai Zasshi 2012; 109:969-974. [PMID: 22688174] [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: 06/01/2023]
Abstract
A 37-year-old woman was admitted with left upper quadrant pain. Imaging examinations revealed a cystic mass with a diameter of 70 mm near the tail of the pancreas. The mass had a distorted fascicular structure adjacent to the hilum of the spleen. On operation the distorted fascicular structure was revealed to be connective tissue including vessels. On histopathological examination, the mass was strongly suspected to be an accessory spleen because spleen-like stroma was recognized, in spite of degeneration due to infarction.
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Yoshikawa T, Takehara Y, Kikuyama M, Takeuchi K, Hanai H. Computed tomographic enteroclysis with air and virtual enteroscopy: protocol and feasibility for small bowel evaluation. Dig Liver Dis 2012; 44:297-302. [PMID: 22119630 DOI: 10.1016/j.dld.2011.10.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Revised: 09/17/2011] [Accepted: 10/20/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS We describe our optimized protocol for computed tomographic enteroclysis using air as the contrast material and report an early assessment of its clinical performance. METHODS Thirty-one examinations of computed tomographic enteroclysis with air were performed in 30 patients in our hospital from September 2008 to September 2010. The volume of injected air and intra-intestinal pressure were monitored in 16 cases. The data were reviewed for ratios of successful whole small bowel depictions out of the total number of examinations for patients without stenosis. Efforts were made to confirm depicted abnormal findings when possible by other imaging techniques, intra-operative findings, histopathological findings, and subsequent history. RESULTS The injected air volume and final intra-intestinal pressure were 2925 ± 686 ml and 24.5 ± 7.1cm H₂O in cases without stenosis. In 19 examinations with anterograde air injection for patients without stenosis, whole small bowel depiction was achieved in 16 (84.2%). Computed tomographic enteroclysis with air was useful for detecting strictures (in Crohn's disease, malignant lymphoma, metastatic carcinoma), Meckel's diverticulum, and for excluding other obstructive conditions in ileus. CONCLUSIONS Computed tomographic enteroclysis with air has a potential to enable the exploration of the whole small bowel, thereby providing information of small bowel lesions that complements other techniques.
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