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World Journal of Gastroenterology 2015年第7期21卷 2159-2168页

作者： Ryo Inada Shigeki Sekine Hirokazu Taniguchi Hitoshi Tsuda Hitoshi Katai Toshiyoshi Fujiwara ryoji kushima Pathology and Clinical Laboratory Division National Cancer Center Hospital Department of Gastroenterological Surgery Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences Molecular Pathology Division National Cancer Center Research Institute Gastric Surgery Division National Cancer Center Hospital

AIM:To analyze the mismatch repair(MMR)status and the ARID1A expression as well as their clinicopathological significance in gastric ***:We examined the expressions of MMR proteins and ARID1A by immunohistochemistry in consecutive 489 primary gastric *** results were further correlated with clinicopathological ***:The loss of any MMR protein expression,indicative of MMR deficiency,was observed in 38cases(7.8%)and was significantly associated with an older age(68.6±9.2 vs 60.4±11.7,P<0.001),a female sex(55.3%vs 31.3%,P=0.004),an antral location(44.7%vs 25.7%,P=0.021),and a differentiated histology(57.9%vs 39.7%,P=0.023).Abnormal ARID1A expression,including reduced or loss of ARID1A expression,was observed in 109 cases(22.3%)and was significantly correlated with lymphatic invasion(80.7%vs 69.5%,P=0.022)and lymph node metastasis(83.5%vs 73.7%,P=0.042).The tumors with abnormal ARID1A expression more frequently indicated MMR deficiency(47.4%vs 20.2%,P<0.001).A multivariate analysis identified abnormal ARID1A expression as an independent poor prognostic factor(HR=1.36,95%CI:1.01-1.84;P=0.040).CONCLUSION:Our observations suggest that the AIRD1A inactivation is associated with lymphatic invasion,lymph node metastasis,poor prognosis,and MMR deficiency in gastric adenocarcinomas.

关键词： Adenocarcinoma ARID1A Mismatch Repair Stomach Immu

Efficacy of additional treatment with azathioprine in a patient with prednisolone-dependent gastric sarcoidosis

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World Journal of Gastroenterology 2016年第47期22卷 10471-10476页

作者： Masaki Murata Mitsushige Sugimoto Yoshihiro Yokota Hiromitsu Ban Osamu Inatomi Shigeki Bamba ryoji kushima Akira Andoh Department of Gastroenterology Shiga University of Medical Science Hospital Division of Digestive Endoscopy Shiga University of Medical Science Hospital Department of Clinical Laboratory Medicine Shiga University of Medical Science Hospital

Gastric sarcoidosis with noncaseating granuloma is rare. Although corticosteroid produces a dramatic clinical response, it is unknown whether azathioprine show efficacy in prednisolone-dependent cases. Here, we report a case of gastric sarcoidosis in a 25-year-old man with severe epigastlargia. Gastroendoscopy revealed multiple map-like ulcerations. Histological examination showed multiple noncaseating granulomatous lesions in gastric mucosa, which were incompatible with diagnoses of Crohn's disease or tuberculosis. He was started on prednisolone at 30 mg/d, and his symptoms improved within 7-d. The prednisolone was gradually tapered by 5 mg every 2-wk, but oral azathioprine at 50 mg was added after symptoms recurred at tapered dose of 10 mg. Endoscopy 4-wk later showed healing ulcers, and, lymphocytic infiltration was absent. The efficacy of additional azathioprine in gastric sarcoidosis is not well defined. Here, we report a case of prednisolone-dependent gastric sarcoidosis that improved after additional azathioprine, and also review the literature concerning the treatment, especially for prednisolone-dependent cases.

关键词： Azathioprine Granulomatous inflammation Prednisolone Gastric sarcoidosis Helicobacter pylori

Small undifferentiated intramucosal gastric cancer with lymph-node metastasis:Case report

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World Journal of Gastroenterology 2013年第20期19卷 3157-3160页

作者： Tomoyuki Odagaki Haruhisa Suzuki Ichiro Oda Shigetaka Yoshinaga Satoru Nonaka Hitoshi Katai Hirokazu Taniguchi ryoji kushima Yutaka Saito Endoscopy Division National Cancer Center HospitalTokyo 104-0045Japan Gastric Surgery Division National Cancer Center HospitalTokyo 104-0045Japan Pathology Division National Cancer Center HospitalTokyo 104-0045Japan

It has been reported recently that small undifferentiated intramucosal early gastric cancer(EGC) < 20 mm in size without any lymphovascular involvement or ulcerative findings had virtually no risk of lymph-node(LN) ***,the indications for endoscopic resection were expanded to include such undifferentiated EGC *** describe herein a case of a small undifferentiated intramucosal EGC < 20 mm in size without lymphovascular involvement or ulcerative findings that involved lymph-node metastasis.A 57-year-old female underwent pylorus preserving gastrectomy as standard treatment for an undifferentiated EGC 15 mm in size without any ulcerative *** surgical specimen revealed a signet-ring cell carcinoma with a moderately to poorly differentiated adenocarcinoma limited to the mucosa that was 15 mm in size with no lymphovascular involvement or ulcerative *** case involved LN metastasis,however,and the lesion was diagnosed as pathological stage ⅡA(T1N2M0) according to the Japanese Classification of Gastric Carcinoma.

关键词： Early gastric cancer Endoscopic submucosal dissection Expanded indications Lymph-node metastasis Undifferentiated type

Dehiscence following successful endoscopic closure of gastric perforation during endoscopic submucosal dissection

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World Journal of Gastroenterology 2012年第31期18卷 4224-4227页

作者： Masau Sekiguchi Haruhisa Suzuki Ichiro Oda Shigetaka Yoshinaga Satoru Nonaka Makoto Saka Hitoshi Katai Hirokazu Taniguchi ryoji kushima Yutaka Saito Endoscopy Division National Cancer Center HospitalTokyo 104-0045Japan Gastric Surgery Division National Cancer Center HospitalTokyo 104-0045Japan Pathology Division National Cancer Center HospitalTokyo 104-0045Japan

Gastric perforation is one of the most serious complications that can occur during endoscopic submucosal dissection(ESD).In terms of the treatment of such perforations,we previously reported that perforations immediately observed and successfully closed with endoclips during endoscopic resection could be managed *** now report the first case in our medical facility of a gastric perforation during ESD that was ineffectively treated conservatively even after successful endoscopic *** December 2006,we performed ESD on a recurrent early gastric cancer in an 81-year-old man with a medical history of laparotomy for cholelithiasis.A perforation occurred during ESD that was immediately observed and successfully closed with endoclips so that ESD could be continued resulting in an en-bloc *** conservative management was conducted following ESD,however,an endoscopic examination five days after ESD revealed dehiscence of the perforation requiring an emergency laparotomy.

关键词： Early gastric cancer Endoscopic closure Endoscopic submucosal dissection Gastric perforation Laparotomy

Bone metastasis from early gastric cancer following non-curative endoscopic submucosal dissection

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World Journal of Gastroenterology 2013年第30期19卷 5016-5020页

作者： Hiroyuki Kawabata Ichiro Oda Haruhisa Suzuki Satoru Nonaka Shigetaka Yoshinaga Hitoshi Katai Hirokazu Taniguchi ryoji kushima Yutaka Saito Endoscopy Division National Cancer Center Hospital Department of Internal Medicine Saiseikai Matsusaka General Hospital Gastric Surgery Division National Cancer Center Hospital Pathology Division National Cancer Center Hospital

A 67-year-old male underwent endoscopic submucosal dissection(ESD)to treat early gastric cancer(EGC)in *** lesion(50 mm × 25 mm diameter)was histologically diagnosed as poorly differentiated adenocarcinoma,with an ulcer *** the tumor was confined to the mucosa with no evidence of lymphovascular involvement,the ESD was regarded as a noncurative resection due to the histological type,tumor size,and existence of an ulcer finding(as indicated by the 2010 Japanese gastric cancer treatment guidelines,ver.3).Despite strong recommendation for subsequent gastrectomy,the patient refused *** alternative follow-up routine was designed,which included five years of biannual clinical examinations to detect and measure serum tumor markers and perform visual assessment of recurrence by endoscopy and computed tomography scan after which the examinations were performed *** patient's condition remained stable for eight years,until a complaint of back pain in 2010 prompted further clinical *** scintigraphy indicated increased *** examination of biopsy specimens taken from the lumbar spine revealed adenocarcinoma resembling the carcinoma cells from the EGC that had been treated previously by ESD,and which was consistent with immunohistochemical findings of gastrointestinal tract ***,the diagnosis of bone metastasis from EGC was *** reported rates of EGC recurrence in surgically resected cases range 1.4%-3.4%,but among these bone metastasis is very *** our knowledge,this is the first reported case of bone metastasis from EGC following a non-curative ESD and occurring after an eight-year disease-free interval.

关键词： Endoscopic submucosal dissection Early gastric cancer Non-curative resection Bone metastasis Late recurrence

Application of novel magnified single balloon enteroscopy for a patient with Cronkhite-Canada syndrome

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World Journal of Gastroenterology 2017年第22期23卷 4121-4126页

作者： Masaki Murata Shigeki Bamba Kenichiro Takahashi Hirotsugu Imaeda Atsushi Nishida Osamu Inatomi Tomoyuki Tsujikawa ryoji kushima Mitsushige Sugimoto Akira Andoh Department of Medicine Shiga University of Medical Science Comprehensive Internal Medicine Shiga University of Medical ScienceSeta-Tsukinowa Department of Clinical Laboratory Medicine Shiga University of Medical Science Division of Digestive endoscopy Shiga University of Medical Science

We present a case of Cronkhite-Canada syndrome(CCS) in which the entire intestine was observed using a prototype of magnifying single-balloon enteroscope(SIF Y-0007, Olympus). CCS is a rare, non-familial gastrointestinal polyposis with ectodermal abnormalities. To our knowledge, this is the first report showing magnified intestinal lesions of CCS. A 73-year-old female visited our hospital with complaints of diarrhea and dysgeusia. The blood test showed mild anemia and hypoalbuminemia. The esophagogastroduodenoscopy and colonoscopy revealed diffuse and reddened sessile to semi-pedunculated polyps, resulting in the diagnosis of CCS. In addition to the findings of conventional balloon-assisted enteroscopy or capsule endoscopy, magnifying observation revealed tiny granular structures, non-uniformity of the villus, irregular caliber of the loop-like capillaries, scattered white spots in the villous tip, and patchy redness of the villus. Histologically, the scattered white spots and patchy redness of the villus reflect lymphangiectasia and bleeding to interstitium, respectively.

关键词： Balloon-assisted enteroscopy Magnified endoscopy Narrow band imaging Small intestine

Fatal submucosal invasive gastric adenosquamous carcinoma detected at surveillance after gastric endoscopic submucosal dissection

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World Journal of Gastroenterology 2015年第14期21卷 4385-4390页

作者： Akinori Shirahige Haruhisa Suzuki Ichiro Oda Masau Sekiguchi Genki Mori Seiichiro Abe Satoru Nonaka Shigetaka Yoshinaga Shigeki Sekine ryoji kushima Yutaka Saito Takeo Fukagawa Hitoshi Katai Endoscopy Division National Cancer Center Hospital Pathology Division National Cancer Center Hospital Department of Clinical Laboratory Medicine and Diagnostic Pathology Shiga University of Medical Science Gastric Surgery Division National Cancer Center Hospital

An 80-year-old man was under annual surveillance esophagogastroduodenoscopy after endoscopic submucosal dissection(ESD) for early gastric cancer(EGC).Two years after the initial ESD, a 0-Ⅱc type metachronous EGC lesion, 8 mm in size, without an ulcer scar, was found in the gastric *** estimated tumor depth was up to the mucosa, and biopsy revealed well and poorly differentiated *** was performed for this lesion and en bloc resection with negative margins was *** examination revealed an adenosquamous carcinoma 8 mm in size invading the deep submucosal layer(1600 μm), with lymphovascular invasion, consistent with the diagnosis of non-curative *** gastrectomy was recommended for this patient; however, two months after the ESD, preoperative computed tomography revealed multiple liver metastases, and the patient was considered as an unsuitable candidate for surgical *** chemotherapy was therefore started; however, the patient died of gastric cancer 27 mo after the second *** gastric adenosquamous carcinoma localized to the mucosa and submucosa is extremely rare and its clinical behavior is not well *** present report is very significant in that it underscores the distinct possibility of gastric adenosquamous carcinoma being very aggressive and fatal even when detected at an early cancer.

关键词： Early gastric cancer Endoscopic submucosal dissect

Endoscopic ultrasound using ultrasound probes for the diagnosis of early esophageal and gastric cancers

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World Journal of Gastrointestinal Endoscopy 2012年第6期4卷 218-226页

作者： Shigetaka Yoshinaga Ichiro Oda Satoru Nonaka ryoji kushima Yutaka Saito Endoscopy Division National Cancer Center Hospital5-1-1 TsukijiChuo-kuTokyo 104-0045Japan Pathology Division National Cancer Center Hospital5-1-1 TsukijiChuo-kuTokyo 104-0045Japan

Endoscopic ultrasound (EUS) devices were first designed and manufactured more than 30 years ago, and since then investigators have reported EUS is effective for determining both the staging and the depth of invasion of esophageal and gastric cancers. We review the present status, the methods, and the findings of EUS when used to diagnose and stage early esophageal and gastric cancer. EUS using high-frequency ultrasound probes is more accurate than conventional EUS for the evaluation of the depth of invasion of superficial esophageal carcinoma. The rates of accurate evaluation of the depth of invasion by EUS using high-frequency ultrasound probes were 70%-88% for intramucosal cancer, and 83%-94% for submucosal invasive cancer. But the sensitivity of EUS using high-frequency ultrasound probes for the diagnosis of submucosal invasive cancer was relatively low, making it difficult to confirm minute submucosal invasion. The accuracy of EUS using high-frequency ultrasound probes for early gastric tumor classification can be up to 80% compared with 63% for conventional EUS, although the accuracy of EUS using high-frequency ultrasound probes relatively decreases for those patients with depressed-type lesions, undifferentiated cancer, concomitant ulceration, expanded indications, type 0-I?lesions, and lesions located in the upper-third of the stomach. A 92% overall accuracy rate was achieved when both the endoscopic appearance and the findings from EUS using high-frequency ultrasound probes were considered together for tumor classification. Although EUS using high-frequency ultrasound probes has limitations, it has a high depth of invasion accuracy and is a useful procedure to distinguish lesions in the esophagus and stomach that are indicated for endoscopic resection.

关键词： Endoscopic ultrasound High-frequency ultrasound probe Esophageal cancer Gastric cancer Depth diagnosis

Cap polyposis refractory to Helicobacter pylori eradication treated with endoscopic submucosal dissection

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World Journal of Gastrointestinal Endoscopy 2017年第10期9卷 529-534页

作者： Masaki Murata Mitsushige Sugimoto Hiromitsu Ban Taketo Otsuka Toshiro Nakata Masahide Fukuda Osamu Inatomi Shigeki Bamba ryoji kushima Akira Andoh Department of Gastroenterology Shiga University of Medical Science Hospital Division of Digestive Endoscopy Shiga University of Medical Science Hospital Department of Clinical Laboratory Medicine Shiga University of Medical Science Hospital

Cap polyposis is a rare intestinal disorder. Characteristic endoscopic findings are multiple inflammatory polypoid lesions covered by caps of fibrous purulent exudate. Although a specific treatment has not been established, some studies have suggested that eradication therapy for Helicobacter pylori(H. pylori) is effective. We report a case of a 20-year-old man with cap polyposis presenting with hematochezia. Colonoscopy showed the erythematous polyps with white caps from the sigmoid colon to rectum. Histopathological findings revealed elongated, tortuous, branched crypts lined by hyperplastic epithelium with a mild degree of fibromusculosis in the lamina propria. Although H. pylori eradication was instituted, there was no improvement over six months. We then performed en bloc excision of the polyps by endoscopic submucosal dissection(ESD), which resulted in complete resolution of symptoms. ESD may be a treatment option for cap polyposis refractory to conservative treatments. We review the literature concerning treatment for cap polyposis and clinical outcomes.

关键词： Endoscopic submucosal dissection Cap polyposis Eradication therapy Helicobacter pylori

Progress in reducing AC magnetization losses of Bi2223/Ag tapes by introducing interfilamentary oxide barriers

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Progress in Natural Science:Materials International 2010年第1期20卷 104-110页

作者： ryoji INADA Akio OOTA Toyohashi University of Technology 1-1 HibarigaokaTempaku-choToyohashiAichi 441-8580Japan

This paper presents our recent progress for the development of low-loss Bi2223/Ag tapes with interfilamentary oxide *** the compatibility with Bi2223 superconductors,SrZrO3was selected as barrier ***,small amount of Bi2212 was mixed with SrZrO3to improve its ductility for cold *** controlling the thickness of barrier layers among the filaments,reducing the tape width（<3 mm）and twisting the filaments tightly（<5 mm in twist pitch lengths）,coupling frequency fcexceeded 250 Hz even in an AC perpendicular field at *** Jcof the barrier tapes with tightly twisted filaments was in the range of 12-15 kA/cm2at 77 K and *** 50 mT and 50 Hz,the twisted barrier tapes showed 60%-70%lower perpendicular field losses than the conventional 4 mm-width tape with fully coupled filaments.

关键词： Bi2223 tapes interfilamentary oxide barriers filament twisting magnetization losses coupling frequency