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World Journal of Gastroenterology 2008年第30期14卷 4838-4840页

作者： Hiromitsu Kanzaki Shoji Hirasaki Masato Okuda Kenichiro Kudo seiyuu suzuki Department of Internal Medicine Sumitomo Besshi Hospital

The patient was a 33-year-old man with hematochezia. Colonoscopy revealed a Iobulated peduncular polyp with bleeding, about 40 mm in diameter, in the ascending colon. The polyp had both red and white components and a mosaic pattern. Magnifying observation revealed a red rugged surface component, and smooth white nodules with enlarged round or oval crypt openings. Endoscopic polypectomy was performed. Histological examination of the specimen revealed inflammatory granulation tissue in the lamina propria, proliferation of smooth muscle, and hyperplastic glands with cystic change. This polyp was diagnosed as inflammatory myoglandular polyp （IMGP）. Lobulated-type IMGP in the ascending colon is rare.

关键词： Inflammatory polyp Colonoscopy Magnifying endoscopy Endoscopic polypectomy Hematochezia

Inflammatory myoglandular polyp causing hematochezia

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World Journal of Gastroenterology 2008年第34期14卷 5353-5355页

作者： Shoji Hirasaki Masato Okuda Kenichiro Kudo seiyuu suzuki Atsuko Shirakawa Department of Internal Medicine Sumitomo Besshi Hospital Department of Pathology Sumitomo Besshi Hospital

A case of inflammatory myoglandular polyp (IMGP) causing hematochezia is reported. The patient was a 33-year-old man who visited our hospital for further evaluation of hematochezia. Colonoscopy revealed a red, hard, spherical peduncular polyp with erosion and mucous exudation, about 20 mm in diameter, in the descending colon. Excluding the polyp, there was no lesion in the colorectum. Endoscopic polypectomy was performed. Histological examination of the specimen revealed inflammatory granulation tissue in the lamina propria, proliferation of smooth muscle, and hyperplastic glands with variable cystic changes. This polyp was diagnosed as an IMGP. The symptom of hematochezia was resolved after endoscopic resection. Our case shows that treatment is necessary for IMGP if intestinal bleeding occurs and endoscopists should be aware of the endoscopic characteristics of IMGP.

关键词： Inflammatory myoglandular polyp Colonoscopy Endoscopic polypectomy Gastrointestinal bleeding

Inflammatory fibroid polyp occurring in the transverse colon diagnosed by endoscopic biopsy

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World Journal of Gastroenterology 2007年第27期13卷 3765-3766页

作者： Shoji Hirasaki Minoru Matsubara Fusao Ikeda Hideaki Taniguchi seiyuu suzuki Second Department of Internal Medicine Sumitomo Besshi Hospital 3-1 Ohji-cho Niihama 792-8543 Japan

A case of an inflammatory fibroid polyp occurring in the transverse colon and diagnosed by endoscopic biopsy is reported. The patient was an 82-year-old man who visited our hospital for further evaluation of occult blood in stool. The Colonoscopy revealed a small, red, and peduncular polyp, about 6 mm in diameter, in the transverse colon. Histological examination of the biopsy specimen obtained from the polyp revealed proliferation of fibroblasts and infiltration of inflammatory cells such as plasma cells and eosinophils. This polyp was diagnosed as an inflammatory fibroid polyp, which can appear in many different locations throughout gastrointestinal tract, though still rare in the transverse colon.

关键词： Inflammatory fibroid polyp Colonoscopy Inflammation Type Ⅱ pit pattern

Treatment of gastric remnant cancer post distal gastrectomy by endoscopic submucosal dissection using an insulation-tipped diathermic knife

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World Journal of Gastroenterology 2008年第16期14卷 2550-2555页

作者： Shoji Hirasaki Hiromitsu Kanzaki Minoru Matsubara Kohei Fujitav Shuji Matsumura seiyuu suzuki Second Department of Internal Medicine Sumitomo Besshi Hospital

AIM: To evaluate the effectiveness of endoscopic submucosal dissection using an insulation-tipped diathermic knife (IT-ESD) for the treatment of patients with gastric remnant cancer. METHODS: Thirty-two patients with early gastric cancer in the remnant stomach, who underwent distal gastrectomy due to gastric carcinoma, were treated with endoscopic mucosal resection (EMR) or ESD at Sumitomo Besshi Hospital and Shikoku Cancer Center in the 10-year period from January 1998 to December 2007, including 17 patients treated with IT-ESD. Retrospectively, patient backgrounds, the one-piece resection rate, complete resection (CR) rate, operation time, bleeding rate, and perforation rate were compared between patients treated with conventional EMR and those treated with IT-ESD. RESULTS: The CR rate (40% in the EMR group vs 82% in the IT-ESD group) was significantly higher in the IT-ESD group than in the EMR group; however, the operation time was significantly longer for the IT- ESD group (57.6 ± 31.9 min vs 21.1 ± 12.2 min). No significant differences were found in the rate of underlying cardiopulmonary disease (IT-ESD group, 12% vs EMR group, 13%), one-piece resection rate (100% vs 73%), bleeding rate (18% vs 6.7%), and perforation rate (0% vs 0%) between the two groups. CONCLUSION: IT-ESD appears to be an effective treatment for gastric remnant cancer post distal gastrectomy because of its high CR rate. It is useful for histological confirmation of successful treatment. Thelong-term outcome needs to be evaluated in the future.

关键词： Remnant stomach Distal gastrectomy Gastric cancer Endoscopic mucosal resection Insulationtipped diathermic knife

Ileal schwannoma developing into ileocolic intussusception

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World Journal of Gastroenterology 2008年第4期14卷 638-640页

作者： Shoji Hirasaki Hiromitsu Kanzaki Kohei Fujita seiyuu suzuki Kazuyasu Kobayashi Hiromitsu suzuki Hideyuki Saeki Second Department of Internal Medicine Sumitomo Besshi HospitalNiihama 792-8543Japan Department of Surgery Sumitomo Besshi HospitalNiihama 792-8543Japan

Intussusception is rare in adults. We describe a 47-year-old man with ileal schwannoma that led to ileocolic intussusception. Abdominal ultrasonography,abdominal CT scan and barium enema confirmed an ileal tumor. Colonoscopy revealed a peduncular submucosal tumor (SMT) 75 mm long with an ulcerated apex at the ascending colon. The provisional diagnosis was a gastrointestinal stromal tumor of the terminal ileum. Ileocecal resection was carried out and the tumor was histologically diagnosed as schwannoma. Abdominal pain resolved postoperatively. This case reminds us that ileal schwannoma should be included in the differential diagnosis of intussusception caused by an SMT in the intestine.

关键词： Ileal submucosal tumor Invagination Diagnostic imaging 5-100 protein

Minute signet ring cell carcinoma occurring in gastric hyperplastic polyp

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World Journal of Gastroenterology 2007年第43期13卷 5779-5780页

作者： Shoji Hirasaki seiyuu suzuki Hiromitsu Kanzaki Kohei Fujita Shuji Matsumura Eiji Matsumoto Department of Internal Medicine Sumitomo Besshi Hospital 3-1 Ohji-cho Niihama 792-8543 Japan

We describe a 45-year-old woman with minute signet ring cell carcinoma occurring in a gastric hyperplastic polyp. A biopsy specimen obtained from the gastric hyperplastic polyp revealed signet ring cell carcinoma. Endoscopic mucosal resection (EMR) was performed to confirm the diagnosis. Histological examination of the EMR specimen revealed focal signet ring cell carcinoma in the hyperplastic polyp. There are few cases of gastric hyperplastic polyp associated with signet ring cell carcinoma.

关键词： Minute gastric cancer Signet ring cell Endoscopic mucosal resection

Asymptomatic colonic metastases from primary squamous cell carcinoma of the lung with a positive fecal occult blood test

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World Journal of Gastroenterology 2008年第35期14卷 5481-5483页

作者： Shoji Hirasaki seiyuu suzuki Shigeki Umemura Haruhito Kamei Masato Okuda Kenichiro Kudo Department of Internal Medicine Sumitomo Besshi HospitalNiihama 7928543Japan

We describe a 74-year-old man with a colonic metastatic squamous cell carcinoma (SCC) from the lung. His chest X-ray revealed an abnormal shadow in the right upper lobe. Computed tomography (CT) of the chest demonstrated a large lung tumor in the right upper lobe obstructing the right upper bronchus. Bronchoscopy revealed an easy-bleeding tumor in the right upper bronchus that was diagnosed as poorly differentiated squamous cell lung carcinoma. He underwent colonoscopy because he had a positive fecal occult blood test. Colonoscopy revealed a large protruding lesion with central ulceration in the descending colon. Histological examination of the biopsy specimen obtained from the colonic lesion revealed SCC. The lesion was diagnosed as metastatic colonic SCC. He had no abdominal symptoms. He underwent chemotherapy with an infusion of cisplatin 130 mg i.v. day 1, and docetaxel hydrate 100 mg i.v. day 1, repeated every 4 wk, followed by 4 courses of chemotherapy. The primary lesion shrank by less than 10% and was judged to be "Partial Response" (PR) after 3 courses of treatment. The patient still lived 23 wk after the diagnosis of metastatic colonic SCC. Colonic metastasis of primary SCC of the lung is rare.

关键词： Gastrointestinal metastatic tumor Colonic metastasis Large intestine Colonoscopy Chemotherapy

Three cases of Solitary Peutz-Jeghers-type hamartomatous polyp in the duodenum

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World Journal of Gastroenterology 2008年第6期14卷 944-947页

作者： seiyuu suzuki Shoji Hirasaki Fusao Ikeda Eiichiro Yumoto Hiromichi Yamane Minoru Matsubara Department of Internal Medicine Sumitomo Besshi Hospital Niihama Japan

A solitary Peutz-Jeghers-type hamartomatous polyp in the duodenum is rare, and few reports have described its characteristic endoscopic features. We describe three cases of solitary Peutz-Jeghers-type hamartomatous polyp and their endoscopic findings in detail. The polyp in all of our three cases showed an irregularly lobular or nodular surface, whereas adenomas often show a regularly nodular or granular surface. The color of the polyp was whitish in all of our cases. In the present cases, close observation by endoscopy revealed that the solitary Peutz-Jeghers-type hamartomatous polyps looked whitish because of the presence of diffusely scattered white spots on the surface of the polyps. Duodenal polyps that exhibit the aforementioned endoscopic characteristics may be diagnosed as Peutz-Jeghers-type hamartomatous polyps and treated by polypectomy because of the malignant potential.

关键词： Duodenal polyp Hamartoma Peutz-Jeghers polyp

Treatment of over 20 mm gastric cancer by endoscopic submucosal dissection using an insulation-tipped diathermic knife

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World Journal of Gastroenterology 2007年第29期13卷 3981-3984页

作者： Shoji Hirasaki Hiromitsu Kanzaki Minoru Matsubara Kohei Fujita Fusao Ikeda Hideaki Taniguchi Eiichiro Yumoto seiyuu suzuki From Second Department of Internal Medicine Sumitomo Besshi Hospital 3-1 Ohji-cho Niihama 792-8543 Japan

AIM： To evaluate the effectiveness of endoscopic submucosal dissection using an insulation-tipped diathermic knife （IT-ESD） for the treatment of patients with over 20 mm early gastric cancer （EGC）. METHODS： A total of 112 patients with over 10 mm EGC were treated with IT-ESD at Sumitomo Besshi Hospital and Shikoku Cancer Center in the 5 year period from January 2002 to December 2006, including 40 patients with over 20 mm EGC. We compared patient backgrounds, the one-piece resection rate, complete resection （CR） rate, operation time, bleeding rate, perforation rate between patients with over 20 mm EGC [over 20 mm group （21-40 ram）] and the remaining patients （under 20 mm group）. RESULTS： We found no significant difference in the rate of underlying cardiopulmonary disease （over 20 mm group vs under 20 mm group, 5.0% vs 5.6%）, one- piece resection rate （95% vs 96%）, CR rate （85% vs 89%）, operation time （72.3 rain vs 66.5 rain）, bleeding rate （50 vs 4.2%）, and perforation rate （0% vs 1.4%） between the 2 groups. Three patients in each group had submucosal invasion and two in each groups underwent additional surgery. CONCLUSION： There was no significant difference in the outcome resulting from IT-ESD between the 2 groups. Our study proves that IT-ESD is a feasible treatment for patients with over 20 mm mucosal gastric cancer although the long-term outcome should be evaluated in the future.

关键词： Gastric cancer Endoscopic mucosal resection Insulation-tipped diathermic knife Complication

A ruptured large extraluminal ileal gastrointestinal stromal tumor causing hemoperitoneum

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World Journal of Gastroenterology 2008年第18期14卷 2928-2931页

作者： Shoji Hirasaki Kohei Fujita Minoru Matsubara Hiromitsu Kanzaki Hiromichi Yamane Masato Okuda seiyuu suzuki Atsuko Shirakawa Hideyuki Saeki Department of Internal Medicine Sumitomo Besshi Hospital Niihama 7928543 Japan Department of Pathology Sumitomo Besshi Hospital Niihama 7928543 Japan Department of Surgery Sumitomo Besshi Hospital Niihama 7928543 Japan

We describe an 87-year-old woman with a large ileal gastrointestinal stromal tumor (GIST) causing hemoperitoneum. A CT scan demonstrated a large heterogeneous mass measuring about 13 cm × 11 cm in the pelvis and hemoperitoneum, with a non-uniform enhancement pattern. The mass was diagnosed as a GIST originating from the gastrointestinal tract. She underwent an urgent laparotomy and an ileal GIST with a rupture was found 130 cm from the anal to the Treitz’s ligament. Hemoperitoneum caused by ileal GIST rupture is a rare condition. Bleeding in the large tumor leading to rupture of the capsule might cause hemoperitoneum in the present case.

关键词： Intestinal neoplasm Small intestine Extraluminal growth Laparotomy