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Prospective real-time evaluation of diagnostic performance using endocytoscopy in differentiating neoplasia from nonneoplasia for colorectal diminutive polyps(≤ 5 mm)

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World Journal of Gastrointestinal Oncology 2018年第4期10卷 96-102页

作者： takahiro Utsumi Yasushi Sano Mineo Iwatate Hironori Sunakawa Akira Teramoto Daizen Hirata Santa Hattori Wataru Sano Noriaki Hasuike Kazuhito Ichikawa takahiro fujimori Gastrointestinal Center and Institute of Minimally Invasive Endoscopic Care (iMEC) Sano Hospital Department of Pathology Shinko Hospital

AIM To clarify the diagnostic performance of endocytoscopy for differentiation between neoplastic and nonneoplastic colorectal diminutive polyps.METHODS Patients who underwent endocytoscopy between October and December 2016 at Sano Hospital were prospectively recruited. When diminutive polyps(≤5 mm) were detected, the lesions were evaluated by endocytoscopy after being stained with 0.05% crystal violet and 1% methylene blue. The diminutivepolyps were classified into five categories(EC 1 a, 1 b, 2, 3 a, and 3 b). Endoscopists were asked to take a biopsy from any lesion diagnosed as EC1 b(indicator of hyperplastic polyp) or EC2(indicator of adenoma). We have assessed the diagnostic performance of endocytoscopy for EC2 and EC1 b lesions by comparison with the histopathology of the biopsy specimen. RESULTS A total of 39 patients with 63 diminutive polyps were analyzed. All polyps were evaluated by endocytoscopy. The mean polyp size was 3.3 ± 0.9 mm. Among the 63 diminutive polyps, 60 were flat and 3 were pedunculated. The mean time required for EC observation, including the time for staining with crystal violet and methylene blue, was 3.0 ± 1.9 min. Histopathologic evaluation showed that 13 polyps were hyperplastic and 50 were adenomas. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of EC2 for adenoma compared with EC1 b for hyperplastic polyp were 98.0%, 92.3%, 96.8%, 98.0% and 92.3%, respectively. There were only two cases of disagreement between the endoscopic diagnosis made by endocytoscopy and the corresponding histopathological diagnosis.CONCLUSION Endocytoscopy showed a high diagnostic performance for differentiating between neoplastic and non-neoplastic colorectal diminutive polyps, and therefore has the potential to be used for "real-time histopathology".

关键词： Endocytoscopy Diagnostic performance Diminutive polyp Endocytoscopic classification Realtime histopathology

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Size does not determine the grade of malignancy of early invasive colorectal cancer

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World Journal of Gastroenterology 2009年第22期15卷 2708-2713页

作者： Takahisa Matsuda Yutaka Saito takahiro Fujii Toshio Uraoka Takeshi Nakajima Nozomu Kobayashi Fabian Emura Akiko Ono Tadakazu Shimoda Hiroaki Ikematsu Kuang-I Fu Yasushi Sano takahiro fujimori Endoscopy Division National Cancer Center Hospital Clinical Laboratory Division National Cancer Center Hospital Division of Digestive Endoscopy and Gastrointestinal Oncology National Cancer Center Hospital East Department of Surgical and Molecular Pathology Dokkyo University School of Medicine

AIM:To clarify the clinicopathological characteristics of small and large early invasive colorectal cancers(EI-CRCs),and to determine whether malignancy grade depends on size.METHODS:A total of 583 consecutive EI-CRCs treated by endoscopic mucosal resection or surgery at the National Cancer Center Hospital between 1980 and 2004 were enrolled in this study.Lesions were classified into two groups based on size:small(≤10mm) and large(>10mm).Clinicopathological features,incidence of lymph node metastasis(LNM) and risk factors for LNM,such as depth of invasion,lymphovascular invasion(LVI) and poorly differentiated adenocarcinoma(PDA) were analyzed in all resected specimens.RESULTS:There were 120(21%) small and 463(79%) large lesions.Histopathological analysis of the small lesion group revealed submucosal deep cancer(sm:≥1000 μm) in 90(75%) cases,LVI in 26(22%) cases,and PDA in 12(10%) cases.Similarly,the large lesion group exhibited submucosal deep cancer in 380(82%) cases,LVI in 125(27%) cases,and PDA in 79(17%) cases.The rate of LNM was 11.2% and 12.1% in the small and large lesion groups,respectively.CONCLUSION:Small EI-CRC demonstrated the same aggressiveness and malignant potential as large cancer.

关键词：恶性肿瘤大肠癌侵入性早期病理特征康复中心病理特点危险因素

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Magnifying colonoscopy as a non-biopsy technique for differential diagnosis of non-neoplastic and neoplastic lesions

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World Journal of Gastroenterology 2006年第9期12卷 1416-1420页

作者： Shigeharu Kato Kuang I Fu Yasushi Sano takahiro Fujii Yutaka Saito Takahisa Matsuda Ikuro Koba Shigeaki Yoshida takahiro fujimori Division of Gastrointestinal Oncology and Digestive Endoscopy National Cancer Center Hospital East KashiwaChiba 277-8577Japan Division of Gastrointestinal Oncology and Digestive Endoscopy National Cancer Center Hospital East KashiwaChiba 277-8577Japan Department of Surgical and Molecular PathologyDokkyo University School of Medicine880 KitakobaysashiMibuShimotugaTochigi 321-0293Japan Division of Endoscopy National Cancer Center Hospital TsukijiTokyo 104-0045Japan Department of Surgical and Molecular Pathology Dokkyo University School of Medicine 880 KitakobaysashiMibuShimotugaTochigi 321-0293Japan

瞄准：为了澄清与放大结肠镜检查观察的粘膜地窟模式是否对可行，把非肿瘤的息肉与肿瘤的息肉区分开来。方法：从通过 2000 年 3 月的 1999 年 6 月，有 210 损害的 180 个连续病人与放大结肠镜诊断了(CF-200Z，天堂光有限公司，东京，... 详细信息

瞄准：为了澄清与放大结肠镜检查观察的粘膜地窟模式是否对可行，把非肿瘤的息肉与肿瘤的息肉区分开来。方法：从通过 2000 年 3 月的 1999 年 6 月，有 210 损害的 180 个连续病人与放大结肠镜诊断了(CF-200Z，天堂光有限公司，东京，日本) 被注册。有 0.2% 靛青洋红染料的放大和多彩石印版内视镜检查法为粘膜地窟观察被用于每损害。损害出现打字我和 II 地窟模式被活体检视组织学地认为非肿瘤、检验，而损害证明到 V 地窟模式的类型 III 被移开内视镜的联盟者或通过手术。内视镜的诊断和 histologic 诊断的关联然后被调查。结果：在内视镜检查法， 24 损害证明我或 II 坑模式，和 186 损害显示出的一种类型打 III 到 V 坑模式。与 histologic 检查， 26 损害作为非肿瘤的息肉被诊断，并且 184 损害作为肿瘤的息肉被诊断。全面诊断精确性是 99.1%(208/210 ) 。敏感和特性是 92.3%(24/26 ) 并且 99.8%(184/186 ) 分别地。结论：放大结肠镜检查能作为一种非活体检视技术被使用区分肿瘤、非肿瘤的息肉。

关键词：结肠镜检查活组织检查肿瘤检查方法

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Incidence and localization of lymphoid follicles in early colorectal neoplasms

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World Journal of Gastroenterology 2005年第43期11卷 6863-6866页

作者： Kuang-I Fu Yasushi Sano Shigeharu Kato takahiro Fujii Ikura Koba Takayuki Yoshino Atsushi Ochiai Shigeaki Yoshida takahiro fujimori Division of Gastrointestinal Oncology and Digestive Endoscopy Division of Pathology Department of Surgical and Molecular Pathology

AIM: To investigate the incidence and localizations of lymphoid follicles (LFs) in early colorectal neoplasms in human beings.METHODS: From July 1992 to September 1999, a total of 1 324 early colorectal neoplasms were removed endoscopically or surgically at our hospital; 1 031 (77.9%)were available for analysis in this study. Localization of LFs was defined histologically: as submucosal LFs, if located under the muscularis mucosa; and as intramucosal LFs, if located across or oyer the muscularis mucosa.RESULTS: Histologically, the materials included 903intramucosal neoplasms and 128 submucosal cancers.Overall incidence of LFs was 27.2% (280/1 031). The incidence of LFs was significantly higher in females (33.6% vs 24.9%,P=0.0064), the right-sided colon (32.2% vs 25.6%, P=0.0403) and in flat or depressed type lesions (34.6% vs 25.2%, P＜0.0001)as compared to males, left-sided colon and protruding type lesions, respectively. The incidences of intramucosal neoplasms and submucosal cancers were 24.3% and 43.8%, respectively (P＜0.0001). Localizations of LFs (intramucosal LF/submucosal LF) in depressed, flat,and protruding types were 1/24, 14/36, and 131/74,respectively.CONCLUSION: The incidence of LFs in early human colorectal neoplasms significantly differs by gender,location, macroscopic type, and histology. Moreover,localization significantly differs by macroscopic type.

关键词：淋巴卵泡结肠息肉直肠息肉病理机制

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Ectopic hepatocellular carcinoma arising from pancreas: A case report and review of the literature

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World Journal of Gastroenterology 2007年第31期13卷 4270-4273页

作者： Keiichi Kubota Junji Kita Kyu Rokkaku Yoshimi Iwasaki Tokihiko Sawada Johji Imura takahiro fujimori Second Department of Surgery Dokkyo University Hospital 880 Kitakobayashi Mibu Tochigi Japan Department of Surgical and Molecular Pathology Dokkyo University Hospital 880 Kitakobayashi Mibu Tochigi Japan

A 56-year-old man was found to have a pancreatic tail tumor. His blood chemistry showed no infection with hepatitis B or C virus and no elevations of tumor markers or pancreatic hormones. Abdominal ultrasound showed an encapsulated, rather heterogeneous, hypoechoic tumor, 6.5 cm in maximum diameter, with a beak sign. Helical dynamic CT revealed an irregularly enhanced tumor with pooling of contrast medium in the delayed phase. Abdominal angiography showed a hypervascular tumor. With a tentative diagnosis of non-functional islet-cell tumor, the patient underwent resection of the pancreatic body and tail with splenectomy. The contour of the liver and its surface were normal. In microscopic examination, tumor cells arranged in a trabecular pattern with focal bile pigment resembling hepatocellular carcinoma (HCC). Immunohistochemically, these tumor cells were positivefor HEPPAR-1, CAM5.2, cytokeratin 18 and COX-2, but negative for MUC-1, and cytokeratins 7, 20 and 8. These results supported a diagnosis of HCC without any adenocarcinoma component. The patient is currently doing well without any signs of recurrence in either the remaining pancreas or liver three years after surgery. We report the rare case with ectopic HCC in the pancreas with a review of the literature.

关键词：肝细胞癌肝异位胰腺疾病治疗

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Primary signet-ring cell carcinoma of the colon at early stage: A case report and a review of the literature

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World Journal of Gastroenterology 2006年第21期12卷 3446-3449页

作者： Kuang-I Fu Yasushi Sano Shigeharu Kato Hiroki Saito Atsushi Ochiai takahiro fujimori Yutaka Saito Takahisa Matsuda takahiro Fujii Shigeaki Yoshida Division of Gastrointestinal Oncology and Digestive Endoscopy National Cancer Center Hospital East KashiwaChiba 277-8577Japan Department of Surgical and Molecular PathologyDokkyo University School of Medicine880 KitakobaysashiMibuShimotugaTochigi 321-0293Japan Division of Gastrointestinal Oncology and Digestive Endoscopy National Cancer Center Hospital East KashiwaChiba 277-8577Japan Division of Pathology National Cancer Center East Research Institute Chiba 277-8577Japan Department of Surgical and Molecular Pathology Dokkyo University School of Medicine 880 KitakobaysashiMibuShimotugaTochigi 321-0293Japan Division of Endoscopy National Cancer Center Hospital TsukijiTokyo 104-0045Japan

经历了外科到将切除的一个 67 岁的人多重胃的癌症 4 年以前，为监视结肠镜检查访问了我们的医院。揭示的结肠镜检查一变色，在直径的 7 公里，有在结肠左曲附近的横向的冒号的中央消沉的提高公寓的损害。尽管内视镜检查法和钡灌肠的调... 详细信息

经历了外科到将切除的一个 67 岁的人多重胃的癌症 4 年以前，为监视结肠镜检查访问了我们的医院。揭示的结肠镜检查一变色，在直径的 7 公里，有在结肠左曲附近的横向的冒号的中央消沉的提高公寓的损害。尽管内视镜检查法和钡灌肠的调查结果粘膜下层侵略是暗示的，病人选择了经历内视镜的粘膜切除术。resected 标本的病理学的检查揭示了图章戒指房间癌和积极外科的边缘。第二个手术被动，并且到淋巴结的剩余肿瘤或转移都没在 resected 标本被发现。由在一个早阶段检测并且对待的图章戒指房间癌组成的三原色表面的癌症是极其稀罕的。我们在场一个盒子和评论文学。

关键词：结肠癌内窥镜检查病理机制临床

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Pneumoscrotum: A rare manifestation of perforation associated with therapeutic colonoscopy

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World Journal of Gastroenterology 2005年第32期11卷 5061-5063页

作者： Kuang-I Fu Yasushi Sano Shigeharu Kato takahiro Fujii Masanori Sugito Masato Ono Norio Saito Kiyotaka Kawashima Shigeaki Yoshida takahiro fujimori Division of Gastrointestinal Oncology and Digestive EndoscopyNational Cancer Center Hospital East KashiwaChiba 277-8577Japan Division of SurgeryNational Cancer Center Hospital East KashiwaChiba 277-8577Japan Department of Surgical and Molecular PathologyDokkyo University School of Medicine 880 KitakobaysashiMibuShimotugaTochigi 321-0293Japan

Pneumoscrotum is uncommon and also rarely reported as a complication associated with colonic perforation. A case of colonic perforation in delayed fashion associated with EMR, revealed by pneumoscrotum, is reported and the associated literatures are reviewed. A 52-year-old male received piecemeal EMR for a laterally spreading tumor 35 mm in size in our hospital. He complained of enlargement of the scrotum and revisited our hospital the day after the procedure. A diagnosis of pneumoscrotum was made, and as most such cases have been reported to be associated with pneumoperitoneum, colonic perforation was suspected. Free air but no fluid collection was found by abdominal computed tomography, and delayed colonic perforation was diagnosed. However, as there were no clinical signs of peritoneal irritation,conservative treatment was administered and the patient recovered uneventfully. Pneumoscrotum could be a sign of colonic perforation after EMR, and treatment should be carefully chosen.

关键词：结肠镜治疗方法并发症肠穿孔

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Successful endoscopic procedures for intraductal papillary neoplasm of the bile duct:A case report

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World Journal of Gastroenterology 2010年第7期16卷 909-913页

作者： Kohei Tsuchida Michiko Yamagata Yasuyuki Saifuku Dan Ichikawa Kazunari Kanke Toshimitsu Murohisa Masaya Tamano Makoto Iijima Yukiko Nemoto Wataru Shimoda Toshiaki Komori Hirokazu Fukui Kazuhito Ichikawa Hitoshi Sugaya Kazuhito Miyachi takahiro fujimori Hideyuki Hiraishi Department of Gastroenterology Dokkyo Medical UniversityTochigi 321-0293Japan First Department of Surgery Dokkyo Medical UniversityTochigi 321-0293Japan Department of Surgical and Molecular Pathology Dokkyo Medical UniversityTochigi 321-0293Japan

Attention has recently been focused on biliary papillary tumors as the novel disease entity intraductal papillary neoplasm of the bile duct(IPNB),which consists of papillary proliferation of dysplastic biliary epithelium.As even benign papillary tumors are considered as premalignant,some investigators recommend aggressive surgical therapy for IPNB,although no guidelines are available to manage this disease.Few reports have described long-term follow-up of patients with benign IPNB without radical resection.If patients with IPNB who are treated only with endoscopic procedures are noted,clinical profiles and alternative therapies other than resection may be recommended.We report the case of a patient who experienced repetitive cholangitis for 10 years and was finally diagnosed with IPNB.Radical resection could not be recommended because of the age of the patient,therefore,endoscopic sphincterotomy was performed.Although an endoscopic retrograde biliary drainage catheter was placed several times for repetitive cholangitis,the patient has done well during follow-up.Our case may offer insights into the natural course and management decisions for the novel disease entity of IPNB.

关键词： Biliary tract neoplasms Papilloma Endoscopic sphincterotomy Endoscopic retrograde biliary drainage

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Alpha-fetoprotein-producing colon cancer with atypical bulky lymph node metastasis

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World Journal of Gastroenterology 2006年第47期12卷 7715-7716页

作者： Kuangi Fu Akihiro Kobayashi Norio Saito Yasushi Sano Shigeharu Kato Hiroaki Ikematsu takahiro fujimori Yasushi Kaji Shigeaki Yoshida Department of Radiology Dokkyo University School of Medicine 880 Kitakobaysashi Mibu Shimotuga Tochigi 321-0293 Japan Department of Gastrointestinal Oncology and Digestive Endoscopy National Cancer Center Hospital East Kashiwa Chiba 277-8577 Japan Department of Surgery National Cancer Center Hospital East Kashiwa Chiba 277-8577 Japan Department of Gastrointestinal Oncology and Digestive Endoscopy National Cancer Center Hospital East Kashiwa Chiba 277-8577 Japan Department of Surgical and Molecular Pathology Dokkyo University School of Medicine 880 Kitakobaysashi Mibu Shimotuga Tochigi 321-0293 Japan Department of Radiology Dokkyo University School of Medicine 880 Kitakobaysashi Mibu Shimotuga Tochigi 321-0293 Japan

Alpha-fetoprotein (AFP)-producing colorectal cancer is extremely rarely reported until now. All of the reported cases harboring synchronous hematogenous spread including liver and/or lung metastasis had a poor prognosis and died within 12 mo. We here describe a 71-year old man with AFP-producing colon cancer who presented with an unusual bulky lymph node metastasis instead of hematogenous spread. He underwent adjuvant chemotherapy in addition to curative surgical resection, which prolonged his survival.

关键词：结肠癌淋巴细胞胎蛋白 X线断层摄影术

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Surgical treatment of HCC in a patient with lamivudine-resistant hepatitis B cirrhosis with adefovir dipivoxil

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World Journal of Hepatology 2010年第8期2卷 318-321页

作者： Takashi Akima Masaya Tamano Hidetsugu Yamagishi Keiichi Kubota takahiro fujimori Hideyuki Hiraishi Department of Gastroenterology Dokkyo Medical University Department of Gastroenterology Dokkyo Medical University Koshigaya Hospital Department of Surgical and Molecular Pathology Dokkyo Medical University Second Department of Surgery Dokkyo Medical University

We describe a 77-year-old woman with chronic hepatitis B who became resistant to lamivudine.She was started on adefovir(10 mg daily)while still continuing lamivudine therapy.Four mo later her liver function improved and serum Hepatitis B virus(HBV)-DNA level became undetectable.Three years after the start of additional adefovir treatment,hepatocellular carcinoma (HCC)was detected and the patient underwent a successful hepa-tectomy.Our findings suggest tha-t the addition of adefovir to ongoing lamivudine therapy cannot completely suppress hepatocarcinogenesis,but is useful for improving liver function in patients with lamivudine-resistant HBV-related cirrhosis,allowing HCC surgery.

关键词： Hepatitis B virus Hepatocellular carcinoma Hepatocarcinogenesis Lamivudine Adefovir dipivoxil

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