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Mucosal necrosis of the small intestine in myopathy,encephalopathy,lactic acidosis,and stroke-like episodes syndrome

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World Journal of Gastroenterology 2012年第41期18卷 5986-5989页

作者： keita fukuyama Yasuhide Ishikawa Tetsuro Ogino Hidenobu Inoue Ryoya Yamaoka Tetsuro Hirose Tomohiko Nishihira Department of Gastroenterological Surgery Takamatsu Red Cross HospitalTakamatsu 760-0017Japan Department of Pathology Takamatsu Red Cross HospitalTakamatsu 760-0017Japan

This report presents a case of massive mucosal necrosis of the small intestine in a patient with mitochondrial myopathy,encephalopathy,lactic acidosis,and stroke-like episodes(MELAS),which particularly affects the brain,nervous system and muscles.A 45-year-old Japanese female,with an established diagnosis of MELAS,presented with *** tomography showed portomesenteric venous gas and pneumatosis *** underwent a resection of the small intestine.A microscopic study showed necrosis of the mucosa and vacuolar degeneration of smooth muscle cells in the arterial *** showed anti-mitochondrial antibody to be highly expressed in the crypts adjacent the necrotic *** microscopic and immunohistochemical findings suggested the presence of a large number of abnormal mitochondria in MELAS to be closely linked to mucosal necrosis of the small intestine.

关键词：小肠黏膜坏死性酸中毒肌病脑病酸性综合征乳

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Unexpected metastasis of intraductal papillary neoplasm of the bile duct without an invasive component to the brain and lungs:A case report

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World Journal of Gastroenterology 2020年第3期26卷 366-374页

作者： Nguyen Hai Nam Kojiro Taura Masashi Kanai keita fukuyama Norimitsu Uza Hirona Maeda Yojiro Yutaka Toyofumi F Chen-Yoshikawa Manabu Muto Shinji Uemoto Division of Hepato-Biliary-Pancreatic Surgery and Transplantation Department of SurgeryGraduate School of MedicineKyoto UniversityKyoto 606-8501Japan Department of Clinical Oncology Pharmacogenomicsand Palliative MedicineGraduate School of MedicineKyoto UniversityKyoto 606-8507Japan Department of Gastroenterology and Hepatology Graduate School of MedicineKyoto UniversityKyoto 606-8507Japan Department of Diagnostic Pathology Kyoto University HospitalKyoto 606-8507Japan Toyofumi F Chen-Yoshikawa Department of Thoracic.SurgeryGraduate School of MedicineKyoto UniversityKyoto 606-8507Japan Department of Therapeutic Oncology Graduate School of MedicineKyoto UniversityKyoto 606-8507Japan

BACKGROUND Despite an expanding number of studies on intraductal papillary neoplasm of the bile duct(IPNB),distant metastasis remains unexplained especially in cases of carcinoma in *** the present study,we report a rare and interesting case of IPNB without invasive components that later metastasized to lungs and *** SUMMARY A 69-year-old male was referred to our hospital due to suspected *** tests on admission reported a mild elevation of alkaline phosphatase,γ-glutamyl transpeptidase,and total bilirubin in *** retrograde cholangiography revealed a filling defect in the common bile duct(CBD)extending to the left hepatic *** cholangioscopy delineated a tumor in the CBD that had a papillary *** computed tomography and magnetic resonance cholangiopancreatography detected partial blockage ot interlude in the CBD leading to cholestasis without evidence of ***,a diagnosis of IPNB cT1N0M0 was *** hepatectomy with bile duct reconstruction was *** examination confirmed an intraepithelial neoplasia pattern without an invasive component and an R0 resection *** patient was monitored carefully by regular ***,at 32 mo after the operation,a 26 mm tumor in the lungs and a 12 mm lesion in the brain were detected following a suspicious elevated CA 19-9 ***-assisted thoracoscopic surgery of left upper lobectomy and stereotactic radiotherapy are *** addition to histopathological results,a genomic profiling analysis using whole exome sequencing subsequently confirmed lung metastasis originating from bile duct *** This case highlights the important role of genomic profiling analysis using whole exome sequencing in identifying the origin of metastasis in patients with IPNB.

关键词： Intraductal papillary neoplasm of the bile duct Distant metastasis Invasive component Whole exome sequencing CA 19-9 Case report

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