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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 *** 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 *** 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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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 *** was started on adefovir(10 mg daily)while still continuing lamivudine *** mo later her liver function improved and serum Hepatitis B virus(HBV)-DNA level became *** years after the start of additional adefovir treatment,hepatocellular carcinoma (HCC)was detected and the patient underwent a successful *** 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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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

AIM： To clarify whether mucosal crypt patterns observed with magnifying colonoscopy are feasible to distinguish non-neoplastic polyps from neoplastic polyps. METHODS： From June 1999 through March 2000, 180 consecutive patients with 210 lesions diagnosed with a magnifying colonoscope （CF-200Z, Olympus Optical Co., Ltd., Tokyo, Japan） were enrolled. Magnification and chromoendoscopy with 0.2% indigo-carmine dye was applied to each lesion for mucosal crypt observation. Lesions showing types Ⅰ and Ⅱ crypt patterns were considered non-neoplastic and examined histologically by biopsy, whereas lesions showing types Ⅲ to Ⅴ crypt patterns were removed endoscopically or surgically. The correlation of endoscopic diagnosis and histologic diagnosis was then investigated. RESULTS： At endoscopy, 24 lesions showed a type Ⅰ or Ⅱ pit pattern, and 186 lesions showed type Ⅲ to Ⅴ pit patterns. With histologic examination, 26 lesions were diagnosed as non-neoplastic polyps, and 184 lesions were diagnosed as neoplastic polyps. The overall diagnostic accuracy was 99.1% （208/210）. The sensitivity and specificity were 92.3% （24/26） and 99.8% （184/186）, respectively. CONCLUSION： Magnifying colonoscopy could be used as a non-biopsy technique for differentiating neoplastic and non-neoplastic polyps.

关键词： Non-biopsy technique Magnifying colonoscopy Indigo-carmine dye spraying Pit Pattern

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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 Iocalizations 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 over the muscularis RESULTS： Histologically, the materials included 903 intramucosal 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〈O.O001） 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〈O.O001）. 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： Lymphoid follicle Early colorectal neoplasm Carcinogenesis

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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： Hepatocellular carcinoma Ectopic liver Ectopic hepatocellular carcinoma Pancreas Pancreatictumor Islet-cell tumor

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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

A 67-year-old man, who had undergone surgery to resect multiple gastric cancers 4 years ago, visited our hospital for surveillance colonoscopy. Colonoscopy revealed a discolored, 7-mm in diameter, flat-elevated lesion with central depression in the transverse colon near the splenic flexure. Although the findings of endoscopy and barium enema were suggestive of submucosal invasion, the patient chose to undergo endoscopic mucosal resection. Pathological examination of the resected specimen revealed signet-ring cell carcinoma and a positive surgical margin. A second operation was performed, and no residual tumor or metastasis to lymph nodes was found in the resected specimens. Primary colorectal cancers composed of signet-ring cell carcinoma detected and treated at an early stage are extremely rare. We present a case and review the literature.

关键词： Signet-ring cell carcinoma Early colorectal cancer Endoscopic mucosal resection

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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 alter 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 alter EMR, and treatment should be carefully chosen.

关键词： Pneumoscrotum Colonic perforation Endoscopic mucosal resection

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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： Alpha-fetoprotein Colon cancer Bulky lymph node metastasis Computed tomography Colonoscopy

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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 （≤10 ram） and large （〉10 ram）. 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 （sin： 1〉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, ***： Small EI-CRC demonstrated the same aggressiveness and malignant potential as large cancer.

关键词： Colorectal cancer Submucosal invasion Lymph node metastasis Endoscopic mucosal resection

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Narrow-band imaging observation of colorectal lesions using NICE classification to avoid discarding significant lesions

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World Journal of Gastrointestinal Endoscopy 2014年第12期6卷 600-605页

作者： Santa Hattori Mineo Iwatate Wataru Sano Noriaki Hasuike Hidekazu Kosaka Taro Ikumoto Masahito Kotaka Akihiro Ichiyanagi Chikara Ebisutani Yasuko Hisano takahiro fujimori Yasushi Sano Gastrointestinal Center and Institute of Minimally Invasive Endoscopic Care Sano Hospital Department of Gastroenterology Kobe Minimally Invasive Treatment Center of Cancer Medical Oncology/Hematology Kobe University Graduate School of Medicine Department of Pathology Shinko Hospital

AIM: To assess the risk of failing to detect diminutive and small colorectal cancers with the "resect and discard" ***: Patients who received colonoscopy and polypectomy were recruited in the retrospective study. Probable histology of the polyps was predicted by six colonoscopists by the use of NICE classification. The incidence of diminutive and small colorectal cancersand their endoscopic features were assessed. RESULTS: In total, we found 681 cases of diminutive(1-5 mm) lesions in 402 patients and 197 cases of small(6-9 mm) lesions in 151 patients. Based on pathology of the diminutive and small polyps, 105 and 18 were non-neoplastic polyps, 557 and 154 were low-grade adenomas, 18 and 24 were high-grade adenomas or intramucosal/submucosal(SM) scanty invasive carcinomas, 1 and 1 were SM deeply invasive carcinoma, respectively. The endoscopic features of invasive cancer were classified as NICE type 3 ***: The risk of failing to detect diminutive and small colorectal invasive cancer with the "resect and discard" strategy might be avoided through the use of narrow-band imaging observation with the NICE classification scheme and magnifying endoscopy.

关键词： Image-enhanced endoscopy Narrow-band imaging Resect and discard NICE classification Magnifying endoscope Colonoscopy SM-d

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