Primary low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma with polypoid appearance. Polypoid gastric MALT lymphoma: A clinicopathologic study of eight cases.

In the current study, we report eight cases with primary low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma endoscopically characterized by polypoid lesions in order to highlight their clinicopathologic significance. Four patients were male, their ages ranging from 40 to 78 years old. The resected specimens revealed a histology of low-grade MALT lymphoma characterized by dense lymphocytic infiltration predominantly in the submucosa and a relatively monotonous proliferation of centrocyte-like cells with reactive follicles and infrequent lymphoepithelial lesions. The tumor cells were of CD5-, CD10-, CD20+, BCL2+ and cycline D1- phenotype, and showed a monoclonal rearrangement of immunoglobulin heavy chain genes in the five of six cases examined. Interestingly, Helicobacter pylori (H. pylori) was detected in three (37.5%) of the eight patients, which was significantly lower than previous reports. Two of the H. pylori-positive cases initially underwent H. pylori eradication, but showed no change in their lymphomas after the cure of H. pylori infection. The clinicopathologic findings of the present cases appeared to closely resemble those of colorectal MALT lymphoma with a polypoid appearance and few association of H. pylori infection in their pathogenesis. These gastric polypoid cases may merit separate consideration because of the therapeutic problems they pose.

Endoscopic resection of small duodenal carcinoid tumors with strip biopsy technique.

BACKGROUND: Most cases of duodenal carcinoid have conventionally been treated by surgical resection. The aim of our study was to explore the feasibility of endoscopic resection in small duodenal carcinoids. METHODS: The study population consisted of seven patients with small duodenal carcinoids. The diagnosis was confirmed by preoperative biopsies. The depth of tumor invasion was evaluated by endosonography. RESULTS: The carcinoid was detected by endosonography in all cases. Size ranged ultrasonographically from 1.5 mm to 7 mm. Tumor invasion was confined to the submucosa in all patients. Endoscopic resection was performed with the strip biopsy technique using a two-channel endoscope. In six patients, the specimens were resected without severe complications. Five of them were confirmed histologically to be typical carcinoids. In one patient, carcinoid was not detected histologically in the specimen. In the remaining patient, a perforation occurred. However, the huge ulcer was managed conservatively. Follow-up endoscopy revealed no evidence of recurrent or residual tumor in any patient. CONCLUSION: Small duodenal carcinoids confined to the submucosa can be resected endoscopically and preoperative endosonography is necessary for the determination of endoscopic resectability.

Evaluation of handling methods in the histological diagnosis of Helicobacter pylori: the effect of filter paper.

OBJECTIVES: Few studies have evaluated the handling methods used in the histological diagnosis of Helicobacter pylori. Filter paper has conventionally been used as a receptacle for the biopsy specimen before fixation. The aim of this study was to determine the presence of any effect caused by the use of filter paper. METHODS: The study population consisted of 104 consecutive patients undergoing endoscopic examination. Two antral biopsy specimens from the same area were obtained from each patient. One specimen was put onto a piece of filter paper, and the other into a plastic case. The specimens were fixed overnight in buffered formalin, embedded in paraffin, sectioned, and stained with hematoxylin and eosin and Giemsa. A direct smear was also prepared from 77 patients by vigorously rubbing the filter paper on a glass slide and staining it with Giemsa. RESULTS: The detection rate of H. pylori was 47.1% (49 of 104) for the filter paper method, 56.7% (59 of 104) for the plastic case method, and 57.7% (60 of 104) for either of the two methods. Of the 60 positive patients, 11 filter paper specimens were negative, whereas only one plastic case specimen was negative. Statistical analysis revealed a significant difference between the two groups (p < 0.01). On the amount of H. pylori, the filter paper method showed a significantly lower grade than the plastic case method (p < 0.05). In the Giemsa-stained smears, H. pylori was identified in 17 (22.1%) of the 77 patients studied. CONCLUSIONS: Use of filter paper may decrease the sensitivity for detection of H. pylori infection. We recommend not using filter paper in the histological diagnosis of H. pylori.

Giant splenic cyst with high serum concentration of CA 19-9. Failure of treatment with percutaneous transcatheter drainage and injection of tetracycline.

BACKGROUND: Recently, several cases of nonparasitic true splenic cyst with high serum concentration of carbohydrate antigen (CA 19-9) have been reported. CASE: We report a giant splenic cyst presenting with high serum concentration of CA 19-9 in a 21-year-old man without a history of previous trauma. Imaging techniques showed a huge monolocular cyst of the spleen, and laboratory data showed increased serum CA 19-9 levels (326 U/ml; normal, < 37 U/ml). Serologic test was negative for parasitic infection. These findings led us to the diagnosis of epithelial splenic cyst. Percutaneous transcatheter drainage and injection of tetracycline were performed for 2 weeks. The cyst shrank, and the serum CA 19-9 level decreased favorably. However, cystic fluid reaccumulated in a month. CONCLUSIONS: The accumulation of cystic fluid in splenic epithelial cysts may be attributable not only to the secretion of the lining cells but also to influx from the splenic sinuses.

Primary malignant melanoma of the esophagus presenting with massive hematemesis.

A 66-year-old Japanese man was admitted to our hospital, presenting with massive hematemesis. Emergency endoscopy revealed a bleeding tumor at the esophagogastric junction. The endoscopic appearance of the tumor was that of a Borrmann 2-like tumor, with a brownish-black discoloration. Bioptic histology confirmed the diagnosis of malignant melanoma. Atypical melanocytes with junctional changes were also found at a small pigmented patch in the lower esophagus, separate from the gross tumor. Melanocytosis was noted in the adjacent esophageal epithelium in the resection specimen following surgery. No primary lesion was found elsewhere, even in the patient's skin. These pathologic findings support the possibility of multicentric occurrence of malignant melanoma in esophageal melanocytosis. The patient is alive 11 months later, with multiple liver metastases. Massive hematemesis is an unusual presentation of primary malignant melanoma of the esophagus.

Duodenal carcinoid tumor: endosonographic imaging and endoscopic resection.

A 75-yr-old Japanese woman was shown by endoscopy to have a sessile polyp in the duodenal bulb. Endoscopic biopsy confirmed the diagnosis of carcinoid tumor. The endoscopic ultrasound probe showed a 6-mm hypoechoic tumor that was confined to the submucosal layer; the underlying muscularis propria layer was intact. On the basis of these findings, endoscopic resection was chosen, and the tumor was completely resected by the strip biopsy technique with prior hypertonic saline and epinephrine injection; there were no complications.

Incidence of peptic ulcer in men is inversely correlated with blood pressure: study in an apparently healthy Japanese population.

OBJECTIVE: To study the role of autonomic nervous innervation in the etiology of peptic ulcer, we investigated the blood pressure in patients with peptic ulcer. METHODS: In 100,085 Japanese adults who were undergoing health screening examinations, including barium meal study, there were endoscopic evaluation-confirmed diagnoses of gastric ulcer in 769 cases and of duodenal ulcer in 344 cases. The blood pressure in those patients was compared with that in 57,208 normal Japanese controls with no gastrointestinal abnormalities, as confirmed by barium meal study. RESULTS: The blood pressure of younger and middle-aged men with gastric and duodenal ulcer were lower than those of normal control men. In women, except for the diastolic pressure of those in their 50s, the blood pressure in patients with peptic ulcer and normal controls did not differ significantly. The incidence of duodenal ulcer or of gastric ulcer in men was inversely related to the systolic and diastolic pressure. No definite relationship in this respect was seen in women. CONCLUSIONS: An inverse relationship was observed between the occurrence of peptic ulcer and the blood pressure level in Japanese men, but not in women. The relationship may be mediated by an inhibitory effect of the sympathetic nervous system on ulcer formation in hypertensive subjects. The reason for the sex difference in this respect is unknown.

Effects of FK506, an immunosuppressive agent, on genesis of water-immersion stress-induced gastric lesions in rats.

We examined the effects of FK506, an immunosuppressive agent, on the genesis of water immersion stress-induced gastric lesions in rats. Using high-performance liquid chromatography, four kinds of prostaglandins, ie, 6-keto-prostaglandin F1 alpha, prostaglandin F2 alpha, prostaglandin E2, and prostaglandin D2, were detected, and no leukotrienes were detected in gastric mucosa in rats without stress. After 6 hr of stress, gastric lesions developed with decreases in all prostaglandin contents, and the emergence of peptide leukotrienes was observed. Intramuscular administration of FK506 (0.1, 0.25, 0.5, 1.0, and 2.0 mg/kg) reduced lesion index dose-dependently. Administration of FK506 at doses over 0.25 mg/kg decreased all prostaglandin contents, but did not affect the increase in leukotriene contents. Pretreatment with famotidine or omeprazole reduced lesion index, and the protective effects were equivalent to those of 1.0 mg/kg of FK506, although FK506 did not affect gastric secretion during water-immersion stress. Water-immersion stress did not change the activities of xanthine oxidase in either stomach or serum. Polyoxyethylene-modified superoxide dismutase did not prevent gastric lesions. Water-immersion stress significantly increased myeloperoxidase activity in gastric mucosa, and FK506 reduced the increase in myeloperoxidase activity induced by stress. From our results, other factors besides gastric acid secretion and tissue eicosanoid contents, such as chemoattractant factor, might also be involved in the genesis of water-immersion stress-induced gastric lesions in rats.

Study on the acceleration in healing of ethanol-induced gastric lesions in rats by methylprednisolone.

This study was designed to determine the influences of methylprednisolone (MP, CAS 2375-03-3) on the genesis and healing of gastric lesions induced by 50% ethanol in relation to the changes in gastric mucosal prostaglandin (PG) and leukotriene (LT) contents and vascular permeability. Intragastric administration of 1 ml of 50% ethanol induced hemorrhagic lesions in the fundic portion, and these lesions were not affected by 20 mg/kg of MP injected subcutaneously 30 min before ethanol administration. In untreated rats, 4 kinds of PGs, i.e., 6-keto-PGF1a, PGF2a, PGE2, and PGD2, were determined in gastric mucosa by high performance liquid chromatography (HPLC), but no LTs were detected. Administration of ethanol significantly reduced all PG contents and increased production of peptide-LTs in gastric mucosa. Pretreatment with MP did not influence ethanol-induced changes in PG and peptide-LT contents. Ethanol-induced lesions required 96 h for total healing. Ulcer healing was not affected by MP, which was injected subcutaneously twice daily from 1 h after ethanol administration until the end of the experiment, and complete ulcer healing was observed after 72 h. MP did not affect ethanol-induced decrease in PG contents, their recoveries, or peptide-LT contents. Ethanol increased vascular permeability and MP reduced this increase. These results suggest that MP does not have a hazardous effect, but is rather beneficial with regard to healing of ethanol-induced gastric lesions through prevention of the increase in vascular permeability caused by ethanol, and that it affected neither gastric mucosal PG nor peptide-LT contents.

Reduction of adverse effects of indomethacin by anti-allergic drugs in rat stomachs.

This study was designed to elucidate the role of leukotrienes (LT) in indomethacin-induced gastric ulcers in relation to effects of clinically available anti-allergic drugs, azelastine (Azeptin, CAS 58581-89-8) and oxatomide (CAS 60607-34-3). Azelastine (2 mg/kg) or oxatomide (30 mg/kg) was administered intragastrically once 15 min before intragastrical administration of 12 mg/kg of indomethacin. Mucosal prostaglandins (PGs) and LTs were measured by high-performance liquid chromatography (HPLC). In the control rats, 4 kinds of PGs, i.e., 6-keto-PGF1 alpha, PGF2 alpha, PGE2 and PGD2, were detected in gastric mucosa, but no LT was detected. Administration of indomethacin caused severe gastric ulcers (lesion scores; 31.2 +/- 11.1 mm), and all prostaglandins were diminished completely. In contrast, LTC4 and LTD4 (peptide-LTs) were detected and the sum of their levels was 18.5 +/- 7.1 ng/g tissue. Irrespective of indomethacin administration, lesion scores were remarkably reduced in rats treated with azelastine or oxatomide (17.0 +/- 8.1 and 16.0 +/- 8.0, respectively). Azelastine and oxatomide treatment did not improve mucosal PG levels, however, both drugs reduced significantly increases in peptide-LT level, 9.3 +/- 4.6 and 8.6 +/- 4.4, respectively. These results suggest that increases in mucosal LT levels are also involved in the formation of indomethacin-induced gastric ulcers. Combined therapy using anti-allergic drugs and non-steroidal anti-inflammatory drugs might be recommended.

Age-associated decreases in prostaglandin contents in human gastric mucosa.

This study was designed to clarify effects of ageing on human gastric mucosal prostaglandin (PG) contents. Forty examinees were divided into 5 age groups of 8 persons each, as follows: age under 40, age 40-49, age 50-59, age 60-69, and age over 70. PG contents in human gastric mucosa were measured by microcolumn high performance liquid chromatography (HPLC) with helium/cadmium laser induced fluorescence detection using biopsy samples obtained by endoscopy. The contents of 6-keto-PGF1 alpha, PGF2 alpha, PGE2, and PGD2 in the under 40 group were 638 +/- 39, 97 +/- 16, 468 +/- 68, 497 +/- 86 (pg/mg tissue), respectively. No significant differences in PG contents among groups aged under 70 were observed. In contrast, significantly low PG contents in the over 70 group were observed, i.e., the contents of 6-keto-PGF1 alpha, PGF2 alpha, PGE2, and PGD2 were 311 +/- 58, 36 +/- 8, 196 +/- 48, 171 +/- 40, respectively, and their contents were significantly lower than those in other age groups. In conclusion, gastric mucosal PG contents decrease significantly in over 70 years-old and this might be a contributing factor in the pathogenesis of gastric ulcers in elderly people.

Prevalence of gallbladder polyps among apparently healthy Japanese: ultrasonographic study.

The prevalence of gallbladder polyps was investigated in apparently healthy Japanese who underwent abdominal ultrasonography as part of their health screening examination. The polyps found were differentiated from gallstones, adenomas, or carcinomas as much as possible, and were considered to be cholesterol polyps. The prevalence of such gallbladder polyps was higher among males in every decade of age evaluated. The subjects with gallbladder polyps were more obese than the control group without gallbladder polyps, on abdominal ultrasonograms. The prevalence of gallbladder polyps rose in accordance with a rise in obesity index. At each range of obesity index, the prevalence of gallbladder polyps was higher among males. The prevalence of gallbladder polyps was highest among the middle-aged (40- and 50-yr-old) males, similar to the curve of the obesity index. In females, the obesity index increased with age, with no accompanying rise in the prevalence of gallbladder polyps. These data suggest that obesity contributes to the formation of cholesterol polyps of the gallbladder.

Effect of duodenal mucosal blood flow on duodenal alkaline secretion in rats.

To investigate the role of duodenal mucosal blood flow (DMBF) in the regulation of duodenal alkaline secretion (DAS), both parameters were measured before and after the administration of various drugs in rats. The DMBF was determined using an electrolytically generated hydrogen gas clearance technique, and the DAS was measured by the perfusion method. The administration of dulcerozine, a potent duodenal ulcerogenic agent, at a dose of 250 mg/kg and serotonin at a dose of 20 mg/kg, which produces duodenal ulcerations with an acid load, decreased both DMBF and DAS. On the other hand, the administration of secretin at a dose of 10 U/kg increased both parameters. There were parallel changes in DMBF and DAS. It is concluded, therefore, that DAS may be regulated by DMBF and that both parameters may be involved in the defense mechanism of duodenal mucosa.

[Endoscopic ultrasonography in the assessment of invasive cardiac cancer].

The aim of this study was to assess the accuracy and limitation of Endoscopic ultrasonography (EUS) in the preoperative evaluation of the cardiac cancer (cancer in the area less than 2 cm from the esophago-gastric junction). EUS was preoperatively performed in 20 patients with cardiac cancer. These cases were visualized by the water immersion method and balloon contact method. The results were correlated with the histology of resected specimens. EUS was accurate in assessing the depth of tumor infiltration. Over all accuracy of EUS for cardiac cancer was 90%. Recognition of ultrasonographic patterns had enabled us to judge the mode of tumor infiltration whether expansive or infiltrative. Microscopical spread over 5 mm to the esophagus of the cardiac cancer could be detected by EUS. EUS was accurate in diagnosing thoracic lymph nodes (No. 110, 111, 112) metastasis of the cardiac cancer (accuracy 86%). EUS was valuable in the clinical diagnosis of the cardiac cancer.