Argon plasma coagulation for the treatment of early gastric cancer.

BACKGROUND/AIMS: Endoscopic mucosal resection (EMR) is widely used to treat early gastric cancer and is considered safe and effective. However, its indication range is limited. Other endoscopic treatment options are needed for patients with surgical risks. The aim of the study was to evaluate the safety and effectiveness of argon plasma coagulation (APC) for the treatment of early gastric cancer. METHODOLOGY: APC was done in 23 patients (mean age, 77.5 years) with early gastric cancer. The depth of tumor invasion, estimated primarily by endoscopic ultrasonography, was mucosal in 19 patients and submucosal in 4. EMR was not indicated in 4 cases, and 14 cases were not successfully treated by EMR alone. All patients were followed up for more than 12 months (median, 42.0+/-20.8 months). RESULTS: Fifteen patients had no recurrence and survived. Four patients had no recurrence, but died of causes other than gastric cancer. Cancer recurred in four patients. Recurrence was managed by repeated treatment with APC, with no technical problems. No serious complications occurred. CONCLUSIONS: APC is useful for follow-up treatment of early gastric cancer after EMR. APC may also be effective for radical treatment of early gastric cancer, especially in elderly patients and patients in whom surgical intervention is contraindicated.

A case of Weber-Christian disease associated with myelodysplastic syndrome.

We report the case of a 73-year-old man with myelodysplastic syndrome (MDS) who developed Weber-Christian disease (WCD). Bone marrow aspirates showed refractory anemia with abnormal karyotypes such as trisomy 8, trisomy 8 and 14, and trisomy 8, 9, and 14. The patient had intermittent fever associated with multiple tender erythematous nodules on the skin. A biopsy sample taken from a nodule revealed focal subcutaneous infiltration of neutrophils and necrotizing fat tissue. We diagnosed the patient as having lobular panniculitis associated with myelodysplastic syndrome. The serum levels of soluble interleukin-2 (IL-2) receptor, interferon-Gamma, IL-1-Beta, IL-6 and tumor necrosis factor-Alpha were elevated in the active state but returned to normal after prednisolone therapy. This finding appears to implicate a T-cell immune response in the pathogenesis of Weber-Christian disease.

Clinical usefulness of multiplanar reconstruction images obtained by multi-slice computed tomographic angiography for early-stage Takayasu's arteritis.

We describe a case of Takayasu's arteritis discovered during the early stage (pre-pulseless stage). Cervical ultrasonography and multiplanar reconstruction (MPR) images obtained by computed tomography (CT) showed thickening and stenosis of the walls of the common carotid arteries. However, magnetic resonance arteriography (MRA), volume rendering (VR) imaging CT, and maximum intensity projection (MIP) imaging CT could detect no obvious abnormality. We emphasize the importance of noninvasive vascular investigation with cervical ultrasonography and MPR imaging CT to support the diagnosis of early-stage Takayasu's arteritis.

Behçet's disease associated with myelodysplastic syndrome with elevated levels of inflammatory cytokines.

Abstract We report the case of a 56-year-old Japanese woman with Behçet's disease and myelodysplastic syndrome (MDS), who had a history of episodic high-grade fever, recurrent oral and genital ulcers, and erythema nodosum, during a 13-year period from 1989 to 2002. Bone marrow aspirates obtained in January 1995 showed refractory anemia with trisomy 8, a subtype of MDS. Her serum levels of soluble interleukin-2 receptor (IL-2R), interferon-γ, IL-1ß, IL-6, IL-8, and granulocyte-macrophage colony stimulating factor in the active state were higher than those in the inactive state, whereas those of tumor necrosis factor-α and IL-10 did not increase even in the active state. In this case, it was speculated that a T-cell immune response might have been involved in the disease pathogenesis, and that the repeated febrile episodes might have been a manifestation of neutrophil hyperfunction induced by increased serum levels of inflammatory cytokines.

[Epstein-Barr virus-associated posttransplant lymphoproliferative disease after renal transplantation].

A 24-year-old Japanese male was admitted to our hospital because of lymphadenopathy in his left neck. He had a nine-year history of chronic renal failure, and had received an ABO-mismatched renal allograft and splenectomy in August 2000 after one year of hemodialysis treatment. After renal transplantation, he was treated with FK506, methylprednisolone (mPSL), and mycophenolate mofetil (MMF) as an immunosuppressants for his graft maintenance. On admission, April 2001, he underwent lymphadenectomy, and the immunohistochemical studies revealed that the tumor cells expressed EBV-LMP and EBNA-2 antigens with the histology of diffuse large B-cell lymphoma. Our diagnosis was an Epstein-Barr virus (EBV)-associated posttransplant lymphoproliferative disease (PTLD), and we reduced the dose of immunosuppressive agents and treated the patient with rituximab. In this case, there may have been two principal risk factors associated with PTLD: first, the patient was treated with higher levels of immunosuppressive agents because of the ABO-mismatched transplantation, and second, he was an EBV-seronegative recipient at the time of pretransplantation.

[Endocrine cell carcinoma (atypical carcinoid) of the ileocecal region adjacent to an adenocarcinoma].

An 86-year-old woman was admitted because of right lower abdominal pain. A 7 by 6 cm tumor palpable in the right lower quadrant was poorly mobile. Abdominal CT scan showed a huge tumor with a strong enhancement effect. Barium enema and colonoscopic examination revealed a submucosal tumor located from the cecum to the ascending colon on the oral side. An undifferentiated adenocarcinoma was suspected after examination of the biopsy specimen, right hemicolectomy was performed. The tumor invaded the retroperitoneal membrane. Histological examination showed a very atypical carcinoid tumor with central necrosis invading the veins. Pathohistologically, the huge tumor was diagnosed as endocrine cell carcinoma or atypical carcinoid. Furthermore, an elevated lesion, 2.5 cm in size, was revealed in the cecum closed to the huge tumor. Histological examination showed that the polypoid lesion was early moderately differentiated adenocarcinoma. There was no transition between the two tumors. The patient was discharged, but died of local recurrence 9 months after the surgery. Endocrine cell carcinoma of the large bowel is rare, in particular of the ileocecal region. Endocrine cell carcinoma of the ileocecal region adjacent to an adenocarcinoma without transition had not been reported previously in Japan.