Marked reduction in the number of white globe appearance lesions in the noncancerous stomach after exchanging vonoprazan for esomeprazole treatment: a follow-up case report.

Recently, an association has been suggested between development of white globe appearance lesions in the noncancerous stomach and treatment with a potassium-competitive acid blocker or a proton pump inhibitor. We previously reported two cases with development of white globe appearance lesions after vonoprazan treatment, suggesting a similar association. Here, we present the follow-up report of one of those two cases, concerning a 68-year-old woman who developed multiple white globe appearance lesions 1 year after starting vonoprazan treatment for severe gastroesophageal reflux disease leading to esophageal stricture. The patient refused to continue vonoprazan treatment after the lesions developed, and esomeprazole was initiated instead. Three months later, most of the white globe appearance lesions had disappeared, without worsening of her gastroesophageal reflux disease. Histologically, mucosal structural changes induced by vonoprazan, such as parietal cell protrusion with oxyntic gland dilatation, remained unchanged, whereas the gastric glands became less packed and a small calcification in the concentrated eosinophilic material was observed in a remaining white globe appearance cyst after esomeprazole treatment. Here, we discuss possible pathogenic mechanisms of these dramatic gastric mucosal changes observed in the present case, based on our endoscopic and histological findings.

Development of white globe appearance lesions in the noncancerous stomach after vonoprazan administration: a report of two cases with a literature review.

White globe appearance has recently been identified as a novel endoscopic marker useful in the diagnosis of early gastric cancer. Recently, this lesion has also been reported in the noncancerous stomach, including cases with autoimmune atrophic gastritis, although the clinical significance remains unclear. We present the details of a 68-year-old woman who began vonoprazan therapy for severe gastroesophageal reflux disease causing esophageal stricture. On follow-up endoscopy 1 year after beginning vonoprazan, multiple white globe appearance lesions developed in all sections of her stomach, except for the antrum. We also detected lesions during a yearly follow-up in the noncancerous stomach of a 70-year-old man who had received vonoprazan for 3 years. Lesions in both cases constituted cystic gland dilatations containing eosinophilic material. There was no evidence of accompanying autoimmune atrophic gastritis in either patient. This report is the first to our knowledge describing newly developed white globe appearance lesions in the noncancerous stomach during follow-up in two cases who received vonoprazan. Our findings suggest that these lesions in the noncancerous stomach might be associated with vonoprazan treatment. We investigated the two cases endoscopically and histologically, and we report our findings with a literature review.

Pneumatosis cystoides intestinalis lesions changing into yellowish plaque-like elastosis lesions during healing.

Pneumatosis cystoides intestinalis (PCI) is a rare disease characterized by multiple gas-filled cysts in the intestinal wall. The majority of patients with PCI are asymptomatic and have a benign clinical course without treatment. Regular colonoscopic follow-up is not always clinically necessary for PCI; therefore, whether all patients with PCI eventually achieve complete endoscopic resolution remains unclear. We herein present the details of an asymptomatic 58-year-old man diagnosed with PCI in the right colon in 2011 by colonoscopy. We followed him using colonoscopy for 8 years without treatment. The PCI lesions gradually changed into multiple flat yellowish plaque-like lesions, and biopsies revealed that these were elastosis, which is a very rare pathological finding in the colon. To our knowledge, only two reports discuss morphological or histological changes similar to those of PCI. Because the development of yellowish plaque-like lesions histologically representing elastosis associated with PCI is an unrecognized entity, we herein discuss its clinical features, endoscopic findings, and histological findings with a literature review.

Pneumatosis cystoides intestinalis accompanied by intestinal spirochetosis.

Pneumatosis cystoides intestinalis (PCI) is a rare but well-recognized entity characterized by multiple gas-filled cysts in the intestinal wall. Although the pathogenesis of PCI remains unclear, several theories, including a bacterial theory, have been postulated. Intestinal spirochetosis (IS) is an uncommon condition defined by the presence of spirochetes attached to the surface of the colonic epithelium. The nature of IS as a commensal or pathogenic process remains debatable. However, recent evidence supports the idea that IS can be invasive and highly pathogenic in both immunocompromised and immunocompetent individuals. We present the case of a 35-year-old asymptomatic and immunocompetent man who underwent colonoscopy because of a positive fecal blood test. Multiple submucosal cystic lesions were detected accompanied by erythematous areas along the ascending colon. Computed tomography-colonography and biopsy specimens from the erythematous areas confirmed coexisting PCI and IS. Both PCI and IS recovered completely 3 months after administration of metronidazole. To the best of our knowledge, this case represents only the second report of the extremely rare concurrence of PCI with IS. Taking into account the published literature, we also discuss the possibility that the development of PCI may be related to IS.

Solitary extramedullary plasmacytoma of the rectum complicating ulcerative colitis.

Solitary extramedullary plasmacytoma (EMP) arising in the rectum is an extremely rare clinical entity. Only ten cases have been reported in the English-language literature. We experienced a case of an EMP in the rectum of a 55-year-old man with an 8-year history of proctitis-type ulcerative colitis (UC). The plasmacytoma appeared as an 8-mm semipedunculated polypoid lesion in the actively inflamed rectal mucosa when the remittent UC flared. The tumor was treated using endoscopic mucosal resection. This is the second case of rectal EMP associated with UC after a similar report was published in 2004. Both patients had a chronic history of proctitis-type UC and were taking no immunosuppressive agents that could cause Epstein-Barr virus-associated plasmacytoma, such as thiopurines. The UC activity seemed to correspond well with the development of the rectal EMP. Therefore, we herein discuss a possible association between rectal EMP and UC and review the past literature of rectal EMP.

Homozygous deletion on the chromosomal region 5q12.3 in human lines of small-cell lung cancers.

Loss of heterozygosity at the polymorphic loci on the long arm of chromosome 5 is observed in about 80% of human small-cell lung cancer (SCLC). Absence of inactivating mutations in the APC gene on 5q14 suggests the involvement of another tumor suppressor gene. We found a homozygous deletion of sequence tagged site sequence G73332on 5q12.3 in 2 of 12 human SCLC cell lines, Lu130 and Lu134. One copy of chromosome 5q was lost in these cell lines, and the remaining allele had a deletion in a more restricted region. A polymerase chain reaction-based analysis of yeast artificial chromosome, bacterial artificial chromosome (BAC), and lambda-phage clones narrowed the region of homozygous deletion to a fragment cloned within one BAC. Sequencing analysis revealed that a DNA fragment of approximately 25 kb was deleted interstitially, probably because of recombination through Alu repetitive sequences in Lu130 and Lu134 cells. This deletion was not detected in normal lymphocyte DNA from 98 unrelated individuals. No candidate genes, however, were detected within this region or in the adjacent 150-kb fragment. The absence of microsatellite instability and the presence of an interstitial deletion as well as gross chromosomal aberration suggest that the genomic integrity of Lu130 and Lu134 cells might possibly be affected by Alu-mediated recombination in addition to chromosomal instability. The identical breakpoints in Lu134 and Lu135 cells as well as the same genotypes at all 33 polymorphic loci examined on various chromosomes strongly suggest that these cell lines share the same genetic materials, at least in part, during the establishment or propagation of cell lines.