Endoscopic features of gastric neuroendocrine carcinoma.

BACKGROUND AND AIM: The endoscopic features of gastric neuroendocrine carcinoma (G-NEC) have not been clarified; therefore, they were investigated in relation to clinicopathological findings. METHODS: Consecutive patients with G-NECs who had undergone endoscopic or surgical resection at our institution between January 2005 and March 2022 were included in this retrospective study. The endoscopic and clinicopathological findings of the lesions were analyzed to provide information of diagnostic value. In addition, cases of gastric neuroendocrine tumor (G-NET) and common-type gastric adenocarcinoma treated in the same study period were identified to compare the endoscopic findings between each G-NEC versus G-NET, and G-NEC versus common-type gastric adenocarcinoma. Patients with common-type gastric adenocarcinoma were matched for age, sex, tumor size, and depth of tumor invasion in 1:3 ratio. RESULTS: Among 15 patients with 15 G-NECs, submucosal tumor-like marginal elevation (87%), adherent white coat (67%), and ulceration with a distinct border (60%) were characteristic endoscopic findings in white-light images. Magnifying narrow-band imaging endoscopy revealed an absent microsurface (MS) pattern plus disrupted irregular microvessel (MV) in five (71%) of seven cases with evaluable MS and MV patterns. The area with an absent MS pattern plus disrupted irregular MV corresponded to the histological finding of NEC component in all five cases. These endoscopic features were all significantly more frequent in G-NECs than G-NETs (n = 22) or common-type gastric adenocarcinomas (n = 45). CONCLUSIONS: These endoscopic features should be taken into consideration to increase the index of suspicion and to improve the accuracy of target biopsies for G-NEC.

[Esophageal Angiolipoma:Report of One Case and Literature Review].

Esophageal angiolipoma is a rare disease with unspecific clinical manifestations.This paper reported a case of esophageal angiolipoma confirmed by upper gastrointestinal endoscopy and summarized the clinical manifestations,endoscopic and pathological features,treatment and prognosis of the patients by reviewing the relevant literature,aiming to provide references for clinical diagnosis and treatment of this disease in the future.

Esophageal Angiolipoma:Report of One Case and Literature Review / 中国医学科学院学报

Esophageal angiolipoma is a rare disease with unspecific clinical manifestations.This paper reported a case of esophageal angiolipoma confirmed by upper gastrointestinal endoscopy and summarized the clinical manifestations,endoscopic and pathological features,treatment and prognosis of the patients by reviewing the relevant literature,aiming to provide references for clinical diagnosis and treatment of this disease in the future.

Endoscopic and pathohistologic features of early gastric signet ring cell carcinoma presented as elevated type: A case report.

Background: Almost all early gastric signet ring cell carcinomas (SRCCs) are the flat or depressed type, and the elevated type is rare. Here, we report the endoscopic and pathohistologic features of a rare case of SRCCs presented as the elevated type. Case presentation: A 54-year-old man underwent esophagogastroduodenoscopy in our hospital because of intermittent upper abdominal pain for 6 years. White light endoscopy revealed an elevated lesion that is smooth and reddish and covered with normal mucosa and looked like a polyp. Magnifying endoscopy with narrow-band imaging showed broadened intervening parts, an elongated pit, and a dense microvascular network with focal irregularity. The lesion was considered as early gastric cancer and completely resected with endoscopic submucosal dissection. Pathohistological examination confirmed that the lesion was pure early SRCC that was limited within the mucosal lamina propria (T1a). Conclusion: Elevated pure gastric SRCC is rare. This is a report of early pure gastric SRCC presented as the elevated type and the description of its endoscopic and pathohistologic features, which will contribute to the early detection of gastric SRCC.

Comparison of characteristics between true rectal neuroendocrine tumors and rectal hyperplastic polyps among patients with endoscope-diagnosed rectal neuroendocrine tumors.

Background: To explore the white light endoscopy and endoscopic ultrasonography (EUS) features of rectal hyperplastic polyps (rHP) misdiagnosed as rectal neuroendocrine neoplasms (rNENs). In rNENs with a diameter of 5-10 mm, the endoscopic findings are not typical and some of them are similar to rHP, so it is not uncommon to misdiagnose rNENs as rHP. However, misdiagnosis of rHP as rNENs has not been reported in the literature, which can alert clinicians to the existence of this possibility and avoid over-treatment. Methods: We collected 245 cases of rectal submucosal tumor (SMT) diagnosed by endoscopy in our hospital from January 2015 to December 2020 and 103 patients with suspected rNENs identified through endoscopy. A retrospective analysis was conducted of the shape, color, vascular dilatation, and boundary on the surface of the lesion under white light endoscope, and the source, boundary, and echo characteristics of EUS. We also analyzed the endoscopic features of rHP misdiagnosed as rNENs. Endoscopic diagnosis and pathological diagnosis were reviewed by a senior endoscopic expert and pathologist respectively. The counting data were tested and analyzed by χ2 test and Fisher exact probability method. Results: A total of 103 cases of rNENs were diagnosed by endoscope, among whom 75 cases were confirmed as rNENs (72.8%) and 8 cases as rHP (7.8%) by histopathology. There was no significant difference between rNENs and rHP in terms of gender, age, clinical manifestation, shape and color of lesions, dilatation of blood vessels on the surface, and location of lesions. Meanwhile, there were significant differences in whether the boundary of the lesion was clear under white light endoscopy, and the source, echo, and boundary of the lesion under EUS. Conclusions: The morphology of some rHP is similar to rNENs under endoscopy. The boundary is clear under white light endoscopy and the source, echo, and boundary under EUS are helpful for the diagnosis of rNENs and rHP.

Early verrucous cell carcinoma of the esophagus: a case report and endoscopic and histologic features.

BACKGROUND: Verrucous cell carcinoma of the esophagus (VCCE) is an extremely rare tumor and generally detected at advanced stage. Despite of its slow growth and well differentiation, it has very poor prognosis with high mortality. Therefore, early detection is a critical to improve patients' survival. However, no early cases of VCCE have been reported and the endoscopic features of early VCCE are not well described. We herein report the endoscopic and histologic features of an early VCCE. CASE PRESENTATION: A 54-year-old man with a history of excessive alcohol and tobacco use was admitted to our hospital because of chronic persistent swallowing dysfunction for six months. White light endoscopy revealed a flat lesion covered with scattered leukoplakia in the middle esophagus. Magnifying endoscopy with narrow-band imaging showed tiny irregular papillary microsurface structure. The lesion was considered as early esophageal cancer and completely resected with endoscopic submucosal dissection. Histological examination confirmed that the lesion was early VCCE which was limited within the mucosal lamina propria (m2). CONCLUSION: VCCE is rare with poor prognosis. This is a report of early VCCE and description of its endoscopic features which will contribute to early detection of these cancers.

Clinical characteristics of 47 cases of intestinal Beh?et′s disease / 中华消化杂志

Objective:To summarize the clinical features of intestinal Beh?et′s disease, so as to provide reference for the diagnosis of the disease.Methods:From April 1 2014 to January 31 2019, the clinical data of 47 patients diagnosed as intestinal Beh?et′s disease at the Second Hospital of Hebei Medical University were retrospectively analyzed, which included initial symptoms, gastrointestinal symptoms, complications, erythrocyte sedimentation rate (ESR), the levels of C reactive protein (CRP), hemoglobin, serum albumin, results of acupuncture test, gastrointestinal involved site and ulcer shape. At the same time, gender differences of clinical manifestations were compared. Chi-square test was used for statistical analysis.Results:Among 47 patients with intestinal Beh?et′s disease, the initial symptoms of 26 (55.3%) cases were gastrointestinal symptoms. Abdominal pain was the most common symptom, the others were diarrhea, anorexia, abdominal distension and perianal abscess, and the incidence rate was 80.9%(38/47), 46.8% (22/47), 42.6% (20/47), 36.2% (17/47) and 2.1% (1/47), respectively. The main complications were gastrointestinal bleeding, perforation and obstruction, and the incidence rates was 40.4% (19/47), 4.3% (2/47) and 4.3% (2/47), respectively. Thirty-seven (78.7%) patients had different degrees of hypoalbuminemia (serum albumin<35 g/L). The CRP level of 36(76.6%) patients increased. The ESR of 36 (76.6%) patients increased. Twenty-two (46.8%) patients had mild anemia (hemoglobin<90 g/L). The acupuncture test was positive in 25 (53.2%) patients. The involved sites of gastrointestinal tract were terminal ileum and ileocecal junction, colon, esophagus, duodenum and jejunum, stomach, and rectum, the proportion was 57.4% (27/47), 27.2% (13/47), 23.4% (11/47), 23.4% (11/47), 17.0% (8/47) and 8.5% (4/47), respectively. All 47 (100.0%) patients had oral ulcers. 62.1%(18/29) patients presented with multiple ulcers under endoscope. The shape of ulcer was round ulcer, irregular ulcer, and longitudinal ulcer, the proportion was 48.3% (14/29), 34.5% (10/29) and 17.2 (5/29), respectively. The incidence rate of genital ulcer of female patients with intestinal Beh?et′s disease was higher than that of male patients with intestinal Beh?et′s disease (85.7%, 18/21 vs. 30.8%, 8/26), and the difference was statistically significant ( χ2=14.189, P<0.01). There were no significant differences between the female group and the male group in the incidence rate of oral ulcer, abdominal pain, diarrhea, and positive rate of acupuncture test (100.0%, 21/21 vs. 100.0%, 26/26; 85.7%, 18/21 vs. 76.9%, 20/26; 42.9%, 9/21 vs. 50.0%, 13/26; 52.4%, 11/21 vs. 58.3%, 14/26, all P>0.05). Conclusions:The common clinical symptoms of intestinal Beh?et′s disease are oral ulcers, abdominal pain, diarrhea and genital ulcer. Female patients with intestinal Beh?et′s disease are more likely to develop genital ulcer than male patients with intestinal Beh?et′s disease. Multiple ulcers are more common under endoscopy, which are round ulcer, irregular ulcer and longitudinal ulcer. The most common sites are the terminal ileum and ileocecal junction, followed by colon, esophagus and other parts.

A rare clinical entity: stump appendicitis. Case report and complete review of literature.

BACKGROUND: Stump appendicitis is a rare delayed complication post-appendectomy and it represents a diagnostic problem as clinicians are often not very familiar with this pathology. MATERIALS AND METHODS: One case of stump appendicitis has been reported in a 54 year old woman, whose acute phase was conservatively treated in our Department. A review of Medline literature was also carried out, from 1945 to 2015, showing 111 cases of stump appendicitis. RESULTS: Stump appendicitis has been reported after either open or laparoscopic appendectomy, in a range between days to several years from the first procedure. Nowadays, it is not considered yet as a possible differential diagnosis in patients with pain in the right iliac fossa previously undergone appendectomy. For this reason, the diagnosis can be delayed and complications such as acute abdomen, perforation, sepsis can occur. Completion appendectomy is the treatment of choice for stump appendicitis. CONCLUSIONS: The aim of this article is to underline the importance of stump appendicitis. Clinicians should be aware of the possibility of SA and they should confirm any clinical suspicion throughout radiologic images, in order to promptly recognize this entity and to avoid the related complications.

Endoscopic features and associated histology of an basaloid squamous cell carcinoma of the esophagus at the very early stage.

BACKGROUND: Basaloid squamous cell carcinoma of the esophagus (BSCCE) is generally detected at advanced stage and the prognosis is poorer than advanced conventional esophageal squamous cell carcinoma. Therefore, early detection is a critical to improve patients' survival. However, only a few cases of early BSCCE have been reported and the endoscopic features of early BSCCE are not well described. We herein report the endoscopic features and associated histology of an early BSCCE limited within the mucosal lamina propria (m2). To our knowledge, this is the earliest BSCCE reported to date. CASE PRESENTATION: A 62-year-old male patient was admitted to our hospital because of epigastric pain for 3 months. White light endoscopy revealed a flat lesion with mild sloping at the periphery. The lesion was covered with leukoplakia, and normal vascular network could not be seen in the lesion. Magnifying endoscopy with narrow-band imaging showed abnormal intra-papillary capillary loop categorized as type B1 according to the classification of the Japan Esophageal Society. Iodine staining revealed a less-stained lesion. The lesion was completely resected through endoscopic submucosal dissection. Histopathologically, tumor cells, which were limited within the mucosal lamina propria, formed solid nests and lobule structures, with ribbon-like arrangement of sparse cytoplasm and round to ovoid hyperchromatic nuclei. A final diagnosis of early BSCCE was established. CONCLUSIONS: This is the earliest BSCCE reported to date. The prominent lesion with a gentle rising slope and less-staining or abnormal stain might be initial feature of early BSCCE.

Endoscopic features and genetic background of inflammatory bowel disease complicated with Takayasu arteritis.

BACKGROUND AND AIM: Takayasu arteritis (TA) is occasionally complicated with inflammatory bowel disease (IBD). This study assessed the endoscopic and genetic features of IBD complicated with TA (IBD-TA). METHODS: This study retrospectively reviewed the clinical charts of 142 TA patients (14 men and 128 women; median age 48.5 years [range, 18-97 years]). Human lymphocyte antigen (HLA) types and a single-nucleotide polymorphism rs6871626 in the IL12B gene were assessed in 101 and 81 patients with TA, respectively. RESULTS: Inflammatory bowel disease was diagnosed in 13 (9.2%) of the 142 patients. The endoscopic features of IBD-TA at initial diagnosis (n = 8) showed discontinuous and focal mucosal inflammations (n = 7, 87.5%), and only one case was diagnosed as ulcerative colitis (UC) at the first colonoscopy. In the genetic comparison of HLA class I between TA patients with IBD and those without IBD, HLA-B*52:01 and C*12:02 were more frequent in the IBD-TA group (P = 0.001 and P = 0.009, respectively). Meanwhile, HLA-DRB-1*15:02, DQA-1*01:03, DQB-1*06:01, and DPB-1*09:01 as HLA class II were positively associated with IBD-TA (P = 0.004, P = 0.019, P = 0.019, and P = 0.002, respectively). IL12B rs6871626 did not show an association with IBD-TA compared with that with TA without IBD. CONCLUSIONS: The endoscopic findings of IBD-TA at initial diagnosis were atypical for UC or Crohn's disease. IBD-TA possessed the HLA haplotype, which had a susceptible effect on UC.

Stump appendicitis. A case report.

INTRODUCTION: Today, the diagnosis of SA is usually not considered as the etiology for right lower quadrant pain in patient with history of appendectomy, resulting in delaying making the correct diagnosis and treatment. Obviously, other more common causes should be excluded first. DISCUSSION: Stump appendicitis (SA) was first described by Rose in 1945. The commonest presenting symptom are abdominal pain (right lower quadrant pain 59%, non specific abdominal pain 16%, and central abdominal pain radiating to the right lower quadrant 14%). PRESENTATION OF CASE: A 54-year-old appendectomized woman presented with recent history of abdominal pain with periumbilical pain radiating to the right side and in the right iliac fossa, in the absence of fever, vomiting or other symptoms. Elective colonoscopy revealed appendicular orifice clogged by big fecalith, with hyperemic surrounding mucosa and CT confirmed "stump appendicitis". After 30 days of therapy with metronidazole 500mg/day and mesalazine 1000mg×2/day, the patient was submitted to surgery and appendectomy was performed, with a specimen of 24mm stump appendicitis. CONCLUSION: SA may well be considered as one of the differential diagnoses of acute right lower abdominal pain even in patients with history of appendicectomy.

Endoscopic features and management of diminutive colorectal submucosal invasive carcinoma.

BACKGROUND AND AIM: The vast majority of diminutive (∼5 mm) colorectal tumors consist of a very low prevalence of advanced neoplasia, and a predict-resect-and-discard policy has been proposed recently in Western countries. The histology of some diminutive colorectal tumors reveals carcinoma, not adenoma, although the frequency is relatively low. Clarifying the endoscopic features of diminutive submucosal invasive colorectal carcinoma (CRC) during colonoscopy is important for managing diminutive lesions. METHODS: A total of 111 cases of submucosal invasive CRC ≤ 10 mm were analyzed. The incidence of submucosal invasion in early CRC per gross type, size, location, pit pattern diagnosis, and rate of lymph node (LN) metastasis was evaluated. RESULTS: In diminutive tumors, the overall submucosal invasion rate in early CRC was 9.6%; however, depressed tumors had a significantly higher frequency of submucosal invasion than protruded or flat elevated tumors. There were no significant differences in the distribution of submucosal invasive CRC between the diminutive tumors and those that were 6-10 mm. The pit pattern diagnosis of diminutive submucosal invasive CRC was type VI pit pattern in all cases. Each case of submucosal invasive CRC was completely resected by en bloc endoscopic resection, and there were no cases of LN metastasis. CONCLUSION: Diminutive tumors with depression have a high frequency of submucosal invasive CRC and an initial indication for endoscopic resection.

Upper gastrointestinal endoscopic features and predictable factors for clinical severity in the patients with tsutsugamushi disease / 대한내과학회지

BACKGROUND: Scrub typhus is a febrile zoonosis resulting from infection with Orientia tsutsugamushi. Attentions for tsutsugamushi disease are growing about its ecologic, epidemiologic and clinical characteristics according to increasing patients and these studies were helpful to understand the pathophysiology and many clinical features of tsutsugamushi disease. Although scrub typhus has been treated successfully with the introduction of effective antibiotics, life-threatening serious complications including gastrointestinal bleeding were still remained. The authors here intended to describe different endoscopic characteristics of the gastrointestinal manifestation of tsutsugamushi disease, and then to evaluate the clinical significance of upper gastrointestinal endoscopic feature and clinical severity index (CSI) as the predictable factors for clinical severity of tsutsugamushi disease. METHODS: One hundred and forty two patients who were diagnosed as tsutsugamushi disease at Masan-Samsung Hospital from January 2001 to December 2002 were enrolled. Patients were recommended to be taken upper gastrointestinal endoscopy irrespective of abdominal symptoms and 40 patients were classified into 5 degrees by endoscopic findings. All patients were classified by CSI based on clinical symptoms and laboratory findings. Correlations among CSI, hospital stay, and endoscopic grade were analyzed. RESULTS: The older patients (p=0.0018) and the patients with lower serum hemoglobin (p=0.0049), lower serum albumin (p<0.0001), higher serum bilirubin (p=0.0109), higher BUN (p<0.0001) and creatinine (p=0.0223), and longer activated prothrombin time (p=0.0193) had significantly longer hospital stay. The patients with longer hospital stay had significantly severe esophagogastroduodenoscopic (EGD) findings (p=0.0017). Patients with higher CSI score had significantly longer hospital stay (p=0.0069) and more severe EGD finding (p=0.0062). CONCLUSIONS: There were significant correlations between CSI, hospital stay, and EGD grade in this study. CSI and endoscopic feature may be useful as the predictable factors for clinical severity in tsutsugamushi disease.

Submucosal Invasive Cancer in the Colon / 대한소화기내시경학회지

BACKGROUND AND AIMS: A superficially invasive cancer in the colon is considered a candidate for an endoscopic resection. Therefore, detecting a superficially invasive cancer and differentiating it from a massively invasive cancer is an important key in selecting proper treatment. In order to accomplish this purpose, exact knowledge of the characteristics of submucosal invasive cancers is required. In this study, attempts to define those endoscopic features and draw guidelines for treatment were made. METHODS: Recently, 23 submucosal invasive cancers were experienced. All of them were detected by an endoscopic examination, and were treated by endoscopic therapy and/or surgical resection. These cancers were reviewed and analyzed with emphasis on size, configuration, differentiation, and treatment. RESULTS: The most common sizes ranged from 10 mm to 19 mm (47.8%). There were two minute lesions below 5 mm. The most common type of lesions was sessile (43.5%). Most lesions showed redness and 60.9% showed hardness. Many cases had characteristic features such as nodules (47.8%), bleeding easily upon touch (39.1%), erosion (39.1%), and white spots (34.8%). Other characteristic features were expanded figures, depressions, and mucosal convergence. Moderately-differentiated adenocarcinomas were predominant (8/15, 53.3%), and there were four polypoid cancers (4/17, 23.5%). In 43.5% of the lesions, only endoscopic treatment was enough. Forty-four percent of all patients treated endoscopically needed additional surgical resections because of uncertainty with respect to complete excision of the cancer and/or a poorly-differentiated adenocarcinoma with lymphatic invasion. There was no lymph node metastasis in any of the patients who underwent surgical resections, and three of them had no residual tumors, as the endoscopic treatment had completely excised the cancer. CONCLUSIONS: Accurate information on submucosal invasive cancers and recognition of the endoscopic characteristics of submucosal invasive cancers are necessary for their detection and management in an early stage. Moreover, it is possible to differentiate superficially invasive cancers from massively invasive ones by their characteristic features. Therefore, in selected patients with superficially invasive cancers, surgical resections can be avoided.