Long-term follow-up of gastric adenocarcinoma with chief cell differentiation using upper gastrointestinal tract endoscopy.

During upper endoscopic screening, a 71-year-old asymptomatic woman was found to have a small, yellowish, superficial elevated lesion in the upper third of her stomach, without any signs of atrophic mucosa. The patient underwent endoscopic follow-up once a year for approximately five years; however, changes in the tumor were barely detectable. Endoscopic mucosal resection was performed, and a histological examination confirmed the diagnosis of gastric adenocarcinoma with chief cell differentiation (GA-CCD). GA-CCD is rare; therefore, its clinicopathological features remain unknown. This case suggests that only barely detectable endoscopic changes may be observed in GA-CCD during long-term follow-up.

Gastritis associated with Epstein-Barr virus infection.

Infectious mononucleosis is a self-limiting clinical syndrome caused by primary Epstein-Barr virus (EBV) infection. EBV-associated gastritis, however, has rarely been documented. We report a case of a 17-year-old woman who presented with fever, sore throat, and epigastric pain. Upper endoscopy revealed diffuse granular mucosae and elevated lesions in the stomach. Histologically, the biopsied mucosa was infiltrated by numerous atypical lymphocytes. From clinical, histopathologic, immunohistochemical, and in situ hybridization analyses, we diagnosed EBV-associated gastritis. Her symptoms spontaneously resolved, and follow-up endoscopy revealed improvement and no atypical lymphocytes. To prevent misdiagnosis and unnecessary treatment, the possibility of EBV-associated gastritis should be considered.

Cap polyposis (CP) which relapsed after remission by avoiding straining at defecation, and was cured by Helicobacter pylori eradication therapy.

A 52-year-old woman was diagnosed with cap polyposis (CP) with characteristic clinical, endoscopic, and histological features. By avoiding straining at defecation, her symptoms improved temporarily, however recrudesced. She was diagnosed with Helicobacter pylori (H. pylori) infection, and received eradication therapy successfully. After this eradication therapy, her symptoms and colonoscopic findings recovered completely. Only two reports in the English language literature have discussed the relationship between CP and eradication therapy for H. pylori, all patients achieved complete recovery. We recommend H. pylori testing for all cases of CP and H. pylori eradication therapy if necessary.

Pancreatic injury successfully treated with endoscopic stenting for major pancreatic duct disruption.

We present a 43-year-old Japanese man with major pancreatic duct disruption caused by blunt pancreatic head damage. Computed tomography (CT) revealed pancreatic head injury, and endoscopic retrograde pancreatography showed pancreatic duct disruption at the injury site along with contrast media leakage. We placed a pancreatic stent for 3 months, after which closure of the pancreatic duct fistula was confirmed. CT on the 9th hospital day showed acute pancreatic fluid collections, but these had disappeared at the 3 month follow-up CT. The patient has remained asymptomatic at follow-up for 3 years.

Spontaneous esophageal submucosal hematoma in which the course could be observed endoscopically.

A 66-year-old man was hospitalized after vomiting blood after inducing vomiting using his fingers due to laryngeal discomfort. Upper digestive tract endoscopy revealed a large, dark red mass that connected from the upper esophagus to the lower esophagus. Esophageal submucosal hematoma was diagnosed using endoscopy, X-ray images, a small-diameter ultrasonic probe, and chest CT scanning. Pain from the epigastrium to the larynx disappeared after 3 days. Melena occurred on Day 3. Endoscopic examination revealed that the hematoma had collapsed over a wide area. Endoscopic examination after one week showed that the mucous membrane covering the hematoma had peeled away revealing an extensive shallow ulcer in the esophagus. Endoscopic examination after one month confirmed the ulcer had scarred and healed.

Spontaneous dissection of the superior mesenteric artery in four cases treated with anticoagulation therapy.

Reports of spontaneous dissection of the superior mesenteric artery are rare. Diagnosis in the acute stage has been considered difficult, but we encountered four cases from November 1998 to November 2001. All four cases were diagnosed using abdominal CT scanning in the acute stage and could be treated conservatively. All patients were provided anticoagulation therapy upon fasting. The mean period of continuous abdominal pain was 10.2 days, the mean period of fasting was 27.2 days, and the mean number of in-hospital days was 44.5. There is no established opinion on treatment, but conservative treatment is considered possible if there are no symptoms or if it has not been aggravated.