[A case of juvenile polyposis limited to the stomach accompanied by double gastric cancers and Ménétrier's disease].

A 48-year-old woman who had innumerable polyps in her stomach for 4 years visited our hospital to receive further examinations. Her younger brother had undergone gastrectomy because of cancer with gastric polyposis. Gastrography and gastroscopy showed numerous reddish polyps finger-like in form with much mucin in the antrum. On the other hand, polyposis in the corpus and fornix was nodular which formed giant folds. There was no polyps in other organs, therefore, we diagnosed juvenile polyposis limited to the stomach accompanied with Ménétrier disease. Double carcinoma were proved histologically after total gastrectomy. 55.8% of juvenile poplyposis limited to the stomach are accompanied with neoplasms, however, the rate of preoperatively correctly diagnosed neoplasms was 55%, so total gastrectomy was recommended.

[Case of scattered gastritis associated with ulcerative proctitis].

A 59-year-old man who had ulcerative proctitis for 18 years visited our hospital because of stomach pain. Proctitis had been in remission stage for five recent years by the mesalazine administration. Esophagogastroduodenoscopy (EGD) showed scattered patchy erosions at the corpus of the stomach. Anti-acid secretory agents was administrated, however, erosive change worsened in multiplicity and in area. Biopsied specimen of gastric mucosa showed specific findings resembling to cryptitis, crypt abcess and focally enhanced gastritis. H. pylori infection was negative by some examinations. Our patient had no history of taking non steroidal anti-inflammatory drugs (NSAIDs) so far. From the findings above, it was considered that gastric lesion was strongly related to the ulcerative proctitis. 5-aminosalicylic acid (750 mg, three times daily) ground to powder was administered with predonisolon (20 mg, once daily). Five month later, all the erosions disappeared completely on EGD and biopsied specimen revealed a reduction of inflammatory cells. The present case has a rare gastric lesion with patchy pattern (not diffuse pattern) which is strongly associated with ulcerative proctitis.

[A case of polypoid type ganglioneuroma of the decsending colon].

A 32-year-old woman came to our hospital with purpose of careful examination for anemia. Colonoscopy was revealed a solitary protrusion with irregular shape covered with red and discolored mucosa of the descending colon. Surface of this lesion was smooth, which had flexibility in dynamic study with infusion of the air and water. Additionally, multiple ulcer scars was recognized on this lesion. After dye-spraying using by crystal-violet, no neoplastic pits was detected on the lesion except for asteroidal pits and pattern of pinecone on reddish protrusions. Endoscopic ultrasonography demonstrated a thickened low echoic layer (from 2nd to upper half of the 3rd layer) and anechoic structure in higher reddish part of the lesion. Diagnostic EMR was performed with no complication. Histological examination was revealed a spindle cells and ganglion cells in much fiber which was positive for immunostaining of S-100 ptotein. Hyperplastic glands were seen with no neoplastic change in reddish protrusion. Therefore, Diagnosis of polypoid ganglioneuroma of the descending colon was made. To a rare thing, our case was the 16th reported case of ganglioneuroma in large intestine without neurofibroma-1 or multiple endocrine neoplasm.