Enteritis cystica profunda with lipoma in the second portion of the duodenum: a case report.

Enteritis cystica profunda (ECP), a rare and benign condition, is defined as the displacement of the glandular epithelium into the submucosa and more profound layers of the small intestinal wall leading to the formation of mucin-filled cystic spaces. ECP frequently occurs in the ileum or jejunum and is associated with diseases such as Crohn disease and Peutz-Jeghers syndrome. ECP also develops in the absence of known pathology. ECP in the duodenum is very rare and mostly occurs without associated conditions. In this report, we present a rare case of ECP without an associated disease, in the second portion of the duodenum distal to the ampulla of Vater and coexisting with lipoma within the polypoid lesion.

[Anisakiasis Induced Segmental Jejunum Obstruction].

Human anisakiasis is a disease caused by an infestation of the third stage larvae of family anisakidae. The ingested larvae invade the gastrointestinal wall, causing clinical symptoms that include abdomen pain, nausea, and vomiting. Although enteric anisakiasis is extremely rare, it can induce intestinal obstruction. We report a case in which emergency surgery was needed due to intestinal obstruction that coincided with symptoms related to anisakiasis, along with a brief literature review.

Predictive Factors for Severe Outcomes in Ischemic Colitis.

BACKGROUND/AIMS: Ischemic colitis includes a wide clinical spectrum ranging from mild to severe forms. This study aimed to determine the factors that are related to the occurrence of severe ischemic colitis. METHODS: This multicenter study was conducted retrospectively in Korea. The patients were divided into mild and severe groups. This study surveyed clinical characteristics, blood tests, endoscopic findings, and imaging studies. RESULTS: In the comparison of comorbidities, the severe group had a higher ratio of chronic kidney disease than the mild group (p=0.001). In the blood test, the severe group had a reduced number of platelets (p=0.018) and a higher C-reactive protein value (p=0.001). The severe group had a higher ratio of involvement of the right colon (p=0.026). The Eastern Cooperative Oncology Group (ECOG) performance status score of the patients showed that the severe group had higher scores than the mild group (p=0.003). A multivariate analysis showed that chronic kidney disease and high ECOG performance status scores were significant risk factors. CONCLUSIONS: If patients diagnosed with ischemic colitis are also treated for chronic kidney disease or have poor performance status, more attention and early intervention are necessary.

Adenosquamous carcinoma of the ascending colon: a case report and review of the literature.

An adenosquamous carcinoma is a malignancy that has both glandular and squamous histologic components. Both components are malignant and have potential to metastasize. An adenosquamous carcinoma of the large bowel is rare, and its clinicopathologic behavior is not fully understood. It is reported to be more aggressive and have a worse prognosis when it is compared with an adenocarcinoma alone. We present a case of an adenosquamous carcinoma in the ascending colon which was laparoscopically resected and followed by adjuvant chemotherapy.

Efficacy of endoscopic submucosal resection with a ligation device for removing small rectal carcinoid tumor compared with endoscopic mucosal resection: analysis of 100 cases.

AIM: Conventional endoscopic mucosal resection (EMR) of carcinoid tumors is often associated with involvement of the resection margin, which necessitates further intervention. Endoscopic submucosal resection with a ligation device (ESMR-L) is a novel technique for the removal of carcinoid tumors. The aim of the present study was to compare the clinical usefulness of endoscopic submucosal resection with a ligation device with that of EMR for the complete resection of rectal carcinoid tumors. METHODS: Between January 2001 and October 2010, a total of 100 patients with 100 rectal carcinoid tumors that were estimated to be 10 mm or less in diameter and that were resected either using ESMR-L or EMR were recruited for this study. The complete resection rate and complications associated with these two procedures were analyzed. RESULTS: Forty-five out of 100 lesions were resected using ESMR-L, and 55 lesions were resected using EMR. Histopathologically, all tumors were free from lymphovascular and perineural invasion. The overall ESMR-L complete resection rate was higher than that of EMR (93.3% vs 65.5%, respectively, P = 0.001). Furthermore, the location of the tumors had no influence on the complete resection rate when ESMR-L was carried out, in contrast to the results of EMR. The procedure-related variables of procedure time and complication rate were not significantly different between the two groups. CONCLUSION: ESMR-L is a significantly superior modality to EMR for the complete removal of small rectal carcinoid tumors that are 10 mm or less in diameter.

[A case of isolated hepatic lymphangioma].

Hepatic lymphangioma is a rare benign neoplasm. It usually occurs as a part of systemic lymphangiomatosis. Isolated hepatic lymphangioma is extremely rare. A 58-year-old woman with weight loss was referred for the evaluation of chronic renal insufficiency and hepatic mass. Abdominal computed tomography showed 3 cm sized multilobulated cystic lesion with calcification and thick septal enhancing focus in the segment V of the liver. On abdominal magnetic resonance imaging, the masses exhibited low signal intensity on the T1-weighted images and high signal intensity on the T2-weighted images. Malignant tumor could not be ruled out, and therefore, the patient underwent right anterior segmentectomy of the liver. Gross pathology reveraled a 3.0×2.2×1.5 cm mass with multichamber cyst, which was filled with mucoid material. Histologically the mass was composed of irregularly shaped vascular channels filled acellular homogeneous lymph fluids. The final diagnosis was hepatic isolated cavernous lymphangioma. Herein, we report a case of isolated hepatic lymphangioma and also review the existing literature.

Aberrant expression of MUC3 and MUC4 membrane-associated mucins and sialyl Le(x) antigen in pancreatic intraepithelial neoplasia.

INTRODUCTION: Ductal adenocarcinoma of the pancreas has recently been suggested to arise from histologically identifiable ductal lesions known as pancreatic intraepithelial neoplasia (PanINs). Altered levels and patterns of mucin gene expression have been reported to occur in epithelial cancers. AIM: To examine the pattern of expression of membrane-associated mucins, MUC3 and MUC4, and a mucin-associated carbohydrate tumor antigen, sialyl Le(x), in these precursor lesions and ductal adenocarcinoma of the pancreas. METHODOLOGY: A total of 144 PanIN lesions and 85 cases of ductal adenocarcinoma of the pancreas were examined by using immunohistochemistry and in situ hybridization methods. RESULTS: MUC3 showed a progressive increase in expression in PanINs of increasing dysplasia and was also highly expressed in ductal adenocarcinoma. In contrast, neoexpression of MUC4 and sialyl Le(x) antigen was observed, mainly in PanIN-3 and ductal adenocarcinoma. In addition, a decrease in the expression of MUC3 and MUC4 was correlated with the degree of de-differentiation of the tumor. CONCLUSION: Aberrant expression of membrane mucins MUC3 and MUC4 and of a mucin-associated carbohydrate tumor antigen Sialyl Le(x) in PanINs and adenocarcinoma further supports the progression model for pancreatic adenocarcinoma.

Aberrant expression of MUC5AC and MUC6 gastric mucins and sialyl Tn antigen in intraepithelial neoplasms of the pancreas.

BACKGROUND & AIMS: It has recently been suggested that infiltrating adenocarcinoma of the pancreas arises from histologically well-defined precursor ductal lesions called pancreatic intraepithelial neoplasia (PanIN-1A, -1B, -2, and -3). This study examined alterations in the pattern and the level of expression of several mucin genes (MUC1, MUC2, MUC5AC, and MUC6) and mucin-associated tumor antigens (Nd2 and sialyl Tn) in these precursor lesions. METHODS: We examined 139 PanINs and 68 infiltrating ductal adenocarcinomas of the pancreas by using immunohistochemistry and in situ hybridization methods. RESULTS: Overexpression of MUC1, a pan-epithelial mucin, and MUC6, a pyloric-gland mucin, and de novo expression of MUC5AC, a gastric foveolar mucin, was observed in all stages of PanINs and invasive ductal adenocarcinoma. In contrast, the expression of mucin-associated carbohydrate antigen, sialyl Tn, was markedly increased only in PanlN-3 and invasive ductal adenocarcinoma. In addition, a decrease in the expression of these mucin-associated peptide and carbohydrate antigens was correlated with the degree of differentiation of the tumor. CONCLUSIONS: Expression of both gastric-foveolar and pyloric-gland mucin in PanINs is an early event, whereas sialyl Tn expression is a late event in the recently defined progression model of pancreatic carcinogenesis. This altered mucin gene expression provides new insight into the role of cell lineage-associated metaplasia in pancreatic carcinogenesis.