Early gastric mixed neuroendocrine-non-neuroendocrine neoplasm with early poor prognosis after endoscopic submucosal dissection: A case report.

Early gastric mixed neuroendocrine-non-neuroendocrine neoplasms (MiNENs) are rare diseases, with no data on their incidence and prognosis. We report the case of intramucosal gastric MiNENs for endoscopic submucosal dissection (ESD) treatment. An 80-year-old male underwent esophagogastroduodenoscopy for screening and was suspected of early gastric cancer type 0-IIa+IIc on the lesser curvature of the antrum, for which ESD treatment was performed. Histopathologically, the diagnosis was MiNENs. Synaptophysin-positive adenoductal structures were observed in the adenocarcinoma component, suggesting that adenocarcinoma had dedifferentiated into neuroendocrine carcinoma. The tumor was located within the mucosal layer, with lympho-vascular invasion. The patient was kept under observation; however, 6 months after the ESD, computed tomography scan revealed prominent ascites, enlarged lymph nodes, and liver metastases, and MiNENs were suspected to have poor prognosis. If MiNENs diagnosis is made preoperatively or postoperatively, surgical resection may be considered as treatment regardless of the tumor depth or lympho-vascular invasion.

Gastric adenocarcinoma of fundic gland type arising from heterotopic gastric glands during a 19-year follow-up period.

A 73-year-old man with prior history of duodenal ulcer has been undergoing periodic upper gastrointestinal endoscopy since 1999. In 2017, a 25-mm submucosal tumor-like protrusion was detected in the lesser curvature of the upper stomach; histological examination of the lesion revealed gastric adenocarcinoma of fundic gland type. En bloc resection was achieved using endoscopic submucosal dissection. The patient was histopathologically diagnosed with gastric adenocarcinoma of fundic gland type arising from heterotopic gastric glands. Immunohistochemical staining was positive for MUC5AC, MUC6, pepsinogen I, and proton pump but negative for MUC2 and CD10. Moreover, the patient's Ki-67 labeling index score was extremely low. The presence of MUC5AC indicated that the tumor differentiated to the foveolar epithelium and fundic glands. Gastric adenocarcinoma of fundic gland type that differentiates to several directions has a higher malignant potential than the disease that differentiates to chief cells. A retrospective review of the patient's previous endoscopic examination revealed that the submucosal tumor-like protrusion existed since 2000; tumor size increased from 8 mm in 2000 to 25 mm in 2017. The present case is rare in that the carcinoma arose from heterotopic gastric glands. Moreover, the 19-year follow-up revealed that the tumor differentiated to the foveolar epithelium, considered as having high-grade malignancy.

A multicentre randomised trial to compare the efficacy of omeprazole versus rabeprazole in early symptom relief in patients with reflux esophagitis.

BACKGROUND: Proton pump inhibitors (PPIs) are affected by cytochrome P450 2C19 (CYP2C19) polymorphisms. This study compared the effect of two PPIs on early symptom relief in Japanese patients with reflux esophagitis, classified by the CYP2C19 phenotype. METHODS: Patients with reflux esophagitis were randomised to treatment with omeprazole 20 mg or rabeprazole 10 mg once daily. The CYP2C19 phenotype [homozygous extensive metaboliser (homoEM), heterozygous extensive metaboliser (heteroEM) or poor metaboliser (PM)] of each patient was determined. The primary efficacy endpoint was early, sufficient (Global Overall Symptom scale score 1 or 2), sustained (maintained for ≥7 days) reflux symptom relief. RESULTS: Of the 199 patients included in this analysis, the proportion achieving sufficient, sustained reflux symptom relief was higher with omeprazole than with rabeprazole on day 1 (35.6 vs. 22.4%; p = 0.041) and day 2 (43.6 vs. 28.6%; p = 0.028); there was no significant difference between the two groups on days 3-7. Among patients with the CYP2C19 PM phenotype, sufficient, sustained reflux symptom relief was higher with omeprazole than with rabeprazole on days 4-7 (62.5-66.9 vs. 31.6%; p ≤ 0.03); differences were not significant on days 1-3, or among those with the homoEM or heteroEM phenotypes on days 1-7. CONCLUSIONS: In Japanese patients with reflux esophagitis, omeprazole 20 mg is more effective than rabeprazole 10 mg at achieving early, sufficient, sustained reflux symptom relief in individuals with the CYP2C19 PM phenotype, and is similarly effective to rabeprazole 10 mg in those with heteroEM or homoEM phenotypes.

A case of lymphomatoid gastropathy: a self-limited pseudomalignant natural killer (NK)-cell proliferative disease mimicking NK/T-cell lymphomas.

Natural killer (NK)/T-cell lymphomas exhibit aggressive tumor behavior and have a poor prognosis. Recently, self-limited pseudomalignant NK-cell proliferative disorders of the stomach mimicking NK/T-cell lymphomas have been recognized. We report a rare case of lymphomatoid gastropathy in a 71-year-old female. The patient underwent esophagogastroduodenoscopy (EGD) because of slight epigastric discomfort which revealed a 10-mm, reddish, flat elevation with erosion on the posterior wall of the lower gastric body. Histological examination of biopsy specimens showed atypical NK/T cell infiltration with cytoplasmic CD3+, CD4-, CD5-, CD7+, CD8-, CD16-, CD20-, CD56+, CD68-, CD117-, MPO-, TIA1+, and granzyme B+. Epstein-Barr virus-encoded RNA in situ hybridization was negative. Three months later, repeated endoscopic examination surprisingly revealed spontaneous regression of the lesion without any treatment. It is important that endoscopists consider this rare entity in the differential diagnosis, and excessive treatment should be avoided.

[Black esophagus due to acute necrotizing esophagitis: four case reports].

We describe four patients with acute esophageal necrosis who were admitted to hospital due to upper gastrointestinal bleeding. "Black esophagus" is endoscopically defined as diffuse dark pigmentation of the esophageal wall. The underlying conditions were ketoacidosis in three of the patients and diabetes mellitus in two. Three patients responded well to empirical supportive therapy and one patient died of coexisting illness rather than the esophageal status. Acute esophageal necrosis is a rare entity that should be considered in the differential diagnosis of upper gastrointestinal bleeding.

[Sleep apnea syndrome].

The association between gastroesophageal reflux disease (GERD) and obstructive sleep apnea syndrome (OSAS) has recently been suggested. Patients with OSAS have a high frequency of nocturnal GER, and patients with GERD have various sleep-related symptom such as snoring and apnea. However, the causal relation between OSAS and GERD has not been sufficiently elucidated. The treatment of OSAS with nasal continuous positive airway pressure significantly reduces GERD symptom and nocturnal GER in both patients with and without OSAS. On the other hand, treatment of GERD in patients with OSAS improves the number of arousal during sleep, but one study showed a significant decline of apnea index. It is necessary to make further studies evaluating the association and treatment of OSAS and GERD.