The rendezvous technique involving insertion of a guidewire in a percutaneous transhepatic gallbladder drainage tube for biliary access in a case of difficult biliary cannulation.

Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic method and treatment approach for biliary diseases. However, biliary cannulation can be difficult in some cases. We performed ERCP in a 97-year-old woman with abdominal pain resulting from acute cholangitis caused by choledocholithiasis and observed difficult biliary cannulation. Eventually, the patient was successfully treated with the rendezvous technique. We could not cannulate the biliary duct during ERCP twice. Therefore, we placed a percutaneous transhepatic gallbladder drainage (PTGBD) tube without intrahepatic dilation. The rendezvous technique was performed using the PTGBD tube. The patient did not experience pancreatitis or perforation.

Asymptomatic anisakiasis of the colon incidentally diagnosed and treated during colonoscopy by retroflexion in the ascending colon.

A 74-year-old man with diabetes underwent colonoscopy as routine screening for colon cancer. An Anisakis larva was found incidentally during colonoscopy using the retroflexion technique in the ascending colon, and was removed using a forceps. Asymptomatic colonic anisakiasis is very rare, and few reports have described diagnosis and treatment of anisakiasis during colonoscopy by the retroflexion technique in the ascending colon. We have reported this rare case along with a literature review.

A case of hepatic pseudolymphoma observed without surgical intervention.

We report a case of liver pseudolymphoma that has been followed up without surgical resection after the diagnosis. A 63-year-old woman with a hepatic hypo-echoic lesion, 16mm in diameter was referred to our hospital. Laboratory data on admission were within normal limits. Serum HbsAg and HCVAb were negative. Abdominal computed tomography revealed an enhanced round lesion at the same location of the liver. Histopathological examination of the biopsy specimen demonstrated aggregation of the small round cells, lacking cytologic atypia or mitotic figures. These cells were B lymphocytes with staining of kappa and lambda light chains at equal frequency. Furthermore, monoclonal band was not detected by the polymerase chain reaction (PCR) method for the position of the third complementarity-determing region (CDR3) in the immunoglobulin heavy chain (IgH). These results suggested that the cells infiltrated in the lesion were polyclonal and benign nature. This case was observed carefully without surgical operation. During the course, Helicobacter pylori were successfully eradicated. Follow-up study after 18 months showed that the diameter of the tumor had decreased from 16mm to 8mm, suggesting no evidence of the malignant transformation.

p53 negativity, CDC25B positivity, and metallothionein negativity are predictors of a response of esophageal squamous cell carcinoma to chemoradiotherapy.

AIM: Esophageal squamous cell carcinoma is generally sensitive to chemoradiotherapy (CRT), but some cases are not. Using a retrospective analysis, we aimed to identify the predictors of the response by esophageal squamous cell carcinoma to definitive CRT. METHODS: The intensities of expression of p53, Ki67, Bcl-2, Bax, cyclin D1, VEGF, CDC25B, and metallothionein (MT) were evaluated immunohistochemically in the biopsy specimens obtained before CRT, and the intensities of their expression were tested for correlations with the clinical effects of CRT. RESULTS: The esophageal squamous cell carcinomas with negative p53, positive CDC25B, and negative MT expression were found to be significantly more sensitive to CRT. In addition, p53 positivity and CDC25B positivity respond well to CRT. CONCLUSION: Esophageal squamous cell carcinomas with negative p53, positive CDC25B, and negative MT expressions respond well to CRT. Even with p53 positivity, if with CDC25B positivity, CRT can be expected.

A case of esophageal stricture due to metastatic breast cancer diagnosed by endoscopic mucosal resection.

Metastasis of breast cancer to the esophagus has been reported but is rare. It is often difficult to diagnose metastases of breast cancer to the esophagus because they are often located in the submucosa and covered with normal mucosa. Although several methods have been reported in order to obtain specimens for pathological diagnosis, the adverse effects including bleeding and perforation were considerable problems. We report a case of a patient with esophageal stricture due to metastatic breast cancer to the esophagus. Pathological diagnosis was successfully obtained using endoscopic mucosal resection of the esophagus.