Discovery of the primary site of esophageal squamous cell carcinoma based on axillary lymph nodes metastasis detected with fluorodeoxyglucose positron-emission tomography: report of a case.

A 60-year-old Japanese man with no chief complaints underwent 18F-fluorodeoxyglucose positron-emission tomography (FDG-PET) during a medical check-up. FDG-PET revealed high tracer uptake in the left supraclavicular and axillary regions but no significant uptake in the esophageal region. However, upper gastrointestinal endoscopy revealed an ulcerative tumor in the middle third of the esophagus. Endoscopic biopsy revealed moderately differentiated squamous cell carcinoma. The patient underwent chemoradiotherapy. Follow-up FDG-PET and computed tomography after therapy revealed a complete response in the lymph nodes. The patient underwent subtotal esophagectomy with gastric tube reconstruction through the posterior mediastinum. However, metastasis to the axillary lymph nodes was detected 16 months after surgery, and lymph node dissection was performed. To our knowledge, this is the first reported case in which the primary site of esophageal squamous cell carcinoma was discovered on the basis of axillary lymph node metastasis detected with FDG-PET.

[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.