A case report of early rectal carcinoma, IIa + IIc type, with no invasion of the submucosa

A 66-year-old woman was admitted to the Hakodate Chuo Hospital because of abdominal discomfort. A barium enema study revealed a deformity of the middle Houston's valve of the rectum and granular lesions at the Rb region of the rectum. A colonoscopic examination showed the IIa + IIc type of early rectal carcinoma. A resected specimen also revealed IIa + IIc type early rectal carcinoma, 8 X 13 mm in diameter, and well-differentiated adenocarcinoma with no invasion of the submucosa. Infiltration into the lymphatic vessels and regional lymph node metastasis were not encountered. The deformity of the rectal Houston's valve was checked by a barium enema study. It should be emphasized that early detection of colorectal carcinoma with no invasion of the submucosa, requires careful barium enema studies and colonoscopic examination.     

A case of small squamous cell carcinoma with a grading of IIa + IIc, an early gastric cancer type

A case of a 78-year old woman, complaining of epigastralgia, is reported. A series of gastrointestinal examinations revealed a small, elevated lesion with a central depression in the antrum. Since a fiberoptic biopsy had shown a Group V classification, a partial gastrectomy was performed. Tumor nodules, judged to be metastatic, were noticed in the liver and regional lymph nodes. Histologic scrutiny disclosed a keratinizing tumor that measured 1.0 X 0.9 cm in diameter and was largely a squamous cell carcinoma with a small focus indicating an adenocarcinoma. This tumor was confined to the muco-submucosal layers with prominent vascular permeation. No adenocarcinomatous components were found in the metastatic foci. The patient died eight months after operation. In light of our experience, together with what has been found in a review of the literature, we feel that a squamous carcinoma and an adenosquamous carcinoma of the stomach to be more aggressive than an ordinary adenocarcinoma and keeping this point in mind, they should be considered differentiated from an adenoacanthoma.     

A type IIa early carcinoma in multiple submucosal cysts of the stomach--a case report

The case of a 60-year-old Japanese man with an early gastric carcinoma in submucosal multiple cysts is presented, and the morphology and histogenesis had complained of dysphagia, and an upper gastrointestinal barium study and endoscopy revealed an irregular-shaped, flat polypoid tumor in the antral mucosa. The resected stomach had a polypoid lesion, 11.0 x 12.0 cm, but no erosion or ulcer in the greater antral curvature was seen, and cut section showed many cysts containing mucus. A subsequent histological examination revealed a well differentiated adenocarcinoma of the mucosal layer. This early carcinoma was sited on and surrounded by multiple cystic lesions. These histological findings suggested that this carcinoma had developed from the mucosa that had an underlay of submucosal cysts.     

Gastric lymphosarcoma associated with early carcinoma (type IIa)--a case report

We report a case of gastric lymphosarcoma associated with early carcinoma (type IIa). Lymphosarcoma was also seen in the small intestine, but there were no metastatic lesions in the lymph nodes , liver, and peritoneum. This suggest that lymphosarcoma was the primary cancer in both the stomach and small intestine. Microscopically, the early carcinoma was a moderately differentiated tubular adenocarcinoma . Only two earlier cases of coexistent gastric lymphosarcoma and early gastric carcinoma have been reported in the literature.     

Multiple submucosal cysts of the stomach associated with IIc + III type early gastric cancer--report of a case

A 59-year-old man was admitted with a complaint of epigastric discomfort, under the diagnosis of gastric cancer, subtotal gastrectomy was performed. In the resected specimen IIc + III type early gastric cancer were observed at the lesser curvature of the corpus and multiple submucosal cysts in almost entire area of the stomach. Histologic examination confirmed early adenocarcinoma and an atypical epithelium, which was present separately. Submucosal cysts consisted of a pseudo-pyloric-gland-type of epithelium, containing some fundic glandular and foveolar epithelium. Frequent erosion and regenerated epithelium and extensive intestinal metaplasia were observed in the gastric mucosa. There was no carcinomatous change in the submucosal cysts.     

A case of type IIa early gastric cancer complicated with multiple endocrine cell micronests in pernicious anemia

The patient, a 5-year-old male, was diagnosed as having pernicious anemia at our hospital in 1969. By means of an upper G-I series, he was found to have a gastric protruded lesion on the greater curvature of the upper corpus in 1983. After an endoscopic polypectomy, a type II a early gastric cancer was diagnosed which, histologically, showed a well-differentiated adenocarcinoma and a total gastrectomy was performed. From the histologic findings of the resected stomach, the were multiple endocrine cell micronests, that coincided with the distribution of intestinal metaplasia localized in the fundic gland area.     

Primary amyloidosis associated with early gastric carcinoma(IIb like IIa type) diagnosed by preoperative gastric biopsy--a case report

A case of primary amyloidosis associated with intramucosal adenocarcinoma of the stomach, diagnosed by preoperative biopsy, is reported. A 77-year-old man was admitted to our hospital with complaints of vertigo and general fatigue. X-ray and endoscopic examination revealed a IIb-like IIa type protruded lesion on the cardia of the stomach. A biopsy specimen from the protruded lesion disclosed well differentiated tubular adenocarcinoma and amyloid deposition. Partial gastrectomy was performed on August, 18, 1981. Upon histological study, a diagnosis of primary amyloidosis associated with intramucosal well differentiated tubular adenocarcinoma was made. We suggest that the histogenesis of this gastric carcinoma was related to the gastric lesion due to primary amyloidosis. Careful review of the Japanese literature disclosed that ours is the first case report of primary amyloidosis associated with early gastric carcinoma diagnosed by pre-operative gastric biopsy.     

JNET 2B型结直肠早期肿瘤黏膜下层深度浸润的特征及临床意义

目的:探讨结直肠早期肿瘤表面结构特征,期望能够找到预测JNET 2B型病灶黏膜下组织深层浸润的特点。方法:回顾性纳入在本院诊断为JNET 2B型结直肠早期肿瘤共47 例。内镜特征包括分叶结构消失、表面存在深凹陷、呈现分层现象、紧实感、皱襞集中、Vi重度不整或存在Vn结构或JNET 2B重度不整,并分析其与病灶浸润深度的关系。结果:分叶结构消失者黏膜层/黏膜下层浅层（M/SM-s） 4例（13.3%）,黏膜下层深层（SM-d ）11例（64.7%）,P=0.001;紧实感者M/SM-s 2例（6.7%）,SM-d 11例（64.7%）,P=0.001;Vi重度不整或存在Vn结构者M/SM-s 3例（10.0%）,SM-d 13例（76.5%）,P=0.001;JNET 2B重度不整者M/SM-s 3例（10.0%）,SM-d 16例（94.1%）,P=0.001;以上均有统计学意义。而表面存在深凹陷者、呈现分层现象者和皱襞集中者无统计学意义。结论:对于结直肠JNET 2B型早期肿瘤,当病灶表面具有分叶结构消失、紧实感、Vi重度不整或存在Vn结构,以及JNET 2B重度不整时,常提示病灶具有深层浸润,需推荐外科手术干预。     

Case of early gastric carcinoma (type IIc) and macroscopic submucosal tumors containing ectopic glands

A 69 year-old male was admitted to our hospital with early gastric carcinoma (Type IIc) and two macroscopic submucosal tumors. He had suffered from gastroduodenal ulcer for about forty years; postoperative histologic examination revealed the gastric ectopic glands to be a paracancerous lesion.     

A comparative morphological study of gastric and colorectal cancer--differences in early type IIc and advanced type 4 cancer

Five hundred and nineteen gastric and 883 colorectal cancers have been compared macroscopically according to their Japanese classification. Most early cancers were found to be of a protruded (I and IIa) type in the intestine and a depressed (IIc) type in the stomach, and it is felt that their histogenesis in the mucosa may play an important role in causing this difference. Type 4 advanced cancer is common in the stomach, but rare in the intestine. Histologically, most type 4 gastric cancers present scirrhous findings. Type 4 colorectal cancers can be classified into 4 groups based on their pathological characteristics, such as lymphangiosis, muconodular, mixed, and scirrhous types.     

A case of duodenal carcinoid associated with early gastric carcinoma

This case involves a 51-year-old female. In 1983, a gastroscopic examination disclosed a submucosal tumor in the duodenum. In 1986, during follow-up observation, on her visit to hospital an early gastric carcinoma at the antrum was found. Thus, a distal gastrectomy, which entailed the complete removal of the Group 2 lymph nodes and the hepatoduodenal, intra-mesenteric lymph nodes, and Billroth I reconstructive surgery were both performed. A histopathological examination revealed that the antral lesion was a carcinoma, sig. m. ly0. v0. n(-), and that a lesion at the duodenal bulb was carcinoid, with cell that were positive to Grimelius staining and to somatostatin serotonin by an immunological staining. A metastases to the lymph nodes but only along the upper trunk of the common hepatic artery, also was found.     

Ulcerative colitis complicated by early carcinoma of the rectum and cholecystolithiasis

Reported is a case of a 73-year-old male with a history of ulcerative colitis that had started at the age of 57. In 1985, on receiving a barium enema, a polypoid lesion was found in his rectum. In 1986, the results of a colonoscopy showed that the polypoid lesion had reached an IIa-aggregated elevation, and biopsies of this lesion were diagnosed as an adenoma or a hyperplastic polyp. A year later, in 1987, another biopsy specimen was taken and was histologically diagnosed as being an adenomatous cancer. Thus, a pull-through operation and a cholecystectomy were performed. The lesion was 4.5 x 3.0 cm in diameter, and the histological findings showed it to be a well-differentiated adenocarcinoma with a submucosal invasion. Accordingly, physicians should be advised that patients with a longstanding ulcerative colitis ought to undergo periodic examination that includes a colonoscopy and a biopsy of any suspicious growth.     

A case of hepatocellular carcinoma with a duodenal invasion from metastatic lymph node

A 64-year-old male, who had been diagnosed as having hepatocellular carcinoma, was admitted to hospital and underwent transcatheter arterial infusion therapy. CT and US examinations revealed a large tumor with air in its center. Barium meal examination of the duodenum showed a large filling defect with a central excavation. At endoscopic examination, a dark reddish tumor was seen protruding into the duodenal lumen. A biopsy specimen from this tumor revealed a hepatocellular carcinoma. The patient subsequently died of hepatic coma following gastrointestinal bleeding. An autopsy revealed that metastatic lymph nodes had infiltrated into the adjacent duodenum. Nine previous cases of duodenal metastasis from a hepatocellular carcinoma have been reported in the Japanese literature.     

头部巨大瘢痕鳞状细胞癌伴颅骨、硬脑膜侵犯一例

头部皮肤瘢痕癌是皮肤恶性肿瘤之一,其中鳞状细胞癌最常见,以局部浸润、颅骨破坏为主,其潜伏期较长,容易误诊,本文报道1例近期发生的头部疤痕鳞状细胞癌,以提高临床医师对这类疾病的认识,达到减少头部皮肤瘢痕的癌变和提高此类疾病生存率的目的。     

A case of small cell undifferentiated carcinoma (SCUC) of the rectum treated with etoposide, cis-platinum and radiotherapy]

A 29-year-old-woman with recurrent cancer of rectum was treated with Etoposide, cis-platinum and external irradiation. Previous postoperative chemotherapies consisted of MMC, CPA, VCR and HCFU. Histologically, the tumor invaded in sheets and nests, and consisted of round to ovoid malignant cells with high nuclear/cytoplasmic and hyperchromatic nuclei with a coarse, clumped, or stippled chromatin pattern. Most cells demonstrated a positive reaction by Grimelius and NSE staining. Eight months after surgery, we switched to Etoposide cis-platinum and external irradiation, because of local recurrence. Etoposide (total 725 mg) and cis-platinum (total 100 mg) were injected into bilateral iliac artery and 60 Gy radiotherapy was performed. The patient showed a good response, and a complete response (CR) was evident for the following 42 months. Thus, Etoposide, Cis-platinum and radiotherapy are considered an effective combination therapy for a patient with small cell undifferentiated carcinoma.     

A case of early primary adenosquamous carcinoma of the stomach

Primary adenosquamous carcinoma of the stomach is rare. Most cases are advanced when detected since there are only two cases of the early stages of this type of cancer in the literature. The histogenesis of this type of stomach carcinoma is still under discussion. In this paper an early stage of adenosquamous carcinoma of the stomach in a 56-year-old female is reported. The localization and characteristics of two type of cancer cells, adeno and squamous cell carcinoma cells, were studied using cytokeratin and PAS stainings.