Celiac Disease Diagnosed after Gastrectomy for Gastric Cancer

Celiac disease is a systemic autoimmune disorder leading to manifestations of malabsorption syndrome. A 47-year-old Japanese man developed severe diarrhea after surgery for gastric cancer. The diarrhea persisted for seven months, leading to a state of malabsorption. Celiac disease was suspected based on small bowel capsule endoscopy findings. The duodenal findings observed during gastric cancer surgery were reassessed, and Marsh-Oberhuber classification type 3c celiac disease was diagnosed. The anti-tissue glutaminase antibody test results were positive. The patient was started on a gluten-free diet, following which the diarrhea resolved, and the nutritional status improved. Adjuvant therapy after gastric cancer surgery was initiated.     

Lack of Association of Helicobacter pylori Seroprevalence and Gastric Cancer in a Population with Low Gastric Cancer Incidence

Background: Previous studies have suggested that infection with Helicobacter pylori is associated with an increased risk of gastric adenocarcinoma. Methods: We examined the sera of 111 Caucasian patients with histologically confirmed gastric cancer (36 with cancer of the cardia, 70 with cancer of the body or antrum, and 5 with stump carcinomas after Billroth-II procedures) and 111 age-matched controls with colorectal carcinomas for the presence of H. pylori IgG antibodies by enzyme-linked immunoassay. Results: The overall prevalence of H. pylori infection was 58.6% (65 of 111) in gastric cancer patients as compared with 50.5% (56 of 111) in matched control subjects (odds ratio, 1.39; 95% confidence interval, 0.82 to 2.36). Carcinomas of the cardia were not linked to H. pylori infection (odds ratio, 1.25; 95% confidence interval, 0.49 to 3.18), nor were carcinomas of the body and antrum (odds ratio, 1.26; 95% confidence interval, 0.65 to 2.46), nor diffuse or intestinal-type carcinomas (odds ratios, 1.79 and 1.0; 95% confidence intervals, 0.69 to 4.67 and 0.34 to 2.91, respectively). Age, sex, and height of the IgG immune response did not affect risk. Conclusions: In contrast to previous results, these data do not provide evidence that the contribution of H. pylori infection to the carcinogenesis of gastric cancer is of major significance in a population with low gastric cancer rates and with high socioeconomic status.     

α-Fetoprotein Producing Early Gastric Cancer

Abstract: A 53-year-old male suspected of having a testicular tumor associated with a moderately high titer of α-Fetoprotein (AFP), was shown to have a IIa + IIc type early gastric cancer in the cardia. The urological diagnoses made from the operated specimen were orchitis and epididimitis. Because of the moderately high titer of AFP (30–80 ng/ml), it was suspected that he had a hepatocellular carcinoma (HCC). A routine upper gastrointestinal endoscopy performed prior to the celiac angiography to assess for a liver tumor revealed gastric cancer. HCC was ruled out using celiac angiography and a total gastrectomy was performed. The operative findings of: P₀ H₀ N₄ S₀ corresponded with stage IV gastric cancer. Subsequently his AFP decreased to an undetectable level and the patient is in a good postoperative condition. The resected tumor was a well differentiated tubular adenocarcinoma and stained positive for AFP. A differential diagnosis with the subtype of AFP excluded the possibility of a yolk sac tumor but did not permit differentiation of the HCC from gastric cancer. A diagnosis of AFP producing gastric cancer must be carefully considered when HCC has been excluded in patients with high AFP titers.     

Primary Gastric Carcinoma with the Bull's eye Sign in a Case of Breast Cancer — Immunohistochemical Differentiation from Metastatic Cancer—

Abstract: A 53-year-old female, who had undergone a mastectomy for breast cancer 4 years previously, was found to have gastric cancer. Judging from the Bull's eye sign of the upper GI series and endoscopy, it appeared to be a metastatic gastric cancer. Histopathological findings of biopsy specimens revealed adenocarcinoma and metastases from the breast cancer were not negligible. However, the surgically resected specimen had different immunohistochemical staining for CEA, Alcian blue, 115D8, and C-erb B2 from the breast cancer. The tumor was finally diagnosed as a primary gastric carcinoma. This case shows that immunohistochemical studies are useful for differentiation between metastatic and primary gastric cancer     

Autoimmune Pancreatitis with Gastric Cancer: Some IgG4-related Diseases May Be Paraneoplastic Syndrome

A 70-year-old man was referred to our department for the treatment of early gastric cancer. Contrast-enhanced computed tomography (CT) incidentally showed diffuse enlargement of the pancreas with a capsule-like rim, and blood tests showed elevated serum IgG4 levels, leading to a diagnosis of autoimmune pancreatitis (AIP). Endoscopic treatment for gastric cancer was performed, and pathological findings showed adenocarcinoma with abundant IgG4-positive plasma cell infiltration. Thereafter, the serum IgG4 levels normalized, and the findings of AIP disappeared on CT without steroid treatment. These findings suggest that the gastric cancer activated an IgG4-related immune response, resulting in the development of AIP.     

A Case of Early Gastric Cancer Manifesting as a Submucosal Tumor

Abstract: Gastric cancer manifesting as a submucosal tumor (SMT) is not common. A gastric barium meal and endoscopic studies performed on a 49-year-old male with epigastric pain, revealed an elevated lesion with bridging folds and central depression on the posterior wall of the lower body. An endoscopic ultrasonography (EUS) revealed a hypoechoic mass lesion within the submucosal layer. Due to an increase in the size of the tumor and its central depression during the subsequent year and a half, the patient was admitted for closer examination. Endoscopic biopsy material from the deeper layer, obtained by mucosal resection, revealed a poorly differentiated adenocarcinoma. Microscopic examination of the resected stomach showed a poorly differentiated adenocarcinoma within the submucosal layer, with considerable lymphocyte infiltration. Immunohistological examination disclosed marked T cell infiltration adjacent to the cancer cells. We suggest that considerable lymphocyte infiltration, particularly T cells, may have some role in the protective reaction against cancer cells. Our case was diagnosed as being cancer 18 months after the first endoscopic study. The biopsy material taken from the depression at the time of the first examination showed benign findings and a EUS revealed typical SMT. In the case of SMT shown by EUS to be a hypoechoic mass lesion in the submucosal layer, it is recommended that biopsy material be obtained from the deeper layer using methods available such as artificial ulcer formation.     

HP阳性浅表性胃炎与弥漫型胃癌的关系探讨

利用粘液组化法对２８２例胃癌活检标本进行分类，同时用硼酸美蓝蓝染色法对胃癌癌旁粘膜作组织切片检测ＨＰ。结果：１５０例肠型胃癌中其癌旁粘膜以萎缩性炎症为主，占７９．３３％，ＨＰ检出率为３６．６７％；１１６例弥漫型胃癌中，癌旁以浅表性胃炎为多见（６２．９３％），总ＨＰＢ是性率为５７．７５％，其中７３例癌旁少表性胃炎，６９．８６％见ＨＰ感染。同时发现青年组中弥漫型胃癌的发生率二倍于肠型胃癌。显示弥漫型胃     

Clinicopathologic Characteristics of Interval Gastric Cancer in Korea

Background/AimsInterval gastric cancer (IGC) is defined as cancer that is diagnosed between the time of screening and postscreening esophagogastroduodenoscopy (EGD). Unfortunately, little is known about the characteristics of IGC in Korea, a country with a high incidence of gastric cancer. The aim of this study was to evaluate the clinicopathologic characteristics of IGCs in Korea.MethodsFrom January 2006 to July 2011, a total of 81,762 subjects underwent screening EGD at Yonsei University Health Promotion Center, Seoul, Korea. We defined missed cancer as cancer diagnosed within 1 year of screening EGD and latent cancer as cancer diagnosed more than 1 year after EGD.ResultsA total of 16 IGC patients (17 lesions; three missed cancers and 14 latent cancers) were identified, with a mean age of 60.68 years and a mean interval time of 19.64 months. IGCs tended to be undifferentiated (12/17, 70.6%), located in the lower body of the stomach (12/17, 70.6%) and exhibited flat/depressed endoscopic morphology (11/17, 64.7%). The patients with missed cancer were generally younger than the patients with latent cancer (51.3 years vs 62.8 years, p=0.037), and the patients with undifferentiated cancer were significantly younger than those with differentiated cancer (57.0 years vs 68.8 years, p=0.008).ConclusionsIGCs tended to be undifferentiated, located in the lower body of the stomach, and exhibited flat/depressed endoscopic morphology.     

Gastric Ulcer and Risk of Cancer

Abstract In 1976, 121 patients with benign gastric ulcer and 13 with gastric carcinoma were diagnosed in our department by endoscopy, cytology and directed biopsies. At a 5-year follow-up, 78 of these patients were re-examined with endoscopy and biopsies. None had developed gastric cancer during the observation time. Of the 78 patients who underwent endoscopy, 16 had gastric ulcer, 2 duodenal ulcer and 27 atrophic gastritis, including 3 with moderate dysplasia of the gastric mucosa. The patients with ulcer had remarkably few symptoms. Only few data are available concerning the postulated link between gastric ulcer disease and gastric malignancy. The cancer-ex-ulcere hypothesis seems to be a medical dogma. However, well planned prospective studies with endoscopic follow-up of gastric ulcers are needed to elucidate the question properly     

A Case of Turner's Syndrome with Crohn's Disease

Abstract: A case of Crohn's disease that developed during the follow-up of Turner's syndrome is presented in this paper, together with references to the literature. This case had a mosaic pattern (45X46Xi (Xq)) in chromosomal analysis and BW52, DR2 in HLA typing with autoantibodies.     

Application of a Video Microscope to Observe the Gastric Mucosal Surface,Especially in Early Gastric Cancer

Abstract: The surface of cancerous mucosa in 30 surgically resected cases of early gastric cancer (22 differentiated and 8 undifferentiated adenocarcinoma) was observed through a video microscope. The mucosal surface showed characteristic findings of a pit pattern, composed of elevations and depressions of the surface, as previously reported when a dissecting microscope was used. The pit patterns of the cancerous mucosa were classified into five types under 200 × magnification: oval or round (type I), tubular or slightly branching (type II), irregular sulcus (tupe Ill), mesh-like (type IV) and non-structural or destroyed (type V). Most differentiated cancers had type I to 1V pit patterns, in contrast with undifferentiated cancers which mostly had a type V pit pattern. Our observations suggest that a video microscope is useful to observe magnified gastrointestinal mucosal lesions and to recognize the characteristic features of the surface such as the pit pattern.     

A Case of Pachydermoperiostosis with Watery Diarrhea,Giant Gastri Rugae,and Endocrine Disorder

Abstract: A 31-year-old man, cook, who had had persistent watery diarrhea for about a month visited our hospital. He had already been diagnosed as having pachydermoperiostosis. An examination of the upper gastrointestinal tract revealed that he had giant gastric rugae. The histology was compatible with hypertrophic gastritis accompanied with marked hyperplasia of the fundic gland and foveolar epithelia. The output of gastric juice was high in volume, although its acidity normal. The barium transit time of the small intestine was reduced to 15 minutes. His diarrhea was, thus, considered to be induced by gastrointestinal hyperfunction. The patient's glucose tolerance was abnormal and basal Cortisol secretion level was high. Pachydermoperiostosis has been the focus of attention for skin and bone changes, and the frequency of this disease with endocrine disorders seems rather high, but accompanying gastrointestinal disorders have so far not often been reported in Japan. The results of our investigation strongly suggest that pachydermoperiostosis is a systemic disease.     

Evidence of Epstein-Barr Virus Association with Gastric Cancer and Non-Atrophic Gastritis

Different lines of evidence support an association between Epstein-Barr virus (EBV) and gastric cancer (GC). The main understood risk factor to develop GC is infection by Helicobacter pylori (H. pylori), which triggers a local inflammatory response critical for progression from gastritis to GC. The role of EBV in early inflammatory gastric lesions has been poorly studied. A recent study proposed a cutoff value of 2000 EBV particles to identify patients with increased chances of infection of the gastric epithelium, which may favor the inflammatory process. To better understand the role of EBV in cancer progression, we analyzed 75 samples of GC, 147 control samples of non-tumor gastric tissue derived from GC patients and 75 biopsies from patients with non-atrophic gastritis (NAG). A first-round PCR was used for EBV detection in tumor and non-tumor controls and a more sensitive nested PCR for gastritis samples; both PCRs had lower detection limits above the proposed cutoff value. With this strategy 10.67% of GC, 1.3% of non-tumor controls and 8% of gastritis samples were found positive. An EBER1 in situ hybridization showed EBV infection of epithelial cells in GC and in a third of NAG samples, while in the other NAGs infection was restricted to the mononuclear cell infiltrate. EBV-positive GCs were enriched in lace and cribriform patterns, while these rare patterns were not observed in EBV negative samples. Our results support a role for EBV in GC and early precursor lesions, either as directly oncogenic infecting epithelial cells or indirectly as an inflammatory trigger.     

Immunohistochemical Study of Estrogen Receptor in the Penetrating Type of Early Gastric Cancer

Abstract: The estrogen receptor was studied in a total of 42 cases of gastric carcinoma which included 14 cases of the penetrating type of early gastric carcinoma (PEN), 14 cases of the common type of early gastric carcinomas (EA) and 14 cases of the advanced gastric carcinomas (AD). An immunohistochemical study using the anti-ER-D5 antibody revealed that the detection of estrogen receptor-positive tumor cells was significantly higher in the PEN group and in the AD group than in the EA group. Moreover, the incidence of estrogen receptor immunoreactivity in infiltrative and scirrhous PENs was significantly higher than that in non-infiltrative and non-scirrhous PENs. These results suggests that the estrogen receptor may play an important role in infiltrative proliferation and scirrhous growth in the PENs. Furthermore, the results indicated that ER immunostaining procedures applied to endoscopic biopsy specimens could be useful for the endoscopic diagnosis of PEN-type early gastric cancer.     

胃癌组织ras族基因突变与预后的关系

应用多聚酶链延伸反应－限制性片段长度多态笥分析法（PCR－RFLP）对88例福尔马林液固定，石蜡包埋胃癌组织C－Ha-ras第12位和13位，K－ras第12位和13位及N－ras第12位密码子的点突变进行检测，结果发现ras基因总突为18．2％（16．88），以c-Ha-ras第12位密码子突变率最高（13．6％），点突变的发生与肿瘤浆膜浸润，淋巴结转移，临床病理分期及术后生存期密切相关。以上结果提示，检测胃癌组织ras族基因点突变有助于判断胃癌患者的预后。     

“小粘膜”型胃癌诊断的探讨

所谓“小粘膜”型胃癌系指病灶直径小于４ｃｍ,局限于粘膜层或仅有轻度粘膜下层侵犯的早期胃癌。本文总结经内镜发现并得到手术、病理证实的“小粘膜”型胃癌１２例,着重对期诊断问题作一探讨。     

Giant Lymph Node Hyperplasia (Castleman's Disease) Associated with Temporal Arteritis

Giant lymph node hyperplasia is a lesion of lymphoid tissue, which may be accompanied by systemic manifestations like fever, anaemia and hyperglobulinaemia. A case is described with temporal arteritis, an association hitherto not described in the literature.     

Laparoscopic Gastrectomy for Early Gastric Cancer after Endoscopic Mucosal Resection

Abstract: In 1991, we first performed a simple technique of Iaparoscopy-assisted Bill-roth I gastrectomy for patients with mucosal gastric cancer. Endoscopic mucosal resection (EMR) sometimes fails to completely resect the early gastric cancer lesion, nor does it give full histopathology of the resected stomach. The aim of this study was to review the surgical and pathological findings of eight patients who underwent laparoscopic gastrectomy after EMR for early gastric cancer. Of 54 patients with early gastric cancer who were treated with laparoscopic gastrectomy between 1994 and 1998, eight patients underwent surgery after EMR. The resected margin of the EMR specimens was positive in three and suspicious in five; and three underwent laparoscopic wedge resection of the stomach, while five underwent Iaparoscopy-assisted distal gastrectomy with regional lymph node dissection. All but one resected stomach had residual cancer tissue in the mucosa or submucosa, and three patients had multiple gastric cancers. The results indicated that remnant cancer tissue might be present when the resected margin of the EMR specimen was positive or suspicious. Partial resection or distal gastrectomy under laparoscopy is useful for such patients who have undergone EMR for early gastric cancer. (Dig Endooc 1999; 11:132–136)     

Taking Control of Alzheimer's Disease: A Training Evaluation

The purpose of the current study was to evaluate a training program for persons with early-stage Alzheimer's disease and their care partners. Care partners were mailed two surveys, one for themselves and one for the person with dementia. Domains covered in the training included an overview of cognitive disorders, treatment of symptoms including medications, research updates and opportunities, memory and safety enhancement techniques, legal and financial planning, driving, ways to stay active, becoming an advocate, and communication. The results indicate a high level of participant satisfaction and impact on current lifestyles. Lifestyle changes such as diet, physical and mental exercises were likely to be made in tandem, by the person with dementia and the care partner together. Further, the results provide insights into the perceptions of the care partners and the persons with dementia as they learn about the disease and live through its progression. The program had positive impacts for the person with dementia and for the care partner in increasing knowledge of Alzheimer's disease, providing comfort with sharing the diagnosis, personal planning, and in decision making. Although many had taken important decision-making actions prior to the training, an additional twenty percent prepared or revised their wills, health care proxies, durable powers of attorney, or medical directives and looked into asset protection after participating in the training.