Primary histiocytic sarcoma of the stomach:A case report with imaging findings

Histiocytic sarcoma(HS)is a rare malignant neoplasm that originates from a histiocytic hematopoietic lineage characterized by histiocytic differentiation and its corresponding immunophenotypic features.We herein reported a case of primary HS of the stomach which was confirmed through histopathologic examination and immunohistochemical staining.A 52-year-old woman presented with progressive difficulty in feeding and dull pain in the epigastric region.Gastroscopy,endo-scopic ultrasonography,double contrast examination, and computed tomography revealed a mass located on the posterior wall of fundus and lesser curvature of the stomach.Microscopically,the cytoplasm of the tumor cells was abundant and eosinophilic.Immunohisto-chemical staining revealed that the tumor cells were positive for CD45RO and CD68.It is difficult to differentiate HS of stomach from other gastric malignancies by radiological evaluation alone.However,HS may be considered when a protruding and ulcerated mass in stomach shows heterogeneous hypervascular features.To the best of our knowledge,this is the first report in English language literature that emphasizes the imaging findings of human gastric HS.     

Unusual gastric polyp showing submucosal proliferation of glands: Case report and literature review

We report an unusual pedunculated polyp in the stomach in a 41-year-old woman. She was hos-pitalized because of epigastric discomfort. Endoscopy revealed a polyp with a long stalk in the fundus of the stomach. The polypectomyzed polyp measured 23 × 18 × 9 mm and was characterized by submucosal proliferation of glands and cystic dilatation. The surface of the polyp was covered with gastric mucosa of fundic or pyloric gland type. The glandular structures consisted of various types of lining cells, including pyloric or mucous-neck cell type, surface mucous (foveolar) cell type, parietal-like cells, and somatostatin-positive cells. The submucosal glandular or cystic elements were connected with the overlying gastric mucosa through a defect of the muscularis mucosa, suggesting that this polyp may have been formed by the heterotopic inverted downgrowth of mucous glands into the submucosa. We discuss the histogenesis of this rare polyp and present a review of the literature. Received June 18, 1997; accepted Feb. 27, 1998     

Heterotopic gastric mucosa of the gallbladder

A case of heterotopic gastric mucosa in the fundus of the gallbladder is reported. A 23-year-old man, who had been healthy and asymptomatic, visited our hospital because of abnormal findings in a liver enzyme test given during a routine health screening. Ultrasonography demonstrated a highly echogenic polypoid mass in the fundus of the gallbladder. The gallbladder mass was confirmed by both computed tomography and intravenous cholangiogram. After a 10-month follow up, laparoscopic cholecystectomy was performed. Intraoperative touch smear cytology of this lesion revealed class II cells. The surgical specimen revealed a 15×10×5 mm polypoid lesion in the fundus, with no gallstones in the gallbladder. Histologically, the polypoid lesion consisted of both fundic type and pyloric type gastric glands located in the mucosa of the gallbladder. In the literature, 42 cases of heterotopic gastric mucosa of the gallbladder have been reported, only 3 of which, including this present case, were found incidentally, with no apparent symptoms.     

Primary small cell carcinoma of the lesser omentum

Although pulmonary small cell carcinoma (SCC) is seen frequently, SCC that originates from the extrapulmonary organs is extremely rare. We herein report a case of a SCC located in the lesser omentum. A 61-year-old male was admitted to our department due to intermittent epigastralgia for 2 months. Ultrasonography (US) revealed an irregular hypoechoic mass measuring about 58 mm × 50 mm × 45 mm under the left lobe of the liver. Magnetic resonance imaging (MRI) was performed to verify the irregular mass with T1- and T2- weighted images between the left lobe of liver and the stomach. At laparotomy, the well-circumscribed neoplasm was found in the lesser omentum, and the fundus of the neoplasm was located in the root of left gastric artery. Intraoperative microscopic evaluation of frozen sections revealed malignancy of the lesser omentum. Resection of the neoplasm was performed, and the combined resection of the vagal nerve was also performed for the partial adhesion. Pyloroplasty was performed for avoiding delayed gastric emptying caused by combined resection of vagal nerve. The lymph nodes dissection at lesser curvature and right cardia was also performed with a negative result. Based on the histological findings, the final diagnosis of primary lesser omental SCC was confirmed. The pathologic staging showed locoregional disease.     

Post-gastrectomy osteopenia in the rat: bone structure is preserved by retaining 10%-30% of the oxyntic gland area

BACKGROUND: The acid-producing part of the rat stomach (fundus) is rich in endocrine cells, i.e. ECL cells and A-like cells. The ECL cells operate under gastrin control and manufacture histamine, the chromogranin-derived peptide pancreastatin and an unidentified peptide hormone. The A-like cells produce ghrelin, a newly discovered growth hormone-releasing hormone. Surgical removal of the entire glandular stomach (gastrectomy, Gx) or the acid-producing part (fundectomy, Fx) causes osteopenia, which is striking in the calvaria. We speculate that the osteopenia develops after surgical removal of the fundus, because the fundus hosts agents that preserve bone. This study examines how much of the fundus is needed to preserve normal skull bone. METHODS: Increasing portions of the fundus were resected surgically. The serum gastrin, ghrelin and pancreastatin concentrations were measured. The rats were killed after 10 weeks and the calvariae were subjected to transillumination analysis and quantitative histomorphometry. RESULTS: Fx elevated serum gastrin in proportion to the amount of fundus resected, i.e., the more fundus that was resected, the higher the serum gastrin concentration. Serum ghrelin and pancreastatin concentrations were reduced proportionally to the amount of fundus resected. In rats subjected to 90% or 100% Fx, the calvariae displayed the anticipated pattern of bone loss. No bone loss was seen when 70% or less of the fundus was resected. CONCLUSIONS: The results of the present study indicate that 10%-30% of the fundic mucosa is needed to preserve bone. The Gx/Fx-evoked osteopenia may be explained by hormonal deficiency caused by surgically eliminating or diminishing one of the endocrine cell populations in the fundic mucosa.     

Antigen shared by HeLa-like human cell line and gastric mucosa

An antigen of human gastric mucosa immunologically related to the antigen of established HeLa-like cell lines (CL-GMA) is described. In gel-immunodiffusion test the antigen was revealed in 10/10 samples of normal gastric mucosa (including all parts of stomach), in 15/16 samples of cancer patients' gastric mucosa 5-10 cm distant from tumor and in 2/2 samples of ulcer patients' mucosa 5-10 cm distant from the ulcer. However, the antigen was undetectable at a distance 1-2 cm from ulcer. Homogenates of 39 embryonic organs and tissues were screened for the presence of CL-GMA. CL-GMA was detected in 7/7 samples of gastric mucosa. The antigen was revealed in trace amounts in 1/4 samples of small intestine mucosa and in 1/4 samples of spleen. Screening of 66 human tumors revealed CL-GMA in 13/16 samples of gastric cancer and in trace amounts in 2 tumors of non-stomach localization (larynx and rectum). Analysis of aceton-fixed paraffin sections by means of immunofluorescence revealed be CL-GMA in all parts of stomach. CL-GMA localized in the basal area of high columnar epithelial cells. The antigen was almost or totally undetectable in poorly differentiated adenocarcinomas of stomach and in tumors of other localization. We could not detect CL-GMA in the sera of various cancer patients by means of immunodiffusion and/or dot-blotting.     

Acute massive gastric dilatation: severe ischemia and gastric necrosis without perforation

Acute massive gastric dilatation is a rare event and though it can occur in a multitude of medical conditions, its pathogenesis is still debated. It leads almost invariably to gastric necrosis with or without perforation which calls for emergency surgical treatment. We present the case of a 22 year-old male patient of normal weight with acute massive gastric dilatation due to a binge eating episode leading to gastric parietal ischemia with mucosal necrosis. Abdominal computed tomography established the diagnosis of acute massive gastric dilatation. After partial decompression of the stomach, the patient emptied his stomach by vomiting. Eight hours after gastric decompression, an upper endoscopy was performed showing ischemia with areas of necrotic gastric mucosa in the fundus and along the greater curvature. Despite presence of ischemia and gastric necrosis, conservative treatment was successful. Psychiatric assessment revealed a borderline mentally retarded young man, but no current diagnosis of a typical eating disorder. Physicians should be aware that binge eating habits may cause acute massive gastric dilatation in patients of normal weight who are not diagnosed as having a typical eating disorder. Prompt diagnosis of acute gastric dilatation and decompression of the stomach even when gastric ischemia and mucosal necrosis is present, may avoid unnecessary laparotomy.     

小儿慢性胃炎辨证分型与内镜象及幽门螺杆菌感染的相关性研究

[目的]探讨小儿慢性胃炎中医证型与胃黏膜改变及幽门螺杆菌感染之间的内在关系.[方法]将符合入选条件的404例慢性胃炎患儿中医辨证分型后进行胃镜检查及尿素13C-呼气试验(13 C-UBT)检查,并登记造表,进行统计学处理.[结果]肝胃不和型胃炎主要表现为胃黏膜充血和微小结节形成,脾胃湿热型胃炎表现以黏膜斑和黏膜糜烂为主,胃络瘀血型胃炎则以胃黏膜出现出血斑点为主,脾胃虚弱型胃炎以胃黏膜水肿为主,胃阴不足型胃炎以胃黏膜花斑为主.13 C-UBT阳性率实证高于虚证,与证型无相关性;13C-UBT值实证高于虚证,尤以肝胃不和型和脾胃湿热型为最高.[结论]小儿慢性胃炎中医辨证分型与胃黏膜改变及幽门螺杆菌感染之间存在实质性联系,为辨证施治提供了理论基础.     

Acute gastric hemorrhage secondary to wandering spleen

Summary A patient presenting with acute life-threatening upper gastrointestinal hemorrhage caused by a wandering spleen is reported. Emergency laparotomy revealed profuse gastric bleeding, large engorged varicose veins in the gastric wall, and a normal liver parenchyma. Gastroscopy after arrest of the hemorrhage showed varicose veins in the fundus without esophageal varices. Angiography revealed an ectopic spleen, occlusion of the splenic vein, and large venous collaterals in the gastric fundus. Elective splenectomy was performed. Wandering spleen as a cause of left-sided portal hypertension, also referred to as segmental splenic hypertension, is discussed.     

Paraesophageal hiatus hernia,which has progressed for 8 years: report of a case

We report a case of a paraesophageal hernia, which was successfully treated with laparoscopic surgery after a natural history of eight years. Eight years before surgery only the fundus of the stomach was included in the hernia sac. At surgery, although the gastroesophageal junction and fundus were found in their normal positions, the distal half of the stomach and the omentum were pulled into the thorax, which demonstrated an organoaxial gastric volvulus. As the omentum tightly adhered to the top of the hernia sac and there was no tight adhesion between the stomach and hernia sac, the omentum could serve as the lead point for the gastric volvulus. This patient was successfully treated with laparoscopic surgery and is presently in good condition without any recurrence of the hernia.     

Inflammatory pseudotumor of the liver and spleen

We report the case of a 44-year-old woman with an inflammatory pseudotumour of the liver and spleen. This concomitant association has been rarely described. Our patient presented with a 2-day history of low grade fever and pain in the right hypochondrium and lower abdomen, and an abdominal scan revealed a contrast-enhanced mass in the liver in addition to an enlarged spleen with another contrast-enhanced mass. The patient was admitted to the hospital with the diagnosis of multiple liver abscesses and a spleen mass which suggested a neoplasm such as lymphoma. The final diagnosis was made by ultrasound-guided liver mass biopsy, and splenectomy. We review the literature, and highlight the difficulties of diagnosing this entity.     

Role of endothelin-1 in repeated electrical stimulation-induced microcirculatory disturbance and mucosal damage in rat stomach

The aim of the present study was to clarify the involvement of endogenous endothelin in the pathogenesis of gastric mucosal damage. The rat stomach was exposed and repeated electrical stimulation (RES) was applied to the small arterial wall close to the lesser curvature. Significant mucosal haemorrhagic lesions (ulcer and erosion) were noted within 30 min after RES. Intravital microscopic observations revealed that an arteriolar constriction occurred in the submucosal layer of the rat stomach approximately 5 min after the completion of RES. Following the arteriolar constriction, the mucosal blood flow of the rat stomach, which was monitored by using a laser Doppler velocimeter, decreased to approximately 30% of the control value. The plasma immunoreactive endothelin-1 level in the regional blood of the stomach was significantly increased immediately after RES preceding the decrease in mucosal blood flow. Immunohistochemical studies revealed that endothelin-1 and big-endothelin-1 were detectable in the arteriolar endothelium around the muscularis mucosa, supporting the involvement of endothelin-1 in RES-induced mucosal ischaemia. In addition, BQ-123, a specific antagonist of the endothelin A (ET_A) receptor, attenuated the reduction of blood flow and the development of haemorrhagic lesions observed in gastric mucosa subjected to RES. The results of the present study suggest that an excessive production of endothelin-1 in the arteriolar endothelium leads to microvascular derangements accompanied by haemorrhagic alterations of the gastric mucosa.     

Blood flow distribution in the stomach of cats with gastric ulcer.

Ulcer was induced in the anterior wall of the antrum by a subserous injection of 0.3 ml of a 20% acetic acid solution. Carbonized microspheres 15 plus or minus 5 mu in diameter and labelled with 169Yb were used to measure blood flow in different regions and layers of the stomach. Approximately 2-3 million microspheres were injected into the left ventricle of the heart. Simultaneously a blood sample was drawn from the distal aorta at a flow of 1 ml/min. Standardized tissue samples were punched from the lesser curvature and the anterior and posterior walls of the antrum, corpus, and fundus. In each sample the mucosa was separated from the muscularis. The radioactivity of the blood and tissue samples was determined, and the blood flow was calculated for each tissue sample. Three groups of animals were examined: 1) anaesthetized control animals, 2) animals laparotomized one week before examination, 3) animals with a one-week ulcer. In the control animals the blood flow was found to be the same in corresponding regions of the anterior and posterior walls of the stomach. The flow was slightly lower in the antrum than the fundus. The flow was similar in the different regions of the muscularis. The muscularis flow was markedly lower than the mucosa flow. In the laparotomized animals the blood flow was found to be increased in the muscularis of the corpus. In the ulcer animals the mucosa flow was increased in the anterior wall of the antrum, and the muscularis flow was increased in the antrum and the anterior wall of the corpus.     

A Case of Gastric Lipoma Removed by Endoscopic Polypectomy

Abstract: A rare case of gastric lipoma removed by endoscopic polypectomy is presented herein. A 64-year-old female was found to have a polypoid lesion in the stomach on periodic X-ray examination. Endoscopy revealed a submucosal tumor located on the posterior wall of the antrum. Endoscopic ultrasonography demonstrated a homogeneous, hyperechoic mass continuous with the submucosal layer, suggesting a lipoma. Because the likelihood of the tumor ultimately causing obstruction or prolapse into the duodenum was high, endoscopic polypectomy was performed. There were no complications. The histological examination revealed a mass of mature adipose tissue underneath the normal mucosa, which was consistent with the diagnosis made prior to polypectomy. The preferred treatment for gastric lipomas to date has been surgical excision, because the diagnosis is difficult to make prior to treatment. In the literature, only 17 cases undergoing endoscopic treatment for gastric lipomas have been reported. Endoscopic ultrasonography and computed tomography apparently facilitate preoperative diagnosis of lipomas.     

Foregut duplication cysts of the stomach with respiratory epithelium

Gastrointestinal duplication is a congenital rare disease entity. Gastric duplication cysts seem to appear even more rarely. Herein, two duplications cysts of the stomach in a 46 year-old female patient are presented. Abdominal computed tomography demonstrated a cystic lesion attached to the posterior aspect of the gastric fundus, while upper gastrointestinal endoscopy was negative. An exploratory laparotomy revealed a non-communicating cyst and a smaller similar cyst embedded in the gastrosplenic ligament. Excision of both cysts along with the spleen was performed and pathology reported two smooth muscle coated cysts with a pseudostratified ciliated epithelial lining (respiratory type).     

Endoscopic Management of Gastric Phytobezoars — Report of a Case

Abstract: We report a case of two large stomach phytobezoars whose removal from the stomach was achieved by means of endoscopic fragmentation. The patient was a 42-year-old who had a history of vagotomy with pyloroplasty and practiced excessive consumption of fruits and vegetables; a follow-up endoscopy revealed two large phytobezoars attached to the mucosa of the fundus and corpus. In two sessions, the phytobezoars were fragmented with large-diameter polypectomes and a third endoscopy revealed no sign of the remaining parts, which had obviously passed through the pylorus and had been excreted with the feces. The successful endoscopic management of the phytobezoars in this case suggest that this procedure may be the treatment of choice in such cases, especially since surgery and its potential complications are avoided. (Dig Endosc 1999; 11: 165–168)     

慢性胃炎肝胃不和证本质的探讨(附150例报告)

为探讨慢性胃炎肝胃不和证的本质，以食道胃内压、胃肠激素、血环核苷酸、幽门螺杆菌、胃粘膜血流量及温度等项目为观察指标，结果发现肝胃不和组食管下括约肌静息压、屏障压、胃体压、胃窦压均明显低于正常对照组；幽门括约肌压力则明显低于正常对照组及脾胃虚弱组。血清胃泌素水平高于正常对照组，血浆胃动素浓度高于正常对照组和脾胃虚弱组，血浆胰高糖素水平高于正常对照组、低于脾胃虚弱组。血浆cAMP明显增高，cAMP／cGMP比值较正常及脾胃虚弱组增高。HP感染阳性率及胃粘膜活动性炎症检出率明显高于脾胃虚弱组。胃内各部位粘膜血流量及表面温度较正常对照组轻度减少，但无显著性差异。表明慢性胃炎肝胃不和证存在着胃、食道运动功能障碍、胃肠激素分泌异常及植物神经功能紊乱。     

Solitary pedunculated polypoid gastric gland heterotopia

A solitary pedunculated gastric polyp in the gastric fundus was removed from an asymptomatic 36-year-old woman with normal gastric acid secretion and a normal serum gastrin level. This lesion exhibited distinctive histological features including prominent proliferation of pseudopyloric glands, fundic glands, foveolar epithelium and a fibromuscular stroma. Moreover, its surface was entirely covered by a layer of normal gastric epithelium. Biopsies of the background mucosa taken from the gastric fundus revealed only mild superficial gastritis. A gastric gland heterotopia was diagnosed because of its unique morphology.     

胃镜下慢性胃炎与中医辨证分型的相关性研究

[目的]研究胃镜下慢性胃炎(CG)与中医辨证分型的相关性。[方法]对476例门诊CG患者进行常规胃镜检查,辨证分型记录,均行幽门螺杆菌(Hp)检测及胃黏膜活检作出病理诊断。[结果]CG患者性别与辨证分型无关;患者年龄与辨证分型相关(P<0.05),年长者多见脾胃虚弱型;患者Hp感染与辨证分型无关;患者中慢性浅表性胃炎(CSG)、慢性萎缩性胃炎(CAG)、肠上皮化生(IM)、不典型增生(ATP)与辨证分型有关(P<0.05),坐标图显示CAG、ATP表现脾胃虚弱型,胃络瘀血型在坐标右上象限,IM表现胃阴不足型在坐标左上象限,CSG表现脾胃湿热型、肝胃不和型均在坐标左下象限。[结论]CG的微观变化与中医辨证结合使其诊断更臻完善,拓展了中西医结合诊治CG的新思路。