A Case of Lymphangioma Coexistent with Tubular Adenoma in the Descending Colon and a Review of the Literature

Abstract: We recently encountered a case of lymphangioma of the colon which coexisted with a tubular adenoma. The patient was a 71-year-old male who was admitted for physical therapy for lumbago caused by osteoarthritis. He had no evident abdominal symptoms and no weight loss. Although mild anemia and hypoproteinenia were observed, his stool occult blood test was negative and tumor markers revealed no significant changes. A barium enema revealed two elevated lesions in the descending colon. The proximal lesion appeared to be semipedunculated and its form changed following postural changes. The distal lesion was pedunculated. When the patient changed his posture, the head and stalk of the lesion were identified, Both lesions were removed by endoscopic polypectomy. The proximal lesion was histologically diagnosed as being a cavernous lymphangioma, while the distal one was found to be a tubular adenoma. Lymphangioma of the colon is considered to be rare. In Japan, 102 cases including the present case have been reported to date. The coexistence of this disease with neoplasmic lesions of the colon has been reported in 20 cases, including 7 cancer cases and 16 adenoma cases; some cases had overlapping coexistence. The frequency of coexistence of a lymphangioma with cancer or adenoma seems to be rather high. The relationship between lymphangioma and these lesions is unknown. The coexistence of neoplasmic lesions may be accidental. The patients with this coexistence had no characteristic features, except for a high incidence of gastrointestinal bleeding. At least 43% of the coexisting cancers were found in the cecum, the vermiform appendix and the hepatic flexure, indicating the necessity of a detailed examination of the entire colon in cases where a lymphangioma is detected.     

The mechanisms of hepatic sinusoidal endothelial cell regeneration: A possible communication system associated with vascular endothelial growth factor in liver cells

Vascular endothelial growth factor (VEGF) has been shown to induce proliferation of sinusoidal endothelial cells in primary culture. To elucidate the mechanisms of sinusoidal endothelial cell regeneration in vivo, mRNA expression of VEGF and its receptors, flt-1 and KDR/flk-1, were studied in rat livers. Northern blot analysis revealed that VEGF-mRNA was expressed in hepatocytes immediately after isolation from normal rats. In contrast, non-parenchymal cells, including sinusoidal endothelial cells, expressed VEGF receptor-mRNA. Vascular endothelial growth factor-mRNA expression in hepatocytes was decreased during primary culture, but increased following a peak of DNA synthesis, induced by addition of epidermal growth factor or hepatocyte growth factor to the culture medium at 24 h of plating. In a 70% resected rat liver, VEGF-mRNA expression increased with a peak at 72 h after the operation, and mRNA expression of VEGF receptors between 72 and 168 h. In such a liver, mitosis was maximal in hepatocytes at 36 h and in sinusoidal endothelial cells at 96 h. Also, mRNA expression of both VEGF and its receptors was significantly increased in carbon tetrachloride-intoxicated rat liver compared with normal rat liver. Vascular endothelial growth factor expression was minimal in Kupffer cells isolated from normal rats, but marked in activated Kupffer cells and hepatic macrophages from the intoxicated rats. Vascular endothelial growth factor-mRNA expression was also increased in activated stellate cells from these rats and in the cells activated during primary culture compared with quiescent cells. We conclude that increased levels of VEGF expression in regenerating hepatocytes may contribute to the proliferation of sinusoidal endothelial cells in partially resected rat liver, probably through VEGF receptors up-regulated on the cells. Also, VEGF derived from activated Kupffer cells, hepatic macrophages and stellate cells may be involved in this proliferation in injured rat liver.     

A Comparative Study Between Laparoscopic Findings and Histological Stages in Primary Biliary Cirrhosis

Abstract: Histopathologically, early lesions of primary biliary cirrhosis (PBC) are focal within the liver and there is segmental involvement of the bile ducts. In addition, the development of PBC is variable within the liver. PBC is characterized by the following laparoscopic findings: reddish patch, mesh-like white marking and gentle undulation, etc. In the present study, we analyzed the correlation between the laparoscopic findings and the histological stage as per Scheuer's classification in 22 patients with PBC. The results of this study are summarized as follows: 1) Reddish patch was frequently observed in the early stage of PBC. 2) Mesh-like white marking was observed in cases of stage I, II and III. 3) Gentle undulation was seen in stage II and III. The absence of this finding is useful in the diagnosis of stage I. 4) In stage IV, these three findings were not observed. 5) From these three findings, it was difficult to differentiate stage II or III. But the presence of portal hypertension and increased vascularity of the liver capsule were observed in accordance with the progression of the disease. Indications of portal hypertension were seen even in the early stage and in some asymptomatic cases of PBC. In conclusion, the laparoscopic findings such as reddish patch, mesh-like white marking, gentle undulaion and portal hypertension are very valuable for stage diagnosis and the evaluation of prognosis in patients with PBC.     

Screening for growth hormone deficiency using urinary growth hormone measurement

The diagnostic approach in growth hormone deficiency (GHD) is complicated. Two or more provocative tests are essential for definitive diagnosis of GHD. However, such testing cannot be carried out routinely on all subjects with short stature because of the need for hospitalization and blood sampling. A simple screening method for GHD would be of great value. Human growth hormone (hGH) levels were measured in the early morning urine of 192 children aged 7–15 years with height 2.0 s.d. below the mean for their ages. Sixty-eight subjects were selected because they showed a urinary hGH level < 10 ng/g creatinine. They were further examined in terms of bone age and plasma insulin-like growth factor (IGF-I) levels. In 30 subjects, the ratio of bone age: chronological age was < 0.8 and/or plasma IGF-I level was < 0.7 U/mL. Finally 24 of these subjects were examined with provocative tests and other endocrinological tests. Eleven subjects proved to have poor growth hormone secretion and one subject was diagnosed as having Turner syndrome. In conclusion, 11 patients with GHD were diagnosed from 192 children with short stature using urinary hGH measurement as the first screening method. These findings suggests that urinary hGH measurement could be a useful and simple method for detecting GHD.     

Successful treatment of retinoic acid syndrome with high-dose dexamethasone pulse therapy in a child with acute promyelocytic leukemia treated with ATRA

A 5 year old female developed femoral pain, fever, and hemorrhagic tendency. She was diagnosed as having acute promyelocytic leukemia (APL). Approximately 2 weeks after the administration of all-trans retinoic acid (ATRA), she developed a high fever, edema, and respiratory distress which met the criteria for retinoic acid syndrome. At first, we tried to treat the patient with oral corticosteroid, however, this approach was unsuccessful. Considering the worsening of her condition, we then chose to administer a large dose of intravenous dexamethasone therapy for 3 days. Immediately after this therapy, she became afebrile, respiratory distress and edema disappeared, and there was a general improvement of the symptoms. All-trans retinoic acid at the reduced dose of 25 mg/m², was continued for an additional 6 weeks and then discontinued. Since the cessation of dexamethasone and ATRA, there has been no relapse of APL in this patient. Although based on only one case, we recommend the intravenous high-dose dexamethasone pulse therapy (13 mg/m² per day, for 3 days) for treating retinoic acid syndrome which develops in pediatric APL patients treated with ATRA.     

Serum vitamin A concentrations in asthmatic children in Japan

BACKGROUND: Vitamin A is an essential micronutrient with important roles in immunity and maintenance of normal epithelial cell differentiation. Little information is available regarding the relationship between vitamin A concentrations and asthma despite the repair of epithelial and other structural changes being of utmost importance for the relief of symptoms and control of the disease. The authors evaluated vitamin A and vitamin E concentrations in well-nourished children with asthma. METHODS: The serum vitamin A and vitamin E concentrations were measured by high performance liquid chromatography methods. Statistical analysis was performed using the Mann-Whitney U-test and Peason's correlation coefficient test. RESULTS: According to these methods, the mean serum vitamin A concentrations were significantly lower (19.41+/-7.45 microg/dL, mean+/-SD) in asthmatic children than controls (29.52+/-11.34 microg/dL, P=0.0001). To compare the correlation of C-reactive protein and serum vitamin A concentrations, there was also significant difference between the two groups. CONCLUSION: The data suggest that there is a correlation between vitamin A deficiency and the mechanism of asthmatic response. These data support that the mechanism of hypovitaminosis A in asthmatic children may involve not only the acute phase response but also the various degrees of chronic epitherial damage of airways.     

Magnetic Resonance Imaging is Superior to Cardiac Scintigraphy to Identify Nonresponders to Cardiac Resynchronization Therapy

Background: Left ventricular (LV) postero-lateral scar and total scar burden are factors responsible for a poor response to cardiac resynchronization therapy (CRT). Contrast-enhanced magnetic resonance imaging (CMR) and ^99mTc-2-methoxy isobutyl isonitrile single photon emission computed tomography (SPECT) perfusion imaging are widely used to detect myocardial scar tissue; however, their ability to detect regional scars and predict a positive response to CRT has not been fully evaluated.
Methods: CMR and SPECT were performed in 17 patients with dilated cardiomyopathy (DCM) and seven patients with ischemic cardiomyopathy (ICM) before CRT. All images were scored, using a 17-segment model. To analyze the LV scar regions by CMR, we assessed the transmural delayed enhancement extent as the transmural score in each segment (0 = no scar, 4 = transmural scar). Similarly, a perfusion defect score was assigned to each segment by SPECT (0 = normal uptake, 4 = defect).
Results: By both SPECT and CMR imaging, the total scar score was significantly higher in the ICM than in the DCM group. An LV postero-lateral wall scar region was detected using both imaging modes. By SPECT imaging, the percentage of regional scar score in the LV inferior wall was significantly higher in the DCM than in the ICM group.
Conclusions: By SPECT imaging in the DCM group, severe perfusion defects, due to attenuation artifacts, were frequently observed in the LV inferior wall, resulting in the overestimation of scar tissue. CMR identified nonresponders to CRT more reliably than SPECT in patients with DCM.     

Maximum tumor diameter is a simple and valuable index associated with the local extent of disease in clinically localized prostate cancer

BACKGROUND: The present study was undertaken to investigate the association of pathological features, including the total tumor volume (TTV), maximum tumor area (MTA), and maximum tumor diameter (MTD), with the local extent of disease in clinically localized prostate cancer. METHODS: Serial whole sections of the prostate from 164 patients who underwent radical prostatectomy for localized prostate cancer were investigated. The correlations between the indicators of tumor size, including the TTV, MTA, and MTD, and other pathological parameters were evaluated. RESULTS: The MTD, MTA, and TTV were significantly correlated with each other. Multivariate stepwise logistic regression analysis indicated that the Gleason score, perineural invasion, microvascular invasion, and MTD were significant independent parameters associated with extraprostatic disease. CONCLUSION: The histological tumor grade, perineural invasion, microvascular invasion, and tumor size were correlated with the local extent of disease. The MTD, a simple, easy, and inexpensive parameter, is a more significant pathological feature associated with the local extent of disease than the MTA or TTV.