Publications by authors named "Tomohiro Sase"

33 Publications

Ischemic hepatitis with infectious endocarditis: A case report.

Biomed Rep 2021 Nov 22;15(5):97. Epub 2021 Sep 22.

Department of Gastroenterology, Suzuka General Hospital, Suzuka, Mie 513-8630, Japan.

A 58-year-old woman was admitted to Suzuka General Hospital with fever. She was diagnosed with infectious endocarditis based on the presence of anterior mitral leaflet vegetation on the echocardiography analysis and isolation of by blood culture. During treatment, the hepatic enzymes levels, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH) and alkaline phosphatase (ALP) were increased without any abdominal symptoms. Prolonged prothrombin time (PT) and prothrombin time international normalized ratio were observed, and acute hepatic failure was diagnosed. However, the hepatic injury resolved spontaneously with restoration of the PT value after the hepatic enzymes (AST, ALT, LDH and ALP) peaked. Diffusion-weighted imaging of hepatic magnetic resonance imaging showed diffuse high intensity of the entire liver except for part of the left lobe. The hepatic injury was diagnosed as ischemic hepatitis caused by embolization from the vegetation associated with infectious endocarditis. The recovery from hepatic ischemia was thought to be due to hepatic blood supply from extrahepatic collateral blood. After antibiotic treatment, the patient underwent resection of the vegetation on the anterior mitral valve leaflet. Hepatic artery occlusion is rare, but it may cause severe hepatic complications. During follow-up of infectious endocarditis, clinicians should be aware of the potential for whole organ ischemic damage caused by vessel occlusion, as well as hepatic ischemic damage.
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http://dx.doi.org/10.3892/br.2021.1473DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8493543PMC
November 2021

Early stage clear cell adenocarcinoma coexisting with tubular adenoma and adenoma with clear cell change in the colon.

Clin J Gastroenterol 2021 Apr 8;14(2):589-593. Epub 2021 Jan 8.

Department of Clinical Laboratory Medicine, Shiga University of Medical Science, 520-2192, Seta Tsukinowa, Otsu, Shiga, Japan.

Primary clear cell adenocarcinoma (CCA) of the colorectum is rare. We report a case of a 57-year-old man with early-stage CCA with conventional tubular adenoma and tubular adenoma with clear cell change in the transverse colon, diagnosed with image-enhanced endoscopy. The tumor was then treated with endoscopic submucosal dissection. The endoscopic findings characteristic of clear cell adenoma/adenocarcinoma could not be identified. Therefore, similar diagnostic tools as for conventional colorectal adenoma/cancer were considered. The pathogenesis of the clear cell change was unknown, but it might appear with the progression of the malignancy.
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http://dx.doi.org/10.1007/s12328-020-01334-xDOI Listing
April 2021

The spontaneous clearance of hepatitis E virus (HEV) and emergence of HEV antibodies in a transfusion-transmitted chronic hepatitis E case after completion of chemotherapy for acute myeloid leukemia.

Clin J Gastroenterol 2020 Apr 24;13(2):252-259. Epub 2019 Jul 24.

Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.

A 64-year-old woman was infected with hepatitis E virus (HEV) during chemotherapy for leukemia. By retrospective analyses of stored serum from the blood products and the patient, the source of the infection was determined to be platelet concentration (PC) transfused during chemotherapy. The partial nucleotide sequence of the HEV strain isolated from the donated PC and that from the patient's sera was identical and was subgenotype 3b. Clinical indicators such as alanine aminotransferase, HEV RNA titer, and anti-HEV antibodies in the serum were investigated from the beginning of the infection until 1 year after the termination of HEV infection. HEV RNA had propagated over 6 months and then cleared spontaneously after the completion of chemotherapy. Anti-HEV antibodies appeared in the serum just before the clearance of HEV RNA. Interestingly, HEV RNA was detected in the patient's urine, spinal fluid, and saliva. The HEV RNA titers in those samples were much lower than in the serum and feces. No renal, neurological, or salivary gland disorders appeared during the follow-up. We observed virological and biochemical progress and cure of transfusion-transmitted chronic hepatitis E in the patient despite an immunosuppressive status during and after chemotherapy against hematological malignancy.
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http://dx.doi.org/10.1007/s12328-019-01024-3DOI Listing
April 2020

Hepatic Injury without Granulomatous Formation Associated with Intravesical Bacillus Calmette-Guérin Therapy.

Intern Med 2019 May 10;58(10):1429-1432. Epub 2019 Jan 10.

Department of Pathology, Suzuka General Hospital, Japan.

A 74-year-old man developed hepatic injury after intravesical Bacillus Calmette-Guérin (BCG) therapy for bladder carcinoma. Although hepatitis-associated disseminated BCG was suspected, granulomatous formations were undetectable. The hepatic injury was considered to have resulted from an allergic reaction to BCG therapy because a histopathological assessment revealed enlarged portal areas with eosinophils and neutrophils. The hepatic injury was resolved by prednisolone. This case suggested that hepatic injury associated with BCG therapy might be due to an allergic mechanism unrelated to disseminated BCG disease. A liver biopsy is needed to confirm the histopathological findings of hepatic injury after BCG therapy in order to differentiate allergic hepatic injury from infectious hepatic injury.
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http://dx.doi.org/10.2169/internalmedicine.2073-18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6548914PMC
May 2019

Early stage clear cell adenocarcinoma of the colon examined in detail with image-enhanced endoscopy: a case report.

Clin J Gastroenterol 2018 Dec 30;11(6):465-469. Epub 2018 Jul 30.

Department of Pathology, Niigata Cancer Center Hospital, 2-15-3, Kawagishicho, Chuo-ku, Niigata-Shi, Niigata, Japan.

Primary clear cell adenocarcinoma (CCA) of the colorectum is a rare tumor. We report on a 48-year-old man with early stage CCA in the descending colon who underwent detailed examination with image-enhanced endoscopy, such as magnifying endoscopy with narrow-band imaging and crystal violet staining. The tumor was treated successfully with endoscopic mucosal resection at our hospital.
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http://dx.doi.org/10.1007/s12328-018-0889-6DOI Listing
December 2018

Gastric adenocarcinoma coexisting with a reddish semipedunculated polyp arising from Helicobacter pylori-negative normal gastric mucosa: a report of two cases.

Clin J Gastroenterol 2018 Dec 18;11(6):481-486. Epub 2018 Jul 18.

Happy GI Clinic, 2-9-33 Honmachi, Kameyama, Mie, Japan.

We experienced two cases of adenocarcinoma coexisting with a hyperplastic polyp arising from Helicobacter pylori-negative normal gastric mucosa. The first case was of a 59-year-old man. Esophagogastroduodenoscopy revealed a protruding lesion measuring 4 mm in diameter on the greater curvature of the middle gastric body. The second case was of a 47-year-old man. Esophagogastroduodenoscopy showed a protruding lesion measuring 5 mm located at the greater curvature of the upper gastric body. The absence of atrophic changes in the entire gastric mucosa was confirmed endoscopically in both cases. Multiple H. pylori tests were all negative. Endoscopically, these protruding lesions appeared as reddish, semipedunculated polyps. Hyperplastic polyps were suspected based on white light endoscopic findings. Magnified endoscopy with narrow band imaging could not predict the coexistence of cancer. However, histopathological examination of the resected specimen revealed focal cancer at the surface of the gastric hyperplastic polyps. Considering the possibility that cancer may be coexisting in polyps, when reddish polyps are detected in H. pylori-negative normal gastric mucosa, it is important to perform a biopsy, or a careful follow-up endoscopy.
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http://dx.doi.org/10.1007/s12328-018-0887-8DOI Listing
December 2018

Usefulness of Endoscopic Transpapillary Tissue Sampling for Malignant Biliary Strictures and Predictive Factors of Diagnostic Accuracy.

Clin Endosc 2018 Mar 31;51(2):174-180. Epub 2017 Aug 31.

Department of Surgery, Suzuka General Hospital, Suzuka, Japan.

Background/aims: It is sometimes difficult to distinguish between malignant and benign biliary strictures using imaging studies alone, and pathological diagnosis is necessary. The aim of this study was to determine the usefulness of endoscopic transpapillary tissue sampling and factors predictive of diagnostic accuracy.

Methods: From April 2008 to December 2014, 136 patients underwent endoscopic transpapillary tissue sampling for malignant biliary strictures. The cytological and histological findings were reported as negative, suspicious, or positive. Suspicious and positive findings were defined as pathologically positive.

Results: The sensitivity was 65.0% for forceps biopsy, 49.5% for brush cytology, 46.2% for bile aspiration cytology, and 21.9% for endoscopic nasobiliary drainage cytology. The combination of these procedures improved the sensitivity (72.8%). Endoscopic transpapillary tissue sampling was more sensitive for lesions of biliary origin (91.4%) than for extrabiliary lesions (66.3%). In surgical cases, the sensitivity for tumors with an infiltrative growth pattern (53.3%) was significantly lower than for a tumor with an expanding or intermediate growth pattern (87.5%).

Conclusions: Combining procedures can improve diagnostic accuracy. It may be possible to predict the sensitivity of endoscopic transpapillary tissue sampling by evaluating the etiology and tumor growth pattern using preoperative imaging studies.
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http://dx.doi.org/10.5946/ce.2017.082DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5903074PMC
March 2018

A case of diminished pericardial effusion after treatment of a giant hepatic cyst.

Clin J Gastroenterol 2017 Aug 18;10(4):377-382. Epub 2017 May 18.

Department of Cardiology, Suzuka General Hospital, 1275-53 Yasuduka-cho, Suzuka, Mie, 513-8630, Japan.

A 75-year-old woman was discovered to have a pericardial effusion when she was admitted to our hospital because of a giant hepatic cyst. We could not detect the cause of the effusion and diagnosed idiopathic pericardial effusion. The patient underwent transcutaneous drainage of the hepatic cyst and an injection of antibiotics. There was no communication between the pericardial effusion and the hepatic cyst. Although the hepatic cyst was reduced in size, the pericardial effusion showed no remarkable change immediately after treatment; however, 5 months later, the pericardial effusion was found to be diminished. The pericardial effusion might have been caused by the physical pressure of the giant hepatic cyst and disturbance in the balance between the production and reabsorption of the pericardial fluid. When we experience a huge hepatic cyst, we should take into account its influence against the surrounding organs, including the intrapleural space.
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http://dx.doi.org/10.1007/s12328-017-0748-xDOI Listing
August 2017

Hemostasis by esophageal stent placement for management of esophageal tumor bleeding:a case report.

Nihon Shokakibyo Gakkai Zasshi 2016 ;113(12):2029-2034

Department of Gastroenterology, Suzuka General Hospital.

A 67-year-old male was diagnosed with advanced esophageal cancer. A computed tomography scan showed multiple intra-abdominal lymphadenopathies. Because the tumor was thought to be unresectable, we initiated chemotherapy. Twelve months later, the patient was admitted to our hospital because of hematemesis. Gastroduodenoscopy revealed oozing bleeding from the esophageal tumor. Hemostasis was not achieved with conservative treatment, and frequent blood transfusions were required. Endoscopic hemostasis was difficult to achieve because of the malignant esophageal stenosis. To treat the malignant esophageal stricture and esophageal tumor bleeding, we attempted to insert an esophageal covered self-expandable metallic stent. After the procedure, hemostasis was achieved by mechanical tamponade. Here we report a rare case of esophageal tumor bleeding that was managed with mechanical tamponade using an esophageal covered self-expandable metallic stent.
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http://dx.doi.org/10.11405/nisshoshi.113.2029DOI Listing
May 2017

An impacted minor papilla stone in a patient with pancreas divisum that caused acute exacerbation of chronic pancreatitis: a case report.

Nihon Shokakibyo Gakkai Zasshi 2016 ;113(11):1916-1922

Department of Gastroenterology, Suzuka General Hospital.

A 75-year-old woman with epigastric pain was admitted to our emergency department. She was diagnosed with an acute exacerbation of chronic pancreatitis based on the results of blood tests and abdominal computed tomography (CT). The abdominal CT and magnetic resonance cholangiopancreatography revealed pancreas divisum. Abdominal CT also showed a stone in the minor papilla, with impaction of the stone being the most likely cause of the acute episode. Therefore, endoscopic sphincterotomy of the minor papilla and endoscopic naso-pancreatic duct drainage were performed to remove the stone and decrease the internal pressure of the pancreatic duct. These procedures improved the patient's clinical status. The naso-pancreatic drainage tube was removed, and her pancreatitis has not recurred. Herein, we report a rare case of an impacted minor papilla stone in a patient with pancreas divisum that caused an acute exacerbation of chronic pancreatitis.
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http://dx.doi.org/10.11405/nisshoshi.113.1916DOI Listing
March 2017

A case of gastric crystal-storing histiocytosis.

Nihon Shokakibyo Gakkai Zasshi 2016 ;113(6):968-74

Department of Gastroenterology, JA Suzuka General Hospital.

A 54-year-old male patient underwent upper gastrointestinal endoscopy, which revealed a 25-mm brown region in the angular section of the greater curvature of the stomach. The region was histologically determined to be gastric mucosa with an accumulation of histiocytes containing eosinophilic substances in the cytoplasm and chronic inflammatory cell infiltration. Histiocytes were immunohistologically positive for CD68, IgG, and κ. Based on these findings, the patient was diagnosed with gastric crystal-storing histiocytosis comprised of histiocytes phagocytosing IgG-κ-type immunoglobulin. This is a rare disease of which there have been no previous reports that included long-term follow-up. Here, we report the case with a literature review.
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http://dx.doi.org/10.11405/nisshoshi.113.968DOI Listing
February 2017

[Acute obstructive suppurative pancreatic ductitis after endoscopic retrograde cholangiopancreatography in a patient with carcinoma of the pancreatic head:a case report].

Nihon Shokakibyo Gakkai Zasshi 2016 ;113(2):289-95

Department of Gastroenterology, Suzuka General Hospital.

An 85-year-old woman with jaundice was referred to our hospital where she was diagnosed with obstructive jaundice due to carcinoma of the pancreatic head based on blood tests and abdominal computed tomography (CT). We performed endoscopic retrograde cholangiopancreatography (ERCP) for biliary drainage, but 5 days after the procedure, she complained of epigastric pain. Laboratory data revealed an elevated white blood cell count and a high serum amylase concentration. Follow-up CT 6 days after the ERCP revealed that the main pancreatic duct diameter had increased since the time of admission. Therefore, ERCP was performed for pancreatic ductal drainage. Purulent pancreatic juice was drained by endoscopic placement of a nasopancreatic drainage tube in the main pancreatic duct, resulting in marked alleviation of clinical symptoms;however, after removal of the tube, the abdominal pain recurred. Subsequent endoscopic placement of a pancreatic stent improved her clinical status once again. Herein, we report this rare case of acute obstructive suppurative pancreatic ductitis in a patient with carcinoma of the pancreatic head.
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http://dx.doi.org/10.11405/nisshoshi.113.289DOI Listing
February 2017

A case of a resectable single hepatic epithelioid hemangioendothelioma with characteristic imaging by ADC map.

Clin J Gastroenterol 2015 Dec 7;8(6):406-13. Epub 2015 Oct 7.

Department of Surgery, Suzuka General Hospital, 1275-53 Yasuduka-cho, Suzuka, Mie, 513-8630, Japan.

A 47-year-old woman with a single-nodule hepatic tumor was referred to our hospital. She had no symptoms. The tumor was located at the surface of the right lobe of the liver; it showed peripheral low signal intensity on a magnetic resonance imaging apparent diffusion coefficient (ADC) map, and an influx of blood flow into the peripheral area of the tumor at the early vascular phase on perflubutane microbubble (Sonazoid(®)) contrast-enhanced (CE) ultrasonography. Since we suspected a malignant tumor, the patient underwent surgical resection. The hepatic tumor was resected curatively. Pathological examination revealed that the tumor was composed of epithelioid cells with an epithelioid structure and/or cord-like structure. Immunohistochemical staining was positive for cluster of differentiation 34 and factor VIII-related antigen. Based on the above, a final diagnosis of hepatic epithelioid hemangioendothelioma (EHE) was made. Hepatic EHE is a rare hepatic tumor: only a few cases of hepatic EHE with curative resection have been reported. We were unable to reach a diagnosis of hepatic EHE by imaging studies; however, an ADC map was useful in showing the malignant potential of the tumor, and CE ultrasonography was useful in revealing the peripheral blood flow of the tumor. When an unusual hepatic mass is encountered, hepatic EHE should be kept in mind, and the mass should be inspected with more than one imaging modality, including an ADC map, in the process of differential diagnosis.
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http://dx.doi.org/10.1007/s12328-015-0604-9DOI Listing
December 2015

[Rupture of a gastroduodenal artery aneurysm caused by duodenal ulcer: a case report].

Nihon Shokakibyo Gakkai Zasshi 2015 Oct;112(10):1830-5

Department of Gastroenterology, Suzuka General Hospital.

A 73-year-old man with a history of tarry stools was admitted to our hospital. Gastroduodenoscopy on admission revealed an ulcer with an exposed vessel at the duodenal bulb. During endoscopic clipping for prevention of re-bleeding, a large amount of bleeding from the vessel was observed. Hemostasis was achieved after the procedure. However, 7 days later, the patient passed a large amount of tarry stools and experienced hypovolemic shock. Endoscopic re-examination revealed a pulsatile aneurysmal vessel at the base of the duodenal ulcer. Abdominal contrast-enhanced computed tomography and abdominal angiography demonstrated an aneurysm of the gastroduodenal artery, which was successfully treated with transcatheter arterial embolization. Thus, here we report a rare case of an aneurysm of the gastroduodenal artery caused by a duodenal ulcer.
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http://dx.doi.org/10.11405/nisshoshi.112.1830DOI Listing
October 2015

Neuroendocrine tumor G3: a pancreatic well-differentiated neuroendocrine tumor with a high proliferative rate.

Clin J Gastroenterol 2015 Dec 6;8(6):414-20. Epub 2015 Oct 6.

Department of Surgery, Suzuka General Hospital, 1275-53, Yamanohana, Yasuzuka, Suzuka-shi, Mie, Japan.

A 68-year-old man was referred to our hospital because of left upper quadrant pain. Contrast enhanced computed tomography showed a low density mass with delayed contrast effects as well as para-aortic node swelling with homogenous contrast effects. Histological examination of specimens obtained by endoscopic ultrasound fine needle aspiration revealed a pancreatic neuroendocrine tumor (NET) G2, according to the World Health Organization 2010 classification, and lymph node metastasis. Distal pancreatectomy and lymph node dissection were performed. On histological examination, the tumor showed well-differentiated morphology with an organoid pattern. The Ki67 labeling index was 21.6 %, and the mitotic count was 25/10 high power fields. As mentioned above, we made a final diagnosis of the lesion as "NET G3," because the tumor presented with well-differentiated morphology. Chemotherapy with Everolimus was administered. Liver metastasis occurred 11 months after the first operation, and a partial hepatectomy was performed. Histological findings were similar to those of the first operation. Herein we present a case of pancreatic well-differentiated neuroendocrine tumor with a high proliferative rate referred to as "NET G3," and review the relevant literature.
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http://dx.doi.org/10.1007/s12328-015-0609-4DOI Listing
December 2015

[Gastric intramucosal cancer spreading to submucosal heterotopic gastric glands].

Nihon Shokakibyo Gakkai Zasshi 2015 ;112(9):1657-63

Department of Gastroenterology, JA Suzuka General Hospital.

A 73-year-old man was referred to our hospital for further examination of an intra-abdominal mass. An upper gastrointestinal endoscopy revealed a 0-IIa+IIc lesion on the lesser curvature of the middle body. The lesion was diagnosed as early gastric cancer (tub1, SM), and a partial gastrectomy was performed. Pathological evaluation revealed a well-differentiated intramucosal adenocarcinoma that had partially spread to the submucosa. On immunohistochemical examination, the lesion displayed an intestinal phenotype. The submucosal lesion had poor stromal reaction, and there was smooth muscle tissue surrounding the lesion. As mentioned earlier, we diagnosed the lesion as a gastric intramucosal cancer spreading to the submucosal heterotopic gastric glands.
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http://dx.doi.org/10.11405/nisshoshi.112.1657DOI Listing
February 2017

[A case of polyp-type ampullary carcinoma-in-adenoma within the ampullary channel, displaying an intraductal growth pattern].

Nihon Shokakibyo Gakkai Zasshi 2015 Aug;112(8):1517-24

Department of Gastroenterology, Suzuka General Hospital.

A 70-year-old woman with jaundice was referred to our hospital. Obstructive jaundice caused by common bile duct (CBD) stones was diagnosed based on the results of blood tests, abdominal computed tomography, and endoscopic retrograde cholangiopancreatography. We attempted to remove the CBD stones endoscopically. After endoscopic sphincterotomy, a polypoid lesion was exposed at the ampulla of Vater. Histological examination of a biopsy specimen from the ampullary lesion revealed a tubular adenoma, and the patient underwent pylorus-preserving pancreatoduodenectomy. Pathological examination of the resected specimen revealed a polyp-type ampullary carcinoma-in-adenoma arising from the ampullary channel. Herein, we report a rare case of polyp-type ampullary carcinoma-in-adenoma displaying an intraductal growth pattern.
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http://dx.doi.org/10.11405/nisshoshi.112.1517DOI Listing
August 2015

So-called carcinosarcoma of the duodenum with a chondrosarcomatous component.

Clin J Gastroenterol 2015 Oct 7;8(5):268-74. Epub 2015 Aug 7.

Department of Surgery, Suzuka General Hospital, 1275-53, Yamanohana, Yasuzuka, Suzuka-shi, Mie, Japan.

Carcinosarcoma is a biphasic malignant tumor consisting of both carcinomatous and sarcomatous components, and its occurrence in the duodenum is very rare. In the present report, we describe a case of so-called carcinosarcoma of the duodenum with a chondrosarcomatous component. A 79-year-old man was referred to our hospital because of anorexia, weight loss, and jaundice. A preoperative imaging examination showed a hypovascular mass located in the pancreatic head. Histological examination of specimens obtained through a forceps biopsy revealed anaplastic carcinoma (spindle cell type), and a pancreatoduodenectomy was performed. Histologically, the tumor showed an elevated lesion with a wide base in proximity to duodenal mucosal carcinoma. The tumor was found to be predominantly composed of sarcoma with carcinomatous and chondrosarcomatous components. There was a transitional zone between the carcinomatous and sarcomatous components, and a portion of the sarcomatous component was positive for cytokeratin, and negative for vimentin. As mentioned above, we diagnosed the lesion as so-called carcinosarcoma with a chondrosarcomatous component.
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http://dx.doi.org/10.1007/s12328-015-0595-6DOI Listing
October 2015

A case of a stomach gastrointestinal stromal tumor with extremely predominant cystic formation.

Clin J Gastroenterol 2015 Aug 26;8(4):197-201. Epub 2015 Jun 26.

Department of Gastroenterology, Suzuka General Hospital, 1275-53, Yasuduka-cho, Suzuka, Mie, 513-8630, Japan,

A 79-year-old male was referred to the hospital with a history of abdominal discomfort. Abdominal computed tomography revealed a cystic tumor with irregular wall thickness, approximately 50 mm in diameter, along the lesser curvature of the gastric body. Magnetic resonance imaging visualized the mass as signal-hyperintense on T2-weighted imaging. Esophagogastroduodenoscopy showed a submucosal tumor with normal mucosa. Surgery was performed and the 60 × 50 × 50 mm mass was resected. The resected tumor comprised cystic and solid regions; the cystic region was filled by light bloody serous fluid. On histological examination, a solid region of the resected tumor showed a spindle-cell appearance. The diagnosis was gastric gastrointestinal stromal tumor (GIST) with predominant cystic formation. GISTs are usually solitary tumors, but in this case the tumor demonstrated extremely predominant cystic formation. Lesions with a hemorrhage or necrosis may form large cystic spaces. GISTs may show extensive cystic changes in response to tyrosine kinase inhibitor treatment; however, this patient had not undergone any such treatment before diagnosis. This represents an interesting case of a gastric GIST with predominant cystic formation occupying most of the tumor volume. Care should be taken to differentiate between GISTs and actual intra-abdominal cystic lesions.
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http://dx.doi.org/10.1007/s12328-015-0577-8DOI Listing
August 2015

Gastric intramucosal adenocarcinoma with an invasive micropapillary carcinoma component.

Clin J Gastroenterol 2015 Feb 29;8(1):14-7. Epub 2014 Nov 29.

Department of Gastroenterology, Suzuka General Hospital, Yamanohana, Yasuzuka, Suzuka-Shi, Mie, 1275-53, Japan,

A 70-year-old woman was referred to our hospital because of early gastric cancer (lesser curvature of the antrum, 0-IIc, tub1, 15 mm) and underwent endoscopic submucosal dissection. Microscopically, the lesion was found to be confined to the mucosa, and predominantly composed of well-differentiated tubular adenocarcinoma with a micropapillary component. On immunohistochemical examination, the characteristic "inside-out pattern" of the micropapillary component was observed; thus, we diagnosed the lesion as gastric cancer with a micropapillary component. Invasive micropapillary carcinoma is a rare subtype of gastric carcinoma, and, to our knowledge, this is the first case of invasive micropapillary carcinoma of the stomach confined to the mucosa.
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http://dx.doi.org/10.1007/s12328-014-0541-zDOI Listing
February 2015

[A case of invasive micropapillary carcinoma of the pancreas concomitant with intraductal papillary mucinous neoplasm].

Nihon Shokakibyo Gakkai Zasshi 2014 Nov;111(11):2149-56

Department of Gastroenterology, JA Suzuka General Hospital.

Invasive micropapillary carcinoma (IMPC), a rare subtype of adenocarcinoma, has a high incidence of lymph node metastasis and is associated with a poor prognosis. A 77-year-old woman was admitted to our hospital for the assessment of intraductal papillary mucinous neoplasm (IPMN). We diagnosed her with pancreatic cancer concomitant with IPMN and performed pancreaticoduodenectomy. The lesion was predominantly composed of ductal adenocarcinoma with a micropapillary component. On immunohistochemical analysis, a characteristic " inside-out pattern" was observed in the micropapillary component. This confirmed the diagnosis of pancreatic cancer with a micropapillary component. In the present report, we describe a very rare case of IMPC of the pancreas.
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November 2014

[A case of calcifying fibrous tumor in the abdominal wall, morphologically resembling a gastric submucosal tumor].

Nihon Shokakibyo Gakkai Zasshi 2014 Mar;111(3):529-34

Department of Gastroenterology, JA Suzuka General Hospital.

We report an extremely rare case of a calcifying fibrous tumor (CFT) occurring in the abdominal wall. A 43-year-old woman was referred to our hospital because of a gastric submucosal tumor. Imaging findings revealed a gastric submucosal tumor with calcification. Endoscopic ultrasound-guided fine-needle aspiration was attempted to obtain a tissue specimen; however, the tumor was not adequately visualized because of calcification. Local excision was performed because of the tumor growth and the risk of progression to gastrointestinal stromal tumor. The tumor was histologically diagnosed as a CFT. We describe the imaging and pathological findings, and discuss the differential diagnosis and histogenesis of CFT.
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March 2014

[A case of heterochrony and ectopic recurrence of a gastric signet ring cell carcinoma following partial gastrectomy].

Nihon Shokakibyo Gakkai Zasshi 2014 Jan;111(1):98-104

Department of Pathology, JA Suzuka General Hospital.

A 53-year-old woman was referred to our hospital with a round, discolored lesion measuring 4mm in diameter that was identified as a minute gastric signet ring cell carcinoma. According to the Japanese classification of gastric carcinoma, it was graded as type 0-IIb. Seven years back, the woman had undergone pylorus-side gastrectomy for a small signet ring cell carcinoma, and the present lesion was assumed to result from heterochrony and ectopic recurrence. Endoscopic submucosal dissection was performed for the minute lesion. Clinicopathological findings revealed gastric mucosal cancer without invading lymph vessels or veins, similar to the previous lesion. We therefore report two very rare lesions in the same case. This case report demonstrates the importance of performing regular follow-up gastroduodenoscopy to detect recurrence in patients with these lesions.
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January 2014

Primary liver tumor associated with Werner syndrome (adult progeria).

Hepatol Res 2011 Dec;41(12):1260-5

Department of Gastroenterology, Suzuka General Hospital, Yasuduka-cho, Suzuka, Mie Department of Clinical Cell Biology and Medicine, Chiba University Graduate School of Medicine, Inohana, Chuo-ku, Chiba, Japan.

A 57-year-old woman was admitted to our hospital with characteristic aging of the face and thin body. Before admission, she had been treated for diabetes mellitus type 2 and had undergone amputation of the right leg due to ischemic disease. Abdominal computed tomography revealed primary liver tumor. Biopsy of the liver mass revealed poorly differentiated adenocarcinoma, not hepatocellular carcinoma. Genetic sequencing indicated a homozygous mutation in the Werner syndrome gene (WRN) and she was diagnosed with Werner syndrome with primary liver tumor. She declined medications for the liver tumor and eventually died 6 months after diagnosis. Werner syndrome is a rare autosomal recessive disorder associated with premature aging, and most cases of Werner syndrome have been reported from Japan. The main causes of death with Werner syndrome are malignancy and atherosclerotic vascular disease. With respect to malignancy, non-epithelial tumors are more common in Werner syndrome patients than in the general population. Some cases also show complications of epithelial tumors, as in the present case. When a liver tumor of unknown etiology is accompanied by characteristic aging of the face, Werner syndrome should be suspected and a comprehensive search for other tumors and complications of metabolic disorders undertaken.
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http://dx.doi.org/10.1111/j.1872-034X.2011.00877.xDOI Listing
December 2011

Bleeding from a gastric hyperplastic polyp during anticoagulation therapy.

Intern Med 2011 15;50(12):1349. Epub 2011 Jun 15.

Department of Gastroenterology, Suzuka General Hospital, Japan.

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http://dx.doi.org/10.2169/internalmedicine.50.5365DOI Listing
October 2011

[A case of pancreatic mucinous carcinoma with special reference to diagnostic usefulness of contrast enhanced ultrasonography].

Nihon Shokakibyo Gakkai Zasshi 2011 Mar;108(3):470-7

Department of Gastroenterology, Suzuka General Hospital, Japan.

A 72-year-old man was admitted to our hospital for further investigation of pancreatic mass. Ultrasonography revealed hypoechoic mass with hyperechoic and aechoic area. Contrast enhanced ultrasonography (CE-US) revealed a vascular image in the lesion. CT showed some enhanced parts of low density mass in the pancreatic body, which was recognized as low-, high- and relatively high-intensity mass on T1-, T2-WI MRI and MRCP, respectively. The final pathological diagnosis showed mucinous carcinoma. CE-US may be useful for diagnosis of mucinous carcinoma.
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March 2011

Frequency of abnormal biphasic aPTT clot waveforms in patients with underlying disorders associated with disseminated intravascular coagulation.

Clin Appl Thromb Hemost 2006 Apr;12(2):185-92

Second Department of Internal Medicine, Mie University School of Medicine, Tsu, Japan.

Abnormal biphasic waveform (BPW) patterns were previously reported when the activated partial thromboplastin time (aPTT) was performed in plasma from patients with disseminated intravascular coagulation (DIC). In this study, the prevalence of the BPW was examined in a cohort of 508 hospitalized patients with elevated fibrinogen degradation products (FDP) levels (>10 microg/mL). The presence of a BPW was automatically flagged by the MDA analyzer when the slope of the precoagulation phase in the waveform exceeded a threshold value of -0.25%T/sec. In our cohort, 76 patients (15%) were diagnosed with overt DIC according to the criteria recently proposed by the International Society of Thrombosis and Haemostasis (ISTH), whereas 96 patients (18.9%) were diagnosed with DIC following the criteria of the Japanese Ministry of Health and Welfare (JMHW). The JMHW and ISTH criteria agreed in 93% of cases (kappa coefficient 0.76). The concordance between both scoring systems was high in patients with infection but low in solid cancer. The BPW appeared in 65 patients (12.8%), with the highest prevalence (23.6%) in patients with infection. The BPW was more prevalent in the subgroup of patients with DIC: 59.2% and 47.9% for DIC diagnosed by ISTH and JMWH scores, respectively. The prevalence of the BPW was particularly high in patients with DIC and infection: 86.4% and 75.0% for DIC diagnosed by ISTH and JMWH scores, respectively. For the total cohort, the presence of the BPW was significantly associated with DIC. Odds ratios were 29.9 and 19.0 for ISTH and JMWH scores, respectively (p<0.0001). The BPW showed a moderate sensitivity (59.2% for the ISTH score; 47.9% for the JMWH score), but a high specificity (95.4% for both scores). Waveform analysis of the aPTT potentially provides a practical tool in risk assessment of critical care patients, in whom development of DIC is known to worsen the prognosis.
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http://dx.doi.org/10.1177/107602960601200206DOI Listing
April 2006

Elevated levels of leukocyte tissue factor mRNA in patients with venous thromboembolism.

Thromb Res 2005 28;116(4):307-12. Epub 2005 Jan 28.

Department of Laboratory Medicine, Mie University School of Medicine, Tsu, Japan.

Tissue factor (TF) mRNA levels in leukocyte and TF antigen in plasma were examined in patients with deep vein thrombosis (DVT). Although TF mRNA levels in leukocytes were higher in patients with DVT than in healthy volunteers, they were lower in patients with DVT than in those with solid cancer and those with disseminated intravascular coagulation (DIC). On the other hand, the plasma levels of TF antigens were markedly high in patients with DVT/pulmonary embolism (PE). Analysis of the role of underlying disease of DVT showed no significant difference in TF mRNA levels and TF antigens among patients with solid cancer, post-surgical, other diseases and those free of underlying diseases. In patients with VTE, plasma levels of D-dimer, soluble fibrin, GE-XDP and plasminogen activator inhibitor-1 did not correlate with TF mRNA or TF antigen. In analysis of 18 patients with PE with and without DVT, TF mRNA levels in leukocytes correlated with the plasma levels of D-dimer. These findings suggest that TF in leukocytes is more likely to be involved in the development of thrombosis in PE than DVT.
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http://dx.doi.org/10.1016/j.thromres.2004.12.013DOI Listing
October 2005

Hemostatic abnormalities and leukocyte activation caused by infection in patients with malignant lymphoma during chemotherapy.

Thromb Res 2006 18;117(6):671-9. Epub 2005 Jul 18.

Second Department of Internal Medicine, Mie University Hospital, Tsu, Japan.

Hemostatic parameters were examined before and during 102 courses of chemotherapy in 42 patients with malignant lymphoma with high risk for infection. The white blood cell count was significantly reduced in all patients at days 1 and 3, but significantly increased at days 7 and 9, compared to before chemotherapy. At day 7 of chemotherapy, tissue factor (TF) mRNA levels in leukocytes were significantly increased in all patients, especially those with infection. Plasma concentrations of granulocyte elastase derived-XDP (GE-XDP) levels correlated with D-dimer levels during chemotherapy in patients with malignant lymphoma, suggesting that the elevated D-dimer is fibrin products degraded by granulocyte elastase. GE-XDP, C-reactive protein (CRP), GE-XDP and D-dimer were significantly higher in patients with infection, disseminated intravascular coagulation (DIC) and acute respiratory distress syndrome (ARDS) than those without. In patients with DIC or ARDS, TF mRNA correlated with D-dimer, and GE-XDP correlated with leukocyte count, CRP and D-dimer, suggesting that inflammatory changes due to thrombosis may cause the activation of leukocytes in patients with malignant lymphoma during chemotherapy. Activated leukocytes and granulocyte elastase may elicit a hypercoagulable state and ARDS in patients with malignant lymphoma during chemotherapy.
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http://dx.doi.org/10.1016/j.thromres.2005.06.001DOI Listing
July 2006

Haemostatic abnormalities and thrombotic disorders in malignant lymphoma.

Thromb Haemost 2005 Jan;93(1):153-9

Second Department of Internal Medicine, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.

We examined haemostatic abnormalities and thrombotic disorders in 217 patients with malignant lymphoma. Plasma levels of fibrinogen and D-dimer were significantly higher in patients with malignant lymphoma than in healthy subjects. The incidence of severe complications, such as disseminated intravascular coagulation (DIC) and interstitial pneumonia (IP), differed with each clinical stage or histological type, but they occurred frequently in stage IV or natural killer (NK) cell lymphoma. Plasma levels of fibrinogen degradation products (FDP) and D-dimer, leukocyte tissue factor (TF) mRNA and plasma TF antigen were significantly higher in stage IV than in stage I, II or III. Plasma levels of FDP, D-dimer, and leukocyte TF mRNA in NK cell lymphoma were markedly higher than in other types of lymphoma. Immunohistochemical staining of NK cell lymphoma revealed that granulocyte macrophage colony-stimulating factor was positive in tumour cells, whereas von Willebrand factor and TF were positive in vascular endothelial cells of surrounding tissue. Our results suggested that patients with stage IV disease and NK cell lymphoma were in abnormal thrombotic and haemostatic state, and may frequently develop DIC and IP. One of the mechanisms of DIC and IP may involve elevated cytokine production by lymphoma cells, which can stimulate the expression of TF in blood cells or surrounding tissue.
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http://dx.doi.org/10.1160/TH04-04-0260DOI Listing
January 2005
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