Endoscopic Removal of Pedunculated Leiomyoma of the Sigmoid Colon.

BACKGROUND: The large bowel is a rare site for leiomyomas. Furthermore, a colonic pedunculated leiomyoma is very rare. Complete endoscopic removal of a colonic leiomyoma can be problematic because of its submucosal origin. CASE REPORT: We report a colonic pedunculated leiomyoma that was removed by endoscopic polypectomy without complications. A 74-year-old man was referred to our hospital because of constipation. Colonoscopy demonstrated a 1-cm pedunculated polyp that was connected to a minute stalk within the sigmoid colon. It was removed by snare polypectomy. Histopathological examination demonstrated normal mucosa overlying a well-circumscribed proliferation of eosinophilic spindle cells arising in association with the muscularis mucosae. Immunohistological findings were positive for desmin and smooth muscle actin. The polyp was diagnosed as a leiomyoma. More than 9 months later, the patient remains well, with no further symptoms. CONCLUSION: For small, pedunculated leiomyomas, endoscopic snare polypectomy is thought to be a useful approach for both treatment and diagnosis.

Endoscopic mucosal resection of a rectal malakoplakia in a healthy adult.

Malakoplakia in the gastrointestinal tract is rare in healthy young people without underlying disease. Sufficient tissue is required for accurate diagnosis. We describe a malakoplakia that developed in a healthy young woman and was treated by endoscopic mucosal resection (EMR). A 40-year-old woman with a history of taking oral contraceptives until one year earlier was referred to our hospital with anal bleeding and constipation. A colonoscopy carried out at our another hospital 18 months earlier disclosed no abnormal findings. Colonoscopy at presentation revealed a yellowish-white tumor, 5 mm in diameter, in the rectum. The lesion was slightly protruded and had a smooth flat surface, without erosion or ulceration. EMR was carried out for a definitive diagnosis. Histopathological examination showed that the tumor contained granular histiocytes, positive for CD68 and negative forcytokeratin (AE1/AE3). Several histiocytes contained intracytoplasmic round bodies (Michaelis-Gutmann bodies), which reacted positively with periodic acid-Schiff and calcium (Von Kossa) stains. Intracytoplasmic Escherichia coli (von Hansemann bodies) were identified by Giemsa staining. Based on these results, the tumor in the rectum was diagnosed as a malakoplakia. Following EMR, the patient did not receive further treatment for malakoplakia because she had no symptoms associated with malakoplakia. She has been well for more than 9 months, with no symptoms of disease. Awareness of colorectal malakoplakia is important in patients taking steroids, including oral contraceptives.

Primary T-cell lymphoma associated with tubulovillous adenoma of the rectum: report of a case.

We report what to our knowledge is the first documented case of "peripheral T-cell lymphoma-not otherwise specified" (PTCL-NOS) associated with a rectal adenoma. Colorectal lymphomas are relatively uncommon, but colorectal T-cell lymphomas are extremely rare. The patient was a 92-year-old woman, referred to our hospital for investigation of anal bleeding. Rectal examination revealed a 3-cm pedunculated polypoid mass 5 cm above the anal verge. We performed a transanal local excision, and histopathological examination revealed a tubulovillous adenoma, with the diffuse proliferation of large lymphoid cells mainly discernible in the mucus membrane lamina propria, with infiltration to the submucosal layer. Immunohistochemical examination of the lymphoid cells revealed positive staining for CD3, weak staining for CD4 and CD8, and negative staining for CD5, CD10, CD20, CD56, CD79a, TIA-1, and Granzyme B. The tumor was diagnosed as PTCL-NOS associated with rectal tubulovillous adenoma. The patient died 28 days after surgery, most probably of progression of the PTCL-NOS.

[Trial of outpatient anti-cancer chemotherapy with infusion of 5-FU and cisplatin for advanced gastric and colorectal cancers].

We carried out a pilot study on the clinical efficacy and safety of outpatient anti-cancer chemotherapy with 5-FU and CDDP for 5 patients with advanced cancer of the stomach or colon, using two disposable balloon pumps. The protocol was combined chemotherapy with continuous intravenous infusion of 5-FU (500 mg/body/day) and CDDP (10 mg/body/day) in 5-day courses for 1 week, and the therapy was repeated as long as possible. Pharmacokinetic study showed that the mean serum concentration of 5-FU was 64.3+/-9.2 ng/ml, and the serum concentration of total Pt increased continuously during CDDP injection. Thus, both drugs were injected, safely and surely. One patient had a clinically evaluable lesion, and the anti-tumor effect of this case was SD. But the serum CEA level was decreased in 3 cases. The side effect of Grade 3 and 4 was not seen, but nausea, vomiting, anorexia, and weight loss were observed frequently. This therapy enabled the patients to stay home 51.6+/-10.0 days longer than with the usual methods in hospital, and this therapy was thought to improve their quality of life. Thus, this therapy is feasible and quite useful, but much attention must be paid to the patient's oral uptake during the therapy, and the clinical effects should be evaluated in randomized control trials.

Survey of residual tetracycline antibiotics and sulfa drugs in kidneys of diseased animals in the Aichi Prefecture, Japan (1995-1999).

Animal kidneys were collected in order to survey the incidence of tetracycline (TC) antibiotics and sulfa (SA) drug residues in slaughtered animals that did not pass inspection for human consumption by the Japanese Food Sanitation Law and the Meat Inspection Law at the slaughterhouses in Aichi Prefecture, Japan, from April 1995 to March 2000. The kidneys were analyzed by AOAC Official Method 995.09 for TCs and our previously reported liquid chromatographic method for SAs. Among 292 animals (94 cattle and 198 pigs), 106 (36.6%) and 41 (14.0%) contained TCs and SAs, respectively, including chlortetracycline, 59 (20.2%); oxytetracycline, 47 (16.1%); sulfamonomethoxine, 35 (12.0%); sulfadimethoxine and sulfamethoxazole, each 2 (0.7%); and sulfamerazine and sulfisoxazole, each 1 (0.3%). A small number of animals (5 cattle and 9 pigs) contained more than one drug residue. The frequency of residue detections was significantly higher for TCs than SAs in both cattle and pig kidneys (p < 0.001).

The ultrasonic trocar provides an easy, sharp, bloodless, and repeatable approach to the abdominal cavity.

Reusable trocars have the advantage of being more cost-effective than disposable trocars. However, the reusable trocar does lose its sharpness on insertion with repetitive insertion. Nonreusable trocars are expensive, but the sharpness of the knife facilitates insertion. Nonreusable trocars have a safety shield system designed to decrease abdominal organ injury, though the potential problem of bleeding from the abdominal wall port site has yet to be resolved. We therefore developed a novel ultrasonic vibrating trocar that does not lose its sharpness even with repetitive insertion. This trocar prevents bleeding by means of an ultrasonic cavitation effect. The ultrasonic vibrating trocar has the advantage of ease of insertion, and the force required for new reusable trocar insertion was only 34% of the force required for insertion of commercially available nonreusable trocars. The force required for multiply used conventional reusable ultrasonic vibrating trocar insertion, ie, 900 insertions, was maintained at less than 46% of the force required by the corresponding nonreusable trocars. Bleeding from the abdominal wall was prevented by an ultrasonic cavitation effect.