Diverticular perforation of terminal ileum associated with chemotherapy for non-small cell lung carcinoma: a case report.

A 71-year-old man was diagnosed with advanced non-small cell lung carcinoma and treated with chemotherapy developed ileocecal diverticulitis three times over the last 2 months of receiving second-line treatment. During the fourth diverticulitis event, the patient presented with fever and abdominal pain, worsening after 5 days. Abdominal computed tomography showed ascites and intra-abdominal free air, suggesting bowel perforation with acute diffuse peritonitis. We performed emergency surgery; the surgical findings showed diverticulosis with perforated diverticula in the ileocecal region. We performed ileocecal resection, an ileostomy and a mucous fistula of the ascending colon. Histopathological examinations revealed pseudodiverticula at the perforation, where the mucosa was depressed through the muscularis propria. Hence, we diagnosed perforated ileal diverticulitis. Repeated diverticulitis triggered by chemotherapy might have resulted in perforation. Small bowel diverticula are rare, but diverticulitis can occur in patients receiving chemotherapy and with cases of unexplained fever and abdominal pain.

Visinin-like 1, a novel target gene of the Wnt/ß-catenin signaling pathway, is involved in apoptosis resistance in colorectal cancer.

BACKGROUND: Abnormal activation of Wnt/ß-catenin signaling is associated with various aspects of cancer development. This study explored the roles of novel target genes of the Wnt/ß-catenin signaling pathway in cancer cells. METHODS: Using the haploid chronic myelogenous leukemia cell line HAP1, RNA sequencing (RNA-seq) was performed to identify genes whose expression was increased by APC disruption and reversed by ß-catenin knockdown (KD). The regulatory mechanism and function of one of the candidate genes was investigated in colorectal cancer (CRC) cells. RESULTS: In total, 64 candidate genes whose expression was regulated by Wnt/ß-catenin signaling were identified. Of these candidate genes, the expression levels of six were reduced by ß-catenin KD in HCT116 CRC cells in our previous microarray. One of these genes was Visinin-like 1 (VSNL1), which belongs to the neuronal calcium-sensor gene family. The expression of VSNL1 was regulated by the ß-catenin/TCF7L2 complex via two TCF7L2-binding elements in intron 1. VSNL1 KD-induced apoptosis in VSNL1-positive CRC cells. Additionally, forced expression of wild-type VSNL1, but not a myristoylation, Ca2+ -binding, or dimerization-defective mutant, suppressed the apoptosis induced by camptothecin and doxorubicin in VSNL1-negative CRC cells. CONCLUSION: Our findings suggest that VSNL1, a novel target gene of the Wnt/ß-catenin signaling pathway, is associated with apoptosis resistance in CRC cells.

Giant filiform polyposis with high-grade dysplasia: A case report and review of the literature.

Introduction and importance: Filiform polyposis, a rare condition also referred to as inflammatory polyposis or pseudopolyposis, is commonly observed in cases of inflammatory bowel disease, such as ulcerative colitis or Crohn's disease. It is generally considered a benign tumour characterised by multiple finger-like projections that are mostly observed in the transverse and descending colon. Case presentation: A 69-year-old woman with a history of ulcerative colitis for 18 years who underwent temporary decompression ileostomy for large bowel obstruction at another hospital was referred to our institution for further investigation. Abdominal computed tomography revealed bowel wall thickening of the transverse colon, and colonoscopy revealed stenosis in the hepatic flexure obstructing the endoscope. Although several biopsies of the tumour showed no malignancy, laparoscopic subtotal colectomy with lymph node dissection was performed. Histopathological findings revealed localised filiform polyposis with dysplasia. Clinical discussion: Filiform polyposis has been considered a benign inflammatory polyp without any risk of dysplasia. We accumulated previous cases of giant filiform polyposis and reviewed their characteristics. The presented case of filiform polyposis with ulcerative colitis complicated with high-grade dysplasia highlights the importance of considering malignancy in patients with filiform polyposis. Conclusion: In cases of giant filiform polyposis, even when no malignancy is detected, surgical resection should be considered for the possibility of a malignant component of dysplasia.

Percutaneous sonographically assisted endoscopic gastrostomy for difficult cases with interposed organs.

OBJECTIVES: The aim of this retrospective observational study was to clarify the usefulness and safety of percutaneous sonographically assisted endoscopic gastrostomy or duodenostomy (PSEGD) using the introduction method. METHODS: The information for the sequential 22 patients who could not undergo standard percutaneous endoscopic gastrostomy (PEG) and underwent PSEGD for 3 y was extracted and was reviewed. In standard PEG, we performed pushing out of the stomach from the mediastinum and full distention to adhere the gastric wall to the peritoneal wall without interposing of the intraperitoneal tissues by air inflation and a turning-over procedure of the endoscope, four-point square fixation of the stomach to the peritoneal wall by using a Funada-style gastric wall fixation kit under diaphanoscopy, extracorporeal thumb pushing, and in difficult cases extracorporeal ultrasound guidance, and if necessary confirmation of fixation of the gastric wall to the peritoneal wall and placement of the PEG tube without any interposed tissues by using ultrasound. RESULTS: Twenty-one patients (95.5%) successfully underwent PSEGD. Early complications (more than grade 2 in Clavien-Dindo classification) just after the procedure occurred in one case (active oozing). We did not encounter a case with mispuncture of the intraperitoneal organs and tissues. Delayed complications occurring within 1 mo were pneumonia in five patients, including death in three cases; bleeding from puncture site in two patients; and atrial fibrilation in one patient. CONCLUSION: PSEGD using the introduction method is a useful procedure for difficult patients in whom intraperitoneal organ or tissue is suspected to be interposed between the abdominal wall and stomach.