A case of colonic muco-submucosal elongated polyp (CMSEP) misdiagnosed as a inverted colonic diverticulum (ICD).

CMSEP is a large intestine polyp with a long and broad stalk and a "worm-like" appearance which is covered by normal mucosa. The submucosal layer consists of edematous and fibrotic interstitium, adipose tissue, dilated blood vessels, and lymphatic follicles[1]. Endoscopic magnification of the mucosal surface showed a uniform honeycomb pattern of regular blood vessels, with soft and deformable "folds" and "gyrus" at the top. The exact pathogenesis of CMSEP is still unclear.

Calcifying fibrous tumor and pathological analysis.

A 55-year-old male presented to our outpatient department with complaints of upper abdominal dull pain. Gastroscopy revealed a submucosal eminence at the greater curvature of the gastric body, with smooth surface mucosa, and biopsy pathology indicated inflammation. Physical examination showed no obvious abnormalities, and laboratory results were within the normal range. Computerized tomography (CT) showed thickening of the gastric body. Endoscopic submucosal dissection (ESD) was performed,and representative photomicrographs of histologic sections were shown.

Clinical Efficacy and Mechanism of Transcutaneous Neuromodulation on Functional Dyspepsia.

BACKGROUND AND AIMS: Prokinetics and proton pump inhibitors are first-line drugs for functional dyspepsia (FD) patients. However, no available treatment is effective for most FD patients, and the pathogenesis is still unclear. The purpose of this study was to investigate the therapeutic effect of transcutaneous neuromodulation (TN) on FD and its potential mechanisms. MATERIALS AND METHODS: Fifty-seven FD patients were enrolled in the study and randomly divided into 3 groups (TN Neiguan (PC6) group, TN Zusanli (ST36) group, and sham TN group) that received corresponding treatment respectively for 4 weeks. Then, all the patients enrolled received TN PC6 combined with ST36 treatment for another 4 weeks. Dyspepsia symptom questionnaire, Medical outcomes study item short form health survey (SF-36), Hospital Anxiety and Depression Scale were used to assess the severity of symptoms. Gastric accommodation, gastric emptying rate, and related parameters of electrogastrogram were used to assess the pathophysiological mechanism of FD. The possible gastrointestinal hormonal mechanism involved was assessed by detecting serum ghrelin, neuropeptide Y, and vasoactive intestinal peptide. The possible duodenal inflammation mechanism involved was assessed by detecting duodenal mucosa. RESULTS: TN treatment reduced the dyspepsia symptom score ( P <0.05) and improved the quality of life. After TN treatment, the gastric accommodation ( P <0.01), the gastric emptying rate ( P <0.01), and the percentages of preprandial ( P <0.05) and postprandial ( P <0.05) gastric slow waves (GSW) were increased. The proportions of preprandial ( P <0.05) and postprandial ( P <0.05) gastric electrical rhythm disorder were reduced. The double acupoint combination therapy further enhanced the therapeutic effect of single acupoint. In addition, the levels of ghrelin ( P <0.001) and neuropeptide Y ( P <0.001) were significantly increased, the level of vasoactive intestinal peptide ( P <0.001) was significantly decreased, and the total number of mast cells ( P <0.001) in the duodenal bulb was significantly decreased after double acupoints combination therapy. CONCLUSIONS: TN treatment significantly improves the dyspepsia symptoms of FD patients and their quality of life. TN treatment increases the percentage of normal GSW, reduces the proportion of gastric electrical rhythm disorder, and improves the gastric accommodation and gastric emptying rate. The therapeutic effect of TN may be caused by regulating gastrointestinal hormone secretion and alleviating local inflammatory responses in duodenum. In addition, the improvement of TN on GSW was closely related to the decrease of bradygastria.

Gastric schwannoma diagnosing gastric stromal tumor.

A 45-year-old male visited our hospital for a medical examination without any clinical complaints. The patient had an gastroscopy, which revealed a 30mm*30mm hemispherical submucosal tumor arising from the lesser curvature of the gastric body , suggesting a gastrointestinal stromal tumor (GIST) as a preoperative diagnosis;Endoscopic resection was determined to be the best choice and the patient underwent a endoscopic full-thickness resection and endoscopic purse-string suture. Except for a slight low fever, the patient was well recovered and was discharged on his 7th post-operation. Pathological analysis and immunohistochemical staining showed fascicular growth of neoplastic Schwann cells and confirmed the diagnosis of gastric schwannoma through high positivity for S-100 protein.

An unusual cause of a protuberant lesion of the gastric antrum.

A 58-year-old man presented to our hospital due to upper abdominal pain for 2 months. Gastroscopy showed a 1.5×1.5×1 cm3 protuberant lesion in the gastric antrum. Magnifying endoscopy with blue laser imaging showed roughly normal micro-surface and micro-vessel structure. Endoscopic ultrasonography showed the lesion originated from the muscularis propria, with low-density irregular cystic echo. Then the patient received treatment of gastrointestinal lesions with endoscopic submucosal dissection. During the operation, it could be seen that the lesion was mainly located in the submucosa, the local depth of which reached the muscularis mucosae. It was tan-white in color, with toughness and cystic tactile sensation. The operation went smoothly and his recovery was good. Pathological studies showed that pancreatic tissue was found in the lesion, which was composed of exocrine acini and ducts. Meanwhile, dilated cystic glands were found in the excised specimens. He was eventually diagnosed as ectopic pancreas in gastric antrum complicated with gastritis cystica profunda (GCP).

Gastric inverted hyperplastic polyp with heterotopic pancreas: a rare case of submucosal eminence of the antrum.

A 43-year-old female underwent gastroscopy due to abdominal discomfort. Gastroscopy showed a submucosal eminence at the greater curvature of the antrum, with smooth surface mucosa, biopsy pathology suggests inflammation. We scheduled an endoscopic ultrasonography (EUS) for her. EUS revealed that the size of the lesion was about 8.7mm*10.8mm, with hypoechoic changes, which originated in the submucosa. Endoscopic submucosal dissection was performed, and representative photomicrographs of histologic sections were shown. The patient was diagnosed with gastric inverted hyperplastic polyp (GIHP) with heterotopic pancreas (HP).

An uncommon case of gastrointestinal bleeding: Meckel's diverticulum with ectopic gastric mucosa.

A 25-year-old woman visited our department due to intermittent defecation of black stool and periumbilical pain for 2 years. Abdominal physical examination showed no obvious abnormality. Laboratory examination showed positive fecal occult blood. Because bleeding lesions were not found by gastroscopy or colonoscopy, she underwent double-balloon enteroscopy examination. It was found that a diverticulum was formed in the terminal ileum, with blood exudation. After repeated washing, the blood disappeared. However, after a period of time, blood exudation could still be detected there. She was diagnosed as Meckel's diverticulum with hemorrhage. Considering the patient's repeated gastrointestinal bleeding, surgical treatment was performed. Surgical specimens showed a 2.5×2.3×1.5 cm3 intestinal diverticulum with a soft texture, and the mucosa was grayish white. Postoperative pathological showed ectopic gastric mucosa with chronic inflammatory cell infiltration. The diverticulum had been found to contain gastric fundus gland tissues which were mainly composed of parietal cells and main cells. The patient recovered well after operation.

d-Carvone inhibits the JAK/STAT3 signaling pathway and induced the apoptotic cell death in the human gastric cancer AGS cells.

Globally, gastric cancer is one of the leading cause of death. Surgical and chemotherapy constitute an important treatment regimen. Unfortunately, less than 20 persons out of 100 patients are live on almost 5 years. Hence, a nontoxic, effective and significantly enhancing novel therapeutic agent is required. d-Carvone is a natural terpenoid present in the essential oils and abundant in the seeds of caraway, as well as known folk medication for diarrhea, acidity, and other gastric disorders. Nevertheless, the role of d-carvone on gastric cancer and its underlying molecular mechanism resides enigmatic. Cells were treated with d-carvone to find out the IC50 by MTT assay. This study shows that 20 and 25 µM d-carvone has induced the reactive oxygen species production and mitochondrial membrane potential in gastric cancer AGS cells, which were evaluated by 2,7-dichlorofluoresceindiacetate and Rh123 staining methods, respectively. The effect of d-carvone against the Janus kinase 2 (JAK2)/signal transducer and activator of transcription 3 (STAT3) pathway was studied through immunoblotting. Then, we found that it effectively inhibited the proliferation of cell, and the induction of cell apoptosis was scrutinized by dual, 4',6-diamidino-2-phenylindole, and also propidium iodide staining methods. We also explored the fundamental molecular signaling mechanism of the d-carvone and our data depicts that d-carvone induced apoptosis cell death by mitochondrial reactive oxygen species production and downregulation of the and JAK and STAT3 signaling molecules. These overall findings support that the d-carvone inhibits the JAK/STAT3 signaling pathway and induces cell death in the gastric cancer AGS cells.

Ink stained gastric lesions: a rare cause of gastrointestinal bleeding.

A 61-year-old male was hospitalized in our department due to Intermittent melena for 4 days. Laboratory tests showed a reduced hemoglobin level (10.7 g/L). Abdominal computed tomography (CT) showed gastric wall thickening in the gastric body.

Acute abdominal pain caused by accidental ingestion of Latoia species larva: a case report.

We report the clinical and endoscopic manifestations in a patient with acute abdominal pain caused by the accidental ingestion of a Latoia consocia (Walker) larva. Clinical data including the patient's medical history, and the results of physical examination, laboratory tests, and gastroscopy were collected. Based on this rare case, we discuss the clinical characteristics and manifestations, diagnostic methods, and principles of this disease.

Rare cause of appendicitis: Mechanical obstruction due to Fasciolopsis buski infestation.

This study aimed to improve the understanding of the clinical characteristics of patients with fasciolopsiasis and thus reduce misdiagnosis and inappropriate treatment. We retrospectively analyzed the clinical data of two patients with fasciolopsiasis which caused appendicitis. Fasciolopsis buski infestation as a cause of appendicitis is very rarely seen in the clinic. The clinical characteristics, clinical manifestations, diagnostic methods and the principles of treatment in these two patients were analyzed.