Type B2 vessels and infiltrative growth patterns b and c are associated with lymphatic invasion in pT1a-lamina propria mucosa esophageal squamous cell carcinoma.

BACKGROUND: Tumor growth pattern correlates with outcomes in patients with esophageal squamous cell carcinoma (ESCC), however, the clinical significance of the tumor growth pattern in pT1a-lamina propria mucosa (LPM) type of ESCC was unclear. This study was conducted to clarify clinicopathological features of tumor growth patterns in pT1a-LPM type ESCC and the relationship between tumor growth patterns and magnifying endoscopic findings. METHODS: Eighty-seven lesions diagnosed as pT1a-LPM ESCC were included. Clinicopathological findings including tumor growth pattern and narrow band imaging with magnifying endoscopy (NBI-ME) in the LPM area were investigated. RESULTS: Eighty-seven lesions were classified as infiltrative growth pattern-a (INF-a): expansive growth (n = 81), INF-b: intermediate growth (n = 4) and INF-c: infiltrative growth pattern (n = 2). Lymphatic invasion was shown in one INF-b and one INF-c lesion. NBI-ME and histopathological images were matched for 30 lesions. The microvascular pattern was classified into types B1 (n = 23) and B2 (n = 7) using the JES classification. All 23 type B1 lesions were classified as INF-a without lymphatic invasion. Type B2 lesions were classified as INF-a (n = 2), INF-b (n = 4) and INF-c (n = 1), and lymphatic invasion was present in two lesions (INF-b and INF-c). The rate of lymphatic invasion was significantly higher in type B2 than type B1 (p = 0.048). CONCLUSIONS: The tumor growth pattern of pT1a-LPM ESCC was mostly INF-a in type B1 patterns. Type B2 patterns are rarely present in pT1a-LPM ESCC, however lymphatic invasion with INF-b or INF-c was frequently observed. Careful observation before endoscopic resection with NBI-ME is important to identify B2 patterns to predict histopathology.

A case of gastric-type adenoma with chief cell and parietal cell differentiation surrounded by complete intestinal metaplasia.

A man in his 70s received Helicobacter pylori eradication therapy after endoscopic submucosal dissection (ESD) of the stomach. A small, yellowish, protuberant lesion was later observed on the anterior wall of the lower body of the stomach on surveillance esophagogastroduodenoscopy. Narrow band imaging-magnified endoscopy showed an irregular pit and net-like vascular pattern, with the background mucosa having a light blue crest pattern. A biopsy was performed, which led to a diagnosis of adenoma with a gastric phenotype, so repeat ESD was performed. The freshly resected specimen showed a small, protuberant, flat lesion with a clear margin, and hematoxylin and eosin staining showed mild architectural and nuclear atypia. The shape of the atypical gland was similar to that of a fundic gland. MUC5AC, MUC6, pepsinogen A, and H+/K+ ATPase expressions were positive, and CD10 expression was negative, indicating that this tumor could not only differentiate to mucous neck cells but also to chief cells, parietal cells and foveolar epithelium. Therefore, this 4-mm tumor was diagnosed as a type 0-IIa tubular adenoma with fundic gland differentiation. The background mucosa showed complete intestinal metaplasia. Traditionally, gastric-type adenoma has been defined as the pyloric gland-type, but our case had a fundic gland phenotype. Therefore, a new fundic-gland adenoma subtype should be considered in this case.

Recent trends of Japanese hepatocellular carcinoma due to HCV in aging society.

BACKGROUND/AIMS: The mean age of hepatocellular carcinoma (HCC) patients has increased (=65 years old). We want to identify the recent trend of the clinical features of HCC patients due to hepatitis C virus (HCV) (HCV-HCC). METHODOLOGY: From 2000 to 2009, 855 naive HCC patients were admitted. HCV-HCC patients were divided into two groups, first period group (2000-04, n=270) and second period group (2005-09, n=343) and the clinical features of HCV-HCC were investigated. RESULTS: There was no difference in gender, TNM stage and percentages of HCV-HCC between the periods. On the other hand, the ratio of HCV-HCC patients with worse liver function (Child-Pugh B or C), elderly (=75 years old) and the population of patients treated with low invasive radiofrequency ablation were increased (30.0% to 42.0%, 17.2% to 35.8% and 25.1% to 36.2%, respectively; p<0.01). The 1y-, 3y- and 5y-survival rate of HCV-HCC did not show differences (82.1%, 60.5% and 44.7% vs. 81.8%, 56.9% and 37.7%, respectively; p=0.219). CONCLUSIONS: The ratio of aged HCV-HCC as well as HCV-HCC patients with worse liver function was increased. The less invasive treatment for HCC in these patients and the quick anti-viral treatment for HCV patients should be considered to avoid occurrence of HCC in Japan.

An association between body mass index and estimated glomerular filtration rate.

Chronic kidney disease (CKD) is a major public health problem. However, few studies have examined the significance of body mass index (BMI) as a risk factor for the development of CKD in the general Japanese population. Study participants without a clinical history of stroke, transient ischemic attack, myocardial infarction, angina or renal failure (754 men aged 56+/-15 [mean+/-SD] years and 962 women aged 59+/-13 years) were randomly recruited from a single community at the time of their annual health examination. We examined the relationship between increased weight (i.e., BMI) and renal function evaluated by the estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease Study Group equation. Increased BMI was consistently associated with reduced eGFR. Estimated GFR was lower in participants with upper normal body weight (BMI, 22.0 to 24.9 kg/m2) or who were overweight or obese (BMI>or=25 kg/m2), compared with participants with lower normal body weight (BMI, 18.5 to 21.9 kg/m2). Stepwise multiple regression analysis using eGFR as an objective variable, adjusted for various risk factors as explanatory variables, showed that BMI (beta=-0.075) was significantly and independently associated with eGFR, in addition to age, log triglycerides, low-density lipoprotein cholesterol and log fasting blood glucose. Compared with those with lower normal body weight, multivariate-adjusted odds ratios for moderately reduced renal function, defined as an eGFR<60 mL/min/1.73 m2, were 1.86 (1.01-3.42) for upper normal weight and 2.02 (1.01-4.03) for overweight or obese individuals. In conclusion, increased BMI is strongly associated with decreased eGFR in community-dwelling healthy persons.

Colonic intussusception caused by anisakiasis: a case report and review of the literature.

A 67-year-old woman presented with periumbilical pain. Contrast-enhanced computed tomography findings indicated intussusception of the ascending colon without ischemia or necrosis, and we performed successful colonoscopy to treat the condition. Furthermore, an edematous area caused by anisakis was detected in the ascending colon and the anisakis was removed. The patient noted that she had eaten raw fish one day before the symptoms developed. Although colonic intussusception caused by anisakiasis is extremely rare, colonoscopy should be performed in colonic intussusception patients suspected of having anisakiasis in order to avoid invasive resection.

Huge pancreatic acinar cell carcinoma with high levels of AFP and fucosylated AFP (AFP-L3).

A 25-year-old Japanese woman with a large abdominal tumor (10 cm in diameter) and high level of serum alpha-fetoprotein (AFP, 1,222.4 ng/mL) was introduced and admitted to our hospital in January 2011. Pre-operative imaging modalities could not identify the tumor origin. There was no chronic hepatic viral disease, however, the elevated level of fucosylated AFP (87.8%) and connection with the left hepatic lobe led us to diagnose the tumor as a hepatocellular carcinoma. Surgical resection was performed in February. Histological findings revealed a pancreatic acinar cell carcinoma (ACC). Herein, we provide details of this difficulty to diagnose a case of ACC.

An association between the estimated glomerular filtration rate and carotid atherosclerosis.

OBJECTIVE: Chronic kidney disease (CKD) is a major public health problem. There is conflicting evidence concerning whether CKD is an independent risk factor for carotid intima-media thickness (IMT). PATIENTS AND METHODS: The study subjects were 428 men aged 70+/-15 (mean+/-standard deviation) years and 582 women aged 75+/-12 years enrolled consecutively from patients in the Medical Department of Seiyo Municipal Nomura Hospital. Carotid IMT was derived via B-mode ultrasonography and CKD was evaluated by the estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease Study equation. RESULTS: In men, age (p<0.001), systolic blood pressure (p<0.001), antihypertensive drug use (p<0.001), HDL-C (p=0.006), LDL-C (p=0.004), prevalence of diabetes (p=0.035) and eGFR (p<0.001) were significantly correlated with carotid IMT. In women, age (p<0.001), systolic blood pressure (p<0.001), antihypertensive drug use (p<0.001), HDL-C (p=0.035), LDL-C (p=0.017) and eGFR (p<0.001) were significantly correlated with carotid IMT. Stepwise multiple linear regression analysis using IMT as an objective variable, adjusted by various factors as explanatory variables, showed that eGFR was a significant independent contributing factor along with known risk factors in men (beta, -0.096; p=0.018) and women (beta, -0.080; p=0.035). CONCLUSIONS: Our data suggested that eGFR was associated with an increased prevalence of carotid atherosclerosis independent of common cardiovascular risk factors in both men and women.

An association between decreased estimated glomerular filtration rate and arterial stiffness.

OBJECTIVE: Chronic kidney disease (CKD) is a major public health problem, but there is controversy over whether or not CKD is an independent risk factor for peripheral arterial stiffness in community residents. PATIENTS AND METHODS: We randomly recruited 107 men, aged 68+/-9 (mean +/- standard deviation) years, and 203 women, aged 67+/-7 years during their annual health examination in a single community. Study subjects did not have a clinical history of cerebrovascular disease or current neurological abnormalities. Peripheral arterial stiffness was evaluated by mean pulse wave velocity (PWV) determined at three points: from heart to the carotid artery, to the brachial artery, and to the ankle, and CKD was evaluated by estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease Study Group equation. RESULTS: Estimated GFR was significantly correlated with mean PWV (r=-0.317, p<0.001). Stepwise multiple linear regression analysis using mean PWV as an objective variable, adjusted by explanatory variables, showed that eGFR (beta,-0.171; p<0.001) significantly contributed to mean PWV, along with age, body mass index, systolic blood pressure, diastolic blood pressure, and antihypertensive drug use, and improved multiple coefficient of determination in the model. CONCLUSION: Decreased eGFR is associated with an increased risk of arterial stiffness in community residents.