An unusual cause of life-threatening upper gastrointestinal bleeding.

A previously healthy 56-year-old female was hospitalized with intermittent melena and transient syncope for 1-month duration. Physical examination on admission showed heart rate was 105 beats per minute and blood pressure was 89/55 mmHg. Her hemoglobin was 6.7 g/dl. She received fluid infusion, blood transfusion, acid suppression and hemostasis treatment. Abdominal enhanced computed tomography (CT) demonstrated a well-defined mass with uniform adipose density in the antrum measuring 4 × 5 cm. Gastroscopy revealed a giant submucosal tumor with superficial ulceration in anterior wall of the gastric antrum. Endoscopic ultrasound (EUS) showed a homogeneous, well-circumscribed, hyperechoic mass originated from the submucosa layer. Distal partial gastrectomy was performed. Postoperative histopathology examination of the resected specimen revealed the tumor was composed of closely arranged and uniformly shaped proliferative mature adipocytes, which located in the submucosa layer with superficial mucosal ulcer. The patient was diagnosed as giant gastric lipoma with superficial ulcer and no symptoms was observed in 3 months follow-up.

An unusual gastric mass mimicking a gastrointestinal stromal tumor.

We reported a patient diagnosed as Gastrointestinal stromal tumor according to the patient's age, past medical history, and CT images, but interestingly, SGIH was diagnosed on the basis of postoperative pathology after surgery.

A novel modified endoscopic method for treating patients with refractory gastro-esophageal disease and moderate hiatus hernia

Background and aim: endoscopic anti-reflux mucosectomy (ARMS) is effective for patients with refractory gastroesophageal reflux disease (rGERD) with small hiatus hernia. However, evidence of its applicability in patients with larger hernia sac is lacking. This study aimed to evaluate the efficiency and safety of ARMS for patients with rGERD with moderate hiatus hernia (3-5 cm) and determine the appropriate resection range. Methods: thirty-six patients with rGERD with moderate hiatus hernia were enrolled. They were divided into 2/3 and 3/4 circumferential mucosal resection groups. The patients received modified ARMS. The gastroesophageal reflux disease questionnaire (GERD-Q) and DeMeester scores, endoscopy, 24-h pH monitoring results and lower esophageal sphincter (LES) resting pressure were compared pre- and post-procedure. Therapeutic effects and complications of the two mucosal resection ranges were analyzed. Results: thirty-six patients were enrolled in this study, all of whom had undergone ARMS surgery with at least six-month follow-up. In the 2/3 circumferential mucosal resection group, the GERD-Q score, acid exposure time (AET) and DeMeester score improved significantly compared with those before surgery (p < 0.001). In the 3/4 circumferential mucosal resection group, the GERD-Q score, AET and DeMeeter score worsened after six months (p < 0.001), but there was no difference between the two groups (p > 0.05). In both groups, there was no significant improvement in the ratio of esophagitis grade C/D and LES resting pressure after treatment compared with the baseline values (p > 0.05), and no postoperative bleeding or perforation was observed. The incidence of postoperative esophageal stenosis in the 2/3 circumferential mucosal resection group was lower than that in the 3/4 circumferential mucosal resection group (p = 0.041). (AU)

An unusual cause of recurrent abdominal pain in a middle-aged man.

A 54-year-old man was hospitalized with intermittent periumbilical pain for 1-month duration. Abdominal contrast-enhanced computed tomography (CT) revealed target-sign and a fat density mass measuring 2.0 × 2.5-cm in the distal ileum. Part mesenteric tissues and blood vessels were embedded and the wall of the affected intestinal tube was thickened and edematous. His symptom was alleviated after conservative treatment and he refused further management. The patient was hospitalized again with the same symptoms and abdominal CT findings 4 years later. Exploratory laparotomy was performed. A palpable mass in the ileum was found measuring 3.0 × 3.0-cm and partial enterectomy was performed. Postoperative histopathology revealed the resected mass was composed of proliferating mature adipocytes surrounded by few fibrous connective tissue. Hyperplastic fibroblast and inflammatory exudative necrotic tissue were found on the surface of the mass. The patient was diagnosed as ileum fibrolipoma with intussusception. He was discharged home uneventfully and no symptoms was observed in 12 months follow-up.

A novel modified endoscopic method for treating patients with refractory gastro-esophageal disease and moderate hiatus hernia.

BACKGROUND AND AIM: endoscopic anti-reflux mucosectomy (ARMS) is effective for patients with refractory gastroesophageal reflux disease (rGERD) with small hiatus hernia. However, evidence of its applicability in patients with larger hernia sac is lacking. This study aimed to evaluate the efficiency and safety of ARMS for patients with rGERD with moderate hiatus hernia (3-5 cm) and determine the appropriate resection range. METHODS: thirty-six patients with rGERD with moderate hiatus hernia were enrolled. They were divided into 2/3 and 3/4 circumferential mucosal resection groups. The patients received modified ARMS. The gastroesophageal reflux disease questionnaire (GERD-Q) and DeMeester scores, endoscopy, 24-h pH monitoring results and lower esophageal sphincter (LES) resting pressure were compared pre- and post-procedure. Therapeutic effects and complications of the two mucosal resection ranges were analyzed. RESULTS: thirty-six patients were enrolled in this study, all of whom had undergone ARMS surgery with at least six-month follow-up. In the 2/3 circumferential mucosal resection group, the GERD-Q score, acid exposure time (AET) and DeMeester score improved significantly compared with those before surgery (p < 0.001). In the 3/4 circumferential mucosal resection group, the GERD-Q score, AET and DeMeeter score worsened after six months (p < 0.001), but there was no difference between the two groups (p > 0.05). In both groups, there was no significant improvement in the ratio of esophagitis grade C/D and LES resting pressure after treatment compared with the baseline values (p > 0.05), and no postoperative bleeding or perforation was observed. The incidence of postoperative esophageal stenosis in the 2/3 circumferential mucosal resection group was lower than that in the 3/4 circumferential mucosal resection group (p = 0.041). CONCLUSION: modified ARMS is effective for patients with rGERD with moderate hiatus hernia, but it cannot significantly increase the postoperative resting pressure of the LES. The 2/3 circumferential mucosal resection can reduce the incidence of postoperative esophageal stenosis.

Endoscopic submucosal dissection of a rare antral mass: gastric fibrolipoma.

A 60-year-old man was hospitalized with upper abdominal pain for 2-month duration. He had no previous history of symptoms related to his upper gastrointestinal tract. Physical examination was unremarkable. A semicircular round mass with smooth surface was found at the gastric antrum measuring 2.0 × 2.0-cm by gastroscopy. Endoscopic ultrasound (EUS) demonstrated a heterogeneous hyperechoic mass originated from the submucosal layer. Abdominal computed tomography (CT) revealed a fat-density mass with internal mixed density at the gastric antrum. His complete blood test, liver, renal, coagulation function and tumor markers were within reference values. Endoscopic submucosal dissection (ESD) was performed. Postoperative histopathology examination revealed the tumor was composed of closely arranged proliferating mature adipocytes with consistent size and shape. Collagen fiber hyperplasia between adipocytes was found in focal area. The patient was diagnosed as gastric fibrolipoma. He was discharged home uneventful and no symptoms was found in 12 months follow-up.

A rare cause of upper gastrointestinal bleeding in an elderly female: gastric angiolipoma.

A 83-year-old woman with previous history of gallstone was hospitalized with intermittent melena of 1-week duration. Gastroscopy showed a protuberant mass with thick pedicle and superficial ulcer measuring 3.0 × 4.0-cm in the lower gastric body (Fig. 1. A). Biopsy of the ulcer indicated chronic inflammation without evidence of malignancy. Abdominal contrast-enhanced computed tomography demonstrated a well-defined and mixed density mass with heterogeneous enhancement in the gastric body. The final diagnosis was gastric angiolipoma.

Endoscopic submucosal dissection of an unexpected symptomatic esophageal mass: intramural esophageal hematoma.

A 53-year-old man with a history of hypertension was hospitalized with retrosternal pain during eating for 1-month duration. He had no previous history of symptoms related to his upper gastrointestinal tract. Physical examination was unremarkable. The patient was diagnosed as intramural esophageal hematoma (IEE) and no symptoms was observed in 12 months follow-up.

Endoscopic resection of a rare duodenal polypoid mass: duodenal angiolipoma.

A 73-year-old man was hospitalized with upper abdominal pain of 1-month duration. Gastroscopy revealed a pedunculated polypoid mass with smooth surface and slightly yellowish color in the duodenal bulb. A long strip shaped mass with very low density in the duodenal was found in abdominal computed tomography . The mass was removed successful by endoscopic mucosal resection. The resected specimen measured 1.5 × 3.0-cm. Histopathology examination revealed a tumor in the submucosa which composed of mature adipose tissue and proliferative blood vessels. The final diagnosis was duodenal angiolipoma. The patient was discharged home uneventfully and no symptoms was observed in 6 months follow-up.None.

The KRAS/Lin28B axis maintains stemness of pancreatic cancer cells via the let-7i/TET3 pathway.

Increasing evidence demonstrates that Lin28B plays critical roles in numerous biological processes including cell proliferation and stemness maintenance. However, the molecular mechanisms underlying Lin28B nuclear translocation remain poorly understood. Here, we found for the first time that KRAS promoted Lin28B nuclear translocation through PKCß, which directly bound to and phosphorylated Lin28B at S243. Firstly, we observed that Lin28B was upregulated in pancreatic cancer, contributing to cellular migration and proliferation. Furthermore, nuclear Lin28B upregulated TET3 messenger RNA and protein levels by blocking the production of mature let-7i. Subsequently, increased TET3 expression could also promote the expression of Lin28B, thereby forming a Lin28B/let-7i/TET3 feedback loop. Our results suggest that the KRAS/Lin28B axis drives the let-7i/TET3 pathway to maintain the stemness of pancreatic cancer cells. These findings illuminate the distinct mechanism of Lin28B nuclear translocation and its important roles in KRAS-driven pancreatic cancer, and have important implications for development of novel therapeutic strategies for this cancer.

Downregulation of IQGAP1 inhibits epithelial-mesenchymal transition via the HIF1α/VEGF-A signaling pathway in gastric cancer.

As an oncogene, IQ-domain GTPase-activating protein 1 (IQGAP1) regulates the epithelial-mesenchymal transition (EMT) of several cancers, such as breast cancer, thyroid cancer, and esophageal squamous cell carcinoma. However, the role of the scaffold protein IQGAP1 on EMT in gastric cancer remains unclear. Therefore, the present work was performed to address the question. Our results showed that IQGAP1 expression is upregulated in human gastric cancer specimens and cell lines. Furthermore, IQGAP1 knockdown inhibited the migratory ability of gastric cancer cells and reduced the expression of mesenchymal phenotype markers, including Slug, ß-catenin, Snail, Vimentin, and N-cadherin, as well as vascular endothelial growth factor-A (VEGF-A) secretion in gastric cancer cells. Conversely, IQGAP1 downregulation increased the epithelial phenotype marker E-cadherin. Furthermore, IQGAP1 silencing not only downregulated hypoxia-inducible transcription factor 1α (HIF1α) but also limited its translocation from the cytosol to the nucleus. Collectively, our results indicated that EMT was regulated by IQGAP1, which was associated with VEGF-A, since other data demonstrated that HIF1α was involved in VEGF-A expression. Therefore, we speculated that IQGAP1 regulated EMT of gastric cancer partially via the HIF1α/VEGF-A signaling pathway. IQGAP1 may serve as an effective therapeutic biomarker for gastric cancer.