Gastric adenocarcinoma of fundic gland mucosa type localized in the submucosa: A case report.

RATIONALE: Gastric adenocarcinoma of fundic gland type (GA-FG) is a new histological type of gastric cancer manifesting with differentiation into a fundic gland. Furthermore, gastric adenocarcinoma of fundic gland mucosa type (GA-FGM) is a tumor that shows differentiation into not only a fundic gland but also foveolar epithelium and a mucous gland. These tumors tend to invade the submucosal layer. However, no cases of these tumors being localized only in the submucosa have been reported. Here, we present a case of GA-FGM localized in the submucosa and describe the cytological features of this tumor. To our knowledge, this is the first reported case of GA-FGM localized in the submucosa. PATIENT CONCERNS: A man in his early 70s was referred to our institution because of the detection of a gastric submucosal tumor during a health checkup. DIAGNOSES: Gastric adenocarcinoma of fundic gland mucosa type. INTERVENTIONS: Endoscopic ultrasound-guided fine-needle aspiration (FNA), endoscopic submucosal dissection (ESD), and total gastrectomy with lymph node dissection were performed. OUTCOMES: The FNA specimen showed epithelial cells with low-grade atypia. In the ESD specimen, adenocarcinoma showing a gastric fundic gland mucosa-like morphology was observed. Immunohistochemical analysis showed positive staining for pepsinogen I, H+/K+-adenosine triphosphatase, MUC6, and MUC5AC and negative staining for MUC2 and CD10, indicating tumor differentiation into fundic gland mucosa. Therefore, the tumor was diagnosed as GA-FGM, with localization in the submucosal layer. Total gastrectomy and lymph node dissection were performed because of the positive margins of the ESD specimen. Neither residual tumor nor lymph node metastasis was detected; however, many foci of heterotopic gastric glands (HGGs) were observed in the gastric wall, suggesting that GA-FGM arose from an HGG. After treatment, no recurrence was observed during a 1-year follow-up period. LESSONS: Various tumors may arise from HGGs. Furthermore, when an FNA specimen shows gastric fundic gland mucosa-like epithelial cells with weak atypia, the possibility of GA-FG and GA-FGM should be considered.

Prognostic factors in patients with idiopathic portal hypertension: Two Japanese nationwide epidemiological surveys in 1999 and 2005.

AIM: To investigate factors affecting disease prognosis among patients with idiopathic portal hypertension (IPH). METHODS: Two Japanese nationwide epidemiological surveys on IPH were conducted in 1999 and 2005. Analyzing data from each cross-sectional survey separately, we examined the consistent prognostic factors detected from each analysis and assessed the effect of treatments for varices on IPH prognosis. Outcome was the disease condition at last observation compared with that at diagnosis, categorized into two levels (recovered/improved and unchanged/aggravated/deceased). To evaluate the association with each characteristic, we calculated adjusted odds ratio (OR) and 95% confidence interval (CI) using a binary model for logistic regression. RESULTS: Among 160 patients with IPH in 1999 and 85 in 2005, 10% had aggravated disease at a mean of 6-7 years after the diagnosis. Statistically significant ORs were observed for two factors: esophageal varices, especially of F(2-3) stage, at diagnosis (OR = 6.83, 95% CI = 2.10-22.1 in 1999; OR = 10.7, 95% CI = 1.08-105 in 2005) ameliorated IPH; and hepatic encephalopathy at diagnosis (OR = 0.19, 95% CI = 0.03-1.04 in 1999; crude OR = 0.05, 95% CI = 0.01-0.60 in 2005 using a proportional odds model) worsened IPH. Further analyses explained that the apparent ameliorating effect of esophageal varices was due to the effect of subsequent treatment (OR = 4.59, 95% CI = 0.89-23.7 in 2005). CONCLUSION: The prognosis of IPH would be better if varices were adequately controlled. Patients with liver failure at diagnosis would be at high risk for subsequent disease aggravation.

Establishment and issues of new educational system by nutrition teachers.

The Japanese school lunch system, which has over 100 y of history, has gained world attention for its well-developed and steady system, healthy Japanese-style menus including rice, and educational programs utilizing the school lunch system. Meanwhile, risk factors of health among students have been continuously worsening for the past dozen years or so. Therefore, Japan had hastened to develop better educational programs utilizing the school lunch and nutritional teachers. Under such circumstances, the Japanese Diet passed a bill to amend the School Education Law (hereinafter called the Amendment) which includes the establishment of an educational system by nutrition teachers in May, 2004. This system will be enforced in April, 2005. This system by nutrition teachers in Japan is well organized in both the legal and administrative senses and is attracting domestic and international attention as an example of an educational measure to improve the dietary life of students. The reason for this article in English is the additional intention of enlightening other countries by showing the political promotion problems of educational administration agencies, educational contents of nutrition teachers and some issues of the new educational system by nutrition teachers.

Food and nutrient intakes among nomads living in three different areas of Inner Mongolia, China.

The subjects, from Mongolian-style gel tribes, aged 6-79 years, living in three different areas of Inner Mongolia, were asked about their daily food consumption in August 2001 using the 24-hr dietary recall method. There were no significant differences in food intakes between males and females of the same age group in the same area, with a few exceptions, although considerable variation was found among individuals and areas for the amount of foods consumed. Some subjects consumed greater amounts of wheat, vegetables, fruits, and vegetable oils, which suggested they had changed their eating patterns. All subjects drank large quantities of tea, to which was added milk (sheep/goat), cream, butter, parched millet and/or sawa. This traditional tea supplied vitamins and minerals such as vitamin A, iron and calcium.