Journals Clinical Journal of Gastroente...

Clinical Journal of Gastroenterology
Sami Matrood, Christian Görg, Ehsan Safai Zadeh, Amjad Alhyari
Perivascular epithelioid cell tumors (PEComa) are rare mesenchymal neoplasms that arise from soft tissue of various organs such as the stomach, intestines, and lungs. We report a rare case of a primary PEComa of the liver and its characteristics on contrast-enhanced ultrasound (CEUS) in a 51-year-old female patient with an incidental finding of a hypoechoic liver lesion with peripheral hypervascularization on Doppler ultrasound. CEUS showed homogenous hypervascularity in the arterial phase that was consistent in the portal phase...
March 25, 2023: Clinical Journal of Gastroenterology
Chihiro Matsumoto, Naoki Enomoto, Kazuhiko Yamada, Daiki Kato, Shusuke Yagi, Kyoko Nohara, Norihiro Kokudo, Kento Misumi, Toru Igari
A 78-year-old man presented with a large abdominal mass detected by ultrasonography during a regular checkup. Even if the mass was > 10 cm in diameter, he was asymptomatic. Computed tomography detected an oval-shaped mass, with a maximum diameter of 12 cm, adjacent to the greater curvature of the stomach. Esophagogastroduodenoscopy revealed a 20 mm slightly depressed (type 0-IIc) lesion on the posterior wall of the gastric antrum, which was confirmed to be adenocarcinoma. Three cycles of combination chemotherapy with S-1 and oxaliplatin were administered as neoadjuvant chemotherapy...
March 25, 2023: Clinical Journal of Gastroenterology
Makomo Makazu, Kazuya Koizumi, Sakue Masuda, Ryuhei Jinushi, Kento Shionoya, Toshitaka Tsukiyama
Spontaneous retroperitoneal hematoma is rare and can cause duodenal obstruction. We report four cases of spontaneous retroperitoneal hematoma with duodenal obstruction, wherein endoscopic ultrasound was useful for diagnosis. The patients complained of vomiting with stable vital signs. Computed tomography, esophagogastroduodenoscopy, and endoscopic ultrasound findings were similar in all cases. Contrast-enhanced computed tomography revealed a low-density mass around the 2nd to 3rd part of the duodenum. Esophagogastroduodenoscopy showed an edematous, reddish, but non-neoplastic duodenal mucosa with stenosis of the lumen...
March 24, 2023: Clinical Journal of Gastroenterology
Kazuki Nakamura, Yasutaka Ishii, Masahiro Serikawa, Tomofumi Tsuboi, Tetsuro Hirano, Shinya Nakamura, Juri Ikemoto, Kenichiro Uemura, Koji Arihiro, Shiro Oka
Solid pseudopapillary neoplasm (SPN) of the pancreas is a low-grade, malignant pancreatic tumor that occurs predominantly in young females. In this report, an extremely rare case of multicentric SPNs in a middle-aged male is discussed. A 55-year-old man was incidentally found to have a mass in the pancreatic body on abdominal ultrasonography during a medical checkup. Contrast-enhanced computed tomography (CT) revealed masses with 50-mm and 25-mm diameters with internal calcification in the pancreatic body and tail, respectively...
March 23, 2023: Clinical Journal of Gastroenterology
Toshihiro Nakayama, Kyoji Ito, Fuyuki Inagaki, Michi Kobayashi, Akiyo Tanabe, Fuminori Mihara, Nobuyuki Takemura, Norihiro Kokudo
In malignant pheochromocytoma, the survival benefit of metastasectomy remains unclear. However, excessive catecholamines secreted from pheochromocytomas can cause cardiovascular and cerebrovascular complications. Debulking metastasectomy can be performed to reduce excess catecholamine secretion when curative resection is impossible. We present a case of metastatic pheochromocytoma to the liver, wherein a significant reduction in catecholamine secretion was achieved by repeat debulking hepatectomy. A 62-year-old woman who had undergone left adrenalectomy for primary pheochromocytoma 10 years prior to our surgical management, had multiple liver metastases of pheochromocytoma...
March 21, 2023: Clinical Journal of Gastroenterology
Mai Nakamura, Fuyuki Inagaki, Nobuyuki Takemura, Yuhi Yoshizaki, Kyoji Ito, Fuminori Mihara, Norihiro Kokudo
Primary pancreatic signet ring cell carcinoma (PPSRCC) is a rare and aggressive tumor with poor prognosis. Here, we report a case of PPSRCC treated with curative surgery. A 49-year-old man presented with right mid-abdominal pain. Imaging tests showed a 3.6 cm tumor extending around the head of the pancreas, the second portion of the duodenum, and the retroperitoneum. Involvement of the right proximal ureter resulted in moderate right hydronephrosis. A subsequent tumor biopsy revealed suspected pancreatic adenocarcinoma...
March 20, 2023: Clinical Journal of Gastroenterology
Taiki Okumura, Takefumi Kimura, Yu Hihara, Katsuaki Inoue, Atsushi Maruyama, Satoru Joshita, Takeji Umemura
Primary biliary cholangitis (PBC) is a chronic progressive cholestatic liver disease of uncertain etiology. Although PBC is frequently complicated by Sjögren's syndrome and chronic thyroiditis, it can also be associated with a variety of other autoimmune disorders. We herein describe a rare case of immune thrombocytopenic purpura (ITP) coexistence with PBC and localized cutaneous systemic sclerosis (LcSSc). A 47-year-old woman with PBC and LcSSc who was positive for antiphospholipid antibody experienced a rapid decrease in platelet count to 1...
March 4, 2023: Clinical Journal of Gastroenterology
Masayuki Akita, Hiroaki Yanagimoto, Daisuke Tsugawa, Tetsuo Ajiki, Atsuhiro Masuda, Masato Komatsu, Tadahiro Goto, Masahiro Kido, Hirochika Toyama, Takumi Fukumoto
BACKGROUND: Intracholecystic papillary neoplasm (ICPN) is one of the precursors of gallbladder cancer defined in the 2010 World Health Organization classification of tumors. We herein report ICPN with pancreaticobiliary maljunction (PBM), which is a high-risk factor for biliary cancer. CASE PRESENTATION: A 57-year-old female presented with abdominal pain. Computed tomography showed a swollen appendix and gallbladder nodules with bile duct dilatation. Endoscopic ultrasonography revealed a gallbladder tumor spreading into the cystic duct confluence accompanying PBM...
March 3, 2023: Clinical Journal of Gastroenterology
Kazuya Miyaguchi, Hiroshi Yamaguchi, Yoshikazu Tsuzuki, Hajime Tokita, Hisashi Matsumoto, Hideki Ohgo, Shinichi Ban, Hidetomo Nakamoto, Hiroyuki Imaeda
The pathologic diagnosis of duodenal tumors is a developing field; however, its overview remains unclear. We describe a rare case of a duodenal gastric-type neoplasm in a 50-year-old woman. She visited her primary care doctor with complaints of upper abdominal pain, tarry stools, and shortness of breath on exertion. She was admitted owing to a stalked polyp with erosion and hemorrhage in the descending part of the duodenum. Endoscopic mucosal resection (EMR) was performed on the polyp. Histologically, the resected polyp was a lipomatous lesion in the submucosal layer, composed of mature adipose tissues...
March 3, 2023: Clinical Journal of Gastroenterology
Tetsu Tomonari, Hironori Tanaka, Takahiro Tanaka, Tatsuya Taniguchi, Masahiro Sogabe, Yutaka Kawano, Koichi Okamoto, Hiroshi Miyamoto, Yasushi Sato, Tetsuji Takayama
The efficacy of lenvatinib (LEN) plus transcatheter arterial chemoembolization (LEN-TACE) has been reported, but its effect on unresectable hepatocellular carcinoma (HCC) refractory to LEN therapy has not been demonstrated. We report a case of HCC refractory to multiple molecular-targeted agents (MTA) treatments, including LEN, that was successfully treated with LEN-TACE. A 59-year-old man was referred to our department with multiple HCCs and a background of hepatitis B virus infection. TACE was the initial treatment...
March 1, 2023: Clinical Journal of Gastroenterology
Nozomi Furuichi, Atsushi Naganuma, Takuya Kaburagi, Yuhei Suzuki, Takashi Hoshino, Nobuyuki Shibusawa, Suguru Horiguchi, Takeshi Hatanaka, Satoru Kakizaki, Toshio Uraoka
We herein report three cases of immune-related hypopituitarism after atezolizumab-bevacizumab treatment for hepatocellular carcinoma (HCC). Case 1 was a man in his 60s with hepatitis C-related liver cirrhosis. He had been diagnosed with HCC and undergone surgical resection. However, HCC recurred 17 months after surgery. After 13 cycles of atezolizumab-bevacizumab therapy, general fatigue, appetite loss, and muscle weakness appeared. The plasma levels of adrenocorticotropic hormone (ACTH) and cortisol were decreased...
February 23, 2023: Clinical Journal of Gastroenterology
Shintaro Iwanaga, Hiroko Inomata, Maiko Tabuchi, Ryu Sasaki, Naoyuki Yamaguchi, Kazuhiko Nakao
Right aortic arch is caused by a malformation of the aorta while Kommerell's diverticulum is a saccular aneurysm arising at the origin of the subclavian artery. Both diseases are caused by malformations during embryonic development and can subsequently cause compression of the esophagus and trachea due to abnormal arterial migration. Here, we report five cases of esophageal stenosis due to aortic angiogenesis anomalies. Three of the five cases had aortic running abnormalities, noted on computed tomography (CT)...
February 23, 2023: Clinical Journal of Gastroenterology
Ai Toyodome, Seiichi Mawatari, Ohki Taniyama, Sho Ijuin, Haruka Sakae, Kazuaki Tabu, Kohei Oda, Kotaro Kumagai, Takashi Tasaki, Akio Ido
An 87-year-old man consulted a former doctor with a complaint of black stool and was admitted to hospital because of anemia and multiple gastric ulcers. The laboratory findings showed that his hepatobiliary enzyme levels and inflammatory response were elevated. Computed tomography showed hepatosplenomegaly and enlarged intra-abdominal lymph nodes. Two days later, he was transferred to our hospital due to deterioration of his liver function. Since he had low level of consciousness and his ammonia level was high, we diagnosed him with acute liver failure (ALF) with hepatic coma, and started on-line hemodiafiltration...
February 22, 2023: Clinical Journal of Gastroenterology
Yumiko Yamashita, Yasutaka Ishii, Masahiro Serikawa, Wataru Okamoto, Tomofumi Tsuboi, Yumiko Tatsukawa, Shinya Nakamura, Tetsuro Hirano, Juri Ikemoto, Shiro Oka
Intrahepatic cholangiocarcinoma (ICC) is a malignant liver tumor with poor prognosis. Various mutations in cancer-predisposing genes have been reported in ICC, and germline BRCA1/2 mutations, which are the causative genes for hereditary breast and ovarian cancer syndrome (HBOC), have been reported in many patients with ICC. Here, we report a case of unresectable ICC with a germline BRCA1 mutation. A 73-year-old man was found to have a mass in the left lobe of the liver on abdominal ultrasonography during a medical check-up and was referred to our institution...
February 17, 2023: Clinical Journal of Gastroenterology
Takanobu Iwadare, Takefumi Kimura, Yusuke Nagata, Hiroshi Suzuki, Hideo Kunimoto, Hiroyuki Kitabatake, Ayako Seki, Yasuhide Ochi, Etsuo Hara, Takeji Umemura
Malignant peritoneal mesothelioma (MPeM) is a rare disease with a poor prognosis that develops in the mesothelial cells of the peritoneum. We encountered a 48-year-old man with no prior asbestos exposure who visited our hospital with abdominal pain. Laboratory findings showed elevated C-reactive protein of 15.5 mg/dL. Contrast-enhanced computed tomography (CT) detected a Fitz-Hugh-Curtis syndrome-like contrast effect on the liver surface and thickening of the peritoneum. Blood culture, Mycobacterium tuberculosis-specific IFN-γ release assay, Chlamydia trachomatis and Neisseria gonorrhoeae DNA testing, and antinuclear antibody were all negative...
February 13, 2023: Clinical Journal of Gastroenterology
Takumi Yanagita, Takuto Hikichi, Yuichi Waragai, Hiroshi Shimizu, Yuta Takahashi, Naoto Abe, Choichiro Hashimoto, Hiromi Kumakawa, Masao Kobayakawa, Hiromasa Ohira
The malignant gastrointestinal endometriosis transformation is represented by endometriosis-associated intestinal tumors. Endometrioid adenocarcinoma and clear cell adenocarcinoma are most common among the endometrial cancers of all organs. Only four cases of mixed serous carcinoma and large cell neuroendocrine carcinoma have been reported, and all these cases originated from the uterus. A 59-year-old woman with a month's history of bloody stools was admitted. She was stable until the hematochezia occurred but is 11 years post-hysterectomy...
February 10, 2023: Clinical Journal of Gastroenterology
Satoshi Takakusagi, Hinako Tanaka, Atsushi Naganuma, Satoru Kakizaki, Kei Shibuya, Tatsuya Ohno, Hitoshi Takagi, Toshio Uraoka
We herein report two cases of huge hepatocellular carcinoma (HCC) that were successfully treated by carbon ion radiotherapy after atezolizumab plus bevacizumab treatment. Case 1, an 84-year-old man, was diagnosed with HCC (maximum diameter: 11 cm) with portal invasion and presented HCC rupture. After obtaining hemostasis with transcatheter embolization, three cycles of atezolizumab-bevacizumab therapy were administered, and marked shrinkage of the HCC was confirmed. However, he developed jaundice, liver damage and cerebral subcortical hemorrhage...
February 7, 2023: Clinical Journal of Gastroenterology
Masanori Fukushima, Kazuaki Tajima, Ryu Sasaki, Yasuhiko Nakao, Kosuke Takahashi, Eisuke Ozawa, Satoshi Miuma, Takeharu Kato, Hisamitsu Miyaaki, Kazuhiko Nakao
An 86-year-old man presented with recurrence of hepatocellular carcinoma (HCC) after surgery. Atezolizumab plus bevacizumab was initiated. After the third course of atezolizumab plus bevacizumab therapy, petechial purpura appeared on the extremities and trunk. Laboratory tests revealed isolated severe thrombocytopenia without evidence of combined coagulopathy. He was diagnosed with immune thrombocytopenic purpura (ITP), and high-dose immunoglobulin and Helicobacter pylori eradication therapies were administered...
February 6, 2023: Clinical Journal of Gastroenterology
Naoshi Odagiri, Akihiro Tamori, Kohei Kotani, Hiroyuki Motoyama, Etsushi Kawamura, Atsushi Hagihara, Hideki Fujii, Sawako Uchida-Kobayashi, Masaru Enomoto, Norifumi Kawada
Atezolizumab plus bevacizumab (Atezo + Bev) is the first immunotherapy for hepatocellular carcinoma (HCC), and in the current guidelines, it is positioned as the first-line chemotherapy for unresectable cases. Herein, we report a case of HCC with pseudoprogression followed by a complete response to Atezo + Bev. A 56 year-old man was diagnosed with intermediate-stage HCC, as defined by the Barcelona Clinic Liver Cancer system stage B. Computed tomography (CT) revealed multiple lesions in the liver without any extrahepatic lesions...
February 5, 2023: Clinical Journal of Gastroenterology
Shinnosuke Nakayama, Kazuyoshi Matsumura, Akihisa Fukuda, Hiroshi Seno
A 54-year-old man referred to our hospital for abdominal distension. He had no medical history. On physical examination, he complained lower abdominal distention, and had no spontaneous pain or tenderness. The blood tests showed that CEA and CA19-9 levels were within normal limits. Colonoscopy revealed a submucosal tumor with irregularities and mucosal defects in the descending colon. Computed tomography (CT) showed a 3-cm-diameter mass in the descending colon and ascites. Due to the presence of ascites, laparoscopic examination was performed, which revealed multiple peritoneal seeding of the tumor...
February 3, 2023: Clinical Journal of Gastroenterology
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