BACKGROUND Colorectal cavernous hemangioma is a rare vascular malformation resulting in recurrent lower gastrointestinal hemorrhage,and can be misinterpreted as colitis.Surgical resection is currently the mainstay of ...BACKGROUND Colorectal cavernous hemangioma is a rare vascular malformation resulting in recurrent lower gastrointestinal hemorrhage,and can be misinterpreted as colitis.Surgical resection is currently the mainstay of treatment,with an emphasis on sphincter preservation.CASE SUMMARY We present details of two young patients with a history of persistent hematochezia diagnosed with colorectal cavernous hemangioma by endoscopic ultrasound(EUS).Cavernous hemangioma was relieved by several EUS-guided lauromacrogol injections and the patients achieved favorable clinical prognosis.CONCLUSION Multiple sequential EUS-guided injections of lauromacrogol is a safe,effective,cost-efficient,and minimally invasive alternative for colorectal cavernous hemangioma.展开更多
AIM: To analyze the clinical characteristics of small bowel tumors detected by double-balloon enteroscopy (DBE) and to evaluate the diagnostic value of DBE in tumors. METHODS: Four hundred and forty consecutive DBE ex...AIM: To analyze the clinical characteristics of small bowel tumors detected by double-balloon enteroscopy (DBE) and to evaluate the diagnostic value of DBE in tumors. METHODS: Four hundred and forty consecutive DBE examinations were performed in 400 patients (250 males and 150 females, mean age 46.9 ± 16.3 years, range 14-86 years) between January 2007 and April 2012. Of these, 252 patients underwent the antegrade approach, and 188 patients underwent the retrograde approach. All the patients enrolled in our study were suspected of having small bowel diseases with a negative etiological diagnosis following other routine examinations, such as upper and lower gastrointestinal endoscopy and radiography tests. Data on tumors, such as clinical information, endoscopic findings and opera-tion results, were retrospectively collected. RESULTS: Small bowel tumors were diagnosed in 78 patients, of whom 67 were diagnosed using DBE, resulting in a diagnostic yield of 16.8% (67/400); the other 11 patients had negative DBE findings and were diagnosed through surgery or capsule endoscopy. Adenocarcinoma (29.5%, 23/78), gastrointestinal stromal tumor (24.4%, 19/78) and lymphoma (15.4%, 12/78) were the most common tumors. Among the 78 tumors, 60.3% (47/78) were located in the jejunum, and the overall number of malignant tumors was 74.4% (58/78). DBE examinations were frequently performed in patients with obscure gastrointestinal bleeding (47.4%) and abdominal pain (24.4%). The positive detection rate for DBE in the 78 patients with small bowel tumors was 85.9% (67/78), which was higher than that of a computed tomography scan (72.9%, 51/70). Based on the operation results, the accuracy rates of DBE for locating small bowel neoplasms, such as adenocarcinoma, gastrointestinal stromal tumor and lymphoma, were 94.4%, 100% and 100%, respectively. The positive biopsy rates for adenocarcinoma and lymphoma were 71.4% and 60%, respectively. CONCLUSION: DBE is a useful diagnostic tool with high clinical practice value and should be considered the gold standard for the investigation of small bowel tumors.展开更多
AIM:To study the diagnostic value of immunoglobulin heavy chain(IgH)and T-cell receptorγ (TCR-γ)gene monoclonal rearrangements in primary gastric lymphoma(PGL).METHODS:A total of 48 patients with suspected PGL at ou...AIM:To study the diagnostic value of immunoglobulin heavy chain(IgH)and T-cell receptorγ (TCR-γ)gene monoclonal rearrangements in primary gastric lymphoma(PGL).METHODS:A total of 48 patients with suspected PGL at our hospital were prospectively enrolled in this study from January 2009 to December 2011.The patients were divided into three groups(a PGL group,a gastric linitis plastica group,and a benign gastric ulcer group)based on the pathological results(gastric mucosal specimens obtained by endoscopy or surgery)and follow-up.Endoscopic ultrasonography(EUS)and EUSguided biopsy were performed in all the patients.The tissue specimens were used for histopathological examination and for IgH and TCR-γ gene rearrangement polymerase chain reaction analyses.RESULTS:EUS and EUS-guided biopsy were successfully performed in all 48 patients.In the PGL group(n=21),monoclonal IgH gene rearrangements were detected in 14(66.7%)patients.A positive result for each set of primers was found in 12(57.1%),8(38.1%),and 4(19.0%)cases using FR1/JH,FR2/JH,and FR3/JH primers,respectively.Overall,12(75%)patients with mucosal-associated lymphoid tissue lymphoma(n=16)and 2(40%)patients with diffuse large B-cell lymphoma(n=5)were positive for monoclonal IgH gene rearrangements.No patients in the gastric linitis plastica group(n=17)and only one(10%)patient in the benign gastric ulcer group(n=10)were positive for a monoclonal IgH gene rearrangement.No TCRgene monoclonal rearrangements were detected.The sensitivity of monoclonal IgH gene rearrangements was 66.7%for a PGL diagnosis,and the specificity was96.4%.In the PGL group,8(100%)patients with stage IIE PGL(n=8)and 6(46.1%)patients with stage IE PGL(n=13)were positive for monoclonal IgH gene rearrangements.CONCLUSION:IgH gene rearrangements may be associated with PGL staging and may be useful for the diagnosis of PGL and for differentiating between PGL and gastric linitis plastica.展开更多
Heterotopic gastric mucosa(HGM) in the rectum is an extremely rare clinical entity which may be missed or misdiagnosed due to a lack of knowledge.In the present study,a 14-year-old girl visited our hospital due to a 5...Heterotopic gastric mucosa(HGM) in the rectum is an extremely rare clinical entity which may be missed or misdiagnosed due to a lack of knowledge.In the present study,a 14-year-old girl visited our hospital due to a 5-year history of repeated hematochezia.Colonoscopy showed a solitary superficial depressed lesion approximately 5 cm in size and a concomitant 1.5 cm deep diverticulum in the rectum.Histological examination of the endoscopic biopsy showed typical ectopic gastric mucosa in the depressed lesion and inside the diverticulum.Narrow band imaging further confirmed the histological results.Endoscopic ultrasound indicated that the lesion originated from the mucosal layer,and partially involved the submucosal layer.Endoscopic submucosal dissection was performed in this patient due to the large size and shape of the lesion.No bleeding,perforation or other adverse events were observed.The presence of HGM in the diverticular cavity greatly increased the surgical difficulty.A literature review was also carried out in our study.展开更多
BACKGROUND Angiolipoma is a benign tumor and is generally found in subcutaneous tissues.Angiolipomas are rare in the gastrointestinal tract,including the stomach.Preoperative diagnosis of the tumor is difficult,althou...BACKGROUND Angiolipoma is a benign tumor and is generally found in subcutaneous tissues.Angiolipomas are rare in the gastrointestinal tract,including the stomach.Preoperative diagnosis of the tumor is difficult,although there are several radiological examinations such as computed tomography and endoscopic ultrasound.CASE SUMMARY We report a 24-year-old Chinese man with multiple gastric angiolipomas,with a positive stool occult blood examination. Endoscopic biopsy only showed nonspecific inflammation. Histological examination of the specimen by endoscopic snare resection showed that the tumor consisted of adipose tissues and blood vessels. We also performed a literature review. After the use of proton pump inhibitor,the fecal occult blood test was negative. Due to the difficulty of resecting multiple lesions in the stomach completely and the benign characteristics of angiolipoma,we chose to have regular upper gastrointestinal endoscopy evaluation of the lesion. No evidence of significant change in lesion size was detected after 3-years follow-up.CONCLUSION Gastric angiolipoma is rare,and benign neoplasm should be considered when lesions occur submucosally in the gastrointestinal tract.展开更多
BACKGROUND Gastric metastasis from renal cell carcinoma(RCC) is an extremely rare clinical entity.Due to an easily neglected RCC history,nonspecific symptoms and underrecognized endoscopic presentation may lead to a p...BACKGROUND Gastric metastasis from renal cell carcinoma(RCC) is an extremely rare clinical entity.Due to an easily neglected RCC history,nonspecific symptoms and underrecognized endoscopic presentation may lead to a potential diagnostic pitfall in daily clinical practice.CASE SUMMARY We present a case of metastatic gastric tumors arising from RCC 5 years after radical nephrectomy.Simultaneous,multifocal metastases to the gallbladder,pancreas and soft tissue were observed.One year previously,a solitary submucosal discoid tumor with a central depression was detected in the gastric fundus in a 65-year-old man.Endoscopic ultrasonography(EUS) showed a 1.12 x 0.38 cm lesion originating from the deeper mucosal layers with partially discontinuous submucosa.One year later,the endoscopic findings of the lesion showed various changes.A large lesion of the protruding type(2.5 cm × 2 cm) was found in the fundus at the same location.EUS showed a heterogeneous mass that involved the mucosa and submucosal layer.In addition,two small similar submucosal lesions 0.4-0.6 cm in size were detected.These lesions had a central depression,surface mucosal congestion and thickened vessels.The two adjacent lesions in the fundus were resected by endoscopic submucosal dissection.Based on the postoperative pathological analysis,the patient was diagnosed with gastric metastasis from RCC.CONCLUSION Gastric metastasis from RCC should be considered in patients with a history of RCC irrespective of the time interval involved.展开更多
基金Supported by Natural Science Foundation of Zhejiang Province,No.LY20H030010Medical Health Science and Technology Project of Zhejiang Provincial Health Commission,No.2019-KY1-001-181.
文摘BACKGROUND Colorectal cavernous hemangioma is a rare vascular malformation resulting in recurrent lower gastrointestinal hemorrhage,and can be misinterpreted as colitis.Surgical resection is currently the mainstay of treatment,with an emphasis on sphincter preservation.CASE SUMMARY We present details of two young patients with a history of persistent hematochezia diagnosed with colorectal cavernous hemangioma by endoscopic ultrasound(EUS).Cavernous hemangioma was relieved by several EUS-guided lauromacrogol injections and the patients achieved favorable clinical prognosis.CONCLUSION Multiple sequential EUS-guided injections of lauromacrogol is a safe,effective,cost-efficient,and minimally invasive alternative for colorectal cavernous hemangioma.
文摘AIM: To analyze the clinical characteristics of small bowel tumors detected by double-balloon enteroscopy (DBE) and to evaluate the diagnostic value of DBE in tumors. METHODS: Four hundred and forty consecutive DBE examinations were performed in 400 patients (250 males and 150 females, mean age 46.9 ± 16.3 years, range 14-86 years) between January 2007 and April 2012. Of these, 252 patients underwent the antegrade approach, and 188 patients underwent the retrograde approach. All the patients enrolled in our study were suspected of having small bowel diseases with a negative etiological diagnosis following other routine examinations, such as upper and lower gastrointestinal endoscopy and radiography tests. Data on tumors, such as clinical information, endoscopic findings and opera-tion results, were retrospectively collected. RESULTS: Small bowel tumors were diagnosed in 78 patients, of whom 67 were diagnosed using DBE, resulting in a diagnostic yield of 16.8% (67/400); the other 11 patients had negative DBE findings and were diagnosed through surgery or capsule endoscopy. Adenocarcinoma (29.5%, 23/78), gastrointestinal stromal tumor (24.4%, 19/78) and lymphoma (15.4%, 12/78) were the most common tumors. Among the 78 tumors, 60.3% (47/78) were located in the jejunum, and the overall number of malignant tumors was 74.4% (58/78). DBE examinations were frequently performed in patients with obscure gastrointestinal bleeding (47.4%) and abdominal pain (24.4%). The positive detection rate for DBE in the 78 patients with small bowel tumors was 85.9% (67/78), which was higher than that of a computed tomography scan (72.9%, 51/70). Based on the operation results, the accuracy rates of DBE for locating small bowel neoplasms, such as adenocarcinoma, gastrointestinal stromal tumor and lymphoma, were 94.4%, 100% and 100%, respectively. The positive biopsy rates for adenocarcinoma and lymphoma were 71.4% and 60%, respectively. CONCLUSION: DBE is a useful diagnostic tool with high clinical practice value and should be considered the gold standard for the investigation of small bowel tumors.
基金Supported by The Scientific Research Foundation of the Ministry of Health,China,the Medical and Health Science Foundation,Zhejiang Province,China,No.WKJ-2009-2-021
文摘AIM:To study the diagnostic value of immunoglobulin heavy chain(IgH)and T-cell receptorγ (TCR-γ)gene monoclonal rearrangements in primary gastric lymphoma(PGL).METHODS:A total of 48 patients with suspected PGL at our hospital were prospectively enrolled in this study from January 2009 to December 2011.The patients were divided into three groups(a PGL group,a gastric linitis plastica group,and a benign gastric ulcer group)based on the pathological results(gastric mucosal specimens obtained by endoscopy or surgery)and follow-up.Endoscopic ultrasonography(EUS)and EUSguided biopsy were performed in all the patients.The tissue specimens were used for histopathological examination and for IgH and TCR-γ gene rearrangement polymerase chain reaction analyses.RESULTS:EUS and EUS-guided biopsy were successfully performed in all 48 patients.In the PGL group(n=21),monoclonal IgH gene rearrangements were detected in 14(66.7%)patients.A positive result for each set of primers was found in 12(57.1%),8(38.1%),and 4(19.0%)cases using FR1/JH,FR2/JH,and FR3/JH primers,respectively.Overall,12(75%)patients with mucosal-associated lymphoid tissue lymphoma(n=16)and 2(40%)patients with diffuse large B-cell lymphoma(n=5)were positive for monoclonal IgH gene rearrangements.No patients in the gastric linitis plastica group(n=17)and only one(10%)patient in the benign gastric ulcer group(n=10)were positive for a monoclonal IgH gene rearrangement.No TCRgene monoclonal rearrangements were detected.The sensitivity of monoclonal IgH gene rearrangements was 66.7%for a PGL diagnosis,and the specificity was96.4%.In the PGL group,8(100%)patients with stage IIE PGL(n=8)and 6(46.1%)patients with stage IE PGL(n=13)were positive for monoclonal IgH gene rearrangements.CONCLUSION:IgH gene rearrangements may be associated with PGL staging and may be useful for the diagnosis of PGL and for differentiating between PGL and gastric linitis plastica.
基金Supported by the National Natural Science Foundation of China,No.81600413 and No.81600414
文摘Heterotopic gastric mucosa(HGM) in the rectum is an extremely rare clinical entity which may be missed or misdiagnosed due to a lack of knowledge.In the present study,a 14-year-old girl visited our hospital due to a 5-year history of repeated hematochezia.Colonoscopy showed a solitary superficial depressed lesion approximately 5 cm in size and a concomitant 1.5 cm deep diverticulum in the rectum.Histological examination of the endoscopic biopsy showed typical ectopic gastric mucosa in the depressed lesion and inside the diverticulum.Narrow band imaging further confirmed the histological results.Endoscopic ultrasound indicated that the lesion originated from the mucosal layer,and partially involved the submucosal layer.Endoscopic submucosal dissection was performed in this patient due to the large size and shape of the lesion.No bleeding,perforation or other adverse events were observed.The presence of HGM in the diverticular cavity greatly increased the surgical difficulty.A literature review was also carried out in our study.
文摘BACKGROUND Angiolipoma is a benign tumor and is generally found in subcutaneous tissues.Angiolipomas are rare in the gastrointestinal tract,including the stomach.Preoperative diagnosis of the tumor is difficult,although there are several radiological examinations such as computed tomography and endoscopic ultrasound.CASE SUMMARY We report a 24-year-old Chinese man with multiple gastric angiolipomas,with a positive stool occult blood examination. Endoscopic biopsy only showed nonspecific inflammation. Histological examination of the specimen by endoscopic snare resection showed that the tumor consisted of adipose tissues and blood vessels. We also performed a literature review. After the use of proton pump inhibitor,the fecal occult blood test was negative. Due to the difficulty of resecting multiple lesions in the stomach completely and the benign characteristics of angiolipoma,we chose to have regular upper gastrointestinal endoscopy evaluation of the lesion. No evidence of significant change in lesion size was detected after 3-years follow-up.CONCLUSION Gastric angiolipoma is rare,and benign neoplasm should be considered when lesions occur submucosally in the gastrointestinal tract.
基金Supported by the Natural Science Foundation of Zhejiang Province,No. LY19H030009 and No. LY20H030010。
文摘BACKGROUND Gastric metastasis from renal cell carcinoma(RCC) is an extremely rare clinical entity.Due to an easily neglected RCC history,nonspecific symptoms and underrecognized endoscopic presentation may lead to a potential diagnostic pitfall in daily clinical practice.CASE SUMMARY We present a case of metastatic gastric tumors arising from RCC 5 years after radical nephrectomy.Simultaneous,multifocal metastases to the gallbladder,pancreas and soft tissue were observed.One year previously,a solitary submucosal discoid tumor with a central depression was detected in the gastric fundus in a 65-year-old man.Endoscopic ultrasonography(EUS) showed a 1.12 x 0.38 cm lesion originating from the deeper mucosal layers with partially discontinuous submucosa.One year later,the endoscopic findings of the lesion showed various changes.A large lesion of the protruding type(2.5 cm × 2 cm) was found in the fundus at the same location.EUS showed a heterogeneous mass that involved the mucosa and submucosal layer.In addition,two small similar submucosal lesions 0.4-0.6 cm in size were detected.These lesions had a central depression,surface mucosal congestion and thickened vessels.The two adjacent lesions in the fundus were resected by endoscopic submucosal dissection.Based on the postoperative pathological analysis,the patient was diagnosed with gastric metastasis from RCC.CONCLUSION Gastric metastasis from RCC should be considered in patients with a history of RCC irrespective of the time interval involved.
