Primary Omental Myxoid Leiomyosarcoma: Report of a Case and a Review of the Literature

A 41-year-old Japanese woman who presented with right lower abdominal pain underwent partial omental resection with tumor excision, leaving no residual tumor. The tumor was diagnosed as a myxoid leiomyosarcoma that apparently originated in the greater omentum. A recurrent omental tumor was excised at 4.5 months after the first operation, and then at 5.5 months after this, CT revealed metastatic sarcoma at the surface of the liver (S7) and the left upper abdomen. She died 20 months after the last operation despite treatment of the metastases with MAID therapy (mesna, adriamycin, ifosfamide, dacarbazine). A literature review revealed that this tumor mainly occurs in the uterus, soft tissue, and cardiovascular system, with a preponderance among middle-aged to elderly women. The present report is the first description of primary omental myxoid leiomyosarcoma

Brain Metastasis from Gastrointestinal Stromal Tumor: A Case Report and Review of the Literature

Metastasis of gastrointestinal stromal tumor (GIST) into the central nervous system is extremely rare. We report a patient with synchronous GIST and brain metastasis. At disease onset, there was left hemiplegia and ptosis of the right eyelids. Resection cytology of the brain tumor was reported as metastasis of GIST. After positron emission tomography examination, another tumor in the small bowel was discovered, which suggested a small bowel GIST associated with intracranial metastasis. Immunohistochemical analysis of the intestinal tumor specimen obtained by double balloon endoscopy showed a pattern similar to the brain tumor, with the tumors subsequently identified as intracranial metastases of jejunal GIST. After surgical resection of one brain tumor, the patient underwent whole brain radiation therapy followed by treatment with imatinib mesylate (Gleevec; Novartis Pharma, Basel, Switzerland). Mutational analysis of the original intestinal tumor revealed there were no gene alterations in KIT or PDGFRα. Since the results indicated the treatment had no apparent effect on either of the tumors, and because ileus developed due to an intestinal primary tumor, the patient underwent surgical resection of the intestinal lesion. However, the patient's condition gradually worsen and she subsequently died 4 months after the initial treatment

ジョシ ダイガクセイ ノ トウ タイシャノウ カンレン ショケンコウシヒョウチ ニ オヨボス シソアブラ セッシュ ト ユウサンソ ウンドウ トレーニング ノ エイキョウ

しそ油はα-リノレン酸を主体とするn-3系多価不飽和脂肪酸源の代表的食品である。多価不飽和脂肪酸は,体内に摂取することにより種々の生理効果を示すことが最近明らかになってきているが,本研究はこの効果を生活習慣病の一次予防に活用する試みの一環として,同様にその効果が期待されている有酸素運動トレーニングと併用することの有効性を検討する意図で企画された。しそ油を毎日20gずつ18人の女子大学生ボランティアに摂取させ,そのうち8人に有酸素運動トレーニングを負荷し,呼吸循環機能,糖代謝機能,血漿脂質パターン,体内活性酸素関連物質,免疫能を中心とする生体防御機能諸指標値を測定した。その結果,しそ油の単独摂取がトレーニングとの併用の有無に関わらず有酸素機能の向上に寄与すること,またしそ油の摂取が空腹時血糖値の低下や血漿中性脂肪値の低下をもたらすことを確認した。一方でしそ油の摂取は血漿過酸化脂質レベルの上昇もたらすが,同時に運動トレーニングを負荷することによって,その上昇が抑制されることを示唆する結果が得られ,その機構として,運動による体内ビタミンCによるビタミンEの還元的活性化の促進がある可能性が示唆された。これらの結果は,食事によるn-3系多価不飽和脂肪酸とビタミンCなどの抗酸化成分の適切な摂取と適度の強さの有酸素運動トレーニングを併用することが,包括的な疾病一次予防に有用な方策である可能性を示している

Risk stratification for advanced colorectal neoplasia based on the findings of the index and first surveillance colonoscopies.

Risk stratification by index colonoscopy is well established for first surveillance endoscopy, but whether the previous two colonoscopies affect the subsequent advanced neoplasias has not been established. Therefore, the subsequent risk based on the findings of the index and first surveillance colonoscopies were investigated. This retrospective, cohort study was conducted in two clinics and included participants who had undergone two or more colonoscopies after index colonoscopy. High-risk was defined as advanced adenoma (≥ 1 cm, or tubulovillous or villous histology, or high-grade dysplasia). Based on the findings of the index and first surveillance colonoscopies, patients were classified into four categories: category A (both colonoscopy findings were normal), category B (no high-risk findings both times), category C (one time high-risk finding), and category D (high-risk findings both times). The incidence of subsequent advanced neoplasia was examined in each category. A total of 13,426 subjects were included and surveyed during the study periods. The subjects in category D had the highest risk of advanced neoplasia (27.4%, n = 32/117). The subjects in category A had the lowest risk (4.0%, n = 225/5,583). The hazard ratio for advanced neoplasia of category D compared to category A was 9.90 (95% Confidence interval 6.82-14.35, P<0.001). Classification based on the findings of index and first surveillance colonoscopies more effectively stratifies the risk of subsequent advanced neoplasia, resulting in more proper allocation of colonoscopy resources after two consecutive colonoscopies

Preoperative Diagnosis of Intestinal Endometriosis by Magnifying Colonoscopy and Target Biopsy

Endometriosis can affect any portion of the gastrointestinal tract. A preoperative definitive diagnosis of intestinal endometriosis is difficult, because there is no characteristic endoscopic finding and the endoscopic biopsies usually sample insufficient endometrial tissue for pathologic diagnosis. To our knowledge, the magnifying endoscopic features of intestinal mucosal endometriosis have not been well documented. In this study, we report a case of intestinal endometriosis diagnosed preoperatively by magnifying image-enhanced colonoscopy and target biopsy. A 45-year-old woman was referred to our hospital with abdominal pain in the left lower quadrant. Colonoscopy showed a submucosal tumor-like lesion of approximately 30 mm in diameter exhibiting surface reddening and granular changes in the sigmoid colon. Magnifying endoscopy revealed sparsely distributed round pits in the granules. The mucosal biopsy specimen from the granule provided the diagnosis of intestinal endometriosis. Segmental sigmoidectomy was performed, and pathological examination revealed that the surface colonic mucosa was partially replaced by endometrial tissue, which accounted for the granular change detected in the colonoscopy. It can be speculated that the round pit might reflect the endometrial glands surrounded by endometrial stroma. This case illustrated the characteristic finding and utility of magnifying endoscopy for mucosal intestinal endometriosis