Helicobacter suis-Associated Gastritis Mimicking Conventional H. pylori-Associated Atrophic Gastritis

A 45-year-old Japanese man underwent esophagogastroduodenoscopy, which revealed spotty redness at the gastric fornix, mucosal swelling, diffuse redness in the corpus, and mucosal atrophy in the gastric angle and antrum. Histological examination showed rod-shaped bacteria that appeared larger than Helicobacter pylori. The patient tested positive for rapid urease test, and serum anti-H. pylori IgG antibody test results were negative. Further examination of the bacteria revealed that H. suis antibody test was positive, and the presence of H. suis was confirmed using H. suis-specific real-time PCR. H. suis was successfully eradicated after triple therapy with vonoprazan, amoxicillin, and clarithromycin. This case reinforces the notion that non-H. pylori Helicobacter species such as H. suis and H. heilmannii may be involved in the pathogenesis of active gastritis in patients who test negative for H. pylori antibodies

Endocrinological Changes after Anamorelin Administration in Patients with Gastrointestinal Cancer

Changes in hormone levels in patients with cancer cachexia after anamorelin administration have not been fully investigated. This study aimed to determine how anamorelin affects the endocrine system in patients with gastrointestinal cancer and cachexia. We prospectively enrolled 13 patients and comprehensively investigated their body weight and levels of serum albumin, hemoglobin A1c (HbA1c), and hormones before (week 0) and 3 and 12 weeks after anamorelin administration. The variables were evaluated at week 3 in 9 patients and at week 12 in 5 patients. At week 3, anamorelin administration resulted in body weight gain and increased the levels of growth hormone and HbA1c, as well as insulin-like growth factor-1 standard deviation scores (IGF-1 SD scores). At the same time, negative correlations were observed between ΔIGF-1 SD score and Δthyroidstimulating hormone (TSH) and between ΔIGF-1 SD score and Δfree testosterone. ΔBody weight and ΔIGF-1 SD score correlated positively at week 12. These results suggest that TSH and free testosterone levels can be affected 3 weeks after anamorelin administration; however, those variables tend to return to a state of equilibrium, and anabolic effects of anamorelin appear in long-term (≥ 12 weeks) users

PERIPHERAL AMELOBLASTOMA OF THE BUCCAL MUCOSA : WITH A REVIEW OF THE LITERATURE

A peripheral ameloblastoma arising on the buccal mucosa is exceedingly rare. Only three document cases have been reported, and we present one additional case of this tumor. In this case, the lesion repeatedly occurred in the same location in spite of twice local excisions. The first lesion was diagnosed as basal cell carcinoma with ameloblastomatous features. The pathological findings of the lesion were palisading of the peripheral cells of epithelial masses and structures resembling stellate reticulum, which could also be observed also in peripheral ameloblastomas. The second lesion was diagnosed as basal cell adenoma, and the third as peripheral ameloblastoma. The histogenesis of peripheral ameloblastomas and intraoral basal cell carcinomas are discussed, especially with reference to the lesions of the buccal mucosa

Expression of c-myc, c-fos and CA19-9 in Human Non-Malignant and Malignant Gallbladder Tissues

Immunohistochemical study was performed on expressions of c-myc, c-fos and CA19-9 in gallbladder tissue with or without malignant lesions. A total of 81 tissues were divided into four groups including 47 carcinomas, 3 dysplasias, 17 metaplasias and 14 normal lesions. After these tissues were routinely fixed in 10% formalin solution and embedded in paraffin, 4 micrometer-thick sections were made and stained with hematoxylin-eosin to classify the type of lesions. Immunohistochemical stains were carried out for c-myc and c-fos oncoproteins, and CA19-9. The percentages of positive reaction for c-myc oncoprotein were 77%, 67%, 88% and 36%, those for c-fos oncoprotein were 83%, 66%, 35% and 7%, and those for CA19-9 were 85%, 100%, 88% and 71% in carcinoma, dysplasia, metaplasia and normal tissues, respectively. These results suggest that c-myc and c-fos oncogenes play some kind of roles in malignant transformation of the gallbladder tissues and that abnormal expression of CA19-9 is the sign of antigen reversion of carcinoma cells toward embryonic cells of the gallbladder tissue

Morphological and Biochemical Evaluation of the Induction of Atherosclerosis in Japanese Quails

A total of 77 birds were divided into 7 groups which were fed the following diets : Group I, basal ; Group II, 5% corn oil (CO) + 0.5% cholesterol (CH) ; Group III, 5% CO + 2% CH; Group IV, 5% CO + 4% CH; Group V, 15% CO + 0.5% CH ; Group V I, 15% CO + 2% CH; Group VII, 15% CO + 4% CH. Significant increase of serum lipid, accumulation of lipid in the liver, and lipid-rich aortic lesions were produced in Groups IV, VI and VIII. However, hyperlipidemia correlated well with the extent of hepatic lipid accumulation and severity of aortic atherosclerosis in Group VI. Proliferating intimal cells showed positive reaction to antibodies for vimentin and alpha-1-antichymotrypsin implicating an important role of phenotypical transformation of intimal cells from the medial fibroblastic cells in the development of aortic atherosclerosis. These results suggest that Japanese quail is highly susceptible to atherosclerosis, and the optimal dietary level of cholesterol and corn oil is 2% and 15%, respectively to induce lipid-rich aortic lesions in Japanese quail

Characterization of Gastric Tissue-Resident T Cells in Autoimmune and Helicobacter pylori-Associated Gastritis

Data regarding the in-depth surface marker profiles of gastric tissue-resident lymphocytes in autoimmune and Helicobacter pylori-associated gastritis are lacking. In this study, we investigated potential differences in lymphocyte composition between these profiles. We enrolled patients with autoimmune (n = 14), active (current infection of H. pylori in the stomach; n = 10), and inactive gastritis (post-eradication of H. pylori; n = 20). Lymphocytes were isolated from the greater curvature of the stomach and lesser curvature of the body and analyzed using flow cytometry. The CD8(+)/CD3(+) and CD4(+)/CD3(+) ratios differed between the samples. Body CD4(+)/antrum CD4(+), which is calculated by dividing the CD4(+)/CD3(+) ratio in the body by that in the antrum, was significantly higher in autoimmune gastritis (3.54 +/- 3.13) than in active (1.47 +/- 0.41) and inactive gastritis (1.42 +/- 0.77). Antrum CD8(+)/CD4(+) in autoimmune gastritis (7.86 +/- 7.23) was also higher than that in active (1.49 +/- 0.58) and inactive gastritis (2.84 +/- 2.17). The area under the receiver operating characteristic curve of antrum CD8(+)/CD4(+) was 0.842, and the corresponding optimal cutoff point was 4.0, with a sensitivity of 71.4% and a specificity of 93.3%. We propose that an antrum CD8(+)/CD4(+) ratio > 4.0 is a potential diagnostic marker for autoimmune gastritis

Scoring systems for differentiating gastrointestinal stromal tumors and schwannomas from leiomyomas in the stomach

There is no practical predictive model for the diagnosis of gastrointestinal stromal tumors (GISTs). To establish a practical predictive model for the diagnosis of subepithelial lesions in the stomach, we reviewed patients with GISTs (n = 89), schwannomas (n = 7), and leiomyomas (n = 28). The tumor was more frequently found along the gastric cardia in the leiomyoma group (57.1%) than in the GIST/schwannoma group (2.1%, P < .01). Contrast enhancement (57.3% vs 0%, P < .01) and intra-tumoral necrosis (34.4% vs 0.0%, P < .01) were more frequently observed in the GIST/schwannoma group than in the leiomyoma group. On endoscopic ultrasonography, 58.3% of GISTs/schwannomas showed uneven echogenicity, whereas the echogenicity was uneven in 21.4% of leiomyomas (P < .01). There were no differences between the tumor color and the presence or absence of ulcer formation, tumor bleeding, irregularity of the tumor margin, cystic spaces, and hyperechoic spots between the 2 groups. Based on these results, we developed a 2-step diagnostic algorithm for GISTs/schwannomas. The first step comprises 1 endoscopic feature: a cardiac or non-cardiac location. Tumors with a cardiac location were judged as leiomyomas and those with a non-cardiac location were judged as GISTs/schwannomas, with 96.9% sensitivity and 57.1% specificity for GIST/schwannoma diagnosis. The second step comprises a combination of endoscopic (non-cardiac location), radiologic (positive contrast enhancement and intra-tumoral necrosis), and endosonographic (uneven echogenicity) features for a total of 4 points. We assigned 1 point to each feature. Tumors with scores of 2 to 4 were judged as GISTs/schwannomas, with 81.3% sensitivity and 92.9% specificity for GIST/schwannoma diagnosis. Our predictive model will be a practical guide for the management of gastric subepithelial lesions

Endoscopic findings of gastric neoplasms in familial adenomatous polyposis are associated with the phenotypic variations and grades of dysplasia

Patients with familial adenomatous polyposis (FAP) are at increased risk of developing gastric neoplasms. However, endoscopic findings have not been sufficiently investigated. We investigated the phenotypic expression of gastric adenoma (low-grade dysplasia) and gastric cancer (high-grade dysplasia or carcinoma) in patients with FAP and clarified their relationships to endoscopic findings. Of 29 patients with FAP who underwent esophagogastroduodenoscopy between 2005 and 2020, 11 (38%) had histologically confirmed gastric neoplasms, including 23 lesions of gastric adenoma and 9 lesions of gastric cancer. The gastric neoplasms were classified into 3 phenotypes (gastric, mixed, or intestinal type) according to the immunostaining results and evaluated for location (U or M region: upper or middle third of the stomach or L region: lower third of the stomach), color (same as the background mucosa, whitish, or reddish), macroscopic type (elevated, flat, or depressed), background mucosal atrophy (present or absent), fundic gland polyps in the surrounding mucosa (present or absent), and morphologic changes in tumor size. Elevated whitish gastric adenomas were further subdivided by macroscopic type (flat elevated, protruded, or elevated with a central depression) and color (milky- or pinkish-white). The gastric adenomas included gastric (11/23, 48%), mixed (4/23, 17%), and intestinal (8/23, 35%) phenotypes. In contrast, no lesions of gastric cancers showed a gastric phenotype (0/9, 0%), while 5 (56%) and 4 (44%) lesions were intestinal and mixed phenotypes, respectively. Gastric cancers were significantly more likely than gastric adenomas to present as reddish depressed lesions with gastric atrophy. All gastric-type adenomas occurred in non-atrophic mucosa, in mucosa with fundic gland polyps in the periphery, in the U or M region, and as flat elevated or protruded lesions with a milky-white color. Half of the lesions increased in size. Meanwhile, the typical endoscopic features of intestinal-type adenomas included occurrence in the L region and elevated pinkish-white lesions with central depression. None of the intestinal-type adenomas increased in size during the observation period. We believe that these endoscopic features will be useful for the prompt diagnosis and appropriate management of gastric neoplasms in patients with FAP