Morphometrical Study on the Sclerotic Inferior Vena Cava in Chronic Lung Disease

The purpose of this study is to determine the relationship between chronic lung disease (CLD) and morphological changes in the inferior vena cava (IVC) from postmortem materials. The IVC and pulmonary truncus were obtained from 70 cases with CLD and/or cor pulmonale and from 23 controls. The tissues were processed for light and electron microscopic studies. The adventitia was by far the thickest component of the IVC wall. The total wall, intimal, and adventitial thicknesses were all significantly greater in the CLD cases than in the controls (p<0.001), but there was no significant difference in the ratio of adventitia thickness to wall thickness. The incidence of intimal thickening was 13.0% and 37.3% in controls and in CLD respectively. Electron microscopic examination of the IVC from the CLD cases revealeda marked increase in the amount of extracellular matrix including collagen, elastic fibers and ground substances in the adventitia as compared with the controls. No foam cells were detected in the thickened intima of the IVC. PA, right ventricular thickness and RV/LV ratio were greater in CLD than in controls. The blood gas levels of the CLD cases indicated obvious hypoxia (PaO2 54.2 mmHg). This study suggests that increased venous pressure and hypoxia might be implicated in the pathogenesis of phlebosclerosis in patients with CLD

AN AUTOPSY CASE OF PARATHYROID CARCINOMA

A case of hyperfunctioning parathyroid carcinoma was found in a 78-year-old female who had suffered from hypercalcemia for 5 years. She died of renal failure and pulmonary edema. Autopsy revealed an encapsulated tumor arising from the left upper parathyroid gland. Histologically, fibrous trabeculae, capsular invasion and blood vessel invasion were occasionally present in this tumor, suggesting that this tumor was malignant. However, mitotic figures were rarely observed. We reviewed reported cases of parathyroid carcinoma and discussed about the significance of mitosis for diagnosis

Endoscopic submucosal dissection of a minute intramucosal adenocarcinoma in Barrett\u27s esophagus.

A 73-year-old man with short segmental Barrett\u27s esophagus underwent esophagoscopy, and a slightly depressed, discolored lesion was found on the anterior wall of the lower esophagus. Under a provisional diagnosis of differentiated adenocarcinoma without local lymph node metastasis, endoscopic submucosal dissection (ESD) was carried out. En bloc resection with tumor-free lateral/basal margins was accomplished without complication. The resected area was 12 x 15 mm in size, whereas the neoplastic lesion was 4 x 4 mm. Histopathological examination confirmed intramucosal well-differentiated tubular adenocarcinoma without angiolymphatic invasion adjacent to the muscularis mucosae. Repeated esophagoscopy 6 months after ESD showed neither locally recurrent nor metachronous lesions. Considering that Barrett\u27s esophagus is a precancerous condition, one may recommend eradication of both the neoplastic and non-neoplastic lesion with using ESD.Without Figure

Peyer’s Patches in the Terminal Ileum in Ulcerative Colitis: Magnifying Endoscopic Findings

Peyer’s patches (PPs), a major component of the gut-associated lymphoid tissue, serve as important antigen entry sites in mucosal immunity. PPs may play a role in the extension of ulcerative colitis (UC) into the terminal ileum. We sought to clarify the magnified endoscopic findings of the PPs in the terminal ileum of UC patients. Eighteen UC patients underwent magnifying chromoendoscopy before initial treatment to evaluate the follicle-associated epithelium (FAE) on the PPs domes and the surrounding villi. In 8 UC patients, as in healthy controls, the PPs’ domes were slightly elevated, covered with the regular FAE lining, and surrounded by dense and bulky villi; however, in 10 UC patients, the PPs’ domes were irregular, and the surrounding villi were sparse and atrophic. These abnormal findings within the PPs were associated with minimal mucosal lesions but not with backwash ileitis; both electron microscopy and magnifying endoscopy confirmed that these lesions were reversible following remission with prednisolone-mesalazine therapy. Similar to Crohn’s disease patients, UC patients commonly had abnormalities in the FAE on PPs’ domes and the surrounding villi on magnifying endoscopy

Role of Parathyroid Hormone/Parathyroid Hormone-Related Peptide on Cell Proliferation in the Gastric Mucosa

Parathyroid hormone-related peptide (PTHrP) is widely expressed in normal tissues and elicits various functions through the PTH/PTHrP receptor. Relaxation effects of PTHrP on gastrointestinal smooth muscle cells were well documented, but the physiological role on mucosal growth and differentiation is little known. The purpose of this study was to evaluate the expression of PTHrP and PTHPTHrP receptor in the rat gastric mucosa, and the role of PTHrP on mucosal cell proliferation. Male Wistar rats were used in this study. Localization of PTHrP and PTH/PTHrP receptor were observed by immunohistochemistry and in situ hybridization. Expression of PTH/PTHrP receptor mRNA were examined by RNase protection assay in control and stress condition. Double staining with BrDU incorporation was performed to differentiate cell cycle states. Cell proliferative effect by external PTHrP-(1-34) was evaluated by BrDU incorporation. PTHrP immunopositive cells were encountered in and around the mucosal neck area. PTH/PTHrP receptor immunoreactivity was observed in the gastric mucosa broadly. Cells with stronger expression for PTHrP and its cognate receptor were located in the vicinity of generative zone. But BrDU incorporating cells were negative for both PTHrP and PTH/PTHrP receptor. By RNase protection assay, PTH/PTHrP receptor mRNA expression was weak in a steady state, and the receptor expression increased at stress. External PTHrP-(1-34) did not show cell proliferative effect in a steady state. At stress BrDU incorporation was suppressed significantly, and PTHrP-(1-34) increased BrDU incorporation. These observations suggest that PTHrP and PTH/PTHrP receptor involve maintenance of mucosal growth and differentiation in the stomach

Adenocarcinoma of the Small Intestine in a Young Adult Diagnosed by Double-balloon Enteroscopy

A 29-year-old man presented with a 3-month history of abdominal pain and appetite loss. Superficial lymph node adenopathy was noted. Systemic computed tomography showed multiple liver and lung metastases, as well as ascites. No abnormalities were found on upper gastrointestinal endoscopy and colonoscopy; therefore, double-balloon enteroscopy was performed. A stenosis with reddish and edematous mucosal changes from the third part of the duodenum to the upper jejunum was noted; on histopathology of the biopsy specimens, adenocarcinoma was diagnosed. Thus, the patient had advanced small intestinal cancer with carcinomatous peritonitis and liver metastases. Although the patient was given chemotherapy with cisplatin and 5-fluorouracil, he died 2 months after commencing treatment. Primary small intestinal carcinoma is a rare malignancy; most cases cannot be detected on routine gastrointestinal endoscopy due to their location. Our experience suggests that double-balloon enteroscopy is useful for diagnosing small intestinal adenocarcinoma