A 47-year-old Japanese woman with a 5-year history of alcoholism was admitted to the Ryukyu University Hospital for the treatment of the alcoholism. For evaluation of observed changes in her bowel habits, she underwent colonoscopy, which revealed seven small polyps spread throughout the entire large intestine. Six of the polyps were in the colon; one was an adenoma and five were hyperplastic polyps. The remaining polyp, in the rectum, was an 8-mm submucosal tumor. Pathological analysis of a biopsy of the lesion in the rectum indicated a possible diagnosis of adenocarcinoma. Endoscopic ultrasonography (EUS) demonstrated a submucosal hypoechoic nodule, involving the mucosa and the muscularis propria. Subsequently, the patient underwent a radical low anterior resection of rectum. The lesion was a submucosal tumor with ulceration. The tumor consisted of granular tumor cells which were positive for S-100 protein, neuron-specific enolase, and periodic acid schiff (PAS) stain, but negative for desmin and vimentin. Granular cell tumor is rare in the gastrointestinal tract. As a result, such tumors can be misinterpreted to indicate a possible malignancy on either a biopsy or EUS.

BackgroundColonic metastasis from breast carcinoma is very rare. Here, we report a case of colonic metastasis from breast carcinoma.Case presentationThe patient was a 51-year-old woman. She had upper abdominal pain, vomiting, and diarrhea, repeatedly. We performed abdominal contrast-enhanced computed tomography (CT) to investigate these symptoms. The CT scan revealed a tumor in the ascending colon with contrast enhancement and showed an expanded small intestine. For further investigation of this tumor, we performed whole positron emission tomography-computed tomography (PET-CT). The PET-CT scan revealed fluorodeoxyglucose uptake in the ascending colon, mesentery, left breast, and left axillary region. Analysis of biopsy samples obtained during colonoscopy revealed signet ring cell-like carcinoma. Moreover, biopsy of the breast tumor revealed invasive lobular carcinoma. Therefore, the preoperative diagnosis was colonic metastasis from breast carcinoma. Open ileocecal resection was performed. The final diagnosis was multiple metastatic breast carcinomas, and the TNM classification was T2N1M1 Stage IV.ConclusionsWe presented a rare case of colonic metastasis from breast carcinoma. PET-CT may be useful in the diagnosis of metastatic breast cancer. When analysis of biopsy samples obtained during colonoscopy reveals signet ring cell-like carcinoma, the possibility of breast cancer as the primary tumor should be considered.

It is important to choose the optimal treatment for DM in myotonic dystrophy, because the patients have hyperinsulinemia caused by specific mechanism and could not reduce the insulin resistance. Metformin improved hyperglycemia through increased insulin-independent glucose uptake in peripheral muscle. We believe metformin is the optimal agent for these patients.

The sensitivity of cancers to radiotherapy or chemotherapy may be in¯uenced by susceptibility to apoptosis. We evaluated whether expression of three proteins regulating apoptosis, p53, bcl-2, and bax, could predict the eect of radiotherapy in esophageal cancers. We used immunohistochemical staining for these protein regulators of apoptosis to study biopsy specimens obtained from 25 patients with esophageal squamous cell carcinoma before they underwent preoperative radiotherapy. Eectiveness of radiotherapy was assessed by barium esophagography, esophagoscopy, and computed tomography. Radiotherapy was eective in 12 patients and ineective in 13 patients. Biopsy specimens from the 25 patients showed expression of p53, bcl-2, and bax to be 48.0%, 32.0%, and 76.0% respectively. Eectiveness of radiotherapy was correlated with p53 expression (p = 0.047), but bcl-2 and bax expression showed no relationship to eectiveness of radiotherapy. Expression of p53 protein in biopsy specimens may predict eectiveness of preoperative radiotherapy in esophageal cancers.

our knowledge, no case of Barrett's adenocarcinoma associated with eventration of the diaphragm has previously been reported. We report here such a rare case and discuss the association of Barrett's esophagus and eventration of the diaphragm. Case reportA 71-year-old woman initially presented with epigastralgia and dysphagia in early May, 1997. On July 9, she was referred to our Department of Surgery at the Ryukyus University Hospital to undergo thorough examination and treatment after presenting at a local hospital with worsening of these symptoms.She had no contributory family history. Her past medical history revealed that she had previously undergone an appendectomy at 38 years of age, and that elevation of the left diaphragm was detected during a regular medical checkup at 44 years of age. However, she had not complained of any symptoms since then.On physical examination at admission, her respiratory sounds were diminished over the lower left lung field, but otherwise no abnormalities were observed. Chest X-ray revealed elevated left diaphragm, while the heart had shifted toward the right (Fig. 1). Esophagography showed dilatation of the lower esophagus and partial obstruction by a mass with a ragged surface in the lower esophagus. Barium meal stagnated in the esophagus and streamed only slightly into the stomach (Fig. 2). Computed tomography (CT) and magnetic resonance imaging (MRI) revealed increased wall thickness of the abdominal esophagus through the cardia of the stomach and elevated thin diaphragm (Fig. 3). Endoscopic examination showed a large cauliflower-type tumor in the distal esophagus approximately 36 cm away from the incisors. The tumor occupied most of the esophageal lumen and the endoscopic fiber could not get through to the anal side of the tumor. Abstract:We report a rare case of Barrett's adenocarcinoma associated with acquired eventration of the diaphragm in a 71-year-old woman. She initially developed dysphagia and epigastric discomfort in May, 1997. On July 9, she was referred to our Department of Surgery at the Ryukyus University Hospital for thorough examination and treatment. Esophageal adenocarcinoma and eventration of the diaphragm were revealed by exhaustive examinations, including chest X-ray, computed tomography, and magnetic resonance imaging, and proximal gastrectomy with reconstruction of jejunal interposition was performed, on August 8. Histologically, the tumor revealed that the adenocarcinoma arose from short-segment Barrett's esophagus (SSBE). It thus appears that eventration of the diaphragm may induce SSBE and Barrett's adenocarcinoma. We therefore recommend that periodic examinations of the esophagus and stomach be performed in patients with eventration of the diaphragm. Barrett's adenocarcinoma associated with acquired eventration of the diaphragm is reported. Patients with eventration of the diaphragm should undergo periodic examinations of the esophagus and stomach.