Background. Endoscopic findings have traditionally been evaluated on the basis of differences in color and changes in surface structure. We examined whether microvascular patterns on magnifying endoscopy could be used to diagnose benign and malignant superficial esophageal lesions and to estimate the depth of tumor invasion. Methods. Magnifying endoscopic findings were compared with histopathological features for 405 superficial lesions arising in the esophagus, including 191 esophageal cancers. Results. Microvascular patterns on magnifying endoscopy were classified into 4 types. Type 1 was characterized by thin, linear capillaries in the subepithelial papilla and was generally seen in normal mucosa. Type 2 was characterized by distended, dilated vessels, and the shape of capillaries in the subepithelial papilla was preserved. Type 2 was generally seen in inflammatory lesions. Type 3 was characterized by spiral vessels with an irregular caliber and crushed vessels with red spots, and the arrangement of the vessels was irregular. Type 3 was generally seen in m1 or m2 cancers. Type 4 was characterized by multilayered, irregularly branched, reticular vessels with an irregular caliber. Type 4 was generally seen in cancers with m3 or deeper invasion. Avascular areas (AVAs) and stretched type 4 vessels were seen in cancers with downward growth. The size of AVAs was closely related to the depth of tumor invasion. Conclusions. Histopathological features of superficial esophageal cancers can be diagnosed by evaluating microvascular patterns on magnifying endoscopy. The size of AVAs and associated type 4 vessels can be used to assess the extent and depth of tumor invasion.
Background. We examined the current status and diagnostic accuracy of currently available techniques for tumor staging and assessed treatment outcomes in patients with superfi cial esophageal cancer who received esophaguspreserving therapy, such as endoscopic mucosal resection (EMR) alone or combined with chemoradiotherapy (CRT). Methods. In 274 patients with superfi cial esophageal cancer, we examined the depth of tumor invasion and the degree of lymph node metastasis by means of endoscopy, magnifying endoscopy, endoscopic ultrasonography (EUS), computed tomography (CT), and cervical and abdominal ultrasonography (US). We compared treatment outcomes among treatment groups according to the depth of tumor invasion. Results. The rates of correctly diagnosing the depth of tumor invasion were 89.6% on conventional endoscopy, 90.1% on magnifying endoscopy, and 85% on scanning with a high-frequency miniature ultrasonic probe (miniature US probe). Diagnostic accuracy for the m3 or sm1 cancers was poor. Magnifying endoscopy allowed invasion to be more precisely estimated, thereby improving diagnostic accuracy. However, lesions that maintained their surface structure despite deep invasion were misdiagnosed on magnifying endoscopy. A miniature US probe was useful for the assessment of such lesions. The diagnostic accuracy of EUS for lymph node metastasis was 83%, with a sensitivity of 76%. The sensitivity of CT was 29%, and that of cervical and abdominal US was 17%. Patients with m1 or m2 cancer had good outcomes after esophagus-preserving therapy. Although there were no signifi cant differences in survival rates, many patients with sm2 or sm3 cancer who received CRT died of their disease. Nodal recurrence was diagnosed by EUS. In patients who received CRT, the time to the detection of recurrence was slightly prolonged. Conclusions. Long-term follow-up at regular intervals is essential in patients with m3 or sm esophageal cancers who receive esophagus-preserving treatment. At present, EUS is the most reliable technique for the diagnosis of lymph node metastasis and is therefore essential for pretreatment evaluation as well as for follow-up. Earlier detection of recurrence at a level that would potentially salvage treatment remains a topic for future research.
Background:Recently, esophageal microcancers have been frequently diagnosed and are receiving increasing attention as initial findings of cancer. We examined whether the clinicopathological features and microvascular patterns of esophageal microcancers on magnifying endoscopy are useful for diagnosis. Methods: Magnifying endoscopy was performed to examine the histopathological features of 55 esophageal cancers measuring Յ10 mm in diameter (34 small cancers, 16 microcancers, and five supermicrocancers). Results: Although some lesions were detected only on iodine staining, most were detected on conventional endoscopic examination. Most small cancers and microcancers were m1 or m2; some were m3 or sm2. Supermicrocancers were dysplasia or m1 cancer. As for the microvascular pattern, most m1 and m2 cancers showed type 3 vessels, while most submucosal cancers showed type 4 vessels. Conclusions: Microvascular patterns on magnifying endoscopy are useful for the differential diagnosis of benign and malignant esophageal cancers and for estimating the depth of tumor invasion. The shape of small lesions is often altered considerably by biopsy. Residual tumor may persist unless the basal layer of the lesion is included in biopsy specimens, even in microcancers. Consequently, endoscopic mucosal resection, without biopsy, is being performed in increasing numbers of patients with lesions suspected to be cancer on the basis of their microvascular patterns.
We report herein the case of a 63-year-old male with hemoperitoneum secondary to exogastric leiomyoma. The patient had been receiving anticoagulation therapy for a cerebral embolism and complained of sudden, severe abdominal pain. A sonogram and computed tomography scan showed an exogastric mass and massive ascites. A peritoneal puncture proved the presence of an intraperitoneal hemorrhage. An emergency laparotomy revealed a pedunculated bleeding tumor, thus confirming the preoperative diagnosis of a ruptured exogastric tumor. A microscopic analysis of the excised tumor demonstrated gastric leiomyoma. Other authors have reported hemoperitoneum secondary to gastric myogenic tumors, but no cases of leiomyomas could be found in the literature.
In conclusion, the management of splenic infarct may initially be conservative provided the patient is hemodynamically stable and has no signs of uncontrolled sepsis. Otherwise, a partial or subtotal splenectomy and splenic auto-implants, if technically possible, have to be performed, in order to treat the aforementioned complications. References1 O'Donnell J, McGreal G, Daly P et al. Management of patients undergoing splenectomy in an Irish teaching hospital: impact of guidelines.
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