Background-Although polypoid lesions ofthe gall bladder are frequently observed in asymptomatic subjects, the natural history of these lesions has never been studied using ultrasonography. Aim-The natural history of polypoid lesions ofthe gall bladder was investigated using ultrasonography. Subjects-Among 4343 patients who presented to the outpatient clinic of Tsuchiura Kyodo General Hospital in 1988, 111 subjects were diagnosed as having polypoid lesions of the gall bladder by ultrasonography. Among these patients, two had gall bladder carcinoma. The remaining 109 subjects (58 female; age: median 54, range 25-89) were enrolled in this study. Methods-The subjects were followed up by ultrasonography once or twice a year until 1994. Results-Four patients received cholecystectomy and two patients died of other causes during the observation period. In one patient, gall bladder carcinoma was found, but its location was different from that of the pre-existing polyp. The size of the lesions did not change in 88.3% of the other 130 patients during this period, even among those in whom the initial size ofthe lesion exceeded 10 mm. There was no apparent correlation between the change in the diameter ofthe polypoid lesions and patients' sex or age. Conclusion-Most polypoid lesions of the gall bladder detected by ultrasonography are benign. (Gut 1996; 39: 860-862) Keywords: gall bladder carcinoma, gall bladder polyp, prognosis, ultrasonography.Ultrasonography has been widely used in clinical medicine, and its usefulness has been reported in the diagnosis of calculous gall bladder disease.' Mass surveys for abdominal disease have recently been performed using ultrasonography, and polypoid lesions of the gall bladder have been one of the most common findings.There are several studies that describe the prevalence of gall bladder polyps.2A6 One epidemiological study in Japan shows that the prevalence of gall bladder polyps was 6.28% in men and 3.5% in women,2 and another showed 5.3%/o in men.3 In Denmark, the prevalence was 4.6% and 4.3% in men and women, respectively,4 and 5.9% and 5.8% in men and women, respectively, in a 70 year old population.5 The prevalence was as low as 1.3% in the United Kingdom.6 However, the only report on the prognosis ofpolypoid lesions of the gall bladder is an old study using cholecystography. Therefore, the natural history of patients with polypoid lesions of the gall bladder was studied in this study. MethodsUltrasonographic examinations were carried out on 4343 patients in the outpatient clinic of the Department of Internal Medicine, Tsuchiura Kyodo Hospital from 1 January to 31 December 1988. Among these patients, 1 1 1 were diagnosed as having polypoid lesions of the gall bladder. Two of them had gall bladder carcinoma. The remaining 109 subjects (58 females; age: median 54, range 25-89) were enrolled in this study. After an overnight fast, ultrasonographic examination was performed by a radiology licensed :echnician using an Aloka Echo Camera SSD-650CL equipped with a 3.5 MHz tran...

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Gastric adenomas may eventually progress to adenocarcinomas at varying rates. The purpose of the present study was to identify gene-expression profiles linked to the heterogeneous nature of gastric adenoma as compared to adenocarcinoma. Suppression subtractive hybridisation analysis was performed to extract relevant genes from two cases of low-and high-grade gastric adenomas. The identified genes were quantified by RT -PCR in 14 low-grade adenoma, nine high-grade adenoma and nine adenocarcinoma samples, followed by hierarchical clustering analysis to separate tumours into groups according to their gene-expression profiles. Nine genes previously implicated in carcinogenesis in a variety of organs, including three genes related to gastric adenocarcinoma, were identified. The overexpression of these genes in gastric adenoma has not been reported previously. The clustering analysis of these nine genes across 32 cases identified three groups, one of which consisted primarily of adenocarcinomas, whereas the other two groups consisted of adenomas. One group of adenomas, characterised by larger tumour size, exhibited gene-expression profiles of an intestinal cell lineage implicated in the pathogenesis of an intestinal-type gastric adenocarcinoma. Another adenoma group consisting of low-grade adenomas with smaller tumour size exhibited a unique expression profile. In conclusion, clustering analysis of expression profiles using a limited number of genes may serve as molecular markers for gastric adenoma with different biological properties. Although the prognostic values of these gene-expression profiles need to be evaluated in further follow-up study of adenoma cases, these findings add new insights to (a) our understanding of the pathogenesis of gastric tumours, (b) the development of specific tumour markers for clinical practice, and (c) the design of novel therapeutic targets.

Nonalcoholic steatohepatitis is an increasingly recognized clinicopathologic condition. We report two cases of nonalcoholic steatohepatitis in middle-aged Japanese women whose clinical and laboratory data mimicked autoimmune hepatitis. Histologic findings of both cases were definite steatohepatitis with portal and pericellular fibrosis. Both patients' HLA-DR haplotypes were DR4 and DR2, which are frequently observed in Japanese patients with autoimmune hepatitis. Our cases suggest a diversity in the pathogenesis of nonalcoholic steatohepatitis.

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