A useful new endoscopic marking technique for endoscopic mucosal resection of early gastric cancer

Synchronous colitic cancers and microcarcinoids in a patient with long-standing and extensive ulcerative colitis: a case report and review of the literature

We report a case of colitic cancer detected by target biopsies at surveillance colonoscopy in a patient with long-standing and extensive ulcerative colitis. At first, the detected colitic cancer was removed by endoscopic mucosal resection as the patient refused surgical resection. However, total proctocolectomy with an ileal-J-pouch anal anastomosis was performed additionally after informed consent had been obtained from the patient, as the resected specimen included invasive cancer histologically. Surprisingly, histologic examination of the surgical specimens revealed another flat invasive colitic cancer and 2 microcarcinoids, which were not detectable by preoperative colonoscopy or by macroscopic investigation of the surgically resected specimen. The occurrence of carcinoid in patients with ulcerative colitis has been reported only sporadically. In addition, coexistence of colitic cancer and carcinoids is extremely rare. Cases of this rare combination reported previously in the English literature are summarized and discussed.

Three-dimensional MDCT Gastrography Compared With Axial CT for the Detection of Early Gastric Cancer

OBJECTIVE

To assess the diagnostic performance of multidetector-row computed tomography (CT) 3-dimensional CT gastrography (3-D CTG) to detect early gastric cancer (EGC) compared with axial CT images alone.

METHODS

Contrast-enhanced multidetector-row CT scanning was performed on 39 patients with histopathologically proven EGC. By using volume-rendering technique, CTG images were created and interval reviews of both the axial images without and with 3-D CTG images were performed independently by 2 radiologists retrospectively. The stomach was divided into 4 segments (ie, the cardia or fundus, body, angle, and antrum). For 156 gastric segments, the radiologists determined the presence of the lesion using a 5-point confidence level. The radiologists' performance for the lesion detection was evaluated by means of receiver operating characteristic analysis. Interobserver agreement was also analyzed. The ability of CTG to reveal the extent and the morphological features of the lesions was also evaluated and compared with the results of conventional studies.

RESULTS

Histopathologically, 41 EGCs were identified in 39 patients: 1 lesion was located in the fundus, 16 in the body, 9 in the angle, and 15 in the antrum. When 3-D CTG images were used, the receiver operating characteristic curve (AZ) analysis revealed a significant improvement in the diagnostic performance of both reviewers (AZ using axial CT images only, 0.608 and 0.602 for reviewers 1 and 2, respectively; AZ using CTG images, 0.821 and 0.822 for reviewers 1 and 2, respectively) (P < 0.05). The 3-D CTG also improved the sensitivity from 27% to 73% for reviewer 1 and from 29% to 76% for reviewer 2 (P < 0.05), as compared with the sensitivity when using axial CT images only. In addition, almost perfect agreement was achieved for CTG (weighted kappa, 0.836), whereas there was only moderate agreement for the axial CT images (weighted kappa, 0.445). The CTG provided information similar to that obtained by barium study and endoscopy in 51.6% and 59.5%, respectively, of the cases.

CONCLUSIONS

The combined interpretation of axial and 3-D CTG was significantly better for detecting EGC, with a diagnostic confidence higher than that using axial CT imaging alone.