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Furuta A, Omoto S, Inoue T, Yanai M, Iwabe H, Takihara H, Ishibashi K, Tanaka H, Matsuura K, Ogata S, Yokomura A, Hoshikawa M, Kono M, Koriyama T, Tazawa T, Tsuyuguchi E, Yamasaki Y, Esumi S, Tsuruta Y, Shishimoto T, Yamamoto M, Ono W. Successful endoscopic submucosal dissection of colorectal lipoma with an overlying adenoma. JGH Open 2023; 7:456-457. [PMID: 37359118 PMCID: PMC10290265 DOI: 10.1002/jgh3.12901] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/26/2023] [Indexed: 06/28/2023]
Abstract
We report the case of a 65-year-old woman whose colonoscopy revealed a soft submucosal tumor approximately 7 cm in diameter in the ascending colon with an overlying flat lesion. The tumor was diagnosed as a lipoma with an overlying adenoma. Endoscopic submucosal dissection (ESD) was performed. Pathological examination revealed that the epithelium was a low-grade tubulovillous adenoma, while the submucosal yellow tumor was a lipoma. ESD appears to be a safe and effective treatment for colorectal lipomas overlying lipomas with colorectal adenomas.
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Affiliation(s)
- Akito Furuta
- Department of GastroenterologyKishiwada Tokushukai HospitalKishiwadaJapan
| | - Shunsuke Omoto
- Department of GastroenterologyKindai University Faculty of MedicineOsaka‐sayamaJapan
| | - Taro Inoue
- Department of GastroenterologyKishiwada Tokushukai HospitalKishiwadaJapan
| | - Mitsuru Yanai
- Department of PathologySapporo Tokushukai HospitalSapporoJapan
| | - Hideo Iwabe
- Department of internal medicineKamagaya General HospitalKamagayaJapan
| | | | - Kohei Ishibashi
- Department of GastroenterologyKishiwada Tokushukai HospitalKishiwadaJapan
| | - Hironori Tanaka
- Department of GastroenterologyKishiwada Tokushukai HospitalKishiwadaJapan
| | - Ko Matsuura
- Department of GastroenterologyKishiwada Tokushukai HospitalKishiwadaJapan
| | - Shunsuke Ogata
- Department of GastroenterologyKishiwada Tokushukai HospitalKishiwadaJapan
| | - Akitaka Yokomura
- Department of GastroenterologyKishiwada Tokushukai HospitalKishiwadaJapan
| | - Masato Hoshikawa
- Department of GastroenterologyKishiwada Tokushukai HospitalKishiwadaJapan
| | - Michihito Kono
- Department of GastroenterologyKishiwada Tokushukai HospitalKishiwadaJapan
| | - Takasi Koriyama
- Department of GastroenterologyKishiwada Tokushukai HospitalKishiwadaJapan
| | - Tomohiko Tazawa
- Department of GastroenterologyKishiwada Tokushukai HospitalKishiwadaJapan
| | - Eri Tsuyuguchi
- Department of GastroenterologyKishiwada Tokushukai HospitalKishiwadaJapan
| | - Yasuo Yamasaki
- Department of GastroenterologyKishiwada Tokushukai HospitalKishiwadaJapan
| | - Shun Esumi
- Department of GastroenterologyKishiwada Tokushukai HospitalKishiwadaJapan
| | - Yoshimasa Tsuruta
- Department of GastroenterologyKishiwada Tokushukai HospitalKishiwadaJapan
| | | | - Masaki Yamamoto
- Department of GastroenterologyKishiwada Tokushukai HospitalKishiwadaJapan
| | - Wataru Ono
- Department of GastroenterologyKishiwada Tokushukai HospitalKishiwadaJapan
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Shishimoto T, Oura S, Motozato K, Tanaka H, Takamatsu S, Ono W. Epithelioid Hemangioendothelioma of the Liver Showing Spontaneous Complete Regression after the Cessation of Methotrexate Intake. Case Rep Oncol 2023; 16:628-633. [PMID: 37900849 PMCID: PMC10601717 DOI: 10.1159/000531133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 05/15/2023] [Indexed: 10/31/2023] Open
Abstract
A 71-year-old man with slight fever and dull abdominal pain was referred to our hospital. He had been receiving methotrexate (MTX) to treat his rheumatoid arthritis for more than 6 years but stopped taking MTX after admission due to the rapid aggravation of his liver function. Computed tomography (CT) showed multiple liver lesions with late enhancement, highly suggesting them to be cholangiocarcinomas. Tumor marker levels were normal except for a slightly elevated PIVKA-II level, i.e., 45 mAU/mL (range 0-40 mAU/mL). We did a biopsy to the largest lesion and endoscopic biliary drainage to make a definitive diagnosis of the hepatic lesions and treat jaundice, respectively. Pathological study showed round, polygonal, and spindle-shaped epithelial atypical cells growing in a sarcomatoid fashion. Atypical cells were positive for CD31, CD34, vimentin, and TFE3, and some of them had intracellular vacuoles, leading to the diagnosis of epithelioid hemangioendothelioma (EHE) of the liver. The patient got well 4 weeks after the endoscopic biliary drainage. CTs showed marked regression of the EHE lesions 3 months after biliary drainage and complete regression in 12 months. The patient further developed Hodgkin lymphoma in the para-aortic lymph nodes 23 months after the biliary drainage and is now under chemotherapy for the malignant lymphoma. We, however, have not detected any EHE lesions in the liver or distant organs for at least 16 months after the confirmation of complete regression of the EHE lesions. Oncologists should note the spontaneous regression of the EHE and investigate the correlation between MTX cessation and EHE regression.
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Affiliation(s)
- Takahiro Shishimoto
- Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Shoji Oura
- Department of Surgery, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Kenichiro Motozato
- Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Hiroto Tanaka
- Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Seigo Takamatsu
- Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Wataru Ono
- Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
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Yoshimoto T, Takihara H, Yoshihara T, Inoue T, Ishibashi K, Uraoka M, Nakamura A, Hiramatsu S, Baba S, Abe S, Matsuura K, Hoshikawa M, Taketani R, Tanaka H, Motozato K, Tanigawa Y, Nakao E, Yokomura A, Kono M, Kagari K, Furuta A, Sunada A, Maejima K, Tsuyuguchi E, Yamasaki Y, Shishimoto T. Usefulness of "Nelaton Attachment" for endoscopic submucosal dissection of colorectal neoplasms. Endosc Int Open 2019; 7:E1187-E1191. [PMID: 31475238 PMCID: PMC6715429 DOI: 10.1055/a-0961-7542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 03/12/2019] [Indexed: 12/28/2022] Open
Abstract
Background and study aims Although colorectal endoscopic submucosal dissection (ESD) has enabled high en bloc resection rates regardless of tumor size, colorectal ESD is still a challenging procedure. We developed a novel device called the Nelaton Attachment, which allows endoscopists to manipulate the ESD knives using two fingers of their left hand while holding the endoscope with their right hand. We retrospectively investigated the efficacy and safety of the Nelaton Attachment for colorectal ESD. We compared efficacy and safety between Nelaton Attachment and non-Nelaton Attachment groups, and also conducted an ex vivo experiment to evaluate the effect of the Nelaton Attachment. Patients and methods We retrospectively reviewed 36 consecutive patients with 37 colorectal tumors who had undergone ESD at Kishiwada Tokushukai Hospital and Naritatomisato Tokushukai Hospital between April 2016 and September 2018. The Nelaton Attachment was used for 22 of the 37 colorectal ESDs. In the ex vivo experiment, endoscopists inserted and withdrew an ESD knife 2 cm using two fingers of their left hand with and without the Nelaton Attachment. Results Median procedure time was significantly shorter in the Nelaton Attachment group (38 min [range 6 - 195 min]) compared to the non-Nelaton Attachment group (75 min [range 17 - 198 min]; P = 0.030). Median time to complete the ex vivo experiment five times was significantly faster with the Nelaton Attachment than without the Nelaton Attachment ( P = 0.001). Conclusions Use of the Nelaton Attachment for colorectal ESD is feasible and safe, and may facilitate colorectal ESD procedures.
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Affiliation(s)
- Taiji Yoshimoto
- Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan,Corresponding author Taiji Yoshimoto Department of GastroenterologyKishiwada Tokushukai Hospital4-27-1 Kamori cho KishiwadaOsaka 596-0042Japan+81-072-445-9793
| | - Hiroshi Takihara
- Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Tomoatsu Yoshihara
- Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Taro Inoue
- Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Kohei Ishibashi
- Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Masanao Uraoka
- Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Akihiro Nakamura
- Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Shinsuke Hiramatsu
- Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Shinichi Baba
- Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Shun Abe
- Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Ko Matsuura
- Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Masato Hoshikawa
- Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Rika Taketani
- Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Hironori Tanaka
- Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Kenichiro Motozato
- Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Yuji Tanigawa
- Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Eisuke Nakao
- Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Akitaka Yokomura
- Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Michihito Kono
- Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Kenji Kagari
- Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Akito Furuta
- Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Asuka Sunada
- Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Kenji Maejima
- Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Eri Tsuyuguchi
- Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Yasuo Yamasaki
- Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Takahiro Shishimoto
- Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
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