Clinical Journal of Gastroenterology最新文献

Primary gastric squamous cell carcinoma (GSCC) or gastric adenosquamous carcinoma (GASC) is an uncommon histologic type for which no standard treatment has been established. The prognosis is poor, and there are few reports of effective treatment. Here, we experienced a case of GASC that was diagnosed preoperatively as GSCC and could be operated on after successful preoperative chemotherapy with pembrolizumab, 5-fluorouracil, and cisplatin. Although it is challenging to differentiate GSCC from GASC preoperatively, we report a case that may help select preoperative chemotherapy.

Hepatic reactive lymphoid hyperplasia (RLH), also known as hepatic pseudolymphoma, is a rare benign condition that predominantly affects middle-aged-to-elderly women and is often associated with autoimmune disorders. The imaging features of hepatic RLH frequently mimic those of malignant hepatic tumors, such as hepatocellular carcinoma (HCC), cholangiocarcinoma, or metastatic liver tumors, making its diagnosis based solely on imaging modalities challenging, often leading to unnecessary surgical resection. However, the optimal diagnostic strategy for hepatic RLH remains controversial. Here, we report a case of hepatic RLH diagnosed via biopsy following radiofrequency ablation (RFA). The hepatic nodule exhibited arterial-phase enhancement and portal-phase washout on contrast-enhanced ultrasonography, suggesting HCC. However, these findings were absent on contrast-enhanced computed tomography and gadolinium-ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging, suggesting an alternative diagnosis. Therefore, RFA was performed, followed by tumor biopsy for a definitive diagnosis. Histopathological examination and immunostaining of post-RFA biopsied specimens revealed lymphoid follicles composed of cells positive for CD3, CD10, and CD20, maintained polarization for Ki-67 positivity and negativity for diffuse Bcl-2 expression within the nodule, consistent with hepatic RLH. This case highlights the diagnostic utility of post-RFA biopsy, particularly when hepatic RLH is suspected, because it allows for both histological and immunohistochemical evaluation.

Pancreatic metastases of renal cell carcinoma, like pancreatic neuroendocrine neoplasms, are hypervascular tumors, so their differentiation is often difficult. In addition, renal cell carcinomas are also often positive for somatostatin receptor scintigraphy, which has been recognized as a diagnostic imaging tool, especially for neuroendocrine neoplasms. We herein report a case of pancreatic metastasis of renal cell carcinoma positive for somatostatin receptor scintigraphy in which the diagnosis was made by EUS-FNA 12 years after the resection of renal cell carcinoma and the expression of somatostatin receptor subtypes in the resected specimens of pancreatic metastasis was examined.

Esophageal cancer is a prevalent malignancy with high mortality rates worldwide, often warranting aggressive treatment modalities, such as chemoradiotherapy or radiotherapy. Although these treatments are effective, they can predispose patients to secondary malignancies, posing challenges for long-term management. Here, we present a case report detailing the development and management of secondary malignancies following radiotherapy for esophageal adenocarcinoma. A 78-year-old man presented with symptoms resulting in the diagnosis of esophageal adenocarcinoma with multiple lung metastases. Complete remission was achieved through chemotherapy with docetaxel, cisplatin, and S-1, followed by intensity-modulated radiation therapy. Seven years later, surveillance revealed a squamous cell carcinoma at the post-radiotherapy site; however, endoscopic resection was deemed challenging owing to fibrotic changes. Photodynamic therapy (PDT) with talaporfin sodium was administered, resulting in complete response without complications. This case highlights the potential for secondary malignancies following radiotherapy for esophageal adenocarcinoma and the efficacy of PDT as salvage therapy. This report underscores the importance of vigilant post-treatment surveillance and the need for tailored management strategies. Future research should focus on understanding the mechanisms of radiation-induced carcinogenesis, evaluating the long-term outcomes of PDT, and developing preventive strategies to enhance patient care and outcomes.

Background: Severe immune-related adverse events (irAEs) in steroid-refractory patients remain a clinical challenge among older patients with hepatocellular carcinoma (HCC) treated with immune checkpoint inhibitors. Although infliximab is recommended for steroid-refractory irAE colitis, its safety and outcomes in older patients with liver disease remain unclear. Here, we report a case that highlights the safety and effectiveness of single-dose infliximab for steroid-refractory irAE colitis in an older patient with HCC.

Case presentation: An 84-year-old man with alcohol-related HCC received STRIDE therapy (durvalumab plus tremelimumab). On day 35, he developed a severe headache, followed by watery and bloody diarrhea on day 40. Based on the clinical course and endoscopic findings, the patient was diagnosed with grade 4 irAE colitis. His condition was refractory to prednisolone (60 mg/day), and a single dose of infliximab (400 mg) was administered on day 5 of steroid therapy. Rapid clinical improvement and remission were observed, and lenvatinib was resumed on day 220 without irAE recurrence.

Conclusion: Single-dose infliximab may be a safe and effective option for severe irAE colitis in older patients with HCC, allowing continuation of cancer therapy. This case may serve as a practical reference for clinicians managing severe irAEs in high-risk populations.

Nivolumab is a first-line treatment for unresectable esophageal cancer; however, immune-related adverse events (irAEs) can be severe. We report a rare case of long-term survival without chemotherapy after the resolution of lung metastases potentially triggered by a nivolumab-induced irAE. A 70-year-old man with cStage III cervical esophageal squamous cell carcinoma received definitive chemoradiotherapy. One month later, lung and bone metastases were detected. Chemotherapy with fluorouracil and cisplatin was continued, followed by palliative radiotherapy. Although the primary tumor disappeared, the lung metastases progressed, and nivolumab was administered. After a single dose, the patient developed multiple irAEs, including interstitial pneumonia, hypophysitis, and polymyalgia rheumatica. These were managed with corticosteroids. Subsequently, the pulmonary metastases regressed and eventually disappeared. Radiotherapy was also performed for later local recurrences. No further systemic therapy was given, and the patient has remained alive in the 45 months. This case suggests that not only nivolumab-induced immune activation but also multidisciplinary treatment, including chemotherapy and radiotherapy, may contribute to durable tumor control in advanced esophageal cancer.

Introduction: Retrograde colonic intussusception is a rare condition in adults, often caused by organic lesions such as tumors. Autonomic dysfunction in disorders like multiple system atrophy (MSA) might contribute to its occurrence.

Case presentation: An 81-year-old bedridden woman with a history of MSA presented with severe abdominal pain and abdominal distension lasting 4 days. She had chronic severe constipation managed with laxatives and manual disimpaction. CT imaging revealed retrograde intussusception of the rectum into the sigmoid colon. Endoscopic reduction was attempted but was unsuccessful due to scope impassability. Emergency laparotomy identified a 4-5 cm tumor at the lead point, and manual reduction resulted in bowel perforation. Hartmann's procedure with D2 lymphadenectomy was performed. The tumor was histopathologically diagnosed as a tubulovillous adenoma with no malignant features. The patient's postoperative recovery was uneventful except for a urinary tract infection (Clavien-Dindo Grade II), and she was transferred to a rehabilitation facility on postoperative day 24.

Conclusion: Failure of reduction by air enema should raise suspicion for retrograde intussusception, warranting prompt surgery if an organic lead point is suspected.

Carbohydrate restriction (ketogenic diet) is a cancer treatment that reduces energy production by oxidative phosphorylation in mitochondria of cancer cells and increases it through anaerobic glycolysis in cytoplasm. We report a patient in whom progression of pancreatic cancer recurrence was suppressed solely by a ketogenic diet for 9-month post-surgery. A 60-year-old female with a diagnosis of pancreatic cancer underwent pancreatoduodenectomy after 3 cycles of chemotherapy with gemcitabine plus nab-paclitaxel. Multiple pulmonary metastases were observed 22 months after the surgery. We administered gemcitabine plus nab-paclitaxel for 1 year. As the partial response continued for 1 year, we performed radiotherapy for the remnant pulmonary metastases followed by administration of S-1 for 6 months. Ten months after radiotherapy, CT showed exacerbation of the pulmonary metastases. As treatment, she requested severe carbohydrate restriction. After 9 months of the ketogenic diet, CT revealed stable disease. A ketogenic diet may have the therapeutic effect of suppressing tumor progression if strictly applied.

Background: Edwardsiella tarda (E. tarda) is a rare human pathogen. Extra-intestinal infections of E. tarda are particularly uncommon, with only one case of recurrent cholangitis caused by E. tarda reported to date.

Case presentation: A 77-year-old man suffered acute calculous cholecystitis 5 days after eating eel and raw fish. Culture results from bile obtained via percutaneous gallbladder drainage revealed E. tarda infection, and an 8-day course of intravenous cefmetazole led to clinical resolution. However, the patient returned with fever and laboratory signs of obstructive cholangitis 5 weeks later. Contrast-enhanced computed tomography showed a migrated gallstone in the distal common bile duct. Endoscopic retrograde cholangiopancreatography drained the purulent bile, and cultures from the bile and blood were again positive for E. tarda. A 10-day course of cefmetazole, along with biliary stent placement resulted in complete recovery.

Conclusion: E. tarda can cause relapsing biliary tract infections despite appropriate initial treatment. Clinicians should consider this rare pathogen in cases of recurrent cholangitis, especially for patients with recent consumption of raw or undercooked aquatic animals. A detailed dietary history and targeted microbiological testing are essential for accurate diagnosis and management.

Paradoxical responses (PRs) to anti-tuberculosis (anti-TB) treatment refer to the worsening of pre-existing tuberculous lesions or the emergence of new lesions in patients whose clinical symptoms initially improved with therapy. PRs are less common in HIV-negative patients, and presentations as tuberculous hepatic abscesses are rare. Furthermore, PRs occurring after completion of TB treatment are uncommon, making it difficult to distinguish them from TB relapse. We report herein a case of late-onset post-treatment PR, presenting 11 years after completion of treatment for a tuberculous hepatic abscess in an HIV-negative patient. A 51-year-old HIV-negative woman undergoing maintenance hemodialysis, with a history of pulmonary TB with hepatic and splenic abscesses, completed anti-TB treatment 11 years earlier. She was hospitalized after multiple liver nodules were detected on computed tomography. Suspecting a tuberculous hepatic abscess due to TB relapse or PR, we performed an ultrasound-guided liver biopsy. Histopathological analysis revealed epithelioid granulomas with caseous necrosis. However, both polymerase chain reaction and culture for TB were negative. She was therefore diagnosed with late-onset post-treatment PR and carefully observed without treatment. The liver abscesses eventually regressed spontaneously. This case highlights the importance of considering PRs even long after TB treatment completion and underscores the need to avoid unnecessary administration of anti-TB drugs.