A bezoar, a mixture of various undigested foreign substances in the gastrointestinal tract, causes intestinal obstruction at times. We report a case of non-surgical treatment in old age patient. An 89-year-old female presented with epigastric pain, general weakness, and intermittent melena for 1 month. There were episodic attacks of vomiting. An abdominal computed tomography scan showed a 5×4 cm, firm, atypically shaped mass at the stomach body and duodenal bulb with interspersed gas. Endoscopy showed a mass of fiber impacting the antrum pylorus, and the endoscopist failed to remove the bezoar at the first attempt. We subscribed olive oil for few days to make the bezoar small, and eventually, it was fragmented and removed without surgery. A phytobezoar is not uncommon disease required surgical removal if obstructive system developed. Ingestion of olive oil would be a helpful substitute for immediate operation in case of phytobezoar.
Surgery is the primary treatment for adenocarcinoma originating from the esophagogastric junction. However, many physicians attempt various endoscopic treatments for the cases of early adenocarcinoma and high-grade dysplasia of esophagogastric junction in order to avoid the high risk of complications associated with surgical resection. Recently, there is an increasing tendency to use endoscopic mucosal resection for the management of early esophageal cancer due to low morbidity and mortality rates. We report here on a case of early adenocarcinoma at esophagogastric junction successfully treated with endoscopic mucosal resection.
Gastrointestinal stromal tumors (GISTs) are common mesenchymal tumors that arise in the wall of the gastrointestinal tract. We report a case of obscure gastrointestinal bleeding due to a GIST of the jejunum successfully documented by videocapsule endoscopy (VCE) and single-balloon enteroscopy (SBE). A 36-year-old man with hematochezia was referred for further evaluation of no evidence of bleeding focus on esophagogastroduodenoscopy and colonoscopy. A VCE showed a suspicious ulcerative hyperemic mass that located in about 1 hour apart from duodenal second portion. SBE revealed a nonbleeding 4×2 cm mass with an ulcer at the proximal jejunum. The patient underwent laparoscopic resection without complication. Histological examination revealed a well circumscribed, dumbbell-shaped firm mass comprised of spindle cells. Immunohistochemical staining for CD 117 was diffusely positive, whereas staining for S-100, CD 34 and MIB-1 was all negative. It was confirmed to be a low-grade GIST at the proximal jejunum.
Gastric polyp is histologically very diverse and its classification is still unsettled. The purpose of the article is to classify the endoscopically diagnosed polypoid lesions and to evaluate their malignant potential.
A retrospective study was done on 142 cases of endoscopically diagnosed gastric polypoid lesions from September 1993 to May 1996. We investigated their clinical findings, histopathology, and nuclear gradings of PCNA by immunohistochemistry.
1) The mean age is 57.9 and sex ratio os 0.8:1
2) The most prevalent location is antrum(57.7%).
3) Morphologically, Yamada type II is the most frequent(35.9%).
4) Histologically, lesions are classified as true polyps and reactive lesions. True polyps are subclassified as hyperplastic polyp(61.2%), adenomatous polyp(19.4%), mixed adenomatous and hyperplastic polyp(10.2%), fundic gland polyp(2.0%), and adenocarcinoma(7.1%). Reactive lesions are subclassified as chronic superficial gastritis(68.2%), mucosal hyperplasia(15.9%), edema of lamina propria(9.1%), xanthoma(4.5%), and ectopic pancreas(2.3%).
5) Atypical changes is accompanied in 12 cases(20%) of hyperplastic polyps.
6) Adenocarcinoma arising from adenomatous polyp is noted in 6 cases. In hyperplastic polyp one case is combined with adenocarcinoma.
7) Among the true polyps single lesions are 127 cases(89.4%), and multiple lesions, 15 cases(10.6%)
8) Immunohistochemical staining for proliferating cell nuclear antigen(PCNA) reveals that hyperplastic polyps show focal positive rection in the area of pit and fundus, and adenomatous polyps show diffuse positive reaction. Dysplastic foci in both adenomatous and hyperplastic polyps shows diffuse positive reaction of PCNA.
Endoscopically diagnosed polypoid lesions show variable histologic findings ranging from chronic superficial gastritis to adenocarcinoma. They are mainly subclassified as histologically true polyps and reactive lesions. Some of true polyps have atypical changes of varing dgree in not only adenomatous polyps but also hyperplastic polyps.