Laparoscopic enucleation of insulinomas.

Hypothesis: Laparoscopic enucleation of insulinomas is safe and effective and is associated with a short hospital stay.

Design: Case series identified through retrospective review of medical records.

Setting: University of California, San Francisco Medical Center, a tertiary care referral hospital.

Key factors for successful en bloc endoscopic submucosal dissection of early stage gastric cancer using an insulation-tipped diathermic knife.

Background/aims: En bloc endoscopic mucosal resection (EMR) is presently considered to be the treatment of choice for endoscopically resectable early stage gastric cancer (EGC). Although a new EMR technique using an insulation-tipped diathermic knife (endoscopic submucosal dissection using an IT knife: IT knife-ESD) is reportedly suitable for en bloc resection, a failure in en bloc resection (piecemeal resection) can occur. We retrospectively analyzed factors affecting the success rate of en bloc resection by IT knife-ESD.

Pancreatic carcinoma that completely obstructs the Wirsung duct without dilatation of the main pancreatic duct.

Background And Aim: Pancreatic carcinomas in which the main pancreatic duct (MPD) is completely obstructed are almost always associated with dilatation of the upstream MPD. However, some carcinomas are not associated with MPD dilatation despite complete MPD obstruction. This paradoxical phenomenon has not been well documented.

En bloc endoscopic mucosal resection of a large early stage gastric cancer by combined use of an insulation-tipped diathermic knife and a grasping forceps percutaneously inserted into the gastric lumen.

A new endoscopic mucosal resection using an insulation-tipped diathermic knife (IT knife-EMR) is a promising procedure for en bloc resection of an early stage gastric cancer. However, the use of this procedure for a large lesion on the greater curvature of the gastric middle-upper body is technically difficult. With the help of a grasping forceps percutaneously inserted into the gastric lumen, which allowed traction to be applied to the lesion, a 66-year-old man with a large tumor (49mm in diameter) on the greater curvature of the gastric middle body underwent IT knife-EMR.

High mobility group A1 is expressed in metastatic adenocarcinoma to the liver and intrahepatic cholangiocarcinoma, but not in hepatocellular carcinoma: its potential use in the diagnosis of liver neoplasms.

Background: An increased level of high mobility group A (HMGA) gene/protein expression has been demonstrated to be associated with many human neoplasms originating from a variety of tissues. However, HMGA1 expression has not yet been studied in hepatic tumors. In this study, we analyzed HMGA1 expression in hepatic primary and metastatic tumors in order to verify whether determination of the HMGA1 expression level could provide any diagnostic advantages in the pathological diagnosis of hepatic tumors.

Risk factors for acute pancreatitis after endoscopic papillary balloon dilation.

Background/aims: Although EPBD (endoscopic papillary balloon dilation) may cause acute pancreatitis, risk factors for post-EPBD pancreatitis have not been well described. We retrospectively analyzed risk factors predictive of acute pancreatitis after EPBD.

Methodology: A total of 101 patients underwent EPBD for choledocholithiasis.

Matrix metalloproteinases may contribute compensationally to tumor invasion in T1 colorectal carcinomas.

Background: Few investigators have focused on possible interactions among several MMPs collectively.

Materials And Methods: Immunostaining for MMP-7, MMP-2 and MT1-MMP was performed on 51 early invasive (T1) colorectal carcinomas, and correlations between the expressions of pairs of MMPs were examined.

Results: MMP-7 expression was positive at the invasive front in 18 (35%) out of 51 tumors.

Laminin-5 gamma 2 chain and matrix metalloproteinase-2 may trigger colorectal carcinoma invasiveness through formation of budding tumor cells.

Unlabelled: Tumor budding has been reported to be significantly associated with lymph node or distant metastasis in colorectal carcinomas. We attempted to elucidate the contributing factors for the formation of budding tumor cells.

Patients And Methods: Fifty T1 colorectal carcinomas were immunostained using several antibodies against adhesion-related molecules, and the associations between tumor budding and clinicopathological factors were examined.

Coexpression of matrilysin and laminin-5 gamma2 chain may contribute to tumor cell migration in colorectal carcinomas.

We attempted to examine the correlation between matrilysin and laminin-5 gamma2 chain expression with reference to the number of dedifferentiation units along the entire invasive front (tumor budding). Immunostaining for hMMP-7 and laminin-5 gamma2 chain was performed in 50 T1 colorectal carcinomas, and immunoreactivity was evaluated at the invasive front of the tumor. On hematoxylin-eosin sections, the number of tumor budding was counted.

Cavernous Pancreatic Ductal Ectasia with Smooth Muscle Proliferation Causing Recurrent Acute Pancreatitis.

Pancreatic cystic lesions have various etiologies,including pseudocyst (inflammatory cyst), retentioncyst, congenital cyst, and neoplastic cyst (1).Recently, we experienced a case with a uniquepancreatic cyst-like lesion causing recurrent acutepancreatitis. This patient had multiple cystic dilatations of branch pancreatic ducts surrounded by proliferationof smooth muscle tissue, with neither neoplastic nor inflammatory changes.

Predictive factors for acute pancreatitis and hyperamylasemia after endoscopic papillary balloon dilation.

Background: Although endoscopic papillary balloon dilation may result in acute pancreatitis or hyperamylasemia, the risk factors for these complications have not been well documented. Risk factors predictive of acute pancreatitis and hyperamylasemia after endoscopic papillary balloon dilation were retrospectively analyzed.

Methods: In 118 patients who underwent endoscopic papillary balloon dilation for choledocholithiasis, postendoscopic papillary balloon dilation acute pancreatitis and hyperamylasemia (at least 3-fold elevation) were investigated.

Laminin-5 gamma2 chain expression as a possible determinant of tumor aggressiveness in T1 colorectal carcinomas.

This study was undertaken to clarify the associations between laminin-5 y2 chain expression, and tumor budding and lymph node metastasis or local recurrence (locoregional failure) of 50 T1 colorectal carcinomas immunohistochemically. Fifteen (30%) of 50 lesions were positive for laminin-5 gamma2 chain expression. By univariate analysis, less histological differentiation (P = 0.

Clinical utility of grading criteria for submucosal invasion in the prognosis of T1 colorectal carcinomas.

Background: The clinical utility of relative and absolute grading criteria for submucosal invasion in T1 colorectal carcinomas has been controversial.

Methods: In 51 T1 colorectal carcinomas, depth of submucosal invasion was graded either according to a modified Haggitt's classification (a relative criterion) or by direct measurement using a micrometer (an absolute criterion), and immunostaining for E-cadherin, alpha-catenin, beta-catenin, matrilysin, and CD44 variant 6 was performed on formalin-fixed, paraffin-embedded sections. The associations between lymph node metastasis or local recurrence (locoregional failure) and tumor budding, and clinicopathologic parameters and immunoreactivity were examined statistically.

Diagnostic significance of high mobility group I(Y) protein expression in intraductal papillary mucinous tumors of the pancreas.

Introduction: Overexpression of the high mobility group I(Y), [HMGI(Y)], gene/proteins has been demonstrated in many types of human malignancies, suggesting that HMGI(Y) may play a vital role in the oncogenic transformation of cells.

Aims: To analyze HMGI(Y) expression in intraductal papillary mucinous tumor (IPMT) of the pancreas to verify whether determination of the HMGI(Y) expression level could provide any diagnostic advantages in the pathological diagnosis of IPMT.

Methodology: Thirty-three different lesions from 25 patients with IPMT, including 20 with mild dysplasia, 7 with moderate dysplasia, and 6 with carcinoma, were analyzed immunohistochemically with use of an HMGI(Y)-specific antibody.

Differential diagnosis of benign versus malignant nonfunctioning islet cell tumors of the pancreas: the roles of EUS and ERCP.

Background: Differentiation between benign and malignant nonfunctioning islet cell tumors of the pancreas before surgery is often difficult. The roles of EUS and ERCP were evaluated in the differential diagnosis of these tumors.

Methods: Seven patients with histologically confirmed nonfunctioning islet cell tumors (4 benign, 3 malignant) underwent EUS and ERCP.