Animals ; Colon ; pathology ; Dogs ; Female ; Graft Survival ; Intestinal Mucosa ; pathology ; transplantation ; Mouth Mucosa ; pathology ; transplantation ; Reconstructive Surgical Procedures ; Urethra ; surgery

OBJECTIVETo investigate the possibility of urethral reconstruction with a free colonic mucosal graft.

METHODSTen female dogs underwent a procedure in which the urethral mucosa was totally removed and replaced with a free graft of colic mucosa. A urodynamic study was performed before the operation and sacrifice. The dogs were sacrificed 8 to 16 weeks after the operation for histological examination of the urethra.

RESULTSUrethral stricture developed in 1 dog. The results of urody namic studies showed that the difference in maximum urethral pressure between pre-operation and pre-sacrifice in the remaining 9 dogs was not of significance (P > 0.05). Histological examination revealed that the colonic free mucosa survived inside the urethral lumen of the 9 dogs. Plicae surface and unilaminar cylindric epithelium of the colonic mucosa was observed in dogs sacrificed 8 weeks after the operation. Plicae surface and unilaminar cylindric epithelium of the colonic mucosa was not observed and metaplastic transitional epithelium covered a large proportion of the urethral mucosa in dogs sacrificed 12 weeks after the operation.

CONCLUSIONSUrethral mucosa can be replaced by colonic mucosa without damaging the continence mechanism in female dogs. This technique is useful when local or preputial skin and buccal or bladder mucosa are not available.

Animals ; Colon ; transplantation ; Dogs ; Female ; Intestinal Mucosa ; transplantation ; Urethra ; pathology ; surgery ; Urologic Surgical Procedures

Endoscopic submucosal dissection (ESD) is an useful therapeutic technique for large gastrointestinal epithelial tumors that it provides an en bloc resection. Although there is some controversy about the role of ESD for colorectal lesions, for large lesions in the distal rectum, ESD has the advantage of preserving anal function. However, the large amount of insufflating gas used during the procedure can cause severe abdominal pain and discomfort. Moreover, high intra-luminal pressure caused by a by large amount of gas can cause a micro-perforation. There is no consensus as to whether ESD is the optimal treatment for synchronous large colorectal laterally spreading tumors (LSTs) that cannot be removed en-bloc by conventional endoscopic mucosal resection. Here, a case with two neighboring synchronous large LSTs, one located in the rectum and the other in the distal sigmoid colon, were sequentially removed by separate ESD procedures performed on two consecutive days in a patient who could not tolerate a long procedure.
Adenoma, Villous/diagnosis ; Colonoscopy ; Colorectal Neoplasms/*diagnosis/pathology/surgery ; *Dissection ; Humans ; Intestinal Mucosa/pathology/surgery ; Male ; Middle Aged ; Neoplasms, Multiple Primary/*diagnosis/pathology/surgery ; Rectum/pathology

BACKGROUND/AIMS: Submucosal tumors of the esophagus are rare lesions among all esophageal neoplasms. The purpose of this study was to evaluate the clinicopathologic features of esophageal submucosal tumors treated by surgical approach. METHODS: We analyzed the clinicopathologic and endoscopic ultrasonographic features of 18 esophageal submucosal tumors which were treated by surgical approach at Boramae Medical Center and Seoul National University Bundang Hospital from January 2005 to June 2012. RESULTS: The mean age was 48.9 years old and male to female ratio was 2.6:1. Asymptomatic patients were most common (77.8%). In endoscopic ultrasonographic finding, the majority tumor arouse in the middle (55.6%) and lower (44.4%) esophagus, and appeared as hypoechoic lesion (72.2%) in the 4th layer (83.3%). The most common indication for surgical approach was unclear biological behavior of the tumor. Minimally-invasive technique using thoracoscopy was applied for the enucleation (83.3%). The mean diameter of the tumor was 5.4 cm, and the final diagnosis was leiomyoma (89.9%) and gastrointestinal stromal tumor (11.1%). CONCLUSIONS: Leiomyoma was the most common submucosal tumor in esophagus. However, endoscopic ultrasonography was not able to differentiate between leiomyoma and gastrointesinal stromal tumor. For more accurate diagnosis and treatment, minimally-invasive approaches may be suitable for the surgical enucleation of indicated esophageal submucosal tumor.
Adult ; Aged ; Esophageal Neoplasms/*pathology/*surgery/ultrasonography ; Esophagus/pathology ; Female ; Gastrointestinal Stromal Tumors/diagnosis/surgery ; Humans ; Intestinal Mucosa/*pathology ; Leiomyoma/diagnosis/surgery ; Male ; Middle Aged ; Retrospective Studies ; Thoracoscopy

BACKGROUND/AIMS: While endoscopic resection could be considered as the best choice for the treatment of small rectal carcinoid, the colonoscopic biopsies performed at the time of detection may lead to scar and ulcer formation and cause unpredicted difficulty in the endoscopic resection. This study was evaluated to analyze the relationship between the post-biopsy scar and the limitation of submucosal elevation for the endoscopic resection of rectal carcinoids. METHODS: Twenty two cases of rectal carcinoid which received prior biopsies before the endoscopic resection were retrospectively compared with 20 non-biopsied cases. All two groups were treated by endoscopic resection from January 2000 to December 2007. There was no difference in the clinical characteristics and endoscopic findings such as size and location between the two groups. RESULTS: The limited submucosal elevation was experienced in 17 cases (77%) in the biopsy group, significantly more frequent than 9 cases (45%) in the non-biopsy group (p=0.03). The colonoscopic findings which contribute to difficult submucosal elevation were the depressive scar formation after biopsy, the size less than 5 mm in the biopsy group, active ulcer formation after biopsy. Regarding the resection method, endoscopic submucosal dissection was frequently adopted (23% vs. 5%) in the biopsy group. The frequency of endoscopic piecemeal resection in biopsy group was higher than non-biopsy group (23% vs 10%), and all cases were subsequently resected by other endoscopic methods. CONCLUSIONS: The post-biopsy scar can interfere with successful submucosal elevation for endoscopic resection of rectal carcinoids. The number of forcep biopsy should be minimized in the diagnostic colonoscopy when endoscopic resection is planned rectal carcinoids.
Adult ; Aged ; Biopsy ; Carcinoid Tumor/*pathology/surgery ; Cicatrix/pathology ; Colonoscopy ; Female ; Humans ; Intestinal Mucosa/surgery ; Male ; Middle Aged ; Rectal Neoplasms/*pathology/surgery ; Risk Factors

To compare the safety and efficacy between endoscopic submucosal dissection (ESD) and radical surgery (RS) for the treatment of large colorectal laterally spreading tumors (LST) larger than 50 mm in diameter. 
 Methods: From January 2011 to January 2016, a total of 82 patients were diagnosed as large LST without deep submucosal invasion (T1 SM2, ≥1 000 µm) in the Second Xiangya Hospital of Central South University. Among them, 52 patients were treated by ESD and the other 30 patients were treated by RS [laparoscopic-assisted colectomy (LAC)/open colectomy (OC)]. The clinic data were retrospectively analyzed and the en-bloc resection rate, en-bloc R0 resection rate, local recurrence, complication, procedure time and hospital stay were collected and analyzed.
 Results: The lesion sizes were (5.80±1.20) cm and (5.53±0.69) cm in diameter for ESD and RS groups, respectively (P>0.05). En-bloc resection rates, en-bloc R0 resection rates and recurrence rates showed no significant difference between the ESD group and RS group (P>0.05). Complication rate of the ESD group (7.69%, 4/52) was much lower than that in the RS group (33.33%, 10/30; P<0.01). The ESD group also had a shorter hospital stay and operation time than the RS group (P<0.05).
 Conclusion: ESD appears to be a safe, minimal invasive and effective strategy for treating large LST and it is obviously better than RS in the aspects of hospital stay, operation time and short-term complication.
Colorectal Neoplasms ; pathology ; surgery ; Dissection ; Endoscopic Mucosal Resection ; standards ; Humans ; Intestinal Mucosa ; pathology ; surgery ; Neoplasm Recurrence, Local ; pathology ; surgery ; Retrospective Studies ; Treatment Outcome

No abstract available.
Diagnosis, Differential ; Endosonography ; Female ; Humans ; Incidental Findings ; *Intestinal Mucosa/pathology/radiography/surgery ; Intestinal Polyps/*diagnosis/pathology/radiography/surgery ; Middle Aged ; Neoplasms, Fibroepithelial/*diagnosis/pathology/radiography/surgery ; Predictive Value of Tests ; Rectal Neoplasms/*diagnosis/pathology/radiography/surgery ; Tomography, X-Ray Computed

Local recurrence after endoscopic piecemeal mucosal resection (EPMR) for colorectal tumors is a crucial issue. However, such recurrence is usually detected within one year and cured with additional endoscopic treatment, which makes EPMR acceptable. Herein, we report a rare case of repeatedly recurrent colon cancer involving the appendiceal orifice after EPMR, which was not cured with additional endoscopic treatments. A 67-year-old man was referred to us for endoscopic treatment of a 25 mm cecal tumor spreading to the appendiceal orifice in May 2002. The tumor was resected with EPMR, showing well differentiated intramucosal adenocarcinoma with a positive lateral cut margin of tubular adenoma. Endoscopic surveillance was conducted and the first local recurrence was detected in August 2006. Although we resected it endoscopically, the second local recurrence was found in September 2007 and we removed it with endoscopic resection again. However, the third local recurrence was detected in March 2008. Although endoscopic resection was performed also for the third recurrence, curative resection was not achieved. In February 2009, laparoscopic assisted colectomy was performed and histopathological examination showed well differentiated adenocarcinoma with deep submucosal invasion. This case is important in considering indication for endoscopic resection in colorectal tumors involving the appendiceal orifice.
Adenocarcinoma/*diagnosis/pathology/surgery ; Aged ; Appendiceal Neoplasms/complications ; Colectomy ; Colonic Neoplasms/*diagnosis/pathology/surgery ; Colonoscopy ; Humans ; Intestinal Mucosa/pathology ; Male ; Neoplasm Recurrence, Local ; Recurrence

Endoscopic tattooing with India ink is generally regarded as a safe procedure that enables ready identification of endoluminal cancer from the serosal surface. However, significant complications have been reported, including local inflammatory pseudotumor formation, peritonitis, rectus muscle abscess, small bowel infarction, and phlegmonous gastritis. Although the mechanism of complication is not completely understood, it may be related to the chemical compounds contained in the ink solution and enteric or extraenteric bacterial inoculation by injection needle or the ink itself. Authors encountered a case of a 60-year-old man with a resectable sigmoid colon cancer which was tattooed with India ink for subsequent localization in the intraoperative setting. During the laparoscopic operation, the proximal and distal margin of the lesion appeared edematous with bluish color. The distal resection margin was extended approximately 5 cm more than expected because of long extent of edematous mucosa. Histologic examination of the edematous tattooing area revealed an ink abscess spreading laterally above the muscularis propria. Although tattooing is widely used and relatively safe, the presented case indicates the risk of infection or inflammation by tattooing.
Abscess/*diagnosis/etiology/pathology ; Carbon/*adverse effects ; Colonoscopy ; Humans ; Intestinal Mucosa/pathology/surgery ; Laparoscopy ; Male ; Middle Aged ; Sigmoid Neoplasms/surgery ; *Tattooing

Hemangioma of the esophagus is a rare form of benign esophageal tumor. It usually presents as a single lesion located in the lower third of the esophagus and is mostly asymptomatic. However, it may occasionally cause hematemesis and/or obstruction. Surgical resection is the conventional treatment modality for managing esophageal hemangioma, but less invasive approaches such as endoscopic therapy are recently becoming more widely employed. Herein, we report a case of a 54-year-old man who presented with an esophageal hemangioma that was successfully treated by endoscopic mucosal resection without any complications.
Antigens, CD31/metabolism ; Esophageal Diseases/*diagnosis/surgery ; Esophagoscopy ; Esophagus/diagnostic imaging/metabolism/pathology ; Hemangioma/*diagnosis/surgery ; Humans ; Intestinal Mucosa/metabolism/pathology ; Male ; Middle Aged ; Tomography, X-Ray Computed