In this study, we investigated the diagnostic performance of magnifying endoscopy (ME) with third-generation narrow-band imaging (3G-NBI) for early gastric cancer (EGC), primarily in patients with Helicobacter pylori eradication. This was a post hoc analysis of a multicenter, randomized trial comparing 3G-NBI, texture and color enhancement imaging, and white-light imaging in gastric neoplasm (GN) detection. For all detected lesions, the endoscopic diagnosis of ME using 3G-NBI was compared with the pathological diagnosis. The primary analyses focused on the sensitivity and specificity of ME with 3G-NBI for EGC or non-EGC. The diagnostic performance was analyzed according to confidence level, macroscopic type, lesion size, and H. pylori infection status. This study included 901 patients; 228 suspected GN lesions in 187 patients were analyzed. The lesions were diagnosed with EGC in 62 (27 with high confidence) and non-EGC in 166 (91 with high confidence) patients using ME with 3G-NBI and pathologically diagnosed as EGC in 61 and non-EGC in 167 patients. The overall diagnostic performance was sensitivity and specificity of 70.5
A 64-year-old man underwent endoscopic submucosal dissection (ESD) for squamous cell carcinoma in the upper thoracic esophagus. The resected specimen was histopathologically diagnosed as esophageal squamous cell carcinoma with pathological invasion to the T1a-lamina propria mucosae without lymphovascular invasion and was determined to have been curatively resected. Twenty-six months after ESD, the patient had an increased serum carcinoembryonic antigen (CEA) concentration of 14.0 ng/mL. Comprehensive examination revealed multiple lymphadenopathies. A biopsy of the right supraclavicular lymph node confirmed metastasis of squamous cell carcinoma. Immunohistochemical study for CEA was focally positive in the primary ESD specimen, whereas nearly all tumor cells in the metastatic lesion were positive. Therefore, it was considered that the metastatic lesion originated from the CEA-positive subpopulation of the primary tumor. This is the first case of lymph node metastatic recurrence detected based on an increased serum CEA concentration after ESD for esophageal squamous cell carcinoma with invasion to the T1a-lamina propria mucosae. Serum CEA measurement was useful for detecting the recurrence. Furthermore, this case suggests that CEA immunohistochemical study may be useful for the assessment of metastatic risk following curative ESD for esophageal squamous cell carcinoma.
PURPOSE:Few reports have investigated the attitudes of medical students and early residents toward medical oncology and their career decisions. This study aimed to assess recognition, interest, and factors influencing the intention to specialize in medical oncology among medical students and junior residents. METHODS:A 20-item questionnaire survey was conducted online from November to December 2024. Participants were recruited from medical universities, university hospitals, and general hospitals across Japan. Responses regarding perceptions of medical oncology and decisive factors for career choice were analyzed. RESULTS:A total of 632 medical students and junior residents completed the survey. Among them, 545 (86%) recognized medical oncology, and 243 (38%) considered it a potential future career. The correlation coefficient between academic year and recognition of medical oncology was 0.976, whereas that between academic year and interest was -0.810. Sensitivity of interest, defined as the proportion of participants considering medical oncology as a career among those interested in it, was highest in third-year students (0.78). Multivariate analysis identified interest in cancer treatment as the strongest predictor of considering medical oncology as a career (contribution rate, 43%; range, 1.62; partial correlation coefficient, 0.28). CONCLUSION:Recognition of medical oncology increased with academic year, whereas interest declined. Interest in cancer treatment was the strongest predictor of intention to specialize in medical oncology.
BACKGROUND:A free-floating thrombus in the ascending aorta is a rare but clinically significant condition that can cause cerebral and peripheral arterial embolism. Preoperative differentiation from primary aortic tumors, particularly intimal sarcoma, remains challenging even with positron emission tomography-computed tomography (PET-CT). Optimal treatment strategies have not been established. CASE PRESENTATION:A 49-year-old man presented to our emergency department with acute right lower extremity ischemia. Contrast-enhanced computed tomography revealed acute occlusion of the right common femoral artery, and emergent thrombectomy was performed on the same day. He had experienced a cryptogenic cerebral infarction two months earlier; although echocardiography had shown no intracardiac thrombus, he had been managed with anticoagulation alone. To identify the source of recurrent embolism, contrast-enhanced computed tomography from the neck to the pelvis was performed, revealing a pedunculated mass in the ascending aorta. PET-CT showed no abnormal uptake. On hospital day 10, ascending aortic replacement with a prosthetic graft was performed. Intraoperative epi-aortic echocardiography was used to identify the thrombus location and determine a safe cross-clamp site, thereby avoiding deep hypothermic circulatory arrest. The mass was resected together with a ring-shaped segment of the aortic wall at its attachment site to prevent local recurrence. Pathological examination confirmed an organizing thrombus without neoplastic features. The postoperative course was uneventful, and the patient was discharged on postoperative day 13. At 5-year follow-up, no recurrent embolic events or new thrombus formation has been observed. CONCLUSIONS:In patients with a pedunculated free-floating thrombus in the ascending aorta presenting with recurrent systemic embolism, early surgical intervention, including graft replacement, is a reasonable therapeutic option. Graft replacement enables complete excision of the attachment site for recurrence prevention and provides a definitive histopathological diagnosis. However, further accumulation of cases is needed to establish optimal management strategies for this rare condition.
Gastric cancer remains a significant health burden, especially in Asia. Potassium-competitive acid blockers (P-CABs) provide stronger acid suppression than proton pump inhibitors (PPIs), but their long-term impact on metachronous gastric cancer (MGC) remains unclear. This study evaluated the incidence and duration-dependent risk of MGC in P-CAB/PPI users. This multicenter retrospective cohort study included patients from 15 institutions in Japan who underwent endoscopic or surgical resection for gastric cancer between 2014 and 2022. After exclusions, 7172 patients who had received H. pylori eradication were analyzed. Chronic use of P-CAB/PPI was defined as administration for more than 3 months. The primary outcome was the incidence of MGC. Cox regression models were used, along with subgroup analyses based on duration and initial treatment type (endoscopy versus surgery). During a median follow-up of 5.8 years, MGC developed in 342 patients. The incidence was highest among P-CAB users (20.9 per 1,000 person-years), followed by PPI users (13.5) and non-users (7.1). Both P-CAB and PPI use were independently associated with increased MGC risk (hazard ratio 3.89 and 1.75, respectively). The association between P-CAB use and MGC was stronger with longer durations of use (hazard ratio 3.44 for < 1 year, 3.95 for 1–3 years, and 9.36 for > 3 years) and was particularly evident in the post-endoscopic group (hazard ratio 4.22) in subgroup analyses. Chronic use of P-CAB/PPI were associated with MGC. Longer duration may be associated with increased risk of MGC. Further studies are warranted to validate these findings.
