Comparison of Magnifying Endoscopy with Blue Light Imaging and Narrow Band Imaging for Determining the Invasion Depth of Superficial Esophageal Squamous Cell Carcinoma by the Japanese Esophageal Society’s Intrapapillary Capillary Loop Classification

Blue light imaging (BLI) and narrow-band imaging (NBI) are two modalities that enable narrow-band light observation. We aimed to compare the diagnostic ability of magnifying endoscopy with BLI (ME-BLI) and NBI (ME-NBI) for determining the invasion depth of superficial esophageal squamous cell carcinoma (SESCC) by the Japanese Esophageal Society’s intrapapillary capillary loop (IPCL) classification. We enrolled 81 patients between 2014 and 2018, and the still endoscopic images for diagnosing the invasion depth at the same part in ME-BLI and ME-NBI were registered. Two blinded investigators reviewed them and diagnosed the invasion depth by the IPCL classification. Subsequently, the diagnostic yields in two modalities were compared. The overall accuracies for the invasion depth by the IPCL classification in ME-BLI and ME-NBI did not differ significantly (67.9–71.6% vs. 72.8–74.1%). In the analysis based on the invasion depth, the sensitivities and positive predictive values in tumors invading the muscularis mucosa or submucosa ≤200 µm were low (23.1–30.8% and 16.7–25.0%, respectively) in both modalities. In conclusion, the diagnostic ability for determining the invasion depth of SESCC by the IPCL classification was relatively similar in ME-BLI and ME-NBI, but diagnosis by magnifying endoscopy alone might not be satisfactory.

Possibilities of nailfold capillaroscopy in the differential diagnosis of immuno-inflammatory and rheumatological diseases

This article considers capillaroscopic changes in the patients with systemic sclerosis compared to the patients with a group of rheumatological diseases (rheumatoid arthritis, polymyositis, osteoarthritis) and the patients with idiopathic pulmonary hypertension. All the patients diagnosed with systemic sclerosis according to nailfold capillaroscopy had a characteristic combination of capillary disorders (Raynauds syndrome): the expansion of all three segments of the capillary loop, the loss of capillaries, and the destruction of the nail fold. In the comparison groups, the capillaroscopic picture was represented by single pathological changes that did not add up to the pathognomonic scleroderma patterns, with the exception of the groups with dermato/polymyositis, where 2 patients had significant Raynauds syndrome. There were also significant differences in the density of the capillaries in the patients with systemic sclerosis in comparison with the other groups.

A Case of Esophageal Xanthoma with Epithelial Reactive Inflammation with a Characteristic Finding of Narrow-Band Imaging Magnifying Endoscopy

A 75-year-old woman had a 5 mm slightly elevated yellowish lesion in her thoracic esophagus. Narrow-band imaging magnifying endoscopy (NBI-ME) revealed aggregations of a tiny white substance beneath each intrapapillary capillary loop with weaving, dilatation, and a different shape. In this case, an irregular caliber was absent. The biopsy specimen taken from the lesion showed cells with large nuclei and increased chromatin clumping in the basal layer. These cells were positive for p53. Endoscopic submucosal dissection was performed for the purpose of excisional biopsy. Finally, it was diagnosed as an esophageal xanthoma with a benign epithelial reactive inflammation. This is the first report of esophageal xanthoma showing the characteristic NBI-ME finding of esophageal xanthoma. Further studies are required to determine whether the characteristic finding of NBI-ME is generally found in esophageal xanthomas.

Ultramorphological Characteristics of Podocyte Development in the Human Fetal Metanephros

The aim of this study was to determine the developmental characteristics of podocytes in the human fetal metanephros using scanning electron microscopy, light microscopy, and transmission electron microscopy. Kidney samples of 15 human fetuses of both sexes (gestational age 10–22 weeks) were analyzed. At the S-shaped body stage, primitive podocytes were arranged in a layer of cuboidal cells beneath the vascular cleft. When observed from Bowman’s space, the demarcation between adjacent podocytes was not clear, but mild depressions indicated cell boundaries. At the more advanced S-shaped body stage, podocytes were polygonal, with a flat apical surface. They were in close contact, but boundaries between adjacent cells were distinct. After initial separation of their apical parts, podocytes continued to separate from each other along their lateral sides. Their shape changed from polygonal to spherical, resembling clusters of grapes. Cytoplasmic buds could be seen at the base of some podocytes initially, when all podocytes were spherical. Parallel with the development of the first capillary loops, wider intercellular spaces were noted between elliptical-shaped podocytes. Podocytes then developed cytoplasmic processes and became flattened and star shaped. Their cell bodies separated from the glomerular basement membrane through the insertion of thick processes under the cell body. Thick primary processes ramified to form the foot processes, which interdigitated on the surface of capillary loops. During the capillary loop stage, the degree of differentiation of the podocytes varied among various glomerular regions, as well as within the same capillary loop.

Rare Primary Esophageal Paget’s Disease Diagnosed on a Large Bloc Specimen Obtained by Endoscopic Mucosal Resection

Primary esophageal Paget’s disease is rare. Only a few case reports have described the intraepithelial papillary capillary loop (IPCL) pattern obtained by magnified Narrow Band Imaging (M-NBI) endoscopy in this rare pathology. This report highlights the usefulness of M-NBI and the successful diagnosis using a large bloc specimen obtained by endoscopic mucosal resection with the cap method (EMR−c). A 53-year-old man was referred to endoscopic examination for dysphagia. The endoscopic image revealed a ring-shaped scarring of the esophagus suggestive for eosinophilic esophagitis. The IPCL pattern by M-NBI endoscopy showed an inflammatory pattern, and the entire epithelium of the esophagus was not stained by Lugol iodine spraying. Based on six biopsies randomly performed, a poorly differentiated adenocarcinoma was diagnosed. Since the M-NBI pattern and the histology were completely different, EMR−c was performed to obtain large bloc specimens for a more detailed diagnosis. The pathological findings revealed extensive Paget’s cells infiltration into the epithelium and multifocal invasion from the mucosa to the submucosal layer with adenocarcinoma. In conclusion, a large bloc specimen by EMR-c might be more useful than a small biopsy for an accurate diagnosis of the rare esophageal Paget’s disease.Key words: – – .Abbreviations: EMR−c: endoscopic mucosal resection with cap method; IPCL: intraepithelial papillary capillary loop; LVLs: Lugol-voiding lesions; M-NBI: magnified Narrow Band Imaging; PET-CT: Positron-Emission Tomography and Computed Tomography.