ABSTRACT
BACKGROUND/AIMS: Recently, variable gastrointestinal track tumors including early stage malignancies are treated by endoscopic procedure. However, the discrepancy of histologic diagnosis may sometimes exist between the pretreatment forceps biopsy results and those of post treatment specimen. So the prediction of malignant lesion is important in the aspect of treatment selection. In this study, we investigated the predictable factors of the histologic discrepancy through the clinical, endoscopic features of the lesion diagnosed as adenocarcinoma in the post-endoscopic treatment specimen after the adenoma was diagnosed by the endoscopic forceps biopsy. METHODS: From March 2005 to April 2009, 129 gastric tumor lesions (129 patients) which were not diagnosed as malignancy and treated with endoscopic procedure were enrolled retrospectively. We compared the pretreatment endoscopic forceps biopsy results and post-treatment specimen biopsy results, then, analyzed the tumor characteristics. RESULTS: Twenty-one cases (16.3%) were diagnosed as malignancy after endoscopic treatment. Especially, discrepancy occurred more frequently in depressed lesions than in flat or elevated lesions (41.7% vs. 13.7%, p=0.012), and in lesions diagnosed as high grade adenomas than low or moderate grade adenomas (33.3% vs. 11.1%. p=0.004). CONCLUSIONS: In cases of depressed type lesions in the pretreatment endoscopy or those diagnosed as high grade adenoma in the pretreatment forceps biopsy, we should consider combined malignant lesion. Therefore, treatment modalities ensuring accurate diagnosis and potentially curative resection, should be carefully selected and performed in cases which have these features.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Adenoma/pathology , Age Factors , Biopsy , Gastroscopy , Predictive Value of Tests , Sex Factors , Stomach Neoplasms/pathologyABSTRACT
Adenomyoma is a nonneoplastic lesion that can be found anywhere in the gastrointestinal tract, but it's rarely found in the ampulla of Vater. To the best of our knowledge, it is a benign lesion, but most cases are misdiagnosed as carcinoma or adenoma by a preoperative endoscopic or radiologic procedure, and this leads to unnecessarily extensive surgical resection. We report here on a case of ampulla of Vater adenomyoma that resulted in biliary and pancreatic duct dilatation. The tumor was diagnosed by endoscopic papillectomy.
Subject(s)
Adenoma , Adenomyoma , Ampulla of Vater , Dilatation , Gastrointestinal Tract , Pancreatic DuctsABSTRACT
Lymphoid polyp is a very rare disease that commonly occurs in the rectum. It is a benign, focal or diffuse lesion that typically occurs where clusters of lymphoid follicles are present. The polyp is composed of well differentiated lymphoid tissue. It can generally be differentiated from malignant lymphoma by the proliferation of normal lymphoid tissue, which has a prominent follicular pattern and a clearly defined germinal center. There have been only a few reports of lymphoid polyps of the rectum, and there have been no reports of lymphoid polyp in the ampulla of Vater. We experienced a case of lymphoid polyp in the ampulla of Vater associated with tubulopapillary adenoma, and the patient first presented with jaundice, weight loss and general weakness.
Subject(s)
Humans , Adenoma , Ampulla of Vater , Germinal Center , Jaundice , Lymphoid Tissue , Lymphoma , Polyps , Rare Diseases , Rectum , Weight LossABSTRACT
Polyarteritis nodosa is a systemic necrotizing vasculitis that affects mainly small and medium-sized arteries that involve multiple organs. In addition to the systemic involvement of classical vasculitis, localized vasculitis involves blood vessels within a confined vascular distribution or single organ without clinical evidence of generalized inflammation. Localized vasculitis of the gastrointestinal tract is a rare entity. In particular, a limited involvement of the small bowel is an unusual manifestation of polyarteritis nodosa. In this report, we describe a case of biopsy-proven polyarteritis nodosa presenting as small bowel bleeding without other systemic manifestations.
Subject(s)
Arteries , Blood Vessels , Gastrointestinal Tract , Hemorrhage , Inflammation , Polyarteritis Nodosa , VasculitisABSTRACT
Ampullary adenoma is rare but clinically important because it is a premalignant lesion. Use of endoscopic gastroduodenoscopy has increased detection of adenoma of the major duodenal papilla. Endoscopic papillectomy is a promising technique to supplant surgical ampullectomy, because it is less aggressive and more stable. However, various complications include bleeding, perforation, pancreatitis and cholangitis. We describe pancreatic and biliary strictures associated with cholangitis, and bile reflux through the pancreatic duct to the minor duodenal papilla after endoscopic papillectomy. Pancreatic and biliary strictures have not been hitherto reported complications. We performed endoscopic papillary balloon dilatation, minor papilla papillotomy and inserted a drain tube through the accessory pancreatic duct.
Subject(s)
Adenoma , Ampulla of Vater , Bile , Bile Reflux , Cholangitis , Constriction, Pathologic , Dilatation , Hemorrhage , Pancreatic Ducts , PancreatitisABSTRACT
OBJECTIVE: We wanted to evaluate whether tumors located in a segmental border zone are predisposed to local recurrence after performing segmental transarterial chemoembolization for hepatocellular carcinoma. MATERIALS AND METHODS: Seventy-three hepatocellular carcinoma nodules were retrospectively analyzed for local tumor recurrence after performing segmental transarterial chemoembolization by using follow-up CT studies (median follow-up period: 20 months, range: 4-77 months). The tumors were divided into two groups according to whether the lesions were located at the segmental border zone (Group I) or not (Group II). Comparison of the tumor characteristics and chemoembolization methods between the two groups was performed using the chi-square test. The local recurrence rates were compared by Kaplan-Meyer method and analyzed with the log rank test. RESULTS: Local tumor recurrence occurred for 25 hepatocellular carcinoma nodules (42.9%). The follow-up periods, tumor characteristics and chemoembolization methods between Groups l and ll were comparable. The local recurrence rate was 64.0% (16/25) in Group I and 18.8% (9/48) in Group II. The difference was statistically significant on the univariate and multivariate analyses (p = 0.000 for both). CONCLUSION: Tumor location in a segmental border zone was a significant risk factor for local tumor recurrence after performing segmental transarterial chemoembolization for hepatocellular carcinoma.
Subject(s)
Middle Aged , Male , Humans , Female , Aged , Adult , Risk Factors , Retrospective Studies , Proportional Hazards Models , Neoplasm Recurrence, Local , Liver Neoplasms/pathology , Iodized Oil/administration & dosage , Doxorubicin/administration & dosage , Chi-Square Distribution , Chemoembolization, Therapeutic , Carcinoma, Hepatocellular/pathologyABSTRACT
Allopurinol is frequently used for the treatment of hyperuricemia and gout. Sometimes, a life-threatening reaction develops, as is illustrated by the following case report. We describe a 60-year-old male patient who was treated with allopurinol because of asymptomatic hyperuricemia, and he was presented with fever, skin rash, eosinophilia, worsening renal function and vanishing bile duct syndrome. In this report, we discussed vanishing bile duct syndrome as a serious side effect of allopurinol, and we briefly reviewed the etiology, prevention, and treatment modalities for vanishing bile duct syndrome.
Subject(s)
Humans , Male , Middle Aged , Allopurinol/adverse effects , Bile Duct Diseases/etiology , Drug Hypersensitivity/complications , English Abstract , Gout Suppressants/adverse effectsABSTRACT
BACKGROUND: Hepatocellular carcinoma remains a highly chemoresistant neoplasm and is a common malignancy with poor prognosis in Korea. We performed a phase II study to evaluate the efficacy and toxicities of topotecan and cisplatin combination chemotherapy for advanced hepatocellular carcinoma. METHODS: Between November 1999 and May 2001, ten patients with histologically proven hepatocellular carcinoma were enrolled in this study. The median age was 54 (range: 53~74) years and all were male. Six patients demonstrated stage IV, 1 stage IIIC, 2 stage IIIB and 1 stage IIIA. Six patients showed a ECOG performance status of 1. The treatment regimen consisted of topotecan 1.25 mg/m2 and cisplatin 20 mg/m2 for 5 days. The treatment was repeated every 4 weeks. Toxicities were evaluated according to WHO toxicity criteria. RESULTS: All ten patients were evaluable for response and toxicity. There was only one patient who achieved partial response. The overall response rate was 10% (95% C.I.) and the response duration was 46 weeks. The median survival of all patients was 21 (range: 17~54+) weeks. During a total of 24 cycles, neutropenia of WHO grade 3 and 4 occurred in 33%, thrombocytopenia in 33% and anemia in 21%. In non-hematologic toxicity, diarrhea and hepatoxicity of grade 3 occurred in 1 and 2 patients, respectively. But there was no treatment-related death. CONCLUSION: When used in this dose and schedule, topotecan and cisplatin combination chemotherapy does not seem to be effective for patients with advanced hepatocellular carcinoma.
Subject(s)
Aged , Humans , Male , Middle Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma, Hepatocellular/drug therapy , Cisplatin/administration & dosage , Liver Neoplasms/drug therapy , Topotecan/administration & dosage , Treatment OutcomeABSTRACT
Primary adrenal lymphoma is extremely uncommon. The tumor is accidentally discovered by abdominal ultrasonography(USG), computed tomography(CT) or magnetic resonance imaging (MRI) in patients with nonspecific symptoms and diagnosed at operation or autopsy. In this case, a 60-year-old man was admitted for the evaluation of mild left frank discomfort for two months before admission. The abdominal USG was performed and showed the dense masses in both adrenal glands. The laboratory tests including blood count, chemistry and hormonal tests showed the normal levels except for the basal ACTH level of 108 pg/ml(normal range: 9~52 pg/ml). The 123I MIBG scan was normal. The bilateral adrenalectomy was done. The tumor was diagnosed as diffuse large B-cell non-Hodgkin's lymphoma(NHL) according to the Revised European-American lymphoma(REAL) classification. He was treated with the adjuvant combination chemotherapy of CHOP(cyclophosphamide, adriamycin, vincristine and prednisolone) but expired due to sepsis after the second chemotherapy. We describe the first case of primary bilateral adrenal NHL in Korea. Primary adrenal lymphoma should be included in the differential diagnosis of suprarenal mass.
Subject(s)
Humans , Middle Aged , 3-Iodobenzylguanidine , Adrenal Glands , Adrenalectomy , Adrenocorticotropic Hormone , Autopsy , B-Lymphocytes , Chemistry , Classification , Diagnosis, Differential , Doxorubicin , Drug Therapy , Drug Therapy, Combination , Korea , Lymphoma , Lymphoma, Non-Hodgkin , Magnetic Resonance Imaging , Sepsis , VincristineABSTRACT
A choledochal cyst is relatively rare lesion in the biliary system, and a carcinoma arising from such a cyst is rarely reported. Until now, a case of a hepatocellular carcinoma combined with a choledochal cyst had not been reported. A 45-year-old woman was recently admitted due to abdominal pain. An abdominal computed tomography revealed a 5 cm-sized low attenuative mass involving the right anterior and left medial segment of the liver and gallbladder fossa. An endoscopic retrograde cholangiopancreatogram showed fusiform dilatation of the common bile duct, but anomalous union of pancreaticobiliary duct was not observed. Fine-needle aspiration of the liver was conducted and yielded a hepatocellular carcinoma. On celiac arteriography, a hypervascular hepatic mass was also found. Transarterial chemoembolization was performed. It is believed this may be the first case of a choledochal cyst combined with a hepatocellular carcinoma in the literature. Hence, this case is herein reported with a review of related literatures.
Subject(s)
Female , Humans , Middle Aged , Abdominal Pain , Angiography , Biliary Tract , Biopsy, Fine-Needle , Carcinoma, Hepatocellular , Choledochal Cyst , Common Bile Duct , Dilatation , Gallbladder , LiverABSTRACT
A 71-year-old man was admitted due to abdominal distension and periumbilical pain. He was diagnosed as having mucinous ductal ectasia (MDE) of the pancreas three months prior, but refused an operation. Three months later, an abdominal computed tomography revealed more dilated pancreatic duct, newly developed liver metastasis and ascites in comparison with previous findings. Fine-needle aspiration cytology of the cystic lesion in the pancreatic head was conducted and yielded adenocarcinoma. Also, an ascitic fluid cytology determined adenocarcinoma. This patient was diagnosed to be inoperable and received palliative chemotherapy and pain control. The patient expired 5 months after the initial diagnosis.
Subject(s)
Aged , Humans , Adenocarcinoma , Ascites , Ascitic Fluid , Biopsy, Fine-Needle , Diagnosis , Dilatation, Pathologic , Drug Therapy , Head , Liver , Mucins , Neoplasm Metastasis , Pancreas , Pancreatic DuctsABSTRACT
A 68-year-old man was admitted due to abdominal pain. He was diagnosed as having recurrent pancreatitis with a pseudocyst, which is communicated through the main pan- creatic duct. An endoscopic pancreatic sphincterotomy and insertion of a nasopancreatic tube into the main pancreatic duct via transpapillary drainage were performed. As a result, the pseudocyst disappeared and the pain was relieved. Thus it was concluded that transpapillary drainage via the main pancreatic duct is a safe and effective treatment for pancreatic pseudocysts, which is communicated through the main pancreatic duct.
Subject(s)
Aged , Humans , Abdominal Pain , Drainage , Pancreatic Ducts , Pancreatic Pseudocyst , PancreatitisABSTRACT
A case of IgA lambda nonsecretory multiple myeloma in a 66-year-old man was reported. Despite of the osteolytic lesions both protein electrophoresis and protein immunoelectrophoresis of serum and urine of the patient were normal. Bone marrow biopsy at iliac crest showed 8% plasma cells and aspiration cytology of the lesion of rib revealed 73% plasma cells. When examined by immunofluorescence with monospecific antisera the cytoplasm of the immature plasma cell showed predominantly the presence of IgA and lambda chains.
Subject(s)
Aged , Humans , Biopsy , Bone Marrow , Cytoplasm , Electrophoresis , Fluorescent Antibody Technique , Immune Sera , Immunoelectrophoresis , Immunoglobulin A , Multiple Myeloma , Plasma Cells , RibsABSTRACT
Hepatie hilar ductal carcinoma is relatively rare, but the prognosis is known to be poor because an early diagnosis is difficult. Because the majority of patients are already infiltrated into adjacent organ by itself at the diagnosis, the rate of resectability is low. The best method of treatment is curative resection, and the range of tumor invasion is very important. The preoperative diagnosis is difficult because the cholangiography may be normal in cases of superficial invasion. Multifocal lesions within the biliary tract may be identified in as many as 10 percent of patients, Especially, the papillary type has the best prognosis and is associated with multiple tumors within the bile duct. We report a case that percutaneous transhepatic cholangiogram showed normal distal common bile duct, but the hepatic hilar confluence and ampulla of Vater lesion was confirmed as adenocarcinoma.
Subject(s)
Humans , Adenocarcinoma , Ampulla of Vater , Bile Ducts , Biliary Tract , Carcinoma, Ductal , Cholangiocarcinoma , Cholangiography , Common Bile Duct , Diagnosis , Early Diagnosis , Pancreas , PrognosisABSTRACT
One hundred and sixteen Korean adults with biopsy-proven acute viral hepatitis were studied to determine the etiology and the outcome of the disease using paired sera obtained during acute and convalescent phases. The prevalence of acute viral hepatitis A, B, D and non-A non-B were 3.4%, 60.3%, 0.9% and 35.3%, respectively: hepatitis B virus infection was the most common cause and the hepatitis D virus superinfection was almost negligible. Only eleven (26.8%) of 41 patients with AVH NANB were negative for all serological markers of HBV. The rest (73.2%) were positive for at least one HBV marker: HBsAg was positive in 31.7%. Therefore, the presence of HBV serologic markers in the sera does not exclude the diagnosis of AVH NANB in Korea. In patients with acute viral hepatitis B, 27% remained positive for HBsAg. Chronic hepatitis developed in 12.8% and 17% patients with acute hepatitis B and non-A non-B, respectively. Progression to chronic hepatitis in patients with acute viral hepatitis B and non-A non-B occurred more commonly, although statistically not significant, in male sex and in patients who did not have clinical jaundice during the acute phase and who showed bridging necrosis in their liver biopsies. Age did not influence the progression to chronic hepatitis.