Bladder Malakoplakia Mimicking Bladder Cancer / 대한내과학회지

Malakoplakia is an extremely rare granulomatous disease caused by infection and known to occur mostly in immune-compromised hosts. The most common site of involvement is the bladder. Patients with malakoplakia of the bladder present with multiple intravesical masses and are often misdiagnosed with bladder cancer. As a result, appropriate treatment is delayed. Here we report a case of a patient with malakoplakia of the bladder that was misdiagnosed as bladder cancer.

Osteochondrolipoma Presenting as a Popliteal Cyst

Here, we describe a popliteal mass that was initially misdiagnosed as a simple popliteal cyst, which finally turned out to be osteochondrolipoma. A 63-year-old housewife presented with sustained knee pain in association with a palpable mass on the popliteal fossa. The mass was in the posteromedial area and soft, non-tender, non-movable in the posteromedial area. Using plain radiography, the mass appeared as a round, soft tissue density lesion containing bony fragments. We performed an ultrasound-guided needle biopsy in conjunction with magnetic resonance imaging, followed by an open excisional biopsy. Microscopically, histological sections showed a lipoma with cartilaginous and osseous differentiation, finally diagnosed as osteochondrolipoma. In conclusion, popliteal masses are not always simple cysts, and the evaluation of masses in the popliteal fossa is always necessary.

A Case of Splenic Botryomycosis Caused by Streptococcus mitis in a Patient with a Previous Distal Gastrectomy / 대한내과학회지

Botryomycosis is an uncommon chronic suppurative bacterial infection of the skin and visceral organs seen primarily in immunocompromised patients. Here, we report a case of splenic botryomycosis caused by Streptococcus mitis in a 53-year-old immunocompetent woman with a history of distal gastrectomy for advanced gastric cancer.

A Case of Alveolar Adenoma Involving Multiple Lung Nodules / 대한내과학회지

Alveolar adenoma is a very rare benign intraparenchymal lung tumor originating from type II pneumocytes. It can be mistaken for other benign tumors or lung cancer in radiological images. It is especially difficult to distinguish alveolar adenoma from sclerosing hemangioma. A small aspiration biopsy specimen, such as with percutaneous needle aspiration, is insufficient for a pathological diagnosis. Surgical resection is the only method by which a pathological diagnosis can be made and the disease treated. An alveolar adenoma presenting as multiple nodules is very rare and has to our knowledge not been reported in Korea previously. Here, we report a case of alveolar adenoma in multiple nodules in a 57-year-old female and review the literature.

A Case of Meningeal Carcinomatosis from Prostate Cancer / 대한내과학회지

Meningeal carcinomatosis in patients with prostate cancer is very rare. Recently, we experienced a case of meningeal carcinomatosis in a patient with prostate cancer. He had undergone a radical prostatectomy 11 years before presentation and had undergone chemotherapy 4 years before presentation due to bone metastases. This time, he visited the emergency department because of a seizure. Although cerebrospinal fluid (CSF) examinations did not reveal malignant cells, we diagnosed meningeal carcinomatosis based on positive CSF prostate-specific antigen and magnetic resonance imaging (MRI) findings. The diagnosis was confirmed pathologically. We treated the patient with whole brain radiotherapy and intrathecal chemotherapy. We report a case of prostate cancer with meningeal carcinomatosis with a literature review.

Clinical Outcomes of Stercoral Colitis / 대한내과학회지

BACKGROUND/AIMS: Stercoral colitis is an inflammatory condition related to increased intraluminal pressure, itself caused by impacted fecal material. Stercoral colitis is a rare condition and has a generally poor prognosis. The aims of this study were to investigate the clinical characteristics and outcomes of stercoral colitis according to management strategy. METHODS: From January 2004 to August 2009, 11 patients were diagnosed with stercoral colitis at our center. The medical records of these individuals were reviewed retrospectively with regard to the clinical characteristics, management strategy, and clinical outcomes. We defined severe stercoral colitis as stercoral colitis complicated by systemic inflammatory response syndrome, sepsis, or septic shock. RESULTS: Eleven patients (three men and eight women) with a mean age of 70+/-8 years were included. Ten patients were elderly with constipation as a predisposing factor. Nine patients had severe stercoral colitis according to out criteria. Of these, five patients underwent surgery, and the other four were treated with a conservative management strategy. One patient (20%) in the surgical group and all patients in the conservative management group (n=4) died. CONCLUSIONS: Stercoral colitis should be considered in elderly patients with predisposing factors and presents as fecal impaction with colonic wall thickening or pericolic fat stranding on CT scan. In patients with severe stercoral colitis, early surgery may be effective in reducing mortality.

A Case of Ischemic Colitis after Bee Venom-induced Anaphylaxis / 대한소화기내시경학회지

Anaphylaxis is a potentially life-threatening allergic reaction, presenting with various clinical symptoms. The most common etiologies of anaphylactic reactions include allergic responses to food, medications, latex, and Hymenoptera stings. In its classic form, anaphylaxis typically involves the cutaneous, respiratory and cardiovascular systems. Gastrointestinal symptoms, including nausea, vomiting, diarrhea and cramping abdominal pain, can occur transiently but mucosal lesions are rarely detected. We recently experienced a case of ischemic colitis presenting with hematochezia after bee venom-induced anaphylactic shock. To the best of our knowledge, this is the first case in Korea. We report the case with a review of the literature.

A Case of Gastrointestinal Bleeding after a Snake Bite / 대한내과학회지

The clinical presentation of snake bites varies greatly. Symptoms range from only bite marks to muscle spasms, paralysis, altered mental status, and muscle weakness. In severe cases, symptoms may include life threatening coagulopathy or gastrointestinal bleeding owing to increased vascular permeability. In this report, the patient presented with massive gastrointestinal bleeding after a snake bite and recovered with conservative treatment.

A case of Castleman's disease patient treated successfully with cyclic high-dose steroid therapy / 대한내과학회지

Castleman's disease is rare, and its cause is unknown. Although various treatments have been attempted, no standard treatment has been established for it. A 51-year-old male on hemodialysis with end-stage renal disease was admitted to our hospital with fever and myalgia. He was diagnosed with multicentric Castleman's disease (MCD) of the hyaline vascular type. Considering his underlying disease and general condition, cyclic high-dose steroid therapy (prednisolone 1 mg/kg/day for 5 days) was administered every 4 weeks, eight times in total. After this, no symptomatic manifestations of MCD or signs on computed tomography were observed. We report an immunocompromised patient diagnosed with MCD of the hyaline vascular type, who was successfully treated with cyclic high-dose steroid therapy.

Simultaneous Melanosis Duodeni and Melanosis Ilei in a Patient Taking Oral Iron / 대한소화기내시경학회지

Melanosis means the accumulation of brown or black pigment in an organ. Melanosis can be observed in virtually all parts of the gastrointestinal tract. However, it most frequently affects the colon. It is said that melanosis in small intestine is very rare, and no case has been reported in which melanosis was simultaneously noted in duodenum and ileum without involving the colonic mucosa. Here we report a case of melanosis duodeni and melanosis ilei which were found simultaneously in a 56-year-old female patient with chronic renal failure and heart failure who had been taking oral ferrous sulfate for 3 years.

Two Cases of Ischemic Colitis after Colonoscopy / 대한소화기내시경학회지

Ischemic colitis is the most common form of ischemia in the gastrointestinal tract. It results from inadequate blood flow in the colon that leads to inflammation of the colon. Though this disease frequently affects the elderly with risk factors of ischemia, younger patients may be affected too. Several conditions such as major vascular occlusion, small vessel disease, shock, some medications, colonic obstructions and hematologic disorders can predispose individuals to ischemic colitis. Ischemic colitis following colonoscopy is rare. Here we report 2 cases of ischemic colitis which developed after colonoscopic procedures in patients without risk factors of ischemia.

Spontaneous Rupture of Mediastinal Teratoma

Mediastinal teratoma is a rare mediastinal tumor. Patients with mediastinal teratoma are usually asymptomatic and are diagnosed incidentally with chest radiography or CT, but they may develop symptoms via a rupture into adjacent structures, which results in chemical pneumonia, massive hemoptysis, hemothorax, pericardial effusion, or respiratory distress. We report a case of a ruptured teratoma in a 31-year-old female presenting with cough and brown-colored sputum. Chest radiography and computed tomography of the chest showed an inhomogenous anterior mediastinal mass with fat and fluid component. It was successfully treated by surgical resection. Although mature teratomas are rare, we should be familiar with the unique CT features of a ruptured teratoma to make sure of a correct diagnosis.

Endometrioid Adenocarcinoma Arising from Endometriosis of the Uterine Cervix: A Case Report

Endometrioid adenocarcinoma arising from endometriosis of the uterine cervix is rare in premenopausal woman. We describe here a patient with this condition and review the clinical and pathological features of these tumors. A 48-yr-old woman complaining of severe dysmenorrhea was referred for investigation of a pelvic mass. Total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. Histological examination revealed an endometrioid adenocarcinoma directly adjacent to the endometriosis at the uterine cervix, with a transition observed between endometriosis and endometrioid adenocarcinoma. The patient was diagnosed as having endometrioid adenocarcinoma arising from endometriosis of the uterine cervix and underwent postoperative chemotherapy. Gynecologists and pathologists should be aware of the difficulties associated with a delay in diagnosis of endometrioid adenocarcinoma arising from endometriosis when the tumor presents as a benign looking endometrioma.

Development of Two Cases of Acute Colitis after Soap Enemas / 대한소화기내시경학회지

Acute diarrhea is caused by many situations such as infections, drugs, autoimmune diseases, immunodeficiency, ischemia and toxins. In addition, enema induced-colitis also causes acute diarrhea. Damage to the colon has been reported after exposure to a number of rectally administered agents, the better known of which are soaps and detergents used as cleansing enemas. Soap enemas cause corrosive colitis due to the saponification reaction as well as toxic materials. We report two cases of acute colitis induced by soap enemas administered in preparation for cesarean sections.

A case of small cell carcinoma of pulmonary type of ovary associated with huge mucinous cystadenocarcinoma / 대한산부인과학회지

Small cell carcinoma of ovary is extremely rare. This neoplasms compose predominantly or exclusively of small round cells with scant cytoplasm. There are two types of primary small cell carcinoma of ovary described in the literature : the hypercalcemic type and the pulmonary type. The first 11 patients with a primary ovarian small cell carcinoma of the pulmonary type were described by Eichorn et al. in 1992. The prognosis of this tumor is very poor and only limited data on the treatment of this tumor type are available. In the present case report, we describe a patient with the pulmonary type of small cell carcinoma associated with huge mucinous cystadenocarcinoma with a brief review of the concerned literatures.

Juxtacortical Glomus Tumor of the Tibia with an Uncertain Malignant Potential

Glomus tumors are mesenchymal neoplasms that are composed of modified smooth muscle cells of the normal glomus body. Most glomus tumors are benign and they occur in the distal extremities, and particularly the subungual lesions that occur in the hand, the wrist and the foot. We report here on a case of a solid type glomus tumor that had an uncertain malignant potential with a juxtacortical location at the distal tibia, and there were no neoplastic erosion of the cortical surface and no periosteal reaction. The tumor cells showed mild nuclear atypia and moderate mitotic activity (3-5/10HPF). Prominent intranuclear cytoplasmic pseudoinclusions were also observed. This case is interesting due to the very unusual tumor location of the juxtacortical area of the long bone, the atypical histologic features and the unique cytological finding of cytoplasmic intranuclear inclusions throughout the tumor cells.

Micropapillary Carcinoma of the Gallbladder

Micropapillary carcinoma (MPC) is a rare variant of carcinoma, and it is composed of small papillary neoplastic cell clusters lying within clear lacunar spaces that simulate lymphovascular channels. This tumor has been described in the several organs such as the breast, lung, urinary bladder and salivary gland and it is known to be frequently associated with a high incidence of lymphatic invasion and metastasis in lymph nodes, resulting in poor clinical outcome. We present here a case of MPC in the gall bladder, and this type of case has not been previously described. Histologically, the tumor was composed of micropapillary carcinoma with tight clusters of micropapillary aggregates in the background of tubular adenoma. Focal invasive micropapillary components were also noted in the submuscular connective tissue. A metastatic lesion in a regional lymph node also showed an entirely micropapillary pattern.

Massive Perivillous Fibrin Deposition in Placenta

Massive perivillous fibrin deposition (MFD) is a rare condition characterized by heavy accumulation of fibrin in intervillous or perivillous spaces encasing villi throughout the placenta. This condition may cause varying degrees of placental insufficiency, leading to a significantly increased risk of intrauterine growth retardation, intrauterine death, and pre-term delivery. However, the objective criteria for the diagnosis of MFD have not been clearly established. We report a case of MFD associated with intrauterine growth retardation and preterm premature rupture of membranes.

A case of rifampicin-induced interstitial pneumonitis / 대한내과학회지

Rifampicin is a powerful agent for the treatment of pulmonary tuberculosis. However, it may induce several adverse effects, including rare cases of lung toxicity. Here, we report a case of rifampicin-induced interstitial pneumonitis. A 57-year-old woman diagnosed with cerebellar tuberculoma developed progressive dyspnea after the 5th day of anti-tuberculosis medication. Chest X-ray revealed newly developed ground glass opacities on both lower lung fields. Drug-induced pneumonitis was suspected and all anti-tuberculosis medications were halted. Transbronchial lung biopsy was consistent with desquamative interstitial pneumonitis. After clinical improvement, a rechallenge test with each anti-tuberculosis medication was attempted. No primary anti-tuberculosis drug except rifampicin triggered recurrence of symptoms, supporting a diagnosis of rifampicin-induced interstitial pneumonitis. Clinicians should be aware of this rare, but serious, side effect of rifampicin treatment.

Unusual Bronchopulmonary Foregut Malformation Associated with Pericardial Defect: Bronchogenic Cyst Communicating with Tubular Esophageal Duplication

We report a case of unusual bronchopulmonary foregut malformation composed of a mediastinal bronchogenic cyst with sequestrated lung tissue and communicating tubular esophageal duplication associated with complete pericardial defect. A 18-yrold man, who had suffered from dry cough and mild dyspnea, was admitted because of an incidentally detected chest mass. A computed tomography scan demonstrated a cystic mass with an air fluid level connected with esophagus in the middle mediastinum. The surgically resected mass was a pleural invested accessory lobe of the lung (8.0x7.0x4.5 cm) connected with the esophageal wall by a tubular structure (3.0 cm in length and 2.0 cm in diameter). A complete left pericardial defect was also identified. Histologically, the cystic wall was composed of fibrovascular connective tissue with a smooth muscle layer, mixed seromucous glands and cartilage, and the inner surface of the cyst was lined by ciliated pseudostratified columnar epithelium. The inner surface of the tubular structure was lined by non-keratinizing or keratinizing squamous epithelium, and the wall contained submucosal mucous glands, muscularis mucosa, and duplicated muscularis propria. This case is important in understanding the embryological pathogenesis of the variable spectrum of the bronchopulmonary foregut malformation.