Stent-stone Complex Developed after Long-term Plastic Biliary Stent Placement / 대한췌담도학회지

Plastic biliary stents are commonly used during endoscopic retrograde cholangiopancreatography. Main indication for biliary stenting is benign or malignant obstruction. Plastic stents can be used as an escape route in patients with large common bile duct stones to provide drainage until definitive treatment. But, stent occlusion is the main disadvantage, limiting their patency to around 3 months, after which replacement is recommended. A biliary stent can act as a nidus for the biliary stone formation leading to stent-stone complex after long-term stent placement. This report was a case of a large stent-stone complex after plastic stent placement for 4 years. The stent-stone complex was successfully removed by mechanical lithotripsy and ballon catheter. In all other cases where plastic stents are placed into the common bile duct we should keep in mind that stents can act as nidus for stone formation, as all foreign bodies do.

Meningiomas with Rhabdoid or Papillary Components : Prognosis and Comparison with Anaplastic Meningiomas

Papillary and rhabdoid meningiomas are pathologically World Health Organization (WHO) grade III. Any correlation between clinical prognosis and pathologic component is not clear. We analyzed the prognoses of patients with meningiomas with a rhabdoid or papillary component compared to those of patients with anaplastic meningiomas. From 1994 to June 2013, 14 anaplastic meningiomas, 6 meningiomas with a rhabdoid component, and 5 meningiomas with papillary component were pathologically diagnosed. We analyzed magnetic resonance imaging (MRI) findings, extent of removal, adjuvant treatment, progression-free survival (PFS), overall survival (OS), and pathologic features of 14 anaplastic meningiomas (group A), 5 meningiomas with a predominant (≥50%) papillary or rhabdoid component (group B1), and 6 meningiomas without a predominant (<50%) rhabdoid or papillary component (group B2). Homogeneous enhancement on MRI was associated with improved PFS compared to heterogeneous enhancement (p=0.025). Depending on pathology, the mean PFS was 134.9±31.6 months for group A, 46.6±13.4 months for group B1, and 118.7±19.2 months for group B2. The mean OS was 138.5±24.6 months for group A and 59.7±16.8 months for group B1. All recurrent tumors were of the previously diagnosed pathology, except for one tumor from group B1, which recurred as an atypical meningioma without a papillary component. Group B1 tumors showed a more aggressive behavior than group B2 tumors. In group B2 cases, the pathologic findings of non-rhabdoid/papillary portion could be considered for further adjuvant treatment.

Radiological Follow-up of a Cerebral Tuberculoma with a Paradoxical Response Mimicking a Brain Tumor

We report a case of a paradoxical response of a tuberculoma in the brain mimicking a brain tumor. A 76-year-old woman presented with a 2 week history of headache, dysarthia, and orthopnea. Brain magnetic resonance images (MRI) revealed two rim-enhancing lesions on the pons and occipital lobe, and chest computed tomography showed randomly distributed miliary nodules. The tentative diagnosis was tuberculosis (TB) of the brain and lung. She complained of right hemiparesis and worsening general weakness after taking the anti-TB medication. On the monthly follow-up images, the enhanced lesions were enlarged with increased perfusion and choline/creatinine ratio, suggesting a high grade glioma. A surgical resection was completed to diagnose the occipital lesion, and the tuberculoma was pathologically confirmed by a positive TB-polymerase chain reaction. The anti-TB medication was continued for 13 months. A follow-up MRI showed decreased size of the brain lesions associated with perilesional edema, and the clinical symptoms had improved. Brain tuberculoma could be aggravated mimicking brain malignancy during administration of anti-TB medication. This paradoxical response can be effectively managed by continuing the anti-TB drugs.

Reactive Lymphoid Hyperplasia Treated with Radiofrequency Ablation / 대한내과학회지

Reactive lymphoid hyperplasia (RLH) is a rare benign liver mass that is characterized by proliferation of non-neoplastic lymphocytes extranodally. To date, only 43 cases have been reported in the English literature and 2 cases in the Korean literature. We report a case of hepatic RLH in a 36-year-old woman who had been diagnosed two years previously with an intrahepatic tumor that measured 0.6 x 1.0 cm on abdominal ultrasonography. Her medical history was otherwise unremarkable. On follow-up ultrasonography, the hepatic mass had increased in size. We biopsied the liver mass and the histopathologic findings confirmed reactive lymphoid hyperplasia. Radiofrequency ablation (RFA) was performed instead of surgical resection. The patient is currently doing well with no sign of relapse 1 year and 8 months after the RFA.

Subacute Ischemic Colitis Developed after Severe Watery Diarrhea / 대한소화기내시경학회지

Ischemic colitis represents most common form of gastrointestinal ischemia, usually developed in elderly or debilitated patient with a variety of underlying medical problems. The presumed etiologies are numerous. It usually presents as an acute abdominal illness with bloody diarrhea. Subacute ischemic colitis in healthy adults develops spontaneously in the absence of major vasculature occlusion, and the original insult precipitating the ischemic event usually cannot be established. Diagnosis is based on the clinical symptom, barium study, colonoscopic and histopathologic findings. Therapy and outcome are depen-dent on the severity of disease. It usually requires only medical management and is asso-ciated a good prognosis. We report a case of subacute ischemic colitis in healthy adults developed after severe watery diarrhea with literatures.

A case of posterior urethral polyp / 대한비뇨기과학회지

Urethral polyp is an unusual cause of bladder outlet obstruction in male patients. Diagnosis is made by cystourethrography and is confirmed by transurethral biopsy. We report on an infant with a congenital polyp of the prostatic urethra with brief review of literature.