Sphincter of Oddi incompetence associated with duodenal stenosis in a newborn: A case report.

Newborn incompetence of the sphincter of Oddi is rare. While there are many causes of reflux of air or ingested contrast material into the biliary tree in adults, in the newborn, it is usually due to incompetence of the sphincter of Oddi associated with partial or complete duodenal obstruction. This paper presents upper gastrointestinal series findings of incompetence of the sphincter of Oddi associated with duodenal stenosis in a 3-day-old newborn. If pneumobilia is identified in the newborn, although the possibility is low, clinicians should consider incompetence of the sphincter of Oddi with duodenal obstruction as well as portal vein gas.

[Rice Bodies Presenting as Intra-Articular Masses in Pediatric Idiopathic Arthritis: A Case Report]. / 소아기 특발성 ê´€ì ˆì—¼ 환자에서 ê´€ì ˆ 내 ì¢ ì–‘í˜•íƒœë¡œ 나타난 쌀소체: 증례 ë³´ê³ .

Rice bodies are commonly detected in adults with rheumatoid arthritis and rarely occur in children. An 11-year-old female adolescent who visited our hospital for evaluation of knee pain underwent a MRI scan, which revealed an intra-articular mass. Arthroscopic examination of the mass confirmed conglomerated rice bodies. We report a case of rice bodies that clinically presented as intra-articular masses.

[Complete Rupture of the Extensor Hallucis Longus Tendon with Accessory Slip Mimicking a Partial Rupture: A Case Report]. / 부분파열로 오인된 긴엄지발가락폄근의 주힘줄의 ì™„ì „íŒŒì—´ê³¼ 동반된 보조힘줄: 증례 ë³´ê³ .

The accessory tendon of the extensor hallucis longus is a common type of extensor hallucis longus variation. This is a case of a 38-year-old female patient who initially considered conservative treatment for a suspected partial rupture, but finally underwent surgery after being diagnosed with a complete rupture of the main tendon and accessory tendon medial to the main tendon on MRI scan.

[Primary Neuroendocrine Carcinoma of the Breast: A Case Report and Literature Review]. / ìœ ë°©ì—ì„œ 발생한 원발성 ì‹ ê²½ë‚´ë¶„ë¹„ì•”ì¢ : 증례 ë³´ê³ ì™€ ë¬¸í—Œê³ ì°°.

In general, neuroendocrine cancer develops in the digestive or respiratory tract, and when it is found in other organs, it is often due to metastasis. Primary neuroendocrine carcinoma of the breast occurs very rarely, and the exact clinical picture, radiological findings, treatment and prognosis are not well known. Furthermore, only a small number of literature reports have been published. Here, we report the imaging findings of primary neuroendocrine carcinoma in the breast of a 51-year-old female, along with a literature review.

[Radiologic Manifestations of Pulmonary Nuclear Protein in Testis Midline Carcinoma: A Case Report]. / 폐에 발생한 ê³ í™˜ 핵단백질 ì •ì¤‘ì„ ì•”ì˜ ì˜ìƒì˜í•™ì  소견: 증례 ë³´ê³ .

Nuclear portein in testis (NUT) midline carcinoma is a very rare and low-differentiating malignant epithelial tumor that differentiates very aggressively and has poor prognosis. NUT midline carcinoma occurring in the lungs in particular can be confused with other cancers because few cases have been reported in Korea to date and can show various histological forms. Reports of radiology findings are very rare worldwide. Here we report the imaging findings of pulmonary NUT midline carcinoma in a 25-year-old female along with pathological findings.

Intraductal papillary mucinous neoplasm mimicking a duodenal tumor.

Intraductal papillary mucinous neoplasms of the pancreas are characterized by ductal dilatation, mucus secretion, and intraductal papillary growth. Intraductal papillary mucinous neoplasms can cause fistulation and extend to adjacent organs. However, they rarely present as large mass in the small bowel that causes bowel obstruction. Herein, we describe a case of intraductal papillary mucinous neoplasm that protruded into the duodenal lumen through the ampulla of Vater, presented as a large duodenal tumor, and developed duodenal obstruction. A 78-year-old woman was admitted to the emergency department with a 2-day history of vomiting and epigastric pain and 2 kg weight-loss in 2 months. Esophagogastroduodenoscopy showed a duodenal mass; however, the endoscope could not pass further, and visualization of the entire tumor was impossible. Computed tomography and magnetic resonance imaging revealed a heterogeneous enhancing mass measuring 8 cm in the second portion of the duodenum, which continued further as an intraductal mass of the pancreas. The main pancreatic duct was dilated, and the parenchyma was atrophied. The biopsy showed a well-differentiated adenocarcinoma and an intact overlying duodenal mucosa. Surgical option of treatment was offered to the patient; however, she refused it due to her advanced age and personal religious beliefs. Thus, we conclude that the experience and knowledge gathered through this patient regarding intraductal papillary mucinous neoplasms could provide further understanding of this disease and evolve subsequent patient care.

Appendiceal schwannoma presenting as acute appendicitis.

Schwannomas are nerve sheath tumors that rarely occur in the gastrointestinal tract. In the gastrointestinal tract, schwannomas are mostly found in the stomach and small bowel. Herein, we describe a case of appendiceal schwannoma that caused appendix obstruction and developed acute appendicitis. An 83-year-old woman was admitted to the emergency department with 3 days' history of abdominal pain. She had tenderness and rebound tenderness in the lower right quadrant. Computed tomography revealed a 1.3 cm mass in the appendix orifice, with associated distal appendiceal dilatation and wall thickening. The patient underwent emergency surgery (laparoscopic partial cecectomy). Histopathological examination confirmed that the mass was a schwannoma and was associated with acute suppurative appendicitis. Our case is significant in that it adds to another rarely reported case of appendiceal schwannoma. Moreover, it is important to recognize the presence of an appendiceal tumor associated with acute appendicitis.

Retroperitoneal cystic schwannoma mimics liquefied hematoma.

Schwannomas are nerve sheath tumors that seldom occur in the retroperitoneal region. Herein, we describe an incidentally detected retroperitoneal schwannoma that mimicked liquefied hematoma on computed tomography. A 61-year-old man was admitted to the emergency department with chest pain caused by a fall at a construction site. Chest computed tomography incidentally revealed a retroperitoneal cystic mass measuring 10 cm, in addition to multiple rib fractures and hemopneumothorax. The patient frequently consumed alcohol and had a history of repeated trauma; therefore, we considered the following 2 conditions: retroperitoneal cystic tumor and liquefied hematoma. He underwent complete surgical excision, and a histopathological examination confirmed the mass as a schwannoma. Experience and knowledge regarding the computed tomography findings of retroperitoneal cystic schwannoma are useful for the differential diagnosis of infrequent retroperitoneal tumors.

Imaging Findings of Metaplastic Breast Carcinoma with Chondroid Differentiation: A Case Reports.

Metaplastic carcinoma of the breast is a heterogeneous group of neoplasms with mixed epithelial and mesenchymal differentiation. Metaplastic carcinoma of the breast is a rare and aggressive malignancy, with high recurrence and metastasis. Metaplastic carcinoma with chondroid differentiation is an uncommon subtype that tends to have a relatively good prognosis than that of other subtypes. We report the imaging features of three cases of pathologically proven metaplastic carcinoma with chondroid differentiation as follows: a high-density mass with amorphous or coarse heterogeneous calcifications on mammography; a microlobulated or partially indistinct, complex cystic, and solid mass on sonography; and a relatively circumscribed or partially indistinct, irregular mass with heterogeneous T2 high-signal intensity and heterogeneous or rim enhancement with initial fast enhance ment and delayed washout on MRI.

[A Rare Case of Thoracic Intradural Epidermoid Cyst after Spinal Cord Stimulator Insertion: A Case Report]. / 척수 자극기 ì‚½ìž ìˆ ì„ 받았던 환자에게 드물게 생긴 흉추부 경막내 표피양 ë‚­ì¢ : 증례 ë³´ê³ .

Spinal epidermoid cysts are extremely rare benign tumors and can be congenital or acquired. Acquired spinal epidermoid cysts are found in the lumbosacral region. To our knowledge, no case of epidermoid cyst related to spinal cord stimulator insertion has yet been reported. We report the MRI findings of a rare case of thoracic intradural epidermoid cyst acquired after spinal cord stimulator insertion in a 50-year-old female.

Emphysematous gastritis: Impressive radiological findings.

Emphysematous gastritis is a rare form of phlegmonous gastritis, characterized by the formation of air in the gastric wall by gas-forming microorganisms. Early diagnosis and treatment are important because of its fatal consequences (high morbidity and mortality). A 64-year-old woman presented to our emergency department with abdominal discomfort, nausea, and general weakness. An abdominal examination revealed severe epigastric tenderness, and laboratory findings revealed elevated inflammatory markers. A computed tomography scan revealed gas within the gastric wall and marked gastric wall thickening. Herein, we present a case of early diagnosed emphysematous gastritis, which was successfully treated conservatively without surgery.

Omental actinomycosis mimicking a foreign body infection.

Actinomycosis is a chronic suppurative granulomatous disease caused by Actinomyces species. Abdominal actinomycosis is a rare condition and difficult to diagnose before surgery. Here, we report a case of omental actinomycosis mimicking a foreign body infection on computed tomography (CT). A 47-year-old man presenting with abdominal pain had a heterogeneous area comprising a 2-cm long linear radiopaque material with surrounding enhancing soft tissue density lesions and fat infiltrates, measuring 9 × 8 cm in the omentum of the right upper quadrant on CT. We assumed that the linear radiopaque material was a foreign body, such as a fish bone. Laparoscopy-assisted right hemicolectomy and partial omentectomy were performed under radiological suspicion of foreign body infection. Histological examination revealed the omental lesion to be actinomycosis. The patient was treated with antibiotics for 10 weeks, and he recovered well without any complication. Omental actinomycosis mimicking a foreign body infection is rare. The experience and knowledge regarding the variable CT findings of abdominal actinomycosis are useful because it should be differentiated from malignancy and other inflammatory conditions.

Ectopic prostate tissue presenting as a giant pelvic mass with seeding nodules.

We report a case of ectopic prostate tissue presenting as multiple lesions resembling a giant pelvic mass with seeding nodules. A 60-year-old man was admitted to the general surgery department of our hospital with an incidentally discovered pelvic mass on computed tomography performed at an outside hospital. The computed tomography scan showed a well-demarcated heterogeneous enhancing mass of 14 cm on the right side of the urinary bladder, and other similarly small nodules were observed in the pelvic cavity and perianal area. Physical examination showed a palpable mass in the suprapubic area; however, the patient did not complain of urinary system symptoms. Laboratory examination showed an elevated level of prostate-specific antigen (12.18 ng/mL). Suprapubic incision and mass resection were performed. The surgeon removed two of the masses and dissected the pelvic lymph nodes. Pathological examination confirmed that both masses were ectopic prostate tissues, and focal adenocarcinoma (<5%) was noted in the largest mass (Gleason score, 3 + 3 = 6). The Prostate-specific antigen level returned to normal postoperatively.

Rupture-mediated large uterine defect at 30th gestational week with protruded amniotic sac and fetal head without fetal compromise after laparoscopic electromyolysis: Case report and literature review.

BACKGROUND: We describe a case of a rupture-mediated large uterine defect, which occurred on the 30th gestation week presenting a protruding amniotic sac sac without fetal compromise after a laparoscopic electromyolysis. CASE PRESENTATION: A 28-year-old woman in her 30th week of gestation (gravida 2, para 0) presented with whole abdominal and right lower quadrant pain at Sanggye Paik Hospital. Ultrasound examination showed normal amniotic fluid and placentation but with breech presentation. She had undergone laparoscopic right ovarian cystectomy due to endometriosis 5 years earlier. Cardiotocography revealed an intermittent variable deceleration and no uterine contraction. Magnetic resonance imaging ruled out acute appendicitis. Four hours later, we observed a protrusion of the amniotic sac with the fetal head through a large uterine defect on magnetic resonance imaging, and performed emergency cesarean section. A boy was delivered without fetal compromise. During the cesarean section, multiple myometric wall defects and thinning were identified. After reconstruction of the uterine wall, the flaccid uterus bled persistently; thus, a cesarean hysterectomy was performed. Packed red cells and frozen plasma were transfused. The mother and neonate had uneventful puerperal and neonatal courses, respectively. After cesarean hysterectomy, we were informed that the mother had undergone a combined laparoscopic electromyolysis during the laparoscopic right ovarian cystectomy. Three years later, the child showed normal neural development. CONCLUSIONS: Before myomectomy or electromyolysis, patients should be informed of the possibility of uterine rupture during subsequent pregnancies. If a pregnant woman has abdominal pain, clinicians should take a detailed history of uterine surgery and consider uterine rupture. Although, fortunately, the outcomes in this case were uneventful, urgent delivery is required when uterine rupture is diagnosed.

The clinical factors for predicting severe diverticulitis in Korea: a comparison with Western countries.

BACKGROUND/AIMS: It is unclear whether the risk factors associated with complicated diverticulitis in Asian and Western countries are the same. We evaluated the risk factors associated with severe diverticulitis (SD) in Korea and compared the clinical characteristics of diverticulitis according to location. METHODS: A retrospective review of 190 patients hospitalized with acute diverticulitis from January 2005 to June 2010 was conducted. SD was defined as one of the following: perforation, abscess, obstruction, sepsis, or peritonitis that required an urgent operation. RESULTS: Twenty-four patients (12.6%) were diagnosed with SD. SD was significantly associated with older age, a fever over 38℃, changes in bowel habits and a high visceral adipose tissue (VAT)/total adipose tissue (TAT) ratio. Multivariate analysis showed that the risk factors for developing SD were an age of 40 years or more (odds ratio [OR], 3.2; p=0.032), male gender (OR, 4.0; p=0.021) and left-sided diverticulitis (OR, 6.2; p=0.017). Right-sided diverticulitis (n=175, 92.1%) was significantly associated with younger ages, fewer changes in bowel habits, fewer comorbidities and non-SD. CONCLUSIONS: This study suggests that the risk factors for developing SD in Korea, where right-sided diverticulitis is predominant, are the male gender, an age of more than 40 years old, and left-sided diverticulitis. Given that there are different risk factors for developing SD in Western countries, different strategies for the treatment of diverticulitis in the Korean population seem to be needed.

Suppression of autophagy and activation of glycogen synthase kinase 3beta facilitate the aggregate formation of tau.

Neurofibrillary tangle (NFT) is a characteristic hallmark of Alzheimer's disease. GSK3ß has been reported to play a major role in the NFT formation of tau. Dysfunction of autophagy might facilitate the aggregate formation of tau. The present study examined the role of GSK3ß-mediated phosphorylation of tau species on their autophagic degradation. We transfected wild type tau (T4), caspase-3-cleaved tau at Asp421 (T4C3), or pseudophosphorylated tau at Ser396/Ser404 (T4-2EC) in the presence of active or enzyme-inactive GSK3ß. Trehalose and 3-methyladenine (3-MA) were used to enhance or inhibit autophagic activity, respectively. All tau species showed increased accumulation with 3-MA treatment whereas reduced with trehalose, indicating that tau undergoes autophagic degradation. However, T4C3 and T4-2EC showed abundant formation of oligomers than T4. Active GSK3ß in the presence of 3-MA resulted in significantly increased formation of insoluble tau aggregates. These results indicate that GSK3ß-mediated phosphorylation and compromised autophagic activity significantly contribute to tau aggregation.

Seminoma in undescended testis.

A testicular carcinoma in intraabdominal undescended testis can mimic other mesenteric or retroperitoneal mass. The identification of pampiniform plexus draining the mass can play an important role in diagnosis of testicular carcinoma in undescended testis. We report a case of seminoma in intraabdominal undescended testis, draining into pampiniform plexus and thrombus within it.

[Clinical significance of incidentally detected bowel wall thickening on abdominal computerized tomography scan].

BACKGROUND/AIMS: Due to widespread use of computerized tomography (CT) scan to examine patients with variable disease or complaints, detection of incidental or unsuspected gastrointestinal abnormalities are not uncommon. Clinical significance of incidentally detected bowel wall thickening (BWT) on abdominal CT scan is uncertain at present. Despite the necessity for the clinical guidelines describing the evaluation of incidental bowel wall thickening on CT scan, there have been few studies concerning these radiological abnormalities. Our objective was to determine whether endoscopic evaluation is necessary for the evaluation of these abnormal findings. METHODS: This study evaluated one hundred and forty patients with incidentally detected BWT on abdominal CT scan in Inje University Sanggye Paik Hospital from 2001 to 2003. 102 patients of those were proceeded by endoscopic evaluation. Forty-eight patients had received upper endoscopy, 26 patients had colonoscopy, while 28 patients had sigmoidoscopy. RESULTS: Endoscopic work up revealed significant abnormalities in 83% of patients with incidental findings of the distal esophagus, 73% of patients with thickening of the stomach, 35% of patients with thickening of the right colon, and 71% of patients with thickening of the sigmoid colon and rectum. CONCLUSIONS: Although significant pathologic findings are less common in thickening of the right colon than other bowel wall thickening, all of these incidental findings on CT scan warrant further endoscopic evaluation.