Nonossifying fibroma developed in metaphysis and epiphysis--a case report.

Nonossifying fibroma is developed in childhood and adolescence and is usually asymptomatic. It is typically arises in the metaphysis of long bone and migrates toward the diaphysis with growth. We present a very rare case of nonossifying fibroma involving metaphysis and epiphysis of the distal femur in a 20-year-old man. Nonossifying fibroma is a benign fibroblastic lesion, which is also termed benign cortical defect and fibroxanthoma. A nonossifying fibroma rarely causes problems and does not interfere with healing or growth. The lesions are usually asymptomatic. With growth and remodeling of the bone, the lesion typically disappears and is replaced with normal bone. However, the lesion may weaken the involved bone, causing fracture. The lesion typically arises in the metaphysis of long bones and may migrate toward the diaphysis with growth. There have never been reports of nonossifying fibroma involving epiphysis that we know of. We report a very rare case of nonossifying fibroma involving metaphysis and epiphysis in a young adult. Written, informed consent was obtained from the patient to publish this case report, including the images.

Benign Gastric Ulcer with Epstein-Barr Virus Infection Mimicking Malignant Gastric Ulcer.

Epstein-Barr virus (EBV) is the cause of infectious mononucleosis, which is characterized by fever, lymphadenopathy, and sore throat. On the other hand, gastrointestinal symptoms of EBV infection like dyspepsia, abdominal pain are non-specific and rarely encountered, which means it is difficult to diagnose gastric involvement of EBV infection without suspicion. The relation between gastric carcinoma and gastric lymphoma associated with EBV infection is well defined, but relations with other EBV-associated gastrointestinal diseases such as gastritis and peptic ulcer disease have rarely been reported. We report a case of benign gastric ulcer with EBV infection confirmed by endoscopic and histological findings.

[Is it useful to perform additional colonoscopy to detect unmatched lesion between positron emission tomography/computed tomography and colonoscopy?].

BACKGROUND/AIMS: Incidentally detected focal 18F-fluorodeoxyglucose (FDG) uptake was compared with colonoscopy. We investigated the characteristics of colon adenomas which were revealed on PET/CT. Then we identified whether additional colonoscopy was necessary in patients with lesions which were revealed on PET/CT but had no matched lesions on colonoscopy. METHODS: We retrospectively reviewed 95 patients who underwent colonoscopy within a 6 month interval after they had focal FDG uptake from January 2010 to May 2012 at National Police Hospital in Korea. Also, we analyzed 30 patients who underwent additional colonoscopy within 2 years after they had no matched lesions on primary colonoscopy. RESULTS: PET/CT depicted 54.6% (41/75) of adenomas and adenocarcinomas. The PET visibility of colon adenoma was significantly associated with degree of dysplasia (p=0.027), histologic type (p=0.040), and the size (p=0.038). The positivity rate was increased with higher degree of dysplasia (low-grade dysplasia, 47%; high-grade dysplasia, 78%; adenocarcinoma, 100%) and villous patterns of histologic type (tubular, 46.8%; tubulovillous, 87.5%; villous, 100%). Patients with adenomas larger than 10 mm (87.5%) had higher detection rate compared to those with adenomas smaller than 10 mm (49.0%). Among the 30 patients who underwent additional colonoscopy, only one patient had a 6 mm sized tubular adenoma (low-grade dysplasia). CONCLUSIONS: Incidental focal colonic uptake may indicate advanced adenoma or adenocarcinoma. Thus, it justifies performing colonoscopy for identifying the presence of colon neoplasms. However, in case of unmatched lesions between PET/CT and colonoscopy, there was little evidence that additional colonoscopy would yield benefits.

[A case of pleomorphic liposarcoma in a patient with Crohn's disease taking azathioprine].

Azathioprine is frequently used for the treatment of inflammatory bowel diseases (IBD) such as Crohn's disease and ulcerative colitis. Lymphomas, squamous cell carcinomas, and undifferentiated pleomorphic sarcomas have been reported among patients receiving azathioprine therapy. Herein, we report a case of pleomorphic liposarcoma of chest wall which occurred in a 44-year-old man with Crohn's disease taking azathioprine. He was diagnosed with Crohn's disease 3 years ago after suffering from abdominal pain and hematochezia for 12 years. He had been taking 50 mg of azathioprine per day for 23 months when he visited the thoracic and cardiovascular surgery clinic due to right chest palpable mass that had rapidly grown during the past 2 months. Excisional biopsy was performed and the mass was diagnosed as pleomorphic liposarcoma. Therefore, he underwent radical excision of the right chest wall mass, which measured 11.0 × 6.5 cm in size. He is scheduled to receive radiation therapy and chemotherapy.