Spontaneous Regression of Recurred Hepatocellular Carcinoma with Multiple Lung Metastases

Hepatocellular carcinoma (HCC) is the most common form of liver malignancy. Spontaneous regression of HCC is extremely rare phenomenon and mechanism of regression remains ob-scure. 75-year-old woman previously diagnosed with hepatitis C virus-related liver cirrhosis was found to have single mass in liver with elevation of alpha-fetoprotein level to 10,320 ng/mL. Transarterial chemoembolization (TACE) was performed. 27 months after TACE recurred HCC with multiple lung nodules were confirmed. The patient refused any therapeutic modality. The patient underwent follow-up without any anti-cancer treatment. 8 months after recur-rence follow up computed tomography scan revealed spontaneous regression of HCC and completely disappeared lung nodules. The patient is currently doing well and without any evidence of recurrence. The causes of spontaneous regression of HCC are not well understood. Proposed mechanisms are ischemic injury, biological factors, herbal medicine, immunological variations. Further studies are necessary to improve our understanding of this rare phenom-enon.

Clinical Factors for Consideration in Patients with Gastric Hyperplastic Polyps Treated by Endoscopic Polypectomy

BACKGROUND/AIMS: Hyperplastic polyps are the most common type of gastric polyps that constitute 30~93% of all benign epithelial gastric polyps. The overall prevalence of dysplasia in patients with hyperplastic polyps is believed to be 2 cm). We aimed to identify the clinical features of hyperplastic polyps that undergo neoplastic transformation. MATERIALS AND METHODS: Between March 2011 and June 2013, 315 hyperplastic polyps that were removed by endoscopic polypectomy from 217 patients were analyzed retrospectively. RESULTS: Neoplastic transformations were found in 5 cases (1.6%), including 3 cases of adenoma (1.0%) and 2 cases of adenocarcinoma (0.6%). Polypectomy-associated complications were noted in only 2 cases (0.6%), which were bleeding in both cases. Neoplastic transformation was significantly associated with the absence of hyperemia on endoscopy (non-neoplastic transformation group, n=26 [8.4%] vs. neoplastic transformation group, n=3 [60%]; P=0.006). However, no other significant differences was found between these groups in terms of age, sex, presence of Helicobacter pylori, size, location, number of detected polyps in each patient, and endoscopic appearances such as nodular changes or erosions and shape. CONCLUSIONS: No clinical factors were associated with the neoplastic transformation of hyperplastic polyps. In addition, neoplastic transformations were almost impossible to identify using endoscopy. Therefore, endoscopic polypectomy could be considered for the accurate diagnosis and definitive treatment of gastric hyperplastic polyps <1 cm in size.

Clinical Efficacy of Entecavir and Factors Predicting Long-Term Treatment Response in Nucleoside-Naive Patients with Chronic Hepatitis B / 대한내과학회지

BACKGROUND/AIMS: The aims of this study were to characterize the treatment response to entecavir and to examine factors affecting that response. METHODS: A total of 77 nucleoside-naive patients with chronic hepatitis B who had received entecavir (0.5 mg daily) for at least 48 weeks were consecutively enrolled between March 2007 and March 2011. The rates of virological response (hepatitis B virus [HBV] DNA < 116 copies/mL), biochemical response (alanine aminotransferase < or = upper limit of normal), hepatitis B e antigen (HBeAg) loss, and seroconversion were retrospectively analyzed. RESULTS: The cumulative rates of virological response at 12, 24, 48, 96, and 144 weeks were 59.7%, 82%, 88.3%, 89.6%, and 93.1%, respectively; biochemical response rates were 51.9%, 74%, 84.4%, 94.8%, and 98.3%, respectively; HBeAg loss rates were 10.5%, 18.4%, 28.9%, 36.8%, and 47.4%, respectively; and HBeAg seroconversion rates were 7.9%, 18.4%, 21.1%, 28.9%, and 39.5%, respectively. In multivariate analysis, independent predictors associated with HBV DNA polymerase chain reaction (PCR) negativity were the absence of HBeAg at baseline (p = 0.006) and early virological response (HBV DNA < 2,000 copies/mL after 12 weeks of therapy; p = 0.027). In univariate analysis, early virological response was an independent factor predicting HBeAg loss (p = 0.001). CONCLUSIONS: Entecavir induced excellent biochemical and virological responses in nucleoside-naive patients with chronic hepatitis B. Early virological response was an independent factor predicting HBV PCR negativity and HBeAg loss, and can be used to predict long-term treatment response to entecavir.

A Case of Spontaneous Esophagopleural Fistula Successfully Treated by Endoscopic Stent Insertion

The most common cause of esophagorespiratory fistulas (ERFs) is associated with malignancy. The use of self-expandable metal stents is effective for the treatment of malignant ERFs, but benign ERF is rare, which is why its optimal treatment is not defined yet. There have been few reports describing benign esophagopleural fistula and its treatments in South Korea. Here, we report a rare case of spontaneous esophagopleural fistula, which was successfully treated by endoscopic placement of a membrane covered metal stent.

A Case of Triple Early Gastric Cancer with Bone Marrow Metastasis / 대한내과학회지

The clinical outcome of early gastric cancer (EGC) has gradually been improving, and the 5-year survival rate for patients with EGC has been reported to exceed 85% in most studies. However, in some rare cases, EGC is associated with distant metastasis. Bone metastases from stomach cancer are usually osteolytic lesions. Although there have been a few reports of EGC with bone marrow metastasis, cases of triple EGC with bone marrow metastasis are rare. We report a 50-year-old male patient who was diagnosed with triple EGC with bone marrow metastasis. This case can be considered to be rare because the patient had no spread of the disease to other organs.

Is Endoscopic Mucosal Resection a Sufficient Treatment for Low-Grade Gastric Epithelial Dysplasia?

BACKGROUND/AIMS: The rate of diagnosis of gastric adenoma has increased because esophagogastroduodenoscopy is being performed at an increasingly greater frequency. However, there are no treatment guidelines for low-grade dysplasia (LGD). To determine the appropriate treatment for LGD, we evaluated the risk factors associated with the categorical upgrade from LGD to high grade dysplasia (HGD)/early gastric cancer (EGC) and the risk factors for recurrence after endoscopic treatment. METHODS: We compared the complication rates, recurrence rates, and remnant lesions in 196 and 56 patients treated with endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR), respectively, by histologically confi rming low-grade gastric epithelial dysplasia. RESULTS: The en bloc resection rate was significantly lower in the EMR group (31.1%) compared with the ESD group (75.0%) (p1 cm with surface redness and depressions. CONCLUSIONS: For the treatment of LGD, EMR resulted in a higher incidence of uncertain resection margins and a lower en bloc resection rate than ESD. However, there was no signifi cant difference in recurrence rate.

A Case of Mantle Cell Lymphoma Exhibiting Features of Gastric Linitis Plastica Type of Advanced Gastric Cancer

Mantle cell lymphoma has a broad spectrum of endoscopic presentations, such as thick, rigid folds that are indispensible on air insufflation, superficial confluent ulceration, or a polypoidal mass protruding into the lumen. The exact diagnosis is difficult to make because the lesion is in the submucosal layer and inaccessible by biopsy. Lesions will often exfoliate necrotic cells which make interpretation difficult, or they may be too small in number and size and thus indistinguishable from anaplastic carcinoma. We report a case of mantle cell lymphoma with diffuse wall thickening of the whole stomach in a 51-year-old man. The series of endoscopic findings in this case support the role of differential diagnosis of linitis plasica type of advanced gastric cancer with mantle cell lymphoma.

A Case of Gastroduodenal Fistula Caused by Gastric Ulcer

Gastroduodenal fistula or double pylorus is a very rare condition. It is a fistulous communication between gastric antrum and duodenal bulb. It can be either congenital or acquired. In most cases it is thought to be a complication of gastric ulcer. We recently experienced a case of gastroduodenal fistula in 70 year-old man presenting as epigastric pain. He was diagnosed with non ST elevation myocardial infarction previously, and was taking aspirin. Gastroduodenal communication was revealed by endoscopy. We report a case of gastroduodenal fistula that developed in man who was taking aspirin, with review of the literature.

A Case of Duodenal Leiomyoma Showing False Positive Fluorine-18-fluorodeoxyglucose Positron-Emission Tomography

Duodenal leiomyomas are rare benign tumors of mesenchymal origin. Generally, Fluorodeoxyglucose (FDG)-PET would have a negative finding in leiomyomas. A 52-year-old man was referred to our hospital with melena. Gastroendoscopy revealed the presence of a huge submucosal tumor with ulceration at the duodenum bulb. Subsequent CT demonstrated a poorly enhanced oval mass adjoining the duodenal bulb. FDG-PET scan demonstrated an excessive accumulation of FDG in the lesion. A definitive diagnosis of duodenal leiomyoma was made on the basis of the pathologic finding of his surgical specimen. We report in this first case that duodenal leiomyma may show a potential pitfall of giving a positive FDG-PET result. Through this case, we would like to caution clinicians against PET-dependent evaluations of malignant potential of duodenal submucosal tumors.

An Unusual Case of Duodenal Obstruction due to Metastatic Cervical Cancer

We report a rare case of cervical cancer with duodenal obstruction accompanied by obstructive symptoms, which was treated using duodenal stenting. A 48-year-old woman was diagnosed with stage IV cervical cancer (according to the International Federation of Gynecology and Obstetrics staging system), which had invaded the vagina, the uterine body, and the external iliac and common iliac lymph nodes. Endoscopy showed an encircling mass with erythematous mucosa and luminal narrowing in the second and third portions of the duodenum, which prevented the endoscope from advancing. We placed an uncovered stent in the duodenum, which ameliorated abdominal discomfort, nausea, and vomiting, and simultaneously performed a biopsy. Endoscopic stent insertion appears to be the most effective treatment for duodenal obstruction in patients with advanced cancer.