A Case of Desmoid Tumor Presenting as Intra-abdominal Abscess / 대한소화기학회지

Desmoid tumor is a rare benign tumor derived from fibrous sheath or musculoaponeurotic structure. The tumor is benign histologically but considered as malignant clinically because it has high propensity on infiltrative growth with local invasion and tendency to recurrence after local excision. Especially, when this tumor happens to be in the intra-abdomen, the prognosis is worse because it can cause intestinal obstruction, ureter obstruction and, fistula formation. It also can invade major vessels in abdomen. This tumor occurs more frequently in patients with familial adenomatous polyposis (FAP), in post-partume women, and at old surgical incision site. However, in this case, the patient had neither previous surgery nor a FAP history. We report a rare case of the young male patient who presented with an acute abdomen and underwent laparotomy and was found to have an intra-abdominal desmoid tumor with abscess formation.

A Case of a False Positive FDG-PET/CT Scan in Esophageal Leiomyoma / 대한소화기내시경학회지

Esophageal leiomyoma is relatively rare disease, but can appears with a high uptake of fluorodeoxuglucose (FDG), a false-positive finding on a FDG PET/CT scan. A 64- year-old woman after a total thyroidectomy due to papillary and follicular carcinoma showed a high uptake of FDG in the distal esophagus on a subsequent FDG PET/ CT scan. The presence of an esophageal leiomyoma was suspicious from preoperative findings of endoscopic ultrasound and computed tomography, and an esophagectomy and proximal gastrectomy were performed, as the presence of a malignant lesion could not be excluded. As high uptake of FDG in the lesion on an FDG PET/CT scan corresponds to an esophageal cancer, an esophagectomy and proximal gastrectomy were performed and the lesion was confirmed as an esophageal leiomyoma after surgical biopsies. We report this case with a review of the relevant literature.

An NH(2)-terminal truncated cytochrome P450 CYP3A4 showing catalytic activity is present in the cytoplasm of human liver cells

Cytochrome P450 3A4 (CYP3A4), is the dominant human liver hemoprotein enzyme localized in the endoplasmic reticulum (ER), and is responsible for the metabolism of more than 50% of clinically relevant drugs. While we were studying CYP3A4 expression and activity in human liver, we found that anti-CYP3A4 antibody cross-reacted with a lower band in liver cytoplasmic fraction. We assessed the activities of CYP3A4 and its truncated form in the microsomal and cytoplasmic fraction, respectively. In the cytoplasmic fraction, truncated CYP3A4 showed catalytic activity when reconstituted with NADPH-cytochrome P-450 reductase and cytochrome b5. In order to determine which site was deleted in the truncated form in vitro, we transfected cells with N-terminal tagged or C-terminal tagged human CYP3A4 cDNA. The truncated CYP3A4 is the N-terminal deleted form and was present in the soluble cytoplasmic fraction. Our result shows, for the first time, that N-terminal truncated, catalytically active CYP3A4 is present principally in the cytoplasm of human liver cells.

Diagnosis and Treatment of Adult Intussusception Due to Gastrointestinal Lipoma

PURPOSE: In contrast to childhood intussusception, adult intussusception is a rare disease and usually has a specific etiology. Malignancy is the leading cause, and gastrointestinal lipoma has been infrequently reported as a cause of adult intussusception. However, GI lipoma can be easily diagnosed by current radiologic studies and can be managed less aggressively than intussusception with a malignant etiology. METHODS: 5 adult (above 16 years old) patients have been identified to be operated on from January 1990 to June 1999 in Korea University Hospital due to intussusception caused by gastrointestinal lipoma. Their preoperative radiologic findings, operative methods and clinical results were analyzed, retrospectively. RESULTS: There were 3 male and 2 female patients, and the mean age was 49. Simple abdominal X-rays were taken in all 5 patients, and mechanical obstructive patterns were present in 4 cases. Abdominal CT or ultrasonography was performed in 4 patients preoperatively and demonstrated a lipoma in 3 cases (75%). In one patient, who showed toxic signs caused by mechanical intestinal obstruction, emergency exploration was undertaken without further preoperative radiologic study. The lipoma was located at the jejunum in 1 case, at the ileum in 2 cases and at the cecum in 2 cases. Resection of the involved segment of the bowel after reduction of intussusception was done in 3 cases and resection of involved bowel without reduction was done in the remaining 2 cases. Consequently, segmental resection of the small bowel was performed in 2 cases and a right colectomy in 3 cases. There was no postoperative morbidity or mortality. CONCLUSION: Adult intussusception caused by a gastrointestinal lipoma can be easily diagnosed by using CT or ultrasonography. It can be safely managed through reduction and resection of the lesion unless there is strangulation.

Small Bowel Obstruction in Patients with a Prior History of gastriontestinal Malignancies

Surgeons are often faced with the problem of bowel obstruction in a patient who has previously undergone operation for malignant disease. Mechanical obstruction secondary to recurrent carcinoma is associated with poor survival. Surgical attempts to relieve malignant obstruction have significant morbidity and mortality rates and limited success in resolving symptoms. Then there is a temptation to assume that the obstruction is due to advanced malignancy and that death is inevitable. But a benign, correctable cause of obstruction will be found in about 25% of these patients. For this study, we had selected 63 cases of small bowel obstruction in patients with a previous operation for cancer which were admitted at Korea University Hospital between 1990 to 1995. The 43 men and 20 women had a mean age of 55.5 years. Forty one cases(65%) had obstruction due to recurrent carcinoma. The location of primary malignancies were as follows: 47 of the patients(74.6%) had adenocarcinoma of the stomach, 16 patients(25.4%) had adenocarcinoma of the colorectum. The median interval from the original operation for the malignancies until the development of bowel obstruction was 17.5 months. In our study, the small bowel obstruction due to recurrent carcinoma was frequently predicted when ascites and pleural effusion were present. We concluded that patients with no known recurrence or a short interval to the development of mechanical obstruction should be aggressively treated with surgery and for patients with known abdominal recurrence in whom nonoperative therapy fail, the surgical palliation are inevitable.