Two Cases of Advanced Gastric Carcinomas Showing Features of Submucosal Tumors / 대한소화기내시경학회지

Gastric carcinoma showing the features of a submucosal tumor (SMT) is extremely rare. The incidence of this type of tumor has been reported to be 0.1~0.63%. We report two cases of advanced gastric carcinomas showing the features of SMT. A 58-year-old man visited our hospital with a melena. An endoscopic examination revealed a 3.0 cm sized protruding lesion on the posterior wall of the gastric antrum. Most of the tumor surface was covered with normal mucosa and ulceration was observed in the center. Although the histological diagnosis could not be obtained prior to surgery, a gastrectomy was performed due to the high risk of malignancy. The tumor was diagnosed histologically as a lymphoepithelioma-like carcinoma. The other patient was a 64-year-old man with the chief complaint of epigastric discomfort. An endoscopic examination revealed a SMT like lesion with a central ulceration and hard coated exudate in the high body of the stomach. The microscopic examination revealed a poorly differentiated vimentin-positive adenocarcinoma. Unfortunately, he died from the disease two months later.

A Case of Combined Hepatocellular-Cholangiocarcinoma with Underlying Schistosomiasis

Combined hepatocellular-cholangiocarcinoma is a rare form of primary liver cancer showing features of both hepatocellular and biliary epithelial differentiation. We report here on a case with collision tumor, which apparently was the coincidental occurrence of both hepatocellular carcinoma and cholangiocarcinoma underlying schistosomiasis. A 39-year-old-Philippine female was transferred to our hospital for evaluation of a liver mass that was found on ultrasonography at a local hospital. HBsAg and Anti-HCV were negative and serum alpha-fetoprotein (AFP) level was normal. The tumor mass was histologically diagnosed as adenocarcinoma by sono-guided biopsy before the operation. Partial lobectomy was performed and we histologically identified the concurrent occurrence of hepatocellular carcinoma and cholangiocarcinoma, (a "collision type carcinoma").

A Case of Esophageal Involvement in Pemphigus Vulgaris / 대한소화기내시경학회지

Pemphigus vulgaris is a rare chronic disorder that is characterized by the development of bullae on the skin and mucous membrane due to an acantholysis mediated by circulating autoantibodies. It begins as painful, non- healing ulcerations in the mouth. After a period of weeks to months, the condition progresses to the skin. Occasionally, skin lesions may develop as the initial manifestation of this disease. However, esophageal involvement of pemphigus vulgaris is rare. An 84-year-old man was referred due to chest pain, dysphagia, oral ulcerations and facial bullae. The histopathological findings showed a suprabasal blister and acantholysis in the epithelium of the facial skin. An endoscopic examination revealed exfoliated erosions, ulcerations and hemorrhagic bullae on the oral and esophageal mucosa. The patient was started on high dose of corticosteroids and azathioprine, but there was no clinical improvement. The use of cyclophosphamide led to the remission of the lesions.

A Case of Eosinophilic Gastroenteritis in a Patient with Traumatic Hypopituitarism / 대한소화기내시경학회지

Eosinophilic gastroenteritis is a rare gastrointestinal disorder that can present with a variety of symptoms such as abdominal pain, vomiting, diarrhea and ascites. It is characterized by eosinophilic infiltration of the gastrointestinal wall. Its incidence has increased recently. However, the etiology and pathogenesis of this disease are not well understood. The relationship between hypopituitarism and eosinophilic gastroenteritis is unclear. A corticotropin deficiency and eosinophilia are observed in approximately 90% of traumatic hypopituitarism. We encountered a case of eosinophilic gastroenteritis with eosinophilic ascites in a patient with traumatic hypopituitarism including central diabetes incipidus. Abdominal computed tomography showed diffuse wall thickening of the esophagus, stomach and small bowel with a large amount of ascites. Cytologic examination of ascites showed heavy dense infiltration of eosinophils. The patient was treated with corticosteroid and responded rapidly. Two months later, she was admitted again with a relapse of symptoms. We report this case with a brief review of the relevant literature.

A Case of Cured Diabetes Mellitus after Pheochromocytoma Removal / 대한내분비학회지

Pheochromocytoma is usually associated with a combination of various clinical manifestations caused by the overproduction of catecholamines. It is frequently accompanied by impaired glucose tolerance operating through 2-and-adrenergic mechanisms. A 41-year-old-woman was admitted to the hospital because of poorly-controlled diabetes mellitus and hypertension. She had suffered intermittent paroxysmal attacks of headache and chest discomfort and had been treated intermittently over a 2 year period for diabetes mellitus and hypertension. At admission, the levels of serum epinephrine, norepinephrine urinary excretion of total metanephrine, and VMA were all abnormally elevated. Adrenal CT showed a well-defined, homogenous mass in the right adrenal region and the tumor was diagnosed as pheochromocytoma. After tumor resection, the increased blood level of catecholamines, the urinary excretion of total metanephrine, and VMA were normalized, as was the hyperglycemia state. Diabetes mellitus of the patient was considered permanently resolved after tumor removal by the result of glucose tolerance in 75g oral glucose tolerance test.

Liver Abscess Formation in Non-Tumorous Parenchyma after Transcatheter Arterial Chemoembolization (TACE) for the Treatment of Hepatocellular Carcinoma Associated with Pneumobilia / 대한간학회지

Transcatheter arterial chemoembolization (TACE) is widely used to treat inoperable hepatocellular carcinoma and metastatic tumor of the liver. Among the complications occurring after TACE, liver abscess formation in HCC is a fatal complication. The reported incidence of this complication ranges from 0% to 3.3%. Moreover, liver abscess formation in non-tumorous parenchyma is very rare. The pathogenic mechanism of this complication has been linked to several factors but retrograde enteric bacterial contamination of the biliary tract appears to be the most commonly implicated cause. The major risk factors of the biliary tract infection are pneumobilia, portal vein thrombosis, bilo-enteric anastomosis and biliary obstruction. We report a rare case of liver abscess formation in non-tumorous liver parenchyma after TACE for the treatment of hepatocellular carcinoma in a patient with pneumobilia.

Two Cases of bilateral diffuse cystic lesion / 결핵

Lymphangioleiomyomatosis(LAM) is a rare disease of unknown etiology that occurs mainly in woman in her reproductive age. We recently experienced two cases of bilateral diffuse cystic lesion of the lung on chest X-ray and HRCT. The first case, a 26-year-old female, who had been diagnosed with tuberous sclerosis be the presence of clinical manifestation such as mental retardation, bilateral renal angiomyolipoma, adenoma sebaceum and generalized seizure, was admitted due to recently developed hemoptysis. Chest PA showed diffuse ground-glass opacity with radiolucent cystic lesions of various sizes on both lung fields. HRCT showed innumerable small cystic lesions with suspicious diffuse ground-glass opacity on both lung fields. The second case, a 30-year-old female was admitted due to dyspnea and spewing of blood-tinged sputum for 2 weeks, shortly after delivery. Chest PA showed diffuse reticular and ground-glass opacities on both lung field. HRCT showed multiple well-difined and relatively uniform size air cysts with a uniform wall thickness on entire both lung fields, with small amount of right pleural effusion. By thoracoscopic lung biopsy she was diagnosed with pulmonary lymphangioleiomyomatosis. We report these cases with a brief review of the literatures.