The contribution of BCA-1 and apoptosis in gastric MALT lymphoma generation / 대한내과학회지

BACKGROUND: In spite that several lines of evidence suggest that gastric MALT lymphoma arises from Helicobacter pylori (H. pylori)-associated acquired MALT(mucosa-associated lymphoid tissue), the exact underlying pathogenic mechanism has not yet been clearly exploited. The high expression of B cell attracting chemokine-1 (BCA-1) and modulation of cell death by apoptosis have been suggested as possible pathogenic determinants for whether the cases with H. pylori infection will develop MALToma or not. METHODS: We have studied the expression of BCA-1 and its receptor CXCR5 in gastric tissue samples obtained from patients suffering with H. pylori-positive gastritis, H. pylori-negative gastritis and H. pylori-positive low grade MALT lymphoma, respectively. TUNEL (Terminal deoxynucleotidyl Transferase Biotin-dUTP Nick End Labeling) staining for detecting apoptotic cells was also included. Furthermore, the changes of the BCA-1 and CXCR5 expressions before and after the complete remission of MALToma were compared. The in vitro influencing effect of H. pylori infection on the BCA-1 and CXCR5 expression was observed. RESULTS: Significantly higher levels of BCA-1 and its receptor CXCR5 expression were observed in H. pylori-positive MALToma specimens as compared with either the H. pylori-positive gastritis or H. pylori-negative gastritis specimens; its levels were significantly reduced after the remission of MALToma. In contrast to the increased apoptotic activity after H. pylori infection, a significant reduction of epithelial apoptosis was observed in the H. pylori-positive MALToma specimens. H. pylori infection directly induced the expression of BCA-1 in the cultured gastric epithelial cells. CONCLUSION: The up-regulated BCA-1 expression and the decreased apoptosis in H. pylori infected gastric epithelial cells might contribute to the development of MALT lymphoma.

A Case of Primary Malignant Melanoma of the Esophagus Treated by Esophagectomy / 대한소화기내시경학회지

A primary malignant melanoma of the esophagus is a very rare disease representing approximately 0.1~0.2% of all esophageal neoplasms and 0.5% of all mucosal melanomas. Despite a surgical resection, a primary malignant melanoma of the esophagus has a poor prognosis, mainly due to the fast development of hematogenous and lymphatic metastases. However, a resection of the tumor appears to be the treatment of choice. Local excision does not prolong the survival of patients. After a radical excision, the mean survival time is 7~12 months and the estimated 5 year survival is 4.2%. However, after a local excision, the average survival time is 9 months and there is no report of a patient who survived more than 1year. We encountered a 55-year-old woman with a primary malignant melanoma of the esophagus, who underwent a radical esophageal resection with a lymph node dissection. We report this case with a review of the relevant literature.

A Case of a Retained Surgical Sponge Diagnosed by Colonoscopy / 대한소화기내시경학회지

Gossypibomas, retained surgical sponges are prone to creat adhesions and to encapsulate, or to provoke an exudative response, with or without accompanying bacterial infection. Often a process of transmural migration can occur and we experienced a case which was diagnosed by colonoscopy. A 24 year-old female patient who had a history of Cesarean section 4 months ago came to the hospital with a complaint of intermittent right lower quadrant pain. A thread of surgical sponge was found by colonoscopy from ascending colon to cecum. At laparotomy, a transmurally migrating surgical sponge through the colonic fistula at the cecal base with surrounding abscess cavity was found. Adding a case report, the fate of intraperitoneal forgotten surgical sponges is reviewed.

The Usefulness of Endoscopic Ultrasonography and Endoscopy in Diagnosing Depth of Invasion of Early Gastric Cancer for the Selection of Proper Candidates for Endoscopic Mucosal Resection / 대한소화기내시경학회지

BACKGROUND/AIMS: If a cancer lesion without ulcer can be correctly staged as mucosal, it can be a candidate for curative endoscopic treatment such as endoscopic mucosal resection. The aim of this study was to evaluate the usefulness of EUS and endoscopy in diagnosing mucosal cancer of stomach. METHODS: Findings of endoscopy and EUS were independently reviewed by the conventional criteria for diagnosing depth of invasion and compared with histologic findings in 65 patients having EGC without ulcers. RESULTS: Overall accuracy of diagnosing depth of invasion were 69% by endoscopy and 78% by EUS. The accuracy rates according to the macroscopic type by endoscopy were 86% (12/14) for type I, 75% (3/4) for type IIa, 75% (9/12) for type IIa+IIc, 50% (2/4) for type IIc+IIa, 66% (19/29) for type IIc and 0% (0/2) for type IIc+IIb. The accuracy rates according to the macroscopic type by EUS were 93% (13/ 14) for type I, 50% (2/4) for type IIa, 75% (9/12) for type IIa+IIc, 50% (2/4) for type IIc+IIa, 83% (24/29) for type IIc and 50% (1/2) for type IIc+IIb. All lesions that were classified as limited to the mucosa on both conventional endoscopy and EUS in type I (n=9), IIa (n=2), IIa+IIc (n=2) and IIc (n=11) were limited to the mucosa by histologic findings. CONCLUSIONS: This study suggests that if both modalities show the findings of mucosal lesion in type I and IIc of EGC, endoscopic mucosal resection may be considered as a curative treatment.

Impaired Glucose Tolerance Associated with Klinefalter Syndrome / 대한내분비학회지

Klinefelter syndrome is one of the most common forms of primary hypogonadism and infertility in males. It is a clinical syndrome consisting of gynecomastia, azoospermia, and increased urinary excretion of follicle-stimulating hormone. Fequency of diabetes mellitus, emphysema, asthma, breast cancer increase in Klinefelter syndrome. We report a 16-year-old male patient with impaired glucose tolerance in association with Klinefelter syndrome, which was confirmed by chromosome analysis. The mechanism of impaired glucose tolerance in this patient was peripheral insulin resistance which clarified by euglycemic hyperinsulinemic clamp test.