A Case of Metastatic Squamous Cell Carcinomas from the Endocervix to the Stomach without Local Recurrence

Extra-pelvic spread of squamous cell carcinoma (SCC) of the cervix to the stomach is extremely rare. We report a case of a 50-year-old woman who presented with dysphagia two years after diagnosis of SCC of the cervix. At esophagogastroduodenoscopy, there was a 1.5x1.2 cm sized ulcero-fungating mass at the cardia portion just beneath the esophagogastric junction which was biopsied for a suspected neoplastic lesion. Histologic and immunohistochemical examinations showed a SCC with characteristics identical to her original tumor from the cervix confirming gastric metastasis. Therefore, we report a case of endocervical SCC with metastatic lesions in the stomach 2 years after the initial diagnosis.

A Case of Metastatic Squamous Cell Carcinomas from the Endocervix to the Stomach without Local Recurrence

Extra-pelvic spread of squamous cell carcinoma (SCC) of the cervix to the stomach is extremely rare. We report a case of a 50-year-old woman who presented with dysphagia two years after diagnosis of SCC of the cervix. At esophagogastroduodenoscopy, there was a 1.5x1.2 cm sized ulcero-fungating mass at the cardia portion just beneath the esophagogastric junction which was biopsied for a suspected neoplastic lesion. Histologic and immunohistochemical examinations showed a SCC with characteristics identical to her original tumor from the cervix confirming gastric metastasis. Therefore, we report a case of endocervical SCC with metastatic lesions in the stomach 2 years after the initial diagnosis.

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.

A Case of a Foreign Body in the Common Bile Duct Caused by Lipiodol / 대한소화기내시경학회지

Finding a foreign body in the common bile duct (CBD) is very rare. Transcatheter arterial chemoembolization (TACE) has been widely used for the treatment of hepatocellular carcinoma and metastatic liver tumors, and especially when the tumors are not surgically resectable. We experienced a patient with a CBD foreign body 47 days after performing TACE for single hepatic metastasis of adrenal cortical carcinoma. The foreign body in the common bile duct was high attenuated on the pre-enhanced computed tomography (CT) and it was not observed on the previous CT. We successfully extracted it via a basket after performing endoscopic sphincterotomy; this foreign body was dark black color, flexible and smooth. It was not observed on the follow-up CT scan after one month. The foreign body in the common bile duct was tumor tissue that contained lipiodol and it was near the bile duct. We report here on a rare case of a foreign body in the common bile duct, and it was caused by lipiodol after performing TACE.

The Use of Uncovered Self-Expandable Metallic Stents for Palliation ofGastric Outlet Obstruction Caused by Stomach Cancer / 대한소화기내시경학회지

BACKGROUND/AIMS: The purpose of this study is to investigate the effectiveness and safety of the use of uncovered self-expandable metallic stents as a palliative therapy for gastric outlet obstruction caused by stomach cancer. METHODS: A total of 36 patients who underwent uncovered stent insertion were investigated. Hanarostents (uncovered pyloric/duodenal stents, M.I. Tech Co., Ltd.) were used in the procedures. The technical success rate, clinical success rate, presence of clinical symptoms and complications were estimated during the study period. RESULTS: The technical success rate for stent replacement was 97.2% (35 out of 36 patients) and the clinical success rate was 91.7% (33 out of 36 patients). The mean dysphagia scores before and after the procedures were 2.44 and 0.92, respectively. The median hospital stay after stenting was 10 days and the mean follow-up period was 91 days. Thirteen patients died during the follow-up period (mean survival, 70 days). The complication rate was 22.2% (8 out of 36 patients). Restenosis occurred in four cases, bleeding in two cases, pain in one case and stent migration in one case. There were no deaths related to the procedures. CONCLUSIONS: These findings suggest that placement of uncovered self-expandable metallic stents for gastric outlet obstruction caused by stomach cancer results in good symptomatic improvement with a low rate of complications.

The effect of curative surgical resection and adjuvant radiotherapy in patients with extrahepatic bile duct cancer / 대한내과학회지

BACKGROUND/AIMS: To evaluate the effect and prognostic factors related to curative surgical resection and adjuvant radiotherapy in patients with extrahepatic bile duct cancer. METHODS: The authors performed a retrospective analysis of 53 patients with extrahepatic bile duct cancer who were treated at Chungnam National University Hospital between 1998 and 2005. 18 patients (Group 1) were managed with percutaneous bile drainage (n=13) or endoscopic bile drainage (n=5), 17 patients (Group 2) underwent only curative resection, and 18 patients (Group 3) received radiotherapy after curative resection. The radio-sensitizer used in these patients was 5-FU. RESULTS: Three-year overall survival was 5.6% in group 1, 64.7% in group 2, and 61.1% in group 3, with no significant difference noted between group 2 and group 3. The disease-free survival rate was 64.7% in group 2 and 66.7% in group 3, with no significant difference noted between the two groups. We evaluated age, sex, differentiation, tumor location, perineural invasion, operative method, lymphovascular tumor emboli, T stage, and N stage as possible prognostic factors. T stage, N stage, and operative method were significant factors in group 2, but age was the only significant factor in group 3. Group 2 patients had longer overall survival than did group 3 patients with well-differentiated cancer, but group 3 patients had longer survival than did group 2 patients with lymph node metastasis. The recurrence rate was 34.3% (mean value) and was no different between group 2 and group 3. Recurrence sites included local tissue, such as liver, and regional lymph nodes. There were no serious complications during radiotherapy. CONCLUSIONS: Patients who underwent curative surgical resection and adjuvant radiotherapy after surgery had no statistically significant difference in survival or recurrent rates. However, curative surgery is considered to be the only method to improve survival. Our results suggest that radiotherapy after curative resection may improve survival in patients with lymph node metastasis.

Docetaxel-Cisplatin-5-FU Combination Chemotherapy as a First-line Treatment in Patients with Metastatic or Recurred Gastric Cancer / 대한소화기학회지

BACKGROUND/AIMS: The purpose of this study was to investigate the efficacy and safety of 'docetaxel-5-FU-cisplatin' combination chemotherapy as a first-line treatment in patients with metastatic or recurrent gastric cancer. METHODS: We investigated a total of 51 patients who were diagnosed as pathologically proven gastric cancer and received 'docetaxel-5-FU-cisplatin' combination chemotherapy between March 2001 and March 2006. All the cases were surgically unresectable because they were either metastatic or recurred gastric cancer. We studied these cases retrospectively on the basis of medical records. The administered doses of decetaxel was 75 mg/m2 and cisplatin 60 mg/m2 on day 1, 5-FU 750 mg/m2 over 24 hrs on day 1 to day 5, every 4 weeks. RESULTS: Among the 51 patients, 21 patients had Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0, 27 patients had PS 1, 3 patients had PS 2. For response rates, 7 (13.7%) achieved complete response, 17 (33.3%) partial response, 12 (23.5%) stable disease, and 15 (29.4%) progressive disease, respectively. The overall response rate was 47.1%. The median time to progression was 6.7 months (2-34 months). Median overall survival was 14.6 months (2.7-62.5 months). Median disease free survival was 9.5 months (4.2-21.9 months). National Cancer Institute-common toxicity criteria (NCI-CTC) grade 4 leukopenia occurred in 10 cases (per 229 cycles). Grade 4 neutropenia occurred in 51 cases, grade 4 thrombocytopenia in 2 cases. Grade 1 mucositis occurred in 32 cases, grade 1 myalgia in 6 cases. CONCLUSIONS: 'docetaxel-5-FU-cisplatin' combination chemotherapy is an active and tolerable regimen as a first-line treatment in patients with metastatic or recurred gastric cancer.

Abnormalities of liver function tests in patients with hyperthyroidism / 대한내과학회지

BACKGROUND: Abnormalities of liver function tests are common in patients with hyperthyroidism and may reflect thyroid hormone status. The aim of our study was to analyze the frequency of abnormal liver function tests in the patients with hyperthyroidism at diagnosis and the association with the thyroid function state after antithyroid therapy. METHODS: Three hundred seventy eight patients with hyperthyroidism who visited Chungnam National University Hospital from June 2004 to May 2005 and had no other causes for abnormal liver function tests were examined. At diagnosis, 272 of 378 patients had various abnormalities seen on the liver function tests. Among 272 patients, 65 were followed up for liver function tests and were analyzed for sex, age, use of an antithyroid drug, and thyroid function tests after administration of an antithyroid drug. We analyzed the frequency of liver function abnormalities and the relevance between abnormalities of liver function and the thyroid function state. RESULTS: Abnormalities in AST, ALT, total bilirubin, alkaline phosphatase and GGT were observed in 16.4%, 31.0%, 3.2%, 48.7% and 26.9% of the 378 patients with hyperthyroidism, respectively. The level of alkaline phosphatase was the most common abnormal parameter. After antithyroid therapy, 48 (73.8%) of 65 patients had normalization of their liver function abnormalities. The normalization rate for AST, ALT, alkaline phosphatase and GGT were higher in the euthyroid status group than the sustained hyperthyoid status group. The normalization rate for ALT was significantly higher in the female group than in the male group, but the effect of antithyroid drug use and age on the normalization rate was not statistically significant. CONCLUSIONS: These findings indicate that abnormalities of liver function tests are common in patients with hyperthyroidism and these abnormalities are strongly associated with thyroid hormone status.