Granular Cell Tumors of the Cecum: Report of Two Cases and Review of Literature / 계명의대학술지

A granular cell tumor (GCT) is a relatively rare benign tumor that has been seldom reported since Abrikossoff first described it as a granular cell myoblastoma in 1926. While GCTs can occur anywhere in the human body, they are very rarely observed in the gastrointestinal tract and are especially rare in the large intestine. Most GCTs are small and asymptomatic and are often found by endoscopy, upper gastrointestinal series, and autopsy. We report two cases in which a submucosal tumor in the cecum was accidentally discovered by colonoscopy and was subsequently removed by colon polypectomy and endoscopic mucosal resection. Immunohistochemical analysis of the samples confirmed both cases as GCT. The literature review and reports of other growths in the gastrointestinal tracts support the necessity for proper identification of GCTs within the body to differentiate them from more malignant tumors.

Granular Cell Tumors of the Cecum: Report of Two Cases and Review of Literature / 계명의대학술지

A granular cell tumor (GCT) is a relatively rare benign tumor that has been seldom reported since Abrikossoff first described it as a granular cell myoblastoma in 1926. While GCTs can occur anywhere in the human body, they are very rarely observed in the gastrointestinal tract and are especially rare in the large intestine. Most GCTs are small and asymptomatic and are often found by endoscopy, upper gastrointestinal series, and autopsy. We report two cases in which a submucosal tumor in the cecum was accidentally discovered by colonoscopy and was subsequently removed by colon polypectomy and endoscopic mucosal resection. Immunohistochemical analysis of the samples confirmed both cases as GCT. The literature review and reports of other growths in the gastrointestinal tracts support the necessity for proper identification of GCTs within the body to differentiate them from more malignant tumors.

A Case of Anisakiasis Invading the Stomach and the Colon at the Same Time after Eating Anchovies

Anisakiasis of the gastrointestinal tract is caused by the ingestion of raw fish or uncooked food infested with Anisakis larvae. A large number of cases of gastric anisakiasis have been reported in countries where the eating of raw fish is customary. However, there have been few reports of anisakiasis of the colon confirmed by colonoscopy and also very few reports of endoscopic ultrasonographic findings of anisakiasis. A 47-year-old man had epigastric pain with nausea after eating raw anchovies. Endoscopy found a living tubular structure penetrating into the lesser curvature of the stomach and the midtranseverse colon area. It was withdrawn with biopsy forceps. We report a case of anisakiasis simultaneously invading the stomach and the colon confirmed by endosopic utrasonographic findings and biopsy findings.

Two Cases of Colon Polyp Bleeding With Massive Hematochezia in Elderly Patients

The annual incidence of hospital admissions for lower gastrointestinal bleeding in the United States and Europe is 0.02%. Massive hemorrhage from a solitary colon polyp is an extremely rare case. We report two consecutive patients with a single polyp, which was the source of bleeding. The first case is a 68-year-old male patient who visited Daejeon Sun Hospital with the chief complaint of considerable hematochezia. An 1.2 cm colon polyp with active bleeding was observed on the colonoscopy. The second case is a 74-year-old female patient with symptoms of hematochezia. A blood-clot attached, 3.0 cm sized Yamada type-IV colon polyp was examined on the colonoscopy. One case was a sessile polyp, and the other one was a thick-stalked pedunculated polyp. Both types of polyps were supplied with more vessels than other polyps, and both patients were taking aspirin. The two patients underwent snare polypectomy and were discharged without further bleeding evidence.

A Large Symmetrical Esophageal Ulcer Caused by Thermal and Compressive Injury from a Solid Foodstuff Known as 'Song-Pyen' / 대한내과학회지

There are many possible causes of esophageal ulcer, such as reflux esophagitis, pill-induced esophagitis, infectious esophagitis, tuberculosis, syphilis, Behcet's disease, radiation injury, caustic injury, foreign body-induced injury, esophageal cancer, and so on. However, there are only a few cases of esophageal ulcer by thermal injury from food, and most of these were caused by liquids; few are related to ingestion of solid food. We experienced a case of a large symmetrical esophageal ulcer caused by thermal and compressive injury from a hot solid foodstuff known as 'Song-pyen', a traditional Korean food, and report the natural course of healing by conservative treatment, with a review of the few available reports regarding such injuries.

A Case of Focal Intramural Abscess Due to a Fish Bone Ingestion in a Healthy Middle Aged Woman / 대한소화기내시경학회지

Gastric wall abscess is a one form of phlegmonous gastritis and there are scare reports on this. Gastric wall abscess is a purulent inflammatory disease and it is commonly caused by a focal injury to the gastric mucosa such as a penetrating trauma from an ingested foreign body or an endoscopic biopsy where by bacterial infection occurs throughout all the layers of the gastric wall. With symptoms such as abdominal pain and fever, making the diagnosis after an operation was possible in the past, but it has recently become possible to make the diagnosis before the operation via esophagogastroduodenoscopy, endoscopic ultrasonography and/or abdominal computed tomography. We recently experienced a case of gastric wall abscess that was associated with a foreign body (presumably a fish bone) in a healthy middle aged woman. By performing generalized esophagogastroduodenoscopy and abdominal computed tomography at a primary medical institution, we made an early diagnosis and treated the patient. Herein, we report on this case and we review the relevant literature.

Pathological Findings of a Renal Biopsy Showing Chronic Hepatitis B in A Patient with Acute Hepatitis A / 대한내과학회지

Hepatitis A is usually a self-limited liver disease that is treated conservatively. Acute renal injury complicating acute hepatitis A in the absence of fulminant hepatic failure is rare. We experienced a 33-year-old man who was healthy, and did not know that he was a hepatitis B virus (HBV)carrier with non-fulminant hepatitis A. He developed an acute kidney injury that necessitated dialysis therapy and a renal biopsy. He recovered within about 1 month. Pathologically, the renal biopsy showed acute tubular necrosis. It also showed IgA nephropathy and mesangium proliferation with glomerular nephritis, which are seen in chronic viral hepatitis B. We describe the association of acute hepatitis A with acute kidney injury and report the pathological findings of a renal biopsy related to chronic hepatitis B in an acute hepatitis A patient discovered by chance.

A case of deep, wide drug-induced esophageal ulcer / 대한내과학회지

There are many possible causes of esophageal ulcer, including reflux esophagitis, the ingestion of foreign bodies or caustic agents, radiation exposure, viral infections, tuberculosis, Candida infection, Bechet's disease, and esophageal cancer. Patients with drug-induced esophagitis typically have a history of ingesting medication with little or no fluid immediately before going to bed. Here, we present the case of a 31-year-old man complaining of dysphagia and odynophagia for 4 days. The patient reported taking oral medication for acute sinusitis 12 days prior. Endoscopic examination revealed a large, deep esophageal ulcer consistent with esophageal cancer or cytomegalovirus esophagitis. The exam also revealed several esophageal erosions resembling herpes simplex virus esophagitis. However, based on the patient's history and subsequent histologic findings, drug-induced esophagitis was diagnosed and the patient was successfully treated with a proton pump inhibitor. Lesions showed improvement upon follow-up endoscopy 1 month later.

A Case of Gastritis Cystica Profunda Presenting with a Submucosal Cystic Tumor / 대한소화기내시경학회지

Gastritis cystica profunda (GCP) is a lesion characterized by elongation of the gastric foveolae with hyperplasia and cystic dilatation of the gastric glands that extends into the submucosal layer. In most cases, gastritis cystica profunda develops in patients who have undergone a gastroenterostomy, with or without gastric resection. GCP may present not only as a submucosal tumor or as solitary or diffuse polyps, but GCP is also rarely seen as a giant gastric mucosal fold. A patient arrived at our hospital with dyspepsia. Gastroduodenoscopy (EGD) showed the presence of a submucosal tumor measuring 3 cm in the widest diameter in the body of the stomach. A CT scan demonstrated the cystic nature of the lesion and endoscopic ultrasound (EUS) depicted a homogeneous hypoechoic, unilocular cystic mass without any internal solid component. EGD, CT and EUS findings suggested that the lesion was more likely to be benign than malignant. The lesion was treated with an endoscopic mucosal resection (EMR), and the lesion was finally diagnosed as gastritis cystica profunda. A follow-up EGD demonstrated that all mucosal surfaces were well healed four weeks after the EMR.

A Case of Intestinal Obstruction Caused by Strangulated Femoral Hernia Accompanying Soft Tissue Necrosis / 대한소화기학회지

Intestinal obstruction involves a partial or complete blockage of the bowel which results in the failure of intestinal contents to pass through. The mechanical causes of obstruction may include the followings: hernias, postoperative adhesions or scar tissue, impacted feces, gallstones, tumors, granulomatous processes, intussusception, volvulus, foreign bodies, and etc. Hernias are the third leading cause of intestinal obstruction by 10% approximately. However, most hernias are the cases with abdominal wall, inguinal or internal hernia. Femoral, obturator, lumbar, or sciatic hernia as the cause of obsturction is rare. Furthermore, the cases accompanying soft tissue necrosis are seldomly reported. Herein, we report a case of intestinal obstruction caused by strangulated femoral hernia accompanying soft tissue necrosis in a 78-years-old female patient.

A Randomized, Prospective, Comparative, Multicenter Study of Rabeprazole and Ranitidine in the Treatment of Reflux Esophagitis / 대한소화기학회지

BACKGROUND/AIMS: This study was done to evaluate the efficacy of rabeprazole (proton-pump-inhibitor) and ranitidine (H2-receptor antagonist) in the symptom relief and treatment of erosive esophagitis diagnosed by endoscopy. METHODS: A total of 110 patients with typical gastroesophageal reflux disease (GERD) symptoms were enrolled in this multicenter study. They were randomized into rabeprazole group (53 patients) and ranitidine group (57 patients) respectively. The patients in rabeprazole group were given 10 mg of rabeprazole and ranitidine group received 300 mg of ranitidine before breakfast and dinner for 8 weeks. After the end of treatment, we evaluated the endoscopic healing rate of reflux esophagitis and symptomatic improvement. RESULTS: After 8 weeks of treatment, rabeprazole group showed significantly higher complete endoscopic cure rate than ranitidine group (86.8% [46/53] vs. 57.9% [33/57], p=0.001) and higher symptomatic improvement of heartburn (91.2% [31/34] vs. 76.2% [32/42], p=0.085), especially in the first 7 days (76.7% vs. 45.3%, p=0.008). Also, rabeprazole group showed significantly higher improvement of regurgitation symptom than ranitidine group (100% [35/35] vs. 83% [39/47], p=0.009). Both group showed no differences in the improvement of chest pain and globus sensation. All the adverse events (rabeprazole group 4 events vs. ranitidine group 3 events) were mild and there was no abnormality in laboratory test. CONCLUSIONS: In patients with GERD, rabeprazole 10 mg b.i.d. is superior to ranitidine 300 mg b.i.d. in healing of reflux esophagitis and resolving typical GERD symptoms. Rabeprazole is an effective and well-tolerated drug for GERD treatment.

A Case of Gastric Metastasis from Small Cell Lung Carcinoma / 대한소화기학회지

Gastric metastasis of lung carcinoma is a rare entity which is detected mostly at autopsy. Patients diagnosed as having those on lifetime are extremely rare. In addition to our case, 54 cases of lung carcinoma metastasis to the gastro-intestinal tract have been reported in the literature since 1961. We report a case of gastric metastasis originated from small cell lung carcinoma. The patient was a 87-year-old man. He refused lung biopsy and further treatment and died 2 months after the diagnosis. This is the case of gastric metastsis originated from lung carcinoma, which was confirmed by immunohistochemical staining.

A Case of Chronic Acalculous Cholecystitis Diagnosed by Delayed Contrast Emptying in Gallbladder / 대한소화기학회지

Chronic acalculous cholecystitis is a diagnosis of exclusion in patients complaining acalculous biliary pain. The possible causes of acalculous biliary pain are chronic gallbladder (GB) inflammation, GB dysfunction, cholesterolosis, cystic duct stenosis or microlithiasis. Recently, laparoscopic cholecystectomy is the choice of treatment for acalculous biliary pain. We experienced a 32-year-old woman whose initial symptoms were right upper quadrant pain and nausea only. The abdominal computed tomography, DISIDA scan, and upper and lower endoscopic examinations were nonspecific. Up to 48 hours after endoscopic retrograde cholangiopancreatography, contrast emptying of GB was delayed, implying dysfunctional GB. As the patient's right upper quadrant pain and tenderness became aggravated, the laparoscopic cholecystectomy was done and the final diagnosis of chronic acalculous cholecystitis was confirmed.

A Case of Lower Gastrointestinal Bleeding due to Angiodysplasia in the Terminal Ileum / 대한소화기내시경학회지

Angiodysplasia has been recognized as an important cause of lower gastrointestinal bleeding, but it is difficult to confirm the lesions. Angiodysplasia in the small bowel could be the most probable cause of bleeding particularly in the elderly patients when usual methods fail to document the focus. Small bowel angiodysplasias have been diagnosed by angiography and/or surgery at the sites where usual endoscope could not reach, and treated by medical therapy, angiographic embolization or surgery. We experienced a case of a bleeding angiodysplasia in the terminal ileum in a 51-year-old man who was taking anti-platelet agents. The lesion was diagnosed by colonoscopy, and bleeding was easily controlled with hemoclipping.

Effects of iNOS inhibitor on IFN-gamma production and apoptosis of splenocytes in genetically different strains of mice infected with Toxoplasma gondii

To evaluate the role of nitric oxide (NO) in IFN-gamma production and apoptosis of splenocytes in genetically different strains of mice with toxoplasmosis, BALB/c (a toxoplasmosis resistant strain) and C57BL/6 (a toxoplasmosis susceptible strain) mice were infected with Toxoplasma gondii cysts orally and subsequently injected intraperitoneally with aminoguanidine, an iNOS inhibitor (AG; 35 mg/kg per mouse daily for 14 days). When BALB/c or C57BL/6 mice were infected with T. gondii without AG treatment, number of brain cysts, NO and IFN-gamma production by splenocytes, and percentages of apoptotic splenocytes were increased compared to uninfected control mice without AG treatment. AG treatment increased the number of brain cysts, and reduced NO and IFN-gamma production in T. gondii-infected C57BL/6 mice. In contrast, in T. gondii-infected BABL/c mice, the number of brain cysts, and NO and IFN-gamma production of splenocytes was not altered by treatment with AG. However, the percentages of apoptotic splenocytes in T. gondii-infected BALB/c or C57BL/6 mice were not affected by AG treatment. These results suggest that NO modulates IFN-gamma production in T. gondii-infected C57BL/6 mice, and that NO is involved in mediating a protective response in toxoplasmosis susceptible, but not resistant, mice strain during acute infection.

Epidemiological study of clonorchiasis and metagonimiasis along the Geum-gang (River) in Okcheon-gun (County), Korea

The endemic status of clonorchiasis and metagonimiasis along the Geum-gang (River) in Okcheon-gun (County) in Korea was examined. From February to December 2000, stools of total 1,081 inhabitants living in 5 villages were examined. Each stool specimen was examined by both the cellophane thick smear method and the formalin-ether sedimentation technique. Egg-positive cases were further analyzed by Stoll's egg-counting technique, and praziquantel was administered to positive cases. The egg-positive rates for Clonorchis sinensis and Metagonimus species were 9.3% and 5.5%, respectively, and the double infection rate was 3.5%. The numbers of eggs per gram (EPG) of feces of C. sinensis and Metagonimus sp. were 918 +/-1.463 and 711+/-947, respectively. The egg-positive rates for C. sinensis and Metagonimus sp. in the riverside area were 14.2% and 8.4%, respectively, which were significantly higher than those of the inland area (3.2% and 1.7%, respectively). The egg-positive rates of C. sinensis and Metagonimus sp. in males (16.7% and 10.0%) were significantly higher than those of females (3.5% and 1.8%). However, there were no significant differences of EPG values between localities and sexes. The prevalence of clonorchiasis and metagonimiasis in this survey was significantly lower than that in the previous reports. However, there is still a high prevalence of infection with C. sinensis and Metagonimus sp. in this region, especially in the riverside area.

A Case of Triple Synchronous Primary Colon Cancer Diagnosed by Colonoscopy before Operation / 대한소화기내시경학회지

Multiple primary colorectal carcinomas are not rare and occur more often than what can be ascribed to chance, but the frequencies on record vary. The tumors are usually classified as synchronous if they are present at the same time. It is often difficult to detect all these multiple lesions preoperatively:a correct diagnosis is frequently obtained only upon examination of the resected specimen. Triple synchronous primary colon cancer is an exceedingly rare disease. Despite of its rarity, multiple colon cancers should be investigated in the patients in whom clinical or laboratory evidence of colon cancer is suspected. Recently, we experienced one case of triple synchronous primary colon cancer diagnosed by colonoscopy before operation and report here with the review of the literature.

Effects of specific monoclonal antibodies to dense granular proteins on the invasion of Toxoplasma gondii in vitro and in vivo

Although some reports have been published on the protective effect of antibodies to Toxoplasma gondii surface membrane proteins, few address the inhibitory activity of antibodies to dense granular proteins (GRA proteins). Therefore, we performed a series of experiments to evaluate the inhibitory effects of monoclonal antibodies (mAbs) to GRA proteins (GRA2, 28 kDa; GRA6, 32 kDa) and surface membrane protein (SAG1, 30 kDa) on the invasion of T. gondii tachyzoites. Passive immunization of mice with one of three mAbs following challenge with a lethal dose of tachyzoites significantly increased survival compared with results for mice treated with control ascites. The survival times of mice challenged with tachyzoites pretreated with anti-GRA6 or anti-SAG1 mAb were significantly increased. Mice that received tachyzoites pretreated with both mAb and complement had longer survival times than those that received tachyzoites pretreated with mAb alone. Invasion of tachyzoites into fibroblasts and macrophages was significantly inhibited in the anti-GRA2, anti-GRA6 or anti-SAG1 mAb pretreated group. Pretreatment with mAb and complement inhibited invasion of tachyzoites in both fibroblasts and macrophages. These results suggest that specific antibodies to dense-granule molecules may be useful for controlling infection with T. gondii.