A Case of Intrahepatic Sarcomatoid Cholangiocarcinoma Mimicking Liver Abscess / 대한췌담도학회지

Sarcomatoid transformation of intrahepatic cholangiocarcinoma is rarely found but usually has very poor prognosis due to the lack of effective approaches for early detection and its aggressive nature. We report a case of this tumor type, in a 60-year-old man who was referred to our hospital for further evaluation of screening-detected, asymptomatic hepatic lesion. Clinical diagnosis was elusive despite performance of different imaging modalities and a transcutaneous liver biopsy. Pathology of the surgically resected tumor demonstrated intrahepatic sarcomatoid cholangiocarcinoma. In our case, tumor cells expressed strong immunoreactivity to both cytokeratin-19 and vimentin. We assume the relatively good prognosis of this patient would be expected because surgery played a critical role at an early stage of the tumor.

Comparison of Autofluorescence Imaging Endoscopic Findings with Pathologic Findings after Endoscopic Submucosal Dissection of Gastric Neoplasms

BACKGROUND/AIMS: All epithelial cells emit autofluoresce, with tumor cells emitting weaker autofluorescence. We categorized patterns of autofluorescence imaging (AFI) and compared their clinical characteristics and pathology findings after endoscopic submucosal dissection. METHODS: Twenty patients were enrolled, comprising 4 adenomas and 16 early gastric cancers. AFI findings were classified as follows: G0 (well-defined pink lesion on a green background with a clear interface over > or =50% of its area), G1 (pink-green mottled lesion on a green background with a clear interface over <50% of its area), P1 (pink-green mottled lesion on a purple background with a clear interface over <50% of its area), and P2 (vague lesion on a purple background with a clear interface over < or =10% of its area). RESULTS: Most of the patients (80%) were male, and their median age was 62.4 years (range: 46-78 years). The lesion sizes by white-light mode, AFI mode, and pathology were 20.8+/-13.1, 22.8+/-15.4, and 20.0+/-17.7 mm (mean+/-SD), respectively. Sixteen cases of adenocarcinoma were classified as follows: G0 (n=10), G1 (n=2), P1 (n=2), and P2 (n=2). The G0 group has no p53 positive lesions, unlike the non-G0 group (p=0.044). All cases with the P1 and P2 patterns were of the gastric and intestinal types, respectively. CONCLUSIONS: AFI images of gastric tumors were categorized into four patterns that were useful for defining the resection margin in 87.5% of cases, with G0 being the most common pattern (62.5%).

A Case of Inflammatory Myofibroblastic Tumor Diagnosed with Double-balloon Enteroscopy / 대한소화기내시경학회지

Gastrointestinal bleeding from an unknown origin occurs in 2~10% of patients with a small bowel lesion. The recent developments in capsule endoscopy and double- balloon enteroscopy have helped improve the accuracy of a diagnosis of small bowel bleeding. Inflammatory myofibroblastic tumors are most often observed in the lungs of young adults but have rarely been reported in conjunction with a small bowel bleeding episode. We report a case of a bleeding inflammatory myofibroblastic tumor in the jejunum that had been diagnosed as non specific jejunal bleeding by capsule endoscopy and confirmed by double- balloon enteroscopy.

The Endoscopic Ultrasonographic Survey of Benign Mesenchymal Tumor in Upper Gastrointestinal Tract / 대한소화기내시경학회지

BACKGROUND/AIMS: A gastrointestinal mesenchymal tumor contains a leiomyoma and gastrointestinal stromal tumor (GIST). The natural course can vary according to the histology and other characteristics. This study evaluated the natural course of a benign mesenchymal tumor in the upper gastrointestinal tract using endoscopic ultrasonography (EUS). METHODS: Submucosal mesenchymal tumors are considered benign according to the following criteria of EUS: 1) the tumor originates from the muscularis mucosa or muscularis propria; 2) is well demarcated, homogenous and hypoechoic; and 3) has a regular surface. In this study, the changes of size, internal echo pattern and marginal regularity were evaluated retrospectively in 26 lesions that all were < 3 cm and were followed up for more than 2 years. RESULTS: The average size of the tumors on EUS was 11.5 mm. The mean follow-up period was 47.4 months. The follow-up EUS revealed no change in echo features in any patient. In only one patient, the size of the tumor increased from 26 to 34 mm without a change in the internal echo or marginal regularity after 24 months. This patient underwent a laparoscopic gastric wedge resection. The pathologic diagnosis was a leiomyoma. CONCLUSIONS: Most small submucosal tumors that are compatible with the EUS criteria of a benign GIST/ leiomyoma do not change over a period of 24 months, and the EUS criteria are effective in diagnosing benign GISTs/leiomyomas. A benign GIST/leiomyoma at EUS might be followed up by EUS at an interval of 2 years.

A case of coronary artery-pulmonary artery fistula communicated with aorto-pulmonary fistula via common channel detected by Multidetector row CT (MDCT) and coronary angiography / 대한내과학회지

A congenital coronary artery fistula is a rare condition, which is an abnormal communication of the coronary artery with the ventricles or atriums or the pulmonary artery. A case of 69 year-old man, complaining of recent aggravating chest pain for 5 months is reported. The coronary angiography shows coronary artery-pulmonary artery fistula. Multidetector row CT shows coronary artery-pulmonary artery fistula combined with aortopulmonary fistula via common channel and the fistulas were surgically ligated.

A case of swallow syncope with sinus pause and vasovagal syncope / 대한내과학회지

A 73 year-old male presented with recurrent episodes of syncope associated with swallowing. Head up tilt test revealed positive response and electrocardiogram revealed a sinus pause with swallowing of carbonated beverages. Underlying esophageal or cardiac disease was not found after evaluation. These findings suggest that a disturbance in the autonomic feedback loop of cardiovascular reflex led to the vasovagal syncope and swallow syncope in this patient. We experienced a case of swallow syncope with sinus pause and vasovagal syncope diagnosed by head up tilt test. This is the first case in Korea that presented with both swallow syncope and vasovagal syncope.