Colonic lymphoid hyperplasia presenting as a submucosal tumor / 대한내과학회지

No abstract available.

Clinical Characteristics and Malignant Predictive Factors of Pancreatic Neuroendocrine Tumors / 대한소화기학회지

BACKGROUND/AIMS: Neuroendocrine tumors (NET) of the pancreas are rare. Its prognosis is better than pancreas adenocarcinoma due to the slow growth, however, malignant NET of the pancreas are observed. The purposes of this study were to evaluate the clinical characteristics and to find the predictive factors of NET which are associated with malignancy and survival. METHODS: We retrospectively evaluated the clinical outcomes of 122 patients with NET of the pancreas who were pathologically diagnosed at Asan Medical Center between 1990 and 2006. RESULTS: Mean age of the patients was 48.9+/-14.0 years and there was no gender predilection. The major clinical manifestations were abdominal pain (44.0%) in non-functional tumor, neuroglycopenic symptoms (100%) in insulinoma and diarrhea (60%) in gastrinoma. Tumor size ranged from 4 to 140 mm (average 29.8+/-23.22). Ninety cases (73.8%) were classified as benign tumors and 32 cases (26.2%) as malignant. In multivariate analysis of clinical characteristics, large sized tumor (>20 mm, p=0.001) was confirmed as sole independent factor to predict malignant NET. Surgical resection was performed in 114 patients. All patients with benign NET are still alive without recurrence. Six out of 32 patients with malignant NET died at an average 40.3 months after diagnosis. The factors indicating favorable outcome were small size of tumors (p=0.046), resection of primary tumor (p=0.000), absence of lymph node invasion (p=0.0116) and distant metastasis (p=0.0005). CONCLUSIONS: Large NET of the pancreas, regardless of their functioning status, were more likely to be associated with malignancy and predictor of worse survival.

Clinical Characteristics, Recurrence Features, and Treatment Outcomes of 55 Patients with Autoimmune Pancreatitis / 대한소화기학회지

BACKGROUND/AIMS: The purpose of this study was to assess the clinical characteristics, recurrence features, and treatment results of patients with autoimmune pancreatitis (AIP) and to determine the clinical predictive factors associated with recurrence. METHODS: We analyzed the clinical, radiologic, laboratory, and recurrence features. We also evaluated treatment methods and outcomes, and clinical predictive factors associated with recurrence in 55 patients with AIP. RESULTS: AIP may be misdiagnosed as pancreatic cancer due to the following characteristic features: (1) clinical findings similar to those of pancreatic cancer including weight loss (60.0%), obstructive jaundice (54.5%), and recent-onset diabetes (29.1%) as the major symptoms; (2) a preponderance in elderly men (mean, 57.7 years old; male, 81.8%); (3) pancreatic mass in computer tomography (21.8%). Serum IgG/IgG4 was elevated in 67.4% of cases. Other organ involvements were noted in 43.6% of cases. All patients (52/52) received steroid treatment have shown complete resolution or marked improvement in the presenting manifestations for which steroids were instituted. After median observation period of 32.8 (1-106) months, 9 patients (3-year cumulative recurrence rate, 20.0%) recurred. There was no significant clinical predictive factor for the recurrence of AIP. However, elevated serum IgG4 preceded recurrence in all patients whose serum IgG4 levels were checked at recurrence. CONCLUSIONS: It is reasonable to understand AIP as a pancreatic lesion reflecting systemic disease, so called 'IgG4-related fibroinflammatory disease'. Steroid trial may be a practical diagnostic tool and a therapeutic one. Recurrence was not uncommon after the steroid treatment and serum IgG4 could be a monitoring marker for the recurrence in clinical practice.

Clinicopathologic Review of 41 Cases of Pancreatic Mucinous Cystic Neoplasms / 대한소화기학회지

BACKGROUND/AIMS: Intraductal papillary mucinous neoplasms (IPMN) and mucinous cystic neoplasms are included in mucin-producing pancreatic tumors. The reports about IPMN are not uncommon but those about the mucinous cystic neoplasms are relatively few. The aims of this study were to define the natural history of resected mucinous cystic neoplasms of the pancreas and to identify the findings which suggest malignancy. METHODS: The authors retrospectively evaluated the clinical outcomes of 41 patients with mucinous cystic neoplasms who were surgically resected at Asan Medical Center between 1995 and 2004. RESULTS: Women (n=33) were more frequently affected than men (n=8). Thirty three patients (80.6%) had adenoma, 1 (2.4%) borderline malignancy, 1 (2.4%) carcinoma in situ, and 6 (14.6%) invasive mucinous cystadenocarcinoma. The most frequent symptom was abdominal pain (39%). About half of the enrolled patients were asymptomatic. Unilocular type (79%) was more frequent than the multilocular type (21%) on gross morphology. The tumor size of invasive mucinous cystic neopolasms was larger than that of non-invasive mucinous cystic neoplalsms (p=0.01). Abdominal pain was more frequent in invasive mucinous cystic neoplasms (p=0.026). On gross morphology, mural nodules were detected in 4 of 6 patients with invasive mucinous cystic neoplasms. However, they were not detected in any patients with non-invasive mucinous cystic neoplasms. Recurrence developed in none of the 35 patients with non-invasive mucinous cystic neoplasms, however 2 of the 6 patients with invasive mucinous cystic neoplasms died within 5 years. CONCLUSIONS: Clinical predictors of invasive mucinous cystic neoplasms are suggested to be tumor size and abdominal pain. The prognosis of the non-invasive mucinous cystic neoplasms is excellent when curative resection is performed.

Mass-forming focal-type autoimmune pancreatitis difficult to differentiate from pancreatic cancer / 대한내과학회지

Autoimmune chronic pancreatitis (AIP) typically manifests as diffuse pancreatic swelling and diffuse irregular narrowing of the main pancreatic duct. Recently, mass-forming focal-type AIP, which shows focal pancreatic swelling with mass and focal narrowing of the main pancreatic duct, has been reported. Since this type of AIP is difficult to differentiate from pancreatic cancer, the greater part of these cases have been treated surgically, with the diagnosis confirmed thereafter. Here we report a case of mass-forming focal-type AIP detected in the head of the pancreas; it has been successfully treated with steroids.

Endoscopic Removal of a Severed, Impacted Lithotomy Basket in the Pancreatic Duct in a Patient with Pancreas Divisum: Endoscopic Removal of Severed, Impacted Basket / 대한소화기내시경학회지

Therapeutic endoscopy in patients with pancreas divisum has continued to evolve with the availability of minor papilla endoscopic sphincterotomy, stenting, or sphinteroplasty. A combination of a sphincterotomy followed by balloon/basket deployment and emergency mechanical lithotripsy had facilitated the removal of impacted or large stones in the pancreatic and biliary ducts. The impaction of the basket with captured stones or rupture of the basket traction-wire during mechanical lithotripsy are rare complications. We report the successful retrieval of a center-severed and impacted lithotomy basket in the duct of Santorini in a 47-year-old patient with pancreas divisum. Endobiliary biopsy forceps were introduced into minor papilla, the basket was drawn and the stone was removed successfully after 2 months. To the best of our knowledge, this is a first report of the removal of a center-severed and impacted lithotomy basket in the pancreatic duct.

Combined endoscopic sphincterotomy and large balloon sphincteroplasty for bile duct stones / 대한내과학회지

BACKGROUND: The combined use of small endoscopic sphincterotomy (EST) followed by endoscopic papillary large balloon dilation (EPLBD) might be associated with a lower incidence of procedure-related complications such as pancreatitis, bleeding or perforation, compared to the use of EPLBD or a large EST alone. The aim of this retrospective study was to evaluate the utility of a combined EST and EPLBD method for the removal of common bile duct (CBD) stones that could not be extracted by use of an EST and conventional techniques. METHODS: Between March 2005 and September 2006, a total of 35 patients with CBD stones were enrolled. Fourteen patients had received a previous EST, and 21 patients underwent an EST. The sphincterotomy site was then dilated with a 12~18 mm diameter balloon. RESULTS: The average number of stones was 3.6+/-2.9 (range: 110). The average maximum stone diameter was 26.11+/-8.88 mm (range: 12~50 mm). Complete stone removal was accomplished in 31 patients (88.6%). In 9 patients (25.7%), a mechanical lithotripsy was required. No episode of true pancreatitis occurred. A procedure-related perforation occurred in one patient (2.8%) and the patient was treated with NPO and antibiotics. No procedure-related bleeding or mortality was observed. The procedure was performed safely in 9 patients (25.7%) with a periampullary diverticulum and in 14 patients (40.0%) with a previous EST. CONCLUSIONS: Combined EST and EPLBD may be a safe and effective method, and may be a good alternative treatment for removing CBD stones that cannot be extracted by an EST and conventional techniques. However, prospective studies based on a large number of patients are needed.