A Case of Synchronous Triple Primary Cancers Occurring in the Stomach, Colon and Liver

Multiple primary cancers are defined as more than two primary cancers occuring in one patient, synchronously or metachronously. Detection of multiple primary cancers have been increased gradually, because of the improvement of diagnostic and therapeutic tools. Nevertheless, synchronous triple primary cancers have been regarded as rare disease. Here, we report a case of synchronous triple primary cancers occurring in the stomach, colon and liver. The patient was a 68-year-old man who complained intermittent dyspepsia. All of these cancers were diagnosed by upper and lower GI endoscopy, and abdominal CT scans in early stages. The patient was managed successfully with endoscopic submucosal dissection and radiofrequency ablation.

A Case of IgA Nephropathy Associated with Thin Basement Membrane Disease / 대한신장학회지

IgA nephropathy and thin basement membrane disease are common glomerular diseases in persistent microscopic hematuria with or without proteinuria. However, these two conditions cannot be easily distinguished on the biochemical or urinary findings alone. Therefore, renal biopsy is required for correct identification of the two conditions in most cases. Recently, it has been reported that thinning of glomerular basement membrane is accompanied with precipitation of electron dense deposits in some patients with IgA nephropathy. We report a case of IgA nephropathy associated with thin basement membrane disease in a 19-year-old male with microscopic hematuria and mild proteinuria. After 2 years' treatment with angiotensin II receptor blocker, the patient exhibited persistent microscopic hematuria but decreased proteinuria. Our finding concurs with the previous reports indicating that patients with both IgA nephropathy and thin basement membrane disease do not have different clinical features compared to those with IgA nephropathy alone. In addition, clinical outcome does not appear to be affected by thin basement membrane disease when these two conditions are combined.

Acyclovir-induced Acute Renal Failure in a Patient With Suspected Acute Retinal Necrosis Syndrome

PURPOSE: To report a case of acyclovir-induced acute renal failure (ARF) suspected as acute retinal necrosis syndrome. CASE SUMMARY: The authors report a 55-year-old male patient who presented with left eye visual disturbance due to suspected acute retinal necrosis syndrome. Non-oliguric ARF developed after the infusion of intravenous acyclovir (850 mg every 8 hours). The patient did not show any uremic symptoms or signs. The crystal was not discovered in the urine. After stopping the acyclovir infusion and hydration, acyclovir-induced ARF was reversed. CONCLUSIONS: Although possessing critical nephrotoxicity, acyclovir is a useful antiviral drug. Therefore, when using acyclovir, the importance of hydration and preventing acyclovir-induced ARF should be considered.

A Case of Psoas Abscess Caused by Candida glabrata / 감염과화학요법

Infections due to Candida species are becoming more frequent in several patient population and settings. The proportion of non-albicans Candida spp. causing candidemia has increased during the recent decades. Especially, fungaemia due to Candida glabrata has reduced susceptibility to azoles. We report a case of iliopsoas abscess caused by Candida glabrata. A 51-year-old male diabetic patient was admitted with fever and both hip joint pain. Abdominal CT scan revealed huge left iliopsoas intramuscular abscess and left perinephric abscess. The abscess was drained percutaneously. Cultures of the pus were positive for Candida glabrata. The patient's condition improved after abscess drainage and was discharged with oral antifungal agent.

F-18 FDG PET-positive Fibrous Dysplasia in a Patient with Intestinal Non-Hodgkin's Lymphoma / Journal of the Korean Cancer Association, 대한암학회지

Fibrous dysplasia (FD) is a common benign bone disorder of an unclear etiology. It is known that FD can appear without an increased FDG uptake on F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT). However, there are also several reports that FD showed increased FDG uptake and this mimicked malignant bone involvement on FDG-PET. Herein we describe a case of biopsy-proven FDG-PET positive FD in a patient with intestinal non-Hodgkin's lymphoma (NHL). A 45-year-old woman was diagnosed with intestinal NHL, which was removed by right hemicolectomy. After the operation, the FDG-PET/CT scan showed hypermetabolic activity in the right transverse process of the T10 vertebra. The patient then received a total of 6 cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) chemotherapy every 3 weeks. After completion of the planned chemotherapy, the 2nd FDG-PET/CT showed increased FDG uptake (SUVmax=6.0 g/mL) of the previous bone lesion. The MR images revealed a T1-hypointense lesion with sharp borders in the same region, and this showed homogenous contrast enhancement on the fat-suppressed T1-weighted images. After the radiologic studies were carefully reviewed, the bone lesion was assumed to be benign such as FD. We performed bone biopsy and the histological examination confirmed the diagnosis of FD. In conclusion, bone lesions with FDG uptake need to be carefully interpreted when evaluating patients with known malignancy.

A Study to Validate the Pretest Probability of Malignancy in Solitary Pulmonary Nodule / 결핵및호흡기질환

BACKGROUND: Solitary pulmonary nodules (SPN) are encountered incidentally in 0.2% of patients who undergo chest X-ray or chest CT. Although SPN has malignant potential, it cannot be treated surgically by biopsy in all patients. The first stage is to determine if patients with SPN require periodic observation and biopsy or resection. An important early step in the management of patients with SPN is to estimate the clinical pretest probability of a malignancy. In every patient with SPN, it is recommended that clinicians estimate the pretest probability of a malignancy either qualitatively using clinical judgment or quantitatively using a validated model. This study examined whether Bayesian analysis or multiple logistic regression analysis is more predictive of the probability of a malignancy in SPN. METHODS: From January 2005 to December 2008, this study enrolled 63 participants with SPN at the Kangnam Sacred Hospital. The accuracy of Bayesian analysis and Bayesian analysis with a FDG-PET scan, and Multiple logistic regression analysis was compared retrospectively. The accurate probability of a malignancy in a patient was compared by taking the chest CT and pathology of SPN patients with <30 mm at CXR incidentally. RESULTS: From those participated in study, 27 people (42.9%) were classified as having a malignancy, and 36 people were benign. The result of the malignant estimation by Bayesian analysis was 0.779 (95% confidence interval [CI], 0.657 to 0.874). Using Multiple logistic regression analysis, the result was 0.684 (95% CI, 0.555 to 0.796). This suggests that Bayesian analysis provides a more accurate examination than multiple logistic regression analysis. CONCLUSION: Bayesian analysis is better than multiple logistic regression analysis in predicting the probability of a malignancy in solitary pulmonary nodules but the difference was not statistically significant.

Duodenal Mucosa-Associated Lymphoid Tissue Lymphoma: A Case Report

Primary duodenal mucosa associated lymphoid tissue (MALT) lymphoma is very rare, and little is known about its clinical course or effective treatment. We describe a case of primary duodenal MALT lymphoma that was resistant to Helicobacter pylori (H. pylori) eradication and regressed after chemotherapy with cyclophosphamide, vincristine, and prednisolone (CVP). A 71-year-old woman was referred to our department because of epigastric pain and dyspepsia. Gastroduodenoscopy revealed an irregular mucosal nodular lesion with ulceration extending from the bulb to the second portion of the duodenum. Histopathological examination of a biopsy specimen disclosed low-grade MALT lymphoma composed of atypical lymphoid cells with lymphoepithelial lesion. Abdominal CT scans revealed 0.5 to 1.5 cm lymph nodes in the peritoneal cavity, suggestive of lymph node metastasis. We successfully eradicated H. pylori but did not see signs of remission. We administered systemic CVP chemotherapy every 3 weeks. After 6 courses of CVP, the patient achieved complete remission and was followed up without recurrence for about a year.

A Case of Mixed Type Renal Tubular Acidosis with Primary Sjogren`s Syndrome / 대한신장학회지

56-year old woman was hospitalized for severe weakness and generalized bone pain, so she was immediately evaluated for the multiple bone lesions under the impression of malignancy with bone metastasis at the department of oncology. No underlying malignancy was found and the patient was referred to the division of nephrology, where patient was diagnosed as mixed type renal tubular acidosis (RTA) with clinical features of both type 1 and type 2 RTA. Type 2 RTA was diagnosed by high fractional excretion of bicarbonate over 15% and multiple bone lesions, and type 1 RTA was diagnosed by the presence of nephrocalcinosis and sustained high urine pH over 7.0 in spite of severe metabolic acidosis (pH <7.2) with low serum bicarbonate level. She also had findings characteristic of primary Sjogrens syndrome. The treatment started with sodium bicarbonate, vitamin D, calcium and analgesics. In the following seven months, acidosis and symptoms such as bone pain were improved gradually.