A Case of Small Duodenal Carcinoid Tumor with Liver Metastasis / 대한소화기학회지

Carcinoid tumors are slow growing submucosal tumors with metastatic potential that arise from enterochromaffin cell. The annual incidence of carcinoid tumor is 2 to 3 per 100,000. Carcinoid tumor of duodenum is very rare with an incidence of about 8% among gastrointestinal carcinid tumor. As a endoscopic examination and immnohistochemical stain are developed, an rate of detection is increasing. Among the possible factor of metastatic prediction, tumor size >10 mm, central depression or ulcer, invasion below submucosa, lymphatic or venous invasion are associated with higher metastatic potential. Specially, in case of tumor size <10 mm, in duodenum, there is no report of metastasis to liver in Korea. But, recently, we experienced a rare care of duodenal carcinoid measured by less than 10 mm with liver metastsis. Thus, we report here this case with a review of literature.

A Case of Protein-losing Enteropathy Associated with Small Bowel Villous Atrophy / 대한소화기학회지

Protein losing enteropathy is described as a diverse group of disorders associated with excessive loss of serum proteins into the gastrointestinal (GI) tract. The etiology of protein losing enteropathy is various. Increased mucosal permeability to protein as a result of cell damage, mucosal erosion, or lymphatic obstruction may develop protein losing enteropathy. Celiac disease is a common cause of protein losing enteropathy associated with small bowel villous atrophy in Europe. We experienced a case of protein losing enteropathy associated with small bowel villous atrophy of unknown origin. A 36-year-old woman was admitted due to chronic watery diarrhea and weight loss. Laboratory findings showed total protein 4.7 g/dL, albumin 2.7 g/dL, cholesterol 100 mg/dL, WBC 6,000/mm(3) (lymphocyte 13.6%) with the absence of proteinuria. On esophagogastroduodenoscopic examination, duodenal ulcer scar was noted on the bulb and colonoscopic finding was nonspecific. On small bowel enteroscopy, jejunal and ileal villi was scantly noticed. Small bowel biopsy showed marked villous atrophy. Her symptoms did not improve after supportive care. Gluten free diet was tried because celiac disease could not be ruled out completely. Diarrhea ceased and body weight regained after gluten free diet.