Autoimmune Gastritis Accompanied by a Schwannoma Presenting as a Subepithelial Tumor

Autoimmune gastritis (AIG), a chronic inflammatory disease occurs as a result of a complex interaction between host-related and environmental factors. AIG may progress to severe atrophic gastritis secondary autoimmune-mediated parietal cell destruction in the stomach. AIG can be diagnosed based on anti-parietal cell antibody tests and endoscopy, which reveals widespread gastric corpus atrophy in patients with low serum pepsinogen I levels, a low pepsinogen I/II ratio, and elevated serum gastrin levels on serological testing. Tissue biopsy findings, which include mucosal atrophy and lymphocytic infiltration of the lamina propria may be useful for diagnostic confirmation. Decreased gastric acid secretion causes hypergastrinemia and enterochromaffin-like (ECL) cell proliferation, which can lead to neuroendocrine tumor development. Additionally, an autoimmune response results in parietal and chief cell injury, and proliferating ECL cells are detected in the deep mucosal layers in patients with AIG. Therefore, this condition may easily be misdiagnosed as a subepithelial tumor, and establishing a differential diagnosis for other types of subepithelial tumor accompanied by AIG is challenging. We present the case of a 54-year-old woman who was diagnosed with AIG with a concomitant subepithelial tumor based on serologic tests and biopsy findings and underwent wedge resection, which confirmed diagnosis of a schwannoma.

Localized Gastric Amyloidosis with Kappa and Lambda Light Chain Co-Expression

Esophagogastroduodenoscopy for cancer screening was performed in a 55-year-old woman as part of a health screening program, and revealed a depressed lesion approximately 20 mm in diameter in the lesser curvature of the mid-gastric body. Several biopsy specimens were collected as the lesion resembled early gastric cancer; however, histopathologic evaluation revealed chronic active gastritis with an ulcer and amorphous eosinophilic material deposition. Congo red staining identified amyloid proteins, and apple-green birefringence was shown using polarized light microscopy. Immunohistochemical staining revealed the presence of kappa and lambda chain-positive plasma cells. There was no evidence of underlying plasma cell dyscrasia or amyloid deposition in other segments of the gastrointestinal tract. Echocardiography and computed tomography of the chest, abdomen, and pelvis did not show any significant findings. Thus, the patient was diagnosed with localized gastric amyloidosis with kappa and lambda light chain coexpression.

Usefulness of Gastroscope in Patients with Incomplete Colonoscopy

BACKGROUND/AIMS: Conventional colonoscopy is limited in some patients with several causes, such as fixed angulation, extensive loop or adhesion. Therefore, small-caliber scopes are considered alternatives to unsuccessful conventional colonoscopy. The aim of this study is to evaluate the usefulness of gastroscope in patients with unsuccessful colonoscopy. METHODS: From May 2008 to April 2009, a total of 2,548 colonoscopies were performed in Wonkwang University Hospital. The gastroscope was used subsequently when conventional colonoscopy failed. RESULTS: There were 27 cases (1.06%) of unsuccessful colonoscopy. The causes of failure were assessed as fixed angulation of the sigmoid colon (59.2%, 16/27), excessive looping (14.8%, 4/27), stricture (14.8%, 4/27), sigmoid diverticulosis (7.4%, 2/27), and adhesion of transverse colon (3.7%, 1/27). The average time of intubation to cecum with the gastroscope was 7 minutes and 28 seconds (range, 2 to 20 minutes). With the gastroscope, 77.8% (21/27) were intubated to the cecum. The pain score of gastroscope was reduced, as compared with that of conventional colonoscopy (4.95 vs. 5.94, P<0.001). CONCLUSIONS: Gastroscope would be a useful alternative tool in patients with unsuccessful colonoscopy.

Intralobar Pulmonary Sequestration Showing Increased Serum CA19-9 / 결핵및호흡기질환

Carbohydrate antigen 19-9 (CA19-9) is a specific tumor marker of the biliary, pancreatic and gastrointestinal tracts. CA19-9 is occasionally elevated in serum in patiens with benign pulmonary diseases such as bronchiectasis, idiopathic interstitial pneumonia or collagen disease-associated pulmonary fibrosis. Intralobar pulmonary sequestration is an uncommon congenital lung anomaly. It is dissociated from the normal tracheobronchial tree and is supplied by an anomalous systemic artery. There have been some reports of elevation of CA19-9 in this lesion. We report a case of intralobar pulmonary sequestration with elevated serum CA19-9 in a 29-year-old man who was diagnosed with bronchiectasia of left lower lung field on general check up. He had no evidence of any malignant disease in pancreatobiliary or gastrointestinal tracts. Elevated serum CA19-9 level might be encountered with benign pulmonary disease such as pulmonary sequestration.

Inhibitory Effects of 1',2'-Dihydrorotenone on Osteoclast Differentiation and Bone Resorption In Vitro and In Vivo / 체질인류학회지

It is important to identify therapeutic compounds with no adverse effects for use in the chemotherapy of patients with bone-related diseases. The aim of this study was to identify a new compound that inhibits osteoclast differentiation and bone resorption. Herein, we examined the effects of 1',2'-dihydrorotenone on osteoclast differentiation and bone resorption in vitro and in vivo. 1',2'-dihydrorotenone inhibited receptor activator of NF-kappaB ligand (RANKL)-induced osteoclast differentiation of cultured bone marrow macrophages (BMMs) in a dose-dependent manner. However, 1',2'-dihydrorotenone did not exert cytotoxic effect on BMMs. 1',2'-dihydrorotenone suppressed the expression of c-fos and NFATc1 as well as osteoclast-specific genes in BMMs treated with RANKL. Treatment with RANKL inhibited the expression of inhibitors of differentiation/DNA binding (Id)1, 2, and 3; however, in the presence of 1',2'-dihydrorotenone, RANKL did not suppress the expression of Id1, 2, and 3. Furthermore, 1',2'-dihydrorotenone inhibited bone resorption and considerably attenuated the erosion of trabecular bone induced by lipopolysaccharide treatment. Taken together, these results suggest that 1',2'-dihydrorotenone has the potential to be applied in therapies for bone-related diseases.

A Tuberculous Peritonitis Presenting as Submucosal Tumors

Tuberculous peritonitis is not an uncommon disease, but the diagnosis is often missed and delayed because of the variability of disease presentation and non-specific clinical manifestations. In this report, we discuss a rare case of tuberculous peritonitis which presented as a submucosal mass in the colon. A 61-year-old woman registered at our hospital for a physical check-up. She had a weight loss of 3 kg over the past 6 months. The colonoscopic findings showed submucosal lesions (4 and 6 mm in size, yellow in color, and hard) which were suspected to be a carcinoid tumor. However, an abdomen-pelvic CT scan and laparoscopic findings suggested peritoneal tuberculosis. The result of laparoscopic biopsies was chronic granulomatous inflammation without caseous necrosis. After the standard anti-tuberculosis medications for 6 months, the previous lesions on the CT scan had resolved.

Anisakiasis of the Colon: Report of Two Cases / 대한소화기내시경학회지

Anisakiasis is a rare finding in the colon in comparison with its involvement in the stomach. Also, anisakiasis of the colon is usually incidentally diagnosed during either endoscopy or on operation for intestinal obstruction due to the fact that anisakiasis of the colon does not have typical clinical features. In other words, the diagnosis of colonic anisakiasis is usually made after surgical exploration. We herein report on two cases of anisakiasis of the colon that were treated successfully by colonoscopic removal of the worm without any surgery. A review of the related literature is included.

Papillary Muscle Rupture Complicating a Papillary Muscle Abscess

Spontaneous rupture of a papillary muscle from a papillary abscess is extremely rare. Most cases of papillary muscle ruptures are due to myocardial infarction or trauma. We describe the clinical course of a 68-year-old man who died from a papillary muscle rupture as a complication of a papillary muscle abscess due to Streptococcal pyogenes septicemia.

A Case of Spontaneous Biloma Complicated with Choledocholithiasis and Chronic Cholecystitis / 대한소화기학회지

A biloma is an encapsulated bile collection outside the biliary tree. Most cases of biloma are caused by iatrogenic injury or trauma. Intrahepatic rupture of the biliary tree due to nontraumatic cause is a rare event. A 68- year-old man was admitted because of abdominal pain and fever. He had no past history of abdominal surgery, instrumentation or trauma. Computed tomography (CT) scan and magnetic resonance cholangiopancreatography (MRCP) demonstrated a large subcapsular fluid collection in the right liver associated with choledocholithiasis and cholecystitis. Biloma was confirmed by sono-guided percutaneous needle aspiration and was drained through a pigtail catheter. After the successful treatment by percutaneous drainage and endoscopic sphincterotomy, the patient recovered. Here, we report an uncommon case of spontaneous biloma formation in association with choledocholithiasis with a review of literatures.

A case of adrenal cystic lymphangioma / 대한내과학회지

Cystic lesions of adrenal gland are rare and those are most often identified incidentally during radiological investigation, surgery for unrelated process or at the time of autopsy. Most of cystic lesions are usually asymptomatic and less than 10 cm in diameter. Clinical management of an adrenal cyst can be aided by the imaging findings. Surgery is indicated for large and complicated cysts, parasitic cysts, uncertain cyst, and functioning or malignant cysts. We present a case of a 36-year-old female with the benign and non-functioning cyst that was detected by clinical assay and imaging study. The 4 X 2 cm right adrenal cyst contained linear calcification and septation. Laparoscopic resection and histologic findings were compatible with epithelial cyst of lymphangiomatous type of adrenal gland. With this case, diagnostic features of adrenal cysts are discussed.