A case of primary T cell lymphoma of the liver presented as FUO / 대한내과학회지

Primary non-Hodgkin's lymphoma of the liver, an organ normally devoid of a native lymphoid tissue, is very rare. We report a case of primary hepatic T-cell lymphoma in a 18-year-old girl, with review of literature. The pateint admitted with fever for 5 months. The ultrasonography revealed a 10 x 7 cm sized mass in the left lobe of the liver. On abdominal CT, the mass was poorly enhancing and low attenuated. On MRI, the signal intensity of the mass was low in T1 weighted image, heterogeneously high in T2 weighted image, and peripherally enhanced in contrast enhancing T1 weighted image. The biopsy specimen obtained by laparatomy showed anaplastic tumor. The malignant cells were positive for T-cell lineage (CD3, CD44, CD45RO). There was no evidence of the lymphoma in other regions. The patient was treated with CHOP (cyclophosphamide, adriamycin, vincristine and prednisolone) chemotherapy without objective response. The patient died of sudden cardiogenic shock.

Spontaneous Submucosal Dissection of the Esophagus: A case report / 대한소화기내시경학회지

A 55-year-old male was admitted to our hospital complaining of chest discomfort, dysphagia and severe pain on swallowing. Esophageal manometry identified the lower esophageal sphincter as having no response to swallow. Barium swallow showed typical esophagograms of double barrelled esophagus or mucosal stripe. An endoscopic examination revealed an appearance as if an esophago-tracheal fistula had been made at the level of the upper thoracic esophagus. Also, two slitlike mucosal tears were seen on the lower esophagus. Subsequent fasting and total parenteral nutrition for several weeks failed to bring about any improvement in his symptoms. So, as a treatment, primary closure of the upper opening of the false channel was performed under general anesthesia. Soon after the surgical procedure, the patients symptoms disappeared except for mild dysphagia. He was discharged after oral intake had been judiciously commenced with fluids and soft diets. During his follow-up in the out-patient department, he was examined and found to have no specific symptoms including fever or dysphagia. Moreover, there was great improvement from the massive dissection of the esophagus on esophagogram.

Clinical Review of Hepatic Adenoma reported in Korea / 대한내과학회지

OBJECTIVES: Hepatic adenoma is a rare benign tumor, occuring in women of child-bearing age and it is known that hepatic adenoma is associated with history of oral contraceptive use in about 90% of cases, rarely with type I glycogen storage disease or anabolic steroids. There have been five cases of hepatic adenoma reported in Korea and three cases have been confirmed in our hospital. We examined the clinical findings of these eight cases and compare them with those of hepatic adenoma reported in western countries. METHODS: We reviewed five cases published in medical literature of Korea and three cases confirmed in our hospital. The clinical, laboratory, and radiological features of the eight cases were examined and all were pathologically proven cases as hepatic adenoma. RESULTS: Six cases were male and two cases were female. Mean age of them were 37+/-6 years old which ranged from 24 to 45 years old. Two cases of female did not have history of ingestion of oral contraceptives and six cases of male did not have history of having anabolic steroids. The associated diseases were chronic hepatitis B in two cases, glycogen storage disease type I in one case, and ovarian mucinous cystadenoma in one case. The presenting symptoms were upper abdominal discomfort in five cases, chronic fatigue in one case and two cases had no symptom. Hepatic adenomas were single mass in seven cases and only one case suspected of having glycogen storage disease showed six nodules. The mean diameter of the eight hepatic adenoma was 7.7+/-3.7cm which range from 2.0cm to 15cm. Seven of the eight cases were larger than 5cm in diameter. but there was no case of intraperitoneal bleeding. In laboratory studies, AST/ALT was elevated(81/84IU/L, normal range less than 40IU/L) in one case which was suspected of glycogen storage disease. Alkaline phosphatase were elevated in four cases and elevated alpha-FP was not found in any case. Hepatic adenoma was shown as hyperechoic mass with indistinct margin by ultrasonography and hypodense mass with contrast enhancement by computed tomography. Hepatic adenoma showed isodense or low signal intensity in T1WI, and low or high signal intensity in T2WI. Hepatic angiography showed hypervascular mass in six cases but avascular mass in two cases. CONCLUSION: The reported cases of hepatic adenoma were predominant in men, associated with chronic hepatitis B in two cases, and females with hepatic adenoma had no history of having oral contraceptive. Despite the large size of hepatic adenoma, there was no case accompanied by peritoneal bleeding. These findings contrasts with those of hepatic adenoma reported in western countries. Therefore the pathogenesis and clinical course of hepatic adenoma in Korea may be different with those of hepatic adenoma occurring in western countries and further studies are needed.

Crohn's Disease with Intraabdominal Abscess as the Initial Diagnosis / 대한소화기내시경학회지

Intraabdominal abscesses and their sequalae have long been observed in patients with Crohn's disease. Patients with Crohn's disease account for little more than 0.5% of all patients coming to laparotomy for intraabdominal abscess. However, an intraabdceninal abscess will develop as a complication of Crohn's disease in 12 to 25% of patients. For enteroparietal abscess, incision and drainage with later definitive resection is the optimal therapy, However, primary en bloc resection is performed with excellent results recently. We experienced a case of Crohn's disease whose initial problem was intraabdorninal abscess. After surgery, we confirmed Crohn's disease.