Clinical Significance of Serum CA-125 in Korean Females with Ascites

PURPOSE: Mycobacterium tuberculosis is endemic in Korea. Because tuberculous peritonitis is characterized by ascites, abdominal pain, abdominal mass and elevation of serum CA-125, it can be confused with ovarian malignancies. The aim of this study was to evaluate the significance of serum CA-125 level in the differential diagnosis of tuberculous peritonitis and ovarian malignancy in a Mycobacterium tuberculosis-endemic area. MATERIALS AND METHODS: The medical records of patients diagnosed with tuberculous peritonitis (n=48) or epithelial ovarian malignancy (n=370) at Samsung Medical Center from January 2000 to October 2009 were retrospectively reviewed. RESULTS: Median serum CA-125 level in the epithelial ovarian cancer group was significantly higher than that in the tuberculous peritonitis group (p< or =0.01). Only one patient (2.1%) in the tuberculous peritonitis group had a serum CA-125 level over 2000 U/mL. However, 109 patients (29.5%) in the epithelial ovarian cancer group had a serum CA-125 level over 2000 U/mL. At the CA-125 ranges of 400 to 599 and 600 to 799, the proportions of those with tuberculous peritonitis were 24% and 21.9%, respectively. At a serum CA-125 level over 1000 U/mL, however, the proportion of tuberculous peritonitis was much lower (2.1%). CONCLUSION: Tuberculous peritonitis should be considered in the evaluation of female patients with ascites and high serum CA-125.

A Case of Pulmonary Blastomycosis Mimicking Pulmonary Tuberculosis / 결핵및호흡기질환

Blastomyces dermatitidis is a dimorphic fungus that causes the systemic pyogranulomatous disease known as blastomycosis. Blastomycosis most often involves the lungs, skin, and may involve nearly every organ in the body. It is difficult, however, to diagnose blastomycosis in the early stage of pulmonary disease because clinical manifestations are varied from subclinical infection to acute respiratory distress syndrome. Since blastomycosis is often accompanied by granulomatous inflammation in histopathologic findings, differentiation from other etiologic diseases is important. We report a case of a 45-year-old male with pulmonary blastomycosis who had been misdiagnosed with tuberculosis for 3 months.

A Case of Non-Small Cell Lung Cancer in a Respiratory Bronchiolitis Associated Interstitial Lung Disease Patient / 결핵및호흡기질환

Respiratory bronchiolitis-associated interstitial lung disease is one of the smoking-related interstitial lung diseases. Histopathologically, it shows respiratory bronchiolitis, which is characterized by the accumulation of pigmented macrophages within the respiratory bronchioles, accompanying peribronchiolar inflammation. Clinically, it is presented with respiratory symptoms such as a cough, sputum and dyspnea on exertion. It is well known that the incidence of malignancy in interstitial lung disease is high, but in respiratory bronchiolitis-associated interstitial lung disease the report of accompanying malignancy is rare. Here we report a case of a 60-year-old male heavy smoker presented with a cough, sputum and clubbing finger. A chest computed tomography (CT) of the patient did not show any shadow suspected of malignancy, but adenocarcinoma was found on a transbronchial lung biopsy and on a surgical lung biopsy with respiratory bronchiolitis-associated interstitial lung disease.

A Case of Interstitial Pneumonitis with Acute Live Injury Caused by Herbal Medicine Made from Golden Thread / 결핵및호흡기질환

So far more than 350 drugs have been reported to be the cause for lung injury and the incidence tends to increase. Although infiltrative lung disease is the most common pattern of drug-induced lung injury, it can appear in the form of alveolar changes, vasculitis and other injury. Herbal medicine also has been known as a cause for interstitial pneumonitis, but it is difficult to identify the key herbal medicine because of the complex components of the contents. Till date, there is no report of pneumonitis caused by golden thread. Here we report a case of a 54-year-old male who developed interstitial pneumonitis with acute liver injury caused by herbal medicine made from golden thread.

Association between Thyroid Cancer and Advanced Colorectal Neoplasia

BACKGROUND/AIMS: Colorectal cancer and thyroid cancer are common diseases with relatively higher survival rates compared with other cancers. The number of patients identified with colorectal cancer or thyroid cancer who develop multiple primary malignancy during long-term follow-up is increasing with advances in diagnostic techniques and treatment modalities. However, the association between colorectal cancer and thyroid cancer is uncertain, and few data have been reported in Korea. This study examined the association between thyroid cancer and colorectal neoplasm. METHODS: We retrospectively investigated 363 patients who underwent a colonoscopy, among patients diagnosed with thyroid cancer between January 2004 and December 2008 at Samsung Medical Center. The control group was comprised of 2,494 patients who underwent screening colonoscopy for the first time within the study period at the center for health promotion at Samsung Medical Center between March 2004 and December 2005. RESULTS: The detection rates in patients with thyroid cancer were 4.7% (17/363) for advanced adenomas and 2.8% (10/363) for colorectal cancer. In the control group, it was 3.2% (79/2,494) for advanced adenomas and 0.3% (7/2,494) for colorectal cancer. A multivariate analysis revealed that the presence of thyroid cancer had an odds ratio of 1.893 (95% confidence interval, 0.868-4.128, P=0.109) in favor of finding at least one advanced colorectal neoplasm. CONCLUSIONS: The results indicate that thyroid cancer is not associated with advanced colorectal neoplasm. Survivors of thyroid and colorectal cancer live longer and hence are at risk for second primary cancers. Therefore, further studies that prospectively evaluate the association between thyroid cancer and colorectal advanced neoplasm are needed.