24 Weeks Treatment with Pegylated Interferon Alfa Plus Ribavirin May Be Possible in Genotype 1 Chronic Hepatitis C Patients with Rapid Virological Response Who Have Low Pretreatment Viremia / 대한소화기학회지

BACKGROUND/AIMS: The standard treatment for chronic hepatitis C infected with hepatitis C virus (HCV) genotype 1 is a combination of pegylated interferon alfa and ribavirin over a 48 weeks period. It is unclear if 24 weeks treatment is possible for patients showing a rapid virological response (RVR) without compromising the sustained virological response (SVR) in Korea. METHODS: Between June 2005 and September 2008, among patients chronically infected with the HCV genotype 1 who were treated with pegylated interferon alfa subcutaneously once weekly plus ribavirin based on body weight, 55 patients who had low pretreatment viral load (<600,000 IU/mL) and RVR were enrolled. A total of 55 patients were divided into 24 weeks treatment group (n=29) and the standard treatment group (n=26). The HCV RNA was quantitatively assessed before treatment, and after 12 weeks of treatment, and also qualitatively assessed after 4 weeks of treatment, at end of treatment (24 weeks), and 24 weeks after end of treatment. RVR was defined as undetectable HCV RNA at the 4 weeks of treatment. RESULTS: Among the 55 patients, SVR was achieved in 100% (29/29) of the patients in 24 weeks treatment and 96.2% (25/26) of the patients in the standard treatment (p=0.473). CONCLUSIONS: HCV genotype 1 infected patients with a low baseline HCV RNA concentration who become HCV RNA negative at week 4 may be treated for 24 weeks without compromising sustained virlolgical response. However, an additional trial will be needed to optimize the treatment duration.

A Case of Rectal Leiomyosarcoma Presenting as a Semipedunculated Polypoid Mass / 대한소화기내시경학회지

Rectal leiomyosarcoma is an extremely rare disease. Anal bleeding, rectal pain and a sensation of pressure in the anus are the most common symptoms. It tends to form a polypoid intraluminal mass and commonly originates from the muscularis propria, but may arise from the muscularis mucosa, or in the walls of the blood vessels. Characteristically, leiomyosarcoma has very high mitotic activity and is, on immunohistochemical staining, positive for actin and desmin, but negative for c-kit and S-100. We experienced a case of a rectal leiomyosarcoma in a 54 year-old man who presented with anal bleeding. Colonoscopic examination revealed a 4.5 cm-sized semipedunculated polypoid mass at mid-rectum. We confirmed that it was a leiomyosarcoma histologically by endoscopic resection with mechanical snaring. Low anterior resection followed by radiation therapy was performed. We report here on this case with a review of the relevant literature.

Permanent sudden hearing loss associated with peginterferon and ribavirin combination therapy during hepatitis C treatment / 대한내과학회지

Peginterferon and ribavirin combination therapy for chronic hepatitis C is associated with major adverse effects, and systemic side effects are common. However, little is known about the influence of peginterferon on hearing loss, although it has been described as a rare complication of standard interferon. A 65-year-old man with chronic hepatitis C (genotype 2) developed sudden unilateral right-sided hearing loss just after finishing 24 weeks of treatment with peginterferon alpha 2a (180 microg/week) and ribavirin (800 mg/day). The audiological examination revealed a right-sided sensorineural hearing loss. Auditory brain-stem response measures confirmed the diagnosis. The hearing loss did not respond to corticosteroid therapy. The auditory disability remained unchanged 12 months after the end of treatment, although no HCV RNA was detectable 24 weeks after the end of treatment. We report a patient who developed irreversible hearing loss just after completing treatment with peginterferon and ribavirin

A Case of Primary Biliary Malignant Lymphoma Mimicking Klatskin Tumor / 대한소화기학회지

Primary non-Hodgkin's lymphoma of the extrahepatic bile duct presenting as obstructive jaundice is extremely rare. A 60-year-old man was admitted due to suddenly developed jaundice. Computerized tomography and endoscopic retrograde cholangiopancreatography showed a tumor at the proximal common hepatic duct. These clinical and radiologic findings resembled those of Klatskin tumor. The resection of the common hepatic duct tumor, lymph node dissection, and Roux-en-Y hepaticojejunostomy were carried out. There was no regional lymph node metastasis and no residual tumor at the resection margins. Histology and immunohistochemistry of the resected specimen confirmed a diffuse large B-cell malignant lymphoma involving the common hepatic duct. The patient is scheduled to receive adjuvant chemotherapy. In summary, primary non-Hodgkin's lymphoma of the extrahepatic bile duct, despite its rarity, should be considered in the differential diagnosis of causes for obstructive jaundice. An accurate histopathologic diagnosis and surgical resection combined with chemotherapy may be the approach to offer a chance for cure.

A Case of Rapidly Improved Menetrier's Disease after Short-term Treatment with Proton Pump Inhibitor / 대한소화기내시경학회지

Menetrier's disease is a rare illness that is characterized by diffuse tremendous thickening of the gastric wall caused by excessive proliferation of the mucosa of unknown cause. An exact diagnosis is crucial due to the excellent prognosis as compared to other malignant lesions such as a gastric lymphoma and infiltrative gastric carcinoma. A 23-year-old woman presented with epigastric discomfort and dyspepsia. A rapid urease test, a test for H. pylori using serum IgG antibody, and a (13)C-urea breath test were all negative. A gastroscopic examination revealed a wide lesion encircling the lumen, which showed diffusely hard and thickened folds from an angle to the upper body near the cardia. Endoscopic ultrasonography showed diffusely hypoechoic thickness of the second wall layer, but the other wall layers were well preserved. The patient was diagnosed with Menetrier's disease without H. pylori infection, and the patient rapidly improved after short-term treatment with a proton pump inhibitor.

A case of multiple small cell carcinoma of the esophagus / 대한내과학회지

The extra-pulmonary sites of a small cell carcinoma are the salivary glands, pharynx and larynx, esophagus, stomach, pancreas, colon, rectum, skin and cervix. Primary small cell carcinoma of the esophagus is extremely rare with an incidence ranging from 0.8~2.4% of all esophageal malignancies. There have been approximately 20 cases reported in the Korean literature thus far. However, there has not been a reported case of multiple small cell carcinoma of the esophagus. We report a case of multiple small cell carcinoma of the esophagus in a 61-year-old man who presented with a 2 month-history of progressive dysphagia with a review of the relevant literature.

A Case of Cowden's Disease Associated with Breast Cancer / 대한소화기학회지

Cowden's disease, also known as various hamartomatous malformations of multiple organs, is a rare autosomal dominant disorder. The most important feature of Cowden's disease is its frequent association with malignant neoplasm, particularly in the breast and thyroid gland. Cowden's disease with malignant neoplasms, is quite rare in Korea so far. We report a case of Cowden's disease associated with breast cancer in a 41-year-old female who underwent routine health cheek-up.

A Case of Giant Colonic Lipoma Showing Spontaneous Resolution after Endoscopic Partial Resection / 대한소화기학회지

Generally, colon lipoma is mildly symptomatic or asymptomatic. However, sometimes it may present with symptoms, such as pain, constipation, obstruction, or bleeding and may be the leading point for intussusception, particularly in large size (>20 mm). Giant colon lipoma may warrant the removal to exclude confusion with other lesions that have a malignant potential and to control symptoms. Currently, surgical resection should be considered for giant lipoma more than 20 mm in diameter due to the high risk of perforation or bleeding, especially when the lesion is broadly-based. We report here a case of spontaneous resolution acquired after endoscopic partial resection for the symptomatic giant colon lipoma with broad-base requiring surgery.