Gastrointestinal Stromal Tumor of the Stomach Presenting as a Perigastric Abscess

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. A 77-year-old man was referred for the evaluation of general weakness and leukocytosis. Computed tomography showed a 9.5×6.5-cm cavitary lesion with an air-fluid level near the stomach, which was thought to be a perigastric abscess. Upper endoscopy revealed a fistula on the greater curvature at the mid body of the stomach. The margin of the fistula opening was clearly demarcated, and yellow turbid fluid oozing from the fistula was seen. Laparoscopic wedge resection was performed at the perforated area of the stomach. Immunohistochemistry revealed CD117 expression. A diagnosis of intermediate-risk GIST was made. No recurrence was identified within 18 months after the operation. The final diagnosis was perforated gastric GIST communicating with the gastric lumen and presenting as an intra-abdominal abscess.

A Case of a Rapidly Progressive Small Bowel Lymphoma with High Ki-67 Expression

Primary intestinal lymphoma is a rare disease. It accounts for approximately 1~4% of gastrointestinal malignancy. Extranodal lymphoma of the intestine mainly arises from B cells. Diffuse large B-cell lymphoma is the most common type of the disease. Approximately 40% of intestinal lymphoma can be cured, while 60% have varied disease progression. Ki-67 proliferation has been recently used as an index of cell growth to predict the progression of the disease. Reported herein is a case of a rapidly progressive small bowel diffuse large B-cell lymphoma in a 51-year-old man with a high Ki-67 expression level. He visited the emergency department because of hematochezia. Abdominal computed tomography revealed distal small bowel segmental wall thickening. He underwent operation due to spontaneous small bowel perforation. The result of the pathological examination of the resected specimen was compatible with diffuse large B-cell lymphoma. The Ki-67 index within 5 months was 90%.

Helicobacter pylori Eradication Rate in Patients with Diabetes

BACKGROUND/AIMS: The prevalence of diabetes mellitus is increasing. Little is known about the difference in Helicobacter pylori eradication rates between diabetic patients and non-diabetics. The aim of this study was to compare the eradication rate between diabetic and non-diabetic patients. MATERIALS AND METHODS: The medical records of patients who received a proton pump inhibitor (PPI)-based eradication therapy between 2012 and 2015 were retrospectively reviewed. All the patients underwent endoscopic biopsy to confirm H. pylori infection. Successful eradication was confirmed by using the ¹³C-urea breath test, biopsy, or rapid urease test, which was performed at least 4 weeks after the end of eradication therapy. RESULTS: A total of 1,402 patients were included. The eradication rate was 74.3% (1,041/1,402; 95% CI, 72.0~76.5%). Excluding 151 patients who were confirmed to have no diabetes, 182 diabetic and 1,069 non-diabetic patients were compared. No significant difference (P=0.667) in eradication rate with PPI-amoxicillin-clarithromycin therapy was found between the diabetic (75.8%, 138/182; 95% CI, 69.6~82.0%) and non-diabetic groups (74.0%, 791/1,069; 95% CI, 71.4~76.6%). Peptic ulcer was much more common in the diabetic group than in the non-diabetic group (67.0% vs. 57.9%, P=0.038). CONCLUSIONS: The H. pylori eradication rate with PPI-based triple therapy in the diabetic patients was probably not different from that in non-diabetic patients.

Protective Effect of Topical Vitamin D3 against Photocarcinogenesis in a Murine Model

BACKGROUND: Although the incidence of non-melanoma skin cancer is increasing, there are no effective practical preventive measures other than avoiding sun exposure. OBJECTIVE: To elucidate the protective effect of topical application of biologically active vitamin D3 (calcitriol) on skin cancer development caused by exposure to ultraviolet (UV). METHODS: Groups of hairless mice were topically treated with either calcitriol or vehicle immediately after exposure to UVB and UVA three times weekly for the initial 20 weeks, and without UV exposure in the following 6 weeks. Tumor number was counted and biopsies were done for histopathologic analysis. The changes of cyclobutane pyrimidine dimer (CPD) were evaluated 1 hour and 11 hours after short term of UV exposure and application of calcitriol. For safety evaluation, blood test and body weights were evaluated at 23rd and 25th week. RESULTS: Total tumor count and number of tumors less than 3 mm in size tended to be fewer in calcitriol group, and tumors more than 3 mm in size showed significantly lower tumor formation rate in calcitriol group. Single application of calcitriol reduced CPD at 1 hour and 11 hours after UV exposure. Histopathologic analysis showed tumors with lower grade malignancy in calcitriol group which suggested a delay in tumor progression. However, serum levels of calcium and phosphate in calcitriol group were above normal range, and weight loss was found. CONCLUSION: Topical calcitriol may suppress the formation and progression of UV-induced non-melanoma skin cancer by enhancing the repair mechanism of UV damage.