A Case of Granular Cell Tumor of Cecum Misdiagnosed as Carcinoid Tumor

Granular cell tumors (GCTs) are relatively rare submucosal tumors with an incidence of 10% in the gastrointestinal tract. In the gastrointestinal tract, the esophagus is the most common site for GCTs, while the colorectum is an uncommon site. GCTs are often found incidentally as small, submucosal tumors on esophagogastroduodenoscopy. On endoscopic ultrasonography (EUS), GCTs usually have a homogeneous hypoechoic pattern. EUS cannot adequately distinguish GCTs from carcinoid tumors. We report a case of a cecal GCT that was misdiagnosed as a carcinoid tumor by EUS and was treated by endoscopic mucosal resection, along with a review of the literature.

Endoscopic Ultrasonographic Findings of Esophageal Tuberculosis: Case Report / 대한소화기내시경학회지

Esophageal tuberculosis is a rare disease that is difficult to diagnose with esophagogastroduodenoscopy (EGD), endoscopic ultrasonography (EUS), and computerized tomography. The patients with esophageal tuberculosis show diverse endoscopic findings, but ulcerative lesion in the middle esophagus is usually found. In Korea, the endoscopic ultrasonographic findings of esophageal tuberculosis have not been described. The main endoscopic ultrasonographic findings of esophageal tuberculosis include heterogeneous or homogeneous hypoechoic masses in the esophageal wall with hyperechoic spots inside, interruption of the esophageal adventitia, and mediastinal lymphadenopathy. In this report, we describe two patients with esophageal tuberculosis, and they presented with submucosal tumor. In these patients, esophageal tuberculosis was diagnosed by EGD, EUS, and performing tuberculosis phase chain reaction on the endoscopic biopsies.

Endoscopic Ultrasonography in Upper Gastrointestinal Subepithelial Lesions / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic ultrasonography (EUS) is known for its value to characterize incidentally found subepithelial lesions, and we so reviewed our data to validate the norm. METHODS: We analyzed the records of the patients with suspected subepithelial lesions at the time of endoscopy, which was performed from Aug. 2001 to Oct. 2004. RESULTS: The data includes 622 patients (248 males) with average age of 52 years (age range 15~83 years). Extraluminal compression was noted in 10.1% of the patients. Intraluminal lesions were dominant in the stomach and their average size was 14.8 mm. The inner three wall layers were the predominant layers of origin. Mesenchymal tumors were the most frequent EUS impression. Pathologic findings were available for 88 patients and 80.7% of them were benign. Compared with the pathology, the diagnostic accuracy of EUS was 78.4%. The differentiation of malignant and benign GISTs by the EUS findings was 56.3%. Among the 60 EUS cases that had follow up data available (at mean interval of 12.2 months) and who also had less than 3 cm benign lesions, growth was detected only in 10 cases (17%). Pathology confirmed that the lesions in 3 of them were benign. CONCLUSIONS: More than 10% of the subepithelial lesions found from endoscopy were extraluminal compression. The majority of intramural lesions were benign. The EUS impression was relatively accurate and helpful for the management of upper gastrointestinal submucosal lesions.

A Case of High Grade Dysplasia in Sporadic Fundic Gland Polyp / 대한소화기내시경학회지

Fundic gland polyps (FGP) are the most common type of gastric polyps, with an incidence on endoscopy of 0.8~1.9%. They have been considered as benign lesions, without the potential for malignant transformation. High grade dysplasia and gastric adenocarcinomas associated with FGP have been described in patients with familial, as well as attenuated adenomatous polyposis (FAP). In contrast, dysplasia associated with FGP in non-FAP patients is extremely rare, and there have been no reports of sporadic FGP with high grade dysplasia in the Korean literature. Herein, we report one case of high grade dysplasia associated with sporadic FGP in a non-FAP patient treated with an endoscopic polypectomy.

A Case of Lower Esophageal Muscular Ring Presenting with Dysphagia / 대한소화기학회지

There are diverse ring-like narrowings in the lower esophagus: mucosal ring, muscular ring, ring-like annular peptic stricture. Esophageal muscular ring is extremely rare and generally asymptomatic. It occurs at the proximal border of the esophageal vestibule that corresponds to the upper end of the lower esophageal sphincter. We experienced a case of lower esophageal muscular ring with a symptom of intermittent mild dysphagia for 40 years and report the findings with a review of the literature.

A Case of Mallory-Weiss Syndrome Complicating Pregnancy in a Patient with Scleroderma

The majority of patients with scleroderma have gastrointestinal involvement, and a few experience gastrointestinal hemorrhage, however, gastrointestinal hemorrhage due to Mallory-Weiss syndrome is very rare. We report upon a 24-year-old pregnant woman with scleroderma who had gastrointestinal hemorrhage due to Mallory-Weiss syndrome.

A Case of Relapsing Polychondritis Associated with Myelodysplastic Syndrome with Erythroid Hypoplasia/Aplasia

Relapsing polychondritis (RP) is a rare multisystem disorder. Myelodysplastic syndrome (MDS) with erythroid hypoplasia/aplasia is a rare form of myelodysplasia. Several cases of RP associated with MDS have recently been described. However, RP associated with MDS with erythroid hypoplasia/aplasia has never been reported. There was only one case report of polymyalgia rheumatica associated with MDS with erythroid hypoplasia/aplasia. In this study, we report a 79-year-old patient with RP, who developed MDS subtype refractory anemia (RA) with erythroid hypoplasia/aplasia, a very characteristic subtype of MDS.

A Case of Rapidly Progressive Glomerulonephitis Associated with Anti-Glomerular Basement Membrane Antibody and p-Antineutrophilic Cytoplasmic Antibody / 대한신장학회잡지

Rapidly progressive glomerulonephritis(RPGN) is clinical syndrome characterized by rapid loss of renal function within several weeks to months, with histologic finding of extensive crescent formation. We report a case of RPGN associated with anti-glomerular basement membrane antibody(anti-GBM Ab) and perinuclear-antineutrophilic cytoplasmic antibody(p- ANCA), which rapidly progressed to chronic renal failure. A 44-year-old male was referred to our hospital for evaluation of pitting edema and proteinuria. Both anti-GBM Ab and p-ANCA were detected in serum. Percutaneous renal biopsy showed many crescents with some fibrinoid materials and heavy deposits of IgG. He was treated with pulse methylprednisolone, followed by oral corticosteroid and cyclophosphamide. In spite of immunosuppressive therapy, his renal function deteriorated rapidly and uremic symptoms including pulmonary edema were aggravated. He was started on hemodialysis and he has received regular hemodialysis without recovery of renal function. Further studies will be needed to determine the clinical significance of combined anti- GBM Ab and ANCA.