Lymphoepithelial cyst of the pancreas mimicking malignant cystic tumor: report of a case

Lymphoepithelial cysts of the pancreas are a type of true cyst that can mimic pseudocysts and cystic neoplasms. They are very rare, non-malignant lesions that are unilocular or multilocular cystic lesions lined predominantly by mature squamous epithelium and surrounded by non-neoplastic lymphoid elements. We, herein, present a patient with a cystic pancreas tumor mimicking a malignant cystic neoplasm. The patient was admitted with upper abdominal discomfort. Computed tomography showed a 64x39 mm cystic mass in the pancreas tail. She underwent distal pancreatectomy and splenectomy. In the fluid analysis of the pancreas cystic mass, the CEA and CA19-9 were 618 ng/ml and 3.9 U/ml, respectively. The resected pancreas specimen showed a 6.5 cm-sized cyst the pancreas tail. The cyst was well circumscribed and multilocular. The final pathology report of the resected pancreas specimen noted that the cyst was multilocular, and the cyst lining was showing stratified squamous epithelium covering the lymphoid tissue (containing lymphoid follicles), which was consistent with a lymphoepithelial cyst. The patient recovered uneventfully from surgery and has been doing well for the past 3 months. A differential diagnosis of cystic pancreatic lesions is important. We suggest that lymphoepithelial cysts, although very rare, may be included in the differential diagnosis of cystic pancreatic tumors.

Polyarteritis nodosa presented as a dilatation of the intrahepatic bile duct

Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis of small- and medium-sized arteries in multiorgan systems. PAN may affect the gastrointestinal tract in 14%-65% of patients, but rarely involves the biliary tract and liver. We describe a patient without underlying disease who was diagnosed with PAN during resection of the gallbladder and liver.

A Novel Germline Mutation in Exon 10 of the SMAD4 Gene in a Familial Juvenile Polyposis

Familial juvenile polyposis (FJP) is a rare autosomal dominant hereditary disorder that is characterized by the development of multiple distinct juvenile polyps in the gastrointestinal tract and an increased risk of cancer. Recently, germline mutations, including mutations in the SMAD4, BMPR1A, PTEN and, possibly, ENG genes, have been found in patients with juvenile polyps. We herein report a family with juvenile polyposis syndrome (JPS) with a novel germline mutation in the SMAD4 gene. A 21-year-old man presented with rectal bleeding and was found to have multiple polyps in his stomach, small bowel, and colon. His mother had a history of gastrectomy for multiple gastric polyps with anemia and a history of colectomy for colon cancer. A review of the histology of the polyps revealed juvenile polyps in both patients. Subsequently, mutation screening in DNA samples from the patients revealed a germline mutation in the SMAD4 gene. The pair had a novel mutation in exon 10 (stop codon at tyrosine 413). To our knowledge, this mutation has not been previously described. Careful family history collection and genetic screening in JPS patients are needed to identify FJP, and regular surveillance is recommended.

The Usefulness of a Colonoscopy with Biopsy in the Early and Accurate Diagnosis of Ischemic Colitis

BACKGROUND/AIMS: Ischemic colitis has a clinical spectrum ranging from mild reversible colitis to an acute fulminant course. Early and accurate diagnosis is therefore mandatory for a good clinical outcome. The aim of this study is to evaluate the efficacy and safety of a colonoscopy and histological examination with biopsy in the early and accurate diagnosis of ischemic colitis. METHODS: We investigated the clinical characteristics and endoscopic findings with the histopathology of 89 cases of ischemic colitis from October 2002 to August 2012 in a tertiary-care hospital. All patients underwent a colonoscopy with biopsy within a few days of the onset of symptoms, and the histological features from the biopsy specimens were reviewed. In addition, the occurrence of complications by colonoscopy with biopsy was evaluated. RESULTS: The mean age of the patients was 65.8+/-12.6 years (male:female, 1:2.2). The major combined disorders were hypertension (51.7%), diabetes (31.5%), and arrhythmia (19.1%). The clinical features usually presented with hematochezia (83.1%), abdominal pain (77.5%), and diarrhea (60.7%). The involved patterns were the left colon (56.2%), right colon (39.3%), and pancolon (4.5%). Based on the main histological features of ischemic colitis, including glandular atrophy (67.4%), hemorrhage (61.8%), capillary thrombi (42.7%), and coagulative necrosis of mucosa (29.2%), 67 of the 89 cases (75.3%) could be confirmed with ischemic colitis. There were no serious complications such as bowel perforation or major bleeding following the colonoscopy with biopsy. CONCLUSIONS: A colonoscopy with biopsy is beneficial and safe for the early and precise diagnosis of ischemic colitis.

Bowel infarction due to intestinal mucormycosis in an immunocompetent patient / 대한외과학회지

Mucormycosis is a fatal opportunistic fungal infection that typically occurs in immunocompromised patients. The classical manifestation of mucormycosis is a rhinocerebral infection, and although primary gastrointestinal infection is uncommon, it has an extremely high mortality rate in immunocompromised patients. Furthermore, cases of gastrointestinal mucormycosis in an immunocompetent host are rarely reported. Here, we describe our experience of a male patient, with no underlying disease, who succumbed to a bowel infarction caused by intestinal mucormycosis during mechanical ventilatory care for severe pneumonia and septic shock.

Application of Mini-abdominoplasty after Conservative Excision of Extensive Cesarean Scar Endometriosis

Endometriosis is defined as the presence of functioning endometrial tissue outside the uterine cavity, and the standard treatment is extensive surgical excision. Cesarean scar endometriosis is a type of cutaneous endometriosis arising on or near a Cesarean section scar. A 44-year-old woman presented with a 9x6 cm sized dark-brown, stony-hard, irregular, lower abdominal mass of four years duration. The patient had a history of two Cesarean deliveries, 14 and 16 years ago. Suspecting endometriosis, we excised the tumor conservatively rather than extensively to prevent incisional hernia considering the benign nature of the tumor and the low possibility of recurrence because the patient's age was near menopause, along with simultaneous bilateral salpingo-oophorectomy that was performed in this case. On reconstruction, mini-abdominoplasty was adopted to avoid possible wound complications and cosmetic deformities. The patient was satisfied with the cosmetic results, and neither recurrence nor functional problems occurred during the 1-year follow-up period. Plastic surgeons should keep in mind the possibility of cutaneous endometriosis in an abdominal mass of a female of reproductive age with a previous history of pelvic or intra-abdominal surgery. An optimal result from oncological, functional, and cosmetic standpoints can be achieved with conservative excision followed by mini-abdominoplasty of extensive Cesarean scar endometriosis.

Appendiceal Intussusception Showing Various Shapes During a Colonoscopy / 대한소화기내시경학회지

Appendiceal intussusception is a rare disease with variable clinical findings, ranging from acute appendicitis to chronic recurrent abdominal pain or rectal bleeding. Occasionally, it is incidentally discovered with no symptoms. Because a preoperative diagnosis is difficult, it can be diagnosed either after surgery, in the case of acute appendicitis, or after a polypectomy, based on being mistaken for a polyp. During a colonoscopy, an appendiceal intussusception should be suspected if the appendiceal orifice is not observed at the cecum and there is a polypoid lesion at the location where the appendiceal orifice is expected. Treatments are usually determined according to preceding diseases. It is important that the colonoscopist avoid careless endoscopic removal by mistaking the intussusception for a polyp.

Squamous Cell Carcinoma and Basal Cell Carcinoma Simultaneously Arising in a Nevus Sebaceus: A Case Report

PURPOSE: Nevus sebaceus is a congenital hamartomatous lesion, typically involving head and neck. Various benign and malignant neoplasms can develop in association with nevus sebaceus. We report a case of simultaneous occurrence of squamous cell carcinoma and basal cell carcinoma in nevus sebaceus. METHODS: A 73-year-old man presented with erythematous to black verrucous nodules on the right subauricular area. The upper part was accompanied with inflammation and ulceration, and no specific findings suspicious for malignant degeneration were found in the lower part preoperatively. The mass was totally excised and the defect was directly closed. Lymph nodes were not involved on concomitant neck dissection. RESULTS: Histopathologic examination confirmed the presence of squamous cell carcinoma in the upper part and basal cell carcinoma in the lower part of a nevus sebaceus. Negative margins were achieved on resection. No clinical problems were found during the 3-month follow-up period. CONCLUSION: We experienced a rare case of simultaneous occurrence of squamous cell carcinoma and basal cell carcinoma within the same nevus sebaceus. Because patients with nevus sebaceus have risk of malignant changes, surgical excision and work-up for recurrence and metastasis should be considered in suspicious cases. And even in a totally asymptomatic case, the possibility of occult secondary cancer should be informed before surgery in aged patients.

A case of juxtapapillary gangliocytic paraganglioma treated with endoscopic resection / 대한내과학회지

Gangliocytic paraganglioma is a rare tumor that is usually seen in the duodenum. This neoplasm generally behaves in a benign fashion, although instances of recurrence and lymph node metastasis have been described. We experienced a case of incidentally found gangliocytic paraganglioma treated with endoscopic resection. A 61-year-old man was referred because of submucosal tumor adjacent to the major papilla. Endoscopic biopsy revealed paraganglioma. Abdominal CT showed that there was no evidence of a duodenal mass or lymphadenopathy. This tumor was resected endoscopically by electrosurgical snare polypectomy. The excised tumor measured 1.0 cm in diameter. Histopathological examination revealed a benign gangliocytic paraganglioma and the resection margins were free of tumor. At the 6-month follow-up, the patient was still asymptomatic and no residual tumor was detected at the resection site.

A Case of Splenic Artery Aneurysm Mimicking Gastric Submucosal Tumor / 대한소화기내시경학회지

Splenic artery aneurysm is an uncommon clinical entity. Most of these aneurysms are asymptomatic, but if an aneurysm ruptures, it can be fatal and its mortality rate reaches 70 percent. Regardless of the presence of symptoms, if the size of the asymptomatic aneurysm is larger than 2 cm in diameter or the patient is pregnant, then the anurysm should be treated. A 74-year-old female visited our hospital complaining of nonspecific epigastric discomfort. Endoscopic examination of the stomach revealed a submucosal tumor like protruding mass in the body and it was finally diagnosed as a splenic artery aneurysm by computed tomography. We report here on a case of a splenic artery aneurysm that mimicked a submucosal tumor, and this aneurysm was treated with surgery.

Two Cases of Eosinophilic Gastroenteritis and One Case of Hypereosinophilic Syndrome Presenting with Various Gastrointestinal Symptoms / 대한소화기내시경학회지

Eosinophilic gastroenteritis is a rare disorder of unknown origin that is pathologically characterized by marked infiltration of eosinophils in the wall of the gastrointestinal tracts. Eosinophilic gastroenteritis is often classified according to the layer of the bowel wall involved. We experienced two cases of eosinophilic gastroenteritis. One case having whole small bowel wall involvement resulting in small bowel obstruction and eosinophilic ascites underwent bowel resection followed by oral steroid treatment. The other case having mucosal layer involvement with chronic diarrhea and hypoalbuminemia was treated with oral corticosteroid and responded dramatically. In addition, we report one case of hypereosinophilic syndrome involving the gastrointestinal tracts. The patient presented with abdominal pain, ascites, and urticaria. and also showed good response to oral steroid.

A Recurred Case of a Mature Ovarian Teratoma Presenting as a Rectal Mass / 대한소화기학회지

Mature teratoma is the most common germ cell tumor of the ovary. The tumor is essentially a benign neoplasm and surgical resection of the tumor is the treatment of choice. Recurrence with colorectal involvement after surgical removal of the primary lesion is exceedingly rare and has not been reported in Korea. We present a 43-year-old patient with a rectal mass who had already undergone left oophorectomy due to mature cystic teratoma and right oophorectomy due to hemorrhagic corpus luteum. The rectal mass was composed of a mature teratoma tissue. We postulate that leakage of the tumor elements from the cyst wall led to peritoneal tumor implantation and invasion to the rectal wall.

Clinicopathologic Significance of p53 and c-erbB-2 Protein Expression in Breast Carcinoma / 한국유방암학회지

PURPOSE: Reliable prognostic factors, including clinicopathological parameters (Ed-alternatively, "Reliable clinicopathologic prognostic factors") such as tumor size, axillary lymph node involvement, histologic grade, menopausal patient status and steroid receptor status, are necessary in the management of breast cancer for predicting clinical course and as guide lines for adjuvant therapy. Recently, many reports have shown that expression of p53 and c-erbB-2 products is associated with poor prognosis. To elucidate the clinical value of p53 and c-erbB-2 protein expression as prognostic factors, their immunoreactivities were compared with known clinicopathologic prognostic factors. METHODS: The expressions of p53 and c-erbB-2 proteins were analyzed by immunohistochemical method with formalin-fixed and paraffin-embedded tissue samples of 71 invasive breast carcinomas accumulated between 1996 and 1999 at Chungbuk National University Hospital. The expressions of p53 and c-erbB-2 proteins were compared with established prognostic factors such as tumor size, axillary lymph node involvement, histologic grade, menopausal patient status and steroid hormone receptor status. Statistical significance was analyzed by chi-square test. RESULTS: The immunoreactivities of p53 and c-erbB-2 proteins were detected in 29.6% and 46.5%, respectively, of the samples. p53 positivity was significantly higher in breast car-cinoma that showed higher histologic grade or was metastasized to more than 3 axillary lymph nodes (P<0.05). There were no significant correlations between c-erbB-2 positivity and known clinicopathologic prognostic factors. CONCLUSION: This study suggests that expression of p53 protein could be used as a prognostic indicator in the management of breast cancer. But the impact of p53 and c- erbB-2 protein expression on overall survival and disease free survival rates should be evaluated further before being used as independent prognostic factors.

Clinicopathologic Significance of p53 and c-erbB-2 Protein Expression in Breast Carcinoma

PURPOSE: Reliable prognostic factors, including clinicopathological parameters (Ed-alternatively, "Reliable clinicopathologic prognostic factors") such as tumor size, axillary lymph node involvement, histologic grade, menopausal patient status and steroid receptor status, are necessary in the management of breast cancer for predicting clinical course and as guide lines for adjuvant therapy. Recently, many reports have shown that expression of p53 and c-erbB-2 products is associated with poor prognosis. To elucidate the clinical value of p53 and c-erbB-2 protein expression as prognostic factors, their immunoreactivities were compared with known clinicopathologic prognostic factors. METHODS: The expressions of p53 and c-erbB-2 proteins were analyzed by immunohistochemical method with formalin-fixed and paraffin-embedded tissue samples of 71 invasive breast carcinomas accumulated between 1996 and 1999 at Chungbuk National University Hospital. The expressions of p53 and c-erbB-2 proteins were compared with established prognostic factors such as tumor size, axillary lymph node involvement, histologic grade, menopausal patient status and steroid hormone receptor status. Statistical significance was analyzed by chi-square test. RESULTS: The immunoreactivities of p53 and c-erbB-2 proteins were detected in 29.6% and 46.5%, respectively, of the samples. p53 positivity was significantly higher in breast carcinoma that showed higher histologic grade or was metastasized to more than 3 axillary lymph nodes (P<0.05). There were no significant correlations between c-erbB-2 positivity and known clinicopathologic prognostic factors. CONCLUSION: This study suggests that expression of p53 protein could be used as a prognostic indicator in the management of breast cancer. But the impact of p53 and c- erbB-2 protein expression on overall survival and disease free survival rates should be evaluated further before being used as independent prognostic factors.

A Case of Gastrointestinal Amyloidosis Presenting with Hematochezia / 대한소화기내시경학회지

Amyloidosis is a disorder of protein metabolism that leads to extracellular deposition of amyloid in tissues and organs. Multiple organ dysfunction can be induced by deposition of amyloid. Diagnosis is established by histologic demonstration of amyloid protein in involved tissue using Congo red staining. A 72 year-old woman was admitted due to mild abdominal pain, diarrhea and hematochezia. Duodenoscopic and colonoscopic findings were nonspecific, however, multiple biopsies showed amyloid deposits characterized by green birefringence under polarized light. The findings of small bowel series and abdominal CT were compatible with amyloidosis. We experienced a case of amyloidosis with involvement of the whole bowel.

A case of hepatic veno-occlusive disease / 대한내과학회지

Veno-occlusive disease of the liver was first reported by Chiari in 1899. Pyrrolizidine-containing substances, chemotherapeutics and hepatic radiation injury can cause this disorder. Bone marrow and renal allograft recipients are at risk for the development of veno-occlusive lesions. Veno-occlusive disease produces a syndrome of painful hepatomegaly, jaundice and fluid accumulation. The disease affects central vein and zone 3 of the liver acinus. We discuss a patient with tender hepatomegaly and high fever due to veno-occlusive lesion. We mis-diagnosed this case as acute cholecystitis because of clinical symptoms and radiological findings of GB wall thickening. During the laparotomy, she was found to have a congested liver and dilatation of superficial lymphatics of the liver surface. The Liver biopsy showed centrilobular congestion and hepatocyte necrosis in acinar zone 3. We could not determine the etiological factor in this patient. We considered that she suffered a mild form of veno-occlusive disease and recovered spontaneously within 1 month.

Stomach Cancer Presenting with Meigs' Syndrome

Meigs' syndrome is defined by the presence of ascites and hydrothorax in association with "fibroma-like" benign ovarian tumors. Tumor extirpation resulted in a resorption of the ascites and a pleural effusion. A Krukenberg tumor resulting from stomach cancer would be highly suggested when stomach cancer, ovarian tumor, and ascites are found concomitantly. However, when a patient presents with ovarian tumor, stomach cancer, and repeated cytologic examination of the ascitic fluid renders negative results, stomach cancer associated with Meigs' syndrome should be considered in the differential diagnosis. We report a case of stomach cancer presenting with Meigs' syndrome in a 70-year-old woman who had been referred for control of intractable ascites. The patient was cured by radical subtotal gastrectomy and bilateral oophorectomy.

Does the Colorectal Cancer Among Koreans Share the Same Pathological Features by Geographical Distribution: A Nationwide Survey of Surgically Resected 1,676 Cancers from 1,602 Patients

BACKGROUND: This nationwide survey was undertaken to characterize the general pathological features of colorectal cancer in Korea, and especially to elucidate the geographical characteristics by means of their anatomical distribution. METHODS: We analysed 1,676 colorectal cancers (from 1,602 patients) surgically resected in 1998 at 15 institutions from nine geographical sites in Korea. RESULTS: The topographic incidence of colorectal cancer in seven out of the total nine geographical sites, was the highest in the rectum (32-54%); and those from Wonju and Cheongju were in the sigmoid colon (28% for both). The right colon cancer incidence was 42% in Wonju and 36% in Cheongju, while it was 17-22% in the other areas. The cecal cancer incidences in Wonju and in Taegu were 7% and 8%, respectively, but 0-4% in the other areas. As for histology, moderately differentiated adenocarcinoma was the most frequent (46-84%), except for in Wonju and Chonju, where the most predominant type was well differentiated (63% and 52%, respectively). CONCLUSION: The incidence of right colon cancer was higher in Wonju and Cheongju, than in the other geographical sites. The cecal predilection was prominent in Taegu and Wonju. The Elucidation of geographical differences in degree of differentiation for tubular adenocarcinoma seems to require further cumulative study with strict guidelines.

Mesenteric Lymphadenitis Due to Yersinia enterocolitica: A case report

Mesenteric lymphadenitis due to Yersinia enterocolitica infection is not common in Korea. Although most cases of Yersinia enterocolitica-induced mesenteric adenitis are self limited, cardinal features of Yersinia enterocolitica-induced mesenteric adenitis are so similar to those of acute appendicitis that some of the patients undergo laparotomy with suspected appendicitis. The findings on laparotomy in such patients are usually enlarged mesenteric nodes with a normal or slightly inflamed appendix. Because histologic examination of the removed mesenteric lymph nodes reveals reactive hyperplasia in most cases, it is usually difficult to suspect Yersinia enterocolitica infection on morphology of the resected nodes. But suppurative granulomata of mesenteric lymph nodes, uncommonly encountered in Yersinia enterocolitica infection, strongly suggest yersinial infection. We report a case of mesenteric lymphadenitis in a 10-year-old boy, who underwent laparotomy with suspected acute appendicitis. The removed lymph node showed several suppurative granulomata in the cortex, suggesting yersinial infection. Serologic study confirmed Yersinia enterocolitica serotype O:3 infection.

Expression Pattern of Insulin - like Growth Factor - II in Human Fallopian Tubal Epithelium / 대한산부인과학회잡지

No abstract available.