Peroral Direct Cholangioscopic-Guided Biopsy and Photodynamic Therapy Using an Ultraslim Upper Endoscope for Recurrent Hepatocellular Carcinoma with Intraductal Tiny Nodular Tumor Growth

Bile-duct invasion is rare in patients with hepatocellular carcinoma (HCC). We report a case that received peroral direct cholangioscopy (PDCS)-guided endoscopic biopsy and photodynamic treatment (PDT) for recurrent HCC with intraductal tiny nodular tumor growth. A 64-year-old woman presented with recurrent right upper-quadrant pain. Six months previously she had been diagnosed with HCC with bile-duct invasion in the right anterior segment and had received right anterior segmentectomy. On pathological examination, the margin of resection was clear, but macroscopic bile-duct invasion was noted. On admission, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP) revealed a 0.5-cm-sized polypoid mass at the hilar portion. ERCP-guided biopsy failed, and an ampullary stricture was noted. PDCS-guided endoscopic biopsy was thus performed, and histopathology of the retrieved specimen revealed HCC. The patient submitted to PDT. There was no procedure-related complication. After 1 month of PDT the polypoid lesion and scar change at the hilar lesion had disappeared.

Rectal injury induced by anorectal manometry in two patients without a history of surgery / 대한내과학회지

Colorectal injury related to anorectal manometry is very rare and is mostly associated with previous rectal surgery. We experienced two cases of colorectal injury related to anorectal manometry in patients without a history of surgery. The anorectal manometry finding of the first patient suggested rectal hyposensitivity, and the maximum tolerable volume was measured as 350 mL. After anorectal manometry, she complained of hematochezia. Sigmoidoscopy showed a deep 5 cm ulcer with vessel exposure at the rectum. She recovered after conservative treatment. In the second case, rectal bleeding occurred while measuring the maximal tolerable rectal volume. A 2.5 cm mural defect and 4 cm mucosal defect were detected in the rectosigmoid area at sigmoidoscopy. Computed tomography showed intraperitoneal free air around the distal sigmoid colon. She improved after conservative management. We suggest that anorectal manometry be performed with great caution, even in patients without a history of surgery.

A Case of Sarcoidosis with Pancytopenia as Resulting from Bone Marrow Involvement / 결핵및호흡기질환

Sarcoidosis is a granulomatous disease that can involve any organ, although it primarily involves the lungs, intrathoracic lymph nodes, skin, and eyes. We present a case of sarcoidosis with pancytopenia, resulting from bone marrow involvement. A 35-year-old man was admitted to hospital for chronic cough and blurred vision. On chest computed tomography, there were multiple pulmonary nodules and mediastinal lymph nodes enlargement. As the patient also showed pancytopenia, we performed a bone marrow biopsy, as well as a transbronchial lung biopsy. Both biopsies showed non-caseating granulomas. We diagnosed the patient with sarcoidosis with pulmonary, bone marrow, uvea, liver and spleen involvement. After oral steroid therapy, the patient's symptoms as well as his pancytopenia improved. We present this case to demonstrate the significance of bone marrow biopsy in cases of sarcoidosis with pancytopenia, as well the possibility of clinical improvement with steroid treatment.

A case of intramedullary nocardiosis in a patient after hematopoietic stem cell transplantation / 대한내과학회지

Nocardiosis is uncommon in healthy people but occurs as an opportunistic infection in patients after hematopoietic stem cell transplantation, solid organ transplantation, malignancy, or acquired immune deficiency syndrome. Involvement of Nocardia in the spinal cord is rare; to our knowledge, only six cases have been reported. We report here the case of a 54-year-old man with a spinal cord abscess and epidural and paraspinal abscesses in the thoracic and lumbar spinal cord, causing paraplegia, voiding and defecation difficulties, and combined lung involvement, which developed 5 months after allogeneic hematopoietic stem cell transplantation. Nocardia grew in a fungus culture obtained by percutaneous lung biospy and CT-guided aspiration of the spinal abscess. A double combination regimen of antibiotic therapy (imipenem/cilastatin sodium, amikacin) was given. His paraplegia and his voiding and defecation difficulties improved considerably. To our knowledge, this is the first reported case of spinal cord Nocardiosis observed after allogeneic hematopoietic stem cell transplantation.

A case of intramedullary nocardiosis in a patient after hematopoietic stem cell transplantation / 대한내과학회지

Nocardiosis is uncommon in healthy people but occurs as an opportunistic infection in patients after hematopoietic stem cell transplantation, solid organ transplantation, malignancy, or acquired immune deficiency syndrome. Involvement of Nocardia in the spinal cord is rare; to our knowledge, only six cases have been reported. We report here the case of a 54-year-old man with a spinal cord abscess and epidural and paraspinal abscesses in the thoracic and lumbar spinal cord, causing paraplegia, voiding and defecation difficulties, and combined lung involvement, which developed 5 months after allogeneic hematopoietic stem cell transplantation. Nocardia grew in a fungus culture obtained by percutaneous lung biospy and CT-guided aspiration of the spinal abscess. A double combination regimen of antibiotic therapy (imipenem/cilastatin sodium, amikacin) was given. His paraplegia and his voiding and defecation difficulties improved considerably. To our knowledge, this is the first reported case of spinal cord Nocardiosis observed after allogeneic hematopoietic stem cell transplantation.