Xanthogranulomatous Inflammation in Terminal Ileum Presenting as an Appendiceal Mass: Case Report and Review of the Literature

Xanthogranulomatous inflammation (XGI) is a rare benign inflammatory disease characterized by aggregation of lipid-laden foamy macrophages. This disease entity has been described in various organs but most commonly in the kidney and gallbladder. The occurrence of this disease in the lower gastrointestinal tract is extremely rare. Its clinical importance is that it can be misdiagnosed as an infiltrative cancer. In this case report, a 52-year-old male complained of right lower quadrant abdominal pain for a period of 3 months. Abdominal computed tomography revealed appendiceal mass and colonoscopy revealed multiple erythematous nodular lesions in the terminal ileum and appendiceal orifice, mimicking appendiceal cancer. Right hemicolectomy was done and the pathological specimen revealed XGI of the terminal ileum. To our knowledge, this is the first case of XGI in terminal ileum presenting as abdominal pain and the appendiceal mass on radiologic findings.

Microsatellite Instability Is Associated with the Clinicopathologic Features of Gastric Cancer in Sporadic Gastric Cancer Patients

PURPOSE: Replication error is an important mechanism in carcinogenesis. The microsatellite instability (MSI-H) of colorectal cancers is associated with the development of multiple cancers. The influence of MSI-H on the development of multiple gastric cancers in sporadic gastric cancer patients has not been defined. This study was performed to reveal the association between the clinicopathologic features and MSI in sporadic gastric cancers. MATERIALS AND METHODS: Between July 2004 and March 2009, the clinicopathologic characteristics, including MSI status, were evaluated in 128 consecutive patients with sporadic gastric cancers. None of the patients had hereditary non-polyposis colorectal cancer of familial gastric cancer. The markers that were recommended by the NCI to determine the MSI status for colorectal cancers were used. RESULTS: MSI-H cancers were found in 10.9% of the patients (14/128). Synchronous gastric cancers were shown in 4 patients (3.1%). Synchronous cancers were found in 2 of 14 patients with MSI-H gastric cancer (14.3%) and 2 of 114 patients with MSS gastric cancer (1.8%; P=0.059, Fisher's exact test). Among the patients with synchronous cancer 50% (2/4) had MSI-H cancer, but 9.7% of the patients (12/124) without synchronous cancer had MSI-H cancer. MSI-H (RR, 24.7; 95% CI, 1.5~398.9; P=0.024) was related with to synchronous gastric cancer, but age, gender, family history, histologic type, location, gross morphology, size, and stage were not related to synchronous gastric cancer. CONCLUSIONS: MSI is associated with the intestinal-type gastric cancer and the presence of multiple gastric cancers in patients with sporadic gastric cancer. Special attention to the presence of synchronous and the development of metachronous multiple cancer in patients with MSI-H gastric cancer is needed.

The Usefulness of Computed Tomography for Patients with Equivocal Acute Appendicitis

PURPOSE: We wanted to determine the usefulness of computed tomography (CT) for patients with clinically-suspected but equivocal acute appendicitis, and we wanted to evaluate the differences of the sensitivity and specificity of CT according to the period of time from onset of the signs and symptoms to the performance of CT. METHODS: A retrospective study was done on 273 patients who visited our hospital for acute abdominal pain from Jan. 2003 to Dec. 2005, and they could not be excluded as suffering from acute appendicitis by their symptoms nor signs. RESULTS: Forty-three (15.8%) of the 273 patients did not undergo operation because their condition was not diagnosed as acute appendicitis and 190 patients were diagnosed as acute appendicitis by CT. The other 40 patients underwent diagnostic laparotomy because acute appendicitis could not be confirmed and any other diagnosis could not be made. The patients were classified into 6 groups according to the period of time from the onset of symptoms and signs to the performance of CT. The sensitivity of CT after 48 hours was statistically significantly increased as compared to performing CT before 48 hours (92.3% vs. 75.8%, respectively; P=0.023). CONCLUSION: Forty-three (15.8%) of the patients with clinically- suspected but equivocal acute appendicitis avoided unnecessary laparotomy by undergoing CT. The sensitivity was increased for diagnosing acute appendicitis by CT when it was performed after 48 hours from the onset of symptoms and signs, but caution may be needed during interpretation because of the false positives (2 patients;4.7%) could due to secondary change of other diseases