Synchronous Multiple Colorectal Cancer Occurring in Polyposis

The frequencies of multiple synchronous carcinomas of the colon and the rectum have been reported to range from 2.1 to 6.3%. Currently, the frequency is higher in colorectal cancer patients, and the diagnosis is better due to the many diagnostic tools that have been developed. There are a few reported cases of five cancers in a patient at the same time. We report here on the case of five synchronous cancers arising from the colon and the rectum in a patient without a familial history of colon cancer or of genetic predisposing factor. The patient was a 62-yr-old woman who presented with frequently loose stool for six months and intermittent abdominal pain for two months. Colonoscopic examination revealed two adenocarcinomas, one each at the sigmoid colon and the rectum; the cancer in the sigmoid colon was obstructed at nearly 40 cm above the anal verge. Computed tomographic colonoscopy revealed many other polyps and masses in the colon and a metastatic mass at segment 8 in the liver. A total proctocolectomy and ileostomy were performed. Histologic evaluation revealed the five lesions to be adenocarcinomas invading the pericolic fat; 1 out of 30 lymph nodes was invaded by the cancer cells.

Clinical Experiences of Fitz-Hugh-Curtis Syndrome

PURPOSE: Fitz-Hugh-Curtis (FHC) syndrome has been described as perihepatitis associated with pelvic inflammatory disease during surgery. Recently, on computerized tomography a linear enhancement of the liver capsule was detected in a patient with FHC syndrome. We studied to evaluate the clinical course of the disease. METHODS: Sixteen patients diagnosed with FHC syndrome from CT findings were retrospectively studied from April, 2006 to June, 2008. RESULTS: The mean age of the patients was 25.9 (19~35) years and mean duration of abdominal pain was 3.9 (1~14) days. The most common complaint was right upper quadrant area pain (11 cases, 68.8%). 12 patients showed leukocytosis and all the patients had elevated serum C-reative protein levels. All the patients had normal liver function. Among the 9 patients which had polymerase chain reaction test for sexually transmitted disease (Chlamydia trachomatis, Ureaplasma urealyticum, Neisseria gonorrheae, Mycoplasma hominis), all showed more than one positive results (Chlamydia trachomatis 6 cases, Ureaplasma urealyticum 6 cases, Mycoplasma hominis 2 cases). On simple abdomen X-ray, 7 cases (43.8%) showed paralytic ileus. 14 cases received only antibiotic treatment, but 1 case had to take operation (laparoscopic-assisted adhesiolysis) due to constant abdominal pain and prolonged ileus. CONCLUSION: It is important to rule out FHC syndrome by using CT findings, especially young women with right upper abdominal pain and PID. Usually, FHC syndrome can be treated easily with proper antibiotics.

The Utility of Modified Triple Test for Preoperative Diagnosis of Breast Diseases / 한국유방암학회지

PURPOSE: The number of people who visit outpatient departments for a self-examination, health examination or an examination about breast disease has recently been increasing. Among these peoples, some of them have abnormal finding for their breasts, and several diagnostic methods are presently being used for the accurate diagnosis of these patients. In this study, we wished to increase the diagnosis rate of breast disease and we wanted to create the opportunity for obtaining accurate diagnosis by using mammography, ultrasonography and fine needle aspiration biopsy. METHODS: From January 2000 to December 2002, 127 patients among all the patients who visited department of surgery, were clinically assessed with using ultrasonography, mammography, fine needle aspiration biopsy and postoperative histopathology after they had first undergone excisional biopsy. We had calculated the sensitivity, specificity, the positive predictive value, the negative predictive value and the diagnostic accuracy of each diagnostic method. We assigned points for the diagnostic result and we then calculated the sensitivity and specificity via these points. RESULTS: The sensitivity of ultrasonography, mammography and fine needle aspiration biopsy was 94.9%, 82.1% and 94.9%, respectively, and the specificity was 62.5%, 90.9% and 93.2%, respectively. The positive predictive value was 52.9%, 80% and 86.0%, and the negative predictive value was 96.5%, 92% and 97.6%, and the diagnostic accuracy was 72.4%, 88.2% and 93.7%, respectively. We divided the results by the benign and malignant nature of the findings with using points, and on this triple test, the sensitivity was 97.4%, the specificity was 97.7%, the positive predictive value was 95%, the negative predictive value was 98.9% and the diagnostic accuracy was 97.6%. CONCLUSION: When diagnosing breast disease, the modified triple test showed that it reduce the rate of performing unnecessary surgical operations. Good skilled technique when performing fine needle aspiration biopsy can help to future reduce this rate even more.