A Case of Colonic Pseudoobstruction Related to Bacterial Overgrowth Due to a Sigmoidocecal Fistula / 대한소화기학회지

Colocolic fistulas are usually a complication of an inflammatory or neoplastic process. Development of these abnormal bowel communications may lead to bacterial overgrowth. We report on a 71-year-old man with a one-year history of recurrent abdominal distension and irregular bowel habits. Abdominal X-rays and computed tomography showed multiple air-fluid levels and loops of distended bowel without evidence of mechanical obstruction or diverticulitis. Colonoscopy showed a fistulous tract between the sigmoid colon and cecum. Results of a lactulose breath test showed high fasting breath CH4 levels, which were thought to be the result of intestinal bacterial overgrowth. The patient was diagnosed with a colonic pseudo-obstruction associated with bacterial overgrowth due to a sigmoidocecal fistula. We recommended surgical correction of the sigmoidocecal fistula; however, the patient requested medical treatment. After antibiotic therapy, the patient still had mild symptoms but no acute exacerbations.

All-trans Retinoic Acid-induced Nephrotic-range Proteinuria in a Patient with Acute Promyelocytic Leukemia

All-trans retinoic acid (ATRA) is a potent differentiating agent for the treatment of acute promyelocytic leukemia (APL). Although ATRA is generally well-tolerated, some patients develop side effects, the most severe of which is ATRA syndrome. We report on a patient with APL who developed isolated nephrotic-range proteinuria during ATRA therapy for remission-induction. ATRA was discontinued and the proteinuria decreased significantly 5 days after dexamethasone treatment. The occurrence of isolated proteinuria during ATRA treatment is a rare adverse event.

Sarcoidosis Initially Presenting as a Nasal Cavity Mass Misdiagnosed as Tuberculosis / 결핵및호흡기질환

We experienced a rare case of sinonasal sarcoidosis initially presenting as nasal cavitary mass. When the clinical course was different from that of typical tuberculosis, physician should think the possibility of sarcoidosis, and re-biopsy or retrospective review of pathological findings might be helpful.

A case of gastric hepatoid adenocarcinoma misdiagnosed as an extragonadal germ cell tumor / 대한내과학회지

Hepatoid adenocarcinoma is a rare variant of adenocarcinoma that can occur in the stomach. This neoplasm has a poor prognosis and it frequently presents at an advanced stage of disease; it is clinically characterized by increased serum levels of alpha-fetoprotein (AFP) in most cases. We experienced a case of hepatoid adenocarcinoma of the stomach with multiple liver metastases that mimicked germ cell tumor in a 43-year-old man. He had incidentally detected gastric adenocarcinoma via gastrofibroscopy and he underwent subtotal gastrectomy. The postoperative pathologic stage was II (T2N1M0). He complained of epigastric pain. The serum AFP was markedly increased (227,325 IU/mL) and abdominal CT revealed multiple liver masses. We considered these as extragonadal germ cell tumors that occurred in the liver because of the markedly elevated AFP, the short duration of follow-up and early stage of stomach cancer at the that time. To confirm the diagnosis, biopsy of liver mass was done and he was diagnosed with hepatoid adenocarcinoma.