Small Bowel Metastasis from Breast Cancer: A Case Report / 대한소화기학회지

Breast cancer is a common malignancy in women and frequently metastasizes to various organs such as liver, lung, brain, bone and so on. But metastasis to gastrointestinal tract is rare. We describe a 73-year-old woman with small intestinal metastasis of breast cancer. She was diagnosed as right breast cancer in stage I, received modified radical mastectomy 6 years ago and had been followed up without any evidence of residual disease. During investigation for lower abdominal pain and weight loss of 9 kg, we found a small bowel mass. The histology of the tissue taken from small bowel mass was adenocarcinoma, poorly differentiated. The immunohistochemical stain of this specimen showed 75% positivity of estrogen receptor and 90% positivity of progesterone receptor. This is a case of small bowel metastasis from breast cancer and we report this case with a review of literatures.

A Case of Gastropericardial Fistula as a Complication after Esophagectomy with Esophagogastrostomy for Esophageal Cancer / 대한소화기내시경학회지

The gastric pedicle is commonly used for the reconstruction following the resection of esophageal cancer. We recently experienced a case in which gastric ulcer occurred eighteen months postoperatively. A 60 year-old man complaining of chest pain, dry cough, mild fever and chills was admitted to the emergency room. The patient had a history of esophagectomy and esophagogastrostomy because of esophageal cancer. Chest X-ray and CT scan showed pneumopericardium. Upper GI contrast study showed a fistulous tract between the stomach pedicle and the pericardium. Upper GI endoscopy showed beating heart through the fistulous opening. The patient expired with sepsis on the twenty second days after an emergent operation. Gastropericardial fistula caused by a peptic ulcer perforation after the esophgectomy and esophagogastrostomy operation is a very rare complication and brings a fatal result. Early detection using the chest radiography, electrocardiogram, echocardiography, upper GI study and physical examination, and an immediate treatment are therefore mandatory.

A Case of Metastatic Hepatocellular Carcinoma of the Ovary / 대한소화기학회지

Although advances in imaging technology have allowed for earlier detection of disease, hepatocellular carcinoma is usually asymptomatic and discovered at an advanced stage with metastasis. The most common sites of metastasis include lung, peritoneum, adrenal gland, and bone, but rarely, the nasal cavity, orbit, gallbladder, and ovary can be metastatic sites. We experienced a case of metastatic hepatocellular carcinoma of the ovary in a living patient. The differential diagnosis includes hepatoid yolk sac tumor of the ovary, primary or metastatic hepatoid carcinoma and primary or metastatic oxyphil cell tumor of the ovary. To the best of our knowledge, there have been eight cases of metastatic hepatocellular carcinoma of the ovary in the English literature and only six cases discovered in living patients. This is the first report of a metastatic hepatocellular carcinoma of the ovary in Korea.

A Case of Klippel-Trenaunay-Weber Syndrome Presenting with Esophageal and Gastric Varices Bleeding / 대한소화기학회지

Klippel-Trenaunay-Weber syndrome is a congenital vascular disorder consisted of a variety of vascular malformations, enlargement of the involved limb, and varicose veins. We report a case of Klippel-Trenaunay-Weber syndrome presenting portal hypertension and varices bleeding caused by hypoplasia of the portal vein. Portal hypertension was caused by portal vein hypoplasia associated with Klippel-Trenaunay-Weber syndrome. There were three episodes of variceal bleeding, and hemostasis were achieved by endoscopic band ligation, Sugiura operation, and splenic artery embolization respectively. Although successful hemostasis was achieved, an additional procedures to reduce portal hypertension were needed to prevent repeated episodes of variceal bleeding.

A Case of Spontaneous Regression of Advanced Gastric Cancer / 대한소화기내시경학회지

Spontaneous regression may occur in malignancies such as hypernephroma, neuroblastoma, malignant melanoma, choriocarcinoma, and bladder tumor, but yet it is extremely rare in carcinoma of the stomach. So far, 19 cases have been reported in the English literature and the mechanisms underlying this intriguing phenomenon remain unknown. A 48-year-old man with histologically-verified advanced gastric carcinoma had received no treatment since its diagnosis. However, gastric carcinoma was no longer detectable by endoscopy and histology after 4 years. Thus, we report a case of spontaneous regression of carcinoma of the stomach with a brief review of relevant literatures.

A Case of Spontaneous Regression of Advanced Gastric Cancer / 대한소화기내시경학회지

Spontaneous regression may occur in malignancies such as hypernephroma, neuroblastoma, malignant melanoma, choriocarcinoma, and bladder tumor, but yet it is extremely rare in carcinoma of the stomach. So far, 19 cases have been reported in the English literature and the mechanisms underlying this intriguing phenomenon remain unknown. A 48-year-old man with histologically-verified advanced gastric carcinoma had received no treatment since its diagnosis. However, gastric carcinoma was no longer detectable by endoscopy and histology after 4 years. Thus, we report a case of spontaneous regression of carcinoma of the stomach with a brief review of relevant literatures.

Human Cytomegalovirus Pneumonia and Pulmonary Aspergillosis in a Patient with Acute Myelogenous Leukemia following Chemotherapy / 감염

Cytomegalovirus (CMV) pneumonia is one of the major causes of morbidity and mortality in immunocompromised patients such as transplant recipients. But CMV pneumonia is unusually reported among adults with leukemia who have not undergone transplantation. Because it is a cause of life-threatening pneumonia in adults with leukemia receiving potent immunosuppressive therapies, CMV has emerged as an important pathogen. We report a case of CMV pneumonia and invasive pulmonary aspergillosis in a patient with acute leukemia who have not undergone transplantation. A 31-year-old man with acute myelogenous leukemia developed high fever on day 9 of second consolidation chemotherapy. Six days later, chest radiography showed patchy consolidation with central cavity on right upper lung. Considering fungal pneumonia, amphoterin B was started, then fever was subsided. Chest CT showed necrotizing pneumonia with cavity formation in posterior segment of right upper lobe. Because of several episodes of hemoptysis, lobectomy was performed. Grossly, the area of focal necrosis with central cavity formation and multiple small interstitial nodules were observed. In the area of interstitial nodules, giant cells with intranuclear inclusion and perinuclear halo were found. In the area of focal necrosis, fungal hyphae with acute branching and septation were found. Ganciclovir and immunoglobulin were administered for CMV pneumonia. On day 62 of the chemotherapy, the patient discharged with improved symptoms. After several weeks, unrelated HLA-matched allogeneic stem cell transplantation was performed. On day 14 of transplantation, the patient died due to septic shock of unknown cause.

A Case of Scrub Typhus with Acute Respiratory Distress Symdrome and Meningoencephalitis / 결핵

Scrub typhus is an acute, febrile disease of humans that is caused by Orentia Tsutsugamushi. It is transmitted through the bite of chiggers. The spectrum of the clinical severity for scrub typhus ranges from mild to sever e with fatal complication such as meningoencephalitis, pneumonitis, myocarditis. Severe pulmonary involvement e.g. acute respiratory distress syndrome(ARDS) and meningoencephalitis have rarely been obseved since the introduction of specific antibiotic therapy. We experienced a case of scrub typhus manifested with ARDS and meningoencephalitis. The patient was treated with doxycycline, anticonvulsant and mechanical ventilator thrapy.

A Case of Double Pylorus Associated with Ectopic Pancreas Presenting with Gastric Ulcer Bleeding / 대한소화기내시경학회지

Duplication of the pylorus is one of the rare anormalies of the intestinal tract. Most of the reported cases are secondary double pylorus caused by peptic ulcer. However, double pylorus may be a congenital anomaly sometimes combined with ectopic pancreas. Recently, we experienced a case of double pylorus combined with ectopic pancreas in a 76-year-old man. The patient presented with gastric ulcer bleeding. An esophagogastroduodenoscopy confirmed the presence of double pylorus, but subsequent endoscopic hemoclipping failed to control bleeding from an ulcer on the lesser curvature of the prepyloric antrum. The microscopic examination of the surgically resected specimen showed an ectopic pancreatic tissue in the gastric wall near the ulcer lesion. We report this case with a collected review of the Korean literature.

Two Cases of Colon Adenocarcinoma Transformed from Colonic Adenoma / 대한소화기내시경학회지

The prevalence of colorectal cancer is increasing now in Korea and the principal strategy of its management is early detection and surgical resection. Current discussion of the topic of colorectal polyps and cancer is largely based on the concept of the adenoma-carcinoma sequence, which is thought to be the most probable pathogenesis for colorectal cancer. But the case reports about colonic adenocarcinoma arising from adenoma in clinical practice between short interval are rare in Korea. We experienced two cases of colon cancer, which were transformed from small adenoma can not be removed because of patients' refusal, 3 years ago. So we present these cases with a review of relevant literatures.

Human Herpes Virus-6 Meningoencephalitis Following Allogeneic Hematopoietic Stem Cell Transplantation / 감염

Two cases of human herpesvirus-6 (HHV-6) encephalitis that occurred after allogeneic hematopoietic stem cell transplant (HSCT) are presented. Both patients reported fever, skin rashes, and neurological symptoms, characterized by disorientation, confusion and drowsy mental status. HHV-6B DNA was detected from the cerebrospinal fluid (CSF) specimens by a multiplex polymerase chain reaction (PCR) assay including EBV, CMV, HHV-6B. After treatment with intravenous gan ciclovir for 2~3 weeks, all clinical manifestations were resolved and the HHV-6B DNA was cleared from the CSF in both patients. HHV-6 should be considered as a possible cause of neurological symptoms after HSCT, and prompt antiviral treatment should be begun.