Is a Preoperative Gastrointestinal Endoscopy for Second Primary Cancer Detection in Head and Neck Cancer Necessary? Ten-year Registry Data / 대한소화기학회지

BACKGROUND/AIMS: In head and neck squamous cell carcinoma, second primary gastrointestinal tumors are not uncommon. However, it is unclear whether a screening endoscopy is needed for detecting gastrointestinal neoplasm in patients with head and neck cancer. Therefore, we analyzed the prevalence and independent risk factors for second primary gastrointestinal neoplasm in head and neck squamous cell carcinoma. METHODS: A consecutive series of 328 patients with primary head and neck squamous cell carcinoma that underwent esophagogastroduodenoscopy or colonoscopy were included using our registry. An age- and sex-matched group of 328 control subjects was enrolled. We assessed risk factors of synchronous gastrointestinal cancer. RESULTS: The prevalence of esophageal cancer with head and neck squamous cell carcinoma was significantly higher than that of the control group (1.5% vs. 0.0%, p=0.011). An age of 54 years or more (OR, 1.033; 95% CI, 1.008-1.059; p=0.009) and male gender (OR, 4.974; 95% CI, 1.648-15.013; p=0.004) were risk factors for concomitant colorectal cancer or adenomas in the head and neck squamous cell carcinoma patients. CONCLUSIONS: Preoperative colonoscopy can be recommended for detecting synchronous second primary colorectal lesions in head and neck squamous cell carcinoma patients with male sex regardless of age, and esophagogastroduodenoscopy is necessary in all head and neck squamous cell carcinoma patients for detecting esophageal cancer.

A case of pedunculated hepatic hemangioma mimicking submucosal tumor of the stomach / 대한간학회지

Hepatic hemangioma is the most common benign tumor of the liver. Most such hemangiomas are small, asymptomatic, and have an excellent prognosis. Giant hepatic hemangioma has been reported in the literature, but the exophytic and pedunculated forms of hepatic hemangioma are rare. A 56-year-old woman was referred to our hospital under the suspicion of having a gastric submucosal tumor. Abdominal computer tomography (CT) scans showed a pedunculated mass from the left lateral segment of the liver into the gastric fundus, exhibiting the atypical CT findings of hepatic hemangioma. We therefore decided to perform laparoscopic resection based on the symptoms, relatively large diameter, inability to exclude malignancy, and risk of rupture of the exophytic lesion. The pathology indicated it to be a cavernous hemangioma of the liver. Herein we report a case of pedunculated hepatic hemangioma mimicking a submucosal tumor of the stomach due to extrinsic compression of the gastric fundus.

A Case of Hypertrophic Cardiomyopathy Complicated by Acute Myocardial Infarction and Ventricular Tachycardia: Slow Coronary Artery Flow

Many patients with hypertrophic cardiomyopathy experience chest pain, and some of these patients are diagnosed with acute myocardial infarction. Acute myocardial infarction in the setting of hypertrophic cardiomyopathy can occur without coronary atherosclerosis. Although the exact pathophysiologic mechanism of this remains unclear, some pathologic studies have suggested that small vessel coronary artery disease in patients with hypertrophic cardiomyopathy may play a major role in producing myocardial ischemia. Small vessel disease can be suspected when the coronary angiogram shows patent epicardial coronary arteries with slow flow of the angiographic contrast medium. We report here on a case of hypertrophic cardiomyopathy that was complicated with acute myocardial infarction, and this induced catastrophic refractory ventricular tachycardia.

A Case of Duodenal Intramural Hematoma and Hemoperitoneum after Therapeutic Endoscopy in a Patient with Chronic Renal Failure / 대한소화기내시경학회지

Duodenal intramural hematoma is mostly caused by blunt abdominal trauma. It is also less commonly reported as a complication of anticoagulation therapy or as a blood dyscrasia, and as a complication of diagnostic/ therapeutic endoscopy. The presentation of these patients is abdominal pain, vomiting, fever and hematochezia, and this is rarely accompanied with intestinal obstruction, severe pancreatitis and acute peritonitis as its complications. The diagnosis is made clear by performing abdominal ultrasonography and abdominal computed tomography. We reported here on one case of intramural duodenal hematoma and hemoperitoneum after performing endoscopic hemostasis in a chronic renal failure patient who was on maintenance hemodialysis.

A Case of Endobronchial Aspergillosis in a Renal Transplant Patient / 대한신장학회지

In immunocompromised renal transplant patients, aspergillosis can be a life-threatening opportunistic infection. Aspergillus is a ubiquitous organism in our environment, so pulmonary aspergillosis usually results from the ingrowths of the colonized Aspergillus in bronchial trees, pulmonary cysts or cavities. We have experienced a case of endobronchial aspergillosis developed in a renal transplant patient with neutropenia. Bronchoscopic biopsy revealed a necrotizing Aspergillus bronchitis in the orifice of the lateral segmental bronchus of left upper lobe. The patient received total 2,760 mg intravenous liposomal amphotericin B. There was no endobronchial lesion on follow up bronchoscopy and biopsy was also negative. This case serves as a reminder to clinicians that Aspergillus should be kept in mind as a possible infectious organism in renal transplant patients.