A Case of Gastric Lipoma with Hemorrhage / 대한소화기내시경학회지

Gastric lipoma is rare submucosal tumor, accounting for less than 3% of all be- nign gastric tumor. Most are usually asymptomatic, but on occasion, they may present with abdominal pain, obstruction, dyspepsia, intussuception and gastrointestinal bleeding. Surgical resection is definitive diagnostic and therapeutic procedure. Surgical removal of gastric lipoma should be considered in the following situations: 1) the lesion is large, 2) the lesion is difficult to differentiate from malignant tumor, 3) the patient is symptomatic or has recurrent bleeding or obstruction. We report a case of gastric lipoma with bleeding in a 67-year-old male. Gastroscopy showed active gastric ulcer with fresh blood clot. Although medical conservative treatment was done, bleeding was continued. We referred patient to general surgical department for open surgical procedure and subtotal gastrectomy was performed. Histopathological examination of surgical gastric segment showed 5 5.5 cm sized ulcerated mass. Microscopic finding of cross section showed uniform and mature adipose cell, finding consistent with lipoma. We confirmed it submucosal gastric lipoma with ulcer bleeding.

Influence of cathepsin D expression on prognosis in non-small cell lung cancer / 결핵

BACKGROUND: Cathepsin D, an aspartic lysosomal proteinase, is believed to be involved in local invasion and metastasis of tumor cells by its proteolytic activity and has been described to be associated with tumor progression and prognosis in some human malignancies including breast cancer. But, its prognostic value for human lung cancer remains to be determined. The purpose of this study is to determine clinicopathological and prognostic significance of cathepsin D expression in non-small cell lung cancer. METHOD: Using a polyclonal antibody, immunohistochemical analysis of cathepsin D was performed on paraffin embedded sections of tumors obtained surgically from 54 patients with non-small cell lung cancer (37 squamous cell carcinoma, 14 adenocarcinoma, 2 large cell carcinoma, and 1 undifferentiated carcinoma). RESULTS: Eighteen patients (33.3%) showed positive immunoreactivities of cathepsin D in tumor cells. No significant correlation of cathepsin D expression in tumor cells was found in p-stage (surgical-pathologic stage), tumor size, tumor factor, nodal involvement, and differentiation. Of 54 patients, 29 (53.7%) patients showed moderate to massive cathepsin D-positive stromal cells within the tumor tissues, while the rest (46.3%) showed few cathepsin D-positive stromal cells within the tumor tissues. Cathepsin D expression n stromal cells was significantly associated with p-stage in non-small cell lung cancer (p=0.031). No significant correlation of the degree of cathepsin D-positive stromal cells was found in tumor size, T-factor, nodal involvement, differentiation. Cathepsin D expression status in tumor cells and stromal cells was not significantly associated with prognosis expressed by survival rate. The results of multivariate analyses of variables possibly associated with progonosis showed that nodal involvement was the only independent prognostic factor in all patients. CONCLUSION: Cathepsin D expression in stromal cells was significantly associated with p-stage in non-small cell lung cancer. However, it was not related to other clinicopathologic features and prognosis, and Cathepsin D expression in tumor was not related to p-stage and prognosis.

A Case of Metastatic Carcinoma en Cuirasse and Nodular Carcinoma from Gastric Carcinoma / 대한내과학회지

Cutaneous metastases from gastric carcinoma are uncommon. The frequency of metastses to the skin from gastric carcinoma have ranged from 0.3% to 0.4%. Carcinoma en cuirasse, first described by Velpeau in 1838, is marked sclerodermatous change and characterized by a difffuse morphea-like induration of the skin and represents a rare manifestations of breast carcinoma metastatic to the chest wall. It is vary rarely seen in lung, stomach, kidney and other metastasizing malignancies. We report a case of carcinoma en cuirase and nodular carcinoma from gastric carcinoma in a 36-year-old male who complained chiefly of multiple cutaneous nodules. He had mixed lesions of an erythematous morphea-like induration on the neck and multiple erythematous nodules on the chest and abdomen. Gastroscopy finding showed a Borrmann type IV advanced gastric carcinoma. Histopathologic examination of skin and stomach showed atypical cells with pleomorpic, hyperchromatic nuclei and scanty, eosinophilic cytoplasm, which are consistent with poorly differentiated adenocarcinoma. Immunohistochemical stainings showed positive reaction for cytokeratin. He died three months after the appearance of cutaneous lesions.

A Case of Saccular Arteriosclerotic Aortic Aneurysm Associated with Thrombus in Aortic Arch

An aortic aneurysm is described as a permanent localized dilatation of the aorta having a diameter at least 1.5 times that of the expected norrnal diameter of that given aortic segment. Thoracic aortic aneurysms are much less common than are aneurysms of the abdominal aorta. Thoracic aneurysms are classified by the portion of aorta involved, I.e., the ascending, arch, or descending thoracic aorta. We experienced a case of saccular arteriosclerotic aortic aneurysm associated with thrombus in aortic arch in a 78 year-old male who had history of hypertension. He was admitted to Kwangju Veterans Hospital complaining of drowsy mental state and swelling of left foreann. The chest X-ray, chest CT and echocardiogram showed saccular dilatation(maximal diarneter ; 7.67~7.86cm) associated with thrombus in aortic arch. He refused operation because of old age, so he was conservatively rnanaged including propranolol. We report this case of saccular arteriosclerotic aneurysm of aortic arch with a brief review of literature.

A Case of Polycythemia Vera Presenting with Angina Pectoris without Coronary Artery Stenosis

The majority of ptients with ischemic heart disease such as angina pectoris and myocardial infarction have coronary atherosclerosis as a underlying cause. However, in unusual conditions such as variant angina, aortic valvular heart disease, hypertrophic cardiomyopathy, vasculitis, hypercoagulable states, coronary atherosclerosis is not the cause. Polycythemia vesa is a myeloproliferative disease characterized by infrequent thromboembolic complications such as ischemic heart disease. We report a case of polycythemia vera presenting with angina pectoris without coronary artery stenosis with the review of the literature.

Histochemical and Immunohistochemical Stain of Helicobacter pylori from the Gastric Mucosa / 대한내과학회지

No abstract available.

Polyneuropathy in Patients with Chronic Obstructive Pulmonary Disease / 결핵

The incidence, type arid distribution of polyneuropathy in patients with chronic obstructive pulmonary disease (COPD) were assessed and also analyzed the causative factors. Forty-four patients, mean age 66.1 years (42 male, 2 female), have been investigated with arterial gas analysis, pulmonary function test, clinical and electrodiagnostic studies. None of them had conditions known to affect the peripheral nervous system such as metabolic disorders or drugs. In a selected group of 44 patients, electrophysiological findings of polyneuropathy were found in 22 patients(50%), clinical polyneurtpathy were diagnosed in 13 patients(9 patients were diagnosed by electrophysiological studies, 4 patients were normal by electrophysiological studies). These findings indicate that subclinical polyneuropathy( 13 patisnts, 30%) more conimorily occurs than clinical polyneuropathy( 9 patients, 20%) in associated with COPD. In the patients with polyneuropathy, the lesions were predominant axonal degeneration, the changes were more involved in leg than arm, more frequently affected sensory fibers. We could not find etiologic factor to cause polyneuropathy in COPD patients.

3 Cases of Primary Adenocarcinoma of the Duodenum / 대한소화기내시경학회지

Primary adenocarcinoma of the duodenum is a rare disease, representing 0.35% of all gastrointestinal neoplasm and 0.042% of all malignant neoplasm. Since Ham-burger described the first duodenal caricinoma in 1746, the incidence has shown an increasing tendency. Compared with upper gastrointestinal contrast studies, the gastroduodenoscopy has gained an increasing popularity as an invesitigative tool in recent years. But the diagnosis is usually made at a very late stage because the symptoms are often non-specific, which contributes to delayed diagonsiss and poorer prognosis. We have experienced two cases of the primary carcinoma of the duodenal bulb and one case of carcinoma of the second portion, which were diagnosed by biopsy with gastrofiberoscopic endoscopy and operative finding. So we report three csses with a brief review of literature.