A Case of Intestinal Hemorrhage in Patient with Primary Amyloidosis / 대한소화기내시경학회지

Although intestinal bleeding is known to occur in amyloidosis, it is rare as a presenting symptom or sole manifestation of the disease. We experienced a case of intestinal hemor-rhage in a 64-year old female patient with primary amyloidosis, kappa type. Antral muco-sal erosions were discovered and one shallow healing ulcer at the angle. Colonoscopy revealed multiple purplish nodules in the sigmoid colon and descending colon, as well as a large shallow ulcer with blood clots in the sigmoid colon which was suspected to be the intestinal hemorrhage site. Endoscopic biopsy established amyloidosis. Polarizing microscopy after Congo red staining and immunohistochemical staining identified primary amyloid, kappa type. A case of intestinal hemorrhage in patients with primary amyloidosis is presented and the literature is reviewed.

A Case of Gastric Carcinosarcoma with Pancreatic / 대한소화기내시경학회지

Carcinosarcoma of the stomach is regarded as a rare malignant neoplasm composed of both carcinomatous and sarcomatous components in a given tumor. Few cases have been reported since 1904. This is a case of carcinosarcoma of the stomach in a 61-year-old man. He suffered from indigestion, vomiting, and epigastric pain. Endoscopic finding showed a huge protruding mass with intact mucosa on the posterior wall of the antrum up to the pylorus. Surgery was performed and carcinosarcoma with pancreatic invasion was confirmed by pathology.

A Case of Acute Gastric Anisakiasis Causing Massive Hematemesis / 대한소화기내시경학회지

Acute gastric anisakiasis is caused by gastric mucosal penetration from an Anisakis larvae. It occurs with those who ingest raw or inadequately cooked saltwater fish or squid containing anisakis. The clinical symptoms are severe abdominal pain, nausea, vomiting, diarrhea, and so on. A case of acute gastric Anisakiasis with massive hematemesis was presented. Initial endoscopic examination revealed an edematous or raised erosive lesion with a small blood clot-covered vessel in the fundus which was thought to be a stigmata of recent bleeding. The lesion was treated with an epinephrine-hypertonic saline injection, electrocoagulation, and an ethanol injection. A follow-up gastroscopy revealed an artificial coagulation-induced ulcer at the previous bleeding site. At the ulcer margin, a whitish linear worm was found with half of its body penetrating the gastric mucosa. The worm was removed using biopsy forceps and the patient was subsequently placed on a soft diet. The next day however, hematemesis recurred. Gastroscopic band ligation of the vessel was performed with a cessation of bleeding. Three weeks later, a gastroscopy determined that the ulcer had completely healed.

A Case of Boerhaave's Syndrome Involving Nasogastric Tube Penetration into the Pleural Cavity / 대한소화기내시경학회지

Boerhaave's syndrome, spontaneous esophageal rupture, is lethal and associated with a 70% survival rate despite emergent surgical management in recent reports. Early diagnosis and management is critical for more favorable outcome. But, it is difficult to diagnose early because of the low incidence and lack of specific symptoms and signs. We experienced 37 year-old male patient with Boerhaave's syndrome who was heavy drinker, and suffered from chronic renal failure. He visited a hospital because of hematemesis and severe back pain. He was transferred to our hospital with a nasogastric tube insertion, which was penetrating the distal esophagus. A radiologic examination revealed that the distal tip was located in the left pleural cavity. It was assumed that the tube had passed through the preexisting perforation site. Operation was not performed emergently due to delay in diagnosis and severe hyperkalemia. The patient was in a septic condition, but had recovered slowly after systemic broad spectrum antibiotic therapy, pleural drainage and intrapleural antibiotic injections. An esophagography revealed no leakage of gastro-grafin on the 14th hospital day, and he later completely recovered from sepsis.

A Case of Synchronous Stage-IV Advanced Gastric Cancer / 대한소화기내시경학회지

Multiple primary malignancy is called when two cancers occur independently in one individual. Multiple primary malignancy may be divided into two groups, synchronous or metachronous depending on the interval between their diagnosis. Synchronous cancer is diagnosed simultaneously or within an interval of 6 months and metachronous cancer at interval of more than 6 months. Since Billroth reported the first case of multiple primary malignancy, many cases have been reported partly owing to the advancement of diagnostic procedures and treatment modalities. The incidence of multiple primary malignancy tends to increase and it is fundamental that patients who have been treated for cancer receive a careful follow-up study. Here we report on a case of stage-IV advanced gastric cancer with stage-I renal cell carcinoma which was discovered during the staging procedure of gastric cancer. Both cancers were confirmed histologically and classified as gastric adeno-carcinoma and renal cell carcinoma.