A Case of Primary Follicular Lymphoma Arising in the Rectum / 대한소화기내시경학회지

Follicular lymphoma (FL) is one of the most common non-Hodgkin's lymphomas in the United States, but it is relatively rare in Asia. FL typically arises in lymph nodes together with spleen, liver, and bone marrow involvement. So, primary extra-nodal FL without peripheral nodal involvement is rare. Histologically, it shows nodular aggregates of lymphoma cells and positivity for CD 10, CD 20 and bcl-2. Not only the stage, but also the grade is associated with the survival rate. Grade 3 FL presents a worse prognosis than does grade 1 and 2 FL and this should be treated with an anthracycline based CHOP regimen. We report here on a case of primary follicular lymphoma arising in the rectum; this was observed in a 58-year-old woman who complained of anorexia, dyspepsia and diarrhea.

Endoscopic Treatment of Benign Hypopharyngeal Tumors / 대한소화기내시경학회지

During endoscopy, most endoscopists insert endoscopes into the esophagus without visual aid in order to minimize the discomfort to patients. However, studies have shown that visual guided insertion imposes little discomfort, is safe and can increase the diagnostic rate of abnormal pathology of the throat. As for the treatment of hypopharyngeal lesions, cases of endoscopic treatment are rare and any guidelines have not been clearly defined yet. However, endoscopic treatment may be feasible in selected cases. Several procedures, such as endoscopic mucosal resection with cap (EMR-C) and saline injection polypectomy can be applied. We experienced seven patients who had benign hypopharyngeal masses that were removed endoscopically without serious complications. Compared to surgical treatment, endoscopic removal of the benign hypopharyngeal tumors does not require general anesthesia; it is simple, less invasive and less costly. Therefore, endoscopy should be regarded as a treatment option. However, further studies are required before widespread application of endoscopic removal for the definitive treatment of hypopharyngeal masses, including malignancies.

A Case of Submucosal Tumor-like Early Gastric Adenocarcinoma Diagnosed by Endoscopic Mucosal Resection / 대한소화기내시경학회지

In rare cases, early gastric cancer resembles the endoscopic features of a submucosal tumor (SMT). A correct histological diagnosis is difficult with repeated biopsy specimens because they are covered with normal mucosa. Some features known to suggest malignant SMT include a size greater than 3 to 5 cm, a rapid growth rate, echoheterogeneity and irregular margins on endoscopic ultrasonography (EUS). Various techniques including US-guided biopsy, partial removal by an endoscopic snare excision, as well as EUS with a fine needle aspiration were used to enhance the diagnostic accuracy. We recently experienced a case of early gastric cancer, presenting as a submucosal tumor-like lesion, which was confirmed by endoscopic mucosal resection. We report this case with a review of the relevant literature.

A case successfully treated with percutaneous drainage of infected hepatic cyst in a patient with adult polycystic kidney disease / 대한내과학회지

Even though it is a rare complication to have hepatic cyst infection in adult polycystic kidney disease, the patient is expected to be complicated with sepsis or acute cholangitis and die if not treated properly. The typical clinical manifestations of hepatic cyst infection are fever and right upper quadrant abdominal pain. Liver enzyme and serum bilirubin levels may be elevated. The clinical outcome of hepatic cyst infection is better when antibiotic and drainage are performed simultaneously than only antibiotic is used. We experienced a case of infected hepatic cyst from a 58-year-old male patient receiving hemodialysis with autosomal dominant polycystic kidney disease. Due to his persistent fever and leukocytosis during intravenous antibiotic therapy, we performed percutaneous drainage of hepatic cyst. Because the drainage fluid presented leukocytosis and deep yellow color, we diagnosed the case as a hepatic cyst infection. We applied both percutaneous drainage of infected liver cyst and antibiotic and we observed clinical improvement.

A Case of Nonsurgical Treatment in Boerhaave's Syndrome Concomitantly Developed with Acute Pancreatitis / 대한소화기내시경학회지

Spontaneous rupture of the esophagus is an uncommon disease which was first reported by Boerhaave in 1724. This esophageal rupture usually occurs during nausea or vomiting, with incoordinate esophageal contraction. Early diagnosis and prompt surgical repair are critical for survival; however late recognition of esophageal rupture is not unusual. In recent years, a variety of nonsurgical approaches have been proposed, particularily in the case of delayed diagnosis. We have experienced one case of Boerhaave's syndrome concomitantly developed with acute pancreatitis which was successfully treated by nonsurgical measures including endoscopic clipping, antibiotics and hyperalimentation. We review the choice of treatment method in delayed diagnosed Boerhaave's syndrome.

A Case of Giant Cavernous Hemangioma of Transverse Colon Associated with Hematochezia / 대한소화기내시경학회지

Gastrointestinal hemangiomas are not common and congenital lesion. Intestinal bleeding is the most common symptom of it. Hemangiomas were classified with capillary, cavernous and mixed type. Cavernous hemangioma is most common. Colonic cavernous hemangioma is rare and are usually arising in the sigmoid colon or/and rectum. Transverse colonic cavernous hemangioma are very rare. Gastrointestinal hemangioma is commonly developed in childhood and in young adults. Fifty eight-year-old man who complained of hematochezia was admitted. Physical examination was unremarkable. Stool occult blood was positive. Abdominal computerized tomography show normal finding. Colonoscopic examination showed giant and bluish-purple colored vascular malformation, 15 cm in length with tough bleeding, on the transverse colon. The patient underwent segmental resection of transverse colon for confirmatory diagnosis and treatment. The final pathologic diagnosis of the resection lesion was cavernous hemangioma of the transverse colon. We report a case of giant hemangioma of the transverse colon associated with hematochezia, with review of relevant literature.

A Case of Acute Tetrachloroethylene Poisoning Complicated by Acute Renal Failure / 대한신장학회잡지

Tetrachloroethylene is widely used as a solvent for degreasing operations and for dry cleaning. Accidental overexposure of tetrachloroethylene produces central nervous system depression which may be followed by hepatic and renal damage. Renal changes are usually mild and reversible with removal of the offending agent. The relationship between exposure to tetrachloroethylene and chronic renal failure remains controversial. Acute or subacute tetrachloroethylene poisoning has been occasionally observed in dry cleaners and fatal cases have been rarely reported. We experienced a case of acute tetrachloroethylene poisoning complicated by acute renal failure. After ingestion of 200 mL tetrachloroethylene, a 32- year-old man was admitted to the clinic in semicoma. Under the conservative treatment, the clinical condition of the patient improved consideravely, but acute renal failure developed. After 5 times hemodialysis during the admission, he recovered completely from acute renal failure.