A Case of Cavernous Hemangioma of the Colon / 대한소화기내시경학회지

Gastrointestinal cavernous hemangiomas are rare, with an incidence of about 1 per 15,000 persons and the second most common vascular lesions of the colon. They are generally congenital, with their origin in embryologic sequestrations of mesodermal tissue. Enlargement occurs by projection of budding endothelial cells. These lesions are a significant cause of rectal bleeding with anemia, obstruction and rarely platelet sequestration, although approximately 10% of patients remain asymptomatic. On endoscopy, cavernous hemangiomas characteristically present as deep violet-blue nodular, compressible lesions that are associated with mucosal congestion and edema. Unfortunately chronic inflammatory changes often mask findings that could lead to proper diagnosis. The results of several kinds of treatment have not been satisfactory, although abdominoperineal resection is the most often recommended procedure. We report a case of relatively huge cavernous hemangioma of the colon that developed in an old aged patient with intermittent hematochezia.

A Case of Gallstone Ileus Following Endoscopic Sphincterotomy / 대한소화기내시경학회지

Gallstone ileus is caused by mechanical obstruction of the gastrointestinal tract by the gallstone and accounts for 1~3% of all intestinal obstructions. Endoscopic sphincterotomy (EST) is the accepted treatment of choice for choledocholithiasis. Recognized complications of EST include bleeding, acute pancreatitis, retroperitoneal perforation. However, gallstone ileus is a rare complication of EST. A 70-year-old woman was admitted to our hospital with right upper quadrant pain. Abdominal ultrasound revealed single common bile duct (CBD) stone. ERCP was performed to remove the large CBD stone without mechanical lithotripsy. Nausea, vomiting and abdominal pain were developed after stone removal. Plain abdomen X-ray and computerized tomography represented marked dilatation of small bowel loops without definite obstructive lesion. Because the mechanical obstruction was sustained, explorolaparotomy was performed. On the operation, single stone was impacted at the distal ileum, narrowed by previous radiotheraphy. We reported a case of gallstone ileus after the removal of CBD stone following EST without lithotripsy.

A Case of Mucosa-Associated Lymphoid Tissue Lymphoma in the Esophagus Accompanied by Bronchus-Associated Lymphoid Tissue Lymphoma / 대한소화기내시경학회지

Mucosa-associated lymphoid tissue (MALT) is specially adapted component of the immune system protecting the permeable surface of the gastrointestinal mucosa, bronchial mucosa and other mucosa. Chronic infection of the stomach by Helicobacter pylori, Hashimoto's thyroiditis, Sjogren syndrome in the salivary gland and other chronic inflammatory and autoimmune disease lead to the accumulation of MALT in the mucosa and MALT lymphoma arises from this acquired MALT. MALT lymphoma is histologically characterized by proliferation of centrocyte-like cells that invade the epithelium and lymphoepithelial lesion form. Gastrointestinal MALT lymphoma is clinically important because it is a localized, slow progressive disease and has a long survival and favorable clinical course compared with other lymphoma. Esophageal MALT lymphoma is extremely rare, so we report, radiologic, endoscopic and pathological findings and clinical course in a case of esophageal MALT lymphoma with brouchas-associated lymphoid tissue (BALT) lymphoma with a review of literature.

Extraskeletal Ewing`s Sarcoma on the Duodenum / 대한소화기내시경학회지

Extraskeletal Ewing's sarcoma is a rare primary malignant soft tissue tumor that has the same pathological characteristics of skeletal Ewing's sarcoma. It is known that the differential diagnosis of Ewing's sarcoma from undifferentiated rhabdomyosarcoma, neuroblastoma, reticulum cell sarcoma, and malignant lymphoma by the histologic studies only are not easy because their histologic findings are nearly similar each other. Therefore, immunohistochemical method, electron microscopic examination, cytogenetic study, or molecular gene study are used together to confirm the diagnosis. It chiefly involves the lower extremity, soft tissues of the paravertebral region, and adjacent chest wall. We recently experienced a case of extraskeletal Ewing's sarcoma of duodenum in a 21-year old female. The patient underwent Whipple's operation and postoperative combined chemotherapy were done.