Carcinoma of ampulla of vater with extensive invasion to the whole pancreas / 대한내과학회지

Carcinoma of ampulla of Vater is a papillary neoplasm arising in the last centi meter of the common bile duct (CBD) where it passes through the wall of the duodenum and ampulla of Vater. We report the case of an ampulla of Vater cancer with the characteristic extensive invasion to the whole pancreas. A 53-year old female was admitted to our hospital with chief complaint of epigastric pain, steatorrhea, and weight loss for 2 months. On physical examination, epigastric tenderness was detected. Gastroduodenoscopic biopsy from the mass revealed well differentiated adenocarcinoma. Abdominal CT demonstrated intraduodenal protruding mass with diffuse invasion to the whole pancreas. Arterial phase helical CT scan revealed intense heterogenous enhancement of entire pancreas. She underwent the Whipple procedure with total pancreatectomy. Final pathologic diagnosis was adenocarcinoma of ampulla of Vater with invasion of the whole pancreas and metastasis to the large number of regional lymph nodes.

Two Cases of Autoimmnune Hepatitis Associated with Systemic Lupus Erythematosus / 대한간학회지

Autoimmune hepatitis (AIH) is a chronic necroinflammatory liver disease of unknown cause associated with circulating autoantibodies and high serum globulin level. Systemic lupus erythematosus (SLE) is a disease of unknown etiology in which tissues and cells are damaged by pathogenic autoantibodies and immune complex, affecting multiple organs including the liver, kidney, and CNS. The difference between the hepatic involvement of SLE and autoimmune hepatitis has not been clearly defined in the past due to similarities in clinical and biochemical features. A scoring system for the diagnosis of AIH has been established, and AIH and SLE-associated hepatitis have been defined as two different entities, although both have the same autoimmune features such as polyarthralgia, hypergammaglobulinemia and circulating autoantibodies. AIH has been considered to occur infrequently in SLE. We report two cases of AIH which simultaneously satisfied the criteria of SLE.