A Case of Acinar Cell Carcinoma of Pancreas, Manifested by Subcutaneous Nodule as Initial Clinical Symptom / 대한소화기학회지

Pancreas acinar cell carcinoma (ACC) accounts for only 1-2% of pancreatic exocrine malignant tumor. The symptoms of patients with ACC are usually non-specific, for example the anorexia and weight loss. Patients may develop Schmid's triad including subcutaneous fat necrosis, polyarthritis, and eosinophilia. We reported a case of ACC which was manifested by subcutaneous nodule as initial clinical symptom. To our knowledge, this is the first reported case of ACC presenting as subcutaneous fat necrosis in Korea.

A Case of Undifferentiated (Embryonal) Liver Sarcoma Mimicking Klatskin Tumor in an Adult / 대한소화기학회지

Undifferentiated sarcoma is an uncommon primary malignant tumor of the liver typically occurring in older children. It is also referred to as malignant mesenchymoma, fibromyxosarcoma, or mesenchymal sarcoma. We experienced a case of undifferentiated sarcoma in 72-year-old male. Contrast enhanced liver CT scan revealed a 3.4 cm heterogeneously enhancing, ill-defined, and low attenuated mass in the left liver and subtle intrahepatic duct dilatation. And, in tubogram, there were segmental stenosis and occlusion from the hilum to the proximal common bile duct. We did ultrasonography guided liver biopsy. The pathologic finding revealed infiltrative growth of atypical cells with rhabdoid features. Some atypical cells showed clear cytoplasm, but no organoid pattern was identified. The stroma around atypical cells was filled with eosinophilic hyaline material. These tumor cells were positive for vimentin only, and the tumor was consistent with undifferentiated sarcoma of the liver.

A Case of Dieulafoy's Lesion with Pseudoaneurysm in the Sigmoid Colon / 대한소화기내시경학회지

Dieulafoy's lesions are characterized by a single large tortuous arteriole in the submucosa, and this arteriole does not undergo normal branching. These lesions are an uncommon cause of massive, sometimes fatal gastrointestinal bleeding; this had been reported to be the cause of 0.3~1.5% of the cases of major gastrointestinal bleeding. The lesions mainly occur in the proximal stomach, but they may occur in all parts of the gastrointestinal tract, including the small bowel, colon and rectum. Endoscopy is a common method for the diagnosis and treatment of Dieulafoy's lesions. However, in the case of a high risk lesion, angiography, laparoscopy or laparotomy can be performed instead. We experienced a rare case of bleeding from a Dieulafoy's lesion with pseudoaneurysm in the sigmoid colon. Angiography with embolization was performed, but the patient expired due to rebleeding. We report on this case along with a review of the relevant literature.

The relationship between the ApoB/ApoA-I ratio and non-alcoholic fatty liver disease in prediabetic patients / 대한내과학회지

BACKGROUND/AIMS: The apolipoprotein B/A-I ratio (ApoB/A-I) is a powerful clinical indicator of atherosclerosis. Although numerous reports have shown the effect of non-alcoholic fatty liver disease (NAFLD) on cardiovascular disease, few reports have examined the relationship between NAFLD and the ApoB/A-I ratio. The aim of the study was to determine the association between NAFLD and the ApoB/A-I ratio in prediabetic patients. METHODS: This cross-sectional study was performed with data obtained from 701 patients (mean age, 47.9+/-9.6 years) diagnosed with prediabetes. Serum lipid profiles including lipoprotein, apolipoprotein, and calculated ApoB/A-I ratio as well as metabolic syndrome parameters such as fasting glucose and insulin were measured in each subject. RESULTS: Among the 701 patients, 340 (48%) had NAFLD. The number of male patients was 490 (NAFLD+, 276; and NAFLD-, 214). The odds ratios for the prevalence of NAFLD increased according to the quartiles of the ApoB/A-I ratio (1.886, 2.245, and 2.587) (p<0.001). CONCLUSIONS: The prevalence of NAFLD correlated with high ApoB/A-I ratio, suggesting that NAFLD increases the risk for atherosclerosis progression in male prediabetic patients.

A Case of Gastric Adenocarcinoma Mimicking a Gastrointestinal Stromal Tumor / 대한소화기내시경학회지

Gastric adenocarcinoma is the second most common cause of cancer death worldwide, but there are some geographical differences in its incidence. Gastointestinal stromal tumor (GIST) is an uncommon disease with a wide spectrum of aggressive behavior. These two tumors have a distinct pathogenesis. GIST is frequently identified as an incidental lesion found by routine endoscopy or in resection specimens that are removed for other reasons. We report a case of a gastric adenocarcinoma mimicking GIST in a 79-year-old woman. GIST was suggested by endoscopic ultrasonography and computed tomography scanning, but gastric adenocarcinoma was confirmed by gastroduodenoscopic biopsy. We performed a subtotal gastrectomy with Billroth I, lymph node dissection and transverse colon segmentectomy, and a 15.0x7.5x5.5 cm-sized gastric tumor was confirmed pathologically. Immunohistochemistry was positive for carcinoembryonic antigen and focal weakly positive for cytokeratin7 and cytokeratin20.

A Case of Successful Management of Paraquat Poisoning with Severe Pulmonary Fibrosis

Paraquat, a potent herbicide, has caused many fatalities through indiscriminate use and suicides. With ingestion of more than one mouthful of 20% paraquat, death is usually caused by pulmonary fibrosis. We experienced a case of paraquat poisoning with severe pulmonary injury. The patient had swallowed about two mouthfuls of 24% commercial paraquat. Hemoperfusion was done within a few hours after ingestion, and then combination therapy with several antioxidants, steroids, and diuretics was given. Initially, ground glass opacities, consolidation, and irregular lines appeared in the patient's high resolution computed tomography (HRCT). Several months later, lung lesions had improved. The improvement has continued until recently.