Gastric Yolk Sac Tumor: A Case Report and Review of the Literature

Gastric yolk sac tumors are extremely rare and their prognosis is poor; most patients have widespread metastases at the time of diagnosis. The treatment of gastric yolk sac tumors consists of aggressive chemotherapy combined with radiotherapy and surgery. Here, we first report a case of gastric yolk sac tumor presenting as an early gastric cancer that was cured after a gastrectomy with lymphadenectomy.

Our Experience of Gastritis Cystica Profunda Cases and Its Clinical Study / 대한소화기내시경학회지

BACKGROUND/AIMS: Gastritis cystica profunda (GCP) is a rare disease that is characterized by a hyperplastic and cystic dilatation of the pseudopyloric gland with submucosal invasion. GCP is regarded as a benign lesion. However, there is some controversy regarding its malignant potential. This study reviewed the clinical features and association with malignancy. METHODS: From January 2001 to June 2005, 1,010 cases of resected and 1,228 cases of an endoscopic mucosal resection or polypectomy were examined. RESULTS: Thirty-nine cases (1.7%) were confirmed pathologically and were not associated with prior gastric surgery mostly. The mean age was 60.0+/-11.4 years old and there were 29 male patients. The body was most commonly located on the longitudinal axis (57.1%). Eleven cases (28.2%) were not associated any other gastric lesion, the majority of which were the polypoid type (82.0%). However, two cases were found as a hypertrophic mucosal fold, and a submucosal tumor, respectively. Seventeen cases (43.6%) were associated with early gastric cancer. CONCLUSIONS: Despite its rarity, GCP should be considered when an endoscopically polypoid lesion or submucosal tumor (SMT) is found. Because of its association with early gastric cancer or adenoma, more study will be needed to examine the relationship between GCP and gastric carcinogen

Clinicopathological Features and Differences of p53 and Ki-67 Expression in Adenosquamous and Squamous Cell Carcinomas of the Stomach / 대한소화기학회지

BACKGROUND/AIMS: This study reviewes the clinicopathological features, prognosis, and differences in the expression of p53 and Ki-67 immunochemical staining in squamous cell and adenosquamous carcinoma of the stomach. METHODS: From January 1995 to June 2005, 2,282 cases of gastric carcinoma were resected surgically in our hospital and 191 additional cases were resected by endoscopic mucosal resection. Retrospective pathologic review and immunochemical staining of p53 and Ki-67 were performed. RESULTS: The study consists of eight cases (0.032%) of primary squamous cell carcinoma (one case) and adenosquamous carcinoma (seven cases) without early gastric cancer. Six cases (75.0%) were male and two cases were female. The mean age was 66 year-old. The clinical presentation and physical findings did not differ from those of adenocarcinoma. The mean tumor size was 5.2+/-1.7 cm. Macroscopically, five were Borrmann type 3 (62.5%) and three were type 2. At the initial diagnosis, six (75%) were stage IV based on TNM tumor staging. Six cases (75%) progressed despite the therapy while two cases responded to the treatment. The median survival time was 11.0 months (range 4.3+/-17.7). Overexpression of p53 was seen in five cases (62.5%) and their survival was poor when compared to the p53-negative group (p=0.04). The mean Ki-67 labeling index was 70.0+/-20.8%, and was not associated with p53 staining (p>0.05). CONCLUSIONS: Adenosquamous and squamous cell carcinoma of the stomach are very rare. They tend to be at advanced stages on initial diagnosis, and progress rapidly. They show p53 protein overexpression and high Ki-67 labeling index, which might be related to poor prognosis.

Early duodenal carcinoma successfully resected by endosopic mucosal resection / 대한내과학회지

Primary duodenal adenocarcinoma is rare disease with a poorly defined natural history. It represents less than 0.35% of all gastrointestinal tract malignant neoplasms and accounts for up to 33 to 45% of small bowel cancers. Diagnosis is always late because of the non-specific symptoms, consequently leading to poor prognosis. Surgical resection is the only potentially curative treatment, but not all patients whose tumor is removed necessarily survive long term. Recent widespread use of endoscopy has increased early detection of duodenal adenocarcinoma. Thanks to early detection, duodenal adenocarcinoma can now be treated endoscopically, which allows the patient's quality of life to be maintained. We have experienced one case of the primary early duodenal adenocarcinoma of the first portion, which was diagnosed by biopsy with endoscopic examination as part of a routine medical evaluation and was resected by endoscopic mucosal resection technique. We report the first primary early duodenal adenocarcinoma successfully treated by EMR method in Korea.

Long-Term Outcome of Endoscopic Balloon Dilatation of Benign Pyloric Stricture / 대한소화기내시경학회지

BACKGROUND/AIMS: Balloon dilatation is a useful alternative to surgery in patients with benign pyloric stenosis. However, little data are available on the long-term outcome of the procedure. This report was attempted to determine the safety and efficacy of endoscopic balloon dilatation for 14 patients with gastric outlet obstruction caused by duodenal ulcer. METHODS: Review of medical records or telephone interview was performed retrospectively. RESULTS: Follow-up was conducted for median 18.5 months (3-48 months). Gastric outlet strictures had a median diameter 6 mm (range, 2-9 mm). Five (35.7%) patients had active ulcer. 12 mm to 18 mm balloons were inflated a median of 1 times (range, 1-4 times) for a median of 4 minutes (range, 1-11 minutes). Thirty-two procedure (1.5/patient) were performed; 9 patients (64.3%) had one treatment and 5 patients (35.7%) had multiple treatment. Immediate symptomatic relief was achieved in 13 patients (92.8%) and 7 patients (50%) achieved sustained symptomatic relief. Dilatation failed only in 2 patients (14.3%) ultimately and both recovered by palliative bypass surgery. No complication was noted during treatment. CONCLUSIONS: Endoscopic balloon dilatation is safe and effective for most patients with gastric outlet obstruction induced by duodenal ulcer. And due to limitation of retrospective aspect of this report, further prospective, randomized studies must be performed.

The Comparative Study of Ligation and Histoacryl(R) Injection in Gastric Varix Bleeding / 대한소화기내시경학회지

BACKGROUND/AIMS: The variceal bleeding has high rebleeding rate, and mortality rate was higher in gastrix varix. Managements of variceal bleeding were included such as drugs, endoscopic procedures, surgical management and radiological intervention. Recently histoacryl(R) injection method has been introduced. We have compared the effects of the endoscopic ligation and Histoacryl(R) injection therapy (HAI) in patient with gastric variceal bleeding. METHODS: We analyzed the effects of hemostasis, complications, rebleeding rates, and survival rates in gastric varix bleeding of 22 patients with Histoacryl(R) injection therapy and 20 patients with endoscopic ligation therapy, from January 1995 to March 1999. RESULTS: There were no difference in the complication rate between the 2 stretigies (12/14). Most common complication was chest pain in EVL group, but fever was common in HAI group. Also early and post rebleeding rates were not different in both groups. The main cause of death during follow up period was rebleeding in both groups. The survival rates were 65.0% in EVL group and 77.0% in HAI group (p>0.05, duration: 23+/-2, 28+/-4 month), and there was no difference in mortlity rate (p=0.77). CONCLUSIONS: There were no difference in the hemostatic effect, complications, rebleeding rate and survival rate in EVL group and HAI group. However, evaluation of larger numbers of patients and prospective studies were needed to define the effectiveness and complications of these therapies.

The Correlation of Bile Acid and Gastroduodenal Lesions in Hepatobiliary, Pancreas Diseases / 대한소화기내시경학회지

BACKGROUND/AIMS: Various gastric and duodenal lesions were observed in patients with obstructive biliary disease. Previously we knew that serum bile acid level may be correlated with gastric and duodenal lesion in obstructive biliary disease. Now we will confirm the correlation of the serum bile acid concentration and gastro-duodenal lesions. METHODS: A clinical analysis of the endoscopic finding and serum bile acid concentration was carried out in 120 patients with hepatobiliary and pancreas disease, from January 1999 to December 1999, in the department of Internal medicine, Chungnam National University Hospital. RESULTS: 1) In the 120 patients, sex distribution showed predominance in the males (84/36). 2) Disease profiles were included, liver cirrhosis (66.7%), hepatocellular carcinoma (38.3%), pancreatic cancer (15.8%). 3) The gastroduodenal lesions were erosive gastritis (33.3%), gastric ulcer (20.0%), duodenal ulcer (16.7%) in orders. 3) According to serum bile acid concentration, gastroduodenal lesions were more than in elevated bile acid concentration group. CONCLUSIONS: Gastroduodenal lesions in hepatobiliary and pancreas disease patients were related with serum bile acid concentration.

A Case of Acute Acalculous Cholecystitis and Acute Hepatitis due to Salmonella Typhi / 대한간학회지

Salmonella infection is an acute systemic disease that can lead to diffuse organ involvement with septicemia and cause clinically a variety of complications. But acute acalculous cholecystitis and acute hepatitis with jaundice due to Salmonella typhi occurred rarely. A 42 years old female was admitted with fever, chilling sensation and abdominal pain. On admission, the blood, stool, bile acid and bone marrow cultures were positive for Salmonella typhi. The patient had subsequently developed acute acalculous cholecystitis and acute hepatitis with jaundice. Her symptoms and signs resolved after cholecystostomy, parenteral antibiotic (ciprofloxacin) and supportive treatment. We report a case of acute acalculous cholecystitis and acute hepatitis with jaundice in a 42-ear-ld female, whose conditions were recovered completely after cholecystostomy and administration of ciprofloxacin, with reviewing the literatures.