Risk Factors for Dieulafoy Lesions in the Upper Gastrointestinal Tract

BACKGROUND/AIMS: The purpose of this study is to verify the risk factors associated with Dieulafoy lesion formation in the upper gastrointestinal tract. METHODS: A case-control study was performed by reviewing the electronic medical records of 42 patients who were admitted to a tertiary medical center in the Daejeon region for Dieulafoy lesions from September 2008 to October 2013, and the records of 132 patients who were admitted during the same period and who underwent endoscopic examination for reasons other than bleeding. We analyzed clinical and endoscopic findings retrospectively, and searched for risk factors associated with Dieulafoy lesion formation. RESULTS: All 42 patients diagnosed with Dieulafoy lesion had accompanying bleeding, and the location of the bleeding was proximal in 25 patients (59.5%), the middle portion in seven patients (16.7%), and distal in 10 patients (23.8%). Antiplatelet agents (p=0.022) and alcohol (p=0.001) use showed statistically significant differences between the two groups. The odds ratios (95% confidence intervals) of the two factors were 2.802 (1.263 to 6.217) and 3.938 (1.629 to 9.521), respectively. CONCLUSIONS: This study showed that antiplatelet agents and alcohol consumption were risk factors associated with Dieulafoy lesion formation in the upper gastrointestinal tract.

Risk Factors for Dieulafoy Lesions in the Upper Gastrointestinal Tract

BACKGROUND/AIMS: The purpose of this study is to verify the risk factors associated with Dieulafoy lesion formation in the upper gastrointestinal tract. METHODS: A case-control study was performed by reviewing the electronic medical records of 42 patients who were admitted to a tertiary medical center in the Daejeon region for Dieulafoy lesions from September 2008 to October 2013, and the records of 132 patients who were admitted during the same period and who underwent endoscopic examination for reasons other than bleeding. We analyzed clinical and endoscopic findings retrospectively, and searched for risk factors associated with Dieulafoy lesion formation. RESULTS: All 42 patients diagnosed with Dieulafoy lesion had accompanying bleeding, and the location of the bleeding was proximal in 25 patients (59.5%), the middle portion in seven patients (16.7%), and distal in 10 patients (23.8%). Antiplatelet agents (p=0.022) and alcohol (p=0.001) use showed statistically significant differences between the two groups. The odds ratios (95% confidence intervals) of the two factors were 2.802 (1.263 to 6.217) and 3.938 (1.629 to 9.521), respectively. CONCLUSIONS: This study showed that antiplatelet agents and alcohol consumption were risk factors associated with Dieulafoy lesion formation in the upper gastrointestinal tract.

A Case of Gastric Leiomyosarcoma with Multiple Metastases / 대한소화기학회지

Leiomyosarcoma is an uncommon tumor that originates from various organs, including uterus, kidney, retroperitoneum, and soft tissues. In particular, leiomyosarcoma of the stomach is extremely rare. Only 9 cases have been reported worldwide since the discovery of KIT-activating mutation. A 48-year-old woman was admitted to our hospital with abdominal discomfort and generalized weakness. Upon detection of multiple nodules in both lung on chest posterior-anterior radiograph taken at the time of admission, chest CT was performed and it revealed multiple mass lesions in the lung, liver, and pancreas along with multiple lymph node metastases. On endoscopic examination, a 2.0 cm sized ulcerofungating mass lesion was found on the stomach body. Biopsy was performed and the mass lesion proved to be leiomyosarcoma confirmed by immunohistochemical staining. Chemotherapy was thus initiated, but the patient died after one year due to tumor progression. Our experience suggests that leiomyosarcoma can manifest aggressive behavior in its early stage. Herein, we report a case of gastric leiomyosarcoma with multiple metastases along with review of relevant literature.

Adenosquamous Carcinoma in Distal Transverse Colon in a 72-Year-Old Female Patient

Adenocarcinoma accounts for most of the malignant tumors which originate from the colon, whereas the adenosquamous carcinoma is rather rare, totaling to about 0.06% of all colon cancers. Herein, we present a case of adenosquamous carcinoma of the transverse colon with hepatic metastasis. The patient is a 72-year-old woman who is presented with a chief of lower abdominal pains. Her colonoscopy has indicated an ulcerofungating mass about 4 cm x 3 cm in size in the distal transverse colon, and the biopsy confirmed her diagnosis of adenosquamous carcinoma. An abdominopelvic computed tomography shows an circumferential enhancing mass on her distal transverse colon with three hepatic metastatic nodules. Transverse colectomy and hepatectomy are later being performed.

A Rare Case of Gastric Carcinosarcoma with Neuroendocrine Differentiation

Carcinosarcoma of the stomach is a rare biphasic tumor that consists of both carcinomatous and sarcomatous components. In the gastrointestinal tract, carcinosarcoma is most frequently seen in the esophagus and rarely in the stomach. Tubular or papillary adenocarcinomas are common carcinomatous components, whereas mesenchymal sarcomatous components may vary. Neuroendocrine carcinomatous differentiation in carcinomatous components is extremely rare. We report a 62-year-old female patient with a history of dyspepsia for one-month-history. Endoscopic findings showed a ulcerofungating lesion, which infiltrated from the posterior wall of the antrum to the posterior wall of the gastric angle. Radical subtotal gastrectomy was performed. In the resected specimen, immunohistochemical studies showed two positive reactions for epithelial and mesenchymal markers. Based on the above findings, the patient was diagnosed with a gastric carcinosarcoma with neuroendocrine differentiation.

A Rare Case of Gastric Carcinosarcoma with Neuroendocrine Differentiation

Carcinosarcoma of the stomach is a rare biphasic tumor that consists of both carcinomatous and sarcomatous components. In the gastrointestinal tract, carcinosarcoma is most frequently seen in the esophagus and rarely in the stomach. Tubular or papillary adenocarcinomas are common carcinomatous components, whereas mesenchymal sarcomatous components may vary. Neuroendocrine carcinomatous differentiation in carcinomatous components is extremely rare. We report a 62-year-old female patient with a history of dyspepsia for one-month-history. Endoscopic findings showed a ulcerofungating lesion, which infiltrated from the posterior wall of the antrum to the posterior wall of the gastric angle. Radical subtotal gastrectomy was performed. In the resected specimen, immunohistochemical studies showed two positive reactions for epithelial and mesenchymal markers. Based on the above findings, the patient was diagnosed with a gastric carcinosarcoma with neuroendocrine differentiation.