A Case of a Primary Esophageal Bezoar after a Total Gastrectomy / 대한소화기내시경학회지

An esophageal bezoar, although uncommon, is now recognized as a distinct clinical entity. An esophageal bezoar is rare but can form due to regurgitation of a gastric bezoar, motor disorder or anatomical abnormality, or following a gastrectomy. In general, bezoars are most often found in the stomach, and are formed by the accumulation of foreign ingested materials, including vegetable material and hair. In Korea, no case of a primary esophageal bezoar has been reported after a total gastrectomy. We report a case of an endoscopically treated primary esophageal bezoar that occurred after a total gastrectomy, without complications.

A Case of Early Gastric Adenocarcinoma and Intraabdominal Schwannoma in a Patient with Neurofibromatosis Type I / 대한소화기내시경학회지

Neurofibromatosis is an autosomal dominant hereditary disorder with an overall incidence of one in 3,000~4,000, and type 1 (Von Recklinghausen's neurofibromatosis) characterized by the presence of multiple cutaneous neurofibromas, axillary and groin freckling, and cafe- au-lait spot. The neurofibromatosis type 1 gene is a tumor suppressor gene. Patients with the neurofibromatosis type 1 are at increased risk of developing nervous system neoplasm, including plexiform neurofibromas, optic gliomas, ependymomas, meningiomas, astrocytomas, and pheochromocytomas. Neurofibromas may undergo secondary malignant degeneration and sarcomatous changes. Patients with neurofibromatosis type 1 show a high incidence of Wilm's tumor, rhabdomyosarcoma, nonlymphocytic leukemia, and pheochromocytoma but the gastrointestinal involvement appears to be relatively rare and usually consists of neurofibroma, ganglioneuroma, and leiomyoma. We have identified a case of early gastric adenocarcinoma and intraabdominal schwannoma in a 65-year-old man afflicted with neurofibromatosis type 1.

A Case of Anal Gland Cyst Treated by Endoscopic Resection / 대한소화기내시경학회지

The anal canal is the most distal part of the gastrointestinal tract, and it is developed and formed during the embryonic period. Infection is the most common disease process that occurs around the anorectum, yet tumors or cysts are occasionally encountered. The abnormal development of these parts of the gastrointestinal track during the embryonic period can result in congenital lesions that are discovered in young children or adults. A 72-year-old woman presented to us with postprandial lower abdominal discomfort and fecal incontinence. An anorectal mass was felt on the rectal examination. The colonoscopy demonstrated a submucosal tumor that was closely located to the anorectal junction. The tumor was excised with a snare and it was diagnosed as an analgland cyst due to the histologic features. It is necessary to differentiate anal gland cyst from the other diseases that have submucosal characters, such as carcinoid tumor.

A Case of Primary Esophageal Small Cell Carcinoma with Gastric Metastasis / 대한소화기내시경학회지

Gastric metastasis of malignant tumors is relatively rare but has been reported in cases of malignant melanoma, lung cancer, breast cancer and squamous cell carcinoma of the esophagus. Primary small cell carcinoma of the esophagus is very rare and is an extremely aggressive tumor. Regional lymph node involvement, and distant metastasis to other organs including liver, bone, skin, lung, bone marrow, and brain are common at the time of initial diagnosis. To date, there has been no case reported of gastric metastasis from primary esophageal small cell carcinoma. A 72-year-old man presented with dysphagia for 2 months. An esophagogastroduodenoscopy revealed esophageal carcinoma with a submucosal tumor in the upper body of the stomach. Pathologic examination revealed an esophageal small cell carcinoma, and gastric submucosal infiltration of the small cell carcinoma was noted. We report a case of primary esophageal small cell carcinoma with submucosal tumor like gastric metastasis.

A Case of Malakoplakia Treated by Antibiotics in the Rectum / 대한소화기내시경학회지

Malakoplakia is a rare chronic inflammatory process, most commonly affecting the urinary tract. This entity was first described by Michaelis and Gutman in 1902. As of 1995, only 85 cases of malakoplakia of the gastrointestinal tract has been reported. The common sites of colonic involvement are the rectum, sigmoid, and right colon, in descending order of frequency. The most common disease associated with malakoplakia is colorectal carcinoma. Surgical resection is the treatement of choice for cases associated with carcinoma or complications. But in other cases, medical treatment could be attempted. Antimicrobial drugs, such as trimethoprime-sufamethoxazole, rifampin, or as recently suggested, ciprofloxacin can be used. We report a case of rectal malakoplakia treated by ciprofloxacin with a review of literatures.

Relationships Between the Expressions of CDX1 and CDX2 mRNA and Clinicopathologic Features in Colorectal Cancers

BACKGROUND: CDX1 and CDX2 are members of the caudal-type homeobox gene family and control the proliferation and differentiation of intestinal mucosal cells. Their expressions are commonly reduced in colorectal cancer, but reports about the relationships between their expressions and clinicopathologic features are rare. The aim of this study was to examine the expressions of CDX1 and CDX2 mRNAs in colorectal cancers and to assess the relationships between their expressions and clinicopathologic features. METHODS: CDX1 and CDX2 mRNA expressions were analyzed by real-time polymerase chain reaction in 48 colorectal cancers and in adjacent non-tumorous normal mucosal tissue. RESULTS: CDX1 and CDX2 mRNA expressions were significantly reduced in colorectal cancer tissues versus normal mucosal tissues (p=0.001, p=0.042, respectively). As compared with paired normal mucosal tissues, colorectal tissues showed reduced CDX1 mRNA expression in 64.6% (31/48) and reduced CDX2 mRNA expression in 66.7% (32/48) of cases. A statistically significant positive correlation was found between the expressions of CDX1 mRNA and CDX2 mRNA in colorectal cancer (r=0.543, p< 0.001). However, the expressions of CDX1 and CDX2 mRNAs were not related to age, sex, cancer location, differentiation, lymphatic or vascular invasion, lymph node metastasis, stage or serum carcinoembryonic antigen level. CONCLUSIONS: CDX1 and CDX2 mRNA expressions were found to be significantly reduced in colorectal cancers, but these expressional changes were not found to be related to clinicopathologic features.

A Case of Ileocecal Burkitt`s Lymphoma with Intussusception in an Adult / 대한소화기내시경학회지

Burkitt`s lymphoma is a distinct pathologic entity characterized by a diffuse proliferation of small, noncleaved cells of B-lymphocytes origin. It was first reported as "jaw sarcoma" in East African children and described as endemic in tropical Africa. Burkitt`s lymphoma usually occurs in youth and children, but it is very rare in an adult gastrointestinal tract of an adult. We recently experienced an unusual case of Burkitt`s lymphoma in a 69-year-old male with lower abdominal pain and a mass. A colonoscopy and abdominal CT scan detected an ileocecal fungating mass with intussusception, and the histologic examination of the resected and biopsy specimens showed infiltration of medium-sized lymphoblasts with characteristic "starry sky" machrophages. So we report it with a brief review of literatures.

A Case of Gastric Lymphoepithelioma-like Carcinoma Presenting as a Submucosal Tumor / 대한소화기내시경학회지

Lymphoepithelioma-like carcinoma (LELC) occurs in esophagus, stomach, bile duct, salivary gland, lung, uterus, skin, and so on. The incidence of gastric LELC is 1~4 percents of all stomach cancers. Gastric LELC has a lymphoid stroma and shows a good prognosis and high association with Epstein-Barr virus. We experienced a case of patient with gastric LELC. The patient was 49-year-old woman. and the endoscopic finding showed a submucosal tumor with central erosion. The histologic findings of endoscopic biopsies were suggestive of low grade MALT lymphoma. but the histologic findings of the surgical specimen were consistent with gastric LELC. We report a case of gastric LELC presenting as a submucosal tumor, with a brief review of the literature.

A Pancreaticobiliary Maljunction (New Komi Classification, Type IIIc3) with a Choledochal Cyst, Common Bile Duct Stones and Pancreatic Duct Stones / 대한소화기내시경학회지

A pancreaticobiliary maljunction (PBM) is synonymous with abnormal union of the pancreaticobiliary ducts (AUPBD), anomalous arrangement of the pancreaticobiliary ductal system, etc. PBM is a congenital anomaly defined as a union of the pancreatic and biliary ducts located outside the duodenal wall. Free reflux of pancreatic juice up to the biliary tree and/or bile up to the pancreatic duct occurs. Accordingly, various pathologic conditions occur in the biliary tract and pancreas. Although the common channel is long in most cases, some patients have more complicated junctions of the pancreatic and bile ducts. We report a case of PBM with choledochal cyst and stones of the pancreaticobiliary duct in a 39 year-old woman.

A Case of Gastric Wall Abscess Associated with Gastritis Cystica Profunda / 대한소화기내시경학회지

Gastric wall abscess is a form of phlegmonous gastritis and has been very rarely reported. The pathogenesis of gastric wall abscess is thought to involve a focal injury to the gastric mucosa such as a penetrating trauma from an ingested foreign body or an endoscopic biopsy, where by bacterial infection occurs. Gastritis cystica profunda is a rare disease in which hyperplasia of mature glandular epithelium extends into the tissues beneath the submucosa. It shows multiple small cysts in the mucosa and submucosa of the stomach. To our knowledge, the association of gastric wall abscess with gastritis cystica profunda has never been reported yet. We, recently, experienced a case of gastric wall abcess associated with gastritis cystica profunda. Herein, we report it with a brief review with literatures.

Emphysematous Gastritis Developed in a Patient with Klatskin's Tumor / 대한소화기내시경학회지

Emphysematous gastritis is a rare disease characterized by air in the wall of the stomach due to gas-forming microorganisms. This lethal entity was first described by Fraenkel in 1889. Forty-six cases have been reported so far in the literature. The predisposing factors include corrosive ingestion, immunocompromized state, alcohol abuse, cancer, diabetes and so on. Computed tomography is the procedure of choice for early diagnosis. Only prompt diagnosis and treatment can avoid mortality. Initial antibiotic therapy should cover gram-negative organisms and anaerobes. We report a case of emphysematous gastritis in a 41-year-old man with Klatskin's tumor.

Relationship of CDX1 mRNA and CDX2 mRNA expression and clinicopathologic features in colorectal cancers / 대한내과학회지

BACKGROUND: CDX1 and CDX2, members of the caudal-type homeobox gene family, control proliferation and differentiation of intestinal mucosal cells. Their expression is reduced commonly in colorectal cancers, but reports about the relationship between their expression and the clinicopathologic features are rare. The aim of this study was to examine CDX1 mRNA and CDX2 mRNA expression in colorectal cancers and to assess the relationship between their expression and the clinicopathologic features. METHODS: CDX1 mRNA and CDX2 mRNA expression were analyzed by real-time polymerase chain reaction in 48 colorectal cancers and their adjacent non-tumorous normal mucosas. RESULTS: CDX1 mRNA and CDX2 mRNA expression were decreased significantly in colorectal cancers than in normal mucosas (p=0.001, p=0.042, respectively). In comparison with paired normal mucosas, colorectal cancers showed decreased CDX1 mRNA expression in 64.6% (31/48) and decreased CDX2 mRNA expression in 66.7% (32/48). There was a statistically significant correlation between CDX1 mRNA and CDX2 mRNA expression in colorectal cancers (r=0.543, p<0.001). CDX1 mRNA and CDX2 mRNA expression were not related to age, sex, location of cancer, differentiation, lymphatic or vascular invasion, lymph node metastasis, stage and serum carcinoembryonic antigen level in colorectal cancers. CONCLUSION: CDX1 mRNA and CDX2 mRNA expression were decreased significantly in colorectal cancers, but were not related to the clininopathologic features.

A Case of Extramedullary Plasmacytomas of Posterior Mediastinum, and Gingiva associated with Fulminant Hepatic Failure, which Developed in the Course of Multiple Myeloma / 대한혈액학회지

Multiple myeloma is usually restricted to bone marrow, but extramedullary involvement can occur in the form of plasmacytomas. Several cases of multiple myeloma which developed into mutiple extramedullary involvements have been reported. We report a case of extramedullary plasmacytomas of posterior mediastinum, and gingiva, which developed in the course of mutiple myeloma in a 57-year-old man. The patient progressed to fulminant hepatic failure resulting in rapid fatal outcome.

Clinical Characteristics of a Cutaneous Anthrax Outbreak Occurred in the Chang-Nyeong, Kyoungsangnamdo, Korea / 감염

BACKGROUND: Anthrax is a zoonotic disease caused by Bacillus anthracis, a gram-positive, spore- forming bacillus. Several cases of anthrax have been reported in Korea; it occurred as an outbreak after ingesting raw meat of an anthrax-infected cow. Among those reported cases, most of them were of gastrointestinal anthrax and a case report of cutaneous anthrax was also included. An outbreak of anthrax occurred in a village of Chang-Nyeong, Kyoungsangnamdo, Korea on July, 2000. The source of infection was the meat of an infected cow. We investigated clinical features and epidemiologic characteristics of the outbreak. METHODS: Subjects were inhabitants and visitors who were exposed to the contaminated meat by ingestion or handling. Diagnosis and classification of clinical forms of anthrax were done according to the CDC case definition. A group of investigators composed of epidemiologists and medical doctors visited the village, and examined the residents and visitors exposed to contaminated meat by interviewing with standard questionare and physical examination. RESULTS: Among 40 persons who contacted meat by ingestion and/or handling, 5(12.5%) developed cutaneous anthrax and 2 of them died; 4 were confirmed cases and 1 was suspected case. B. anthracis was isolated from the vesicular lesions of hands or forearms in those 4 confirmed cases and, in one patient who died of meningitis, the organism was also isolated in blood culture. All patients were of cutaneous anthrax, 3 were recovered and 2 died due to complications : one of meningitis and the other of intracranial hemorrhage. All 40 people consumed meat in cooked state not in raw. No anthrax occurred in 28 persons who only ingested cooked meat without any contact with the raw meat. Five cases of cutaneous anthrax were developed among those 12 persons who handled raw meat in preparation for cooking. CONCLUSION: Anthrax should be suspected in patients with cutaneous lesions of vesicle or eschar on their exposed area after contacting animals or animal products, especially in an outbreak.

Clinical significance of chromosomal abnormalities and immunophenotype in adult acute myelogenous leukemia / 대한내과학회지

BACKGROUND: This study was performed to identify the incidence and prognostic significance of chromosomal abnormalities as well as clinical significance of immuno phenotype in patients with acute myelogenous leukemia (AML). METHODS: The chromosomal abnormalities, immunophenotype and their hematologic/clinical correlations were studied in 68 patients with de novo AML admitted to Pusan National University Hospital between January 1996 and December 2000. 47 of 68 patients had received induction chemotherapy and we analysed the response of treatment according to the karyotype pattern and immunophenotype. RESULTS: The karyotypic patterns were divided into three groups; favorable (t (8;21), t (15;17) and inv (16); n=19, 28%), poor (-5, del (5q), -7, der (1;7), abn (3q) and complex karyotypes; n=11, 16%) and intermediate group (other abnormalities or normal karyotype; n=38, 56%). The incidence of chromosomal abnormalities was 56% (38/68) and overall complete remission (CR) rate of 47 evaluable patients was 64%. The CR rates of favorable, intermediate and poor groups were 88%, 59% and 44%, respectively (p=0.021). The median survival time of all patients was 7 months, those of poor and intermediate groups being 2 months and 6 months. The median survival time of favorable group was not reached (p=0.008). The overall 5 year survival rate was 38% and those of favorable, intermediate and poor groups were 68%, 31% and 9%, respectively (p=0.009). Expression of CD7, CD14, CD33, CD34 and terminal deoxynucleotidyl transferase had no impact on CR rate and overall survival. In multivariate analysis, both age and chromosomal abnormalities influence significantly on prognosis. CONCLUSION: Cytogenetic study is important in predicting the outcome of patients with AML. And the treatment must be tailored according to the result of cytogenetics such as this study.

A case of pachydermoperiostosis with peptic ulcer disease / 대한내과학회지

We experienced a Korean patient with complete form of pachydermoperiostosis. He presented with typical features consisting of clubbing with spade like enlargement of the hand and feet, thickening of facial skin and scalp, irregular thickening of cortex with periosteal new bone formation involving radii, ulnae, tibiae, and fibulae. Classically, pachydermoperiostosis is characterized by a triad of finger clubbing, periostitis, skin and soft tissue changes, giving an acromegaloid look. A variety of associated abnormalities have been described such as cranial suture defects, female escutcheon, bone marrow failure. There are a few reports documenting gastric ulcer, hypertrophic gastropathy and Crohn's disease as accompanying diseases. The patient had upper gastrointestinal bleeding caused by hemorrhagic gastritis and duodenal ulcer. A case is herein reported of pachydermoperiostosis accompanied by peptic ulcer disease.

A Case of Dermatomyositis Associated with Thyroid Cancer / 대한류마티스학회지

Dermatomyositis is an autoimmune connective tissue disorder characterized by symmetrical proximal muscle weakness due to chronic inflammation and degeneration of skeletal muscle. Cancer occurs in patients with dermatomyositis with a frequency estimated between 15~20%. The common sites of malignancy are stomach, breast, ovary, lung and etc. The cases that have been reported so far are dermatomyositis associated with lymphoproliferative disorder and cancer of colon, liver, pancrease, pharynx, uterine cervix, testis, kidney. But dermatomyositis associated with thyroid cancer has not been reported in Korea. We, the authors, experienced a case of dermatomyositis associated with the thyroid cancer and as such we are reporting the case with literature reviews.