Significance of Expression of Cell Cycle Related Proteins and Apoptosis Related Proteins in Follicular Adenoma and Follicular Carcinoma of Thyroid

PURPOSE: To explore the role of cell cycle regulators and apoptosis regulators in carcinogenesis of thyroid, the expression of cell cycle related proteins (cyclin D1, Ki-67) and apoptosis related proteins (survivin, caspase 3, bcl-2, p53) were investigated in follicular adenoma and follicular carcinoma of thyroid. METHODS: The following formalin-fixed paraffin embedded surgical specimens were immunohistochemically stained by avidin-biotin complex method for cyclin D1, Ki-67, survivin, caspase 3, bcl-2, p53; 15 cases of follicular adenoma (FA), 31 cases of minimally invasive follicular carcinoma (MIFC) and 12 cases of widely invasive follicular carcinoma (WIFC). RESULTS: The overexpression of six gene products in follicular neoplasms of thyroid was noted in varying frequency. Among them, increased Ki-67, caspase 3 index and overexpression of bcl-2 were noted in statistically significant, widely invasive follicular carcinoma than that of follicular adenoma and minimally invasive follicular carcinoma. CONCLUSION: These results suggest that the overexpression of Ki-67, caspase 3, bcl-2 appear to play an important role during follicular carcinogenesis of thyroid. In addition, the overexpression of these proteins is related to the differentiation of MIFC and WIFC. However, further molecular genetic studies are required to determine the interrelationships between the expression of cell cycle related proteins and apoptosis related proteins.

Adrenal Ganglioneuroma Treated by Laparoscopic Surgery

Adrenal ganglioneuromas are rare benign tumors arising from the neural crest tissue of the sympathoadrenal nervous system. Because most of these tumors are hormonally silent and patients with them are often asymptomatic, they are often identified incidentally in patients undergoing abdominal imaging studies for unrelated reasons. Diagnosis of this entity is very difficult to make, with definitive diagnosis being based on histological examination. Surgical resection may be both diagnostic and therapeutic. A technique for laparoscopic adrenalectomy of benign adrenal tumors has recently been developed. If the tumor is excised with an adequate resection margin, the postoperative prognosis is very good. In this report, we describe two cases of adrenal ganglioneuroma that were treated using a laparoscopic resection procedure, and we also present a review of the pertinent literature.

Efficacy of Hepatic Arterial Infusion Therapy for Advanced Hepatocellular Carcinoma Using 5-Fluorouracil, Epirubicin and Mitomycin-C / 대한소화기학회지

BACKGROUND/AIMS: Prognosis of advanced hepatocellular carcinoma (HCC) treated by conventional therapies has been considered to be poor. The aim of this study was to evaluate the efficacy of hepatic arterial infusion therapy (HAIT) using FEM (5-fluorouracil, epirubicin, mitomycin-C) regimen for advanced HCC. METHODS: Eighteen patients received repeated HAIT using an implanted drug delivery system. Of the 18 patients, 8 patients had HCC with portal vein tumor thrombosis, 9 patients had recurrent HCC after transarterial chemoembolization (TACE) and 1 patient after surgical resection. The patients received 5-fluorouracil (330 mg/m2, every week), epirubicin (30 mg/m2, every 4 weeks) and mitomycin-C (2.7 mg/m2, every 2 weeks). RESULTS: Mean age was 51 years. The response rate (complete response+partial response) by tumor size on abdominal CT was 38.9%. Survival ranged from 2 to 24 months and the median survival time was 8 months. The cumulative survival rate of responders group was significantly higher than non-responders group (p=0.0385). The mean levels of serum alpha-FP and PIVKA-II in responders group decreased after HAIT (3,179 ng/mL and 2,850 ng/mL) than before (11,218 ng/mL and 4,396 ng/mL), but not significantly. Chemotherapy-related side effects were nausea, vomiting and alopecia. Three patients had catheter-related complications. One patient developed gastric ulcer. CONCLUSIONS: HAIT using FEM regimen is a useful therapeutic option for patients with advanced HCC with portal vein tumor thrombosis or ineffective response to other therapies.

Clinical Review of Cholelithiasis after Gastric Resection in Gastric Cancer Patients

PURPOSE: An increased incidence of cholelithiasis has been widely reported following a truncal vagotomy and gastrectomy in benign peptic ulcer disease. However, there have been few studies on cholelithiasis following a gastrectomy in gastric cancer patients. Therefore, the incidence, influencing factors, natural course and whether a prophylactic cholecystectomy is required during a gastrectomy were investigated. METHODS: 1, 057 patients with gastric cancer, who received a gastrectomy at Chung-Ang University Hospital between January, 1992 and December, 2001, were reviewed. Of the 1, 057 patients, 591 were included in this study, with 420 and 46 patients excluded due to lack of follow-up after the gastrectomy and because they received a preoperative or concomitant cholecystectomy, respectively. Age, gender, extents of gastrectomy, anastomosis methods and cancer staging were investigated as factors for potential correlation with any incidence. Furthermore, the interval between the gastrectomy and the discovery of cholelithiasis and the number of patients receiving a cholecystectomy due to cholecystitis during the follow-up period were also studied. RESULTS: The preoperative prevalence of cholelithiasis was 7.22% (46/637). The incidence of cholelithiasis after a gastrectomy was 7.61% (45/591), with a mean duration of 32.13+/-28.18 months. There were no significant differences in the incidences of cholelithiasis according to age, gender, extents of gastrectomy or stage (P>0.05). 23 cases of cholelithiasis (50%) were detected within 24 months and 80% (36/45) of all cases developed within 48 months. Among the 45 gallstone patients, only 6 (13.33%) developed acute cholecy- stitis and received a cholecystectomy. CONCLUSION: The incidence of cholelithiasis after a gastrectomy was very low, and was independent of age, gender, and other influencing factors in our study. Therefore, close observation and follow-up evaluation would be helpful in the prevention and detection of cholelithiasis. Also further study will be needed on the relationship between the methods of anastomosis and the incidence of cholelithiasis. The clinical benefits of a prophylactic cholecystectomy during a gastrectomy should also be studied carefully.

Factors Associated or Related to with Pathological Severity of Nonalcoholic Fatty Liver Disease

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) has been more and more often regarded as a serious disorder, because nonalcoholic steatohepatitis (NASH), a part of NAFLD, may progress to the end stage of liver disease. Though an advanced age, obesity, diabetes mellitus (DM) etc. being not infrequent conditions in Korea, are known to exacerbate the severity of this disease, there are only a few Korean reports on this subject. The purpose of this study is to identify possible factors that might add up to the pathological severity of this disorder in Korean patients. METHODS: Of 60 patients with steatosis found at liver biopsy, 43 NAFLD patients were reviewed retrospectively after exclusion of other liver diseases. RESULTS: The cases of steatosis were mild, moderate, and severe in 9, 10, and 24 patients, respectively. The degree of necroinflammatory activity was mild, moderate, and severe in 33, 9, and 1 patients, respectively. There were no established factors directly related to these classes. As to fibrosis, the cases were classified as none, mild, moderate, severe, and cirrhotic in 9, 11, 16, 7, and 0 patients, respectively. The stage of fibrosis correlated with the age (p< 0.001), BMI (body mass index) (p=0.032), and the platelet count (p=0.009), but the presence of NASH was associated only with BMI (p=0.002) and obesity (p=0.001). CONCLUSION: It seems that there are no factors that are directly related to the degree of steatosis or necroinflammatory activity. BMI seems to be a unique factor directly related to both the severity of fibrosis and the presence of NASH. The age and the platelet count are factors that are directly related to the degree of fibrosis but not to the presence of NASH.

A Case of Duodenal Fistula Caused by Intestinal Tuberculosis / 대한소화기내시경학회지

Intestinal hemorrhage, fistula formation, and intestinal obstruction are the common complications associated with intestinal tuberculosis. However, duodenal fistula due to intestinal tuberculosis is very rare. We experienced a case of 26-year-old woman with a fistula in the duodenum referred to our hospital due to abdominal pain. Esophagogastroduodenoscopy showed a fistula at the duodenum with lymph node. After 2 months of anti-tuberculous medication, abdominal pain was improved and fistula size decreased. We report a case of fistula caused by duodenal tuberculosis.

A Case of Primary Small Cell Carcinoma in the Common Bile Duct / 대한소화기학회지

Extrapulmonary primary small cell carcinoma comprises approximately 4% of all small cell carcinoma. In the common bile duct, small cell carcinomas are extremely rare. We experienced a 60-year-old woman with small cell carcinoma arising in the common bile duct. Abdominal CT scan revealed an intraluminal mass in the proximal common bile duct and multiple lymphadenopathies. Microscopic examination of the tumor revealed proliferation of small monotonous anaplastic cells, which were characterized with hyperchromatic nuclei, high nuclear to cytoplasmic ratio, and frequent mitosis. By immunohistochemical stain, the tumor cells were strongly positive for chromogranin, synaptophysin, and CD56. We report this case with a review of literatures.

Esophageal Mucosal Desquamation with Hemorrhage in Bullous Pemphigoid: A Case Report / 대한소화기학회지

Bullous pemphigoid is a subepidermal blistering skin disease, usually occurred in the elderly. It is an autoimmune disease associated with circulating autoantibodies directed against structural components of hemodesmosome. Rarely, it can involve the esophagus, which can be complicated by upper gastrointestinal hemorrhage. We report a case of bullous pemphigoid with esophageal mucosal desquamation and hemorrhage in patient with chronic renal failure.

A case of primary hepatic angiosarcoma: Report of a case and review of previous Korean cases / 대한내과학회지

Primary hepatic angiosarcoma, which is malignant tumor originated from endothelial cell of vessel, is rare condition and is found at only one of fifty thousand autopsy cases. Six cases of hepatic angiosarcoma have been reported in Korea. Two of them were thought as be metastasized from spleen and other four were primary. In spite of foreign reports that lung and spleen is frequent metastatic sites of this tumor, metastatic case had not been reported in Korea yet. So we report a case of primary hepatic angiosarcoma presenting as hemoptysis and metastasized to lung and spleen with review of previously reported cases.

Gastric metaplasia and Helicobacter pylori infection of duodenal mucosa in duodenal ulcer / 대한내과학회지

BACKGROUND: The roles of gastric metaplasia and Helicobacter pylori (H. pylori) infection of duodenal mucosa in the pathogenesis of duodenal ulcer has been emphasized. Though there are a few reports which compared degree of these two risk factors between the duodenal ulcer and control groups, the reports which compared ulcer site with nonulcer site within ulcer group are rare. The aim of this study was to compare the frequencies of gastric metaplasia and H. pylori infection between both sites within ulcer group, as well as between both groups. METHODS: The active duodenal ulcer patients group (n=30) and control group (n=31) were selected. The frequency of gastric metaplasia and H. pylori infection were compared among the ulcer sites, the nonulcer sites of ulcer patients, and the intact duodenal mucosa of controls. RESULTS: The frequencies of gastric metaplasia and H. pylori infection were higher at ulcer sites than nonulcer sites within ulcer group, however, there were no differences between the nonulcer sites of ulcer group and control group. Positivities of H. pylori infection at metaplastic area were not different at 3 compared sites. CONCLUSION: It seems that duodenal ulcer develop more frequently at area of gastric metaplasia infected by H. pylori. However, further evaulation about the pathogenesis of duodenal ulcer is necessary because there are lots of duodenal ulcer cases which are not accompanied by gastric metaplasia.

A Case of CMV Infection Associated with Simultaneous Esophageal and Colonic Ulcers / 대한소화기내시경학회지

Gastrointestinal cytomegalovirus (CMV) disease causes substantial morbidity and mortality in immunocompromised patients, especially in transplant recipients and those who infected with HIV. Although acute infection is generally asymptomatic or produces only non-specific symptoms in the immunocompetent host, acute CMV infection accompanies gastrointestinal ulceration in a small number of patients. The colon is the most common site of the infection, although it may occur in other gastrointestinal tract. CMV infection associated with simultaneous esophageal and colonic ulcers has not been reported in Korea. We report a patient with subarchnoid hemorrhage who had suffered from simultaneous esophageal and colonic ulcers associated with CMV infection which showed characteristic histologic findings of CMV infection.

Histological Comparison of Endoscopic Forceps Biopsy with Endoscopic Resection in Gastric Mucosal Elevated Lesion / 대한소화기내시경학회지

BACKGROUND/AIMS: The correct histological diagnosis of gastric adenoma is important, because it has been reported to be precancerous lesion and associated with focal gastric carcinoma. However, there is some discrepancy between the histology of the forceps biopsy and that of the endoscopic resection. In this study, we compared the histologic findings of gastric mucosal elevated lesion between the specimens of forceps biopsy and endoscopic resection. METHODS: We reviewed retrospectively 137 cases of gastric mucosal elevated lesion which had been removed by the resection such as polypectomy or endoscopic mucosal resection. All patients had undergone forceps biopsy before endoscopic resection. We compared the histologic findings of the specimens by forceps biopsy with those by resection. RESULTS: The histologic fidings were accordant at 101 of the 137 cases (73.7%), and different at 30 cases (21.9%). Among the 86 cases with adenoma in the biopsied specimens, 10 cases (11.6%) were finally diagnosed as gastric cancer in the resected specimens. CONCLUSIONS: Because biopsy specimens may not be presentative of the entire lesion, endoscopic resection of gastric mucosal elevated lesion is needed for accurate histologic diagnosis and treatment if adenoma is suspected.

Segmental Groove Pancreatitis: Report of One Case

Groove pancreatitis is a special form of chronic pancreatitis in which scarring is found mainly in the groove between the pancreatic head, duodenum, and common bile duct. Preoperative differentiation between groove pancreatitis and pancreatic cancer is difficult. Here we report one case of segmental groove pancreatitis diagnosed by clinical and radiological features. The patient was a 46-year old man with severe abdominal pain, weight loss, and a long history of alcohol abuse. Computed tomography revealed swelling of the pancreatic head and a heterogeneously enhanced low-density lesion in the groove. MR images revealed a mass in the groove that had a low signal on T1-weighted images and a low signal relative to the pancreatic head on T2-weighted images. T1-weighted images on dynamic study showed the medial wall thickening of descending duodenum, several small cysts in the groove and thickened duodenal wall. The patient has been under conservative treatment for 2 months and his severe abdominal pain has improved.

A Case of Duodeno-cecal Fistula Developed due to Foreign Body / 대한소화기내시경학회지

Gastrointestinal foreign bodies are a common problem. It can be managed by observation, endoscopic removal, and/or surgical intervention. Bowel perforation, obstruction, bleeding, fistularization and abscess formation are common significant complications associated with foreign bodies.A 38-year-old woman with a toothbrush in the duodenum was referred to our hospital due to abdominal pain. Three years ago, she ingested a tooth brush. Esophagogastroduodenoscopy showed a tooth brush placed in the second portion of the duodenum. We removed a tooth brush by a snare and found a fistula at the junction of the second and third portion of the duodenum. Upper gastrointestinal series revealed a fistula between the duodenum and cecum. We report a case of duodeno-cecal fistula developed due to a toothbrush ingested 3 years before.

A Case of Intraluminal Gallbladder Hematoma after Percutaneous Liver Biopsy / 대한간학회지

Percutaneous liver biopsy is valued in the diagnosis of diffuse or localized liver disease. Serious complications after ultrasonography-guided liver biopsy are rare. We report a case of a 69-year-old man who underwent a percutaneous liver biopsy for the evaluation of his underlying liver disease with subsequent late complication of intraluminal gallbladder hematoma.

A Case of Gastric Metastasis from Breast Carcinoma Manifested by Upper Gastrointestinal Bleeding / 대한소화기내시경학회지

Breast carcinoma is common malignancy in women and frequently metastasize to multiple organ such as lung, bone, lymph node and liver. But metastasis to gastrointestinal tract is rare and only two cases have been reported in Korea. We experienced a case of upper gastrointestinal bleeding caused by gastric metastasis from ductal carcinoma of breast and report this case with review of several literatures.

A case of bypass arthritis-dermatitis syndrome after bypass gastrojejunostomy / 대한내과학회지

Bypass surgery, as therapy for morbid obesity, was introduced in 1952. Multiple complications such as arthritis and dermatitis as well as liver dysfunction, renal injury, diarrhea, malnutrition and electrolyte imbalance were reported after bypass surgery. Recently, we have experienced a case of bypass arthritis-dermatitis syndrome in a patient after pyloric exclusion and bypass gastrojejunostomy due to traumatic duodenal perforation. He complained arthralgia of left knee, both wrist and both ankle and developed erythematous maculopapular rash over lower extremities. He was successfully treated with NSAIDs and clindamycin.