A Rare Case of Early Gastric Cancer Combined with Underlying Heterotopic Pancreas

Heterotopic pancreas in the stomach is usually asymptomatic and benign. Here, we presented a rare case of an early gastric cancer overlying a heterotopic pancreas. A 48-year-old woman underwent esophagogastroduodenoscopy, which revealed a subepithelial mass measuring 2.0×1.5 cm on the gastric antrum with a 1-cm erosive erythematous discoloration on the surface. A biopsy specimen showed moderately differentiated tubular adenocarcinoma. Endosonography showed a heterogeneous hypoechoic mass measuring 1.3×0.6 cm, with indistinct margins in the second and third layers of the gastric wall; anechoic tubular structures within the mass were suggestive of heterotopic pancreas. Distal gastrectomy was performed, which confirmed an early gastric cancer confined to the mucosa, and a separate underlying heterotopic pancreas. Although heterotopic pancreas is most likely benign, careful endoscopic observation of the mucosal surface is necessary to avoid overlooking a coincident early gastric cancer.

Primary Follicular Lymphoma in the Rectum Incidentally Found on Screening Colonoscopy / 대한소화기학회지

The gastrointestinal tract is the most common site of extra-nodal non-Hodgkin lymphoma. However, the incidence of primary rectal lymphoma is extremely rare. Among the primary gastrointestinal lymphomas, follicular lymphoma has been described as a rare disease. It is difficult to diagnose rectal lymphoma due to its variable growth patterns and inadequate biopsies. Majority of patients with rectal lymphoma have non-specific symptoms or negative biopsies, often delaying the diagnosis. Our patient is a 62-year-old female. Two sessile and smooth subepithelial lesions with a yellowish normal mucosa were found on a screening colonoscopy. The initial mucosal biopsy finding was chronic inflammation, but we were highly suspicion of malignancy; we performed an endoscopic mucosal resection. Herein, we present a rare case of rectal follicular lymphoma diagnosed by endoscopic mucosal resection with a literature review.

Clinicopathological Characteristics of Gastric Hepatoid Adenocarcinoma

BACKGROUND/AIMS: Gastric hepatoid adenocarcinoma (GHA), a rare type of primary gastric cancer, is characterized by a histology resembling hepatocellular carcinoma. Previous case studies reported that patients with GHA have a poor prognosis due to early lymph node or liver metastasis, but information concerning GHA is still limited. Therefore, we aimed to evaluate the clinicopathological features of GHA. MATERIALS AND METHODS: We reviewed the medical records of 9 patients who were diagnosed as having GHA between January 2011 and December 2016. The clinicopathological characteristics of these patients were retrospectively analyzed. RESULTS: The median age of the patients at diagnosis was 68.9 years. Seven of the 9 patients were male. Serum AFP levels were elevated in 3 of 4 patients. All the tumors were >4 cm (range, 4~12 cm), and 7 tumors were located at the lower third of the stomach. Five tumors were classified as Borrmann's type 3, with a purple, berry-like surface. Of the 6 patients without distant metastasis, 5 received curative-intent surgery and 3 received adjuvant chemotherapy. Three patients with distant metastasis received either palliative operation and/or chemotherapy. Their median survival time was 11.8 months (range, 1~36 months). Two patients with elevated serum CEA levels had poor outcomes. CONCLUSIONS: GHA is a rare subtype of gastric cancer that is prone to liver metastasis. All GHAs are advanced gastric cancer with a purple, berry-like surface at diagnosis. Although the prognosis of advanced-stage GHA is poor, active multimodality treatment might provide some benefit.

Sesame-like Pigmentation in the Duodenum

No abstract available.

An Atypical Gastric Subepithelial Lesion in a Young Female Patient / 대한소화기학회지

No abstract available.

Clinical Significance of Extraluminal Compressions according to the Site of the Esophagus

BACKGROUND/AIMS: Differentiation of an extraluminal compression from a true subepithelial tumor (SET) in the esophagus by using endoscopy alone is often difficult. EUS is known as the best method for differentiating an extraluminal compression from a true SET. Extraluminal compression in the esophagus is occasionally observed, but its clinical significance has been rarely reported. Therefore, we aimed to evaluate the clinical significance of extraluminal compression in the esophagus according to the location of the lesion. MATERIALS AND METHODS: Sixty-one patients were diagnosed as having an extraluminal compression in the esophagus by using EUS between January 2006 and March 2014. Some patients underwent chest computed tomography for accurate diagnosis. RESULTS: The extraluminal compression was located at the mid-esophagus in 26 cases, lower esophagus in 22 cases, and upper esophagus in 13 cases. Of the 61 cases, 55 were caused by normal structures and 6 were caused by pathological lesions. The causes of the normal structures were the aorta, vertebra, trachea, left main bronchus, azygos vein, and diaphragm. The causes of the pathological lesions were engorged vessels and calcified lymph nodes. The posterior wall was the most frequent location of the extraluminal compression. However, the lesions in the anterior and right walls showed a higher frequency of pathological lesions than those in other sites. CONCLUSIONS: If the extraluminal compression is found in the anterior and right walls of the esophagus, more careful evaluation should be performed considering the high frequency of pathological lesions in the site.

Two Cases of Russell Body Gastritis Treated by Helicobacter pylori Eradication

Russell body gastritis was first defined in 1998, but not many cases have been reported since then. The exact causes and process of this condition are unknown yet; however, considering the reported cases, it has been highly suggested to have correlation with Helicobacter pylori infection. Russell body gastritis has a non-specific clinical presentation of gastritis such as gastric mucosal edema in the macroscopic view. It can be mistaken as xanthoma, signet ring cell carcinoma, or a malignant lymphoma including mucosa-associated lymphoid tissue lymphoma and plasmocytoma. Russell body gastritis features polyclonal immunoglobulin and is differentiated from Mott cancer, of which immune globulin has monoclonal aspect. Authors report here two cases of Russell body gastritis with examined endoscopic findings as well as a review of related literature on the association of all reported cases of Russell body gastritis with H. pylori infection.

A Case of Splenic Pseudoaneurysmal Rupture Misrecognized as Bleeding from Gastric Submucosal Tumor / 대한소화기내시경학회지

Splenic arterial pseudoaneurysm is an uncommon life-threatening complication of acute and chronic pancreatitis. Pseudoaneurysm can lead to massive bleeding into the abdominal cavity and the retroperitoneum. Less commonly, it may rupture directly into the stomach, small bowel or pancreatic duct and may present as an acute gastrointestinal hemorrhage. It can be diagnosed by various imaging modalities including computerized tomography, ultrasound and angiography. Percutaneous transvascular embolization of the pseudoaneurysm is one of the alternative treatment methods. Here we present a case of splenic arterial pseudoaneurysmal rupture misrecognized as bleeding from a gastric submucosal tumor in patient with hematemesis. We also review the literature.

Two Cases of Gastric Marginal Zone B Cell Lymphoma Treated with a Single Agent Chemotherapy / 대한소화기내시경학회지

Gastric marginal zone B cell lymphoma of the MALT type (MALT lymphoma) is usually accompanied by a Helicobacter pylori (H. pylori) infection. Most gastric MALT lymphomas regress after the eradication of H. pylori. Therefore, H. pylori eradication therapy is an effective first-line treatment for gastric MALT lymphoma. A second-line treatment for patients who fail to respond to eradication therapy, including radiotherapy and chemotherapy, produces a good response and survival rate. We encountered 2 cases of H. pylori eradication-resistant gastric MALT lymphoma, which were treated with cyclophosphamide monotherapy. A complete response was obtained in both cases after a treatment duration of 3 months and remission continued for 15 and 18 months, respectively. Treatment-related toxicity was mild. Oral monochemotherapy might be an alternative, effective and safe treatment modality for patients with gastric MALT lymphoma who are resistant to H. pylori eradication therapy.

A Case of Fitz-Hugh-Curtis Syndrome in a Male / 대한소화기학회지

Fitz-Hugh-Curtis syndrome has been described as focal perihepatitis accompanying pelvic inflammatory disease caused by Neisseria gonorrhea and Chlamydia trachomatis. The highest incidence occurs in young, sexually active females. However, the syndrome has been reported to occur infrequently in males, according to the foreign literature. The predominant symptoms are right upper quadrant pain and tenderness, and pleuritic right sided chest pain. The clinical presentation is similar in men and women. In women, the spread of infection to liver capsule is thought to occur directly from infected fallopian tube via the right paracolic gutter. In men, hematogenous and lymphatic spread is thought to be postulated. Recently, we experienced a case of Fitz-Hugh-Curtis syndrome occurred in a man. As far as we know, it is the first report in Korea, and we report a case with a review of the literature.