Clinical Features of Abdominal Actinomycosis: A 15-year Experience of A Single Institute

This study was designed to evaluate the clinical features of abdominal actinomycosis and to assess its therapeutic outcome. We reviewed patients with abdominal actinomycosis in Seoul St. Mary hospital, between January 1994 and January 2010. Twenty-three patients (5 male and 18 female, mean age, 47.8 yr; range, 6-75 yr), with abdominal actinomycosis were included. Emergency surgery was performed in 50% due to symptoms of peritonitis. The common presentation on preoperative computerized tomography was a mass with abscess, mimicking malignancy. The mean tumor size was 7.0 cm (range, 2.5-10.5). In all patients, actinomycotic masses were surgically removed. Mean duration of hospital stay was 17.8 days (range, 5-49). Long term oral antibiotic treatment (mean 4.2 months; range, 0.5-7.0 months) were administered to all patients. All patients were free of recurrence after a median follow up of 30.0 months (mean 35.5 +/- 14.8 months, range, 10.0-70.0 months); recurrence was not seen in any patient. In conclusion, abdominal actinomycosis should be included as a differential diagnosis when an unusual abdominal mass or abscess presents on abdominal CT. Assertive removal of necrotic tissue with surgical drainage and long term antibiotic treatment provide a good prognosis in patients with actinomycosis.

Steroid Responsive Pancreatic Mass-Forming Type 2 Autoimmune Pancreatitis / 대한소화기학회지

Autoimmune pancreatitis (AIP) has two distinct subsets. Type 1 AIP or lymphoplasmacytic sclerosing pancreatitis is systemic disease with the elevation in serum levels of the IgG4. Type 2 AIP, also called duct-centric pancreatitis, features granulocyte epithelial lesions with duct obstruction in the pancreas without systemic involvement. Here, we report a case of type 2 AIP diagnosed by pathology, which is the first report in Korea. The case is a 56-year-old woman who presented with anorexia and vomiting. Computed tomography revealed mass-like lesion in the pancreatic head and the compression of the distal common bile duct and the head portion of the main pancreatic duct. Serum levels of the IgG4 were normal. Histologic examination revealed a dense neutrophil infiltration in the pancreatic parenchyme associated with extensive fibrosis, thereby confirming the diagnosis of type 2 AIP. The abnormalities in the clinical, laboratory, and radiological findings improved after oral steroid treatment.

A case of ectopic Cushing's syndrome combined with papillary thyroid carcinoma / 대한내과학회지

Locating a corticotropin-releasing hormone (CRH)- or adrenocorticotropic hormone (ACTH)-secreting tumor is challenging. A 69-year-old woman admitted to our hospital for generalized edema was diagnosed with ectopic Cushing's syndrome. We attempted to find an ectopic tumor and could establish no ectopic focus except a retropharyngeal mass in the neck. We diagnosed the retropharyngeal mass as thyroid papillary carcinoma and examined whether the thyroid papillary carcinoma was the ectopic focus. No relationship between thyroid papillary carcinoma and ectopic Cushing's syndrome has been established. We failed to find another ectopic focus, except for the increased uptake of the retropharyngeal mass on fluorodeoxyglucose positron emission tomography (FDG-PET). Ectopic Cushing's syndrome combined with thyroid papillary carcinoma is very rare, so we report this case along with reviews of related literatures.

A case of adrenocortical adenoma clinically mimicking pheochromocytoma / 대한내과학회지

The coexpression of cortical and medullary features in a single adrenal cortical cell has been recognized, leading to terms such as cortico-medullary cells. Here, we reported a case of adrenocortical adenoma consisting of cortico-medullary cells that clinically mimicked pheochromocytoma. A 52-year-old woman was admitted to our hospital complaining of an 8-month history of paroxysmal palpitation with refractory hypertension. A 24-hour urine study revealed increased norepinephrine and metanephrine levels. Computed tomography of the abdomen revealed a 1.0x0.9-cm mass in the left adrenal gland. The patient subsequently underwent unilateral laparoscopic adrenalectomy for a presumptive pheochromocytoma. Light microscopic findings of the left adrenal mass indicated an adrenocortical adenoma, but electron microscopy identified lipid vacuoles and smooth endoplasmic reticulum, along with dense core neurosecretory granules, so-called cortico-medullary cells. This is the first report of the detection of cortico-medullary cells in adrenocortical adenoma presenting as pheochromocytoma in Korea.

A Case of Chronic Expanding Hematoma with Initial Presentation as Massive Hemotpysis through Bronchopleural Fistula in the Thorax / 결핵및호흡기질환

Chronic expanding hematoma of the thorax is a specific subtype of the chronic empyema. It presents as a slowly expanding intrathoracic mass which result in dyspnea or recurrent hemoptysis. The symptoms develop months or years after tuberculous pleurisy, trauma or surgery. Usually, it shows three common findings: a giant mass lesion in the thorax, some surrounding calcifications, the absence of signs or symptoms of infection. We report a case of chronic expanding hematoma of the thorax, initially presenting as massive hemoptysis through bronchopleural fistula which resulted in radiologic findings of new air-fluid level within the previous pleural lesion filled with unknown materials.

A Case of High Dose Cytosine Arabinoside Induced Stevens-Johnson Syndrome in a Patient with Malignant Lymphoma

Many chemotherapeutic agents induce variable cutaneous adverse reactions. Among the side effects, Stevens-Johnson syndrome is rare, but a fatal complication. There are two prior reports of cytosine arabinoside (ARA-C) induced toxic epidermal necrolysis, which is considered in the continuum of Stevens- Johnson syndrome. The prior cases were female patients under 16 years old with acute lymphocytic leukemia. We treated a 77-year-old man with recurrent mantle cell lymphoma who developed Stevens- Johnson syndrome after high dose ARA-C therapy. This is the first case of ARA-C induced Stevens- Johnson syndrome in Korea.