A Case of carcinoid tumor of ampulla of vater presenting as asthmatic symptoms / 대한내과학회지

The carcinoid tumor of the ampulla of Vater is extremely rare. We report a case of 57-year old male with carcinoid tumor of ampulla of Vater. This patient had been presented with bronchial asthma for one year. Abdominal CT finding revealed diffuse dilatation of common bile duct and pancreatic duct, and also ampullary soft mass protruded into duodenal lumen. The correct diagnosis was made preoperatively by endoscopic retrograde cholangiography with biopsy. Pancreatico- duodenectomy with lymph nodes dissection was performed. Malignant carcinoid tumor originating from ampulla of Vater was diagnosed with pericholedochal lymphatic metastasis. Surgical removal led to complete resolution of asthmatic symptoms.

A Case of Complete Agenesis of Dorsal Pancreas / 대한소화기내시경학회지

Agenesis of dorsal pancreas is a rare congenital anomaly that arises from the failure of the dorsal pancreatic bud of endodermal cells to form the body and tail of the pancreas. It may be associated with diabetes mellitus, pancreatic exocrine dysfunction, or abdominal pain. Complete or partial agenesis of dorsal pancreas has been reported in a small number of pediatric and adult patients. A case is herein described involving a complete agenesis of dorsal pancreas and diabetes mellitus. A 38-year-old man with a 7-months history of non-insulin dependent diabetes mellitus was admitted due to weight loss and abdominal pain. Abdominal ultrasonography and computed tomography showed a normal biliary tree and enlarged head of the pancreas without visualization of the pancreatic body and tail. Endoscopic retrograde cholangiopancreatography (ERCP) revealved the short duct of Wirsung in the uncinate process and a head without opacification of any ducts in the pancreatic body or tail. The patient underwent explo-laparotomy for evaluation of the suspected pancreatic cancer. The patient was diagnosed as having complete agenesis of the dorsal pancreas by ERCP, CT, and surgery.

Is It Necessary to Examine Precisely about Extrahepatic Duct in Patients with Normal Liver Function Showing EHD Dilatation Alone on Abdominal Ultrasonography? / 대한소화기내시경학회지

BACKGROUND AND AIMS: It is necessary to study about extrahepatic bile duct (EHD) lesions in cases with abnormal liver function test (LFT) and clinical symptoms, even though abdominal ultrasonography could not find out the bile duct lesions. It is unclear however, whether the precise examination of EHD lesions are necessary in asymptomatic patients with normal liver function showing EHD dilatation without any lesions on abdominal ultrasonography (US). METHODS: We examined prospectively about EHD using endoscopic ultrasonography (EUS), followed by endoscopic retrograde cholangiopancreatography (ERCP) in fifty-three patients with normal LFT showing only EHD dilatation on US. The mean EHD diameter on US was 9.1 1.4 mm. RESULTS: The EHD dilatations alone on EUS were 41.5% and the EHD dilatations with lesions were 58.5%. The observed lesions of EHD by EUS were bile duct stones in 32.1%, thickening or stricture of distal bile duct in 17.0%, ampullary mass in 5.7% and CBD polyps in 3.8%. Three cases of ampullary mass were confirmed as 2 cases of T1 ampullary cancer and 1 case of papillitis. Examination by ERCP revealed EHD dilatation alone in 49.1% and bile duct lesions in 50.9%. ERCP could not detect the 2 cases of CBD polyp and 2 cases of distal bile duct thickening. CONCLUSIONS: In patients with normal LFT showing only EHD dilatation on abdominal US, EHD lesions can be detected in high frequency. Therefore, further examination about dilatated EHD should be conducted and for this purpose, EUS is be recommended as a useful tool.

A Case of Late Presentation of Congenital Cystic Adenomatoid Malformation of the Lung / 결핵

Congenital cystic adenomatoid malformation of the Lung(CCAM) is characterized by anomalous fetal development of terminal respiratory structures, resulting in an adenomatoid proliferation of bronchiolar elements and cystic formation. CCAM was first described and differentiated from other cystic lung disease in the English literature by Ch'in and Tang in 1949. CCAM is a rare, potentially lethal form of congenital pulmonary cystic disease and the salient features of lesion are an irregular network of terminal respiratory bronchiole-like structures and macrocysts variably lined by pseudostratified ciliated columnar epithelium and simple cuboidal epithelium. Adult presentation of CCAM of the lung is so tare that only 9 cases have been reported in the literature of date. The pathogenesis of CCAM remains disputed and reseachers have variously proposed that the lesion represents a developmental anomaly, hamartoma, or a form of pulmonary dysplasia. Van Dijk and Wagenvoort divided CCAM into three subtypes: cystic, intermediated, and solid. These correspond to types I, II, and III of Stocker. In adults, the evaluation of cystic or multicystic lung disease requires consideration of a differential diagnosis including the acquired lesions of lung abscess, cavitary neoplasm or inflammatory mass, bullous disease, bronchiectasis, and postinflammatory pneumatocele. Congenital lesions such as sequestration, bronchopulmonary-foregut anomalies, and bronchogenic cyst are also encounted. The definitive treatment for CCAM is complete removal of the involved lobe. Partial lobectomy leads to multiple complications, including severe post-operative infection. We report a case of CCAM in a 14-year-old female presentated with a pneumothorax and large bullae, who was treated by surgical remove of the involved lobe.

A Case of Arrhythmogenic Right Ventricular Dysplasia

Arrhythmogenic right ventricular dysplasia is a rare heart muscle disorder of unknown cause that primarily involves the right ventricle. It is characterized pathologically by fibrofatty replacement of the right ventricular myocardium. Clinical manifestations include structural and functional abnormalities of the right ventricle, electrocardiographic depolarization/repolarization changes, and presentation with sudden death or ventricular arrhythmias of right ventricular origin. It is one of the important causes of the ventricular arrhythmia or sudden death among apparently healthy young people. We report a case of arrhythmogenic right ventricular dysplasia with the review of the literature.