Identifying Small Bowel Gastrointestinal Stromal Tumor as the Culprit Lesion in Obscure Gastrointestinal Bleeding: Emphasis on Angiographic Findings

Gastrointestinal stromal tumors (GISTs) are not uncommon and often cause gastrointestinal bleeding. GISTs occurring in the small intestine are occasionally difficult to identify by endoscopy and CT. In this case, the patient underwent CT three times before surgery, and the lesion was found to be located in a different area of the abdominal cavity on each CT scan. Moreover, the lesion was missed in the first two CT images because it was difficult to distinguish it from the nearby collapsed small intestine. The lesion was eventually detected through angiography; however, the correct diagnosis and treatment were delayed for 3 years because it was mistaken for a vascular malformation, which is the most common cause of obscure GI bleeding in elderly patients. This report emphasizes the need for interventional radiologists to be updated and vigilant of the angiographic features of GISTs to make an accurate diagnosis and establish a management strategy.

High grade carcinoma ex pleomorphic adenoma of parotid gland: a case report

Pleomorphic adenoma is the most prevalent benign tumor of the parotid gland, and shows potential malignancy. Carcinoma ex pleomorphic adenoma (CXPA) can occur in 3%-15% of pleomorphic adenoma cases. Owing to its clinical similarity to benign tumors, critical information related to CXPA can be easily overlooked, leading to frequent misdiagnosis of the condition. In this article, we report a rare case of CXPA found in the 55-year-old male patient with characteristic clinical, radiographic, and histological features, and subsequent treatment.

MRI Findings of an Ampulla of Vater Neuroendocrine Tumor with Liver and Lymph Node Metastasis: a Case Report

An ampulla of Vater neuroendocrine tumor (AOV-NET) is a rare subset of gastroenteropancreatic neuroendocrine tumors (GEP-NETs). Very few studies have been undertaken regarding MRI findings of an AOV-NET. We report on a case of a 59-year-old woman diagnosed with an AOV-NET with liver and lymph node metastasis, with an emphasis on the MRI findings. This case shows rare and precious typical MRI findings of an AOV-NET. The MRI visualized the AOV-NET very well and is helpful for the differentiation of an AOV-NET from other tumors in the ampullary area as well as with treatment planning.

A Case of Isolated Leptomeningeal Carcinomatosis from Advanced Gastric Cancer / 대한소화기학회지

Leptomeningeal carcinomatosis (LMC) is rare metastatic form of gastric cancer. Most cases are diagnosed in the final stage after multiple distant metastasis. An 84-year-old woman was admitted with melena, headache and vomiting. Esophagogastro-duodenoscopy showed an ulceroinfiltrating lesion at the stomach (Borrmann class III), and biopsy revealed a signet ring cell carcinoma. The abdominal-pelvic CT showed no evidence of metastasis. A sudden decrease of consciousness was noted, but the brain CT showed no active lesion while the brain MRI revealed enhancement of leptomeninges. A lumbar puncture was performed and the cerebrospinal fluid study revealed malignant neoplastic cells. With family consent, no further evaluation and treatment were administered and she died six weeks after the diagnosis of gastric cancer. We report an extremely rare case of a patient who initially presented with neurologic symptoms, and was diagnosed LMC from advanced gastric cancer without any evidence of metastasis in abdomen and pelvis.

Acute Pancreatitis Induced by Quetiapine in an Elderly Patient

Quetiapine is an atypical antipsychotic that is frequently used to manage delirium in geriatric patients. Acute pancreatitis associated with quetiapine has rarely been reported. A 70-year-old male presented with severe abdominal pain a few hours after taking a dose of quetiapine prescribed for delirium. Despite the lack of risk factors of pancreatitis in his medical history, the patient had a slight increase of serum lipase and amylase levels. His general condition improved on discontinuation of quetiapine. A month later, quetiapine was readministered for the recurrence of delirium. Subsequently, the patient developed the same symptom with a significant increase in serum pancreatic enzyme levels, confirming that quetiapine induced the pancreatitis. We reported the first case of quetiapine-induced pancreatitis in Korea, together with a review of the literature.

The Expression Pattern of Annexin A1 in Urinary Bladder Urothelial Carcinoma and Its Clinicopathologic Significance

BACKGROUND: Annexin A1 (ANXA1) is known to be involved in the progression and differentiation of various tumors. However, its significance and role in bladder carcinogenesis has not been fully elucidated. To determine the role ANXA1 plays in urothelial carcinoma (UC), we investigated the expression of ANXA1 protein in normal urothelial tissue, carcinoma in situ (CIS), and UC of the urinary bladder. METHODS: Protein expression level of ANXA1 and its subcellular localization were analyzed in 88 cases of UCs and corresponding 24 normal tissues and 24 CISs by immunohistochemistry. RESULTS: ANXA1 was significantly down-regulated at all subcellular localization in CIS and in the cytoplasm and membrane of cells of UC, compared to normal tissues. No significant correlation between ANXA1 expression level and tumor depth (pT), growth pattern, and recurrence was found. However, cytoplasmic and membranous ANXA1 were significantly up-regulated in high grade than in low grade UC (p=0.02 in cytoplasm and p=0.03 in membrane). CONCLUSIONS: These results suggest that ANXA1 dysregulation is involved in urothelial carcinogenesis and ANXA1 is potentially a marker for the pathologic differentiation of UC.

Fine-Needle Aspiration Cytology of the Nodal Marginal Zone Lymphoma

BACKGROUND: Nodal marginal zone lymphoma (NMZL) is a rare B-cell neoplasm consisting of heterogeneous cellular components and residual B-cell follicles. Because of such histological features, it is difficult to diagnose NMZL by fine needle aspiration (FNA) cytology. We reviewed FNA cytology of NMZL to identify a cytological clue to avoid misdiagnosing NMZL. METHODS: Histological, cytological, and clinical findings of seven cases of NMZL were reviewed. RESULTS: Most cases showed nodular aggregates of lymphohistiocytes derived from the germinal center irrespective of histological pattern. The cellular components were heterogeneous and composed of mature small lymphocytes, intermediate and large lymphocytes, immunoblasts, tingible body macrophages, and follicular dendritic cells. Intermediate-sized neoplastic cells with a pale nucleus were observed but difficult to identify because of admixed non-neoplastic cells, which outnumbered neoplastic cells. Except for one case with a high proportion of intermediate-sized cells, the other six cases were initially diagnosed as reactive hyperplasia. A flow cytometric analysis was performed in two cases and failed to demonstrate a monoclonal B-cell population. CONCLUSIONS: The FNA showing a reactive hyperplasia-like smear pattern should be carefully observed by experienced cytopathologists to identify intermediate-sized neoplastic cells. Clinical information including the size of the lymph nodes is important to avoid a misdiagnosis.

A Case of Exceptionally Rapid Growing Cardiac Myxoma / 영남의대학술지

Myxoma is the most common type of primary cardiac tumor and about 75% of myxomas occur in the left atrium of the heart. Most myxomas are diagnosed by echocardiography. The growth rate of myxoma is clearly unknown and newly developed myxoma is difficult to understand clearly the onset of growth. We describe the case of a newly developed huge left atrial myxoma (7x7 cm)which showed no echocardiographic evidence of the tumor four years ago. Four years later the patient underwent transthoracic echocardiography due to preoperative evaluation that was normal. Nine months later, she presented with dyspnea. Transthoracic echocardiography showed a large mass located in left atrium. Pathology showed a myxoma that measured 7x7 cm implying a growth rate of 0.15x0.15 cm/month.

Enterobius vermicularis Ova in a Vaginal Smear

Enterobius vermicularis is one of the most common parasites found in the intestine of humans. The gravid female worms migrate outside the anus to release eggs on the perianal skin. Rarely, they migrate to the genitourinary tract in female patients. We present a case in which pinworm eggs were found in a cervicovaginal smear of a 37-year-old woman. The eggs were elongated oval shaped and flattened on one side. The thick, double contoured birefringent shell stained bright yellow or orange. Some coarsely granular embryos or curved larvae were enclosed in the refractile shell. Empty eggs or wrinkled shells with clumped granular material were also present. Although pinworm eggs are easily identified because of their characteristic morphologic appearance, careful screening is needed due to the frequent masking by inflammatory cells.