Clinical Study and Review of Articles (Korean) about Retrorectal Developmental Cysts in Adults

PURPOSE: A retrorectal developmental cyst (tailgut cyst, epidermoid cyst, dermoid cyst, teratoma, and duplication) is very rare disease, and the symptoms are not characteristic so that sometimes this disease is still misdiagnosed as a supralevator abscess or a complex anal fistula. We would like to present a clinical approach to this disease. METHODS: We retrospectively examined the charts of 15 patients who were treated for retrorectal cysts from January 2001 to November 2009. RESULTS: All 15 patients were female. The average age was 41 years (range, 21 to 60 years). Fourteen patients (93.3%) were symptomatic, and the most common symptom was anal pain or discomfort. Nine patients (60%) had more than one previous operation (range, 1 to 9 times) for a supralevator abscess, an anal fistula, etc. In 12 patients (80%), the diagnosis could be made by using the medical history and physical examination. Thirteen cysts (80%) were excised completely through the posterior approach. The average diameter of the cysts was 4.8 cm (range, 2 to 10 cm). Pathologic diagnoses were 8 tailgut cysts (53.3%), 5 epidermoid cysts (33.3%) and 2 dermoid cysts (13.3%). The average follow-up period was 18.3 months (range, 1 to 64 months). CONCLUSION: In our experience, high suspicion and physical examination are the most important diagnostic methods. If a female patient has a history of multiple perianal operations, a retrorectal bulging soft mass, a posterior anal dimple, and no conventional creamy foul odorous pus in drainage, the possibility of a retrorectal developmental cyst must be considered.

A Case of Mirizzi Syndrome Misdiagnosed as a Cholangiocarcinoma / 한국간담췌외과학회지

The Mirizzi syndrome is a rare benign cause of obstructive jaundice. It is particularly interesting to surgeons because the surgery has to be carefully planned to avoid unnecessary damage to the common bile duct. Furthermore, it gives a differential diagnosis dilemma for surgeons as well as radiologist because there are no diagnostic procedures or clinical features that have a perfect access. As a result, the Mirizzi syndrome often has been mistaken for gallbladder cancer and cholangiocarcinoma. We experienced of a 76-year-old male patient, whose clinical symptoms were jaundice, epigastric pain and fever with chill and misdiagnosed as a cholangiocarcinoma with liver metastasis.

Prognostic Value of Preoperative Serum CEA and CA19-9 Levels in Gastric Cancer Patients

PURPOSE: The clinical significance of preoperative serum levels of tumor markers CEA and CA19-9 was evaluated in gastric cancer patients. METHODS: Serum levels of CEA and CA19-9 were measured in 1, 310 patients with gastric cancer who underwent laparotomies over a recent 10-year period (1992~2001). The correlations between the serum levels of tumor markers and several clinicopathological factors were evaluated by univariate analysis. The significance of the tumor markers as prognostic factor was assessed by multivariate analysis. RESULTS: The positivity rates of CEA and CA19-9 were 17.5% and 13.4%, respectively. The positivity rate of CEA was higher in the elderly, in male patients, and in those with histologically differentiated tumors, whereas CA19-9 positivity was related to tumor location. In addition, the positivity rates of each tumor marker were significantly correlated with tumor size, gross type, depth of invasion, lymph node metastasis, peritoneal and liver metastases, and cancer stage. A significant difference in survival was observed between patients positive and negative for CEA and CA19-9. The multivariate analysis showed that in addition to gross type, depth of invasion, lymph node metastasis, peritoneal and liver metastasis, preoperative serum CEA and CA19-9 levels among those undergoing However, multivariate analysis of curatively resected cases identified gross type, depth of invasion, lymph node metastasis, and CA19-9 as significant prognostic variables. CONCLUSION: Preoperative serum CEA and CA19-9 determination in patients with gastric cancer is of value for the prediction of tumor progression and prognosis. However, serum CA19-9 level was more useful than CEA as a1 prognostic factor in patients undergoing curative resection.