A Case of Metastatic Gastric Synovial Sarcoma / 대한소화기내시경학회지

Synovial sarcomas are malignant soft tissue neoplasms that develop from tendon and bursa near the large joints and frequently occur in the lower extremities of young male adults. They usually recur within 2 years after surgical treatment. The lung is a common metastatic site and rarely reported as the primary site of synovial sarcoma. The stomach is a very rare primary site of synovial sarcoma and recently only two cases of primary gastric synovial sarcoma were reported. We report a case of metastatic gastric synovial sarcoma in a 53-year-old male 4 years after surgical treatment of primary lung synovial sarcoma. The tumor had histologic, immunohistochemical and ultrastructural features of biphasic synovial sarcoma of the soft tissue.

An Immunohistochemical study of the origin and differentiation of gastric stromal tumor / 대한내과학회지

BACKGROUND: Gastrointestinal stromal tumors (GISTs) have the subject of debate and controversy regarding their histogenesis, criteria on malignancy, prognostic features, site-specificity and their nomenclature. These tumors have various phenotypical features and are generally divided into (1) tumors showing differentiation toward smooth muscle cells (2) tumors showing apparent differentiation toward neural elements (3) tumors showing dual differentiation toward smooth muscle and neural elements (4) tumors lacking differentiation toward either cell type (uncommitted type). This study was performed to identify the possible origin and differentiation of gastric stromal tumor. METHODS: This study was performed on 38 patients who had gastric stromal tumors on endoscopy or endoscopic ultrasonography and confirmed by endoscopic or surgical resection between January 1994 and June 1999 at Department of Internal Medicine, Korea University College of Medicine. Formalin-fixed, paraffin-embedded tissues were studied by immunohistochemical method for detecting the presence of CD 34, CD 117, Vimentin, SMA, Desmin, S-100, PGP 9.5 and NSE. RESULTS: The patients' age ranged from 26 to 81 years old, with an average age of 53.8 years. The male to female ratio was 1:1.2. Endoscopic resections were performed on 22 patients and surgical operations on 16 patients. The average tumor size was 25.3 mm in diameter. On immunohistochemical staining method, the uncommitted type was found in 18 patients (47.4%), of which 17 patients (94.4%) were CD117 (+), CD34 (+), Vimentin (+), 12 patients (31.6%) had muscular differentiation, 7 patients (18.4%) showed neural differentiation and 1 patient (2.6%) showed differentiation toward both neural and muscular immunohistochemical pattern. CONCLUSION : Gastric stromal tumors showed phenotypical diversity in immunohistochemical staining suggesting different histogenesis. Most uncommitted type had a phenotype of intersititial cells of Cajal (ICC) and this evidence supports the hypothesis that uncommitted type has the origin of ICC.

Clinical Significance of Total Colonoscopy in Patients with Active Pulmonary Tuberculosis without Gastrointestinal Symptoms / 대한소화기내시경학회지

BACKGROUND/AIMS: Pulmonary tuberculosis may coexist with intestinal tuberculosis even in the absence of gastrointestinal symptoms. The aim of this prospective study was to define the colonoscopic findings of early lesions of intestinal tuberculosis, incidence of asymptomatic intestinal tuberculosis in patients with active pulmonary tuberculosis and to evaluate the clinical response after standard anti- tuberculosis chemotherapy. METHODS: We examined 59 Korean patients with active pulmonary tuberculosis, who had no gastrointestinal symptoms. Patients underwent diagnostic total colonoscopy up to terminal ileum for evaluation of intestinal tuberculosis. Follow-up total colonoscopy was also done in 1~3 months after start of treatment. RESULTS: Intestinal tuberculous lesions were found in 54% of patients. The common locations of lesion were terminal ileum (84%) and cecum (69%). The combination of circumferential ulceration, hyperemic mucosa and erosions of the colon was the most common finding (37.5%), the combination of hyperemia and ulceration occurred in 34.4% of patients and hyperemia with/without erosion in 12.5%. The direction of ulceration was transevere in relation to long axis of the colon but occasionally longitudinal. Although most ulcers were multiple in number and various in size but some paitents had isolated single ulcer with erosion. All of the lesions regressed within 1~3 months of treatment. CONCLUSIONS: During screening total colonoscopy, if there are nonspecific hyperemia, erosion or shallow ulcer on colon or terminal ileum, it is necessary to check up chest X-ray for rule out tuberculous lesion, especially in countries with a high prevalence of tuberculosis.

A case of abnormally exposed nodular shaped-bronchial vessel occurred massive hemorrhage during bronchoscopy / 결핵

A 43 years old woman with a previous history of healed tuberculosis presented with a recurrent hemoptysis. On a broncoscopy inspection, three nodular shaped mass-like lesions (0.5cm in diameter) were found on the right lower lobar bronchus. Massive hemoptysis occurred when the specimen were taken during bronchoscopy. The bleeding could not be controlled by non-surgical treatment. Consequently, she underwent a right lower lobectomy in order to control the bleeding. The patient died of respiratory failure 3 days later. A brochoscopic biopsy revealed an abnormal blood vessel just beneath the bronchial respiratory epithelium.

A case of abnormally exposed nodular shaped-bronchial vessel occurred massive hemorrhage during bronchoscopy / 결핵

A 43 years old woman with a previous history of healed tuberculosis presented with a recurrent hemoptysis. On a broncoscopy inspection, three nodular shaped mass-like lesions (0.5cm in diameter) were found on the right lower lobar bronchus. Massive hemoptysis occurred when the specimen were taken during bronchoscopy. The bleeding could not be controlled by non-surgical treatment. Consequently, she underwent a right lower lobectomy in order to control the bleeding. The patient died of respiratory failure 3 days later. A brochoscopic biopsy revealed an abnormal blood vessel just beneath the bronchial respiratory epithelium.

A Case of Primary Adenosquamous Carcinoma of the Liver Presented with Liver Abscess

Primary adenosquamous carcinoma of the liver is a very rare type of cholangiocarcinoma and is defined as a cancer containing both squamous and adenomatous components in the same lesion. Recently, we experienced a primary adenosquamous carcinoma of the liver presented as liver abscess. A 63-year-old man was presented with a 4-day history of fever and chill. The radiologic study showed a 4 cm-sized, central hypoattenuated mass with peripheral rim enhancement in the left lobe of the liver. Ultrasonography-guided aspiration and biopsy suggested an adenocarcinoma with abscess in the liver. At laparotomy, the tumor occupied the left lobe of the liver and invaded the right diaphragm. An extended left lobectomy and a partial excision of the involved diaphragm were done. Grossly, the tumor was 6x5x5 cm in size and had an eccentric necrosis. Microscopically, the tumor was composed of adenocarcinoma and squamous cell carcinoma with a transitional area.

Cases of hypothermia with Osborne's J wave on ECG / 대한내과학회지

Authors report two cases of hypothermic patients with Osborne's J wave on electrocardiogram. A 46-year-old male with liver cirrhosis was brought to the emergency room by ambulance due to comatous mental status. On exammination, the body temperature was below 35 degree C. By rewarming using warm normal saline intravenous infusion and hot pack application on the chest, his body temperature rose up to 36 degree C and regained consciousness. Later, he expired with afterdrop phenomenon. Another 41-year-old stuporous quadriplegic male with post-traumatic cerebral palsy was brought to the emergency room by his family complaining weakness and vomiting. On exammination, the body temperature was below 35degree C. He was rewarmed using warm normal saline intravenous infusion and hot pack application on the chest. However, he could not regain his normal body temperature and expired due to irreversible shock.

A Case of Mucous Gland Adenoma of the Trachea / 결핵

Mucous gland adenoma of the bronchus is a rare benign tumor arising from the bronchial mucous gland. It accounts for less than 0.5 % of all lung tumors. In adults, tracheal tumors are most often malignant. Among benign tumors arising in the trachea, mucous gland adenoma of the trachea is extremely rare. First case was reported by Ferguson and Cleeland in 1988, as "Mucous gland adenoma of the trachea". Microscopic study shows it to arise from normal submucosal mucous glands forming glandular or tubular structures composed of mucous secreting cells. Common symptoms were cough, hemoptysis, recurrent and protracted pneumonia, shortness of breath, and wheeze. Duration of symptoms before diagnosis varied from a few weeks to 10 years with prolonged symptoms being usual. Management of these tumors should be complete excision, including pulmonary resection because two instances of recurrence after local excision have been reported.

Pleural fluid to serum cholinesterase ratio for the differential diagnosis of transudates and exsudates / 결핵

BACKGROUND: The criteria established by Light et al in 1972 have been used widely for the differential diagnosis of the pleural effusions in transudates and exsudates. However, in recent years, several reports have agreed that these criteria misclassified an important number of effusions. For this reason, different parameters have been proposed for differentiation the transudates from exudates. Nevertheless, all these alternative parameters have not been better than the past criteria of Light et al. In response the usefulness of two parameters for differentiation pleural transudate from exudates were evaluated : pleural fluid cholinesterase level and pleural fluid to serum cholinesterase ratio. METHODS: A total of forty-three patient with know causes of the pleura effusion by diagnostic thoracentesis were studied. The following criteria for differentiating the pleural effusions in transudates and exsudates were analyzed : Light's criteria, the pleural fluid cholesterol level, the pleural fluid to serum cholesterol ratio. the pleural fluid cholinesterase level, and the pleural fluid to serum cholinesterase ratio. RESULTS: The conditions of forty-three patients were diagnosed. Ten were classified as having transudates and thirty-three as exudates. The percentage of effusions misclassified by each parameter was as follows : Light's criteria, 9.3% ; pleural fluid cholesterol, 2.3% ; pleural fluid to serum cholesterol ratio, 2.3% ; pleural fluid cholinesterase, 4.7% ; and pleural fluid to serum cholinesterase ratio, 2.3%. CONCLUSIONS: The pleural fluid to serum cholinesterase ratio is one of the accurate criteria for differentiating pleural transudates from exudates. If further studies confirm these results, the cholinesterase ratio could be used as the first step in the evaluation of pleural effusion and if evaluated together with the other criteria, the differentiation of pleural transudate from exsudates will become more accurate.

Two Cases of Unilateral developmental deficiency of lung found in Identical Twin / 대한내과학회지

Unilateral developmental deficiency of lung is rare. As the most of those, unilateral agenesis or Scimitar syndrome(hypogenetic lung syndrome) had been reported. We experienced that two cases of unilateral developmental deficiency of lung, which is different form each other, are found in identical twin. To our knowledge, this condition has not been reported before. We evaluated lung parenchyma and bronchus(; simple chest PA, chest CT(HRCT, 3DCT)), vasculatures(; pulmonary angiography and cardiac catheterization) and combined anomalies (;abdominal ultrasound, echocardiography, routine blood chemistry, and chromosomal study). This 31 yrs old twin female patient was confirmed as an unilateral agenesis of left upper lobe and hypoplasia of left lower lobe without combined anomalies. She's twin younger sister was confirmed as unilateral agenesis of right lung with atrial septal defect(ASD).

A Case of Left Ventricular Pseudoaneurysm Detected by Transesophageal Echocardiography

Left ventricular pseudoaneurysm, in which a ventricular free wall rupture is locally contained by adherent pericardium, is a rare complication of myocardial infarction. Compared w'th a true left ventricular aneunsm, a pseudoaneurysm has a greater propensity to sudden rupture, with catastrophic sequelae. Pseudoaneurysm may be surgically curable, a prompt and accurate diagnosis is thus essential. Transthoracic echocardiography has been the procedure of choice in the diagnosis of pseu- doaneurysm. Transesophageal echocardiography can provide more accurate information than transthoracic echocardiography for the evaluation of ventricular pseudoaneurysm located in posterior and inferior wall. We experienced a case of pseudoaneurysm of left ventricle in a 75-year-old female who presented with dyspnea. A large pseudoaneurysm of left ventricle vith narrow neck was de- tected by transesophageal echocardiography.

A Case of Digoxin-like Immunoreactive Substance(DLIS) Poisoning After Ingestion of Fried Water Toad (Bufo Stejnegeri Schmidt) / 대한내과학회지

Everybody knows that toads are not eatable because of their toxins. But water toads are very similar to frogs morphologically, so fried water toads are eaten by some people on occasion. It has been studied that the granular glands of the toads secrete toxins known as digoxin-like immunoreactive substances (DLIS) such as bufogenins and bufotoxins. DLIS have cross-reactivity with micro particle enzyme immunoassay for the quantitative mea surement of digoxin. We report a case of DLIS poisoning in 56-year-old male patient who showed vomiting, syn cope, and marked bradyarrhythmia with block (heart rate down to 29 beats per minute) after ingestion of the fried water toads (Bufo stejnegeri Schmidt).