A case of port site metastasis of unexpected gallbladder carcinoma after laparoscopic cholecystectomy / 대한내과학회지

Laparoscopic cholecystectomy (LC) is considered as the gold standard operation for the removal of a nonmalignant, diseased gallbladder. With the increasing number of LCs, a number of gallbladder carcinomas have been unexpectedly found either during or following this procedure. The removal of unexpected gallbladder carcinomas by LC can cause also a new complication, port site metastasis (PSM), which is developed by the implantation of tumor cells into the abdominal wall at the port site. We report a rare case of PSM of gallbladder carcinoma which was unsuspected at the time of LC. A 65-year-old man underwent LC at another hospital for calculous cholecystitis. The histologic examination revealed an adenocarcinoma of the gallbladder infiltrating the muscle wall. Despite the surgeon's advice, the patient refused any additional treatment. Ten months after surgery, he visited our hospital because of a painful and palpable subcutaneous mass at the scar of the periumbilical trocar incision. The mass was biopsed and histological examination confirmed metastasis from the gallbladder carcinoma.

A case report of malignant paraganglioma with hepatic metastases / 대한내과학회지

We report a case of malignant paraganglioma with hepatic metastases. A 70-year old woman developed huge hepatic tumor 2years after complete resection of the retroperitoneal paraganglioma. CT imaging of abdomen revealed huge hepatic masses, which had not been found previously. A needle biopsy on the liver was performed, resulting in a diagnosis of malignant paraganglioma. These tumors are usually benign but can occasionally produce local and distant metastases. Development of metastatic localizations is the only formal proof of malignancy as histology cannot distinguish between benign and malignant paragangliomas. Surgery is the basis of treament and should be performed early in the operable course. Both chemotherapy and radiotherapy could be given, but satisfactory outcomes were not obtained. We suggest that close investigations for metastasis in patient with paraganglioma, seemed benign initially, as well as periodic follow up examinations should be emphasized.

A case of malignant acanthosis nigricans associated with gastric adenocarcinoma / 대한내과학회지

The new onset of acanthosis nigricans in an adult-especially when the lesions appear on mucosal membranes such as the lips, periocular areas, and anus-may be indicative of an underlying tumor. Adenocarcinoma of the gastrointestinal tract is the most common malignancy-most often cancer of the stomach. A 72 years old female had disseminated, symmetrically distributed, brownish black pigmentation and papillary hypertrophy on the intertriginous and flexural areas for 12 months, and gastric adenocarcinoma was confirmed during the evaluation of internal malignancy. The cutaneous finding of acanthosis nigricans was a significant cutaneous marker of internal malignancy in this case.

A Case of Uric Acid Nephropathy as first presentation of Acute Lymphoblastic Leukemia / 대한내과학회지

Acute uric acid nephropathy is a kind of acute renal failure and results from uric acid crystal deposition within the collecting ducts and the distal tubules due to rapid increase of serum uric acid concentration. Hyperuricemia can be, in the relation to the underlying physiology, clas sified into the three categories. i.e., increased urate pro duction, decreased uric acid excretion, or a combination of the two. It is most commonly presented in the lympho proliferative or myeloproliferative disorders after effective cytolytic chemotherapy in the form of tumor lysis syn drome. But we have recently experienced a case of a 73 year-old female patient with acute lymphoblastic leuke mia whose first presentation was acute uric acid nephrop athy, spontaneously developed without chemotherapy and so report it with review of related literatures.

A Case of Primary Systemic Amyloidosis Predominantly Presenting Nephrotic Syndrome and Peripheral Neuropathy / 대한신장학회잡지

Primary systemic amyloidosis is a progressive disease that is frequently fatal. Nephrotic syndrome is present in almost one-third, congestive heart failure in one-quarter, and peripheral neuropathy in one-sixth of patients at the time of diagnosis. If heart or renal failure are presented, survival rate is poor. We experienced a case of a 66 year-old female patient who had complained lower leg edema and paresthesia of extremities for about 5 months. The laboratory findings were consistent with nephrotic syndrome, but the lower leg edema was non-pitting and the cause of paresthesia was unknown. We performed kidney and nerve biopsy and confirmed a case of primary systemic amyloidosis. In this case, presence of postural hypotension, probable cardiac involvement and relatively long spikes along the outside of the glomerular capillary loops on methenamine silver stain is suggestive of poor prognosis. We can predict chronic renal failure and congestive heart failure in the course of this case. We report a case of primary systemic amyloidosis predominantly presenting nephrotic syndrome and peripheral neuropathy with review of related literatures.