A Case of Autoimmune Pancreatitis Manifested by a Pseudocyst and IgG4-Associated Cholangitis.

Autoimmune pancreatitis (AIP) is a benign disorder and a unique form of chronic pancreatitis with several characteristic features. A cystic formation that mimics a pseudocyst is a rare finding. There have been a few reports of AIP complicated by pancreatic cysts. We present a case of AIP with multiple pseudocysts and obstructive jaundice caused by IgG4-associated cholangitis. We initially missed the diagnosis due to the pseudocyst. Based on the computed tomography images, laboratory findings and the therapeutic response to steroids, the case was diagnosed as AIP with pseudocysts and associated cholangiopathy.

Endoscopic findings and clinical features of esophageal tuberculosis.

OBJECTIVE: Mycobacterial involvement of the esophagus is rare. Similar abnormal lesions of the esophagus may be confused with esophageal cancer and deep fungal infections. We studied the clinical features, endoscopic findings, the role of histopathology, and the outcome of antituberculosis treatment in patients with esophageal tuberculosis. METHODS: A single center based, retrospective study was performed. We reviewed the clinical and pathological records of patients with esophageal tuberculosis that were clinically diagnosed from 1997 to 2006. RESULTS: Esophageal tuberculosis, confirmed by histology, was found in six patients. Five patients presented with local symptoms. The mean number of endoscopic sessions for a diagnosis was 1.8 sessions (range 1-3). For the histopathology, caseous necrosis was found in four patients but positive acid fast bacilli stains and tuberculosis-polymerase chain reaction were not detected. Patients diagnosed with esophageal tuberculosis tolerated medical therapy and responded well. CONCLUSION: Because esophageal tuberculosis presents with various, diverse clinical features, and endoscopic findings, it is difficult to diagnose at one session of endoscopy. However, esophageal tuberculosis should be considered in the differential diagnosis if ulcerative lesions were found in the mid esophagus.

Endoscopic resection of duodenal neoplasms: a single-center study.

BACKGROUND: Premalignant duodenal lesions such as adenomas are rare. Surgical resection has been the standard approach to the treatment of these lesions. Endoscopic resection of superficial premalignant or malignant lesions of the gastrointestinal tract is used with increasing frequency. This study aimed to evaluate the safety and efficacy of endoscopic resection of duodenal neoplasms. METHODS: Patients with nonampullary duodenal adenomas or duodenal adenocarcinomas without familial polyposis syndrome between August 2002 and February 2009 were retrospectively analyzed. Data including location and size, technique used for the endoscopic resection, complications, and follow-up evaluation of the lesions were reviewed. RESULTS: The study enrolled 24 patients with duodenal neoplasms. Of these patients, 23 had duodenal adenomas and 1 had an adenocarcinoma confined to the mucosa. The mean age of the patients was 57 years (range, 40-82). In terms of location, 12 lesions (50%, 12/24) were found in the second portion of the duodenum, and 11 (45.8%, 11/24) were found in the first portion. Tubular adenomas were the most common type (17/24, 70.8%). There were four cases of the villotubular type and three of the villous type. Conventional endoscopic mucosal resection (EMR) was performed for 19 patients, EMR with ligation (EMR-L) for 3 patients, and snare polypectomy for 2 patients. Complete resection was achieved for 87.5% (21/24) of the patients, and the recurrence rate was 8.3% (2/24). All the complications were intraprocedural bleeding (n = 7), with no occurrence of perforation or infection. During a median follow-up period of 6 months (range, 3-36 months), recurrence of the duodenal neoplasm was observed in two cases. There was no procedure-related mortality. CONCLUSIONS: Endoscopic resection of duodenal neoplasms was safe and effective treatment. During the short-term follow-up evaluation, EMR showed outcomes and complications comparable with prior procedures, including adenocarcinomas confined to the mucosa.

Hemophagocytic syndrome associated with bilateral adrenal gland tuberculosis.

We report a case of a patient who presented with hemophagocytic syndrome (HPS) and adrenal crisis associated with bilateral adrenal gland tuberculosis, and resulted in a poor outcome. A 50-year-old man was transferred to our hospital from a local clinic due to fever, weight loss, and bilateral adrenal masses. Laboratory findings showed leukopenia, mild anemia, and elevated lactate dehydrogenase. Computed tomography (CT) of the abdomen revealed bilateral adrenal masses and hepatosplenomegaly. CT-guided adrenal gland biopsy showed numerous epithelioid cells and infiltration with caseous necrosis consistent with tuberculosis. Bone marrow aspiration and biopsy showed significant hemophagocytosis without evidence of malignancy, hence HPS associated with bilateral adrenal tuberculosis was diagnosed. During anti-tuberculosis treatment the patient showed recurrent hypoglycemia and hypotension. Rapid ACTH stimulation test revealed adrenal insufficiency, and we added corticosteroid treatment. But pancytopenia, especially thrombocytopenia, persisted and repeated bone marrow aspiration showed continued hemophagocytosis. On treatment day 41 multiple organ failure occurred in the patient during anti-tuberculous treatment and steroid replacement.