Jae Kyu Sung

Chungnam National University Hospital, Sŏul, Seoul, South Korea

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Publications (35)18.52 Total impact

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    ABSTRACT: Leiomyosarcoma is an uncommon tumor that originates from various organs, including uterus, kidney, retroperitoneum, and soft tissues. In particular, leiomyosarcoma of the stomach is extremely rare. Only 9 cases have been reported worldwide since the discovery of KIT-activating mutation. A 48-year-old woman was admitted to our hospital with abdominal discomfort and generalized weakness. Upon detection of multiple nodules in both lung on chest posterior-anterior radiograph taken at the time of admission, chest CT was performed and it revealed multiple mass lesions in the lung, liver, and pancreas along with multiple lymph node metastases. On endoscopic examination, a 2.0 cm sized ulcerofungating mass lesion was found on the stomach body. Biopsy was performed and the mass lesion proved to be leiomyosarcoma confirmed by immunohistochemical staining. Chemotherapy was thus initiated, but the patient died after one year due to tumor progression. Our experience suggests that leiomyosarcoma can manifest aggressive behavior in its early stage. Herein, we report a case of gastric leiomyosarcoma with multiple metastases along with review of relevant literature.
    The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi 02/2015; 65(2):112-7. DOI:10.4166/kjg.2015.65.2.112
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    ABSTRACT: Spontaneous gastric perforation is a rare complication of gastric lymphoma that is potentially life threatening since it can progress to sepsis and multi-organ failure. Morbidity also increases due to prolonged hospitalization and delay in initiating chemotherapy. Therefore prompt diagnosis and appropriate treatment is critical to improve prognosis. A 64-year-old man presented to the emergency department with severe abdominal pain. Chest X-ray showed free air below the right diaphragm. Abdominal CT scan also demonstrated free air in the peritoneal cavity with large wall defect in the lesser curvature of gastric lower body. Therefore, the patient underwent emergency operation and primary closure was done. Pathologic specimen obtained during surgery was compatible to diffuse large B cell lymphoma. Fifteen days after primary closure, the patient received subtotal gastrectomy and chemotherapy was initiated after recovery. Patient is currently being followed-up at outpatient department without any particular complications. Herein, we report a rare case of gastric lymphoma that initially presented as peritonitis because of spontaneous gastric perforation. (Korean J Gastroenterol 2015;65:43-47).
    The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi 01/2015; 65(1):43-7. DOI:10.4166/kjg.2015.65.1.43
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    ABSTRACT: One of the most important prognostic factors in esophageal carcinoma is lymph node metastasis, and in particular, the number of affected lymph nodes, which influences long-term outcomes. The esophageal lymphatic system is connected longitudinally and transversally; thus, the pattern of lymph node metastases is very complex. Early esophageal cancer frequently exhibits skipped metastasis, and minimal surgery using sentinel node navigation cannot be performed. In Korea, most esophageal cancer cases are squamous cell carcinoma (SCC), although the incidence of adenocarcinoma has started to increase recently. Most previous reports have failed to differentiate between SCC and adenocarcinoma, despite the fact that the Union for International Cancer Control (7th edition) and American Joint Committee on Cancer staging systems both consider these separately because they differ in cause, biology, lymph node metastasis, and outcome. Endoscopic tumor resection is an effective and safe treatment for lesions with no associated lymph node metastasis. Esophageal mucosal cancer confined to the lamina propria is an absolute indication for endoscopic resection, and a lesion that has invaded the muscularis mucosae can be cured by local resection if invasion to the lymphatic system has not occurred.
    11/2014; 47(6):523-9. DOI:10.5946/ce.2014.47.6.523
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    ABSTRACT: Endoscopic submucosal dissection (ESD) is a widely accepted treatment for early gastric and esophageal cancer. Compared to endoscopic mucosal resection, ESD has the advantage of enabling en bloc removal of tumors regardless of their size. However, ESD can result in a large artificial ulcer, which may lead to a considerable deformity. Circumferential mucosal defects of more than three-fourths the esophageal circumference, long longitudinal mucosal defects (>30 mm), and lesions in the upper esophagus are significant risk factors for the development of post-ESD strictures of the esophagus. In the stomach, a circumferential mucosal defects more than three-fourths in extent and longitudinal mucosal defects >5 cm are risk factors of post-ESD stricture. If scheduled early, regular endoscopic balloon dilation is effective in controlling and preventing post-ESD stricture. Moreover, intralesional steroid injections or oral steroids can achieve remission of dysphagia or reduce the need for repeated endoscopic balloon dilation. However, further study is needed to improve the prevention of stricture formation.
    11/2014; 47(6):516-22. DOI:10.5946/ce.2014.47.6.516
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    ABSTRACT: Purpose A colonoscopic polypectomy is an important procedure for preventing colorectal cancer, but it is not free from complications. Delayed hemorrhage after a colonoscopic polypectomy is one infrequent, but serious, complication. The aim of this study was to identify the risk factors for delayed hemorrhage after a colonoscopic polypectomy. Methods This was a retrospective case-control study based on medical records from a single gastroenterology center. The records of 7,217 patients who underwent a colonoscopic polypectomy between March 2002 and March 2012 were reviewed, and 92 patients and 276 controls were selected. Data collected included comorbidity, use of antiplatelet agents, size and number of resected polyps, histology and gross morphology of resected polyps, resection method, and use of prophylactic hemostasis. Results The average time between the procedure and bleeding was 2.71 ± 1.55 days. Univariate and multivariate analyses revealed that the size of the polyps was the only and most important predictor of delayed hemorrhage after a colonoscopic polypectomy (odds ratio, 2.06; 95% confidence interval, 1.12-1.27; P = 0.03). Conclusion The size of resected polyps was the only independent risk factor for delayed bleeding after a colonoscopic polypectomy. The size of a polyp, as revealed by the colonoscopic procedure, may aid in making decisions, such as the decision to conduct a prophylactic hemostatic procedure.
    08/2014; 30(4):182-5. DOI:10.3393/ac.2014.30.4.182
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    ABSTRACT: Hyperplastic polyps are the most common type of gastric polyps that constitute 30~93% of all benign epithelial gastric polyps. The overall prevalence of dysplasia in patients with hyperplastic polyps is believed to be <2%, and higher in patients with large polyps (>2 cm). We aimed to identify the clinical features of hyperplastic polyps that undergo neoplastic transformation.
    01/2014; 14(3):181. DOI:10.7704/kjhugr.2014.14.3.181
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    ABSTRACT: Anterograde jejunojejunal intussusception after total gastrectomy is a very rare postoperative complication. We report a 54-year-old man with a history of total gastrectomy, uncut Roux-en-Y gastric bypass, and Braun's jejunojejunal anastomosis. An upper gastrointestinal endoscopy revealed a bulky, reddish mass in the efferent loop with congestion, edema, and mucosal bleeding. An emergency computed tomography showed a target-like multilayered wall thickening in the afferent loop and a lamellar structure arranged in a concentric circle. Surgical exploration revealed an anterograde intussusception of the afferent proximal jejunum adjacent to the jejunojejunostomy site. This is a very uncommon occurrence because most intussusceptions after total gastrectomy are of the retrograde type. Moreover, anterograde jejunojejunal intussusception tends to occur in the early postoperative period. We report a case of late postoperative anterograde jejunojejunal intussusception after total gastrectomy with Braun's jejunojejunal anastomosis in a 54-year-old Korean man and review the related literature.
    01/2014; 14(4):283. DOI:10.7704/kjhugr.2014.14.4.283
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    ABSTRACT: Carcinosarcoma of the stomach is a rare biphasic tumor that consists of both carcinomatous and sarcomatous components. In the gastrointestinal tract, carcinosarcoma is most frequently seen in the esophagus and rarely in the stomach. Tubular or papillary adenocarcinomas are common carcinomatous components, whereas mesenchymal sarcomatous components may vary. Neuroendocrine carcinomatous differentiation in carcinomatous components is extremely rare. We report a 62-year-old female patient with a history of dyspepsia for one-month-history. Endoscopic findings showed a ulcerofungating lesion, which infiltrated from the posterior wall of the antrum to the posterior wall of the gastric angle. Radical subtotal gastrectomy was performed. In the resected specimen, immunohistochemical studies showed two positive reactions for epithelial and mesenchymal markers. Based on the above findings, the patient was diagnosed with a gastric carcinosarcoma with neuroendocrine differentiation.
    01/2014; 14(2):121. DOI:10.7704/kjhugr.2014.14.2.121
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    ABSTRACT: Previous studies reported that oxaliplatin is associated with sinusoidal obstruction syndrome. However few reports on oxaliplatin induced liver fibrosis are found in the literature. Furthermore pathogenesis of liver fibrosis is not well known. We report a case of 45-yr-old Korean man in whom liver fibrosis with splenomegaly developed after 12 cycles of oxaliplatin based adjuvant chemotherapy for colon cancer (T4N2M0). Thorough history taking and serological examination revealed no evidence of chronic liver disease. Restaging CT scans demonstrated a good response to chemotherapy. Five month after chemotherapy, he underwent right hepatectomy due to isolated metastatic lesion. The liver parenchyma showed diffuse sinusoidal dilatation and centrilobular vein fibrosis with necrosis without steatosis. We could conclude that splenomegaly was due to perisinusoidal liver fibrosis and liver cell necrosis induced portal hypertension by oxaliplatin. In addition, to investigate the pathogenesis of liver fibrosis, immunohistochemical stains such as CD31 and α-smooth muscle actin (α-SMA) were conducted with control group. The immunohistochemical stains for CD31 and α-SMA were positive along the sinusoidal space in the patient, while negative in the control group. Chemotherapy with oxaliplatin induces liver fibrosis which should be kept in mind as a serious complication.
    Journal of Korean medical science 12/2013; 28(12):1835-8. DOI:10.3346/jkms.2013.28.12.1835 · 1.25 Impact Factor
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    ABSTRACT: The most common cause of esophagorespiratory fistulas (ERFs) is associated with malignancy. The use of self-expandable metal stents is effective for the treatment of malignant ERFs, but benign ERF is rare, which is why its optimal treatment is not defined yet. There have been few reports describing benign esophagopleural fistula and its treatments in South Korea. Here, we report a rare case of spontaneous esophagopleural fistula, which was successfully treated by endoscopic placement of a membrane covered metal stent.
    01/2013; 46(1):91-4. DOI:10.5946/ce.2013.46.1.91
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    ABSTRACT: Extra-pelvic spread of squamous cell carcinoma (SCC) of the cervix to the stomach is extremely rare. We report a case of a 50-year-old woman who presented with dysphagia two years after diagnosis of SCC of the cervix. At esophagogastroduodenoscopy, there was a 1.5×1.2 cm sized ulcero-fungating mass at the cardia portion just beneath the esophagogastric junction which was biopsied for a suspected neoplastic lesion. Histologic and immunohistochemical examinations showed a SCC with characteristics identical to her original tumor from the cervix confirming gastric metastasis. Therefore, we report a case of endocervical SCC with metastatic lesions in the stomach 2 years after the initial diagnosis.
    01/2013; 13(1):55. DOI:10.7704/kjhugr.2013.13.1.55
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    ABSTRACT: The clinical outcome of early gastric cancer (EGC) has gradually been improving, and the 5-year survival rate for patients with EGC has been reported to exceed 85% in most studies. However, in some rare cases, EGC is associated with distant metastasis. Bone metastases from stomach cancer are usually osteolytic lesions. Although there have been a few reports of EGC with bone marrow metastasis, cases of triple EGC with bone marrow metastasis are rare. We report a 50-year-old male patient who was diagnosed with triple EGC with bone marrow metastasis. This case can be considered to be rare because the patient had no spread of the disease to other organs.
    01/2013; 84(1):71. DOI:10.3904/kjm.2013.84.1.71
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    ABSTRACT: Colloid carcinoma of the liver is very rare, and its clinicopathologic features have not been well characterized yet. We describe herein a case of colloid carcinoma of the liver. Imaging revealed a lobulated mass, measuring 12 cm in diameter at the right lobe of the liver with direct invasion of adjacent peripheral intrahepatic bile ducts. Right hemihepatectomy of the liver was performed according to the possibility of the tumor's malignant behavior. Histopathological examination of the specimen revealed large extracelluar stromal mucin pools containing floating cuboidal to columnar neoplastic cells without ovarian-like stroma. This case seemed to be colloid carcinoma arising in association with intraductal papillary neoplasm of the liver. (Korean J Gastroenterol 2012;60:386-390).
    The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi 12/2012; 60(6):386-90. DOI:10.4166/kjg.2012.60.6.386
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    ABSTRACT: OBJECTIVE: To determine if the level of serum C-reactive protein (CRP) can be used to differentiate between inflammatory diarrhea and non-inflammatory diarrhea in patients with acute infectious diarrhea or acute gastrointestinal infection. METHODS: This was a retrospective study based on medical records from a single military hospital located in Daejeon, Republic of Korea. The records of 1,085 patients who presented with abdominal pain, fever (≥37.8 °C), and diarrhea between May 2008 and May 2011 were reviewed, and 538 patients were selected. The eligible patients had undergone abdominal contrast tomography (CT) or colonoscopy within 3 days and blood sampling on the day of admission. The selected patients were divided into two groups on the basis of their abdominal CT or colonoscopy findings: group A, the inflammatory diarrhea group (n = 234), and group B, the non-inflammatory diarrhea group (n = 304). We then compared the clinical and laboratory characteristics of these two groups. RESULTS: Erythrocyte sedimentation rate and CRP levels were significantly higher in group A (inflammatory diarrhea) patients than group B (non-inflammatory diarrhea) patients (16.47 ± 5.46 vs. 15.29 ± 5.72 (P < 0.05), respectively, and 4.92 ± 2.49 vs. 1.79 ± 0.95 (P < 0.05), respectively). Multivariate analysis revealed that CRP level on admission was the most important predictor of inflammatory diarrhea (OR 7.39, P < 0.05). Receiver operating characteristic analysis results also showed that CRP had the highest area-under-the-curve value (0.91; 95 % confidence interval 0.88-0.93; P < 0.05) for distinguishing inflammatory diarrhea from non-inflammatory diarrhea. At a cut-off level of 3.08 mg/dL, CRP had a sensitivity of 82 % and a specificity of 85 %. CONCLUSIONS: CRP as a diagnostic marker of inflammatory diarrhea was superior to the other inflammatory markers and clinical characteristics we evaluated in this study. A patient's CRP level on admission may aid clinical decision-making, for example initiating empiric antibiotics therapy and/or performing additional clinical tests.
    Digestive Diseases and Sciences 08/2012; DOI:10.1007/s10620-012-2365-3 · 2.55 Impact Factor
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    ABSTRACT: Mantle cell lymphoma (MCL) is an uncommon type of gastrointestinal lymphoma. MCL is a distinct subtype of B-cell non-Hodgkin lymphomas. The major subtype of MCL is characterized by the presence of multiple lymphomatous polyposis (MLP), in which multiple polyps are observed along the gastrointestinal tract. The malignant cells express pan B-cell marker and the T-cell marker cluster of differentiation 5. The chromosomal translocation t(11;14)(q13;q32) that causes cyclin D1 overexpression is commonly observed on the cytogenetic analysis of MCL. Survival improvement has recently been achieved for patient with MCL by the successful introduction of monoclonal antibodies and dose-intensified approaches for treatment, including autologous stem cell transplantation strategies. Some reports suggest that there is an increased incidence of second malignancies in patients with MCL or lymphoma. We report a case of MCL involving the colon; the patient was a 60-year-old man who complained of low abdominal discomfort during defecation. During the workup, a meningioma was unexpectedly discovered. On analysis, the tumor was found to be a t(11;14)-negative and non-MLP-type MCL.
    The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi 07/2012; 60(1):56-60. DOI:10.4166/kjg.2012.60.1.56
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    ABSTRACT: Primary ovarian lymphoma is a rare malignancy whose symptoms or signs are usually nonspecific. In this article, we report a very rare case initially presenting as a rectal submucosal-tumor-like lesion with a defecation disturbance caused by primary ovarian lymphoma with bilateral involvement. A 42-year-old woman visited chungnam national university hospital complaining of persistent defecation disturbance for 6 months. Colonoscopy demonstrated compression of the rectum by an extrinsic mass mimicking a rectal submucosal tumor. Magnetic resonance imaging detected bilateral ovarian tumors, 9.3 cm and 5.4 cm each in diameter, compressing the rectum without enlarged lymph nodes. The diagnosis was established following a bilateral adnexectomy and histological studies of the excised tissue. The tumor was classified as a diffuse large B-cell lymphoma. The patient was prescribed six cycles of standard CHOP (cyclophosphamide, hydroxydaunorubicin, vincristine, prednisolone) regimen and is presently on treatment.
    Journal of the Korean Society of Coloproctology 04/2012; 28(2):111-5. DOI:10.3393/jksc.2012.28.2.111
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    ABSTRACT: Primary signet ring cell carcinoma (SRC) of colon at early stage is quite rare. Only 26 cases were reported until now. We report an early stage of primary SRC which was misdiagnosed as a juvenile polyp and treated with polypectomy followed by surgical resection. A 21-year-old male was administered for hematochezia. Abdominopelvic enhanced computed tomography revealed a polyp with active bleeding at the proximal rectum just below the rectosigmoid junction. Colonoscopy examination revealed a colon polyp with 0.5 cm sized head. Polypectomy was performed with snare and the polyp was completely removed. Biopsy revealed SRC. Surgical resection was also performed and there were no residual tumor or lymph node metastasis in the surgical specimen.
    Gut and liver 01/2012; 6(1):129-31. DOI:10.5009/gnl.2012.6.1.129 · 1.49 Impact Factor
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    ABSTRACT: Duodenal leiomyomas are rare benign tumors of mesenchymal origin. Generally, Fluorodeoxyglucose (FDG)-PET would have a negative finding in leiomyomas. A 52-year-old man was referred to our hospital with melena. Gastroendoscopy revealed the presence of a huge submucosal tumor with ulceration at the duodenum bulb. Subsequent CT demonstrated a poorly enhanced oval mass adjoining the duodenal bulb. FDG-PET scan demonstrated an excessive accumulation of FDG in the lesion. A definitive diagnosis of duodenal leiomyoma was made on the basis of the pathologic finding of his surgical specimen. We report in this first case that duodenal leiomyma may show a potential pitfall of giving a positive FDG-PET result. Through this case, we would like to caution clinicians against PET-dependent evaluations of malignant potential of duodenal submucosal tumors.
    01/2012; 12(3):198. DOI:10.7704/kjhugr.2012.12.3.198
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    ABSTRACT: Breast cancer is the most common malignancy among American women and, after lung cancer, the second greatest cause of female cancer deaths. Even with early diagnosis and application of new therapies, approximately 50% of patients are still at risk of developing distant metastasis. The common metastasic sites of breast cancer are the distant lymph nodes, bone, lungs, liver, and brain. Gastrointestinal tract metastases are less common and are detected in less than 5% of all breast cancer patients. Duodenal metastasis of breast cancer occurs at a low rate and until now there have been only few reported cases. Gastrointestinal metastasis usually derives from lobular breast cancer rather than ductal breast cancer, which is the much more common cell type of breast cancer. In this report, we present a rare case of a 65-year-old female who presented with duodenal metastasis from invasive lobular breast carcinoma.
    01/2012; 12(4):280. DOI:10.7704/kjhugr.2012.12.4.280
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    ABSTRACT: Early gastric cancer (EGC) that is undifferentiated or shows submucosal invasion has not been generally accepted as an indication for endoscopic treatment. But recently, experiences with endoscopic submucosal dissection (ESD) for undifferentiated EGC or submucosal invasive (SM) EGC have increased. The aim of this study was to evaluate clinical outcomes of ESD for EGC with undifferentiation or submucosal invasion. Between August 2005 and August 2009, among 210 EGCs treated using ESD at our hospital, 18 lesions were diagnosed as undifferentiated gastric cancer and 41 as SM gastric cancer. A retrospective analysis was done on the medical records of these patients. Mean follow-up periods were 19.39±11.2 months. During the follow-up period, local recurrence was noted in 4 lesions. Local recurrence rates of the EGC groups (group 1, mucosal cancer with undifferentiation; group 2, SM cancer with differentiation; group 3, SM cancer with undifferentiation) were 10%, 4.5%, and 50%, respectively. Groups 1 and 2 were not significantly different in local recurrence rates compared to the mucosal cancer with differentiation group (p=0.061, p=0.125, respectively). The undifferentiated EGC group was significantly lower in curability using ESD than the differentiated EGC group (55.6% vs. 89.6%, p=0.000). The curability of the SM EGC group was lower than the mucosal EGC group (36.6% vs. 98.9%). Complete resection using ESD is difficult in undifferentiated and SM gastric cancers. SM cancer with undifferentiation should be treated immediately by salvage operation. For mucosal cancer with undifferentiation or SM cancer with differentiation, one should consider careful short-term follow-up.
    12/2011; 44(2):116-22. DOI:10.5946/ce.2011.44.2.116