[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] ABSTRACT: 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.
[Show abstract][Hide abstract] 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. · 0.84 Impact Factor
[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] 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; · 2.26 Impact Factor
[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] 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. · 1.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although notably common, irritable bowel syndrome (IBS) has no specific cure. Lifestyle modification may be as important as medication; however, few studies support the effectiveness of such modifications. We performed this observational study of IBS patients to explore further the role of lifestyle changes in treatment.
This study included 831 men who enlisted in 2010 as armed surgeon cadets and 85 women who concurrently entered the Armed Forces Nursing Academy. Of these 916 participants, 89 were diagnosed with IBS using the Rome III criteria. Subjective changes in bowel habits, quality of life, pain, stress, stool frequency and stool consistency were surveyed before and after 9 weeks of army training. We evaluated the lifestyle risk factors that impacted improvement in IBS symptoms by comparing those who responded to lifestyle modification (the responding group) to those who did not respond (the nonresponding group).
More than half of the participants (63%) reported that their symptoms improved after training. The quality of life and levels of pain and stress significantly improved after military training. Initial stress levels before military training and smoking history affected IBS symptom improvement.
Lifestyle modification may be effective in managing IBS patients.
Gut and liver 12/2011; 5(4):472-7. · 1.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We retrospectively analyzed comparative toxicities and efficacies of chemotherapy regimens in advanced gastric cancer (AGC) patients who achieved complete response (CR) after chemotherapy.
We reviewed the medical records of 1,203 patients, who were pathologically diagnosed as AGC in a single center between January 2001 and October 2007. On the basis of the Response Evaluation Criteria in Solid Tumors, CR was evaluated with abdominal computed tomography. Toxicities were evaluated using the National Cancer Institute's common toxicity criteria before each chemotherapy cycle.
Among the 1,203 AGC patients enrolled in this study, 568 received chemotherapy and 635 received best supportive care. The major chemotherapy regimens were 5-fluorouracil, leucovorin and oxaliplatin (FOLFOX), docetaxel, cisplatin and 5-fluorouracil (DCF) and 5-fluorouracil, leucovorin and irinotecan (FOLFIRI). Among the 568 patients, 51 (9.0%) achieved CR (49 [8.6%] with FOLFOX [n=12], DCF [n=26], or FOLFIRI [n=11] and 2 [0.3%] with etoposide, leucovorin and 5-fluorouracil). For patients administered FOLFOX, DCF, and FOLFIRI, the median time to disease progression was 4 months (range, 1.8-59.5), 15 months (range, 2.9-31.2) and 10 months (range, 2.0-39.5), and the median survival times were 48 months (range, 5.9-74.0), 37 months (range, 14.0-86.0), and 30 months (range, 6.0-50.0), respectively. Grades 3-4 mucositis occurred mostly in patients administered DCF (n=8, 30.8%). Grades 3-4 leucopenia were observed in 1 (8.3%), 11 (42.3%), and 4 (36.4%) patients administered FOLFOX, DCF and FOLFIRI, respectively. No statistically significant differences were observed in the 3 regimens.
All 3 regimens (FOLFOX, DCF and FOLFIRI) were active and tolerable. Their efficacies and toxicities were not significantly different.
The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi 12/2011; 58(6):311-7.
[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] ABSTRACT: A primary leiomyosarcoma of the kidney is a rare, but highly aggressive, neoplasm, accounting for only 0.1% of all invasive renal tumors. Local or systemic recurrence is common, but a leiomyosarcoma is difficult to diagnose preoperatively. We recently encountered an interesting case of an unusual recurrence of a renal leiomyosarcoma. A 57-year-old woman visited our hospital complaining of lower abdominal pain. Four years previously, she had undergone a left nephrectomy. She had a primary leiomyosarcoma of the kidney that had been misdiagnosed as a renal cell carcinoma. Colonoscopy revealed the presence of a lesion similar to a submucosal tumor in the descending colon. Postoperative pathologic examination confirmed that the mass was a recurrent leiomyosarcoma. We report this unusual case and present a review of the literature.
Journal of the Korean Society of Coloproctology 10/2011; 27(5):270-4.
[Show abstract][Hide abstract] ABSTRACT: Recently colonoscopy and screening programs have led to the detection and removal of increasing numbers of early colorectal cancer (ECC), which can reduce its related mortality. We analysed the clinical, endoscopic, and histologic findings, as well as the follow-up data, to evaluate the effectiveness and the long-term results of endoscopic mucosal resection (EMR) for ECC.
We analysed, retrospectively, 94 lesions in 92 patients who underwent EMR for ECC from January 2002 to June 2009.
The overage age of patients was 60 years old. The mean follow-up period was 22.1 months (6-80). En bloc resection rate was 64.9%. Submucosal invasion was found in 30 cases (31.9%). De novo cancer rate was 26.6% which had higher submucosal invasion rate (60%, p=0.003). The complete resection rate was 87.2%, and there was no recurrence of cancer during follow-up (p=0.000). Twelve incomplete resection cases had received further surgical treatments. No procedure-related mortality was found and no recurrent malignancy was found except 1 case.
This study shows that EMR is an effective and safe treatment for ECC. En bloc resection provides precise histologic information and prevention of tumor recurrence.
The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi 04/2011; 57(4):230-6.
[Show abstract][Hide abstract] ABSTRACT: We describe moderate hyperbilirubinemia in a 28-year-old man who suffered from gallstones and splenomegaly, with combined disorders of hereditary spherocytosis (HS) and Gilbert's syndrome (GS). Since it is difficult to diagnose HS in the absence of signs of anemia, we evaluated both the genetic mutation in the UGT1A1 gene and abnormalities in the erythrocyte membrane protein; the former was heterozygous for a UGT1A1 allele with three mutations and the latter was partially deficient in ankyrin expression. This is the first report of the concomitance of HS and GS with three heterozygous mutations [T-3279G, A (TA)7TAA, and G211A] in the UGT1A1 gene.
The Korean Journal of Hepatology 09/2010; 16(3):321-4.
[Show abstract][Hide abstract] ABSTRACT: We performed retrospective study in order to compare oxaliplatin, leucovorin, and fluorouracil (FOLFOX) versus irinotecan, leucovorin, and fluorouracil (FOLFIRI) in recurred or metastatic gastric adenocarcinoma.
We investigated 56 patients who were diagnosed with recurred or metastatic gastric adenocarcinoma in a single center during march, 2003 to march, 2008. The patients received either FOLFOX or FOLFIRI chemotherapy.
There were no significant difference between the Oxaliplatin group (30 patients) and Irinotecan group (26 patients) in sex, age, and ECOG performance (p<0.05). Oxaliplatin group showed 1 case of CR (3.3%) and 12 cases of PR (40%), making the response rate 43.3%. Irinotecan group showed CR in 2 cases (7.7%) and PR in 10 cases (38.5%), making the response rate 46.2%. The median value of time to progression was 4 months in the oxlaplatin group and 4.5 months in the irinotecan group. The overall survival showed no significant difference (p=0.784), with the irinotecan group (9.7 months) being slightly longer than the Oxaliplatin group (8.3 months). Grade 3/4 neutropenia occurred similarly in both groups (4 cases in the oxalplatin group, 9 in the irinotecan group).
Both combination treatment can be used safely and effectively in recurred or metastatic gastric adenocarcinoma.
The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi 01/2010; 55(1):26-32.