Sarcomatous hepatocellular carcinoma (HCC) is a rare primary liver cancer. Pathogenesis of sarcomatous transformation of HCC has not yet been elucidated. Sarcomatous HCC has highly invasive and metastatic potential, compared with ordinary HCC. We present here two cases of sarcomatous hepatocellular carcinoma with an unfavorable prognosis. Other cases reported in Korean literature of this uncommon tumor were also reviewed.
Carcinoma, Hepatocellular ; Liver Neoplasms ; Prognosis

Infarction of the greater omentum is an uncommon cause of acute abdominal pain, usually diagnosed during surgery for suspected appendicitis. However, during the last decade, preoperatively diagnosed omental infarctions successfully managed with conservative treatments have been increasingly identified with expanded utilization and technical advancements of sonography and computed tomography (CT). We report a case of omental infarction in a middle aged woman. Diagnosis was confirmed by abdominal CT, and she was successfully managed with conservative treatments including analgesics and prophylactic antibiotics. Follow-up CT performed 14 days after discharge revealed a decrease of infarct area without any intra-abdominal complications. This report emphasizes that nonoperative management of omental infarction may be safe and effective in most cases.
Abdomen, Acute ; Abdominal Pain ; Analgesics ; Anti-Bacterial Agents ; Appendicitis ; Female ; Follow-Up Studies ; Humans ; Infarction ; Middle Aged ; Omentum

Cyproterone acetate is an antiandrogenic drug that has been used in prostatic cancer. The drug is thought to be well-tolerated but has hepatotoxic effects. An 89 year-old man treated with cyproterone acetate 300 mg/d for prostatic cancer presented with a hepatotoxic reaction. Toxic hepatitis was diagnosed and cyproterone acetate was stopped immediately. The patient was treated with supportive management and a corticosteroid, but he died 28 days after administration due to liver failure. A liver biopsy performed after his death revealed the presence of acute hepatitis with cirrhosis. Underlying cirrhosis was not suspected before his death. Ultimately, the case was diagnosed as fulminant hepatic failure due to cyproterone acetate with underlying cryptogenic liver cirrhosis. This case and current literature highlight the hepatotoxic potential of cyproterone acetate and illustrate the importance of clinical surveillance, especially in patients with unrecognized liver disease.
Biopsy ; Cyproterone ; Cyproterone Acetate ; Drug-Induced Liver Injury ; Fibrosis ; Hepatitis ; Humans ; Liver ; Liver Cirrhosis ; Liver Diseases ; Liver Failure ; Liver Failure, Acute ; Prostatic Neoplasms

Actinomycosis is a chronic suppurative and granulomatous disease caused by a Gram-negative anaerobic bacterium, Actinomyces israelii, which is among the normal flora of the oral cavity and gastrointestinal tract of humans and animals. It is characterized by sulfur granule formation and can involve the cervicofacial area, chest, abdomen, and pelvis. The most common predisposing factors are the presence of an intrauterine contraceptive device, previous trauma, appendectomy, colon diverticulum, and gastrointestinal perforation. Primary gastric actinomycosis is an extremely rare disease. Three cases of gastric actinomycosis have been reported in people who had a subtotal gastrectomy for stomach cancer in Korea. We report a case of primary gastric actinomycosis in a 59-year-old man with untreatable hepatocelluar carcinoma. His actinomycosis was cured with penicillin therapy.
Abdomen ; Actinomyces ; Actinomycosis ; Animals ; Appendectomy ; Carcinoma, Hepatocellular ; Diverticulum, Colon ; Gastrectomy ; Gastrointestinal Tract ; Humans ; Intrauterine Devices ; Korea ; Middle Aged ; Mouth ; Pelvis ; Penicillins ; Rare Diseases ; Stomach Neoplasms ; Stomach Ulcer ; Sulfur ; Thorax

Carcinosarcoma of the esophagus is a rare malignant neoplasm that consists of both carcinomatous and sarcomatous components, accounting for approximately 1~2% of all esophageal neoplasms. The terms previously used to describe this tumor include pseudosarcoma, pseudosarcomatous carcinoma, polypoid carcinoma, so-called carcinosarcoma, true carcinosarcoma, and spindle cell carcinoma. Although about 11 cases of esophageal carcinosarcoma have been reported in Korea, none have included findings from positron emission tomography. Here, we report a case of esophageal carcinosarcoma in a 63-year-old man who presented with a 3 month history of progressive dysphagia and weight loss. Positron emission tomography shows expanding hot uptake (mSUV, 9.94) in the distal esophagus.
Accounting ; Carcinosarcoma ; Deglutition Disorders ; Esophageal Neoplasms ; Esophagus ; Humans ; Korea ; Middle Aged ; Positron-Emission Tomography ; Weight Loss

There are many possible causes of esophageal ulcer, including reflux esophagitis, the ingestion of foreign bodies or caustic agents, radiation exposure, viral infections, tuberculosis, Candida infection, Bechet's disease, and esophageal cancer. Patients with drug-induced esophagitis typically have a history of ingesting medication with little or no fluid immediately before going to bed. Here, we present the case of a 31-year-old man complaining of dysphagia and odynophagia for 4 days. The patient reported taking oral medication for acute sinusitis 12 days prior. Endoscopic examination revealed a large, deep esophageal ulcer consistent with esophageal cancer or cytomegalovirus esophagitis. The exam also revealed several esophageal erosions resembling herpes simplex virus esophagitis. However, based on the patient's history and subsequent histologic findings, drug-induced esophagitis was diagnosed and the patient was successfully treated with a proton pump inhibitor. Lesions showed improvement upon follow-up endoscopy 1 month later.
Adult ; Candida ; Cytomegalovirus ; Deglutition Disorders ; Eating ; Endoscopy ; Esophageal Neoplasms ; Esophagitis ; Esophagitis, Peptic ; Follow-Up Studies ; Foreign Bodies ; Humans ; Methylmethacrylates ; Polystyrenes ; Proton Pumps ; Simplexvirus ; Sinusitis ; Tuberculosis ; Ulcer

Pseudocystocolonic fistula is a rare, but occasionally lethal event in acute pancreatitis. Surgery has been the mainstay treatment, but recent literature has reported improvements in non-surgical therapies. Here, we report a case of acute pancreatitis complicated by pseudocystocolonic fistula that was treated by non-surgical means. A 58-year-old man, who consumed excessive alcohol, was admitted with severe abdominal pain. Abdominal computed tomography (CT) showed multiple pancreatic pseudocysts and fistula in the descending colon associated with acute pancreatitis. The fistula opening was identified by colonoscopy, and a diagnosis of pseudocystocolonic fistula was made. The pseudocyst was lavaged with saline through a percutaneous cystic drainage catheter and the patient became asymptomatic. Follow-up abdominal CT confirmed the disappearance of the colonic fistula and multiple pseudocysts. We also provide a review of the most effective non-surgical therapies for pseudocystocolonic fistula associated with acute pancreatitis.
Abdominal Pain ; Catheters ; Colon ; Colon, Descending ; Colonoscopy ; Drainage ; Fistula ; Follow-Up Studies ; Humans ; Middle Aged ; Pancreatic Pseudocyst ; Pancreatitis

The desire to maintain youth and beauty has led to an increase in the use of health foods and herbs. Because Polygonum multiflorum Thunb. is thought to prevent hair loss and maintain black hair, this herb in particular has captured public interest in Korea and China. Although there have been many reports regarding the toxic effects of herbs and health foods, the potential toxicity of this herb has not yet been reported. Here, we discuss two cases of toxic hepatitis due to Polygonum multiflorum ingestion and present a review of the relevant literature.
Adolescent ; Beauty ; China ; Drug-Induced Liver Injury ; Eating ; Hair ; Food, Organic ; Humans ; Korea ; Polygonum

Sarcomatoid carcinoma is a rare malignant neoplasm that may develop in various organs. Hepatocellular carcinoma with sarcomatous changes after anticancer therapy, such as hepatic arterial chemoembolization, has been reported, but primary sarcomatoid carcinoma of the liver is uncommon. Here, we report two cases of primary liver sarcomatoid carcinoma associated with glomerulonephritis in two men (68 and 55 years old, respectively) without any risk factors. Neither man was an alcoholic nor a hepatitis virus carrier, nor did either have a prior medical history of disease. Tumor markers were within normal ranges. In both men, imaging studies revealed a mass in the liver, with metastatic lesions on either the lung or sacrum, respectively. Histopathologic examination of the liver and kidney revealed sarcomatoid carcinoma of the liver and glomerulonephritis.
Alcoholics ; Carcinoma, Hepatocellular ; Glomerulonephritis ; Hepatitis Viruses ; Humans ; Kidney ; Liver ; Lung ; Male ; Reference Values ; Risk Factors ; Sacrum ; Sarcoma ; Biomarkers, Tumor

Sjogren's syndrome is an autoimmune disease that presents mainly as dry eyes and mouth, and occasionally with extra-glandular symptoms. A peripheral neuropathy is present in 10~30% of the cases with extra-glandular symptoms, although a tonic pupil caused by destruction of the ciliary ganglion is rare. We report a case of rheumatoid arthritis with Sjogren's syndrome presenting as a tonic pupil. A 29-year-old woman was admitted for evaluation of polyarthralgia and a tonic pupil. On physical examination, she had polyarthritis involving the jaws, shoulders, wrists, and hands. Her pupils were anisocoric and did not react to light, but constricted promptly to pilocarpine. Biopsy of the minor salivary gland showed lymphocyte infiltration. Rose-Bengal stain was positive. She was diagnosed with rheumatoid arthritis with Sjogren's syndrome and treated with prednisolone and hydroxychloroquine. Three months later, her polyarthritis had improved markedly, but she still had a tonic pupil.
Adult ; Arthralgia ; Arthritis ; Arthritis, Rheumatoid ; Autoimmune Diseases ; Biopsy ; Eye ; Female ; Ganglion Cysts ; Hand ; Humans ; Hydroxychloroquine ; Jaw ; Light ; Lymphocytes ; Mouth ; Peripheral Nervous System Diseases ; Physical Examination ; Pilocarpine ; Prednisolone ; Pupil ; Salivary Glands, Minor ; Shoulder ; Sjogren's Syndrome ; Tonic Pupil ; Wrist