Carcinoid tumors arising in the extrahepatic bile duct are very rare, accounting for only 0.2%~2% of all gastrointestinal carcinoid tumord. We experienced one case of a carcinoid tumor in the common bile duct. A 43-years-old man was unexpectedly found to have a carcinoid tumor of the common bile duct. This patient had no obstructive jaundice, yet we thought that this tumor was a clinically malignant tumor, so we performed pylorus preserving pancreatoduodenectomy. Pathologically, an ill-demarcated mass that measured 1.5x1.5cm in size had invaded into the pancreas. Immunohistochemically, the mass was founded to be chromogranin, synaptophysin and CD56 positive. The patient who underwent curative resection is alive and disease-free at time of this publication. This report also reviews the relevant literature on carcinoid tumors in the common bile duct.
Bile Ducts, Extrahepatic ; Carcinoid Tumor* ; Common Bile Duct* ; Humans ; Jaundice, Obstructive ; Pancreas ; Pancreaticoduodenectomy ; Publications ; Pylorus ; Synaptophysin

To evaluate the long-term prognosis of biliary atresia after Kasai operation, a total of 14 patients (of the 41 patients operated upon from 1982 to 1997), who had been followed up for more than 10 years, were included in this retrospective study. Eleven out of 14 patients survived with their native livers, and their data analyzed for age at operation, clearing time of jaundice, histological outcome, postoperative complications, effectiveness after the application of an intussusception anti-reflex valve, and quality of life. Average age at surgery was 62.8 days. Serum bilirubin was normalized within three months in all patients. Six among the eleven long-term survivors had ascending cholangitis as one of the postoperative complications. The application of an intussusception anti-reflux valve did not show any statistical significance in long-term survival. Most of long-term survivors appeared to enjoy good quality of life. Kasai operation might not be the definitive treatment for biliary atresia; however, Kasai operation made it possible to achieve long-term survival for patients with biliary atresia when the patients were detected and treated as early as possible.
Biliary Atresia ; Bilirubin ; Cholangitis ; Humans ; Intussusception ; Jaundice ; Liver ; Postoperative Complications ; Prognosis ; Quality of Life ; Retrospective Studies ; Survivors

OBJECTIVE: To determine the diagnostic performance of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and DCE ultrasound (DCE-US) for predicting response to neoadjuvant chemotherapy (NAC) in breast cancer patients. MATERIALS AND METHODS: This Institutional Review Board-approved prospective study was performed between 2014 and 2016. Thirty-nine women with breast cancer underwent DCE-US and DCE-MRI before the NAC, follow-up DCE-US after the first cycle of NAC, and follow-up DCE-MRI after the second cycle of NAC. DCE-MRI parameters (transfer constant [Ktrans], reverse constant [kep], and leakage space [Ve]) were assessed with histograms. From DCE-US, peak-enhancement, the area under the curve, wash-in rate, wash-out rate, time to peak, and rise time (RT) were obtained. After surgery, all the imaging parameters and their changes were compared with histopathologic response using the Miller-Payne Grading (MPG) system. Data from minor and good responders were compared using Wilcoxon rank sum test, chi-square test, or Fisher's exact test. Receiver operating characteristic curve analysis was used for assessing diagnostic performance to predict good response. RESULTS: Twelve patients (30.8%) showed a good response (MPG 4 or 5) and 27 (69.2%) showed a minor response (MPG 1–3). The mean, 25th, 50th, and 75th percentiles of Ktrans and Kep of post-NAC DCE-MRI differed between the two groups. These parameters showed fair to good diagnostic performance for the prediction of response to NAC (AUC 0.76–0.81, p ≤ 0.007). Among DCE-US parameters, the percentage change in RT showed fair prediction (AUC 0.71, p = 0.023). CONCLUSION: Quantitative analysis of DCE-MRI and DCE-US was helpful for early prediction of response to NAC.
Breast Neoplasms* ; Breast* ; Drug Therapy* ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging* ; Prospective Studies ; ROC Curve ; Ultrasonography*

PURPOSE: To evaluate the magnetic resonance imaging (MRI) and clinicopathological features of triple negative breast cancer, and compare them with those of non-triple negative breast cancer. MATERIALS AND METHODS: This study included 231 pathologically confirmed breast cancers from January 2007 to May 2008. We retrospectively reviewed the MRI findings according to the Breast Imaging Reporting and Data System (BI-RADS) lexicon: mass or non-mass type, mass shape, mass margin, non-mass distribution, and enhancement pattern. Histologic type, histologic grade, and the results for epidermal growth factor receptor, p53, and Ki 67 were reviewed. RESULTS: Of 231 patients, 43(18.6%) were triple negative breast cancer. Forty triple negative breast cancers (93.0%) were mass-type lesion on MRI. A round or oval or lobular shape (p=0.006) and rim enhancement (p=0.004) were significantly more in triple negative breast cancer than non-triple negative breast cancer. In contrast, irregular shape (p=0.006) and spiculated margins (p=0.032) were significantly more in non-triple negative breast cancer. Old age (p=0.019), high histologic grade (p<0.0001), EGFR positivity (p<0.0001), p53 overexpression (p=0.038), and Ki 67 expression (<0.0001) were significantly associated with the triple negative breast cancer. CONCLUSION: MRI finding may be helpful for differentiation between triple negative and non-triple negative breast cancer.
Breast ; Breast Neoplasms ; Humans ; Information Systems ; Magnetic Resonance Imaging ; Receptor, Epidermal Growth Factor ; Receptors, Progesterone ; Retrospective Studies

PURPOSE: The purpose of this study was to evaluate the B-mode sonographic and sonoelastographic features of high risk lesions of the breast. MATERIALS AND METHODS: From April 2009 to February 2010, 1390 patients with breast lesions underwent US-guided core-biopsy. Among them, 13 lesions were confirmed to be pure sclerosing adenosis by subsequent surgical excision or on imaging follow-up of more than 1 year. Two radiologists retrospectively analyzed the B-mode sonography according to the Breast Imaging Reporting and Data System classification. The sonoelastographic images were classified into 5 elasticity scores according to the Itoh classification and the strain ratio between the mass and the surrounding fat tissue was reviewed. We considered the sonoelastographic patterns to be suspicious for the case with a score of 4 and 5 and a strain ratio of more than a 2.24. RESULTS: The common B-mode sonographic features of sclerosing adenosis were an irregular shape (69.2%, 9 of 13), an indistinct margin (92.3%, 12 of 13), hypoechogenicity (76.9%, 10 of 13) and category 4A, a low suspicion of malignancy (61.5%, 8 of 13). The common sonoelastographic features were a score of 2 (42%, 6 of 13) and a strain ratio < 2.24 (69.2%, 9 of 13). CONCLUSION: Sclerosing adenosis showed suspicious B-mode sonographic findings, but it had benign sonolastographic features.
Breast ; Elasticity ; Elasticity Imaging Techniques ; Follow-Up Studies ; Humans ; Information Systems ; Retrospective Studies ; Sprains and Strains

Background : hypercalciuria is defined as normocalcemia and increased urinary calcium excretion without any cause. Many studies have demonstrated that urinary calcium excretion is increased and glomerular hematuria is related to hypercalciuria in diabetic patients with severe proteinuria. This study was undertaken to elucidate whether patients with NIDDM are hypercalciuric and whether there is a pathophysiologic relationship between urinary calcium excretion, hematuria and the degree of diabetic nephropathy. The purpose of this study was to evaluate the incidence of hypercalciuria in NIDDM patients and the possible relationship among urinary calcium excretion, hematuria and proteinuria in diabetic nephropathy. Methods : We studied with 18 control subjects and 101 NIDDM patients without urinary infection. NIDDM patients with normal renal function (s- Cr<133micromol/L) followed at Kangbuk Samsung Hospital were included in this study from June, 1993 through March, 1995. Control group included 18 normal subjects and 101 NIDDM patients were divided into 3 groups : normoalbuminuria group, microalbuminuria group and macroalbuminuria group. Urinary albumin excretion rate (microalbumin) and urinary calcium and creatinine excretion ratio were measured. Kruskal-Wallis 1-way ANOVA test and multifactorial regression test were used to analyze. Results : 1) Age, duration of DM and serum creatinine level in macroalbuminuria group were significantly higher than normoalbuminuria group. 2) Calcium-creatinine ratio was significantly higher in NIDDM patients than in control subjects. Among diabetics it is significantly higher in microalbuminuria and macroalbuminuria groups than normoalbuminuria group. The incidence of hypercalciuria is 44.6% in patients with NIDDM. 3) Albumin excretion rate is correlated positively with calcium-creatinine ratio(r=0.26, p=0.0006), while no correlation was observed with serum creatinine, serum calcium, fasting blood glucose, postprandial 2hrs blood glucose, HbA1C, creatinine clearance, and body mass index. 4) Hematuria was observed in 3 cases with hypercalciuria(6.7%) and 4 cases without hypercalciuria(7.1%). No significant difference was observed between two groups. Conclusion : Hypercalciuria was more frequent in patients with NIDDM than in control. The severity of calciuria was correlated with the progression of diabetic nephropathy. There was no definite correlation between urinary calcium excretion and hematuria.
Blood Glucose ; Body Mass Index ; Calcium ; Creatinine ; Diabetes Mellitus, Type 2* ; Diabetic Nephropathies ; Fasting ; Hematuria* ; Humans ; Hypercalciuria* ; Incidence ; Proteinuria

PURPOSE: We wanted to evaluate the sensitivity and specificity of screening mammography and ultrasonography for breast examinations and we assessed the clinical usefulness of breast ultrasound for cancer screening. MATERIALS AND METHODS: Of all the women who visited the health promotion center of seven medical institutions from Mar 2004 to Feb 2005, we compared the sensitivity and specificity between a single use of mammography and mammography with ultrasonography for the patients who underwent both mammography and ultrasonography. Here, the reference criteria were the follow-up and the histopathology, which were performed after one year. RESULTS: A total of 1123 patients underwent both mammography and ultrasonography and they could be followed up for a year. For the 1123 patients who underwent both mammography and ultrasonography, the sensitivity and specificity of a single use of mammography were 14.3% and 86.9%, respectively. The sensitivity and specificity of mammography with ultrasonography were 85.7% and 85.9%, respectively. These results showed that the sensitivity was significantly increased when mammography was combined with ultrasonography (< 0.05). CONCLUSION: The sensitivity was improved for the cases that underwent both mammography and ultrasonography.
Breast ; Early Detection of Cancer ; Female ; Follow-Up Studies ; Health Promotion ; Humans ; Mammography ; Mass Screening ; Sensitivity and Specificity*

BACKGROUND/AIMS: The meaning of specialized intestinal metaplasia (SIM) in the diagnosis of Barrett's esophagus (BE) is not clear. This study was designed to determine the clinical significance of SIM in the diagnosis of Barrett's esophagus. MATERIALS AND METHODS: Biopsies were taken from 601 subjects with endoscopically suspected columnar-lined esophagus. Under light microscopy with Alcian-blue stain, SIM was identified. Demographic characteristics, gastroesophageal (GE) reflux symptoms and endoscopic findings were compared between the SIM-present group and the SIM-absent group. RESULTS: Among 601 subjects, 184 (30.6%) were confirmed by pathology to have SIM. Age over 40 years (P<0.001) and a medication history of proton pump inhibitor or H2 blocker were found more frequently in the SIM-present group (P=0.01) than in the SIM-absent group. Any of 7 GE reflux symptoms (heartburn, acid regurgitation, chest pain, hoarseness, globus sensation, cough and epigastric soreness) were more frequent in the SIM-present group than SIM-absent group (P<0.001). Specifically, heartburn, chest pain and cough were significantly more common in the SIM-present group. There was no clinically significant difference associated with endoscopic findings or other clinical characteristics. CONCLUSIONS: When subjects with endoscopically suspected BE are analyzed based on the presence or absence of SIM, the SIM-present group was significantly associated with GE reflux symptoms suggestive of frequent GE reflux. However, the presence of SIM did not correlate with endoscopic findings.
Barrett Esophagus ; Biopsy ; Chest Pain ; Cough ; Esophagus ; Gastroesophageal Reflux ; Heartburn ; Hoarseness ; Light ; Metaplasia ; Microscopy ; Prospective Studies ; Proton Pumps ; Sensation

BACKGROUND/AIMS: Chronic gastritis is a common finding during endoscopy and it is very important to describe it correctly. This study was designed to evaluate the distribution of endoscopic gastritis and the differences according to age, sex or area. MATERIALS AND METHODS: A clinical analysis was conducted on 25,536 subjects who had undergone an upper endoscopy for routine health check-up. Endoscopic gastritis was classified into four types, superficial gastritis, erosive gastritis, atrophic gastritis and intestinal metaplasia. The distribution of the four types of gastritis was evaluated according to sex, age and area. RESULTS: 51.6% of the patients had experienced at least one of the symptoms (epigastric pain or discomfort, soarness, dyspepsia, abdominal pain) on at least a few occasions during the previous year. The incidence of normal gastric finding was 3,593 (14.1%). 21,943 (85.9%) subjects have at least more than one of endoscopic gastritis. The number of cases with superficial gastritis was 7,983 (31.3%), erosive gastritis 6,054 (23.7%), atrophic gastritis 6,918 (27.1%), and intestinal metaplasia 1,181 (7.1%). Erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men than women (P<0.001) and in the older age group (> or =60 years) than younger age group (P<0.001). CONCLUSIONS: The prevalence of endoscopic gastritis was very common, 85.9%. In addition, erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men and in the older age group, which is similar to gastric cancer or peptic ulcer. Cautious regular endoscopic follow-up might be necessary regardless of gastrointestinal symptoms in Korea.
Dyspepsia ; Endoscopy ; Female ; Gastritis ; Gastritis, Atrophic ; Helicobacter pylori ; Humans ; Incidence ; Korea ; Male ; Metaplasia ; Peptic Ulcer ; Prevalence ; Stomach Neoplasms

BACKGROUND/AIMS: Chronic gastritis is a common finding during endoscopy and it is very important to describe it correctly. This study was designed to evaluate the distribution of endoscopic gastritis and the differences according to age, sex or area. MATERIALS AND METHODS: A clinical analysis was conducted on 25,536 subjects who had undergone an upper endoscopy for routine health check-up. Endoscopic gastritis was classified into four types, superficial gastritis, erosive gastritis, atrophic gastritis and intestinal metaplasia. The distribution of the four types of gastritis was evaluated according to sex, age and area. RESULTS: 51.6% of the patients had experienced at least one of the symptoms (epigastric pain or discomfort, soarness, dyspepsia, abdominal pain) on at least a few occasions during the previous year. The incidence of normal gastric finding was 3,593 (14.1%). 21,943 (85.9%) subjects have at least more than one of endoscopic gastritis. The number of cases with superficial gastritis was 7,983 (31.3%), erosive gastritis 6,054 (23.7%), atrophic gastritis 6,918 (27.1%), and intestinal metaplasia 1,181 (7.1%). Erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men than women (P<0.001) and in the older age group (> or =60 years) than younger age group (P<0.001). CONCLUSIONS: The prevalence of endoscopic gastritis was very common, 85.9%. In addition, erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men and in the older age group, which is similar to gastric cancer or peptic ulcer. Cautious regular endoscopic follow-up might be necessary regardless of gastrointestinal symptoms in Korea.
Dyspepsia ; Endoscopy ; Female ; Gastritis ; Gastritis, Atrophic ; Helicobacter pylori ; Humans ; Incidence ; Korea ; Male ; Metaplasia ; Peptic Ulcer ; Prevalence ; Stomach Neoplasms