A 73-year-old male presented a six-month history of buttock pain radiating into his thigh. The MRI revealed a large enhancing mass lesion involving the sacrum, with extension into the sacral canal. The tumor markers were measured to distinguish skeletal metastasis of carcinoma from primary bone tumor. The CA 19-9 was elevated. Despite the investigation, the primary site of cancer could not be found. Sacral bone biopsy was done. The pathologic examination revealed necrosis, chronic granulomatous inflammation, and multinucleated giant cells, consistent with tuberculosis. Sacral tuberculosis is rare in patients with no history of tuberculosis. Such solitary osteolytic lesions involving the subarticular region of large joints may mimic bone neoplasms and may be called "tuberculous pseudotumors." This case report intends to emphasize that bone tuberculosis should be a differential diagnosis in the presence of atypical clinical and radiological features. As tuberculous lesions may be mistaken for neoplasms, a small amount of fresh tissue should be sent for culture even if clinical diagnosis of a tumor seems likely. Described herein is a case of sacral tuberculosis mimicking metastatic bone tumor with elevated CA 19-9.
Aged ; Biopsy ; Bone Neoplasms ; Buttocks ; Diagnosis, Differential ; Giant Cells ; Humans ; Hydrazines ; Inflammation ; Joints ; Male ; Necrosis ; Neoplasm Metastasis ; Sacrum ; Thigh ; Tuberculosis ; Tuberculosis, Osteoarticular ; Biomarkers, Tumor

BACKGROUND: The phosphoinositide 3-kinase (PI3K)/Akt/mammalian target of rapamycin (mTOR) signaling axis has emerged as a novel target for cancer therapy. Agents that inhibit this pathway are currently under development for lung cancer treatment. In the present study, we have tested whether dual inhibition of PI3K/Akt/mTOR signaling can lead to enahnced antitumor effects. We have also examined the role of autophagy during this process. METHODS: We analyzed the combination effect of the mTOR inhibitor, temsirolimus, and the Akt inhibitor, GSK690693, on the survival of NCI-H460 and A549 non-small cell lung cancer cells. Cell proliferation was determined by MTT assay and apoptosis induction was evaluated by flow cytometry and terminal deoxynucleotidyl transferase dUTP nick end labeling assay. Autophagy induction was also evaluated by acridine orange staining. Changes of apoptosis or autophagy-related proteins were evaluated by western blot analysis. RESULTS: Combination treatment with temsirolimus and GSK690693 caused synergistically increased cell death in NCI-H460 and A549 cells. This was attributable to increased induction of apoptosis. Caspase 3 activation and poly(ADP-ribose) polymerase cleavage accompanied these findings. Autophagy also increased and inhibition of autophagy resulted in increased cell death, suggesting its cytoprotective role during this process. CONCLUSION: Taken together, our results suggest that the combination of temsirolimus and GSK690693 could be a novel strategy for lung cancer therapy. Inhibition of autophagy could also be a promising method of enhancing the combination effect of these drugs.
Acridine Orange ; Apoptosis ; Autophagy ; Axis, Cervical Vertebra ; Blotting, Western ; Carcinoma, Non-Small-Cell Lung ; Caspase 3 ; Cell Death ; Cell Proliferation ; DNA Nucleotidylexotransferase ; Flow Cytometry ; Lung Neoplasms ; Oxadiazoles ; Phosphatidylinositol 3-Kinases ; Poly(ADP-ribose) Polymerases ; Proteins ; Sirolimus ; TOR Serine-Threonine Kinases

Endoscopic submucosal dissection (ESD) has been successfully performed in thrombocytopenic conditions such as in patients with liver cirrhosis but successful ESD for early gastric cancer (EGC) in hematologic diseases has rarely been reported. A 52-year-old male patient, who had previously been diagnosed with myelodysplastic syndrome 2 years ago, was admitted to our hospital for ESD of EGC. ESD was performed successfully in this patient after platelet concentrates transfusion on the day of ESD. ESD might be an option for the treatment of EGC in thrombocytopenia due to hematologic diseases when optimal supportive managements are applied.
Early Detection of Cancer ; Endosonography ; Gastric Mucosa/*surgery ; Gastroscopy ; Humans ; Male ; Middle Aged ; Myelodysplastic Syndromes/complications/*diagnosis/pathology ; Stomach Neoplasms/complications/*diagnosis/pathology ; Tomography, X-Ray Computed

Sunitinib as a multitarget tyrosine kinase inhibitor is one of the anti-tumor agents, approved by the United States Food and Drug Administration to use treat gastrointestinal stromal tumor and metastatic renal cell carcinoma. The agent is known to commonly induce adverse reactions such as fatigue, nausea, diarrhea, stomatitis, esophagitis, hypertension, skin toxicity, reduciton in cardiac output of left ventricle, and hypothyroidism. However, it has been reported to rarely induce adverse reactions such as nephrotic syndrome and irreversible reduction in renal functions, and cases of intestinal perforation or pneumatosis interstinalis as such reactions have been consistently reported. In this report, a 66-year old man showing abdominal pain had renal cell carcinoma and history of sunitinib at a dosage of 50 mg/day on a 4-weeks-on, 2-weeks-off schedule. Seven days after the third cycle he was referred to the hospital because of abdominal pain. Computed tomography showed pneumoperitoneum with linear pneumatosis intestinalis in his small bowel. The patient underwent surgical exploration that confirmed the pneumatosis intestinalis at 100 cm distal to Treitz's ligament. We report a rare case of intestinal perforation with pneumatosis intestinalis after administration of sunitinib to a patient with metastatic renal cell carcinoma.
Aged ; Antineoplastic Agents/adverse effects/*therapeutic use ; Carcinoma, Renal Cell/*drug therapy ; Drug Administration Schedule ; Humans ; Indoles/adverse effects/*therapeutic use ; Intestinal Perforation/*diagnosis/etiology/surgery ; Kidney Neoplasms/*drug therapy ; Lung/radiography ; Male ; Pneumatosis Cystoides Intestinalis/*diagnosis/etiology ; Positron-Emission Tomography ; Pyrroles/adverse effects/*therapeutic use ; Tomography, X-Ray Computed

We report a case of a chronic hemodialysis patient who developed hypermagnesemia due to an overdose of magnesium-containing laxative and paralytic ileus resulting in colonic perforation. Despite intravenous calcium infusion and daily hemodialysis, the patient developed ischemic colitis and intestinal perforation. Colonic perforation accompanied with hypermagnesemia in hemodialysis patients has rarely been reported. This case suggests that hypermagnesemia should be considered in renal failure patients as this can result in life-threatening events despite prompt treatment.
Colitis, Ischemic/*chemically induced/diagnosis/surgery ; Constipation/*drug therapy/surgery ; Female ; Humans ; Intestinal Perforation/*chemically induced/surgery ; Laxatives/adverse effects/*poisoning ; Magnesium/*poisoning ; Middle Aged ; *Renal Dialysis

PURPOSE: Influenza-associated neurologic complications in children are diverse. But there has been little long-term and large-scale research about neurologic complications of seasonal influenza. This study aimed to identify the incidence, characteristics, and risk factors for neurologic complications in children hospitalized with influenza. METHODS: Retrospective analysis was conducted on the clinical data of 940 children hospitalized with confirmed influenza infection from Oct, 2010 to May, 2016 in Kwangju Christian Hospital. RESULTS: A total of 940 children with influenza were hospitalized, of whom 96 (10.2%) had neurologic complications:81 children presented febrile seizures (8.6%) and some included 12 other seizures (1.3%),1 encephalitis (0.1%), 1 Guillain-Barré syndrome (0.1%), 1 aseptic meningitis (0.1%). They had good prognosis except the encephalitis child. The incidence of neurologic complications was significantly higher in influenza A than in influenza B (11.9% vs. 7.0%, P=0.036). The incidence of influenza A was highest in February, while that of influenza B was highest in March and April. The monthly distribution of neurological complications reflected the influenza incidence. The risk factors for influenza-associated neurologic complications were underlying neurologic disease and young age. No significant clinical differences were observed between influenza A and B in febrile seizure. CONCLUSION: Febrile seizures are the most common neurologic complication with good prognosis. Although encephalitis/encephalopathy is rare, it can be severe with sequelae, so prompt diagnosis and treatment should be initiated. And influenza vaccine should be encouraged to children with underlying neurologic disease.
Child* ; Diagnosis ; Encephalitis ; Guillain-Barre Syndrome ; Gwangju ; Humans ; Incidence ; Influenza A virus ; Influenza B virus ; Influenza Vaccines ; Influenza, Human ; Meningitis, Aseptic ; Prognosis ; Retrospective Studies ; Risk Factors ; Seasons* ; Seizures ; Seizures, Febrile

A 48-year-old male visited the emergency room of the authors' hospital due to nausea, vomiting, and myalgia for four days. Acute hepatitis A was identified from the serologic marker of the hepatitis A virus. Mild elevation of the serum creatinine and creatinine phosphokinase (CPK) suggested rhabomyolysis, which was confirmed with the serum aldolase, myoglobin, and urine myoglobin. With supportive care, both the liver and renal functions were recovered gradually and fully. This case shows that rhabdomyolysis can be one of the mechanisms of renal complication in cases of acute symptomatic hepatitis A.
Acute Kidney Injury ; Creatinine ; Emergencies ; Fructose-Bisphosphate Aldolase ; Hepatitis ; Hepatitis A ; Hepatitis A virus ; Humans ; Kidney ; Liver ; Male ; Middle Aged ; Myoglobin ; Nausea ; Rhabdomyolysis ; Vomiting

BACKGROUND/AIMS: Atrophic gastritis (AG) and intestinal metaplasia (IM) are commonly encountered pathologic conditions during gastroscopy in Korea. These conditions were considered as pre-neoplastic lesions in many previous studies. Management and follow-up of these lesions have been performed arbitrarily since there are no standard guidelines. The aim of this study was to investigate the endoscopists' opinions on these conditions using web-based survey. MATERIALS AND METHODS: An e-mail based survey composed of 22 questionnaires related to the clinical and endoscopic management of AG and IM was performed. RESULTS: These questionnaires were e-mailed to 495 endoscopists and replies were obtained from 168 endoscopists. IM was more commonly diagnosed by histologic evaluation regardless of position, patient care, and experience. Most endoscopists recommended follow up endoscopy annually in IM compared to a 2 year interval in AG. Less experienced endoscopists and endoscopists caring hospitalized patients tended to not eradicate Helicobacter pylori in patients with AG and IM. CONCLUSIONS: Endoscopists approach to the patients with AG and IM differred according to their position, patient care, and experience. We need new guidelines for the surveillance and management of AG and IM in Korea.
Electronic Mail ; Endoscopy ; Follow-Up Studies ; Gastritis, Atrophic* ; Gastroscopy ; Helicobacter pylori ; Humans ; Korea ; Metaplasia* ; Patient Care ; Surveys and Questionnaires

Alagille syndrome is a complex autosomal dominant disorder secondary to defects in the Notch signaling pathway, primarily caused by mutations in the Jagged1 (JAG1) gene. The liver, heart, skeleton, face and eyes are the body parts most commonly involved. Alagille syndrome may mimic other causes of high gamma-glutamyl transferase (GGT)-linked cholestasis, most notably biliary atresia in the neonatal period. Infants with Alagille syndrome are occasionally misdiagnosed as cases with biliary atresia due to variations in clinical features that might be expressed in early infancy. We describe a case of Alagille syndrome mimicking biliary atresia, identified by sequencing analysis of the JAG1 gene in a newborn. During counseling, family members of the patient have also been found to demonstrate various phenotypes and levels of disease severity of Alagille syndrome.
Alagille Syndrome* ; Biliary Atresia* ; Cholestasis ; Counseling ; Heart ; Human Body ; Humans ; Infant ; Infant, Newborn* ; Liver ; Phenotype ; Skeleton ; Transferases

BACKGROUND: In cancer cells, autophagy is generally induced as a pro-survival mechanism in response to treatment-associated genotoxic and metabolic stress. Thus, concurrent autophagy inhibition can be expected to have a synergistic effect with chemotherapy on cancer cell death. Monensin, a polyether antibiotic, is known as an autophagy inhibitor, which interferes with the fusion of autophagosome and lysosome. There have been a few reports of its effect in combination with anticancer drugs. We performed this study to investigate whether erlotinib, an epidermal growth factor receptor inhibitor, or rapamycin, an mammalian target of rapamycin (mTOR) inhibitor, is effective in combination therapy with monensin in non-small cell lung cancer cells. METHODS: NCI-H1299 cells were treated with rapamycin or erlotinib, with or without monensin pretreatment, and then subjected to growth inhibition assay, apoptosis analysis by flow cytometry, and cell cycle analysis on the basis of the DNA contents histogram. Finally, a Western blot analysis was done to examine the changes of proteins related to apoptosis and cell cycle control. RESULTS: Monensin synergistically increases growth inhibition and apoptosis induced by rapamycin or erlotinib. The number of cells in the sub-G1 phase increases noticeably after the combination treatment. Increase of proapoptotic proteins, including bax, cleaved caspase 3, and cleaved poly(ADP-ribose) polymerase, and decrease of anti-apoptotic proteins, bcl-2 and bcl-xL, are augmented by the combination treatment with monensin. The promoters of cell cycle progression, notch3 and skp2, decrease and p21, a cyclin-dependent kinase inhibitor, accumulates within the cell during this process. CONCLUSION: Our findings suggest that concurrent autophagy inhibition could have a role in lung cancer treatment.
Apoptosis ; Apoptosis Regulatory Proteins ; Autophagy ; Blotting, Western ; Carcinoma, Non-Small-Cell Lung ; Caspase 3 ; Cell Cycle ; Cell Cycle Checkpoints ; Cell Death ; DNA ; Epidermal Growth Factor ; Flow Cytometry ; Lung ; Lung Neoplasms ; Lysosomes ; Monensin ; Phosphotransferases ; Poly(ADP-ribose) Polymerases ; Proteins ; Quinazolines ; Receptor, Epidermal Growth Factor ; Receptor, erbB-2 ; Sirolimus ; Stress, Physiological ; TOR Serine-Threonine Kinases ; Erlotinib Hydrochloride