Biopsy is required to confirm lymph node (LN) metastasis in position emission tomography (PET)-positive LN due to the low specificity of PET. Currently, invasive surgical techniques such as mediastinoscopy or mediastinotomy are standard procedures for obtaining LN specimen. It would be desirable to have a less invasive way of sampling suspicious LN. Herein, we report a case of successful endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) for the diagnosis of CT-negative and PET-positive LN that was found after curative resection in lung cancer. To the best of our knowledge, this is the first description in Korea to perform EUS-FNA for the evaluation of metastatic LN during the follow-up period after lung cancer resection.
Biopsy ; Biopsy, Fine-Needle* ; Diagnosis ; Electrons* ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Endosonography ; Follow-Up Studies ; Humans ; Korea ; Lung Neoplasms* ; Lung* ; Lymph Nodes* ; Mediastinoscopy ; Neoplasm Metastasis ; Sensitivity and Specificity

Combination therapy with inteferon-alpha and ribavirin is an approved therapy for patients with chronic hepatitis C. However, even with the use of pegylated interferon, response rates are still poor in many difficult-to-treat groups, especially with genotype 1 and high viral loads. Retreatment of these patients remains challenging. Newer combinations are being investigated to optimize chances of attaining a sustained response in these groups. Thymosin alpha 1 is a polypeptide with immunomodulatory properties that has been suggested to increase response rates in patients with chronic hepatitis C. Herein, we describe two cases of retreatment patients with chronic hepatitis C who have failed prior pegylated interferon and ribavirin therapy. They received triple combination therapies of thymosin alpha 1, pegylated interferon and ribavirin and achieved sustained virological responses. These cases support that thymosin-alpha 1 may increase the efficacy of pegylated interferon plus ribavirin in the treatment of non-responders to previous combination therapy.
Data Collection ; Genotype ; Hepatitis C, Chronic* ; Hepatitis, Chronic* ; Humans ; Interferons* ; Retreatment ; Ribavirin* ; Thymosin* ; Viral Load

Granulocytic sarcoma is an extramedullary tumor composed of immature granulocytic cells. These tumors usually occur simultaneously with or follow after the onset of acute myeloid leukemia (AML) or other myeloproliferative disorders. Rarely, it is the first manifestation of AML which appears several months before the onset of leukemia. We report a case of a 48-year-old man presenting with symptoms of small bowel obstruction. Laparotomy and open biopsy were performed. Immunohistochemical studies showed that the neoplastic cells were of myeloid lineage positive for myeloperoxidase and leukocyte common antigen, but negative for CD3, 20, 56, 79a, and cytokeratin. Initially, there was no evidence of blood or bone marrow involvement suggesting acute leukemia or other myeloproliferative disorders. The findings were consistent with the diagnostic findings of solitary granulocytic sarcoma (preleukemic). However, one month later, bone marrow biopsy revealed 57% myeloblasts. Sequentially, the patient developed FAB M2 acute myeloid leukemia. Induction chemotherapy including cytarabine and idarubicine was done which led to complete remission. Allograft bone marrow transplantation was performed later, and there is no evidence of recurrence till present.
Allografts ; Antigens, CD45 ; Biopsy ; Bone Marrow ; Bone Marrow Transplantation ; Cytarabine ; Granulocyte Precursor Cells ; Humans ; Idarubicin ; Induction Chemotherapy ; Keratins ; Laparotomy ; Leukemia ; Leukemia, Myeloid, Acute ; Middle Aged ; Myeloproliferative Disorders ; Peroxidase ; Recurrence ; Sarcoma, Myeloid*

Colonoscopy is regarded as a relatively safe procedure and is widely performed. However, complications such as bleeding, perforation, and coagulation syndromes can occur during colonoscopy. Although bowel perforation is as rare as 0.4-1.9% of cases, it is the most serious and awful adverse event which can lead to a death. Colon perforation may occur as either intraperitoneal or extraperitoneal, or in combination. Right subdiaphragmatic free air suggests intraperitoneal perforation while pneumoretroperitoneum, pneumomediastinum, pneumopericardium, and subcutaneous emphysema suggest extraperitoneal perforation. Combined intraperitoneal and extraperitoneal perforation is very rare. Herein, we present a case of combined intraperitoneal and extraperitoneal colon perforation which manifested as pneumoretroperitoneum, pneumomediastinum, pneumopericardium, and subcutaneous emphysema. The lesion was closed with endoscopic clipping.
Colon ; Colonoscopy ; Hemorrhage ; Intestinal Perforation ; Mediastinal Emphysema* ; Pneumopericardium ; Retropneumoperitoneum* ; Subcutaneous Emphysema*

A 69-year-old woman with dyspepsia and poor oral intake was diagnosed as advanced gastric cancer. Clinical staging was stage IV with inoperable status, and thus, three cycles of palliative chemotherapy with paclitaxel and cisplatin were performed. Follow up endoscopy and positron emission tomography with computed tomography (PET-CT) revealed marked decrease in the primary stomach lesion and metastatic lymph nodes. Distal gastrectomy and D2 lymph node dissection were performed with gastrojejunostomy. Later pathological examination demonstrated tumor invading submucosa. However, there was no pathologic evidence of lymph node metastasis. Only the necrotic areas without viable carcinoma cells were noted in regional lymph nodes located along the left gastric artery and common hepatic artery. Because of the excellent response to chemotherapy, R0 resection was carried out. Herein, we report a case of advanced gastric cancer showing complete remission of metastatic lymphadenopathy after palliative chemotherapy.
Aged ; Arteries ; Cisplatin ; Drug Therapy* ; Dyspepsia ; Endoscopy ; Female ; Follow-Up Studies ; Gastrectomy ; Gastric Bypass ; Hepatic Artery ; Humans ; Lymph Node Excision ; Lymph Nodes* ; Lymphatic Diseases ; Neoplasm Metastasis ; Paclitaxel ; Positron-Emission Tomography ; Stomach ; Stomach Neoplasms*

BACKGROUND/AIMS: Distinguishing benign and malignant lymph nodes by the findings of endoscopic ultrasonography (EUS) is still controversial. We tried to evaluate EUS findings of benign mediastinal and abdominal lymphadenopathy (BLAP) confirmed by EUS-guided fine needle aspiration (FNA). METHODS: A total of 37 patients with enlarged mediastinal or abdominal lymph nodes (diameter > or =1 cm) were enrolled and EUS-FNA was performed. Final diagnosis was based on FNA cytology and follow up imaging studies (CT scans or EUS). RESULTS: Thirteen patients were confirmed to have BLAP by EUS-FNA. Causes of BLAP were as follows; (i) extrapulmonary tuberculosis in six cases including patients with postoperative states due to cervical cancer and advanced gastric cancer, (ii) Kikuchi disease in one case, (iii) hypereosinophilic syndrome in one case, (iv) reactive hyperplasia in five cases including patients with postoperative states due to thyroid cancer, lung cancer, and EGC with ESD. EUS findings of BLAP revealed that median lymph node size was 24.7 mm. Lymph nodes were oval or round shaped in 9 cases, sharp borders in 9 cases, hypoechoic echo pattern in 7 cases, heterogenous internal echo pattern in 7 cases. Other findings included internal septation, calcification, multiplicity, attachment to the gastrointestinal tract wall, and conglomeration. CONCLUSIONS: EUS findings of BLAP were not different from those of malignant lymphadenopathy previously reported in other studies.
Biopsy, Fine-Needle* ; Diagnosis ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Endosonography ; Follow-Up Studies ; Gastrointestinal Tract ; Histiocytic Necrotizing Lymphadenitis ; Humans ; Hypereosinophilic Syndrome ; Hyperplasia ; Lung Neoplasms ; Lymph Nodes ; Lymphatic Diseases* ; Stomach Neoplasms ; Thyroid Neoplasms ; Tuberculosis ; Uterine Cervical Neoplasms

BACKGROUND/AIMS: Obstruction of the main pancreatic duct (MPD) has been considered one of the major causes for pain in chronic pancreatitis (CP). In this study, we evaluated the efficacy of MPD stenting in painful CP, and tried to determine a guideline for stent removal. METHODS: Sixteen patients with painful CP who underwent MPD stenting were included. Follow up ERCP was performed 3 months after stenting in all patients. Stents were removed in patients who achieved pain relief, complete stone clearance, and decreased MPD diameter after 3 months. RESULTS: Before stenting, ERCP showed MPD stricture in 11 cases, MPD dilatation by stone in 1 case, concomitant stricture and stone in 4 cases. After stenting, complete pain relief was achieved in 13 patients (81.3%) and partial pain relief was achieved in 3 patient (18.7%). There was no patient whose pain was not relieved. Stents were removed in 7 patients who achieved pain relief, complete stone clearance, and decreased MPD diameter after 3 months. Decrease of MPD diameter was significantly greater in patient who could remove stent than those who could not (72.9% vs. 127.9% of initial MPD diameter, p=0.008). CONCLUSIONS: If partial or full pain relief is achieved after MPD stenting and follow up ERCP after 3 months shows decreased MPD diameter compared to the initial one, stent removal might be considered.
Cholangiopancreatography, Endoscopic Retrograde ; Constriction, Pathologic ; Dilatation ; Follow-Up Studies ; Humans ; Pancreatic Ducts* ; Pancreatitis, Chronic* ; Stents*

BACKGROUND/AIMS: Various diagnostic advantages of percutaneous transhepatic cholangioscopy (PTCS) for the determination of the range of tumor and for the characterization of cholangioscopic findings have been reported. The aim of our study is to evaluate the diagnostic and therapeutic role of PTCS in patients with hilar strictures and to investigate its causes. METHODS: We retrospectively studied the medical records and cholangioscopic reports of 177 patients who received PTCS for hilar strictures between January 2000 and December 2005 at Asan Medical Center, Seoul. For each patient, cholagnioscopy, biopsy result, computed tomography (CT) and magnetic resonance cholangiopancreaticography (MRCP), operation, and pathologic reports were collected. RESULTS: Most patients had malignant hilar strictures or biliary papillomatosis while a few had benign hilar strictures. Presence of tumor vessel on PTCS was a useful diagnostic tool since direct observation of the tumor vessel strongly suggested a malignant tumor in the bile duct. The sensitivity of tumor vessel alone was 56.1%, and sensitivity of PTCS biopsy alone was 76.9%. However, sensitivity of biopsy combined with cholangioscopy of the tumor vessel was 88.4%, which was statistically significant compared with biopsy or tumor vessel alone. CONCLUSIONS: PTCS biopsy combined with cholangioscopic observation was useful in differential diagnosis of hilar strictures. PTCS also had a therapeutic role in some patients with incurable malignant hilar lesion.
Bile Ducts ; Biopsy ; Cholangiocarcinoma ; Cholangiography ; Chungcheongnam-do ; Constriction, Pathologic* ; Diagnosis, Differential ; Humans ; Medical Records ; Papilloma ; Retrospective Studies ; Seoul

BACKGROUND/AIMS: The authors examined whether the response to interferon (IFN) therapy can affect the development of hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) patients. METHODS: Out of 353 biopsy-proven CHB patients, 229 (65%) were treated with IFN-alpha for 6 to 12 months. They were followed for a median period of 75 months (range, 6-120). In patients treated with IFN, biochemical and virologic responses were evaluated at the end of treatment (EOT). The cumulative incidence rates of HCC were calculated and analyzed in relation to baseline characteristics as well as biochemical and virologic responses to IFN therapy. RESULTS: The overall cumulative incidence of HCC was 0%, 0.8%, 3.7% and 5.5% at 3, 5, 7 and 8 years, respectively. Age, serum AFP levels and the stage of fibrosis were significantly associated with the occurrence of HCC. As a whole, IFN therapy did not affect the occurrence of HCC. Among the patients treated with IFN, biochemical responders had low HCC incidence rates compared with non-responders (p=0.018). However, the HCC incidence rates of virologic responders were not different from non-responders (p=0.203). CONCLUSIONS: Biochemical rather than virologic response to IFN therapy may be more closely associated with decrease of HCC incidence in CHB patients.
Carcinoma, Hepatocellular* ; Fibrosis ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Incidence* ; Interferons*

BACKGROUND/AIMS: Interactions between H. pylori and gastric epithelial cells contribute to gastric inflammation and epithelial damage. This study was performed to evaluate the gene expression profile of AGS cells by adhesion of H. pylori. METHODS: Changes in AGS cell gene expression induced by co-culturing with H. pylori (G69a strain) (4, 12, 24, 48 hours) were monitored using oligonucleotide microarray. Real-time reverse transcription-polymerase chain reaction (RT-PCR) was performed for data validation by the Assay-on-Demand Gene Expression product method. RESULTS: A total of 270 (2.66%) and 19 genes (0.19%) were up-regulated in AGS cells by H. pylori adhesion. Gene ontology analysis showed that up-regulated genes were categorized into endolipidase activity (17 genes), receptor binding (17 genes), integrin binding (4 genes), and two down-regulated genes into GTP binding category. The expression levels of 20 up- and 5 down-regulated genes were quantified by real-time RT-PCR. Sixteen genes involving cytokine activity (IL8, IL1B, TNF), hydrolase activity (PTP4A1, ERCC1, CASP8, CASP7, ACIN1), VIP receptor activity (VIPR2), and neuropeptide Y receptor activity (GPR83) were confirmed to be up-regulated. Five genes, namely, ARF3, M17S2, DDB2, AWP1, and WTAP were confirmed to be down-regulated. CONCLUSIONS: Host genes are significantly changed by H. pylori adhesion, which might explain the gastroduodenal pathogenesis induced by H. pylori infection.
Epithelial Cells ; Gene Expression* ; Gene Ontology ; Guanosine Triphosphate ; Helicobacter pylori* ; Helicobacter* ; Inflammation ; Oligonucleotide Array Sequence Analysis ; Receptors, Neuropeptide Y ; Receptors, Vasoactive Intestinal Peptide ; Transcriptome*