Adenosquamous carcinomas of the intestine are rare tumors, especially when they occur in the small bowel. We report a case of primary adenosquamous carcinoma of the proximal jejunum in a 66 year old woman with no underlying pathologic condition. The tumor mainly consisted of well differentiated squamous cell carcinoma showing keratin pearl and conspicuous intercellular bridges, and minor portion revealed well differentiated adenocarcinoma. The tumor seemed to have originated from the mucosal epithelium, invading the entire wall and metastasizing to the regional lymph nodes. Previous reports of adenosquamous carcinoma of the small intestine have been associated with metastatic disease from distant sites or intestinal duplication. In the colon, squamous cell differentiation have been seen in about 0.05% of adenocarcinomas and in 0.4% of adenomata. The pathogenesis of squamous cell carcinoma of the intestine is unknown, but some possible mechanisms are proposed. :1)malignant transformation of squamous cell epithelium in the submucosa, 2)aberrant differentiation of stem cells to squamous cell with subsequent malignant change, 3)squamous metaplasia of glandular cells with subsequent malignant change, 4)transformation of an adenosquamous into an epidermoid carcinoma.
Adenocarcinoma ; Aged ; Carcinoma, Adenosquamous* ; Carcinoma, Squamous Cell ; Cell Differentiation ; Colon ; Epithelium ; Female ; Humans ; Intestine, Small ; Intestines ; Jejunum* ; Lymph Nodes ; Metaplasia ; Stem Cells

PURPOSE: We performed this study to evaluate the mean serum levels of insulin-like growth factor (IGF)-I, insulin-like growth factor binding protein(IGFBP)-2 and IGFBP-3 in healthy Korean children according to age and sex. METHODS: Ninety two healthy children, consisting of 42 boys and 50 girls, were classified into five groups according to age:neonate; infancy; early childhood; late childhood; and adolescence. We measured serum levels of IGF-I, IGFBP-2 and IGFBP-3 by enzyme-linked immunosorbent assay(ELISA) and analysed the serum levels according to sex and age group. RESULTS: For boys, the mean serum levels of IGF-I(ng/mL) in neonate, infancy, early childhood, late childhood and adolescence were 41.1+/-3.6, 70.9+/-33.7, 103.5+/-97.2, 89.8+/-46.5 and 51.4+/-27.8, respectively. Those of IGFBP-2(ng/mL) were 8.2+/-3.4, 5.8+/-0.4, 9.3+/-4.0, 9.5+/-1.1 and 7.0+/-0.5, respectively. Those of IGFBP-3(ng/mL) were 559.2+/-215.2, 1,333.3+/-692.5, 2,254.6+/-1,513.8, 2,447.1+/-1,464.2, 1,533.6+/-807.4, respectively. For girls, the mean serum levels of IGF-I(ng/mL) according to five age groups were 53.3+/-9.5, 99.3+/-45.8, 69.6+/-51.1, 106.2+/-67.0 and 145.1+/-127.8, respectively. Those of IGFBP-2 (ng/mL) were 9.1+/-7.4, 5.3+/-0.9, 6.9+/-2.0, 10.5+/-3.0 and 7.9+/-1.3, respectively. Those of IGFBP-3(ng/ mL) were 858.2+/-433.4, 1,834.8+/-851.3, 1,404.3+/-570.2, 2,203.5+/-899.4 and 2,029.3+/-1,316.7, respectively. There were significant positive correlations observed between IGF-I and IGFBP-3 levels(r=0.589, P= 0.000). CONCLUSION: IGF-I and IGFBP-3 levels increased as children get older. The peak level of IGFBP-3 was observed in late childhood for both boys and girls, suggesting a current trend of children reaching peak growth velocity before adolescence. The IGFBP-2 level was higher in neonates compare to infancy, suggesting that IGFBP-2 is an important substance for fetal growth.
Adolescent ; Child* ; Female ; Fetal Development ; Humans ; Infant, Newborn ; Insulin-Like Growth Factor Binding Protein 2 ; Insulin-Like Growth Factor Binding Protein 3* ; Insulin-Like Growth Factor I

The idiopathic hypereosinophilic syndromes are rare hematologic disorders showing a wide spectrum of diseases with eosinophilia and associated organ damage. Three criteria for diagnosis include persistent eosinophilia of at least 1, 500 eosinophils/mm3 for longer than 6 months, or death before 6 months with signs and symptoms of hypereosinophilic disease; lack of evidence for parasitic, allergic or other known causes of eosinophilia; and signs and symptoms of organ involvement. We report a case of a 8 month-old male patient who had persistent marked eosinophilia reaching peak eosinophil count more than 100, 000/mm3, and organ dysfunction involving the bone marrow, heart, brain, lung and spleen. This patient, who did not respond to administration of prednisolone or hydroxyurea alone, has been treated successfully with hydroxyurea and interferon alpha-2b combination therapy.
Bone Marrow ; Brain ; Diagnosis ; Eosinophilia ; Eosinophils ; Heart ; Humans ; Hydroxyurea* ; Hypereosinophilic Syndrome* ; Infant ; Interferons* ; Lung ; Male ; Prednisolone ; Spleen

Kikuchi's disease is a self-limiting benign disease characterized by cervical lymphadenopathy, but it can be mistaken for malignant disease, and when involved lymph nodes are unusually located, diagnosis can be more difficult. The authors report the case of a 19-year-old man with Kikuchi's disease, who had isolated intraabdominal lymphadenopathy and increased 18-fluoro-deoxyglucose (FDG) uptake in positron emission tomographycomputed tomography (PET-CT). Although its incidence is extremely rare, intra-abdominal Kikuchi's disease with increased FDG uptake in PET-CT image should be considered in the differential diagnosis when constitutional symptoms mimic those of malignant lymphoma.
Abdomen ; Diagnosis, Differential ; Electrons ; Histiocytic Necrotizing Lymphadenitis ; Humans ; Hydrazines ; Incidence ; Lymph Nodes ; Lymphatic Diseases ; Lymphoma ; Positron-Emission Tomography ; Young Adult

Lupus enteritis is a rare, severe complication of systemic lupus erythematosus (SLE), needing prompt diagnosis and proper management. However, SLE rarely presents as lupus enteritis at the time of initial diagnosis. Thus, delayed diagnosis and misdiagnosis are common. We report a case of a 25-year-old woman with lupus panenteritis. The patient had multiple hospitalizations for abdominal pain, nausea, and diarrhea, initially without any other symptoms suggestive of SLE, but was later observed to have malar rash and oral ulcers. Laboratory investigations were compatible with SLE, including positive antinuclear antibody (1:320) with speckled pattern. CT revealed diffuse hypodense submucosal thickening of the stomach, the entire small bowel, colon, appendix, and rectum. Treatment with high-dose corticosteroids followed by maintenance therapy with mycophenolate mofetil, hydroxychloroquine, and azathioprine resulted in clinical improvement. Diagnosis of lupus enteritis requires a high index of suspicion given the low incidence and nonspecific clinical findings.
Abdominal Pain/complications ; Adrenal Cortex Hormones/therapeutic use ; Adult ; Brain/diagnostic imaging ; Diagnosis, Differential ; Diarrhea/complications ; Endoscopy, Gastrointestinal ; Enteritis/pathology ; Female ; Humans ; Lupus Erythematosus, Systemic/complications/*diagnosis/drug therapy ; Magnetic Resonance Imaging ; Nausea/complications ; Tomography, X-Ray Computed

OBJECTIVE: To describe the angiographic embolization as a safe and an effective alternative treatment in the management of obstetrical hemorrhage and in preserving fertility. METHODS: Between March 1999 and May 2003, 43 patients at Asan Medical Center underwent angiographic embolization for the management of obstetrical hemorrhage. All cases received arterial embolization because of obstetrical hemorrhage unresponsive to conservative management or prophylaxis for massive obstetrical hemorrhage. Medical records were reviewed and detailed to collect adequate clinical data such as clinical status, underlying conditions, amount of transfusion, embolization sites, materials of embolization, duration of the procedure, complications associated with embolization, hospital stay, and the success rate. Patients were contacted by telephone to obtain long-term outcome for menstruation, desire for conception, and subsequent pregnancies. RESULTS: We have experienced the clinical successful embolization in 37 (86.0%) of 43 patients of obstetrical hemorrhage resulting from various causes. The main cause of hemorrhage was atony of uterus (n=17), followed by abnormal placentation (n=6), genital tract laceration (n=5). The average amount of blood transfusion was 7.0 units (range; 0-36 units). The average length of the time for the procedure was 68.2 minutes (range; 30-150 minutes). The average duration of hospitalization was 6.4 days (range; 3-20 days). The main complication after embolization was numbness and pain on right lower extremities in 5 cases and vessel dissection occurred in 1 case. But there was no major complication related to the procedure. We were able to follow up 28 patients. In all cases menses resumed spontaneously soon after the procedure. Seven cases of long-term follow-up became pregnant, and 3 cases of them completed gestations giving birth to healthy babies. CONCLUSION: The results suggest that angiographic embolization is a relatively noninvasive and highly effective method for the management of obstetrical hemorrhage and a useful technique for preserving fertility.
Blood Transfusion ; Chungcheongnam-do ; Female ; Fertility ; Fertilization ; Follow-Up Studies ; Hemorrhage* ; Hospitalization ; Humans ; Hypesthesia ; Lacerations ; Length of Stay ; Lower Extremity ; Medical Records ; Menstruation ; Parturition ; Placentation ; Pregnancy ; Telephone ; Uterus

Objective: To propose standardized MRI-proton density fat fraction (PDFF) cutoff values for diagnosing hepatic steatosis, evaluated using contemporary PDFF measuring methods in a large population of healthy adults, using histologic fat fraction (HFF) as the reference standard. Materials and Methods: A retrospective search of electronic medical records between 2015 and 2018 identified 1063 adult donor candidates for liver transplantation who had undergone liver MRI and liver biopsy within a 7-day interval. Patients with a history of liver disease or significant alcohol consumption were excluded. Chemical shift imaging-based MRI (CS-MRI) PDFF and high-speed T2-corrected multi-echo MR spectroscopy (HISTO-MRS) PDFF data were obtained. By temporal splitting, the total population was divided into development and validation sets. Receiver operating characteristic (ROC) analysis was performed to evaluate the diagnostic performance of the MRI-PDFF method. Two cutoff values with sensitivity > 90% and specificity > 90% were selected to rule-out and rule-in, respectively, hepatic steatosis with reference to HFF ≥ 5% in the development set. The diagnostic performance was assessed using the validation set. Results: Of 921 final participants (624 male; mean age ± standard deviation, 31.5 ± 9.0 years), the development and validation sets comprised 497 and 424 patients, respectively. In the development set, the areas under the ROC curve for diagnosing hepatic steatosis were 0.920 for CS-MRI-PDFF and 0.915 for HISTO-MRS-PDFF. For ruling-out hepatic steatosis, the CS-MRI-PDFF cutoff was 2.3% (sensitivity, 92.4%; specificity, 63.0%) and the HISTO-MRI-PDFF cutoff was 2.6% (sensitivity, 88.8%; specificity, 70.1%). For ruling-in hepatic steatosis, the CS-MRI-PDFF cutoff was 3.5% (sensitivity, 73.5%; specificity, 88.6%) and the HISTO-MRI-PDFF cutoff was 4.0% (sensitivity, 74.7%; specificity, 90.6%). Conclusion In a large population of healthy adults, our study suggests diagnostic thresholds for ruling-out and ruling-in hepatic steatosis defined as HFF ≥ 5% by contemporary PDFF measurement methods.

Exogenous lipoid pneumonia is an uncommon disease that's caused by aspirating lipid formulations. Squalene, obtained from shark liver oil, is one of the causative agent and this is commonly used by some Koreans as a health promoting medication. We report here on a case of exogenous lipoid pneumonia that developed after ingestion of squalene capsules. The case showed milky BAL fluid and multiple pulmonary consolidations.
Bronchoalveolar Lavage Fluid ; Capsules ; Eating ; Liver ; Pneumonia ; Sharks ; Squalene