The pancreatic cystic lesions are known to be incidentally found up to 10-15% of patients undergoing cross-sectional imaging. And the prevalence of mucinous cystic neoplasm which has malignant potential is known to be up to 25% of all pancreatic cystic neoplasm in South Korea. The symptoms included abdominal pain, palpable mass, weight loss, loss of appetite, jaundice, asymptomatic and etc. However, spontaneous rupture of pancreatic mucinous cystadenocarcinoma (MCAC) is an extremely rare complication. Here we report a case of spontaneous rupture of pancreatic MCAC in a 72-year-old male with review of the literature. To the best of our knowledge, this is the first ruptured case of pancreatic MCAC in male patient.
Abdominal Pain ; Aged ; Appetite ; Cystadenocarcinoma, Mucinous* ; Humans ; Jaundice ; Korea ; Male ; Mucins* ; Pancreas ; Pancreatic Cyst ; Prevalence ; Rupture ; Rupture, Spontaneous* ; Weight Loss

BACKGROUND: Livedoid vasculitis is a distinctive dermatosis characterized by recurrent chronic ulceration and infiltrated purpuric papules on the lower limbs. OBJECTIVE: The purpose of this study was aimed at evaluating the clinical and histopathological features of livedoid vasculitis. METHODS: The hospital charts and histopathologic slides of patients with livedoid vasculitis diagnosed at Asan Medical Center from 1989 to 1999 were reviewed. RESULTS: Twelve male and seven female patients were enrolled in this study(M: F=1.7: 1). The mean age at onset was 30.3 years in men and 25.3 years in women. The mean duration of illness was 3.3 years in male patients and 5.7 years in female patients. All the patients were presented with recurrent chronic ulceration and atrophic scarring. Twelve patients(63.2%) complained of severe pain and tenderness of the lesions and 5 patients(26.3%) complained of itching sensation. In three patients(15.8%), the lesions developed or aggravated in summer. Alcohol intake was aggravating factor in two patients(10.5%) and smoking was in one patient(5.3%). In five patients(26.3%), livedoid vasculitis develops in association with several diseases. Associated diseases were diabetes mellitus in 2 patients(10.5%), antiphospholipids antibody syndrome in 2 patients(10.5%), and protein S deficiency in 1 patient(5.3%). Histopathological examination revealed hyalinized blood vessels, partial to complete obstruction of dermal blood vessels with fibrinoid thrombi, endothelial swelling, and extravasation of RBCs in upper and mid-dermis. Panniculitis-like feature was common finding(73%). In six patients(31%), moderate to severe inflammatory reaction was observed in dermis. Five patients were treated with aspirin, dipyridamole, and pentoxifylline, and among them, only 1 patient(20%) were improved. All the treatment response including pentoxifylline alone, or pentoxifylline plus aspirin, dipyridamole, or corticosteroid was unsatisfactory. In cases of three patients whom were treated with low-dose danazol, all the patients(100%) showed marked improvement. One patient was treated with dapsone with improvement. CONCLUSION: Livedoid vasculitis is a distinct dermatosis with characteristic clinico-pathological features. Low-dose danazol or dapsone may be useful therapeutic options in this intractable disease.
Aspirin ; Blood Vessels ; Chungcheongnam-do ; Cicatrix ; Danazol ; Dapsone ; Dermis ; Diabetes Mellitus ; Dipyridamole ; Female ; Humans ; Hyalin ; Lower Extremity ; Male ; Pentoxifylline ; Protein S Deficiency ; Pruritus ; Sensation ; Skin Diseases ; Smoke ; Smoking ; Ulcer ; Vasculitis*

BACKGROUND: There has been considerable controversy about the relationship between angiolymphoid hyperplasia with eosinophilia(ALHE) and Kimura's disease. Recent reports have suggested that they are two different diseases. OBJECTIVE: The purposes of this study was aimed at evaluating the clinical and histopathological characteristics of ALHE and Kimura"s disease and differential points between them. METHODS: The hospital charts and histopathologic slides of 5 patients with ALHE and 2 patients with Kimura's disease diagnosed at Asan Medical Center from 1989 to 2000 were reviewed. We also reviewed the previously published reports of the patients with ALHE and Kimura's disease in Korea. In total, we studied 14 cases of ALHE and 29 of Kimura's disease. RESULTS: 1.Eight male and six female patients(M:F=1.3:1) were enrolled in ALHE group and twenty-four male and five female(M:F=4.8:1) in Kimura's disease. The mean age at diagnosis of ALHE was 25 years in men and 40 years in women. The mean age of Kimura's disease was 30 years in men and 33 years in women. 2.Head and neck were the most frequently involved sites in ALHE(92.9%) and Kimura's disease(89.7%). Especially, among the sites, the ear(57.1%) in ALHE and the mandible(44.8%) in Kimura's disease were the most commonly involved. One patient(7.1%) with ALHE and three(10.3%) with Kimura's disease had the lesions bilaterally. 3.Pruritus was the most common symptom in both the diseases. Lymphadenopathy was present in only one patient with ALHE, whereas 51.7% of patients with Kimura's disease had it. One patient with ALHE had underlying arteriovenous malformation. One case showing pregnancy-associated Kimura's disease was reported. Gastric lymphoma was followed in one case of Kimura's disease. 4.Laboratory investigation showed hypereosinophilia in 41.7% of patients with ALHE(5/12) and 96.4% of Kimura's disease(27/28). Elevated IgE was in 2 cases of ALHE(2/4) and 5 cases of Kimura's disease(5/6). 5.Histopathological examination revealed that angioproliferating lesion comprised of plump epithelioid or histiocytoid endothelial cells and accompanying eosinophils and lymphocytes characterized ALHE. In contrast, Kimura's disease was characterized by deeper lesions showing proliferation of vascular structure with less plump endothelial cells and more fibrotic stroma with many lymphoid follicular structures 6.ALHE was improved with CO2 laser, electrocautery, excision, embolization of underlying arteriovenous malformation and dapsone. However, Kimura's disease tended to recur despite various treatment modalities. CONCLUSIONS: In Korea, Kimura's disease was more common than ALHE. ALHE and Kimura's disease may be different diseases because they showed different clinical and histopathological features.
Angiolymphoid Hyperplasia with Eosinophilia* ; Arteriovenous Malformations ; Chungcheongnam-do ; Dapsone ; Diagnosis ; Electrocoagulation ; Endothelial Cells ; Eosinophils ; Female ; Humans ; Hyperplasia ; Immunoglobulin E ; Korea* ; Lasers, Gas ; Lymphatic Diseases ; Lymphocytes ; Lymphoma ; Male ; Neck

BACKGROUND/AIMS:Studies on re-infection of Helicobacter pylori are limited. This study was designed to determine if there are clinical features of H. pylori re- infection related to gastroduodenal diseases or histological findings. METHODS: From a population of patients that were treated for H. pylori eradication from May 2003 to September 2007, 129 subjects were enrolled. Regimens were PPI-based triple or quadruple agents and follow-up methods were UBT, CLO or histology. RESULTS: A total of 29 subjects experienced a recurrence (within one year, 17 subjects; between one and two years, eight subjects; more than two years, four subjects). Recurrence periods were 2 to 32 months, and the mean period was 12.62+/-8.40 months. Among 29 subjects, eight subjects had chronic atrophic gastritis, 14 subjects had a peptic ulcer, five subjects had stomach cancer and two subjects had a MALT lymphoma; there were no statistical differences of the odds ratio between matched diseases. By use of the Updated Sydney System, neither H. pylori colonization density nor neutrophil infiltration nor monocyte infiltration grade in histology was associated with recurrence or re-infection. CONCLUSIONS: Neither histological findings nor gastroduodenal diseases was associated with H. pylori re-infection. The re-infection rate in this study was approximately 6.2%. This rate was slightly higher than rates reported in other recent studies in Korea.
Colon ; Follow-Up Studies ; Gastritis, Atrophic ; Helicobacter ; Helicobacter pylori ; Humans ; Korea ; Monocytes ; Neutrophil Infiltration ; Odds Ratio ; Peptic Ulcer ; Recurrence ; Stomach Neoplasms

Pancreatic arteriovenous malformation (AVM) is an extremely rare condition with various clinical manifestations. We report herein a case of recurrent acute pancreatitis due to pancreatic AVM in a 49-year-old man. This patient presented with epigastric pain that had developed after consuming alcohol 2 days prior to admission. Serum amylase and lipase levels were elevated and computed tomography revealed focal low-attenuation lesions with peripancreatic infiltrations in the pancreatic tail and multiple collateral vessels around the low-attenuation lesions. He was diagnosed with acute pancreatitis and pancreatic AVM. Although he had stopped drinking after the first attack of acute pancreatitis, his pancreatitis recurred twice within 3 months. He underwent a distal pancreatectomy after the third attack of acute pancreatitis. He was free of symptoms for 2 years after the pancreatectomy.
Amylases ; Arteriovenous Malformations ; Drinking ; Humans ; Lipase ; Middle Aged ; Pancreatectomy ; Pancreatitis