This report presents a case of metasric calcinosis cutis resembling pseudoxanthoma elasticum in clinical appearance. The patient, 19-year-old man, has dull yellowish firm folded lesion on both axillae, and immobility of lower extremities because of bony osteoporosis, knee fracture, impaired renal function, Skin biopsy, bone marrow biopsy, bone X-ray, and laboratory findings showed metastatic calcinosis cutis due to histiocytosis X and chronic renal failure.
Axilla ; Biopsy ; Bone Marrow ; Calcinosis* ; Histiocytosis, Langerhans-Cell ; Humans ; Kidney Failure, Chronic ; Knee ; Lower Extremity ; Osteoporosis ; Pseudoxanthoma Elasticum* ; Skin ; Young Adult

Gastritis cystica polyposa(GCP) is a polypoid cystic lesion showing all the histological features of the hyperplastic polyps and the cysts penetrating through the mucularis mucosae. Most reported GCP lesions were developed at gastraenterostomy stomas. It is rare that GCP develops without history of previous gastroenterostomy. In 1990, however, Kim et al reported a GCP presenting as a submucosal tume-like lesion in a 69-year-old man. Recently, we had experienced two consecutive cases of GCP diagnosed by endoscopic polypectomy. The first case was 49-year-old housewife without history of previous gastric surgery. Esophagogastroduodenoscopy(EGD) showed a 2.0x1.5x1.5cm sized lobulated polypoid lesion with a broad stalk on the anterior wall of the distal antrum. The second case was 45-year-old woman without history of previous gastric surgery. EGD revealed a 1.0 x 1.0 x l.0 cm sized polypoid lesion with a pedicle on the greater curvature aspect of the upper body and two duodenal ulcers with pseudodiverticulum formation. These lesions were endoscopically polypectomized and diagnosed as GCP by the histologic examination.
Aged ; Duodenal Ulcer ; Female ; Gastritis* ; Gastroenterostomy ; Humans ; Middle Aged ; Mucous Membrane ; Polyps

Although variation is the rule with pancreatic duct morphology, certain variants occur as a result of altered embroological development. These ductal configurations, most striking deviations from the normal configuration, may be classfied according to alterations of embryological development. These congenital variants of pancreatic duct may be important for several reasons. First, the pseudomass effect of ductal anomalies can be mistaken for carcinoma by the inexperienced radiologists. Second, whether or not the anomaly is important, it is present in many patients with recurrent pacreatitis. Original descriptions were based on small sampling of postmortem studies and surgical specimen, but more recently the advent of endoscopic retrograde cholangiopancreatography(ERCP) has confirmed of the work of early anastomists and increased awareness of these variants. To evalute of frequency, characteristics of associated disease and clinical significance of pancreatic anomalies, we have reviewed of 5330 case of ERCP filmes which were undertaken between July, 1973 and August, 1993. Having reviewed of ERCP filmes, we found out 9 case of pancreatic duct variants. Among them, 7 cases were classified as ductal duplication anomalies, 4 cases of number variation, most, bifuricaiton and 3 cases of form variation, which were composed of loop, spiral and terminal N. Three cases of fusion anomalies were also noted, which were 2 cases of panceratic divisum and 1 case of incomplete pancreatic divisum. The associated diseases were 6 cases of bile duct and galbladder stones and 3 cases of pancreatic cancer. We could not find out the case of congenital anomalies as cause of obstructive pain and pseudomass effect.
Bile Ducts ; Cholangiopancreatography, Endoscopic Retrograde* ; Humans ; Pancreatic Ducts* ; Pancreatic Neoplasms ; Pancrelipase ; Strikes, Employee

PURPOSE: The development of publicized screening methods for breast carcinoma detection has led to a marked increase in the discovery of ductal carcinoma in situ (DCIS) or DCIS with microinvasion (DCIS-MI). Axillary lymph node status has been believed to be not only an indicator of prognosis, but also a direction of adjuvant therapy. But the incidence of axillary metastasis in DCIS or DCIS-MI has diversely found in from 0% to 20%. This study was performed to analyze the incidence of axillary metastasis and the predictive factors associated with axillary lymph node metastasis in DCIS or DCIS-MI. METHODS: Patients with DCIS or DCIS-MI and axillary lymph node dissection from 1987 to 2004 were selected from Korea University Medical Center. We reviewed their medical records for age, palpability and size of the tumor, histolgic subtype, nuclear grade, hormone receptor status, and pathologic slides. RESULTS: Fifty two patients in DCIS and Thirty eight patients in DCIS-MI were included in the study. Axillary lymph node metastases were identified in 2 patients (3.8%) in DCIS and 4 patients (10.5%) in DCIS-MI. Tumor size and nuclear grade in DCIS had a borderline significance in association with microinvasion. We could not be able to find any predictive factor associated with axillary lymph node metastasis in DCIS and DCIS-MI. CONCLUSION: Axillary lymph node metastasis in DCIS or DCIS-MI appeared to be not low and there was no predictive factor associated with axillary lymph node metastasis in DCIS and DCIS-MI. But DCIS patients with large tumor size and poor nuclear grade have the high possibility associated with microinvasion, therefore, in that cases, there is a need to consider the possibility of axillary metastasis.
Academic Medical Centers ; Breast ; Breast Neoplasms ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Humans ; Incidence ; Korea ; Lymph Node Excision ; Lymph Nodes* ; Mass Screening ; Medical Records ; Neoplasm Metastasis* ; Prognosis

The causes of jaundice in patients with hepatocellular carcinoma are usually attributed to the underlying liver diseases or extensive hepatic destruction by tumor. Obstructive jaundice by the intraluminal tumor fragment of intrahepatic and/or extrahepatic bile duct in hepatocellular carcinoma is exceedingly rare and usually diagnosed by operation or autopsy. Recently, we observed a patient in whom the fragment of tumor from the primary hepatocellular carclnoma obstructed the common hepatic duct, which was confirmed by peroral choledochoscopy. Using peroral choledochoscopy. we could see the mass located at the common hepatic duct and diagnose histologically by cytologic examination of aspirated material of common bile duct. We describe here this rare case with review the literature on primary hepatocellular carcinoma with jaundice caused by biliary obstruction.
Autopsy ; Bile Ducts, Extrahepatic ; Carcinoma, Hepatocellular* ; Common Bile Duct ; Hepatic Duct, Common* ; Humans ; Jaundice ; Jaundice, Obstructive* ; Liver Diseases

To evaluate the clinical significance of anomalous pancreaticobiliary ductal union(PBDU), we analysed 11 cases(0.19%) of anomalous PBDU among 5675 cases performed ERCP from Jan. 1973 to Aug. 1992. According to the classification of Kimura et al., 4 cases were type 1(P-C union) and 7 cases type 2(C-P union). The length of common channel ranged from 1.5 cm to 3.1 cm(mean 1.9 cm). The common associated disease were choledochal cyst(7 cases), carcinoma of the gallbladder(5 cases) and biliary stone(3 cases). Four cases of carcinoma of the gallbladder were type 1. The incidence of anomalous PBDU was significantly higher in cases with carcinoma of the gallbladder(5 cases among 49 cases) than in case without carcinoma of the gallbladder(6 cases among 5626 cases). And the incidence of gallbladder carcinoma(45%) among the 11 cases of anomalous PBDU was significantly higher than that(0.78%) among those who did not have anomalous PBDU. In conclusion, the common associated diseases with the anomalous PBDU were choledochal cyst, carcinoma of the gallbladder and stone, and the anomalous PBDU may be risk factor in the development of carcinoma of the gllbladder.
Cholangiopancreatography, Endoscopic Retrograde* ; Choledochal Cyst ; Classification ; Gallbladder ; Incidence ; Risk Factors

A submucosal lymphatic cyst is a thin-walled cyst, lined by flattened lymphatic endothelium, containing thin serous fluid. It rarely causes clinical symptoms, and it is incidentally discovered during fiberoptic panendoscopy or radiologic study in most cases. It is an extremely rare benign tumor of the stomach; however, a submucosal lymphatic cyst should be considered if a pliable and benign submucosal lesion is detected during fiberoptic panendoscopy. We report a case of submucosal lymphatic cyst of the stomach which showed a typical clinical picture. This report is the first case of submucosal lymphatic cyst of the stomach in Korea to the best of our knowledge.
Age Factors ; Biopsy ; Case Report ; Gastric Mucosa/pathology ; Human ; Lymphangioma/etiology/*pathology/surgery ; Male ; Middle Age ; Stomach Neoplasms/etiology/*pathology/surgery

A submucosal lymphatic cyst is a thin-walled cyst, lined by flattened lymphatic endothelium, containing thin serous fluid. It rarely causes clinical symptoms, and it is incidentally discovered during fiberoptic panendoscopy or radiologic study in most cases. It is an extremely rare benign tumor of the stomach; however, a submucosal lymphatic cyst should be considered if a pliable and benign submucosal lesion is detected during fiberoptic panendoscopy. We report a case of submucosal lymphatic cyst of the stomach which showed a typical clinical picture. This report is the first case of submucosal lymphatic cyst of the stomach in Korea to the best of our knowledge.
Age Factors ; Biopsy ; Case Report ; Gastric Mucosa/pathology ; Human ; Lymphangioma/etiology/*pathology/surgery ; Male ; Middle Age ; Stomach Neoplasms/etiology/*pathology/surgery

Biliary enteric fistulas which are caused by gallstone, peptic ulcer and carcinoma are an uncommon disease. Their incidence appears to increase recently with the advent of endoscopy. The usual types of the fistulas are choledochoduodenal, cholecystoduodenal and cholecystocolonic. But, cholecystogastric fistulas are very rare. Their symptoms are usually nonspecific and pneumobilia has been considered as a clue, but the diagnosis is difficult in most cases. At present, endoscopy is very helpful to the diagnosis. The treatment of asymptomatic fistulas is still in dispute. Endoscopic management is being used at times in recent days. We recently experienced a case of cholecystogastric fistula accidentally. During the evaluation for the cause of anemia, we suspected a fistula on endoscopy and confirmed it on endoscopic fistulography and managed it by endoscopic papillotomy and stone extraction.
Anemia ; Diagnosis ; Dissent and Disputes ; Endoscopy ; Fistula* ; Gallstones ; Incidence ; Peptic Ulcer ; Sphincterotomy, Endoscopic

PURPOSE: Cholecystectomy in patients with an intact gallbladder after endoscopic removal of stones from the common bile duct (CBD) remains controversial. We conducted a case-control study to determine the risk of recurrent CBD stones and the benefit of cholecystectomy for prevention of recurrence after endoscopic removal of stones from the CBD in Korean patients. MATERIALS AND METHODS: A total of 317 patients who underwent endoscopic CBD stone extraction between 2006 and 2012 were included. Possible risk factors for the recurrence of CBD stones including previous cholecystectomy history, bile duct diameter, stone size, number of stones, stone composition, and the presence of a periampullary diverticulum were analyzed. RESULTS: The mean duration of follow-up after CBD stone extraction was 25.4+/-22.0 months. A CBD diameter of 15 mm or larger [odds ratio (OR), 1.930; 95% confidence interval (CI), 1.098 to 3.391; p=0.022] and the presence of a periampullary diverticulum (OR, 1.859; 95% CI, 1.014 to 3.408; p=0.045) were independent predictive factors for CBD stone recurrence. Seventeen patients (26.6%) in the recurrence group underwent elective cholecystectomy soon after endoscopic extraction of CBD stones, compared to 88 (34.8%) in the non-recurrence group; the difference was not statistically significant (p=0.212). CONCLUSION: A CBD diameter of 15 mm or larger and the presence of a periampullary diverticulum were found to be potential predictive factors for recurrence after endoscopic extraction of CBD stones. Elective cholecystectomy after clearance of CBD stones did not reduce the incidence of recurrent CBD stones in Korean patients.
Adult ; Aged ; Bile Duct Diseases/*diagnosis/epidemiology/surgery ; Case-Control Studies ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy/*methods ; Common Bile Duct/*pathology/radiography ; Elective Surgical Procedures ; Female ; Gallstones/epidemiology/*surgery ; Humans ; Incidence ; Male ; Middle Aged ; Recurrence ; Republic of Korea/epidemiology ; Risk Factors ; *Sphincterotomy, Endoscopic