Inflammatory pseudotumor of the liver is a rare benign tumor with microscopic finding of fibrous stroma and chronic inflammatory cell infiltration. Predominance of plasma cells, histiocytes, lymphocytes, some eosinophils and whorled pattern of fibrosis is often characteristic. Due to similar radiologic appearance of hepatocellular carcinoma, inflammatory pseudotumor of the liver was often misdiagnosed and hepatic resection is often performed before preoperative tissue diagnosis. We report a case of inflammatory pseudotumor, which was a 47-year-old woman with fever, upper aMominal pain and weight loss, diagnosed by sonoguided liver biopsy and treated with antibiotic therapy only without surgery. After two weeks of treatment, the radiologic image of the mass was almost disappeared with improvement of previous symptoms. This opportunity and the possible effectiveness of antibiotic treatment should keep in mind in the differential diagnosis of the hepatic mass with similar radiologic appearance of hepatocellular carcinoma.
Biopsy ; Carcinoma, Hepatocellular ; Diagnosis ; Diagnosis, Differential ; Eosinophils ; Female ; Fever ; Fibrosis ; Granuloma, Plasma Cell* ; Histiocytes ; Humans ; Liver* ; Lymphocytes ; Middle Aged ; Plasma Cells ; Weight Loss

BACKGROUND: In our previous study, the prevalence of the known causes of thyroid tumorigenesis was relatively rare in Korean population, suggesting genetic and environmental differences exist. Screening of genetic alteration in papillary thyroid carcinoma(PTC) and follicular adenoma(FA) in whole genomic scale was needed prior to search on individual genes of possible causes. METHODS: Ten cases of PTC without ret/PTC-I, -2, -3 rearrangement and 5 cases of follicular adenoma were included in the study of microsatellite marker allelotyping. Sixty two microsatellite markers available, were chosen to cover the known sites of loss of heterozygosity(LOH) involved in thyroid tumors, tumor suppressor genes and terminal portion of each chromosomes. PCR was performed on tumor DNA and leukocytes DNA from each patient with MDE gel electrophoresis to detect LOH. Same specitnens as above, 3 case of normal thyroid tissues and NPA, ARO cell lines were included in the study of comparative genomic hybridization(CGH). Tumor and control DNAs were hybridized to metaphase chromosome with differential stainings with fluorescein and rhoda-mine-dUTP. Obtained results were analyzed by multicolor fluorescence computer assisted image analyzer. RESULTS: In allelotyping, LOH were detected in 5 cases of PTC, 2 cases on D10S1435, 1 case each on D2S1780, DSS1099, D11S1986, D16S539, 1 case of PTC revealed LOH on DSS1099, D11S1986. In FA, LOH were detected in 3 cases on D1S534, D1S226, Dl 1S907, D22S683, DXS9807. In CGH, Xp addition was noticed in 1 case of PTC, 12q and 10p addition was noticed in 1 case each, 16q deletion and 17q addition in 1 case of FA. CONCLUSION: No hot spot of LOH was noticed in microsatellite marker allelotyping, neither of common chromosomal change in CGH study suggesting unbalanced translocation or gene amplification more than 5-10 Mb may be involved in the genetic alteration of PTC and FA.
Adenoma* ; Carcinogenesis ; Cell Line ; Comparative Genomic Hybridization ; DNA ; Electrophoresis ; Fluorescein ; Fluorescence ; Gene Amplification ; Genes, Tumor Suppressor ; Humans ; Leukocytes ; Mass Screening ; Metaphase ; Microsatellite Repeats ; Polymerase Chain Reaction ; Prevalence ; Thyroid Gland* ; Thyroid Neoplasms*

BACKGROUND: Periampullary diverticulum has been commonly discovered during endoscopic retrograde cholangiopancreatography(ERCP) in patients with various pancreaticobiliary diseases such as cholelithiasis and its clinical significance has been noted. Recently, periampullary diverticulum is known to be associated with choledocholithiasis, various pancreatobiliary diseases and intestinal symptoms. Our aims of study was to investigate characteristics of periampullary diverticulum and to determinate the positive relationship between periampullary diverticulum and choledocholithiasis, and to determinate whether periampullary diverticulum influences on the cannulation rate and complication performing ERCP and endoscopic sphincterotomy(EST). METHODS: We reviewed 162 of 594 cases, which had periampullary diverticulums on ERCP during the past 6 years, and investigated size, location and number of periampullary diverticulums with special reference to the location of cholelithiasis. We also compared success rate and complication rate of ERCP and EST in cases with or without periamullary diverticulum. RESULTS: The incidence of periampullary diverticulum was 27.3%(male 48.1%, female 51.9%). and increased after 50 years old. In anatomical characteriastics of periampullary diverticulum, most of the diverticulum was single(90.1%). Size was usually smaller than 1cm(48.8%) and was seperated from ampulla of Vater, type III(59.2%). Choledocholithiasis was more frequently found in patients with periampullary diverticulum(58.9%) than in patients without diverticulum(43.1), especially in type II(attatching type). Failure rate of ERCP was 14.8% with periampullary diverticulum and was 14.6% without it. Bleeding, one of serious complications of EST, was noted in 4 patients with periampullary diverticulum, and one patient was operated to control the bleeding. CONCLUSIONS: Periampullary diverticulum might be related with choledocholithiasis, but usually does not interfere with procedure of ERCP.
Ampulla of Vater ; Catheterization ; Cholangiopancreatography, Endoscopic Retrograde ; Choledocholithiasis ; Cholelithiasis ; Diverticulum* ; Female ; Hemorrhage ; Humans ; Incidence ; Middle Aged

Ectopic ACTH syndrome is frequently caused by lung cancer and uncommonly by other tumors such as thymic carcinoid. For its treatment, early diagnosis and complete resection is irresponsible, but some cases are remained unlocalized in spite of all diagnostic modalities. Here we report a case of ectopic ACTH syndrome which was localized by PET but could not be localized by conventional technique. A tumor at thymic area was ACTH secreting thymic carcinoid which was operated but couldnt resect completly. Glucocorticoid hypersecretion was persisted with chemotherapy, radiotherapy, and ketoconazole treatment. Patient died of sepsis after 12 months of diagnosis.
ACTH Syndrome, Ectopic* ; Adrenocorticotropic Hormone ; Carcinoid Tumor* ; Diagnosis ; Drug Therapy ; Early Diagnosis ; Humans ; Ketoconazole ; Lung Neoplasms ; Radiotherapy ; Sepsis