Patients with early gastric cancer (EGC) may be associated with an increased risk of having a second primary cancer. Metachronous primary malignancies may have an influence on the long term prognosis of these patients. We report here on two cases of bile duct cancer after performing subtotal gastrectomy for EGC. A 59-year-old man underwent pylorus preserving pancreaticoduodenectomy (PPPD) under the diagnosis of bile duct cancer, and this was done 5 years after he had undergone gastrectomy. The pathological specimens were different between the EGC and bile duct cancer according to their morphology and immunohistochemical staining, and this case was determined to be metachronous double cancer. The second case was a 39-year-old man who received PPPD for bile duct cancer 4 years after undergoing gastrectomy. Double primary malignancies of bile duct cancer and gastric cancer are very rare.
Adult ; Bile ; Bile Duct Neoplasms ; Bile Ducts ; Gastrectomy ; Humans ; Middle Aged ; Neoplasms, Second Primary ; Pancreaticoduodenectomy ; Prognosis ; Pylorus ; Stomach Neoplasms

BACKGROUND/AIMS: Common bile duct ligation will induce cholestatic fibrosis or cirrhosis in the rat. However, the degree of histologic changes following ligation of the common bile duct appears to vary widely due to recanalization of the bile duct in the distensible extrahepatic system. The purpose of this study is to compare liver damages induced by traditional simple ligation of bile duct with those induced by ethanolic sclerosis of bile duct and ligation. METHODS: Twenty rats of 7 weeks-aged Spraugue-Dawley (body weight 200~250 gm) were divided into 2 groups, common bile duct ligation (BDL group n=10), and 60% ethanol infusion into the common bile duct before bile duct ligation (ETL group n=10). After 7 weeks, all animals were sacrificed. Gross findings, histologic findings (Ki-67 and Masson- trichrome staining), and liver function test were compared. RESULTS: During the experiment, 5 rats of BDL group and 4 rats of ETL group died. In the operative findings, diameter of bile duct in BDL group was dilatated 8~15 mm, but there was no dilatation in ETL group. In the histologic findings of extrahepatic bile duct, epithelial cells were maintained well in BDL group, but they were all cast off or destroyed in ETL group. Liver fibrosis and cell proliferation are more prominent in the ETL group. Also, ETL group showed worse liver function test than that of BDL group. CONCLUSION: Liver fibrosis or cirrhosis by prolonged bile duct ligation is a well-known experimental model. In this study, we demonstrated that a new method of bile duct ligation (ethanol infusion before bile duct ligation) which abolishes bile duct distention accompanied with simple bile duct ligation is more effective to produce liver fibrosis or cirrhosis.
Animals ; Bile Ducts* ; Bile Ducts, Extrahepatic ; Bile* ; Cell Proliferation ; Common Bile Duct ; Dilatation ; Epithelial Cells ; Ethanol* ; Fibrosis ; Ligation ; Liver Cirrhosis* ; Liver Function Tests ; Liver* ; Models, Theoretical* ; Rats ; Sclerosis*

PURPOSE: Cyclooxygenase-2 (COX-2) expression is up-regulated in several types of human cancers and it has been suggested that COX-2 is closely inked to carcinogenesis. The objectives of this study were to investigate COX-2 expression in periampullary cancer and to evaluate the association of the clinicopathological factors with its expression. METHODS: Thirty specimens which were resected from patients with periampullary cancers (13 pancreatic adenocarcinomas, 8 common bile duct cancers, 9 ampulla of vater cancers) were investigated by immunohistochemical staining using Anti COX-2 monoclonal Ab. The 30 specimens were divided into stain-positive and stain-negative groups. The correlation between COX-2 expression and the various clinicopathological factors including the tumor size, nodal metastasis, differentiation, perineural and vascular invasion, were studied. RESULTS: COX-2 was expressed in 69% of pancreatic adenocarcinomas, 100% of common bile duct cancers and 78% of ampulla of vater cancers. However there was no significant correlation between COX-2 expression and the clinicopathological factors. CONCLUSION: COX-2 is highly expressed in periampullary cancer. Even though there was no correlation with the clinicopathological factors, the utility of the COX-2 inhibitors in preventing or treating periampullary cancer remains undetermined but warronts further investigation.
Adenocarcinoma ; Ampulla of Vater ; Carcinogenesis ; Common Bile Duct ; Cyclooxygenase 2 Inhibitors ; Cyclooxygenase 2* ; Humans ; Ink ; Neoplasm Metastasis

Blastic natural killer (NK) cell lymphoma is a rare neoplasm characterized by blastoid tumor cells expressing CD4 and CD56, with predominant skin involvement. Although this tumor has been regarded as a neoplasm related to NK cell, recent studies suggested that it is derived from plasmacytoid dendritic cells, but not from NK cell. Herein we report 4 cases of CD4+CD56+ lineage marker- blastic NK cell lymphomas with a review of literatures. The patients were 3 men and one woman. Three of them were young (17, 18, and 22 yr old). Three patients had skin lesions, at initial presentation in two patients and during the course of disease in other patient. Histologically, tumors consisted of monotonous medium to large blastoid cells showing no necrosis, angiocentric growth or epidermotrophism. All four tumors were CD4+ and CD56+. Three expressed CD68 antigen. Lineage specific markers for B- and T cell were negative. All tumors did not express myeloperoxidase. T-cell receptor gene rearrangement, EBV, CD13 and CD33 were negative. In one patient, tumor cells arranged in Homer-Wright type pseudorosette and expressed terminal deoxynucleotidyl transferase(TdT). Despite the standard lymphoma chemotherapy, the tumors, except one lost during follow-up, progressed and relapsed. The patients died 8-60 months after diagnosis.
Adolescent ; Antigens, CD4/*analysis ; Antigens, CD56/*analysis ; Cell Lineage ; Female ; Humans ; Killer Cells, Natural/immunology/*pathology ; Lymphoma, T-Cell/immunology/*pathology ; Male ; Middle Aged

BACKGROUND/AIMS: The incidence of duodenal tumors has increased by health surveillance. However, preoperative diagnosis of subepithelial duodenal tumors remains difficult because of the wide variety of pathologies and the location of the tumors. We analyzed endoscopic, radiological, and pathological features of subepithelial benign duodenal tumors (BDTs), which were treated by surgical resection. METHODS: Five patients with subepithelial BDTs treated by surgical resection were analyzed retrospectively. We compared the preoperative and postoperative diagnosis and evaluated the clinical presentations, endoscopic and radiological findings, surgical treatments, pathological results, and outcomes of these patients. RESULTS: All the patients underwent successful surgical resection. There were two cases of gastrointestinal stromal tumors (GISTs) treated with segmental duodenectomy, one case of carcinoid tumor treated with antrectomy, one case of gangliocytic paraganglioma treated with ampullectomy, and a lipoma removed by mass excision. The two GISTs were in the duodenal third and fourth segment close to the pancreas, and it was difficult to exclude pancreatic tumors by imaging studies. All the patients remained healthy for more than three years. CONCLUSIONS: Subepithelial BDTs are rare and difficult to diagnosis. Awareness and preoperative diagnosis of subepithelial BDTs can lead to minimally invasive treatment, including endoscopic or local surgical resection.
Carcinoid Tumor ; Diagnosis ; Duodenum ; Gastrointestinal Stromal Tumors ; Humans ; Incidence ; Lipoma ; Pancreas ; Paraganglioma ; Pathology ; Retrospective Studies

Idiopathic adulthood ductopenia (IAD) is a chronic cholestatic liver disease of unknown etiology characterized by adult onset, an absence of autoantibodies, inflammatory bowel disease, and a loss of interlobular bile ducts. In the present report, a case fulfilling the IAD criteria is described. A 19-year-old man was admitted to the hospital for persistent elevation of transaminases and alkaline phosphatase without clinical symptoms. Viral hepatitis markers and autoantibodies were absent. The patient had a normal extrahepatic biliary tree and had no evidence of inflammatory bowel disease. A liver biopsy specimen showed absence of interlobular bile ducts from 58% of the portal tracts. He was diagnosed with IAD and was treated with ursodeoxycholic acid.
Adult ; Cholestasis, Intrahepatic/*diagnosis/etiology/pathology ; Chronic Disease ; Humans ; Male

Acute cholangitis usually develops in congenital hepatic fibrosis (CHF), accompanied by cystic dilated bile ducts. However, it can also develop in simple CHF and may lead to critical course. A 30-year old man presented with recurrent acute cholangitis without bile duct dilatation. He visited the hospital for febrile sense and abdominal pain in the right upper quadrant. He had been admitted several times for hepatosplenomegaly and cholangitis since childhood and received a liver biopsy 15 years ago. Abdominal computed tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP) revealed hepatosplenomegaly and a mildly dilated bile duct without stones or biliary cysts. His condition improved after conservative treatment. However, during a two-month follow up period, the patient experienced three episodes of acute cholangitis. A liver biopsy was performed and showed periportal fibrosis and intrahepatic ductular dysplasia, characteristics of congenital hepatic fibrosis. The periportal fibrosis and the infiltration of inflammatory cells were aggravated compared to 15 years ago. There was no evidence of hepatic cirrhosis. He was diagnosed with congenital hepatic fibrosis with recurrent acute cholangitis without intrahepatic duct dilatation, and conservatively treated with antibiotics.
Acute Disease ; Adult ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis/complications/*diagnosis ; Humans ; Liver Cirrhosis/complications/*congenital/pathology ; Male ; Recurrence ; Tomography, X-Ray Computed

BACKGROUND/AIMS: In order to determine the malignant potential of gallbladder adenoma for progression to carcinoma, we evaluated the histopathologic features of adenoma and adenoma-related lesions on cholecystectomized specimens. METHODS: Among 1,847 cholecystectomized specimens, 63 specimens from 26 benign adenomas, 9 carcinomas in situ (CIS), and 28 invasive carcinomas were selected. A pathologist reviewed all specimens and selected benign adenomas, CIS in the adenoma, and adenoma residue in invasive carcinomas. Adenomas and adenoma-related lesions were classified according to morphology (tubular, tubulopapillary, and papillary) and the consisting epithelium (biliary, pyloric metaplasia, and intestinal metaplasia). The age and the size of the benign adenomas and carcinomas in the adenoma were also compared. RESULTS: Adenoma and adenoma-related lesions were found in 34 out (1.8%) of all resected gallbladder. Among 9 CIS and 28 invasive carcinomas, adenoma-related lesions were detected in 7 and 1 case, respectively. All eight carcinomas arising in the adenoma were well-differentiated solitary tumors. The diameters of the carcinomas in the adenoma were, on average, larger than that of the benign adenomas (1.8 cm vs. 0.9 cm, p=0.01). The patients with carcinomas in the adenoma were, on average, older than those with benign adenomas, although the difference was insignificant (57 years vs. 47 years, p=0.09). The morphology and consisting epithelium did not differ between the benign adenomas and carcinomas in the adenoma. The malignant transformation occurred in 23.5% of adenomas. CONCLUSIONS: Gallbladder adenoma is a rare disease, although malignant transformation occurs frequently. Adenoma is a precancerous lesion and the adenoma-carcinoma sequence is one of the gallbladder cancer carcinogenesis.
Adenoma/epidemiology/*pathology/surgery ; Adult ; Age Factors ; Aged ; Carcinoma/epidemiology/pathology/surgery ; Cell Transformation, Neoplastic ; Cholecystectomy ; Cystadenoma/epidemiology/pathology/surgery ; Female ; Gallbladder Neoplasms/epidemiology/*pathology/surgery ; Gallstones/complications ; Humans ; Male ; Middle Aged ; Neoplasm Invasiveness

Prognosis of placental abruption depends on gestational age and the status of the mother and the fetus, and perinatal mortality was almost entirely attributable to prematurity. A midtrimester women with placental abruption was successfully treated by expectant management including fetal surveillance, serial ultrasonography and maternal hematologic examination, and delivered a healthy baby 11 weeks later. We suggest that expectant management may be considered as a good treatment option until fetal lung maturation is documented in preterm pregnancy with placental abruption if there is no maternal or fetal compromise.
Abruptio Placentae* ; Female ; Fetus ; Gestational Age ; Humans ; Live Birth* ; Lung ; Mothers ; Perinatal Mortality ; Pregnancy ; Pregnancy Trimester, Second* ; Prognosis ; Ultrasonography

We report a case of pancreatic pseudocyst presenting as an intramural gastric tumor on upper gastrointestinal examination, endoscopic ultrasound and computed tomography of the abdomen. Pancreatic pseudocysts in the stomach wall is rare and the most of them presented as a cystic mass, but this case was presented as a gastric mural solid tumor. Exploration revealed an about 4 4 2 cm sized round mass at the midbody of great curvature of stomach, it was in the muscle layer, and removed by surgical operation. The correct diagnosis of this case was established postoperately on the pathologic examination revealed pancreatic pseudocyst.
Abdomen ; Diagnosis ; Pancreatic Pseudocyst* ; Stomach ; Ultrasonography