Aneurysmal fibrous histiocytoma(AFH) is a histologic variant of dermatofibroma. The importance of the recognition of AFH as a variant of dermatofibroma lies in the differential diagnosis because the histologic appearance of AFH is very similar to dermatofibrosarcoma protuberans and other vascular malignancies, such as Kaposi's sarcoma and angiosarcoma. A 32-year-old man was seen for a nodular mass on the right popliteal fossa of 4 years' duration. The excisional biopsy specimen showed a relatively well circumscribed tumor mass in the dermis. In addition to compact storiform proliferation of spindle cells, there were multiple, irregular, blood-filled, aneurysmal tissue spaces that were devoid of lining of endothelial cells. Also, deposition of hemosiderin was prominent, particularly in the periphery of the aneurysmal spaces. Immunohistochemical stain for CD34 were negative to most tumor cells. After excisional therapy, there was no evidence of recurrence during the period of ten months' follow-up.
Adult ; Aneurysm* ; Biopsy ; Dermatofibrosarcoma ; Dermis ; Diagnosis, Differential ; Endothelial Cells ; Follow-Up Studies ; Hemangiosarcoma ; Hemosiderin ; Histiocytoma, Benign Fibrous* ; Humans ; Recurrence ; Sarcoma, Kaposi

Lichen nitidus(LN) is an uncommon chronic inflammatory disease of shiny, flat-topped, flesh-colored uniform papules most commonly located on the penis, forearms and wrists, lower abdomen, and thighs. LN almost has localized distribution, but in rare cases, it may become generalized. In Korea, three cases of generalized LN were reported. We report here three cases of generalized lichen nitidus in 31-year-old man, 8-year-old boy, and 6-year-old girl who had generalized numerous pinhead-sized, erythematous to flesh-colored, shiny papules. Microscopically, they had typical appearance of LN.
Abdomen ; Adult ; Child ; Female ; Forearm ; Humans ; Korea ; Lichen Nitidus* ; Lichens* ; Male ; Penis ; Thigh ; Wrist

BACKGROUND: Many tumor markers have been investigated for early diagnosis of the malignancy, yet they were turned out to be inappropriate for the purpose. This study was carried out to investigate the efficacy of tumor markers. METHODS: Employing radioimmunoassay, CEA, AFP, CA19-9, PSA, CA125 were done in 31,389 patients(20,878 males, 10,511 females) who visited our medical screening center from Jan. 1 1997 to Dec. 31 1997. RESULTS: Total mean value of CEA is 1.90+/-1.37 ng/mL(male: 2.17+/-1.37, female: 1.37+/-0.86). Male showed significantly higher level of CEA. Only 2 subjects had values over 25 ng/mL, and one was diagnosed to have stomach cancer but the other did not. Total mean value of AFP is 2.46+/-6.47 ng/mL (male: 2.32+/-3.55 ng/mL, female: 2.73+/-10.06 ng/mL). Female showed significantly higher level of measured AFP. One had AFP value over 400 ng/mL and was diagnosed of hepatoma. Total mean value of CA19-9 is 11.48+/-7.61 ng/mL,(male: 10.9+/-26.78 ng/mL, female: 12.61+/-8.97 ng/mL). Female showed significantly higher CA19-9. 65 subjects (male: 31, female: 34) showed measured CA19-9 level over 37 ng/mL. 5 subjects had values over 100 ng/mL and 1 subject was diagnosed of pancrease cancer. Total mean value of PSA is 0.79+/-1.88 ng/mL. 90 subjects showed measured PSA level over 4 ng/mL and mean value in this group was 10.92 ng/mL. 54 subjects were older than age 50. 4 out of 90 subjects were diagnosed of prostate cancer. Total mean value of CA125 is 13.08+/-10.93 ng/mL. 160 subjects showed measured CA125 level over 35 ng/mL. 19 subjects had value over 100 ng/mL and none of the malignancy was detected. CONCLUSION: Tumor markers are inappropriate measures for screening of malignancy.
alpha-Fetoproteins ; Carcinoembryonic Antigen ; Carcinoma, Hepatocellular ; Early Diagnosis ; Female ; Humans ; Male ; Mass Screening* ; Pancreas ; Pancrelipase ; Prostatic Neoplasms ; Radioimmunoassay ; Stomach Neoplasms ; Biomarkers, Tumor*

BACKGROUND: Our previous data suggested that IgE-mediated histamine release from basophil was elevated in the atopic asthmatic children. Basophil may play an important role in the development of the IgE-dependent, late phase response in allergen induced airway disease. So the existence of enhanced basophil histamine release in asthma could promote airway reactivity and obstruction. PURPOSE: The purpose of this study is to determine the relationship between IgE-mediated basophil histamine releasability (BHR) and airway hyperresponsiveness or markers of atopy in atopic children. METHODS: Twelve atopic asthmatics and four healthy atopics who were sensitive to D.p and D.f were selected. Their median age was 11.2 years old, their mean serum IgE level was 897+/-276 IU/mL and mean total eosinophil count was 536+/-71/mm3. Total eosinophil counts, total IgE, D.p and D.f-specific IgE, pulmonary function test, and methacholine provocation test were performed. IgE-mediated basophil histamine release by D.f allergen and goat-antihuman IgE antibody were measured by automated fluorometric assay. The relationship between histamine release and airway hyperresponsiveness or atopic markers was investigated. RESULTS: PC20 inversely correlated with anti-IgE antibody-mediated BHR (r=-0.50, P<0.05). Serum total IgE concentration correlated with anti-IgE antibody-mediated BHR (r=0.54, P<0.05). Serum concentrations of specific IgE to D.p correlated with anti-IgE antibody-mediated BHR (r=0.66, P<0.05). PC20 correlated correlated with FEF25-75% (r=0.75, P<0.05) and inversely with the total eosinophil counts (r=-0.69, P< 0.01). CONCLUSION: IgE-mediated basophil histamine releasability is inversely correlated with airway hyperresponsiveness, and correlated with total or specific-IgE in atopic children. These findings suggest that basophil histamine releasability is easy and useful method of diagnosis and monitoring response to treatment in atopic disease.
Asthma ; Basophils* ; Child* ; Diagnosis ; Eosinophils ; Histamine Release ; Histamine* ; Humans ; Immunoglobulin E ; Methacholine Chloride ; Respiratory Function Tests

The primary esophageal lymphoma is extremely rare, and shows various morphologic characteristics. Only a single case of mucosa-associated lymphoid tissue (MALT) type lymphoma confined to the esophagus has been reported in the literature. A 61-yr-old man was referred to our hospital for evaluation of an esophageal submucosal tumor (SMT) that had been detected incidentally by endoscopy. He had a history of pulmonary tuberculosis with long-term anti-tuberculosis medication 15 yr before, and also had a history of syphilis, which had been treated one year before. He had been taking a synthetic thyroid hormones for the past 10 months because of an autoimmune thyroiditis. Endoscopy showed a longitudinal round and tubular shaped smooth elevated lesion, which was covered with intact mucosa and located at the mid to distal esophagus, 31 cm to 39 cm from the incisor teeth. Endoscopic ultrasonography (EUS) showed a huge longitudinal growing intermediate- to hypo-echoic mass located in the submucosal layer with internal small, various sized honeycomb-like anechoic lesions suggesting germinal centers. Subsequently, he underwent a surgery, which confirmed the mass as a primary esophageal low-grade B-cell lymphoma of MALT type.
Alcoholism/complications ; Diagnosis, Differential ; Esophageal Neoplasms/pathology* ; Esophageal Neoplasms/radiography ; Esophageal Neoplasms/ultrasonography ; Esophagoscopy ; Gastritis/complications ; Helicobacter Infections/complications ; Hemangioma, Cavernous/diagnosis ; Human ; Incidental Findings ; Lymphoma, Mucosa-Associated Lymphoid Tissue/pathology* ; Lymphoma, Mucosa-Associated Lymphoid Tissue/radiography ; Lymphoma, Mucosa-Associated Lymphoid Tissue/ultrasonography ; Male ; Middle Aged ; Mucous Membrane/pathology ; Neoplasm Invasiveness ; Smoking ; Thyroiditis, Autoimmune/complications

BACKGROUND/AIMS: The aim of this study was to identify which patients are more susceptible to severe anal pain after colonoscopy and to determine the usefulness of lidocaine gel in reducing the anal pain. METHODS: A prospective trial was performed with 150 consecutive outpatients who underwent a colonoscopic examination. The patients were randomized into three groups: they received topical treatment of lidocaine gel (n=48) or lubricant gel (chlorhexidine gluconate) (n=48), or no treatment (n=54) just after the procedure. Data regarding the procedures were collected and the patients were phone-interviewed on the next day. RESULTS: Seventy of 150 (46.7%) had moderate to severe pain (VAS score>or=4). A multiple regression analysis found that the presence of hemorrhoid was significantly (p<0.05) associated with severe anal pain after colonoscopy. Among three groups, there was no significant difference of the pain scores on the procedure day on the next day. However, patients' subjective evaluation about the usefulness of the gel was significantly better in the lidocaine group than in the placebo group in patients who had moderate to severe pain (79.2% vs. 43.5%, p<0.05). CONCLUSIONS: A palliative management is more required for patients who complain moderate to severe pain just after colonoscopy or those with hemorrhoid
Colonoscopy* ; Hemorrhoids ; Humans ; Lidocaine* ; Outpatients ; Prospective Studies*

BACKGROUND/AIMS: Endoscopic mucosal resection (EMR) of early gastric cancer (EGC) or gastric flat adenoma has been widely accepted as a useful method due to its minimal invasiveness and satisfactory post- procedure results in maintaining a good quality of life for patients. The purpose is to define the long-term effect and usefulness of EMR of EGC and gastric flat adenoma. METHODS: We analysed, retrospectively, 101 lesions in 96 cases that could be followed-up were analyzed. Endoscopic surveillance with histological examination was carried out every three months for one year after the treatment, every six months for the second year, and annually thereafter. RESULTS: 1) The mean follow-up period was 17.7 months (1-78). 2) Of the 101 lesions, there were 6 recurrences (5.9%), the mean period was 17.3 months (2-37). One of 28 EGC, five of 73 gastric flat adenoma showed recurrence. 3) The recurrence rate tended to be higher in as the size increased (p=0.06). In the lesions which were resected by planned piecemeal, 10% of those lesions recurred (4/40), while 3.3% (2/61) of those lesions recurred in which lesions were resected en bloc (p=0.21). 4) With respect to location of the primary lesions, the recurrence rate was higher in the lesions of the cardia (50%, p<0.05). CONCLUSIONS: We concluded that the size and location of the lesions were related to recurrence after EMR, but sex, pathology, and resection methods were not related.
Adenoma* ; Cardia ; Follow-Up Studies* ; Humans ; Pathology ; Quality of Life ; Recurrence ; Retrospective Studies ; Stomach Neoplasms*

BACKGROUND/AIM: Endoscopic screening for the detection of premalignant high-grade dysplasia remains time consuming and is subject to sampling error. We performed this study to determine the clinical usefulness of laser endoscopic spectra analyzer (LESA-7) in gastrointestinal cancer and dysplastic lesions. METHODS: Seventeen patients with histologically proven carcinoma or adenoma with or without high-grade dysplasia were treated with oral administration of 5-ALA (20 mg/kg). PDD was performed 4 hours later. The fluorescence was excited by a helium-neon laser with emission at 637 nm. The generated fluorescence light was collected and fed into a multi-channel analyzer and the full spectrum was displayed in real time (LESA-7). RESULTS: In most of malignant tumors, a clear protoporphyrin IX-related dual-peaked fluorescence signal at about 635 and 700 nm was identified in the fluorescence spectra. However, it was not fully identified in bile duct cancers. In PDD of post-EMR in order to detect residual lesions (gastric flat adenoma 1, early gastric cancer 2), a dual spectra was not identified. CONCLUSIONS: PDD with 5-ALA might be useful for the detection of dysplasia and carcinoma in the gastrointestinal tract.
Adenoma ; Administration, Oral ; Bile Duct Neoplasms ; Diagnosis* ; Fluorescence ; Gastrointestinal Neoplasms* ; Gastrointestinal Tract ; Humans ; Mass Screening ; Selection Bias ; Stomach Neoplasms

BACKGROUND/AIMS: This is the study to clarify the relation between the mucosal patterns by magnifying endoscopy and the histologic findings in the gastric mucosal elevated lesions. METHODS: The objectives were 51 lesions from 48 patients with gastric mucosal elevated lesions. Gastric mucosal elevated lesions have been magnified up to 80 times by using the magnifying endoscope and were obtained tissue. Magnifying mucosal patterns were classified into 6 types (dot, sulciolar, reticular, irregular, destructive and abnormal vessel pattern) and two group (Group A: dot, sulciolar, reticular pattern-preservation of mucosal arrangement, Group B: irregular, destructive, abnormal vessel pattern-destruction of mucosal arrangement). And then we compared the relation between the mucosal patterns and the histologic findings in the gastric mucosal elevated lesions. RESULTS: In magnifying mucosal patterns, dot, sulciolar, reticular, irregular, destructive, and abnormal vessel pattern were 8, 5, 15, 4, 12, 7, respectively. There was significant difference in the rate of severe dysplasia or carcinoma between two groups (Group A: 0% (0/28), Group B: 70% (16/23) (p<0.05)). The score of intestinal metaplasia and atrophy in group A were less than that of group B (p<0.05). CONCLUSIONS: Irregularity, destruction and abnormal vessel formation of gastric mucosal pattern by magnifying endoscope may be suspected the histologic malignancy in the gastric mucosal elevated lesions.
Atrophy ; Endoscopes ; Endoscopy* ; Humans ; Metaplasia

The anatomy of the pancreatic ducts and their variations are best defined through a pancreatography, which is especially useful for determining the appropriate endoscopic management. Pressure in the pancreatic ductal system has been shown to be significantly higher in patients with painful chronic pancreatitis and dilated ducts when compared with pressure in controls. The aim of pancreatic drainage procedures is to improve the outflow of pancreatic juice, thereby lowering intraductal pressure and affording relief of pain. It is necessory for both endoscopic pancreatic sphincterotomy (EPS) and stenting have to be performed at the papilla of the dominant duct, which is the Wirsung duct (embryologic "ventral" duct), in the majority such of cases. An EPS of the minor papilla should be considered when the duct of Santorini (embryologic "dorsal" duct) predominates, as in patients with complete or incomplete divided ducts or with a distorted connection between the ventral and the dorsal duct. In these patients, access to the main pancreatic duct (MPD) is easier through the duct of Santorini. A 42 year-old man was admitted with chronic recurrent pancreatitis. Minor papilla sphincterotomy and endoscopic stent placement were performed for the drainage of the dorsal pancreatic duct. After stenting of the minor papilla, abdominal pain disappeared and pancreatitis did not develop after a 7 month follow-up, the stent was changed.
Abdominal Pain ; Adult ; Drainage ; Follow-Up Studies ; Humans ; Pancreatic Ducts ; Pancreatic Juice ; Pancreatitis ; Pancreatitis, Chronic* ; Sphincterotomy, Endoscopic ; Stents*