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A Case of Metastatic Malignant Melanoma in Stomach.

June Hyuk LEE ; Kuk Kyung LEE ; Sang Byung BAE ; Eun Joo KIM ; Il Kwun CHUNG ; Hong Soo KIM ; Sang Heum PARK ; Moon Ho LEE ; Sun Joo KIM ; Dae Joong KIM

Korean Journal of Gastrointestinal Endoscopy.2000;20(6):472-476.

Malignant melanomas are common metastatic lesions in the gastrointestinal tract. There are some descriptions for endoscopic findings but few reports on the endoscopic ultrasonographic findings of metastatic malignant melanomas in the stomach. A 67-year-old woman was admitted due to indigestion persisting for 1 month. She had a 3x4 cm sized black pigmented skin lesion on her left foot. An abdominal ultrasonography and CT scan revealed multiple variable sized round lesions in the liver, suggesting metastatic lesions. An endoscopy revealed multiple, elevated lesions with central ulcerations and a star shaped black pigmentation around the ulcer mound on the antrum of the stomach, as well as huge ulcers with black pigmented bases on the upper body. An endoscopic ultrasonography determined that the depths of the elevated lesions on the antrum were 1imited to the mucosal layer and that huge ulcers on the upper body were invading the serosa simultaneously. The skin lesion was diagnosed as a malignant melanoma and the stomach lesion were also confirmed to be metastatic malignant melanomas. The case of malignant melanomas that metastased to the stomach and had unusual endoscopic ultrasonographic findings is herein reported.
Aged ; Dyspepsia ; Endoscopy ; Endosonography ; Female ; Foot ; Gastrointestinal Tract ; Humans ; Liver ; Melanoma* ; Neoplasm Metastasis ; Pigmentation ; Serous Membrane ; Skin ; Stomach* ; Tomography, X-Ray Computed ; Ulcer ; Ultrasonography

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A Case of a Gastric Submucosal Lymphatic Cyst Associated with Early Gastric Cancer.

Kwang Jin JEONG ; Yong Kun KIM ; Geon Jo LIM ; Dae Hyun CHOI ; Jin Do KIM ; Ju Hong LEE ; Dae Yong KOO ; Sang Ik SUH ; Kyong Yoon LEE ; Il Son LEE

Korean Journal of Gastrointestinal Endoscopy.2000;20(6):468-471.

A lymphatic cyst of the stomach is rare benign tumor which is composed of thin-walled lymphatic space lined by benign-appearing endothelial cells. It rarely manifests clinical symptoms, so it is found incidentally in most cases. Recently, a case of submucosal lymphatic cyst associated with early gastric cancer was experienced. An endoscopy revealed a slightly elevated, edematous lesion adjacent to the malignant ulcer. This case is herein reported with a brief review of related literature.
Endoscopy ; Endothelial Cells ; Lymphocele* ; Stomach ; Stomach Neoplasms* ; Ulcer

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Three Cases of Double Pylorus Due to Gastroduodenal Fistula Complicating Peptic Ulceration: Disappearance of gastroduodenal fistula in 1 case after eradication of a Helicobacter pylori infection.

Ho Jin SONG ; Sang Woo KIM ; Hyun Jung BOK ; Byung Wha HA ; Seong Hyun SON ; Joon Ho WANG ; Kang Moon LEE ; Dong Soo LEE ; Youngg Sang YANG ; In Sik CHUNG ; Doo Ho PARK

Korean Journal of Gastrointestinal Endoscopy.2000;20(6):464-467.

Double pylorus is either a congenital abnormality or an acquired complication of peptic ulcer disease. An accessory channel normally connects the lesser or greater curvatore of the prepyloric antrum with the duodenal bulb. Three cases of double pylorus, an unusual complication of peptic ulcer disease is herein reported. A peptic ulcer lay in the accessory channel in all cases. In one of the cases, the fistula closed spontaneously after Helicobacter pylori eradication. The remaining 2 patients became asympto-matic despite the persistence of the accessory channel.
Congenital Abnormalities ; Fistula* ; Helicobacter pylori* ; Helicobacter* ; Humans ; Peptic Ulcer* ; Pylorus*

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Endosonographic Findings of Submucosal Tumor-like Gastric Lesion Caused by Fibrotic Ulcer Healing.

Dong Jin YOUN ; Myung Soo KIM ; Young Keun YOON ; Chan Hee HAN ; Gwang An KWUN ; Jin Oh KIM ; Joo Young CHO ; Joon Seong LEE ; Moon Sung LEE ; Chan Sup SHIM

Korean Journal of Gastrointestinal Endoscopy.2000;20(6):460-463.

It is known that multiple ulcers of the gastric antrum are often accompanied by marked submucosal fibrosis during the healing process, and that this may result in a deformity of the gastric wall. Thus, benign antral ulcers may be misinterpreted as intramural tumors, or even malignant ulcers when the surrounding edema is pronounced and sharply defined. It is possible for an endoscopic ultrasonography (EUS) to detect which layer has a submucosal tumor (SMT) in the five-layer structures of the digestive tract wall. In the diagnosis of SMT of the upper digestive tract, EUS allows for the visualization of the structures underlying the gastrointestinal wall in a noninvasive manner and has a great advantage over conventional modalities such as endoscopy and X-ray examination. The EUS findings of 2 cases of submucosal tumor-like gastric lesion caused by fibrotic ulcer healing are herein reported with a brief review of relevant literature.
Congenital Abnormalities ; Diagnosis ; Edema ; Endoscopy ; Endosonography ; Fibrosis ; Gastrointestinal Tract ; Pyloric Antrum ; Stomach Ulcer ; Ulcer*

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A Case of Behcet's Disease with Esophageal and Ileocecal Valve Ulcers.

Young Woo PARK ; Hyung Joo KWON ; Moo Yeol LEE ; Cheol Ho LEE ; Jin Kwan KIM ; Mi Young KIM ; In Seog HWANG ; Heung Sun YU ; Young Muk KIM ; Dong Yun LEE ; Joon Sang LEE

Korean Journal of Gastrointestinal Endoscopy.2000;20(6):456-459.

Behcet's disease is a multisystemic, chronic inflammatory disease with a triad of symptoms including oral ulcers, genital ulcers, and inflammatory ocular lesions. While intestinal Behcet's disease commonly affects the ileocecal region, esophageal ulceration with odynophagia is very uncommon. A 38-year-old male patient was admitted due to odynophagia, a postprandial epigastric burning sensation, and right lower quadrant abdominal pain. He had a history of recurrent oral and genital ulcerations. An esophagogastroduodenoscopy revealed relatively well demarcated ulcerative lesions with mucosal nodularities on the mid to distal esophagus which was suspected to be esophageal cancer. But repeated biopsies showed lymphocytic and plasma cell infiltrations on the lamina propria. A colonoscopy revealed a well demarcated, deep ulcerative lesion with stenotic narrowing in the ileocecal valve. The diagnosis of intestinal Behcet's disease with an esophageal ulcer was made on the basis of clinical and pathological findings. The patient was treated with steroids and sulfasalazine and the response was favorable.
Abdominal Pain ; Adult ; Biopsy ; Burns ; Colonoscopy ; Diagnosis ; Endoscopy, Digestive System ; Esophageal Neoplasms ; Esophagus ; Humans ; Ileocecal Valve* ; Male ; Mucous Membrane ; Oral Ulcer ; Plasma Cells ; Sensation ; Steroids ; Sulfasalazine ; Ulcer*

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The Efficacy of Intraluminal Radiotherapy after Metallie Stent Insertion in Malignant Biliary Tract Obstruction.

In Han KIM ; Don Haeng LEE ; Jong Gil YOO ; Kye Sook KWON ; Hyeon Geun CHO ; Won CHOI ; Pum Soo KIM ; Hyung Gil KIM ; Yong Woon SHIN ; Young Soo KIM ; Sung Gwon KANG ; Woo Chul KIM

Korean Journal of Gastrointestinal Endoscopy.2000;20(6):449-455.

BACKGROUND/AIMS: Inoperable malignant biliary tract obstructions (MBTO) are best palliated by drainage procedures followed by radiation therapy. In order to administer high doses in a short time to the central part of the tumor, internal radiotherapy has been proposed for a palliative goa1. The aim of this study is to investigate the effect of intraluminal radiotherapy (ILRT) to the stent patency and patients survival time after expandable metallic stent insertion in MBTO. METHODS: Between August 1996 and July 1998, 28 patients (17 females, 11 males, average age 61.4 years) with inoperable MBTO were provided with percutaneous transhepatic biliary drainage (12 patients; bile duct cancer, 8 patients; pancreatic head cancer, 4 patients; gallbladder cancer; 4 patients; lymph node metastasis from stomach cancer). The 14 patients were treated by only metallic stent. The other 14 patients were treated by metallic stent insertion and followed by ILRT. The ILRT was done by iridium-192 (mean dosage 23.3 Gray, 5 fractions). RESULTS: There were no significant differences in the two groups regarding age, sex, type of disease, and location of the obstruction. The patients tolerated ILRT well. CONCLUSIONS: The ILRT after expandable metallic stent was safe and effective in stent patency and the patient's surviva1 time in inopcrable MBTO.
Bile Duct Neoplasms ; Biliary Tract* ; Drainage ; Female ; Gallbladder Neoplasms ; Head and Neck Neoplasms ; Humans ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Radiotherapy* ; Stents* ; Stomach

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An Intraductal Papillary Mucinous Tumors (IPMT) of the Pancreas: Clinical, Radiologie, and Pathologie Findings Acccrding to Its Subtypes.

Kyo Sang YOO ; Eun Taek PARK ; Byeong Cheol LIM ; Hyun Ju PARK ; Jong Chul KIM ; Si Yeol LEE ; Young Mi LEE ; Jung Ho KIM ; Kyung Duk KIM ; Dong Wan SEO ; Sung Koo LEE ; Myung Hwan KIM ; Young Il MIN

Korean Journal of Gastrointestinal Endoscopy.2000;20(6):443-448.

BACKGRONDS/AIMS: Patients with a branch duct type intraductal papillary mucinous tumor (IPMT) of the pancreas with hyperplasia are suggested to be followed up without resection. The aims of this study were to compare the clinical, radiologic, and pathologic findings among the subtypes of IPMT and to find the factors that could predict a hyperplastic lesion preoperatively. METHODS: Twenty two patients with IPMT of the pancreas who underwent surgical resection were investigated. The subtypes of IPMT were classified into the main duct type (7 patients), branch duct type (6 patients), and combined type (9 patients) based on the pathologic findings of the surgical specimens. The clinical, radirologic, and pathoiogic findings of each subtype were analyzed. RESULTS: Asymptomatic patients were more common in the branch duct type of IPMT (p=0.01). The diameter of the main pancreatic duct was <7 mm in most of the branch duet types of IPMT (5/6). Hyperplastic lesions were more likely to be the branch ciuct type (5/6, p=0.01). CONCLUSIONS: A hyperplastic lesion can be predicted if a lesion is the branch duct type of IPMT with the diameter of the main pancreatic duct < 7 mm and without symptoms. Therefore, IPMT of the pancreas with these findings can be followed up without an operation.
Humans ; Hyperplasia ; Mucins* ; Pancreas* ; Pancreatic Ducts

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Diagnostic Usefulness of Eedoscopic Ultrasongraphy for Extraluminal Compressions Mimicking Submucosal Tumors.

Myung Soo KIM ; Jin Oh KIM ; Dong Jin YOUN ; Chan Hee HAN ; Joo Young CHO ; Joog Seong LEE ; Moon Sung LEE ; Chan Sup SHIM

Korean Journal of Gastrointestinal Endoscopy.2000;20(6):437-442.

BACKGROUND/AIMS: When a submucosal lesion is discovered through an upper gastrointestinal endoscopy, it may be often difficult to differentiate an extra-gastric compression from a true submucosa1 tumor (SMT). An endoscopic ultrasonography (EUS) provides information about the relationship between a lesion and the gastric or esophageal wall. Furthermore, EUS helps in identifying the compression caused by surrounding organs. The diagnostic usefulness of EUS for extralumina1 compressed lesion was assessed. METHODS: The 261 patients who received an endoscopic diagnosis of submucosal tumors had EUS examinations performed. The results of EUS to additional diagnostic procedures such as UGI, USG, CT scan or tissue biopsy were then compared. RESULTS: Of 261 patients who received endoseopic diagnosis as SMT, extraluminal compression existed in 46 (17.6%) cases and true intramural lesion were found in 215 (82.4%) cases on EUS. The causes of extraluminal compression are lymph nodes (2 case.), the gallbladder (12 cases), the pancreas (9 cases), the spleen (6 cases), a pancreatic pseudocyst (5 cases), pancreatic cancer (2 cases), a hepatic cyst (2 cases), the left lobe of the liver (4 cases), hepatoma (1 case), a mesenteric tumor (2 caws) and a splenic vein (1 case). CONCLUSIONS: EUS is considered to be a useful diagnostic method not only for differential diagnosis of extraluminal compression from true SWT, but also for clarifying the cause of extraluminal compressed lesions.
Biopsy ; Carcinoma, Hepatocellular ; Diagnosis ; Diagnosis, Differential ; Endoscopy, Gastrointestinal ; Endosonography ; Gallbladder ; Humans ; Liver ; Lymph Nodes ; Pancreas ; Pancreatic Neoplasms ; Pancreatic Pseudocyst ; Spleen ; Splenic Vein ; Tomography, X-Ray Computed

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The Risk Factors for Rebleeding with Heat Probe Thermocoagulation in Bleeding Peptie Ulcer Patients.

Sang Goo LEE ; Hee Jung SON ; Young Ho KIM ; Gwang Hyun RYU ; Suk Ho LEE ; Jong Kyun LEE ; Joon Hyoek LEE ; Kyu Taek LEE ; Poong Lyul LEE ; Jae J KIM ; Kwang Cheol KOH ; Seung Woon PAIK ; Jong Chul RHEE ; Kyoo Wan CHOI

Korean Journal of Gastrointestinal Endoscopy.2000;20(6):431-436.

BACKGROUND/AIMS: The precise rebleeding rate and risk factors of rebleeding after heat probe thermocoagulation in peptic ulcer patients with bleeding are not clear and still need to be evaluated. If we could identify the pre-dictors for rebleeding, the mortality rate might be loweted with early retreatment or surgery in these high risk group. METHODS: The 94 patients in whom heat probe was applied were enrolled and the 18 patients with bleeding tendencies. Initial hemostasis was defined as hemostasis persisting for 24 hours post-treatment and permanent hemostasis as absence of bleeding for 7 days after therapy. Rebleedig was defined as oozing or spurting hemorrhage in the ulcer base and/or unstable vital signs and continuting tarry or bloody stool or hematemesis after therapy. RESULTS: In 35 patients with active bleeding sign, initial hemostasis was obtained in 30 (85.7%) patients. After having achieved initial hemostasis, 9 (30.0%) patients rebled. In 41 ulcer patients with non-bleeding visible vessel, 40 cases (97.6%) achieved successful pre-vention of rebleeding. No evident complication was observed. With univariate analysis, bleeding ulcer patients with spurting and oozing hemorrhage had a higher re-bleeding rate than those with non-bleeding visible vessel. CONCLUSIONS: The heat probe thermocoagulaton is relative safe and effective procedure to protect bleeding in pectic ulcer patients with non-bleeding visible vessel, but insufficient to hemostasis in bleeding peptic ulcer patients with spurting or oozing in ulcer base. Spurting and oozing hemorrhage are the only risk factors of rebleeding after initial hemostasis with heat probe thermocoagulation in peptic ulcer patients with bleeding.
Electrocoagulation* ; Hematemesis ; Hemorrhage* ; Hemostasis ; Hot Temperature* ; Humans ; Mortality ; Peptic Ulcer ; Retreatment ; Risk Factors* ; Ulcer* ; Vital Signs

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The Clinical Usefulness of Esophagogastreduodenoscopy in Neonates and Infants.

Jin Woo LEE ; Kwang An KWON ; Kun Joo KIM ; Il Kwen CHUNG ; Moo Jun BAEK ; Yong Sik MIN ; Hye Kyung LEE ; Hong Soo KIM ; Sang Heum PARK ; Moon Ho LEE ; Sun Joo KIM

Korean Journal of Gastrointestinal Endoscopy.2000;20(6):425-430.

BACKGROUND/AIMS: Endoscopic examination of upper gastrointestinal tract disease in infancy and childhood was introduced 2 decades ago. However, clinical indication, premedication, endoscopic features, and practical problems have been infrequently reported in neonate and infants, Therefore, the usef'ulness and problems of endoscopy in these pediatric patients was evaluated. METHODS: Twelve pediatric patients who underwent endos-copic examination which involved a choledochoscope, bronchoscope, and gastrofibroscope included 8 neonates and 4 infants who suffered from gastrointestinal symptoms. Drugs for premedication were chloral hydrate, diazepam, midazolam and ketamine in single or combined administration. RESULTS: Clinical manifestations were hematemesis (67%), melena (42%), vomiting (8%), weight loss (8%), fever (8%) and irritability (8%). Indica-tions for endoscopic examination were upper gastrointestinal Weeding (67%), upper gastrointestinal obstruction (8%), acute drug intoxication (8%), foreign bodies in the stomach (8%) and evaluation for varix (8%). Endo-scopic findings revealed a gastric ulcer (48%), acute gastric mucosal lesion (8/<), external compression on the duodenum (8%), a gastric foreign body (8%), acute esophago-gastritis (8%) and esophageal and gastric varix (8%). Therapeutic endoscopy was performed in 2 patients, One case of hypoxia occurred during diagnostic endoscopy. CONCLUSIONS: Endoseopic examination of the upper gastrointestinal tract is a useful and safe proce-dure to detect diseases in neonates and infants if it is done by experienced endocopists and in the circumstances of adequate premedication.
Anoxia ; Bronchoscopes ; Chloral Hydrate ; Diazepam ; Duodenum ; Endoscopy ; Esophageal and Gastric Varices ; Fever ; Foreign Bodies ; Hematemesis ; Humans ; Infant* ; Infant, Newborn* ; Ketamine ; Melena ; Midazolam ; Premedication ; Stomach ; Stomach Ulcer ; Upper Gastrointestinal Tract ; Varicose Veins ; Vomiting ; Weight Loss

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