BACKGROUND/AIMS: The aim of this study was to determine the structural chromosomal aberrations, such as loss of heterozygosity (LOH) and microsatellite instability (MSI), at multiple tumor suppressor gene loci in gastric epithelial neoplasia categorized by the revised Vienna classification. METHODS: All tissue samples were excised by endoscopic mucosal resection. Sixty category 3 (low-grade adenoma) tissue samples and 51 category 4 samples (high-grade adenoma and intramucosal carcinoma with adenoma) were examined at the 7 sets of microsatellite loci linked to the tumor suppressor gene locus. RESULTS: For category 3 and 4 tissue samples, there were no differences in the frequencies of LOH-positive chromosomes or the extent of chromosomal loss. The Helicobacter-pylori (H. pylori)-positive rate was significantly higher in MSI-positive category 4 samples than in category 3 samples (p=0.04). The frequency of MSI positivity was significantly higher in category 4 samples than in category 3 samples (p=0.003). CONCLUSIONS: H. pylori infection is associated with genetic instability of the premalignant lesion. MSI occurs in the early stages of gastric carcinogenesis and its occurrence increases during malignant transformation. Detection of MSI in premalignant gastric lesions may be a surveillant of risk of malignant transformation.
Adenoma ; Chromosome Aberrations ; Genes, Tumor Suppressor ; Loss of Heterozygosity ; Microsatellite Instability ; Microsatellite Repeats ; Succinimides

Superior mesenteric artery (SMA) syndrome is caused by compression of the transverse part of the duodenum between the SMA and the aorta, where the distance between these vessels decreases with loss of mesenteric fat. It occurs most frequently in patients with rapid weight loss. Conventionally, the diagnosis is established by digital fluoroscopy and contrast-enhanced spiral computed tomography (CT). A 17-year old woman was admitted via the emergency department with postprandial fullness, nausea, and bile stained vomiting. The initial radiological examination revealed severe gastroptosis. Fluoroscopic evaluation after barium swallowing failed due to a markedly distended stomach. The diagnosis of SMA syndrome was made by endoscopic ultrasound (EUS) using a mini-probe. EUS findings were in good agreement with the CT angiogram. A conservative trial was attempted, but symptoms remained refractory. Surgery was an alternative option and we treated the patient successfully with laparoscopic duodeno-jejunostomy.
Aorta ; Barium ; Bile ; Deglutition ; Duodenum ; Emergencies ; Female ; Fluoroscopy ; Humans ; Mesenteric Artery, Superior ; Nausea ; Stomach ; Superior Mesenteric Artery Syndrome ; Tomography, Spiral Computed ; Vomiting ; Weight Loss

Jejunal diverticulosis is a rare malady and it is often asymptomatic. It may lead to chronic non-specific or acute symptoms such as malabsorption, intussusception, obstruction, bleeding, perforation and abscess formation. It usually is seen as an incidental finding on computerized tomography, enteroclysis or during an emergency operation. Since the advent of double balloon enteroscopy and capsule endoscopy, several cases of small bowel diverticulosis with complications have recently been reported. Lipomas are the rare benign tumors of the small intestine with no malignant potential and they are mostly incidentally encountered during investigation of the gastrointestinal tract. We report here on a case of massive small bowel bleeding with jejunal diverticulosis, and a pedunculated elongated lipoma was incidentally found.
Abscess ; Capsule Endoscopy ; Diverticulum ; Double-Balloon Enteroscopy ; Emergencies ; Gastrointestinal Tract ; Hemorrhage ; Incidental Findings ; Intestine, Small ; Intussusception ; Lipoma

Inflammatory myofibroblastic tumors (IMTs) are solid neoplastic mesenchymal proliferations composed of myofibroblastic spindle cells admixed with inflammatory infiltrates. The documented sites in the gastrointestinal tract include the esophagus, small intestine, colon, appendix, rectum, pancreas, spleen, liver, and Meckel's diverticulum. Biliary IMTs are rare, and IMTs arising from the ampulla of Vater have not been reported previously. Herein we report the case of a 65-year-old woman with an extrahepatic biliary obstruction due to IMT of the ampulla of Vater, and a successful therapeutic approach using endoscopic ultrasonography and endoscopic papillectomy.
Aged ; Ampulla of Vater ; Appendix ; Colon ; Endosonography ; Esophagus ; Female ; Gastrointestinal Tract ; Humans ; Intestine, Small ; Liver ; Meckel Diverticulum ; Myofibroblasts ; Pancreas ; Rectum ; Spleen

Isolated spontaneous dissection of the superior mesenteric artery (SMA) without aortic dissection is a rare cause of acute mesenteric ischemia. A sudden decrease of intestinal blood flow can lead to fatal complications such as ischemic necrosis, shock, and death. Therefore, early diagnosis and therapeutic approach before the occurrence of intestinal infarction are the most important factor to determine the patient's prognosis. A 52-year-old male presented with postprandial periumbilical pain, and isolated spontaneous dissection of the superior mesenteric artery with mural thrombus was detected by abdominal computed tomography with contrast enhancement. By the percutaneous implantation of vascular metallic stent via femoral artery, he was treated successfully. We report a case of isolated spontaneous dissection of the SMA treated by a percutaneous endovascular stent replacement with a review of literature.
Aneurysm, Dissecting/complications/*diagnosis/surgery ; Humans ; Male ; *Mesenteric Artery, Superior/radiography ; Mesenteric Vascular Occlusion/etiology/surgery ; Middle Aged ; *Stents ; Tomography, X-Ray Computed

Isolated spontaneous dissection of the superior mesenteric artery (SMA) without aortic dissection is a rare cause of acute mesenteric ischemia. A sudden decrease of intestinal blood flow can lead to fatal complications such as ischemic necrosis, shock, and death. Therefore, early diagnosis and therapeutic approach before the occurrence of intestinal infarction are the most important factor to determine the patient's prognosis. A 52-year-old male presented with postprandial periumbilical pain, and isolated spontaneous dissection of the superior mesenteric artery with mural thrombus was detected by abdominal computed tomography with contrast enhancement. By the percutaneous implantation of vascular metallic stent via femoral artery, he was treated successfully. We report a case of isolated spontaneous dissection of the SMA treated by a percutaneous endovascular stent replacement with a review of literature.
Aneurysm, Dissecting/complications/*diagnosis/surgery ; Humans ; Male ; *Mesenteric Artery, Superior/radiography ; Mesenteric Vascular Occlusion/etiology/surgery ; Middle Aged ; *Stents ; Tomography, X-Ray Computed

Buerger's disease, or thromboangiitis obliterans, is a nonatherosclerotic inflammatory disease affecting the small- and medium-sized arteries and veins of the extremities (arms, hands, legs, and feet). It is most common in the Orient, Southeast Asia, India, and the Middle East, and usually affects men aged between 20 and 40 years, although it is becoming more common in women. It is well established that most such patients smoke heavily and experience an improvement in symptoms following smoking cessation. Mesenteric involvement in Buerger's disease is extremely rare; however, we describe herein two cases of colon ischemia in patients who were previously diagnosed with lower-extremity Buerger's disease. In one case, the patient developed colonic obstruction, and surgical resection was performed. Histopathologic findings were compatible with the chronic stage of Buerger's disease. In the other case, angiography revealed abrupt occlusion of the inferior mesenteric artery with numerous collateral vessels, just like the corkscrew appearance found in the extremities. If patients with established Buerger's disease of the extremities complain of gastrointestinal symptoms, early interventional diagnosis should be performed to prevent intestinal obstruction and gangrene.
Aged ; Angiography ; Arteries ; Asia, Southeastern ; Colon ; Extremities ; Female ; Gangrene ; Hand ; Humans ; India ; Intestinal Obstruction ; Ischemia ; Leg ; Male ; Mesenteric Artery, Inferior ; Middle East ; Smoke ; Smoking Cessation ; Thromboangiitis Obliterans ; Veins

Hyperplastic polyps are usually found in the stomach and they account for 50 to 90% of all gastric epithelial polyps. In contrast to the adenomatous polyps, it has been reported that most hyperplastic polyps are benign. However, in rare cases hyperplastic polyps have revealed carcinoma, and the incidence of malignant changes is generally recognized to be about 1 to 3%. Most of the reported cases of a hyperplastic gastric polyp with a transformation to adenocarcinoma were well differentiated histopathologically. Herein we report on an extremely rare case that involved the association of a hyperplastic polyp and focal signet ring cell carcinoma in the remnant stomach after subtotoal gastrectomy.
Adenocarcinoma ; Adenomatous Polyps ; Carcinoma, Signet Ring Cell ; Gastrectomy ; Gastric Stump ; Incidence ; Polyps ; Stomach

Inflammatory bowel diseases (IBD) is heterogeneous, chronic relapsing disorder. Inappropriate and exaggerated immune response for the luminal antigen is known as a main pathogenesis. Genetic, infectious, and environmental factors are responsible for unbalanced immune response, but the definite pathogenesis is still unclear. Genetic factor is the most important role of all. That is based on high concordance rate of identical twins and family history. The incident rate and prevalence of IBD for the Asian population is relatively lower than Western population, and the lack of NOD2 or TLR4 genetic polymorphisms in Korea and Japanese population suggests the difference in genetic background between Asian and Western population. In Korea, the case of familial aggregation of IBD is pretty rare. We report a case of the daughter with ulcerative colitis and her mother with Crohn's disease who have a -159C/T promoter polymorphism of CD14 gene for IBD.
Antigens, CD14/genetics ; Colitis, Ulcerative/*diagnosis/drug therapy/genetics ; Colonoscopy ; Crohn Disease/*diagnosis/genetics ; Female ; Genetic Predisposition to Disease ; Humans ; Mesalamine/therapeutic use ; Middle Aged ; Mothers ; Polymorphism, Restriction Fragment Length ; Tomography, X-Ray ; Young Adult

Inflammatory bowel diseases (IBD) is heterogeneous, chronic relapsing disorder. Inappropriate and exaggerated immune response for the luminal antigen is known as a main pathogenesis. Genetic, infectious, and environmental factors are responsible for unbalanced immune response, but the definite pathogenesis is still unclear. Genetic factor is the most important role of all. That is based on high concordance rate of identical twins and family history. The incident rate and prevalence of IBD for the Asian population is relatively lower than Western population, and the lack of NOD2 or TLR4 genetic polymorphisms in Korea and Japanese population suggests the difference in genetic background between Asian and Western population. In Korea, the case of familial aggregation of IBD is pretty rare. We report a case of the daughter with ulcerative colitis and her mother with Crohn's disease who have a -159C/T promoter polymorphism of CD14 gene for IBD.
Antigens, CD14/genetics ; Colitis, Ulcerative/*diagnosis/drug therapy/genetics ; Colonoscopy ; Crohn Disease/*diagnosis/genetics ; Female ; Genetic Predisposition to Disease ; Humans ; Mesalamine/therapeutic use ; Middle Aged ; Mothers ; Polymorphism, Restriction Fragment Length ; Tomography, X-Ray ; Young Adult