Squamous cell carcinoma of the gallbladder (GB) is uncommon and often presents at an advanced stage; therefore, it is associated with more aggressive behavior and a worse prognosis than those of adenocarcinoma. Herein, we report the case of an 82-year-old woman presenting a weight loss of 5 kg and epigastric discomfort over the previous 3 months. Abdominal computed tomography and magnetic resonance cholangiopancreatography revealed an infiltrative mass in the GB with hepatic invasion. Endoscopic ultrasound-guided fine needle biopsy using a 20-G core needle was performed, and the pathological examination revealed keratin pearls and an intracellular bridge, which are characteristics of squamous cell differentiation consistent with squamous cell carcinoma. Endoscopic ultrasound-guided fine needle biopsy was useful for obtaining an accurate histological diagnosis of GB masses without the need for surgery.
Adenocarcinoma ; Aged, 80 and over ; Biopsy, Fine-Needle ; Carcinoma, Squamous Cell ; Cholangiopancreatography, Magnetic Resonance ; Diagnosis ; Epithelial Cells ; Female ; Gallbladder ; Humans ; Needles ; Prognosis ; Weight Loss

Squamous cell carcinoma of the gallbladder (GB) is uncommon and often presents at an advanced stage; therefore, it is associated with more aggressive behavior and a worse prognosis than those of adenocarcinoma. Herein, we report the case of an 82-year-old woman presenting a weight loss of 5 kg and epigastric discomfort over the previous 3 months. Abdominal computed tomography and magnetic resonance cholangiopancreatography revealed an infiltrative mass in the GB with hepatic invasion. Endoscopic ultrasound-guided fine needle biopsy using a 20-G core needle was performed, and the pathological examination revealed keratin pearls and an intracellular bridge, which are characteristics of squamous cell differentiation consistent with squamous cell carcinoma. Endoscopic ultrasound-guided fine needle biopsy was useful for obtaining an accurate histological diagnosis of GB masses without the need for surgery.

BACKGROUND/AIMS: Presence of enhanced mural nodules, which can be visualized using computed tomography (CT), is one of high-risk stigmata in branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs). Conversely, the absence of enhanced mural nodules on preoperative imaging does not exclude malignant risk. The present study aimed to investigate other morphological features as predictors of malignancy in “pure” BD-IPMNs without enhanced mural nodules on CT. METHODS: This retrospective study included 180 patients with surgically confirmed “pure” BD-IPMNs of the pancreas and no enhanced mural nodules on preoperative CT. The study was conducted at 15 tertiary referral centers throughout South Korea. Univariate and multivariate analyses were used to identify significant predictors of malignancy. RESULTS: BD-IPMNs with low-grade (n=84) or moderate-grade (n=76) dysplasia were classified as benign; those with high-grade dysplasia (n=8) or invasive carcinoma (n=12) were classified as malignant. The multivariate analysis revealed that cyst size ≥30 mm (odds ratio, 8.6; p=0.001) and main pancreatic duct diameter ≥5 mm (odds ratio, 4.1; p=0.01) were independent risk factors for malignancy in “pure” BD-IPMNs without enhanced mural nodules on CT. Endoscopic ultrasound detected enhanced mural nodules (6/82) that had been missed on CT, and two IPMNs with enhanced mural nodules were malignant. CONCLUSIONS: In patients with “pure” BD-IPMNs who have no enhanced mural nodules on CT, cyst size ≥30 mm and main pancreatic duct diameter ≥5 mm may be associated with malignancy.
Christianity ; Humans ; Korea ; Mucins* ; Multivariate Analysis ; Pancreas* ; Pancreatic Ducts ; Retrospective Studies ; Risk Factors ; Tertiary Care Centers ; Ultrasonography

A 75-year-old woman with hypertension presented with acute suppurative cholangitis. Chest radiography revealed severe kyphosis. Abdominal computed tomography revealed a large stone impacted in the common bile duct (CBD). The patient underwent emergent endoscopic retrograde cholangiopancreatography, and cholangiography revealed a large stone (7×3 cm) in the CBD that could not be captured using a large basket. We could not use the percutaneous approach for stone fragmentation by using a cholangioscope because of severe degenerative kyphosis. Finally, we performed holmium laser lithotripsy under peroral cholangioscopy by using an ultraslim endoscope, and the large stone in the CBD was successfully fragmented and removed without complications.
Aged ; Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Common Bile Duct* ; Endoscopes ; Female ; Gallstones ; Humans ; Hypertension ; Kyphosis* ; Lasers, Solid-State ; Lithotripsy ; Lithotripsy, Laser* ; Radiography ; Thorax

Extracranial carotid artery dissection may manifest as arterial stenosis or occlusion, or as dissecting aneurysm formation. Anticoagulation and/or antiplatelet therapy is the first-line treatment, but because it is effective and less invasive than other procedures, endovascular treatment of carotid artery dissection has recently attracted interest. We encountered two consecutive cases of traumarelated extracranial internal carotid artery dissection, one in the suprabulbar portion and one in the subpetrosal portion. We managed the patient with suprabulbar dissection using a self-expandable metallic stent and managed the patient with subpet-rosal dissection using a balloon-expandable metallic stent. In both patients the dissecting aneurysm disappeared, and at follow-up improved luminal patency was observed.
Adult ; Carotid Artery Injuries/complications ; Carotid Artery, Internal, Dissection/etiology/radiography/*therapy ; Case Report ; Cerebral Angiography ; Human ; Male ; *Stents

BACKGROUND: Intracranial lipomas are uncommon benign lesions of the central nervous system. They preferentially occur near the midline, most frequently in the pericallosal cistern, and are often associated with various neurologic and systemic anomalies. Since the advent of CT scanning and MR imaging, unexpected findings of intracralial lipomas have increased. We identified 11 cases of intracranial lipomas diagnosed by CT and MR and analyzed their characteristic clinical and radiologic findings. METHODS: We retrospectively reviewed 11 cases of intracranial lipomas. MR was used in all cases and CT in three. RESULTS: There were seven men and four women whose ages ranged from six months to 76 years, with a mean of 39 years. Six (55%) lipomas were located in the quadrigeminal plate and five (45%) in the pericallosal area. The pericallosal lipomas were divided into three cases of curvilinear type and two cases of tubulonodular type. Of the six quadrigeminal lipomas, five cases (83%) were associated with either hypoplasia of the unilateral (four) or bilateral (one) superior and/or inferior colliculus. One case of quadrigeminal lipoma was associated with hypoplasia of the cerebellar vermis, agenesis of the septum pellucidum, and glioblastoma multiforme. All cases of pericallosal tubulonodular type were associated with dysgenesis of the corpus callosum and enlarged ventricles. However, all cases of pericallosal curvilinear type were not associated with other anomalies. Four (36%) cases found incidentally were asymptomatic. Seizure was the most frequent clinical presentation in five (45%) cases, followed by headaches in three (27%) and mental retardation in one (9%). Of five seizures cases, three had secondary generalized seizures and two had generalized tonic clonic seizures. CONCLUSIONS: Quadrigeminal and pericallosal lipomas were the most common types of intracranial lipomas. Sixty-three percent of the lesions were associated with adjacent brain malformations of varying degrees. Four cases were asymptomatic, while the others presented with seizures, headache, and mental retardation. (J Korean Neurol Assoc 19(2):149~154, 2001)
Brain ; Brain Neoplasms ; Central Nervous System ; Corpus Callosum ; Female ; Glioblastoma ; Headache ; Humans ; Inferior Colliculi ; Intellectual Disability ; Lipoma* ; Magnetic Resonance Imaging ; Male ; Retrospective Studies ; Seizures ; Septum Pellucidum ; Tectum Mesencephali ; Tomography, X-Ray Computed

BACKGROUND: Intracranial lipomas are uncommon benign lesions of the central nervous system. They preferentially occur near the midline, most frequently in the pericallosal cistern, and are often associated with various neurologic and systemic anomalies. Since the advent of CT scanning and MR imaging, unexpected findings of intracralial lipomas have increased. We identified 11 cases of intracranial lipomas diagnosed by CT and MR and analyzed their characteristic clinical and radiologic findings. METHODS: We retrospectively reviewed 11 cases of intracranial lipomas. MR was used in all cases and CT in three. RESULTS: There were seven men and four women whose ages ranged from six months to 76 years, with a mean of 39 years. Six (55%) lipomas were located in the quadrigeminal plate and five (45%) in the pericallosal area. The pericallosal lipomas were divided into three cases of curvilinear type and two cases of tubulonodular type. Of the six quadrigeminal lipomas, five cases (83%) were associated with either hypoplasia of the unilateral (four) or bilateral (one) superior and/or inferior colliculus. One case of quadrigeminal lipoma was associated with hypoplasia of the cerebellar vermis, agenesis of the septum pellucidum, and glioblastoma multiforme. All cases of pericallosal tubulonodular type were associated with dysgenesis of the corpus callosum and enlarged ventricles. However, all cases of pericallosal curvilinear type were not associated with other anomalies. Four (36%) cases found incidentally were asymptomatic. Seizure was the most frequent clinical presentation in five (45%) cases, followed by headaches in three (27%) and mental retardation in one (9%). Of five seizures cases, three had secondary generalized seizures and two had generalized tonic clonic seizures. CONCLUSIONS: Quadrigeminal and pericallosal lipomas were the most common types of intracranial lipomas. Sixty-three percent of the lesions were associated with adjacent brain malformations of varying degrees. Four cases were asymptomatic, while the others presented with seizures, headache, and mental retardation. (J Korean Neurol Assoc 19(2):149~154, 2001)
Brain ; Brain Neoplasms ; Central Nervous System ; Corpus Callosum ; Female ; Glioblastoma ; Headache ; Humans ; Inferior Colliculi ; Intellectual Disability ; Lipoma* ; Magnetic Resonance Imaging ; Male ; Retrospective Studies ; Seizures ; Septum Pellucidum ; Tectum Mesencephali ; Tomography, X-Ray Computed

BACKGROUND AND PURPOSE: Platelet aggregation plays an important role in thrombogenesis. Thus antiplatelet agents, such as aspirin and ticlopidine, have been in usage to prevent for recurrent ischemic stroke. Triflusal is known to selectively inhibit cyclooxygenase in platelet rather than in vessel wall. And thus can be more beneficial in its antiplatelet aggregatory effect. There has been no comparative study between triflusal and ticlopidine on its antiplatelet aggregatory effect and side effects till now. Our comparative study between these two agents is to provide useful information on clinical utilization. METHODS: Triflusal(900mg/day) and ticlopidine(500mg/day) were administered in 31 and 37 patients, who suffered from acute ischemic stroke. Their efficacy in platelet aggregation and the incidence of clinical and laboratory side effects were compared in one week and one month after the administration of the drugs. RESULTS: Platelet aggregation was more effectively inhibited in triflusal group, especially induced by collagen or epinephrine(p<0.01). No significant difference was noted in the incidence of side effects in both groups. In five patients of the ticlopidine group, the drug was withdrawn due to skin rash and/or increased liver enzymes. CONCLUSION: Triflusal had more effectively inhibited platelet aggregation in this study. Severe side effects even requiring discontinuation of the drug were noted in five patients of ticlopidine group.
Aspirin ; Blood Platelets ; Collagen ; Exanthema ; Humans ; Incidence ; Liver ; Platelet Aggregation ; Platelet Aggregation Inhibitors ; Prostaglandin-Endoperoxide Synthases ; Stroke ; Ticlopidine*

Infarction in the territory of the posterior choroidal artery(PChA) is rare. The main clinical manifestations of the PCHA infarction are known to be visual field defect, sensory-motor dysfunction, neuropsychological disturbances. Neuropsychological disturbances include of transcortical aphasia and amnesia. The latter disturbance is very rare and reported to be transient. We report a 77 year old man who presented with severe selective amnesia due to PChA infarction. Neurologic examination revealed right homonymous hemianopsia. Brain MRI showed infarction of PChA territory and multiple lacunes in the preventricular deep white matter.
Aged ; Amnesia* ; Aphasia ; Arteries* ; Brain ; Choroid* ; Hemianopsia ; Humans ; Infarction* ; Magnetic Resonance Imaging ; Neurologic Examination ; Visual Fields

Infarction in the territory of the posterior choroidal artery(PChA) is rare. The main clinical manifestations of the PCHA infarction are known to be visual field defect, sensory-motor dysfunction, neuropsychological disturbances. Neuropsychological disturbances include of transcortical aphasia and amnesia. The latter disturbance is very rare and reported to be transient. We report a 77 year old man who presented with severe selective amnesia due to PChA infarction. Neurologic examination revealed right homonymous hemianopsia. Brain MRI showed infarction of PChA territory and multiple lacunes in the preventricular deep white matter.
Aged ; Amnesia* ; Aphasia ; Arteries* ; Brain ; Choroid* ; Hemianopsia ; Humans ; Infarction* ; Magnetic Resonance Imaging ; Neurologic Examination ; Visual Fields