The most common metastatic sites of gastric cancer are liver, lung, bone and adrenal gland. However, skin metastases from gastric cancer are relatively rare. We herein report a case of advanced gastric cancer with perianal skin metastasis in a 70-year-old male. On admission, patient presented with epigastric pain. Endoscopy and abdominal CT scan demonstrated the stage IV gastric cancer. He had one painless nodule on perianal skin area, biopsy of that lesion showed a feature of poorly differentiated adenocarcinoma clinically from the stomach. We suspected that the perianal lesion was originated from gastric cancer.
Aged ; Anal Canal ; Humans ; Male ; Neoplasm Staging ; Skin Neoplasms/*diagnosis/pathology/*secondary ; Stomach Neoplasms/*diagnosis/pathology

PURPOSE: Currently, using perforator artery flaps especially anterolateral thigh flaps are widely used for reconstruction of extremities, head and neck. Obtaining a precise anatomical picture prior to operation will translate to a more accurate, efficient and safe procedure. Authors used 3D-image work up via 64-slice MDCT to make a more precise preoperative plan. METHODS: A total of 10 patients underwent soft tissue reconstruction with anterolateral thigh flap from December 2006 to December 2007. The 64-Channel MDCT (LightSpeed VCT, GE, USA) was used and 3D images were reconstructed. Findings from MDCT were applied to the preoperative planning and confirmed with intraoperative findings. RESULTS: The average number of perforator arteries from lateral circumflex femoral artery was 2. The average lengths of vascular pedicle from the origin of lateral circumflex femoral artery to the first and second perforator artery were 11.0cm and 20.0cm, respectively. The average diameter of the pedicle artery was 2.2mm. The locations of the perforator arteries were mapped and localized on the body surface based on the MDCT result. These were confirmed through direct visualization intraoperatively. CONCLUSION: MDCT has an advantage of obtaining accurate images of the general anatomy and even fine structures like perforator arteries. By using this state- of-the-art diagnostic imaging technique, it is now possible to make an operative plan safely and easily.
Arteries ; Diagnostic Imaging ; Extremities ; Femoral Artery ; Head ; Humans ; Imidazoles ; Neck ; Nitro Compounds ; Thigh

The stomach is the most frequently noted site (50~60%) of gastrointestinal stromal tumor. This tumor is categorized into three subtypes (the spindle cell type, the epithelioid type or mixed type) according to the shape of the cells that make up the tumor. We herein report on a case of gastrointestinal stromal tumor with an epithelioid subtype in a 60-year-old male. On admission, the patient presented with epigastric pain and melena. Endoscopy revealed a submucosal tumor with a central ulcer at the gastric body. Gastric wedge resection was performed. The tumor cells showed a rounded shape and positive staining for CD117. Because the epithelioid type gastrointestinal stromal tumor is unusual in Korea, we report here on this case along with a review of the relevant literature.
Endoscopy ; Gastrointestinal Stromal Tumors* ; Hemorrhage* ; Humans ; Korea ; Male ; Melena ; Middle Aged ; Stomach ; Ulcer

The stomach is the most frequently noted site (50~60%) of gastrointestinal stromal tumor. This tumor is categorized into three subtypes (the spindle cell type, the epithelioid type or mixed type) according to the shape of the cells that make up the tumor. We herein report on a case of gastrointestinal stromal tumor with an epithelioid subtype in a 60-year-old male. On admission, the patient presented with epigastric pain and melena. Endoscopy revealed a submucosal tumor with a central ulcer at the gastric body. Gastric wedge resection was performed. The tumor cells showed a rounded shape and positive staining for CD117. Because the epithelioid type gastrointestinal stromal tumor is unusual in Korea, we report here on this case along with a review of the relevant literature.
Endoscopy ; Gastrointestinal Stromal Tumors* ; Hemorrhage* ; Humans ; Korea ; Male ; Melena ; Middle Aged ; Stomach ; Ulcer

Hyperplastic polyps occur either sporadically or as a symptom of polyposis syndrome. When individuals exceed 50 polyps, they are diagnosed with hyperplasic polyposis. Moreover, since such cases are even more sporadic than hyperplastic polyps, the course toward this occurrence has not been properly evaluated. A change to malignancy in hyperplastic polyps is rare; however, when multiple lesions are present, the tendency increases. Colorectal polyposis syndromes with gastric polyps include familial adenomatous polyposis, Gardners syndrome, Peutz-Jeghers syndrome, juvenile polyposis and others with a non-genetic origin. Three cases of multiple colorectal hyperplastic polyposis with gastric hyperplastic polyposis have been reported worldwide; however, a case associated with multiple colonic adenomas has not yet been reported. This study reviews the existing literature and reports our recent experience of a case, in which a 53 year-old man with colorectal and gastric hyperplastic polyposis with associated multiple colonic adenomas.
Adenoma* ; Adenomatous Polyposis Coli ; Colon* ; Gardner Syndrome ; Humans ; Hyperplasia ; Middle Aged ; Peutz-Jeghers Syndrome ; Polyps

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumor of the gastrointestinal tract, and they represent about 2% of all neoplasms of the gastrointestinal tract. GISTs primarily affect the stomach (50~60%), but they can also affect the small intestine (20~30%), large intestine (7%) and esophagus (1%). The clinical manifestations of GISTs vary according to the location and size of the mass. GISTs are generally KIT (CD117)-positive and are diagnosed by immunohistochemistry. Tumor size and mitotic activity are the best predictive prognostic features. The treatment of choice for primary GIST is complete surgical resection with a negative margin. A 78-year-old man who presented with melena and diffuse abdominal pain was admitted to our hospital. Esophagogastroduodenoscopy, colonoscopy, angiography and an RBC scan were performed but we were unable to locate the focus of the hemorrhage. A gastrointestinal stromal tumor (GIST) of the jejunum was diagnosed after laparotomy.
Abdominal Pain ; Aged ; Angiography ; Colonoscopy ; Endoscopy, Digestive System ; Esophagus ; Gastrointestinal Hemorrhage* ; Gastrointestinal Stromal Tumors* ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Immunohistochemistry ; Intestine, Large ; Intestine, Small ; Jejunum* ; Laparotomy* ; Melena ; Stomach

Capsule endoscopy is being increasingly used for investigating GI bleeding of an obscure origin and also the bleeding that's due to Crohn's disease. Capsule endoscopy is a safe procedure with few complications. Complications of capsule endoscopy are capsule retention, incomplete small bowel examination, swallowing disorders and technical complications. However, capsule retention still remains a major concern. Crohn's disease may rarely show its first manifestation as GI bleeding. We present here a case of obscure GI bleeding in which the diagnosis of isolated Crohn's enteritis was made by using wireless CE. The retained capsule at the jejunal stricture of Crohn's disease was successfully retrieved by performing double balloon enteroscopy.
Capsule Endoscopy ; Constriction, Pathologic ; Crohn Disease* ; Deglutition Disorders ; Diagnosis ; Double-Balloon Enteroscopy* ; Gastrointestinal Hemorrhage ; Hemorrhage ; Methods

BACKGROUND: Cystic neoplasms of the pancreas are being recognized with increased frequency. In 1993, a report on 123 cases of cystic neoplasms of the pancreas diagnosed over a period of 32 years was published in Korea. Many changes on the concept of cystic neoplasms of the pancreas have been made, including classification and diagnostic criteria. The present study was conducted wherein a new survey on cystic neoplasms of the pancreas in Korea. METHODS: Cystic neoplasms of the pancreas diagnosed over a period of 12 years, from 1993 to 2004 in 25 university hospitals throughout Korea were collected. They were classified according to the World Health Organization classification of cystic neoplasms of the pancreas. RESULTS: A total of 1264 cases of cystic neoplasms of the pancreas were diagnosed. The diagnoses and frequencies are as follows: intraductal papillary mucinous neoplasm, 499 (39.5%); mucinous cystic neoplasm, 318 (25.2%); serous cystic neoplasm, 232 (18.4%); solid pseudopapillary neoplasm, 192 (15.2%); cystic endocrine neoplasm, 11 (0.8%); lymphoepithelial cyst, 8 (0.6%); acinar cell neoplasm, 3 (0.2%); mature teratoma, 1 (0.1%). Increase in the annual number of diagnoses was evident. In intraductal papillary mucinous neoplasm and mucinous cystic neoplasm, a significant increase in mean age was seen in patients with malignant neoplasms. CONCLUSIONS: Cystic neoplasms of the pancreas are diagnosed with increasing frequency in Korea, the most common being intraductal papillary mucinous neoplasm of the pancreas. In intraductal papillary mucinous neoplasm and mucinous cystic neoplasm, the grade of dysplasia increased with mean age, suggesting an adenoma-carcinoma sequence.
Acinar Cells ; Classification ; Diagnosis ; Hospitals, University ; Humans ; Korea* ; Mucins ; Pancreas* ; Teratoma ; World Health Organization

There has been a number of reports recently describing the pathogen potential of irregular asporogenous gram positive rods (IGPR), also referred as coryneforms or diphtheroids. This may be due to a greater number of opportunistic infections occurring in patients who are immunosuppressed or implanted with prostheses. The documentation of endocarditis caused by IGPR is difficult. Because all the result of culture is not always positive and these cultures need long-period incubation, and there are sometimes pseudo-positive cases due to the contamination in blood sampling. An early diagnosis and adequate treatment are important for the better result. We describe the case of bio prosthetic valve endocarditis in a 61-year-old woman who enduring chronic hemodialysis. This is the first case reported of bioprosthetic valve endocarditis by Corynebacterium in Korea.
Corynebacterium* ; Early Diagnosis ; Endocarditis* ; Female ; Gram-Positive Rods ; Humans ; Korea ; Middle Aged ; Opportunistic Infections ; Prostheses and Implants ; Renal Dialysis

Methotrexate is commonly used in rheumatoid arthritis as an anti-inflammatory agent, but treatment with methotrexate can lead to severe side effects, especially pulmonary complication. Interstitial pneumonitis is one of the most important pulmonary adverse effects of methotrexate and most patient present with a subacute febrile illness and peripheral eosinophilia is seen in about a half of patients. Almost all patients have abnormal chest roentgenograms and bibasilar interstitial infiltration with alveolar pulmonary consolidations is the most characteristic finding. Interstitial inflammation with mononuclear cell infiltration is a characteristic pathologic feature and findings that suggest acute hypersensitivity pneumonitis, such as bronchiolitis, granuloma formation with giant cells, and infiltration with eosinophils are often present. Methotrexate-induced pneumonitis is a potentially life threatening and unpredictable complication but it is difficult to make a definite diagnosis in the absence of high index of clinical suspicion. Early recognition and appropriate management may avoid the serious outcome. Herein we report a case of methotrexate-induced pneumonitis in a patient with rheumatoid arthritis.
Alveolitis, Extrinsic Allergic ; Arthritis, Rheumatoid* ; Bronchiolitis ; Diagnosis ; Eosinophilia ; Eosinophils ; Giant Cells ; Granuloma ; Humans ; Inflammation ; Lung Diseases, Interstitial ; Methotrexate* ; Pneumonia* ; Thorax