A presumptive diagnosis of bone metastasis can be easily made when a patient with a history of colorectal cancer develops bone lesions that are seen on follow-up imaging. In this case report, we describe a patient whose multiple bone lesions were wrongly attributed to a recurrence of rectal cancer rather than being identified as multiple myeloma lesions. When clinicians detect new, abnormal, bony lesions in a patient with a previous history of cancer, they should consider diseases such as multiple myeloma in their differential diagnosis.
Adenocarcinoma* ; Colorectal Neoplasms ; Diagnosis ; Diagnosis, Differential ; Follow-Up Studies ; Humans ; Multiple Myeloma* ; Neoplasm Metastasis* ; Rectal Neoplasms ; Recurrence

The case of a 23-year-old female treated with aggressive high-dose therapy for Burkitt's lymphoma is reported. A positron emission tomography and computed tomography scan after completion of chemotherapy revealed a residual hypermetabolic lesion in the right pelvic cavity. A pelvic magnetic resonance imaging scan showed circumferential wall thickening at the tip of the appendix. A laparoscopic exploration and appendectomy were performed, and a pathologic examination of the resected appendix revealed xanthogranulomatous appendicitis. This is a rare case of a xanthogranulomatous appendicitis mimicking remnant Burkitt's lymphoma after completion of chemotherapy.
Appendectomy ; Appendicitis* ; Appendix ; Burkitt Lymphoma* ; Drug Therapy* ; Female ; Humans ; Magnetic Resonance Imaging ; Positron-Emission Tomography ; Young Adult

According to the author's request, in this paper, the eighth author's (Bong-Seong Kim) affiliation should be corrected.

PURPOSE: During the course of disease, nearly 30% of ulcerative colitis patients receive surgical therapy. Total proctocolectomy with ileal pouch anal anastomosis is a standard procedure. However, the effectiveness of laparoscopic surgery in ulcerative colitis has not yet been proven. We aimed to evaluate the clinical course of both laparoscopic and open surgeries of a total proctocolectomy with ileal pouch anal anastomosis. METHODS: We reviewed charts of 34 patients who underwent a total proctocolectomy with ileal pouch anal anastomosis between April 2005 and April 2014. The laparoscopic group (n=21) and the open group (n=13) were compared retrospectively in accordance with patients' demographics, clinical features, operative data, and postoperative complications within and after 30 days after the operation. RESULTS: Patient characteristics were not significantly different between the two groups. The laparoscopic group had a longer duration of disease before the operation (42.3+/-48.5 vs. 105+/-97.6, p=0.019). The operative results, including operation time and estimated blood loss, were not different in both groups. The postoperative outcomes of laparoscopic surgery were not different from those of open surgery in postoperative complications within and after 30 postoperative days. The rate of reoperation and readmission was not different, and the days until first gas passing and soft diet were not significantly different. CONCLUSION: Laparoscopic surgery in ulcerative colitis is a feasible and safe procedure. Laparoscopic surgery may provide an alternative approach to open surgery in carefully selected ulcerative colitis patients.
Colitis, Ulcerative* ; Demography ; Diet ; Humans ; Laparoscopy ; Postoperative Complications ; Reoperation ; Retrospective Studies ; Ulcer*

PURPOSE: There are a number of reports suggesting that widespread propagation of weeds and high concentration of weed pollen have been contributed to climate change. We investigated the interrelationship between allergenic pollen concentration, allergic symptom and meteorological factor. METHODS: We collected data of pollen concentration and meteorological factors in 7 stations nationwide during between 1998 and 2012. We recruited total 297 allergic patients sensitized to weed pollens from each station, conducted a survey about allergic symptom, and calculated symptom index. We surveyed the vegetation area of ragweed and Japanese hop. Based on these data, we performed the long-term trend analysis (X11-ARIMA, autoregressive integrated moving average) on regional pollen concentration, and correlation analysis to investigate the interrelation between weed pollen concentration, allery symptom index and meteorological factor. We have also done regression analysis on vegetation area and maximal pollen concentration. RESULTS: Long-term trend analysis showed the increasing trend of pllen concentration in Seoul. Weed pollen concentration, allergy symptom index and each meteorological factor were not correlated significantly. Regression analysis revealed that increase of weed vegetation area results in increase of weed pollen concentration. Through this regression equation, we estimated the vegetation area that can product pollen concentration triggering allergenic risk. CONCLUSION: Meteorological factors, pollen concentration and allergic symptoms should be consistently assessed and the relationship between each factor should be analyzed, considering climate change. It is necessary to verify the equation for pollen estimation by vegetation area and set up a policy for vegetation control focused on the reduction of allergenic pollen.
Ambrosia ; Asian Continental Ancestry Group ; Climate Change ; Humans ; Humulus ; Hypersensitivity ; Meteorological Concepts ; Plant Weeds ; Pollen ; Rhinitis, Allergic, Seasonal* ; Seoul

PURPOSE: Circumferential resection margin (CRM) involvement is a well-known predictor for poor prognosis in rectal cancer. However, the significance is controversial in some studies. Accordingly, this study attempted to examine the prognostic impact of CRM involvement in stage III rectal cancer. MATERIALS AND METHODS: Between January 1990 and December 2007, a total of 449 patients who underwent curative resection followed by complete adjuvant chemoradiotherapy for stage III rectal cancer located within 12 cm from the anal verge were selected. Patients were divided into a CRM-positive group (n=79, 17.6%) and a CRM-negative group (n=370, 82.4%). RESULTS: With a median follow-up of 56.6 months, recurrent disease was seen in 53.2 and 43.5% of the CRM-positive and CRM-negative group, respectively. CRM involvement was an independent prognostic factor for 5-year systemic recurrence-free survival (HR: 1.5, CI: 1.0-2.2, p=0.017). However, no significant difference was observed for local recurrence rate between the two groups (13.0 and 13.5%, respectively, p=0.677). CONCLUSION: In this study, local recurrence rate did not differ according to CRM involvement status in stage III rectal cancer patients, although CRM involvement was shown to be an independent poor prognostic factor. Accordingly, validation of the results of this study by further large prospective randomized trials is warranted.
Aged ; Biological Markers ; Chemoradiotherapy/*methods ; Female ; Fluorodeoxyglucose F18/pharmacology ; Follow-Up Studies ; Humans ; Lymphatic Metastasis ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Positron-Emission Tomography ; Prognosis ; Rectal Neoplasms/diagnosis/*surgery/*therapy ; Recurrence ; Surgical Procedures, Operative ; Tomography, X-Ray Computed ; Treatment Outcome

Prediction of malignancy or invasiveness of branch duct type intraductal papillary mucinous neoplasm (Br-IPMN) is difficult, and proper treatment strategy has not been well established. The authors investigated the characteristics of Br-IPMN and explored its malignancy or invasiveness predicting factors to suggest a scoring formula for predicting pathologic results. From 1994 to 2008, 237 patients who were diagnosed as Br-IPMN at 11 tertiary referral centers in Korea were retrospectively reviewed. The patients' mean age was 63.1 +/- 9.2 yr. One hundred ninty-eight (83.5%) patients had nonmalignant IPMN (81 adenoma, 117 borderline atypia), and 39 (16.5%) had malignant IPMN (13 carcinoma in situ, 26 invasive carcinoma). Cyst size and mural nodule were malignancy determining factors by multivariate analysis. Elevated CEA, cyst size and mural nodule were factors determining invasiveness by multivariate analysis. Using the regression coefficient for significant predictors on multivariate analysis, we constructed a malignancy-predicting scoring formula: 22.4 (mural nodule [0 or 1]) + 0.5 (cyst size [mm]). In invasive IPMN, the formula was expressed as invasiveness-predicting score = 36.6 (mural nodule [0 or 1]) + 32.2 (elevated serum CEA [0 or 1]) + 0.6 (cyst size [mm]). Here we present a scoring formula for prediction of malignancy or invasiveness of Br-IPMN which can be used to determine a proper treatment strategy.
Adenocarcinoma, Mucinous/*pathology ; Adult ; Aged ; Aged, 80 and over ; Carcinoembryonic Antigen/blood ; Carcinoma, Pancreatic Ductal/*pathology ; Carcinoma, Papillary/*pathology ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Invasiveness ; Neoplasm Staging ; Pancreatic Neoplasms/*pathology ; Predictive Value of Tests ; ROC Curve ; Tomography, X-Ray Computed

An intraductal papillary mucinous neoplasm (IPMN) of the pancreas is an uncommon tumor characterized by the production of mucin in the pancreatic duct that occasionally involves the formation of fistulas with surrounding organs, including the stomach, duodenum and common bile duct. The mechanism underlying the formation of such fistulas is direct invasion by a tumor or a combination of high pressure in the main pancreatic duct and inflammatory stimulation. A 73-year-old man was referred to our hospital due to the presence of a gastric ulcer detected on screening gastroscopy. Endoscopic findings showed the presence of a whitish thick mucin coated ulcerative lesion that appeared as a perforation or fistula opening. Abdominal computed tomography and magnetic resonance cholangiopancreatography demonstrated the presence of an IPMN of the pancreas and multiple fistula formation with the neighboring organs. An endoscopic biopsy was carried out to obtain pancreatic tumor tissue through the pancreatogastric fistula and the mass was confirmed as a mucinous adenocarcinoma. To the best of our knowledge, this is the first case of an IPMN associated with a pancreatojejunal fistula and duodenal ulcer bleeding due to fistula formation.
Adenocarcinoma, Mucinous ; Aged ; Biopsy ; Cholangiopancreatography, Magnetic Resonance ; Common Bile Duct ; Duodenal Ulcer ; Duodenum ; Fistula ; Gastroscopy ; Hemorrhage ; Humans ; Mass Screening ; Mucins ; Pancreas ; Pancreatic Ducts ; Stomach ; Stomach Ulcer ; Ulcer

PURPOSE: We aim to analyze the clinical course and the recurrence patterns after surgical treatment in patients with intestinal Behcet's disease and to determine the prognostic factors. METHODS: Thirty-eight patients with intestinal Behcet's disease who had undergone operations between 1979 and 2007 were analyzed. Clinical characteristics between the recurrent group (n=24) and the non-recurrent group (n=14) were compared. The cumulative recurrence rates were calculated by using the Kaplan-Meier method, and the results were compared by using the log-rank test. RESULTS: The median follow-up was 120 months. The median age of the 38 patients was 36.5 years, and the patients included 26 males and 12 females. Recurrences after surgical treatment were observed in 24 patients, and reoperations were performed in 21 patients. The mean age at operation was 35.7 years in the recurrent group and was less than 43.4 years in the non-recurrent group (P=0.030). Clinical subtypes of Behcet's disease (complete or incomplete vs. suspicious) and the cause of operation (presence vs. absence of a perforation or fistula) were different between the recurrent and the non-recurrent groups (P=0.048, P=0.014, respectively). The 5-year cumulative recurrence rate and reoperation rate for all patients with intestinal Behcet's disease who underwent operations were 52.7% and 36.0%, respectively the clinical subtypes and the cause of the operation were significant factors affecting the cumulative recurrence and the reoperation rates. CONCLUSIONS: Intestinal Behcet's disease demonstrates high recurrence and reoperation rates after surgical treatment. More careful follow up is needed to these surgical patients with high risk of recurrence and reoperation.
Female ; Follow-Up Studies ; Humans ; Male ; Prognosis ; Recurrence ; Reoperation

PURPOSE: Clinical anastomotic leakage remains a major problem after a low anterior resection for rectal cancer, so indentifing risk factors influencing anastomotic leakage is important. The aim of this study was to assess the association between risk factors and anastomotic leakage. RESULTS: One thousand two hundred eight patients underwent a primary resection for rectal cancer from June 1993 to March 2007. We used hospital records and the colorectal cancer registry to analyze retrospectively the case histories of those patients. The operations were performed using a low anterior resection with the double stapling method. All patients underwent a tumor-specific mesorectal excision. Of the total, thirty-eight patients showed anastomotic leakage. Univariate and multivariate analyses were performed to assess the risk factors affecting to the anastomotic leakage. RESULTS: The rate of anastomotic leakage was 3.2% (38 of 1,208 patients) with a mortality rate of 7.9% (3 of 38 patients). The overall mortality rate was 0.3% (3 of 1,208 patients). Males accounted for 28 of the 38 patients with leakage, and female accounted for the the account for the remnant 10. The mean age was 53.7 years (33~74 years). The mean leakage day was 11.8th day (3~37th day) after the operation, and the mean hospital day was 39.2 days (7~131 days). The mean body mass index (BMI) was 22.7 kg/m2 (15.7~30.8 kg/m2). The mean operation time was 230.5 minutes (90~425 minutes), and the mean bleeding loss was 519.5 cc (0~3,500 cc). CONCLUSIONS: Significant risk factors for anastomotic leakage after primary resection for rectal cancer were the transfusion amount during surgery, a preliminary colostomy, and nodal stage.
Anastomotic Leak* ; Body Mass Index ; Colorectal Neoplasms ; Colostomy ; Female ; Hemorrhage ; Hospital Records ; Humans ; Male ; Mortality ; Multivariate Analysis ; Rectal Neoplasms* ; Retrospective Studies ; Risk Factors*