A 53-year-old woman was admitted with epigastric discomfort and weakness. Laboratory examination at admission showed mild anemia and proteinuria. Esophagogastroduodenoscopy revealed marked mucosal atrophy, diffuse nodularity and granular appearance with mucosal friability. Biopsy was performed on the antrum and body of the stomach. On the next day, the patient began to complain of severe dyspnea, and hypoxia was present on pulse oximetry. Therefore, emergency echocardiography was conducted and it showed restrictive cardiomyopathy along with thrombus in the left atrium. With time, heart failure was aggravated despite intensive management. The result of gastric biopsy revealed amyloid deposits which stained positively with Congo red. On immunohistochemistry study, kappa and lambda chain were present. In addition, kappa chain was significantly elevated in urine and serum on electrophoresis. Although the patient was finally diagnosed as having primary gastric amyloidosis with restrictive cardiomyopathy, her general condition rapidly deteriorated and died at 12th hospital day. When obscure gastric lesion is encountered, performing gastric biopsy is strongly recommended since it be primary gastric amyloidosis. Herein, we present an unusual case of primary gastric amyloidosis.
Amyloidosis/complications/*diagnosis/pathology ; Endoscopy, Digestive System ; Female ; Heart Atria/diagnostic imaging ; Heart Failure/complications/*diagnosis ; Humans ; Immunoglobulin kappa-Chains/blood/urine ; Immunoglobulin lambda-Chains/blood/urine ; Immunohistochemistry ; Magnetic Resonance Imaging ; Middle Aged ; Stomach Diseases/complications/*diagnosis/pathology ; Thrombosis/diagnosis/diagnostic imaging ; Tomography, X-Ray Computed ; Ultrasonography

It is of great importance to measure the lesion area in scientific research and clinical practice. The present study aims to solve barrel distortion and measure lesion area with the technology of computer visualization. With the ultimate purpose to obtain the precise lesion area, the study, based on the original endoscopy system and digital image processing technology, dealt with the correction of barrel distortion by lens adjustment, calculated the gastric ulcer area with the aid of Qt database and finally developed an image processing software--Endoscope Assistant (EAS). The results showed that the EAS was accurate in vitro. It was employed to measure the gastric ulcer area of 45 patients and the results were compared with the traditional formula method. It could be well concluded that this technology is safe, accurate and economical for measuring gastric ulcer area.
Algorithms ; Gastroscopy ; methods ; Humans ; Image Enhancement ; Image Processing, Computer-Assisted ; methods ; Software ; Stomach Diseases ; diagnosis ; pathology

No abstract available.
Child, Preschool ; Cysts/pathology ; Endoscopy, Gastrointestinal ; Female ; Humans ; Pancreatic Diseases/*diagnosis/pathology/ultrasonography ; Pancreatic Ducts/pathology ; Stomach Diseases/*diagnosis/pathology/ultrasonography ; Tomography, X-Ray Computed

Accessory spleen can be mistaken as a gastric subepithelial mass, and may not be differentiated in CT or endoscopic ultrasonography (EUS). A gastric subepithelial mass was detected on routine endoscopy in a 39-year old woman with history of splenectomy. In subsequent CT and EUS, the subepithelial mass was located on the fourth layer of the stomach. To make a definite diagnosis, EUS-guided fine needle aspiration (FNA) was performed, and a splenic tissue was demonstrated in histologic examination. EUS-guided FNA can be beneficial in the diagnosis of accessory spleen which mimics a gastric subepithelial mass.
Adult ; Antigens, CD34/metabolism ; Biopsy, Fine-Needle ; Endosonography ; Female ; Gastroscopy ; Humans ; Immunohistochemistry ; Splenic Diseases/pathology ; Stomach Neoplasms/*diagnosis/pathology ; Tomography, X-Ray Computed

OBJECTIVETo explore the value of dual-time-point (18)F-fluorodeoxyglucose integrated positron emission and computed tomography ((18)F-FDG PET-CT) in differentiation of malignant from benign gastrointestinal diseases.

METHODSSixty five patients with suspected gastrointestinal lesions underwent dual-time-point (18)F-FDG PET-CT imaging. Standardized uptake value (SUV) was calculated for semi-quantitative assessment. The SUV of the two acquisitions were signed SUV(early) and SUV(delayed), respectively. Then the change of SUVmax (ΔSUVmax) was calculated. The ROC curves of the SUV(early), SUV(delayed) and ΔSUV were drawn to find the best cut-off point value for differential diagnosis, and then the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated, respectively.

RESULTSOf the malignant lesions, the SUVmax in delayed imaging were significantly higher than those in early imaging, while there were no significant differences of SUVmax between the two images of the benign lesions. The ΔSUVmax of the malignant lesions were significantly higher than that of the benign ones. Taking the SUVmax higher than 9.2 in early imaging as positive diagnostic criteria, the sensitivity was 72.7%, the specificity was 85.7%, the positive predictive value was 91.4%, the negative predictive value was 60.0%, and the accuracy was 76.9%. Taking the SUVmax higher than 10.9 in delayed imaging as positive diagnostic criteria, the sensitivity was 75.0%, the specificity was 90.5%, the positive predictive value was 94.3%, the negative predictive value was 63.3%, and the accuracy was 80.0%. Taking the ΔSUVmax higher than 5.1% as positive diagnostic criteria, the sensitivity was 95.5%, the specificity was 85.7%, the positive predictive value was 93.3%, the negative predictive value was 90.0%, and the accuracy was 92.3%. The accuracy of dual-time-point (18)F-FDG PET-CT imaging was significantly higher than that of single-time point (18)F-FDG PET-CT imaging.

CONCLUSIONDual-time-point (18)F-FDG PET-CT imaging is a useful method for differentiating malignant from benign gastrointestinal diseases, and it is superior to the single-time point (18)F-FDG PET-CT imaging.

Adenocarcinoma ; diagnosis ; pathology ; Adult ; Aged ; Aged, 80 and over ; Colitis ; diagnosis ; pathology ; Colorectal Neoplasms ; diagnosis ; pathology ; Diagnosis, Differential ; Female ; Fluorodeoxyglucose F18 ; Follow-Up Studies ; Gastritis ; diagnosis ; pathology ; Gastrointestinal Diseases ; diagnosis ; pathology ; Gastrointestinal Neoplasms ; diagnosis ; pathology ; Humans ; Male ; Middle Aged ; Positron-Emission Tomography ; methods ; Predictive Value of Tests ; Proctitis ; diagnosis ; pathology ; Proctocolitis ; diagnosis ; pathology ; ROC Curve ; Radiopharmaceuticals ; Sensitivity and Specificity ; Stomach Neoplasms ; diagnosis ; pathology ; Tomography, X-Ray Computed ; methods

Actins ; metabolism ; Adenocarcinoma ; pathology ; Adult ; Diagnosis, Differential ; Endometriosis ; pathology ; Epithelium ; pathology ; Female ; Gastrointestinal Stromal Tumors ; pathology ; Hamartoma ; metabolism ; pathology ; Humans ; Muscle, Smooth ; pathology ; Stomach Diseases ; metabolism ; pathology

No abstract available.
Amyloidosis/*diagnosis/pathology/ultrasonography ; Endoscopy, Gastrointestinal ; Female ; Humans ; Middle Aged ; Stomach Diseases/*diagnosis/pathology/ultrasonography ; Tomography, X-Ray Computed

A 63-year-old man with a history of hepatitis-B-related hepatocellular carcinoma (HCC) in the left lateral portion of the liver received repeated transcatheter arterial chemoembolization (TACE) and salvage radiotherapy. Two months after completing radiotherapy, he presented with dysphagia, epigastric pain, and a protruding abdominal mass. Computed tomography showed that the bulging mass was directly invading the adjacent stomach. Endoscopy revealed a fistula from the HCC invading the stomach. Although the size of the mass had decreased with the drainage through the fistula, and his symptoms had gradually improved, he died of cancer-related bleeding and hepatic failure. This represents a case in which an HCC invaded the stomach and caused a hepatogastric fistula after repeated TACE and salvage radiotherapy.
Carcinoma, Hepatocellular/complications/radiography/*therapy ; *Chemoembolization, Therapeutic ; Drainage ; Gastric Fistula/*etiology ; Gastroscopy ; Hepatitis B/diagnosis ; Humans ; Liver Diseases/*etiology ; Liver Neoplasms/complications/radiography/*therapy ; Male ; Middle Aged ; Neoplasm Invasiveness ; Stomach/pathology ; Tomography, X-Ray Computed

Hepatosplenic candidiasis is also called chronic disseminated candidiasis and usually seen in patients with hematologic malignancies who have just recovered from an episode of neutropenia. Gastric candidiasis most commonly present as a mucosal lesion such as an ulcer or erosions, but other gastric lesion is very rare. We experienced a case of gastric candidiasis which presented as gastric subepithelial mass in a 60-year old woman who had undergone the 2nd consolidation chemotherapy due to acute myeloid leukemia. The pathologic diagnosis was confirmed by fine needle aspiration of the gastric subepithelial mass under the guidance of endoscopic ultrasonography.
Candidiasis/*diagnosis/immunology ; Endoscopy, Gastrointestinal ; Female ; Humans ; *Immunocompromised Host ; Middle Aged ; Stomach Diseases/microbiology/*pathology/ultrasonography ; Tomography, X-Ray Computed

Behcet's disease (BD) has been recognized as multi-systemic chronic vasculitic disorder of recurrent inflammation, characterized by the involvement of multiple organs and resulting in orogenital ulcers, uveitis, and skin lesions. Involvement of the central nervous system, vessels, and intestines in BD often leads to a poor prognosis. Digestive manifestations in BD have been reported in up to 1-60% of cases, although the rate varies in different countries. The most frequent extra-oral sites of gastrointestinal involvement are the ileocecal region and the colon. Gastric or esophageal involvement is reported to be very rare. Moreover, there have been no reports on the simultaneous involvement of the esophagus, stomach, ileum, and colon. Here, we present a 55-year-old Korean man with intestinal BD and multiple ileal and colonic ulcerations complicated by perforation, gastric ulcer with bleeding followed by perforation, and esophageal ulcers with bleeding.
Behcet Syndrome/complications/*diagnosis/pathology ; Cecal Diseases/complications/pathology ; Diagnosis, Differential ; Endoscopy, Digestive System ; Gastrointestinal Diseases/complications/*diagnosis ; Gastrointestinal Hemorrhage ; Humans ; Intestinal Perforation/*diagnosis/etiology/pathology ; Male ; Middle Aged ; Peptic Ulcer Perforation/pathology ; Stomach Ulcer/complications/pathology