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강화미,이정남,김민웅,김치훈,박종환,윤지훈,김형욱,박승근,박희욱,김혜숙 대한소화기내시경학회 2005 Clinical Endoscopy Vol.31 No.4
Angiosarcoma accounts for 1% of all soft tissue sarcoma. Common sites of occurrence include the skin, breast, soft tissue, and liver. It metastasizes to the lungs, bone, and spleen. The cause of hepatic angiosarcoma in the 60% of cases is unknown, although specific risk factors such as vinyl chloride, arsenic, thorotrast and external-beam irradiation have been identified. Since 1986, about eight cases of hepatic angiosarcoma have been reported in Korea, but it had not been reported in which the hepatic angiosarcoma invaded to the stomach, yet. So we report a case of histopathologically confirmed primary hepatic angiosarcoma with gastric involvement. In this case, a sixtythree-year-old female was presented with indigestion and epigastric soreness for 1 year. Endoscopic examination of the stomach revealed a submucosal tumor-like protruding mass from the antrum to angle. The mucosal surface showed severe hyperemia and shallow ulcerative change was seen. Endoscopic biopsy and percutaneous liver biopsy confirmed the diagnosis of hepatic angiosarcoma invading the gastric wall. 혈관육종은 모든 연부조직육종의 1%를 차지하며 피부, 연부조직, 유방, 간 등에서 호발하며 폐, 비장, 골, 간 등으로 전이된다. 특히 간 혈관육종은 원발성 간암의 2%를 차지하며 몇 가지 소인이 밝혀졌으나 약 60%에서는 그 정확한 원인을 알 수 없으며, 증상이 비특이적이고 임상경과가 급속히 진행되므로 대부분의 환자에서 예후가 나쁜 것으로 알려져 있다. 국내에서는 1986년부터 산발적으로 보고되어 왔으나 간 혈관육종이 위로 전이된 증례는 거의 없다. 본 증례에서는 소화불량을 주소로 내원한 63세 여성에서 상부 위장관 내시경 검사를 시행하여 심한 점막 발적과 궤양을 동반한 점막하 양상의 종괴를 발견하였고, 간 혈관육종이 위로 침윤하여 발생한 것임을 확인한 증례를 경험하였기에 문헌고찰과 함께 보고한다.
결핵성 복막염과 감별이 어려운 클라미디아 트라코마티스 복막염
강화미 ( Hwa Mi Kang ),오태훈 ( Tae Hoon Oh ),강건희 ( Gun Hi Kang ),전태주 ( Tae Joo Joen ),서동대 ( Dong Dae Seo ),신원창 ( Won Chang Shin ),최원충 ( Won Choong Choi ),양근호 ( Keun Ho Yang ) 대한소화기학회 2011 대한소화기학회지 Vol.58 No.2
Lymphocytic ascites with low serum-ascites albumin gradient (SAAG) are observed mainly in tuberculous peritonitis, peritoneal carcinomatosis, and pancreatic disease. However, pelvic inflammatory disease (PID) induced generalized peritonitis causing diffuse ascites has been rarely described. We report a 26-year old female patient, who was diagnosed as generalized peritonitis with diffuse ascites due to Chlamydia trachomatis infection. Gynecologic examination did not show the clue of PID and in the analysis of ascites, low SAAG, predominant lymphocyte count and high level of adenosine deaminase were noted. Although the best impression was tuberculous peritonitis on the base of these findings, the laparoscopic finding was consistent with PID and the PCR for C. trachomatis infection in cervical swab was positive. This case suggests that C. trachomatis peritonitis should be considered as a rare cause of low SAAG and lymphocytic ascites in sexually active women and should be intensively evaluated including laparoscopic examination. (Korean J Gastroenterol 2011;58:111-116)
강화미 ( Hwa Mi Kang ),오태훈 ( Tae Hoon Oh ),서지영 ( Ji Young Seo ),전태주 ( Tae Joo Joen ),서동대 ( Dong Dae Seo ),신원창 ( Won Chang Shin ),최원충 ( Won Choong Choi ),김정연 ( Jung Yeon Kim ) 대한소화기학회 2011 대한소화기학회지 Vol.58 No.4
Background/Aims: Hyperplastic polyps (HPs) are the most common cause of all benign epithelial gastric polyps, constituting 30 to 93%. Although gastric HPs are usually considered as benign lesions compared with adenoma, neoplastic transformation has been known to occur rarely. We aimed to identify the clinical factors of gastric HPs predicting for neoplastic transformation. Methods: Between January 2002 to August 2010, a total of 274 gastric HPs, which had been removed by endoscopic polypectomy or surgical resection from 210 patients, were analyzed retrospectively. Results: Neoplastic transformation was found in 15 cases (5.5%) of 274 HPs including 10 cases of low grade dysplasia (3.7%), 2 cases of high grade dysplasia (0.7%) and 3 cases of adenocarcinoma (1.1%). Neoplastic transformations were significantly associated with >1 cm in size (n=10 [66.7%] vs. n=91 [35.1%], p=0.024), with pedunculated shape (n=9 [60.0%] vs. n=62 [23.9%], p=0.002), with previous history of gastrectomy (n=3 [20.0%] vs. n=3 [1.2%], p=0.002) and with synchronous neoplastic lesions occurring elsewhere in the gastric mucosa (n=5 [33.3%] vs. n=31 [12.0%], p=0.021). However, no significant difference was found between HPs with and without neoplastic transformation in terms of age, sex, number of polyps detected per patient, location, macroscopic appearance such as erosion, hyperemia. Conclusions: Neoplastic transformation of gastric HPs had significant relationships with >1 cm in size, pedunculated shape, postgastectomy state, and synchronous neoplastic lesion. Therefore, endoscopic polypectomy should be considered in these HPs to avoid the risk of missing HPs with neoplastic potential. (Korean J Gastroenterol 2011;58:184-189)
박종환,강화미,김민웅,김치훈,윤지훈,김형욱,박승근,박희욱,옥종한 대한소화기내시경학회 2005 Clinical Endoscopy Vol.31 No.4
Primary esophageal involvement by tuberculosis is rare. Clinical symptoms are variable and nonspecific in which dysphagia is the most common presenting symptom. Endoscopic findings are also diverse and nonspecific and ulcerative form is a common manifestation. For a definite diagnosis, Endoscopic biopsies are useful but typical granuloma is seen in approximately 50% of cases and acid-fast bacilli are demonstrated in less than 25% of patients. Fine needle aspiration cytology and polymerase chain reaction are helpful for diagnosis. A 54-year-old man was presented with throat discomport. Endoscopy demonstrated hematoma like lesion with pus discharge from ulceration in the proximal esophagus. Esophageal tuberculosis was confirmed based on the biopsy and culture results, and he was treated with antituberculous medications. At the follow-up endoscopy, 6 months later, previous lesion was completely healed to scar 결핵의 식도침범은 드물며 임상양상은 다양하고 비특이적이며 연하곤란이 가장 흔하다. 내시경 소견 역시 다양하고 비특이적이며 궤양형을 보이는 경우가 흔하다. 확진을 위해서는 내시경 조직검사가 도움이 되나 전형적인 육아종은 약 50% 정도에서 보이고 항산균도 25% 미만에서 나타난다. 세침흡인 세포진 검사 및 중합효소연쇄반응을 이용한 검사도 진단에 도움이 된다. 54세 남자 환자가 인후부의 불편감을 주소로 내원하였다. 상부 위장관 내시경 검사에서 상부식도에 농의 배출을 동반한 점막 병변이 관찰되었다. 조직검사 및 배양검사에서 식도 결핵으로 확진되었고 항결핵제 투여 후 6개월째에 시행한 추적내시경 검사에서 반흔만 남기고 치유된 소견이 관찰된 바 문헌고찰과 함께 보고하는 바이다.