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간세포암 환자에서 경동맥화학색전술 후 종양혈전의 이동에 의해 합병된 급성 폐쇄성 담관염: 증례보고 및 문헌고찰
박형철 ( Hyung Chul Park ),박현범 ( Hyun Bum Park ),정조윤 ( Cho Yun Chung ),정민우 ( Min Woo Jung ),주영은 ( Young Eun Joo ),최성규 ( Sung Kyu Choi ),조성범 ( Sung Bum Cho ) 대한소화기학회 2014 대한소화기학회지 Vol.63 No.3
Intraductal tumor invasion of hepatocellular carcinoma (HCC) is considered rare. Transarterial chemoembolization (TACE) is effective for tumor thrombus of HCC in the bile duct. However, a few cases of obstructive jaundice caused by migration of a tumor fragment after TACE have recently been reported. The aim of this study was to identify factors that affect tumor migration after TACE. At this writing, a review of the medical literature disclosed seven reported cases of biliary obstruction caused by migration of a necrotic tumor cast after TACE. We, herein, report on an additional case of acute obstructive cholangitis complicated by migration of a necrotic tumor cast after TACE for intrabile duct invasion of HCC, in a 71-year-old man. The tumor cast in the common bile duct was removed successfully using a basket during ERCP and was pathologically confirmed to be a completely necrotic fragment of HCC. The patient`s symptoms showed dramatic improvement. In summary, physicians should be aware of acute obstructive cholangitis complicated by tumor migration in a patient undergoing TACE. We suggest that an intrabile duct invasion would be a major predisposing factor of tumor migration after TACE and drainage procedures such as ERCP or percutaneous transbiliary drainage could be effective treatment modalities in these patients.
위장관 ; 위장관기질종양과 구별되는 위 신경초종의 초음파 내시경 특징
박형철 ( Hyung Chul Park ),손동준 ( Dong Jun Son ),오형훈 ( Hyung Hoon Oh ),옥찬영 ( Chan Young Oak ),김미영 ( Mi Young Kim ),정조윤 ( Cho Yun Chung ),명대성 ( Dae Seong Myung,),김종선 ( Jong Sun Kim ),조성범 ( Sung Bum Cho ),이 대한소화기학회 2015 대한소화기학회지 Vol.65 No.1
Background/Aims: Gastric schwannoma (GS), a rare neurogenic mesenchymal tumor, is usually benign, slow-growing, and asymptomatic. However, GS is often misdiagnosed as gastrointestinal stromal tumors (GIST) on endoscopic and radiological examinations. The purpose of this study was to evaluate EUS characteristics of GS distinguished from GIST. Methods: A total of 119 gastric subepithelial lesions, including 31 GSs and 88 GISTs, who were histologically identified and underwent EUS, were enrolled in this study. We evaluated the EUS characteristics, including location, size, gross morphology, mucosal lesion, layer of origin, border, echogenic pattern, marginal halo, and presence of an internal echoic lesion by retrospective review of the medical records. Results: GS patients comprised nine males and 22 females, indicating female predominance. In the gross morphology according to Yamada`s classification, type I was predominant in GS and type III was predominant in GIST. In location, GSs were predominantly located in the gastric body and GISTs were predominantly located in the cardia or fundus. The frequency of 4th layer origin and isoechogenicity as compared to the echogenicity of proper muscle layer was significantly more common in GS than GIST. Although not statistically significant, marginal halo was more frequent in GS than GIST. The presence of an internal echoic lesion was significantly more common in GIST than GS. Conclusions: The EUS characteristics, including tumor location, gross morphology, layer of origin, echogenicity in comparison with the normal muscle layer, and presence of an internal echoic lesion may be useful in distinguishing between GS and GIST.