Kyung-Jin Seo

Multidetector-row computed tomography (MDCT) features of small bowel obstruction (SBO) caused by Meckel's diverticulum.

OBJECTIVES To report the multidetector-row computed tomography (MDCT) findings of small bowel obstruction (SBO) caused by Meckels diverticulum. MATERIALS AND METHODS Ten patients (9 men and 1 woman; age range, 2-44 years; median age, 21years) with surgical proven Meckels diverticulum who presented SBO on the preoperative MDCT were included in the study. RESULTS On MDCT, all patients presented with SBO, either high-grade (n=6) or low-grade obstruction (n=4). Meckels diverticulum was identified in five patients (n=5, 50%) on preoperative MDCT. In the five patients in whom a diverticulum was not seen on preoperative MDCT, MDCT showed a transition site on ileum with dilated proximal loops (n=3), pneumoperitoneum (n=1), jejuno-jejunal intussusception (n=1). Transition zone was located near midline in four patients (4/5, 80%). CONCLUSION The diagnosis of Meckels diverticulum complicated SBO can be made with certainty when the diverticulum is visualized on preoperative MDCT. However, the preoperative diagnosis is difficult if the Meckels diverticulum is not noted on the MDCT. When the obstructive processes are visualized in the lower abdomen or pelvis, particularly near the midline, one should keep in mind that SBO may be caused by Meckels diverticulum without prior surgical history.

Unusual Esophageal Mass as a Cause of Dysphagia

Department of Internal Medicine, Department of Hospital Pathology, Uijeongbu St. Mary’s Hospital, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, South Korea 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 Question: A 73-year-old man with underlying alcoholic liver cirrhosis presented with a 1-month history of dysphagia.

Sonography of Invasive Apocrine Carcinoma of the Breast in Five Cases

Objective To evaluate the sonographic features of invasive apocrine carcinoma (IAC) of the breast. Materials and Methods This study included five pathologically proven cases of IAC, and their sonographic features were retrospectively analyzed according to the Breast Imaging Reporting and Data System (BI-RADS) lexicon. Results All five lesions involved the left breast and were seen as irregularly shaped masses. All lesions, except one, had a parallel orientation to the chest wall. All five lesions showed noncircumscribed margins and heterogeneous echotexture; however, they showed various posterior features. One lesion had edema as an associated feature. Sonographic assessments were classified as BI-RADS category 4 in all five cases. Conclusion Invasive apocrine carcinoma sonographic findings are difficult to differentiate from those of invasive ductal carcinoma of no special type.

Micropapillary urothelial carcinoma in a renal transplant recipient: a case report on urine cytomorphology emphasizing differentiation from high‐grade urothelial carcinoma

mas show an intimate admixture of carcinomatous and sarcomatous elements. A variety of mesenchymal components and growth patterns have been described in PSC, which include intersecting spindle cell fascicles, storiform pattern, pseudoangiomatous and haemangiopericytomatous patterns, rhabdomyoblastic, and cartilaginous differentiation, an osteosarcomatous component and a variable degree of myxoid change. Similarly, giant cells, variable pleomorphism, mitotic activity, necrosis and lymphovascular invasion have also been documented. The sarcomatoid component is believed to develop from the carcinomatous areas by dedifferentiation. Most PSCs show a minor epithelial component in the form of papillary, verrucous or basaloid SCC. Immunohistochemically, the spindle cell component shows diffuse vimentin expression and focal EMA, AE1/AE3 and S-100 positivity; other mesenchymal markers are usually negative. Most PSCs are highgrade tumours. Of the cases reported by Velazquez et al., 89% had an aggressive clinical course with inguinal node metastasis. The mean age of these patients was 59 years. Sarcomatoid carcinomas, which are rare in the penis, occur more frequently in other sites, such as the head and neck, oesophagus, kidney and prostate. The morphological features of PSC and sarcomatoid carcinoma of other locations are indistinguishable. Inguinal lymph node aspirate in the present case showed a distinct biphasic morphology. Although SCC is the most common malignancy of the penis, it was disregarded because of a lack of essential features, such as keratinization and nuclear pyknosis; immunocytochemically, p63 negativity confirmed the absence of squamous differentiation. The non-haemorrhagic nature of the aspirate, absence of endothelial differentiation and histiocytic cells, and the presence of epithelioid to spindle cell transition excluded the possibilities of angiosarcoma/ haemangioendothelioma, malignant fibrous histiocytoma and fibrosarcoma. CD99 positivity excluded synovial sarcoma. Metastatic amelanotic melanoma was ruled out by the tight clustering of cells (unusual in melanoma), melan-A and HMB-45 negativity and CK positivity. The positive expression of CK and negative expression of SMA and desmin excluded leiomyosarcoma and rhabdomyosarcoma. Although, tumour cells were S-100 positive, a strong immunoexpression of CK excluded a malignant peripheral nerve sheath tumour (MPNST). Thus, a high index of suspicion with an appropriate ICC panel facilitated the precise diagnosis of metastatic PSC. Interestingly, in contrast with the cases recorded in the literature, our case lacked squamous differentiation with the expression of both epithelial and mesenchymal antigens in both spindle and epithelial cell components.

A huge necrotic liver mass in a 45-year-old woman: delayed hepatic metastasis of a gastrointestinal stromal tumor.

A 45-year-old woman was referred with a huge mass of the liver. She complained of a vague abdominal discomfort that had persisted for 1 month. She had no history of liver disease, and physical examination revealed mild abdominal distension. Pertinent laboratory test results were unremarkable. She had a history of small intestinal resection for a gastrointestinal stromal tumor (GIST) 11 years prior (Fig. 1A). Computed tomography (CT) showed a heterogeneous hypervascular tumor with central necrosis, occupying left hemiliver and right paramedian sector of the liver, measuring 20 × 13 cm (Fig. 1B). Positron emission tomography-CT using 18F-fluorodeoxyglucose showed intense hypermetabolic activity (maximum standardized uptake value 8.2) along the peripheral solid portion of the tumor with central photon defect area representing necrosis (Fig. 1C). A tumor biopsy revealed small round/ spindle-shaped cells surrounded by fibrous tissue. Immunohistochemical stainings revealed vimentin reactivity, as well as CD117 reactivity. On c-kit A huge necrotic liver mass in a 45-year-old woman: delayed hepatic metastasis of a gastrointestinal stromal tumor

Endoscopic resection of asymptomatic, colonic, polypoid arteriovenous malformations: Two case reports and a literature review

A colonic arteriovenous malformation (AVM) is a significant vascular lesion of the gastrointestinal tract and a common cause of lower gastrointestinal bleeding. AVMs are usually identified endoscopically as bright red, flat lesions. AVMs with a polypoid appearance are extremely rare in the large intestine. We present two cases of colonic polypoid AVM, which were detected incidentally during screening colonoscopy. Both the patients had no history of gastrointestinal bleeding such as melena or hematochezia. Colonoscopy revealed pedunculated polyps overlaid by hyperemic mucosa in the ascending colon and proximal sigmoid colon. Microscopic examination showed aberrant vessels with thickened, hypertrophic walls in the mucosa and the submucosa, and arteries were directly connected to veins without capillary beds. These features were compatible with a diagnosis of AVM with a polypoid appearance. No immediate or delayed bleeding was noted after polypectomy.

Clinicopathological Characteristics of Serrated Polyposis Syndrome in Korea: Single Center Experience

Background/Aim. Serrated polyposis syndrome (SPS) is a rare condition characterized by multiple serrated polyps throughout the colon and rectum. The aim of this study was to evaluate the clinicopathological characteristics of SPS in Koreans. Methods. This retrospective analysis of prospectively collected data was performed using information from the endoscopy, clinical records, and pathology database system of Uijeongbu St. Marys Hospital. Consecutive patients satisfying the updated 2010 World Health Organization criteria for SPS between June 2011 and May 2014 were enrolled. Results. Of the 17,552 patients who underwent colonoscopies during the study period, 11 (0.06%) met the criteria for SPS. The mean age of these patients was 55.6 years. Ten patients (91%) were males. None had a family history of CRC or a first-degree relative with SPS. Seven patients (64%) had synchronous advanced adenoma. One patient had coexistence of SPS with CRC that was diagnosed at the initial colonoscopy. Five patients (45%) had more than 30 serrated polyps. One of the patients underwent surgery and 10 underwent endoscopic resection. Conclusion. The prevalence of SPS in this study cohort was comparable to that in Western populations. Considering the high risk of CRC, correct diagnosis and careful follow-up for SPS are necessary.

Definitive radiotherapy for cutaneous epithelioid hemangioendothelioma: a case report and literature review

Epithelioid hemangioendothelioma (EHE) is a rare tumor of the vascular endothelium and the most common involved sites are liver, lung and bone. Approximately one-third are also known to occur in other sites, such as the skin or large vessels. Although a number of treatment modalities have been tried, treatment responses after definitive radiotherapy (RT) have not been well described. Here, we report the case of multiple cutaneous EHE on both feet in an 81-year-old woman successfully treated by definitive RT. She underwent definitive RT of 60 Gy using a volumetric modulated arc therapy and all involved lesions were completely resolved with a small residual discoloration. At 20 months of follow-up after completion of RT, no progressive or recurrent lesions on either foot were observed.

Gastroenteropancreatic—origin neuroendocrine carcinomas: Three case reports with favorable responses following localized radiotherapy and a review of literature

Rationale: The radiotherapy (RT) responses of gastroenteropancreatic (GEP)-origin neuroendocrine tumors remain unclear. We report cases of favorable response after localized RT of GEP-origin neuroendocrine carcinomas (GEP-NECs). Patient concerns: 1. An 82-year-old male presented with a lower esophageal mass. Positron emission tomography computed tomography (PET-CT) scan showed a lower esophageal mass and gastrohepatic lymph nodes. 2. A 52-year-old female presented with abdominal discomfort. CT scan showed a 9.8 cm-sized enhancing mass in the lesser sac abutting the stomach, pancreas and liver. 3. A 54-year-old male patient presented with anal pain and bleeding. CT scan showed a remnant mass in the perirectal area after trans-anal excision. Diagnoses: The diagnoses of GEP-NECs were pathologically confirmed by biopsy or excision, and immunohistochemical stainings of Ki-67, CD56, synaptophysin and chromogranin-A. Interventions: 1. The patient was treated with definitive RT. 2. The patient was treated with RT after two cycles of etoposide-cisplatin chemotherapy. 3. The patient was treated with adjuvant RT. Outcomes: 1. Complete remission was achieved based on CT scan four months after RT. 2. CT scan showed partial regression of the mass with a 5 cm-diameter at six months after RT. Adjuvant chemotherapy was administered after RT. 3. The residual mass was almost completely regressed at CT scan four months after RT. Lessons: In cases of GEP-NECs, RT can be a useful treatment modality with favorable tumor response for patients with inoperable conditions or those suffering from bulky tumor masses.

Apocrine Ductal Carcinoma In Situ Presenting as a Large, Cystic Breast Mass: An Uncommon Presentation of a Rare Breast Lesion

A 73-year-old woman underwent screening mammography at our hospital 2 years ago, and we detected a 3.3 9 2.4-cm sized, left breast mass in the 3 o’clock direction. Although she then refused further evaluation, she recently returned with a palpable mass in the same location. Her medical history of diabetes mellitus induced end-stage renal disease which required hemodialysis during the past 2 years. On the previous and most recent mammograms, the mass showed an anterior circumscribed and posterior obscured margin and had a few, scattered calcifications. Only the mass size increased to 8.0 9 7.0-cm.