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Tuberculosis of the cystic duct lymph node is very rare. Only four cases have been reported in the literature. This paper presents the case of a young male patient with a tuberculous cystic duct lymph node and chronic cholecystitis, who was diagnosed with cystic duct stones and a gall bladder polyp preoperatively.

Giant colonic diverticulum (GCD) is a rare condition defined by diverticular size over 4 cm. Its presentation is usually asymptomatic.We herein report a rare presentation of ruptured GCD in elderly man who suffered from abdominal pain. The patient underwent primary repair and ileostomy to shorten the operation time instead of Hartmann's operation. Post-operative CT revealed complicated GCD with rupture.The exact mechanism of GCD generation is questionable. Most of case is discovered by radiologic exam or computed tomography (CT) incidentally. The most common complications of GCD are perforation and abscess formation.Symptoms of GCD are like those of usual diverticulosis. But, considering the severity of complications, it is better to prioritize surgical treatment at diagnosis.

Objectives Vacuum-assisted breast biopsy (VABB) is a widely used technique for the diagnosis of breast lesions. It is carried out with local anesthesia, but procedural pain and stress are still problematic. Dexmedetomidine is a α-2 receptor agonist that can sedate without significant respiratory depression. The study aimed to report the effectiveness of sedation with monitored anesthesia care (MAC) using dexmedetomidine in VABB. Methods This was a retrospective chart review of patients who received VABB under MAC with dexmedetomidine. Forty-seven patients during the period of February 2015 to July 2016 were included. We collected data on patient characteristics, infusion drug and dose, induction to incision time, anesthetic, operation, and recovery time and other complications and vital signs. Results The mean operating time was 50.1 ± 24.9 minutes, and the anesthetic time was 71.2 ± 28.3 minutes. The mean time from induction to incision was 17.0 ± 5.2 minutes, and the recovery time was 20.1 ± 10.3 minutes. None of the patients needed an advanced airway management. Further, none of them showed hemodynamic instability. Conclusions VABB was successfully performed with MAC using dexmedetomidine, and there was no respiratory depression or hemodynamic instability.

Spontaneous bleeding from a short gastric artery in the absence of pre-disposing trauma is reported very rarely. To the best of our knowledge, the published literature includes only 14 cases. Young men comprise almost all of the patients, and were induced by vomiting or gagging. The patients usually required emergent surgery. Our patient, a 32-year-old man, was diagnosed with spontaneous hemoperitoneum due to short gastric artery tearing after a few instances of vomiting. We managed him conservatively including fluid, vitamin K and antifibrinolytic agent without surgery. (Korean J Gastroenterol 2016;68:152-155)

Purpose: This study was conducted to evaluate the systemic inflammatory response in colorectal cancer patients, and to estimate the usefulness of the Glasgow prognostic score (GPS) as a prognostic factor. Methods: Patients with biopsy-proven colorectal adenocarcinoma who were operated between April 2005 and December 2008 were enrolled in this study. The GPS was estimated based on the measurement of CRP and serum albumin level. The GPS was compared with other clinicopathological factors. Univariate and multivariate analyses were performed to evaluate the factors affecting cancer-specific survival. Results: GPS was significantly higher in patients with anemia, thrombocytosis, a high neutrophil to lymphocyte ratio, tumor of the colon, and large tumor. Patient age, gender, serum CEA level, tumor gross appearance, TNM stage, and tumor differentiation were not related with the GPS. In univariate analysis, hemoglobin, CEA, gross appearance of tumor, TNM stage, tumor differentiation, and GPS were associated with cancer-specific survival. In multivariate analysis, TNM stage (III or IV : I or II; hazard ratio [HR], 12.322; P = 0.015), tumor differentiation (poorly differentiated : well or moderately differentiated; HR, 3.112; P = 0.021), and GPS (GPS 2 : GPS 0 or 1; HR, 5.168; P = 0.003) were identified as independent prognostic factors in colorectal cancer. Conclusion: Our study showed that the GPS was an independent variable from tumor stage and a good and convenient prognostic factor in colorectal cancer patients.

Objective To investigate the characteristics of recurrences that occurred 5 or more years after curative resection for gastric cancer. Methods We analyzed recurrences among 1,299 patients with gastric cancer who underwent curative operations at the Department of Surgery, Inje University Seoul Paik Hospital between September 1998 and December 2002. Recurrences were classified as within 2 years (early), 2–5 years (intermediate), and more than 5 years (late) after gastrectomy. The clinicopathologic findings of the patients with late recurrence were compared with those of patients in the other two recurrence groups, with special reference to the patterns of recurrence. Both univariate and multivariate analyses were performed, incorporating factors such as operation type, T-stage, N-stage, stage, lymphatic invasion, neural invasion, histology, tumor size, and recurrence site. Results At the time of last follow-up, recurrence occurred in 266 (20.5%) patients. Recurrence times were classified as 5 years (23 patients). The late recurrence rate was 8.6%. The occurrence of recurrence >5 years after gastrectomy was significantly correlated with age, operation type, T-stage, N-stage, stage, lymphatic invasion, neural invasion, histology, tumor size, location and recurrence site (P

Inflammatory myofibroblastic tumor (IMT) of the liver is a very rare lesion that has radiologic similarity with malignant liver tumor. Differential diagnosis of IMT from a malignant lesion of the liver is very important because surgical resection is not mandatory for IMT. Lipiodol computed tomography is a very sensitive and specific diagnostic tool for hepatocellular carcinomas (HCC). Herein, we describe a case of IMT that had dense lipiodol uptake in the tumor and mimicked HCC. To our knowledge, previously, only one case of IMT with dense lipiodol retention has been reported.

Purpose: Local recurrence and distant metastasis are major prognostic factors associated with breast cancer. Lymphovascular invasion is an important pathway of metastatic spread. CD44 and D2-40 are assumed to be related with invasion of malignant cells to the adjacent lymphatic or vascular structures by different mechanisms. This study was conducted to examine whether CD44 and D2-40 expression together have prognostic value in invasive carcinoma of the breast. Methods: A total of 46 surgically resected tissue samples of invasive carcinoma of the breast were analyzed for immunohistochemical expression of CD44 and D2-40, along with other clinicopathologic factors. Association between patient related factors and disease free survival was evaluated by statistical analysis. Results: Disease free survival was shorter in CD44-positive patients (median, 66.5 months) than in CD44-negative patients (median, 112.6 months; P Conclusion: We concluded that expression of CD44 and D2-40 is associated with unfavorable prognosis. Concurrent positivity of both markers may be useful in predicting malignant relapse following surgical resection with shorter disease free survival in patients with invasive carcinoma of the breast.

Background We conducted this retrospective study to analyze the relationship between the distance of the proximal resection margin (PRM) and the pattern of recurrence in patients with gastric cancer who underwent curative gastrectomy. Methods In our series, there were 774 patients who underwent curative gastrectomy for gastric adenocarcinoma. Thus, we classified our clinical series of patients into the distal gastrectomy group (n = 529) and the total gastrectomy group (n = 245). The clinical pathologic data and PRM distance were collected. Univariate and multivariate analyses were performed to evaluate association between PRM distance and locoregional recurrence. Results The mean distance of the PRM was 4.03 cm in the total gastrectomy group. The distance of the PRM had a significant correlation with advanced T-stage, advanced N-stage,vascular invasion,lymphatic invasion, neural invasion, histological undifferentiation, greater tumor size, and the upper third of the tumor location. On multivariate analysis, tumor recurrence showed only the independent prognostic factor N-stage (P

Purpose The aim of this study was to assess the expressions of CD44 and CD133 in colorectal cancer tissue by using immunohistochemical staining and to analyze the clinical significance of the expressions related to other clinicopathological data and survival results. Methods One hundred sixty-two patients with a biopsy-proven colorectal adenocarcinoma who were operated on between January 1998 and August 2004 were enrolled in this study. Immunohistochemical staining for CD44 and CD133 was performed on primary colorectal cancer tissue, metastatic lymph nodes, and synchronous and metachronous metastatic tumor tissues if available. Results CD44 expression was stronger in the primary tumor than in metastatic lymph nodes (P < 0.001), and CD133 expression tended to be stronger in primary tumor than in metastatic lymph nodes (P = 0.057). No significant correlation was found between the CD44 and the CD133 expressions. The cases with recurrence showed low expression of CD44 (P = 0.017). CD133 expression was lower in cases with elevated CA 19-9 serum levels (P = 0.028) and advanced T stage (P = 0.038). Multivariate analysis proved that low expression of CD44 was an independent prognosis factor for short disease-free survival (P = 0.028). Conclusion Low CD44 expression was correlated with increased tumor recurrence and short disease-free survival, and low CD133 expression was associated with advanced tumor stage. We suggest that further studies be performed to evaluate whether the immunohistochemical method for determining the CD44 and the CD133 expressions is appropriate for exploring cancer stem-cell biology in patients with colorectal cancer.

Carcinosarcoma is a rare malignant, biphasic tumor comprised of carcinoma and sarcoma components. In the gastrointestinal tract, carcinosarcoma is most frequently seen in the esophagus and rarely in the stomach. We report a 51-year-old female patient with 2-month-history of epigastric pain and dyspepsia. Endoscopic finding revealed a huge ulcerative lesion that infiltrated from the antrum to the mid-body. An endoscopically taken biopsy revealed poorly differentiated malignant round cell neoplasm. After the palliative subtotal gastrectomy, immunohistochemical studies showed two positive reactions for the epithelial marker and mesenchymal marker. Based on the above findings, the patient was diagnosed with gastric carcinosarcoma. The immunohistochemical analysis is a critical method in making an accurate diagnosis of carcinosarcoma.

Colorectal cancer is the third most common malignancy in Korea. In contrast, pericolic or mesenteric lymphoma is relatively rare. We experienced an extremely rare case of synchronous primary colon cancer in the ascending colon with T-cell lymphoma in the pericolic lymph node. A 79-year-old woman presented with complaints of epigastric and right lower abdominal pain combined with anorexia and nausea. Colonoscopic evaluation and biopsy were performed, and the diagnosis was cecal adenocarcinoma. She underwent right hemicolectomy with lymph node dissection. The pathology report revealed adenocarcinoma in cecum with metastasis to 1 regional lymph node out of 37 lymph nodes. In addition, there was malignant angioimmunoblastic T-cell lymphoma in 1 pericolic lymph node. There was no evidence of lymphoma in ileum, cecum and ascending colon, so the possibility of early phase of lymphoma was suggested.

Purpose: Prognostic indicators are used increasingly in clinical trials and to guide surveillance for patients with colorectal cancer (CRC). The significance of a preoperative, elevated erythrocyte sedimentation rate (ESR) as a predictive indicator for malignancy and for prognosis in colorectal cancer has not been elucidated. Hence, the current study was conducted to evaluate the ESR as a prognostic indicator in patients with CRC. Methods: This study enrolled 232 patients who underwent surgery in our hospital between 1997 and 2004. ESR with clinicopathologic features and overall survival were evaluated retrospectively. Results: The ESRs of 139 patients were elevated, and those of 93 patients were normal. Elevated ESR was associated with the male gender, decreased hemoglobin, increased platelet count, high preoperative CEA, high preoperative CA19-9, tumor size (≥5 cm), T stage, and TNM stage. Patients with elevated ESR had poorer survival (P=0.001), but a multivariate analysis did not reveal an elevated ESR as an independent factor for prognosis. Conclusions: Preoperative elevation of ESR in patients with CRC suggests the presence of a tumor with aggressive behavior and a poor outcome.

Purpose: The significance of serum levels of CEA and CA19-9 in forming a prognosis for colorectal cancer patients remains as subject for debating. The aim of this study is to assess their correlations with tumor pathology and their prognostic values. Methods: We analysed the data on 274 patients with colorectal cancer who had been treated by resection from Jan. 1997 to Aug. 2005. Correlation of the preoperative serum values of CEA and CA19-9 with clinocopathologic features, including prognosis, of the patients was investigated. Results: The positivity rates of the two tumor markes were significantly correlated with tumor size, differentiation, TNM staging, venous invasion, and neural invasion. In addition, the positivity rate of CEA was related to lymphatic invasion and that of CA19-9 to gender. In the univariate analysis, CEA (P＜0.001), CA19-9 (P＜0.001), tumor size (P=0.011), TNM staging (P＜0.001), lymphatic invasion (P=0.003), venous invasion (P＜0.001), neural invasion (P＜0.001), and differentiation (P=0.023) correlated with survival of the patients. In the stepwise multivariate analysis, an advanced TNM stage (P＜0.001), positive venous invasion (P=0.011), and positive neural invasion (P=0.013) were independent prognostic factors for poor survival. Conclusions: Our results demonstrated that high serum levels of tumor markers were associated with more aggressive cancers, but in the multivariate analysis, CEA and CA19-9 were found not to be independent prognostic factors.