Choi Young Deok;Choi Sang Wook;Jeon Eun Jeong;Jeong Jeong Jo;Min Ki Ouk;Lee Kang Hoon;Lee Sung;Rhyu Mun Gan
Journal of Gastric Cancer
/
v.4
no.2
/
pp.109-120
/
2004
Purpose: Individual gastric cancers demonstrate complicated genetic alterations. The PCR-based analysis of polymorphic microsatellite sequences on cancer-related chromosomes has been used to detect chromosomal loss and microsatellite instability. For the purpose of preoperative usage, we analyzed the correspondance rate of the microsatellite genotype between endoscopic biopsy and surgical specimens. Materials and Methods: Seventy-three pairs of biopsy and surgical specimens were examined for loss of heterozygosity and microsatellite instability by using 40 microsatellite markers on eight chromosomes. Microsatellite alterations in tumor DNAs were classified into a high-risk group (baselinelevel loss of heterozygosity: 1 chromosomal loss in diffuse type and high-level loss of heterozygosity: 4 or more chromosomal losses) and a low-risk group (microsatellite instability and low-level loss of heterozygosity: 2 or 3 chromosomal losses in diffuse type or $1\∼3$ chromosomal losses in intestinal type) based on the extent of chromosomal loss and microsatellite instability. Results: The chromosomal losses of the biopsy and the surgical specimens were found to be different in 21 of the 73 cases, 19 cases of which were categorized into a genotype group of similar extent. In 100 surgical specimens, the high-risk genotype group showed a high incidence of nodal involvement (19 of 23 cases: $\leq$5 cm; 23 of 24 cases: >5 cm) irrespective of tumor size while the incidence of nodal involvement for the low-risk genotype group depended on tumor size (5 of 26 cases: $\leq$5 cm; 18 of 27 cases: >5 cm). Extraserosal invasion was more frequent in large-sized tumor in both the high-risk genotype group ($\leq$5 cm: 12 of 23 cases; >5 cm: 23 of 24 cases) and the low-risk genotype group ($\leq$5 cm: 7 of 26 cases; >5 cm: 16 of 27 cases). The preoperative prediction of tumor invasion and nodal involvement based on tumor size and genotype corresponded closely to the pathologic tumor stage (ROC area >0.7). Conclusion: An endoscopic biopsy specimen of gastric cancer can be used to make a preoperative genetic diagnosis that accurately reflect the genotype of the corresponding surgical specimen.
Kim, Hak Sun;Kim, Hyoung Bok;Chung, Hoon-Jae;Yang, Jea Ho
Journal of Korean Society of Spine Surgery
/
v.25
no.4
/
pp.180-184
/
2018
Study Design: Case report Objectives: To document fistula formation between the disc and dura by an unrecognized dural tear after percutaneous endoscopic lumbar discectomy (PELD). Summary of Literature Review: The risk of durotomy is relatively low with PELD, but cases of unrecognized durotomies have been reported. An effective diagnostic tool for such situations has not yet been identified. Materials and Methods: A patient twice underwent transforaminal PELD under the diagnosis of a herniated lumbar disc at L4-5. She still complained of intractable pain and motor weakness around the left lower extremity at 6 months postoperatively. Magnetic resonance imaging showed no specific findings suggestive of violation of the nerve root. However, L5 and S1 nerve root injury was noted on electromyography. An exploratory operation was planned to characterize damage to the neural structures. Results: In the exploration, a dural tear was found at the previous operative site, along with a fistula between the disc and dura was also found at the dural tear site. The durotomy site was located on the ventrolateral side of the dura and measured approximately 5 mm. The durotomy site was repaired with Nylon 5-0 and adhesive sealants. The patient's preoperative symptoms diminished considerably. Conclusions: Fistula formation between the disc and dura can be caused by an unrecognized dural tear after PELD. Discography is a reliable diagnostic tool for fistulas formed by an unrecognized durotomy.
We report an unusual case of postoperative early gastric cancer with liver metastasis mimicking pancreaticobiliary carcinoma. A 73-year-old man with early gastric cancer was transferred for endoscopic treatment. The patient underwent endoscopic submucosal dissection for the treatment of the early gastric cancer. The pathological diagnosis was adenocarcinoma with extension to the deep submucosa and some lymphatic invasion. Therefore, subsequent a subtotal gastrectomy was performed. The histological results demonstrated residual adenocarcinoma confined to the mucosa. The resection margin and lymph node metastasis were negative. Thus, he was closely monitored for recurrence every 6 months. After 2 years, he was suddenly suspected of developing liver metastasis and local recurrence. He received a liver biopsy, and the pathological result was poorly differentiated adenocarcinoma. Immunohistochemical staining suggested pancreaticobiliary carcinoma rather than metastatic adenocarcinoma from the stomach or colon, but primary focus was not found. We were sure that the recurrent stomach cancer metastasized to the liver because stomach cancer can show heterogeneous cytokeratin (CK) expression pattern with various histological features. Therefore, no single CK expression pattern has diagnostic value for distinguishing gastric carcinoma. The patient underwent chemotherapy for metastatic stomach cancer.
A 9-year old, castrated male Pekingese dog weighing 6.9 kg was referred with one week history of dyspnea, depression, yellow vomiting and abdominal distension. Refractory right lung field opacity was diagnosed as spontaneous right cranial lung lobe torsion (LLT) with collapsed middle lobe on the computed tomography. Four days after diagnosis, right fourth intercostal thoracotomy was performed under propofol-remifentanil based total intravenous anesthesia (TIVA). Right cranial and middle lung lobes were twisted together in a clockwise direction. ENDOPATH-ETS-FLEX-45, an articulating endoscopic linear cutting stapler was applied at the hilus and there were no complications after resection. The patient recovered favorably and has been doing well up to one year follow up. Lung lobe torsion is an uncommon condition in small breed dogs, this case report suggests serial lung lobe torsion of cranial lobe followed by middle lobe in small breed dog, and immediately after diagnosis surgical intervention is beneficial to prevent progression of LLT. Furthermore, using self cutting stapling device and TIVA technique will be helpful for lung lobectomy in dogs.
Jung, Da Hyun;Kim, Jie-Hyun;Lee, Yong Chan;Lee, Sang Kil;Shin, Sung Kwan;Park, Jun Chul;Chung, Hyun Soo;Kim, Hyunki;Kim, Hoguen;Kim, Yong Hoon;Park, Jae Jun;Youn, Young Hoon;Park, Hyojin
Journal of Gastric Cancer
/
v.15
no.4
/
pp.246-255
/
2015
Purpose: The importance of Helicobacter pylori eradication after endoscopic resection (ER) of gastric neoplasms remains controversial. In this study, we clarified the importance of H. pylori eradication for metachronous lesions after ER. Materials and Methods: This study included 3,882 patients with gastric neoplasms who underwent ER. We included patients infected with H. pylori who received eradication therapy. Among them, 34 patients with metachronous lesions after ER and 102 age- and sex-matched patients (nonmetachronous group) were enrolled. Background mucosal pathologies such as atrophy and intestinal metaplasia (IM) were evaluated endoscopically. The expression levels of CDX1, CDX2, Sonic hedgehog (SHH), and SOX2 were evaluated based on H. pylori eradication and the development of metachronous lesions. Results: The eradication failure rate was higher in the metachronous group than in the nonmetachronous group (P=0.036). Open-type atrophy (P=0.003) and moderate-to-severe IM (P=0.001) occurred more frequently in the metachronous group. In patients with an initial diagnosis of dysplasia, the eradication failure rate was higher in the metachronous group than in the nonmetachronous group (P=0.002). In addition, open-type atrophy was more frequent in the metachronous group (P=0.047). In patients with an initial diagnosis of carcinoma, moderate-to-severe IM occurred more frequently in the metachronous group (P=0.003); however, the eradication failure rate was not significantly different between the two groups. SHH and SOX2 expression was increased, and CDX2 expression was decreased in the nonmetachronous group after eradication (P<0.05). Conclusions: Open-type atrophy, moderate-to-severe IM, and H. pylori eradication failure were significantly associated with metachronous lesions. However, eradication failure was significantly associated with dysplasia, but not carcinoma, in the metachronous group. Thus, H. pylori eradication may play an important role in preventing metachronous lesions after ER for precancerous lesions before carcinomatous transformation.
Kim, Je-Yeon;An, Ji-Yeong;Choi, Min-Gew;Noh, Jae-Hyung;Sohn, Tae-Sung;Kim, Sung
Journal of Gastric Cancer
/
v.6
no.1
/
pp.47-51
/
2006
The origin of a submucosal tumor is difficult to determine by endoscopic biopsy. One type of submucosal tumor, which originates in Schwann cell, a schwannoma represents 0.2% of all gastric tumors. We experienced the case of a 57-year-old female patient with a gastric schwannoma presenting with melena and anemia. Computed tomography and upper gastrointestinal endoscopy showed a protruded huge mass from 3 cm below the cardia to angle. Seven endoscopic biopsies indicated only necrotic debri and granulation tissue, chronic gastritis. Because we suspected an advanced gastric cancer, or lymphoma with bleeding, It was performed an operation for an exact diagnosis and a treatment for bleeding. A-post-operative histopathological, immunohistochemical examination led to the final diagnosis of a gastric schwannoma.
Purpose: Screening image-enhanced endoscopy for gastrointestinal malignant lesions has progressed. However, the influence of the color enhancement settings for the laser endoscopic system on the visibility of lesions with higher color contrast than their surrounding mucosa has not been established. Materials and Methods: Forty early gastric cancers were retrospectively evaluated using color enhancement settings C1 and C2 for laser endoscopic systems with blue laser imaging (BLI), BLI-bright, and linked color imaging (LCI). The visibilities of the malignant lesions in the stomach with the C1 and C2 color enhancements were scored by expert and non-expert endoscopists and compared, and the color differences between the malignant lesions and the surrounding mucosa were assessed. Results: Early gastric cancers mainly appeared orange-red on LCI and brown on BLI-bright or BLI. The surrounding mucosae were purple on LCI regardless of the color enhancement but brown or pale green with C1 enhancement and dark green with C2 enhancement on BLI-bright or BLI. The mean visibility scores for BLI-bright, BLI, and LCI with C2 enhancement were significantly higher than those with C1 enhancement. The superiority of the C2 enhancement was not demonstrated in the assessments by non-experts, but it was significant for experts using all modes. The C2 color enhancement produced a significantly greater color difference between the malignant lesions and the surrounding mucosa, especially with the use of BLI-bright (P=0.033) and BLI (P<0.001). C2 enhancement tended to be superior regardless of the morphological type, Helicobacter pylori status, or the extension of intestinal metaplasia around the cancer. Conclusions: Appropriate color enhancement settings improve the visibility of malignant lesions in the stomach and color contrast between the malignant lesions and the surrounding mucosa.
Journal of Cerebrovascular and Endovascular Neurosurgery
/
v.25
no.4
/
pp.411-419
/
2023
Objective: Optochiasmatic cavernoma is an extremely rare cerebral lesion. They account for approximately 1% of all cavernomas of the central nervous system. Reports on this pathology are limited. Abrupt visual deterioration is a common symptom of the disease. Treatment strategy and visual outcomes after different treatment approaches remain a subject for discussion. Methods: Patients operated in a period 2005-2021 were analyzed in this study. All patients preoperatively underwent computed tomography (CT) scan, CT-angiography, and magnetic resonance imaging (MRI). Visual function of the patients was assessed pre-op, post-op and at the follow-up. Duration of visual dysfunction was noted as well. Surgical details were also extracted from medical notes. All patients were followed up, and control MRI was performed one month after operation. We assessed surgical series of optochiasmatic cavernomas published for last 10 years. Further comparative analysis with our data was performed. Results: Five patients were included into this study. There were four men and one woman. Mean age comprised 33.8 years (range 20-48 years). Most patients were admitted to our hospital due to visual disturbances (80%). Visual function improved in four patients. Visual function was unchanged in one patient, lacking visual distur-bancies pre-op. Complication developed in one patient. Conclusions: Optochiasmatic cavernomas are encountered extremely rare. Despite the use of contemporary diagnostic options, differential diagnosis remains challenging. Full diagnostic work-up is mandatory. After the diagnosis is made, surgical treatment should be considered first. Total microsurgical or endoscopic transsphenoidal removal of the optochiasmatic cavernoma is a relatively safe and effective treatment method facilitating improvement of visual function.
Purpose : The aim of this study was evaluating the efficacy of endoscopic $Deflux^{(R)}$ submucosal injection in children with primary vesicoureteral reflux (VUR). Methods : Retrospective analysis of medical record was conducted on 38 children (59 ureters) who underwent endoscopic $Deflux^{(R)}$ injection due to primary VUR. Data were collected from March 2000 to February 2006. Mean infused amount of $Deflux^{(R)}$ was 0.77 cc. After $Deflux^{(R)}$ injection, patients were reassessed by voiding cystourethrogram (VCUG) 6 months later. Results : The success rate of endoscopic $Deflux^{(R)}$ submucosal injection 6 months later by VCUG was 100% for grade 1 VUR, 87.5% for grade 2, 60% for grade 3, 26.6% for grade 4, 16.6% for grade 5, respectively and there was negatively significant correlation between success rate and grade of VUR (P<.01). Degree of improvement of VUR by endoscopic $Deflux^{(R)}$ submucosal injection was not related to age at diagnosis, time to operation, existence of voiding dysfunction or constipation and infused amount of $Deflux^{(R)}$. However, group with anticholinergics medication had significantly lower success rate than non-medication group (P<0.047). Conclusion : Endoscopic $Deflux^{(R)}$ submucosal injection is effective therapy in patient with primary VUR, especially low grade VUR. It can be not only a useful substitute for prophylaxis with antibiotics, but also an effective management prior to ureteroneocystostomy in children with primary VUR.
Park, Jong Hoon;Kim, Jeong Hoon;Kwon, Do Hoon;Kim, Chang Jin;Khang, Shin Kwang;Cho, Young Hyun
Journal of Korean Neurosurgical Society
/
v.58
no.4
/
pp.334-340
/
2015
Objective : Pineal parenchymal tumors (PPTs) in adults are rare, and knowledge regarding their optimal management and treatment outcome is limited. Herein, we present the clinical results of our series of PPTs other than pineoblastomas managed by stereotactic radiosurgery (SRS) at upfront setting. Methods : Between 1997 and 2014, nine consecutive adult patients with the diagnosis of PPTs, either pineocytoma or pineal parenchymal tumor of intermediate differentiation, were treated with SRS. There were 6 men and 3 women. The median age was 39 years (range, 31-53 years). All of the patients presented with symptoms of hydrocephalus. Endoscopic third ventriculostomy and biopsy was done for initial management. After histologic diagnosis, patients were treated with Gamma Knife with the mean dose of 13.3 Gy (n=3) or fractionated Cyberknife with 32 Gy (n=6). Results : After a mean follow-up of 78.6 months (range, 14-223 months), all patients were alive and all of their tumors were locally controlled except for one instance of cerebrospinal fluid seeding metastasis. On magnetic resonance images, tumor size decreased in all patients, resulting in complete response in 3 patients and partial response in 6. One patient had experienced temporary memory impairment after SRS, which improved spontaneously. Conclusion : SRS is effective and safe for PPTs in adults and can be considered as a useful alternative to surgical resection at upfront setting.
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