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Volume 36(1); January 2008
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Targeting Colon Cancer Cells with Fluorescent Magnetic Nanoparticles Conjugated to Anti-epidermal Growth Factor Receptor Antibodies
Chang Wook Kim, M.D., Young Seok Cho, M.D., Tae Jong Yoon, Ph.D.*, Hyung Keun Kim, M.D., Sung Soo Kim, M.D., Ki Yuk Chang, M.D., Hiun Suk Chae, M.D., Myung Gyu Choi, M.D. and Kyu Yong Choi, M.D.
Korean J Gastrointest Endosc 2008;36(1):1-6.   Published online January 30, 2008
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Background
/Aims: The aim of this study was to evaluate targeting the epidermal growth factor receptors (EGFRs) of colon cancer cells with fluorescent magnetic nanoparticles (FMNP) conjugated to anti-EGFR antibodies. Methods: The expression of EGFRs was evaluated in the HT-29 colon cancer cell lines and the control H-520 lung cancer cells by performing Western blot analysis. We synthesized silica-overcoated iron oxide nanoparticles that contained rhodamine B isothiocyanate (RITC) within a silica shell of a controllable thickness. This FMNP was conjugated to anti-EGFR mouse monoclonal antibody. The cells were treated with this probe conjugate for 4 hours and then the targeting was assessed via confocal microscopy. The fluorescence properties were evaluated for their binding to the expressed EGFRs with using a FACScan flow cytometer. Results: EGFR was expressed in the HT-29 cells, as assessed by Western blot analysis. Red fluorescence was only detected in the membrane regions of the HT-29 cells on the confocal microscope imaging. On the FACS analysis, there was a significant shift of fluorescence intensity for the HT-29 cells. Conclusions: Our data show the feasibility of targeting colon cancer cells with FMNP conjugated with anti-EGFR antibodies in vitro. (Korean J Gastrointest Endosc 2008;36:1-6)
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Endoscopic Bilateral Metal Stent Placement with a Y-Configured Dual Stent for Advanced Hilar Carcinoma
Jong Ho Hwang, M.D.*, Dae Hwan Kang, M.D., Sang Yong Lee, M.D.*, Kyung Yeob Kim, M.D., Jae Sup Eum, M.D., Ji Young Kim, M.D., Do Hoon Kim, M.D., Gwang Ha Kim, M.D., Jeong Heo, M.D., Geun Am Song, M.D. and Mong Cho, M.D.
Korean J Gastrointest Endosc 2008;36(1):7-13.   Published online January 30, 2008
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Background
/Aims: Palliative endoscopic or percutaneous internal drainage is widely used for treating hilar cholangiocarcinoma. Yet unilateral biliary drainage does not completely improve jaundice and it can induce acute cholangitis by the undrained contrast media. To investigate this technique's technical and clinical effectiveness, a newly devised Y-configured dual stent was used for treating advanced hilar malignancies. Methods: From May, 2005 to May, 2007, 20 hilar malignancies (men: women=9:11, age=70.5 yr) that were not suitable for surgical resection were included in this study. For bilateral metal stent placement, a biliary stent with a wide open central mesh was first inserted. After this, another stent without a hole was inserted into the contralateral hepatic duct through the open central mesh of the first stent. Results: Bilateral metal stent insertion was done in 14 of 20 patients. Among the 14 patients in whom bilateral stents were successfully placed, the rate of functional success was 100%. There were no early complications. As a late complication, stent occlusion occurred in 4 of 14 patients (28.5%), and one of these patients had a plastic stent inserted. The other 3 patients were treated with percutaneous transhepatic biliary drainage. The median stent patency period was 231 days. Conclusions: The bilateral metal stent method using the Y stent is safe and effective for bilateral biliary drainage in patients with unresectable hilar malignancies. (Korean J Gastrointest Endosc 2008;36:7-13)
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A Case of Hereditary Hemorrhagic Telangiectasia Treated by Argon Plasma Coagulation
Min Kyu Jung, M.D., Ju Young Lee, M.D., Hyun Chaol Lee, M.D., Seong Woo Jeon, M.D., Chang Min Cho, M.D., Won Young Tak, M.D. and Young Oh Kweon, M.D.
Korean J Gastrointest Endosc 2008;36(1):14-17.   Published online January 30, 2008
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Rendu-Osler-Weber disease is characterized by hereditary transmission, and by the presence of multiple telangiectases of the skin, mucous membranes, and internal organs. We present a case of Rendu-Osler-Weber disease with bleeding from gastric telangiectases that was successfully treated by endoscopy with the use of argon plasma coagulation (APC). A 65-year-old woman presented with melena. Endoscopy disclosed multiple telangiecatses in the whole stomach. APC was performed at an output of 50 W and with an argon gas flow rate of 2 L/min. Only multiple ulcers at the treated sites were seen 7 days after the procedure and fibrotic scars with contracted mucosal folds without active bleeding signs were noted 2 months later. (Korean J Gastrointest Endosc 2008;36:14-17)
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A Case of Synchronous Quintuple Early Gastric Cancer
Kyu Re Joo, M.D., Jae Kwang Kim, M.D., Chang Whan Kim, M.D., Jin Il Kim, M.D., Joo Ho Ham, M.D., Hong Jun Yang, M.D., Keun Jong Cho, M.D., Tea Ho Kim, M.D., Jae Kwang Kim, M.D., Suk Won Han, M.D. and Kyu Young Choi, M.D.
Korean J Gastrointest Endosc 2008;36(1):18-21.   Published online January 30, 2008
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The frequency of multiple gastric cancers has recently been on the increase due to the development of improved diagnostic methods, such as endoscopy, chromoscopy, and pathological methods. To prevent relapse by a remnant cancer, it is critical to determine the surgical area after evaluating the entire synchronous multiple gastric cancer area using closed endoscopy and a radiological evaluation prior to surgery. There have been no prior reports of a diagnosis of quintuple gastric cancer before surgery, although; a diagnosis of quadruple gastric cancer has been previously reported. Here we describe a 65-year-old male patient who received a diagnosis of early quintuple gastric cancer by endoscopy before surgery. (Korean J Gastrointest Endosc 2008;36:18-21)
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A Granular Cell Tumor Located in the Gastric Cardia
Jin Sup Park, M.D., Gwang Ha Kim, M.D., Mi Ra Kim, M.D., Hong Ryul Jeong, M.D., Jae Hoon Cheong, M.D., Chan Ho Park, M.D., Sun Mi Lee, M.D., Tae Oh Kim, M.D., Jeong Heo, M.D., Dae Hwan Kang, M.D., Geun Am Song, M.D. and Mong Cho, M.D.
Korean J Gastrointest Endosc 2008;36(1):22-26.   Published online January 30, 2008
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First described in 1926 by Abrikossoff, a granular cell tumor is a benign lesion and commonly involves the skin, connective tissue, and breast, but rarely the esophagus. The origin of granular cell tumors is controversial. The tumor is thought to arise from a Schwann cell origin, based on characteristics such as the positive expression of S-100 protein determined by immunohistochemical staining. A 29-year-old female was referred from the local clinic because of a polypoid lesion in the gastric cardia. After performing endoscopy and endoscopic ultrasonography, a 1.5 cm submucosal tumor covered with normal mucosa was found in the gastric cardia. Endoscopic mucosal resection revealed a tumor that initiated in the esophagus, and grew into the cardia. Immunohistochemical analysis revealed strong positive staining for S-100 protein, confirming the presence of a granular cell tumor. (Korean J Gastrointest Endosc 2008;36:22-26)
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A Case of Brunner's Gland Hyperplasia of the Duodenal Second Portion with Annular Stricture Causing an Induced Obstruction
Hyeon Woo Byun, M.D., Jin Lee, M.D., Yu Jin Lim, M.D., Chan Soo So, M.D., Seung Yong Han, M.D., Min Ho Choi, M.D., Hyun Joo Jang, M.D. and Sea Hyub Kae, M.D.
Korean J Gastrointest Endosc 2008;36(1):27-30.   Published online January 30, 2008
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Brunner's gland hyperplasia is a tumor arising from the Brunner's gland and the lesions account for 10.6% of benign duodenal tumors. These lesions are usually asymptomatic and detected incidentally by endoscopy or by a UGI barium study. In the case of severe and atypical forms, these lesions cause bleeding, intestinal obstruction or intussuception. However, Brunner's gland hyperplasia causing an annular duodenal stricture and subsequent intestinal obstruction has been rarely reported. We report here a very rare case of Brunner's gland hyperplasia presenting as an annular stricture and obstruction. (Korean J Gastrointest Endosc 2008;36:27-30)
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A Case of Febrile Colonic Tuberculosis that Became Defervescence after Colonoscopic Polypectomy
Seong Deuk Baek, M.D., Jung Hyun Lee, M.D., Jung Il Seo, M.D. and Chang Woo Lee, M.D.
Korean J Gastrointest Endosc 2008;36(1):31-35.   Published online January 30, 2008
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The clinical manifestations, radiological and endoscopic findings of colonic tuberculosis are non-specific. A diagnosis of colonic tuberculosis is usually difficult because the condition can mimic tumors. Fever occurs in 60∼85% of patients with tuberculosis, which is one of the important signs of disease activity, and usually resolves by the second week after beginning treatment. However, there are some patients who remain febrile beyond a reasonable treatment period or develop fever during treatment. Such cases raise issues, such as cytokine release from tuberculous granuloma, drug induced fever, drug resistance, and drug malabsorption. We encountered a patient with polypoid colonic tuberculosis who presented with prolonged fever after commencing treatment and became defervescence after a colonoscopic polypectomy. We report this case with a review of the relevant literature. (Korean J Gastrointest Endosc 2008;36:31-35)
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Two Cases of Melanosis Ilei Developed after Long-standing Charcoal Ingestion
Myung Suk Kim, M.D., Yong Bum Park, M.D., Byeong Wha Ha, M.D., Dae Young Cheung, M.D., Jin Il Kim, M.D., Se Hyun Cho, M.D., Soo-Heon Park, M.D. and Jae Kwang Kim, M.D.
Korean J Gastrointest Endosc 2008;36(1):36-39.   Published online January 30, 2008
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Melanosis ilei is an extremely rare condition in which black pigment, consisted of aluminum, magnesium, or silicon, accumulate in the terminal ileal mucosa. Medical treatment with charcoal enhances the neutralization of the toxic material and elimination of many drugs. In addition, it has been used as a traditional remedy in some oriental countries to relieve chronic diarrhea, abdominal pain, or acute enterocolitis, which is made up carbon, oxygen, aluminum, magnesium, silicon, calcium, and palladium. Two patients taking the charcoal for a long time underwent a colonoscopy to evaluate chronic diarrhea or abdominal pain. The colonoscopy revealed a normal colonic mucosa and multiple geographic black-pigmented mucosal changes at the terminal ileum. Therefore, it was assumed that melanosis ilei can develop in patients with long-standing charcoal ingestion. To the best of our knowledge, this is the first case of melanosis ilei associated with the ingestion of charcoal. (Korean J Gastrointest Endosc 2008;36:36-39)
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Minute-depressed Type of Submucosal Colon Cancer
Yeon Soo Kim, M.D., Soon Woo Nam, M.D., Jeong Ok Kim, M.D.*, Young Hwa Ki, M.D., Chun Young Song, M.D., Seung Woo Lee, M.D., Sang Bum Kang, M.D. and Dong Soo Lee, M.D.
Korean J Gastrointest Endosc 2008;36(1):40-43.   Published online January 30, 2008
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The development of colorectal cancer has been known as the adenoma-carcinoma sequence. Yet another route for cancer development has recently been proposed, which is call the de novo pathway based on the reports of the depressed-type early colorectal cancers. Early colorectal cancer is defined as invasive tumor limited to the colorectal mucosa or submucosa, regardless of the presence or absence of lymph node metastasis. Especially, depressed type colorectal cancers have a much higher rate of submucosal invasion and rapid progression despite of their relatively small sizes. Our case displayed a depressed type tumor that was only 5mm in diameter and it had invaded the deep submucosal layer (SM3); this was resected by operation with no predictive endoscopic finding. So, the depressed type tumor can show deep invasion or lymph node metastasis despite of its small size. (Korean J Gastrointest Endosc 2008;36:40-43)
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A Solitary Colonic Neurofibroma in a Patient without Neurofibromatosis
Kyeong Ok Kim, M.D., Byung Ik Jang, M.D., Hee Jung Moon, M.D., Sang Hoon Lee, M.D., Jun Young Lee, M.D., Kyu Hyung Lee, M.D., Si Hyung Lee, M.D., Youn Sun Park, M.D., Jae Won Choi, M.D., Jong Ryul Eun, M.D., Tae Nyun Kim, M.D. and Heon Ju Lee, M.D.
Korean J Gastrointest Endosc 2008;36(1):44-47.   Published online January 30, 2008
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Neurofibromas are usually manifestations of neurofibromatosis type 1 (Nf1). There are usually multiple lesions on presentation. Solitary neurofibromas of the colon are extremely rare. A 34-year-old Asian male came to our hospital for non-specific findings, except for a complaint of loose stools for 2 months. A colonoscopy was performed. A sessile polyp 0.4 cm in diameter was detected at the sigmoid colon. Microscopically, a biopsy from the polyp showed proliferation of spindle cells in the mucosa, myxoid changes and infiltration of inflammatory cells. Immunohistochemical staining was positive for S-100 protein. The above morphological and immunohistochemical characteristics were consistent with a diagnosis of a neurofibroma. Only 13 cases of isolated colonic neurofibromatosis without Nf1 have been documented in the literature. We report this case as an isolated neurofibroma of the colon is even a rarer manifestation, and only three cases have been published in the clinical literature. (Korean J Gastrointest Endosc 2008;36:44-47)
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A Case of Polypoid Ganglioneuroma of the Colon
Byoung Wook Bang, M.D., Seok Jeong, M.D., Chul Hyun Kim, M.D., Don Haeng Lee, M.D., Joon Mee Kim, M.D.*, Jung Il Lee, M.D., Jin-Woo Lee, M.D., Kye Sook Kwon, M.D., Hyung Gil Kim, M.D., Yong Woon Shin, M.D. and Young Soo Kim, M.D.
Korean J Gastrointest Endosc 2008;36(1):48-51.   Published online January 30, 2008
AbstractAbstract PDF
A ganglioneuroma is a benign tumor composed of ganglion cells, nerve fibers, and supporting cells that originates from the neural crest. An occurrence of a ganglioneuroma is mainly along the pathway of the sympathetic chain. However, it is rare to find the lesion in the gastrointestinal tract. A ganglioneuroma of the gastrointestinal tract appears to involve predominantly the colon and rectum, but rarely involves the upper gastrointestinal tract. An intestinal ganglioneuroma is divided into three subgroups: a polypoid ganglioneuroma, ganglioneuromatous polyposis, and diffuse ganglioneuromatosis. A polypoid ganglioneuroma is not associated with systemic disease. However, ganglioneuromatous polyposis and diffuse ganglioneuromatosis are highly associated with systemic diseases. A 33-year-old woman who had no specific family history visited our institution with a complaint of abdominal discomfort. A single polyp was found incidentally in the descending colon during a colonoscopy and it was treated by snare polypectomy. The patient had no associated systemic disease and histology of the polyp revealed a ganglioneuroma. We report a patient with a polypoid ganglioneuroma of the colon. (Korean J Gastrointest Endosc 2008;36:48-51)
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A Case of Small Cell Carcinoma of the Rectum Associated with Ulcerative Colitis
Yoon Jung Kim, M.D., Eun Uk Jung, M.D., Myoung Joo Kang, M.D., Sang Won Park, M.D., Paul Choi, M.D., Ji Hyun Kim, M.D., Sung Jae Park, M.D., Sam Ryong Jee, M.D., Eun Taek Park, M.D., Youn Jae Lee, M.D., Sang Hyuk Lee, M.D. and Sang Young Seol, M.D.
Korean J Gastrointest Endosc 2008;36(1):52-55.   Published online January 30, 2008
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Small cell carcinoma associated with ulcerative colitis is a rare malignancy of the colon, so we report here on a case of small cell carcinoma (SCC) of the large bowel. A 60-yr-old woman had been diagnosed with ulcerative colitis about 10 years previously, and she was then continuously treated with 5-ASA. Colonoscopy was being done every two years for cancer surveillance. The last colonoscopy was done 16 months previously. At that time, colonoscopic finding was mild left side colitis. She was hospitalized because of severe abdominal pain and acute constipation that developed 2 weeks previously. During the colonoscopic examination, an obstructive mass was noted on the rectum. Pathology revealed small cell carcinoma. NSE (neuron specific enolase) and Synaptohpysin were strongly positive. Chromogranin and Cytokeratin were focally positive to a weak degree. So, the patients received a Hartmann's operation (T-colostomy). The mass had grossly invaded the adjacent peritoneum and serosa. Therefore, only the mass was removed. She then received chemotherapy with cisplatin and irinotecan for 2 cycles. She achieved a stable state 2 months after the operation. Only a few cases of colorectal SCC associated with ulcerative colitis have been reported, and its etiology remains unknown. Thus, we report here on a small cell carcinoma arising from ulcerative colitis. (Korean J Gastrointest Endosc 2008;36:52-56)
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