Clinical Endoscopy

원저 : 식도 위장관 ; 실리콘 피막형 인공식도관을 이용한 악성식도협착 및 식도기관지누공의 치료 ( Original Articles : Esophagus , Stomach & Intestine ; Silicone - Covered Self - Expandable Metal Stents for the Palliation of Malignant Esophageal Obstruction and Esophagorespiratory Fistulas ): Korean J Gastrointest Endosc 1998;18(1):1-10. Published online November 30, 1997

Abstract PDF: Background
Esophageal cancer can induce progressive dysphagia and occasionally develop esophagorespiratory fistulas. Surgically incurable disease is present in over 60% of patients at the time of presentation and in such a means, relief of dysphagia is one of the important treatment modes in the majority of these patients. Implantation of stents is widely used for improvement of dysphagia and sealing of esophagorespiratary fistulas. Methods: Silicone-covered self-expandable metal stents were used in 19 consecutive patients with malignant esophageal obstruction(n=14) or esophageal obstruction with esophagorespiratory fistulas (n=5). Results: The stents were successfully inserted in all patients. Dysphagia improved in 18 of 19 patients(95%). All fistulas were sealed and symptoms due to bronchial aspiration disappeared. Complications occurred during follow-up including chest pain(11 patients), aspiration pneumonia(4 patients), reflux esophagitis(2 patients), stent migration(2 patients), tumor overgrowth(2 patients) and hemorrhage(1 patient). Three of the 4 patients with aspirtion pneumonias and a patient with hemorrhage suffered from dysfunction of upper esophageal sphincter after implantation of stents in upper esophageal carcinoma. But, Tumor ingrowth and perforation did not occur. Two patients died of massive hemorrhage and respiratory failure caused by aspiration pneumonia. Conclusion: These results suggest that implantation of silicone-covered self-expandable metal stents is a rapid and effective procedure for the palliative treatment of malignant esophageal obstruction and esophagorespiratory fistulas. (Korean J Gastrointest Endosc 18: 1-10, 1998)

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원저 : 식도 위장관 ; 기능성 소화불량증 환자에서 Helicobacter pylori 의 유형에 따른 위 조직학적 소견 및 혈청 위펩티드 농도 ( Original Articles : Esophagus , Stomach & Intestine ; Gastric Histopathology and Serum Levels of Gastric Peptides according to Types of Helicobacter Pylori in Patients with Functional Dyspepsia ): Korean J Gastrointest Endosc 1998;18(1):11-20. Published online November 30, 1997

Abstract PDF: Background
/Aims: Clinical isolates of Helicobacter pylori(H. pylori) can be divided into at least two major types. Type I bacteria express VacA(vacuolating cytotoxin) and CagA(cytotoxin-associated antigen), type II bacteria do not exp~ress VacA or CagA. The purpose of this study is to evaluate the changes of gastric histology and serum level of gastric peptides(gastrin and pepsinogen) according to the bacteriological types in H. pylori infection. Methods: In patients with H. pylori-positive functional dyspepsia, we classified the type of infection serologically by detecting IgG antibodies to CagA and VacA. Each patient was also evaluated for the degree of gastric inflammation and serum concentrations of gastrin and pepsinogen(PG). IgG antibodies to these proteins and concentrations of gastrin and PG were detected by using a immuno-blot kit and a radioimmunoassay kit, respectively, from the sera of each patient. From endoscopically biopsied antral specimens, the degree of gastric inflammation was evaluated by scoring inflammatory changes. (Korean J Gastrointest Endosc 18: 11-20, 1998)

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원저 : 식도 위장관 ; 만성 간질환에서 Indocyanine Green 정맥투여 후의 복강경 검사소견 ( Original Articles : Esophagus , Stomach & Intestine ; Peritoneoscopic Examination of the Liver Disease Stained by Intravenous Injection of Indocyanine Green ): Korean J Gastrointest Endosc 1998;18(1):21-24. Published online November 30, 1997

Abstract PDF: Background
/Aims: Peritoneoscopy allows the clinician to assess the activity of the surface of the liver and helps him to make a prognosis in cases of liver disease by judging the structural changes of the surface. In chromoperitoneoscopy using an intravenous injection of indocyanine green(ICG), hepatic parenchyme is stained after intravenous injection of ICG while interstitial connective tissue, fatty deposition and hepatoma are not. So diagnostic accuracy is, therefore believed to be elevated in chromoperitoneoscopy than conventional peritoneoscopy or blind liver biopsy. This study was performed to assess the clinical usefulness of chromoperitoneoscopy in various chronic liver diseases. Methods: Intravenous ICG was administered at 2 mg/Kg mixed with 20 cc of saline in 30 cases with several kinds of hepatic disorders during conventional peritoneoscopic examinatians. Liver surface was examined 5 minutes after ICG injection. (Korean J Gastrointest Endosc 18: 21-24, 1998)

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원저 : 담도 췌장 ; 담석췌장염의 진단과 치료에서 조기 내시경적 시술의 유용성 ( Original Articles : Biliary Tract & Pancreas ; Effectiveness of Early Endoscopic Procedures on the Diagnosis and Treatment of the Gallstone Pancreatitis ): Korean J Gastrointest Endosc 1998;18(1):25-32. Published online November 30, 1997

Abstract PDF: Background
/Aims: Gallstone pancreatitis has showed higher mortality and morbidity rate as compared to other causes of pancreatitis, and the proper timing of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) is still controversial. But recent several trials reveals early ERCP/EST is safe procedure and can reduce mortality and complication rate in gallstone pancreatitis. Methods: To assess the safety and effectiveness of early ERCP/EST, we perfomed ERCP and EST, if necessary, in 40 cases of acute gallstone pancreatitis. Results: 1) Early ERCP group (in 72 hours) were 27 cases, delayed group were 13 cases, and 11 early EST group, 16 delayed EST group. No statistically significant difference was found between two groups in blood chemistry and the severity of pancreatitis according to Ranson's criteria, respectively. No remarkable complication due to ERCP or EST was noted, and the hospital days were shorter in early ERCP/EST group with statistical significance, 2) Duodenoscopic findings show 14 normal papillae, 20 papillary edema, hemorrhagic and lacerated papillae in 6 cases. Conclusion: In cases of gallstone pancreatitis, early ERCP and EST is considered as a safe and effective treatment modality. (Korean J Gastrointest Endosc 18: 25-32, 1998)

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원저 : 담도 췌장 ; 경피경간적 담도내시경법에 의한 폐쇄성 담도질환의 진단 및 치료 ( Original Articles : Biliary Tract & Pancreas ; The Evaluation and Treatment of the Obstructive Biliary Disease through the Percutaneous Transhepatic Choledocoscopy ( PTCS ) ): Korean J Gastrointest Endosc 1998;18(1):33-39. Published online November 30, 1997

Abstract PDF: Background
/Aims: Obstructive jaundice is developed from the cholangiocarcinoma, biiliary tract stone, biliary benign stricture and pancreatic head cancer and is rapidly progress to cholangitis or sepsis. So early decompression, accurate diagnosis and treatment are very important. Percutaneous transhepatic choledocoscopy(PTCS) and endoscopic retrograde choledocoscopy(ERCS) have been used for evaluation of the obstructive jaundice. We performed, through the PTCS, electrohydraulic lithotripsy(EHL) for biliary tract stone rernoval, biopsy for diagnosis of biliary stric and self expandible metalic coil stent(EndocoilTM stent, Instent Co.) insertion on biliary stricture to evaluate the usefullness of PTCS in patients with obstructive jaundice. Methods: Between Auguest 1994 and September 1995, PTCS was performed in 37 patients with obstructive jaundice. First, percutaneous transhepatic biliary drainage(PTBD) with 7Fr. drainage tube was done. Three days later, we exchainged the 7Fr. drainage tube with 16Fr.. Seven days later, through the PTCS, we performed EHL, biopsy and EndocoilTM stent insertion. (Korean J Gastrointest Endosc 18: 33-39, 1998) (continue)

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원저 : 담도 췌장 ; 내시경적 제거가 곤란한 총담관결석 환자에서 영구적 담관배액술의 효과 ( Original Articles : Biliary Tract & Pancreas ; Long-Term Effect of Permanent Biliary Stenting for Endoscopically Unextractable Common Bile Duct Stone(s) ): Korean J Gastrointest Endosc 1998;18(1):40-50. Published online November 30, 1997

Abstract PDF: Background
/Aims: Endoscopic sphincterotomy(EST) has become a well-established therapeutic modality for common bile duct stone(s). EST and subsequent stone extraction, including mechanical lithotripsy, can clear bile duct in 85% to 95% of patients. Other therapeutic modalities which have been developed to enhance bile duct clearance including extracorporeal shock-wave lithotripsy, electrohydraulic or laser lithotripsy, and chemical dissolution are high cost, not yet widely available especially in community hospital, yet to be perfected, or still under clinical evaluation. The use of biliary stenting has been proposed as an alternative therapy for patients at high risk for surgery. We carried out this prospective, controlled study to evaluate the long-term effect of biliary stenting for endoscopically unextractable common bile duct stone(s). Methods: Of the 233 patients with common bile duct stone(s) admitted at Gil Hospital from Jan. 1995 to Dec. 1996, the stent group were 14 patients with retained comrnon bile duct stone(s) in which 7Fr polyethylene biliary stent was placed with the proximal end above the stone and the distal end in the duodenum. The control group were 6 patients with common bile duct stone(s) not treated, because of patients refusal of surgical or endoscopic management. Follow-up was achieved by direct interview and telephone, and consisted of prospective analysis of all complications that occured during long-term follow-up period. Complication rates in the both groups were compared using chi-square test and cumulative complication-free rates were calculated by Kaplan-Meier analysis. (Korean J Gastrointest Kndosc 18: 40-50, 1~998) (continue)

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원저 : 담도 췌장 ; Modified Gianturco Z 담도배액관을 이용한 ERBD 법 ( Original Articles : Biliary Tract & Pancreas ; Endoscopic Application of Modified Gianturco Z Biliary Stent ): Korean J Gastrointest Endosc 1998;18(1):51-59. Published online November 30, 1997

Abstract PDF: Palliative treatment of malignant biliary obstructions represent the principal indications of endoscopic or percutaneous transhepatic implantation of endoprostheses. Many kinds of biliary stents have been used to maintain patency of the bile ducts obstructed by benign or malignant strictures. However, the biliary stent in current use, has a tendency to become blocked. In order to maintain a long-term stent patency before clogging, biliary stents with large diameters are needed and some kinds of expandable metal stents are proposed. The Hanaro stent(Sooho medi-tech Co. LTD, Seoul, Korea) is a modified Gianturco Z biliary stent, made of 0,01-inch stainless steel wire with a zigzag pattern. It has a spiral, cylindrical configuration and is 10 mm in expanded diameter. It hes been used only with the percutaneous transhepatic technique. In this article, we describe a new method for endoscopic retrograde placement of a modified Gianturco Z biliary stent. This report describes our experience on endoscopic application of a modified Gianturco Z biliary stent in a patient with malignant obstruction of the distal common bile duct. (Korean J Gastrointest Endosc 18: 51-57, 1998)

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증례 : 식도 위장관 ; Plummer - Vinson 증후군의 내시경적 풍선확장술 치험 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Plummer - Vinson Syndrome Treated with Endoscopic Balloon Dilatation ): Korean J Gastrointest Endosc 1998;18(1):61-65. Published online November 30, 1997

Abstract PDF: Plummer-Vinson syndrome is characterized by dysphagia associated with anemia, glossitis and esophageal web. The cause of this syndrome is still not clear, but the most important one is thought to be the iron deficiency. The patient with small sized ageal web is treated by administration of iron but large sized web with dyspha gia requires breakage of web. In the following case report, we describe a patient with Plummer-Vinson syndrome who showed clinical improvement after treatmeat with endoscopic balloon dilatation of upper esophageal web with a review of literatures. (Korean J Gastrointest Endosc 18: 61-65, 1998)

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증례 : 식도 위장관 ; 인공식도관 삽입으로 치료한 결핵에 의한 식도-기관지누공 환자 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Tuberculous Esophagorespiratory Fistula Managed by Silicone - Covered Self - Expendable Metal Stent ): Korean J Gastrointest Endosc 1998;18(1):66-70. Published online November 30, 1997

Abstract PDF: Esophagorespiratory fistulas resulting from Mycobacterium tuberculosis infection are rare. Whereas most esophagorespiratory fistulas are absolute indication for direct surgical closure, this may not be necessary in the case of those of tuberculous origin. If diagnosed early, the infection and the complicating fistula could be treated effectively with anti- tuberculous chemotherapy without the need for surgical intervention. Despite the sugges- tion of a trend away from direct surgical closure in recent years, it seems that anti tuberculous chemotherapy may not result in healing of the fistula in all patients. So we report a case of tuberculous esophagorespiratory fistula that has severe aspiration pneumorua and effectively treated with implantation of silicone-covered self-expandable metal stent and antituberculous chemotherapy. (Karean J Gastrointest Endosc 18: 66- 70, 1998)

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증례 : 식도 위장관 ; 다발위암을 동반한 원발성 식도 위 중복암 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Synchronous Multiple Primary Cancers in Esophagus and Stomach with Mutiple Gastric Cancers ): Korean J Gastrointest Endosc 1998;18(1):71-75. Published online November 30, 1997

Abstract PDF: A case of synchronous multiple primary esophageal squamous cell carcinomas and multiple gastric adenocarcinomas is reported. The lesions were found on gastrofiberscopic examination for the evaluation of dysphagia and epigastric pain. The esophageal lesions were 2 ulceromfiltrating mass lesions at mid- and lower esophagus and 2 lesions were separated by normal mucosa. The main leiosn of stomach was an ulcerative one (Borrmanns type II) on lower body and the accessory lesion was an EGC IIc like lesion on antrum and 2 lesions were independent. (Korean J Gastrointest Endosc 18: 71-74, 1998)

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증례 : 식도 위장관 ; 국소 선암을 동반한 위선종의 내시경적 절제 후 다른 부위에 새로 발생한 위선종 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of a Newly Developed Adenoma at Different Gastric Location after Endoscopic Excision of the Adenoma with Focal Carcinoma ): Korean J Gastrointest Endosc 1998;18(1):77-80. Published online November 30, 1997

Abstract PDF: Adenomas of the stomach are true neoplasms, representing 8-10% of epithelial gastric polyps. Gastric adenomas are well known to be associated with malignancy and can be regarded as having significant malignant potential. If technically feasible, they should therefore be removed completely by snare cautery and laser therapy. There have been few reports about the newly developed adenomas at other gastric locations after removal or during follow-up surveillance of the primary lesion. We report a case of gastric tubular adenoma which developed at other gastric location after endoscopic mucosectomy. (Korean J Gastrointest Endosc 18: 77-80, 1998)

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증례 : 식도 위장관 ; 위전정부 혈관확장증 ( Gastric antral vascular ectasia ) 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Watermelon Stomach ( Gastric Antral Vascular Ectasia ) ): Korean J Gastrointest Endosc 1998;18(1):81-85. Published online November 30, 1997

Abstract PDF: Watermelon stomach or gastric antral vascular ectasia is a rare disorder causing gastric blood loss and iron deficicncy anemia. Endoscopically, it has characteristic thickened red vascular folds radiating from the pylorus to the antrum. This condition is often mis- diagnosed as antral hemorrhagic gastritis. Diagnosis is made primarily by endoscopy. Histologic examination of the endoscopic mucosal biopsies may confirm the endoscopic diagnosis. Treatment for watermelon stomach includes steroids, estrogen-progesterone combinations, somatostatin antagonists, tranexamic acid, heater probe, and laser therapy. Herein we report a case of watermelon stomach presenting with general weakness and persistent iron deficiency anemia for about 2 years in a 70-year-old woman. (Korean J Gastrointest Endosc 18: 81-84, 1998)

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증례 : 식도 위장관 ; 출생 직후 신생아에서의 내시경적 위장관 이물 제거 3예 ( Case Reports : Esophagus , Stomach & Intestine ; Endoscopic Removal of Gastrointestinal Foreign Bodies in 3 Newborn Infants Immediately after Birth ): Korean J Gastrointest Endosc 1998;18(1):87-91. Published online November 30, 1997

Abstract PDF: Since the introduction of flexible fiberoptic endoscope in clinical medicine from the early 1970s, the size of the caliber has become gradually so smaller and more functional as to be available in children and even in newborn infants. And the indications of gastrointestinal endoscopy have been extended not only to the diagnosis and evaluation of gastrointestinal diseases, but also to the effective management. Foreign body removal is one of the most important indications of therapeutic endoscopy in children. We have successfully removed foreign bodies in 3 newborn infants, using flexible endascope(0; 7.9 mm) without general anesthesia. They were one Nelaton catheter and two DeLee suction catheters which had been incidentaly broken during neonatal routine care in a delivery room. In the case of DeLee suction catheter ingestion, the end of the broken plastic bulb was snared and withdrawn carefully not to injure the esophageal mucosa by its sharp edge. All of the newborn infants got well thereafter and were discharged without any complications. We could avoid the general anesthesia and laparotomy by using flexible endoscope, and these 3 therapeutic endoscopic cases of newborn infants are the youngest patients reported so far. We hereby emphasize that foreign body can be removed easily and safely with routine gastrointestinal endoscope even in newborn infants. (Korean J Gastrointest Endosc 18: 87-91, 1998)

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증례 : 식도 위장관 ; 간 전이 소견없이 유암 증후군을 동반한 십이지장 구부의 유암종 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Duodenal Bulb Carcinoid Tumor Causing a Carcinoid Syndrome without Liver Metastasis ): Korean J Gastrointest Endosc 1998;18(1):92-98. Published online November 30, 1997

Abstract PDF: A primary duodenal carcinoid tumor causing carcinoid syndrome is rare. In case of accompanying carcinoid syndrome in a primary duodenal carcinoid tumor, it mostly suggests massive liver metastasis. In rare case, venous drainage of carcinoid tumor and systemic venous drainage are directly connected without passing through the portal system. Therefore, it is rare and interesting case which a primary duodenal carcinoid tumor accompanies carcinoid syndrome without liver metastasis. We experienced an occasion of a primary carcinoid tumor located in duodenal bulb in a 56 year-old woman. This patient came to our hospital because of intermittent diarrhea, epigastric pain and facial flushing. And it was surely diagnosed as carcinoid tumor by gastrointestinal endoscopic biopsy. She was hospitalized for surgery and we were able to confirm that carcinoid syndrome was accompanied through biochemical test. However, metastatic lesion was not found at liver, small and large intestine. We report this case with reference to documents due to rarity. (Korean J Gastrointest Endosc 18: 92-98, 1998)

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증례 : 식도 위장관 ; 장결핵에 의한 장중첩증 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Intussusception Induced by Intestinal Tuberculosis ): Korean J Gastrointest Endosc 1998;18(1):99-105. Published online November 30, 1997

Abstract PDF: Although intussusception is primarily a disease of children, about 5 to 10 percent of cases occur in adults. The underlying causes of adult intussusception are tumor, postoperative complication, local bowel ischemia, abnormal motility and rarely intestinal tuberculosis. Recently, we experienced a 62-year-old man with intussusception underlying pulmonary tuberculosis. The postoperative pathologic finding was intestinal tuberculosis. For its rarity, we report this case with review of literatures. (Korean J Gastrointest Endosc 18: 99-104, 1998)

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증례 : 식도 위장관 ; Depletion Syndrome 을 동반한 직장 융모성 선종 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Villous Adenoma with Depletion Syndrome ): Korean J Gastrointest Endosc 1998;18(1):107-110. Published online November 30, 1997

Abstract PDF: Massive secretory diarrhea with pre-renal insufficiency, hyponatremia, hypokalemia and metabolic alkalosis or acidosis is associated with some large villous adenomas of the rectum and is called with depletion syndrome. This characteristic fluid and electrolyte depletion syndrome is caused by secretion of sodium, potassium, and fluid from the tumor. PGE2 formation in the villous adenoma appears to be the cause of fluid secretion by the abnormal tumor epithelium. Surgical removal of villous adenoma is the only promising therapy, In case of inoperability, denial of surgical intervention or just for palliative treatment prior to surgery, the use of PG synthetase inhibitors may facilitate the correction of severe fluid-electrolyte deficits. We reported a case of large villous adenoma of the rectum with depletion syndrome aceompanied by secretory diarrhea and fluid and electrolyte depletion with metabolic alkalosis due to severe vomiting. (Korean J Gastrointest Endosc 18: 107-110, 1998)

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증례 : 담도 췌장 ; 담도의 다발성 유두종 1예 ( Case Reports : Biliary Tract & Pancreas ; A Case of Biliary Papillomatosis which Underwent Curative Resection ): Korean J Gastrointest Endosc 1998;18(1):111-115. Published online November 30, 1997

Abstract PDF: Biliary Papillomatosis is an extremely rare pathologic entity. Only about 40 cases of intrahepatic or diffuse intra- and extrahepatic papillomatosis have been described since the first report in 1959 by Caroli. Although this is a histologically benign lesion, its course is unfavaurable because of its tendency to extend to the entire biliary tract, high recurrence rate following local excision and the probability of progression to malignancy. We described herein a case of biliary papillomatosis associated with diffuse bile duct dilatation. The patient, a 59-year-old male, was admitted to our hospital because of right upper abdominal pain and weight loss. Cholangiogram revealed multiple round filling defects in common hepatic duct with intrahepatic bile duct dilatation. The patient underwent Whipple's operation with right lobectomy. Grossly, multiple small pin-head sized polypoid masses were seen in common bile duct, common hepatic duct and right intrahepatic duct. Microscapically, papillary epithelial hyperplasia with moderate cellular atypia was seen and there was no evidence of stromal invasion. He is healthy with a follow-up for 7 months. (Korean J Gastrointest Endosc 18: 111-114, 1998)

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증례 : 담도 췌장 ; 담낭 이중조영술이 진단에 유용했던 만성 담낭염 1예 ( Case Reports : Biliary Tract & Pancreas ; A Case af Chronic Cholecystitis Diagnosed with Double Contrast Study of the Gallbladder ): Korean J Gastrointest Endosc 1998;18(1):117-121. Published online November 30, 1997

Abstract PDF: The combined diagnostic modalities using abdominal ultrasound, endoscopic ultrasound and endascopic retrograde cholangiopancreatogram are useful for the diagnosis of gall bladder disease. But, these diagnostic methods have limitations for the detection of early flat-type gallbladder cancer. To cope with these problems, double contrast study of gallbladder disease is being recently used to diagnose the flat-type cancer of gallbladder in Japan. Herein we report a case of chronic cholecystitis confirmed histologically and assisted by double contrast method of gallbladder, which was diagnosed as a gallbladder polyp by abdominal sonogram at first. The method requires the cystic duct cannulation and placement of the catheter to the gallbladder. And then Barium sulfate and CO2 are injected through the catheter. The patient didnt experience any complication during and after this procedure except for hyperamylasemia. After the simple cholecystectomy, he improved completely. In conclusion, double contrast study of gallbladder can be useful in the diagnosis of the gallbladder disease and compensate for the other dignostic tools. (Korean J Gastrointest Endosc 18: 117-121, 1998)

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증례 : 담도 췌장 ; 특이한 역행성췌담관 조영술 소견을 보인 황색 육아종성 담낭염 1예 ( Case Reports : Biliary Tract & Pancreas ; Unusual Endoscopic Retrograde Cholangiographic Finding in a Case of Xanthogranulomatous Cholecystitis ): Korean J Gastrointest Endosc 1998;18(1):122-128. Published online November 30, 1997

Abstract PDF: Xanthogranulomatous cholecystitis is a rare form of chronic gallbladder inflammation that is characterized by a severe proliferative fibrosis and has rarely been described in the radiologic literature. Like xanthogranulomatous pyelonephritis, it is an entirely benign but unusual expression of a reactive process and may be confused with a malignant neoplasm. Histologically, foamy histiocytes, multinucleated giant cells, other inflammatory cells, fibrous reaction with spindle cells, cholesterol cleft and noncaseating granuloma were found. Treatment of this benign inflammatory condition requires cholecystectomy to remove the focus of inflammation, control subsequent infection and relieve symptoms A case of xanthogranulomatous cholecystitis mimiking carcinoma of the gallbladder on abdominal USG, abdominal CT, and ERCP examination is presented with brief review of the literature (Korean J Gastrointest Edosc 18: 122-128, 1998)

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증례 : 담도 췌장 ; 특이한 췌관 조영술 소견을 보인 췌장 편평상피 선암 ( Adenosquamous carcinoma ) 1예 ( Case Reports : Biliary Tract & Pancreas ; A Case of Adenoequamous Carcinoma of the Pancreas with Unusual Pancreatographic Findings ): Korean J Gastrointest Endosc 1998;18(1):129-135. Published online November 30, 1997

Abstract PDF: Adenosquamous carcinoma of the pancreas is a rare form of pancreatic cancer. Its biological behavior and clinical features are known to be similar to the much more common ductal adenocarcinoma or to pure squamous cell carcinoma, another rare form of pancreatic malignancy. However, the unusual manifestations of cancer, including cystic degeneration and extravasation of contrast to the mass, have also been reported. A 64-year-old man was admitted complaining of abdominal pain. An abdomial CT scan demonstrated an ovoid and cyst-like lesion in the pancreatic head and endoscopic retrograde balloon pancreatography showed segmental narrowing of the main pancreatic duct associated with extravasation of contrast into the cyst-like lesion. Under the impression of pancreatic pseudocyst with chronic pancreatitis, medical therapy including pancreatic stent insertion was given to the patient for four weeks. Finally, a laparotomy was performed due to persistent abdominal pain and a poorly demarcated mass with cystic cavity was resected. Histologic findings were consistent with adenosquamous carcinoma of the pancreas. The unusual features of this rare malignancy which led us to an errorneous initial diagnosis were emphasized. (Korean J Gasitrointest Endosc 18: 129-133, 1997)

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