For neoplasms with undifferentiated histology (PD or SRC), short-term endoscopic follow-up may help to detect residual tumors that form after complete resection via ER. For EGC, the lateral margin may be considered safe if greater than 3 mm. However, the possibility of satellite lesions should be investigated when the gastric adenoma to be resected is surrounded by severe IM.
Background/AimsProton pump inhibitor-responsive esophageal eosinophilia (PPI-REE) is a newly recognized form of eosinophilic esophagitis (EoE) that responds to PPI therapy. It remains unclear whether PPI-REE represents a subphenotype of gastroesophageal reflux disease, a subphenotype of EoE, or its own distinct entity. The aim was to evaluate the clinicopathologic features of PPI-REE.MethodsSix patients were diagnosed with PPI-REE based on symptoms, endoscopic abnormalities, esophageal eosinophilia with ≥15 eosinophils/high-power field, and a response to PPI treatment. Symptoms and endoscopic and pathological findings were evaluated.ResultsThe median follow-up duration was 12 months. Presenting symptoms included dysphagia, heartburn, chest pain, foreign body sensation, acid reflux, and sore throat. All patients had typical endoscopic findings of EoE such as esophageal rings, linear furrows, nodularity, and whitish plaques. Three patients had a concomitant allergic disorder, and one had reflux esophagitis. Four patients exhibited elevated serum IgE, and five had positive skin prick tests. All patients experienced symptomatic resolution within 4 weeks and histologic resolution within 8 weeks after starting PPI therapy. There was no symptomatic recurrence.ConclusionsPPI therapy induced rapid resolution of symptoms and eosinophil counts in patients with PPI-REE. Large-scale studies with long-term follow-up are warranted.
A 24-year-old man was admitted due to an incidentally detected mass in his left testis, which showed radiopaque calcification on plain X-ray film. Left orchiectomy was performed, and the resected testis contained a well-demarcated, hard mass measuring 1.1 cm. Histological analysis revealed that the tumor was composed of neoplastic cells, fibrotic stroma, and laminated or irregularly shaped calcific bodies. The individual cells had abundant eosinophilic or clear cytoplasm with round nuclei, each of which contained one or two conspicuous nucleoli. They were arranged in cords, trabeculae, clusters, and diffuse sheets. There were several foci of intra-tubular growth patterns, with thickening of the basal lamina. Immunohistochemically, the neoplastic cells were positive for S-100 protein and vimentin, focally positive for inhibin alpha, and negative for cytokeratin, CD10, and Melan-A. In addition to reporting this rare case, we also review the relevant literature regarding large cell calcifying Sertoli cell tumors.
Objective Iron-deficiency anemia (IDA) is the most common nutritional deficiency worldwide. However, the information concerning various causes of IDA in adult men is still insufficient. The aim of our study was to evaluate adult men with IDA. Methods We prospectively studied 206 adult men with IDA. All subjects had a direct history taken and underwent a physical examination. Esophagogastroduodenoscopy was performed in most patients, and colonoscopy was conducted if no lesion causing IDA was found or the fecal occult blood test was positive. Results The history of prior gastrectomy and blood-letting cupping therapy that probably had caused IDA were reported in 24 (11.7%) and 11 (5.3%) patients, respectively. In terms of potential causes of IDA, 68 (33.0%) patients were found to have upper gastrointestinal disorders (34 peptic ulcers, 17 erosive gastritis, 16 gastric cancers, and one gastrointestinal stromal tumor). Colonoscopy showed 42 (20.4%) clinically relevant lesions that probably caused IDA: colon cancer (five patients), colon polyps (14 patients), ulcerative colitis (one patient), and hemorrhoids (22 patients). One small bowel tumor was detected at small bowel series. Concerning malignant lesions that were responsible for IDA, 22 malignant lesions were found in patients of 50 years or older, accounting for 16.8% (22 of 131 patients), while only one (1.3%) early gastric cancer was found in the younger patients. Conclusion This study demonstrated that gastrointestinal blood loss is the main cause of IDA in adult men, and that there is a high rate of malignancy in men older than 50 years, emphasizing the need for a complete, rigorous gastrointestinal examination in this group of patients. Considering blood-letting cupping therapy, there is a need to consider culture-specific procedures as a possible cause of IDA.
2054 Background: Iron-deficiency anemia (IDA) is the most common nutritional deficiency worldwide and occurs in 3.5–5.3% of adult men and postmenopausal women. However, the information concerning various causes of IDA in adult men is rare, although it is assumed that chronic gastrointestinal blood loss accounts for the majority. The aim of our study is to prospectively evaluate adult men with IDA. Methods: One hundred and seventy-nine patients with IDA participated in the study from January 2003 to December 2009. Anemia was defined as Hg < 13g/dL using the WHO criteria. IDA was considered present if serum ferritin was 15 ng/mL combined with serum iron concentration < 30 ug/dL with a transferrin saturation of < 10%. However, in patients with IDA as well as inflammatory conditions, serum ferritin < 50 ng/mL in association with RBC MCV of 80 fL with a transferrinn saturation <10% was considered diagnostic IDA. Direct history including blood-letting cupping therapy was obtained. Complete physical examination and fecal occult blood test (FOBT) of three spontaneously passed stools was done in all patients. All patients had complete blood count, serum and total iron binding capacity, and a serum ferritin level. Most patients underwent esophagogastroduodenoscopy (EGD). Colonoscopy was performed if lesion that caused IDA was not found, and/or FOBT was positive. As an additional test, abdominal CT scan or small bowel series were performed according to clinician's discretion. Results: The median age was 56 (range 18 to 86) years old. 158 of 179 (88%) men with IDA had symptoms such as fatigue, dyspnea on exertion, dizziness, or digestive complaints. The history of prior gastrectomy, hemorrhoid, blood-letting cupping therapy that probably had caused IDA were reported in 19 (10.6%), 27 (15.1%), and 10 (5.6%) patients, respectively. FOBT was positive in only 17 (9.5%) subjects. 158 (88.3%) patients underwent EGD. The most common findings from EGD were gastritis (44 patients) and peptic ulcer (29 patients). In terms of finding potential gastrointestinal causes of IDA, fifty-eight (32.4%) patients were found to have upper gastrointestinal disorders (15 patients with erosive gastritis, 18 gastric ulcer, 10 duodenal ulcer, 14 gastric cancer and one gastric gastrointestinal tumor). Ninety-five (53.1%) patients underwent colonoscopy. Evaluation with colonoscopy showed 39 clinically important lesions that probably caused IDA; colon cancer in 5 (2.8%) patients, colon polyp in 12 (6.7%) patients and hemorrhoid in 22 (12.3%) patients. The yield rate of EGD and colonoscopy were 36.7% and 30.5%, respectively. Concerning malignant lesions which were responsible for IDA, 20 malignant lesions were found in patients older than 50 years accounting for 18.7% (20/107 patients). However, about patients younger than 50 years, only one early gastric cancer was found. Conclusions: This prospective study demonstrated that gastrointestinal blood loss is the main cause of IDA in adult men, and that there is a high rate of malignancy in men older than 50 years, emphasizing a complete and rigorous gastrointestinal examination in this group of patients. Taking into account blood-letting cupping therapy, in addition, there is a need to consider culture-specific procedures such as cupping therapy as possible cause of IDA of unknown cause. Disclosures: No relevant conflicts of interest to declare.
Thanks to the introduction of immumomodulators and biologics, therapeutic approaches in Crohn's disease have changed significantly during the past decade. Although new biologic therapy has dramatically improved the treatment of Crohn's disease, a substantial number of patients are refractory to these therapies or lose their initial response. Methotrexate (MTX) is a structural analogue of folic acid that can competitively inhibit the binding of dihydrofolic acid to the enzyme dihydrofolate reductase and has been widely used as immunomodulator in rheumatology area for patients with rheumatoid arthritis and psoriasis. Although MTX has also been shown to be an effective agent for remission induction and maintenance of remission in Crohn's disease, the use of MTX in Crohn's disease has not yet been reported in Korea. Herein, we report a case of Crohn's disease patient who was successfully treated with MTX after treatment failure with thiopurine and anti-tumor necrosis factor.
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