Publications by authors named "Jae-Woon Choi"

35 Publications

Spontaneous heterotopic mesenteric ossification around the pancreas causing duodenal stenosis: A case report with literature review.

Int J Surg Case Rep 2021 Apr 6;81:105702. Epub 2021 Mar 6.

Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea. Electronic address:

Introduction And Importance: Heterotopic mesenteric ossification (HMO) is a rare condition that can be hereditary or nonhereditary. It can lead to small bowel obstruction, which may require corrective surgery. Most affected patients have a history of abdominal surgery or trauma. Spontaneously occurring HMO is even rarer, with only 7 cases reported till date. There has been no previous report of spontaneous peripancreatic HMO.

Case Presentation: A 60-year-old man presented with complaints of recurrent nausea and vomiting for 2 months. Esophagogastroduodenoscopy revealed luminal stenosis and edematous changes involving the second and third parts of the duodenum but not its complete obstruction. Abdominopelvic computed tomography showed faintly enhanced thickening of the involved duodenal walls along with mild dilatation of the common bile duct. Considering the possibility of periampullary cancer, we performed a pylorus-preserving pancreaticoduodenectomy. Histopathological examination confirmed the diagnosis of HMO with extensive fibrosis involving the peripancreatic soft tissue.

Clinical Discussion: The peripancreatic HMO with severe fibrosis can occur duodenal stenosis, and it is mimicking periampullary cancer. However, the preoperative diagnosis of spontaneous HMO is difficult, and a diagnosis confirmed after surgery.

Conclusion: Herein, we described our experience of managing a rare case of duodenal stenosis due to spontaneous HMO involving peripancreatic tissue.
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http://dx.doi.org/10.1016/j.ijscr.2021.105702DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8073193PMC
April 2021

Round Ligament Traction Method During Laparoscopic Hemihepatectomy (with Video).

J Gastrointest Surg 2021 03 19;25(3):861-865. Epub 2021 Jan 19.

Department of Surgery, College of Medicine and Medical Research Institute, Chungbuk National University, Cheong-ju, Republic of Korea.

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http://dx.doi.org/10.1007/s11605-020-04788-zDOI Listing
March 2021

Laparoscopic management for stump appendicitis: A case series with literature review.

Medicine (Baltimore) 2019 Nov;98(47):e18072

Department of Surgery, Chungbuk National University Hospital.

Introduction: Appendectomy is one of the most common emergency surgical operations. Stump appendicitis is a rare complication after appendectomy and is caused by acute inflammation of the remnant part of the appendix. Because of the low index of suspicion owing to a previous history of appendectomy, the diagnosis of stump appendicitis is often delayed.

Methods: Between January 2008 and December 2017, 6 patients were diagnosed with stump appendicitis with or without perforation at a single institution. They had undergone operative management with laparoscopic approach. The clinical data of these patients were retrospectively analyzed by reviewing the medical records and pathologic reports.

Results: Five patients were male, with a mean age of 42.4 years (range 11-77 years). The time interval after initial appendectomy ranged from 2 weeks to 30 years. Three patients underwent laparoscopic completion appendectomy, and the others underwent laparoscopic ileocecectomy. The mean hospital stay was 9 days (range 5-13 days). There were no cases of open conversion.

Conclusions: Stump appendicitis is a rare complication after appendectomy. A laparoscopic procedure can be performed for management of stump appendicitis with or without perforation.
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http://dx.doi.org/10.1097/MD.0000000000018072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6882645PMC
November 2019

Urinary Cell-Free DNA IQGAP3/BMP4 Ratio as a Prognostic Marker for Non-Muscle-Invasive Bladder Cancer.

Clin Genitourin Cancer 2019 06 9;17(3):e704-e711. Epub 2019 Apr 9.

Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Korea. Electronic address:

Background: Disease monitoring in non-muscle-invasive bladder cancer (NMIBC) patients is crucial for early identification of disease recurrence and progression. High IQGAP3/BMP4 and IQGAP3/FAM107A ratios in urinary cell-free DNA (ucfDNA) are a diagnostic biomarker for bladder cancer. We aimed to investigate whether the levels of these biomarkers in ucfDNA can be used to monitor disease recurrence or progression in patients with NMIBC.

Patients And Methods: A total of 103 patients with NMIBC (pTa-pT1) were enrolled. The IQGAP3/BMP4 and IQGAP3/FAM107A ratios in ucfDNA were measured by real-time PCR, and the results were compared with clinical outcome by Kaplan-Meier curves and Cox regression analyses.

Results: Overall, 55 patients (53.4%) experienced recurrence and 29 (28.2%) experienced disease progression during a median follow-up of 42.7 months (range, 6.1-172.2 months). Kaplan-Meier analysis revealed that NMIBC patients with a high IQGAP3/BMP4 ratio had worse recurrence-free survival and progression-free survival (PFS) (P = .001 and < .001, respectively), and those with a high IQGAP3/FAM107A ratio had worse PFS (P = .006). Multivariate Cox regression analysis revealed that the IQGAP3/BMP4 ratio was independently associated with recurrence-free survival (hazard ratio, 2.462; P = .003) and PFS (hazard ratio = 3.871; P = .004), whereas the IQGAP3/FAM107A ratio was not an independent factor for PFS (P = .079).

Conclusion: The IQGAP3/BMP4 ratio in ucfDNA might be a valuable novel biomarker for predicting disease recurrence and progression in patients with NMIBC.
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http://dx.doi.org/10.1016/j.clgc.2019.04.001DOI Listing
June 2019

Intrahepatic Glissonian Approach to the Ventral Aspect of the Arantius Ligament in Laparoscopic Left Hemihepatectomy.

World J Surg 2019 May;43(5):1303-1307

Department of Surgery, College of Medicine and Medical Research Institute, Chungbuk National University, Cheong-Ju, Republic of Korea.

Background: Laparoscopic left hemihepatectomy using the Glissonian approach is technically challenging secondary to a thick Glissonian pedicle and limited maneuverability of laparoscopic instruments. This procedure demands extreme caution owing to the high risk of bile leakage associated with left hemihepatectomy. We describe the technical details and surgical outcomes of the intrahepatic Glissonian approach to the ventral aspect of the Arantius ligament in laparoscopic left hemihepatectomy.

Methods: After detachment of the left side of hilar plate, the meticulous dissection was performed in the liver capsule above the left Glissonian pedicle. Dissection of the ventral aspect of the Arantius ligament creates the space between the liver parenchyma and the left Glissonian pedicle. The left Glissonian pedicle was isolated and encircled using the long curved laparoscopic instrument. During the parenchymal transection, the left Glissonian pedicle was transected using lateral to the Arantius ligament.

Results: Between February 2013 and July 2018, 13 consecutive patients underwent pure laparoscopic left hemihepatectomy. The median operation time was 230 min (range 180-300 min), and the median estimated blood loss was 300 mL (range 100-600 mL). Two patients (15%) required transfusion. The median tumor size was 40 mm (range 10-105 mm). All patients showed negative resection margins. The median postoperative hospital stay was 8 days (range 6-15 days). Major postoperative complications occurred in 1 patient (7.7%). No perioperative deaths occurred.

Conclusion: An intrahepatic Glissonian approach to the ventral aspect of the Arantius ligament is a feasible and effective technique in laparoscopic left hemihepatectomy.
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http://dx.doi.org/10.1007/s00268-019-04907-1DOI Listing
May 2019

A giant lipoma of the parietal peritoneum: Laparoscopic excision with the parietal peritoneum preserving procedure - a case report with literature review.

BMC Surg 2018 Aug 2;18(1):49. Epub 2018 Aug 2.

Department of Radiology, Chungbuk National University Hospital, Cheongju, South Korea.

Background: Lipomas are very common benign tumors of mature fatty tissue that can occur in any part of the body. However, lipomas of the parietal peritoneum are extremely rare.

Case Presentation: A 36-year-old man presented with urinary frequency for 6 months. On computerized tomography of the abdomen and pelvis, a well-defined fatty mass measuring 20 × 11 × 6.5 cm in size, was found in the lower abdominal cavity. We performed a laparoscopic parietal-peritoneum-preserving excision of the mass. The patient was discharged without complications on post-operative day 6.

Conclusions: To our knowledge, a laparoscopic excision with preservation of the parietal peritoneum for a giant parietal peritoneal lipoma has never been reported. Herein, we report a case of a giant lipoma of the parietal peritoneum successfully managed by laparoscopy.
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http://dx.doi.org/10.1186/s12893-018-0382-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6071372PMC
August 2018

Primary hepatic peripheral T-cell lymphoma mimicking hepatocellular carcinoma: a case report.

Ann Surg Treat Res 2017 Aug 28;93(2):110-114. Epub 2017 Jul 28.

Department of Surgery, Chungbuk National University Hospital, Cheongju, Korea.

Peripheral T-cell lymphomas (PTCLs) are aggressive neoplasms which may involve the liver. The imaging manifestations of hepatic lymphoma are highly variable and show overlapping appearances of numerous other hepatic diseases. As the management and prognosis of lymphoma differ markedly from those of other malignant diseases, prompt diagnosis and early effective treatment are very important. Here, we report an atypical case of primary PTCL not otherwise specified involving the liver that exhibited a solitary hepatic mass mimicking hepatocellular carcinoma (HCC) on CT. Liver biopsy is not commonly recommended in highly suspicious cases of HCC. However, in a patient without risk factors for HCC, consideration of other diagnostic possibilities is required and needle biopsy may be a more rational choice. An imaging approach, based on a careful review of clinical and laboratory findings is essential to prevent false-positive diagnosis of HCC and subsequent invasive treatment.
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http://dx.doi.org/10.4174/astr.2017.93.2.110DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5566745PMC
August 2017

Two Cases of Plug or Stone in Remnant Intrapancreatic Choledochal Cysts Treated with Endoscopic Retrograde Cholangiopancreatography.

Clin Endosc 2017 Sep 16;50(5):504-507. Epub 2017 Feb 16.

Department of Internal Medicine, Chungbuk National University College of Medicine, Chungbuk, Korea.

Incomplete resection of choledochal cysts (CCs) that extend deep into the pancreas can lead to protein plug or stone formation, pancreatitis, and cholangiocarcinoma. We encountered two cases of choledocholithiasis in remnant intrapancreatic CCs, in which the patients exhibited symptoms after 3 and 21 years of cyst excision. A 21-year-old woman who had undergone excision of a CC, as a neonate, presented with epigastric pain. Abdominal computed tomography (CT) revealed stones inside the remnant pancreatic cyst, which were removed by endoscopic retrograde cholangiopancreatography (ERCP), and her symptoms improved. A 33-year-old woman, who underwent cyst excision 3 years ago, presented with pancreatitis. Abdominal CT showed a radiolucent plug inside the remnant pancreatic cyst. The soft, whitish plug was removed by ERCP, and the pancreatitis improved. These cases indicate that plugs and stones in CCs have the same pathogenetic mechanism, and their form depends on the time since the incomplete excision surgery.
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http://dx.doi.org/10.5946/ce.2017.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5642059PMC
September 2017

A Modified Liver Hanging Maneuver in Pure Laparoscopic Left Hemihepatectomy with Preservation of the Middle Hepatic Vein: Video and Technique.

J Gastrointest Surg 2017 07 2;21(7):1181-1185. Epub 2017 Feb 2.

Department of Surgery, College of Medicine and Medical Research Institute, Chungbuk National University, Cheong-ju, Republic of Korea.

Background: The liver hanging maneuver is a novel and useful technique that is widely used in open liver resections. The present study describes the surgical technique and outcomes of a modified liver hanging maneuver for pure laparoscopic left hemihepatectomy.

Method: The clinical data of patients who underwent laparoscopic left hemihepatectomy using a modified hanging technique were retrospectively reviewed. The upper end of the hanging tape was placed on the lateral side of the left hepatic vein. The pathway of the tape was situated along the ligamentum venosum.

Results: Sixteen patients underwent pure laparoscopic left hemihepatectomy with the modified hanging technique. The median operation time was 225 min (range 180-300 min), with a median blood loss of 265 ml (range 140-600 ml). Postoperative major complications occurred in one patient (6.3%). The median postoperative hospital stay was 8 days (range 5-15 days). There was no postoperative liver failure or mortality.

Conclusion: This modified liver hanging maneuver is a simple, safe, and reproducible approach as dissection of between the middle and left hepatic vein is not required. This technique may be useful in laparoscopic left hemihepatectomy.
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http://dx.doi.org/10.1007/s11605-017-3369-2DOI Listing
July 2017

LAMP-3 (Lysosome-Associated Membrane Protein 3) Promotes the Intracellular Proliferation of Salmonella typhimurium.

Mol Cells 2016 Jul 21;39(7):566-72. Epub 2016 Jun 21.

Department of Biochemistry, College of Medicine, Chungbuk National University, Cheongju 28644, Korea.

Lysosomes are cellular organelles containing diverse classes of catabolic enzymes that are implicated in diverse cellular processes including phagocytosis, autophagy, lipid transport, and aging. Lysosome-associated membrane proteins (LAMP-1 and LAMP-2) are major glycoproteins important for maintaining lysosomal integrity, pH, and catabolism. LAMP-1 and LAMP-2 are constitutively expressed in Salmonella-infected cells and are recruited to Salmonella-containing vacuoles (SCVs) as well as Salmonella-induced filaments (Sifs) that promote the survival and proliferation of the Salmonella. LAMP-3, also known as DC-LAMP/CD208, is a member of the LAMP family of proteins, but its role during Salmonella infection remains unclear. DNA microarray analysis identified LAMP-3 as one of the genes responding to LPS stimulation in THP-1 macrophage cells. Subsequent analyses reveal that LPS and Salmonella induced the expression of LAMP-3 at both the transcriptional and translational levels. Confocal Super resolution N-SIM imaging revealed that LAMP-3, like LAMP-2, shifts its localization from the cell surface to alongside Salmonella. Knockdown of LAMP-3 by specific siRNAs decreased the number of Salmonella recovered from the infected cells. Therefore, we conclude that LAMP-3 is induced by Salmonella infection and recruited to the Salmonella pathogen for intracellular proliferation.
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http://dx.doi.org/10.14348/molcells.2016.0112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4959022PMC
July 2016

Lateral approach liver hanging maneuver in laparoscopic anatomical liver resections.

Surg Endosc 2016 08 5;30(8):3611-7. Epub 2015 Nov 5.

Department of Surgery, College of Medicine and Medical Research Institute, Chungbuk National University, Cheong-ju, Republic of Korea.

Background: The liver hanging maneuver is a novel technique that is widely used in open liver resection. The hanging technique has been rarely applied during laparoscopic liver resection because a blind dissection between the anterior surface of the inferior vena cava and the liver is required. Dissection between the right and middle hepatic vein is necessary in right hepatectomy, as is dissection between the middle and left hepatic vein in left hepatectomy. The aim of this study was to introduce the lateral approach liver hanging maneuver in laparoscopic anatomical liver resections.

Method: For this technique, the upper end of the hanging tape was placed on the lateral side of the right or left hepatic vein and the lower end of the hanging tape between three Glisson's pedicles. The pathway of the tape was situated along the lateral side of the inferior vena cava in right-sided hepatectomy or the ligamentum venosum in left-sided hepatectomy.

Results: From February 2013 to October 2014, this technique was performed in 35 patients. Of these patients, ten patients underwent a right hepatectomy, 5 patients underwent a right posterior sectionectomy, 12 patients underwent a left hepatectomy, and 8 patients underwent a left lateral sectionectomy. The median operative time was 240 min (range 90-390 min), and median blood loss was 350 ml (range 60-700 ml). Blood transfusion was required in six patients (17.1 %). In two patients (5.7 %), postoperative complications were observed due to intra-abdominal fluid collection and pneumonia, respectively. No postoperative mortality was encountered.

Conclusion: The lateral approach liver hanging maneuver is a simple, safe, and reproducible approach as dissection of the anterior surface of the inferior vena cava and between the three major hepatic veins is not required. This technique may be useful in laparoscopic anatomical liver resections.
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http://dx.doi.org/10.1007/s00464-015-4663-2DOI Listing
August 2016

Lymphoepithelial cyst of the pancreas mimicking malignant cystic tumor: report of a case.

Korean J Hepatobiliary Pancreat Surg 2015 Aug 28;19(3):129-32. Epub 2015 Aug 28.

Department of Surgery, Chungbuk National University, College of Medicine and Medical Research Institute, Cheongju, Korea.

Lymphoepithelial cysts of the pancreas are a type of true cyst that can mimic pseudocysts and cystic neoplasms. They are very rare, non-malignant lesions that are unilocular or multilocular cystic lesions lined predominantly by mature squamous epithelium and surrounded by non-neoplastic lymphoid elements. We, herein, present a patient with a cystic pancreas tumor mimicking a malignant cystic neoplasm. The patient was admitted with upper abdominal discomfort. Computed tomography showed a 64×39 mm cystic mass in the pancreas tail. She underwent distal pancreatectomy and splenectomy. In the fluid analysis of the pancreas cystic mass, the CEA and CA19-9 were 618 ng/ml and 3.9 U/ml, respectively. The resected pancreas specimen showed a 6.5 cm-sized cyst the pancreas tail. The cyst was well circumscribed and multilocular. The final pathology report of the resected pancreas specimen noted that the cyst was multilocular, and the cyst lining was showing stratified squamous epithelium covering the lymphoid tissue (containing lymphoid follicles), which was consistent with a lymphoepithelial cyst. The patient recovered uneventfully from surgery and has been doing well for the past 3 months. A differential diagnosis of cystic pancreatic lesions is important. We suggest that lymphoepithelial cysts, although very rare, may be included in the differential diagnosis of cystic pancreatic tumors.
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http://dx.doi.org/10.14701/kjhbps.2015.19.3.129DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4568600PMC
August 2015

CEACAM6 as detected by the AP11 antibody is a marker notable for mucin-producing adenocarcinomas.

Virchows Arch 2015 Feb 27;466(2):151-9. Epub 2014 Nov 27.

Department of Pathology, Chungbuk National University College of Medicine, 52 Naesudong-ro, Heungduk-gu, Cheongju, 361-763, Korea.

A new monoclonal antibody recognizing CEACAM6, which we named AP11, was generated by immunizing BALB/c mice with phytohemagglutinin-activated human peripheral blood mononuclear cells. This study aims to evaluate whether CEACAM6 can serve as a tumor marker using AP11. We examined the expression of CEACAM6 with AP11 in 11 human carcinoma cell lines by flow cytometry and 439 human tissues including 282 tumor tissues and 157 normal tissues by immunohistochemistry. CEACAM6 epitope recognized by AP11 was well preserved in formalin-fixed and paraffin-embedded tissues. Adenocarcinomas of the stomach (86%), colorectum (95%), pancreas (100%), and lung (83%), urinary bladder (100%), and mucinous ovarian tumors (88%) had a high rate of CEACAM6 immunoreactivity. We observed a variable expression of CEACAM6 in hepatocellular carcinomas (35%), squamous cell carcinomas of the lung (60%), renal cell carcinomas (14%), urothelial carcinomas (13%), serous carcinomas of the ovary (17%), and breast carcinomas (11%). Small-cell carcinomas of the lung, prostatic adenocarcinomas, papillary thyroid carcinomas, malignant melanomas, giant cell tumors, and osteosarcomas were negative for CEACAM6. All normal tissues of various organs were negative for CEACAM6. In conclusion, CEACAM6 as detected by AP11, may serve as a marker for mucin-producing adenocarcinomas of the gastrointestinal tract and ovary as well as non-small cell lung cancer. Thus, AP11 represents a valuable diagnostic tool for detecting CEACMA6-positive cancers.
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http://dx.doi.org/10.1007/s00428-014-1688-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4325187PMC
February 2015

Polyarteritis nodosa presented as a dilatation of the intrahepatic bile duct.

Ann Surg Treat Res 2014 Nov 24;87(5):273-5. Epub 2014 Oct 24.

Department of Surgery, Chungbuk National University College of Medicine and Medical Research Institute, Cheongju, Korea.

Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis of small- and medium-sized arteries in multiorgan systems. PAN may affect the gastrointestinal tract in 14%-65% of patients, but rarely involves the biliary tract and liver. We describe a patient without underlying disease who was diagnosed with PAN during resection of the gallbladder and liver.
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http://dx.doi.org/10.4174/astr.2014.87.5.273DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4217254PMC
November 2014

The experience of transumbilical endoscopic appendectomies.

Ann Surg Treat Res 2014 May 24;86(5):278-82. Epub 2014 Apr 24.

Department of Surgery, Chungbuk National University College of Medicine, Medical Research Institute, Cheongju, Korea.

Minimally invasive surgery is being widely accepted in various fields of surgery. Although several appendectomy techniques have been reported but, there is no standardization. We report here the experiences of transumbilical endoscopic appendectomy in humans. Between July 2008 and September 2010, ten patients with appendicitis successfully underwent transumbilical endoscopic appendectomies. There were 7 cases of suppurative, 2 cases of gangrenous and 1 case of perforated in operative findings. The ages of the patients were 13-56 years (mean age, 32.7 ± 15.4 years). Under general anesthesia, a 15-mm port was inserted through the umbilicus and then a two-channel endoscope was inserted in the peritoneal cavity. After appendix identification, counter-traction of the appendix with a direct abdominal wall puncture using a straight round needle prolene was performed to achieve good visualization of the operative field. Tissue dissection was performed using an endoscopic needle knife. Tissue grasping and resected appendix retrieval were done with endoscopic forceps. The average operation time was 79.5 ± 23.6 minutes (range, 45 to 110 minutes). No procedures were converted to laparoscopic or open appendectomy. Hospital stay was 4-6 days. All patients completely recovered without complications. As it is highly maneuverable, we believe transumbilical endoscopic appendectomy can be a feasible method. And, as surgeons want to proceed from laparoscopic surgery to natural orifice transluminal endoscopic surgery, this procedure could be a triable method.
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http://dx.doi.org/10.4174/astr.2014.86.5.278DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4024928PMC
May 2014

Fate of dyspeptic or colonic symptoms after laparoscopic cholecystectomy.

J Neurogastroenterol Motil 2014 Apr;20(2):253-60

Departments of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Chungcheongbuk-do, Korea.

Background/aims: Gallbladder diseases can give rise to dyspeptic or colonic symptoms in addition to biliary pain. Although most biliary pain shows improvement after cholecystectomy, the fates of dyspeptic or colonic symptoms still remain controversial. This study as-sessed whether nonspecific gastrointestinal symptoms improved after laparoscopic cholecystectomy (LC) and identified the char-acteristics of patients who experienced continuing or exacerbated symptoms following surgery.

Methods: Sixty-five patients who underwent LC for uncomplicated gallbladder stones or gallbladder polyps were enrolled. The patients were surveyed on their dyspeptic or colonic symptoms before surgery and again at 3 and 6 months after surgery. Patients' mental sanity was also assessed using a psychological symptom score with the Symptom Checklist-90-Revised questionnaire.

Results: Forty-four (67.7%) patients showed one or more dyspeptic or colonic symptoms before surgery. Among these, 31 (47.7%) and 36 (55.4%) patients showed improvement at 3 and 6 months after surgery, respectively. However, 18.5% of patients showed continuing or exacerbated symptoms at 6 months after surgery. These patients did not differ with respect to gallstone or gall-bladder polyps, but differed in frequency of gastritis. These patients reported lower postoperative satisfaction. Patients with ab-dominal symptoms showed higher psychological symptom scores than others. However, poor mental sanity was not related to the symptom exacerbation.

Conclusions: Elective LC improves dyspeptic or colonic symptoms. Approximately 19% of patients reported continuing or exacerbated symp-toms following LC. Detailed history-taking regarding gastritis before surgery can be helpful in predicting patients' outcome after LC.
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http://dx.doi.org/10.5056/jnm.2014.20.2.253DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4015198PMC
April 2014

Differential expression of E-cadherin, β-catenin, and S100A4 in intestinal type and nonintestinal type ampulla of Vater cancers.

Gut Liver 2014 Jan 5;8(1):94-101. Epub 2013 Nov 5.

Department of Internal Medicine, Medical Research Institute, Chungbuk National University College of Medicine, Cheongju, Korea.

Background/aims: Epithelial-mesenchymal transition (EMT)-related proteins may exhibit differential expression in intestinal type or pancreatobiliary type ampulla of Vater carcinomas (AVCs). We evaluated the expression of E-cadherin, β-catenin, and S100A4 in intestinal and nonintestinal type AVCs and analyzed their relationships with clinicopathological variables and survival.

Methods: A clinicopathological review of 105 patients with AVCs and immunohistochemical staining for E-cadherin, β-catenin, and S100A4 were performed. The association between clinicopathological parameters, histological type, and expression of EMT proteins and their effects on survival were analyzed.

Results: Sixty-five intestinal type, 35 pancreatobiliary type, and five other types of AVCs were identified. The severity of EMT changes differed between the AVC types; membranous loss of E-cadherin and β-catenin was observed in nonintestinal type tumors, whereas aberrant nonmembranous β-catenin expression was observed in intestinal type tumors. EMT-related changes were more pronounced in the invasive tumor margin than in the tumor center, and these EMT-related changes were related to tumor aggressiveness. Among the clinicopathological parameters, a desmoplastic reaction was related to overall survival, and the reaction was more severe in nonintestinal type than in intestinal type AVCs.

Conclusions: Dysregulation of E-cadherin, β-cadherin, and S100A4 expression may play a role in the carcinogenesis and tumor progression of AVCs.
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http://dx.doi.org/10.5009/gnl.2014.8.1.94DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3916694PMC
January 2014

Clinical, pathological, and immunohistochemical features of adenomyoma in the ampulla of vater.

Korean J Gastroenterol 2013 Dec;62(6):352-8

Department of Internal Medicine, Chungbuk National University College of Medicine, 52 Naesudong-ro, Heungdeok-gu, Cheongju 361-711, Korea.

Background/aims: Ampullary adenomyoma is a benign lesion whose malignant potential has yet to be confirmed. Despite its benign nature, adenomyoma is frequently misdiagnosed as a carcinoma or adenoma and is overtreated by extensive surgery. This study was performed to analyze the clinical, pathological, and immunohistochemical features of adenomyomas in the ampulla of Vater.

Methods: Nine cases of adenomyoma in the ampulla of Vater, diagnosed in Chungbuk National University Hospital between 2008 and 2011, were enrolled in this study. We reviewed the clinical data on the symptoms, laboratory data, and radiologic findings of the abdominal computed tomography and endoscopic retrograde cholangiopancreatography. For pathological analysis, all the slides were reviewed by one pathologist, and immunohistochemical stainings with antibodies against cytokeratin 7 (CK7), cytokeratin 20 (CK20), α-smooth muscle actin (α-SMA), and Ki-67 antigen were performed.

Results: All the cases were CK7 positive and CK20 negative. A strong cytoplasmic expression of α-SMA was confirmed in all cases. The Ki-67 index was less than 1% in eight cases and 5% in one case. Four cases underwent endoscopic papillectomy, and one case received surgical ampullectomy during colorectal cancer surgery. Five cases that underwent endoscopic or surgical treatment remained symptom-free for three years. Four cases that were closely observed with repeated endoscopic examinations exhibited no interval changes in the papillary lesions.

Conclusions: Endoscopic biopsy and immunohistochemistry can aid in the diagnosis of ampullary adenomyomas. Endoscopic papillectomy or surgical ampullectomy is adequate for the treatment of symptomatic ampullary adenomyomas.
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http://dx.doi.org/10.4166/kjg.2013.62.6.352DOI Listing
December 2013

Epithelial-mesenchymal transition-related protein expression in biliary epithelial cells associated with hepatolithiasis.

J Gastroenterol Hepatol 2014 Feb;29(2):395-402

Department of Pathology, Chungbuk National University College of Medicine and Medical Research Institute, Cheongju, Korea.

Background And Aim: Epithelial-mesenchymal transition (EMT) of biliary epithelial cells (BECs) plays major roles in many cholangiopathies. This study evaluated whether EMT of BECs has a role in hepatolithiasis-induced biliary fibrosis and types of BECs that are involved.

Methods: The expression of EMT-related proteins and epidermal growth factor receptor was evaluated by immunohistochemistry of liver tissues from 102 patients with hepatolithiasis, 32 patients with post-hepatitis cirrhosis, and 48 normal livers. Antibodies against E-cadherin, β-catenin, and cytokeratin were used to identify epithelial cells and antibodies against vimentin, S100A4, podoplanin, and α-smooth muscle actin (α-SMA) were used to identify mesenchymal cells. The relationship between clinical and histological parameters and immunohistochemistry findings in BECs, and the surrounding stroma were evaluated.

Results: Loss of E-cadherin and acquisition of S100A4 and vimentin were observed in BECs. In all BECs, cytokeratin and β-catenin expression were unchanged, while podoplanin and α-SMA were not expressed. Although hepatic fibrosis was more severe in post-hepatitis cirrhosis, EMT of BECs was more widespread in hepatolithiasis. In hepatolithiasis, EMT-related proteins were more highly expressed in small bile ducts than in medium or large bile ducts. Their expression was associated with the severity of biliary fibrosis and the expressions of epidermal growth factor receptor. Expression of α-SMA in fibroblasts from the portal space was closely linked to pathological changes in small bile ducts and EMT-related protein expressions in BECs.

Conclusions: Proliferating cholangiocytes that form small bile ducts may contribute to cholangiopathies in hepatolithiasis through an EMT-like phenomenon or through interactions with stromal myofibroblasts.
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http://dx.doi.org/10.1111/jgh.12349DOI Listing
February 2014

Ubiquilin 1 interacts with Orai1 to regulate calcium mobilization.

Mol Cells 2013 Jan 9;35(1):41-6. Epub 2013 Jan 9.

Division of Biochemistry, Chungbuk National University, Cheongju, 361-763, Korea.

Store-operated calcium entry (SOCE) channels composed of Stim and Orai proteins play a critical role in diverse biological processes. Upon endoplasmic reticulum (ER)-mediated calcium (Ca(2+)) depletion, Stim proteins oligomerize with Orai to initiate Ca(2+) influx across the plasma membrane. The ubiquitin-like (UBL) and ubiquitin-associated (UBA) domains of ubiquilin 1 are involved in the degradation of presenilin and polyglutamine proteins. Through screening of Orai1 interaction partner(s) that might have an effect on SOCE, ubiquilin 1 was identified as a target of Orai1. However, the UBL and UBA domains of ubiquilin 1 were dispensable for this interaction. Additionally, ubiquilin 1 and Orai1 colocalized in the cytosolic compartment. Ubiquilin 1 increased the ubiquitination of Orai1, resulting in the formation of a high-molecular-weight form. MG132, a proteasome inhibitor, failed to block the degradation of Orai1, whereas bafilomycin A, a lysosome inhibitor, prevented Orai1 degradation. Confocal microscopy studies demonstrated that a fraction of Orai1 colocalized with ubiquilin 1 and the autophagosomal marker LC3. Because Orai1 is a constituent of SOCE, we determined the effect of ubiquilin 1 on Orai1-mediated Ca(2+) influx. As we expected, intracellular Ca(2+) mobilization, a process normally potentiated by Orai1, was downregulated by ubiquilin 1. Taken together, these findings suggest that ubiquilin 1 downregulates intracellular Ca(2+) mobilization and its downstream signaling by promoting the ubiquitination and lysosomal degradation of Orai1.
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http://dx.doi.org/10.1007/s10059-013-2268-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3887852PMC
January 2013

Bowel infarction due to intestinal mucormycosis in an immunocompetent patient.

J Korean Surg Soc 2012 Nov 29;83(5):325-9. Epub 2012 Oct 29.

Department of Surgery, Chungbuk National University College of Medicine and Medical Research Institute, Cheongju, Korea.

Mucormycosis is a fatal opportunistic fungal infection that typically occurs in immunocompromised patients. The classical manifestation of mucormycosis is a rhinocerebral infection, and although primary gastrointestinal infection is uncommon, it has an extremely high mortality rate in immunocompromised patients. Furthermore, cases of gastrointestinal mucormycosis in an immunocompetent host are rarely reported. Here, we describe our experience of a male patient, with no underlying disease, who succumbed to a bowel infarction caused by intestinal mucormycosis during mechanical ventilatory care for severe pneumonia and septic shock.
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http://dx.doi.org/10.4174/jkss.2012.83.5.325DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3491236PMC
November 2012

Common bile duct dilatation after cholecystectomy: a one-year prospective study.

J Korean Surg Soc 2012 Aug 25;83(2):97-101. Epub 2012 Jul 25.

Department of Internal Medicine, Chungbuk National University College of Medicine, Medical Research Institute, Cheongju, Korea.

Purpose: Bile duct dilatation after cholecystectomy continues to be a matter of controversy. We aimed determine the magnitude of common bile duct (CBD) dilatation after cholecystectomy followed up to 1 year.

Methods: Sixty-four cases (age, 47.3 ± 11.7 years; men, 28; women, 36) enrolled in this study. They received laparoscopic cholecystectomy in Chungbuk National University Hospital for symptomatic cholelithiasis or gallbladder polyps with normal bile duct, less than 7 mm. The CBD diameter was measured by one radiologist using ultrasonography at the maximum point after full length evaluation of extrahepatic bile duct. Forty-five and thirty-one cases were followed at 6 months and 1 year, respectively.

Results: The CBD was dilated slightly from 4.1 mm at baseline to 5.1 mm at 6 months and 6.1 mm at 12 months after cholecystectomy. The number of cases of CBD dilatation of more than 7 mm at 6 months and at 12 months after cholecystectomy were 11 (24.4%) and 9 (29.0%), respectively. Seven cases at 6 months and 5 cases at 12 months showed bile duct dilation of more than 3 mm compared to baseline. There were no cases having bile duct dilation of more than 10 mm.

Conclusion: Postcholecystectomy dilatation of the bile duct occured slightly in most cases. But some cases showed more than 3 mm dilatation over baseline. Asymptomatic bile duct dilatation of up to 10 mm can be considered as normal range in patients after cholecystectomy.
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http://dx.doi.org/10.4174/jkss.2012.83.2.97DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3412191PMC
August 2012

Extended Spectrum-β-Lactamase or Carbapenemase Producing Bacteria Isolated from Patients with Acute Cholangitis.

Clin Endosc 2012 Jun 30;45(2):155-60. Epub 2012 Jun 30.

Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.

Background/aims: This study assessed the antibiotic resistance organisms isolated from the blood and bile of acute cholangitis and evaluated risk factors associated with them and their impact on clinical outcomes.

Methods: The identities and antibiotic resistance profiles of bacteria isolated from 433 cases of acute cholangitis from 346 patients were analyzed. Risk factors and the outcomes of patients infected with them were assessed.

Results: Microorganisms were isolated from 266 of 419 blood cultures and 256 of 260 bile cultures. Isolates from bile and blood were identical in 71% of the cases. A total of 20 extended spectrum-β-lactamase (ESBL)-producers and 4 carbapenemase-producing organisms were isolated from blood, and 34 ESBL-producers and 13 carbapenemase-producers were isolated from bile. Sixty-four (14.8%) cases were infected with any one of these bacteria isolated from blood or bile. Risk factors associated with them in blood were nosocomial infection and prior biliary intervention. In bile, indwelling biliary device was a risk factor associated with them. Antibiotic-resistant bacteria were associated with mortality, independent of other prognostic factors.

Conclusions: ESBL or carbapenemase-producing bacteria were frequently isolated in acute cholangitis patients especially with prior biliary intervention and nosocomial infection. Isolation of antibiotic-resistant bacteria was an independent risk factor of mortality.
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http://dx.doi.org/10.5946/ce.2012.45.2.155DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3401620PMC
June 2012

Microglandular adenosis.

J Breast Cancer 2011 Mar 31;14(1):72-5. Epub 2011 Mar 31.

Department of Surgery, Chungbuk National University, College of Medicine and Medical Research Institute, Cheongju, Korea.

Microglandular adenosis (MGA) of the breast is a very rare and benign proliferative lesion. Most patients complain of a palpable breast mass that may arouse a clinical suspicion of breast cancer. Histopathologically, it is hard to distinguish MGA from breast cancer because of the lack of a myoepithelial layer and infiltrative proliferation. Several studies have reported a strong relationship between MGA and carcinoma arising in MGA, so the mass should be excised completely in cases of MGA determined from a core needle biopsy rather than observation. A 72-years-old woman presented with a palpable breast mass. On physical examination, a mass was palpable in the right upper outer quadrant area and somewhat fixed to the surrounding tissues and pectoralis major muscle. We could not detect any mass or dense lesion on mammography because of a grade 4 dense breast. Ultrasonographic findings revealed a low echoic lesion with indistinct margins. The result of a core needle biopsy was MGA, which was confirmed by excision. We report one case of MGA, which was believed to breast cancer clinically.
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http://dx.doi.org/10.4048/jbc.2011.14.1.72DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3148517PMC
March 2011

Effect of patient safety education in surgical clerkship to develop competencies for managing and preventing medical errors.

Korean J Med Educ 2010 Dec 31;22(4):303-11. Epub 2010 Dec 31.

Department of Surgery, Chungbuk National University College of Medicine, Cheongju, Korea.

Purpose: The aims of this study were to define the necessity and effectiveness of patient safety education during surgical clerkship to develop competency for managing and preventing medical errors.

Methods: Fifty 3rd-year students participated in the patient safety education program during a 4-week surgical clerkship. The students were divided into 4 groups: control group, pretest-only group, education-only group, and pretest and education group. Students were assessed using short essays and an oral exam for reasoning skills, clinical performance exams for patient education and communication skills, and multisource feedback and direct observation of error reporting for real-world problem-solving skills. The results were analyzed with SPSS 14.0K. The reliability (Cronbach alpha) of the entire assessment was 0.893.

Results: There was no difference in scores between early and late clerkship groups. Reasoning skills were improved by the pretest. Reasoning, patient education, and error reporting skills were much more developed by patient safety education. Real-world error identification, reporting, and communication did not change after the 4-week course.

Conclusions: Patient safety education during surgical clerkship is necessary and effective. Error prevention and competency management in the real world should developed.
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http://dx.doi.org/10.3946/kjme.2010.22.4.303DOI Listing
December 2010

[Histopathologic analysis of adenoma and adenoma-related lesions of the gallbladder].

Korean J Gastroenterol 2010 Feb;55(2):119-26

Departments of Internal Medicine, Chungbuk National University College of Medicine and Medical Research Institute, Cheongju, Korea.

Background/aims: In order to determine the malignant potential of gallbladder adenoma for progression to carcinoma, we evaluated the histopathologic features of adenoma and adenoma-related lesions on cholecystectomized specimens.

Methods: Among 1,847 cholecystectomized specimens, 63 specimens from 26 benign adenomas, 9 carcinomas in situ (CIS), and 28 invasive carcinomas were selected. A pathologist reviewed all specimens and selected benign adenomas, CIS in the adenoma, and adenoma residue in invasive carcinomas. Adenomas and adenoma-related lesions were classified according to morphology (tubular, tubulopapillary, and papillary) and the consisting epithelium (biliary, pyloric metaplasia, and intestinal metaplasia). The age and the size of the benign adenomas and carcinomas in the adenoma were also compared.

Results: Adenoma and adenoma-related lesions were found in 34 out (1.8%) of all resected gallbladder. Among 9 CIS and 28 invasive carcinomas, adenoma-related lesions were detected in 7 and 1 case, respectively. All eight carcinomas arising in the adenoma were well-differentiated solitary tumors. The diameters of the carcinomas in the adenoma were, on average, larger than that of the benign adenomas (1.8 cm vs. 0.9 cm, p=0.01). The patients with carcinomas in the adenoma were, on average, older than those with benign adenomas, although the difference was insignificant (57 years vs. 47 years, p=0.09). The morphology and consisting epithelium did not differ between the benign adenomas and carcinomas in the adenoma. The malignant transformation occurred in 23.5% of adenomas.

Conclusions: Gallbladder adenoma is a rare disease, although malignant transformation occurs frequently. Adenoma is a precancerous lesion and the adenoma-carcinoma sequence is one of the gallbladder cancer carcinogenesis.
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http://dx.doi.org/10.4166/kjg.2010.55.2.119DOI Listing
February 2010

Metachronous bile duct cancer nine years after resection of gallbladder cancer.

World J Gastroenterol 2009 Jul;15(27):3440-4

Department of Internal Medicine, College of Medicine, Chungbuk National University, Gaeshindong 62, Heungdukgu, Cheongju 361-711, South Korea.

We report a rare case of a 74-year-old man with metachronous gallbladder cancer and bile duct cancer who underwent curative resection twice, with the operations nine years apart. At the age of 65 years, the patient underwent a cholecystectomy and resection of the liver bed for gallbladder cancer. This was a well-differentiated adenocarcinoma, with negative resection margins (T2N0M0, stage IB). Nine years later, during a follow-up examination, abdominal computed tomography and MRCP showed an enhanced 1.7 cm mass in the hilum that extended to the second branch of the right intrahepatic bile duct. We diagnosed this lesion as a perihilar bile duct cancer, Bismuth type IIIa, and performed bile duct excision, right hepatic lobectomy and Roux-en-Y hepaticojejunostomy. The histological diagnosis was a well-differentiated adenocarcinoma with one regional lymph node metastasis (T1N1M0, stage IIB). Twelve months after the second operation, the patient is well, with no signs of recurrence. This case is compared with 11 other cases of metachronous biliary tract cancer published in the world medical literature.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2712910PMC
http://dx.doi.org/10.3748/wjg.15.3440DOI Listing
July 2009

Correlation of academic achievements with cognitive admission variables and demographics at chungbuk national university graduate medical school.

Korean J Med Educ 2009 Mar 31;21(1):59-66. Epub 2009 Mar 31.

Department of Medical Education, Medical School and Medical Research Institute, Chungbuk National University, Cheongju, Korea.

Purpose: This study was performed to identify academic and nonacademic predictors of the success of entrants to Chungbuk National University Graduate Medical School (CNUMS) during the first 3 years of completion.

Methods: We analyzed the academic achievements in preclinical education in the first 2 years in students who were admitted in 2005 and 2006 and compared them with cognitive admission variables and demographic characteristics.

Results: There was no significant difference in academic achievement between students groups that were classified by gender, age, or academic degree type. Among Medical Education Eligibility Test (MEET) subscale scores, Verbal Reasoning was correlated with 'Medical humanities & social sciences' and 'Basic clinical procedures;' Nature Science Reasoning 1 with 'Basic medical sciences;' and Nature Science Reasoning 2 with 'Basic medical sciences' and 'Clinical medicine.' Undergraduate GPA correlated well with all academic achievements. English test scores did not correlate with academic performance.

Conclusion: Among all of the variables that were examined, undergraduate GPA score was the most reliable variable in predicting academic achievement during the 2-year preclinical medical education, and MEET scores were a secondary indicator of academic achievement at CNUMS.
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http://dx.doi.org/10.3946/kjme.2009.21.1.59DOI Listing
March 2009

Paclitaxel interrupts TGF-beta1 signaling between gallbladder epithelial cells and myofibroblasts.

J Surg Res 2007 Aug 14;141(2):183-91. Epub 2007 Jun 14.

Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, Washington. 98195, USA.

Background: The cellular and molecular mechanisms of fibrogenesis in the extrahepatic biliary epithelium are not known. Transforming growth factor-beta1 (TGF-beta1) is a cytokine implicated in signaling pathways that mediate collagen formation. An observation that paclitaxel (PT), applied topically into the rat common bile duct, inhibited stricture formation led us to hypothesize that PT's effects might be due to interruption of TGF-beta1 signaling between biliary epithelial cells and subepithelial myofibroblasts.

Materials And Methods: We tested this hypothesis using an in vitro cell-culture model in which murine gallbladder epithelial cells (GBEC) are cultured separately or cocultured with human gallbladder myofibroblasts (GBMF).

Results: Exposure to Escherichia coli lipopolysaccharide (LPS) enhanced TGF-beta1 mRNA expression and stimulated TGF-beta1 protein secretion into both apical and basolateral compartments in GBEC. This effect was more prominent with basolateral secretion and was also more pronounced in the coculture system. In GBMF, collagen I mRNA expression and protein secretion were stimulated by treatment with LPS or TGF-beta1. GBMF also expressed TGF-beta1 mRNA, whose levels were enhanced by exposure to either LPS or exogenous TGF-beta1. PT inhibited LPS-induced TGF-beta1 mRNA expression and protein secretion in GBEC in both culture systems. Tumor necrosis factor-alpha mRNA expression and protein secretion were not affected by PT in GBEC, demonstrating that the effects were specific for TGF-beta1. PT also inhibited LPS- and TGF-beta1-induced collagen I mRNA expression and protein secretion in GBMF.

Conclusions: These findings support a model in which GBEC communicate with subepithelial GBMF via TGF-beta1, leading to collagen deposition and fibrosis, and in which GBMF possess autocrine mechanisms involving TGF-beta1 that could regulate collagen production. PT inhibits these fibrogenic pathways.
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http://dx.doi.org/10.1016/j.jss.2006.12.558DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3571727PMC
August 2007

[A case of primary small cell carcinoma arising from the common bile duct].

Korean J Gastroenterol 2006 Dec;48(6):438-42

Department of Internal Medicine, and Pathology, Chungbuk National University, College of Medicine and Medical Research Institute, Heungdeok-Gu, Cheongju, Korea.

Small cell carcinoma is usually seen in the lung, but rarely involves the gastrointestinal tract including biliary tract. A 65 year-old man was admitted because of obstructive jaundice. A smooth-surfaced round intraluminal mass with proximal bile duct dilatation was seen in the proximal common bile duct on endoscopic retrograde cholangiogram. Under the diagnosis of bile duct cancer, pylorus-preserving pancreatoduodenectomy was done. Pathology revealed a 2 cm sized small cell carcinoma in the proximal common bile duct and distal common hepatic duct. On immunohistochemical stain, the tumor cells were positive for neuroendocrine markers CD56 and synaptophysin. After surgery, the patient received 5 cycles of adjuvant chemotherapy with VIP (etoposide, ifosfamide, and cisplatin) regimen. However, the patient died of liver metastasis 12 months after the diagnosis. We report a case of extrapulmonary small cell carcinoma arising from the common bile duct.
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December 2006
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