WCIM 2014 SEOUL KOREA 557
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0931 Lower GI Tract
A Case of Inverted Diverticulitis of Colon Mimicking Subepithelial Tumor
Dongok Jeon1, Ju-Sang Park1, Hyo-Jin Cho1, Jung-Hee Kim1, So-Ya Paik2, Il-Dong KIM3 Pundang Jesaeng Hospital, Departments of Gastroenterology, Korea1, Pathology, Korea2, Surgery, Korea3 Background: Inverted colonic diverticula (ICD) are rarely reported. ICD can be con- fused with elevated polypoid lesions and are occasionally complicated by bleeding and colonic perforation following biopsy or endoscopic resection. We report a case of inverted diverticulitis of ascending colon misdiagnosed as subepithelial tumor.
Case report: A 61-year-old man, who had history of adenomatous colon polyps and an about 3.5 cm sized subepithelial tumor in the ascending colon 5 years ago, pre- sented for surveillance colonoscopy. He had no symptoms. Physical examination and laboratory data were normal. On follow-up colonoscopy, subepithelial tumor without change in size showed a central necrosis communicating to surface in ascending colon. Biopsies revealed chronic infl ammation and elongated crypts without evidence of malignancy. The abdominal CT showed 4 cm sized segmental wall thickening with enhancement in proximal ascending colon. A laparoscopic right hemicolectomy was performed to rule out malignant transformation of subepithelial tumor. Intraoperative fi ndings revealed an infl ammatory mass in proximal ascending colon. Histopathologic evaluation revealed a 3.5x3.0 cm sized diverticulum with multiple mucosal invagi- nations containing inspissated mucoid materials, congested subserosa and fi brinous exudated serosa without malignancy –The fi nal diagnosis was inverted colonic diver- ticulitis of ascending colon. Two years ago, on further history taking, patient had an episode of right lower quadrant abdominal pain, which was misdiagnosed as an infec- tious enterocolitis and resolved with conservative management. Maybe it was thought to be due to colonic diverticulitis.
Conclusion: Because ICD may resemble polypoid lesions in the colon, they should be considered in the differential diagnosis of unusual polypoid lesions by additional imag- ing studies such as EUS and CT.
To our knowledge, this is the fi rst case of ascending ICD complicated with diverticuli- tis.
PS 0932 Lower GI Tract
Ex-Vivo Model for Radiation Induced Gastrointestinal Syndrome Using 3D-Cultured Enteroid
Younjoo Kim1,2, Seung Bum Lee2, Jin Sun Shin1, Sehwan Shim2, Sunhoo Park1,2 Korea Cancer Center Hospital, Korea1, National Radiation Emergency Medical Center Korea Institute of Radiological & Medical Sciences, Korea2
Background: Radiation-induced gastrointestinal syndrome (RIGS) stems from the clo- nogenic loss of crypt cells and villi depopulation and results in mucosal barrier disrup- tion, bacterial invasion, infl ammation and sepsis. One of the major diffi culties for RIGS studies is the fact that crypts are not easily accessed and cultured with traditional means. Ex-vivo culture techniques for single crypt or a stem cell derived enteroid, with essential features of the in vivo tissue architecture, have been recently developed.
Thus, we have adopted the 3D-cultured enteroids for RIGS ex-vivo model, and com- pared the response with 2D-cultured in vitro model.
Methods: To culture enteroid, ten centimeters segments of jejunum were procured from 9-13 week-old C57BL6 mice. Crypts were isolated by EDTA chelation, suspended in Matrigel and grown in culture media containing epidermal growth factor, noggin, R-spondin 1, CHIR99021, and valproate. After 1-3 days in culture, enteroids were split either for propagation or differentiated. The evaluation of enteroids as a valid model for radiation induced injury was performed by measuring MTT assay, budding effi cien- cy of enteroid, and EdU staining. We also used human intestinal epithelial cell lines, InEpC and CaCO2 as IR-induced cellular injury in vitro model.
Results: Enteroid from mouse had multiple crypts (‘budding’) with well-differentiated goblet and Paneth cells, and they were cultured and passaged in 3D culture condition.
In the response of radiation, irradiated enteroid decreased proliferation rate in a dose dependent manner, as measured by MTT assay and budding effi ciency of enteroid. By contrast, in human intestinal epithelial cells, irradiation up to 30Gy showed little or no effect on cell proliferation and death.
