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A case of gastritis cystica polyposa impacting the duodenum Department of Internal medicine & Pathology1, Bundang CHA General Hospital,
College of Medicine, Pochon CHA University Seongnam, Korea
*Jai Ho Yoon, M.D., Chang Il Kwon, M.D., So Young Chong, M.D., Gwang Il Kim, M.D.1 Pil Won Park, M.D., Sung Pyo Hong, M.D.
Gastritis cystica polyposa is an uncommon lesion that usually occurs at the gastroenterostomy site, but it may also develop in the unoperated stomach, which characteristically consisted of polypoid mucosal changes associated with hyperplasia and cystic dilatation of glands which infiltrating into the underlying submucosa. We report a case of gastritis cystica polyposa which presented as a large polypoid mass impacting the duodenum in a 63-year-old male without any history of gastric operation who was admitted for evaluation of anemia. He complained of dyspnea and dyspepsis for 6 months. Upper gastrointestinal endoscopy revealed a large polypoid mass with a stalk originated from the posterior wall of lower body of stomach which impacted the duodenum (Figure A). Because of failure to pulling out with conventional methods including suctioning or grasping with an alligator, a tripod or a net catheter, we fished out the impacted mass using forcep catheter while embracing the neck with a snare catheter. Thereafter snare polypectomy was performed without any complications. The surface of polyp was slightly nodulated and paritially ulcerated. The microscopic findings showed a proliferation of small to medium-sized glands with cystic change located in the muscularis mucosa and submucosa (Figure B). These findings were consistent with gastritis cystica polyposa.
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Small Bowel Adenocarcinoma associated with Crohn's disease : A Case Report
서울대학교병원 소화기내과
*조주연․김상균․송인성
Crohn's disease is associated with a well-documented risk of small bowel adenocarcinoma, particularly when diagnosed at an older age, after longer disease duration, and with more extensive colon involvement. In most previously reported cases, patients involved with small bowel adenocarcinoma as complication of Crohn's disease had a long history of the disease over 10 years.
Here we report an unusual case of a 34-year-old women in whom metastatic primary adenocarcinoma of the small bowel was diagnosed after a 5-year history of Crohn's disease. The patient who had symptoms of low abdominal pain and dysuria was diagnosed with Crohn's disease with complication of cystoenteral fistula in 2002. During treatment for exacerbation of Crohn's disease and gross hematuria in 2007, the patient developed acute obstructive symptoms and underwent explorative laparotomy and small bowel segmental resection. The operation revealed a stenosis of the ileum owing to a mass, which proved to be a small bowel adenocarcinoma. About 3 months after operation, the patient still had persistant gross hematuria with pyruria. She underwent transurethral resection with biopsy of the bladder, and was diagnosed with metastatic adenocarcinoma. Consequently the patient underwent partial cystectomy, she then received palliative chemotheraphy. The reports of small bowel adenocarcinoma associated with Crohn's disease are increasing. However, it remains an uncommon complication of an uncommon disease and it is remarkable for difficult diagnosis and poor prognosis. This case demonstrates the need for surgical assessment with histologic evaluation of patients with small bowel Crohn's disease that fails to improve with conservative management even if the duration of the disease is not longstanding.
