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Unveiling lymph node metastasis in early gastric cancer

World Journal of Gastroenterology 2014年第18期20卷 5389-5395页

作者： Nari Shin Tae-Yong Jeon Gwang Ha Kim do youn park Department of Pathology Pusan National University Hospital and Pusan National University School of MedicineBusan 602-739South Korea Biomedical Research Institute Pusan National University HospitalBusan 602-739South Korea Departments of Surgery Pusan National University Hospital and Pusan National University School of MedicineBusan 602-739South Korea Departments of Gastroenterology Pusan National University Hospital and Pusan National University School of MedicineBusan 602-739South Korea

With respect to gastric cancer treatment,improvements in endoscopic techniques and novel therapeutic modalities[such as endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)]have been ***,EMR/ESD procedures are widely accepted treatment modalities for early gastric cancer(EGC).These procedures are most widely accepted in Asia,including in Korea and *** the present era of endoscopic resection,accurate prediction of lymph node(LN)metastasis is a critical component of selecting suitable patients for EMR/***,indications for EMR/ESD are based on large Japanese datasets,which indicate that there is almost no risk of LN metastasis in the subgroup of EGC ***,there is some controversy among investigators regarding the validity of these ***,there are currently no accurate methods to predict LN metastasis in gastric cancer(for example,radiologic methods or methods based on molecular biomarkers).We recommend the use of a 2-step method for the management of early gastric cancer using endoscopic *** first step is the selection of suitable patients for endoscopic resection,based on endoscopic and histopathologic *** endoscopic resection,additional surgical intervention could be determined on the basis of a comprehensive review of the endoscopic mucosal resection/endoscopic submucosal dissection specimen,including lymphovascular tumor emboli,tumor size,histologic type,and depth of ***,evaluation of clinical application data is essential for validating this ***,gastroenterologists,surgeons,and pathologists should closely collaborate and communicate during these decisionmaking processes.

关键词： Early gastric cancer Endoscopic submucosal dissection Lymph node metastasis Biomarker Clinicopathologic features

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Solitary Peutz-Jeghers-type appendiceal hamartomatous polyp growing into the terminal ileum

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World Journal of Gastroenterology 2014年第16期20卷 4822-4826页

作者： Chang In Choi Dae Hwan Kim Tae Yong Jeon dong Heon Kim Na Ri Shin do youn park Department of Surgery Medical Research InstitutePusan National University HospitalSeo-GuBusan 602-739South Korea Department of Pathology Medical Research InstitutePusan National University HospitalSeo-GuBusan 602-739South Korea

Solitary Peutz-Jeghers type hamartomatous polyp is *** is considered to be related to a variant PeutzJeghers syndrome(PJS)and may be a separate disease entity.A 50-year-old man was referred to our hospital with a diagnosis of intussusception in the terminal ileum and underwent segmental ileal resection with *** identified a 3.5-cm diameter polyp arising from the appendix with ingrowth into the terminal *** polyp was confirmed to be a hamartomatous polyp of Peutz-Jeghers-type,***,the patient had no characteristic manifestations of PJS such as mucocutaneous pigmentation and family *** are few reports of appendiceal hamartomatous polyp in PJS patients and solitary appendiceal hamartomatous polyp is even ***,rather than telescoping,ours is the first reported intussuscepted lesion,to the best of our knowledge.

关键词： Peutz-Jeghers syndrome Hamartomatous intestinal polyposis Neoplasms Intussusception Intestinal obstruction

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Is it possible to differentiate gastric GISTs from gastric leiomyomas by EUS?

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World Journal of Gastroenterology 2009年第27期15卷 3376-3381页

作者： Gwang Ha Kim do youn park Suk Kim Dae Hwan Kim dong Heon Kim Cheol Woong Choi Jeong Heo Geun Am Song Department of Internal Medicine Pusan National University School of Medicine and Medical Research Institute Pusan National University HospitalBusan 602-739 South Korea Department of Pathology Pusan National University School of MedicineBusan 602-739 South Korea Department of Radiology Pusan National University School of MedicineBusan 602-739 South Korea Department of Surgery Pusan National University School of MedicineBusan 602-739South Korea

AIM: To evaluate the ultrasonog raphy (EUS) features of gastric gastrointestinal stromal tumors (GISTs) as compared with gastric leiomyomas and then to determine the EUS features that could predict malignant ***: We evaluated the endoscopic EUS features in 53 patients with gastric mesenchymal tumors conf irmed by histopathologic diagnosis. The GISTs were classif ied into benign and malignant groups according to the histological risk classif ***: Immunohistochemical analyses demon-strated 7 leiomyomas and 46 GISTs. Inhomogenicity, hyperechogenic spots, a marginal halo and higher echogenicity as compared with the surrounding muscle layer appeared more frequently in the GISTs than in the leiomyomas (P < 0.05). The presence of at least two of these four features had a sensitivity of 89.1% and a specifi city of 85.7% for predicting GISTs. Except for tumor size and irregularity of the border, most of the EUS features were not helpful for predicting the malignant potential of GISTs. On multivariate analysis, only the maximal diameter of the GISTs was an independent predictor. The optimal size for predicting malignant GISTs was 35 mm. The sensitivity and specificity using this value were 92.3% and 78.8%, ***: EUS may help to differentiate gastric GISTs from gastric leiomyomas. Once GISTs are suspected, surgery should be considered if the size is greater than 3.5 cm.

关键词： Endoscopic ultrasonography, Gastrointestinal stromal tumor Stomach

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Endoscopic resection of sparganosis presenting as colon submucosal tumor: A case report

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World Journal of Gastroenterology 2016年第19期22卷 4776-4780页

作者： Joong Keun Kim dong Hoon Baek Bong Eun Lee Gwang Ha Kim Geun Am Song do youn park Division of Gastroenterology Departments of Internal Medicine Pusan National University School of Medicine and Biomedical Research Institute Pusan National University Hospital Department of Pathology Pusan National University School of Medicine and Biomedical Research Institute Pusan National University Hospital

Human sparganosis is a rare parasitic disease caused by infection with the tapeworm Sparganum, the migrating plerocercoid(second stage) larva of Spirometra species. Sparganosis usually involves subcutaneous tissues and/or muscles of various parts of the body, but involvement of other sites such as the brain, eye, peritoneopleural cavity, urinary track, scrotum, and abdominal viscera has also been documented. Infections caused by sparganum have a worldwide distribution but are most common in Southeast Asia such as China, Japan, and South Korea. Rectal sparganosis is an uncommon disease but should be considered in the differential diagnosis of unusual and suspicious rectal submucosal tumors. We report a case of rectal sparganosis presenting as rectal submucosal tumor. We performed endoscopic submucosal dissection of the rectal submucosal tumor. The sparganosis was confirmed based on the presence of calcospherules in the submucosal layer on histological examination. Moreover, the result of the immunoglobulin G antibody test for sparganosis was positive but became negative after endoscopic submucosal dissection. Though rare, rectal sparganosis should be considered in the differential diagnosis of rectal submucosal tumor-like lesions. This case suggests that physicians should make effort to exclude sparganosis through careful diagnostic approaches, including detailed history taking and serological tests for parasites. In this report, we aimed to highlight the clinical presentation of Sparganum infection as a rectal submucosal tumor.

关键词： Rectum Submucosal tumor Sparganosis Sparganum Parasite disease

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Intracorporeal esophagojejunostomy using the double stapling technique after laparoscopic total gastrectomy:A retrospective case-series study

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World Journal of Gastroenterology 2015年第10期21卷 2973-2981页

作者： Jae Hun Kim Chang In Choi dong Il Kim Dae Hwan Kim Tae Yong Jeon dong Heon Kim do youn park Department of Surgery Pusan National University Hospital 2nd Bio Medical Research Institute Pusan National University Hospital Department of Pathology Pusan National University Hospital

AIM:To introduce a simple and safe anvil insertion technique to esophagus during laparoscopic total gastrectomy(LTG).METHODS:Between July 2010 and December 2012,58 consecutive patients with early gastric cancer underwent LTG were *** performed a simple and safe Roux-en-Y esophagojejunostomy using the double stapling technique to all *** patients’characteristics,perioperative outcome and histopathologic data were analyzed ***:The mean age and body mass index were59.3±9.7 years and 22.7±2.6 kg/*** mean operation,reconstruction and anvil insertion times(from gastric incision to linear stapling)were 251.8±57.0,43.1±2.8 and 4.2±1.9 min,*** blood loss was 204.6±156.3 m L and there was no open *** postoperative complications were in 8 cases(delayed gastric emptying in 4 cases,pulmonary complication in 2cases,pancreatitis in 1 case,anastomotic stricture in 1case).Anastomotic stricture occurred after discharge and was recovered by endoscopic *** patients were discharged at a mean of 9.6±2.0 d after *** leakage nor bleeding from the esophagojejunostomy occurred *** mean proximal margin of specimen was 2.7±2.8 cm CONCLUSION:Roux-en Y esophagojejunostomy usingthe double stapling technique is simple and rapid,and it may offer a solid,alternative reconstruction method for LTG or proximal gastrectomy.

关键词： Laparoscopic surgery Surgical stapling Roux-en-Y a

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Multimodal treatments of right gastroepiploic arterial leiomyosarcoma with hepatic metastasis:A case report and review of the literature

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World Journal of Clinical Cases 2018年第8期6卷 219-223页

作者： Hyung-Il Seo dong-Il Kim youngsoo Chung Chang In Choi Minjoo Kim Sungpil Yun Suk Kim do youn park Department of Surgery Biomedical Research InstitutePusan National University Hospital Department of Surgery Pusan National University Yangsan Hospital Department of Surgery On Hospital Department of Radiology Biomedical Research Institute Pusan National University Hospital Department of Pathology Biomedical Research Institute Pusan National University Hospital

Leiomyosarcoma of an artery is very rare, and cases with hepatic metastasis are even rarer. We describe a case of a 70-year-old man who after follow up due to rectal cancer, presented with an intra-abdominal hypervascular mass and a hepatic mass. After surgical resection, it was diagnosed as a leiomyosarcoma of the right gastroepiploic artery with hepatic metastasis. Multiple metastases had recurred at the liver. He has survived more than 53 mo through multimodal treatments(three surgical resections, radiofrequency ablation, transarterial chemoembolization, chemotherapies, and targeted therapy). Multimodal treatments, including active surgical resection, may behelpful in the treatment of aggressive diseases such as arterial leiomyosarcoma with metastasis.

关键词： Multimodal treatments Intra-abdominal arterial leiomyosarcoma Hepatic metastasis Arterial leiomyosarcoma Surgical resection

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Is ineffective esophageal motility associated with gastropharyngeal reflux disease?

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World Journal of Gastroenterology 2008年第39期14卷 6030-6035页

作者： Kyung Yup Kim Gwang Ha Kim dong Uk Kim Soo Geun Wang Byung Joo Lee Jin Choon Lee do youn park Geun Am Song Department of Internal Medicine Pusan National University School of MedicineBusanSouth Korea Department of Otolaryngology Pusan National University School of MedicineBusanSouth Korea Department of Pathology Pusan National University School of MedicineBusanSouth Korea

AIM： TO evaluate the association between IEM and gastropharyngeal reflux disease （GPRD） in patients who underwent ambulatory 24-h dual-probe pH monitoring for the evaluation of supraesophageal symptoms. METHODS： A total of 632 patients who underwent endoscopy, esophageal manometry and ambulatory 24-h dual-pH monitoring due to supraesophageal symptoms （e.g. globus, hoarseness, or cough） were enrolled. Of them, we selected the patients who had normal esophageal motility and IEM. The endoscopy and ambulatory pH monitoring findings were compared between the two groups. RESULTS;： A total of 264 patients with normal esophageal motility and 195 patients with the diagnosis of IEM were included in this study. There was no difference in the frequency of reflux esophagitis and hiatal hernia between the two groups. All the variables showing gastroesophageal reflux and gastropharyngeal reflux were not different between the two groups. The frequency of GERD and GPRD, as defined by ambulatory pH monitoring, was not different between the two groups. CONCLUSION： There was no association between IEM and GPRD as well as between IEM and GERD. IEM alone cannot be considered as a definitive marker for reflux disease.

关键词： Ineffective esophageal motility Gastroesophageal reflux disease Gastropharyngeal reflux disease

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Is endoscopic submucosal dissection safe for papillary adenocarcinoma of the stomach?

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World Journal of Gastroenterology 2015年第13期21卷 3944-3952页

作者： Hyun Jeong Lee Gwang Ha Kim do youn park Bong Eun Lee Hye Kyung Jeon Joon Hyung Jhi Geun Am Song Department of Internal Medicine Pusan National University School of Medicine and Biomedical Research Institute Pusan National University Hospital Busan 602-739South Korea Department of Pathology Pusan National University School of MedicineBusan 602-739South Korea

AIM: To identify the clinicopathological predictors of lymph node(LN) metastasis and evaluate the outcomes of endoscopic submucosal dissection(ESD) in papillary adenocarcinoma-type early gastric cancers(EGCs).METHODS: From January 2005 to May 2013, 49 patients who underwent surgical operation and 24 patients who underwent ESD for papillary adenocarcinomatype EGC were enrolled to identify clinicopathological characteristics and predictive factors of LN metastasis and to evaluate the outcomes of ESD for papillary adenocarcinoma-type ***: Most papillary adenocarcinoma-type EGCs were located in the lower third of the stomach and had an elevated macroscopic shape. The overall prevalence of LN metastasis was 18.3%(9/49). The presence of lymphovascular invasion was found to be a predictor of LN metastasis(P = 0.016). According to current indication criteria of ESD, 6 and 11 of the 49 patients had absolute and expanded indications for ESD, respectively. Two patients(11.8%) with expanded indication for ESD had LN metastasis. Of the 24 patients who underwent ESD, 13(54%) achieved out-of-ESD indication, with 9 of those 13 patients undergoing surgical operation due to non-curative resection. CONCLUSION: The use of ESD should be carefully considered for papillary adenocarcinoma-type EGC with suspected ESD indication after pre-treatment work-up because of the higher frequency of LN metastasis and additional surgeries.

关键词： Gastric cancer Papillary adenocarcinoma Endoscopic

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Magnifying endoscopy of gastric epithelial dysplasia based on the morphologic characteristics

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World Journal of Gastroenterology 2014年第42期20卷 15771-15779页

作者： Hwa Mi Kang Gwang Ha Kim do youn park Hong Ryeol Cheong dong Hoon Baek Bong Eun Lee Geun Am Song Department of Internal Medicine Busan Adeventist Hospital Department of Internal Medicine Pusan National University School of Medicine Department of Pathology Pusan National University School of Medicine

AIM: To investigate the difference in magnifying endoscopic findings of gastric epithelial dysplasias (GEDs) according to the morphologic characteristics.

关键词： Stomach Dysplasia Narrow band imaging Magnifying endoscopy Mucin

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Associated factors for a hyperechogenic pancreas on endoscopic ultrasound

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World Journal of Gastroenterology 2010年第34期16卷 4329-4334页

作者： Cheol Woong Choi Gwang Ha Kim Dae Hwan Kang Hyung Wook Kim dong Uk Kim Jeong Heo Geun Am Song do youn park Suk Kim Department of Internal Medicine Pusan National University School of Medicine and the Medical Research Institute Pusan National University Hospital Department of Internal Medicine Pusan National University School of Medicine and the Medical Research Institute Department of Pathology Pusan National University School of Medicine and the Medical Research Institute Department of Radiology Pusan National University School of Medicine and the Medical Research Institute

AIM: To identify the associated risk factors for hyperechogenic pancreas (HP) which may be observed on endoscopic ultrasound (EUS) and to assess the relationship between HP and obesity. METHODS: From January 2007 to December 2007, we prospectively enrolled 524 consecutive adults who were scheduled to undergo EUS. Patients with a history of pancreatic disease or with hepatobiliary or advanced gastrointestinal cancer were excluded. Finally,284 patients were included in the analyses. We further analyzed the risk of HP according to the categories of visceral adipose tissue (VAT) and subcutaneous adipose tissue in 132 patients who underwent abdominal computed tomography scans. RESULTS: On univariate analysis, age older than 60 years, obesity (body mass index > 25 kg/m 2 ), fatty liver, diabetes mellitus, hypertension and hypercholesterolemia were identified as risk factors associated with HP (P < 0.05). On multivariate analysis, fatty liver [P = 0.008, odds ratio (OR) = 2.219], male gender (P = 0.013, OR = 2.636), age older than 60 years (P = 0.001, OR = 2.874) and hypertension (P = 0.044, OR = 2.037) were significantly associated with HP. In the subgroup analysis, VAT was a statistically significant risk factor for HP (P = 0.010, OR = 5.665, lowest quartile vs highest quartile). CONCLUSION: HP observed on EUS was associated with fatty liver, male gender, age older than 60 years, hypertension and VAT.

关键词： Endoscopic Ultrasound Hyperechogenic pancreas Obesity

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