- A Case of ANCA-Negative Generalized Wegener's Granulomatosis.
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Seung Kyu Kim, Yong Jin Kwon, Heae Surng Park, Kwang Won Rhee, Ji Yoon Ha, Hee Sung Ko, Ki Hyun Kim, Min Kwang Byun
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Yeungnam Univ J Med. 2013;30(1):17-20. Published online June 30, 2013
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DOI: https://doi.org/10.12701/yujm.2013.30.1.17
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 Abstract
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- Wegener's granulomatosis is a very rare systemic vasculitis characterized by necrotizing granulomatosis. The detection of antineutrophil cytoplasm antibody (ANCA) is a valuable finding in diagnosing Wegener's granulomatosis because ANCA is positive in approximately 90 percent of patients with active, generalized Wegener's granulomatosis. But ANCA is not necessarily positive to make a diagnosis. A 59-year-old man was transferred to our hospital. He was diagnosed with lung abscess and treated with antibiotics at previous hospital. Initially, the ANCA was negative in immunofluorescence assay but we suspected Wegener's granulomatosis because of systemic inflammatory symptoms. Clinical symptoms deteriorated rapidly so we did bronchoscopic biopsy early. Wegener's granulomatosis was diagnosed according to pathologic finding that reported necrotizing granulomatous inflammation associated with vasculitis. Thus we treated with steroid then clinical symptoms and laboratory findings were improved.
- A Case of Biliary Papillomatosis with Cystic Dilatation of Bile Duct.
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Yoo Mi Park, Kwangwon Rhee, Sun Och Yoon, Ji Yoon Ha, So Young Park, Jung Ho Lee, Sung Ill Jang
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Yeungnam Univ J Med. 2012;29(2):136-140. Published online December 31, 2012
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DOI: https://doi.org/10.12701/yujm.2012.29.2.136
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Abstract
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- A 61-year-old male who complained of right upper quadrant pain was referred to the authors for evaluation after his computed tomography suggested biliary adenocarcinoma. The lesion consisted of multiple cysts with papillary mass and peri-ampullay mass. The patient underwent an operation due to a clinical suspicion of biliary cystadenocarcinoma, but the pathology confirmed biliary papillomatosis (BP) after diagnosing intrahepatic papillary neoplasm with high-grade dysplasia and invasive adenocarcinoma with papillary neoplasm from the distal common bile duct to the duodenum. BP is a disease characterized by multiple papillary masses. Its cause has yet to be discovered. It commonly manifests as bile duct dilation but rarely as a ductal cystic change. Under computed tomography or magnetic resonance imaging, both the BP and the cystic neoplasm can show bile duct dilation and a papillary mass, which makes their differential diagnosis difficult. A confirmative diagnosis can be made through a pathologic examination. BP is classified as a benign disease that can become malignant and may recur, though rarely. Its treatment of choice is surgical resection. Laser ablation or photodynamic therapy can be used for unresectable lesions. In the case featured in this paper, biliary papillomatosis was difficult to differentiate from cystic adenocarcinoma due to diffusely scattered multiple large cystic lesions in the liver, and it was histologically confirmed to have become malignant with cystic duct dilation after the operation. This case is reported herein with a literature review.
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Yeungnam University College of Medicine
