Kosin Medical Journal

Case reports

Gastric cancer with lymphoid stroma mimicking a subepithelial lesion after a 10-year disease-free interval: a case report: Bang Ju Kim, Sung Eun Kim, Seun Ja Park, Moo In Park, Won Moon, Jae Hyun Kim, Kyoungwon Jung, Myung Hun Lee, Jung Wook Lee, Kyung Won Seo, Hee-Kyung Chang; Kosin Med J. 2025;40(3):233-238. Published online September 23, 2025; DOI: https://doi.org/10.7180/kmj.25.123

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Abstract PDF PubReader ePub: A 74-year-old male patient presented to our hospital for treatment of gastric cancer in 2021. He had previously visited our institution in 2011 for assessment of a gastric subepithelial lesion (SEL), which was discovered incidentally during a health screening esophagogastroduodenoscopy (EGD). Endoscopic ultrasonography and abdominal computed tomography were conducted for evaluation of the gastric SEL, revealing an approximately 1 cm lesion arising from the muscularis propria. The lesion was initially thought to represent a mesenchymal tumor such as leiomyoma or gastrointestinal stromal tumor. Owing to its small size and absence of symptoms, no immediate intervention was undertaken, and the patient underwent regular surveillance only. Follow-up was maintained until 2018 and no notable changes in the gastric SEL were detected. The patient then voluntarily discontinued further follow-up. In 2021, a routine health screening EGD identified changes in the gastric SEL, and histopathological analysis confirmed adenocarcinoma. The patient subsequently underwent radical total gastrectomy utilizing the Roux-en-Y technique, with the final pathological diagnosis being stage I (pT2N0M0) gastric cancer with lymphoid stroma (GCLS). As of April 2025, there has been no evidence of cancer recurrence. This case illustrates a lesion initially diagnosed as SEL that later was identified as GCLS after a 10-year interval. Therefore, during EGD, clinicians should consider the potential for SEL-like gastric cancer if an SEL is observed. This report highlights the importance of close monitoring and a thorough diagnostic evaluation.

Brain hemorrhage in patients with advanced hepatocellular carcinoma treated with atezolizumab and bevacizumab: two case reports: Bangju Kim, Hyun Joon Park, Sang Uk Lee, Kwang Il Seo, Jung Wook Lee, Sumin Jo, Jun Yeb Nam; Kosin Med J. 2025;40(2):150-156. Published online June 30, 2025; DOI: https://doi.org/10.7180/kmj.25.114

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Abstract PDF PubReader ePub: A combination of atezolizumab and bevacizumab is currently recommended for treating unresectable advanced-stage hepatocellular carcinoma (HCC), as it has demonstrated superior overall survival and progression-free survival compared to sorafenib. However, concerns have been raised regarding serious adverse events associated with bevacizumab, such as gastrointestinal perforation, fistula, hemorrhage, and arterial thromboembolism. In particular, patients with liver cirrhosis (LC) show an increased risk of variceal bleeding. However, brain hemorrhage associated with the use of bevacizumab in patients with HCC and LC is extremely rare. We encountered two cases of brain hemorrhage in patients with HCC and LC who underwent treatment with atezolizumab and bevacizumab. One patient had no history of hypertension, while the other patient had hypertension that was well-controlled with medication and an unruptured brain aneurysm located on the right side of the anterior communicating artery. Both patients experienced brain hemorrhage after two treatment cycles of atezolizumab with bevacizumab. One patient died due to brain hemorrhage, while the other patient recovered from subarachnoid hemorrhage with successful coil embolization. This case report suggests that if a patient has any high-risk factors associated with brain hemorrhage, physicians should thoroughly consider alternative treatment options for advanced HCC, as brain hemorrhage could be fatal.

Complete response in borderline resectable pancreatic cancer after modified FOLFIRINOX chemotherapy followed by surgical resection: a case report: Seong Hyun Koh, Jung Wook Lee; Kosin Med J. 2025;40(2):136-141. Published online June 18, 2025; DOI: https://doi.org/10.7180/kmj.24.158

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Abstract PDF PubReader ePub: Borderline resectable pancreatic cancer (BRPC) constitutes a challenging subset of cases that fall between clearly resectable and unresectable disease. Pancreatic cancer has a poor prognosis, with a 5-year survival rate of 4.2%. In patients who underwent surgical resection, the 5-year survival rate rose from 1.5% to 17.4%, whereas in those who did not undergo resection, it remained unchanged. Here, we present the case of a patient with BRPC who had no residual tumor during surgery after receiving neoadjuvant FOLFIRINOX chemotherapy. A 57-year-old male patient was hospitalized for abdominal pain and was referred to our hospital for recurrent pancreatitis due to persistent alcohol consumption. Tumor marker testing showed a carbohydrate antigen 19-9 level <2.00 U/mL and a carcinoembryonic antigen level of 4.32 ng/mL. Computed tomography and magnetic resonance cholangiopancreatography revealed signs suggestive of pancreatic cancer, including diffuse gallbladder wall thickening and pancreatic duct dilatation. Endoscopic ultrasound-guided fine needle aspiration biopsy was performed to obtain a tissue sample, and pathological examination confirmed pancreatic ductal adenocarcinoma. Positron emission tomography-computed tomography found no abnormal F-18 fluorodeoxyglucose uptake that would suggest metastasis. Pylorus-preserving pancreaticoduodenectomy was performed, and no visible tumor cells were detected in the resected pancreas after chemotherapy. The patient was followed up for >2 months after surgery without recurrence. The absence of a residual tumor during surgery after upfront chemotherapy in patients with pancreatic cancer is extremely rare and is reported here along with a review of the literature.

Obstructive jaundice caused by tuberculous lymphadenitis accompanied by a mass in the pancreas: a case report: Jong In Jeon, Jung Wook Lee; Kosin Med J. 2025;40(1):66-71. Published online November 13, 2024; DOI: https://doi.org/10.7180/kmj.24.113

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Abstract PDF PubReader ePub: Abdominal tuberculous lymphadenopathy is a rare condition that can cause obstructive jaundice. The feature of tuberculosis lymphadenopathy may resemble those of cancer, metastasis, or lymphoma on computed tomography (CT) or magnetic resonance imaging; therefore, physicians must perform appropriate examinations, make correct diagnoses, and conduct suitable treatment. Herein, we report a case of obstructive jaundice caused by tuberculous lymphadenopathy. The patient was 27 years old, with an initial serum total bilirubin level of 6.76 mg/dL and a direct bilirubin level of 5.64 mg/dL. Aspartate transaminase and alanine transaminase levels were 466 and 801 IU/L, respectively. Abdominal CT revealed a mass-like effect and extraluminal compression accompanying bile duct obstruction. An abrupt bile duct stricture was observed on endoscopic retrograde cholangiopancreatography; thus, a biopsy was performed. However, the specimen which was taken by endoscopic retrograde cholangiopancreatography was confirmed to constitute superficially biopsied bile duct mucosa and benign-looking epithelial cell stripes. Positron emission tomography-CT showed a hypermetabolic lesion in the hepato-duodenal ligament with small lymph nodes in the aortocaval and retrocaval spaces. Additionally, it showed hypermetabolism of the neck lymph node at level II. The neck lymph node was biopsied. Granulomatous inflammation was observed and nested tuberculosis polymerase chain reaction was positive. The patient was treated with anti-tuberculosis medications and underwent endoscopic retrograde biliary drainage without surgery.

Review article

Basic knowledge of endoscopic retrograde cholangiopancreatography: Jung Wook Lee; Kosin Med J. 2023;38(4):241-251. Published online December 26, 2023; DOI: https://doi.org/10.7180/kmj.23.151

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Abstract PDF PubReader ePub: Endoscopic retrograde cholangiopancreatography (ERCP) was first performed in the late 1960s. Due to advancements in instruments, devices, and techniques, ERCP has played an important role in the management and diagnosis of pancreatobiliary disorders. However, ERCP is accompanied by the risk of various complications even if performed by an expert. The incidence of ERCP complications is approximately 4% to 10%, while the incidence of fatal complications, such as death, is less than 0.5%. To prevent adverse events, experts performing ERCP must recognize and address ERCP-related complications and understand the various techniques. In this review, we summarize the complications and techniques of ERCP.

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