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Background/Aims Most common site of metastasis for anaplastic thyroid carcinoma (ATC) is lungs, liver and regional lymph nodes. Gastrointestinal metastasis is unusual. We report a case who presented ATC accompanied with gastric, lung and pancreas metastases. Methods A 64-year-old female with hypertension presented with palpable neck mass and hoarseness. Fine needle aspiration revealed ATC. At that time, she had upper gastroscopy from outside medical center which detected 7-mm-sized EGC at antrum, posterior wall and biopsy was proven as signet ring cell cancer. She underwent endoscopic submucosal dissection (ESD) from our medical center and histopathologic result was large cell carcinoma with rhabdoid phenotype. Chest computed tomography (CT) and abdomen CT, positron emission tomography-CT were done and about 3.6-cm-sized pancreas metastatic cancer and metastatic lung nodules, Lt. para-aortic lymph node metastasis were detected. Results Our initial diagnosis was anaplastic thyroid cancer with lung and pancreas metastasis and early gastric cancer (double primary cancer). But second histopathologic revision of ESD tissue was done and Pax-8 resulted as positive, so the final diagnosis was ATC multiple metastasis. Conclusions Stomach is rare site of ATC metastasis, and metastatic lesions to the stomach are often difficult to distinguish from that of primary gastric cancer. This case could be the useful reference for similar cases. [ABSTRACT FROM AUTHOR]

Background/Aims Paragonimiasis is a parasitic disease caused by Paragonimus species. Lung is the most common site, but other organs such as the central nervous system, liver, intestine, peritoneal cavity, and abdominal wall are also known to be involved. Methods A 57-year-old male was admitted for recurrent lower abdominal pain over 4 weeks. Physical examination revealed mild right lower quadrant tenderness. Laboratory findings revealed no abnormalities with normal eosinophil count. He went through computed tomography scan and there was diffuse peritoneal infiltration and subtle wall thickening of right colon with multiple reactive lymph nodes (Fig. 1A). He underwent colonoscopy and esophagogastroduodenoscopy (EGD), and no abnormal finding was found. We suspected tuberculous peritonitis and performed exploratory laparotomy. Intraoperative findings showed multiple small whitish nodules and abscess on the peritoneum. Pathologic reports confirmed that there were numerous eggs of Paragonimus westermani (Fig. 1B). ELISA was positive for antibodies against P. westermani in the serum. Retrospective history results revealed that he had consumed freshwater crabs. Results He was treated with praziquantel (25 mg/kg, 3 times daily for 3 days) and his pain was resolved after treatment. Conclusions Human infection of Paragonimus species occurs by ingestion of raw or pickled freshwater crustaceans, such as crab or crayfish with metacercariae. The metacercariae excyst in the duodenum, and then pass through the intestinal wall, peritoneal cavity, diaphragm, and pleural cavity to the lung. Due to this mi-gratory route, ectopic infections can occur such as peritoneum. The diagnosis of ectopic infection can be made when worms or eggs of characteristic shape are found on tissue. ELISA for antibodies or molecular identification by PCR can be helpful for diagnosis. [ABSTRACT FROM AUTHOR]

Background/Aims Gastric medullary carcinoma (GMC) is a very rare type of gastric neoplasm typically presenting in elderly males. Here we present a case of a 72-year-old male with an Epstein-Barr virus positive GMC. Methods A 72-year-old man presented to the emergency department with hematemesis. Initial esophagogastroduodenoscopy (EGD) revealed a 3 cm-sized subepithelial tumor with bleeding ulcer at gastric high body (HB). After coagulation therapy, a biopsy was performed on the lesion and chronic gastritis was diagnosed. Three months later, follow up endoscopy revealed that the gastric ulcer had healed. Gastroscopy contrast-enhanced computed tomography (gastroscopy-ECT) showed subepithelial mass at HB and thought to gastrointestinal stromal tumors. A re-biopsy showed a chronic gastritis. The patient was presented 1 year later with melena. EGD revealed an ulcerated subepithelial mass at HB. Endoscopic ultrasound showed hypoechoic mass in the submucosa and gastroscopy-ECT showed no interval change. Twenty months later, he got EGD for healthcare checkup. Endoscopic findings showed subepithelial lesion with early gastric cancer type III and biopsy result confirmed adenocarcinoma, poorly-differentiated. Gastroscopy-ECT revealed that slightly increased size of subepithelial mass. Results The patient underwent subtotal gastrectomy. The final histopathology revealed carcinoma with lymphoid stroma (medullary carcinoma or lymphoepithelioma-like carcinoma) and focal extension to subserosa. In situ hybridization for Epstein-Barr virus-encoded RNA-1 (EBER-1) showed positive result. The tumor was best categorized as a lymphoepithelioma- like carcinoma (LELC). The patient remains alive with no evidence of recurrence after an 18-month follow-up period. Conclusions Although the World Health Organization (WHO) uses GMC and LELC as synonyms for gastric carcinoma with lymphoid stroma, GMC generally refers to microsatellite- unstable solid-type carcinomas, and LELC implies an EBV-driven solid-type carcinoma. All three tumor types feature nests and clusters of poorly or undifferentiated cells showing a syncytial growth pattern surrounded by an intense lymphoplasmacytic cell infiltration. We report EBV positive lymphoepithelioma-like carcinoma through repeated endoscopy and biopsy. [ABSTRACT FROM AUTHOR]