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AIM: To determine the relevance of the 10-mm size criterion of the generally accepted surgical indication for gallbladder polyps (GBPs). METHODS: We collected data of patients who were confirmed to have GBPs through cholecystectomy at Samsung Medical Center between January 1997 and December 2012. Among the patients who underwent cholecystectomy for GBP, those with a definite evidence for malignancy such as adjacent organ invasion, metastasis on preoperative imaging studies, polyp larger than 20 mm, absence of preoperative imaging study results, and patients having gallstones were excluded. We retrospectively collected and analyzed information on patient’s clinical characteristics, symptoms, ultrasonographic findings, and blood laboratory tests. RESULTS: A total of 836 patients who had undergone cholecystectomy were retrospectively analyzed. Seven hundred eighty patients (93%) had benign polyps, whereas 56 patients (7%) had malignant polyps. Of the 56 patients with malignancy, 4 patients (7%) had borderline GBP (10-12 mm) and a patient had small GBP (< 10 mm) with T2 stage. We conducted an ROC curve analysis to verify the 10-mm size criteria (AUC = 0.887, SD = 0.21, P < 0.001). In the ROC curve for polyp size and malignancy, sensitivity and specificity of the 10-mm size criterion was 98.2% and 19.6%, respectively. The specificity of the 11-mm and 12-mm size criteria was 44.6% and 56%, respectively, whereas the sensitivity of these two size criteria was similar. We defined the GBPs of 10 to 12 mm as a borderline-sized GBP, which were found in 411 patients (49%). In this group, there was a significant difference in age between patients with benign and malignant GBPs (47 years vs 60 years, P < 0.05). CONCLUSION: GBPs larger than 13 mm need immediate excision whereas for borderline-sized GBPs detected in young patients, careful medical observation can be a rational decision.

Objective: Helicobacter pylori eradication has widely accepted as a primary treatment for gastric marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT). We evaluated long-term clinical outcome of low-grade gastric MALT lymphoma in a single center. Methods: From 1996 to 2010, a total of 205 H. pylori-infected patients with lowgrade gastric MALT lymphoma were prospectively enrolled in Seoul National University Hospital. Twelve patients were excluded due to presence of extra-gastric MALT lymphoma or other malignancy at initial diagnosis. Complete remission (CR) was defined as no endoscopic findings of lymphoma, and histopathology of complete histological response (ChR) or probable minimal residual disease (pMRD). Tumor response to H. pylori eradication therapy was evaluated by endoscopy and histopathology every 2-3 months till CR and every 6-12 months after achieving CR. Results: Median follow-up period was 5.4 years (range, 1.0-14.4 years). H. pylori was successfully eradicated in 187 (96.9%) of 193 eligible patients. CR was obtained in 170 (88.1%) patients and the median time to achieve CR was 3 months (range, 1-20 months) after H. pylori eradication therapy. Tumor recurrence was found in 7 (4.1%) patients and the median tumor recurrence time was 13 months (range, 3-61 months) after achieving CR. Cumulative recurrence rate was 1.9, 4.2 and 7.8% at 1, 3 and 5 years, respectively. Disease-free survival was 97.0, 96.1 and 94.8% at 3, 5 and 7 years, respectively. Other malignancies were found in 8 (4.1%) of 193 patients, none of whom had metachronous gastric cancer. Five-year and 10-year overall survival rate was 99.4 and 97.4%, respectively. Tumors of the proximal stomach (mid-body to fundus) (odds ratio [OR] 4.39, 95% confidence interval [CI] 1.34-14.43; p=0.015) and low serum total cholesterol level (,170 mg/dL) (OR 4.17, 95% CI 1.27-13.71; p=0.019) increased the risk of non-CR after H. pylori eradication therapy. Conclusions: Most patients with low-grade gastric MALT lymphoma treated by H. pylori eradication therapy showed excellent long-term outcomes. Serum total cholesterol might be a novel predictive marker for tumor response to H. pylori eradication therapy.

Tracheobronchomegaly, or Mounier-Kuhn syndrome, is a rare clinical and radiologic condition characterized by marked tracheobronchial dilatation and recurrent lower respiratory tract infections. It is thought to be due to a congenital anomaly. A diagnosis is typically made using computed tomography (CT) and bronchoscopy. Symptoms can range from minimal with preserved lung function to severe respiratory failure. Here, we present the case of a 50-year-old male who was referred to our hospital for chronic cough, sputum, and dyspnea. In addition, the patient showed tracheobronchomegaly with bronchomalacia on CT and bronchoscopy. This report describes a rare case of Mounier-Kuhn syndrome with a literature review. (Korean J Med 2012;83:357-362)