유방암 환자에서 원발암으로 진단된 갑상선암의 특징

신현원,박지영,정재훈,민용기,이문규,김광원,장혜원,이명식,김선욱 대한내분비학회 2009 Endocrinology and metabolism Vol.24 No.4

Background: Both thyroid and breast cancers occur more frequently in women than in men. Some suggest that estrogen plays a role in the tumorigenesis of both cancers. The aim of this study was to identify the prevalence and clinico-pathologic characteristics of primary thyroid cancer in patients with breast cancer. Methods: We retrospectively obtained clinical and pathologic data for 112 patients diagnosed with both thyroid and breast cancer from a single center. Patients with thyroid cancer were grouped according to the chronological sequence of tumor diagnosis. When thyroid and breast cancers were diagnosed within 12 months of each other, they were considered to have been diagnosed simultaneously. Female patients who had only papillary thyroid cancer were used as a historic control. Results: Between 1994 and 2008, 7,827 patients at our hospital were diagnosed with breast cancer and 6,571 patients with thyroid cancer. There were 112 patients who had both thyroid and breast cancer. All thyroid cancers (111/112) except one hurthle cell cancer were papillary thyroid cancers. Average tumor size of thyroid cancer cases diagnosed 1) after or 2) simultaneously with the diagnosis of breast cancer was significantly lower than that for 3) thyroid cancer cases found before breast cancer diagnosis or 4) historical controls with papillary thyroid cancer [sizes (in cm), respectively, were: 1) 0.9 ± 0.6 2) 0.9 ± 0.5 vs 3) 1.4 ± 0.9 4) 1.4 ± 1.1, P < 0.05]. No patients had distant metastases and there were no statistically significant differences in known risk factors for recurrence and survival of patients with thyroid cancer. Conclusion: Thyroid cancer is the most common second primary malignancy in patients with breast cancer and most of them are papillary thyroid cancers. There are no differences in risk factors for tumor recurrence and patient survival compared with those with conventional papillary thyroid cancer except for differences in tumor size. These difference in size may reflect an increase in medical surveillance in patients after they are diagnosed with breast cancer. Background: Both thyroid and breast cancers occur more frequently in women than in men. Some suggest that estrogen plays a role in the tumorigenesis of both cancers. The aim of this study was to identify the prevalence and clinico-pathologic characteristics of primary thyroid cancer in patients with breast cancer. Methods: We retrospectively obtained clinical and pathologic data for 112 patients diagnosed with both thyroid and breast cancer from a single center. Patients with thyroid cancer were grouped according to the chronological sequence of tumor diagnosis. When thyroid and breast cancers were diagnosed within 12 months of each other, they were considered to have been diagnosed simultaneously. Female patients who had only papillary thyroid cancer were used as a historic control. Results: Between 1994 and 2008, 7,827 patients at our hospital were diagnosed with breast cancer and 6,571 patients with thyroid cancer. There were 112 patients who had both thyroid and breast cancer. All thyroid cancers (111/112) except one hurthle cell cancer were papillary thyroid cancers. Average tumor size of thyroid cancer cases diagnosed 1) after or 2) simultaneously with the diagnosis of breast cancer was significantly lower than that for 3) thyroid cancer cases found before breast cancer diagnosis or 4) historical controls with papillary thyroid cancer [sizes (in cm), respectively, were: 1) 0.9 ± 0.6 2) 0.9 ± 0.5 vs 3) 1.4 ± 0.9 4) 1.4 ± 1.1, P < 0.05]. No patients had distant metastases and there were no statistically significant differences in known risk factors for recurrence and survival of patients with thyroid cancer. Conclusion: Thyroid cancer is the most common second primary malignancy in patients with breast cancer and most of them are papillary thyroid cancers. There are no differences in risk factors for tumor recurrence and patient survival compared with those with conventional papillary thyroid cancer except for differences in tumor size. These difference in size may reflect an increase in medical surveillance in patients after they are diagnosed with breast cancer.

성장호르몬이 결핍된 뇌하수체기능저하증 환자에서 성장호르몬 치료 후 죽상경화증 지표 및 아디포사이토카인의 변화

신현원,정인경,조구영,최철영,김종엽,채영제,조민호,이병완,이성진,박철영,홍은경,김현규,김두만,유재명,임성희,최문기,유형준,박성우 대한내분비학회 2006 Endocrinology and metabolism Vol.21 No.6

Background: It is known that patients with hypopituitarism have a high mortality rate due to the presence of atherosclerosis, cardiovascular diseases and stroke. The aim of this study was the effect of growth hormone (GH) on the atherosclerotic markers and the adipocytokine levels. Method: The study was conducted on 13 adult patients with hypopituitarism and growth hormone deficiency (GHD), and they had been stabilized after receiving hormone replacement therapy for other insufficient pituitary hormones, other than GH, for more than one year. Before treatment with GH, we compared the lipid metabolism, glucose metabolism, cardiovascular risk factors and adipocytokine levels, including adiponectin, leptin, TNF-α and IL-6, between the GHD patients and 13 healthy adults who were of a similar age and gender distribution.Patients with GHD were treated with 1 U/day of GH for 6 months. We measured insulin-like growth factor-Ⅰ (IGF-Ⅰ), blood pressure, body composition, lipid metabolism, glucose metabolism and hs-CRP, cardiac function, adiponectin, leptin, TNF-α and IL-6 levels, flow mediated vasodilation (FMD) and nitroglycerin mediated vasodilation (NMD) before and after GH treatment. Results: The patients with hypopituitarism and GHD showed significantly higher levels of total cholesterol (P = 0.002), low-density lipoprotein cholesterol (LDL-C) (P = 0.036), hs-CRP (P = 0.0087) and leptin (P < 0.001) than did the normal healthy adults. However, there was no difference between the normal adults and the patients with GHD for the systolic and diastolic BP, the levels of apoA, apoB, fasting blood glucose(FBG) and HOMA-IR. In the subjects with GHD after treatment with GH, the level of fat mass (P = 0.0017), total cholesterol (P = 0.004), LDL-C (P = 0.001), leptin (P = 0.013), TNF-α (P < 0.001) and hs-CRP (P = 0.0001) 攀접수일자: 2005년 2월 8일통과일자: 2006년 6월 23일 목적: 성장호르몬 결핍증이 있는 뇌하수체기능저하증 환자에서 심혈관 질환에 의한 사망률이 높은 것으로 알려져 있다. 이에 본 저자는 심혈관 위험 인자, 아디포사이토카인에 대한 성장호르몬의 효과를 알아보고자, 성장호르몬 결핍증 성인과 정상 성인을 먼저 비교하고, 성장호르몬 결핍증 환자에게 6개월간 성장호르몬 투여 후에 전후 결과를 비교하였다. 방법: 대상 환자는 성장호르몬 이외에 부족한 뇌하수체 호르몬의 대체요법을 1년 이상 시행 받아 온 성장호르몬이 결핍된 뇌하수체기능저하증 성인 13명으로 하였다. 성장호르몬 투여 전, 나이 및 성별이 비슷한 13명의 정상 성인과 지질대사, 당대사, 심혈관 질환의 위험 인자 및 adiponectin, leptin, TNF-α, IL-6 등의 아디포사이토카인들을 측정하여 비교하였다. 그리고, 성장호르몬 결핍증 환자에게 성장호르몬 1 U/day를 6개월간 투여하고, 투여 전후로 IGF-I, 혈압, 체조성, 지질 대사, 당 대사, 심혈관 위험 인자인 hs-CRP, adiponectin, leptin, TNF-α, IL-6를 조사하였고, 심장의 구조 및 기능, FMD, NMD을 측정하였다. 결과: 성장호르몬이 결핍된 뇌하수체기능저하증 환자는 정상 성인에 비해 총콜레스테롤 (P = 0.002), LDL-C (P = 0.036), hs-CRP (P = 0.0087), 그리고 leptin (P < 0.001)이 의미있게 높았다. 그러나 정상 성인과 성장호르몬 결핍 환자에서 수축기 및 이완기 혈압, HDL-C, apoA, apoB, 트리글리세리드, 공복 혈당, HOMA-IR, adiponectin, TNF-α, IL-6은 의미있는 차이를 보이지 않았다.성장호르몬 치료 6개월 후 지방량(P = 0.0017), 총콜레스테롤(P = 0.004), LDL-C(P = 0.001), leptin (P = 0.013), TNF-α (P < 0.001), hs-CRP (P = 0.0001)가 유의하게 감소하였고, 제지방량(P = 0.0161), 유리지방산(P = 0.049), FMD (P = 0.0051)는 유의하게 증가하였다. 그러나 수축기 및 이완기 혈압, 골밀도, 트리글리세리드, HDL-C, apoA, apoB, LP (a), 공복 혈당 및 공복 인슐린에 의한 HOMA-IR, EF, LVPW, E/A ratio, IVS, NMD, 내중막두께, adiponectin, IL-6 등은 의미있는 변화를 보이지 않았다.

기관지 내시경으로 확인한 흡입 화상환자에서 HRCT의 의의

신현원,김철홍,신태림,박용범,이재영,엄광석,반준우,장승훈,김동규,이명구,현인규,정기석,이일성 대한결핵 및 호흡기학회 2003 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.97 No.0

갑상선 수질암 세포주 증식에 영향을 주는 물질 탐색

신현원,김근숙,이지인,박지영,민용기,이문규,김광원,정재훈,장혜원,김선욱,이명식 대한내분비학회 2009 Endocrinology and metabolism Vol.24 No.2

Background: Surgical excision is the only effective treatment of medullary thyroid carcinoma (MTC) and there is no certain treatment for recurrence or distant metastasis. Materials that influence MTC cell proliferation were recently reported. Presently, we evaluated the influence of dexamethasone, somatostatin, progesterone, estradiol-17-beta, forskolin and gastrin on MTC cell proliferation and calcitonin secretion. Methods: Genomic DNA was extracted and sequenced from untreated thyroid TT cells and cells treated with 10-5~10-10 M dexamethasone, somatostatin, progesterone, estradiol-17-beta, forskolin or gastrin, and cultured for 1~6 days. Cell proliferation was assessed using a BrdU assay at days 1, 2, 3, and 6. Calcitonin in the culture medium from dexamethasone-treated TT cells was measured at days 1~3. Results: Replacement of cysteine with tryptophan at codon 634 of exon 11 was evident in treated TT cells. There was no significant difference in cell proliferation at days 1~3 in cells treated with somatostatin, progesterone, estradiol-17-beta, gastrin and forskolin, while proliferation was inhibited in dexamethasone-treated cells in a concentration-dependent manner from 10-5~10-8 M with no inhibition evident at 10-10 M. Calcitonin levels in 10-5~10-8 M dexamethasone-treated cells were decreased. Conclusion: Dexamethasone is a potentially useful compound to suppress MTC cell proliferation. Further studies are necessary to explore this potential further prior to clinical use. Background: Surgical excision is the only effective treatment of medullary thyroid carcinoma (MTC) and there is no certain treatment for recurrence or distant metastasis. Materials that influence MTC cell proliferation were recently reported. Presently, we evaluated the influence of dexamethasone, somatostatin, progesterone, estradiol-17-beta, forskolin and gastrin on MTC cell proliferation and calcitonin secretion. Methods: Genomic DNA was extracted and sequenced from untreated thyroid TT cells and cells treated with 10-5~10-10 M dexamethasone, somatostatin, progesterone, estradiol-17-beta, forskolin or gastrin, and cultured for 1~6 days. Cell proliferation was assessed using a BrdU assay at days 1, 2, 3, and 6. Calcitonin in the culture medium from dexamethasone-treated TT cells was measured at days 1~3. Results: Replacement of cysteine with tryptophan at codon 634 of exon 11 was evident in treated TT cells. There was no significant difference in cell proliferation at days 1~3 in cells treated with somatostatin, progesterone, estradiol-17-beta, gastrin and forskolin, while proliferation was inhibited in dexamethasone-treated cells in a concentration-dependent manner from 10-5~10-8 M with no inhibition evident at 10-10 M. Calcitonin levels in 10-5~10-8 M dexamethasone-treated cells were decreased. Conclusion: Dexamethasone is a potentially useful compound to suppress MTC cell proliferation. Further studies are necessary to explore this potential further prior to clinical use.

갑상선 유리질소주형선종 1예

신현원,오영륜,이지인,민용기,이문규,김광원,정재훈,장혜원,김선욱,이명식 대한내분비학회 2009 Endocrinology and metabolism Vol.24 No.1

Hyalinizing trabecular tumor is a rare benign thyroid tumor first described by Carney et al. in 1987. The tumor is characterized by an encapsulated nodule, trabecular arrangement of polygonal, oval, elongated cells, and hyalinized stroma. It is easily confused with papillary thyroid carcinoma or medullary thyroid carcinoma on surgical and cytologic specimens. A 45-year-old man presented with an incidentally detected left thyroid mass. Fine needle aspiration was performed and papillary thyroid carcinoma was suspected. However, the surgical specimen revealed a hyalinizing trabecular adenoma. We present this hyalinizing trabecular adenoma case to share our experience with physicians and specialists.

흡입화상 치료과정에서 생긴 공동성 폐 병변

신현원 ( Hyun Won Shin ),김철홍 ( Cheol Hong Kim ),엄광석 ( Kwang Seok Eom ),박용범 ( Yong Bum Park ),장승훈 ( Seung Hun Jang ),김동규 ( Dong Gyu Kim ),이명구 ( Myung Goo Lee ),현인규 ( In Gyu Hyun ),정기석 ( Ki Suck Jung ),이일성 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.60 No.5

Toxic gases and soot deposition as a consequence of smoke inhalation can cause direct injury to the upper and lower airways and even to the lung parenchyma. A delay in proper and prompt therapy can be detrimental to critically ill burn patients with an inhalation injury. Therefore, serial chest radiography is an important diagnostic tool for pulmonary complications during treatment. The radiographic findings of the chest include normal, consolidation, interstitial and alveolar infiltrates, peribronchial thickening, atelectasis, cardiogenic and non-cardiogenic pulmonary edema, and a pneumothorax as acute complications of smoke inhalation. In addition, bronchiectasis, bronchiolitis obliterans and pulmonary fibrosis can occur as late complications. We encountered a case of 44-year-old male who presented with acute lung injury after an inhalation injury. He required endotracheal intubation and mechanical ventilation due to respiratory failure. He was managed successfully with conservative treatment. Later, a cavitary lesion of the left upper lobe was observed on the chest radiography and computed tomography, which was complicated by massive hemoptysis during the follow-up. However, the cavitary lesion disappeared spontaneously without any clinical consequences. (Tuberc Respir Dis 2006; 60: 564-570)

Carbamazepine에 의한 급성 간질성 신염

신현원 ( Hyun Won Shin ),김종엽 ( Jong Yeop Kim ),문승명 ( Seung Myung Moon ),장우영 ( Woo Yung Jang ),서장원 ( Jang Won Seo ) 대한신장학회 2005 Kidney Research and Clinical Practice Vol.24 No.3

시계열 예측을 위한 EWMA퓨전

신현원(Hyung Won Shin),손소영(So Young Sohn) 대한산업공학회 2002 대한산업공학회지 Vol.28 No.2

조기위암과 바터 팽대부 유암종 및 신세포암이 병발한 동시 삼중복암 1예

최철영,채영제,김종엽,신현원,최민호,장현주,은창수,계세협,이진 대한소화기내시경학회 2006 Clinical Endoscopy Vol.32 No.2

Multiple primary cancer is defined as the multiple occurrence of malignant neoplasm in the same individual. Synchronous cancers are usually defined as finding the second cancer at the same time or within a 6-month period after the diagnosis of the primary lesion, and metachronous cancers are found at more than 6 months after the initial diagnosis. Multiple primary cancers have been increasing reported on due to prolonged lifespans and the improvement of diagnostic techniques. Nevertheless, triple synchronous cancers have been regarded as a relatively rare finding. We report here on an unusual case of triple synchronous cancer of early gastric cancer, carcinoid tumor of the ampulla of Vater and renal cell carcinoma. (Korean J Gastrointest Endosc 2006;32:136-140) 다발성 원발 악성 종양은 한 환자에서 조직학적으로 서로 다른 원발 악성 종양이 동시에 혹은 시간을 달리하여 발생하는 경우를 의미한다. 또한 두번째 종양이 발견된 시기가 처음종양과 같은 시기 또는 6개월 이내이면 동시성으로, 6개월 이후에 발견했을 때는 이시성으로 분류한다. 다발성 원발 악성 종양은 진단 기술과 치료 기술의 발달로 사망률이 감소하고 생존 연령이 증가함에 따라 점차 빈도가 증가하고 관심도 높아지고 있지만 여전히 삼중복암은 드물게 보고되고 있다. 지금까지 다양한 조합의 삼중복암이 보고되었지만, 국내 및 국외에서 보고된 적이 없는 조기위암, 바터 팽대부 유암종, 신세포암 조합의 동시 삼중복암 1예를 경험하여서 보고한다.

대장암 및 다낭종신과 동반된 Caroli병 1예

채영제,최철영,김종엽,신현원,김영순,최민호,장현주,은창수,계세협,이진 대한소화기내시경학회 2006 Clinical Endoscopy Vol.32 No.1

Caroli's disease is defined as a communication between congenital cystic dilatation of the bile duct and the biliary system. Caroli's disease accompanied with autosomal dominant polycystic kidney disease is a very rare finding and the differential diagnosis between Caroli's disease with polycystic kidney disease and a polycystic liver is very important. A 67-year-old male patient was admitted to our hospital for hematochezia, and he underwent hemodialysis for chronic renal failure due to his autosomal dominant polycystic kidney disease. On colonoscopy, ulcero-infiltrative tumor was observed in the sigmoid colon. It was diagnosed as adenocarcinoma on tissue biopsy. On abdominal computerized tomography and magnetic resonance cholangiopancreatography, a number of simple cysts was observed in both kidneys and we were able to identify the communication between the dilated intrahepatic ducts and the intrahepatic cystic lesions, and so we diagnosed this patient as having Caroli's disease. (Korean J Gastrointest Endosc 2006;32:71-74) Caroli병은 선천적인 간내 담관의 낭종 확장이 담관계와 연결된 질환으로 상염색체 우성 다낭종신과 동반되는 Caroli병은 매우 드물며, 다낭종신과 동반된 Caroli병은 다낭종신에 동반될 수 있는 다낭간과의 감별이 진단에 중요하다. 상염색체 우성으로 생각되는 다낭종신으로 인한 만성 신부전으로 혈액투석 중이던 67세 남자 환자가 혈변을 주소로 내원하였다. 대장내시경 검사에서 S상 결장에 궤양침윤형 종괴가 관찰되었으며 병리조직검사에서 선암으로 진단되었다. 복부 컴퓨터단층촬영과 자기공명 담췌관조영술에서 양쪽 신장에 많은 단순 낭종들이 관찰되었고 확장된 간내 담관 및 간내 낭종 병변과 담관 사이의 연결을 관찰하여 Caroli병으로 진단하였다.