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단일기관에서 경험한 췌장 인슐린종의 임상특성 및 치료성적
이선혁(Sun Hyuck Lee),강창무(Chang Moo Kang),김준영(Jun Young Kim),최기홍(Gi Hong Choi),김경식(Kyung Sik Kim),최진섭(Jin Sub Choi),이우정(Woo Jung Lee),김병로(Byong Ro Kim) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.72 No.2
Purpose: We present our experiences of pancreatic insulinoma among the functioning neuroendocrine neoplasm of the pancreas, to review the natural history and suggest proper management. Methods: From June 1990 to August 2006, patients with diagnosis of pancreatic insulinoma were retrospectively reviewed. Results: Thirteen patients (5 men and 8 women) with median age of 42 years (range, 12∼68 years) were investigated. One patient (12%) with pancreatic insulinoma was MEN 1. Intraoperative ultrasound scan (sensitivity, 88%) was the most powerful modality for tumor localization. Sixteen neoplasms with median tumor size 1 cm (range, 0∼3 ㎝) were found. Ten neoplasm (62%) were located in the heads/necks of the pancreas. Six neoplasm (38%) were located in the tails. Five neoplasm (31%) were located around the neck areas near the SMV or PV. Twelve patients (92%) underwent enucleation, and two patients (15%) underwent distal pancreatectomy with splenectomy. 100% of patients with pancreatic insulinoma have survived and the overall disease free 10-year survival was found to be about 85.7%. Conclusion: Exact localization of tumor by intraoperative ultrasound and effective surgical removal can be significantly beneficial for good prognosis.
다발성 글루카곤 생성 내분비세포종을 동반한 췌장 알파세포의 Nesidioblastosis 및 과다증식 1예
강화평 ( Hua Pyong Kang ),김세화 ( Se Wha Kim ),임태섭 ( Tae Seop Lim ),이혜원 ( Hye Won Lee ),최흔 ( Heun Choi ),강창무 ( Chang Moo Kang ),김호근 ( Ho Guen Kim ),방승민 ( Seung Min Bang ) 대한소화기학회 2014 대한소화기학회지 Vol.63 No.4
Nesidioblastosis is a term used to describe pathologic overgrowth of pancreatic islet cells. It also means maldistribution of islet cells within the ductules of exocrine pancreas. Generally, nesidioblastosis occurs in beta-cell and causes neonatal hyperinsulinemic hypoglycemia or adult noninsulinoma pancreatogenous hypoglycemia syndrome. Alpha-cell nesidioblastosis and hyperplasia is an extremely rare disorder. It often accompanies glucagon-producing marco- and mircoadenoma without typical glucagonoma syndrome. A 35-year-old female was referred to our hospital with recurrent acute pancreatitis. On radiologic studies, 1.5 cm sized mass was noted in pancreas tail. Cytological evaluation with EUS-fine-needle aspiration suggested serous cystadenoma. She received distal pancreatectomy. The histologic examination revealed a 1.7 cm sized neuroendocrine tumor positive for immunohistochemical staining with glucagon antibody. Multiple glucagon-producing micro endocrine cell tumors were scattered next to the main tumor. Additionally, diffuse hyperplasia of pancreatic islets and ectopic proliferation of islet cells in centroacinar area, findings compatible to nesidioblastosis, were seen. These hyperplasia and almost all nesidioblastic cells were positive for glucagon immunochemistry. Even though serum glucagon level still remained higher than the reference value, she has been followed-up without any evidence of recurrence or hormone related symptoms. Herein, we report a case of alpha-cell nesidioblastosis and hyperplasia combined with glucagon-producing neuroendocrine tumor with literature review.
최기홍(Gi Hong Choi),김창희(Kim Chang Hee),한대훈(Dai Hoon Han),김동현(Dong Hyun Kim),최새별(Sae Byeol Choi),강창무(Chang Moo Kang),김경식(Kyung Sik Kim),최진섭(Jin Sub Choi),박영년(Young Nyun Park),박준용(Jun Yong Park),김도영(Do Yo 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.4
Purpose: Recent studies have reported improved perioperative and long-term outcomes for the initial postoperative results for patients with a huge HCC. The purpose of this study was to investigate the surgical outcomes of patients with a huge HCC and we wanted to identify any subgroup that would likely benefit from hepatic resection. Methods: From January 1996 to August 2006, 55 patients were diagnosed with a huge HCC (≥ 10cm in diameter). All the tumors were classified as either the expanding nodular type or the non- expanding nodular type. Results: The mean age of the patients was 50.6 years and 39 patients were male. The most common cause of liver disease was hepatitis B virus. The mean size of tumor was 11.9 cm. Microscopic liver cirrhosis was present in 17 patients. Twenty-three patients had tumors of the expanding nodular type. Curative resection was performed in 50 patients. The 5-year diseasefree and overall survival rates after resection were 35.8% and 41.0%, respectively. Univariate analysis revealed that surgical margins of ≤ 1.0, a non-curative resection, the non-expanding nodular type and microscopic vascular invasion were adverse prognostic factors for survival. Multivariate analysis indicated that the gross tumor classification (expanding nodular vs. nonexpanding nodular) was the only independent prognostic factor. Conclusions: Huge HCC is not a homogenous group and the gross tumor pattern may represent the biologic behavior of huge HCC. Because the outcome of surgical treatment is far better than that of non-surgical treatment, resection should be actively considered for patients with a huge HCC. An expanding nodular type tumor is the best candidate for surgical resection.