양성자 방출 단층 CT (PET-CT)에서 과대사 종괴로 발견된 후복강내 신경집종

고평곤 ( Pyung Gohn Goh ),고광훈 ( Kwang Hun Ko ),김의식 ( Eui Sik Kim ),김윤정 ( Yun Jeung Kim ),이수윤 ( Soo Youn Lee ),문희석 ( Hee Seok Moon ),정현용 ( Hyun Yong Jeong ) 대한소화기학회 2011 대한소화기학회지 Vol.57 No.5

Schwannoma is a benign neoplasm of the Schwann cells of the neural sheath. Most schwannomas occur in the head and neck, and extremities and rarely in the retroperitoneal space. The differentiation of a schwannoma from other malignant tumor or benign tumor is very difficult on a preoperative examination with ultrasonography, computed tomography or magnetic resonance imaging. Furthermore, the lesion with increased fluorodeoxyglucose uptake in PET-CT cannot exclude malignant tumor. Therefore, this lesion needs surgical excision and a histological examination with immunohistochemical staining. We report a case of schwannoma occuring in the retroperitoneal space that incidentally discovered by PET-CT for health-check up. Pathologic confirmation by laparoscopic excision was done. (Korean J Gastroenterol 2011;57:323-326)

위 천공에 의한 복막염으로 나타난 위 림프상피종양 암종 1예

고평곤 ( Pyung Gohn Goh ),김의식 ( Eui Sik Kim ),김윤정 ( Yun Jeung Kim ),이수윤 ( Soo Youn Lee ),문희석 ( Hee Seok Moon ),김석현 ( Seok Hyun Kim ),이병석 ( Byung Seok Lee ),정현용 ( Hyun Yong Jeong ) 대한소화기학회 2011 대한소화기학회지 Vol.58 No.4

Gastric lymphoepithelioma-like carcinoma is a rare carcinoma among gastric malignant tumor but has a good prognosis. The carcinoma has histologic feature characterized by small nest of cancer cells mixed with lymphoid stroma. We report a case with lymphoepithelioma-like carcinoma of stomach initially presenting as panperitonitis because of spontaneous tumor perforation. A 56-year-old man visited our emergency room because of epigastric pain. A preoperative abdominal CT scan showed a massive pneumoperitoneum in the upper abdomen, and the presence of gastric cancer in the lesser curvature of the stomach. An emergent laparotomy was performed followed by radical subtotal gastrectomy. Pathologic examination revealed that the tumor was a lymphoepithelioma-like gastric carcinoma. (Korean J Gastroenterol 2011;58:208-211)

Peutz-Jeghers 증후군 환자에서 발생한 췌장 두부의 관내 유두상 점액성 악성 종양 1예

고평곤 ( Pyung Gohn Goh ),문희석 ( Hee Seok Moon ),성재규 ( Jae Kyu Sung ),정현용 ( Hyun Yong Jeong ),송규상 ( Kyu Sang Song ) 대한소화기학회 2010 대한소화기학회지 Vol.55 No.1

Peutz-Jeghers syndrome (PJS), which is characterized by multiple hamartomatous polyps of the gastrointestinal tract and mucocutaneous pigmentation, is a rare autosomal dominant disease. This syndrome is often represented as a surgical emergency with complications of the polyps such as intussusception, small bowel obstruction, bleeding, and volvulus. In particular, many studies have reported that patients with this syndrome have a high risk of gastrointestinal or extragastrointestinal malignancy including gastric, duodenal, jejunal, ileal, and colonic carcinoma as well as malignancies involving other organs such as the gallbladder, biliary tract, pancreas, tonsils, breast, and reproductive system. However, there are few reported cases of an association of this syndrome with extraintestinal malignancy. In addition to that, there is no reported case of this syndrome with malignant tumor or intraductal papillary mucinous tumor of pancreas in Korea. We experienced a case of PJS accompanying intraductal papillary mucinous carcinoma of the pancreas, therefore we report this case with literatures reviewed. (Korean J Gastroenterol 2010;55:73-77)

수막종과 병발한 외투막세포 림프종

김의식 ( Eui Sik Kim ),고평곤 ( Pyung Gohn Goh ),김윤정 ( Yun Jeung Kim ),이수윤 ( Su Youn Lee ),문희석 ( Hee Seok Moon ),성재규 ( Jae Kyu Sung ),이병석 ( Byung Seok Lee ),정현용 ( Hyun Yong Jeong ) 대한소화기학회 2012 대한소화기학회지 Vol.60 No.1

Mantle cell lymphoma (MCL) is an uncommon type of gastrointestinal lymphoma. MCL is a distinct subtype of B-cell non-Hodgkin lymphomas. The major subtype of MCL is characterized by the presence of multiple lymphomatous polyposis (MLP), in which multiple polyps are observed along the gastrointestinal tract. The malignant cells express pan B-cell marker and the T-cell marker cluster of differentiation 5. The chromosomal translocation t(11;14)(q13;q32) that causes cyclin D1 overexpression is commonly observed on the cytogenetic analysis of MCL. Survival improvement has recently been achieved for patient with MCL by the successful introduction of monoclonal antibodies and dose-intensified approaches for treatment, including autologous stem cell transplantation strategies. Some reports suggest that there is an increased incidence of second malignancies in patients with MCL or lymphoma. We report a case of MCL involving the colon; the patient was a 60-year-old man who complained of low abdominal discomfort during defecation. During the workup, a meningioma was unexpectedly discovered. On analysis, the tumor was found to be a t(11;14)-negative and non-MLP-type MCL. (Korean J Gastroenterol 2012;60:56-60)

위장관 ; 진행성 위암에서 항암 화학 치료로 완전 반응을 보인 환자들의 복합항암 화학요법의 독성과 효능의 비교 분석

김윤정 ( Yun Jeung Kim ),고평곤 ( Pyung Gohn Goh ),김의식 ( Eui Sik Kim ),이수윤 ( Su Youn Lee ),문희석 ( Hee Seok Moon ),이엄석 ( Eaum Seok Lee ),성재규 ( Jae Kyu Sung ),김석현 ( Seok Hyun Kim ),이병석 ( Byung Seok Lee ),정현용 ( 대한소화기학회 2011 대한소화기학회지 Vol.58 No.6

Background/Aims: We retrospectively analyzed comparative toxicities and efficacies of chemotherapy regimens in advanced gastric cancer (AGC) patients who achieved complete response (CR) after chemotherapy. Methods: We reviewed the medical records of 1,203 patients, who were pathologically diagnosed as AGC in a single center between January 2001 and October 2007. On the basis of the Response Evaluation Criteria in Solid Tumors, CR was evaluated with abdominal computed tomography. Toxicities were evaluated using the National Cancer Institute`s common toxicity criteria before each chemotherapy cycle. Results: Among the 1,203 AGC patients enrolled in this study, 568 received chemotherapy and 635 received best supportive care. The major chemotherapy regimens were 5-fluorouracil, leucovorin and oxaliplatin (FOLFOX), docetaxel, cisplatin and 5-fluorouracil (DCF) and 5-fluorouracil, leucovorin and irinotecan (FOLFIRI). Among the 568 patients, 51 (9.0%) achieved CR (49 [8.6%] with FOLFOX [n=12], DCF [n=26], or FOLFIRI [n=11] and 2 [0.3%] with etoposide, leucovorin and 5-fluorouracil). For patients administered FOLFOX, DCF, and FOLFIRI, the median time to disease progression was 4 months (range, 1.8-59.5), 15 months (range, 2.9-31.2) and 10 months (range, 2.0-39.5), and the median survival times were 48 months (range, 5.9-74.0), 37 months (range, 14.0-86.0), and 30 months (range, 6.0-50.0), respectively. Grades 3-4 mucositis occurred mostly in patients administered DCF (n=8, 30.8%). Grades 3-4 leucopenia were observed in 1 (8.3%), 11 (42.3%), and 4 (36.4%) patients administered FOLFOX, DCF and FOLFIRI, respectively. No statistically significant differences were observed in the 3 regimens. Conclusions: All 3 regimens (FOLFOX, DCF and FOLFIRI) were active and tolerable. Their efficacies and toxicities were not significantly different. (Korean J Gastroenterol 2011;58:311-317)

만성 C형 간염에서 페그인터페론과 리바비린의 병합치료시 치료 순응도의 중요성

이헌영 ( Heon Young Lee ),고평곤 ( Pyung Gohn Goh ),김민정 ( Min Jung Kim ),김혜진 ( Hye Jin Kim ),은혁수 ( Hyuk Soo Eun ),김의식 ( Eui Sik Kim ),김윤정 ( Yun Jeung Kim ),이수윤 ( Soo Youn Lee ),문희석 ( Hee Seok Moon ),이엄석 ( E 대한소화기학회 2011 대한소화기학회지 Vol.57 No.5

Background/Aims: The combination therapy with peginterferon and ribavirin is a standard treatment for patients with chronic hepatitis C. However, because of the long duration of the treatment and many complications, the reduction of adherence frequently occur. This study aimed to assess influences of reduced medication adherence in the combination therapy of chronic hepatitis C patients. Methods: We retrospectively reviewed the medical records of 82 patients with chronic hepatitis C who received a combination therapy with peginterferon and ribavirin. The patients were categorized into 3 subgroups on the basis of medication adherence. Group 1 comprised patients who received ≥80% of the recommended dosage of both peginterferon and ribavirin. Group 2 comprised those patients who received ≥80% of the recommended dosage of only 1 drug. The patients of Group 3 received <80% of the recommended dosage of both the drugs. Results: Sustained virologic response (SVR)s of patients in Group 1, 2 and 3 were 85.4% (41/48), 85.7% (18/21), and 38.5% (5/13), respectively (p=0.002). SVRs of genotype 1 patients in Group 1, 2 and 3 were 84.2% (16/19), 75% (9/12), and 14.3% (1/7), respectively (p=0.003). SVRs of genotype non-1 patients in Group 1, 2 and 3 were 86.2% (25/29), 100% (9/9), and 66.7% (4/6), respectively (p=0.196). Furthermore are SVRs significantly differed with the degree of medication adherence to either peginterferon or ribavirin (p=0.003 and 0.021, respectively). In multivariate analysis, the peginterferon dose was a significant independent factor associated with SVR. Conclusions: Medication adherence of chronic hepatitis C patients to the combination therapy with peginterferon and ribavirin is very important for achieving SVR. In particular, we think that genotype 1 patients should maintain higher adherence than genotype non-1 patients. (Korean J Gastroenterol 2011;57:294-301)

전이 또는 재발 위암에 대한 Docetaxel, Cisplatin, 5-FU 복합화학요법 효과

강선형 ( Sun Hyung Kang ),김정일 ( Jeong Il Kim ),고평곤 ( Pyung Gohn Goh ),황세웅 ( Se Woong Hwang ),권대순 ( Dae Soon Kwon ),남관우 ( Kwan Woo Nam ),강현모 ( Hyun Mo Kang ),강윤세 ( Yoon Sae Kang ),문희석 ( Hee Seok Moon ),김석 대한소화기학회 2007 대한소화기학회지 Vol.50 No.3

목적: 수술이 불가능한 전이 또는 재발된 위암에서 docetaxel, cisplatin, 5-FU 병합화학요법의 유용성과 안정성을 알아보고자 하였다. 대상 및 방법: 2001년 3월부터 2006년 3월까지 충남대학교병원에서 조직학적으로 확진되고 수술이 불가능한 전이 또는 재발된 위암 환자 중 측정 가능한 병변을 가진 51명을 대상으로 의무기록을 바탕으로 조사하였다. Docetaxel과 cisplatin은 제1일에 75 mg/m2, 60 mg/m2을 3시간 동안 정주하였고 5-FU는 5일간 750 mg/m2로 24시간 정주하였고 주기당 간격은 4주로 하였다. 결과: 51명의 환자 중 ECOG performance status (PS)는 PS 0이 21명, PS 1이 30명이었다. 51명의 환자 중 7명이 완전관해(13.7%), 17명이 부분 관해(33.3%)로 반응률은 47.1%였으며 불변이 12명(23.5%), 진행이 15명(29.4%)이었다. 무진행 생존기간은 중앙값이 6.7개월(2-34개월)이었으며 중앙생존기간은 14.3개월(2.7-62.5개월)이었다. 관해유지기간은 중앙값이 9.5개월(4.2-21.9개월)이었다. 총 229회의 항암치료당 grade 4의 백혈구 감소증이 10예, grade 4의 호중구 감소증이 51예였고 grade 4의 혈소판 감소증이 2예였다. Grade 1의 점막염이 32예가 발생하였고 grade 1의 근육통이 6예가 있었다. 결론: Docetaxel, cisplatin. 5-FU의 항암화학병합요법은 전이 혹은 재발 위암에서 비교적 낮은 독성의 발현과 높은 반응률을 보이는 치료법이다. Background/Aims: The purpose of this study was to investigate the efficacy and safety of ``docetaxel-5-FU-cisplatin`` combination chemotherapy as a first-line treatment in patients with metastatic or recurrent gastric cancer. Methods: We investigated a total of 51 patients who were diagnosed as pathologically proven gastric cancer and received ``docetaxel-5-FU-cisplatin`` combination chemotherapy between March 2001 and March 2006. All the cases were surgically unresectable because they were either metastatic or recurred gastric cancer. We studied these cases retrospectively on the basis of medical records. The administered doses of decetaxel was 75 mg/m2 and cisplatin 60 mg/m2 on day 1, 5-FU 750 mg/m2 over 24 hrs on day 1 to day 5, every 4 weeks. Results: Among the 51 patients, 21 patients had Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0, 27 patients had PS 1, 3 patients had PS 2. For response rates, 7 (13.7%) achieved complete response, 17 (33.3%) partial response, 12 (23.5%) stable disease, and 15 (29.4%) progressive disease, respectively. The overall response rate was 47.1%. The median time to progression was 6.7 months (2-34 months). Median overall survival was 14.6 months (2.7-62.5 months). Median disease free survival was 9.5 months (4.2-21.9 months). National Cancer Institute-common toxicity criteria (NCI-CTC) grade 4 leukopenia occurred in 10 cases (per 229 cycles). Grade 4 neutropenia occurred in 51 cases, grade 4 thrombocytopenia in 2 cases. Grade 1 mucositis occurred in 32 cases, grade 1 myalgia in 6 cases. Conclusions: ``docetaxel-5-FU-cisplatin`` combination chemotherapy is an active and tolerable regimen as a first-line treatment in patients with metastatic or recurred gastric cancer. (Korean J Gastroenterol 2007;50:157-163)

간 외 담관암의 수술과 방사선 치료의 효과

김정일 ( Jeong Il Kim ),강선형 ( Sun Hyoung Kang ),남관우 ( Gwan Woo Nam ),권대순 ( Dae Soon Kwon ),고평곤 ( Pyung Gohn Goh ),황세웅 ( Se Woong Hwang ),고광훈 ( Kwang Hun Ko ),정재훈 ( Jae Hoon Jung ),문희석 ( Hee Seok Moon ),성 대한내과학회 2008 대한내과학회지 Vol.75 No.2

목적: 간 외 담관암의 보존 요법, 근치적 수술 및 수술 후 방사선 치료의 효과를 알아보고자 하였다. 방법: 1998년부터 2005년까지 충남대학교병원에서 간 외담관암으로 치료를 받은 53명을 대상으로 하였다. 18명(1군)은 경피 경간 담도 배액술이나 내시경적 담도 배액술을 받았고, 17명(2군)은 근치적 절제술을 받았으며 18명(3군)은 근치적 절제술 후에 방사선 치료를 받았다. 결과: 1년 생존율은 1군, 2군, 3군이 각각 33.3%, 64.7%, 88.9%였고, 3년 생존율도 제 1군, 2군, 3군에서 각각 5.7%, 64.7%, 61.1%였다. 1군보다 2, 3군에서 의미있는 생존율의 향상이 있었지만 2군과 3군 사이에는 차이가 없었다. 3년 무병 생존율은 2군이 64.7%, 3군은 66.7%로 차이가 없었다. 생존율에 영향을 주는 인자로 성별, 나이, 위치, 주위 신경침범, 수술 방법, 분화도, 림프혈관 종양 색전, T 병기, N 병기를 알아보았다. 2군내에서는 수술 방법, T 병기, N 병기가 의미있는 인자였고, 3군과 비교시에 분화도가 좋을 경우에 생존율이 높았다. 3군내에서는 연령만이 의미있는 인자였고, 2군과 비교시에 림프절의 전이가 있을 경우에 생존율의 유의하게 향상되었다. 재발율은 34.3%로 주위 조직과 림프절에서 주로 재발하였으며 방사선 치료 후에 심각한 부작용은 없었다. 결론: 간 외 담관암은 비수술적인 고식적 치료보다는 근치적 절제술이 생존율 향상에 필수적이다. 또한, 근치적 절제술이 시행된 경우에 연령이 젊고 림프절의 전이가 있을 경우 방사선 치료가 생존율을 높이는데 기여하리라 사료된다. Background/Aims: To evaluate the effect and prognostic factors related to curative surgical resection and adjuvant radiotherapy in patients with extrahepatic bile duct cancer. Methods: The authors performed a retrospective analysis of 53 patients with extrahepatic bile duct cancer who were treated at Chungnam National University Hospital between 1998 and 2005. 18 patients (Group 1) were managed with percutaneous bile drainage (n=13) or endoscopic bile drainage (n=5), 17 patients (Group 2) underwent only curative resection, and 18 patients (Group 3) received radiotherapy after curative resection. The radio-sensitizer used in these patients was 5-FU. Results: Three-year overall survival was 5.6% in group 1, 64.7% in group 2, and 61.1% in group 3, with no significant difference noted between group 2 and group 3. The disease-free survival rate was 64.7% in group 2 and 66.7% in group 3, with no significant difference noted between the two groups. We evaluated age, sex, differentiation, tumor location, perineural invasion, operative method, lymphovascular tumor emboli, T stage, and N stage as possible prognostic factors. T stage, N stage, and operative method were significant factors in group 2, but age was the only significant factor in group 3. Group 2 patients had longer overall survival than did group 3 patients with well-differentiated cancer, but group 3 patients had longer survival than did group 2 patients with lymph node metastasis. The recurrence rate was 34.3% (mean value) and was no different between group 2 and group 3. Recurrence sites included local tissue, such as liver, and regional lymph nodes. There were no serious complications during radiotherapy. Conclusions: Patients who underwent curative surgical resection and adjuvant radiotherapy after surgery had no statistically significant difference in survival or recurrent rates. However, curative surgery is considered to be the only method to improve survival. Our results suggest that radiotherapy after curative resection may improve survival in patients with lymph node metastasis. (Korean J Med 75:194-201, 2008)