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증례 : 소화기 ; 미분화 암종이 동반된 췌장의 파골세포 모양 거대세포종양 1예
김금하 ( Geum Ha Kim ),구양서 ( Yang Suh Ku ),김현옥 ( Hyun Ok Kim ),김길현 ( Kil Hyun Kim ),김건국 ( Koen Kuk Kim ),정동해 ( Dong Hae Jung ),김연석 ( Yeon Suk Kim ) 대한내과학회 2009 대한내과학회지 Vol.77 No.5
본 증례는 췌장의 미부에 발생한 미분화 암종이 동반된 파골세포 모양 거대세포종양의 증례이며 림프절 전이나 원격전이를 보이지 않아 근치적 절제를 시행할 수 있었고, 보조항암화학요법을 이용하여 치료 중이어서 질환에 관한 고찰 및 국내 증례들을 종합하여 보고하는 바이다. An osteoclast-like giant cell tumor of the pancreas is a very rare neoplasm, with only three cases reported in Korea. Due to the rarity of this tumor type, few clinical data are available. We present a case of undifferentiated carcinoma with osteoclast-like giant cell tumor arising in the tail of the pancreas in a 72-year-old woman hospitalized to evaluate epigastric pain and a palpable abdominal mass. Magnetic resonance imaging revealed the presence of a large enhancing mass with septation arising from the tail of the pancreas. A distal pancreatectomy with splenectomy was performed. The pathological diagnosis was undifferentiated carcinoma with osteoclast-like giant cell tumor. Here, we describe the histopathological and immunohistochemical findings and review the clinical features of the cases reported in the Korean literature. (Korean J Med 77:610-615, 2009)
유두주위게실이 내시경유두큰풍선확장술을 이용한 총담관 결석 치료에 미치는 영향
이지원 ( Ji Won Lee ),김정호 ( Jung Ho Kim ),김연석 ( Yeon Suk Kim ),최현석 ( Hyun Seok Choi ),김주승 ( Ju Seung Kim ),정석후 ( Seok Hoo Jeong ),하민수 ( Min Su Ha ),구양서 ( Yang Suh Ku ),김연수 ( Yun Soo Kim ),김주현 ( Ju Hyun K 대한소화기학회 2011 대한소화기학회지 Vol.58 No.4
Background/Aims: Periampullary diverticulum (PAD) causes difficulty in the extraction of common bile duct (CBD) stones with conventional endoscopic therapy. Our study was designed to evaluate the effect of PAD on endoscopic large balloon dilation (EPLBD) with/without limited endoscopic sphincterotomy (EST) for CBD stone treatment. Methods: We retrospectively reviewed cases of 141 patients treated CBD stones by EPLBD with/without limited EST at Gachon Gil Medical Center from September 2008 to February 2010. PAD were classified into three groups according to the location of the papilla and diverticulum. Clinical parameters, endoscopic parameters, and procedure outcomes were analyzed. Results: PAD were identified in 46.1% (65/141), with 23 male (35.4%) and 42 female (64.6%) and a mean age of 72.9±11.1 years. Mean diameter of the stones was 14.8±6.0 mm and mean diameter of CBD was 21.6±7.7 mm. PAD group was significantly older than control group (72.9 vs. 68.6, p=0.043) and the incidence of large stone (≥15 mm) was higher in PAD group (60.0% vs. 42.1%, p=0.034). Success rate of complete removal of stones in the first session was 32/65 patients (49.2%) and overall successful complete stone removal rates was 63/65 (96.9%). There was no significant difference between the PAD and control groups in success rate. Major complications were similar between two groups. Conclusions: PAD is associated with an increased incidence of large bile duct stones and older age. PAD seems to not increase technical failure rate or complication risk on EPLBD with/without limited EST. (Korean J Gastroenterol 2011;58:201-207)
고주파 열치료술로 성공적으로 치료된 간세포암종의 폐전이 1예
박재찬 ( Jae Chan Park ),김연수 ( Yun Soo Kim ),정영걸 ( Young Kul Jung ),강명희 ( Myung Hee Kang ),권오상 ( Oh Sang Kwon ),최덕주 ( Duck Joo Choi ),구양서 ( Yang Suh Ku ),김주현 ( Ju Hyun Kim ) 대한간암학회 2013 대한간암학회지 Vol.13 No.1
Surgical resection or liver transplantation is a main curative modality for hepatocellular carcinoma (HCC). But nowadays local ablation therapy is being accepted as a useful option for local control therapy for HCC. Here we present a case of 59 years old male with hepatitis B virus related liver cirrhosis, who underwent surgery for HCC at S6 two years ago. He had received percutaneous ethanol injection (PEI), radiofrequency ablation (RFA) and multiple sessions of transarterial chemoembolization (TACE) for intrahepatic recurrences of HCC after surgery. A small radio-opaque lesion occurred at the left upper lobe of lung. Metastatic HCC was confirmed by CT-guided percutaneous needle core biopsy. CT-guided RFA for pulmonary metastasis was performed. Now it is been 11 months after the treatment without any recurrence.
HBsAg 음성, anti-HCV 음성인 알코올간경변증에서 anti-HBc 양성 혹은 B형간염바이러스 잠재감염이 간세포암종 발생에 미치는 영향
김민주 ( Min Ju Kim ),권오상 ( Oh Sang Kwon ),정낙소 ( Nak So Chung ),이서영 ( Seo Young Lee ),정혁상 ( Hyuk Sang Jung ),박동균 ( Dong Kyun Park ),구양서 ( Yang Suh Ku ),김유경 ( Yu Kyung Kim ),김연수 ( Yun Soo Kim ),김주현 ( Ju H 대한간학회 2008 Clinical and Molecular Hepatology(대한간학회지) Vol.14 No.1
권광안 ( Kwang An Kwon ),김유경 ( Yu Kyung Kim ),정문기 ( Moon Gi Chung ),박동균 ( Dong Kyun Park ),권오상 ( Oh Sang Kwon ),김선숙 ( Sun Suk Kim ),김연석 ( Yeon Suk Kim ),권소영 ( So Young Kwon ),구양서 ( Yang Suh Ku ),최덕주 ( Du 대한장연구학회 2005 Intestinal Research Vol.3 No.2
목적: 최근 조기대장암의 내시경 치료의 가능성에 대한 관심이 높아지고 있다. 이에 저자들은 조기대장암의 임상양상 및 치료결과에 대하여 알아보고자 하였다. 대상 및 방법: 1999년 7월부터 2004년 6월까지 대장암으로 진단 받은 969명 중 117명(120병소)의 조기대장암 환자의 의무기록을 후향적으로 조사하였다. 결과: 전체 대장암 중 조기대장암의 빈도는 12.1%였고 점막암이 80예, 점막하층암이 40예였다. 조기대장암에서 병변의 평균크기는 1.8 cm, 암조직의 평균크기는 1.1 cm였다. 병변의 평균크기는 점막하층암이 2.2 cm로 점막암의 1.7 cm보다 컸다(p=0.03). 육안적 분류로 편평형에서 점막하층암이 30%로 점막암의 15%보다 높은 경향을 보였다(p=0.07). 조직학적 분화도는 고분화선암이 77.5%였으며, 중등도 분화를 보인 경우는 점막하층암에서 63%로 점막암의 3%보다 유의하게 높았다(p<0.001). 조기대장암에 대한 치료는 점막암 80예중 초치료로 10예에서 수술을 시행하였고, 70예에서 내시경 절제를 하였으며, 이 중 2예에서 추가 수술적 절제를 시행하였다. 점막하층암 40예에서는 초치료로 19예에서 수술을 시행하였으며, 21예가 내시경 절제를 받았고 이 중 13예에서 추가 수술적 절제를 받았다. 결론: 본 연구에서 조기대장암의 빈도는 12.1%로 국내 과거 보고보다 증가하고 있으며, 조기대장암에서 내시경 치료를 고려하는 경우 크기가 2 cm 이상이며 중등도 분화도를 보이는 편평형 조기대장암에서는 점막하층암일 가능성을 고려하는 것이 치료에 도움이 될 것으로 생각한다. Background/Aims: Recently, it has been more interested in the early colorectal cancer (ECC) with possibility of endoscopic treatment. We evaluated the clinicopathological characteristics and the treatment results of the ECC. Methods: 120 cases of ECC from 969 patients with colon cancer were analyzed. The cases of concomitant advanced colon cancer were excluded. Results: 12.1% of total colon cancer was ECC. 80 and 40 cases were mucosal (M) and submucosal (SM) cancer, respectively. The size of lesion and cancer tissue of SM cancer was significantly larger than that of M cancer (lesion size, 2.2 vs. 1.7 cm, p=0.03; cancer size, 1.7 vs. 0.7 cm, p<0.001). The prevalence of flat type in SM cancer was higher than that of M cancer (30% vs. 15%, p=0.07). Moderately-differentiated type was more common in SM cancer than M cancer (63% vs. 3%, p<0.001). 15 cases received the additional operation (M cancer; 2, SM cancer; 13). The metastasis of lymph nodes was verified in 2 cases of SM cancer. Conclusions: The ECC with flat type, more than 2 cm in size and moderately-differentiated type had the possibility of SM cancer. Therefore endoscopic treatment in patients with those characteristics should be considered with caution. (Intestinal Research 2005;3:133-139)