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HER-2/neu유전자 과발현 유방암의 임상병리학적 특성
김철남 ( Chul Nam Kim ) 대한임상종양학회 2009 Korean Journal of Clinical Oncology Vol.5 No.1
서론: 유방암은 다양한 임상경과를 보이는 질환으로 예후 인자의 역할이 매우 중요하다. 현재까지 유방암의 예후 인자로 액와부 림프절의 전이 상태, 원발 종양의 크기, 에스트로겐 수용체와 프로게스테론 수용체 발현 유무, HER-2/neu유전자 과발현 유무 등이 잘 알려져 있다. 본 연구에서는 유방암의 예후 예측에 중요한 역할을 담당하는 HER-2/neu 유전자의 과발현을 면역조직화학염색법을 통해 확인하고 그 결과와 기타 임상병리학적 인자와의 연관성을 알아보고자 하였다. 방법: 1999년 12월부터 2003년 10월까지 유방암으로 수술 받은 119예를 대상으로 하였다. 모든 환자의 유방암 진료기록을 검토하여 진단 당시 나이, 종양의 크기, 조직학적 등급, 핵등급, 림프절 전이여부, 분자생물학적 특성(호르몬수용체, p53, Ki-67, HER-2/neu, 림프혈관침윤)들을 조사하여 분석하였다. 결과: 환자의 평균 나이는 50.3세였으며 전체 119예 중 HER-2/neu 과발현이 있는 경우는 32예(26.9%)였다. 액와 림프절 병기에 따른 HER-2/neu 과발현율이 통계적인 유의성을 보였고(p=0.036), 에스트로겐 수용체나 프로게스테론 수용체는 HER-2/neu 과발현과 관계가 있었으며(p=0.001, p=0.004), p53 단백 발현 유무와 ki-67 지수는 유의한 상관관계가 없었다. 조직학적 소견 중에서는 림프혈관침윤 유무와 조직등급, 핵등급 등이 HER-2/neu 과발현과 통계적으로 연관성이 있는 것으로 나타났다(p=0.029, p=0.041, p=0.001)(Table 1). 다변량 분석을 시행한 결과 핵등급만이 독립적으로 HER-2/neu 과발현과 연관성이 있는 것으로 나타났다(p=0.014)(Table 2). 결론: HER-2/neu유전자 과발현 유방암은 액와림프절 전이, 림프혈관침윤, 조직학적 등급, 핵등급, 호르몬 수용체 발현 정도와 연관성이 있는 것으로 나타났으며, 향후 생존율, trastuzumab 사용 유무 등에 대한 분석을 통해 예후에 미치는 독립적인 영향에 대해 연구되어야 할 것으로 생각된다. Purpose: Clinicopathologic factors associated with prognosis in breast cancer patients have varied. HER-2/neu gene amplification and/or protein overexpression occur in 14-30% of all cases of breast cancer. Among clinicopathologic factors, HER-2/neu gene status has been suggested to be a significant prognostic indicator for breast cancer. The objective of this study was to determine whether HER-2/neu gene expression is associated with other clinicopathologic factors in breast cancer. Methods: The expression of HER-2/neu, Ki-67, p53, estrogen receptor and progesterone receptor was determined immunohistochemically and medical records were reviewed in 119 breast cancer patients, including 87 patients that demonstrated the absent of HER-2/neu expression and 32 patients with the present of HER-2/neu expression. Results: HER-2/neu expression was noted in 32 patients (26.9%) of the 119 breast cancer patients. Of the 87 patients(73.1%) with absent of HER-2/neu expression. There was a significant correlation between HER-2/neu expression and the nodal status (p=0.023), lymphovascular invasion(p=0.029), histologic grade(p=0.041), nuclear grade(p=0.001), estrogen receptor status(p=0.001) and progesterone receptor status(p=0.004). Nuclear grade was statistically significant association factor with HER-2/neu expression status independently in multivariate analysis.(p=0.041, relative risk 0.177, 95% CI 0.043-0.733) Conclusion: This study demonstrates the potential value of the lymph nodal status, lymphovascular invasion, histologic grade, nuclear grade and hormonal receptor status correlating with the status of HER-2/neu expression in human breast cancer.
김민 ( Min Kim ),송태준 ( Tae Jun Song ),강승대 ( Seung Dae Kang ),강종식 ( Jong Sik Kang ),김진숙 ( Jin Suk Kim ),이준성 ( June Sung Lee ),김철남 ( Chul Nam Kim ),김한성 ( Han Seong Kim ) 대한소화기학회 2014 대한소화기학회지 Vol.64 No.6
Low-grade fibromyxoid sarcoma is a slowly growing soft tissue neoplasm that shows benign histologic features but may have clinical course of malignant disease. It has been reported to occur in the thigh, inguinal area, axilla, shoulder, neck, perineum or buttock. However, there have been few cases of abdominal organ involvement. A 21-year-old woman presented with a large palpable abdominal mass. A 7×4 cm sized round soft tissue tumor at right upper quadrant area was identified by abdominopelvic CT scan. Percutaneous ultrasound-guided biopsy revealed features of spindle cell tumor. On exploration, the tumor originated from transvers colon and was attached to gastrocolic ligament, transverse mesocolon and stomach. The tumor could be dissected with transverse colectomy and partial gastrectomy. The excised tumor, measuring 7×5×5 cm, was well demarcated and appeared as an ovoid mass with firm and myxoid cut surface. She was diagnosed with low-grade fibromyxoid sarcoma arising from transverse colon, and is currently being followed-up without recurrence or metastasis. (Korean J Gastroenterol 2014;64:375-379)
이홍태 ( Hong Tae Lee ),김재일 ( Jae Il Kim ),최평화 ( Pyong Wha Choi ),박제훈 ( Je Hoon Park ),허태길 ( Tae Gil Heo ),이명수 ( Myung Soo Lee ),김철남 ( Chul Nam Kim ),장석효 ( Surk Hyo Chang ) 대한외상학회 2011 大韓外傷學會誌 Vol.24 No.1
Purpose: Even though traumatic pancreatic injuries occur in only 0.2% to 4% of all abdominal injuries, the morbidity and the mortality rates associated with pancreatic injuries remain high. The aim of this study was to evaluate the clinical outcomes of traumatic pancreatic injuries and to identify predictors of mortality and morbidity. Methods: We retrospectively reviewed the medical records of 26 consecutive patients with a pancreatic injury who underwent a laparotomy from January 2000 to December 2010. The data collected included demographic data, the mechanism of injury, the initial vital signs, the grade of pancreatic injury, the injury severity score (ISS), the revised trauma score (RTS), the Glasgow Coma Scale (GCS), the number of abbreviated injury scales (AIS), the number of associated injuries, the initial laboratory findings, the amount of blood transfusion, the type of operation, the mortality, the morbidity, and others. Results: The overall mortality rate in our series was 23.0%, and the morbidity rate was 76.9%. Twenty patients (76.9%) had associated injuries to either intra-abdominal organs or extra-abdominal organs. Two patients (7.7%) underwent external drainage, and 18 patients (69.3%) underwent a distal pancreatectomy. Pancreaticoduodenectomies were performed in 6 patients (23.0%). Three patients underwent a re-laparotomy due to anastomosis leakage or postoperative bleeding, and all patients died. The univariate analysis revealed 11 factors (amount of transfusion, AAST grade, re-laparotomy, associated duodenal injury, base excess, APACHE II score, type of operation, operation time, RTS, associated colon injury, GCS) to be significantly associated with mortality (p<0.05). Conclusion: Whenever a surgeon manages a patient with traumatic pancreatic injury, the surgeon needs to consider the predictive risk factors. And, if possible, the patient should undergo a proper and meticulous, less invasive surgical procedure. (J Korean Soc Traumatol 2011;24:1-6)