전이성 피부 샘암종의 면역조직화학적 고찰

최금하(Keum-Ha Choi),장규윤(Kyu Yun Jang) 한의병리학회 2009 동의생리병리학회지 Vol.23 No.5

편평세포암종을 닮은 섬유샘종의 광범위 편평상피화생

차은정(Eun Jung Cha),최금하(Keum Ha Choi),윤현조(Hyun Jo Youn),김동석(Dong Sug Kim),문우성(Woo Sung Moon) 대한외과학회 2009 Annals of Surgical Treatment and Research(ASRT) Vol.76 No.1

We report a fibroadenoma with extensive squamous metaplasia in the breast. A 21-year-old woman presented with a mass of the left breast. Breast ultrasonography showed a 1.8×1.7 cm sized, well-circumscribed mass in left subareolar region. The mass was excised. Grossly, the mass was well circumscribed and the cut surfaces were grayish-white in color and elastic in consistency. Microscopically, the breast lesion showed the histological features of fibroadenoma. There were areas of extensive squamous metaplasia seen as isolated clusters or involving duct. But some metaplastic clusters surrounded by fibrous stroma were compressed and distorted and separation of cells into isolated clusters mimicked invasive carcinoma. Co-expression of CK 5/6, high molecular weight CK and p63 in areas of squamous metaplasia and normal myoepithelial cells supported myoepithelial cell origin of metaplastic cells.

각화극세포종과 편평세포암에서 Lysyl Oxidase (LOX)의 발현: 감별진단에의 유용성

남현민 ( Hyun Min Nam ),최금하 ( Keum Ha Choi ),박건 ( Kun Park ),박석돈 ( Seok Don Park ) 대한피부과학회 2012 大韓皮膚科學會誌 Vol.50 No.3

Background: Because keratoacanthoma (KA) and squamous cell carcinoma (SCC) are very similar with respect to clinical and histological features but are different with respect to prognosis and treatment, it is necessary to differentiate these two diseases. A number of recent studies have been attempted to differentiate these two diseases using immunohistochemical stains; however, the results obtained using these approaches were inconsistent. Objective: The purpose of this study was to examine the expression pattern of polyclonal antibody to lysyl oxidase (LOX) on KA and SCC using an immunohistochemical staining method, and to evaluate the ability of this method in distinguishing these two diseases. Methods: The expression of LOX in 10 cases of KA and 10 cases of SCC, which were confirmed by histopathologic examination, and 10 cases of normal human skin as a control, were evaluated using an immunohistochemical staining method. We divided the degree of immunohistochemical staining into three classifications --high density, low density, and no density-- based on the level of the expression of LOX in the epidermis and the tumor. Evaluation of the immunohistochemical staining was performed by two dermatologists and one pathologist. Results: The rates of high, low, and no density in KA were 50%, 50%, and 0%, respectively. The rates of high, low, and no density in SCC were 40%, 10%, and 50%, respectively. The rates of high, low, and no density in the control group were 70%, 30%, and 0%, respectively. Conclusion: Because the degree of LOX expression in KA and SCC was very diverse, it could not be reliably used as a differential stain for the two diseases. But interestingly, no LOX expression was observed in SCC. This suggests that if expression of LOX is absent, there is a high probability of being diagnosed with a malignant skin tumor rather than a benign skin tumor. (Korean J Dermatol 2012;50(3):220~226)

옻에 의한 전신접촉피부염과 정상 피부에서 항원제시세포의 차이

김의경 ( Ui Kyung Kim ),최금하 ( Keum Ha Choi ),박건 ( Kun Park ),박석돈 ( Seok Don Park ) 대한피부과학회 2013 大韓皮膚科學會誌 Vol.51 No.3

Background: Urushiol is a widely known potent allergen that causes severe contact dermatitis through the epidermis or blood vessels. The role of antigen presenting cells (APC) in allergic contact dermatitis (ACD) is well known, but the role of APC in systemic contact dermatitis (SCD) is not yet fully evaluated. Objective: The aim of this study is to observe the changes of APC in thenormal and SCD skin and to discuss their possible roles in the disease process. Methods: Immunohistochemical differences of the Langerhans cells (LC) and dermal dendritic cells (DDC) were investigated in cases of the normal and SCD skin (Ed note: keep uniformity as above). Immunohistochemical staining with anti-CD1a, S-100 protein, HLA-DR, and factor XIIIa antibodies were performed. The number of CD1a, S-100 protein, and HLA-DR positive cells per mm2 of the epidermis was counted. The number of HLA-DR and Factor XIIIa-positive DDC per mm2 was also evaluated. Results: The LC positive for CD1a and S-100 in the epidermis were slightly higher in SCD, but their difference was not statistically significant. HLA-DR and Factor XIIIa-positive DDC in the dermis weresignificantly increased in the skin of SCD than normal. HLA-DR positive LC in the epidermis was also increased. Conclusion: Our results suggest that DDC plays a more important role than that of epidermal LC in urushiol-induced SCD. Increased HLA-DR-positive LC in the epidermis suggests that antigen delivery through the blood also affects the epidermal Langerhans cell beside the dermal dendritic cells. (Korean J Dermatol 2013;51(3): 179∼184)

옆구리에 유경성 종괴로 발생한 에크린땀구멍종

남현민 ( Hyun Min Nam ),권선용 ( Sun Yong Kwon ),김의경 ( Ui Kyung Kim ),최금하 ( Keum Ha Choi ),박석돈 ( Seok Don Park ),박건 ( Kun Park ) 대한피부과학회 2012 대한피부과학회지 Vol.50 No.7

Eccrine poroma is a benign neoplasm, arising from the eccrine sweat duct. It generally occurs in middle aged individuals and is most commonly found on the sole or the sides of the foot, followed by the hands and fingers. It presents as a solitary, soft or a rather firm consistent, sessile or often slightly pedunculating, tumor. A 47-year-old woman presented with a 2.5×1.5 sized brownish to erythematous pedunculating mass on the left flank. According to histopathologic finding and immunohistochemical staining (epithelial membrane antigen), the final diagnosis was consistent with eccrine poroma. We report here on an interesting case of eccrine poroma presenting as pedunculating mass on the flank, which is an unusual location. (Korean J Dermatol 2012;50(7):647∼649)

흥미영상 : 연속적인 FDG-PET/CT 검사에서 섭취 감소로 관찰된 비소세포암의 뇌전이

박순아 ( Soon Ah Park ),양세훈 ( Sei Hoon Yang ),양충용 ( Chung Yong Yang ),최금하 ( Keum Ha Choi ) 대한핵의학회 2009 핵의학 분자영상 Vol.43 No.5

A 60-year-old woman, who had non-small-cell lung cancer (NSCLC) in left lower lobe underwent brain F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for evaluation of cerebral metastasis. On follow-up FDG-PET/CT, only hypometaolic lesion was detected and progressed in right frontal lobe at 6 months and 10 months, later. Hypermetabolic metastasis was not detected even at last scan time of FDG-PET/CT. Brain MRI showed brain metastasis in right frontal lobe. As might be expected, the physician should take cerebral metastasis into consideration even though there is only hypometabolic change on subsequent FDG-PET/CT in patients with NSCLC. (Nucl Med Mol Imaging 2009;43(5):505-507)

배양켈로이드 섬유모세포에서 유전자 발현

김도현 ( Do Hyeon Kim ),김의경 ( Ui Kyung Kim ),최금하 ( Keum Ha Choi ),박건 ( Kun Park ) 대한피부과학회 2019 大韓皮膚科學會誌 Vol.57 No.2

Background: Keloids are the result of an overgrowth of dense fibrous tissue. The mechanisms involved in keloid formation remain unknown. Objective: To understand the mechanism of keloid formation, differences in gene expression in keloids and normal skin were compared. Gene expression profiles of keloids and normal skin were analyzed. Methods: From microarray analysis, eight genes whose expression profiles showed down-regulation or up-regulation in keloid samples were selected and the expression of these genes were confirmed by real-time polymerase chain reaction to further shed light on the mechanism of keloid formation. Results: The expression levels of FBXO32, NTF3, MEGF6, and ITGA8 were significantly increased in cells isolated from keloid tissue, whereas the expression levels of PTGS2, PITX1, MALL, and AMFR were significantly decreased in keloids compared to normal skin. Conclusion: These differently expressed genes in keloids and normal skin may play an important role in keloid formation. (Korean J Dermatol 2019;57(2):59∼65)

암포테리신, 포사코나졸 병용투여와 암포테리신 세척으로 치료한 비안와두부형 국균증 1예

김상엽(Sang Yeop Kim),고상준(Sang Yeop Kim),최금하(Keum Ha Choi),김상덕(Sang Duck Kim) 대한안과학회 2017 대한안과학회지 Vol.58 No.6

Purpose: To report a case of rhino-orbito-cerebral aspergillosis successfully treated with a combination of amphotericin B, posaconazole and amphotericin B irrigation. Case summary: A 59-year-old male with hypertension, diabetes mellitus and hyperlipidemia was admitted to our neurology department for left facial paresthesia, pain and consulted to ophthalmology for left eyeball pain. His visual acuity was no light perception in the left eye, and fundus examination showed papilledema and a cherry-red spot. Left exophthalmos and complete ptosis with ophthalmoplegia were also observed. Orbital computed tomography revealed left maxillary and ethmoid sinusitis, and nasal endoscopic examination revealed a black eschar adjacent to the middle turbinate. Subsequent biopsy suggested mucormycosis. The patient was immediately treated with a combination of amphotericin B and posaconazole. In addition, left endoscopic sinus surgery was performed and aspergillosis was histopathologically confirmed. The patient underwent amphotericin B irrigation for 5 days after canula insertion up to orbital apex. The patient survived for 18 months and is still alive. Conclusions: A combination of amphotericin B, posaconazole and amphotericin B irrigation using the canula through the orbital apex may be helpful in treating patients with rhino-orbito-cerebral aspergillosis who refuse orbital exenteration. 목적: 암포테리신 B, 포사코나졸의 병용투여와 암포테리신 세척으로 치료한 비안와두부형 국균증 1예를 보고하고자 한다. 증례요약: 당뇨가 있는 59세 남자 환자가 좌측 얼굴 감각이상, 통증을 주소로 본원 신경과에 입원하였고, 좌측 안구통증으로 안과에 의뢰되었다. 시력은 좌안 무광각이었고 안저검사에서 시신경유두부종과 앵두반점이 관찰되었다. 좌안이 우안보다 돌출되어 있었고, 좌측 완전 눈꺼풀처짐과 전체 눈근육마비가 관찰되었다. 안와 전산화단층촬영에서 좌측 상악동염, 사골동염이 관찰되어 코내시경 검사를 시행하였고, 중비갑개 근처에 검은색 괴사딱지가 관찰되어 시행한 조직검사에서 뮤코르진균증이 의심되었다. 이에 즉시 포사코 나졸과 암포테리신 B를 병용투여하였다. 또한 좌측 내시경적 부비동 수술을 시행하였고 이어서 시행한 조직검사에서 국균증으로 확진되었다. 안와꼭지까지 캐뉼라를 삽입한 후 암포테리신 B로 5일간 세척하였다. 18개월째 환자는 생존하고 있는 상태이다. 결론: 안와내용물제거술을 거부한 국균증 환자에서 암포테리신, 포사코나졸의 병용투여와 캐뉼라를 이용한 안와꼭지의 암포테리신 세척으로 좋은 치료 결과를 보여 보고하는 바이다.

초음파 내시경 유도하 조직 검사로 진단된 담낭의 원발성 편평상피암 1예

허원각 ( Won Gak Heo ),전형구 ( Hyung Ku Chon ),최금하 ( Keum Ha Choi ),김태현 ( Tae Hyeon Kim ) 대한내과학회 2019 대한내과학회지 Vol.94 No.4

Squamous cell carcinoma of the gallbladder (GB) is uncommon and often presents at an advanced stage; therefore, it is associated with more aggressive behavior and a worse prognosis than those of adenocarcinoma. Herein, we report the case of an 82-year-old woman presenting a weight loss of 5 kg and epigastric discomfort over the previous 3 months. Abdominal computed tomography and magnetic resonance cholangiopancreatography revealed an infiltrative mass in the GB with hepatic invasion. Endoscopic ultrasound-guided fine needle biopsy using a 20-G core needle was performed, and the pathological examination revealed keratin pearls and an intracellular bridge, which are characteristics of squamous cell differentiation consistent with squamous cell carcinoma. Endoscopic ultrasound-guided fine needle biopsy was useful for obtaining an accurate histological diagnosis of GB masses without the need for surgery. (Korean J Med 2019;94:371-374)

결장 샘암종에서 Claudin-1, β-catenin과 E-cadherin의 발현

차은정 ( Eun Jung Cha ),장규윤 ( Kyu Yun Jang ),최하나 ( Ha Na Choi ),김경열 ( Kyung Ryul Kim ),최금하 ( Keum Ha Choi ),황성호 ( Sung Ho Hwang ),문우성 ( Woo Sung Moon ),강명재 ( Myoung Jae Kang ),이동근 ( Dong Geun Lee ) 대한내과학회 2008 대한내과학회지 Vol.74 No.2

목적: 부착 단백의 발현의 변화에 의한 세포-세포 부착의 파열은 종양 세포의 침윤과 전이에서 중요한 역할을 한다. 이에 이번 연구는 결장 샘암종에서 세포 부착 관련 물질인 claudin-1과 E-cadherin 및 β-catenin이 어떤 역할을 하는지 알아보고자 하였다. 방법: 47예의 결장 샘암종에서 claudin-1과 E-cadherin 및 β-catenin에 대한 면역조직화학적 염색을 시행하여 이들의 발현 양상을 관찰하고, 임상병리학적 인자들과의 상관관계를 분석하였다. 결과: Claudin-1의 발현은 결장 샘암종의 림프절 전이가 많을수록 유의하게 감소하였고(p=0.019), 침윤 부위 종양세포의 조직학적 분화도가 중분화를 보일 때 보다 저등급분화를 보일 때 유의하게 감소하였다(p=0.030). E-cadherin 과 β-catenin의 발현도 저등급분화 샘암종이 중분화 샘암종에 비해 유의한 감소를 보였다(각각 p=0.010, p=0.012). 또한 claudin-1, E-cadherin 및 β-catenin 중에서 2개 이상 단백질 발현의 감소는 샘암종의 조직학적 탈분화와 의미 있는 상관관계를 보였다(p=0.030). 결론: 본 연구의 결과는 결장 샘암종에서 claudin-1, E-cadherin과 β-catenin의 발현 감소가 샘암종의 진행과 종양의 탈분화와 관련이 있음을 시사한다. Background/Aims: Disruption of the cell-to-cell junction with changes in the expression of the junctional proteins is the hallmark of cancer invasion and metastasis. To investigate the roles of claudin-1, β-catenin and E-cadherin in adenocarcinoma of the colon, the relationship of their expression with clinical and pathological factors were examined. Methods: The expression of claudin-1, β-catenin and E-cadherin were examined in 47 cases of adenocarcinoma of the colon by immunohistochemical staining. Results: A reduced claudin-1 expression was associated with advanced lymph node metastasis (p=0.019) and histological dedifferentiation at the invasive front (p=0.030). A reduced expression of β-catenin and E-cadherin were correlated with histological dedifferentiation (p=0.012, p=0.010, respectively). The reduced expression of two or more proteins was correlated with the histological findings of dedifferentiation (p=0.030). Conclusions: These results suggest that loss of claudin-1, β-catenin and E-cadherin expression may be correlated with the progression of adenocarcinoma of the colon and associated with an advanced histological grade. (Korean J Med 74:146-153, 2008)