유두상 혈관내막 증식증의 임상적 보고

이정우,정호윤,이석종,김귀락,최강영,양정덕,조병채,Lee, Jeong-Woo,Chung, Ho-Yun,Lee, Seok-Jong,Kim, Gui-Rak,Choi, Kang-Young,Yang, Jung-Dug,Cho, Byung-Chae 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.3

Purpose: Intravascular papillary endothelial hyperplasia (IPEH), also known as Masson's pseudoangiosarcoma, is a rare disease which is now considered as a reactive process of the endothelium rather than a benign neoplasm. It can occur in any blood vessels in the body but more common in the head and neck region as a solitary, often tender, bluish or reddish nodule. IPEH is characterized by the development of endothelial-lined papillary projections in a vascular lumen, usually associated with thrombotic material, the endothelial cells in the papillary structures showing only slight atypia and occasional mitotic Figures, the absence of tissue necrosis. Methods: 8 patients with IPEH were enrolled in the study from 2002 to 2007. All 8 lesions were surgically excised for histopathologic diagnosis. Results: 4 patients were female. The duration of the lesions ranged from 3 months to 15 years. The tumors were first noted between the ages of 20 and 72 years. 4 patients had lesions on the head; 2 on the toe; 1 on the back; and 1 on the finger, respectively. All lesions were solitary, ranged in size from 2 mm to 27 mm. There were no recurrences. Conclusion: The clinical appearance of IPEH is not specific, presented as a primary neoplasm, and the diagnosis can be established by microscopic examination. Complete surgical excision is the best choice of therapy for patients with IPEH, and is both diagnostic and curative. Awareness of this lesion will prevent incorrect diagnosis and overly aggressive treatment.

비후성 반흔 각질세포와 정상 각질세포의 유전자 비교분석

최성원,정호윤,임영국,김훈남,오지원,김문규,전세화,홍용택,Choi, Sung-Won,Chung, Ho-Yun,Lim, Young-Kook,Kim, Hoon-Nam,Oh, Ji-Won,Kim, Moon-Kyu,Jeon, Sae-Hwa,Hong, Yong-Taek 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.4

Purpose: There is no clear evidence of the original cause of hypertrophic scar, and the effective method of treatment is not yet established. Recently the steps of searching in gene and molecular level are proceeding. we are trying to recognize the difference between keratinocytes of hypertrophic scar and normal skin. Then we do support the comprehension of the scar formation mechanism and scar management. Methods: Total RNAs were extracted from cultured keratinocytes from 4 hypertrophic scars and normal skins. The cDNA chips were prepared. A total of 3063 cDNAs from human cDNA library were arrayed. And the scanning data were analyzed. Results: On microarray, heat shock protein, pyruvate kinase, tumor rejection antigen were more than 2 fold intensity genes. Among them, heat shock 70 kd protein showed the strongest intensity difference. Conclusion: In this study, it can be concluded that heat shock proteins play an important role in the process of wound healing and scar formation. This study provides basic biologic information for scar research. The new way of the prevention and treatment of scar formation would be introduced with further investigations.

진행성 유방암에 있어 유방절제술 후 발생한 광범위 피부결손 부위의 가슴배피판을 이용한 흉벽재건술

김학태,양정덕,정호윤,조병채,김귀락,최강영,이정훈,박호용,Kim, Hak-Tae,Yang, Jung-Dug,Chung, Ho-Yun,Cho, Byung-Chae,Kim, Gui-Rak,Choi, Kang-Young,Lee, Jung-Hun,Park, Ho-Yong 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.6

Purpose: Radical surgical extirpation in advanced breast cancer patients produces extensive loss of skin with large defects requiring plastic surgical procedures for the closure. Many reconstructive methods exist, the choice of which depends upon the characteristic of the wound, extent of resection and patient comorbidities. For adequate coverage of the large skin defects following resection of advanced breast cancer, current authors have performed a thoracoabdominal flap. Methods: From August 2008 to June 2009, 4 cases of thoraco-abdominal flap were performed for chest wall reconstruction after mastectomy of advanced breast cancer. Flap dissection was entirely performed in a subfascial plane and the flap involving the external oblique abdominal muscle. The flap was rotated clockwise in left chest wall defects and counterclockwise in right chest defects and the donor site was closed directly. Results: Their mean age, 55.7 years and the average follow-up interval was 9 months. Patients' oncologic status ranged from stage IIIc to stage IV, it was classified according to the TNM staging system. Flap dimensions ranged between $15{\times}15$ and $25{\times}25\;cm$. One flap sustained a partial loss at the distal margin and revision with pectoralis major musculocutaneous island flap. Conclusion: Large chest wall reconstructions are usually required after radical excision of advanced cancer stages patients with poor general conditions. Thoracoabdominal flap is a simple, quick single-stage procedure, and offer to patient fast recovery, low complication rate, enabling further concomitant adjuvant therapy.

급속소퇴성 선천혈관종 5예

한만훈 ( Man-hoon Han ),정호윤 ( Ho Yun Chung ),이종민 ( Jong Min Lee ),허승 ( Seung Huh ),김준영 ( Jun Young Kim ),이원주 ( Weon Ju Lee ),이석종 ( Seok-jong Lee ) 대한피부과학회 2019 大韓皮膚科學會誌 Vol.57 No.9

Rapidly involuting congenital hemangioma (RICH), a subtype of congenital hemangioma (CH), is fully developed at birth and undergoes rapid involution by 6-14 months of age. Clinically, this vascular lesion differs from both non-involuting CH and infantile hemangiomas. It is important to distinguish between this rare condition and other vascular lesions to ensure appropriate management (active intervention vs. non-intervention). We describe 5 patients diagnosed with RICH based on clinicopathological and/or imaging studies. Three patients showed red-stippled bluish to purplish tense plaques and two showed slightly depressed red-stippled hypopigmented rubbery patches at their initial visit. Spontaneous involution commenced shortly after birth, and complete involution occurred by 16.0±9.9 months of age. Doppler ultrasonography and magnetic resonance imaging were performed for further evaluation. Histopathological examination revealed vascular lobules of various sizes without true arteriovenous microfistulae, and thickened intra- and interlobular vessels were prominent with glucose transporter isoform-1 protein negativity. (Korean J Dermatol 2019;57(9):532∼537)

과급 횡복직근피판술(Supercharged TRAM)을 이용한 유방재건술

양정덕,송재민,이상윤,정호윤,조병채,박호용,정진향,Yang, Jung-Dug,Song, Jae-Min,Lee, Sang-Yun,Chung, Ho-Yun,Cho, Byung-Chae,Park, Ho-Yong,Jung, Jin-Hyang 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.5

Purpose: When reconstruction for patients who have the large contralateral breast or a following large defect after mastectomy is required, conventional pedicled TRAM flap shows the unpredictable occurrence of fat necrosis and skin flap loss in a relatively high percentage due to insufficient blood supply. In an effort to obtain more stable TRAM flap blood circulation, we have performed a supercharged technique using deep inferior epigastric perforators (DIEP) with conventional pedicled TRAM flap. Methods: From September of 2006 to December of 2008, Fourteen supercharged TRAM flap were performed for breast reconstruction after modified radical mastectomy. The contralateral DIEP was anastomosed to the internal mammary vessels in contralateral pedicled TRAM flap or thoracodorsal vessels in ipsilateral pedicled TRAM flap. Nutrient vessels were selected by Multi-Detector Computed tomography (MD-CT) modalities. For the nutrient vessel, we used deep inferior epigastric vessels (DIEV) of the ipsilateral side in 8 patients, DIEV of the contralateral side in 6 patients. In addition, for the recipient vessel, we used thoracodorsal vessels in 8 patients, internal mammary vessels in 5 patients, intercostals artery perforators in 1 patient. Results: The mean age was 46.8 years and the average follow-up interval was 14 months. There were 11 immediate and 3 delayed breast reconstructions. Fat necrosis incidence rate in supercharged TRAM group was lower than in conventional TRAM flap group. There were no differences of the incidences of abdominal hernia in both groups. Conclusion: The supercharged TRAM flap produces an improvement in vascularity that permits use of all four zones of the flap. The breast reconstruction with supercharged technique is reliable and valuable methods which provide sufficient soft tissue from abdomen without significant complications.

유방암 환자에서 피부보존 유방절제술 후 실리콘 보형물을 이용한 즉시 유방재건술

조영규,양정덕,김귀락,정호윤,조병채,박호용,Cho, Young-Kyoo,Yang, Jung-Dug,Kim, Gui-Rak,Chung, Ho-Yun,Cho, Byung-Chae,Park, Ho-Yong 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.6

Purpose: Since skin sparing mastectomy removes the mammary gland and the nipple-areolar complex preserving all mammary skin, it makes the widespread use of implants in immediate reconstruction. This article reports our experience in immediate breast reconstruction after skin sparing mastectomy by using the silicone implants in patients especially who have small to moderate sized and minimal ptotic breast. Methods: From September of 2007 to July of 2009, we performed breast reconstruction for 44 breasts of 40 women with silicone implant after mastectomy. Tumors were divided into 5 malignant types (21 IDC, 18 DCIS, 2 ILC, 2 phylloides tumor, 1 mucinous carcinoma). The implant is placed in a submuscular pocket or in a submuscularsubfascial pocket depending upon the condition of the muscles and skin flaps after mastectomy. Results: The mean age was 47 years and the average follow-up period was 11 months. Cosmetic outcome was assessed by evaluation of photographs and assessment of breast volume and shape, breast symmetry, and overall outcome. About 80% of each of these parameters was scored as good or excellent. Breast complication was developed in a total of 6 cases including 2 capsular contracture, 2 partial skin necrosis due to blue dye injection and 2 implant infection. Conclusion: The use of definitive implants in a skin sparing mastectomy is a one-stage immediate breast reconstruction with low morbidity and acceptable result. This method is considered reliable with favorable aesthetic result.

정맥,림프관기형에서의 혈관경화요법의 효과와 안전성: 장기간 추적관찰

이재철 ( Jae Chul Lee ),김호연 ( Ho Youn Kim ),최윤석 ( Yoon Seok Choe ),이석종 ( Seok Jong Lee ),김도원 ( Do Won Kim ),정호윤 ( Ho Yun Chung ),백승국 ( Seung Kug Baik ),이종민 ( Jong Min Lee ),허승 ( Seung Huh ) 대한피부과학회 2008 대한피부과학회지 Vol.46 No.9

Background: Surgical excision and alcohol sclerotherapy have been used to treat congenital vascular malformations (CVM) with a significant success rate but the methods have also left marked morbidity. The alternative, sclerotherapy using ordinary sclerosants, although resulting in trivial complications, has a relatively low cure rate and is rarely used in Korea for CVM management. Objective: To evaluate the effects and side effects of sclerotherapy using ordinary sclerosants such as polidocanol (POL) and sodium tetradecyl sulfate (STS) for the treatment of CVM of a venous and lymphatic type. Methods: To confirm the long-term effects and safety with at least a 3-year follow-up, we chose a total of 26 patients who had undergone sclerotherapy between 2000 to 2004. There were 22 venous malformations (VMs) and 4 lymphatic malformations (LMs) which were rather small and superficial, not beyond muscular fascia. Sclerotherapy using POL and STS was performed by blind intraluminal and/or intralesional injection without the aid of imaging methods such as ultrasound examination. The results were evaluated by the patients` subjective satisfaction, physical examination, comparison of photographs and/or radiological examinations, then they were classified into 4 groups; excellent (improvement >75%), good (50~75%), fair (25~49%) and poor (<25%). Results: Twenty two VMs comprised 14 in the excellent group (66.7%), 6 in the good group (25.0%), 1 in the fair group (4.2%) and 1 in the poor group (4.2%). Two LMs of macrocystic type revealed excellent results but the other two showing microcystic type revealed poor results. The dose of sclerosant was 0.1 to 2 ml in every session and a total of 1 to 6 sessions (average: 2.2) were performed. Only one VM showed hyperpigmentation as a side effect. Conclusion: Sclerosants for ordinary varicose vein eradication can be used on the treatment of small and superficial venous malformations and macrocystic-lymphatic malformations with relative efficacy and safety. (Korean J Dermatol 2008;46(9):1194~1200)

태반추출물의 인간 섬유아세포에 대한 생물학적 영향

오은정 ( Eun Jung Oh ),신준호 ( Jun Ho Shin ),최진현 ( Jin Hyun Choi ),정호윤 ( Ho Yun Chung ) 한국조직공학과 재생의학회 2010 조직공학과 재생의학 Vol.7 No.2

This study has reported the effects of placenta extract on human fibroblast in vitro. We initiated this study on the basis of the hypothesis that placenta extract can influence the proliferation of fibroblasts, and their biologic function, for example, to express cell specific gene or to produce their own extracellular matrix. Fibroblasts in monolayer culture with or without placenta extract were collected and analyzed by MTS assay, ECM assays, and RT-PCR. In results, placenta extract stimulated the proliferation of fibroblasts in monolayer culture. The phenotype of fibroblast was well maintained during expansion in monolayers. Fibroblast with placenta extract produced ECM, collagen and the growth factor, bFGF, more than control. Fibroblasts with placenta extract expressed high COL1A1 gene. This study provides that placenta extract is needed to expand fibroblasts during tissue cultivation, to maintain their differentiated phenotype and to promote their function. In conclusion, these results suggest that placenta extract during cultivation play an important role to control cell behaviors. Furthermore, these results provide a biologic basis for bioengineering.

과다 유두(Supernumerary Nipple) 2례

이정우,양정덕,이정훈,최강영,김귀락,정호윤,조병채,Lee, Jeong-Woo,Yang, Jung-Dug,Lee, Jung-Hun,Choi, Kang-Young,Kim, Gui-Rak,Chung, Ho-Yun,Cho, Byung-Chae 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.5

Purpose: Supernumerary nipple or polythelia is one of the developmental anomalies occurring at the embryonic stage and this anomaly usually arises from the milk line. While this atypical feature is determined during early developmental stage, it may not come out obviously or become troublesome until puberty or lactation. Moreover, sometimes it is confused with a pigmented nevus. Methods: Case 1, a 18-year-old woman with intramammary supernumerary breast consisted of another nipple with middle sized areola on the right lower breast was admitted for a $2.8{\times}3.1\;cm$-sized mass on the right breast which was starting appeared 1 year earlier. The preliminary cytological examination of the material obtained by needle aspiration biopsy from the mass was revealed by fibroadenoma with no malignant change. The patient had the surgical excision of the mass and accessory breast. Case 2, a 16 year-old woman admitted for intra-areolar polythelia of the left breast, even she doesn't have any family history of polythelia. Since she wanted surgical correction of her atypical nipple for aesthetic and psychological reasons, we reconstructed the areola using transposition flaps in an S-plasty design. Results: Case 1, the excised supernumerary nipple showed following histological features. In the superficial layer, an acanthotic and hyperpigmented epithelium with elongated rete ridges was found. In the dermis, there were follicles with hairs surrounded by hypertrophic sebaceous glands. In the deepest portion, abundant secretory glomerules and excretory ducts of apocrine gland type were observed. Case 2, follow-up visits 3 months after the procedure showed a satisfactory result with good shape and projection of the nipple. Conclusion: We report two cases of aberrant mammary tissue who underwent surgical correction, including complete breast (with nipple, areola, and glandular tissue) and intra-areolar polythelia according to the Kajava's classification, and the results were satisfactory.

선천성 소방성 혈관종 6예

이재철 ( Jae Chul Lee ),김호연 ( Ho Youn Kim ),김병수 ( Byung Soo Kim ),이원주 ( Weon Ju Lee ),이석종 ( Seok Jong Lee ),김도원 ( Do Won Kim ),정호윤 ( Ho Yun Chung ),배한익 ( Han Ik Bae ),손경락 ( Kyung Rak Sohn ) 대한피부과학회 2008 대한피부과학회지 Vol.46 No.2

Tufted angioma is a rare slowly progressive vascular tumor, characterized by histopathologic findings of numerous angiomatous lobules of cannonball appearance within the dermis. It affects children but occurs infrequently at birth. It appears as a clinical imitator of hemangioma of infancy (HOI), so it needs to be differentiated from HOI. Clinically, lesions most often present as red to purple, indurated or nodular plaque, and are usually located on the neck, upper trunk or proximal limb. We report six cases of tufted angioma of congenital onset. We undertook immunohistochemical study using CD31, D2-40 and GLUT1 to rule out other vascular tumors or malformations, particularly HOI. These cases may demonstrate the keys of differential diagnosis between HOI and tufted angioma, which share common features clinically and rarely histopathologically. (Korean J Dermatol 2008;46(2):272∼277)