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담석과 관련이 없는 간내 담도의 국소적 협착을 가진 환자들에서의 담도경의 유용성
이성구,김명환,서동완,박주상,민영일,주연호,강경훈 대한소화기내시경학회 2000 Clinical Endoscopy Vol.21 No.4
Background/Aims: Intrahepatic duct strictures are usually caused by intrahepatic duct stones and. cholangitis, However, focal strictures of the intrahepatic duct unrelated to intrahepatic stones often pose diagnostic problems. This study was undertaken to prospectively evaluate the usefuless of percutaneous transhepatic cholangioscopy in patients with a focal intrahepatic duct stricture and no evidence of a stone. Methods: Twenty two patients with a focal stricture of the intrahepatic duct not related to intrahepatic stones were included. Percutaneous transhepatic cholangioscopic examination including procurement of a biopsy specimen was performed after percutaneous transhepatic biliary drainage. Results: A histopathologic diagnosis was obtained in all patients (10 adenocarcinoma, 1 squamous cell carcinoma, 2 hepatocellular carcinoma, 2 adenoma and 7 benign strictures). Of the 10 patients with bile duct adenocarcinoma, 9 underwent surgery and a curative resection was possible in 8 patients (89%). Six patients (67%) had early-stage bile duct cancer in which the cancer invasion was limited to the mucosa or fibromuscular layer and there was no evidence of lymph node metastasis. Conclusions: Percutaneous transhepatic cholangioscopy in patients with focal stricture of the intrahepatic duct unrelated to choledocholithiasis seems to be very useful for the differential diagnosis including the detection of early bile duct cancer.
이성구,김명환,서동완,박주상,민영일,주연호,강경훈 대한소화기내시경학회 2000 Clinical Endoscopy Vol.21 No.4
Background/Aims: The technique of cholangioscopy has been used in the treatment of bile duct stones or for the diagnosis of various bile duct tumors. However, the cholangioscopic characteristics of the various types of bile duct tumors have not yet been clearly described. Therefore, we analyzed the results of our cholangioscopic examinations and classified the cholangioscopic findings according to tumor histology. Methods: The cholangioscopic finding from 111 patients who had benign or malignant bile duct tumors were reviewed. The mucosal changes, the presence of neovascularization, and the patterns of luminal narrowing were analyzed and compared with the histologic diagnosis, Results: Bile duct adenocarcinoma can be classified into three different types according to the cholangioscopic findings: nodular, papillary, and infiltrative. Bile duct adenoma, hepatocellular carcinoma and other types of bile duct cancer such as mucin-hypersecreting cholangiocarcinoma, biliary cystadenocarcinoma, squamous cell carcinoma also presented with their unique cholangioscopic characteristics. Conclusions: Bile duct tumors seem to show characteristic cholangioscopic findings according to their histology. Cholangioscopic examination seems to be a useful technique in the differential diagnosis of bile duct tumors.
골수로의 원격전이를 동반한 위장의 저등위 점막연관성 림프조직림프종 2 예
김진호,장혜숙,민영일,홍원선,명승재,이미헌,양석균,강경훈,정훈용 대한소화기학회 2000 대한소화기학회지 Vol.36 No.5
Extranodal mucosa-associated lymphoid tissue (MALT) lymphoma constitutes most of the low-grade gastric lymphoma and almost 50% of all gastric lymphoma. The specific recirculation pattern might explain the tendencies of MALT lymphomas to remain localized and to recur preferentially within the gastrointestinal tract. It was known that the rate of gastric MALT lymphoma with bone marrow involvement was low, as less than 10%. We have experienced two patients who presented with nonspecific abdominal pain and dyspepsia. They were diagnosed to have gastric low-grade MALT lymphoma with bone marrow involvement at the time of presentation. The endoscopic findings showed irregular ulcerations. Microscopically, there was monotonous lymphoid infiltration with lymphoepithelial lesions which were consistent with low grade MALT lymphoma. Both patients showed H. pylori-associated chronic gastritis. The results of their bone marrow biopsy showed focal infiltration of neoplastic lymphoid cells. We report two cases of primary gastric low-grade MALT lymphoma with the bone marrow involvement.