위장관 간질 종양으로 Sunitinib치료 후 빠른 반응과 함께 발생한 장관기종 및 장천공 1례

곽형종 ( Hyoung Jong Kwak ),김경민 ( Kyoung Min Kim ),김민호 ( Min Ho Kim ),진공용 ( Gong Yong Jin ),정명자 ( Myoung Ja Chung ) 전북대학교 의과학연구소 2011 全北醫大論文集 Vol.35 No.1

Pneumatosis intestinalis is an unusual intestinal pathology that is characterized by the presence of gas within the intestinal wall, usually in the mucosa or submucosa of the small or large intestine. Sunitinib is a small molecule that inhibits multiple receptor tyrosine kinases such as KIT, vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF). It is use das second-line therapy for patients with imatinib-resistant gastrointestinal stromal tumors (GIST).We report here a 61-year-old male patient diagnosed with recurrent GIST complicated by massive peritoneal metastasis involving the small intestine, with resistance to imatinib. Following rapid response to sunitinib treatment, pneumatosis intestinalis of the small intestine occurred and led to perforation at a previous anastomotic site. In conclusion, the possibility of pneumatosis intestinalis and intestinal perforation associated with rapid response should be considered during antiangiogenic therapy in patients with malignancies involving the gastrointestinal tract.

Klinefelter 증후군 환자에서 진단된 전신성 홍반성 루프스 1예

곽형종 ( Hyoung Jong Kwak ),장규윤 ( Kyu Yun Jang ),정명자 ( Myoung Ja Chung ),문우성 ( Woo Sung Moon ),강명재 ( Myoung Jae Kang ),이동근 ( Dong Geun Lee ),박호성 ( Ho Sung Park ) 전북대학교 의과학연구소 2011 全北醫大論文集 Vol.35 No.1

저자들은 전신성홍반성루푸스와 Klinefelter증후군을 동시에 진단하였던 1예를 경험하였기에 보고하는 바이다. We report a case of SLE related epistaxis(due to thrombocytopenia) in a 16 year-old man with Klinefelter`s syndrome. Clinical outcome was favorable with low doses of corticosteroids. The incidence of systemic lupus erythematosus(SLE) is known to be affected by sex hormone. Patients with Klinefelter`s syndrome were reported to have abnormal sex hormonal metabolism and their chronic estrogenic stimulation seems to affect the pathogenesis of SLE. Therefore, association of SLE and Klinefelter`s syndrome has been considered as a clue of the effect of sex hormone on SLE.

불완전 비틀림을 보인 줄기를 가진 가슴막밑 지방종 1예 보고

곽형종 ( Hyoung Jong Kwak ),차은정 ( Eun Jung Cha ),손경락 ( Kyung Rak Sohn ),구자홍 ( Ja Hong Kuh ),진공용 ( Gong Yong Jin ),정명자 ( Myoung Ja Chung ),장규윤 ( Kyu Yun Jang ) 대한내과학회 2008 대한내과학회지 Vol.74 No.6

지방종은 흔한 양성 연부조직 종양이지만 가슴막에서 기원하는 경우는 매우 드물다. 대부분의 가슴막 지방종은 증상이 없어서 흉부 방사선 사진에서 우연히 발견된다. 저자들은 갑자기 시작한 옆구리 통증을 호소하는 29세 여자에서 발생한 불완전한 뒤틀림을 보인 줄기를 가진 가슴막밑 지방종 한예를 경험하였기에 보고하는 바이다. 흉부 방사선 소견상 좌측 폐 하방에서 난원형의 경계가 분명하고 균일한 음영 증가가 있는 종괴가 관찰되었다. 가슴막공간 내종괴가 의심되어 확진을 하기 위해 비디오 흉강경술을 시행하였다. 절제된 종괴는 10×5 cm 크기의 줄기를 가진 잘 경계지워진 가슴막 종괴로 절단면 상 황색을 띠었고 부분적으로 출혈 부위가 관찰되었다. 조직학적 소견상 종양은 섬유성 격막에 의해 구획 지워져 있었으며 주로 섬유혈관간질을 가지는 성숙한 지방세포로 구성되어 있었다. 종양의 표면은 중피 세포로 피복되어 있었다. 부분적으로 세포밀도가 높은 부위가 관찰되고 소수의 유사분열이 관찰되었으나 전형적인 지방모세포나 비정상적인 유사분열은 관찰되지 않아 지방종으로 진단하였다. Lipoma is a common benign neoplasm, but lipoma arising from the pleura is rare. Most pleural lipomas are asymptomatic and are discovered incidentally on chest radiographs. Here we report an unusual case of a pedunculated subpleural lipoma with incomplete torsion in a 29-year-old woman who presented with flank pain. On chest radiography, there was a well-defined, ellipsoidal, homogeneous, radioopaque mass in the left lower lobe. An intrathoracic tumor was suspected, and video-assisted thoracic surgery was performed to establish the final diagnosis. The resected tumor was a 10×5 cm sized pedunculated pleural mass. The cut surface showed a yellow, well-circumscribed mass with areas of hemorrhage. Histologically, the tumor was composed of mature adipose tissue with fibrous septae composed of fibroblasts. The outer surface of the tumor was covered by mesothelial cells. Some areas were hypercellular, and occasional mitoses were found, but neither lipoblasts nor atypical mitoses were identified.(Korean J Med 74:676-679, 2008)

간세포암종에서 β-catenin의 핵 내 발현과 임상병리적 인자들과의 관계

문우성,곽형종,최하나,황성호,최금하,박호성,장규윤,정명자,강명재,이동근 대한병리학회 2008 Journal of Pathology and Translational Medicine Vol.42 No.4

Background : Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the human liver. However, the molecular changes and mechanisms that regulate the development and progression of HCC remain unclear. Beta-catenin is known as a multi-functional protein that acts as a regulator of the cadherin-mediated cell-cell adhesion system and also in the Wingless/Wnt signal transduction pathway. The aim of this study was to investigate the expression of β-catenin and its possible role in HCC. Methods : We investigated the expression of β-catenin, Ki-67, TP53, α-smooth muscle actin and CD34 by performing immunohistochemical staining for 61 specimens of HCC and their adjacent non-tumorous tissue. We also examined the relationship between the nuclear expression of β-catenin and the clinicopathologic parameters. Results : The altered expression of β-catenin was not detected in the nontumorous liver tissue. The nuclear expression of β-catenin was observed in approximately 16%(10/61) of the HCC specimens. Double immunohistochemical staining for β-catenin and E-cadherin showed a close relationship between nuclear translocation of β-catenin and the loss of the membranous E-cadherin expression. Significant correlation was found between the nuclear translocation of β-catenin and the tumor size, tumor necrosis and the presence of microvessel invasion and intrahepatic metastasis (p<0.05). Conclusions : This data indicates that nuclear translocation of β-catenin could play a role in the growth and progression of HCC.

표재측두동맥에서 발생한 진성동맥류

임정욱,조광철,곽형종 대한신경과학회 2012 대한신경과학회지 Vol.30 No.3

This is a case report of a 50-year-old female who presented to our clinic with headache and left temporal pulsatile mass. Aneurysm was revealed incidentally on a computed tomography angiography of her head. Open surgical resection with aneurysmal trapping was performed under local anesthesia. Histological examination demonstrated a true aneurysm of the superficial temporal artery. There was loss of normal elastin in the internal elastin layer. This case report describes the rare entity along with a review of the literature.

전북대학교병원 한국 인체자원은행의 신선 동결조직에 대한 정도관리

정명자,박신영,백현아,곽형종,홍상현,박호성,장규윤,문우성,강명재,이동근 대한병리학회 2010 Journal of Pathology and Translational Medicine Vol.44 No.3

Background : Molecular tools for tissue profiling generally require collection of fresh frozen tissues (FFT) as sources of high-quality DNA and RNA. Nowadays, researchers carry out large-scale, multi-center studies and they request inter-institutional minimal intrinsic bias, some fundamental similarities, and the same standardized and validated procedures. Methods : This study reports standardized quality control procedure for fresh frozen tissue of the National Biobank of Korea. Results : The main procedures for quality control for FFT are as follows: records related to sample collection such as labeling of samples, transport temperature, lag time from excision of tissue to freezing, and sample size were reviewed for all fresh frozen samples. The stability of RNA and DNA in fresh frozen tissue was evaluated for 3% of collected samples and purity was assessed (ratio of the absorbance at 260 and 280 nm) as was integrity (agarose gel electrophoresis). Stained hematoxylin and eosin sections were reviewed by a pathologist to confirm the diagnosis and to assess how representative the frozen sample was. Conclusions : We introduced that the quality-control criteria for fresh frozen tissue of the NBK. We expect that this study contributes to standardization of collection, storage, and quality control of fresh frozen tissue.

Image analytic study of nuclear area in mantle cell lymphoma

Taehwa Baek,허주령,곽형종,박미자,이혜경 대한혈액학회 2010 Blood Research Vol.45 No.3

Background Malignant lymphomas are classified on the basis of morphology, immunohistochemistry, and genetic and molecular biological features. Morphology is considered the most important and basic feature. Lymphomas can be classified as small, medium, or large depending on the cell size, but this criterion tends to be rather subjective. The aim of this study was to investigate the usefulness of an objective approach based on quantitative measurements. Methods Twenty specimens of mantle cell lymphoma and 2 specimens of the tonsil were examined. The nuclear area of 6,401 tumor cells of mantle cell lymphoma and 743 normal mantle cells of reactive tonsils were measured by 3 authors by using a user-controlled image-analyzer. The images of the nuclei were outlined using the spline method and the i-solution software, and the data were assessed using ANOVA and Student’s t-test. Results The mean nuclear areas of mantle cell lymphoma cells measured by the 3 authors were 37.9 [7.9] mm2, 37.9 [7.2] mm2, and 38.2 [7.7] mm2 and those of normal mantle cells in reactive tonsil were 28.6 [2.3] mm2, 28.8 [2.0] mm2, and 27.0 [3.0] mm2. There was no statistical difference between the 3 observations of mantle cell lymphoma (P=0.580) and normal tonsils. Conclusion For morphology, nuclear area is considered an important feature in the classification schemes of lymphoma. We showed that nuclear area measurement by using image analyzer can be used as an objective quantitative method. We think that nuclear morphometry may play a significant role in the diagnosis of lymphoma.

Solitary schwannoma of the ascending colon

추명수,강현모,선형주,김동민,곽형종 영남대학교 의과대학 2016 Yeungnam University Journal of Medicine Vol.33 No.1

Schwannomas are uncommon neoplasms arising from Schwann cells of the neural sheath. Gastrointestinal schwannomas are rare, accounting for 1% of all malignant gastrointestinal tumors. Colonoscopic biopsy with immunohistochemical (IHC) staining is useful for confirming this tumor. We report on a patient with schwannoma arising from the ascending colon, which was detected by colonoscopy and endoscopic submucosal dissection was attempted. A 41-year-old man presented with abdominal discomfort. The patient was diagnosed with a subepithelial tumor on colonoscopy. He underwent endoscopic submucosal dissection. Histopathology and IHC staining confirmed that the colonic lesion was a benign schwannoma. However, the resection margin was positive. Therefore, laparoscopic ileocolectomy was performed.

노인 환자에서 대량의 혈변을 보였던 대장 용종 출혈 2예

김혜린,강현모,추명수,이광복,남관우,이계성,곽형종 대한노인병학회 2013 Annals of geriatric medicine and research Vol.17 No.2

The annual incidence of hospital admissions for lower gastrointestinal bleeding in the United States and Europe is 0.02%. Massive hemorrhage from a solitary colon polyp is an extremely rare case. We report two consecutive patients with a single polyp, which was the source of bleeding. The first case is a 68-year-old male patient who visited Daejeon Sun Hospital with the chief complaint of considerable hematochezia. An 1.2 cm colon polyp with active bleeding was observed on the colonoscopy. The second case is a 74-year-old female patient with symptoms of hematochezia. A blood-clot attached, 3.0 cm sized Yamada type-IV colon polyp was examined on the colonoscopy. One case was a sessile polyp, and the other one was a thick-stalked pedunculated polyp. Both types of polyps were supplied with more vessels than other polyps, and both patients were taking aspirin. The two patients underwent snare polypectomy and were discharged without further bleeding evidence.

조기위선암과 동시에 발생한 림프상피종양암종 1예

원삼,김혜린,이광복,박우경,윤형식,강현모,곽형종,이계성 조선대학교 의학연구소 2013 The Medical Journal of Chosun University Vol.38 No.3

We report a double primary gastric cancer of different types seen on an endoscopy at the same time. At the first gastroscopy, Lymphoepithelioma-like carcinoma (LELC) appeared to be a benign submucosal tumor (SMT) and gastric adenocarcinoma was limited to the mucosa. Adenocarcinoma was removed by endoscopic submucosal dissection (ESD). However, a followup gastroscopy revealed an enlarged SMT, and another ESD was performed. The patient was additionally diagnosed with gastric LELC. This is the only case that LELC and gastric adenocarcinoma were found at the same time in Korea; therefore, the authors report this case with literature review.