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김라미,이잔디,소의영 대한의학회 2010 Journal of Korean medical science Vol.25 No.7
Primary aldosteronism (PA) is a frequent cause of secondary hypertension and is amenable to surgical intervention when it is caused by aldosterone-producing adenoma (APA). Many patients, however, continue to require antihypertensive medications to control their blood pressure after adrenalectomy. The aim of this study was to determine the preoperative factors that predict clinical outcomes after adrenalectomy in patients with APA. We studied 27 patients (mean age 45±4 yr) who had APA and underwent unilateral adrenalectomy between December 1995 and September 2008 at our institution. Clinical and biochemical data were evaluated at baseline and after a mean follow-up of 51.8±47.0 months (range,6-159). At the end of the follow-up, 16 patients (59.3%) were considered to experience “complete resolution” without postoperative medications, whereas 7 patients (25.9%)“improved” with medications and 4 patients (14.8%) were “uncontrolled.” Three factors (≤2antihypertensive medications [P=0.007], duration of hypertension <6 yr [P=0.002], and serum aldosterone <350 pg/mL [P<0.001]) were the predictive for complete resolution in univariate analysis. Multivariate regression analysis showed that serum aldosterone level (<350 pg/mL) was the single most important factor that predicted complete resolution after surgery (P<0.001). The best preoperative clinical factor that predicted resolution of postoperative hypertension after adrenalectomy is serum aldosterone level (<350 pg/mL).
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김구상,김라미,임현이,강두경,김태희,신현주,김지영,정용식 한국유방암학회 2013 Journal of Breast Disease Vol.1 No.1
Purpose: Ultrasound-guided vacuum-assisted excision (US-VAE) is considered the less invasive method for the histological assessment of breast lesions than surgical excision and also used for removing benign lesions. Some benign lesions require further excision after removing them by US-VAE, because pathologic diagnosis with specimen obtained by US-VAE cannot be confirmative. However, a well-targeted fine-needle aspiration biopsy (FNAB) before US-VAE can provide preoperative diagnosis. The aim of this study is to evaluate the accuracy and safety of FNAB to minimize further excision after performing US-VAE. Methods: From June 2007 to December 2009, US-VAE was performed on 321 patients with benign breast lesions which diagnosed by FNAB. Clinicopathological data, medical records and imaging studies were reviewed. We estimated the further excision rate after carrying out US-VAE and evaluated effectiveness of FNAB for pathologic diagnosis of breast lesions before performing US-VAE. Results: Of 321 lesions, 118 (27.1%) were diagnosed as specific benign, 201 patients (57.9%) as other nonspecific benign or negative malignant cell, 2 (0.6%) as atypical ductal hyperplasia (ADH) at FNAB. The pathologic diagnoses after US-VAE were usually specific benign diseases; fibroadenoma (190 cases, 59.2%), fibrocystic change (51 cases, 15.9%), other benign (68 cases, 21.2%). As indeterminate lesions, ADH (5 cases, 1.6%), borderline phyllodes tumor (4 cases, 1.2%) were diagnosed. Of 321, only three patients (0.9%) were underwent further excision for malignancy. They were diagnosed as malignant after taking US-VAE, two lobular carcinoma in situ and one invasive ductal carcinoma. Conclusion: US-VAE is relatively accurate and effective for removing benign lesion of breast. To reduce the further excision rate, the cytological and pathological confirmation using FNAB should be performed precisely before performing the US-VAE.
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Expression of epidermal growth factor receptor (EGFR) in phyllodes tumor
Ji Young Kim(김지영),Ra Mi Kim(김라미),Woo Sung Hong(홍우성),Hyun Ee Yim(임현이),Tae Hee Kim(김태희),Yong Sik Jung(정용식),Ku Sang Kim(김구상) 대한종양외과학회 2012 Korean Journal of Clinical Oncology Vol.8 No.2
연구배경 및 목적 : 유방 엽상 종양은 유방에서 발생되는 매우 드문 질환으로서 재발 및 전이를 잘 하는 특성이 있다. 그러나 유방 엽상종양의 악성 정도와 임상학적인 예후를 예상할 수 있는 특정한 인자는 아직 정확히 밝혀진 바는 없다. 따라서 본 연구는 유방 엽상종양에서 EGFR의 발현도를 분석하여 이들의 발현과 종양의 악성 정도와의 관계를 평가하고 또한 엽상종양의 분류 및 임상적인 경과와의 관계를 입증하고자 한다. 재료 및 방법 : 1995년 12월부터 2010년 6월까지 본 병원에서 유방 엽상종양으로 수술을 받은 82명의 환자를 대상으로 분석하였으며, 이중 57명은 양성, 11명은 경계성, 14명은 악성 엽상종양으로 분류되었다. EGFR의 발현도를 평가하여 악성도 및 재발과의 관계를 분석하였으며, 엽상종양의 조직학적 특성과 악성도의 관계도 함께 평가하였다. 결과 : 환자들의 평균 나이는 36.6세였으며, 종양의 크기는 평균 46.93mm 였다. 82명의 환자 중 7명은 재발하였다. 엽상종양은 나이가 많을수록 악성일 가능성이 높아지며 (p=0.022). 조직학적인 특징과 악성도 및 재발과의 관계에서도 유의한 차이를 보였다. (p<0.001). EGFR의 발현도는 양성과 악성(p=0.041), 경계성과 악성(p=0.017) 사이에서 유의한 차이를 보였으나, 양성과 경계성 사이에서는 유의한 차이를 보이지 않았다. 결론 : 유방의 엽상종양에서 EGFR은 악성으로 갈수록 발현도가 높아진다. Background : Phyllodes tumorof the breast is a rare stromal-epithelial neoplasm with the potential for invasion and metastatic spread, but the clinical behavior of phyllodes tumor is difficult to predict. Specific parameters that define recurrence and prognosis are not universally estabilished yet. We aim to reveal the relationship of EGFR espression and type of phyllodes tumor. Methods : The study investigated 82 phyllodes tumors (57 benign, 11 borderline, 14 malignant) for EGFR expression using immunohistochemistry (IHC). The staining was correlated to tumor margin status, degree of malignancy, stromal cellularity, mitotic activity, nuclear pleomorphism and stromal overgrowth. Results : There was an increasing trend of stromal EGFR staining with increasing degree of malignancy (p=0.001 between benign and borderline tumors, p=0.021 between borderline and malignant tumors, p<0.001 between benign and malignant tumors). Conclusion : We believe that our findings show that EGFR expression and histological parameters can be used for evaluation of breast phyllodes tumors.
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