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간세포암종으로 오인된 지방성분이 없는 간혈관근지방종 증례 보고
류수형 ( Yong Moon Woo ),우용문 ( Soo Hyung Ryu ),민정화 ( Jeong Wha Min ),김미령 ( Mi Ryeong Kim ),박태영 ( Tae Young Park ),문정섭 ( Jeong Seop Moon ),강윤경 ( Yun Kyung Kang ) 대한소화기학회 2018 대한소화기학회지 Vol.71 No.1
Angiomyolipoma (AML) is a rare benign mesenchymal tumor in the liver, which is composed of blood vessels, smooth muscle, and adipose cells. The proportion of each component varies, making a diagnosis difficult. This paper reports a case of AML in the liver without adipose tissue, mimicking a hepatocellular carcinoma (HCC), which was diagnosed by a surgical tissue biopsy. A 65-year-old woman was admitted for an evaluation of a hepatic mass that had been detected by ultrasonography. The serologic markers of viral hepatitis B and C were negative. The liver function tests and alpha fetoprotein level were within the normal limits. Magnetic resonance imaging revealed a 1.9 cm sized mass in segment 6 of the liver with early arterial enhancement and washout on the delayed phase accompanied by a rim-like enhancement, which is similar to the imaging findings of HCC. A frozen section examination during surgery indicated a hepatocellular neoplasm and suggested the possibility of HCC. On the other hand, the final pathologic diagnosis was epithelioid myoid type of AML with no adipose tissue component. The tumor cells were positive for human melanocyte B-45 and negative for cytokeratin and hepatocyte paraffin 1. This paper reports a very rare case of AML without adipose tissue in the liver mimicking HCC that was diagnosed by a surgical tissue biopsy. (Korean J Gastroenterol 2018;71:49-53)
김형훈 ( Hyung Hun Kim ),김유선 ( You Sun Kim ),옥경선 ( Kyung Sun Ok ),류수형 ( Soo Hyung Ryu ),이정환 ( Jung Hwan Lee ),문정섭 ( Jeong Seop Moon ),이혁상 ( Hyuck Sang Lee ),이혜경 ( Hye Kyung Lee ) 대한소화기학회 2010 대한소화기학회지 Vol.56 No.6
Chronic non-granulomatous jejunoileitis is a rare disease characterized by malabsorption, abdominal pain, and diarrhea that causes shallow ulcers in the small bowel. The etiology of chronic non-granulomatous jejunolieitis remains unknown. A 69-year-old man complained of abdominal pain and lower extremity edema. A 99m-Tc albumin scan showed increased radioactivity at the left upper quadrant, suggesting protein-losing enteropathy. A small bowel follow-through did not disclose any lesions. Wireless capsule endoscopy revealed several small bowel ulcers and strictures. A jejunoileal segmentectomy with end-to-end anastomosis was performed, and the histologic examination revealed non-granulomatous ulcers with focal villous atrophy. Ruling out all other possible diagnoses, we diagnosed our patient with chronic non-granulomatous ulcerative jejunoileitis. Postoperatively, the patient`s abdominal pain and lower extremity edema improved, and the serum albumin normalized. This is the first case of chronic non-granulomatous ulcerative jejunoileitis localized by wireless capsule endoscopy and treated successfully with segment resection. (Korean J Gastroenterol 2010;56:382-386)
만성 C형 간염 환자에서 Gadoxetate disodium 조영 증강 MRI로 진단된 간혈관종
모진원 ( Jin Won Mo ),류수형 ( Soo Hyung Ryu ),박동원 ( Dong Won Park ),윤원재 ( Won Jae Yoon ),김진남 ( Jin Nam Kim ),문정섭 ( Jeong Seop Moon ),심재찬 ( Jae Chan Shim ) 대한간암학회 2015 대한간암학회지 Vol.15 No.1
A hemangioma is the most common benign hepatic tumor. Many hepatic hemangioma tend to be found incidentally, but should be differentiated from malignant tumors, especially in patients with a high risk for malignancy. We presented a 52-year-old woman who diagnosed as hepatic hemangioma. The patient was a chronic alcohol abuser and diagnosed as a hepatic C virus carrier for the first time. Contrast enhanced abdominal computed tomography (CT) revealed a 4cm sized hepatic mass involving both segment 5 and 6. Abdominal CT finding suggested hepatic hemangioma, but could not rule out the malignancy. Because the patient had risk factors for hepatocellular carcinoma, abdominal ultrasonography (US) was performed for further evaluation. But abdominal US also showed atypical finding. For the confirmative diagnosis, dynamic magnetic resonance imaging using gadoxetate disodium (primovist®, Bayer HealthCare, Berlin, Germany) which is the innovative liver cell-specific contrast medium was done, and the patient was diagnosed as hepatic hemangioma. (Journal of Liver Cancer 2015;15:36-40)
복강내로 파열된 가스 형성 화농성 간농양의 성공적인 내과적 치료 증례
이경진 ( Kyung Jin Lee ),류수형 ( Soo Hyung Ryu ) 대한소화기학회 2018 대한소화기학회지 Vol.71 No.1
Gas-forming pyogenic liver abscess (GFPLA) is very rare and has a very high mortality in case of rupture into the abdominal cavity, which usually require surgical treatment. We experienced a case of a ruptured GFPLA due to Klebsiella pneumoniae complicated with peritonitis and sepsis in a 68-year-old diabetic woman. Immediate and aggressive medical treatments including intravenous antibiotics, percutaneous drainage, and continuous renal replacement therapy dramatically improved the liver abscess, peritonitis, and metabolic problems. We report an unusual case of a ruptured GFPLA without surgical management, treated successfully with only medical treatment. (Korean J Gastroenterol 2018;70:45-48)
박태영 ( Tae Young Park ),류수형 ( Soo Hyung Ryu ),문정섭 ( Jeong Seop Moon ) 대한소화기학회 2020 대한소화기학회지 Vol.75 No.3
A visceral artery pseudoaneurysm after ERCP is a rare adverse event that is potentially life-threatening. Most cases reported previously originated from the peripancreatic arteries, including the splenic artery, gastroduodenal artery, or pancreaticoduodenal artery. The mechanism of the occurrence of visceral artery pseudoaneurysms after ERCP has not been elucidated until now. Recently, a pseudoaneurysm rupture originating from the superior mesenteric artery after ERCP was observed in a patient without a history of pancreatitis. This paper reports this case with a review of the relevant literature.
원발성 간암에서 고주파 열치료 후 발생한 부신 호르몬 상승 없는 고혈압 발작증 증례 보고
이경진 ( Kyung Jin Lee ),류수형 ( Soo Hyung Ryu ) 대한소화기학회 2017 대한소화기학회지 Vol.70 No.4
Radiofrequency ablation (RFA) is a minimally invasive procedure that has been considered as a relatively safe treatment for patients with small hepatocellular carcinoma (HCC). However, RFA has been shown to be associated with complications including mechanical and thermal damage. A 74-year-old man with hepatitis C virus-associated HCC was admitted to our hospital. Abdominal computed tomography revealed two lobulated-HCC in segments 4 and 5. He had no medical history of hypertension and cardiac disease. During RFA, blood pressure was elevated to 200/140 mmHg. There was no evidence of pulmonary embolism, aortic dissection, or ischemic heart disease. Laboratory findings for catecholamine surge were all within normal limits. After continuous intravenous nitroglycerin and oral beta-blocker treatment, patient’s blood pressure gradually decreased and back within the normal range. Hypertensive crisis after RFA treatment for HCC is rare. Most reported cases of hypertensive crisis during RFA were related to adrenal gland injury with a release of catecholamine. In our case, the site of HCC was not close to the adrenal gland, and there was no evidence of catecholamine surge. Herein, we report a very rare case of hypertensive crisis without a surge in adrenal hormones after RFA treatment for HCC. (Korean J Gastroenterol 2017;70:198-201)
Daclatasvir와 Asunapreiver 요법에 실패한 만성 C형간염의 다른 직접작용 항바이러스제 재치료
이동훈 ( Dong Hoon Lee ),류수형 ( Soo Hyung Ryu ),명희준 ( Hee Jun Myung ),신윤재 ( Yun Jae Shin ),이시형 ( Si Hyeong Lee ),박태영 ( Tae Young Park ),문정섭 ( Jeong Seop Moon ) 대한소화기학회 2021 대한소화기학회지 Vol.77 No.2
The pegylated interferon plus ribavirin combination therapy has been used as the primary treatment for chronic hepatitis C (CHC) but fails to produce a sustained viral response (SVR) in many patients. In recent years, the treatment of CHC has been rapidly changing because of the introduction of direct-acting antivirals (DAAs), which have a high cure rate. However, retreatment of patients after failure of the first DAA therapy is difficult. We report two rare cases of CHC that showed acquired SVR with other DAA combinations after failure to daclatasvir and asunaprevir. (Korean J Gastroenterol 2021;77:88-91)