기무라씨 질환, 5예 보고

설대위(David J Seel),박윤규(Yoon Kyu Park),이광민(Kwang Min Lee) 대한두경부종양학회 1989 대한두경부 종양학회지 Vol.5 No.1

기무라씨 질환은 특히 두경부 부위에 피하 종괴를 일으키는 만성염증성, 증식성 질환이다. 저자들은 최근 치험하였던 본 질환 5 예를 한국외과 문헌에 처음으로 보고하는 바이다. 기무라씨 질환은 크게는 ALHE(Angiolymphoide Hyperplasia with Eosinophilia) 의 범주에 속한다. 본 질환의 병리학적 특징은 증식된 lymphoid follicles, eosinophilic infiltration 과 혈관의 증식성이다. 이 질환은 이하선, 악하선 및 상부 경부 부위등에 흔히 종괴를 일으키며 이들 종괴들은 피하조직 뿐만 아니라 타액선과 상부 경부 임파선에까지도 파고 든다. 저자들의 증례 중 한명에서는 서혜부에 종괴가 있었으며 새로이 증식된 혈관과 동상들 (Sinusoids) 로 인하여 혈관 분포가 매우 풍부하였다. 저자들 증례 5 명의 평균 연령은 35세이었지만 한명을 제외한 나머지 모두는 38세 이하이었다. 남녀비는 3:2 이었으며 증상의 평균 기간은 5.2 년이었다. 전례에 있어서 말초 혈액 소견상 Eosinophilia 가 있었다. 전례에서 다발성 종괴들을 보였으며 가끔은 대칭적이기도 하였다. 저자들이 시행한 치료 양상은 수술만 시행한 경우와 수술 및 스테로이드 홀몬요법 시행 경우가 각각 1례씩이었고 수술과 방사선조사 경우가 2례이었으며 나머지 1례에서는 수술, 스테로이드 홀몬요법 및 방사선조사의 복합치료를 실시하였다. 저자들은 기무라씨 질환과 ALHE 질환과의 관계를 고찰해 보았으며 기무라씨 질환의 치료 경험을 보고하는 바이다. Kimura's Disease is a chronic inflammatory and proliferative condition producing subcutaneous masses especially in the head and neck area. This report of our experience with 5 patients with this disease is the first in the Korean surgical literature. Kimura's Disease is thought to be part of the larger spectrum of the entity known as angiolymphoid hyperplasia with eosinophilia (ALHE). It is characterized pathologically by hyperplastic lymphoid follicles, eosinophilic infiltration, and vascular proliferation. It produces masses which are most common in the area of the parotid, submandibular gland and upper neck. These masses occupy the subcutaneous tissues but also extend into salivary tissue and into upper neck nodes. One of our patients had masses in the groin. The tumors are extremely vascular due to the presence of new proliferative vessels and sinusoids. The average age of our 5 patients was 35, but all but one case were younger than 38 years of age. The male: female ratio was 3 : 2, and the average duration of symptoms was 5,2years. All patients had peripheral blood eosinophilia. All had multiple masses, sometimes symmetrical. The management was surgery alone in one case, surgery and steroids in one case, surgery and radiotherapy in two cases, and all three modalities in one case. The relationship of this entity to ALHE and our experience in the management of this disease are presented. A clinicopathological discrepancy alerted us to the existence of Kimura's Disease. A nineteen-year old male presented with subcutaneous masses over both mastoid areas present for 3 years (Case III). When biopsy on each side was reported as 'eosinophilic granuloma' we submitted the slides to an internationally expert pathologist. Symmetrically occurring tumors in the peri-parotid subcutaneous areas did not fit any category of neoplasm or granuloma known to us. The diagnosis, made by Dr. Gist Fan at the Ochsner Clinic, was Kimura's Disease. We found two additional cases in a review of soft tissue eosinophilic granuloma previously reported at Presbyterian Medical Center, and since then have diagnosed two new cases. These five cases constitute the basis for this, the largest series to be reported in Korea. These vascular, tumor-like lesions of the skin, subcutaneous areas and subjacent structures of the head and neck have been a variety of names, such as angiolymphoid hyperplasia with eosinophilia, eosinophilic hyperplastic lymphogranuloma, angioblastic lymphoid hyperplasia with eosinophilia, histioid hemangioma, and epithelioid hemangioma. The history of this disease spectrum dates back to 1937 when Kimm and Szeto (1) reported 7 cases of 'eosinophilic hyperplastic lymphogranuloma' in the Proceedings of the Chinese Medical Journal. In 1948 Kimura and his associates(2) reported additional cases in Japan under the title 'On the unusual granulation combined with hyperplastic changes of lymphatic tissue.' From then until 1966 several hundred cases were reported in China and Japan. The first report from the West was by Wells and Whimster(3) in the British Journal of Dermatology, in 1969. These authors coined the term, angiolymphoid hyperplasia with eosinophilia (ALHE). Since that time a debate has ensued as to whether Kimura's Disease and ALHE are distinct entities, or whether Kimura's is part of the larger spectrum of ALHE, perhaps a later or advanced phase. From the clinical perspective, surgeons should be aware of the diagnosis of Kimura's Disease not only as part of the differential diagnosis of head and neck tumors but also because these lesions are indolent, and generally require conservative surgical removal as part of the management program. CASE Ⅰ. A 37-year-old female company employee presented in August 1982 with submental swelling of 12 years'duration and with in guinal swelling of 7 years'duration. The submental mass measured 5x5cm. and the inguinal mass was 8×4cm. in size. Perip-heral eosinophilia varying from 14% t

측두하강 및 측인두강의 원발성 종양

설대위(David J Seel),박윤규(Yoon Kyu Park),조순흠(Soon Heum Cho) 대한두경부종양학회 1989 대한두경부 종양학회지 Vol.5 No.1

There is a difficulty in complete removal of tumor developing at the parapharyngeal space or infratemporal space where they are just under the skull base. We have experienced 3 cases of malignant tumors and 5 cases of benign tumors arising from the parapharyngeal spaces and/or infratemporal space since 1976. We hereby present 8 cases of primary tumors arising in these spaces with a review of anatomical relationship between above spaces, the characteristic symptoms, diagnostic technics, and surgical approaches which should be considered in their management.

CANCER OF THE NASAL FOSSAE

설대위(David J Seel),유봉옥(Bong Ok Yoo),박윤규(Yoon Kyu Park) 대한두경부종양학회 1986 대한두경부 종양학회지 Vol.2 No.1

Nasal fossae의 암이란 비강과 부비동들에서 발생하는 것으로서 환자를 가장 괴롭히며 또한 가장 믿을수 없는 악성종양들중의 하나이다. 비록 본 예수병원 암환자등록부에 의하면 전 암환자의 2.2% 발생빈도로서 주요한 발생빈도를 보이지는 않지만, 이 부위의 암을 치유하는데는 세심하고 철저한 모든 진단적 검사와 과감한 외과 및 치료방사선의 병합치료가 요구된다. 저자들은 지난 22년간 비강 및 부비동(Nasal fossae)에서 발생한 원발성 악성종양중 지유목적의 근치수술을 시행한 68 예를 임상고찰 하였다. 근치수술을 시행했던 68예중 91%에서 제 3 병기 또는 4 병기의 진행된 경우 이었다. 외과적 수술은 한예의 사골동(篩骨洞)종양적출술 및 부분上顎洞절제술 한예를 제외한 66예 모두에서 全上顎洞절제술 (total maxillectomy ) 또는 확장 全上顎洞절제술(extended total maxillectomy) 을 시행하였다. 저자들은 疫學的, 病理學的, 病期및 치료, 재발율과 생존율들을 분석 고찰하였으며 3까지 치료형태를 서로 비교하였다. 즉 수술만 시행한 군, 수술전 방사선 치료 및 수술병합군, 수술과 수술후 방사선치료 병합 군으로 나눴다. 저자들의 예비적(preliminary) 관찰 결과는 2 년간 무병생존율(disease-free 2-year survival )만을 볼때, 수술만 시행한 군에서 40%로써 통계학적으로는 가장 좋았으나 실제는 수술만 시행한 군에서는 단지 40%만이 제 4 病期의 진행된 경우였으나 수술전 방사선치료 또는 수술후 방사선 치료등의 병합치료에서는 제 4 病期의 진행된 상태가 무려 60%나 되었다. 전체적 인 재발율(Overall recurrence rate) 은 68.2%로써 무서울 정도로 높았으며 전체적인 2년 무병율은 23.7%였다. 저자들은 이 분야에서 실패의 원인분석과 치료방법의 선택등에 대한 지침을 제시하고저 한다.

PARATHYROID ADENOMA

설대위(David J Seel),오성수(Sung Soo Oh),박윤규(Yoon Kyu Park),정동규(Dong Kyu Chung) 대한두경부종양학회 1986 대한두경부 종양학회지 Vol.2 No.1

저자들은 부갑상선 선종 3예를 입상고찰과 함께 보고하는 바이다. 부갑상선 기능 항진증이 있는 환자에서 임상증상들이 각각 서로 달랐으며 증상의 다양성과 여러기관의 침범을 볼수 있었다. 제 1 예는 심한 근 쇄약을, 제 2예는 좌 경골의 낭포성골병변을, 제 3예는 상복부동통, 관절통 및 정신장애를 나타냈다. 全例 모두에서 骨의 鑛物質 消失(demineralization)을 보였고 두 예에서는 경부 종괴가 촉지되었고 나머지 한 예만 전형적인 낭포성 섬유성 골염(Osteitis fibrosa cystica)을 보였다. 3예중 2예는 주세포 선종 (Chief cell adenoma) 이었으며 나머지 한 예는 혼합성 세포형(mixed cell type)이었다. 저자들은 본 질환에 대한 진단기준, 외과적 수술방법 및 수술 성공 여부 판정에 대한 지침을 제시하고저 한다.

악성 타액선 종양 114예의 임상고찰

박윤규(Yoon Kyu Park),설대위(David J Seel),정동규(Dong Kyu Chung) 대한두경부종양학회 1985 대한두경부 종양학회지 Vol.1 No.1

The authors reviewed 114 cases of malignant major and minor salivary gland tumors at Presbγterian Medical Center seen from February, 1963 to December, 1983. The results were obtained as follows; 1) Overall male and female sex ratio was 2 : 1. The peak age of patients with major and minor salivary gland tumor were both 5th decade. 2) The ratio of benign and malignant tumor was 83 : 114. The incidence of malignancy in each group was 52 % in parotid (50 patients), 75% in minor salivary gland (45 patients), 49% in submaxillary gland(18 patients) and 25% in sublingual gland (1 patient). 3) The incidence according to the anatomic primary site for minor salivary cancers was 10 cases in the nasal cavity, each 8 in the palate and the maxillary antrum, 7 in the tongue, 5 in the gum, 3 in the larynx and 2 in the buccal mucosa. 4) Adenoid cystic carcinoma was the most common cancer of minor salivary gland and malignant mixed tumor was the most common in major salivary glands, each comprising 34 cases (76%) of minor and 19 cases (28%) of major salivary gland tumors. 5) The incidence of cervical lymph node metastasis was 50 % in the submaxillary gland cancers, 44% in the parotid gland cancers and 21 % in malignant tumors of minor salivary glands. The highest incidence of lymph node metastasis according to histopathological classification was formed in high grade of mucoepidermoid (67 %). 6) Nerve invasion was common in mucoepidermoid carcinoma. According to anatomic site, nerve invasion occurred most often in adenoid cystic carcinoma of the submaxillary gland (44%). 7) The lung was the commonest site for distant metastasis comprising 12 cases among 26 cases in which distant spread occurred. 8) The recurrence rate was 50% for major salivary gland cancer and 52% in cancer of the minor salivary gland. In accordance with pathological classification, adenocarcinoma most frequently recurred after excision. This being seen in 88% of patients undergoing definitive therapy. 9) The determinate 5 year survival rate was 78% in major salivary gland tumors, but 69 % in minor salivary gland tumors.

火傷痕에서 發生한 癌腫 및 肉腫

劉龍吉(Y.K. Yoo),薛大偉(David. J. Seel) 대한외과학회 1972 Annals of Surgical Treatment and Research Vol.14 No.12

舌癌 33例에 對한 考察

康鎭國(Jin Kook Kang),설대위(David J. Seel) 대한외과학회 1968 Annals of Surgical Treatment and Research Vol.10 No.2

上腸間膜 動脈症候郡

金相淳(S.S. Kim),徐相全(S.J. Suh),설대위(David J. Seel) 대한외과학회 1972 Annals of Surgical Treatment and Research Vol.14 No.12

갑상선결절에 대한 고찰

조백환(Baikwhan Cho),김상순(Sangsoon Kim),설대위(David J. Seel) 대한외과학회 1980 Annals of Surgical Treatment and Research Vol.22 No.9

多發性 原發性 惡性腫瘍

김정환(Jung Whan Kim),박윤규(Yoon Kyu Park),정을삼(Eul Sam Chung),설대위(David J. Seel) 대한외과학회 1989 Annals of Surgical Treatment and Research Vol.37 No.3