유방에 발생한 아포크린암종의 세침흡인 세포학적 소견 - 1예 보고-

엄민섭,박진규,이광길,정순희,Eom, Min-Seob,Park, Jin-Kyu,Lee, Kwang-Gil,Jung, Soon-Hee 대한세포병리학회 2003 대한세포병리학회지 Vol.14 No.2

Apocrine carcinoma of the breast is a very rare subtype. Although it has no clinical differences from usual ductal carcinoma of the breast, it should be categorized as a subtype of breast carcinoma because the cells of apocrine carcinoma reveal characteristic abundant eosinophillic cytoplasms with intraductal apical snouting as well as round or oval nuclei and central macronucleoli. On fine needle aspiration cytology, the cells of apocrine carcinoma have a lot of similarity to benign or reactive apocrine cells of the breast. Therefore, it is difficult to make a differential diagnosis of apocrine carcinoma from mammary neoplasms with similar cytologic findings unless the subtle cytologic differences are recognized. We report the cytologic and histologic findings of a case of apocrine carcinoma in the breast of a 40-year-old female patient. After the fine needle aspiration cytology, she received the lumpectomy and lymph node dissection. The cellularity was moderate to high. The cytoplasmic borders of tumor cells of three-dimensional clusters were relatively distinctive, and the cytoplasm was abundant, eosinophilic, and granular. Although the nuclear/cytoplasmic ratio was low, the nuclei of the cells were variable in size and shape with prominent macronucleoli. Histologically, it was a typical invasive apocrine carcinoma, showing numerous cytoplasmic lysosomes and mitochondriae on electron microscopy.

이동성 홍반의 피부 병변으로 내원한 환자들에 대한 고찰

오윤석 ( Yoon Seok Oh ),엄민섭 ( Min Seob Eom ),조미연 ( Mee Yon Cho ),김종배 ( Jong Bae Kim ),최응호 ( Eung Ho Choi ) 대한피부과학회 2008 大韓皮膚科學會誌 Vol.46 No.5

Background: Lyme disease, an infection caused by Borrelia(B.) burgdorferi, has been reported in many countries. But in Korea, only 5 cases of serologically diagnosed lyme disease have been reported. Because several strains of B. burgdorferi were isolated from Ixodes ticks which were captured in Kangwon and Chungbuk province, there might be more cases of serologically undiagnosed lyme diseases presenting with erythema migrans. Objective: To understand the clinical patterns and laboratory findings of erythema migrans in Korea. Methods: A clinical survey was retrospectively performed on 9 patients with erythema migrans which occurred after tick bites. Results: Among 9 patients with erythema migrans, 3 patients were male and 6 patients were female. The onset age of erythema migrans ranged from 26 to 71 years old (mean, 51.3 years old). The mean duration of erythema migrans after tick bite was 26.4 days and the diameter of the lesion ranged from 6 to 34 cm (mean, 18.3 cm). All cases developed from May to September and systemic symptoms such as fatigue, fever and/or chills, myalgia, palpitation, headache, arthralgia and dyspnea were present at the time of hospital visits of 3 patients. Clinically, 3 patterns of erythema migrans were seen; typical target pattern, homogenous and erythematous plaque pattern, and linear solitary plaque pattern with central postinflammatory pigmentation. Only 2 of the 7 patients (28.6%) were seropositive for IgM and IgG antibody titers by enzyme-linked immunosorbent assay in consecutive serologic tests. PCR for Borrelia DNA in paraffin-embedded tissue showed full negativity in 6 patients with erythema migrans. Conclusion: Although lyme disease is not endemic in Korea, some patients with erythema migrans might be undiagnosed as lyme disease serologically with erythema migrans. To take into consideration false negative serelogic results in early erythema migrans, early oral tetracycline therapy should be included through clinical and historical diagnosis. (Korean J Dermatol 2008;46(5):596∼603)

선천성 거대결장 및 특발성 거대결장에서 카할 세포의 역할

유수영,고용택,한애리,정순희,엄민섭,김일호,Yoo, Soo-Young,Koh, Yong-Taek,Han, Ai-Ri,Jung, Soon-Hee,Eom, Min-Seob,Kim, Il-Ho 대한소아외과학회 2002 소아외과 Vol.8 No.2

The etiology of several motility disorders, including persistent megacolon after definitive surgery for Hirschsprung's disease, meconium ileus which is not associated with cystic fibrosis and idiopathic megacolon, is still unclear. Interstitial cells of Cajal (ICC) are thought to modulate gut motility as gastrointestinal pace maker cells. The aim of this study was to evaluate the role of ICC in the bowel walls of the patients (n=15) who had variable motility disorders. The ICC were identified by immunohistochemical staining using an anti-C-Kit antibody and the results were compared with control specimens (n=2). The control group (G1) showed evenly distributed ICC in their bowel walls. The second group (G2, n=5) who had normal bowel movements after Duhamel procedures and the third group (G3, n=4) who had persistent megacolon after Duhamel procedures showed absent or scarcely distributed ICC in their aganglionic bowels. The ICC were immunohistochemical staining using an anti-C-Kit antibody and the results were compared with control specimens (n=2). The control group (G1) showed evenly distributed ICC in their bowel walls. The second group (G2, n=5) who had normal bowel movements after Duhamel procedures and the third group (G3, n=4) who had persistent megacolon after Duhamel procedures showed absent or scarcely distributed ICC in their aganglionic bowels. Whereas ICC were evenly distributed in the ganglionic bowels of G2, they were not seen or scarecely distributed in the ganglionic bowels of G3. Two patients (G4) who suffered from idiopathic megacolon showed absence or decrease of ICC in spite of presence of ganglion cells in their colons. Four neonates (G5) who underwent ileostomy because of meconium obstruction showed absent or markedly decreased ICC in the the colon at the time of ileostomy and the distribution of ICC was changed to a normal pattern at the time of ileostomy closure between 39-104 days of age and their bowel motility were restored after that. The results suggest that lack of ICC caused reduce motility in the ganglionic colons and it may be responsible for the development of various motility disorders. Delayed maturity of ICC may also playa role in the meconium obstruction of neinates.

여출액과 삼출액의 감별진단을 위한 흉막액과 혈청에서의 Cholinesterase 비율의 진단적 의의

조호 ( Jo Ho ),김현일 ( Kim Hyeon Il ),엄민섭 ( Eom Min Seob ),권한진 ( Kwon Han Jin ),오용열 ( O Yong Yeol ),김광석 ( Kim Gwang Seog ),김휘정 ( Kim Hwi Jeong ) 대한결핵 및 호흡기학회 2000 Tuberculosis and Respiratory Diseases Vol.48 No.5

방광으로의 침윤성 전이를 동반한 난소의 경계성 점액성 종양과 연관된 복막 위점액종

차동수 ( Dong Soo Cha ),박철종 ( Chul Jong Park ),한경희 ( Kyoung Hee Han ),엄민섭 ( Min Seob Eom ) 대한산부인과학회 2012 Obstetrics & Gynecology Science Vol.55 No.12

Pseudomyxoma peritonei (PMP) is an uncommon entity characterized by large amount of mucinous-jelatinous fluid disseminated in abdominal cavity and pelvic cavity with implants on omentum and bowel. The symptoms of this disease are mostly abdominal distension, dyspepsia, and intraabdominal palpable mass. The origin of PMP is under investigation yet, that is known to arise from appendix, ovary mostly. Also it`s etiology, treatment, and prognosis are speculative. Rare cases were reported that have invasion to other organ except appendix and ovaries, but we experienced a case of PMP associated with borderline mucinous tumor of ovary with invasive metastasis of bladder. So we report this case with a brief review with literature.

자궁벽내 임신

하정식 ( Ha Jeong Sig ),정인배 ( Jeong In Bae ),조주형 ( Jo Ju Hyeong ),이향아 ( Lee Hyang A ),엄민섭 ( Eom Min Seob ),박광화 ( Park Gwang Hwa ) 대한산부인과학회 2003 Obstetrics & Gynecology Science Vol.46 No.11

Intramural pregnancy is one of the rarest forms of ectopic pregnancy. The pathologic diagnosis of the intramural ectopic pregnancy requires that the myometrium surrounds the products of conception separated from the endometrial cavity or fallopian tubes.

공막염을 동반한 재발성 다발성 연골염

정예진 ( Ye Jin Jung ),박화영 ( Hwa Young Park ),이윤희 ( Yoon Hee Lee ),김주영 ( Joo Young Kim ),윤이나 ( Ie Na Yoon ),정요셉 ( Yo Sep Chong ),엄민섭 ( Min Seob Eom ),전수영 ( Soo Young Jeon ) 대한피부과학회 2009 대한피부과학회지 Vol.47 No.8

Relapsing polychondritis is a rare rheumatologic disorder most commonly presenting as recurring episodes of inflammation in cartilaginous tissues. Auricular chondritis with red ears resembling cellulitisis the most common clinical manifestation. Other manifestations include arthritis, nasal chondritis, and ocular, pulmonary, and cardiovascular disease. Here we report the case of a 54-year-old female patient with relapsing polychondritis and associated scleritis. On histologic examination, the auricle, including cartilaginous tissues, showed loss of the normal basophilia of cartilage and perichondrial infiltration of inflammatory cells. The patient was treated with systemic steroids. Symptoms in both auricles were reduced, scleritis developed, and ocular symptoms were waning. (Korean J Dermatol 2009;47(8):941~944)

신장 ; IgA 신증 환자의 병리소견과 임상경과

이준영 ( Jun Young Lee ),양재원 ( Jae Won Yang ),김재석 ( Jae Seok Kim ),김영섭 ( Young Sub Kim ),박현철 ( Hyeon Cheol Park ),채문희 ( Moon Hee Chae ),최승옥 ( Seung Ok Choi ),엄민섭 ( Min Seob Eom ),한병근 ( Byoung Geun Han ) 대한내과학회 2015 대한내과학회지 Vol.88 No.4

목적: 병리학적 소견을 바탕으로 IgA 신증 환자의 예후를 예측하고자 여러 분류들이 소개되었다. 최근에 소개된 Oxford 분류법과 전자현미경 소견을 이용하여 예후인자와 연관성 및 신생존의 예측 능력을 알아보고자 하였다. 방법: 1997년부터 2007년까지 IgA 신증으로 진단된 환자213명을 후향적으로 조사하여 병리의사가 Oxford 분류법과 전자현미경 소견을 바탕으로 재분류하고 연령, 성별, 단백뇨, 신기능 저하, 고혈압 등과의 연관성 및 신생존율 분석에 적용하였다. 결과: eGFR은 Oxford 분류법의 M, S, E, T 모든 항목과 의미 있는 연관성을 보여 주었고 24시간 소변 단백/크레아티닌 비는 S, E, T 모든 항목과 의미 있는 연관성을 보여 주었다. T 항목만이 신생존율과 통계적으로 의미가 있었으며 전자현미경 소견은 신생존율을 예측하는 능력은 보이지 않았다. 결론: 본 연구에서는 Oxford 분류법의 T 항목인 tubular atrophy/interstitial fibrosis가 단백뇨의 정도를 잘 반영했을 뿐만 아니라 신기능의 악화를 예측할 수 있는 강력한 평가 항목임을 보여주었다. Background/Aims: The Oxford classification of immunoglobulin A nephropathy (IgAN) is a pathology-based prognostic classification system. However, further study is needed to determine its validity. We studied the relationships between the Oxford classification and established prognostic factors and renal survival. We also examined associations between electron microscopy findings and these parameters. Methods: We reviewed and reclassified 213 patients who were diagnosed with IgAN from 1997 to 2007 using the Oxford and World Health Organization (WHO) classification systems. The patients were also categorized by a pathologist using electron microscopy findings, including foot process fusion, glomerular basement membrane thickness, and electron-dense deposits. We examined the correlations between light and electron microscopy data and known prognostic factors (e.g., age, sex, proteinuria, serum creatinine, estimated glomerular filtration rate [eGFR], and blood pressure). The same procedure was applied to renal survival. Results: Patient age increased with the grades of segmental sclerosis (S) and tubular atrophy/interstitial fibrosis (T) (p < 0.05). eGFR decreased significantly with increasing mesangial hypercellularity (M) (p = 0.0034), S (p = 0.0003), endocapillary hypercellularity (E) (p = 0.0411), and T (p < 0.0001). MSET differed significantly by sex (p < 0.0001). The 24-h urine protein/creatinine ratio increased significantly with the degrees of S (p = 0.036), E (p = 0.0155), and T (p = 0.015). The serum creatinine level was significantly higher in patients with T2 than T1 or T0 (p < 0.0001). At the time of biopsy, the degree of tubular atrophy/interstitial fibrosis affected the doubling of serum creatinine or end-stage renal disease. However, the electron microscopy findings did not predict the renal outcome. Conclusions: Our study suggests that tubular atrophy/interstitial fibrosis is significantly associated with proteinuria and renal progression in IgAN.

고인슐린혈성 저혈당을 보인 성인에서의 Nesidiodysplasia 1예

이연,김우재,김문규,김미진,엄민섭,이광길,신영구 대한내과학회 2003 대한내과학회지 Vol.64 No.6

고인슐린혈성 저혈당의 원인 중 nesidioblastosis와 nesidiodysplasia는 신생아 및 유아기에는 가장 많은 원인 질환이나 어른에서는 매우 드물고 여전히 진단 및 치료에 있어서 논란이 많다. 저자 등은 의식저하를 주소로 내원한 성인에서 고인슐린혈성 저혈당으로 진단하여 처음에는 인슐린종을 의심하여 종양 확인을 위한 검사를 시행하여 경피적 경감문맥 정맥혈 채취술과 수술 중 시행한 초음파에서 종양이 의심되는 결절이 있어서 적출 하였으나, 수술 후 병리조직 소견으로 nesidiodysplasia 가 진단된 1예를 경험하였기에 이에 문헌고찰과 함께 보고하는 바이다. Nesidiodysplasia encompasses increased, maldistributed, and/or, improperly regulated or programmed endocrine cells associated with a clinical endocrine dysfunction. It is a frequent cause of hyperinsulinemic hypoglycemia in neonates and infants, but rare in adults. A 63 year-old woman was admitted due to the loss of consciousness and intense sweating. Hyperinsulinemic hypogiycemia was diagnosed. Under the presumptive diagnosis of insulinoma, abdominal ultrasonography and CT scan were done, but no definite tumor was found. Only a suspicious gradient in insulin concentration was found around the body of the pancreas by percutaneous portal venous sampling. While an exploratory laparotomy was performed, an intraoperative sonography was done. As a result, cystic mass like lesion was found. Then mass enucleation was done. Pathologic examination of the enucleated pancreas revealed no mass and the characteristic nesidiodysplasia. However, after the operation, hypoglycemic symptoms were repeated. So we are instructing her to eat meals frequently.

8세 남아에서 발견된 프롤락틴 분비 뇌하수체 거대선종 1예

석기태,심명숙,김영욱,신영구,정순희,엄민섭,한용표,김명순,정춘희 연세대학교 원주의과대학 2000 원주의대논문집 Vol.13 No.1