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이소영 ( So Young Lee ),김진일 ( Jin Il Kim ),김상희 ( Sang Hee Kim ),박용재 ( Yong Jai Park ),김재광 ( Jae Kwang Kim ),우인숙 ( In Sook Woo ),이연수 ( Youn Soo Lee ) 대한내과학회 2008 대한내과학회지 Vol.75 No.6
내시경 소견에서 악성 림프종을 의심하였으나 조직학적으로 간 전이를 동반한 원발성 위 소세포암으로 진단된 환자에서 항암화학요법을 시행하여 유효한 결과를 얻었기에 문헌고찰과 함께 보고한다. Primary gastric small cell carcinoma (SmCC) is rarely encountered and has a poor prognosis, even when discovered at an early stage. A 69-year-old man presented with upper abdominal pain and melena. Endoscopic examination revealed an 8-cm-diameter submucosal tumor with ulceration high on the body of the greater curvature suggesting malignant lymphoma. Histological examination revealed a solid proliferation of small cells with hyperchromatic round nuclei and scant cytoplasm. On immunohistochemical staining, the neoplastic cells were positive for synaptophysin, EMA, and CD56. Abdominal computed tomography (CT) revealed multiple variable-sized low-attenuated masses with peripheral rim enhancement in both hepatic lobes. He was diagnosed with a pure type gastric SmCC with multiple hepatic metastasis. After systemic chemotherapy, the tumor regressed substantially on CT and endoscopy. We report a case of hepatic metastasis of gastric SmCC mimicking gastric lymphoma. (Korean J Med 75:694-699, 2008)
류마티스 관절염 환자에서 Methotrexate와 관련된 간질성 폐렴
김지연 ( Ji Yeon Kim ),김완욱 ( Wan Uk Kim ),김성일 ( Sung Il Kim ),류완희 ( Wan Hee Yoo ),박성환 ( Sung Hwan Park ),홍연식 ( Yeon Sik Hong ),김석찬 ( Seok Chan Kim ),조철수 ( Chul Soo Cho ),김호연 ( Ho Youn Kim ),이연수 ( Youn So 대한류마티스학회 1998 대한류마티스학회지 Vol.5 No.1
The use of oral methotrexate in a low dose given once weekly has become the mainstay of therapy for active and sustained rheumatoid arthritis. Pneumonitis can be expected to occur in patients taking low doses of methotrexate for rheumatoid arthritis. The pathology suggests that methotrexate pneumonitis is a hypersensitivity reaction although arguments have been put forth that it is idiosyncratic. Treatment of presumed methotrexate pneumonitis, even while waiting for special stains, cultures, or tissue sections from bronchoscopic biopsy, should be glucocorticoids given intravenously or by mouth. Empirical antibiotic treatment can be used until infectious causes are ruled out. In recent years there has been an increase in the number of reports of pulmonary complications associated with low-dose methotrexate therapy for rheumatic diseases. Among these complications interstitial pneumonitis has been most often reported (more than 35 cases since the first report in 1983). We report a case of methotrexate-associated pulmonary complication in rheumatoid arthritis confirmed by trans-bronchoscopic lung biopsy, which resolved by treatment of corticosteroid therapy.