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장재율(Jae Yool Jang),안영준(Young Joon Ahn),정중기(Jung Kee Chung),정인목(In Mok Jung),허승철(Seung Chul Heo),황기태(Ki-Tae Hwang),안혜성(Hye Seong Ahn),신은(Eun Shin),서자희(Ja Hee Seo) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.78 No.5
Adenosquamous carcinoma arising in congenital choledochal cyst is very rare and herein we report a case thereof. A 37-year-old woman was referred for further evaluation of pancreas head mass and a hepatic nodule on CT. She had been diagnosed with congenital choledochal cyst at 22-years-old and received Roux-en-Y choledochojejunostomy at that time. Endoscopic ultrasonography-guided biopsy proved the pancreas head mass as a squamous cell carcinoma and liver biopsy also proved the liver mass as a metastatic squamous cell carcinoma. We performed pancreaticoduodenectomy and tumorectomy of metastatic liver nodule. Grossly, the primary lesion was located at intrapancreatic portion of choledochal cyst. Histologically, the primary lesion and hepatic nodule was metastatic adenosquamous carcinoma. So far, there have been only three cases of adenosquamous carcinoma arising in congenital choledochal cyst reported in English-language literature. This is another case and the first case reported in Korea.
김대환(Daehwan Kim),한호성(Ho-Seong Han),윤유석(Yoo-Seok Yoon),조재영(Jai Young Cho),최영록(Youngrok Choi),장재율(Jae Yool Jang),최한림(Hanlim Choi) 대한종양외과학회 2015 Korean Journal of Clinical Oncology Vol.11 No.2
Purpose: Pancreatic surgery is challenging and associated with high morbidity. Therefore, it is important to detect it early before it becomes clinically apparent. The white blood cell (WBC) count useful as a predictive marker of postoperative pancreatic fistula. The aim of this study was to evaluate the diagnostic accuracy of WBC in predicting pancreatic fistula. Methods: Between September 2003 and December 2013, 405 patients underwent elective pancreaticoduodenectomy or pylorus preserving pancreaticoduodenectomy for periampullary malignancy. Among them, 372 patients with no preoperative leukocytosis were enrolled in this study. The serum WBC count was monitored daily until postoperative day 8. The clinic and pathological data of these patients were analyzed by reviewing medical records retrospectively. Results: Thirty patients (8%) developed pancreatic fistula grade B and C. The WBC count, measured every other day, was significantly higher every other day during the first 7 postoperative days in patients who developed pancreatic fistula grade B and C, compared with those patients who did not develop pancreatic fistula. The WBC count cutoff value of 13.07x10<SUP>9</SUP>/L, 10.37 x10<SUP>9</SUP>/L on postoperative day 1,7 yielded a sensitivity of 57%, 70%, specificity of 53%, 67% for the detection of pancreatic fistula. Conclusion: Patients with postoperative fistula grades B and C showed WBC counts that did not decrease on subsequent measurements during the early postoperative period. The measurement of WBC counts after pancreaticoduodenectomy can play a clinically important role in the early detection of pancreatic fistula development even from postoperative one day.
Primary hepatic choriocarcinoma in a female patient
Makhmud Malikov,Eun Shin(신은),Jai Young Cho(조재영),Ho-Seong Han(한호성),You-Seok Yoon(윤유석),Young Rok Choi(최영록),Jae Yool Jang(장재율),Hanlim Choi(최한림),Jae Seong Jang(장재성),Seong Uk Kwon(권성욱),Haeryoung Kim(김혜령) 대한종양외과학회 2015 Korean Journal of Clinical Oncology Vol.11 No.1
Choriocarcinoma is a germ cell tumor belonging to the spectrum of gestational trophoblastic diseases, and occurs most commonly in the gonads. Primary hepatic choriocarcinoma is very rare, especially in females. A 59-year-old woman was referred to our clinic with a history of upper right quadrant pain lasting 1 month. Computed tomography and magnetic resonance imaging revealed a large hypervascular mass in the right liver, characteristic of angiosarcoma. The patient underwent right hemihepatectomy without unexpected events. Histopathology revealed the tumor as a choriocarcinoma, with numerous syncytiotrophoblasts. Immunohistochemistry was positive for β-human chorionic gonadotropin and CK-19, with a Ki-67 labeling index of 90%. The tumor showed focal positivity for CD31 and human placental lactogen. The patient started chemotherapy (vincristine and cyclophosphamide) on postoperative day 16. The patient’s clinical condition improved and she was discharged on postoperative day 17. Primary hepatic choriocarcinoma in female adults is a rare aggressive tumor, and further studies are needed to improve its diagnosis and treatment.