낭종 종양 형태를 보인 췌장 결핵

조성범 ( Sung Bum Cho ) 대한소화기학회 2009 대한소화기학회지 Vol.53 No.5

Pancreatic tuberculosis is a rare clinical entity, presenting as malignancy mimicking pancreatic mass. Therefore, it represents a diagnostic challenge. To date, ten cases have been reported in Korea. I report an additional case and review all Korean reports about pancreatic tuberculosis. A 57-year-old woman presented with abdominal pain. Abdominal computed tomography (CT) revealed a 2.2×1.2 cm cystic mass in pancreatic body. She was followed for nine months, at which time a cystic mass was enlarged to 3.3×2.2 cm in size on the CT. An exploratory laparotomy was performed for the accurate diagnosis and to rule out the possibility of malignant change. Pathological examination of the resected specimen revealed chronic granulomatous inflammation with caseous necrosis and multinucleated giant cells, which was compatible with tuberculosis. Among the 11 cases of pancreatic tuberculosis, five cases were combined with pulmonary tuberculosis. The pancreatic tuberculosis frequently presented with multicystic pancreatic mass (81%) and the most common anatomic locations were the head (73%), tail (18%), and body (9%). Three cases were diagnosed by using US or EUS guided fine needle aspiration biopsy (FNAB), and all cases were medically cured without exploratory laparotomy. In summary, pancreatic tuberculosis, despite its rarity, should be considered for differential diagnosis of pancreatic cystic mass in endemic countries. Clinical suspicion and accurate diagnostic approach including FNAB of pancreatic tuberculosis are needed to avoid performing unnecessary laparotomy. (Korean J Gastroenterol 2009;53:324-328)

난소에 발생한 뮬러리안 점액성 경계성 종양 2 예

조성범(Sung Bum Cho),이은주(Eun Ju Lee),박창수(Chang Soo Park),배덕수(Duk Soo Bae),이제호(Je Ho Lee) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.9

Borderline m llerian mucinous tumor of the ovary is the disease entity that was recently identified. Ovarian mucinous cystadenoma of borderline malignancy that contains foci of intestinal differentiation is well recognized. In contrast, m llerian mucinous borderline tumor has a mucinous epithelium of endocervical type which does not show intestinal differentiation and papillae architecturally similar to those of serous borderline tumors. Clinically, m llerian mucinous borderline tumor presents different characteristics from those of intestinal mucinous borderline tumor. So far as now, none had died of disease recurrence. We report two cases of m llerian mucinous borderline tumor of ovary. Patients age was 24 and 29 years, and their FIGO stage was Ib and Ia, respectively. None of them showed any evidence of recurrence.

급성 간부전의 내과적 치료

조성범 ( Sung Bum Cho ) 대한간학회 2020 간학회 싱글토픽 심포지움 Vol.2020 No.1

증례 : 소화기 ; B형간염보균자에서 발생한 A형간염에 의한 전격간부전 1예

조성범 ( Sung Bum Cho ),이완식 ( Wan Sik Lee ),주영은 ( Young Eun Joo ),최성규 ( Sung Kyu Choi ) 대한내과학회 2009 대한내과학회지 Vol.77 No.1

A형간염은 급성 간염 후 대부분 완치되고 만성화는 되지 않지만 약 0.1%에서 간부전이 발생하며 다른 바이러스간염이나 만성 간질환자에게서 간부전의 위험성이 증가한다. 최근 A형간염이 급격히 증가하면서 B형 및 C형간염 등 만성간질환이 흔한 우리나라에서 HAV 중복감염으로 인한 전격간부전이 우려되고 있다. 저자들은 B형간염보균자에서 HAV 중복감염으로 급격히 간부전이 발생하여 내원 9일만에 사망한 증례를 경험하여 보고하는 바이다. Hepatitis A virus (HAV) is invariably a self-limited infection, with the majority of patients recovering completely. Underlying chronic liver disease and old age are associated with increased severity and an increased risk of fulminant hepatic failure. We report a case of fulminant hepatic failure caused by HAV superinfection in a 36-year-old male hepatitis B carrier. Recently, the incidence of acute hepatitis A in Korean adults has been increasing. Furthermore, Korea is an endemic area for chronic liver disease, including hepatitis B and C. Therefore, the risk of progression to acute fulminant hepatic failure should be considered for hepatitis A patients with impaired liver function, especially with underlying chronic liver disease. (Korean J Med 77:109-112, 2009)

간세포암종 치료

조성범 ( Sung Bum Cho ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

간세포암종 치료는 암종의 다양성과 동반된 간경변 상태에 따라 적절한 치료에도 일관된 경과를보이지 않는 경우가 많아 다 양한 임상 요소를 고려한 다학제 접근을 통한 치료방법이 추천되고 있다. 최근 간세포암종 치료는 기존 치료법의 진보와 더불 어 새로운 표적치료제와 면역치료제가 도입되면서 패러다임의 변화가 시작되고 있으며 이를 반영하여 2018년도 유럽간학회 에서는modified BCLC 병기와 함께 간세포암종 치료 가이드라인이 새롭게 업데이트 되었다. 이번 발표를 통하여 다양한 치 료법과 특성을 소개하여 간세포암 치료를 시작하려는 임상의 및 연구자에게 도움이 되고자 하였다.

식도정맥류 출혈 환자에서 내시경결찰술과 Terlipressin 및Octreotide 병합 요법의 재출혈 예방에 대한 무작위 전향연구(논평참조)

조성범 ( Sung Bum Cho ),박강진 ( Kang Jin Park ),이정수 ( Jung Soo Lee ),이완식 ( Wan Sik Lee ),박창환 ( Chang Hwan Park ),주영은 ( Young Eun Joo ),김현수 ( Hyun Soo Kim ),최성규 ( Sung Kyu Choi ),유종선 ( Jong Sun Rew ),김세종 ( 대한간학회 2006 Clinical and Molecular Hepatology(대한간학회지) Vol.12 No.3

혈액담즙증을 동반한 간외담관 소세포암종

조성범 ( Sung Bum Cho ),박선영 ( Sun Young Park ),주영은 ( Young Eun Joo ) 대한소화기학회 2009 대한소화기학회지 Vol.54 No.3

We report a case of small cell carcinoma of extrahepatic bile duct presenting with jaundice and hemobilia. A 59-year-old woman was admitted due to right upper quadrant pain and jaundice. An abdominal computed tomography revealed a 2 cm sized mass in the extrahepatic bile duct. Endoscopic retrograde cholangiopancreatography revealed bloody discharge coming out of the papillary orifice in endoscopic view and a dilated extrahepatic bile duct with multiple irregular filling defects in cholangiogram. A coronal T2-weighted image revealed a hyper-intense mass at extrahepatic bile duct. Laparotomy was performed, and pathologic examination of resected specimen showed tumor cells having round to oval nuclei with coarsely granular chromatin and scanty cytoplasm, which were immunoreactive for synaptophysin and chromogranin A, compatible with the diagnosis of small cell carcinoma. The small cell carcinoma of bile duct, despite its rarity, should be considered in differential diagnosis of the causes for obstructive jaundice and hemobilia. (Korean J Gastroenterol 2009;54:186-190)

조직검사가 직장 유암종의 내시경 절제에 미치는 영향

조성범 ( Sung Bum Cho ),박선영 ( Sun Young Park ),윤경원 ( Kyeng Won Yoon ),이석 ( Seok Lee ),이완식 ( Wan Sik Lee ),주영은 ( Young Eun Joo ),김현수 ( Hyen Soo Kim ),최성규 ( Sung Kyu Choi ),유종선 ( Jong Sun Rew ) 대한소화기학회 2009 대한소화기학회지 Vol.53 No.1

목적: 직장 유암종은 대장내시경 확대로 발견이 증가하고 있으며 일차로 내시경 절제를 고려해야 한다. 하지만 진단 내시경 시 조직검사로 인한 병변 변형에 의해 내시경 절제에 어려움을 겪는 경우가 있다. 따라서 조직검사 후 변형이 직장 유암종의 내시경 절제에 미치는 영향을 분석하여 치료에 도움이 되고자 하였다. 대상 및 방법: 2000년부터 2007년까지 직장 유암종으로 내시경 절제술을 시행한 42예를 조사하여 진단 시 조직검사 유무에 따라 조직검사군 22예와 조직검사 미시행군 20예로 분류하였다. 조직검사군과 미시행군 간 유암종 크기, 위치 등 임상 차이는 없었다. 각 군 간 점막하 주입 시 융기 제한, 내시경 제거 방법 차이 및 분할 절제 유무 등을 조사하였다. 결과: 내시경 절제술 시 점막하 주입에 따른 점막 융기 제한을 보인 경우가 조직검사군에서 17예(77%)로 미시행군 9예(45%)에 비해 많았다(p=0.03). 점막 융기 제한에 영향을 미치는 내시경 소견은 조직검사로 인한 종괴의 함몰된 반흔이 관찰된 경우, 조직검사를 한 5 mm 이하의 유암종, 조직검사 후 활동 궤양이 있는 경우였다. 내시경 절제 시 올가미를 이용한 절제술, cap을 이용한 흡인절제술, 고무밴드 결찰 후 절제술에서는 두 군 간 차이가 없으나 내시경점막하박리술을 이용한 경우는 조직검사군 5예로 미시행군 1예에 비해 많았다. 분할절제된 경우는 조직검사군 5예(23%)로 미시행군 2예(10%)에 비해 많았으나 유의한 차이는 없었다. 결론: 직장 유암종에서 조직검사로 인한 변형은 내시경 절제 시 점막 융기를 저해하는 요인이 될 수 있다. 따라서 내시경 절제 이전 조직검사는 최소한으로 해야 한다. Background/Aims: While endoscopic resection could be considered as the best choice for the treatment of small rectal carcinoid, the colonoscopic biopsies performed at the time of detection may lead to scar and ulcer formation and cause unpredicted difficulty in the endoscopic resection. This study was evaluated to analyze the relationship between the post-biopsy scar and the limitation of submucosal elevation for the endoscopic resection of rectal carcinoids. Methods: Twenty two cases of rectal carcinoid which received prior biopsies before the endoscopic resection were retrospectively compared with 20 non-biopsied cases. All two groups were treated by endoscopic resection from January 2000 to December 2007. There was no difference in the clinical characteristics and endoscopic findings such as size and location between the two groups. Results: The limited submucosal elevation was experienced in 17 cases (77%) in the biopsy group, significantly more frequent than 9 cases (45%) in the non-biopsy group (p=0.03). The colonoscopic findings which contribute to difficult submucosal elevation were the depressive scar formation after biopsy, the size less than 5 mm in the biopsy group, active ulcer formation after biopsy. Regarding the resection method, endoscopic submucosal dissection was frequently adopted (23% vs. 5%) in the biopsy group. The frequency of endoscopic piecemeal resection in biopsy group was higher than non-biopsy group (23% vs 10%), and all cases were subsequently resected by other endoscopic methods. Conculsions: The post-biopsy scar can interfere with successful submucosal elevation for endoscopic resection of rectal carcinoids. The number of forcep biopsy should be minimized in the diagnostic colonoscopy when endoscopic resection is planned rectal carcinoids. (Korean J Gastroenterol 2009;53:36-42)

간세포암종 감시 검사: 위험도 평가

조성범 ( Sung Bum Cho ) 대한간학회 2019 Postgraduate Courses (PG) Vol.2019 No.1

The purpose of surveillance of hepatocellular carcinoma (HCC) is improved survival with higher chances to offer a curative treatment after diagnosing earlier. The methods of surveillance are feasible, cost-effective and useful clinically in the target risk population. As suggested by cost-effectiveness analyses, an incidence of 1.5% per year or greater would warrant HCC surveillance by ultrasound with or without alpha fetoprotein with current guidelines. The need for individualized methods or intervals of surveillance has recently emerged based on different personal HCC risk. In considering to maximize effectiveness of HCC surveillance, earlier diagnosis of HCC is important at very early HCC stage (BCLC 0, below 2 cm single tumor) with possible to radiofrequency ablation. Individualized methods of HCC surveillance are recently challenged according to risk stratification of HCC.

기도 및 기관지의 금속스텐트 삽입술

조성범,김윤환,신지훈,성득제,김형래,정규병,Cho Sung Bum,Kim Yun Hwan,Shin Ji Hoon,Sung Deuk Jae,Kim Hyoung Rae,Jung Kyu Byung 대한기관식도과학회 2004 大韓氣管食道科學會誌 Vol.10 No.2