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반복된 위궤양 천공 환자에서 우연히 발견된 원발성 간 카르시노이드종양
장은정(Eun Jung Jang),한영석(Young Seok Han),최동락(Dong Lak Choi),박재복(Jae-Bok Park) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.75 No.1
The liver is a common site for carcinoid metastases, and primary hepatic carcinoid tumor (PHCT) is a very rare entity. The diagnosis of PHCT is principally based on the histopathological confirmation of carcinoid tumor and the exclusion of a nonhepatic primary tumor. A 45-year-old man who presented with an intraabdominal abscess caused by recurrent peptic ulcer perforation had a huge heterogeneous mass in the central portion of the liver. The preoperative impression was peripheral cholangiocellular carcinoma. Central bisectionectomy was performed together with difficult adhesiolysis. On surgical exploration, there were no extrahepatic lesions. The postoperative course was uneventful, except for biloma formation, and the pathologic biopsy result was carcinoid tumor with positive immunohistochemical staining for chromogranin A. Our patient has been free of symptoms, including peptic ulcer, and there have been no abnormal findings on the follow-up abdominal images for 1 year. Accordingly, the diagnosis was primary hepatic carcinoid. In conclusion, PHCT should be diagnosed by the absence of extrahepatic lesion on surgical exploration and follow up throughout the clinical and imaging studies. A preoperative suspicion of PHCT is significant for conducting clinical investigations of a tumor’s characteristics.
한영석(Young Seok Han),주대현(Dae Hyun Joo),최동락(Dong Lak Choi) 대한외과학회 2009 Annals of Surgical Treatment and Research(ASRT) Vol.76 No.2
We present a 45-year-old man with chronic pancreatitis and the rare complication of large subcapsular splenic pseudocyst. He suffered from a slow growing left upper quadrant abdominal distension for 2 weeks and pain radiating to his back. On abdominal computed tomography, large subcapsular splenic pseudocyst (25×13×11 cm), multiple small sized pancreatic pseudocysts in the pancreas tail and chronic pancreatitis with multiple pancreatic stones were shown. He underwent percutaneous catheter drainage of the splenic pseudocyst and after 3 weeks, the size of the pseudocyst decreased. But, the pain radiating to his back and poor oral intake was not improved. Distal pancreatectomy, Roux-en-Y pancreaticojejunostomy, and splenectomy were performed and the patient was discharged after 2 weeks. A splenic subcapsular pseudocyst resulting from pancreatitis may be managed by percutaneous drainage, but according to a patient’s clinical symptoms, operative management can be added.
장은정(Eun Jung Jang),한영석(Young Seok Han),최동락(Dong Lak Choi),김호각(Ho Gak Kim) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.75 No.6
Adenosquamous carcinoma of the pancreas is a rare tumor that has a less than favorable prognosis because of its aggressive biological behavior. A 47-year-old man was admitted with complaints of right upper quadrant pain of the abdomen. Abdominal computed tomography (CT) demonstrated a low density solid mass lesion in the uncinate process of the pancreas. Dynamic CT, fine needle aspiration by endoscopic ultrasound and the cytological examination by endoscopic retrograde cholangiopancreatography were performed for making the preoperative diagnosis, but the results were a disappointment. Pylorus preserving pancreatoduodenectomy was performed. The resection specimen was composed of squamous cell carcinoma components mixed with adenocarcinoma. The patient stopped further treatment after his 1st chemotherapy cycle because of his poor condition, which due to multiple metastases to the liver and lymph nodes. We report here on a case of adenosquamous carcinoma of the pancreas and we review the relevant Korean literature.
김민수(Min Soo Kim),한영석(Young Seok Han),최동락(Dong Lak Choi),금윤섭(Yoon Seup Kum) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.75 No.4
Gastrointestinal stromal tumors (GISTs) are a mesenchymal tumor of the digestive tract and they have various clinical characteristics. We report here on the largest extragastric pedunculated GIST of the stomach that has been seen in Korea. The patient was a 67-year-old man with a giant abdominal mass occupying the whole abdomen, and both leg showed swelling for the previous several months. On computed tomography (CT) and magnetic resonance imaging (MRI), this appeared as a septated cystic tumor with a solid component. Laparotomy revealed a giant extragastric tumor arising from the lesser curvature of the stomach that measured 47×34×23 cm and it weighed about 40 kg. Surgical treatment was performed to remove both the giant mass and the gastric wall where the tumor was attached to a 3-cm pedicle. On immunohistochemistry, the tumor was positive for myeloid stem cell antigen (CD34) and c-kit (CD117). The final diagnosis was a pedunculated extragastric type GIST arising from the stomach. The postoperative course was uneventful and the swelling in both legs resolved.