REAL 분류상 B-미만성 대세포 림프종에서 조직학적 아형 분류의 임상적 의의

류민희 ( Min Hee Ryu ),김봉석 ( Bong Seog Kim ),김태원 ( Tae Won Kim ),박연희 ( Yeon Hee Park ),허주령 ( Joo Ryung Huh ),이승숙 ( Seung Sook Lee ),김철우 ( Chul Woo Kim ),류백렬 ( Baek Yeol Ryoo ),김노경 ( Noe Kyeong Kim ),이규형 대한내과학회 2003 대한내과학회지 Vol.65 No.1

목적 : REAL 분류상 B-미만성 대세포 림프종은 다양한 임상경과를 보이는 이질적인 림프종을 포함하고 있는데, 일부 연구에서는 B-미만성 대세포 림프종 중immunoblastic lymphoma (IBL)가 다른 조직아형에 비해 예후가 좋지 않음을 시사하고 있다. 본 연구에서는 B-미만성 대세포 림프종을 형태학적으로 IBL과 non-IBL로 세분화할 필요가 있는지 알아보고자 하였다. 방법 : 1989년부터 1995년까지 3개 병원에서 치료 받은 비호지 Background : Diffuse large B-cell lymphoma (DLBL) category in the REAL classification includes histologically heterogeneous subtypes in Working Formulation or Kiel classification. Some investigators insist that the prognosis of B-cell immunoblastic lympho

절제 가능한 국소 위암에서 수술 전 선행 항암화학요법

류민희(Min-Hee Ryu) 대한종양외과학회 2014 Korean Journal of Clinical Oncology Vol.10 No.1

In localized resectable stage II or III gastric cancer, D2 dissection has been accepted as the standard surgical method worldwide. The Adjuvant Chemotherapy Trial of TS-1 for Gastric Cancer and Capecitabine and Oxaliplatin Adjuvant Study in Stomach Cancer phase III trials have demonstrated that systemic adjuvant chemotherapy can significantly improve recurrence-free survival (RFS) and overall survival (OS) after D2 dissection with absolute survival benefit of 10% to 15% compared with surgery alone. Addition of radiation or intensification of adjuvant chemotherapy has been tried in localized resectable gastric cancer for further improvements of RFS and OS as well. However, addition of radiation after D2 dissection was proven to play no or only a minimal role at its best in reduction of loco-regional recurrences as well as distant metastases. The results of recent large-scale adjuvant trials suggest that more intensified adjuvant treatment including multiple chemotherapeutic agents would not likely induce a better result. For this reason, addition of neoadjuvant chemotherapy to current standard of care may be the only plausible strategy to improve long-term outcomes in localized resectable gastric cancer, and clinical trials of neoadjuvant chemotherapy are now ongoing in gastric cancer.

위암의 보조항암화학요법

류민희 ( Min Hee Ryu ),장대영 ( Dae Young Zang ) 대한내과학회 2012 대한내과학회지 Vol.83 No.3

Gastric cancer remains the second most common malignancy worldwide. Surgical resection with D2 lymph node dissection is the standard of care in localized gastric cancer. However about 40% of patients in East Asia and 70% of patients in Western countries experience recurrence after curative surgical resection of localized gastric cancer. Once recurrence occurs, the prognosis of patients is usually dismal, especially in case of distant metastases. Although many clinical trials of adjuvant treatment were conducted to reduce recurrence of gastric cancer after surgical resection, it was controversial until early 2000s whether adjuvant treatment could improve recurrence-free survival or overall survival in gastric cancer. In early 2000s, adjuvant chemoradiation became the standard of care in the US based on the results of SWOG 9008/INT 0116 trial, where only minor portion of patients underwent D2 lymph node dissection. However, adjuvant chemoradiation was considered not applicable to patients with gastric cancer in East Asia where D2 lymph node dissection is the standard surgical method. Recently, large scale phase III studies including ACTS-GC and CLASSIC trial were conducted in the East Asia. Based on those studies, adjuvant chemotherapy is currently accepted as standard treatment in gastric cancer in the East Asia.

대퇴근막 이식과 전외측 대퇴 유리 피판을 이용한 난치성 경막 외 농양의 치료

박병찬,류민희,김태곤,이준호,Park, Byung-Chan,Ryu, Min-Hee,Kim, Tae-Gon,Lee, Jun-Ho 대한미세수술학회 2009 Archives of reconstructive microsurgery Vol.18 No.1

Purpose: Artificial dura maters are commonly used in cranioplasty, but sometimes they can result in serious postoperative infection. Once complications such as epidural abscess or chronic draining ulcer arise, they are very difficult to treat. In this case, reclosure of dura defect using artificial dura mater may give rise to recurrence of infection. We experienced a case of intractable epidural abscess caused by use of artificial dura. To avoid repeated infection, we decided to use autologous tissue for the coverage of dura and soft tissue defect. Therefore, autologous tensor fascia lata graft and anterolateral thigh free flap were harvested at the same donor site incision to cover composite defect on the scalp and dura mater. Methods: A 13 year old male patient, who underwent the decompression cranioplasty and duroplasty, suffered from the intractable infection lesion. Twice, the epidural abscess was removed, both times the infection recurred. And eventually dura mater was exposed through the infected open wound. Nine months after dura exposed, infected aritificial dura mater was removed and extensive debridement was performed. Through a surgical incision on donor thigh, first, tensor fascia lata graft was harvested in process of the anterolateral thigh flap elevation. After the fascia lata graft was fixed over the dural defect, the anterolateral thigh flap was used to fill the dead space as well as the scalp defect. Results: Postoperatively, no recurrent infection and cerebrospinal fluid leakage are observed for a year. After the surgery, on the first and second day, venous congestion of the flap was observed, this problem was solved by thrombectomy and vein reanastomosis. And partial necrosis of flap occurred, but completely healed as conservative treatment for two weeks. Conclusion: Using the autologous tensor fascia lata graft and anterolateral thigh flap, we could obtain satisfactory results as treatment for the intractable infection lesion after duroplasty. Autologous tensor fascia lata in conjunction with anterolateral thigh flap is useful method for covering composite defect of scalp and dura mater.

대장암 예후인자의 다변량 분석

김동완 ( Dong Wan Kim ),류민희 ( Min Hee Ryu ),김태유 ( Tae You Kim ),허대석 ( Dae Seog Heo ),방영주 ( Yung Jue Bang ),박재갑 ( Jae Gahb Park ),김노경 ( Noe Kyeong Kim ) 대한내과학회 2003 대한내과학회지 Vol.64 No.3

목적 : 본 연구의 목적은 한국인 대장암 환자의 생존율에 영향을 미치는 예후인자를 분석하는 것이다. 방법 : 1990년 1월부터 1992년 12월 까지 조직학적으로 대장암 진단을 받은 406명의 환자를 대상으로 임상적, 병리학적, 실험실적 변수를 후향적으로 조사하였다. 생명표범을 이용하여 생존율을 구하였고, 로그-랭크법으로 단변량 분석을 통해 독립예후인자를 결정하였다. 결과 : 결장암의 5년 전체 생존율은 58.1%, 직장암의 5년 전체 생존율은 58% Background : It is the aim of this study to find out the prognostic factors in Korean colorectal cancer patients Methods : The analysis was performed on 406 patients diagnosed as colorectal cancer between Jan, 1990 and Dec. 1992. Survival rate was calcula

종양 표지 인자로서 혈장 Transforming Growth Factor-β1에 대한 연구

신훈,임창기,최인영,이두연,노동영,류민희,이효석,방영주,박종섭,진승원,Shin, Hoon,Lim, Chang Ki,Choi, In Young,Lee, Doo Yun,Noh, Dong Yong,Ryu, Min Hee,Lee, Hyo Suk,Bang, Yung Jue,Park, Jong Sup,Jin, Seung Won 대한면역학회 2001 Immune Network Vol.1 No.2

Background : Many investigators have found transforming growth factor-${\beta}1$ (TGF-${\beta}1$) to be elevated in tumors. Changes in responsiveness to TGF-${\beta}1$ have been linked to malignant transformation, tumor progression and tumor regression. Many malignant cell lines of epithelial or hematopoietic origin are refractory to the antiproliferative effects of TGF-${\beta}1$. However, a little is known about the association of TGF-${\beta}1$ with progression of malignant tumor. Methods : In this study, we measured the plasma level of TGF-${\beta}1$ in various cancer patients and evaluated the utility of plasma TGF-${\beta}1$ as a possible tumor marker. Plasma TGF-${\beta}1$ levels were measured using enzyme-linked immunosorbent assay in cancer patients and normal controls. Carcinoembryonic antigen (CEA) and alpha-fetoprotein (AFP) as tumor marker were compared with TGF-${\beta}1$ in the aspects of sensitivity and specificity. Results : The mean of plasma TGF-${\beta}1$ levels was $1.219{\pm}0.834ng/ml$ in normal controls, $5.491{\pm}3.598ng/ml$ in breast cancer, $12.670{\pm}10.386ng/ml$ in lung cancer, $5.747{\pm}3.228ng/ml$ in hepatocellular carcinoma and $10.854{\pm}7.996ng/ml$ in cervical cancer. In comparison with CEA and AFP, TGF-${\beta}1$ is more sensitive. Conclusion : We conclude that the high levels of TGF-${\beta}1$ are common in the plasma of cancer patients. These results suggest that the plasma TGF-${\beta}1$ level can be a potent tumor marker in various cancer patients.

대장 신경내분비종양의 임상 경과와 병리 특징

정상훈 ( Sang Hun Jung ),김희철 ( Hee Cheol Kim ),유창식 ( Chang Sik Yu ),장흥문 ( Heung Moon Chang ),류민희 ( Min Hee Ryu ),이재련 ( Jae Lyun Lee ),김정선 ( Jung Sun Kim ),김진천 ( Jin Cheon Kim ) 대한소화기학회 2006 대한소화기학회지 Vol.48 No.2

목적: 대장의 신경내분비종양은 매우 드물고, 통상적인 대장암에 비해 빠르게 진행하며 예후가 매우 나쁘다. 그러나 발생 빈도가 적어 국내에는 아직까지 보고가 없다. 이번 연구는 후향 분석을 통해 대장의 신경내분비종양의 임상 경과 및 병리 특징을 알고자 하였다. 대상 및 방법: 1997년 6월부터 2004년 12월까지 서울아산병원에서 H&E 및 면역조직화학염색에 의해 조직학적으로 대장의 신경내분비종양으로 진단 받은 13예의 환자를 대상으로 하였으며, 대장의 신경내분비암종 10예와 대장의 샘암종에 신경내분비분화를 포함하는 혼합암종이 3예였다. 카르시노이드 종양은 대상에서 제외되었으며, 환자들의 기록은 후향으로 조사하였다. 결과: 4,512명 중 13예(0.3%)의 환자가 대장의 신경내분비종양으로 진단되었다(신경내분비암종 10예, 혼합암종 3예). 환자 나이의 중앙값은 60세(41-83세)였으며, 남자가 6예, 여자는 7예였다. 종양의 발생부위는 직장 9예, 에스자결장 2예, 그리고 맹장과 횡행결장이 각각 1예였다. 면역조직화학염색을 시행한 신경내분비암종 9예 모두 synaptophysin 양성인 반면, chromogranin A는 3예에서 양성이었다. 6차 AJCC TNM병기에 따라 IIIB 병기 2예, IIIC 병기 3예 그리고 IV 병기가 8예였으며, 대장의 신경내분비암종 환자에서는 10예 중 7예에서 원격전이가 있었다. 신경내분비암종 10예와 혼합암종 3예의 중간생존율은 각각 16.4개월과 30개월이었다. 10예의 신경내분비암종 환자 중 항암치료를 받은 5예의 중간생존율은 III 병기 3예와 IV 병기 2예에서 각각 32개월과 17.5개월이었으나, 항암치료를 받지 않은 5예의 중간생존율은 6.2개월이었다. 혼합암종 3예는 모두 항암치료를 받았으며 중간생존율은 30개월이었다. 결론: 대장의 신경내분비종양의 빈도는 0.3%로 매우 드물다. 지금까지 적은 수의 환자와 빠르게 진행되는 종양의 특성으로 유용한 치료방침이 없었으나, 적극적인 병소의 절제와 etoposide/cisplatin을 이용한 항암치료 및 방사선치료는 환자의 생존율을 향상시킬 수 있을 것으로 기대한다. Background/Aims: Colorectal neuroendocrine carcinoma is a rare neoplasm exhibiting fulminant progression and having poor prognosis. The purpose of this study is to verify the clinicopathologic characteristics of colorectal neuroendocrine carcinoma. Methods: From June 1997 to December 2004 at Asan Medical Center, ten patients were originally identified as colorectal neuroendocrine carcinoma on the basis of H&E and immunohistochemical staining (IHC). Carcinoid tumors were excluded in this study. Medical records of thirteen patients were reviewed retrospectively. Results: Ten patients (0.2%) with colorectal neuroendocrine tumors were identified from 4,512patients with colorectal cancer; ten neuroendocrine carcinomas and three adenocarcinomas with neuroendocrine differentiation. Their median age was 60 (41-83) years. The subjects consisted of six males and seven females. Nine tumors were located in the rectum, two in the sigmoid, and each one in the transverse colon and cecum, respectively. Nine of ten neuroendocrine carcinomas expressed synaptophysin, but chromogranin A were expressed in four. All patients were advanced at the time of diagnosis, with AJCC TNM staging: stage IIIB (n= 2), stage IIIC (n=3), and stage IV (n=8). The median survival for ten neuroendocrine carcinomas and three adenocar-cinomas with neuroendocrine differentiation were 16.4 months and 30 months, respectively. Five patients who received chemotherapy showed median survival of 32 months (stage III) and 17.5 months (stage IV), whereas other five patients without chemotherapy died with a median survival of 6.2 months. Conclusions: Colorectal neuroendocrine tumors are extremely rare showing aggressive behavior biologically, i.e fulminant early distant metastasis. Nevertheless, improved survival may be achieved by aggressive multimodality therapy. (Korean J Gastroenterol 2006;48:97-103)

HIV 음성 환자에서 형질모세포종의 세침흡인 세포소견 - 1예 보고 -

이향임,구현령,한은미,공경엽,서철원,류민희,강윤구,박찬정,허주령,Lee, Hyang-Im,Koo, Hyun-Ryung,Han, Eun-Mee,Gong, Gyung-Yub,Suh, Chul-Won,Ryu, Min-Hee,Kang, Yoon-Goo,Park, Chan-Jeong,Huh, Joo-Ryung The Korean Society for Cytopathology 2005 대한세포병리학회지 Vol.16 No.1

Plasmablastic lymphoma (PBL) is a recently described aggressive B-cell neoplasm, which usually manifests as a localized disease of the oral mucosa in individuals infected with human immunodeficiency virus (HIV). Recently we encountered a case of plasmablastic lymphoma manifesting in the left maxillary sinus and cervical lymph node of a previously healthy HIV-negative man, 48 years of age. we conducted a fine-needle aspiration smear of the cervical lymph node, and this was found to be highly cellular with numerous large cells exhibiting eccentrically positioned nuclei, prominent nucleoli, and moderate quantities of basophilic cytoplasm. A biopsy of the mass in the maxillary sinus evidenced diffuse growth of similar plasmablastic cells. These tumor cells were negative for the leukocyte common antigens, CD20, CD3, CD30, and EMA. However, the cells tested positive for CD79a and CD138/syndecan-1. The tumor cells also exhibited L-light-chain restriction. The Ki-67 proliferation index was measured at almost 100%. The patient was diagnosed with plasmablastic lymphoma. After three cycles of combination chemotherapy and radiotherapy, the patient went into complete remission, and currently remains in this state.

증례 : 혈액종양 ; 헬리코박터 제균 치료 후 완전 관해된 방광의 원발성 점막연관 림프조직 림프종 1예

이선표 ( Sun Pyo Lee ),주명수 ( Myung Soo Choo ),류민희 ( Min Hee Ryu ),송민정 ( Min Jeong Song ),서세영 ( Se Young Seo ),정유문 ( Yu Mun Jeong ),서명숙 ( Myeong Sook Seo ),허주영 ( Joo Ryung Huh ) 대한내과학회 2014 대한내과학회지 Vol.87 No.2

방광에서 발생한 원발성 MALT 림프종은 드문 질환으로 만성 방광염과 유사한 임상 증상을 갖고 국내에서 지금까지 보고된 사례는 1예뿐이다. 저자들은 혈뇨를 주소로 내원한 중년 여성에서 만성 방광염에서 병발한 MALT 림프종을 진단하고 방사선 치료나 항암화학요법이 아닌 항생제 투여를 통해 완치하였기에 문헌고찰과 함께 보고하는 바이다. Primary lymphoma of the urinary bladder is rare, comprising 0.2% of extranodal lymphomas. The predominant subtype of mucosa-associated lymphoid tissue (MALT) is extranodal marginal zone lymphoma. We report a case of MALT lymphoma of the urinary bladder in a 53-year-old female patient presenting with a five-year history of persistent hematuria and urinary frequency. A cystoscopy revealed multiple nodular lesions at the posterior wall and trigone of the bladder. The tissue obtained by cold-cup biopsy revealed lymphoid infiltration consistent with low-grade MALT lymphoma. Image studies revealed that the tumor originated from the urinary bladder and there was no evidence of metastases. The patient was positive for a rapid urease test. Because of the relationship between gastric MALT lymphoma and Helicobacter pylori, the patient was treated with antibiotics to eradicate Helicobacter pylori. The lymphoma subsequently disappeared and the patient has remained in persistent complete remission for eight years. (Korean J Med 2014;87:229-233)

증례 : 혈액종양 ; 간 전이를 동반한 VIPoma에서 간동맥 색전술을 이용한 현저한 증상 호전

최윤숙 ( Yun Suk Choi ),고기영 ( Gi Young Ko ),류민희 ( Min Hee Ryu ),강신광 ( Shin Kwang Khang ),김정은 ( Jeong Eun Kim ),송준선 ( Joon Seon Song ),강윤구 ( Yoon Koo Kang ) 대한내과학회 2014 대한내과학회지 Vol.87 No.3

Vasoactive intestinal polypeptide-secreting tumors (VIPomas) cause VIPoma syndrome, which is characterized by watery diarrhea, hypokalemia, and achlorhydria. The treatment options for metastatic VIPomas include somatostatin analogs, cytoreductive surgery, and chemotherapy. We report the case of a 54-year-old male who presented with a peripancreatic mass with multiple hepatic metastases on computed tomography. After resection, the peripancreatic mass was demonstrated pathologically to be a neuroendocrine tumor. Although the patient received systemic chemotherapy and somatostatin analogs for the hepatic metastatic masses, the tumor increased in size. The patient then experienced severe diarrhea, despite treatment with the somatostatin analogs. Elevated serum VIP levels (3,260 pg/mL) and typical symptoms confirmed the diagnosis of VIPoma. We performed hepatic artery embolization (HAE) to reduce the tumor volume and control his symptoms, which led to a very rapid symptomatic response. The patient has remained symptom-free for 18 months with repeated HAE. (Korean J Med 2014;87:363-368)