흉부병소의 경피적 생검: 세침흡인술과 대침절단생검 및 두 검사의 병행법의 유용성 비교$^1$

최영희,김태훈,명나혜,하미나,Choe, Yeong-Hui,Kim, Tae-Hun,Myeong, Na-Hye,Ha, Mi-Na 대한영상의학회 2002 대한영상의학회지 Vol.46 No.3

목적: 흉부의 악성 및 양성 질환에 대해 세침흡인술(FNA)과 대침절단생검(PCNB)을 각각 시행한 예와 두 방법을 병행한 예에 대해 각각의 진단적 유용성을 평가하고자 하였다. 대상과 방법: 1996년 1월부터 1999년 12월 사이에 내원한 환자 중 흉부의 종양 또는 감염성 질환으로 내원하여 진단을 위해 FNA (A군, n=98)나 PCNB (B군, n=31), 혹은 양쪽 모두를 시술 받은(C군, n=84) 213명의 환자를 대상으로 하였다. 모든 검사는 투시유도 하에서 행해졌으며 수술이나 다른 조직검사, 임상소견, 혹은 추적검사 등에 의해 확진되었다. 양성 또는 악성질환의 감별, 폐암의 세포형 진단, 폐결핵의 진단, 그리고 비결핵성 감염질환의 진단, 양성종양의 세포형 진단에 대한 민감도, 특이도 및 정확도를 각각 구하여 비교하였고 세 군에서의 합병증 발생빈도를 비교하여 통계적 유의성을 검정하였다. 결과: 213예 중 79예의 환자는 양성, 134예의 환자는 악성질환으로 판명되었다. A군의 악성질환 진단의 민감도와 특이도는 각각 90.1%와 100%, 양성질환 진단의 민감도와 특이도는 91.5% 와 90.1%이었다. B군의 악성질환 진단의 민감도와 특이도는 각각 90.4%와 100%, 양성질환 진단의 민감도, 특이도는 90.0%와 90.1%이었다. C군의 경우 악성질환 진단의 민감도, 특이도는 각각 95.1%와 100%, 양성질환 진단의 민감도와 특이도는 각각 100%와 92%로서 C군이 A군 또는 B군보다 우월하였다 (p<0.05). 시술 후의 합병증으로 기흉이 A군에서 15.3%, B군에서 13.3%, 그리고 C군에서 20.6%에서 나타났으며, 각혈이 A군에서 7.1%, B군에서 13.3%, 그리고 C군에서 2.9%에서 나타났으며, 세 군의 합병증 발생빈도 사이에 통계적으로 유의한 차이는 없었다 (p>0.05). 기관지폐암 중 소세포암의 진단에 대한 FNA의 민감도, 특이도는 100%와 98.5%이었으며 PCNB의 민감도와 특이도는 각각 90.0%와 98.0%이었고 FNA가 PCNB에 비해 우월하였다 (p<0.05). 결핵에 대한 진단의 민감도와 특이도는 FNA가 35.0%와 100%, PCNB가 20%와 97.2%이었고 FNA가 PCNB에 비해 우월하였다 (p<0.05). 비결핵성 감염질환은 FNA에서, 그리고 양성종양은 PCNB에서 더 정확한 결과를 보이나 통계적 유의성은 확인되지 않았다. 결론: FNA는 결핵의 진단 및 소세포성 폐암과 비소세포성 폐암의 감별진단에 PCNB보다 유용하여 경피적 폐생검 환자에서 일차적으로 시행하는 것이 좋으며, FNA와 PCNB를 병행하면 합병증의 발생빈도의 증가 없이 악성 및 양성질환의 감별진단율을 더 높일 수 있다. Purpose: To assess the diagnostic role of FNA, PCNB, and a combination of both methods in patients who underwent percutaneous transthoracic biopsy for a malignant or benign intrathoracic lesion. Materials and Methods: We retrospectively reviewed the findings of 213 patients with an intrathoracic mass or consolidation who underwent FNA (Group A, n=98), PCNB (Group B, n=31) or a combination of both methods (Group C, n=84). Under fluoroscopic guidance, diagnoses were based on the findings of surgery, biopsy at another site or clinical and radiologic follow-up. In the differential diagnosis of benign and malignant disease, and in the diagnosis of small-cell lung cancer, pulmonary tuberculosis, non-tuberculous infectious disease and benign mass, sensitivity, specificity and accuracy were statistically analysed in each group. Results: Among 213 patients, lesions were malignant in 134 and benign in 79. In group A, sensitivity and specificity were 90.1% and 100% for malignant lesions, and 91.5% and 90.1% for benign, while in group B, the corresponding findings were 90.4% and 100%, and 90.0% and 90.1%. In group C, corresponding rates of 95.1% and 100% (p<0.05) and 100% and 92% (p<0.05) were recorded. In group C, accuracy and sensitivity were higher than in group A or (p<0.05). Post-procedural pneumothorax occurred in 15.3% of group A, 13.3% of group B, and 20.6% of group C, while hemoptysis was found in 7.1% of group A, 13.3% group B, and 2.9% of group C. Among the three groups, the complication rate showed no statistically significant variation (p<0.05). In the specific diagnosis of small-cell lung cancer, the sensitivity and specificity of FNA and PCNB were, respectively, 100% and 98.5%, and 90.0% and 98.0% (p<0.05) ; for tuberculosis, the corresponding figures were 35.0% and 100%, and 20.0% and 97.2 (p<0.05). FNA was better in the diagnosis of non-tuberculous infectious disease, while PCNB was better in the specific diagnosis of benign masses, without statistical significance. Conclusion: FNA is superior to PCNB in the diagnosis of tuberculosis and the differentiation of small cell lung cancer, and is thus the indicated initial approach for the majority of patients who are to undergo transthoracic bigosy. A combination of FNA and PCNB can provide more accurate differentiation between malignant and benign thoracic disease, without increasing the complication rate, than can one method used alone.

혈복증을 동반한 간아세포종

김욱환(Wook Hwan Kim),명나혜(Na Hye Myeong),강용익(Yong Ik Kang),권수인(Soo In Kwon) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.1

Hepatoblastoma is the most common prirnary malignancy of the liver in children, occurring rnost frequently in infant younger than 2 years of age, however, massive hemoperitoneurn caused by spontaneous rupture of a hepatoblastoma is rare. Authours experienced a case of hemoperitoneum caused by spontaneous rupture of hepatoblastoma in a 42 month old male patient, who complained of abdominal pain.(Korean J Gastroentero11994; 26: 197 199)

간질성 폐질환에서 TUNEL 아포프토시스 지수와 임상적 방사선학적, 및 병리학적 지표와의 상관관계

김윤섭 ( Kim Yun Seob ),명나혜 ( Myeong Na Hye ),박재석 ( Park Jae Seog ),지영구 ( Ji Yeong Gu ),이계영 ( Lee Gye Yeong ) 대한결핵 및 호흡기학회 2002 Tuberculosis and Respiratory Diseases Vol.53 No.2

비소세포폐암에서 아포프토시스 억제 단백질 Survivin 발현에 관한 면역조직학적 분석

고미혜 ( Go Mi Hye ),명나혜 ( Myeong Na Hye ),이재환 ( Lee Jae Hwan ),조은미 ( Jo Eun Mi ),박재석 ( Park Jae Seog ),김건열 ( Kim Geon Yeol ),이계영 ( Lee Gye Yeong ) 대한결핵 및 호흡기학회 2000 Tuberculosis and Respiratory Diseases Vol.48 No.6

결핵성 경부 림프절염의 병리소견과 항산균 검출 및 임상소견에 관한 연구

황영준 ( Hwang Yeong Jun ),고미혜 ( Go Mi Hye ),윤세영 ( Yun Se Yeong ),김용호 ( Kim Yong Ho ),김도형 ( Kim Do Hyeong ),이계영 ( Lee Gye Yeong ),김건열 ( Kim Geon Yeol ),명나혜 ( Myeong Na Hye ),박재석 ( Park Jae Seog ) 대한결핵 및 호흡기학회 2000 Tuberculosis and Respiratory Diseases Vol.48 No.5

색소성 피부질환에 대한 큐스위치 알렉산드라이트 레이저 치료직후의 조직, 면역조직화학, 전자현미경적 소견

김유찬 ( Kim Yu Chan ),강원형 ( Kang Won Hyeong ),방동식 ( Bang Dong Sig ),명나혜 ( Myeong Na Hye ),이정구 ( Lee Jeong Gu ) 대한피부과학회 2003 대한피부과학회지 Vol.41 No.8

N/A Background : There have been only a few electron microscopic studies after laser treatment of pigmented skin lesions. Objective : The purpose was to investigate the pathologic, immunohistochemical, and electron microscopic changes following Q-switched alexandrite laser treatment of pigmented skin lesions. Methods : Three patients with acquired bilateral nevus of Ota-like macules, and 2 patients with cafe´au lait macule were irradiated with Q-switched alexandrite laser. Forty biopsies were taken before and immediately after laser treatment. Hematoxylin-eosin, Fontana-Masson, and gp100 staining were performed for the evaluation of the histopathologic and immunohistochemical findings of the specimens. Electron microscopic findings were also evaluated. Results : Histopathologically, suprabasilar separations were observed immediately after laser treatment. Vacuolar alterations of pigment-containing cells were frequently found in the epidermis and/or in the dermis. Fontana-Masson and gp100 staining positivity changed to negative or decreased in the epidermis immediately after laser treatment, while they changed to negative in the dermis. Ultrastructurally, epidermal pigment-containing cells frequently showed severe vacuolar changes in the cytoplasm, pyknotic nuclei, and vacuolated and/or fragmented melanosomes immediately after laser treatment. Dermal melanocytes frequently revealed vacuolated and/or fragmented melanosomes immediately after laser treatment. Conclusion : Histopathologic, immunohistochemical, and electron microscopic examination of pigmented skin lesions immediately after Q-switched alexandrite laser treatment demonstrated vacuolated or fragmented melanosomes and vacuolar alteration of pigment-containing cells in the epidermis and/or in the dermis, which suggested selective photothermolysis of melanosomes. (Korean J Dermatol 2003;41(8) : 1014~1021)

백서에서의 폐쇄성 황달에 대한 Ursodeoxycholic Acid의 치료효과

노임환(Im Whan Roh),김정택(Jung Taik Kim),박효순(Hyo Soon Park),명나혜(Na Hye Myeong) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.3

N/A Background/Aims: Cholestasis and bile duct proliferation are considered to be initiated by the changes in bile composition and/or increasing intraluminal pressure. Especially toxic hydrophobic bile acids such as lithocholic acid, chendodeoxycholic acid(CDCA), and cholic acid cause the damage on the bile duct and hepatocyte and finally bile duct proliferation and cholestasis. It is not clear whether bile per se has an initiating mechanism in bile duct proliferation and if a modification in the bile composition can reduce bile duct proliferation and cholestasis. The aim of this study was to investigate the effect of Ursodeoxycholic acid(UDCA) treatment on both cholestatic markers and bile duct proliferation following bile duct ligation. Methods: After bile duct ligation, male Sprague-Dawley rats weighing 220+ 30 gm were divided into 3 groups and 2 groups among thern were treated for 30 days with either UDCA(10 mg/kg, N=15) or UDCA and CDCA(each 5 mg/kg, N=15). Animals were sacrificed at day 30. Results: The serum activity of alkaline phosphatase, and r-glutamyltransferase(rGTP) was significantly lower(p0.01) in the UDCA-treated rats. Serum GOT, total bilirubin, bile acids were lower(pC0.001) in the UDCA-treated rats compared to both of UDCA and CDCA treated and control group. Histologic examination showed that the number of ductular cells in the portal area was significantly(p0.001), reduced in UDCA-treated compared to UDCA and CDCA treated and contro] groups. The replication activity, assessed as Proliferating Cell Nuclear Antigen(PCNA)-positive cells, was also significantly lower in UDCA treated rats. Lobular bile ductules were decreased about three fold in the UDCA treated group than the other 2 groups. Conversely serum activity of GOT, alkaline phosphatase, rGTP, total bilinbin, chole- sterol was not different between the UDCA and CDCA treated and control rats except significant lower(p0.01) serum bile acid in the UDCA and CDCA treated rats. Conclusion: These data indicate that UDCA treatment significantly reduce the replicative activity and this effect is asso- ciated with both an improvement in serum levels of cholestatic markers and histologic findings. Although the mechanism of choleretic effect followig UDCA administration is still hypothetical, UDCA may reduce the level of irritating bile salts such as chenodeoxycholic acid ancl lithocholic acid and increase periductular bile acid recirculation. Therefore, longterm UDCA treatment support the beneficial effect in cholestatic disease. (Korean J Gastroenterol 1996; 28:402 - 408)

상피성 난소종양에서 p53 과 TGF-β 발현양상에 관한 면역조직화학적 분석

박진완 ( Park Jin Wan ),윤문희 ( Yun Mun Hui ),명나혜 ( Myeong Na Hye ) 대한산부인과학회 2004 Obstetrics & Gynecology Science Vol.47 No.3

목적 : 상피성 난소종양에서의 p53과 TGF-β 발현양상에 관한 면역조직학적 분석을 통하여 양성과 악성 상피성 종양간의 p53과 TGF-β 발현양상과 임상병리학적 소견과의 연관성을 알아보고자 본 연구를 시행하였다. 연구 방법 : 양성 난소종양 22예와 악성 난소종양 9예를 대상으로 포르말린 고정 파라핀 포매조직에서 p53과 TGF-β의 면역조직화학 검사를 시행하여, 양성과 악성 난소종양에서의 이들 발현양상과 임상병리학적 소견을 서로 비교하였다. 결과 : p53 발현양상은 양성종양 (9%)에 비해 악성 상피성 종양 (55%)에서 유의하게 높은 발현빈도를 보였다 (p<0.05). TGF-β 발현양상은 악성 상피성 종양 (67%)에서 양성종양 (23%)에 비해 음성 발현이 유의하게 더 많이 나타났다 (p<0.05). 악성 상피성 난소암에서의 연령, 조직유형, 종양 크기 그리고 병기에 따른 p53와 TGF-β 발현율은 통계적으로 유의한 차이는 없었다. 결론 : 상피성 난소종양에서 p53 단백의 과발현과 TGF-β 단백의 감소가 난소 상피성 종양의 악성화에 관여할 것으로 추정된다. 그러나 상피성 난소암의 암화과정에서의 p53과 TGF-β 단백의 역할을 명확히 하기 위해서는 더 많은 예를 대상으로 한 대단위 연구가 필요할 것으로 사료된다. Objective : To verify the pattern of p53 and TGF-β protein expression in benign and malignant epithelial ovarian tumors. Methods : An immunohistochemical technique was applied to formalin-fixed paraffin-embedded samples of 22 benign and 9 malignant epithelial ovarian tumors using p53 monoclonal antibody and TGF-β polyclonal antibody. Expressions of p53 and TGF-β protein in two histological types were compared, and correlated with clinico-pathologic findings of the respective cases. Results : p53 immunoreactivity of high or intermediate degree was detected in 2 out of 22 benign (9%) and 5 out of 9 malignant (55%) cases. On the other hand, intermediate to high TGF-β expression was found in 17 out of 22 benign (77%), and 3 out of 9 malignant (33%) cases. The prevalence difference of p53 and TGF-β expression between benign and malignant groups were statistically significant (p<0.05). In addition, the prevalence of immunoreactivities of p53 and TGF-β in malignant tumor didn`t show any association with age, tumor size, histologic types and stage. Conclusion : Our results suggest that p53 expression and loss of TGF-β expression may play and important role in malignant transformation of ovarian epithelial cells. However further studies seem to be necessary to know the exact relationship between their roles.

급성 간질성 폐렴에서 조기 부신피질호르몬 치료의 효과

이계영 ( Lee Gye Yeong ),지영구 ( Ji Yeong Gu ),김윤섭 ( Kim Yun Seob ),명나혜 ( Myeong Na Hye ),박재석 ( Park Jae Seog ) 대한결핵 및 호흡기학회 2002 Tuberculosis and Respiratory Diseases Vol.52 No.5

자궁경관내막에서 발생한 청색 모반 2 예

윤문희 ( Yun Mun Hui ),강윤단 ( Kang Yun Dan ),곽민정 ( Gwag Min Jeong ),고재향 ( Go Jae Hyang ),명나혜 ( Myeong Na Hye ),김유찬 ( Kim Yu Chan ),박충학 ( Park Chung Hag ) 대한산부인과학회 2004 Obstetrics & Gynecology Science Vol.47 No.5

Objective : To evaluate the effects of isoflavone intake on estrogen deprivated symptoms in surgically menopaused women. Methods : Premenopausal women who took total hysterectomy with both adnexectomy were randomized into three groups. One group took conjugated equine estrogen 0.625 mg daily for 12 weeks after surgery, the second group took isoflavone 100 mg #3 daily for 12 weeks after surgery, and the third group took no medication for controlled group. Questionnaires about the acute menopausal symptoms, incontinence score, blood lipid profile, bone turnover marker were checked before and 12 weeks after surgery.