증례 : 폐에 발생한 원발성 반지세포암 1예

손준광 ( Jun Gwang Son ),김성호 ( Seong Ho Kim ),선제형 ( Jae Hyung Sun ),박진석 ( Jin Seok Park ),김유일 ( Yu Il Kim ),이숭 ( Soong Lee ),신정현 ( Jung Hyun Shin ) 대한내과학회 2005 대한내과학회지 Vol.69 No.-

반지세포암은 과거에 여러 장기에서 보고되어졌으며 위에서 가장 많이 발생하는 것으로 알려져 있다. 특히 폐 조직에서 반지세포가 나올 경우 일반적으로 전이에 의해 발생한 것으로 생각되어 왔다. 하지만 드물게 폐에서 원발성으로 반지세포암이 발생될 수 있음이 보고되었고, 과거에는 부검이나 다른 장기의 병변이 없는 경우 진단하였으나, 최근 보고들에 따르면 종양 세포들의 형태학적 특징과 면역조직화학염색을 통해 폐의 원발성 반지세포암을 진단하는 예가 증가하고 있다. 저자들의 경우도 기관지 내시경을 통한 조직 검사와 면역조직화학염색으로 반지세포암을 진단하였으며 다른 여러 장기를 검사한 결과 전이 가능한 장기들에서 이상 소견을 발견할 수 없어 폐에 발생한 원발성 반지세포암으로 확진하였고, cisplatin과 paclitaxel의 복합 항암화학요법을 시행하였다. Signet ring cell carcinoma (SRCC) is a unique subtype of adenocarcinoma that is characterized by abundant intracellular mucin accumulation. SRCC can arise in various organs, including stomach, colon, breast, bladder, and prostate. SRCC can also arise as a primary lung tumor, but its incidence is low, ranging from 0.14% to 1.9% in the reported series. Therefore, SRCC in the lung is generally believed to be metastatic. But, recent several immunohistochemical studies have demonstrated that thyroid transcription factor-1 (TTF-1), cytokeratins 7 and 20 are specific markers for SRCC arising in the lung. We report a case of pulmonary SRCC with immunohistochemical characterization in a 54-year-old male. Chest X-ray and chest computed tomography (CT) scan showed a homogeneous mass, approximately 3 cm in diameter and subcarinal lymphadenopathy of left perihilar region. The tumor cells were mainly composed of signet-ring cells and strongly demonstrated cytokeratins (7+/20-). The investigations of whole body failed to reveal any other tumor. On the basis of immunohistochemical studies, we concluded that the tumor was SRCC arising in the lung. (Korean J Med 69:S830-S834, 2005)

근육 내 자극 요법 후 발생한 의인성 기흉 2예

손준광 ( Jun Gwang Son ),오인재 ( In Jae Oh ),정종필 ( Jong Pil Jeong ),김수옥 ( Soo Ok Kim ),주진영 ( Jin Yung Ju ),임정환 ( Jung Hwan Lim ),조계중 ( Gye Jung Cho ),채동렬 ( Dong Ryeol Chae ),김규식 ( Kyu Sik Kim ),김유일 ( Yu Il 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.63 No.5

Recently, intra-Muscular Stimulation (IMS) therapy is being increasingly used for musculoskeletal pain. This procedure is generally regarded as a safe procedure for the general public. Some cases of iatrogenic pneumothorax caused by acupuncture have been reported in the medical literature. However, a case of an IMS therapy associated pneumothorax has not reported. We experienced two cases of iatrogenic pneumothorax after IMS therapy. A 62 year-old man received IMS therapy on the right shoulder due to posterior neck pain. After IMS therapy, acute dyspnea and chest discomfort developed. The other patient was a 74 year-old woman who also received IMS therapy. This patient experienced a nonproductive cough and acute dyspnea after the treatment. As the popularity of this form of alternative medicine increases, we might expect to see more cases of iatrogenic pneumothorax. Physicians should be aware of the adverse events associated with IMS therapy. (Tuberc Respir Dis 2007;63:444-448)

심인성 폐부종과 폐포성 출혈을 보인 갈색세포종

정종필 ( Jong Pil Jeong ),반희정 ( Hee Jung Ban ),김수옥 ( Soo Ock Kim ),손준광 ( Jun Gwang Son ),주진영 ( Jin Yung Ju ),권용수 ( Yong Soo Kwon ),오인재 ( In Jae Oh ),김규식 ( Kyu Sik Kim ),김유일 ( Yu Il Kim ),임성철 ( Sung Chul 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.64 No.3

Pheochromocytoma is derived from the chromaffin tissue. The typical finding of pheochromocytoma is paroxysmal hypertension accompanied with various signs and symptoms that are due to the excess of catecholamines or other bioactive substances. Yet the diagnosis is sometimes difficult to make because its clinical presentation is quite variable. Especially, hemoptysis is a very rare symptom, so the diagnosis is often missed or delayed. Without making the correct diagnosis and then subsequently administering treatment, the condition may be fatal. We herein report on a 68 year-old woman who was admitted because of abdominal pain and hemoptysis. The initial radiologic findings suggested pulmonary edema with alveolar hemorrhage. The urine catecholamine levels were elevated and she developed catecholamine-induced cardiomyopathy. We performed bronchial arterial embolization and we administered alpha blocker medication for controlling the hemoptysis and hypertension. After the temporary symptomatic improvement, her clinical course was aggravated by pneumonia and pulmonary edema. In spite of performing definitive surgery for pheochromocytoma, she died of postoperative hemodynamic instability. (Tuberc Respir Dis 2008;64:219-223)

조기위암이 동반된 악성빈혈

이용국 ( Lee Yong Gug ),이용엽 ( Lee Yong Yeob ),손준광 ( Son Jun Gwang ),선홍주 ( Seon Hong Ju ),한상우 ( Han Sang U ),이지신 ( Lee Ji Sin ),박무림 ( Park Mu Lim ) 대한내과학회 2003 대한내과학회지 증례 특집호 65-5 부록3 Vol.0 No.-

Pernicious anemia is caused by the absence of intrinsic factor from autoimmune destruction of parietal cells. Patients with pernicious anemia are predisposed to the development of gastric cancer. We report here a case of pernicious anemia with early gastr

단일 폐종괴로 발견된 Wegener 육아종증

오인재 ( In Jae Oh ),정종필 ( Jong Pil Jeong ),김수옥 ( Soo Ok Kim ),손준광 ( Jun Gwang Son ),반희정 ( Hee Jung Ban ),임정환 ( Jung Hwan Lim ),조계중 ( Gye Jung Cho ),주진영 ( Jin Young Ju ),김규식 ( Kyu Sik Kim ),김유일 ( Yu Il K 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.63 No.1

Wegener`s granulomatosis is a disease with an unknown etiology that is characterized by necrotizing granulomatous vasculitis involving the upper and lower respiratory tract and the kidneys. The typical pulmonary findings are bilaterally involved multiple variable sized nodules. We report a case of Wegener`s granulomatosis that presented as a single lung mass. A male patient presented with a nasal obstruction, arthralgia, cough, and intermittent dyspnea. The chest radiograph showed a mass, approximately 4.5 cm in diameter, in the right lower lobe. Lung cancer or tuberculosis was initially considered. However, the clinical, laboratory and pathological findings of the mass indicated Wegener`s granulomatosis. The patient was administered prednisolone and cyclophosphamide, and improved temporarily. Unfortunately, the immunocompromised patient expired as a result of respiratory failure with pneumonia. (Tuberc Respir Dis 2007; 63: 88-93)

폐암 억제유전자 RRM1의 단일염기다형성 검사를 위한 PCR-RFLP법과 Real-Time PCR법의 유용성 비교

정주연 ( Ju Yeon Jeong ),김미란 ( Mi Ran Kim ),손준광 ( Jun Gwang Son ),정종필 ( Jong Pil Jung ),오인재 ( In Jae Oh ),김규식 ( Kyu Sik Kim ),김영철 ( Young Chul Kim ) 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.62 No.5

연구배경: 단일염기다형성(Single nucleotide polymorphism, SNP)은 인간의 유전자 서열 1000염기에 1개 빈도로 발견되어 인간은 대략 300만개의 유전자 다형성을 가지고 있다. 이 유전자 다형성의 조합결과로 인간의 개체 간 특성들이 결정되는 것으로 이해되고 있다. 이러한 다형성들의 조합양상에 따라 특이 질환에 대한 유전자 감수성 또한 달라지게 되므로 최근에는 많은 질환들과 유전자 다형성들과의 상관관계를 보는 연구들도 활발하게 진행되고 있다. 이러한 SNP분석은 큰 집단을 대상으로 진행되어지므로 적은 비용으로 정확하게 그리고 대용량으로 분석할 수 있는 방법이 필요하다. 방법: 대상 환자 89명의 genomic DNA를 가지고서 promotor상에 위치한 -37과 -524 염기부위에서 유전자 다형성을 보이는 것으로 보고되어져 있는 RRM1 (ribonucleotide reductase M1) 유전자를 대상으로 PCR-RFLP(polymerase chain reaction-restriction fragment length polymorphism)와 real-time PCR(RT- PCR, TaqMan probe assay)을 동시에 시행한 후 각각의 결과를 비교 분석하였다. 결과: 대상 DNA 89예 중 -37에서는 2예(2.17%), -524에서는 15예(16.26%)가 서로 다른 양상을 보였다. 결과 차이를 보인 샘플 17예를 대상으로 직접 염기서열 분석을 시행하여 본 결과, 17예 모두 RT-PCR에서 확인되었던 결과와 일치함을 확인할 수 있었다. 추가 샘플 138예를 대상으로 RT-PCR을 2회 연속 실행하여 genotyping을 해 본 결과 98%이상의 높은 일치율을 보였으며, 그 중 10예를 무작위로 골라 직접 염기서열 분석을 시행하여 본 결과, 역시 100%일치, 높은 정확도를 보였고 이는 in-tube assay 방식으로 샘플의 오염을 최소화 할 수 있었으며 72 well based system(Corbett Research)을 이용함으로 1회 유전자 증폭반응을 통해 많은 검체를 한 번에 확인할 수 있어 매우 빠른 검사방법 이었다. 결론: 큰 집단을 대상으로 다량의 SNP를 분석하기 위한 실험 방법으로는 RT-PCR이 신속하면서도 정확한 결과를 얻을 수 있는 방법으로 사료된다. Background: Single nucleotide polymorphisms (SNPs), which consist of a substitution of a single nucleotide pair, are the most abundant form of genetic variations occurring with a frequency of approximately 1 per 1000 base pairs. SNPs by themselves do not cause disease but can predispose humans to disease, modify the extent or severity of the disease or influence the drug response and treatment efficacy. Single nucleotide polymorphisms (SNPs), particularly those within the regulatory regions of the genes often influence the expression levels and can modify the disease. Studies examining the associations between SNP and the disease outcome have provided valuable insight into the disease etiology and potential therapeutic intervention. Traditionally, the genotyping of SNPs has been carried out using polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP), which is a low throughput technique not amenable for use in large-scale SNP studies. Recently, TaqMan real-time PCR chemistry was adapted for use in allelic discrimination assays. This study validated the accuracy and utility of real-time PCR technology for SNPs genotyping Methods: The SNPs in promoter sequence (-37 and -524) of lung cancer suppressor gene, RRM1 (ribonucleotide reductase M1 subunit) with the genomic DNA samples of 89 subjects were genotyped using both real-time PCR and PCR-RFLP. Results: The discordance rates were 2.2% (2 mismatches) in -37 and 16.3% (15 mismatches) in -524. Auto-direct sequencing of all the mismatched samples(17 cases) were in accord with the genotypes read by real-time PCR. In addition, 138 genomic DNAs were genotyped using real-time PCR in a duplicate manner (two separated assays). Ninety-eight percent of the samples showed concordance between the two assays. Conclusion: Real-time PCR allelic discrimination assays are amenable to high-throughput genotyping and overcome many of the problematic features associated with PCR-RFLP. (Tuberc Respir Dis 2007; 62: 406-416)

한국인 폐암 환자에서 RRM1 유전자 Promoter의 다형성

고경행 ( Kyung Haeng Ko ),김은정 ( Eun Joung Kim ),오인재 ( In Jae Oh ),김수옥 ( Soo Ock Kim ),손준광 ( Jun Gwang Son ),정종필 ( Jong Pil Jung ),조계중 ( Gye Jung Cho ),주진영 ( Jin Young Ju ),김규식 ( Kyu Sik Kim ),김유일 ( Yu Il 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.61 No.3

연구배경: 약 75%의 비소세포 폐암에서 loss of heterozygosity (LOH)를 보이는 11p15.5에 위치한 ribonucleotide reductase M1 subunit gene(RRM1) 유전자는 ras transformed fibroblast를 이용한 실험에서 암세포의 전이능력을 감소시키는 것으로 보고되어 있어서 암억제 유전자로서의 가능성이 높다. RRM1의 promoter 부위인 exon 1 시작에서 (-)37과 (-)524번째 염기에 A/C 그리고 C/T 다형성이 발견되었는데 이 다형성의 양상에 따라 RRM1 유전자의 발현 정도가 조절될 수 있어서 폐암 발생의 위험도가 다를 수 있다. 대상 및 방법: 전남대학교 병원에 내원한 폐암환자들과 비폐암 대조군 환자 127예와 미국인 폐암 환자 140예의 말초혈액 백혈구로부터 얻은 DNA를 이용하여 미국인과 한국인에서의 유전자 다형성의 분포 및 임상적 의의를 조사하였다. 결과: RRM1 유전자의 Exon 1으로 부터 (-)37 염기에서 A/C 유전자 다형성은 127예 중 CC가 64예(50.4%), AC는 55예(43.3%), 그리고 AA는 8예(6.3%)에서 발견되었다. Allele A의 빈도는 미국인들의 27.9%에 비하여 한국인에서 28.0%로 차이가 없었고, 폐암군과 비폐암군 간에도 유의한 차이는 관찰되지 않았다. RRM1 유전자의 (-)524 염기에서 C 또는 T 유전자 다형성의 양상은 CC가 24예(18.9%), CT는 44예(34.6%), 그리고 TT는 59예(46.5%)에서 발견되었다. Allele C의 빈도는 36.2%로써 미국인의 34.6%와 차이가 없었고, 폐암군과 비폐암군 간에도 차이는 관찰되지 않았다. RRM1 유전자의 (-)37 염기는 인종에 관계없이 70% 이상에서 C 이었고, (-)524 염기는 65% 정도에서 T를 보이고 있었다. 또한 (-)37과 (-)524 염기는 서로 밀접한 상관관계를 보이고 있었다. 즉 (-)37염기가 모두 C인 경우 (-)524 염기도 모두 T인 빈도가 높았고, (-)37 염기가 한 개라도 A를 가지고 있는 경우 (-)524 염기도 C를 가지고 있는 빈도가 높았다 (p<0.001). 결론: RRM1 유전자의 발현을 조절하는 promoter 부위의 두 개의 유전자 다형성의 빈도는 인종 간에 그리고 폐암군과 비폐암군 간에 차이가 없어서 폐암 발생의 위험인자는 아니었다. 그러나 두 유전자 다형성이 서로 특정 조합을 보임으로 그 조합 양상에 따른 promoter 활성도에 대한 연구가 뒤따라야 할 것이다. Background: LOH11A is a region with frequent allele loss (>75%) in lung cancer that is located on the centromeric part of chromosome 11p15.5. Clinical and cell biological studies suggest that this region contains a gene associated with metastatic tumor spread. RRM1 encoding the M1 subunit of ribonucleotide reductase, which is an enzyme that catalyses the rate-limiting step in deoxyribonucleotide synthesis, is located in the LOH11A region. Methods: Polymorphisms were found at nucleotide position (-)37 (C/A) and (-)524 (C/T) from the beginning of exon 1 of the RRM1 gene that might regulate the expression of RRM1. We studied the polymorphisms in 127 Korean individuals (66 lung cancer and 61 normal controls) and compared with those of 140 American patients with lung cancer. Results: CC, AC and AA were found at the (-)37 position in 64(50.4%), 55(43.3%), and 8(6.3%) out of 127 Korean individuals (66 cancer, 61 non-cancer patients), respectively. There was a similar frequency of allele A at (-)37 in the American(27.9%) and Korean population(28.0%). CC, CT and TT was found at the (-)524 position in 24(18.9%), 44(34.6%), and 59(46.5%) out of the 127 Korean individuals, respectively. There was a similar frequency of allele C at (-)524 in the American(34.6%) and Korean population(36.2%). There was no difference in the frequency of the (-)37 and (-)524 genotypes between the cancer and non-cancer group. However there was a significant correlation of the genotypes between (-)37 and (-)524 (p<0.001), which suggests the possible coordination of these polymorphisms in the regulation of the promoter activity of the RRM1 gene. Conclusion: RRM1 promoter polymorphisms were not found to be significant risk factors for lung cancer. However, a further study of the promoter activity and expression of the RRM1 gene according to the pattern of the polymorphism will be needed. (Tuberc Respir Dis 2006; 61: 248-255)

전남대학교 병원에서 2000년 이후 진단된 폐암의 임상 특성

임정환 ( Jung Hwan Lim ),반희정 ( Hee Jung Ban ),오인재 ( In Jae Oh ),김수옥 ( Soo Ok Kim ),손준광 ( Jun Gwang Son ),정종필 ( Jong Pil Jeong ),김규식 ( Kyu Sik Kim ),김유일 ( Yu Il Kim ),임성철 ( Sung Chul Lim ),김영철 ( Young Chu 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.61 No.5

Background: Lung cancer has been the leading cause of cancer death in South Korea since 2000. This study examined the clinical characteristics of lung cancer patients diagnosed in a community hospital from the year 2000 to 2005, and compared these results with previously reported statistical data. Method: The lung cancer data in a form of an electronic medical record was downloaded from the hospital medical information system. The clinical characteristics of the 1,509 patients with lung cancer were analyzed retrospectively. Result: The mean age of the patients was 63.7 years. 82.5% and 74.5% of the patients were men and smokers, respectively. Squamous cell carcinoma (41.6%) was the most common pathology type followed by adenocarcinoma(32.3%) and small cell carcinoma(13.9%). When 604 patients who were diagnosed from 2000 to 2003 were compared with 905 patients diagnosed from 2004 to 2005, the age of patients increased significantly (61.5 years vs. 65.1 years; p<0.001) and the proportion of adenocarcinomas was significantly higher(29.3% vs. 34.4%; p=0.046). Conclusion: Among the major histology types of lung cancer, the incidence of adenocarcinoma has been increasing recently. The age of the lung cancer patients at diagnosis is getting older. This is despite the fact that the distributions of the initial anatomic stages have not changed significantly. (Tuberc Respir Dis 2006; 61: 427-432)

자궁근종을 동반한 원발성 기관지 평활근종

심현정 ( Hyun Jeong Shim ),임정환 ( Jung Hwan Lim ),이석 ( Seck Lee ),김대현 ( Dae Hyun Kim ),박강진 ( Kang Jin Park ),이세련 ( Se Ryeon Lee ),정종필 ( Jong Pil Jeong ),손준광 ( Jun Gwang Son ),김수옥 ( Soo Ok Kim ),오인재 ( In J 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.61 No.5

Leiomyoma of the bronchus is a very rare benign tumor of the lung. Most endobronchial leiomyomas occur as secondary foci of primary uterine leiomyoma. We herein report a case with endobronchial tumor that had a different pathology from a primary resected uterine leiomyoma and was therefor considered a primary endobronchial leiomyoma. A 51-year-old woman with a history of uterine myoma presented with productive cough and fever. Bronchoscopy revealed a lightly yellow colored mass lesion that totally obstructed the orifice of the left lower lobe of the lung. The diagnosis of leiomyoma was made by histological examination of the obtained specimen. We considered the possibility of a benign metastasizing pulmonary leiomyoma. For treatment and differential diagnosis, a left lower lobe lobectomy of the lung and total hysterectomy with bilateral salphingooopherectomy were performed. The differences between lung and uterine lesions were confirmed by morphologic finding and immunohistochemical staining. The pathological diagnosis was primary endobronchial leiomyoma combined with uterine myoma. (Tuberc Respir Dis 2006; 61: 490-495)

거대 폐동맥류 1예

이용엽,손준광,이용국,신홍주,박옥영,최연수,이승,길광채,홍순표 朝鮮大學校 附設 醫學硏究所 2004 The Medical Journal of Chosun University Vol.29 No.1

An aneurysm of the pulmonary artery is a rare entity and a current knowledge is mainly derived from autopsy findings, Pulmonary artery ancurysms arc associated with congenital heart disease : patient ductus arteriosus, ventricular septal detect, atrial septal defect and etc. In the remaining cases, such aneurysms are associated mainly with secondary acquired lesions, such as Behcet's disease, bacterial endocarditis, syphilis, tuberculosis, atherosclerosis, vasculitis, hypertension and trauma. We experienced a case of primary pulmonary artery ancurysm with pericardial effusion detected on a echocardiography in a 79 year-old female. A computed tomographic scan and pulmonary angiography showed dilatation of the main and proximal pulmonary arteries, accompanying by pericardial effusion. We report this case with a brief review of literature. 폐동맥류는 그 빈도가 매우 드물며 저자들은 호흡곤란을 호소하는 폐동맥류 1례를 경험하였기에 보고하는 바이다.