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Outcomes of Diffuse-Type Pigmented Villonodular Synovitis (PVNS) after Open Total Synovectomy
이모세,이수현,서진석,양우익,신규호,Lee, Mo-Ses,Lee, Soo-Hyun,Suh, Jin-Suck,Yang, Woo-Ik,Shin, Kyoo-Ho The Korean Musculoskeletal Tumor Society 2010 대한골관절종양학회지 Vol.16 No.1
목적: 색소 융모 결절성 활액막염은 슬관절을 비롯한 주요 관절에서 드물게 발생하는 연부 조직 종양으로서 수술 적 치료 후 재발 빈도가 높은 것으로 알려져 있다. 본 연구에서는 주요 관절에 발생한 미만형 색소 융모 결절성 활액막염에 대한 활막 전 절제술 후 임상 경과를 보고하고, 기존에 발표 된 문헌과 비교 분석하고자 한다. 대상 및 방법: 1994년 2월부터 2006년 3월까지 미만형 색소 융모 결절성 활액막염으로 치료 받은 21예의 환자를 대상으로 하였으며, 발생 부위는 슬관절 14예, 족관절 5예, 견주관절 2예가 있었다. 평균 추시 기간은 5년 5개월이었다(36-157개월). 발생 연령은 평균 34세였으며 남자가 7명, 여자가 14명이었다. 후향적 연구 방법으로 관절 운동 범위 측정을 포함한 정기적인 임상 양상 평가를 하였다. 결과: 총 21예의 미만형 환자 중 1예를 제외 한 전례에서 활막 전 절제술 및 전기소작술을 통한 보강 치료를 시행하였으며, 정기적인 외래경과 관찰 상 재발이 의심되었던 2예에서 재수술 후, 1예에서만 조직학적 재발이 확진 되었다. 활막 전 절제술을 시행하지 못한 1예와, 재발로 재수술 받은 1예에서 술 후 방사선 치료를 시행 하였다. 임상 기능 평가상 술전과 비교하여 모든 부분에서 통계적으로 유의한 호전이 있었다.(p<0.0001). 슬관절에 발생한 병변으로 수술적 치료를 시행 후 관절 운동 장애로 제약이 있던 환자는 2예(총 14예) 있었다. 결론: 최소 3년 이상의 추시 기간 동안 활막 전 절제술 및 전기 소작술을 통한 보강 치료로 호전된 임상 결과 및 낮은 재발율의 치료 효과를 얻을 수 있었다. 잦은 재발과 주요 관절에 발생하여 국소적 침투, 파괴로 기능 장애를 일으키는 미만형 색소 융모 결절성 활액막염에 치료에 있어 적절한 활막 전 절제술이 시행 될 경우 방사선 보강 치료는 제한 된 경우에만 필요할 것이다. Purpose: Pigmented villonodular synovitis (PVNS) is a rare soft tissue tumor, which usually arises in larger joints, such as the knee. It has a high recurrence rate after surgical treatment. The purpose of this study is to evaluate and analyze the clinical results of diffuse-type pigmented villonodular synovitis cases that were treated with open total synovectomy. Materials and Methods: Between 1994 and 2006, 21 patients who had diffuse-type pigmented villonodular synovitis were selectively reviewed. Among the 21 cases studied, 14 patients presented at the knee, 5 at the ankle, and 2 at the shoulder and elbow. The mean follow up period was 5.5 years (range, 36-157 months). The average age of the patients was 34 years consist of 7 men and 14 women. Clinical outcomes were analyzed retrospectively, including range of motion and complications. Results: Open total synovectomy and adjuvant electrocautrization were done in all cases except one. During the regular follow-up period after the surgery, two patients showed symptoms of recurrence. After re-operation, only one case was pathologically confirmed as a recurrence. The patient who had partial synovectomy and the other patient who had second operation due to recur rence received additional radiation therapy. Clinical outcome scores were improved in every aspect (p<0.0001). 2 out of 14 Patients who had pigmented villonodular synovitis at the knee developed stiff knee after the surgery. Conclusion: After the open total synovectomy with electrocautrization, a low recurrence rate and satisfactory clinical outcome was achieved, observed in a minimum of 3 years of follow-up.
A Case of Sclerosing Mucoepidermoid Thyroid Carcinoma with Eosinophilia (SMECE)
정웅윤(Woung Yoon Chung),양우익(Woo Ik Yang),박정수(Cheong Soo Park) 대한두경부종양학회 2001 대한두경부 종양학회지 Vol.17 No.1
Sclerosing rnucoepidermoid carcinoma with eosinophilia(SMECE)는 1991년 Chan 등이 처음 보고한 이후로 현재까지 전세계적으로 단 17예 만이 보고된 매우 희귀한 갑상선 암종이다. 조직학적으로는 종양 내에 일부 점액성 세포와 증식된 상피성 세포들을 관찰할 수 있고, 조직내 호산구성 세포들이 자주 관찰된다. 대부분의 기질은 밀집된 섬유성 조직으로 구성되어 있으며, 하시모토 갑상선염이 동반되어 있는 것이 특장적이다. 종양의 악성도는 최초 보고인 Chan 등에 의하면 국소 재발 및 원격전이를 거의 하지 않는 예후가 좋은 암종으로 보고되었는데, 이후 여러 문헌에서 국소 침윤, 국소 재발, 원격 전이 및 사망이 발생하여 예후가 매우 불량했던 증례들을 보고한 바 있어 악성도에 대한 시각은 달라지고 있다. 본 저자들은 최근 병리적 진단이 매우 어려웠고, 국소침윤과 림프절 전이 소견을 보였으며, 수술 후 빠른 시일 내에 급속히 재발하였던 악성도가 매우 높은 sclerosing mucoepidermoid thyroid carcinoma with eosinophilia (SMECE) 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.
이하선의 단일섬유종(Solitary Fibrous Tumor) 1예
박정수(Cheong Soo Park),양우익(Woo Ik Yang),백소야(So Ya Paik),정웅윤(Woong Youn Chung),장항석(Hang Seok Chang),황수경(Su Kyung Hwang) 대한두경부종양학회 1999 대한두경부 종양학회지 Vol.15 No.2
Solitary fibrous tumors are commonly arise in the pleura and less commonly in extrapleural sites. In head and neck area, solitary fibrous tumors can occur in nose, paranasal sinus, soft palate, epiglottis, thyroid, parotid and submandibular gland. To our knowledge, this is the 5th case of solitary fibrous tumor arising from the parotid gland in English literature. We report a case of solitary fibrous tumor occurred in the superficial lobe of right parotid gland which was successfully treated by superficial parotidectomy with preservation of the facial nerve.
면역세포화학 염색법과 전자 현미경검사를 통한 뇌하수체 선종의 특징
이은직(Eun Jig Lee),이현철(Hyun Chul Lee),양우익(Woo Ik Yang),김경래(Kyung Rai Kim),김현만(Hyun Man Kim),안광진(Kwang Jin Ahn),정윤석(Yoon Sok Chung),임승길(Sung Kil Lim),김태승(Tae Seung Kim),박찬일(Chan Il Park),최인준(In Joon choi 대한내과학회 1992 대한내과학회지 Vol.43 No.2
N/A Background: The development of immunocytochemistry and the application of electron microscopy improved the knowledge of the pathology and classification of the pitutiary adenomas. We investigated the characteristics of the pituitary adenomas examined by the immunocytochemistry and electron microscopy. Methods: 44 patients with the pituitary adenomas were investigated, using immunocytochemical techniques in paraffin-embedded tissue, and electron microscopy in fresh tissue. Results: The mean age was 38±13 years, and the ratio of male to female was 1: 2.4 and 18 were prolactinomas, 8 acromegalies, 3 acromegalies with hyperprolactinemia, 3 Cushing`s diaseases, 3 FSH secreting adenomas, 1 TSH secreting adenomas, and 6 nonfunctioning adenomas among 44 patients. The agreement between serum prolactin and prolactin immunocytochemistry was 77.3% if the serum prolaetin level to predict lactotrope adenoma was above 50ng/ml; however, the agreement was 93,2% if the serum prolatin level above 100ng/ml. The serum levels of prolactin and growth hormone in sparsely granulated lactotrope and somatotrope adenomas were 1149.6, 109.5ng/ml, respectively, which were higher than those (129.6, 35.9ng/ml) of densely granulated ones. Immunocytochemical and electron microscopic analysis revealed that thirteen were lactotrope adenomas (12 sparsely granulated, and 1 densely granulated), 9 somatotrope adenomas (6 sparsely granulated and 3 densely granulated), 6 gonadotrope, 4 corticotrope (3 symtomatic and 1 silent), 1 mixed somatotrope and lactotrope, 1 mammosomatotrope, 1 thyrotrope, and 9 null cell (6 nononcocytic, and 3 oncocytic) adenomas. Conclusion: The immunocytochemistry, permitting the visualization of intracellular hormones in the tissue of the pituitary adenoma, made exact histologic diagnosis. So, we have known whether the cause of hyperprolactinemia was lactotrope adenoma or functional hyperprolactinemia due to PIF inhibiton. And it was also possible to diagnose silent corticotrope adenoma and gonadotrope adenoma which had no apparent clinical manifestation. Electron microscopic examination of the pituitary adenoma diagnosed by immunocytchemistry showed ultrastructrural characteristics of the adenoma cells containing each hormones, Accordingly, we could subclassify the pituitary adenoma. However, the identification of the adenomas with somewhat similar ultrastrutural features such as null cell, gonadotrope, and thyrotrope adenoma, may be facilitated by immunocytochemistry. Accordingly, both immunocytochemistry and electron microscopy are necessary for the identification and characterization of the pituitary adenomas.
정웅윤(Woong Youn Chung),이효상(Hyo Sang Lee),서진학(Jin Hak Seo),양우익(Woo Ik Yang),박정수(Cheong Soo Park) 대한두경부종양학회 2001 대한두경부 종양학회지 Vol.17 No.1
Background: Primary malignant lymphoma of the parotid gland is a rare disease and defined as any malignant lymphoma that first manifests in the parotid gland, regardless of the subsequent stage of the diseases, whether it arises in the parenchyma or intraglandular lymph nodes. This study was performed to review the clinicopathological characteristics of primary parotid lymphoma and identify its optimal treatment modality. Materials and Methods: Six cases with parotid mass as first presentation of malignant lymphoma between 1988 and 2000, were studied on the basis of clinical features, diagnostic tools, treatment modality, treatment outcomes, and clinical stage by Ann Arbor Criteria. All were microscopically reevaluated and classified by NCI working formulation. Results: All patients were males and mean age was 36.7 years (2-66 years). Rapid growing non-tender mass was presented in all the cases and cervical lymphnodes were palpated in 4 cases. However, there was not any evidence of concurrent autoimmune disease such as Sjogren's syndrom or Rheumatoid arthritis. One case was confirmed by surgical specimen after superficial parotidectomy, 2 by excisional biopsy, and 3 by incisional biopsy. The stage of disease by NCI working formulation was IE in 1 patient, IIE in 4 and IV in 1. All were classified into non-Hodgkin' lymphoma, of which there were 5 cases of B-cell type and 1 case of T-cell type. There were 3 diffuse large cell lymphomas, 1 Burkitt lymphoma, 1 MALT lymphoma and 1 T-lymphoblastic lymphoma. Three cases were treated by chemotherapy only, 2 by radiotherapy only and 1 by chemo-radiotherapy. One case with Burkitt lymphoma was died from the disease and one case was lost to follow-up. The others are alive with no evidence of recurrence. Conclusions: Although primary parotid lymphoma is rare and difficult to diagnose preoperatively, most were detected in early stage and showed a relatively good response to the chemotherapy or radiotherapy like other types of extranodal malignant lymphoma.
이은직(Eun Jig Lee),이현철(Hyun Chul Lee),안광진(Kwang Jin Ahn),임세중(Se Joong Rim),정윤석(Yoon Sok Jung),이관우(Kwan Woo Lee),임승길(Sung Kil Lim),김경래(Kyung Rae Kim),허갑범(Kap Bum Huh),양우익(Woo Ik Yang),박찬일(Chan Il Park),최 대한내과학회 1991 대한내과학회지 Vol.41 No.6
N/A This retrospective study concerns 73 patients with nonfunctioning pituitary adenoma who were operated on during an 9-year period from 1981 to 1989. Among them, 7 men showed positive immunocytochemistry for FSH and negative for other pituitary hormones. Six of them had elevated serum FSH levels, and LH levels were normal. Testosterone levels were low in six patients tested. Their major symptoms were visual impairment, headache, and impotence, which had developed from two months to 2 years before sugery. Primary hypogonadism could be eliminated on clinical grounds (recent onset of hypogonadism, previous fertility, and posttreatment-improvement). Transsphenoidal adenomectomies were performed in all patients, and radiation-therapies were paralleled in 6 of them. Clinical recovery occurred in all patients. One patient who did not received radiation therapy showed regrowth of tumor mass after 18 months. In remaining 6 patients, we haven't found any evidence of tumor recurrence during follow-up period from 10 months to 6.3 years. We conclude that these 7 men had primary gonadotrope adenoma of the pituitary, and present them with a literature review.