췌장고형종양의 초음파 내시경 유도하 조직 검사 임상 진료지침: 대한소화기내시경학회

정문재 ( Moon Jae Chung ),박세우 ( Se Woo Park ),김성훈 ( Seong-hun Kim ),조창민 ( Chang Min Cho ),최준호 ( Jun-ho Choi ),최은광 ( Eun Kwang Choi ),이태훈 ( Tae Hoon Lee ),조은애 ( Eunae Cho ),이준규 ( Jun Kyu Lee ),송태준 ( Tae J 대한소화기학회 2021 대한소화기학회지 Vol.78 No.2

췌장고형종양의 초음파 내시경(endoscopic ultrasound, EUS) 유도하 조직 검사는 기술적 난이도가 높고 침습적이기 때문에 임상에서의 적절한 사용을 위해 엄격한 권고안을 필요로 한다. 이에 대한소화기내시경학회에서는 췌장고형종양의 초음파 내시경 유도하 조직 검사를 위한 임상진료지침을 개발하기 위해 진료지침 개발위원회를 발족하였다. 권고안의 등급과 개별 권고안의 근거 수준은 2014년 출판된 임상진료지침 개발을 위한 Minds Handbook에서 제시된 체계에 기반하여 평가하였다. 본 진료지침 개발위원회는 초음파 내시경 분야의 전문가 16인과 임상진료지침 개발방법론 전문가 1인으로 구성되었으며, 8개 분야에 걸쳐 총 12건의 근거 기반 권고안을 개발하여 췌장고형종양 진단 시 임상의들이 근거에 기반한 임상적 판단을 할 수 있도록 돕고자 하였다. 본 임상 진료지침은 췌장고형종양에서 초음파 내시경 유도하 조직 검사에 대해 다루고 있으며, 권고안에서는 해당 검사의 적응증, 진단 정확도를 최대화하기 위한 기술적 방법론(예: 바늘의 종류 및 직경의 적절한 선택, 충분한 바늘천자횟수, 조직 획득 기술적 방법론, 검체 처리 방법), 시술 관련 합병증, 그리고 숙련도와 교육에 관련된 문제들에 대해 다루고 있다. 본 진료지침은 외부 전문가의 검토를 거쳤으며, 원고 작성 시점까지 보고된 가능한 모든 최신 근거들에 기반하여 최선의 진료 방법을 권고하고 있다. 그러나 모든 임상 상황에 본 진료지침을 일괄적으로 적용할 수는 없으며, 기관의 법적/행정적 상황 및 환자의 개별 임상적 상황과 해당 자원의 가용성 등을 고려하여야 한다. 추후 내시경적 기술의 발전과 이로 인한 변화, 임상에서의 최신 근거를 토대로 본 진료지침이 개정될 수 있다. Endoscopic ultrasound (EUS)-guided tissue acquisition of pancreatic solid tumor requires a strict recommendation for its proper use in clinical practice because of its technical difficulty and invasiveness. The Korean Society of Gastrointestinal Endoscopy appointed a Task Force to draft clinical practice guidelines for EUS-guided tissue acquisition of pancreatic solid tumor. The strength of recommendation and the level of evidence for each statement were graded according to the Minds Handbook for Clinical Practice Guideline Development 2014. The committee, comprising a development panel of 16 endosonographers and an expert on guideline development methodology, developed 12 evidence-based recommendations in eight categories intended to help physicians make evidence- based clinical judgments with regard to the diagnosis of pancreatic solid tumor. This clinical practice guideline discusses EUS-guided sampling in pancreatic solid tumor and makes recommendations on circumstances that warrant its use, technical issues related to maximizing the diagnostic yield (e.g., needle type, needle diameter, adequate number of needle passes, sample obtaining techniques, and methods of specimen processing), adverse events of EUS-guided tissue acquisition, and learning-related issues. This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This guideline may not be applicable for all clinical situations and should be interpreted in light of specific situations and the availability of resources. It will be revised as necessary to cover progress and changes in technology and evidence from clinical practice. (Korean J Gastroenterol 2021;78:73-93)

췌장고형종양의 초음파 내시경 유도하 조직 검사 임상 진료지침: 대한소화기내시경학회

정문재 ( Moon Jae Chung ),박세우 ( Se Woo Park ),김성훈 ( Seong-Hun Kim ),조창민 ( Chang Min Cho ),최준호 ( Jun-ho Choi ),최은광 ( Eun Kwang Choi ),이태훈 ( Tae Hoon Lee ),조은애 ( Eunae Cho ),이준규 ( Jun Kyu Lee ),송태준 ( Tae J 대한췌장담도학회 2021 대한췌담도학회지 Vol.26 No.4

췌장고형종양의 초음파 내시경 유도하 조직 검사 임상 진료지침: 대한소화기내시경학회

정문재 ( Moon Jae Chung ),박세우 ( Se Woo Park ),김성훈 ( Seong-Hun Kim ),조창민 ( Chang Min Cho ),최준호 ( Jun-ho Choi ),최은광 ( Eun Kwang Choi ),이태훈 ( Tae Hoon Lee ),조은애 ( Eunae Cho ),이준규 ( Jun Kyu Lee ),송태준 ( Tae J 대한췌장담도학회 2021 대한췌담도학회지 Vol.26 No.3

Endoscopic ultrasound (EUS)-guided tissue acquisition of pancreatic solid tumor requires a strict recommendation for its proper use in clinical practice because of its technical difficulty and invasiveness. The Korean Society of Gastrointestinal Endoscopy appointed a Task Force to draft clinical practice guidelines for EUS-guided tissue acquisition of pancreatic solid tumor. The strength of recommendation and the level of evidence for each statement were graded according to the Minds Handbook for Clinical Practice Guideline Development 2014. The committee, comprising a development panel of 16 endosonographers and an expert on guideline development methodology, developed 12 evidence-based recommendations in eight categories intended to help physicians make evidence-based clinical judgments with regard to the diagnosis of pancreatic solid tumor. This clinical practice guideline discusses EUS-guided sampling in pancreatic solid tumor and makes recommendations on circumstances that warrant its use, technical issues related to maximizing the diagnostic yield (e.g., needle type, needle diameter, adequate number of needle passes, sample obtaining techniques, and methods of specimen processing), adverse events of EUS-guided tissue acquisition, and learning-related issues. This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This guideline may not be applicable for all clinical situations and should be interpreted in light of specific situations and the availability of resources. It will be revised as necessary to cover progress and changes in technology and evidence from clinical practice. Korean J Pancreas Biliary Tract 2021;26(3):125-147

Btk 유전자 인트론 2 돌연변이에 의한 X연관 무감마글로불린혈증

정문재 ( Moon Jae Chung ),정지예 ( Ji Ye Jung ),손지영 ( Ji Young Son ),구철룡 ( Cheol Ryong Ku ),박병훈 ( Byung Hoon Park ),변민광 ( Min Kwang Byun ),문지애 ( Ji Ae Moon ),김영삼 ( Young Sam Kim ),김세규 ( Se Kyu Kim ),장준 ( Jo 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.65 No.3

X-linked agammaglobulinemia is the most common type of primary immunodeficiency disorder. Mutation ofthe cytoplasmic tyrosine kinase gene, Btk (Bruton`s tyrosine kinase), is known to be the etiology of X-linked agammaglobulinemia. The patients with this disease manifest a B-cell deficiency and low levels of serum immunoglobulin; due to the deficient antibodies, they suffers from recurrent upper and lower respiratory infections. We report here a 24-year-old male with an initial clinical impression of recurrent pneumonia and bronchiectasis. The patient presented with marked pan-hypogammaglobulinemia and the absence of circulating B-lymphocytes on the immunologic study, and he carried a splicing mutation of intron 2 in the Btk gene (IVS2 -3C>G). (Tuberc Respir Dis 2008;65:207-211)

항암화학요법과 수술을 통해 완전 관해를 획득한 진행성 십이지장 유두암 증례

윤해룡,정문재,방승민,박승우,송시영,Hae Ryong Yun,Moon Jae Chung,Seungmin Bang,Seung Woo Park,Si Young Song 대한소화기암연구학회 2014 Journal of digestive cancer reports Vol.2 No.2

Ampulla of Vater (AOV) cancer is rare malignant tumor which arises within the vicinity of the AOV. Metastatic AOV adenocarcinoma has poor prognosis, with an overall survival rate at 2 years ranging from 5 to 10%. The Surveillance, Epidemiology and End Results Program of the National Cancer Institute indicated that lymph node metastasis was present in as many as half of patients which were associated with poor prognosis and liver was the second most common site of distant metastasis in AOV cancer. In this case report, we describe a case of complete resolution of AOV cancer, which was already spread to retroperitoneal lymph node and liver. The patient underwent gemcitabine plus cisplatin chemotherapy for palliative aim. After 12 month of chemotherapy, image study showed partial remission, so intraoperative radiofrequency ablation therapy and pylorus preserving pancreaticoduodenectomy was done. AOV cancer was completely resected and the patient was followed up without recurrence for 7 months.

추가 항암 치료를 거부하는 국소 진행형 췌장암 환자 1례

이희승,정문재,박정엽,방승민,박승우,송시영,Hee Seung Lee,Moon Jae Chung,Jeong Youp Park,Seungmin Bang,Seung Woo Park,Si Young Song 대한소화기암연구학회 2016 Journal of digestive cancer reports Vol.4 No.2

The prognosis for pancreatic cancer patient is very poor. Patients with locally advanced disease have a median survival time of 8 to 12 months, and patients with distant metastases have significantly worse outcomes, with a median survival time of only 3 to 6 months. Approximately 30% of patients with pancreatic cancer present with locally advanced disease defined as unresectable pancreatic cancer without evidence of distant metastatic disease. Primary treatment options in locally advanced pancreatic cancer include chemotherapy and radiotherapy. Here, we reported a patient with locally advanced pancreatic cancer who does not want further chemotherapy because of chemotherapy induced nausea and vomiting. Irreversible electroporation was performed. Irreversible electroporation was well tolerated in this case, and may be a therapeutic modality for selected patients with locally advanced pancreatic cancer.

내시경초음파 세침흡인술을 통한 전이성 미분화육종의 진단

김시영,이희승,정문재,박정엽,방승민,박승우,송시영,Si Young Kim,Hee Seung Lee,Moon Jae Chung,Jeong Youp Park,Seungmin Bang,Seung Woo Park,Si Young Song 대한소화기암연구학회 2017 Journal of digestive cancer reports Vol.5 No.2

A-49-year-old male patient with no specific medical history was admitted to the clinic because of persistent epigastric pain radiating to back for 4 months. He had multiple parenchymal tumors in body and tail of pancreas, para-spinal muscle, and mediastinum on abdomen CT image. Cytologic examination of the pancreas which was done by endoscopic ultrasound guided fine needle aspiration (EUS-FNA) showed adenocarcinoma, whereas histological examination of the para-spinal mass showed undifferentiated sarcoma. Histologic examination of the pancreatic mass was made through endoscopic ultrasound guided fine needle biopsy (EUS-FNB) for accurate diagnosis, and the histologic examination of both the pancreas and posterior mediastinal mass showed the same undifferentiated sarcoma. Therefore, we reviewed the cytopathic tissue obtained from the pancreas for the first time, and it was confirmed to be similar to histologic findings in the mediastinal mass.

HL-60 세포의 Apoptosis에 대한 가미항백탕의 효과

정상필 ( Sang Pil Chung ),김경수 ( Kyeong Su Kim ),송정섭 ( Jung Sup Song ),박성혁 ( Seong Heak Park ),정문재 ( Moon Jae Jung ),이수경 ( Su Kyung Lee ),권영달 ( Young Dal Kwon ),송용선 ( Yung Sun Song ) 한방재활의학과학회 2007 한방재활의학과학회지 Vol.17 No.1

Objectives: To investigate anti-leukemic effect of Gamihangbak-tang(Jiaweikangbai-tang) using human promyelocytic leukemic HL-60 cells. Methods : Cell viability was determined using MTT assay. Morphological change was observed under a fluorescence microscope through DAPI-Methol staining. DNA fragmentation was analyzed by agarose gel electrophoresis. Caspase activity was measured by using a fluorogenic caspase substrate. Cleavage f caspase-3, PARP and Bid, expression of Bcl-2 and Bax, release of cytochrome C, and activation of MAPKs (ERK, JNK, p38) were determined by Western blot analysis. Results : Gamihangbak-tang(Jiaweikangbai-tang) treated HL-60 cells increased time-dependently DNA fragments and apoptotic bodies. Activities of caspase-3, 8, 9 increased on 30min after Gamihangbak-tang(Jiaweikangbai-tang) treatment and greatly increased after 3h treatment. PARP cleavage also increased 89 kDa PARP fragment on 3hr after Gamihangbak-tang(Jiaweikangbai-tang) treatment. Expression of Bcl-2 and Bax in Gamihangbak-tang (Jiaweikangbai-tang) treated HL-60 cells was not changed, but caspase-8-dependent Bid cleavage was observed. Gamihangbak-tang(Jiaweikangbaitang) also induced cytochrome C release from mitochondria into the cytosol. Activation of ERK, p38, and JNK increased in apoptosis induced by Gamihangbak-tang(Jiaweikangbai-tang) in HL-60 cells, but only ERK activation was concerned in Gamihangbak-tang(Jiaweikangbai-tang)-induced apoptosis. Conclusions : Apoptosis induced by Gamihangbak-tang(Jiaweikangbai-tang) in HL-60 cells induce caspase-3 activation through Bid cleavage by caspase-8, caused cytochrome C release from mitochondria, and ERK activation

Gemcitabine/cisplatin 항암치료 후 완전관해가 보고된 전이성 췌장암 환자 2례

조중현 ( Jung Hyun Jo ),정문재 ( Moon Jae Chung,),박정엽 ( Jeong Youp Park ),방승민 ( Seun Gmin Bang ),박승우 ( Seung Woo Park ),정재복 ( Jae Bock Chung ),송시영 ( Si Young Song ) 전북대학교 의과학연구소 2013 全北醫大論文集 Vol.37 No.1

Pancreatic ductal adenocarcinoma has a very poor prognosis. Patients with this type of tumor have a median overall survival of 9 months in locally advanced pancreatic cancer and 3-6 months in metastatic disease. However, there have been rare cases of patients with advanced pancreatic cancer who survived unexpectedly longer without curative surgery. We report two cases of metastatic pancreatic cancer in patients who presented complete remission after receiving gemcitabine/cisplatin chemotherapy and survived for about 10 years. The first case is that of a 51-year-old Korean woman who was diagnosed with pancreatic body cancer with invasion of the celiac artery and supraclavicular lymph node metastasis. The patient received gemcitabine/cisplatin systemic chemotherapy and achieved complete remission after the 12th cycle of chemotherapy. At present, the patient has survived for 10 years and 2 months after diagnosis. The second case is that of a 69-year-old Korean woman who was diagnosed with pancreatic head cancer with liver metastasis. The patient received gemcitabine/cisplatin chemotherapy and achieved complete remission after the 6th cycle of chemotherapy. At present, the patient has survived for 9 years and 2 months after diagnosis. Our study is the first case report of patients who achieved long-term survival with complete remission after receiving chemotherapy alone for metastatic pancreatic cancer.

췌장신경내분비종양의 내과적 치료

성민제 ( Min Je Sung ),정문재 ( Moon Jae Chung ) 대한췌장담도학회 2021 대한췌담도학회지 Vol.26 No.1

췌장신경내분비종양은 랑게르한스 소도에서 기원한 종양을 의미하며, 호르몬 분비에 의한 증상 발현 유무, Ki-67 분열 지수 및 세포분화도를 기준으로 한 분류 외에도, Tumor-Node-Metastasis (TNM) 병기 분류를 통한 병의 진행 정도에 따라 다양한 예후를 보인다. 췌장신경내분비종양의 내과적 치료목표는 증상을 조절하거나, 종양의 성장을 억제하는 것이다. 내과적 치료 약제 중 하나인 소마토스타틴 유사체는 호르몬 분비와 연관된 증상 조절 목적뿐만 아니라 항암 효과를 위해서도 사용되고 있으며, Ki-67 분열 지수가 20% 미만인 WHO 분류기준 Grade 1/Grade 2 (G1/G2) 종양의 진행을 억제하는 데에 효과적인 약물로 받아들여지고 있다. 분자표적치료제 중 everolimus와 sunitinib은 소마토스타틴 유사체 치료 후 진행된 WHO G1/G2 췌장신경내분비종양 환자에서 고려될 수 있다. 항암화학요법은 주로 Ki-67 분열지수가 높거나 급속히 진행하는 종양 또는 타 장기로 전이가 동반된 경우, 다른 치료에 실패하였거나 소마토스타틴 수용체 음성인 신경내분비 암종에 우선적으로 사용이 고려되며, 주로 etoposide/cisplatin 병합 요법이 표준 치료제로 받아들여지고 있다. 하지만 Grade 3 췌장신경내분비종양(well differentiated, high grade) 환자군에 대해서는 아직까지 표준 치료에 대한 가이드라인이 확립되어 있지 않으며, 기존의 전신 항암제에 치료 반응률이 상대적으로 저조한 것으로 보고되고 있어, G1/G2 종양에서 사용되는 소마토스타틴 유사체나 분자표적치료제 등의 치료 반응률을 평가할 연구가 필요한 상황이다. 췌장신경내분비종양은 다양한 임상 경과를 보이는 만큼 다양한 치료의 선택이 필요하며, 내과적 치료뿐만 아니라 원발 부위 및 전이성 병소에 대한 근치적 절제술, 간동맥 색전술과 고주파 소작술 등의 국소 치료, 방사선 동위 원소를 이용한 방사선표적치료(PRRT) 등 모든 가능한 치료 방법을 고려하는 다학제적 접근이 중요하다고 하겠다. Pancreatic neuroendocrine tumor (PNET) refer to tumors originating from the islet of Langerhans and shows various prognosis based on the presence or absence of symptoms due to hormone secretion, the Ki-67 cell proliferation index, and the histologic grade, and according to the degree of disease progression defined by the tumor-node-metastasis (TNM) stage classification. The purpose of medical treatment for PNET is to control symptoms or inhibit tumor growth. Somatostatin analogues can be administered for the purpose of controlling symptoms caused by the secretion of specific hormones, and are accepted as effective drugs for inhibiting the progression of G1/G2 tumors based on World Health Organization (WHO) classification with a Ki- 67 cell proliferation index less than 20%. Among the molecularly targeted agents, everolimus and sunitinib can be considered in patients with WHO G1/G2 PNET showing progression after somatostatin analog therapy. Cytotoxic chemotherapy is generally administered to patients with large tumor volume and rapidly progressing metastatic NET, and etoposide/cisplatin combination therapy has been considered as a standard treatment. For the patient group of Grade 3 PNET (well differentiated) newly classified by the WHO 2017 classification, guidelines for standard treatment have not yet been established. As it has been reported, studies are needed to evaluate the treatment response rate of somatostatin analogues or molecularly targeted therapies for the patient with Grade 3 PNET. It is important to consider a multidisciplinary approach with all possible treatment options including medical treatment, radical resection of primary or metastatic lesions, liver-directed therapies, and peptide receptor radionuclide therapy for the patients with PNET. Korean J Pancreas Biliary Tract 2021;26(1):24-32