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전이성십이지장 내분비암으로 항암화학요법 시행 받고 완전 관해 1년 후 발생한 십이지장 선암 1예
( Bun Kim ),( Ji Hye Heo ),( Joo Won Jung ),( Moon Jae Chung ),( Jeong Youp Park ),( Seung Min Bang ),( Si Young Song ),( Seung Woo Park ) 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.1
위장관내분비암으로 치료 후 동일 부위에서 선암이 발생한 예는 극히 드물다. 저자들은 전이성 십이지장 내분비암으로 항암치료 받고 완전 관해 1년 후 같은 부위에서 선암이 발생하여 보고하는 바이다. 60세 남환은과거력상 30년 전 콩팥결핵으로 결핵 치료받았다. 한달 간의 전신 무력감과 흑색변으로 2009년 6월 외부병원 내원하여 시행한 검사상 십이지장암과 간전이 의심되어 본원으로 전원되었다. 내원 당시 혈압 130/80 mmHg, 맥박 92회, 체온 36.8도이었다. 일반혈액검사상 WBC 4,730/mm3, Hb12.4 g/dL, platelet 144,000/mm3, 혈청생화학검사상 Bun/Cr 17.7/1.16 mg/dL, AST/ALT 15/13IU/L이였다. 종양표지자는 CEA 0.73 ng/mL, CA 19-9 1.8U/mL이었다. 본원에서 시행한 상부위장관내시경상 십이지장의 상부하행각에 궤양융기형 덩어리가 발견되었다. 조직검사상 십이지장에서 poorly differentiated neuroendocrine carcinoma 진단되어 십이지장 내분비암 및 간전이로 2009년 11월까지 6차례 5-FU (1000 mg/m2, Day1~3)/Etoposide(100 mg/m2, Day1~3)/Cisplatin (70 mg/mg2, Day1) 항암치료 후 영상 및 상부내시경 검사상 완전관해 소견 보였으며 이후 정기적 추적관찰 중이었다. 2011년2월 시행한 상부위장관내시 경상 이전 십이지장 병변에 새롭게 생긴 용종으로 조직 검사 시행하여 선암 진단되었다. 영상 검사상 간 S6/7,S7 두군데에 전이 의심되어 intraop RFA 고려하고 2011년 2월 28일 수술 시행하였다. 십이지장 선암은 8번, 12번, 13번 림프절 확장 소견 보여 병합절제와 췌두부 절제술을 시행하였다. 수술 중 초음파로 간종괴는 찾을 수 없었으나 수술전 시행한 MRI상 간우정맥우연을 따라 종괴가 2개 관찰되어 간우후구역절 제술을 함께 시행하였다. 수술 후 병리 조직 검사상 간 조직은 염증 소견 보이고 십이지장은 선암 진단 되었다. 최종적으로 십이지장 선암은 pT1bN0M0으로 1기로 진단되어 추가 항암치료 없이 외래 경과 관찰 중이다. 저자들은 전이성 십이지장 내분비암으로 항암치료 받고 완전 관해 되었으나 1년 후 같은 부위에서 선암이 발생하여 수술 시행후 완전 절제 되어 보고하는 바이다.
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Kim, Bun,Kim, Eun Hye,Park, Soo Jung,Cheon, Jae Hee,Kim, Tae Il,Kim, Won Ho,Kim, Hoguen,Hong, Sung Pil Wolters Kluwer Health 2016 Medicine Vol.95 No.37
<P><B>Abstract</B></P><P>Though endoscopic treatment is an option for T1 colorectal cancer (CRC), the optimal indications and long-term outcomes of this strategy need to be validated. Therefore, the aim of this study is to investigate long-term outcomes of endoscopy versus surgery and optimal indications for endoscopic treatment of T1 CRC.</P><P>This retrospective study included 428 T1 CRC patients treated with initial endoscopy (n = 224) or surgery (n = 204) at Severance Hospital between 2005 and 2012. Patients were subdivided into 4 groups according to conventional indications (CIs) for endoscopic treatment: negative lateral/vertical margins; submucosal invasion depth within 1000 μm; no lymphovascular invasion (LVI); well or moderately differentiated. For prognosis evaluation, short-term outcomes (resection margin and complications) and long-term outcomes (recurrence and cancer-specific mortality) were evaluated.</P><P>Endoscopic treatment achieved en bloc resection in 86.6% of 224 patients. Recurrence and mortality did not differ between the endoscopy and surgery groups with or without CIs. For patients with CIs, although 80 patients were treated endoscopically with 1 (1.3%) recurrence and 0 mortality, 75 patients were treated surgically with 2 (2.7%) recurrence and 1 (1.3%) mortality. Multivariate analysis revealed that LVI positivity and poorly differentiated histology were independently associated with lymph node metastasis (LNM; <I>P</I> < 0.001 and <I>P</I> = 0.001, respectively).</P><P>To determine whether the depth of submucosal invasion among criteria of CIs could be extended for endoscopic treatment, LNM was analyzed by extending the depth of submucosal invasion. There was no LNM in 155 patients within conventional indication. When the depth of submucosal invasion was extended up to 1500 μm, LNM was occurred (1/197 patient [0.5%]). In addition, when the depth of submucosal invasion was extended up to 2000 μm, LNM was increased (4/271 patient [1.5%]).</P><P>Endoscopic treatment is safe, effective, and is associated with favorable long-term outcomes compared to surgery for initial treatment of T1 CRC patients with CIs. However, the risk of LNM makes it unsafe to extend the CIs for endoscopic therapy in these patients.</P>
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( Bun Kim ),( Soo Jung Park ),( Sung Pil Hong ),( Jae Hee Cheon ),( Tae Il Kim ),( Won Ho Kim ) 대한소화기학회 2015 Gut and Liver Vol.9 No.6
Background/Aims: Anemia in patients with inflammatory bowel disease significantly affects the quality of life. The aim of this study was to investigate the frequency of and risk factors for anemia and to describe the management of anemia in patients with intestinal Behcet’s disease (BD) in actual clinical practice. Methods: We included 64 patients with intestinal BD who visited the outpatient clinic of a tertiary referral center in June 2011 and had available laboratory data for the subsequent 6 months. Results: Anemia was detected in 26 patients (40.6%). After 6 months, anemia was still present in 14 of these patients (53.8%). The cause of anemia was investigated in eight patients (30.8%), and oral iron supplementation was prescribed to four patients (15.4%). Of these four patients, two (50%) recovered completely within 6 months. Anemia was associated with a high Disease Activity Index for Intestinal Behcet’s Disease (DAIBD, p=0.024), erythrocyte sedimentation rate (p=0.003), and C-reactive protein (p=0.049) in univariate analysis. In multivariate analysis, the factor predictive for anemia in patients with intestinal BD was a higher DAIBD (≥40, odds ratio, 4.08, 95% confidence interval, 1.21 to 13.71, p=0.023). Conclusions: Although anemia is common in intestinal BD patients, its clinical importance is overlooked in daily practice. Moderate to severe disease activity is predictive of anemia. (Gut Liver 2015,9:750-755)
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( Bun Kim ),( Soo Jung Park ),( Jae Hee Cheon ),( Tae Il Kim ),( Won Ho Kim ),( Sung Pil Hong ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Endoscopic treatment for early colorectal cancer (ECC) with submucosal invasion has been regarded as one of therapeutic options. However, the long-term efficacy has not been validated. Methods: A total of 428 patients with ECC who was treated with endoscopic procedures (n=224) or surgery (n=204), as an initial treatment, at Severance Hospital between January 2005 and March 2012 was included. The patients were subdivided into four groups according to the standard indication (SI) of each therapeutic modality. The SI was defined as achieving negative resection margins and satisfying three of the following criteria; (a) within 1,000 μm from muscularis mucosa; (b) no lymphovascular invasion (LVI); (c) well or moderately-differentiated histology. For prognosis evaluation, short-term outcomes (resection margin and complications) and long-term outcomes (recurrence and cancer-specific mortality) were evaluated. Results: The baseline characteristics were not different between initial endoscopic therapy and surgery in ECC patients with SI except tumor size (18.1±9.2 mm vs. 23.7±14.4 mm, p=0.005). In a total of 224 endoscopic therapies, en-bloc resection was achieved in 86.6%. For complications, delayed bleeding was occurred in one (0.4%) and bowel perforation was occurred in two (0.9%). In 204 initial surgery cases, there were seven of anastomosis site leakage (3.4%), two of intestinal obstruction (1.0%), and one case of urinary dysfunction, pneumonia and mortality (0.5%, respectively). There was no difference in recurrence and cancer-specific mortality between endoscopic therapy and surgical therapy groups with or without SI. In patients with ECC, lymph node metastasis was independently related with positive LVI and poorly-differentiated histology in multivariate analysis (p<0.001 and p=0.001, respectively). Conclusions: Endoscopic treatment with SI is a safe and an effective therapy for ECC as an initial therapeutic option with favorable long-term clinical efficacy compared to surgery.
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The Rebleeding Risk and Prognostic Factors of Acute Hemorrhagic Rectal Ulcer
( Bun Kim ),( Min Seok Han ),( Dong Hoo Joh ),( Dong Jun Lee ),( Hye Sun Shin ),( Soo Jung Park ),( Sung Pil Hong ),( Jae Hee Cheon ),( Tae Il Kim ),( Won Ho Kim ) 대한장연구학회 2012 Intestinal Research Vol.10 No.4
Background/Aims: Acute hemorrhagic rectal ulcer (AHRU) is an important etiology of lower gastrointestinal bleeding in intensive care unit patients and hospital inpatients. Moreover, with increasing elderly populations, and improved survival in critically ill patients, the incidence of AHRU has increased. The aim of this study is to determine rebleeding risk and prognostic factors of AHRU patients. Methods: We retrospectively reviewed 32 patients with AHRU in Severance Hospital from February 2006 to October 2010, collected clinical data, and analyzed their association with the recurrence of bleeding and mortality of patients. Results: The mean age of patients was 65.5 years, and 27 patients (84.4%) showed Eastern Cooperative Oncology Group performance status 3-4. Nineteen patients (59.4%) had recurrent bleeding. Hypoalbuminemia (≤2.5 g/dL) was a risk factor of rebleeding in univariate and multivariate analysis. For patients with chronic liver disease, hypoalbuminemia (≤2.5 g/dL), renal dysfunction (>2 mg/dL) and thrombocytopenia (<150,000/μL) showed relatively earlier rebleeding than those without (P=0.007, P=0.009, P=0.027 and P=0.043, respectively). The endoscopic hemostasis at the first bleeding event was associated with lower early rebleeding rate (P=0.048). In univariate analysis, chronic liver disease, hypoalbuminemia (≤2.5 g/dL) and the prolongation of activated partial thromboplastin time (>40 seconds) increased mortality (P=0.028, P=0.008 and P=0.027, respectively) and the patients with rebleeding showed a tendency toward higher mortality, compared to those without (57.9% vs. 23.1%, P=0.051). Conclusions: In AHRU patients, hypoalbuminemia was a risk factor of rebleeding, and chronic liver disease, hypoalbuminemia, renal dysfunction, thrombocytopenia and no endoscopic treatment at the first bleeding event was correlated with relatively earlier rebleeding. (Intest Res 2012;10:343-349)
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Kim, Jae Ri,Lee, Kyoung-Bun,Kwon, Wooil,Kim, Eunjung,Kim, Sun-Whe,Jang, Jin-Young The Korean Academy of Medical Sciences 2018 JOURNAL OF KOREAN MEDICAL SCIENCE Vol.33 No.42
<P><B>Background</B></P><P>Intraductal papillary neoplasm of the bile duct (IPNB) is a recently defined entity and its clinical characteristics and classifications have yet to be established. We aimed to clarify the clinical features of IPNB and determine the optimal morphological classification criteria.</P><P><B>Methods</B></P><P>From 2003 to 2016, 112 patients with IPNB who underwent surgery were included in the analysis. After pathologic reexamination by a specialized biliary-pancreas pathologist, previously suggested morphological and anatomical classifications were compared using the clinicopathologic characteristics of IPNB.</P><P><B>Results</B></P><P>In terms of histologic subtypes, most patients had the intestinal type (n = 53; 48.6%) or pancreatobiliary type (n = 33; 30.3%). The simple “modified anatomical classification” showed that extrahepatic IPNB comprised more of the intestinal type and tended to be removed by bile duct resection or pancreatoduodenectomy. Intrahepatic IPNB had an equally high proportion of intestinal and pancreatobiliary types and tended to be removed by hepatobiliary resection. Morphologic classifications and histologic subtypes had no effect on survival, whereas a positive resection margin (75.9% vs. 25.7%; <I>P</I> = 0.004) and lymph node metastasis (75.3% vs. 30.0%; <I>P</I> = 0.091) were associated with a poor five-year overall survival rate. In the multivariate analysis, a positive resection margin and perineural invasion were important risk factors for survival.</P><P><B>Conclusion</B></P><P>IPNB showed better long-term outcomes after optimal surgical resection. The “modified anatomical classification” is simple and intuitive and can help to select a treatment strategy and establish the proper scope of the operation.</P>
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