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담관을 침범한 간세포암을 경동맥 화학색전술로 치료한 증례
김희언 ( Hee Yeon Kim ),김창욱 ( Chang Wook Kim ),이창돈 ( Chang Don Lee ),이수림 ( Soo Lim Lee ),원유동 ( Yoo Dong Won ),김예일 ( Ye Il Kim ) 대한간암학회 2013 대한간암학회지 Vol.13 No.2
A 53-year-old female patient visited our hospital complaining of intermittent right upper quadrant pain for 6 months. Computed tomography (CT) scan revealed an irregular shaped tumor at segment 4 of the liver with biliary tumor thrombi extending into the common bile duct. Percutaneous transhepatic biliary drainage was done for decompression of bile duct dilatation. The patient underwent 6 sessions of transarterial chemoembolization (TACE). Partial response was obtained shortly after TACE. However, regrowth of intraductal tumor resulted in an obstructive jaundice. After a slight decompression of the obstructive jaundice, the patient underwent TACE. Jaundice temporarily worsened following the TACE, but improved, and follow-up CT demonstrated some shrinkage of the intraductal mass. This case indicates that obstructive-type jaundice may not be a contraindication for TACE, and aggressive TACE may improve prognoses of patients with hepatocellular carcinoma and biliary tumor thrombi.
조직학적으로 진단된 비알코올 지방간질환에서의 악성 종양 발생 위험
김희언 ( Hee Yeon Kim ) 대한소화기학회 2021 대한소화기학회지 Vol.78 No.6
최근 비알코올 지방간질환에서 간세포암종이나 간 외악성 종양의 발생 빈도가 높아진다는 연구 결과가 많이 보고되고 있다.1-3 그러나, 연구 대상수가 적거나 비알코올 지방간질환의 중증도를 평가하는 표준이 되는 간 조직 소견이 없는 경우가 많았다. 이에 Simon 등4은 스웨덴에서 1966년부터 2016년까지 조직학적으로 진단된 비알코올 지방간질환 환자 8,892명을 대상으로 코호트 연구를 시행하였다. 지방간질환은 조직학적 소견에 따라 단순 지방간(5,959명, 66.8%), 섬유화가 없는 지방간염(1,050명, 11.8%), 간경변증이 없는 섬유화(1,400명, 15.7%), 간경변증(503명, 5.7%)으로 분류하였다. 각각의 비알코올 지방간질환 환자는 연령, 성별, 연도, 주(county)에 따라 비알코올지방간질환이 없는 일반 인구 대조군 39,907명과 매칭되었다. 13.8년의 중앙 관찰 기간 동안 비알코올 지방간질환 환자에서는 1,691건, 대조군에서는 6,733건의 악성 종양이 발생하였다. 대조군에 비해 비알코올 지방간질환 환자에서 악성 종양 발생위험도가 유의하게 높았는데(10.9 vs. 13.8/1,000인년; 보정위험비 1.27 [95% 신뢰구간 1.18-1.36]), 주로 간세포암종 발생 위험도가 높았다(보정위험비 17.08 [95% 신뢰구간 11.56-25.25]). 간세포암종 발생 비율은 단순 지방간, 섬유화가 없는 지방간염, 간경변증이 없는 섬유화, 간경변증 그룹으로 갈수록 증가하였고(각각 0.8/1,000인년, 1.2/1,000인년, 2.3/1,000인년, 6.2/1,000인년; Ptrend<0.01), 당뇨가 있을 때 발생 위험도가 더욱 높아졌다(각각 1.2/1,000인년, 2.9/1,000인년, 7.2/1,000인년, 15.7/1,000인년). 반면에, 비알코올 지방간질환은 췌장암, 신장 및 방광암, 흑색종의 위험도는 약간이지만 통계적으로 유의하게 증가시키고, 다른 종류의 악성 종양의 위험도는 증가시키지 않았다. 이러한 대규모의 연구로 비알코올 지방간질환의 존재 및 조직학적 중등도에 따른 악성 종양 발생 위험도를 정량적으로 추정할 수 있었다. 결론적으로 조직학적으로 증명된 비알코올 지방간질환 환자는 대조군에 비해 악성 종양 발생 빈도가 유의하게 증가하였는데, 주로 간세포암종 발생 위험이 증가하는 것과 관련되었고, 간 외 악성 종양이 기여한 바는 그리 크지 않았다. 간세포암종의 위험도는 간경변증에서 가장 높았지만, 간경변증이 없는 섬유화와 당뇨병이 동반된 경우에도 상당히 위험도가 높았다. 이러한 내용을 근거로 하여 비알코올 지방간질환 환자에서 간세포암종 발생 위험도가 높은 환자군에서는 개별화된 간세포암종 선별 검사가 필요할 것으로 보인다.
수술 후 조기에 재발하여 경동맥화학색전술로 완치된 간세포암종 증례
김희언 ( Hee Yeon Kim ),김창욱 ( Chang Wook Kim ),김성근 ( Sungkeun Kim ),이수림 ( Soo Lim Lee ),구영미 ( Young Mi Ku ),원유동 ( Yoo Dong Won ) 대한간암학회 2018 대한간암학회지 Vol.18 No.2
Although surgical resection is a curative treatment option for solitary hepatocellular carcinoma, high recurrence rate contributes to dismal long-term prognosis after curative resection. Early recurrence within 2 years after surgery is associated with intrahepatic metastasis of primary tumor. Liver regeneration after hepatic resection can accelerate tumorigenesis in remnant liver. Treatment strategies for intrahepatic recurrence after curative resection include salvage transplantation, repeated resection, local ablation, and transarterial chemoembolization (TACE). Here, we report a 51-year-old male who was presented with a single large tumor located at segment 4. The patient was initially treated with surgical resection, but intrahepatic recurrence occurred only 4 months after surgery. He achieved complete remission with repeated TACE and has survived without recurrence for 4 years so far. (J Liver Cancer 2018;18:162-167)
김희언 ( Hee Yeon Kim ),곽승기 ( Seung Ki Kwok ),김완욱 ( Wan Uk Kim ) 대한류마티스학회 2009 대한류마티스학회지 Vol.16 No.1
Dermatomyositis is an idiopathic inflammatory myopathy with characteristic cutaneous lesions and progressive symmetric proximal muscle weakness. An association between dermatomyositis and malignancy has long been reported on. A 73 year-old male patient with had biopsy-proven prostate cancer presented with typical skin lesions and proximal muscle weakness. On the laboratory findings, the muscle enzymes were prominently elevated. EMG and muscle biopsy showed typical findings that were consistent with dermatomyositis. The patient was successfully treated with systemic steroid, intravenous immunoglobulin and methotrexate. In Korea, dermatomyositis is frequently complicated by stomach, lung and breast cancers. To the best of our knowledge, this is the first Korean report of dermatomyositis accompanied by prostate cancer. Here, we describe the case of dermatomyositis with prostate cancer and we briefly review the relevant literatures.
간문맥혈전을 동반한 침윤성 간세포암에서 경피적 경간 폐색술 후 장간맥 혈전의 진행
김희언 ( Hee Yeon Kim ),박정화 ( Chung Hwa Park ),이승원 ( Sung Won Lee ),송도선 ( Do Seon Song ),송명준 ( Myeong Jun Song ),최종영 ( Jong Young Choi ),윤승규 ( Seung Kew Yoon ),배시현 ( Si Hyun Bae ),오정석 ( Jung Suk Oh ),천호종 대한간암학회 2012 대한간암학회지 Vol.12 No.2
Percutaneous transhepatic obliteration of gastroesophageal varices is one of the effective emergency procedure when endoscopic therapy is not indicated or has been failed. One of the major complications of this procedure is portal thrombosis. A 53-year-old male with hepatitis B virus infection was diagnosed of infiltrative hepatocellular carcinoma with right portal vein thrombosis. On the next day after being hospitalization, the patient developed variceal bleeding. With medical management, endoscopic therapy was initially attempted, however, it ended in failure. Emergency percutaneous transhepatic obliteration of bleeding gastroesophageal varices was considered as a next option. Bleeding from gastroesophageal varices was stopped after percutaneous obliateration, however, portal thrombosis was extended to splenic vein or superior mesenteric veins.
김희언 ( Hee Yeon Kim ),김창욱 ( Chang Wook Kim ),이창돈 ( Chang Don Lee ),이수림 ( Su Lim Lee ),원유동 ( Yoo Dong Won ),김예일 ( Ye Il Kim ) 대한간암학회 2014 대한간암학회지 Vol.14 No.1
A 50-year-old male patient visited for further evaluation of arterial enhancing nodules in cirrhotic liver. Computed tomography (CT) scan revealed vaguely nodular, arterial phaseenhancing nodules at segment 8 of the liver with cirrhotic background. Magnetic resonance imaging (MRI) showed four small nodules with early work-up enhancement in arterial phase and rapid washout. Angiography showed hypervascular nodular stains. Hepatocellular carcinoma (HCC) was diagnosed according to the noninvasive diagnostic criteria for HCC. A positron emission tomography (PET) scan was done for staging work-up, and increased uptake was noted in rectum. Subsequently, sigmoidoscopy revealed an ulceroinfiltrative lesion encircling the lumen of the rectosigmoid junction. Laparoscopic low anterior resection with wedge resection of liver was done, suspecting concurrent primary tumors of the rectum and liver. Pathologic examination demonstrated moderately differentiated adenocarcinoma in both rectum and liver, suggesting metastatic rectal carcinoma. The present case indicates that metastatic carcinoma as well as HCC should be considered in the differential diagnosis of irregularly enhancing small nodules even in high-risk patient group for HCC.