연구논문 : B형간염바이러스 감염과 췌장암 발생의 연관성에 관한 연구

홍승권 ( Seung Goun Hong ),김지훈 ( Ji Hoon Kim ),이영선 ( Young Sun Lee ),윤아일린 ( Eileen Yoon ),이현정 ( Hyun Jung Lee ),황진기 ( Jin Ki Hwang ),정은석 ( Eun Suk Jung ),주문경 ( Moon Kyung Joo ),정영걸 ( Young Kul Jung ),연종은 대한간학회 2010 Clinical and Molecular Hepatology(대한간학회지) Vol.16 No.1

목적: B형 및 C형간염바이러스 감염은 간세포암의 주요 위험인자이며, 간내담도암과 비호지킨 림프종의 발생에도 기여한다고 알려져 왔다. 최근 B형간염바이러스의 잠재감염이 있는 경우에 췌장암의 발생이 유의하게 높다는 보고가 있었다. 하지만 B형간염의 유병률이 높은 지역에서의 연구는 부족한 실정으로 한국과 같이 유병률이 높은 지역에서B형 및 C형간염바이러스 감염과 췌장암의 발생과 의 연관성에 대해 알아보고자 하였다. 대상 및 방법: 2003년 1월부터 2007년 12월까지 췌장암으로 진단받은 환자를 대상으로 하였고, 대조군은 그 기간 동안의 위암 환자를 대상으로 2배수의 환자를 진단 시 연령과 성별로 짝짓기하여 선정하였다. 췌장암과 위암의 진단은 조직학적 진단과 경우에 따라 영상학적 소견을 포함한 임상적 진단으로 이루어졌다. 이들의 혈청 HBsAg, anti-HCV의 양성 유무를 확인하였고, 혼란 변수의 보정을 위해 췌장암의 위험인자인 흡연, 음주, 당뇨, 만성 췌장염의 병력에 대해서도 조사하였다. 결과: 췌장암 환자는 506명이었으며 위암 환자는 1,008명으로 조직학적으로 진단된 경우는 각각 58.1%와 97.3%였다. 이들의 평균 나이는 각각 63.5±11.1세, 63.9±11.0세였고, 남녀비는 1.5:1로 연령과 성비에 차이를 보이지 않았다(P>0.05). 단변량 분석에서 HBsAg, anti-HCV양성, 당뇨, 흡연, 음주, 만성 췌장염의 병력에 대한 교차비(95% 신뢰구간)가 각각 0.90 (0.52-1.56; P=0.70), 1.87(0.87-4.01; P=0.11), 2.66(2.04-3.48; P<0.001), 2.30(1.83-2.90; P<0.001), 1.14(0.89-1.46; P=0.31), 4.40(1.66-11.66; P=0.003)이었고, 다변량 분석에서 췌장암 발생에 유의한 독립인자는 당뇨, 흡연, 만성 췌장염의 병력으로 교차비가 각각 2.67(2.00-3.56; P<0.001), 2.49(1.93-3.21; P<0.001), 4.60(1.56-13.53; P=0.006)이었다. 결론: 알려진 위험인자인 당뇨, 흡연, 만성 췌장염의 병력과 달리 HBsAg 및 anti-HCV 양성과 췌장암의 발생은 관련이 없었다. B형간염바이러스 유병률이 높은 지역에서 HBsAg 양성인 경우와 췌장암의 발생과의 관련성을 확인하기 위해 더 많은 연구가 필요할 것이다. Background/Aims: An association between past history of hepatitis B virus (HBV) infection and pancreatic cancer (PC) has recently been reported. We investigated whether HBV and hepatitis C virus (HCV) infections are associated with the development of PC in Korea. Methods: We retrospectively recruited patients with PC and sex-and, age-matched control patients with stomach cancer (SC) during the previous 5 years. Serum HBsAg and anti-HCV were examined, and data on smoking, alcohol intake, diabetes, and the history of chronic pancreatitis (CP) were collected. Results: A total of 506 PC and 1008 SC were enrolled, with respectively 58.1% and 97.3% of these cases being confirmed histologically. The mean age and sex ratio male:female) were 63.5 years and 1.5:1 in the PC patients and 63.9 years and 1.5:1 in the SC patients respectively (P>0.05). The odds ratios (95% confidence interval, 95% CI) in univariate analysis were 0.90 0.52-1.56; P=0.70) for HBsAg, 1.87 (0.87-4.01; P=0.11) for anti-HCV, 2.66 (2.04-3.48; P<0.001) for the presence of diabetes, 2.30 (1.83-2.90; P<0.001) for smoking, 1.14 (0.89-1.46; P=0.31) for alcohol intake, and 4.40 1.66-11.66; P=0.003) for the history of CP. Independent risk factors for PC were presence of diabetes (OR, 2.67; 95% CI, 2.00-3.56; P<0.001), smoking (OR, 2.49; 95% CI, 1.93-3.21; P<0.001) and history of CP (OR, 4.60; 95% CI, 1.56-13.53; P=0.006). Conclusions: There was no significant association between seropositivity for HBsAg or anti-HCV and PC. Further studies are warranted to clarify the association between HBV infection and PC in regions where HBV is endemic. (Korean J Hepatol 2010;16:49-56)

당뇨에서의 췌장암 유병률 및 췌장암과 연관된 당뇨의 임상 양상 -췌장암을 동반한 당뇨 환자와 일반 당뇨 환자의 비교-

홍승권 ( Seung Goun Hong ),김재선 ( Jae Seon Kim ),정성주 ( Sung Joo Jung ),주문경 ( Moon Kyung Joo ),이범재 ( Beom Jae Lee ),연종은 ( Jong Eun Yeon ),박종재 ( Jong Jae Park ),변관수 ( Kwan Soo Byun ),박영태 ( Young Tae Bak ) 대한소화기학회 2009 대한소화기학회지 Vol.54 No.3

Background/Aims: In Korea, the prevalence of pancreatic cancer (PC) in general population has been reported as 7 in 100,000. However, that in diabetes mellitus (DM) has not been elucidated yet. This study was designed to estimate the prevalence of PC among DM patients, and characterize and compare the patients with DM with and without PC. Methods: 5,082 patients (4,890 DM without PC, 78 PC with DM, and 114 PC without DM) were enrolled from Korea University Guro Hospital during a period of 4 years between January 2004 and January 2008. Results: The prevalence of PC in DM patients was 1.6% and that of DM in PC patients was 40.6%. No significant differences in the clinical characteristics except HbAIc and ALP were observed between PC patients with DM and without DM. Among 78 PC patients with DM, DM was diagnosed in 19 (29.4%) and 29 (37.1%) patients concomitantly or within 2 years prior to the diagnosis of PC, respectively. Among the cases with recent onset DM (less than 2 years` duration), the disease duration of DM before the diagnosis of PC was less than 1 year in 14 patients (17.9%) and 1 to 2 years in 15 patients (19.2%). DM patients with PC were found to have significantly higher ALT, total bilirubin, and ALP levels than in DM patients without PC. Conclusions: The prevalence of PC in DM patients was 1.6% and was higher than in the general population. Recent onset DM was frequent in PC patients (less than 2 years` duration). We recommend close follow-up for at least 2 years in new-onset diabetes. (Korean J Gastroenterol 2009;54:167-173)

S-21 : A Case of Primary Rectal Mature Teratoma

( Hyun Sung Park ),( Seung Goun Hong ),( Se Young Jung ),( Shin Myung Kang ),( Sung Hak Lee ),( Kyoung Yong Lee ),( Woo Cho Chung ) 대한내과학회 2013 대한내과학회 추계학술대회 Vol.2013 No.1

Background: A mature teratoma composed of normal derivatives of all three germ layers commonly occurs in ovaries, testes and mediastinum. Mature teratoma affecting the gastrointestinal tract is rare. We report a rare case of primary rectal mature teratoma presenting with lower abdominal discomfort, and surgically resected. Case Report: A 65 year-old woman presented with lower abdominal discomfort started about 2 months ago. Colonoscopy revealed a protruded lesion with a long stalk which looked like a submucosal tumor at about 12 cm from anal verge in the upper rectum. Abdomen CT revealed a 3.6 cm sized fatty mass with internal nodular calcifications located in the rectosigmoid junction. Endoscopic ultrasound revealed about 4 cm-sized hyperechoic, heterogeneous mass with irregular border in an exophytic pattern. Fine-needle aspiration biopsy failed due to hard nature of the mass. The patient had a surgery, and the intraluminal mass was connected to 1.5 cm sized protruding mass outside the serosa. On microscopic examination, the tumor was entirely covered with squamous epithelium and sections showed squamous epithelium, skin appendage, apocrine glands, hair follicle, bronchial epithelium, and bone. Conclusion: Teratoma should be strongly suspected during colonoscopy if hair is seen on the surface of the mass lesion. Because malignant transformation of mature teratoma is uncommon, a minimally invasive surgery or endoscopic polypectomy are usually performed.

A Case of Malignant Granular Cell Tumor in the Sigmoid Colon

Sang Myung Choi,Seung Goun Hong,Shin Myung Kang,Byung Gi Chae,Sung Jin Kim,Pyung Kang Park,Hyun Sung Park 대한소화기내시경학회 2014 Clinical Endoscopy Vol.47 No.2

Granular cell tumor (GCT) is an uncommon, usually benign neoplasm; however, a malignant potential has been described. MalignantGCT is an extremely rare neoplasm showing rapid growth and invasion into adjacent muscles, lymph nodes, or vessels, or even distantmetastasis. We recently experienced a case of a histologically benign or atypical but clinically malignant GCT, with invasion of the lymphnodes and vessels in the sigmoid colon, diagnosed by segmental colon resection with lymph node dissection. We also performed a reviewof relevant medical literature.

Image and Learning : Butterfly in the Esophagus: What Is Wrong?

( Jin Ki Hwang ),( Seung Goun Hong ),( Moon Kyung Joo ),( Jong Jae Park ),( Jae Seon Kim ),( Young Tae Bak ) 대한소화관운동학회 2010 Journal of Neurogastroenterology and Motility (JNM Vol.16 No.1

Delayed Severe Hemobilia after Endoscopic Biliary Plastic Stent Insertion

Sung Hak Lee,Seung Goun Hong,Kyoung yong Lee,Pyung Kang Park,Sung Du Kim,Mahn Lee,Dong Wook Yu,Man Yong Hong 대한소화기내시경학회 2016 Clinical Endoscopy Vol.49 No.3

Hemobilia is a rare gastrointestinal bleeding, usually caused by injury to the bile duct. Hemobilia after endoscopic retrograde cholangiopancreatography (ERCP) is generally self-limiting and patients will spontaneously recover, but some severe and fatal hemorrhages have been reported. ERCP-related bowel or bile duct perforation should be managed promptly, according to the type of injury and the status of the patient. We recently experienced a case of late-onset severe hemobilia in which the patient recovered after endoscopic biliary stent insertion. The problem was attributable to ERCP-related bile duct perforation during stone removal, approximately 5 weeks prior to the hemorrhagic episode. The removal of the stent was performed 10 days before the onset of hemobilia. The bleeding was successfully treated by two sessions of transarterial coil embolization.

A Case of Primary Mature Teratoma of the Rectum

Hyun Sung Park,Seung Goun Hong,Se Young Jung,Shin Myung Kang,Kyoungyong Lee,Dong Wook Yu 순천향대학교 순천향의학연구소 2014 Journal of Soonchunhyang Medical Science Vol.20 No.1

A mature teratoma is a tumor composed of normal derivatives of all three germ layers, and usually occurs in ovaries, testes, or mediastinum. Mature teratoma of the gastrointestinal tract occurs less frequently, and case reports of primary mature teratoma of the rectum have not been published much. Here, we report a 65-year-old woman patient presented with lower abdominal discomfort. Colonoscopy revealed a pedunculated polypoid tumor arising from the rectum with hairs on its surface, and endoscopic ultrasound revealed an exophytic pattern bulging from the serosa. The tumor was removed surgically and confirmed histologically as a benign, primary mature teratoma of the rectum.

췌장 두부 종양의 내시경 초음파 유도 가는 바늘 생검 후 위십이지장동맥 가성동맥류에서 발생한 지연성 출혈

두영재 ( Young Jae Doo ),홍승권 ( Seung Goun Hong ) 대한췌담도학회 2018 대한췌담도학회지 Vol.23 No.4

내시경 초음파 유도 가는 바늘 생검은 췌담도 질환의 진단 영역에서 잘 알려진 안전한 시술이다. 심각한 천공, 췌장염, 출혈, 감염의 합병증은 드물게 보고되고 있다. 시술 후에 발생한 지연성 출혈의 보고는 매우 드물고, 시술 후 가성 동맥류으로 인한 지연성 출혈의 보고는 저자가 알기로는 없는 것으로 알고 있다. 저자는 췌장의 고형성 병변에 대한 내시경 초음파 가는 바늘 생검 후에 발생한 위십이지장 동맥 가성 동맥류로 인한 지연성 출혈을 보고한다. 68세 남자 환자가 췌장두부에 15 mm가량의 종양으로 시술 10일 후에 흑색변을 주소로 재방문하였다. 당시 복부 전산화단층촬영을 시행하였고, 2 cm 가량의 조영증강의 둥근 병변이 췌장의 두부에서 확인되었고, 조직 검사 결과는 악성을 시사하지 않았다. 환자에게 추가 검사를 위하여 입원을 권유하였으나 거부하였다. 12일 후에 환자는 반복되는 흑색변을 주소로 응급실에 재방문하였다. 혈관조영술에서 위십이지장동맥 가성동맥류 소견 및 코일 색전술을 시행한 후 성공적으로 지혈하였다. 환자는 유문 보존 췌십이지장 절제술을 받았고, 병기는 IIB 췌장암으로 진단되었다. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a well-established procedure for the diagnosis of pancreatobiliary disease. Serious complications such as perforation, pancreatitis, hemorrhage, and sepsis are rarely reported. To our knowledge, delayed hemorrhage after EUS-FNA is very rare and hemorrhage from iatrogenic pseudoaneurysm has yet to be reported. We report a case of delayed hemorrhage from gastroduodenal artery pseudoaneurysm, which developed after EUS-FNA of a solid pancreatic lesion. A 68-year-old man presented with tarry stool 10 days after EUS-FNA of a 1.5 cm-sized pancreatic head mass. Abdominal computed tomography showed a 2-cm-sized intensely enhancing round lesion near pancreatic head. EUS-FNA was negative for malignancy. The patient refused admission for further evaluation. Twelve days later, he reported to the emergency room with persistent tarry stool. Angiography showed a gastroduodenal artery pseudoaneurysm. Subsequent coil embolization resulted in successful hemostasis. The patient underwent pylorus-preserving pancreaticoduodenectomy and was diagnosed with stage IIB pancreatic cancer. Korean J Pancreas Biliary Tract 2018;23(4):165-171

이차 병원 건강검진자의 바렛식도 유병률 및 분문부 장상피화생과의 비교 연구

최철영 ( Cheul Young Choi ),서승철 ( Seung Chul Suh ),박재석 ( Jae Serk Park ),이현정 ( Hyun Jeong Lee ),이종섭 ( Jong Sup Lee ),최효선 ( Hyo Sun Choi ),박현성 ( Hyun Sung Park ),홍승권 ( Seung Goun Hong ) 대한소화기학회 2012 대한소화기학회지 Vol.60 No.4

Background/Aims: The purpose of this study was to estimate the prevalence of Barrett`s esophagus (BE) and its association with reflux esophagitis (RE) and peptic ulcer disease detected by free charge endoscopy which was covered by the National Health Insurance at a secondary care hospital, and to compare the results of the biopsy of BE with that of cardiac intestinal metaplasia (CIM). Methods: A total of 4,002 patients underwent endoscopy from March 2010 to December 2012. BE was diagnosed if there was histologically proven specialized intestinal metaplasia, and CIM was diagnosed if intestinal metaplasia was accompanied with chronic gastritis. Results: Four hundred twenty four patients underwent endoscopic biopsy, and the prevalence of BE was 1.0% (42/4,002), The mean age and the proportion of males in BE were significantly higher than those of the rest of study population, and BE had slight tendency related to RE than the rest of study population, CIM was observed in 34 patients and BE and CIM showed similar results, regarding age, sex and association with RE. The mean length of endoscopic Barrett`s mucosa of BE group was 9.2±5.1 mm, and it was similar to that of CIM. Conclusions: The prevalence of BE in the secondary care hospital was not low, and old age and male sex were significantly associated with BE. Because BE was observed in about 10% of biopsied patients and CIM was observed in a similar percentage with BE, the precise targeted biopsy is warranted and the biopsy method should be reestablished through the large prospective study of multiple secondary care hospitals.

남성 궤양성 대장염 환자에서 발생한 흉벽의 괴저성 농피증

최만기 ( Man Ki Choi ),정영주 ( Yeong Joo Jeong ),홍승권 ( Seung Goun Hong ) 대한내과학회 2021 대한내과학회지 Vol.96 No.1

Ulcerative colitis, an inflammatory bowel disease, often exhibits extra-intestinal manifestations including various dermatological problems. Pyoderma gangrenosum (PG) is a painful ulcerative cutaneous disorder characterized by the development of rapidly enlarging nodules. The lesion may become aggravated when ulcerative colitis is active, and it commonly affects the extensor surfaces of the lower extremities but rarely the upper extremities, face, periauricular area, anterior chest, back, or buttocks. We encountered a rare case of PG of the chest wall near the left breast, on the face and pretibial area of a male patient with ulcerative colitis. He had not undergone breast surgery and had no history of trauma. The lesion and symptoms were successfully treated by steroid and mesalazine; there was no need for surgery or more potent drugs. (Korean J Med 2021;96:59-63)