Cisplatin-Based Combination Chemotherapy for Advanced Hepatocellular Carcinoma: A Single Center Experience before the Sorafenib Era

김내유,선종무,김유정,이근욱,김지현,방수미,김진욱,정숙향,이종석 대한암학회 2010 Cancer Research and Treatment Vol.42 No.4

Purpose Systemic chemotherapy is the only option for patients with unresectable/metastatic hepatocellular carcinoma (HCC) who are not candidates for local/regional treatment. However, the response to such treatment and survival are poor, especially in hepatitis B virus (HBV) endemic areas. The aim of this study was to determine the efficacy of cisplatin-based combination chemotherapy and identify a subgroup of advanced HCC patients with favorable responses. Materials and Methods The medical records of all consecutive patients with unresectable/metastatic HCC who received cisplatin-based combination chemotherapy between January 2003 and October 2009 were reviewed. Time to progression (TTP) and overall survival (OS) were determined using Kaplan-Meier analysis. Univariate and multivariate analyses were performed to identify prognostic factors for TTP and OS. Results Data for 46 patients were analyzed. First-line chemotherapies consisted of cisplatin-based combination treatment with doxorubicin, fluoropyrimidines and gemcitabine. The response rate for all patients was 4.3%. The median TTP and OS were 1.8 (95%confidence interval [CI], 1.1 to 2.5) and 7.2 (95% CI, 3.0 to 11.5) months, respectively. Eastern Cooperative Oncology Group (ECOG) performance status (PS), Child classification, Cancer of the Liver Italian Program (CLIP) score and portal vein thrombosis (PVT) were identified by univariate analyses as prognostic factors for TTP and OS. ECOG PS (hazard ratio [HR], 4.51; 95%CI, 1.61 to 12.6; p=0.004) and PVT (HR, 2.12; 95%CI, 1.10 to 4.11; p=0.026) were independent prognostic factors for TTP. Conclusion Cisplatin-based combination chemotherapy in patients with advanced HCC has a low response rate and short TTP regardless of the chemotherapy regimen used. Patients with a good ECOG PS and without PVT can be considered candidates for cisplatin-based combination chemotherapy.

Multiple Myeloma with Biclonal Gammopathy Accompanied by Prostate Cancer

김내유,공수정,김지명,윤선민,이정애 대한진단검사의학회 2011 Annals of Laboratory Medicine Vol.31 No.4

We report a rare case of multiple myeloma with biclonal gammopathy (IgG kappa and IgA lambda type) in a 58-year-old man with prostate cancer who presented with lower back pain. Through computed tomography (CT) imaging, an osteolytic lesion at the L3 vertebra and an enhancing lesion of the prostate gland with multiple lymphadenopathies were found. In the whole body positron emission tomography-computed tomography (PET-CT), an additional osteoblastic bone lesion was found in the left ischial bone. A prostate biopsy was performed, and adenocarcinoma was confirmed. Decompression surgery of the L3 vertebra was conducted, and the pathologic result indicated that the lesion was a plasma cell neoplasm. Immunofixation electrophoresis showed the presence of biclonal gammopathy (IgG kappa and IgA lambda). Bone marrow plasma cells (CD138 positive cells) comprised 7.2% of nucleated cells and showed kappa positivity. We started radiation therapy for the L3 vertebra lesion, with a total dose of 3,940 cGy, and androgen deprivation therapy as treatment for the prostate cancer.

유방 침범을 동반한 원발성 자궁경부림프종 1예

김내유 ( Nae Yu Kim ),조인성 ( In Sung Cho ),공수정 ( Soo Jung Gong ),이미란 ( Mee Ran Lee ),박미자 ( Mee Ja Park ),임춘화 ( Chun Hwa Ihm ),이정애 ( Jung Ae Lee ) 대한내과학회 2008 대한내과학회지 Vol.74 No.4

자궁경부에서 발생하는 악성 림프종은 그 발생이 매우 드물고 질도말검사 등으로 진단이 어려우므로 진단이 늦어져 적절한 치료시기를 놓칠 수 있다. 질출혈, 골반동통 등의 자궁병변을 의심할 수 있는 증상을 보일때 림프종의 가능성을 염두에 두고 조직검사를 통한 조직학적, 면역학적인 확진이 필요하고, 이차 병소의 침범을 확인하기 위하여 양전자 방사 단층 촬영 등을 통한 정확한 병기 결정이 필수적이라 생각한다. 저자들은 성교 후 비정상 질출혈을 주소로 내원한 32세 여자 환자에서 유방 침범을 동반한 미만성 대세포형의 원발성 자궁경부림프종 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Primary lymphoma arising from the uterine cervix has been rarely encountered, and breast involvement is rare because of the relative paucity of lymphoid tissue in the breast. A 32-year-old woman with a primary malignant lymphoma of the uterine cervix and breast involvement is reported. The patient presented with post-coital vaginal bleeding, and punch biopsy of the cervix revealed the diffuse large B cell type of malignant lymphoma. PET-scan was done for staging, and abnormal FDP uptakes were detected in a uterine cervical mass and breast nodule. Ultrasonography-guided needle biopsy was done for the breast mass, and 2 biopsied nodules revealed fibroadenoma and diffuse large B cell lymphoma. The patient (Ann Arbor stage IV) was treated with 6 cycles of combination chemotherapy with CHOP plus rituximab. The patient went into complete remission. Thereafter, 4500cGy pelvic irradiation was done for adjuvant therapy.(Korean J Med 74:435-440, 2008)

Analysis of PAX8 immunohistochemistry in lung cancers: a meta-analysis

정재한,김내유,표정수 대한병리학회 2020 Journal of Pathology and Translational Medicine Vol.54 No.4

Background: In this meta-analysis, we aimed to evaluate the PAX8 immunohistochemical expressions in primary lung cancers and metastatic cancers to the lung. Methods: We identified and reviewed relevant articles from the PubMed databases. Ultimately, 18 articles were included in this meta-analysis. PAX8 expression rates were analyzed and compared between primary and metastatic lung cancers. Results: The PAX8 expression rate in primary lung cancers was 0.042 (95% confidence interval [CI], 0.025 to 0.071). PAX8 expression rates of small cell (0.129; 95% CI, 0.022 to 0.496) and non-small cell carcinomas of the lung (0.037; 95% CI, 0.022 to 0.061) were significantly different (p = .049 in a meta-regression test). However, the PAX8 expression rates of adenocarcinoma (0.013; 95% CI, 0.006 to 0.031) and squamous cell carcinoma (0.040; 95% CI, 0.016 to 0.097) were not significantly different. PAX8 expression rates of metastatic carcinomas to the lung varied, ranging from 1.8% to 94.9%. Metastatic carcinomas from the lung to other organs had a PAX8 expression rate of 6.3%. The PAX8 expression rates of metastatic carcinomas from the female genital organs, kidneys, and thyroid gland to the lung were higher than those of other metastatic carcinomas. Conclusions: Primary lung cancers had a low PAX8 expression rate regardless of tumor subtype. However, the PAX8 expression rates of metastatic carcinomas from the female genital organs, kidneys, and thyroid were significantly higher than those of primary lung cancers.

Regression of a Mucosa-Associated Lymphoid Tissue Lymphoma of the Urinary Bladder After Helicobacter pylori Eradication Therapy in an Elderly Patient

박준형,김내유,이정애,임창범,송영웅,김영훈,김소리,김종우,신상호,공수정 대한노인병학회 2015 Annals of geriatric medicine and research Vol.19 No.4

Primary low-grade lymphoma of the mucosa-associated lymphoid tissue (MALT) type lymphoma of the bladder is rare. A relationship between MALT lymphoma of the urinary bladder and chronic cystitis has been proposed by some reports. Additionally a relationship between MALT lymphoma of the urinary bladder and Helicobacter pylori has been reported. Here we present a case of regression of urinary bladder MALT lymphoma after antibiotic therapy, using H. pylori eradication protocol in an elderly patient, who had a high risk of treatment related mortality in curative systemic chemotherapy. The patient is a 74-year-old woman who had a history of chronic cystitis. She was diagnosed with stage IIA primary MALT lymphoma of the urinary bladder and was treated with H. pylori eradication triple therapy for 2 weeks. After 2 months, there was a marked regression of the bladder MALT lymphoma lesion in a computed tomography scan of the abdomen.

Prognostic Role of Claudin-1 Immunohistochemistry in Malignant Solid Tumors: A Meta-Analysis

표정수,김내유,조원진 대한병리학회 2019 Journal of Pathology and Translational Medicine Vol.53 No.3

Background: Although the correlation between low claudin-1 expression and worse prognosis has been reported, details on the prognostic implications of claudin-1 expression in various malignant tumors remain unclear. The present study aimed to elucidate the prognostic roles of claudin-1 immunohistochemistry (IHC) in various malignant tumors through a meta-analysis. Methods: The study included 2,792 patients from 22 eligible studies for assessment of the correlation between claudin-1 expression and survival rate in various malignant tumors. A subgroup analysis based on the specific tumor and evaluation criteria of claudin-1 IHC was conducted. Results: Low claudin-1 expression was significantly correlated with worse overall survival (OS) (hazard ratio [HR], 1.851; 95% confidence interval [CI], 1.506 to 2.274) and disease-free survival (DFS) (HR, 2.028; 95% CI, 1.313 to 3.134) compared to high claudin-1 expression. Breast, colorectal, esophageal, gallbladder, head and neck, and lung cancers, but not cervical, liver or stomach cancers, were significantly correlated with worse OS. Breast, colorectal, esophageal, and thyroid cancers with low claudin-1 expression were associated with poorer DFS. In the lower cut-off subgroup (< 25.0%) with respect to claudin-1 IHC, low claudin-1 expression was significantly correlated with worse OS and DFS. Conclusions: Taken together, low claudin-1 IHC expression is significantly correlated with worse survival in various malignant tumors. More detailed criteria for claudin-1 IHC expression in various malignant tumors are needed for application in daily practice.

Response to Comment on “Prognostic Role of Claudin-1 Immunohistochemistry in Malignant Solid Tumors: A Meta-Analysis”

표정수,김내유,조원진 대한병리학회 2019 Journal of Pathology and Translational Medicine Vol.53 No.6

Diffuse Large B-Cell Lymphoma Arising within Ileal Neobladder: An Expanding Spectrum of Diffuse Large B-Cell Lymphoma Associated with Chronic Inflammation

이혜경,신현빈,김내유,박현식,박진성 대한암학회 2019 Cancer Research and Treatment Vol.51 No.4

Diffuse large B-cell lymphoma associated with chronic inflammation (DLBCL-CI), specifically arising in ileal neobladder, is a rare neoplasm. We present an unusual case of Epstein– Barr virus (EBV)–positive DLBCL-CI arising within neobladder with detailed clinical, histological, and immunophenotypical features in an immunocompetent patient. An 88-year-old male was admitted for gross hematuria. He had undergone radical cystectomy and ileal neobladder 17 years ago for invasive bladder cancer. Computed tomography showed enhancing lesions on dome and posterior wall of neobladder with mucosal thickening and multiple enlarged retroperitoneal lymphadenopathies. Transurethral resection of neobladder lesion revealed the diffuse infiltration of large lymphoid cells which were positive for CD20, CD30, and multiple myeloma oncogen-1 with EBV-encoded small RNAs co-localizing, and diagnosis of EBV-positive DLBCL-CI was made. After multi-agent chemotherapy, the lesion disappeared. We suggest that clinicians should consider the possibility of DLBCL-CI in patients presented with hematuria during follow-up after bladder reconstruction.

완전 관해된 미만성 거대 B 세포 림프종 환자에서 이차암으로 발생한 결절성 변연부 B 세포 림프종 1 예

공수정,이정애,김내유,이지현 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.-

완전 관해된 미만성 거대 B 세포 림프종 환자에서 이차암으로 발생한 결절성 변연부 B 세포 림프종 1 예

이지현,공수정,이정애,김내유 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.1

서론: 미만성 거대 B 세포 림프종 (Diffuse large B cell lymphoma, 이하 DLBCL)은 치료 직후 2년내에 재발이 흔해 치료 종료 5년까의 추적관찰을 요하며 5년 완전 관해 이후의 재발은 흔치 않은 것으로 알려져 있다. 한편 한국인에서 타장기 침범 없이 림프절에서 발한 결절성 변연부 B 세포 림프종(Nodal marginal zone B cell lymphoma, 이하 NMZL)은 전체 비호지킨 림프종의 0.6%를 차지하는 드문 림프이다. 저자들은 2004년 DLBCL을 진단받고 항암화학요법 시행 후 완전 관해로 경과 관찰하던 중 2010년 우측 경부의 종괴를 주소로 내원하여 시행한 조직검사에서 NMZL로 진단된, 비호지킨 림프종 치료 후 드문 아형(subtype)의 림프종으로 발생된 이차암 (Second primary cancer) 환자증례를 보고하고자 한다. 증례: 2010년 6월, 68세 남자 환자가 약 1개월 전부터 시작된 압통을 동반하지 않은 우측 경부 종괴를 주로 내원하였다. 환자는 2004년 12월, 점진적인 호흡 곤란을 주소로 내원하여 DLBCL 진단받고 2005년 6월까지 6회 RCHOP 항암화학요법을 시행받았다. 그 후 주기적으로 컴퓨터 단층촬영 및 PET-CT를 시행 받았고 완전 관해 되었다. 우측 경부 종괴는 재발이 의심되어 조직검를 시행받았으며, 미만성으로 작은 림프구의 침윤 소견이 보이고 CD20(+), CD3(-), CyclinD1(-) 및 Ki-67에 중등도 양성 (20%)이 관찰되어MZL로 진단되었다. 환자는 컴퓨터 단층촬영 및 PET-CT를 시행 받았으며, 다른 고형장기의 침범 없이 림프절만 침범한 소견이 보여 NMZL로 단되었고, 6회 IMEP (Ifosfamide/Methotrexate/Etoposide/Prednisone) 화암화학요법 시행 받은 후 현재까지 완전 관해를 보이고 있다. 결론: 비호지킨 림프종 치료 후 이차암 발생율은 보고자에 따라 차이가 있어 1.32-8.77%이며, 이중 대부분은 폐암, 유방암과 같은 고형암이며, 이차암으로 비호지킨 림프종의 발생율은 매우 낮은 것으로 보고되고 있다. 특히 NMZL은 MALT 림프종 중 림프절외 (extranodal) 병변 없이 림절침범을 주증상으로 하는 드문 질환으로, NMZL에서는 치료 후 추적 관찰중에 DLBCL로의 조직학적 변환 (histologic transformation)을 보이기도 하지만 본 증례에서처럼 완전 관해된 DLBCL에서 NMZL의 발생은 보고 된 적이 없다. 최초 비호지킨 림프종 진단시 진행된 병기가 차암 발생의 가장 큰 위험 요소로 생각되고 있어, 고위험군에서는 5년 추적 관찰 후에도 재발 및 이차암 발생 가능성에 주의 깊은 관을 요한다. 저자들은 완전 관해된 비호지킨 림프종에서 다른 아형의 비호지킨 림프종으로의 이차암 발생 환자의 드문 예를 경험하여 이에 고하는 바이다.