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정상 면역 환자에서 췌장암으로 오인된 원발성 췌장 칸디다증
김충현 ( Chung Hyoun Kim ),이현민 ( Hyeonmin Lee ),우창곡 ( Chang Gok Woo ),한정호 ( Joung-ho Han ),최한림 ( Hanlim Choi ),박선미 ( Seon Mee Park ) 대한소화기학회 2021 대한소화기학회지 Vol.77 No.1
Pancreatic candidiasis can develop in patients with acute pancreatitis, compromised immune responses, or iatrogenic intervention. This paper reports a case of pancreatic candidiasis presenting as a solid pancreatic mass in a patient without the risk factors. A previously healthy 37-year-old man visited the emergency department with left flank pain. Abdominal CT revealed a 5 cm, irregular heterogeneous enhancing mass accompanied by a left adrenal mass. Positron emission tomography-computed tomography and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) could not discriminate pancreatic cancer from infectious disease. A laparoscopic exploration was performed for an accurate diagnosis. After distal pancreatectomy with splenectomy and left adrenalectomy, pancreatic candidiasis and adrenal cortical adenoma were diagnosed based on the pathology findings. His condition improved after the treatment with fluconazole. This paper reports a case of primary pancreatic candidiasis mimicking pancreatic cancer in an immunocompetent patient with a review of the relevant literature. (Korean J Gastroenterol 2021;77:45-49)
김충현 ( Chung-hyoun Kim ),김선영 ( Sun-young Kim ),정창길 ( Chang-kil Jung ),최정필 ( Jung-pil Choi ),서금수 ( Keum-soo Seo ),이준호 ( Jun-ho Lee ),최제형 ( Jae-hyung Choi ) 영남대학교 의과대학 2017 Yeungnam University Journal of Medicine Vol.34 No.1
Leiomyosarcoma (LMS) of the small intestine is a rare tumor, accounting for about 1% of all malignant mesenchymal lesions in the gastrointestinal tract. Since small bowel tumors are initially asymptomatic and nonspecific, delayed diagnosis and treatment are common. We found that a 44-year-old male patient who came in for lower abdominal pain had partial obstruction in the small bowel. Multiple ascites and ileal tumors involving peritoneal seeding were observed from his abdominal computed tomography. He was diagnosed as epithelioid LMS involving peritoneal transition after surgical resection, and the outpatient department has planned for a conservative therapy with observation. To the best of our knowledge, ileal epithelioid LMS accompanying a huge omental mass, with a size of 18 cm in dimension, and peritoneal seeding has not yet been reported in Korea. We report this rare case with literature review.
윤경현 ( Kyung Hyun Yun ),송성헌 ( Sung Heon Song ),김충현 ( Chung Hyoun Kim ),황찬희 ( Chan Hee Hwang ),이준호 ( Jun Ho Lee ),최재형 ( Je Hyoung Choi ),김선영 ( Sun Young Kim ) 영남대학교 의과대학 2017 Yeungnam University Journal of Medicine Vol.34 No.2
Small cell lung carcinoma (SCLC) is a cancer that shows aggressive behavior, early spread to distant sites, and frequent association with distinct paraneoplastic syndromes. Spontaneous remission of cancer, particularly of SCLC, is a rare biological event. Cases involving spontaneous regression of SCLC were reported, and were associated with paraneoplastic syndromes of the nervous system. This article reports on a 78-yearold man with SCLC in remission, with neurological symptoms. The patient visited the hospital because of generalized weakness, and imaging studies revealed a mass in the lower lobe of the left lung, pathological evaluation showed SCLC. The patient refused oncologic treatment and was treated only with conservative care. In follow-up study the diameter of the mass had decreased from initial 32 mm, 9 months after admission to 20 mm, 17 months after admission to 13 mm. The patient kept complaining of generalized weakness, dizziness, and paresthesia of limbs. We assumed that, in this case, the spontaneous remission of lung cancer was related to the immunologic response directed against the tumor, which is believed to be an important factor in the pathogenesis of paraneoplastic neurologic syndromes.
증례 : 신장 ; 감염성 장염에 합병된 신정맥 혈전증 1예
최재혁 ( Jae Hyuc Choi ),천종운 ( Jong Woon Cheon ),강기훈 ( Kee Hoon Kang ),김승현 ( Seung Hyun Kim ),김충현 ( Chung Hyoun Kim ),윤경현 ( Kyung Hyun Yun ),서금수 ( Kum Soo Seo ) 대한내과학회 2014 대한내과학회지 Vol.87 No.6
신정맥 혈전증은 신증후군에 이차적으로 발생하는 경우가 가장 흔하다. 감염과 관련한 신정맥 혈전증의 증례는 신우신염 및 신농양에 의한 것이 간혹 보고되었다. 71세의 여자가 복통, 구토 및 수양성 설사, 발열을 주소로 내원하였다. 복부 CT에서 전반적인 소장벽의 비후와 함께 좌측 신정맥 혈전증이 발견되었다. 금식 및 항생제 치료로 감염성 장염은 금방 호전되었고 함께 발견된 신정맥 혈전증에 대하여 항응고치료를 시작하였다. 3개월 뒤 시행한 복부 CT에서 신정맥 혈전은 많이 감소되었으나 국소적으로 약간 남아 있었다. 항응고요법을 4개월 더 시행한 후 촬영한 복부 CT에서 잔여혈전은 큰 변화가 없었다. 그 후 와파린을 clopidogrel로 교체 하였고 8개월 뒤 시행한 추적 복부 CT에서 신정맥 혈전은 더 이상 보이지 않았다. Renal venous thrombosis occurs, for the most part, as secondary to nephrotic syndrome. In relation to infection, cases complicated with acute pyelonephritis and renal abscess have been reported. A 71-year-old woman was admitted due to vomiting, abdominal pain, watery diarrhea, and fever. Abdominal computed tomography (CT) revealed diffuse thickening of the small intestinal wall and left renal venous thrombosis. The enteritis rapidly resolved with conservative treatment including fasting and antibiotic therapy, anticoagulation therapy was started. After 3 months, the renal vein thrombosis had much improved, but a tiny remnant thrombus was seen on follow-up abdominal CT. After 4 months of additional anticoagulation therapy, the remnant thrombus remained unchanged, at which point warfarin was switched to clopidogrel, an antiplatelet agent, and after 8 months the remnant thrombus was no longer visible on abdominal CT. (Korean J Med 2014,87:743-746)