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피부 편평세포암 및 전이의 임상조직학적 관찰(2006∼2016)
송성은 ( Sung Eun Song ),노기웅 ( Ki Woong Ro ),허은필 ( Eun Phil Heo ) 대한피부과학회 2017 大韓皮膚科學會誌 Vol.55 No.3
Background: Cutaneous squamous cell carcinoma (cSCC) is a malignant proliferation of keratinocytes of the epidermis. It may have the potential to metastasize distally in contrast to the cutaneous basal cell carcinoma. Objective: We investigated the recent trend of cSCC development from a clinical, histopathological, and prognostic perspective. Methods: One hundred and sixty cases of cSCC in patients who had visited the Samsung Changwon Hospital over the past 10 years (between 2006 and 2016) were retrospectively studied. We analyzed their age, sex, location, etiologic factor, histopathologic finding, and treatment. Results: The average age of cSCC was 77 years old and the sex ratio was 1:2.27. The most commonly involved location was the head and neck (73.13%). The etiologic factors were unknown (61.88%), actinic keratosis (23.13%), Bowen`s disease (10.63%), burn scar (2.5%), chronic eczema (0.63%) and chronic inflammatory disease (0.63%). The average tumor diameter and thickness were 18.1 mm and 3.58 mm, respectively. The degrees of differentiation were well-differentiated (68.75%), moderately differentiated (28.75%) and poorly differentiated (2.5%). The occurrence rate of cSCC metastasis was 6.25% (10 cases/160 cases). The most common primary locations of cSCC metastasis were the lower extremities (5 cases/10 cases) and head and neck (2 cases/10 cases). All 10 cases were metastasis to adjacent lymph nodes. Five cases showed metastasis to distant lymph nodes, the lungs, liver or bone. The average tumor diameter and thickness of cSCC metastasis were 45.3 mm and 9.46 mm, respectively. Histopathologically, the degrees of differentiation were well-differentiated, moderately differentiated and poorly differentiated type (4 cases, 5 cases, and 1 case, respectively). Conclusion: The location of the lower extremities (p=0.000) and a size larger than 20 mm (p=0.000) were related to cSCC metastasis. cSCC metastasis was found at an average of 7.5 months after diagnosis. High-risk cSCC patients should be followed closely, particularly during the first 2 years after diagnosis. (Korean J Dermatol 2017;55(3):178∼185)
자궁 적출술 및 고관절 치환술과 연관되어 하지에 발생한 Stewart-Treves Syndrome 1예
송성은 ( Sung Eun Song ),노기웅 ( Ki Woong Ro ),허은필 ( Eun Phil Heo ) 대한피부과학회 2018 大韓皮膚科學會誌 Vol.56 No.6
Stewart-Treves syndrome (STS) is a rare cutaneous angiosarcoma that develops in chronic lymphedema. The majority of STS is described in the upper extremity after aggressive locoregional therapy for breast cancer and is rarely reported in lower extremities. A 68-year-old woman presented with a 3-month history of multiple purpuric tumorous plaques and nodules on the right posterior thigh. She had a history of radical hysterectomy with lymph node dissection and postoperative radiotherapy due to uterine cervical cancer 16 years ago. She received right total hip replacement surgery due to hip joint avascular necrosis 14 years ago. She had suffered from chronic leg edema, especially on the right side. Skin biopsy on the right posterior thigh showed irregular vascular channels lined by atypical endothelial cells. Special stains showed positivity for CD31, CD34, factor VIII, and D2∼40, which are pan-vascular or lymphatic markers. She showed a pelvic mass and pelvic bone metastasis on radiologic staging work-up. She refused all treatment, including surgery, radiotherapy, and chemotherapy, except for pain control. She died 2 months after diagnosis of this highly malignant tumor. The lymphedema on both lower extremities after uterine cervical cancer treatment was aggravated especially on the right lower extremity after right total hip replacement surgery. Increased weight of the right lower extremity resulted in 4 episodes of recurrent hip dislocation. We contend that these multiple factors (uterine cervical cancer treatment, total hip replacement surgery on the right side, and recurrent hip dislocations) attributed to development of Stewart-Treves syndrome. We herein report a case of Stewart-Treves syndrome of the lower extremity following chronic leg lymphedema after uterine cervical cancer treatment and hip surgery. (Korean J Dermatol 2018;56(6):376∼379)
진원우 ( Won Woo Jin ),박종욱 ( Jong Wook Park ),정진걸 ( Jin Geol Jung ),노기웅 ( Ki Woong Ro ),심상대 ( Sang Dai Shim ),김명화 ( Myung Hwa Kim ),신용우 ( Yong Woo Cinn ) 대한피부과학회 2007 대한피부과학회지 Vol.45 No.7
Sebaceous hyperplasia is not a rare disorder and commonly develops on the face over the age of forty. The typical clinical manifestation is 2~3 mm sized, single or multiple, soft, protuberant, yellowish nodules with central umbilication. Histological examination reveals a group of mature sebaceous lobules and central sebaceous ducts. We describe an unusual case of a 28-year old female patient with grouped premature sebaceous hyperplasia. The lesions presented clinically as grouped, yellowish, umbilicated papules on the left cheek, and had developed at 10 years of age. (Korean J Dermatol 2007;45(7):732∼734)
홍승기 ( Seung Gi Hong ),조선영 ( Sun Young Jo ),노기웅 ( Ki Woong Ro ),허은필 ( Eun Phil Heo ) 대한피부과학회 2019 大韓皮膚科學會誌 Vol.57 No.5
An atypical teratoid/rhabdoid tumor (AT/RT) is a rare malignancy occurring in the first few years of life. This tumor shows rapid growth, a poor response to treatment, and poor prognosis. Cutaneous metastases presents as hamartomatous lesions mimicking skin tags. Immunohistochemical examination shows varied patterns of expression based on the sites of the body affected. Integrase interactor-1 (INI-1) gene sequencing and loss of expression of INI-1 observed with immunostaining can confirm AT/RT. In our patient, the skin lesion was identified at birth. Histopathological examination of the skin lesion could not establish an accurate diagnosis. Two months later, the patient presented with a brain tumor. Immunohistochemical examination of the brain lesion revealed complete loss of INI-1 expression in tumor cells, and the lesion was diagnosed as AT/RT. After that, we can detect the loss of INI-1 expression in the skin on the back. We report a rare case of AT/RT affecting the brain with cutaneous metastasis diagnosed with immunohistochemical staining. (Korean J Dermatol 2019;57(5):274∼278)
White Fibrous Papulosis of the Neck
박종욱 ( Jong Wook Park ),정경은 ( Kyung Eun Jung ),진원우 ( Won Woo Jin ),정진걸 ( Jin Geol Jung ),노기웅 ( Ki Woong Ro ),김명화 ( Myung Hwa Kim ),신용우 ( Yong Woo Cinn ) 대한피부과학회 2008 대한피부과학회지 Vol.46 No.2
White fibrous papulosis of the neck is a rare disorder, characterized by asymptomatic white papules that appear around neck in elderly people. The histopathologic findings showed thickened collagen bundles in the papillary to mid dermis. We report a case of white fibrous papulosis of the neck in a 53-year-old man. (Korean J Dermatol 2008;46(2):231∼233)
박종욱 ( Jong Wook Park ),정경은 ( Kyung Eun Jung ),진원우 ( Won Woo Jin ),정진걸 ( Jin Geol Jung ),노기웅 ( Ki Woong Ro ),김명화 ( Myung Hwa Kim ),신용우 ( Yong Woo Cinn ) 대한피부과학회 2007 대한피부과학회지 Vol.45 No.10
Argyria is a rare skin discoloration caused by silver deposition. We report a case of generalized argyria caused by ingestion of silver solution in a 63-year-old man. He had diffuse slate gray discoloration of sun-exposed skin, prominent face, neck and V of the chest. The histopathologic findings showed brown black granules deposited in the basement membrane zone of eccrine glands, pilosebaceous units, arteriolar wall and dermal elastic fibers. (Korean J Dermatol 2007;45(10):1087∼1089)
치아 결손과 나비뼈 섬유성 이형성증을 동반한 Becker 모반 증후군
정경은 ( Kyoung Eun Jung ),남궁선 ( Koong Sun Nam ),정지민 ( Ji Min Chung ),박종욱 ( Jong Wook Park ),김명화 ( Myung Hwa Kim ),신용우 ( Yong Woo Cinn ),노기웅 ( Ki Woong Ro ) 대한피부과학회 2009 대한피부과학회지 Vol.47 No.5
Becker nevus syndrome is a phenotype characterized by the presence of a Becker nevus in association with unilateral hypoplasia of the breast or other cutaneous, muscular or skeletal defects. We report an interesting case of Becker`s nevus syndrome associated with fibrous dysplasia of the sphenoid bone, tooth abnormalities and facial asymmetry. (Korean J Dermatol 2009;47(5):596~599)
정경은 ( Kyoung Eun Jung ),남궁선 ( Sun Namkoong ),정지민 ( Ji Min Chung ),박종욱 ( Jong Wook Park ),김명화 ( Myung Hwa Kim ),신용우 ( Yong Woo Cinn ),윤세영 ( Se Young Yoon ),노기웅 ( Ki Woong Ro ) 대한피부과학회 2009 대한피부과학회지 Vol.47 No.4
Zinc deficiency is characterized by acrodermatitis enteropathica like eruption such as periorificial dermatitis, diarrhea and mental irritability. This syndrome occurs due to decreased supplementation, increased consumption or decreased bowel absorption of zinc. We report here on a case of acquired zinc deficiency in a patient who was receiving total parenteral nutrition due to ischemic colitis. She showed denuded patches on the perinasal, perioral and perineal area and tense bullae on both hands. She was suffering from diarrhea and mental irritability. Her blood zinc level was 4.9 μg/dl. Subsequent intravenous zinc supplementation cleared up her clinical manifestations. (Korean J Dermatol 2009;47(4):479~482)