Abdominal Wall Metastasis from an Invasive Lobular Carcinoma of the Breast: A Case Report

김하나,손은주,노송미,정우희,육지현,정진 대한영상의학회 2011 대한영상의학회지 Vol.64 No.6

Breast cancer is one of the most common malignancies in women. Breast cancer frequently metastasizes to the bones, lungs, and liver. However, the recurrence of distant soft-tissue metastasis except to the chest wall is extremely rare. Here, we describe our experience with a patient in whom invasive lobular carcinoma of the breast with metastasis to the abdominal wall presented as subcutaneous nodules without local recurrence.

Urinary Decoy Cell Grading and Its Clinical Implications

고명주,정현주,임범진,노송미,김연희 대한병리학회 2012 Journal of Pathology and Translational Medicine Vol.46 No.3

Background: Examination of urine for decoy cells (DCs) is a useful screening test for polyomavirus (PV) activation. We explored the significance of the amount of DCs in persistent shedding, PV nephropathy and acute rejection. Methods: A case-controlled study was performed in 88 renal allograft patients who had DCs detected at least once in four or more urine samples. Results: Fifty one patients were classified into the high-grade shedding group (HG) and 37 patients into the low-grade shedding group (LG) according to DC shedding (≥10 or <10 DCs/10 high power field [HPF]). DC shedding of more than three consecutive months was significantly more prevalent in the HG as compared with their LG counterparts (p<0.0001). Urinary DCs were present for more than one year in 29.4% of the HG and 8.1% of the LG. Real-time polymerase chain reaction for PV was higher in both urine (51.4% vs. 11.1%) and plasma (9.1% vs. 0%) of the HG than the LG. The prevalence of PV nephropathy was higher in the HG than the LG (p=0.019). However, there was no significant difference in the prevalence of acute rejection. Conclusions: Shedding of ≥10 DCs/10 HPF is associated with sustained shedding, polymerase chain reaction positivity and PV nephropathy, but not a predictor of acute rejection.

Primary Bilateral Adrenal Non-Hodgkin’s Lymphoma Presented with Adrenal Insufficiency: A Case Report

이은영,김경민,김광준,노송미,김진석,양우익,임승길 대한내분비학회 2011 Endocrinology and metabolism Vol.26 No.1

Primary adrenal lymphoma is a very rare disease and it is known to have a poor prognosis. We report here on a case of primary adrenal insufficiency that was secondary to primary bilateral adrenal lymphoma. A 54-year old man was hospitalized because of easy fatigability,weight loss and consistent malaise for 6 months. The physical examination revealed hyperpigmentation on the anterior chest and hypotension. According these findings and symptoms, we did a rapid ACTH stimulation test with a clinical suspicion of adrenal insufficiency. He showed an inadequate adrenal response and so he was diagnosed with adrenal insufficiency. The abdominal CT images showed bilateral huge adrenal masses and increased uptake of the adrenal glands on PET. The pathologic diagnosis by ultrasound-guided gun biopsy of the right adrenal gland was diffuse large B cell lymphoma. The patient was administered combination chemotherapy with the R-CHOP regimen, and after 8-cycles of chemotherapy, he achieved complete remission of tumor according to the image studies and he recovered his adrenal function. Primary adrenal lymphoma, although a rare disease, should be considered in patients with bilateral enlargement of the adrenal glands and when the adrenal glands show increased uptake on a PET scan, and especially there is adrenal insufficiency.

Macrolide Resistance Trends in β-Hemolytic Streptococci in a Tertiary Korean Hospital

어영,황규열,장인호,조현미,노송미,김효열,권오건,윤갑준 연세대학교의과대학 2007 Yonsei medical journal Vol.48 No.5

Purpose: Erythromycin-resistant β-hemolytic streptococci (BHS) has recently emerged and quickly spread between and within countries throughout the world. In this study, we evaluate the antimicrobial susceptibility patterns and erythromycin resistance mechanisms of BHS during 2003-2004. Materials and Methods: The MICs of seven antimicrobials were determined for 204 clinical isolates of BHS from 2003 to 2004. Resistance mechanisms of erythromycin-resistant BHS were studied by the double disk test as well as by polymerase chain reaction (PCR). Results: Compared with our previous study, resistance among Streptococcus pyogenes isolates to a variety of drugs decreased strikingly: from 25.7% to 4.8% in erythromycin; 15.8% to 0% in clindamycin; and 47.1% to 19.0% in tetracycline. The prevalent phenotypes and genotypes of macrolide-lincosamide- streptograminB (MLSB) resistance in Streptococcus pyogenes isolates have been changed from the constitutive MLSB phenotype carrying erm(B) to the M phenotype with mef(A) gene. In contrast with Streptococcus pyogenes, resistance rates to erythromycin (36.7%), clindamycin (43.1%), and tetracycline (95.4%) in Streptococcus agalactiae isolates did not show decreasing trends. Among the Streptococcus dysgalactiae subsp. equisimilis isolates (Lancefield group C, G), resistance rates to erythromycin, clindamycin, tetracycline and chloramphenicol were observed to be 9.4%, 3.1%, 68.8%, and 9.4%, respectively. Conclusion: Continual monitoring of antimicrobial resistance among large-colony-forming BHS is needed to provide the medical community with current data regarding the resistance mechanisms that are most common to their local or regional environments.

증례 : 순환기 ; 다량의 심낭 삼출로 발현된 POEMS 증후군 1예

오창명 ( Chang Myung Oh ),방우대 ( Woo Dae Bang ),이상국 ( Sangkook Lee ),조성수 ( Sung Soo Cho ),노송미 ( Songmi Noh ),김진석 ( Jin Seok Kim ),장혁재 ( Hyuk Jae Chang ) 대한내과학회 2011 대한내과학회지 Vol.81 No.2

심낭 삼출은 악성종양, 결핵 등 다양한 원인에 의해 유발되는 질환으로 과거와는 달리 선험적인 치료에 의존하기 보다 정확한 원인 규명의 중요성이 점차 커지고 있다. 저자들은 심낭 삼출을 주된 증상으로 하면서 말초신경병증, 비장비대, 갑상샘저하증, 단세포감마글로불린병증, 피부색소침착, 다모증, 흉막 삼출, 전신 부종, 폐동맥고혈압 등을 동반한 POEMS 증후군 1예를 경험하여 문헌고찰과 함께 보고한다. 심낭 삼출의 치료에 반응이 없으면서 원인을 찾지 못하여 특발성 심낭염으로 진단한 환자의 추가적인 감별 진단의 하나로 POEMS 증후군이 고려되어야 하겠다. Pericardial effusions can be caused by a wide variety of infectious or noninfectious diseases. After a conventional diagnostic work-up, the etiology of pericardial effusion often remains idiopathic. We report a patient with POEMS syndrome whose main clinical problem was recurrent pericardial effusions. Patients with POEMS syndrome often have generalized edema and a pleural effusion, while a pericardial effusion is a very rare complication. A 44-year-old man visited our hospital because of a recurrent pericardial effusion. He was initially diagnosed with idiopathic pericarditis five months prior. We reassessed the patient meticulously and found IgG lambda type monoclonal gammopathy, polyneuropathy, lymphadenopathy, peripheral edema, pleural effusion, hypothyroidism, pulmonary hypertension, hyperpigmentation, hypertrichosis, and papilledema, which we diagnosed as POEMS syndrome. (Korean J Med 2011;81:245-250)

다발성 폐결절로 발견된 카플란증후군

이상국 ( Sang Kook Lee ),이상훈 ( Sang Hoon Lee ),김송이 ( Song Yee Kim ),이우경 ( Woo Kyung Lee ),신동호 ( Dong Ho Shin ),방우대 ( Woo Dae Bang ),노송미 ( Song Mi Noh ),심효섭 ( Hyo Sup Shim ),박병훈 ( Byung Hoon Park ),이경종 ( 대한결핵 및 호흡기학회 2011 Tuberculosis and Respiratory Diseases Vol.70 No.2

We report a case of Caplan`s Syndrome, which presented as multiple pulmonary nodules. A 58-year-old male was admitted to hospital due to multiple pulmonary nodules. In addition, the patient presented with multiple arthritis, and dyspnea on exertion. Rheumatoid arthritis had been diagnosed 35 years ago. The patient had worked as a stonemason for 20 years. Computed Tomography (CT) revealed numerous well-defined tiny nodules scattered in both lungs, which was suspicious of miliary tuberculosis or malignancy. The patient was started on antituberculous medications and referred to our hospital. First, a transbronchial lung biopsy was performed, which showed no evidence of granuloma. It was our opinion that the biopsy was insufficient, and a follow-up video-associated thoracoscopy was performed. The pathological report determined necrotizing granulomatous inflammation and silicosis on background. According to imaging studies, pathologic reports, and clinical symptoms, we concluded that the patient had Caplan`s syndrome. We controlled his rheumatic medications, and instructed him to avoid exposure to hazardous dust.

유방의 과립세포 종양

박세호 ( Se Ho Park ),김승일 ( Seung Il Kim ),박병우 ( Byeong Woo Park ),박형석 ( Hyung Seok Park ),이준상 ( Jun Sang Lee ),이종석 ( Jong Seok Lee ),노송미 ( Song Mi Noh ),구자승 ( Ja Seung Koo ),김민정 ( Min Jung Kim ),김은경 ( E 대한임상종양학회 2010 Korean Journal of Clinical Oncology Vol.6 No.2

유방의 과립세포 종양은 드물게 발생하는 양성 종양으로 말초 신경의 신경섬유초 세포에서 기원하는 것으로 알려져 있다. 과립세포종양의 임상적, 영상의학적 소견은 유방의 악성 종양 소견과 유사하여 양성 종양임에도 불구하고 악성 종양으로 오인되기 쉽다. 저자들은 갑상선 기능 항진증으로 추적 관찰 중인 54세 여자의 우측 유방에서 중심 침생검과 면역조직화학 염색으로 진단된 과립세포종양 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Granular cell tumor (GCT) of the breast is an uncommon, usually benign tumor originating from Schwann cells of peripheral nerves. Clinical and radiological findings of GCTs are similar to those of malignant tumors, and GCTs of the breast are often confused with breast cancer clinically or radiologically. We experienced 1 case of GCT diagnosed by core needle biopsy and immunohistochemical staining in the right breast of 54-year-old woman with Graves`s disease and report the case with a review of the literature.