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본 증례는 유육종증이 피부와 신장을 동시에 침범하여, 특히 신장에서는 육아종성 간질성 신염에 의한 신부전까지 일으켰으나 고용량의 스테로이드에 좋은 치료 반응을 보인 예로써 신기능 저하와 고칼슘혈증이 동반된 환자에서 신장 유육종증은 주요 감별진단에 포함되어야 하겠다. Sarcoidosis is a granulomatous inflammatory disorder of unknown etiology. It can involve any organ and present in various clinical forms, but renal involvement is very unusual. We report on a 68-year-old man with renal sarcoidosis. He presented with unexplained renal impairment, hypercalcemia, and multiple light brown papules on the buttock and lower extremities. Non-caseating granulomas and interstitial nephritis were revealed in skin and kidney biopsies. The serum creatinine, hypercalcemia, and skin lesions rapidly improved on high-dose steroid therapy. One year later, the serum calcium level was normal, and serum creatinine was 1.3 mg/dL. (Korean J Med 77:S1226-S1230, 2009)
김지호 ( Ji Ho Kim ),김성훈 ( Sung Hoon Kim ),박원형 ( Won Hyeong Park ),장지선 ( Ji Sun Jang ),방제소 ( Jei So Bang ),양수현 ( Soo Hyun Yang ),변종훈 ( Jong Hoon Byun ),김윤정 ( Yoon Jung Kim ) 대한소화기학회 2012 대한소화기학회지 Vol.59 No.5
Background/Aims: Recently, variable gastrointestinal track tumors including early stage malignancies are treated by endoscopic procedure. However, the discrepancy of histologic diagnosis may sometimes exist between the pretreatment forceps biopsy results and those of post treatment specimen. So the prediction of malignant lesion is important in the aspect of treatment selection. In this study, we investigated the predictable factors of the histologic discrepancy through the clinical, endoscopic features of the lesion diagnosed as adenocarcinoma in the post-endoscopic treatment specimen after the adenoma was diagnosed by the endoscopic forceps biopsy. Methods: From March 2005 to April 2009, 129 gastric tumor lesions (129 patients) which were not diagnosed as malignancy and treated with endoscopic procedure were enrolled retrospectively. We compared the pretreatment endoscopic forceps biopsy results and post-treatment specimen biopsy results, then, analyzed the tumor characteristics. Results: Twenty-one cases (16.3%) were diagnosed as malignancy after endoscopic treatment. Especially, discrepancy occurred more frequently in depressed lesions than in flat or elevated lesions (41.7% vs. 13.7%, p=0.012), and in lesions diagnosed as high grade adenomas than low or moderate grade adenomas (33.3% vs. 11.1%. p=0.004). Conclusions: In cases of depressed type lesions in the pretreatment endoscopy or those diagnosed as high grade adenoma in the pretreatment forceps biopsy, we should consider combined malignant lesion. Therefore, treatment modalities ensuring accurate diagnosis and potentially curative resection, should be carefully selected and performed in cases which have these features. (Korean J Gastroenterol 2012;59:354-359)