혈전성 미세혈관병증의 병리

설미영,Sol, Mee Young 대한소아신장학회 2013 Childhood kidney diseases Vol.17 No.1

사구체에 면역글로불린은 음성이면서 C3 만 침착되는 경우, 다른 원인이 없는 경우 C3GN을 의심하여야 한다. 광학현미경으로는 세포의 증식이 있는 경우와 없는 경우가 있지만, 전자현미경으로는 EDD가 내피세포 밑으로 혹은 메산지움 등에 침착함을 확인하여야 한다. 대체보체경로의 조절이상이 원인임으로 혈청 C3 치를 비롯하여 CFH, CFI, CFB 등을 측정하여야 하며, C3 nephritic factor, antifactor H 자가항체 등을 조사하는 것이 필요하다. 보체 조절이상을 일으키는 유전자 돌연변이를 조사해 보아야 한다. 예후는 안정적이지만, 치료는 대증적이다. 이론적으로 보체의 활성화를 저지하는 약으로 가능할 것으로 생각되며, C5 항체인 eculizumab으로 치유된 보고도 있다. Thrombotic microangiopathy (TMA) is a microvascular thrombotic lesion caused by endothelial injury and subsequent formation of platelet rich thrombus. TMA is first described as a classical pathologic feature of HUS/TTP. Renal biopsy finding of TMA represents kidney involvement of HUS/TTP as well as other diseases such as malignant hypertension, drug toxicity, eclampsia, pre-eclampsia, and several systemic infections. Autoimmune diseases and transplant kidney sometime also have TMA. It is needed to consider a complete autoimmune work-up of patients presenting with TMA including tests for ANA, ANCA, and ADAMTS13 inhibitory antibodies, because there are several reports of association with TMA in patients of SLE, anti-phospholipid syndrome, and ANCA-associated vasculitis.

Invasine Ductal Carcinoma with Osteoclast-Like Giant Cell in a Young Woman

강현정,최경운,곽희숙,설미영,김지연,Kang, Hyun-Jeong,Choi, Kyung-Un,Kwak, Hee-Suk,Sol, Mee-Young,Kim, Jee-Yeon The Korean Society for Cytopathology 2007 대한세포병리학회지 Vol.18 No.1

Mammary carcinoma with osteoclast-like giant cells is an unusual neoplasm characterized by giant cells, mononuclear stromal cells, and hemorrhage accompanying a low grade carcinoma. We present the cytological findings in a case of invasive ductal carcinoma with osteoclast-like giant cells that was initially confused with a fibroadenoma, due to its well-demarcated and soft mass and the young age of the patient. A 28-year-old female presented with a 4.5 cm, well demarcated, soft and nontender mass in the right breast. Fine needle aspiration cytology (FNAC) showed a combination of low grade malignant epithelial cell clusters and osteoclast-like giant cells. The atypical epithelial cells were present in cohesive sheets and clusters. Osteoclast-like giant cells and bland-looking mononuclear cells were scattered. An histological examination revealed the presence of an invasive ductal carcinoma with osteoclast-like giant cells. We report here the cytological findings of this rare carcinoma in a very young woman. The minimal atypia of the epithelial cells and its soft consistency may lead to a false negative diagnosis in a young woman. The recognition that osteoclastlike giant cells are rarely present in a low grade carcinoma, but not in benign lesion, can assist the physician in making a correct diagnosis.

고혈당증과 신적출 후 신증의 실험적 흰쥐 모형에서 신사구체의 형태계측학적 연구 - 사구체 경화증의 발달 과정과 기전에 관한 연구 -

심영웅 ( Young Woong Shim ),설미영 ( Mee Young Sol ),이경민 ( Kyeong Min Lee ),최경운 ( Kyung Un Choi ),김지연 ( Jee Yeon Kim ),이진숙 ( Jin Sook Lee ),박도윤 ( Do Youn Park ),이창훈 ( Chang Hoon Lee ),서강석 ( Kang Suek Suh ) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.6

목적 : 당뇨병의 가장 흔한 합병증의 당뇨병성 신중에서 현저한 조직 변화인 사구체의 섬유화와 이와 유사한 조직 소견을 보이는 다른 질병들과의 관련성 및 섬유화 기전의 기전의 일단을 밝히기 위하여 연구를 시행하였다. 방 법 : 당뇨병성 신증과 신 조직 일부 소실 후 발생하는 신 적출 후 신증, 생리적 노령화로 인한 사구체 섬유화 등에서 섬유화가 일어나는 시기와 부위, 섬유화의 정도와 시간 경과에 따른 변화 등을 조사하기 위하여 실험 동물 모형을 이용하여 형태계측학적 연구를 하였다. 수컷 Sprague-Dowley (이하 S-D) 흰쥐에 streptozotocin을 꼬리 정맥으로 투여하여 당뇨병성 신증 모델을 만들고, S-D 백서의 우측 신장을 절제하여 과여과 모형을 만들었다. 시술 후 일정 기간이 지난 후 시기별로 희생시켜 Sirius red 염색 표본을 만들어 시구체 단면적과 실질의 섬유화 정도를 측정하고, 전자현미경으로 얻은 사구체 소견에서 메산지움 기질의 면적, 사구체 기저막의 두께, 근위우곡세뇨관 기저막의 두께 등을 조사하였다. 이들에서 질병 시기에 따른 변화, 두 실험군 사이의 차이, 정상 대조군 및 생리적 노화 대조군과의 차이 등을 분석하였다. 결 과 : 당뇨병성 신증 모델에서 사구체 단면적은 실험8주 이후 24주까지 전 예에서 정상 대조군에 비해 크기가 의의있게 증가하였고 신 실질과 사구체 내의 섬유화는 실험 2주 째부터 대조군에 비해 의의있는 교원질 양의 증가가 있었다. 사구체 기저막은 streptozotocin 투여 1주에 희생시킨 군에서도 의의있는 두께의 증가가 있었고, 세뇨관 기저막도 3주에 측정한 군에서부터 현저한 두께의 증가가 있었다. 우측신 절제를 시행한 모형에서 사구체 평면적은 실험 7주군에서 커진 소견이 나타났고 16주 이후의 군대에서는 현저한 크기의 증가 소견이 있었다. 신실질과 사구체의 교원질 염색 소견에서 2주 이후 전 기간에 걸쳐 교원질 양의 증가가 있었고, 사구체 기저막과 세뇨관 기저막 두께는 술 후 2주에 희생시킨 군부터 두께가 의의있게 증가하였다. 생리적 노화과정을 거친 군에서도 사구체의 섬유화가 나타났는데 당뇨병 모형과 신적출 모형에 비해 그 정도는 덜하였다. 당뇨병 모형과 신적출 모형 사이의 사구체 조직 변화는 실험 기간이 긴 군들에서 사구체 평면적의 크기, 교원질 양의 증가, GBM과 TBM의 두께 등이 두 군 모두 현저한 증가를 보였고 신적출 모형에서 실험 최종 기간이 같지 않아 실험 수치의 비교가 의미가 없을 것으로 생각된다. 결 론 : 이상의 성적에 의거하면 신사구체와 간질의 섬유화, GBM과 TBM의 두께 증가는 당뇨병성 신증만의 특징적인 조직 변화는 아니고 신 실질 일부 소실이 일어나는 사구체 질환에서 공통적으로 일어나는 소견이다. 그러므로 본 연구의 대상이 된 당뇨병성 신중, 신적출 후 신증, 그리고 생리적 노화 과정 등에서 공통적으로 나타나는 사구체 모세관의 혈역동학적 변화가 사구체의 섬유화에 병인기전을 밝히는데 중요한 요소가 될 것으로 사료된다. Objective :Diabetic nephropathy and ablation nephropathy are characterized by sclerotic processes in the glomeruli. To elucidate the site, degree and time-honored changes of glomerular sclerosis, morphometric analysis was performed using the experimental animals models. Methods : The animals used were male Sprague-Dowley rats and separated into 4 groups as young mormal control, old control, streptozotocin-injected group, and right nephrectornized group. Chronologically kidney specimens were obtained after each treatment and processed to evaluated histologic changes. To evaluated the glomerular area, interstitial fibrosis and glomerular tuft fibrosis, the kidney specimens were fixed in Buin`s solution, paraffin-embedded and 2 ㎛ sections were Sirius red stained. To study the mesangial area, mesangial matrix area, glomerular basement membrane, and tubular basement membrane, the specimens were fixed in 2,5% glutaraldehyde, epon-embedded, double-stained and examined under the transmission electron microscope. All the specimens were analyzed morphometrically using the Image Pro Plus software. The obtained morphometric data were statistically analyzed to evaluate the differences of fibrotic processes and degree between experimental groups. Results : Diabetic group revealed statistically significant increase of glomerular area from 8th week after streptozotocin injection to 24th week of experimental date. The parenchymal fibrosis and glomerular tuft fibrosis was prominent from the 2nd week of injection and steadily increased until the end of experimental date. The thickness of glomerular basement membrane was significantly increased even at the first week of injection and the tubular basement membrane also increased in thickness at the 3rd week of experiment. Ablation nephropathy model made by right nephrectomy showed increased glomerular area at the 7th week of ablation and the degree were intensified after 16th week of experimental date. The amount of stainable collagen in the renal parenchyme and glomerular tuft increased in the second week kidney sample and steadily increased thereafter until the end of experimental date. The increase of thickness of GBM and TBM also started to appear at the second week of operation. The old control also revealed fibrosis but the degree was less than the diabetic and ablation groups. Both diabetic and ablation nephropathy groups exhibited extensive increase of glomerular area, stainable collagen, thickness of GBM and TBM at the end of experimental date and the ablation group revealed more extensive evidences of fibrosis without statistical significance. Comparison between the experimental groups were meaningless because the duration of the experimental manipulation was not the same. Conclusion: Glomerular and renal interstitial sclerosis and thickening of GBM and TBM are not the specific lesions of the diabetic glomerulopathy and are the common histologic changes occur in the kidney of partial parenchymal loss of any etiology. And it is suggested by this study that the common hemodynamic change involving the diabetic nephropathy, ablation nephropathy and physiologic aging is one of the important pathogenetic factors of glomerular sclerosis.

유방암의 예후인자와 p53 단백과의 연관성

배영태(Young Tae Bae),곽희숙(Hee Sook Kwak),설미영(Mee Young Sol),김남득(Nam Deuk Kim) 대한외과학회 1999 Annals of Surgical Treatment and Research(ASRT) Vol.56 No.4

분비성 유방암 1예

배영태(Young Tae Bae),곽희숙(Hee Sook Kwak),김동헌(Dong Heun Kim),심문섭(Mun Sup Sim),설미영(Mee Young Sol) 대한외과학회 1999 Annals of Surgical Treatment and Research Vol.56 No.3

갑상선의 유두상 암종과 동반된 유리질 소주형 선종의 세침흡인 세포학적 소견 - 1예 보고-

최경운,이진숙,박도윤,이창훈,설미영,서강석,김지연,Choi, Kyung-Un,Lee, Jin-Sook,Park, Do-Youn,Lee, Chang-Hoon,Sol, Mee-Young,Suh, Kang-Suek,Kim, Jee-Yeon The Korean Society for Cytopathology 2003 대한세포병리학회지 Vol.14 No.1

Hyalinizing trabecular adenoma of the thyroid gland is a rare benign neoplasm predominantly diagnosed in middle-aged women. Carney et al. first described this entity that may mimic paraganglioma, medullary carcinoma and papillary carcinoma in 1987. We describe cytologic and histopathologic features of a case of hyalinizing trabecular adenoma combined with occult papillary carcinoma in the opposite lobe. A 55-year-old woman presented with nontender palpable mass of the right neck for 6 months. The aspirate was cellular and contained small clusters and sheets of epithelial cells with abundant filamentous, vacuolated, and ill-defined cytoplasm. The nuclei were slightly pleomorphic and showed nuclear overlapping, nuclear grooves, and intranuclear cytoplasmic inclusions. Histologic examination showed hyalinizing trabecular adenoma in the right lobe and occult papillary carcinoma in the left lobe.

간내 담석증 환자에서 간 담관의 병릭학적 연구

정숙금(Seuk Kum Chung),설미영(Mee Young Sol),이선경(Sun Kyung Lee) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.5

N/A Background/Aims: Although the incidence of intrahepatic biliary stone in Korea is relatively high, the pathogenetic role of intrahepatic biliary ]esion on the genesis of intrahepatic stone is not clearly understood yet. This study was perfomed to investigate the patbological changes of intrahepatic bile ducts in hepatolithiasis and compare with other reports, thus get some information about the pathophysiologic role of those lesions. Methods: Patho]ogical and histochemical studies were done on 43 cases of liver resected for the treatment of intrahepatic biliary stones during last 16 years. Results: The highest incidence was at the 6th decade. Male to female ratio was 1:1.4 (18cases to 25 cases) and mean age was 45.4 years. More than half of the cases complained less than 2 months of biliary symptom duration. Majority of the cases(38 cases, 88.3%) revealed stones in the left intrahepatic bile ducts. Histological changes of the intrahepatic bile ducts harboring biliary stones showed superficial epithelial hyperplasia in 20 cases(46.5%), proliferation of intramural glands in 36 (83.7%), extramural glandular hyperplasia in 42(97.7%), pseudopyloric glands in 3(7.0%)and pancreatic acinus in 3 cases(7.0%), and chronic inflammatory reaction in all the cases examined. Mucin in the pseudopyloric glands were mixture of class m mucin and sialo- and sulphomucin. Conclusions: It is concluded that histologic lesions associated with the intrahepatic biliary stones were chronic inflammatory reaction and proliferation of intrahepatic ductal epithelium and peribiliary glands secondary to the inflammation. Hypersecreted glandular secretion of peribiliary glands can be an augumenting factor of the increment of the biliary stones. (Korean J Gastroenterol 1996; 28: 697 - 704)

촉지 림프절의 세침흡인 세포검사 - 단일 기관의 1,346예 경험 -

신동훈,김지연,강현정,김익두,설미영,최경운,Shin, Dong-Hoon,Kim, Jee-Yeon,Kang, Hyun-Jeong,Kim, Ick-Doo,Sol, Mee-Young,Choi, Kyung-Un The Korean Society for Cytopathology 2007 대한세포병리학회지 Vol.18 No.2

The aim of this study was to evaluate the diagnostic value of fine needle aspiration cytology (FNAC) for the assessment of palpable enlarged lymph nodes. The authors reviewed the results of 1,346 FNACs of palpable enlarged lymph nodes performed at Pusan National University Hospital from 1998 to 2004. Of the 1,346 cases, 1,265 (94.0%) were satisfactory and 81 (6.0%) unsatisfactory. Cytologic diagnoses were judged in 488 cases, based on subsequent histologic diagnoses, clinical follow up, or both. Global results for all malignancies (lymphoid and non-lymphoid neoplasms) based on cases with final diagnoses, showed a sensitivity of 87.4% and a specificity of 98.7%. The overall diagnostic accuracy was 93,2%, and the false negative rate reduced from 12,6% to 7,3% when lymphomatous cases were excluded. The annual data for this period showed that the number of diagnostic lymph node biopsies and the rate of inadequately sampled material markedly decreased. Gene rearrangement studies for IgH and TCR ${\gamma}$ were helful in 30 cases. FNAC is a useful initial diagnostic procedure for the evaluation of palpable enlarged lymph nodes. However, the technique should be assisted by the appropriate ancillary studies and by proper interpretation by a cytopathologist.

돈 혈청 투여에 의한 백서 간 중격상 섬유화에 있어서 비 적출 효과에 대한 연구

나서희(Seo Hee Rha),설미영(Mee Young Sol),이선경(Sun Kyung Lee) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.1

N/A Background/Aims: To elucidate splenic function in hepatic fibrosis, the authors evaluated the effects of splenectomy in experimental hepatic fibrosis. Methods: In splenectomized and non-splenectomized Sprague-Dawley rats, hepatic fibrosis was produced by intraperitoneal injection of normal swine serum. The liver tissue was examined hisiopathologically, immunohistochemically, and ultrastructurally and analyzed quantitatively. Results: The histopathological examination revealed mild septal fibrosis in three of ten at 6th week, mild to severe in five of ten at the 8th week, and severe fibrosis in six of ten at the 10th and 12th week in non-spelenectomized groups but no septal fibrosis through the observed time in splenectomized and control groups. The average number of fat-storing cells was significantly increased in both experimental groups, and increment of the number was more marked in nonsplenectomized ones. Electron microscopy revealed no morphologic differences in the ultrastructure of fat-storing cells between two groups, but there was a tendency of increment in the number of transitional cells in the nonsplenectomized group. Conclusions: It was considered that the hepatic fibrosis induced by administration of foreign sera would be due to activation of fat- storing cells, and that spleen would enhance the hepatic fibrosis by activation of FSC through certain splenic factors. (Korean J Gastroenterol 1996;28: 74 - 84)

위 인환세포 암종에 관한 점액 조직화학적 및 초미세구조적 연구

공경엽(Gyoung Yub Gong),설미영(Mee Young Sol),이선경(Sun Kyung Lee) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.2

N/A The mucin histochemical and ultrastructural studies in signet ring cell carcinoma of stomach were performed for the purpose of investigating phenotypic expression of tumor cells and its histogenesis. The specirnens used in this study were 57 cases of gastric sig- net ring cell carcinoma (12 cases of early cancer and 45 cases of advanced one) which were obtained by gastrectomy during 1990-1991 in Pusan National University Hospital. The specimens were studied with the mucin histochemical stainings of paradoxical concanavalin A, galactose oxidase-Schiff sequence, sialidase galactose oxidase-Schiff reac- tion and periodate borohydride technique/potassiurn hydroxide/periodic acid Schiff proce- dure, and transmission electron microscopic examination. This study disclosed that cancer cells of the signet-ring cell carcinoma could be classified into gastric type (pyloric gland cell type and surface mucous cell type) and intestinal type (small and large bowel goblet cell types, and intestinal absorptive type). Among 57 cases of gastric carcinoma examined, 37 cases(64.9%) consisted of gastric type cells, 3 cases(5.7%) and 17 cases(29.3%) were com- posed of intestinal type cells and rnixed cell population, respectively. There was no statis- tically significant difference in frequency among mucous cell types on the aspect of the site of origin. In 12 cases of early carcinoma, there were 9 cases of pure gastric (75.0%) and 3 cases of mixed type cells(25.0%). In 45 cases of advanced carcinoma, there were 28 cases of gastric(62.2%), 3 cases of intestinal(6.7%), and 14 cases of mixed type cells (31.1 %). According to the result, intestinal type cells were more prevalent in advanced cases than early ones. On the basis of this study it is suggested that gastric signet ring cell carcinoma arises in the nonmetaplastic gastric mucosa while intestinal type cells were developed by intestinal metaplasia within the signet-ring cell carcinoma during advancement of the lesion.(Korean J Gastroenterol 1994; 26: 239 250)