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증례 : 내분비-대사 ; 카테콜아민치가 정상인 발작성 갈색세포종 1예
유정래 ( Jung Re Yu ),진현정 ( Hyoun Jung Chin ),김미연 ( Mi Yeon Kim ),정우성 ( Woo Seong Jeong ),이상아 ( Sang Ah Lee ),이대호 ( Dae Ho Lee ),고관표 ( Gwan Pyo Koh ) 대한내과학회 2012 대한내과학회지 Vol.83 No.4
A 53-year-old woman had a 1.7 cm left adrenal mass on an abdominal computed tomography (CT) scan. She presented with paroxysmal headache, palpitation, sweating, and hypertension. The patient was highly suspected of having a pheochromocytoma, but measurements of 24-hour urinary metanephrine, catecholamines, and vanillylmandelic acid were normal. Plasma and urine catecholamine levels were within the normal range even during paroxysmal episodes. A scintigraphic study with 131I-metaiodobenzylguanidine (MIBG) revealed selective concentration of the radiotracer, corresponding to the CT mass. The patient underwent a left adrenalectomy and the pathological examination confirmed the diagnosis of pheochromocytoma. In this report, we describe a rare case of a symptomatic pheochromocytoma with normal catecholamine levels. Our case illustrates that routine nuclear scintigraphy, such as 131I-MIBG, should be performed even in cases with normal hormonal testing for all patients with high clinical suspicion of pheochromocytoma. (Korean J Med 2012;83:503-509)
증례 : 만성 신질환 환자에서 발생한 원발성 삼출액 림프종 1예
김미연 ( Mi Yeon Kim ),한상훈 ( Sang Hoon Han ),유정래 ( Jung Re Yu ),정우성 ( Woo Seong Jeong ),김현우 ( Hyun Woo Kim ),이재천 ( Jae Chun Lee ),현창림 ( Chang Lim Hyun ) 대한내과학회 2012 대한내과학회지 Vol.83 No.3
저자들은 만성 신부전 환자에서 HHV-8 음성 원발성 삼출액 림프종 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Human herpes virus-8 (HHV-8)-negative primary effusion lymphoma (PEL) is frequently observed in patients with chronic liver disease. We describe herein a case of PEL in a patient with chronic kidney disease. A 59-year-old woman presented with dyspnea. The patient had a history of uncontrolled pleural effusion. The pleural effusion revealed a malignant cell-dominant exudate. Serological tests were negative for human immunodeficiency virus (HIV). Initial chest and abdomen computed tomography showed bilateral pleural effusion; however, no evidence of a tumor mass or lymph node enlargement was found. A malignant lymphoma of diffuse large B-cell type was confirmed by pleural fluid cytology. Immunohistochemical staining of malignant cells was negative for HHV-8. She was treated with rituximab and CHOP (cyclophosphamide, adriamycin, vincristine, prednisolone) chemotherapy. We report a case of PEL in a patient with chronic kidney disease that may be a plausible predisposing factor for HHV-8-negative PEL.