연골-골아세포 변성을 함께 동반한 지방종 1예

은준영,김한조,배상병,이규택 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.-

연골-골아세포 변성을 함께 동반한 지방종 1예

은준영,김한조,배상병,이규택 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.1

지방종은 성숙된 지방세포로 이루어진 결합조직 종양 중 가장 흔한 양성 종양이다. 변이형 지방종중 뼈지방종, 연골지방종도 드물게 보고되고 있으나 뼈, 연골 변이를 동시에 포함하고 있는 경우는 세계적으로 1예만이 보고되었다. 이에 저자들은 우연히 발견된 둔부종괴에서 연골-골아세포 변성을 동시에 포함하는 변이형 지방종을 경험하였기에 보고하는 바이다. 증례: 57세 남자가 내원 1개월 전 우연히 발견된 우측 둔부 종괴를 주소로 내원. 과거력: 특이사항 없음. 이학적 소견: 우측 둔부에 10×10 cm크기의 경계가 불분명하고 압통이 없는 단단한 종괴가 관찰되었다. 검사 소견: 특이 소견 없음 골반 자기공명영상: 우측 큰 볼기근 심부에 12×8×4 cm의 T1 조영증강에서 불규칙한음영증강을 보이는 종괴가 관찰되었고, 우측 큰 모음근까지 침범되어 있었다. 병리 소견: 11×9×7 cm 크기로 표면은 부드럽고 피막이 잘 성되어있었다. 단면은 밝은 노란색을 띠며 국소적으로 연골과 뼈성분이 관찰되었다. 현미경 관찰시 연골-골아세포 변성을 동반한 성숙된 방조직이 관찰되었다. 치료 및 경과: 완전 절제를 시행 받았으며, 현재 5년간 재발없이 경과 관찰 중이다. 고찰: 지방종이 발생하는 원인은 확실히 밝혀지지 않았지만 만성적인 자극이나 외상에 의해 발생한다는 주장들이 있고 최근에는 염색체이상이 대부분에서 관찰되어 이에 대한연구가 좀더 필요한 실정이다. 양성 지방종성 병변은 지방종, 변이형 지방종, 지방종성 종양, 침윤성 지방종, 갈색 지방에서 기원하는 방종 등으로 분류된다. 치료로는 깊이의 정도, 절제시 주위 조직의 손상여부, 피막화 정도, 증상 유무에 따라 달라진다. 점막하에 존재시 증이 없다면 절제 하지 않고 지켜 볼 수 있다. 피막화가 잘되어 있지 않거나 주위에 중요한 근육, 신경등이 분포하고 있는 경우는 완전절제가 힘들수 있는데 이런 경우 임상 소견이나 방사선 소견 등을 통해 절제 범위를 결정한다. 현미경적으로 변연에 종양조직이 남아 있는 경우 재의 확률이 높고 영상을 통한 추적 관찰을 통해 악성화 여부를 확인하여야 한다. 본 증례의 경우 변이형 지방종으로 분류할 수 있고, 피막가 잘되어 있어서 주위 조직의 손상없이 완전 절제가 가능하였다. 요약: 연골변성 또는 골아변성을 동반한 변이형 지방종의 경우 현재까지 악성화 및 재발이 보고된 바는 없다. 하지만 증례가 적고 본 증례처럼 연골-골아세포 변성을 함께 동반한 경우는 세계적으로 1예밖에 없기 문에 향후 더 많은 증례 보고를 통해 악성화 여부, 재발 빈도 및 염색체 이상 유무 등에 대한 연구가 필요하다.

A Case of Acute Parotitis Related to L-Asparaginase Therapy

은준영,박희숙,원종호,이남수,이상철,김경하,홍대식,박성규,김세형,윤진아 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.-

타이타니움 의치상에 대한 다양한 금속표면처리제의 적용이 첨상레진과의 결합강도에 미치는 형향

은준영,조인호,이종혁 대한턱관절교합학회 2006 구강회복응용과학지 Vol.22 No.2

A Case of Acute Parotitis Related to L-Asparaginase Therapy

은준영,박희숙,원종호,이남수,이상철,김경하,홍대식,박성규,김세형,윤진아 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.1

Introduction: L-Asparaginase is one of the chemotherapeutic agent as induction therapy for acute lymphoblastic leukemia and lymphoma. Well known adverse effects of L-asparaginase are allergy, thromboembolism, pancreatitis, and endocrine dysfunction such as hyperglycemia or lipid metabolism. But, acute parotitis is one of the rarest side effects caused by L-asparaginase. So we report the case of acute parotitis due to L-asparaginase. Case report: 22-year-old woman was hospitalized with painless swelling on both submandibular area. She had been taken the first cycle of chemotherapy consisting of dexamethasone, methotrexate, ifosfamide, etoposide and L-asparaginase for recurred NK-T cell lymphoma until ten days before this admission. Vital signs were stable, and there was nontender swelling on both submandibular area. Laboratory findings showed hemoglobin level was 8.6 g/dL, platelet count 214,000/μL, WBC count 2,100/μL(Absoluted neutrophil counts:855), blood urea nitrogen 13 mg/dL, creatinine 0.48 mg/dL, C-reactive protein 0.47 mg/dL(0.01~0.29), amylase 115.4 U/L (28~100), lipase 38 U/L (13~60). Neck computed tomography revealed both symmetrical prominent parotid and submandibular glands without remarkable focal mass like lesions or infection foci. Serum amylase level was normally decreased to 82 U/L at the third admission day. We started chemotherapy two days later. 12 mg of dexamethasone was administered intravenously, and then both submandibular swelling were decreased and subsided on next day. Discussion: The mechanism of the acute parotitis related L-asparaginase are not well identified. Because of it``s similarity with pancreas as digestive organs with high rates of protein synthesis, the depletion of L-asparagine may affect the parotid glands. In conclusion, L-asparaginase should be used carefully, and we should pay attention to occurrence of acute parotitis as acute pancreatitis. And when acute parotitis is suspicious, we should try to find other cause or complication such as viral infection or supurative parotitis by mumps IgM Ab or radiologic finding. And we suggest of possible relationship the recovery of acute parotitis caused by L-asparaginase and use of steroid.

연골-골아세포 변성을 함께 동반한 지방종 1예

은준영,이한민,김한조,배상병,이규택,김성용,오미혜 순천향대학교 순천향의학연구소 2011 Journal of Soonchunhyang Medical Science Vol.17 No.1

Lipomas, which are benign adipose tissue tumors, are the most common tumors of mesenchymal origin in humans. Some variants of lipoma have been described according to the type of tissue present. A rare variant consists of a lipoma with osseous or cartilaginous metaplasia. We present the case of a lipoma with chondro-osteoblastic metaplasia of right buttock in a 57-year-old male. He was referred for a painless mass on the right lateral margin of the buttock, and present for about 1 month. Magnetic resonance images revealed a 12×8×4 cm sized mass with secondary degeneration focally, involving deep portion of the right gluteus maximus muscle, and protruded to adductor magnus muscle. T1 weighted images showed signal enhancement within the mass. He underwent complete resection of the tumor. No recurrence was observed after five years follow-up. Lipoma with chondro-osteoblastic metaplasia is extremely rare disease. Here, we report it along with the corresponding literature.

타이타니움 의치상에 대한 다양한 금속표면처리제의 적용이 첨상레진과의 결합강도에 미치는 영향

은준영(Jun-Young Eun),조인호(In-ho Cho),이종혁(Jong-Hyuk Lee) 대한턱관절교합학회 2006 구강회복응용과학지 Vol.22 No.2

Efficacy and Safety of Oxaliplatin, 5-Fluorouracil, and Folinic Acid Combination Chemotherapy as First-Line Treatment in Metastatic or Recurrent Gastric Cancer

김한조,은준영,전영우,윤진아,김경하,김세형,김현정,이상철,배상병,김찬규,이남수,이규택,박성규,원종호,홍대식,박희숙 대한암학회 2011 Cancer Research and Treatment Vol.43 No.3

Purpose We retrospectively determined the efficacy and safety of the combination of oxaliplatin, 5-fluorouracil (5-FU), and folinic acid (FA) as first-line chemotherapy for patients with metastatic or recurrent gastric cancer. Materials and Methods Between January 2006 and August 2009, 39 patients with histologically-confirmed, metastatic or recurrent gastric cancer underwent chemotherapy, and the results were retrospectively investigated. The chemotherapy regimen consisted of oxaliplatin (100 mg/m2)and FA (200 mg/m2; 2-hour infusion), then 5-FU (2,400 mg/m2; 46-hour continuous infusion)every 2 weeks. Results Thirty-nine patients received a total of 210 treatment cycles. The median number of cycles was 6 (range, 1 to 16). Of the 32 evaluable patients, zero patients achieved a complete response and 11 patients achieved a partial response (response rate, 28.2%). The median timeto-progression and overall survival were 4.3 months (95% confidence interval [CI], 2.0 to 6.5months) and 9.8 months (95% CI, 3.5 to 16.0 months), respectively. The main hematologic toxicity was anemia, which was observed in 119 cycles (56.7%). Grade 3/4 neutropenia was observed in 32 cycles (15.2%). The main non-hematologic toxicity was constipation, which was observed in 91 cycles (46.2%). Peripheral neuropathy occurred in 71 cycles (33.8%); all cases were grade 1 or 2. No treatment-related deaths were reported. Conclusion This study showed that combination chemotherapy with oxaliplatin, 5-FU, and FA is an active and well-tolerated regimen as first-line treatment in patients with metastatic or recurrent gastric cancer.

Hereditary hemorrhagic telangiectasia treated with low dose intravenous bevacizumab

위지완,전영우,은준영,김한조,배상병,이규택 대한혈액학회 2014 Blood Research Vol.49 No.3

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disorder that leads to mucocutaneous telangiectasias, epistaxis, and gastrointestinal bleeding. Depending on the severity and manifestation of the disease, various therapeutic modal-ities have been used, from local bleeding control to surgery or concomitant drug therapy. Several articles under review have presented guidelines for treatment of HHT with bev-acizumab as a direct anti-angiogenesis strategy. Still, neither the exact optimal dose nor the minimum effective dose of intravenous bevacizumab in patients with severe HHT has been reported. A 55-year-old man presented with long-standing epistaxis, recent me-lena, dizziness, and a three-generation family history of chronic epistaxis, anemia, and regular blood transfusions. Treatment with argon plasma coagulation (APC) for the gastro-intestinal bleeding failed to raise hemoglobin levels, we considered using the bevacizumab. We report a patient with severe HHT, who was treated with low-dose bev-acizumab (2 mg/kg) and improved substantially.

Hereditary hemorrhagic telangiectasia treated with low dose intravenous bevacizumab

위지완,전영우,은준영,김한조,배상병,이규택 대한혈액학회 2014 Blood Research Vol.49 No.3

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disorder that leads to mucocutaneous telangiectasias, epistaxis, and gastrointestinal bleeding. Depending on the severity and manifestation of the disease, various therapeutic modal-ities have been used, from local bleeding control to surgery or concomitant drug therapy. Several articles under review have presented guidelines for treatment of HHT with bev-acizumab as a direct anti-angiogenesis strategy. Still, neither the exact optimal dose nor the minimum effective dose of intravenous bevacizumab in patients with severe HHT has been reported. A 55-year-old man presented with long-standing epistaxis, recent me-lena, dizziness, and a three-generation family history of chronic epistaxis, anemia, and regular blood transfusions. Treatment with argon plasma coagulation (APC) for the gastro-intestinal bleeding failed to raise hemoglobin levels, we considered using the bevacizumab. We report a patient with severe HHT, who was treated with low-dose bev-acizumab (2 mg/kg) and improved substantially.