아래눈꺼풀에서 발생한 단독 색소 얼기신경섬유종 1예

윤현정(Hyeon Jeong Yoon),윤경철(Kyung Chul Yoon),김가언(Ga Eon Kim),최 원(Won Choi) 대한안과학회 2017 대한안과학회지 Vol.58 No.3

목적: 저자들은 전신적인 신경섬유종증 없이 눈꺼풀에 단독으로 발생한 얼기 색소성 신경섬유종 1예를 경험하였기에 이를 보고하고자 한다. 증례요약: 출생 직후부터 발견한 우측 아래눈꺼풀 피하의 비교적 경계가 명확한 무통성 종괴를 주소로 12세 남자 환아가 수술적 치료를 원하여 내원하였다. 과거력 상 바터 증후군, 주의력결핍 과잉행동장애로 진단받고 치료 중이었다. 내원 시 시행한 이학적 검사상리쉬소결절, 시신경아교종, 고도근시 등 신경섬유종증에서 나타나는 소견은 보이지 않았다. 병변에 대해 절제생검술을 시행하였으며, 육안소견상 4.0 × 1.5 × 1.5 cm 크기의 불규칙한 모양의 결절이었다. Hematoxylin & eosin 염색상 점액기질을 동반한 다양한 크기의 비후된 신경 다발이 있었으며 증식된 멜라닌세포가 그 주위를 감싸고 있었다. 면역조직화학염색에서 neurofilament, melan-A, HMB-45 (Melanoma marker antibody)에 양성을 보여 얼기 색소성 신경섬유종으로 판명되었다. 피부과에서 시행한 이학적 검사, 뇌자기공명영상촬영 및 유전자 검사에서 전신적인 신경섬유종증의 증거는 없었다. 결론: 신경섬유종증으로 진단된 과거력 및 임상적 소견이 없더라도 눈꺼풀 종물의 감별 진단 시 얼기 색소성 신경섬유종을 고려해야하며, 절제술에 의해 성공적으로 치료될 수 있다. Purpose: Solitary plexiform neurofibroma of the eyelid without neurofibromatosis is a rare disease. We report a case of solitary plexiform pigmented neurofibroma of the eyelid without neurofibromatosis. Case summary: A 12-year-old male visited our clinic with a painless palpable subcutaneous mass on the right lower eyelid. He had a history of Batter syndrome and attention deficit hyperactivity disorder. On initial presentation, clinical features regarding neurofibromatosis such as Lisch nodule, optic nerve glioma, or high myopia were not observed. We performed excision and biopsy of the lower lid mass under general anesthesia. Macroscopically, the tumor was 4.0 x 1.5 x 1.5 cm in size with irregular nodules. Microscopically, the tumor consisted of multiple, variably sized tortous enlarged nerve fascicles with clusters of pigmented cells. Immunohistochemical results revealed expression of S-100 protein. Pigmented cells express both S-100 and melan- A proteins, while nonpigmented cells express S-100 protein only. The tumor was finally diagnosed as plexiform pigmented neurofibroma. Dermatological evaluation revealed no evidence of systemic neurofibromatosis. Conclusions: Plexiform neurofibroma should be considered in the differential diagnosis of an eyelid mass, even if the patient does not have a history or clinical features of neurofibromatosis. Plexiform neurofibroma can be successfully managed with surgical excision.

高御産巢日神の一考察

최 원 재(崔元載, Choi, Won-Jai) 일본어문학회 2010 일본어문학 Vol.51 No.-

本稿は、天孫に降臨を命じた神、つまり司令神のうち、タカミムスヒに焦点を当ててその神の特質や性格などを明らかにしてアマテラス以前の皇祖神の原態について考察したものである。古事記と日本書紀の天孫降臨神話には、司令神に焦点を絞ってみると、タカミムスヒ系の降臨神話と、アマテラス系の降臨神話、また両方を統合した形の三種類の降臨神話があり、皇祖神の二元構造が浮かび上がってくる。そこで本来の司令神を追求してみた結果、天孫降臨神話は本來司令神のタカミムスヒがホノニニギを直接降臨させる伝承であって、アマテラスよりタカミムスヒが本來の命令神․司令神と意識されていたと考えられる。タカミムスヒの神格については、タカミムスヒを日の神(=太陽神)と想定した上で、さらに古代韓國の諸國の始祖伝承を考察した結果、そこには天․天帝=日神(太陽神)の觀念を含み持っていて、それをもってタカミムスヒ=日神は古代韓國に見られる天の至高神(=日神)の到來によるものと捉えた。それは顯宗紀三年の記事からタカミムスヒ信仰の軌跡が韓半島に近い對馬や壹岐あたりと密接なかかわりをもっているからである。

안와에 발생한 피부섬유육종 1예

이동규(Dong Kyu Lee),김가언(Ga Eon Kim),최 원(Won Choi),윤경철(Kyung Chul Yoon) 대한안과학회 2016 대한안과학회지 Vol.57 No.11

목적: 안와에 발생한 피부섬유육종은 발생빈도가 매우 드문 악성 종양으로, 아직까지 국내에서 보고된 바 없다. 저자들은 안와에 발생한 피부섬유육종을 국내에서 최초로 경험하였기에 이를 보고하고자 한다. 증례요약: 66세 남자 환자가 내원 3주 전부터 점점 커지는 양상의 상안검 내측 종괴를 주소로 내원하였다. 이학적 검사상 상안검 내측 부위의 심부에서 딱딱한 종괴가 촉진되었으나 육안상으로 결절형태는 보이지 않았다. 안와전산화단층촬영상 1.2 × 1 × 1 cm의 경계가 명확한 조영증강된 종괴가 발견되었다. 국소 마취하 절제생검을 시행하였고, 조직병리검사 결과 Hematoxylin & Eosin 염색상 높은 세포충실성, 국소적인 비정형세포 및 방추상의 섬유아세포의 나선형배열 소견을 보였으며, 면역조직화학염색상 CD34 양성 소견을 보여 피부섬유육종으로 진단되었다. 조직 절제 후 시행한 양전자 방출 컴퓨터 단층 촬영상 다른 장기로의 전이 소견은 보이지 않았으며, 이후 9개월간 경과관찰하였으나 국소적 재발 없이 수술 부위는 안정적으로 유지되었다. 결론: 피부섬유육종이 안와에 발생할 수 있음을 인지하고 안와종양의 감별진단 시 피부섬유육종도 고려해야 하며, 국소 절제술에 의해 성공적으로 치료될 수 있다. <대한안과학회지 2016;57(11):1777-1780> Purpose: Dermatofibrosarcoma in the orbit is a rare malignant neoplasm. We report an extremely rare case of primary dermatofibrosarcoma in the orbit. Case summary: A 66-year-old male presented with a slowly progressing periorbital mass on his left upper eyelid which developed 3 weeks earlier. On physical examinations, a palpable firm mass under the skin was observed at the superomedial aspect of the left upper eyelid. However, there was no surface nodule or demarcated line on the eyelid. An approximately 1.2 × 1 × 1 cm sized well defined and clearly demancated mass was observed on orbital computed tomography. Excisional biopsy was performed under local anesthesia and pathological examination revealed dermatofibrosarcoma. There was no metabolic evidence of regional or distant metastasis based on positron emission tomography-computed tomography. Nine months after surgical excision there was no evidence of local recurrence. Conclusions: This is the first report in South Korea of dermatofibrosarcoma in the orbit. Dermatofibrosarcoma should be considered following differential diagnosis of a periorbital mass. J Korean Ophthalmol Soc 2016;57(11):1777-1780

양측 눈꺼풀 결막에 국한되어 발생한 면역글로불린 G4 관련 안질환

국경윤(Kyung Yun Kook),문현식(Hyun Sik Moon),윤현정(Hyeon Jeong Yoon),최 원(Won Choi)윤경철(Kyung Chul Yoon) 대한검안학회 2020 Annals of optometry and contact lens Vol.19 No.1

Purpose: To report a case of isolated bilateral tarsal conjunctival immunoglobulin G4 (IgG4)-related ophthalmic disease. Case summary: A 34-year-old male presented with both upper tarsal mass refractory with medical treatment at local hospital from 4 months ago. Slit-lamp examination showed elevated multi-lobular masses on both upper tarsal conjunctiva. Immunochemical stain on specimen showed the ratio of the IgG4+ to IgG+ cells was approximately over 80% and the mean number of IgG4-positive plasma cells was over 100 per high-power field. Therefore, we could finally diagnose his illness as IgG4-related ophthalmic disease. There was no evidence of systemic involvement in other examinations such as blood tests or radiologic examination performed in the rheumatology department of internal medicine. Conclusions: IgG4-related ophthalmic disease is well known to occur in the orbit, especially in the lacrimal gland. However, there are no reported cases of tarsal conjunctival IgG4-related ophthalmic disease in Korea. Therefore, if a tumor is found in the tarsal conjunctiva, appropriate pathologic examination should be performed with the possibility of IgG4-related ophthalmic disease.

감염 검출을 위한 4 가지 Enzyme Immunoassay 법의 평가

엄희섭(Hee Sub Eom),김범수(Pum Soo Kim),이종욱(Jong Wook Lee),배수환(Soo Hwan Pai),이진우(Jin Woo Lee),최 원(Won Choi),이돈행(Don Haeng Lee),권계숙(Kye Sook Kwon),조현근(Hyeon Geun Cho),김형길(Hyung Gil Kim),신용운(Yong Woon Shin) 대한소화기학회 2001 대한소화기학회지 Vol.37 No.5

Background/Aims: Serologic methods for the diagnosis of Helicobacter pylori (H. pylori) infection are simple and inexpensive but have low sensitivity and specificity. We compared four different commercial kits commonly used in Korea for the diagnosis of H. pylori infection. Methods: Forty-one consecutive patients were involved in this study. They all underwent gastric endoscopy and biopsy. To detect H. pylori infection, the biopsy samples were analyzed by histology, culture, and CLO(TM) test and the results were used as a gold standard. We performed serologic tests including Bio-Rad GAP IgG, Radim H. pylori IgG, CLI H. pylori IgG ELISA, and Genedia H. pylori ELISA. The results were analyzed by receiver operating characteristic (ROC) curves. Results: In comparison with a predefined gold standard, the sensitivity of GAP(TM), Genedia(TM), Radim(TM), and Clarke(TM) was 60, 100, 88, and 68%, respectively. The specificity of the tests was 87.5, 81.3, 93.8 and 93.8%, respectively. The adjusted cut-off values using the ROC curves improved the performance of the tests. Conclusions: Four serologic test kits commonly used in Korea are not different in the diagnostic accuracy for the detection of H. pylori infection, but ROC analysis can enable us to reexamine the validity of the cut-off valuse indicated by the manufacturers. Therefore, to optimize accuracy, the diagnostic performances of various serologic kits should be evaluated locally. (Korean J Gastroenterol 2001;37:312-318)

직장 유암종 1 예

정 노 원,강 경 하,최 호 수 대한소화기내시경학회 1999 Clinical Endoscopy Vol.19 No.1

Carcinoid is a tumor that primarily affects the intestinal tract, which arises from entero-chromaffin cells. Rectal carcinoid tumor is a relatively rare neoplasm originated in Kulchitszky cell and clinicians have the difficulties in predicting their malignant potential and in proper treatment. These cells are found to increase in the distal small intestine, are common in the appendix, and then decrease within the mucosa of the colon from cecum to rectum. In the cumulative world literature, the incidence of carcinoids of rectum is slightly higher than 10 percent. All of these tumors are within reach of the rigid procto-sigmoidoscope, most being located between 4 and 13 cm from the anal verge. Eighty five percent are found on the anterior and lateral walls. The tumors are usually submucosal and light yellowish or reddish color. The vast majority of rectal carcinoid tumors are benign, which can be treated by local excision safely. Lesions larger than 2 cm and invading the muscular wall of the rectum should be considered malignant, which are treated by more radical surgery such as abdominoperitoneal resection. We experienced a case of rectal carcinoid tumor, which was excised by endoscopic polypectomy, so we present this case with a review of relevant literatures.

낭성 종양으로 오인된 복강내 결핵 1예

김영수,신용운,권계숙,김범수,김형길,이돈행,조현근,최 원,윤승재,정 석 대한소화기학회 2001 대한소화기학회지 Vol.37 No.3

Although the incidence of tuberculosis has recently been reduced owing to advance of antituberculous drugs, improvement of public health, and early diagnosis with effective treatment, tuberculosis still remains as a major cause of death in Korea. In general, abdominal tuberculosis is described in three main forms; tuberculous peritonitis, gastrointestinal tuberculosis, and a combination of both. The diagnosis of abdominal tuberculosis, especially extraintestinal tuberculosis, is difficult due to vague symptoms and nonspecific laboratory findings. We experienced an interesting and unique case of abdominal tuberculosis. A 27-year-old man who complained of symmetric diffuse abdominal distension revealed a huge cystic mass. After cystectomy, the mass was confirmed as tuberculous cyst involving surrounding organs such as the spleen, pancreas, liver, and transverse colon. His postoperative course has been good since the start of antituberculous medication. The authors have experienced a case of abdominal tuberculosis mimicking cystic mass and report the case with the brief review of literatures.

만성 췌장염과 췌장암에서 면역조직화확염색법을 통한 Ki - 67 , p53 , K - ras 단백 발현에 대한 연구

김영수,김영배,이진우,김인한,신용운,권계숙,이돈행,김범수,조현근,김형길,최 원 대한소화기학회 2001 대한소화기학회지 Vol.37 No.5

Background/Aims: Hyperplasia or dysplasia of pancreatic duct epithelium has been frequently found in the pancreas of pancreatic cancer or chronic pancreatitis. We hypothesized that ductal hyperplasia and dysplasia in the pancreas represent precursor lesions of cancer. Methods: We examined the expression of Ki-67, CEA, p53, K-γαs using the methods of H&E staining and immunohistochemical staining for 11 pancreatic cancer and 12 chronic pancreatitis specimens. For the specimens of pancreatic cancer, we classified the tissue into normal (n=7), ductal hyperplasia (n=3), dysplasia (n=4), and cancer lesion (n=ll). The tissue of chronic pancreatitis were also divided into normal (n=10), ductal hyperplasia (n=4), and dysplasia (n=5). Results: In pancreatic cancer, the Ki-67 index was 3.73±3.58 in normal site, 6.62±4.39 in ductal hyperplasia, 13.47±4.02 in dysplasia, and 37.03±10.05 in cancer tissue (p$lt;0.05). In this study, the expression of p53 protein was observed in 78% of dysplasia and 91% of carcinoma cells t in normal ducts and ductal hyperplasia. K-γαs was expressed in 33% of ductal hyperplasia, 67% of dysplasia, and 80% of cancer tissue but not in normal ducts. Conclusions: These data support the hypothesis that ductal hyperplasia and dysplasia of the pancreas represent precursor lesions of cancer. These results need further evaluation of molecular study of oncogenes.

복직근에 발생한 원발성 복부 방선균증 1 예

김미영,김영수,박상준,신용운,권계숙,이돈행,민효영,조현근,김대혁,김준미,김범수,최 원 대한소화기학회 1999 대한소화기학회지 Vol.33 No.6

Actinomycosis is a chronic granulomatous and suppurative disease caused by Actinomyces species. As a pathogen, it can cause fistulas or sinuses, and may form a mass. Sulfur granules in the lesion, sinu walls or discharge are characteristics of actinomycosis. The most common location of abdominal actinomycosis is the appendix or ileocecal region of the intestine. In addition, actinomycosis has been found in the rectum, the sigmoid and the transverse colon as well as the liver, the pancreas and th pelvis. However, primary rectus abdominis actinomycosis is a rare form of actinomycosis. We repor a case of primary rectus abdominis actinomycosis presenting an abdominal mass in a 60-year-old man whose chief complaint is fever.