• 대한두개안면성형외과학회지
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• 제22권3호
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• pp.157-160
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• 2021

Head and neck cutaneous metastasis of advanced gastric cancer is uncommon, and scalp metastasis is particularly rare. We present the case of a 60-year-old man who was diagnosed with cutaneous metastasis on the scalp originating from advanced gastric cancer. The patient was referred to the plastic surgery department for a scalp mass near the hairline. He had been diagnosed with advanced gastric cancer and undergone total gastrectomy and Roux esophagojejunostomy 3 years previously. The differential diagnosis for a single flesh-colored nodule on the scalp included benign tumors such as epidermal cyst or lipoma; therefore, the patient underwent excision and biopsy. In the operative field, the mass was found to be located in the frontalis muscle. The biopsy result showed that the mass was a metastatic lesion of advanced gastric cancer. Whole-body computed tomography revealed a gastric tumor with blood vessel infiltration, peritoneal carcinomatosis, liver metastasis, and multiple disseminated subcutaneous metastases. Although scalp metastasis originating from an internal organ is extremely rare, plastic surgeons should always consider a metastatic lesion in the differential diagnosis if a patient with a scalp lesion has a history of malignant cancer.

• Journal of Korean Neurosurgical Society
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• 제57권4호
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• pp.258-265
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• 2015

Objective : The purposes of this article are to present 5 cases of intracranial meningioma with leptomeningeal dissemination (LD) and investigate the characteristics of this disease. Methods : We present a retrospective case series of 5 females at our institutions (age ranged 21-72 years, mean 54.6 years) diagnosed with LD of an intracranial meningioma after surgery between 1998 and 2013. A database search revealed 45 cases with LD of meningioma in the English literature. Characteristic features were analyzed and compared. Results : The incidence rate at our institutions of LD of meningioma was 0.9% (5/534). World Health Organization (WHO) grade was distributed as follows: I : 2, II : 2, and III : 1. Time to LD ranged from 2.5 months to 6.9 years; the patient with WHO grade III had the shortest interval to LD. The patient with an intraventricular meningioma (WHO grade II) had the second shortest interval to LD (1.7 years), and simultaneously revealed both LD and extraneuronal metastases. Four of 5 patients showed a disease progression, with the survival ranging from 1 month to 3.8 years after LD. Based on the literature, the initial tumor was an intraventricular meningioma in 9 patients, and their time to LD was shorter on average (mean 1.9 years). Histologically, 26 of 45 (58%) were initially diagnosed with a WHO grade II or III meningioma, and 6 of 19 patients (32%) with WHO grade I revealed malignant transformation. Conclusion : This study shows that intraventricular location and histologically aggressive features seem to increase the chance of LD of meningioma.

• Tuberculosis and Respiratory Diseases
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• 제43권4호
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• pp.651-656
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• 1996

저자 등은 입원 당시 전이성 암 또는 원발성 폐암의 방사선학적 소견을 보인 환자의 진단과정 중에 우리가 흔히 보는 형태가 아닌 유육종증 1예를 경험하여 문헌 고찰과 함께 보고하는 바이다.

• Journal of Yeungnam Medical Science
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• 제29권2호
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• pp.96-101
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• 2012

Allogeneic hematopoietic stem cell transplantation (HSCT) is considered the optimal curative treatment for acute myeloid leukemia (AML), but some patients develop bone marrow relapse due to remnant leukemia, and few patients develop extramedullary relapse without bone marrow relapse. Isolated extramedullary relapse (IMER) is defined as extramedullary relapse without bone marrow relapse. IMER has been reported in various sites, including the skin, soft tissue, and central nervous system(CNS). Isolated CNS relapse is relatively rare and is associated with poor prognosis due to the absence of an optimal treatment for it. Reported herein is a case involving an adult AML woman who suffered from isolated extramedullary relapse in the CNS after allogeneic HSCT. She was treated with intrathecal chemotherapy and whole-brain and spine radiotherapy, followed by systemic chemotherapy. She is currently well, with no evidence of leukemia recurrence for over six years.

• Radiation Oncology Journal
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• 제11권1호
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• pp.119-126
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• 1993

From 1988 to 1991, nineteen patients with unresectable localized pancreatic carcinoma were treated with radiotherapy and/or hyperthermia or in combination with chemotherapy. Radiation dose of 4500-5000 cGy with or without additional 500-1000 cGy was administered over 5 to 6 weeks to the pancreatic tumor area using 10 MV linear accelerator. Five of 19 patients were given chemotherapy, either neoadjuvant or maintenance setting with FAM regimen (5-FU, adriamycin and mitomycin C), which was repeated every 4 weeks for one year or until progression. Symptomatic palliation was achieved in 17 among 19 patients ($89{\%}$) and objective response (complete or partial response in CT finding) was achieved in 5 among 11 patients ($45{\%}$). The median survival time was 9 months and one-year survival rate, $32{\%}$. Local-regional failure was documented in 10 among 13 patients ($77{\%}$) and distant failures were found in the liver (3 patients) and carcinomatosis (2 patients). Prognostic significance of various factors such as age, sex, performance status, tumor location, stage, etc. were assessed. Any factors did not have the prognostic significance in univariate analysis. Treatment was well tolerated in most of the patients with only mild to moderate toxicity.

• Brain Tumor Research and Treatment
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• 제6권2호
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• pp.54-59
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• 2018

Background Leptomeningeal metastasis (LM) is an uncommon, but devastating complication of advanced cancer and has no standard treatment. Herein, we analyzed the clinical characteristics and outcomes of patients with solid tumors who were diagnosed with LM. Methods Between January 2007 and December 2017, we retrospectively analyzed the medical records of patients with solid tumors who were diagnosed with LM. Results A total of 58 patients were enrolled in this study. The median age of patients was 51 years (range, 27-72 years), and 62.1% had a poor Eastern Cooperative Oncology Group (ECOG) performance status (PS) (>2). The common types of primary tumor were breast cancer (39.7%), gastric cancer (25.9%), and non-small cell lung cancer (20.7%). Forty-two patients (72.4%) were diagnosed with LM by MRI of the brain and/or spine and cerebrospinal fluid (CSF) analysis, 14 were diagnosed by CSF analysis alone, and 2 were diagnosed by MRI alone. Treatments for LM were performed in 53 patients (91.4%), and best supportive care was provided for 5 patients (8.6%). Intrathecal chemotherapy, radiotherapy, and systemic chemotherapy were administered in 43 (74.1%), 17 (29.3%), and 24 (41.4%) patients, respectively. The median overall survival of the entire cohort was 2.4 months (95% confidence interval, 1.0-3.7). In the analysis of prognostic factors for survival, a good ECOG PS (${\leq}2$), administration of systemic chemotherapy after LM diagnosis, and a prior history of brain radiation were associated with prolonged survival. Conclusion Although the prognosis of LM in patients with solid tumors is poor, systemic chemotherapy might improve survival in selected patients with a good PS.

• Investigative Magnetic Resonance Imaging
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• 제26권1호
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• pp.32-42
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• 2022

Purpose: To evaluate the clinical benefit of 2D contrast-enhanced T2 fluid-attenuated inversion recovery (CE-T2 FLAIR) image for detecting leptomeningeal metastasis (LM) in the brain metastasis work-up for lung cancer. Materials and Methods: From June 2017 to July 2019, we collected all consecutive patients with lung cancer who underwent brain magnetic resonance image (MRI), including contrast-enhanced 3D fast spin echo T1 black-blood image (CE-T1WI) and CE-T2 FLAIR; we recruited clinico-radiologically suspected LM cases. Two independent readers analyzed the images for LM in three sessions: CE-T1WI, CE-T2 FLAIR, and their combination. Results: We recruited 526 patients with suspected lung cancer who underwent brain MRI; of these, we excluded 77 (insufficient image protocol, unclear pathology, different contrast media, poor image quality). Of the 449 patients, 34 were clinico-radiologically suspected to have LM; among them, 23 were diagnosed with true LM. The calculated detection performance of CE-T1WI, CE-T2 FLAIR, and combined analysis obtained from the 34 suspected LM were highest in the combined analysis (AUC: 0.80, 0.82, and 0.89, respectively). The inter-observer agreement was also the highest in the combined analysis (0.68, 0.72, and 0.86, respectively). In quantitative analyses, CNR of CE-T2 FLAIR was significantly higher than that of CE-T1WI (Wilcoxon signed rank test, P < 0.05). Conclusion: Adding CE-T2 FLAIR might provide better detection for LM in the brain-metastasis screening for lung cancer.

• Tuberculosis and Respiratory Diseases
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• 제43권3호
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• pp.388-402
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• 1996

연구배경 : 미만성 침윤성 폐질환의 진단에 있어 HRCT와 단순흉부X선사진의 역할을 알아보고 진단의 정확성을 비교하고자 하였다. 방법 : 단순흉부X선사진과 HRCT를 시행 하였고, 임상적으로 그리고 병리조직학적으로 확진된 99명의 DILD환자와 12명의 정상인을 대상으로 하였다. 99명의 DILD환자들은 20종류의 급성 및 만성질환을 포함하였다. 단순흉부X선사진과 HRCT는 독립적으로 3명의 흉부 방사선과 의사가 진단명을 모르는 상태에서 임상적 정보 없이 각각 평가하였고, 3개의 가능성이 많은 진단을 선택하였으며 그중 첫번째로 가능한 진단명은 그 진단의 확신도를 3등급으로 나누어 기록하였다. 결과 : HRCT와 단순흉부Xtjs사진은 DILD의 검출에 있어서 민감도가 각각 98.9%와 97.9%이었다. 첫번째 가능한 진단명 중 그답이 옳은 경우는 단순흉부X선사진에서 48%, HRCT에서 60%에서 이루어 졌고, 3개의 감별진단을 모두 포함하였을 때는 단순흉부X선사진의 64%, HRCT의 75%에서 정확한 진단을 하였다. 확신도가 높은 첫번째 진단은 HRCT에서 55%로 단순흉부X선사진의 26% 많았다. 특히 확신도가 높은 첫 번째 HRCT진단이 옳은 경우는 UIP, 속립성 폐결핵, 미만성 세기관지염, 림프행성 폐전이에서 83-93%이었다. 결론 : HRCT와 단순흉부X선사진 모두 DILD의 검출에 있어서 매우 좋은 검사법이다. HRCT는 단순흉부X선사진에 비해 DILD 각 질환의 진단에 보다 정확하다. 특히 HRCT는 임상에서 자주 접하는 UIP, 속립성 폐결핵, 미만성 세기관지염, 림프행성 폐전이의 진단에 매우 유용하며, 드문 질환이지만 BOOP, 폐 조직구 증식증, 폐포성 단백증, LAM 등을 정확하게 진단할 수 있다. 또한 이러한 HRCT 진단들은 단순흉부X선사진 진단에 비해 신뢰도가 높고 정확하다.

• Radiation Oncology Journal
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• 제14권3호
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• pp.221-228
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• 1996

목적 : 난소 미분화세포종의 임상적 특징과 치료 방법, 국소 제어율, 치료 실패 양상, 생존율 등 치료 성적을 분석해 보고, 가임력을 보존하기 원하는 병기 13 환자들에서의 적절한 치료 방침을 찾아보고자 본 연구를 시행하였다. 대상 및 방법 : 1975년 1월부터 1990년 12월까지 연세 의대 신촌 세브란스병원, 연세암센터에서 진단 및 치료를 받은 34명의 난소 미분화세포종 환자를 대상으로 하였다. 이중 2예의 gonadoblastoma(46,XY)와 3예의 혼합 배세포종(mixed germ cell tumor)을 제외하고 나머지 순수 미분화세포종(pure dysgermlnoma) 환자 29예만을 연구 대상으로 하여 치료 방법에 따라 두군으로 나누어 성적을 분석하였다. 1군은 수술후 보조적 방사선치료를 받은 환자로 21예였고, 2군은 수술후 보조적 방사선치료를 하지 않은 군으로 8예였다. 대상 환자의 연령 분포는 8-39세였고 중앙치는 23세였다. 진단 시 임상 증상은 촉지되는 복부 골반부 종괴가 가장 호발하였다. 병기는 I이 23명으로 $89.3\%$로 다수를 차지하였다. 방사선치료는 병기 I, II에서는 전복부조사 20-25 Gy, 골반부에 축소하여 10-15 Gy 추가 조사하였고 종격동과 쇄골 상부의 방사선치료는 대부분 II기 이상의 진행된 병기에서 20-26 Gy 조사하였다. 환자들의 추적 관찰 중앙치는 80개월(13-201개월)이었다. 결과 : 수술후 보조적 방사선치료를 받은 환자인 1군(21예)은 전원 국소제어 및 무병 생존중이었다. 2군은 수술후 보조적 방사선치료를 하지 않은 8예인데 이중 6예에서 국소 재발지 발생하여 4예는 구제 목적의 방사선치료를 받았고 1예는 항암화학요법을 1예는 재수술만 시행 받았다. 구제 치료 결과 방사선치료를 받은 4예중 3예, 항암화학요법 받은 1예 및 재수술을 받은 1예는 완치되었으나, 1예만 암종증(carcinomatosis)으로 진행되어 방사선치료후 11개월에 사망하였다. 그러므로 29예 전체의 5년 국소 제어율 및 5년 생존율은 $96.6\%$(28/29)였다. 일측 난소에 국한된 병기 la 환자 13예 중 7예는 수술 및 수술후 방사선치료를 받았고 이들은 전원 국소제어 되어 20-201개월간(중앙치 80개월) 무병 추적 관찰 중이나, 수술로 일측 난소난 관절제술 후 방사선치료 없이 지내던 6예의 환자 중 5예에서 재발하였으나 이들 모두 방사선치료, 항암화학요법, 재수술 등의 구제치료에 성공하였다. 즉 13예의 병기 la 환자 전원이 20-201개월간 무병 생존 중이다. 결론 : 난소 미분화세포종의 치료에 있어서 수술후 보조적 방사선치료를 부가함으로 종양의 크기, 병기, 수술법에 관계없이 $100\%$ 국소 제어율 및 $100\%$ 5년 생존율을 획득하였다. 수술후 재발한 경우라도 암종증(carclnomatosis)이나 복부 이외의 장기에 원격 전이가 없다면 방사선치료, 항암화학요법 또는 재수술로 구제될 가능성이 매우 높다. 그러므로 가임력을 보존하기 원하는 병기 la 환자에서는 보존적 수술인 일측 난관난소절제술만 시행하고 추적 관찰하는 것도 치료 방법으로 고려될 수 있겠다.

• Journal of Gastric Cancer
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• 제14권2호
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• pp.123-128
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• 2014

Purpose: Since there are no proven tumor markers that reflect the course of gastric cancer, carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) are commonly used alternatives. However, the degree of progression that corresponds to an increase in these markers, and the values of these markers at different cancer stages, remains unclear. Materials and Methods: This study enrolled 1,733 gastric cancer patients who underwent surgery and whose pre-operative CEA and CA19-9 levels were known. Survival curves and mean values of the two markers were compared according to the degree of cancer progression: serosa-unexposed (SU), serosa-exposed (SE), direct invasion (DI), localized seeding (P1), and extensive seeding (P2). Results: The 5-year overall survival rates at each stage differed significantly, except between DI and P1 patients (17.1% vs. 10.5%, P=0.344). The mean CEA values in SU, SE, DI, P1, and P2 patients were 5.80, 5.48, 13.36, 8.06, and 22.82, respectively. The CA19-9 values for these patients were 49.40, 38.97, 101.67, 73.77, and 98.57, respectively. The increase in CEA in P2 patients was statistically significant (P=0.002), and the increases in CA19-9 in DI and P2 patients were significant (P=0.025, 0.007, respectively). There was a fair correlation between the two markers in P2 patients (r=0.494, P<0.001). Conclusions: CA19-9 can be used to assess DI of gastric cancer into adjacent organs. Both markers are useful for predicting the presence of extensive peritoneal seeding.