• 한국간담췌외과학회지
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• 제27권1호
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• pp.40-48
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• 2023

Backgrounds/Aims: Timing of resection for synchronous colorectal liver metastasis (CRLM) has been debated for decades. The aim of the present study was to assess the feasibility of simultaneous resection of CRLM in terms of major complications and develop a prediction model for safe resections. Methods: A retrospective single-center study of synchronous, resectable CRLM, operated between 2013 and 2021 was conducted. Upper limit of 95% confidence interval (CI) of major complications (≥ grade IIIA) was set at 40% as the safety threshold. Logistic regression was used to determine predictors of morbidity. Prediction model was internally validated by bootstrap estimates, Harrell's C-index, and correlation of predicted and observed estimates. Results: Ninety-two patients were operated. Of them, 41.3% had rectal cancers. Major hepatectomy (≥ 4 segments) was performed for 25 patients (27.2%). Major complications occurred in 20 patients (21.7%, 95% CI: 13.8%-31.5%). Predictors of complications were the presence of comorbidities and major hepatectomy (area under the ROC curve: 0.692). Unacceptable level of morbidity (≥ 40%) was encountered in patients with comorbidities who underwent major hepatectomy. Conclusions: Simultaneous bowel and CRLM resection appear to be safe. However, caution should be exercised when combining major liver resections with bowel resection in patients with comorbid conditions.

• 핵의학기술
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• 제27권1호
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• pp.4-6
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• 2023

Technetium-labeled phosphate bone scan was shown to detect bone fractures and bone metastasis in early stage than general radiographs. Therefore, bone scan has become one of the most frequently performed nuclear medicine imaging examination. However, non-osseous radiopharmaceutical uptake on the bone scan are unusual findings. We report a case of diffuse splenic absorption of Tc-99m dicarboxypropane diphosphonate in patients who undergo liver transplantation.

• 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 Gastric Cancer
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• 제3권4호
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• pp.191-194
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• 2003

Purpose: Neuroendocrine carcinomas of the stomach account for only about $0.3\%$ of all gastric tumors. The prognosis of this disease is very poor compared with the common type of gastric adenocarcinoma. The purpose of this retrospective study was to review the clinicopathologic features of 18 cases of this unusual gastric tumor and to establish a treatment strategy for this tumor. Materials and Methods: Excluding 2 cases of non-curative resection and 1 case of operative mortality, 18 cases of typical neuroendocrine carcinoma who had curative resection from January 1991 to December 2000 at Asan Medical Center were analyzed; 6841 gastric cancer patient were treated surgically during the same period. Results: The mean age at the time of diagnosis was 58.6 years (range: $35\∼75$ yr). Sixteen patients were male, and two were female. Eleven tumors ($61.1\%$) developed in the lower part of the stomach, three ($16.7\%$) in the middle part, and three ($16.7\%$) in the upper part. One tumor involved the entire stomach. Eight cases ($44.4\%$) were Borrmann type 2, and six case ($33.3\%$) were Borrmann type 3. The mean tumor size was 6.94 cm (range: $0.6\∼15$ cm). Nine cases ($50\%$) showed recurrence of the disease, and eight of them died within 20 months. Of the nine recurred cases, 7 cases ($77.8\%$) showed liver metastasis. The mean disease-free interval was 6.8 months (range: $2.5\∼11$ months) after surgical resection, and the mean survival was 17.9 months (range: $8\∼40$ months) for recurrence cases. One patient with liver metastasis was treated with a liver-wedge resection just after diagnosis and was still alive for 37.5 months postoperatively. There were 9 deaths after the median follow- up period of 40 months (range: $8\∼72$ months). Conclusion: Gastric neuroendocrine carcinomas frequently recur at the liver, even in early stage cancer, and have a poor prognosis. We experienced a case of successful control of hepatic metastasis by surgical resection and a case of a small cell carcinoma which was successfully controlled with systemic chemotherapy.

• Radiation Oncology Journal
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• 제11권1호
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• pp.103-108
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• 1993

Among the patients with rectal cancer who entered Yonsei University Hospital for management from Jan. 1980 to Dec. 1990, we selected 23 subjects who were received surgical resection of tumor in rectum, and who proved to have liver metastasis during the diagnostic work-up, at the time of the operation, or within 3 months after starting definitive treatment. With those subjects, we investigated the role of radiation therapy by comparison of the treatment results of the patients without radiation therapy (S group) with those of the patients with radiation therapy to the primary site (S+R group). The local control rates of S group and S+R group were $64{\%}$ and $89{\%}$, and 2-year survival rates were $50{\%}$ and $78{\%}$, respectively. Although there was not statistically meaningful difference, local control rate and 2-year survival rate were higher in the group with radiation therapy to primary site than that without radiation therapy. The 2-year survival rates of the case with resection of the liver and the case without it were $63.6{\%}$ and $58.3{\%}$ respectively, which was not statistically significant. Also, the 2-year survival rate of the case with sustained local control was higher than that of the case with local failure, which was statistically significant ($76.5{\%}$ and $16.7{\%}$, p<0.005). From the above results, it is thought that radiation therapy to the primary site might improve the local control rate even in the patients with liver metastasis, which seems to be correlated to the higher survival rate.

• Journal of Digestive Cancer Research
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• 제1권1호
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• pp.48-51
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• 2013

73세 남자 환자로 약 1개월 전부터 상복부 불편감 주소로 본원 내원 후 시행한 상부 내시경 검사상 하체부 전벽측의 조기위암으로 내시경 점막하 박리술을 시행하였다. 조직검사 결과 저분화도(poorly differentiated type)의 선암이 발견되었고, 절제면의 암세포 침범 소견은 없었으나, 점막하 2층(900 um)까지 침윤된 소견과 일부 림프선 전이 소견이 보여 위 절제 수술(subtotal gastrectomy)을 시행하였다. 조직검사 결과 점막층에 국한된 저분화도의 선암이 발견되었고, 그 외 림프절 전이 등의 소견은 보이지 않아 수술 후 병기 1기의 조기위암(T1N0M0, stage IA) 으로 진단 후 추가적인 항암치료 없이 추적관찰을 하였다. 이후 6개월 마다 복부 전산화단층촬영술과 상부 내시경 검사를 시행하였으며, 수술 후 2년째 시행한 복부 전산화단층촬영 결과 간의 다발성의 전이성암으로 의심되는 소견이 관찰되었다. 간 조직 검사를 시행하였고, 조직검사 결과 저분화도의 선암으로 발견되었으며, 원발 병소를 확인하기 위해 면역화학 검사를 시행한 결과 췌담도 계통의 암에서 특징적으로 보일 수 있는 CK7과 CK19이 강양성 소견을 보여 담도암의 간전이로 의심하였다. 이후 췌담도 MRI 및 PET 검사 등을 시행 하였으나, 담도암 등의 소견은 관찰되지 않았다. 위암은 특징적으로 발생 기전에서 다양한 내적 및 외적 원인들(nitrosamine, H. pylori, E-cadherin mutation 등)로 인해 면역 화학 조직검사 결과가 다양하게 나타날 수 있기 때문에(heterogeneous cytokeratin expression pattern) 면역화학 검사 결과만으로 위암 가능성을 배제할 수 없는 것으로 보고되고 있다. 따라서 위암의 간전이로 진단 후 항암치료를 시행하였으며, 면역화학 검사에서 췌담도 계통의 암으로 오인되었던 재발성 전이성 위암의 증례 1례를 문헌고찰과 함께 보고한다.

• Journal of Gastric Cancer
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• 제9권1호
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• pp.10-13
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• 2009

위암의 간전이는 수술적 절제, 전신적 항암약물요법, 간동 맥색전술 등의 여러 가지 치료방법이 사용되고 있으나 예후가 매우 불량하여 아직까지 표준치료방법이 정립되어 있지 않은 상황이다. 최근 간암 등에서 많이 사용되고 있는 고주파열치료(Radiofrequency)가 위암의 간전이 치료방법으로 시도되고 있으나, 아직까지 문헌에 보고된 예는 많지 않아 정확한 치료성적을 판단할 수는 없으나 기존의 수술적 방법에 비교하여 유사한 성적을 보임으로써 위암의 간전이 치료의 새로운 치료방법으로 대두되고 있다. 고주파 열치료의 치료성적을 정확히 평가하기 위하여 위암의 간전이 환자에 대한 전향적 연구가 필요한 실정이다.

• 대한암한의학회지
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• 제10권1호
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• pp.93-98
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• 2005

Angiocentric T-cell lymphoma is a rare form of peripheral T-cell lymphoma. The disease typically manifests clinically as an aggressive, progressively destructive disorder often with a fatal outcome. It is the aim of the present paper to derive further studies evaluating the effectiveness of Korean traditional medicine on angiocentric T-cell lymphoma with intra-abdominal metastasis. A patient with high fever, weight loss, night sweat and general weakness(B symptoms) was diagnosed as angiocentric T-cell lymphoma and chemotherapy was done more than 10 times. But the response to chemotherapy was poor, finally the lymphoma involved liver and spleen. The abdominal CT showed the hepatosplenomegaly, diffuse lymphoma of liver and spleen, massive ascites, minimal pleural effusion. Then the patient gave up the chemotherapy and only herb medications (Bohyunsoamtang-A,B) were administered. The ascites, high fever and hepatosplenomegaly gradually reduced to normal. He survived for 7 years after first diagnosis, which is much longer than average survival time in angiocentric T-cell lymphoma with B symptoms. This case may give us a possibility of that Korean traditional herb medications offer potential benefits for patients with angiocentric T-cell lymphoma, and more researches are needed.

• Nuclear Medicine and Molecular Imaging
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• 제40권5호
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• pp.249-256
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• 2006

목적: 대장-직장암에서 간전이 여부를 진단하기 위한 영상 검사 방법으로 기존에는 CT 촬영을 시행하여 왔다. 최근에는 MR 및 FDG PET을 간전이 진단에 적극적으로 활용하고 있는 추세이다. 이에 이 연구에서는 대장-직장암 환자에서 간전이에 대한 FDG PET의 진단적 가치를 MR과 비교하여 보고자 하였다. 대상 및 방법 대장: 직장암으로 확진된 환자들 중에 간전이를 진단 또는 배제하기 위하여 CT 이외에도 MR 및 F-18-FDG PET (conventional PET 및 fusion PET)을 모두 시행한 환자는 26명이었다. 이 연구에서는 26명의 환자들에게서 영상화 된 35개의 병변을 분석의 대상으로 삼고, FDG PET과 MR의 민감도 및 특이도를 간분엽절제술 및 종양절제술을 통해 얻어진 병리소견 및 임상소견 또는 추적 영상 소견을 표준으로 하여 각각 구하였다. FDG PET과 MR은 평균 7일 간격으로 시행되었으며, 두 검사 사이에 치료적 요법을 시행 받은 환자는 한 명도 없었다. 결과: 병리 결과, 35개의 병변 중에서 18개(51.4%)의 병변은 간전이로 판명되었으며, 나머지 17개(48.6%)는 낭종, 지방, 혈관종, 농양, 호산구성농양 등의 양성 병변으로 판명되었다. 35개의 병변 중 MR과 FDG PET의 진단이 일치한 병변은 간전이 17개(94.4%)와 양성 병변 13개(76.5%)로 전체적으로는 85.7%의 일치도를 보였다. FDG PET의 민감도는 94.4% (17/18), 특이도는 94.1% (16/17)였으며 MR의 민감도는 100% (18/18), 특이도는 82.4% (14/17)이었다. MR에서 위양성을 보였던 3개의 병변은 낭종과 호산구성농양이었고, FDG PET에서 위음성을 보였던 1개의 병변은 직경 8 mm의 작은 병변이었다. 직경 10 mm 이하인 병변들만 분석했을 때, 총 20개의 병변에 대하여 FDG PET은 민감도 85.7%(6/7), 특이도 92.3%(12/13), MR은 민감도 100%(7/7), 특이도 76.9%(10/13)를 보였다. 그 외에도 간전이 병변의 평균 maxSUV는 $6.7{\pm}3.8$로 간전이와 양성병변을 최적으로 감별할 수 있는 maxSUV의 cutoff value는 3.1 이었다. (AUC=0.897, p<0.001, 민감도 83.3%, 특이도 94.1%) 결론: FDG PET은 간전이를 진단하는데 MR과 대등한 민감도와 특이도를 보였다. 통계적으로 유의한 차이를 보이지는 않았지만 간전이에 대한 FDG PET의 음성예측도는 MR보다 높았으며, 직경 10 mm 미만의 작은 병변에 대해서도 FDG PET은 우수한 성적을 보였다. 향후 대장암의 간전이 진단에 FDG PET이 유용하게 이용될 것이다.

• 한국임상수의학회지
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• 제19권4호
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• pp.443-446
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• 2002

A primary metastatic malignant plasma cell tumor was presented in a 7-year-old, female, mixed breed dog. The dog was admitted to Veterinary Teaching Hospital at College of Veterinary Medicine, Seoul National University after suffering from depression, anorexia, and dyspnea. The dog was euthanized due to poor prognosis. At necropsy, numerous, firm and tan round nodules, 1 to 2 cm in diameter were noted in the ribs. The nodules formed chain or were occasionally coalescing, causing osteolysis of the ribs. A large amount of clear fluid was present in the thoracic cavity. The spleen and liver were markedly enlarged and congested. Histologically, the nodular masses were diagnosed as plasma cell tumor which was believed to be originated from the rib. Evidence of metastasis was observed in the spleen, liver, and kidney.