• Tuberculosis and Respiratory Diseases
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• 제73권6호
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• pp.320-324
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• 2012

A 55-year-old woman was admitted for an elevated serum carbohydrate antigen-125 (CA-125) level, and a left pleural effusion, which were detected at a routine health examination. Computed tomography of the chest was performed upon admission, revealing extensive bilateral paratracheal and mediastinal lymph node enlargement with a massive left-sided pleural effusion. Subsequent analysis of the pleural fluid demonstrated consistency with an exudate, no evidence of malignant cells, and a normal adenosine deaminase. However, the pleural fluid and serum CA-125 levels were 2,846.8 U/mL and 229.5 U/mL, respectively. A positron emission tomography did not reveal any primary focus of malignancy. Finally, a surgical mediastinoscopic biopsy of several mediastinal lymph nodes was performed, revealing non-necrotizing granulomas, consistent with sarcoidosis. After a month of treatment of prednisolone, the left pleural effusion had resolved, and after 2 months the serum CA-125 level was normalized.

• 한국임상수의학회지
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• 제41권3호
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• pp.170-177
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• 2024

An adult male dog was presented for hemorrhagic pericardial effusion. Echocardiography and computed tomography revealed nodule-like lesions on the pericardium. Cytology of pericardial effusion and excisional pericardial lesions indicated neoplastic effusion. Histopathology indicated an inflamed neoplasm with a primary differential diagnosis of hemangiosarcoma and malignant mesothelioma (MM). Immunohistochemistry showed that atypical cells were positive for cytokeratin and vimentin, but negative for CD31, strongly favoring pericardial MM. Postoperative NT-proBNP level remained increased, which led to the administration of epirubicin to minimize potential cardiotoxicity. During the 4 cycles of epirubicin treatment, a total cumulative dose of 108 mg/m² was administrated and no effusion recurrence was observed. After a month post-completion of chemotherapy, however, pleural effusion was detected with cardiac masses. The owner requested no further diagnostic investigations and chemotherapy. Due to deteriorating conditions, the dog died 132 days after the first presentation. Our case is the first notable attempt to treat canine malignant mesothelioma with epirubicin, providing the clinicopathologic, diagnostic routine, and clinical course of the affected dog.

• 한국컴퓨터정보학회:학술대회논문집
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• 한국컴퓨터정보학회 2024년도 제69차 동계학술대회논문집 32권1호
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• pp.17-18
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• 2024

악성 흉수의 진단은 세포학적 검사로 암세포를 확인하는 것이 필수적이며 진단율은 50~80%로 나타난다. 양성자 단층 촬영은 비침습적으로 암 병기를 평가하는 유용한 방법이다. 하지만 암이 아닌 다른 원인으로 인한 포도당 대사로 인하여 양전자 단층 촬영만으로 악성 흉수를 진단하는 데 어려움이 있다. 악성 흉수 자동 진단 모델은 암세포를 진단하는데 있어서 보조적인 역할이 가능하다. 이에 따라 본 연구는 컨볼루션 신경망 기반의 딥러닝 모델을 개발하여 악성 흉수 진단 성능을 확인하고 진단의 보조적 목적으로써 딥러닝의 사용 가능성을 확인하고자 하였다. 결과적으로 모델 전반적으로 accuracy 0.7~0.86의 높은 성능을 보였다. 본 연구의 결과를 통해 실제 의료 환경에서 악성 흉수를 진단하는데 딥러닝 모델이 보조적인 역할을 할 수 있을 것으로 기대된다.

• Korean Journal of Radiology
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• 제25권8호
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• pp.706-714
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• 2024

Objective: This study aimed to evaluate the diagnostic performance and procedural characteristics of fluoroscopy-guided percutaneous transthoracic pleural forceps biopsy (PTPFB) in patients with exudative pleural effusion. Materials and Methods: Patients with exudative pleural effusion who underwent PTPFB between May 1, 2014, and February 28, 2023, were included in this retrospective study. The interval between percutaneous catheter drainage (PCD) and PTPFB, number of biopsies, procedural time, and procedure-related complications were evaluated. The sensitivity, specificity, and accuracy of diagnosing malignancy were computed for pleural cytology using PCD drainage, PTPFB, and combined PTPFB and pleural cytology. Results: Seventy-one patients, comprising 50 male and 21 female (mean age, 69.5 ± 15.3 years), were included in this study. The final diagnoses were benign lesions in 48 patients (67.6%) and malignant in 23 patients (32.4%). The overall interval between PCD and biopsy was 2.4 ± 3.7 days. The interval between PCD and biopsy in the group that underwent delayed PTPFB was 5.2 ± 3.9 days. The mean number of biopsies was 4.5 ± 1.3. The mean procedural time was 4.4 ± 2.1 minutes. Minor bleeding complications were reported in one patient (1.4%). The sensitivity, specificity, and accuracy for pleural cytology, PTPFB, and combined PTPFB and pleural cytology were 47.8% (11/23), 100% (48/48), and 83.1% (59/71), respectively; 65.2% (15/23), 100% (48/48), and 88.7% (63/71), respectively; and 78.3% (18/23), 100% (48/48), and 93.0% (66/71), respectively. The sensitivity and accuracy of cytology combined with PTPFB were significantly higher than those of cytological testing alone (P = 0.008 and 0.001, respectively). Conclusion: Fluoroscopy-guided PTPFB is an accurate and safe diagnostic technique for patients with exudative pleural effusion, with acceptable diagnostic performance, low complication rates, and reasonable procedural times.

• Tuberculosis and Respiratory Diseases
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• 제74권2호
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• pp.74-78
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• 2013

A 61-year-old woman came to the hospital with dyspnea and pleural effusion on chest radiography. She underwent repeated thoracentesis, transbronchial lung biopsy, bronchoalveolar lavage, and thoracoscopic pleural biopsy with talc pleurodesis, but diagnosis of her was uncertain. Positron emission tomography showed multiple lymphadenopathies, so she underwent endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal lymph nodes. Here, we report a case of malignant pleural mesothelioma that was eventually diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration. This is an unusual and first case in Korea.

• Asian Pacific Journal of Cancer Prevention
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• 제15권4호
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• pp.1617-1620
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• 2014

Background: Evidence shows direct link of HER2 to increased glycolysis and over production of lactate dehydrogenase (LDH). HER2 overexpression, high LDH and low glucose pleural levels are associated with poor prognosis in lung cancer. Here, their relationships were investigated. Materials and Methods: HER2 positivity was studied using immunohistochemistry in non-small cell lung cancer. Glucose and LDH levels were measured using commercial colorimetric kits. Results: Of 42 patients (29 adenocarcinoma and 13 squamous cell carcinoma), 28 (66.7%) were HER2-negative, 14 (33.3%) were HER2- positive, including 9 (21.4%) weakly stained (1+) and 5 (11.9%) moderately stained (2+) samples. The relationship between HER2 and glucose and LDH levels were tested in 20 newly diagnosed lung cancer patients who had simultaneous pleural and serum samples. Pleural and serum LDH levels were increased, and pleural glucose levels were decreased with the scale of HER2 positivity, and that the difference in glucose levels between HER2-negative group and HER2-positive patients scored at 2+ reached statistical significance (p=0.02). This latter group all had pleural glucose levels below 40 mg/dl. Conclusions: For the first time, we showed a significant association between low pleural glucose level and overexpression of HER2 in lung cancer. Further investigations are warranted to disclose the association of HER2 with low pleural glucose levels in other populations, with a larger sample size, in malignant pleural effusions caused by other types of cancer, and finally to assess employment as a screening tool for finding HER2-positive cases of lung cancer.

• Tuberculosis and Respiratory Diseases
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• 제49권6호
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• pp.733-739
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• 2000

배경 및 방법 : 호산구성 흉막유출의 원인질환과 흉수 내 호산구의 진단적 의의에 대해 알아보고자 1999년 1월부터 12월까지 삼성서울병원에서 흉막유출로 첫번째 흉강천자를 시행 받은 446명을 대상으로 후향적 조사를 실시하여 다음과 같은 결과를 얻었다. 결과 : 1) 전체 환자의 남녀 비율은 3 : 2 였고 연령의 중앙값은 57.0세 였으며 전체 흉막유출 환자중 호산구성 흉막유출은 446명 중 24명(5.4%)에서 조사되었다. 전체 환자들의 질환 분포를 보면 악성종양에 의한 흉막유출 226명(50.7%), 폐렴성 76명(17.0%), 결핵성 53명(11.9%)순으로 상기 3개질환이 전체의 80%를 차지했다. 2) 호산구성 흉망유출 원인 중 악성종양으로 인한 경우는 13명(54%)에서 조사되었고 비호산구성 흉막유출과 비교시 의미있는 차이를 보이지 않았다(54.2% vs 50.5%, p=0.725). 3) 호산구성 흉막유출 환자들의 말초 혈액내 평균 호산구 수는 5.5%로 흉수 내 호산구 수와 연관이 없었고, 악성종양에 의한 흉수의 호산구 수는 31.2%로 양성질환에 의한 흉수의 호산구 26.1%와 비교하여 차이가 없었다(p=0.597). 4) 2번 이상 흉강 천자를 시행 받은 234명의 환자에서 반복 천자시 비호산구성 흉악유출에서 호산구성 흉막유출로 변하는 빈도는 6.4%(15명)로 조사되었다. 결론 : 호산구성 흉막유출은 전 흉막유출의 약 5%에서 발생하며, 원인 질환, 말초 혈액내 호산구 수, 반복적 천자와 무관하였다. 흉막유출에서 호산구가 증가하여도 특별한 진단을 시사하지 않을 것으로 생각된다.

• Tuberculosis and Respiratory Diseases
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• 제63권1호
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• pp.17-23
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• 2007

배경 및 목적: 흉수의 원인은 매우 다양한 만큼 진단에 많은 검사방법이 이용되고 있다. Adenosine Deaminase(ADA)의 활성도는 결핵성 흉수 저류의 진단에 유용한 검사법의 하나로 알려져 있다. ADA의 수치가 높을 수록 결핵을 진단하는 데 더욱 유용하지만, 양성기준을 정하는 데 아직 확정적이지 못하다. 이에 본 연구에서는 ADA와 함께 림프구/중성구 비를 동시에 진단에 적용하였을 때 진단적 가치를 알아보고자 하였다. 방 법: 2005년 1월부터 2006년 2월까지 중앙대학교병원 및 중앙대학교 용산병원에 흉수 저류로 입원하여 진단적 흉수 천자 및 치료를 받은 190명의 환자를 대상으로 하여, 임상 특성과 영상의학적 자료 및 흉수액에 대한 자료를 후향적으로 조사하였다. 결 과: 1) 190명의 원인으로 결핵이 59명(31.1%)이었으며, 부폐렴성 흉막염 45명(23.7%), 악성 흉수 저류 42명(22.1%), 여출액 36명(18.9%), 농흉 8명(4.2%)이었다. ADA 활성도가 1-39 IU/L인 경우가 121 명(63.7%)이었고, 40-75 IU/L 범위에는 29명(15.3%), 75 IU/L를 초과한 경우가 40명(21.0%)이었다. 2) 결핵은 ADA 활성도가 1-39 IU/L인 경우가 5명(8%)이었고, 40-75 IU/L 범위에는 18명(30%), 75 IU/L를 초과한 경우가 36명(60.0%)이었다. ADA가 40-75IU/L사이일 때, 결핵은 18명(62%), 부폐렴성 흉막염 및 농흉은 9명(31%)이었고 악성 흉수염은 1명이었다. ADA 활성도가 40-75 IU/L인 범위 내에서는 결핵성 흉막염(ADA=61.3${\pm}$9.2 IU/L)과 나머지 질환(ADA=53.3${\pm}$10.5 IU/L)에서 ADA의 평균의 차이가 나지 않았다. 3) 림프구/호중구의 비는 결핵성 흉막염은 39.2${\pm}$ 44.6, 비결핵성은 0.2${\pm}$0.2 로 유의한 차이를 보였다. (ADA X 림프구/호중구)의 값은 결핵성 흉막염은 2,445.7${\pm}$2,818.5 IU/L, 비결핵성은 10.6${\pm}$11.3 IU/L으로 매우 큰 차이를 보이는 것을 관찰할 수 있었다. 그리고, ROC 분석을 하였을 때 ADA보다 민감도와 특이도가 유의하게 증가되었다. 결 론: ADA만으로 결핵성 흉수 저류를 진단하기 어려울 때, 림프구/호중구비와 ADA를 곱한 값은 결핵성 흉막염의 더 정확한 감별진단에 도움을 줄 수 있을 것으로 보인다.

• Asian Pacific Journal of Cancer Prevention
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• 제14권1호
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• pp.351-354
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• 2013

Objective: To assess the practical utility of pleural fluid carbonic anhydrase XII (CAXII) quantification for differential diagnosis of effusions. Materials and Methods: Fluid was collected prospectively from fifty patients presenting with lymphocytic pleural effusions for investigation and CAXII was quantified by ELISA. Results: Pleural fluid CAXII concentrations were significantly higher in lung cancer patients (n=30) than in tuberculous controls (n=20). The sensitivity and specificity of this biomarker were 60%and 75%, respectively. CAXII measurement was not inferior to cytological examination in the diagnosis and exclusion of pleural effusions from lung cancer patitents (sensitivity 60% vs. 57%; specificity 75% vs. 100%; positive predictive value 77%; negative predictive value 54%). In patients with negative cytology, it offered a sensitivity of 54%. Conclusions: Pleural fluid CAXII is elevated in pleural effusions from lung cancer patients. Measurement of CAXII may be used in the future as a valuable adjunct to cytology in the diagnostic assessment of patients with pleural effusions related to lung cancer, especially when cytological examination is inconclusive.

• 대한핵의학회지
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• 제35권4호
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• pp.291-292
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• 2001

We report a case of malignant pericardial effusion originated from adenocarcinoma of the lung incidentally diagnosed by bone scintigraphy, prior to echocardiographic detection. A 76 year-old man with adenocarcinoma of the lung underwent Tc-99m MDP bone scintigraphy to evaluate skeletal metastasis. Anterior images of the chest of the bone scintigraphy unexpectedly showed diffuse increased activity in the region of the heart surrounded by an oval-shaped band of increased activity corresponding to the periphery of the cardiac silhouette (Fig. 1). There was no evidence of bony metastasis. Pericardial effusion was confirmed by echocardiography (Fig. 2) and malignant cells were revealed by subsequent microscopic examination of the pericardial fluid. Bone scintigraphy using Tc-99m phosphate compounds is commonly used to detect bony metastasis in cancer patients. Tc-99m phosphate compounds occasionally accumulate in extra-osseous sites, including $pleural^{1,2)},\;pericardial^{3,4)},\;and\;ascitic\;fluids^{5,6)}$. It has been reported that their accumulation in serous effusions should strongly suggest $malignancy^{1-6)}$. The exact mechanism for accumulation of Tc-99m phosphate compounds in serous effusions is unclear. Several investigators have proposed that the radiopharmaceuticals exuded directly from peripheral vessels to the serous cavity due to increased vascularity and vascular permeability, and bleeding by disruption of blood vessels due to cancerous $infiltration^{5,6)}$.