• Journal of Chest Surgery
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• 제11권2호
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• pp.170-174
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• 1978

A case of mediastinal seminoma is presented. A male driver, 27 years old Korean, has been suffered from substernal pain, cough and moderate swallowing difficulty since 5 months prior to this admission. At the time of onset, he visited at a local clinic to find some mass in his anterior mediastinum on chest P-A and lateral X-ray check. Recently, intermittent hiccups with much aggravated dysphagia forced him to visit our hospital, and admitted for radical resection under the impression of anterior superior mediastinal tumor of thymus origin. Median sternotomy was done and total resection of the tumor of 8.0X11.0X3.5cm was done without any specific complication and biopsy of the tumor revealed as primary mediastinal seminoma of the mediastinum. Supplementary prophylactic irradiation therapy was done with a tumor dose of 4,000 rad in 4 weeks after operation. Postoperative hospital course was uneventful and patient was joyful with his occupation for 3 months after discharge.

• Radiation Oncology Journal
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• 제20권1호
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• pp.34-40
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• 2002

목적 : 방사선치료가 세포매개면역을 저하시킨다는 보고들이 있었으나 이를 방사선치료 부위 안의 혈류와 관련해서 고려되지는 않고 있다. 본 연구는 폐암의 방사선치료 후에 발생하는 백혈구 감소, 특히 림프구의 감소를 후향적으로 분석하고, 면역억제의 한 기전으로서 방사선치료 부위 안의 많은 혈액량과 동적인 혈류가 관련될 수 있는지를 알아보고자 한다. 대상 및 방법 : 34명의 폐암환자 들을 대상으로 하였으며, 방사선치료 단독군(RT군)이 10명, 방사선치료와 화학요법 병용군(RT/CT군) 16명, 화학요법 단독군(CT군)이 8명이었다. 말초혈액의 전체 백혈구수와 림프구수, 전체 백혈구수 중 림프구수의 비율(림프구 율)을 방사선치료 전중후에, 화학요법 전후에 측정하였는데 방사선치료 중에는 매 주마다 검사를 하였고, 화학요법과 방사선치료 후에는 좀 더 긴 간격으로 하였다. 환자의 특성과 병변의 특성은 세 군간에 통계적으로 유의한 차이를 보이지 않아다. 치료방법에 있어서도 RT군과 RT/CT군 사이에 총 방사선량, 분할조사선량, 치료면적, 치료용적은 통계학적으로 유의한 차이는 없었다. 방사선치료를 시행한 군(RT군, RT/CT군)과 방사선치료를 시행하지 않은 군(CT군)의 평균 추적기간은 각각 6개월과 8개월이었다. 결과 : 치료 후 전체 백혈구수의 변화는 다른 치료군 간에 의미 있는 차이는 보이지 않았다. 방사선치료를 시행한 RT군과 RT/CT군은 방사선치료 후 훨씬 낮은 림프구수와 림프구 율을 보였다. 치료 전 림프구수와 최종 림프구수 사이의 감소는 방사선치료를 시행한 군과 시행하지 않은 군간에 통계학적으로 유의한 차이를 보였다(p=0.044). 또한 림프구 율에 있어서도 치료 전과 최종 림프구 율 사이의 감소는 방사선치료를 시행한 군과 시행하지 않은 군간에 통계학적으로 유의한 차이를 보였다(p=0.037). 결론 : 림프구 감소증은 화학요법만을 시행한 경우보다 방사선치료를 시행한 경우에 더 현저하였다. 그리고 이러한 림프구 감소증이 폐암의 흉부 방사선치료 후 면역감소의 한 원인이 될 수도 있겠다. 저 선량의 방사선조사 후 림프구의 아포토시스 유도를 보여준 이전의 몇몇 연구들을 함께 생각해 볼 때, 조심스럽게 제안하고 싶은 것은 혹시 본 연구에서 보이는 림프구 감소증이 방사선조사야 내의 많은 혈액량이나 역동적인 혈류와 약간의 관련성이 있을 수도 있다는 것이다.

• Journal of Chest Surgery
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• 제9권2호
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• pp.315-322
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• 1976

This report is a analysis of 72 cases of mediastinal tumors which are originated in mediastinum or probably metastasized from other organs, and classified on the basis of histopathological types. And all are experienced in the Depart. Thoracic and cardiovascular Surgery, National Medical Center from 1959 to April 1976. Among these cases, 58 cases were confirmed by histopathologically, and remained 14 cases were considered as mediastinal tumor by clinically and roentgenologically. In this series, dermoid cyst and teratoma was most frequent tumor among histopathologically confirmed cases(27.6%), and thymoma 20.7%, neurogenic tumors 17.2%, carcinoma 19%, lymphoid tumor 8.6% and others was 5.9%. The cases of not verified histopathologically were 14 cases. The main clinical symptoms were dyspnea on exertion or orthopnea (62.55%), productive or irritative cough (59.77%), decreased breathing sound (43. 09%). S.V.C syndromes was seen in 25.02%, and there were no definitive symptom in 4.2% of all cases. The main treatment method was surgical removal and irradiation therapy.

• Journal of Chest Surgery
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• 제24권8호
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• pp.773-781
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• 1991

We have experienced 47 cases of primary mediastinal tumors & cysts in the Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Hospital, from September, 1979 to November, 1990. The results were as follows: 1. The age distribution was from 6 months to 69 years old and the mean age was 32.3 years old. Of all 47 primary mediastinal tumors and cysts, 21 patients were male and 26 patients were female. 2. The neurogenic tumors[11 cases, 23.4%] were most frequently encountered and followed by thymoma[10 cases. 21.3%] and teratodermoid[9 cases, 19.1%]. 3. The anterosuperior mediastinum[59.6%] was most common tumor location, and followed by posterior mediastinum[25.6%], middle mediastinum[14.9%]. 4. The most common tumors were thymoma and teratodermoid at anterosuperior mediastinum, benign cyst at middle mediastinum, and neurogenic tumor at posterior mediastinum 5. The malignant tumors were 10 cases[21.3%] of the 47 cases and they were all symptomatic. 6. The most common chief complaint at admission was chest pain or discomfort[34%], and followed by coughing[23.4%], and dyspnea[17%]. 7. The successful complete removal was done in 37cases of benign tumors and cysts. In malignant cases, the surgical intervention was done in 3 cases, and 6 cases were treated with irradiation and chemotherapy, and 1 case was only biopsied. 8. The postoperative complications were developed in 7 cases[14.6%]. There was no case of hospital mortality.

• Journal of Chest Surgery
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• 제22권6호
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• pp.1061-1069
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• 1989

A case of liposarcoma was reported in 52 year-old female. She had the operation history due to mediastinal lipoma at other Hospital before 26 months ago. Chest X-ray revealed a huge soft tissue mass- density at the entire right lung field, and left middle and lower lung field at admission. At the lateral film, the mass was located in the anterior and middle mediastinum. Transsternal bilateral thoracotomy was performed, followed by extirpation of liposarcoma, wedge resection of superior vena cava, angioplasty of superior vena cava, and then partial pericardiectomy. The post-operative treatment was 5500 rad irradiation. Post-operative course was uneventful, that was noticed by OPD follow-up for 10 months. Primary liposarcoma of the mediastinum is very rare tumor. This tumor grows to an enormous size, and symptoms are referable to compression of the contiguous intrathoracic structures. The treatment of choice is surgery in all cases. Such an approach serves to establish a tissue diagnosis, to relieve the patients* symptoms, and may results in a cure sometimes. Radiotherapy or/and chemotherapy seems to be ineffective, but should be further studied.

• Journal of Chest Surgery
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• 제23권2호
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• pp.299-308
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• 1990

A review of 50 patients with primary mediastinal tumors or cysts has been done to evaluate clinical and pathological behavior of this heterogeneous group of tumors proved by either excision or biopsy from January 1980 to August 1989 at the cardiovascular department of surgery in Kyungpook National University Hospital. There were 30 males and 20 females in this series. The ages of patients ranged from 4 months to 64 years. The mean age of subjects was 30.4 years. Neurogenic tumors [14 cases, 28%] and teratoma [14 cases, 28%] were most frequently encountered and followed by thymoma [10 cases, 20%] and benign cysts [4 cases, 8%]. The anatomic location of the primary mediastinal tumors or cysts was classified as anterior mediastinum and middle or visceral mediastinum and paravertebral or costovertebral mediastinum on the basis of the Shields’ proposition. In 32 patients[64%], the tumors or cysts were located in anterior mediastinum and in 13 patients[26%], the tumors or cysts were located in paravertebral or costovertebral mediastinum. And the rest 5 patients[10%] had middle or visceral mediastinal tumors or cysts. One of the characteristic features of primary mediastinal tumors or cysts is that some mediastinal tumors or cysts have their own preferred location in the mediastinum. In our series, all of the 14 patients with teratoma and 10 patients with thymoma had the anterior mediastinal location, while 13 of the 14 patients with neurogenic tumors had the paravertebral mediastinal location. 14 patients[28%] were asymptomatic and they all were discovered via so-called “Routine” chest x-ray examination. 39 of 50 patients[78%] were benign. 11 patients[22%] were malignant and they were all symptomatic. 40 patients[80%] were treated with complete resection. 5 patients[10%] were treated with partial resection : 2 of malignant thymoma, 3 of lipoma, neuroblastoma, primary squamous cell carcinoma. The rest 5 patients[10%] were only biopsied: 2 of undetermined malignancy and 3 of hemangioma, lymphoma, primary squamous cell carcinoma. 4 of the 10 patients were treated with combination of irradiation and chemotherapy. Postoperative complications were as followings: Horner’s syndrome [4cases, ado], respiratory failure [3 cases, 6%], pleural effusion[3 cases, 6%], Wound infection[2 cases, 4%] and bleeding, pneumothorax, empyema. There were 5 postoperative deaths [10%]. One patient with neuroblastoma died from intraoperative massive bleeding, 3 patients died early postoperatively from respiratory failure with undetermined malignancy died late postoperatively from congestive heart failure due to direct invasion of the tumor to the heart.

• Journal of Chest Surgery
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• 제11권3호
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• pp.364-367
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• 1978

Embryonal carcinoma of the mediastinum is a very uncommon disease. This is a report of an embryonal carcinoma in the mediastinum found in a 25 years old Korean male patient who had been suffering from chest pain and intractable coughing for 6 months. 5 weeks prior to this admission hemoptysis and high fever were followed. Right exploratory thoracotomy was performed under the impression of a mediastinal tumor, but found to be unresectable. Irradiation therapy was tried, but no response was observed. Patient expired on 78th day postoperatively.

• Radiation Oncology Journal
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• 제1권1호
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• pp.111-118
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• 1983

To evaluate natural history of ovarian dysgerminoma and role of radiation therapy in treatment of ovarian dysgerminoma, retrospective study was carried out in 5 nonirradiated cases and 20 irradiated cases. Conclusions are as follows: 1. Radiation therapy is essential in treatment of ovarian dysgerminoma. 2. Even in stage 1 a, significant recurrence rate is expected in surgery only group. 3. Even in recurrent cases, if adequate radiotherapy is given in stage 1-3, we can predict near complete curability and in stage 4, we can get considerable benefit. 4. Dysgerminoma beyond stage 2 is highly fatal without radiotherapy. 5. Involved field irradiation including whole abdomen and booster RT on bulky tumor area is sufficient in radiotherapy of stage 1, 2, 3, without paraaortic node involvement. Further mediastinal and supraclavicular irradiation is indicated in stage 4 or stage 1, 2, 3, with paraaortic involvement. 6. If bilateral salphingoophorectomy was done. Elective irradiation is recommended in any condition because preservation of ovarian function is not further needed. 7. In cases of small encapsulated stage 1a, We can delay post op. RT under close observation in order to preserve fertility.

• Radiation Oncology Journal
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• 제14권1호
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• pp.53-59
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• 1996

목적 : 암환자에서 방사선치료에 의한 면역기능의 저하에 대해서는 많은 보고가 되어 있다. 저자들은 방사선치료부위중 비교적 활동성 골수를 많이 포함하고 있는 흥부 및 골반강조사 직후 어느정도 면역력의 저하가 오는지 알아보고자 하였다. 대상 및 방법 : 1995년 1월부터 1995년 4월까지 등록된 61 명의 환자중 48 명을 대상으로 분석 하였다. 이중 흉부(조사문, >$150cm^2$)에 방사선치료를 시행한 환자는 29명이었고 전골반강부에 방사선치료를 시행한 환자는 19명 이었다. 연령분포는 36세에서 73세 였으며 평균 및 중간값 모두 57세 였으며 남녀비는 1.3(27/21)이었다. 환자의 면역기능의 지표는 말초혈액검사에서 전혈구 및 감별혈구계산(CBC with D/C), 간기능검사, 신장기능검사 및 림프구아형검사(CD3, CD4, CD8, CDl6, CD56, CDl9)를 시행 하였으며, 검사시기는 방사선치료 직전과 4500 cGy - 5000 cGy 선량에서 동일 검사를 반복시행 하였으며, 1980cGy에서는 전혈구 및 감별혈구계산만 시행하였다. 결과 : 전체환자의 치료전 백혈구 총수는 7017이었으며 방사선치료직후 평균 4470으로 감소하였다(p=0.0000). 감별혈구계산에서는, 림프구수는 평균 2047 에서 537 로(p=0.0000) 로 감소하였고, 호중구, 호염구세포의 절대수도 통계학적으로 유의한 감소를 보였으나, 단핵세포는 변화가 없었으며, 호산구세포는 오히려 방사선치료후 증가하였으나 통계적인 의의는 없었다. 림프구아형에 대한 검사결과는, 모든아형의 절대수가 통계학적으로 유의한 감소를 보였으며, CD4/CD8비는 치료전 평균 1.09에서 0.99로 감소 하였으나 통계적인 유의성은 없었다. 전체 림프구에 대한 비율의 변화를 보면, B림프구(CD 19)는 감소하였으나, 그외 아형의 비율은 방사선치료후 변화를 보이지 않았다. 혈청면역글로불린은 초기 Ig, G, Ig A, Ig M 모두 정상값보다 눌은 수치였으며, 방사선치료에 따른 변화는 Ig M에서만이 통계적으로 유의한 감소를 보였으며, Ig G, A는유의한 변화가 없었다. 결론 : 흉부나 골반강부위의 방사선치료는 림프구의 급격한 저하를 초래하는 반면 단핵구등은 비교적 잘 유지 되었으며, 호산구는 오히려 증가 됨을 알수 있었으나, 인체의 면역과의 관계를 설명하기 위해서는 림프구의 기능변화가 함께 연구 되어져야 하겠다.

• Journal of Chest Surgery
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• 제21권6호
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• pp.1111-1116
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• 1988

Neurofibromatosis is very rare syndrome characterized by abnormal cutaneous pigmentation and numerous skin tumors was described by Smith in 1849, which is inherited as an autosomal dominant trait. Von Recklinghausen reported 2 cases of multiple skin and subcutaneous tumors in 1982. Malignant peripheral nerve tumors, although generally rare, are one of the most characteristic malignant tumors associated with Neurofibromatosis. We have experienced 3 cases of malignant Schwannoma in neurofibroma patients from 1982 to 1988 for 6 years at Thoracic and Cardiovascular surgery department, College of Medicine, Yonsei University, Seoul, Korea. l. One is 62 years old female who was taken total hysterectomy followed by irradiation treatment due to Uterine Carcinoma 21 years ago. She had a large bulging mass on left anterior chest wall and was taken enbloc resection of tumor including rib confirmed malignant Schwannoma. 2. Another is 18 years old female who had large bulging mass on right chest wall and pleural effusion in right thoracic cavity. Thoracentesis revealed a large amount of lymphocytes misdiagnosed of Tbc, pleurisy with Neurofibromatosis. We performed tissue biopsy on bulging mass and the specimen was confirmed malignant Schwannoma 2 months after first diagnosis of Tbc. pleurisy. She was not accessible to radical resection because of far advanced malignant Schwannoma at that time. 3. Third case is 28 years old male who was taken enbloc resection of tumor including rib due to Neurofibroma with Neurofibromatosis at M. hospital 6 months ago. But he had rapid growing mass at operation site again and taken tissue biopsy confirmed of malignant Schwannoma. He was not accessible to enbloc resection due to malignant Schwannoma extending to mediastinal structures.