• Journal of Chest Surgery
• /
• 제37권2호
• /
• pp.180-183
• /
• 2004

우폐하엽의 폐암이 심낭과 좌심방의 하폐정맥 유입구를 침범한 62세 남자 환자에서 심폐체외순환을 이용하여 우폐 중하엽절제술을 시행하였다. 환자는 수술 후 제2일째에 우폐상엽의 국한성 폐부종이 발생하였으며 폐부종이 치료된 후 우폐의 기관지늑막루가 발생하였다. 유경대망을 이용하여 기관지 늑막루를 봉합하였다. 그 후의 임상 경과는 양호하였으며 환자는 현재 6년째 재발 없이 건강히 지내고 있다.

• Journal of Chest Surgery
• /
• 제30권8호
• /
• pp.780-785
• /
• 1997

종격동 종양은 그 발생 위치가 심장과 대혈관, 식도, 그리고 신경조직 등과 같이 인체에 중요한 조직과 인접해 있는 점과 수술적 치료가 비교적 용이하고 그 결과 또한 우수하여 흉부외과 영역에서 매우 흥미있는 질환으로 관심을 끌어 왔다. 저자는 울산의대 서울중앙병원 흉부외과에서 1990년 1월부터 1995년 6월까지 5년 6개월간 수술적 치료를 받은 원발성 종격동 종양 87명을 대상으로 연령과 성별, 진단방법, 임상적 징후 및 증상, 크기, 해부학적 위 치, 수술소견, 병리조직학적 진단에 대하여 관찰하고 전산화 단층촬영(U)소견과 병리조직학적으로 침윤성 을 보였던 종격동 종양에서의 임상적 의의를 분석하여 종격동 종양에 대한 적절한 외과적 치료지침을 얻고자 하였다. 종양의 발생 부위는 전상부 종격동이 50명(57%)으로 가장 많았으며 후부 종격동 30명(35%), 중부 종격동 7 명(8%)순이었다. 병리조직학적 분류로 보면 흉부종 27명(31%), 원발성 낭종 19명(22%), 신경성 종양 19명 (22%), 기형종 10명(10%)순이었다. 병리조직학적으로 침윤성을 보인 경우는 17명(20%)이었으며 전상부 종격 동에 14명(16%), 후부 종격동에 3명(4%)이었다. 종격동 종양 \ulcorner대한 전산화 단층촬영은 87명 모두 시행하였으며, 주위 조직에 침윤성을 보인 경우는 15명(17%)이었다. 종양의 외과적 치료로 완전 절제 80명(92%), 부분 절제 6명(7%), 개흉후 조직검사 1명(2%)을 시행하였다 수술 소견상 14명(16%)에서 주위 조직의 침윤이 의심 되었다. 종양의 크기는 전체 평균 6.0$\pm$3.2 cm 전상부 종격동 종양 6.2$\pm$3.1 cm 중부 종격동 종양 3.9$\pm$ 1.1 cm 후부 종격동 종양 5.8그2.6 cm등이었다. 양성 종양의 크기는 평균 5.5$\pm$2.6 cm 악성종양의 크기는 7.3$\pm$ 4.6 cm이었다. 수술소견상 침윤이 의심된 경우들의 평균 크기는 7.2$\pm$3.8 cm이었고, 소견상 침윤이 의심 된 경우들의 평균 크기는 8.0$\pm$3.8 cm이었다. 병리조직학적으로 침윤성을 보였덜 17명과 CT소견상 침윤성을 보였던 15명과의 상관성은 민감도 (sensitivity) 35%, 특이도(specificity) 87%, 예측도(predictability) 35%이며, 수술소견상 침윤성을 보였던 14명과 의 상관성은 민감도 53%,특이도 93%, 예측도 64%이었다. 또한 종양의 크기와 악성도와의 상관관계에서 크기가 클수록 악성일 가능성이 증가하는 통계적으로 의의 있는 유의성이 있었다. 결론적으로 종격동 종양에 대한 수 珦\ulcorner진단으로 또는 수술시 예측할 수 있는 침윤성은 낭성 종양을 제외 한 경우 병리조직학적 진단과의 일치성이 낮아 종격동 종양의 수술적 치료는 종양을 포함하여 가능한 범위까지 광범위하게 절제하는 것이 수술 결과를 좋게 하는 방법이라고 사료된다.

• Tuberculosis and Respiratory Diseases
• /
• 제77권5호
• /
• pp.215-218
• /
• 2014

Tracheal invasion is an uncommon complication of thyroid cancer, but it can cause respiratory failure. A rigid bronchoscope may be used to help relieve airway obstruction, but general anesthesia is usually required. Tracheal balloon dilatation and stent insertion can be performed without general anesthesia, but complete airway obstruction during balloon inflation may be dangerous in some patients. Additionally, placement of the stent adjacent to the vocal cords can be technically challenging. An 86-year-old female patient with tracheal invasion resulting from thyroid cancer was admitted to our hospital because of worsening dyspnea. Due to the patient's refusal of general anesthesia and the interventional radiologist's difficulty in completing endotracheal stenting, we performed endotracheal tube balloon dilatation and argon plasma coagulation. We have successfully treated tracheal obstruction in the patient with thyroid cancer by using endotracheal tube balloon inflation and a flexible bronchoscope without general anesthesia or airway obstruction during balloon inflation.

• 대한두경부종양학회지
• /
• 제13권1호
• /
• pp.81-85
• /
• 1997

Basal cell adenocarcinoma is a rare, recently described neoplasm of the salivary gland. We have experienced three cases of basal cell adenocarcinoma of the parotid gland. The tumors from patient 1 and patient 2 showed intraparotid growth in superficial lobe without cervical lymphnode metastasis. So, patient 1 and patient 2 underwent only a superficial parotidectomy and subdigastric lymphnode dissection without any adjuvant therapy. They are alive without recurrence or distant metastasis. But that of patient 3 showed widely invasive growth with multiple cervical lymph node metastases. The CT scan showed a $8{\times}7cm$ sized huge mass replacing the parotid gland with irregular margin and multiple lymphnode enlargements along the internal jugular vein. Total parotidectomy with sacrifying the facial nerve and standard radical neck dissection were caried out. Microscopically, the tumor consisted of solid nest and sheet of uniform basaloid cells separated by a fibrous connective tissue stroma with the evidence of lymphovascular invasion. As a result of the lymphnode metastasis and invasiveness of the tumor, radiation therapy was given postoperatively. We thought that close follow-up would be mandatory in this patient because of high risk of possible local recurrence and distant metastasis.

• 대한두개안면성형외과학회지
• /
• 제20권2호
• /
• pp.139-143
• /
• 2019

Here we report a case of a focal atypical proliferative nodule (PN) arising from a congenital melanocytic nevus (CMN). Diagnosis was challenging because it had both benign and malignant clinical features. Unusual histopathology, immunohistochemistry, and intraoperative findings of this atypical PN are discussed. A 5-year-old girl was admitted for a congenital $5{\times}5cm$ sized scalp mass. This hemangioma-like soft mass showed biphasic characteristics such as a slow, gradual, and benign increase in size but worrisome dural invasion with cranial bone defect. We removed the scalp mass with clear resection margins. Interoperatively, we found that the cranial bone defect had already filled. Histopathologic examination showed CMN with focal atypical PN. The nodule showed sharp demarcation and cellular pleomorphism. However, in immunohistochemical study, Ki-67 proliferation index and expression levels of protein S-100 and Melan-A were very low. These were unusual findings of atypical PNs. Despite her worrisome preoperative radiologic features, she showed an indolent clinical course compatible with previously reported biologic behavior. The patient underwent follow-up inspection with magnetic resonance imaging every 6 months for up to 3 years. The nodule appeared to be stationary at the last visit.

• 대한두개안면성형외과학회지
• /
• 제10권2호
• /
• pp.138-141
• /
• 2009

Purpose: Squamous cell carcinoma of the scalp sometimes exhibits unusually aggressive behavior. We report a case of extradordinarily aggressive squamous cell carcinoma of the scalp with invasion into the skull and dura mater. Method: The patient is a 38-year-old man with two cystic masses on the occipital area. He was diagnosed as squamous cell carcinoma in that region and have undergone surgical resections including cortical osteotomy of the skull, several years ago. On this occasion, 3-dimensional computed tomographic imaging revealed an erosive lesion on the occipital bone and magnetic resonance imaging showed two cystic masses invasion into the skull and dura mater. Results: He has undergone wide resection of the masses and cranioplasty with dural repair. Histopathologic examination indicated squamous cell carcinoma with moderate differentiation of the masses, bone marrow and dura mater. Conclusion: Squamous cell carcinoma on the scalp can readily penetrate the full thickness of the cranium and invade the dura mater, sagittal sinus and brain. We suggest wide resection of the scalp and split thickness skin graft with sentinel lymph node biopsy, following by postoperative radiation therapy.

• Journal of Gastric Cancer
• /
• 제11권2호
• /
• pp.109-115
• /
• 2011

Purpose: As the proportion of early gastric cancer (EGC) has recently been increased, minimally invasive treatment is currently accepted as main therapy for EGC. Accurate preoperative staging is very important in determining treatment options. To know the accuracy of endoscopic ultrasonography (EUS), we compared the depth of invasion of the tumor with preoperative EUS and postoperative pathologic findings. Materials and Methods: We retrospectively analyzed 152 patients who underwent EUS before laparoscopic gastrectomy. The preoperative EUS results were compared with the pathological findings. Results: The overall proportion of coincidence for depth of invasion between EUS and pathologic results was 41.4%. Univariate analysis showed that the rate of corrected prediction of EUS for tumor depth significantly decreased for the lesions more than 3cm in diameter (P=0.033), and those with a depressed morphology (P=0.035). In multivariate analysis, the depressed type (P=0.029, OR=2.873) and upper lesion (P=0.035, OR=2.151) was the significantly independent factors influencing the inaccurate prediction of EUS for tumor depth. Conclusions: When we decide the treatment modality considering the clinical depth of invasion by EUS, the possibility of discordance with pathologic results should be considered for the lesions located in the upper third of the stomach and with a depressed morphology.

• Journal of Cancer Prevention
• /
• 제21권2호
• /
• pp.88-94
• /
• 2016

Background: Breast cancer is the most common malignant disease in women. The patients with advanced breast cancer develop metastasis to bone. Bone metastasis and skeletal-related events by breast cancer are frequently associated with the invasiveness of breast cancer cells and osteoclasts-mediated bone resorption. Forsythia koreana is used in oriental traditional medicine to treat asthma, atopy, and allergic diseases. The aim of this study was to evaluate the inhibitory effects of F. koreana extracts on the invasion of breast cancer cells and bone resorption by osteoclasts. Methods: Cell viability was measured by an MTT assay and the migration and invasion of MDA-MB-231 cells were detected by a Boyden chamber assay. The formation of osteoclasts and pit was detected using tartrate-resistant acid phosphatase staining and calcium phosphate-coated plates, respectively. The activities of matrix metalloproteinases (MMPs) and cathepsin K were evaluated by gelatin zymography and a cathepsin K detection kit. Results: The fruit and leaf extracts of F. koreana significantly inhibited the invasion of MDA-MB-231 cells at noncytotoxic concentrations. The fruit extract of F. koreana reduced the transforming growth factor ${\beta}1-induced$ migration, invasion and MMPs activities of MDA-MB-231 cells. In addition, the fruit, branch, and leaf extracts of F. koreana also inhibited the receptor activator of nuclear factor kappa-B ligand-induced osteoclast formation and osteoclast-mediated bone-resorbing activity by reducing the activities of MMPs and cathepsin K. Conclusions: The extracts of F. koreana may possess the potential to inhibit the breast cancer-induced bone destruction through blocking invasion of breast cancer cells, osteoclastogenesis, and the activity of mature osteoclasts.

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

• Journal of Chest Surgery
• /
• 제30권1호
• /
• pp.67-71
• /
• 1997

흉선종은 조직학적으로 양성의 양상을 보인다 하더라도 종종 악성의 경과를 밟는 까닭에 그 치료방침과 예후에 관한 많은 논란이 있어왔다. 이에 서울대학교 의과대학 흉부외과학교실에서는 1987년부터 1994년까지의 최근 8년간 흉선암과 낭종, 유암종을 제외한 흉선종으로 수술받은 41명의 환자들을 대상으로 수술결과와 위 험 인자에 관한 분석을 시도하였다. 남여비는 21 :20으로 차이가 없었으며 평균나이는 46세로 40대에 주로 발생하였다. 중증근무력증 환자는 22명으로 53.7%였으며 수술적 완전절제를 원칙으로하여 31명에서 완전절제를, 7명에서 부분절제, 3명에서 조직생검을 시행하였다. Masaoka의 병기분 류로는 I기가 27례, II기가 4례, III기가 10례였으며 IV기는 없었다. 병리 조직학적으로는 상피세포형이 14례, 임파구형이 11례,혼합형이 19례였으며 수술후 주위조직으로의 침윤이 의심되는 경우 방사선치료 또는 항암화학요법을 추가하였다. 그 결과 수술사망은 없었으며 술후 평균 36개월의 추적조사를 통해 5 명의 환자가 재발하였으며 3명의 환자가 사망하였다. 예후에 관한 위험요인의 분석을 통해 단일 요인으로서 조직학적 침윤유무가 가장 \ulcorner요한 위험 인자임을 알 수 있었다.