• 대한영상의학회지
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• 제84권4호
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• pp.958-963
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• 2023

복막의 모래종암종은 장액성 암종의 드문 한 형태로서 많은 양의 모래종 형성과 인접한 주변 장기로의 침범을 특징으로 하고 있다. 이전 자궁절제술의 과거력이 있는 55세 여자 환자가 심한 복부 통증을 주소로 응급실로 내원하였고 시행한 조영증강 CT에서 복강내 석회화 종괴를 발견하였다. 양쪽 난소는 정상적으로 관찰되었으며 환자의 이전 수술력으로 인하여 이소성 골화로 생각되었다. 진단을 위해 시행한 내시경적 그물막절제를 통하여 최종적으로 일차성 복막 모래종암종으로 진단되었고 부피감량수술을 연속적으로 시행하였다. 복막의 모래종암종은 비록 드물지만 복강내 석회성 종괴 혹은 석회성 결절을 동반한 환자에게서 감별 진단에 포함되어야 할 것이다.

• Journal of Gastric Cancer
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• 제21권2호
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• pp.122-131
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• 2021

Purpose: To date, there are no promising treatments for gastric carcinoma with peritoneal metastasis. Some researchers have suggested a survival benefit of gastrectomy in select patients. This study investigated the survival of gastric carcinoma patients with stand-alone peritoneal metastasis according to the type of treatment modality. Materials and Methods: We reviewed the data of 132 patients with gastric carcinoma and stand-alone peritoneal metastasis. We performed gastrectomy when the primary tumor was deemed resectable and systemic chemotherapy was administered. We analyzed patient survival according to the type of treatment, and the prognostic value of gastrectomy was evaluated in univariate and multivariate models. Results: Among all patients, 70 underwent gastrectomy plus chemotherapy, 20 underwent gastrectomy alone, 36 underwent chemotherapy alone, and 6 received supportive care. The median patient survival was 13 months. Patients who underwent gastrectomy had significantly longer survival than those who did not undergo gastrectomy (14 vs. 8 months, P<0.001). Patients who received chemotherapy showed significantly longer survival than those who did not (13 vs. 7 months, P=0.032). Patients who underwent gastrectomy plus chemotherapy showed better survival than those who underwent other treatments. In multivariate analysis, gastrectomy was found to be an independent prognostic factor (hazard ratio, 0.52; 95% confidence interval, 0.33-0.82) in addition to chemotherapy. Conclusions: Our study showed that patients who underwent gastrectomy plus chemotherapy had the best survival. Although the survival benefit of gastrectomy remains uncertain, it is a favorable prognostic indicator in patients with stand-alone peritoneal metastasis.

• 대한암한의학회지
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• 제23권2호
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• pp.27-33
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• 2018

Objective: The purpose of this study is to report the therapeutic possibility of a primary peritoneal carcinoma (PPC) patient with Traditional Korean Medicine (TKM). Methods: A 37 years old female patient diagnosed with PPC suffered from operation site pain, neck pain, nausea, headache and fatigue after undergoing operation and chemotherapy (Paclitaxel/Carboplain). The patient was treated with acupuncture, pharmacoacupuncture, moxibution and herbal medicine. Laboratory study and National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE), version 5.0 were used to evaluate the safety and adverse events of treatments. The performance status was measured by Eastern Cooperative Oncology Group (ECOG) scale. Results: After treatments, cancer did not show any progression. Related symptoms such as postoperative pain, nausea, fatigue and quality of life have improved. Conclusion: This case study implies that TKM may have therapeutic possibility in treating PPC patient.

• 대한세포병리학회지
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• 제8권1호
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• pp.35-46
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• 1997

The authors reviewed 167 malignant effusions from 110 patients, of which the primary site was established on the basis of either biopsy or surgical resection of the primary neoplasm. Main factors analysed were the distribution of primary organs and the cytohistoiogic correlation of body cavity effusions. The 167 fluid specimens from 110 patients consisted of 90 cases(53.9%) of pleural, 68(40.7%) of peritoneal, and 9(5.4%) of pericardial origins. Histologically they consisted of 82 cases(74.5%) of adenocarcinoma, 8(7.3%) of malignant lymphoma, 6(5.5%) of squamous ceil carcinoma, and 3(2.7%) of small cell carcinoma. The most common site among the primary lesions was the stomach in 25 cases(22.7%) followed by the lung in 21(19.1%), ovary on 17(15.5%), and breast in 7(6.4%). As for the distribution of primary tumors in adenocarcinoma, the most common site was lung un 16 cases (48.5%) in pleural fluid and stomach in 22(48.9%) in peritoneal fluid. In pericardial effusions, all 5 cases were from the lung. As a whole, the cytologic findings of malignant effusion were fairly representative of histologic characteristics of primary lesions. Thus, when the primary lesion Is unknown, careful evaluation of effusion cytology is presumed to be a helpful tooi for tracing the primary tumor.

• Korean Journal of Radiology
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• 제23권5호
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• pp.539-547
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• 2022

Objective: To investigate the association between functional tumor burden of peritoneal carcinomatosis (PC) derived from diffusion-weighted imaging (DWI) and overall survival in patients with advanced ovarian carcinoma (OC). Materials and Methods: This prospective study was approved by the local research ethics committee, and informed consent was obtained. Fifty patients (mean age ± standard deviation, 57 ± 12 years) with stage III-IV OC scheduled for primary or interval debulking surgery (IDS) were recruited between June 2016 and December 2021. DWI (b values: 0, 400, and 800 s/mm²) was acquired with a 16-channel phased-array torso coil. The functional PC burden on DWI was derived based on K-means clustering to discard fat, air, and normal tissue. A score similar to the surgical peritoneal cancer index was assigned to each abdominopelvic region, with additional scores assigned to the involvement of critical sites, denoted as the functional peritoneal cancer index (fPCI). The apparent diffusion coefficient (ADC) of the largest lesion was calculated. Patients were dichotomized by immediate surgical outcome into high- and low-risk groups (with and without residual disease, respectively) with subsequent survival analysis using the Kaplan-Meier curve and log-rank test. Multivariable Cox proportional hazards regression was used to evaluate the association between DWI-derived results and overall survival. Results: Fifteen (30.0%) patients underwent primary debulking surgery, and 35 (70.0%) patients received neoadjuvant chemotherapy followed by IDS. Complete tumor debulking was achieved in 32 patients. Patients with residual disease after debulking surgery had reduced overall survival (p = 0.043). The fPCI/ADC was negatively associated with overall survival when accounted for clinicopathological information with a hazard ratio of 1.254 for high fPCI/ADC (95% confidence interval, 1.007-1.560; p = 0.043). Conclusion: A high DWI-derived functional tumor burden was associated with decreased overall survival in patients with advanced OC.

• 대한핵의학회지
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• 제29권4호
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• pp.484-491
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• 1995

간세포암의 원발병소와 전이병소의 간담도 신티그램 소견을 비교 분석하여 서로 다른 경로에 의한 전이병소에서 신티그램 소견의 차이를 알아보고 전이병소와 원발병소에서 방사능 집적빈도와 출현시간의 상호관계를 규명하고자 하였다. 간세포암으로 진단된 환자 9명의 간외 전이 12예를 대상으로 하였고 전이병소 12예는 폐전이 4예, 골 전이 1예, 우심방 전이 1예, 복벽 전이 1예, 복강 및 후복강 임파절 전이 5예였다. 간담도 신티그램은 $^{99m}Tc-DISIDA$ 370MBq를 주사한 후 10분, 30분, 1시간, 2시간과 4-6시간 지연연상을 얻었다. 그 결과는 다음과 같았다. 1) 간세포암 원발병소 9예중 4예(44%) 전이병소 12예중 5예(42%)에서 방사능집적을 관찰하였고 이중 혈행성전이 5예중 3예(60%}, 직접전이는 2예 모두에서 방사능 집적을 볼 수 있었지만 임파절 전이의 경우 5예 모두에서 방사능 직접이 없었다. 2) 혈행성 전이인 폐 전이가 있었던 4예에서는 원발병소 3예와 전이 병소 3예에서 방사능 집적이 있었고 원발병소는 모두 2시간부터, 전이병소 중 2예는 1시간, 나머지 2시간부터 방사능이 직접되었다. 이중 2예는 원발과 전이병소가 함께 양성으로 나타났는데 모두 원발병소에 비해 전이병소에서 먼저 방사능 직접을 볼 수 있었지만 전이병소에는 직접이 없었다. 3) 직접 전이인 우심방과 복벽 전이는 같은 환자에게서 함께 발생했는데 원발과 전이병소에는 모두 30분 영상에서부터 방사능 직접을 관찰하였다. 4) 임파전이가 있었던 5예 중 원발병소 1에서만 방사능 집적이 있었지만 나머지 4예의 원발병소와 전이병소 5예 전부에서는 방사능 집적이 없었다. 이상의 결과로 간담도 신티그램상 혈행성이나 직접전이병소는 임파 전이병소보다 방사능 집적이 잘 되고 원발과 전이병소가 함께 집적이 잘되고 원발과 전이병소가 함께 전이가 집적되는 경향이 있으며 원발병소에 비해 혈행성이나 직접전이 병소에서 방사능 직접율이 높고, 더 빨리 집적됨을 관찰할 수 있었다. 따라서 간담도신티그래프는 간세포암의 원발성병소보다 혈행성이나 직접 전이병소의 진단에 더 유용하게 사용 될 수 있으며 특히 간세포암 전이의 진단이 애매한 경우에는 특이도를 높힐 수 있는 검사 방법이라고 생각된다.

• Journal of Gastric Cancer
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• 제2권4호
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• pp.195-199
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• 2002

Purpose: Angiogenesis is essential for tumor growth and metastasis and depends on the production of angiogenic factors that are secreted by tumor cells. Vascular endothelial growth factor (VEGF) is the most significant angiogenic factor and a selective mitogen for endothelial cells. VEGF, also known as the vascular permeability factor, acts on endothelial cells to increase microvascular permeability and directly stimulate the growth of new blood vessels. Several studies have reported that the expression of VEGF is correlated with hematogenous recurrence via angiogenesis in gastric carcinomas. This research evaluated the relationship between the expression of VEGF and hepatic and peritoneal recurrence in gastric carcinomas. Materials and Methods: Thirty specimens resected from patients with primary gastric carcinomas who had undergone curative resections were divided into three group: Group I, early gastric carcinomas without recurrence; Group II, advanced gastric carcinomas with hepatic recurrence; and Group III, advanced gastric carcinomas with peritoneal recurrence. The expression of VEGF and the density of the microvessel count were examined using immunohistochemistry. Results: 1) The expression of VEGF in Group II and Group III ($63.2\pm\24.3\%$) was stronger than that in Group I ($7\pm\4.2\%$). The expression of VEGF in Group II ($76.5\pm\13.2\%$) was stronger than that of the Group III ($50\pm\14.2\%$) (P<0.05). 2) The microvessel count in Group II ($49.9\pm14.5$) was more than that in Group I ($8.6\pm2.6$) and Group III ($29.1\pm18.1$) (P<0.05). 3) The microvessel count was increased significantly with increasing the expression of VEGF. Conclusions: The expression of VEGF is associated with advanced stomach cancer and hepatic recurrence has a higher expression of VEGF than peritoneal recurrence with neovascularization. Thus the expression of VEGF can be considered to be a useful indicator of recurrence in gastric carcinoma and especially in hepatic recurrence.

• Journal of Gastric Cancer
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• 제5권4호
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• pp.252-259
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• 2005

위에 발생하는 원발성 소세포암은 매우 드물며 예후는 좋지 않아 초기에 발견되어도 60% 이상이 1년 이내에 사망한다. 본원 외과에서 수술치료를 받은 위소세포암 첫 번째 증례는 수술소견상 복막전이 소견 등으로 근치적 수술이 불가능하여 위공장문합술을 시행하였다. 수술 후 etoposide, cisplatin화학요법을 시행하고 6개월 뒤에 찍은 CT촬영상 복막전이, 림프절전이가 악화되어 paclitaxel, cisplatin으로 약제변경 하였으나 수술 후 14개월째 사망하였다. 두 번째 증례는 내시경 조직검사상 위선암과 소세포암의 복합 소견을 보였으며 CT 촬영상 복강동맥주위 림프절종대 및 간전이 소견이 발견되었다. TS-1과 cisplatin 선행화학요법 2차 시행 후 림프절 종대는 완전관해, 원발소 및 간전이소는 부분관해 소견을 보여 위전절제술 및 확대림프절 절제술을 시행하였다. 수술로 절제된 위 및 주변 림프절 35개의 조직검사상 암세포가 모두 사멸되었으며 위내 원 발병소는 심한 심유화변성 소견을 보여 수술 전 사용한 항암요법이 유의했다고 판단되었다. 이에 수술 후에도 동일 제제로 4차례 추가 투약을 하였다. 수술 후 6개월에 시행한 CT촬영상 간전이가 진행된 소견을 보여 간우엽 후부절제술을 시행하고 이후 ininotecan과 cisplatin을 이용한 항암화학요법을 5차례 시행하고 있으며 술 후 14개월째 생존 중이다. 세 번째 증례는 순수 소세포암으로 근치적 위아전절제술을 시행하였으며 수술 후 5차례에 걸쳐 TS-1, cisplatin 보조항암화학요법 시행하였고 수술 후 13개월째 재발 없이 생존 중이다.