• Tuberculosis and Respiratory Diseases
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• 제41권4호
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• pp.435-439
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• 1994

Lung cancer is the most common fatal malignant lesion in both sexes. Detection of the solitary pulmonary nodule is important because surgical series up to a third of solitary pulmonary nodules are bronchogenic carcinoma. Bronchioloalveolar cell carcinoma is a rare primary lung cancer and surgery is treatment of choice in brochioloalveolar cell carcinoma. We experinced a case of bronchioloalveolar cell carcinoma in solitary pulmonary nodule with cavitary lesion in chest CT scan, which is an uncommon finding in brochioloalveolar cell carcinoma.

• Journal of Chest Surgery
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• 제15권2호
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• pp.148-154
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• 1982

The experience with operative treatment for peripheral situated solitary circumscribed lesions of the lung at the Department of Thorac. & Cardiovasc. Surg., Korea University Hospital during 8 years from March 1974, through April, 1982 was reviewed. Our criteria for Solitary pulmonary nodule were 1. Round or Ovoid shape 2. Surrounded by normal lung Parenchyme 3. Well circumscribed peripheral location 4. No other visible pulmonary diseases on chest X-ray except minimal atelectasis or pneumonitis 5. Largest diameter less than 8 cm Of the 55 patients reviewed, there were 69% of malignancy and 31% of benign pulmonary diseases. In malignancy 38 patients, there were 18 patients with squamous cell carcinoma, 8 patients with undifferentiated large cell carcinoma, 2 patients with undifferentiated small cell carcinoma, 10 patients with adenocarcinoma and patient with metastatic carcinoma. In benign pulmonary nodule 17 patients, here were 5 patients with tuberculoma, 5 patients with aspergilloma, 2 patients with A-V fistula, 1 patient with pulmonary blastoma, 1 patient with paragonimiasis, and 1 patient with lung abscess. Overall male to female occurrence ratio was 39:16, and most prevalent age incidence was 7th decades. Most frequent size distribution was 4-6 cm in diameter. All of benign diseases were cured by resection and 66% of malignancy performed operation and has 75% resectability.

• Journal of Chest Surgery
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• 제46권4호
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• pp.316-318
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• 2013

Thoracoscopic needle aspiration is a good alternative for a centrally-located solitary pulmonary nodule (SPN) suspected of being lung cancer without severe pleural adhesion. The authors report the technique of thoracoscopic needle aspiration biopsy in a SPN just in the medial aspect of the truncus anterior pulmonary artery and the right upper lobe bronchus.

• Tuberculosis and Respiratory Diseases
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• 제47권4호
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• pp.498-506
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• 1999

연구배경 : 고립성 폐결절에 대한 접근에 있어 가장 중요한 것은 결절의 악성여부를 결정하는 것이다. 지금까지 고립성 폐결절의 악성여부에 대한 예측은 주로 방사선학적 소견에 의하여 이루어졌으나 수술 전 진단의 정확성은 보고자에 따라 차이가 있다. 수술 전 진단의 부정확은 고립성 폐결절 자체에 대한 진단의 어려움도 있지만 환자의 임상적 방사선학적 특징들을 통합적으로 고려하지 않은 점 역시 중요한 원인 중의 하나이다. 저자들은 Bayes식 접근법을 이용하여 고립성 폐결절 환자의 임상적 특징과 방사선학적 특징들을 통합적으로 고려하여 결절의 악성 확률을 구하여 진단 및 치료방법의 결정에 도움을 주고자 하였다. 대상 및 방법 : 조직학적으로 확진된 고립성 폐결절 180예를 대상으로 임상적 특징과 방사선학적 특징에 대한 Bayes식 접근법으로 결절의 악성 가능성을 후향적으로 조사하였다. 결 과 : 환자의 임상적 특징 중 연령이 증가할수록, 특히 66세 이상인 경우 likelihood ratio가 높았으며(LR 3.64), 46 pack-year 이상의 흡연력이 있는 경우 악성 가능성이 높았다(LR 8.38). 방사선학적 소견 중 결절의 크기가 클수록, 주위 조직과 경계가 불분명하고 엽상이나 극상모양의 결절이 likelihood ratio가 높았다. 결 론 : Likelihood ratio를 이용한 Bayes식 접근법을 이용하여 고립성 폐결절의 악성 확률을 예측하는 것은 특징적인 방사선학적 소견에만 의존하여 결절의 악성 가능성을 예측하는 것보다 더 정확하며, 결절의 진단이나 치료에 대한 방향을 결정을 하는데 유용한 지표로 이용될 수 있을 것으로 생각된다.

• Journal of Chest Surgery
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• 제50권1호
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• pp.54-58
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• 2017

Primary intrapulmonary thymoma (PIT) is a very rare lesion of uncertain pathogenesis. PIT should be considered when the histopathological appearance of a lung tumor shows features that are uncommon but similar to those of a thymoma. In this case report, we discuss the case of a 5 9-year-old female with a solitary pulmonary nodule that was confirmed to be PIT on the basis of pathological tests. Treatment with complete resection showed good results.

• Journal of Chest Surgery
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• 제22권3호
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• pp.425-435
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• 1989

The solitary pulmonary nodule is considered as a round or ovoid lesion with sharp, circumscribed borders, surrounded by normal appearing lung parenchyme on all sides, and found on a simple chest X-ray without any particular symptoms or signs. There is a wide spectrum of pathologic conditions in the solitary pulmonary nodules prove to be malignant tumors, either primary or metastatic. Most Benign granulomas and other benign conditions can also be seen as solitary nodules. The resection of solitary malignant nodules results in a surprisingly high 5-year survival rate. On the contrary, most benign nodules do not need to be resected and a period of prolonged observation and nonsurgical management is usually indicated. Therefore, the best approach to the controversial management of solitary pulmonary nodules depends on finding factors affecting the probability of malignancy. In this article, clinical records and chest roentgenographies of 60 patients operated on over the past 8 years at the Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital were reviewed. There were 15 malignant nodules and 45 benign nodules and the prevalence of malignancy was 25%. The most common pathologic entity was tuberculoma [21 cases]. The mean age was 55.5*9.6 years in the malignant group, 45.8>12.5 years in the benign group and there was a significant statistical difference between the two groups [P < 0.05]. The malignant ratio in each age group increased with advancing age. The average smoking amount was 35.6*12.9 cigarettes per day in malignant smokers, 20.9* 12.0 cigarettes per day in benign smokers, and there was a significant statistical difference between the two groups [p< 0.05]. The malignant ratio also increased with the increasing smoking amount. Comparing the appearance of the nodule on chest films, 6 calcifications and 7 cavitations were found only in benign nodules, not in malignant nodules. Therefore, calcification and cavitation can be considered as preferential findings for benignity. Previous cancer history was also a significant factor deciding the prognosis of the nodule [p< 0.05]. The average diameter on chest X-ray was 3.07*0.82 cm in malignant nodules, 3.25*1.04 cm in benign nodules and there was no significant statistical difference between the two groups [p< 0.05]. The author used Bayes theorem to develop a simple method for combining individual clinical or radiological factors of patients with solitary nodules into an overall estimate of the probability that the nodule is malignant. In conclusion, patient age, smoking amount, appearance of nodule on chest film such as calcification and cavitation, and previous cancer history were found to be strongly associated with malignancy, but size of nodule was not associated with malignancy. Since these prognostic factors have been found retrospectively, prospective controlled studies are needed to determine whether these factors have really prognostic significance.

• Journal of Chest Surgery
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• 제56권1호
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• pp.1-5
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• 2023

Background: The number of patients with incidentally identified pulmonary nodules is increasing. This study attempted to confirm the usefulness and safety of video-assisted thoracic surgery (VATS) core needle biopsy of pulmonary nodules. Methods: Data from 18 patients diagnosed with pulmonary nodules who underwent VATS core need biopsy were retrospectively reviewed. Results: Of the 18 patients, 15 had malignancies (primary lung cancer, n=14; metastatic lung cancer, n=1), and 3 had benign nodules. Mortality and pleural metastasis did not occur during the follow-up period. Conclusion: In patients with solitary pulmonary nodules that require tissue confirmation, computed tomography-guided percutaneous cutting needle biopsy or diagnostic pulmonary resection sometimes may not be feasible choices due to the location of the solitary pulmonary nodule or the patient's impaired pulmonary function, VATS core needle biopsy may be performed in these patients as an alternative method.

• Tuberculosis and Respiratory Diseases
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• 제64권4호
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• pp.318-323
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• 2008

본 증례는 2년간 크기의 변화가 없다가 천천히 자라는 고립성 폐결절을 경피부 흉강 세침생검을 시행하여 분화도가 좋은 원발성 폐선암을 진단하였고, 근위 림프절 절제를 포함한 좌상엽절제술을 시행하였다. 저자들은 비록 폐결절 크기의 배가시간이 느리며, 알려진 악성의 위험인자가 거의 없어 양성의 가능성이 높은 폐결절이라 하더라도, 조기에 조직검사 를 포함한 적극적인 검사와 치료가 필요하며, 조직검사가 어려울 경우 크기 변화를 예측하기 위해서는 흉부전산화단층촬영으로 추적관찰 하는 것이 필요 하다고 사료되어 이를 문헌고찰과 함께 보고하는 바이다.

• Tuberculosis and Respiratory Diseases
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• 제64권2호
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• pp.133-137
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• 2008

폐흡충증은 폐흡충(Paragonimus westermani)의 중간 숙주인 민물 게, 민물 가재 등의 섭취를 통해 인체에 감염되는 기생충 질환으로, 기흉, 흉수, 낭성 종괴 등 다양한 임상 양상을 보인다. 고립 폐 결절로 형태로 발현하는 경우에는, 폐결핵 및 폐암 등과의 구분이 중요하다. 양전자 방출 단층촬영 검사가 감별 진단에 도움이 되지만, 폐결핵 및 폐 히스토플라스마종 등의 진균 감염에서의 위양성이 보고된 바 있다. 저자들은 48세 남자로 단순흉부촬영상 우연히 발견된 고립 폐 결절에 대한 평가 위해 내원한 환자에게서, 흉부 CT 및 FDG-PET에서 좌폐상엽의 폐문주위에 FDG 섭취가 증가된 고립 폐 결절 양상을 보여 폐암으로 의심하였으나, 폐엽 절제술을 시행 후 폐흡충증으로 진단하여 치료하였기에 문헌 고찰과 함께 보고하는 바이다.

• Tuberculosis and Respiratory Diseases
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• 제69권1호
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• pp.43-47
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• 2010

We report a case of Mycobacterium intracellulare pulmonary infection presenting as a solitary pulmonary nodule (SPN). A 35-year-old male was admitted due to a SPN in the right upper lobe which was detected on the chest radiography being examed due to recurrent cough for 1 year. The computed tomography (CT) revealed a spiculated nodule containing air-bronchogram, which was suspicious of malignancy. We performed transbronchial biopsy and the pathology showed granulomatous inflammation with caseous necrosis. Under the presumptive diagnosis of pulmonary tuberculosis, we started anti-tuberculous medication including isoniazid, rifampin, ethambutol, and pyrazinamide. In one month, however, the sputum culture was positive for Mycobacterium intracellulare. The follow-up chest CT showed slight aggravation of the previous lesions. Under the final diagnosis of Mycobacterium intracellulare pulmonary infection presenting as a solitary pulmonary nodule, we changed the regimen to rifampin, ethambutol, and clarithromycin. The follow-up chest CT after the completion of treatment, revealed resolution of the previous lesions.