• 대한두경부종양학회지
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• 제11권1호
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• pp.36-40
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• 1995

Sebaceous carcinomas of the eyelids are uncommon but lethal tumors. Lesions are usually seen in the elderly, predominantly women. The meibomian glands of the tarsus are the most frequent site of origin. Less commonly, the tumor arises in other sebaceous glands, e.g., the gland of Zeis, eyebrow or caruncle. Regardless of the location, sebaceous malignancies must be considered aggressive neoplasms with a potential for regional and distant metastasis. Diagnosis may be difficult, given the low incidence and inconsistencies in histopathologic classification. Treatment requires wide surgical excision with removal of involved regional lymph nodes and exenteration is reserved for those patients with orbital involvement or diffuse intraepithelial neoplasia. Opinions are divided regarding the use of postoperative irradiation or chemotherapy. Recently we experienced 46-year-old male patient with a 12-month history of painless, firm nodule and conjunctivitis due to sebaceous carcinoma of the left upper eyelid. After surgery, serial sections of the entire conjunctiva and eyelids showed a positive cut margin in medial and lateral border. We report herein this patient that supports irradiation as the postoperative treatment of these tumors in selected patients with a review of literatures.

• 대한수의학회지
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• 제49권1호
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• pp.67-71
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• 2009

A 10-year old female Yorkshire terrier with nasal discharge and swelling was referred to the local animal hospital. Abnormal mass of right nasal cavity was detected in physical examination and radiography. According to the radiographs of the head, there was an evidence of bony destruction in right nose. Oronasal fistula was detected in right maxillary canine teeth. After surgical excision, the sample of nasal mass was refereed to Pathology Department of Veterinary Medicine in Jeju National University. Grossly, the enlarged mass was soft and 3 ${\times}$ 3 cm in size. Histopathologically, the neoplastic mass was composed of tubular to tubulopapillary structures which were lined by single to 6~7 layers of cuboidal to ciliated columnar cells. These neoplastic cells showed invasive tendency to adjacent normal parenchyma. They had uniform, round to oval nuclei, cytoplasm with small vacuoles and indistinct cellular margin. The number of mitotic figures was varied in different areas, ranged from 0 to 4 per high power field. Necrotic foci and infiltration of inflammatory cells including neutrophils, lymphocytes, and plasma cells also presented in the mass. Immunohistochemically, the neoplastic cells demonstrated strong positive reaction for cytokeratin (CK) 18 but were negative for CK 7 and 8. Based on the gross, histopathology and immunohistochemistry, this mass was diagnosed as nasal adenocarcinoma originated from respiratory epithelium.

• 고신대학교 의과대학 학술지
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• 제33권2호
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• pp.191-199
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• 2018

Objectives: We designed the study to compare the oncologic and renal function outcomes of off-clamp, laparoscopic partial nephrectomy (OCLPN) and conventional laparoscopic partial nephrectomy (HCLPN) for renal tumors. Methods: Between March 2008 and July 2015, 114 patients who underwent laparoscopic partial nephrectomy (LPN) of a renal neoplasm were studied. We performed LPN without hilar clamp on 40 patients (OCLPN, Group 1), and conventional LPN with hilar control and renorrhaphy on another 40 patients (HCLPN, Group 2). We retrospectively reviewed the medical records of each patient's age, sex, R.E.N.A.L. nephrometry score (RNS), operation time, complications, hospitalization period, tumor size, positive resection margin, histologic classification of tumor, pathologic stage, Fuhrman grade, estimated blood loss (EBL), warm ischemic time (WIT), and estimated glomerular filtration rate (eGFR) before and one year after surgery. Results: There were no significant differences in age, sex, preoperative eGFR, EBL, surgical (anesthesia) time, and tumor size between the two groups. The mean eGFR was not significantly different between the OCLPN and HCLPN groups 1 month (95 and $86.2mL/min/1.73m^2$, respectively; P = 0.106), 6 months (92.9 and $83.6mL/min/1.73m^2$, respectively; P = 0.151) and 12 months (93.8 and $84.7mL/min/1.73m^2$, respectively; P = 0.077) postoperatively. The change in eGFR after one year was 3.9% in the OCLPN group and -7.9% in the HCLPN group. Conclusions: OCLPN was superior to HCLPN in preserving renal function one year after surgery, and there was no statistically significant difference in tumor treatment results.

• 대한두경부종양학회지
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• 제22권1호
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• pp.23-28
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• 2006

Background and Objectives: Maxillectomy is the mainstay of treatment for malignant tumors of the maxillary sinus(MS). Nevertheless, few have been reported on the surgical outcomes of maxillectomy for malignant tumors of MS in Korean literature. Based on our clinical experience, the authors aimed to present the treatment outcomes of maxillectomy for squamous cell carcinomas(SCC) of MS. Subjects and Methods: We reviewed the medical records of 26 cases of maxillectomies with see of MS, who were treated from 1995 to 2004 at Samsung Medical Center. Most patients(73.1%) were locally advanced stage(T3 or T4a) at initial presentation. Total maxillectomy was performed in 18 cases, which is the most frequent procedure(69.2%). We analyzed the treatment outcomes of see of MS and several variables includeing tumor stage and resection margin to identify predictors for treatment failure after maxillectomy. Follow-up duration ranged from 7 to 89 months with a mean of 33 months. Results: Treatment failure occurred in 7 cases(26.9%), among which 3 were salvaged. Three of 26 maxillectomies(11.5%) showed the positive or close(less than 5mm) resection margin in their posterior resection sites; however it did not coincide with the site of recurrence after radiation therapy. Among patients who had been followed up for more than 6 months, disease-free 3 year survival rate was 100.0% in T1 and T2, 76.2% in T3, 60% in T4a, and 69.6% in total. Conclusion: Even though most of see of MS were detected at locally advanced stage, maxillectomy with or without postoperative radiation therapy for resectable MS see(T1-T4a) provided the acceptable treatment outcome(70%, 3Y disease-free survival rate).

• Asian Pacific Journal of Cancer Prevention
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• 제14권9호
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• pp.5165-5169
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• 2013

Background: To evaluate the pathological characteristics of invasive margins in early-stage cervical squamous cell carcinomas and their association with other clinicopathological features including clinical outcomes. Materials and Methods: Patients with FIGO stage IB-IIA cervical squamous cell carcinomas who received surgical treatment and had available follow-up information were identified. Their histological slides were reviewed for prognostic variables including tumor size, grade, extent of invasion, lymphovascular invasion, involvement of vaginal margin or parametrium, and lymph node metastasis. The characteristics of invasive margins including invasive pattern (closed, finger-like, or spray-like type), degree of stromal desmoplasia, and degree of peritumoral inflammatory reaction were evaluated along the entire invasive fronts of tumours. Associations between the characteristics of invasive margins and other clinicopathological variables and disease-free survival were assessed. Results: A total of 190 patients were included in the study with a median follow-up duration of 73 months. Tumour recurrence was observed in 18 patients (9%). Spray-like invasive pattern was significantly more associated as compared with closed or finger-like invasive pattern (p=0.005), whereas the degree of stromal desmoplasia or peritumoral inflammatory reaction was not. Low degree of peritumoral inflammatory reaction appeared linked with lymph node metastasis (p=0.021). In multivariate analysis, a spray-like invasive pattern was independently associated with marked stromal desmoplasia (p=0.013), whilst marked desmoplasia was also independently associated with low inflammatory reactions (p=0.009). Furthermore, low inflammatory reactions were independently associated with positive margins (p=0.022) and lymphovascular invasion (p=0.034). The patients with spray-like invasive pattern had a significantly lower disease-free survival compared with those with closed or finger-like pattern (p=0.004). Conclusions: There is a complex interaction between cancer tissue at the invasive margin and changes in surrounding stroma. A spray-like invasive pattern has a prognostic value in patients with early-stage cervical squamous cell carcinoma.

• Radiation Oncology Journal
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• 제13권1호
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• pp.41-48
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• 1995

목적 :조기 자궁경부암 환자에서 보조적 방사선치료요법은 근치적수술을 시행하고 재발의 위험이 높은 불량한 예후를 갖는 환자에서 시행되고 있다. 이에 저자는 수술후 방사선치료를 받았던 환자의 생존과 치료실패에 영향을 주는 예후인자를 분석하고자 하였다. 대상 및 방법 :전남대학교병원 치료방사선과에서 1985년 8월부터 1988년 12월까지 수술후 방사선치료를 받았던 자궁경부암 병기 IB와 IIA환자 106명중 기록이 충분한 90명을 대상으로 후향적 분석을 시행하였다. 추적율은 $88\%$(78/90)였고 추적기간의 중간간은 64개월이었다. 결과 : 90명에 대한 5년 생존율및 5년 무병생존율은 각각 $80.0\%$, $80.2\%$였다. 다변량생존분석에서 65명을 대상으로 환자의 연령, 병기, 조직학적 분류, 수술전 혈중 CIA 농도, 출산력, 경부침윤정도, 종양의 육안적 크기, 종양의 궤양성 유무, 임파선 전이 유무, 수술절단면의 소견, 항암제치료 유무를 변수로 분석결과 수술절단면의 조직학적인 소견(p=0.005), 임파선전이유무(p=0.005)가 통계학적으로 의미있는 예후인자였다. 추적기간중 13명에서 재발이 확인되었고 부위별로 보면 골반내 국소재발이 5명, 원격전이가 8명 이었으며 수술후 3개월에서 39개월사이에 발견되었으며 중간값은 19개월이었다. 골반내 전이는 선암(p=0.034)과 경부침윤 10mm 이상(p=0.02) 그리고 항암제치료(p=0.023)를 시행하였던 환자군에서, 원격 전이에 있어서는 임파선전이와 수술절단면에서 암세포가 양성을 보였던 환자군에서 각각 더 높은 전이율을 보였다. 치료에 의한 합병증을 호소하였던 환자는 15명이었으며 가장 흔한 증상은 혈변이나 혈뇨였고 중증의 합병증을 보인 환자는 없었다. 결론 : 이에 저자는 조기자궁경부암 IB와 IIA환자에서 수술병리학적소견중 임파선전이와 불충분한 수술적절제가 예후에 있어서 가장 큰 영향을 보임을 알 수 있었으며 이러한 소견을 보인 환자는 보다 적극적인 보조치료가 필요하리라 사료된다.

• Archives of Plastic Surgery
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• 제33권6호
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• pp.681-687
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• 2006

Purpose: The nose of most Koreans is characterized as a low nasal dorsum, retracted columella, and an acute columella-labial angle. For the surgical correction of the tip and columella, a modified septal extension graft, along with augmentation rhinoplasty has been developed. Methods: With this technique, a septal extension graft is fixed on the entire caudal margin of the septum (the cephalic-caudal axis) and at the same time, it is placed above the anterior nasal spine, in the membranous portion of the septum and at the base of the columella(the anterior-posterior axis). The present report describes the results obtained in 13 patients and offers an analysis of the results as judged by the columella-labial angle and 4 proportional indices(nose height index, nasal bridge length index, nasal tip projection index, columella length index), measured by photogrammetry. Results: The postoperative values obtained in these 5 categories increased significantly compared to the preoperative ones, thus confirming that the projection of tip was augmented, the nose was lengthened, and the columella was advanced caudally and lengthened. Moreover, these positive outcomes were still maintained during the follow-up period, and no side effects, such as saddle nose deformity, were reported. Conclusion: A modified septal extension graft can be considered as an effective method for the surgical correction of the nasal tip and columella in Koreans.

• Journal of Chest Surgery
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• 제57권2호
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• pp.160-168
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• 2024

Background: Data on perioperative outcomes of emergent versus elective resection in esophageal cancer patients requiring esophagectomy are lacking. We investigated whether emergent resection was associated with increased risks of morbidity and mortality. Methods: Data on patients with esophageal malignancy who underwent esophagectomy from 2005 to 2020 were retrospectively analyzed from the American College of Surgeons National Surgical Quality Improvement Program database. Thirty-day complication and mortality rates were compared between emergent esophagectomy (EE) and non-emergent esophagectomy. Logistic regression assessed factors associated with complications and mortality. Results: Of 10,067 patients with malignancy who underwent esophagectomy, 181 (1.8%) had EE, 64% had preoperative systemic inflammatory response syndrome, sepsis, or septic shock, and 44% had bleeding requiring transfusion. The EE group had higher American Society of Anesthesiologists (ASA) class and functional dependency. More transhiatal esophagectomies and diversions were performed in the EE group. After EE, the rates of 30-day mortality (6.1% vs. 2.8%), overall complications (65.2% vs. 44.2%), bleeding, pneumonia, prolonged intubation, and positive margin (17.7% vs. 7.4%) were higher, while that of anastomotic leak was similar. On adjusted logistic regression, older age, lower albumin, higher ASA class, and fragility were associated with increased complications and mortality. McKeown esophagectomy and esophageal diversion were associated with a higher risk of postoperative complications. EE was associated with 30-day postoperative complications (odds ratio, 2.39; 95% confidence interval, 1.66-3.43; p<0.0001). Conclusion: EE was associated with a more than 2-fold increase in complications compared to elective procedures, but no independent increase in short-term mortality. These findings may help guide data-driven critical decision-making for surgery in select cases of complicated esophageal malignancy.

• Radiation Oncology Journal
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• 제13권1호
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• pp.69-78
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• 1995

연조직육종의 치료는 고전적으로 근치적 절제술이 사용되어 왔으나 최근에는 보존적 치료로 대치되고 있으며 이때 방사선치료의 역할도 입증되어 있다. 저자들은 1979년부터 1990년까지 11년 동안 서울대학교병원 치료방사선과에서 수술후 방사선치료를 시행한 연조직육종 환자 74명을 대상으로 후향 분석을 시행하여 방사선치료의 효과와 환자의 재발 및 생존에 영향을 미치는 예후인자를 알아보고자 하였다. 모든 환자의 병리조직학적 소견을 재판독하였으며 지방육종 및 악성섬유조직구종이 제일 많았다 17예에서 국소절제, 55예에서 광범위 절제 그리고 2예에서 근치적 구획절제가 시행되었으며 11예에서는 항암화학요법이 병행되었다. 방사선치료선량의 중앙값은 6000cGy(범위 4200-8820cgy)였으며 환자들의 중앙추적기간은 51개월(범위 3-145개월)이었다. 국소치유율은 5년에 $62.2\%$, 8년에 $60.0\%$이었다. 조직학적 등급, 절제변연의 침윤여부가 국소치유율에 영향을 미치는 유의한 예후인자였으며 조직학적 유형중에서는 지방육종의 경우가 높은 국소치유율을 나타내었다. 전체 생존율은 5년에 $72.3\%$, 8년에 $58.5\%$이었으며, 무병생존율은 5년에 $53.3\%$, 8년에 $48.3\%$이었다. 생존 및 원격전이에 영향을 주는 예후인자로는 역시 조직학적 등급, 절제변연의 침윤여부가 중요하였으며 육종의 발생부위도 생존율에 영향을 주었다. 대부분의 재발은 국소에서 일어났으나 17명의 환자에서는 원격전이가 일어났으며 주로 폐를 침범하였다. 원격전이후의 생존율은 3년에 $15.1\%$로서 원격전이가 생존율을 결정하는 중요한 요인임을 알 수 있었다. 따라서 연조직육종 환자의 수술시 충분한 절제변연을 얻는 것이 매우 중요하며 절제변연이 침범된 경우에는 재수술을 시행함으로써 국소치유율을 향상시킬 필요가 있는 것으로 판단된다. 또한 궁극적인 생존율의 향상을 위하여는 효과적인 항암제의 개발이 시급하다 하겠다.

• Radiation Oncology Journal
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• 제32권2호
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• pp.70-76
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• 2014

Purpose: To review the results of postoperative radiation therapy (PORT) for residual non-small cell lung cancer (NSCLC) following surgical resection and evaluate multiple clinicopathologic prognostic factors. Materials and Methods: A total of 58 patients, who completed scheduled PORT for positive resection margin, among 658 patients treated with PORT from January 2001 to November 2011 were retrospectively analyzed. Radiation therapy was started at 4 to 6 weeks after surgery. Chemotherapy was also administered to 35 patients, either sequentially or concurrently with PORT. Results: The median age of patients was 63 years (range, 40 to 82 years). The postoperative pathological stage I NSCLC was diagnosed in 10 (17.2%), stage II in 18 (31.0%), and stage III in 30 patients (51.7%). Squamous cell carcinoma was identified in 43, adenocarcinoma in 10, large cell in 1, others in 4 patients. Microscopic residual disease (R1) was diagnosed in 55 patients (94.8%), and the remaining three patients were diagnosed with gross residual disease (R2). The median dose of PORT was 59.4 Gy (range, 50.0 to 64.8 Gy). Chemotherapy was administered to 35 patients (60%), and the median follow-up time was 22.0 months (range, 6.0 to 84.0 months). The 3-year locoregional relapse-free survival and distant metastasis-free survival rates were 82.1% and 52.9%, respectively. The median overall survival was 23.8 months (range, 6.0 to 84.1 months), and the 3-year overall survival rate was 58.2%. Chemotherapy did not influence the failure pattern or survival outcome. Conclusion: PORT is an effective modality for improving local tumor control in incompletely resected NSCLC patients. Major failure pattern was distant metastasis despite chemotherapy.