• Journal of Korean Neurosurgical Society
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• 제29권3호
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• pp.309-316
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• 2000

목 적 : 경구강 치상돌기제거술은 두개척추연결부위에 대한 접근법 중 중요한 수술법이나 수술상처의 문제나 수술후 뇌막염 등의 합병증의 문제점과 해부학적으로 익숙하지 않다는 점 때문에 광범위하게 사용되지 않고 있다. 이 부위의 해부학적 구조의 이해를 위해 사체해부를 통한 미세해부학을 기술하고자 한다. 방 법 : 10구의 고정 혹은 비고정 사체두부를 이용하여 경구강 치상돌기제거술을 단계적으로 시행하였다. 각 두부는 두부 고정기를 이용하여 고정하였으며, 고속드릴과 수술현미경을 이용하여 미세수술을 시행하며 각 단계별로 사진을 촬영하였다. 결 과 : 수술단계는 6단계로 나눌 수 있으며, 연구개, 후측 인두부, 근육조직, 골조직, 치상돌기 및 인대, 십자인대 및 경막으로 나눌 수 있다. 결 론 : 이 부위의 해부학적인 지식을 충분히 숙지하면 경구강 치상돌기제거술은 합병증을 피하면서 비교적 용이하게 두개척추연결부위의 다양한 병변에서 사용될 수 있을 것으로 생각된다.

• 대한골관절종양학회지
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• 제7권1호
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• pp.20-27
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• 2001

목적 : 건초에서 생긴 거대세포종은 수부에서 발생하는 종양 중 두 번째로 흔하나 절제술 후에 재발이 드물지 않으며 국내에서의 연구는 많지 않다. 이에, 저자들은 완관절부를 포함한 수부에 생기는 건초의 거대세포종의 임상적 특성과 수술적 치료후 결과를 분석하여 문헌고찰과 함께 보고하고자 한다. 대상 및 방법 : 1991년부터 1998년까지 수부에서 발생한 종물로 절제생검술을 시행받은 환자 중 조직병리학적으로 건초의 거대세포종으로 진단받은 총 38명, 41예에 대해 성별, 나이, 증상, 증상발현기, 종양이 발생한 부위, 발생한 건, 크기, 다발성 여부, 양측성 여부, 방사선학적 소견 및 골 침범, 재발여부 등에 대해 분석하였으며, 추시기간은 평균 13.1개월(5~40개월)이었다. 결과 : 38명 중 여자에서 29명으로 빈발하였고, 발생연령은 6세에서 66세까지 다양하였으나 50대에서 12례로 가장 호발하였으며 평균연령은 40.1세였다. 지배수지와 비지배수지의 발생경향은 비슷하였고(17례:21례), 모두 일측성이었다. 신전건(17례)보다 굴곡건(24례)에서 더 호발하였으며 증상발현기는 2개월에서 120개월(평균 23.4개월)이었다. 증상으로 대부분 무통성 종물을 호소하였으나, 5례에서 압통, 36례에서 운동장애, 5례에서 압박에 의한 신경증상을 호소하기도 하였다. 재발을 주소로 내원한 경우가 3례였다. 부위별 발생빈도는 수지에서 36례, 수장부에서 3례, 완관절부위 장측에서 2례 순으로 빈발하였으며, 수지별 발생빈도는 인지에서 14례(34%)로 가장 많았고, 엄지가 10례(24%), 중지는 9례, 환지는 5례, 소지는 3례의 빈도순을 보였다. 수지상 발생부위는 원위지골간 관절부 및 중위지골부에서 20례(48.8%), 근위지골 및 근위지골간 관절부가 9례, 중수지절관절부가 7례 순으로 호발하였다. 방사선학적 소견상 연부조직에 방사선 비투과적인 균일한 연부조직 음영을 보이고 있었고 3명에서 피질골 미란을 보였다. 37명에서 종양은 단발성 병변이었으나 이 중 4명에서 다엽상으로 넓게 분포하였고, 1명에서 다발성 병변을 보였다. 변연부 절제술후 재발된 경우가 2명으로 재발율은 5.1%였다. 결론 : 수부에서 발생한 건초의 거대 세포종은 호발조건으로 50대, 여성, 인지, 굴곡건, 수지 원위부를 추정해 볼 수 있었으며, 불완전한 변연부 절제술을 시행하거나, 수술 후 재발한 경우, 다발성, 다엽상 소견을 보인 경우 재발이 잘 되므로 이 경우 광범위 절제술이 필요할 것으로 사료된다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제32권2호
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• pp.183-188
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• 2010

Leiomyosarcoma is a malignant neoplasm of smooth muscle origin and mostly originate from the wall of uterus and gastrointestinal tract, but primary leiomyosarcoma of the oral cavity is extremely rare. This tumor has a very poor prognosis due to high recurrence and metastasis rate, with 5 year survival rate of 32%. And regional lymph node metastasis is uncommon event. Complete wide surgical excision is the treatment of choice. A 64-year old man who had a painful ulcerative lesion on the labial & palatal gingiva of #11, 21 visited our department, and was diagnosed as leiomyosarcoma through a biopsy. Partial maxillectomy was carried out, with no following radiotherapy or chemotherapy. After months follow-up, there has been no evidence of recurrence or metastasis. But after months, we clinically find out two enlarged immobile palpable lymph node in right submandibular area of patient. So a biopsy was performed via an extraoral incision under local anesthesia. Histopathologic diagnosis diagnosis of the biopsy was lymph node metastasis of prior existed leiomyosarcoma. We report a case of a primary leiomyosarcoma occurred in a 64 year-old male patient involving the anterior maxillary region with regional lymph node metastasis with a review of literature.

• 대한세포병리학회지
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• 제7권2호
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• pp.151-156
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• 1996

Phyllodes tumor(PT) is a rare distinctive fibroepithelial breast tumor that occasionally shows unpredictable clinical behavior. Wide excision should be the primary treatment of PT and enucleation, the standard procedure for fibroadenoma(FA), is proscribed due to high frequency of local recurrence. Therefore an accurate preoperative diagnosis of PT is essential in order to ensure proper surgical treatment. However, the differentiation between benign PT and FA is often difficult on the basis of cytologic findings. In an attempt to better understand the cytologic features of benign PT and possibly to differentiate PT from FA on the findings of fine needle aspiration(FNA) smears, we reviewed cytologic smears from 22 histologically diagnosed cases each of benign PT and FA, respectively. The cytologic features assessed were cellularity and atypia of both epithelial and stromal components, and shape of epithelial cell clusters. Atypia of stromal cells was more frequent in PT, while blunt branching pattern of epithelial cells was more frequent in FA. The specific cytologic diagnosis of PT is not possible in many cases, but the abundance of stromal cells with moderate nuclear atypia in the correct clinical setting such as older age and larger size(>4cm) allows the diagnosis.

• 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.

• Archives of Plastic Surgery
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• 제35권3호
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• pp.312-315
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• 2008

Purpose: Amelanotic melanoma represents a melanoma with an absence or a small number of melanin pigments and comprises 2% of all melanomas. These melanomas are frequently misdiagnosed, probably because of its nonspecific clinical features and difficulty in diagnosis, resulting in delayed diagnosis and treatment. We report a patient with amelanotic melanoma, who underwent surgical treatment with sentinel lymph node biopsy using gamma probe. Methods: A 32-year-old female was presented with a slowly growing ill-defined, hypopigmented nonerythematous lesion with nail defect on right index finger tip. Preoperative punch biopsy was performed, showing an amelanotic melanoma. Sentinel lymph node biopsy was done using gamma probe(Crystal probe system, CRYSTAL PHOTONICS GmbH, Germany) and confirmed no evidence of regional lymph node metastases. The patient underwent amputation at the proximal interphalangeal joint. Results: Histopathologic findings showed superficial spreading melanoma. There were no melanin pigments in Hematoxylin & Eosin stain but positive immunohistochemical stainings for S-100 protein and Hmb45, which were consistent with amelanotic melanoma. Patient's postoperative course was uneventful without any complication and had no evidence of recurrence of tumor in 6 months follow-up period. Conclusion: Amelanotic melanoma is extremely rare subtype of malignant melanoma with histopathologic findings of atypical melanocytes without melanin pigments. Early detection is crucial since survival is strongly related to tumor thickness and tissue invasion at the time of diagnosis. Wide excision is the treatment of choice and other conjunctive therapy has not been successful.

• 대한두경부종양학회지
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• 제12권1호
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• pp.58-64
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• 1996

The parathyroid adenoma is the most common cause of the primary hyperparathyroidism. The characteristic of primary hyperparathyroidism is hypercalcemia and high value of serum parathyroid hormone. The primary hyperparathyroidism with parathyroid adenoma is treated by excision of parathyroid gland involved. Especially, parathyroid storm in patients with primary hyperparathyroidism is more prevalent than commonly appreciated. The symptoms and signs of the syndrome are not only due to the hypercalcemia, but also to the toxic effects of the parathyroid hormone. Its wide, but nonspecific clinical presentations make it easily confused with other cardiovascular or renal diseases. The mortality rate in untreated cases of parathyroid storm is essentially 40%. A 33 year old woman with primary hyperparathyroidism was found to have a left lower parathyroid adenoma, presented with hypercalcemic crisis. Initially, good responsiveness to a saline infusion, furosemide administration was noted. Unfortunately, she became consciousness disturbance after fine-needle aspiration of the parathyroid tumor. The recurrent storm was refractory to medical therapy, but was treated succesfully by emergent surgical removal tumor revealed a parathyroid adenoma with parathyroid hormone. Hypercalcemia was alleviated postoperatively. These observations corroborated a functioning parathyroid adenoma.

• Radiation Oncology Journal
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• 제37권2호
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• pp.117-126
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• 2019

Purpose: The purpose of this study was to characterize and evaluate the clinical significance of volume changes of soft tissue sarcomas during radiation therapy (RT), prior to definitive surgical resection. Materials and Methods: Patients with extremity or pelvis soft tissue sarcomas treated at our institution from 2013 to 2016 with RT prior to resection were identified retrospectively. Tumor volumes were measured using cone-beam computed tomography obtained daily during RT. Linear regression evaluated the linearity of volume changes. Kruskal-Wallis tests, Mann-Whitney U tests, and linear regression evaluated predictors of volume change. Logistic and Cox regression evaluated volume change as a predictor of resection margin status, histologic treatment response, and tumor recurrence. Results: Thirty-three patients were evaluated. Twenty-nine tumors were high grade. Prior to RT, median tumor volume was 189 mL (range, 7.2 to 4,885 mL). Sixteen tumors demonstrated significant linear volume changes during RT. Of these, 5 tumors increased and 11 decreased in volume. Myxoid liposarcoma (n = 5, 15%) predicted decreasing tumor volume (p = 0.0002). Sequential chemoradiation (n = 4, 12%) predicted increasing tumor volume (p = 0.008) and corresponded to longer times from diagnosis to RT (p = 0.01). Resection margins were positive in three cases. Five patients experienced local recurrence, and 7 experienced distant recurrence, at median 8.9 and 6.9 months post-resection, respectively. Volume changes did not predict resection margin status, local recurrence, or distant recurrence. Conclusion: Volume changes of pelvis and extremity soft tissue sarcomas followed linear trends during RT. Volume changes reflected histologic subtype and treatment characteristics but did not predict margin status or recurrence after resection.

• 대한두개안면성형외과학회지
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• 제18권2호
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• pp.141-144
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• 2017

An odontogenic cutaneous fistula is a pathological communication between the outer skin surface of the face and the oral cavity. Facial cutaneous fistula is a complication of odontogenic infection that is often misdiagnosed with skin infection. We report a rare case, which was diagnosed as basal cell carcinoma based on the biopsy of skin lesions in the patient who had been diagnosed with odontogenic cutaneous fistula. A 64-year-old male patient presented with a cutaneous odontogenic fistula. The patient had undergone surgical extraction of fistula tract and loose tooth before dermatology or plastic surgery consultation. With the biopsy and computed tomography, it was confirmed that fistula and basal cell carcinoma. However, the connection between the fistula and skin cancer was not clear. Positron emission tomography-computed tomography scan was performed and was not detected as other local or distant metastasis. After that, wide excision of the skin lesion was performed. Although skin cancer is not commonly observed, it is necessary to rule out this disease entity by performing biopsy of skin lesions.

• Archives of Plastic Surgery
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• 제36권4호
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• pp.485-488
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• 2009

Purpose: Malignant melanoma of the lower extremity is well known to metastasize to the lymph nodes of the groin. However, in rare cases, the initial site of the nodal disease can be the popliteal fossa. As of yet, there has not been any report on cases with popliteal lymph node metastasis in Koreans. In the following report, authors would like to present two cases of popliteal node metastasis. Methods: A 60 - year - old male patient presented with nodular mass at his left sole. He had popliteal node metastasis detected on preoperative positron emission tomography(PET). Another 67 - year - old man presented with pigmented lesion at his right heel. He also had popliteal node metastasis detected on the MRI. They underwent wide excision of the primary lesion with popliteal node dissection. Results: In the first case, $2.5{\times}2.5cm$ sized metastatic melanoma in popliteal node was pathologically confirmed. There were no postoperative complications, and to date(18 months after the surgery), the patient is alive with no evidence of disease. In the second case, multiple(4) metastatic melanoma in popliteal nodes was confirmed. The patient is alive, but has had interferon therapy for liver metastasis. Conclusion: By increasing the use of lymphoscintigraphy or PET as a preoperative diagnostic work - up for metastasis, even popliteal node metastasis undetectable in a physical exam becomes detectable. When metastatic lymph node is found, node dissection is the standard of care. Therefore, it is essential that we know the anatomy and surgical technique for popliteal lymph node dissection.