• Tuberculosis and Respiratory Diseases
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• 제74권4호
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• pp.169-176
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• 2013

Background: Although the lung is a common site of metastasis, endobronchial metastases (EBM) from extrathoracic malignancies are rare. Previous studies were retrospective reviews of the cases from each single institute, and the last one was performed between 1992 and 2002. We evaluated the characteristics of patients with EBM who had been diagnosed in recent 10 years in our hospital. Methods: We retrospectively reviewed 1,275 patients who had undergone diagnostic bronchoscopic procedures between 2001 and 2011. An EBM was defined as bronchoscopically notable lesion, which was histopathologically identical to the primary tumor. Results: A total of 18 cases of EBM were identified. The mean age was 53 years, and 12 cases of the 18 patients were female. The most common primary malignancies were colorectal cancer and breast cancer (4 cases each), followed by cervix cancer (3 cases) and renal cell carcinoma (2 cases). Cough was the most common symptom. The most common radiologic finding was atelectasis, which was identified in 27.7% of the cases. The median interval from the diagnosis of primary malignancy to the diagnosis of EBM was 14 months (range, 0-112 months). The median survival time from the diagnosis of EBM was 10 months (range, 1-39 months). Conclusion: EBM from extrathoracic malignancies were rare. Colorectal cancer and breast cancer were common as primary malignancies. Fiberoptic bronchoscopy should be performed in all patients, who are suspected of having EBM. If atypical clinical and pathological features are present, appropriate diagnostic studies should be undertaken.

• 대한두경부종양학회지
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• 제14권1호
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• pp.35-39
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• 1998

Objectives: Minimal improvement in the long-term survival of head and neck cancer(HNC) patients has occurred despite a multitude of advances in the control of loco regional disease and a second primary malignancy(SPM) contribute to the continued poor prognosis for the HNC patients. This study was performed in order to identify the clinical characteristics of SPM in the HNC patients. Materials and Methods: The medical records of 354 patients of head and neck squamous cell carcinoma that were followed up after initial treatment during the period of 1987 through 1994 were reviewed. This study examines the medical records of 354 patients with squamous cell carcinoma of the head and neck, of whom 26 subsequently developed a second neoplasm. Results: The actuarial SPM rate was 7.3%, and median time to presentation for the SPM was 26.8 months. The SPM were more likely to occur in male patients who had oral cavity index tumors. Patient whose index tumor was small at diagnosis had a greater chance of developing a second tumor as did those with no cervical lymph node metastases to the neck. Initial treatment modality was not associated with an increased risk of developing a second tumor. The commonest sites for the SPM were the lung and other head and neck area. The 3-year survival for patients who developed a secondary tumor from the time of its diagnosis was 27.8%. Conclusion: The SPM in the head and neck cancer patients are not uncommon and early detection of the SPM will contribute to increase the long-term survival of HNC patients.

• Journal of Hospice and Palliative Care
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• 제17권4호
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• pp.207-215
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• 2014

암의 다발성 뼈 전이는 폐암, 유방암, 전립선암, 신장암 등 다양한 암에서 흔히 관찰된다. 뼈 전이는 뼈에 발생한 이차적인 암으로 통증, 골절, 그리고 체중을 지지하는 뼈의 불안정성을 유발할 수 있어 신체활동과 삶의 질을 저하시킨다. 뼈 전이 치료 시 병리조직소견, 환자의 전신 상태, 침범 부위, 그리고 환자의 신경학적 소견등 다양한 요인을 고려하여 진통제, 수술, 항암화학요법 그리고 방사선 치료 등을 시행하게 된다. 외부 방사선 치료는 전통적으로 국소 뼈 전이로 인한 통증의 치료에 이용되어왔지만 특히 유방암이나 전립선암의 다발성 골형성 뼈 전이의 경우 $^{89}Sr$, $^{186}Re$, $^{188}Re$, $^{153}Sm$ and $^{117m}Sn$ 등의 방사성동위원소를 이용한 치료가 시행되고 있는데, 약제 투여의 간편함, 낮은 부작용, 방사능 피폭위험에서의 안전성, 높은 치료 반응 등 다양한 장점을 가진 치료로 임상에서의 유용성이 점차 증가되고 있다.

• 대한골관절종양학회지
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• 제11권1호
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• pp.94-99
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• 2005

부신경절종은, 신경외배엽 기원의 교감신경 신경내분비 세포로 이루어져 있는, 부신 이외의 부신경절에서 생긴 종양으로, 주로 갑상선, 목동맥체, 종격동, 폐, 십이지장, 대동맥 주변 부위와 후복막 부위에 잘 생긴다. 악성도는 조직학적인 진단에 의한 것이 아니라, 국소 림프절 재발과 원격 전이에 의하여 판별되며, 골 전이가 드물지만 전이가 일어나면 주로 두개골 기저, 척추에 생기며, 드물게 골반골, 대퇴골로 전이한다. 저자들은 대퇴부 피하층에 발생하여 혈관 기원성의 종양과 감별되었던 부신경절종과 조기 골 전이를 보인 후복막에 발생한 부신경 절종을 경험하여 문헌고찰과 함께 보고하고자 한다.

• Journal of Chest Surgery
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• 제37권11호
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• pp.929-932
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• 2004

원발성 폐육종은 미국의 경우 전체 원발성 폐암 발생률의 0.4% 정도의 비율로 발생하는 드문 질환이며 이중 원발성 폐동맥 골육종은 전 세계적으로 극히 드물게 보고되고 있다. 본 증례는 63세 여자 환자로 흉통과 호흡곤란, 어지러움을 주소로 응급실로 내원하여 검사 중 갑자기 쇼크상태에 빠졌다. 반복적인 심폐소생술을 시행하며 심초음파를 실시한 결과 급성 폐동맥 색전증으로 인한 우심부전증으로 진단하여 인공심폐기 가동하에 응급수술을 시행하였다. 주폐동맥을 절개하였을 때 혈전이 주폐동맥에서 좌우 폐동맥에 걸쳐 존재하였고 종괴가 주폐동맥의 우상부쪽 내막에 붙어 있어서 종괴와 혈전을 제거하였다. 환자는 특별한 문제없이 회복되었으며 술 후 조직검사에서 종괴는 폐동맥 골육종으로 진단되었다. 술 후 시행한 검사에서 폐 이외의 장기에서는 골육종이 발견되지 않았으며 좌하행 폐동맥 내에 잔존하는 종괴와 좌우 폐야에서 다발성 결절들이 관찰되어 혈행성 전이가 의심되어 항암치료와 방사선치료를 시행하였으며 수술 후 16개월에 환자는 잔존하는 종괴와 전이성 결절들의 크기는 줄어든 상태로 특별한 증상 없이 지내고 있다.

• Journal of Chest Surgery
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• 제36권11호
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• pp.870-873
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• 2003

과오종은 가장 흔히 보는 폐의 양성종양이나 기관지 내에 발생하는 경우는 드물다. 더욱이 지방종성인 경우는 매우 드물다. 73세 남자에게 한 달 전부터 객혈이 발생되어 입원하였다. 기관지경 검사에서 우상엽기관지를 막고 있는 돌출된 종괴가 발견되었다. 수술 중 얻은 동결 조직에서 양성으로 진단되어 기관지절개만으로 종양을 제거하였다. 저자들은 기관지절개만으로 제거된 지방종성 기관지내 과오종을 경험하여 보고하는 바이다.

• 대한두경부종양학회지
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• 제24권2호
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• pp.174-178
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• 2008

Background and Objectives：Peripheral nerve sheath tumors(PNSTs) are uncommon neoplasm in the head and neck region. The treatment of PNSTs is surgical removal, but excision cause neurologic complications. This study was performed to evaluate the proper diagnosis and treatment of PNSTs with our experiences. Subjects and Method：During the period from October 1994 to July 2007, 58 patients were diagonised with PNSTs in head and neck region. We reviewed medical records and imaging study retrospectively. Result：95%(55/58) of the PNSTs in head and neck were benign；5%(3/58) were malignant peripheralnerve sheath tumors(MPNSTs). 63%(37/58) were neurilemoma, 20%(17/20) were neurofibroma, 2%(1/58) was perineuroma. 55 patients underwent surgery. 80%(45/55) of cases were treated with excision. Enucleation was performed in 7(14%) patients. All cases of benign neurogenic tumors showed no recurrence. Among 3 of MPNSTs 2 patients were Von Recklinghausen’s disease and expired with regional recurrence and lung metastasis. Conclusion：The benign PNSTs can be treated with enucleation if possible and observation can be another choice to minimize neurologic sequele.

• Advances in pediatric surgery
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• 제6권2호
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• pp.95-99
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• 2000

Thyroid carcinoma is relatively rare in children. Eight cases of thyroid carcinoma were among 18 patients operated upon for thyroid tumors at Pediatric Surgery, Asan Medical Center in 11 years' period between 1989 and 2000. Five patients were boys and three were girls. The age distribution ranged from 10 to 14 years with a median age of 11.6 years. We studied clinical presentations, diagnostic workup, pathology, treatment, and follow-up (recurrence, mortality, and survival). All patients presented with anterior neck mass but one with multiple cervical lymph nodes enlargement. Familial history of thyroid cancer was seen in one case. All patients had a cold nodule by 1-131 thyroid scan. Fine needle aspiration (FNA) biopsy was performed in all patients. The right lobe was involved in four patients and the left lobe in two. Two had both lobes involvement. Pathologically, six cases were papillary carcinoma, one was follicular carcinoma, and one insular carcinoma. Four patients underwent unilateral lobectomy and isthmectomy. Total thyroidectomy was performed in three patients. The insular carcinoma case was preoperatively diagnosed as follicular neoplasm by FNA. After confirmation of the pathology by initial right thyroid lobectomy, total thyroidectomy was subsequently done. Cervical lymph node metastases were presented in three cases (37.5%), and lung metastasis in two cases (25%). Three patients received postoperative I-131 ablation. After a median follow-up of 53 months, all patients were alive without evidence of recurrence. In conclusion, thyroid carcinoma in children is frequently associated with lymph nodes involvement and distant metastasis, however, the prognosis is relatively good.

• Tuberculosis and Respiratory Diseases
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• 제62권1호
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• pp.67-70
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• 2007

흉선암종은 드문 종격동의 악성 종양으로서 흉선상피세포에서 기원하지만 흉선종과는 조직학적 특징이 다르다. 흉선종이 자가면역질환을 종종 동반하는데 반해 흉선암종에서 자가면역질환이 동반되는 예는 드물다. 국내에서는 흉선암종과 자가면역질환이 동반된 예가 보고된 적이 없는데 저자들은 전신 근육통을 주소로 내원한 49세 남자 환자가 전신홍반루프스와 흉선암종을 동시에 진단받고 항암치료를 시작한 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

• Tuberculosis and Respiratory Diseases
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• 제43권3호
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• pp.440-448
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• 1996

Bronchial carcinoid tumors are uncommon, constituting approximately 3-5% of all primary lung cancers. Classification of these tumors has evolved substantially as our understanding of the cellular, biologic, and clinical aspects of these neoplasms has improved. Initially, bronchial carcinoids were thought to be benign and therefore were classified as bronchial adenomas. Currently, however, they are well recognized as having the potential for both local invasion and distant metastatic involvement. Consequently, carcinoid tumors are frankly malignant. Thus bronchial adenoma is a misnomer that should no longer be used for bronchial carcinoids. Most investigators currently favor classifying carcinoid tumors as a type of neuroendocrine neoplasm because of their potential to secrete a variety of chemical substances found in both the central nervous system and the epithelial cells of numerous organs. Bronchial carcinoids are usually characterized by a slow growth pattern and a low incidence of metastasis, and histologically conformed by the azurophil staining and the presence of the characteristic neurosecretary granule on electron microscopy. Atypical carcinoid tumor was first defined by Arrigoni et al, who proposed the following criteria for separation of atypical carcinoid from typical carcinoid tumor : 1) increased mitotic activity with 1 mitotic figure per 1-2 high power fields(or 5-10 mitoses /10 HPF), 2) nuclear pleomorphism, hyperchromatism, and an abnormal nuclear-cytoplasmic ratio, 3) areas of increased cellularity with disorganization of the architecture, and 4) tumor necrosis. In contrast, typical carcinoid tumor may have focal cytologic pleomorphism, but necrosis is absent and mitotic figures are rare. Recently we experienced a case of atypical bronchial carcinoid with multiple distant metastasis, so we report this case with a review of the literature.