• 대한두경부종양학회지
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• 제36권2호
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• pp.41-44
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• 2020

Clear cell hidradenoma is a skin adnexal tumor originating from eccrine glands. The risk of local recurrence after surgical resection exceeds 50%, and 6-19% of cases are malignant. The rarity of clear cell hidradenoma and its diverse histological findings make this type of tumor a diagnostic challenge. We present a case of recurrent clear cell hidradenoma of the posterior neck in a 70-year-old woman. The tumor recurred once after complete excision, and did not recur again after 1-cm wide excision and reconstruction with a local bilobed flap. Recurrent clear cell hidradenomas are activated by surgical stimulation, increasing the risk for metastasis. Therefore, we suggest that wide excision with confirmation of a tumor-free margin by frozen-section biopsy should be the first-line treatment for recurrent benign clear cell hidradenoma.

• Advances in pediatric surgery
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• 제1권1호
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• pp.95-99
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• 1995

Neuroblastoma is the most common solid malignancy in childhood. However, a neuroblastoma presenting as bilateral and multifocal is very rare. A male newborn weighing 2.7 kg was born by normal vaginal delivery at 39 weeks' gestation to a 27-year-old mother who had a normal pregnancy. He was in good condition at birth but presented palpable masses in the both upper abdomen and both side of the neck. Ultrasound examination showed the lesions to be $3{\times}3cm$ sized calcified mass in right suprarenal area and $5{\times}3cm$ sized homogenous mass in left suprarenal area. The abdominal mass was also examined by computed tomography with similar findings. With the impression of bilateral neuroblastoma or metastatic spread, the laparotomy was performed on the 13th day of life. Frozen section of biopsy of the left neck mass was obtained, which showed neuroblastoma. Intraoperative findings revealed bilateral adrenal masses which were distinct and anatomically separate. Bilateral adrenalectomy was accomplished and the initial postoperative course was uneventful. The patient was discharged for hopeless and expired at age 45 days. We present bilateral adrenal neuroblastoma considered to be simultaneous occurrence rather than metastases from one site to another.

• Advances in pediatric surgery
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• 제4권1호
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• pp.74-78
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• 1998

Early recognition and surgical treatment of Hirschsprung's disease prevents serious mortality and morbidity from enterocolitis and obstruction. Usually this disease is characterized by a single aganglionic segment of the colon extending distally to the anal margin. In surgical treatment, the surgeon performs a frozen section biopsy to confirm whether there are ganglion cells. If there are intervening ganglionic sites in aganglionic bowel, there may be confusion in diagnosis and treatment. The authors experienced one case of total colonic aganglionosis with skip area. A transverse loop colostomy was performed on a 7 day-old male baby with colon perforation due to Hirschsprung's disease. But intestinal obstruction persisted and required two more operations to find the true nature of the disease. There were aganglionic segments from the anal margin to the terminal ileum 3.7cm proximal to the ileocecal valve. The entire transverse colon and appendix were normally ganglionated.

• 대한세포병리학회지
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• 제16권2호
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• pp.93-97
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• 2005

Merkel cell carcinoma (MCC) is a rare primary cutaneous neuroendocrine carcinoma which commonly presents as a skin nodule, and can develop into regional lymph node metastases, as well as spread systematically. Here, we describe the cytological features of a touch imprint of MCC that arose on the face of a 62-year-old female. This touch imprint was acquired from an incisional biopsy specimen which had been submitted for frozen section. The touch preparation produced a highly cellular imprint of loosely cohesive groups of small- to medium-sized malignant cells exhibiting uniform round to oval nuclei, delicate nuclear membranes, fine chromatin, small nucleoli, and scanty cytoplasm, with occasional paranuclear button-like inclusions. We applied cytokeratin 20 to the touch imprint for immunochemistry, allowing us to visualize the tumor cells with paranuclear dot-like positivity. Both the cytological and immunocytological features were quite distinct.

• Journal of Gastric Cancer
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• 제5권3호
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• pp.186-190
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• 2005

목적: 위암 수술 시 주변 림프절 전이 여부의 파악을 수술 중에 하는 것은 특히 제한적인 수술을 시행하는 경우 도움이 된다. 현재 사용 가능한 방법은 동결절편법, imprint cytology, 그리고 기타 분자학적인 방법들이 있으며 최근의 대부분의 연구들에서는 동결절편 법을 이용하여 그 결과를 보고하고 있다. 본 연구에서는 저자들은 imprint cytology 방법이 위암 수술 증 림프절 전이 여부를 판단하는 데 있어서 가지는 정확도와 실행 가능성에 대해 알아보았다. 대상 및 방법 2001년 4월부터 2003년 3월까지 260명의 연속된 위암 환자를 대상으로 imprint cytology를 시행하였다. 경험이 풍부한 세포 병리학자의 슬라이드 재검토가 있은 후 그 민감도, 특이도, 정확도 등을 구하였다. 결과: 수술 중 시행하는 imprint cytology에 소요되는 시간은 평균 8분이었으며, 민감도, 특이도, 그리고 정확도는 각각 52.2%, 88.8%, 73.8%였다. 결론: 만약 민감도와 특이도가 어느 정도 만족스러운 수준으로 향상된다면 imprint cytology는 수술 중 림프절 전이여부를 파악하는 데 있어서 유용한 방법이 될 수 있다.

• Advances in pediatric surgery
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• 제2권1호
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• pp.33-41
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• 1996

This report present the result of the national survey of pediatric surgeons' preferences on diagnosis and treatment of Hirschsprung's disease(HD) carried out in 1993. The questionnaires were sent to twenty-seven members of the Korean Association of Pediatric Surgeons (KAPS) working in twenty-four institutions. The questionnaires were designed to determine the individual surgeon's preference for the methods of diagnosis and treatment of the disease. Twenty-three pediatric surgeons from twenty institutions returned completed forms. The total number of patients diagnosed with HD in 1992 was 190 in this group. The estimated incidence of HD was 1/3,900. The most important symptom was delayed meconium passing and the most preferred diagnostic procedure was barium study. Anorectal manometric examination was carried out by 13 pediatric surgeons and 19 confirmed the diagnosis before operation by rectal biopsy, 12 with full-thickness biopsy and 7 with suction. Frozen section biopsy during operation was done by 22 surgeons. Eight surgeons did one stage operation if the age of the patient is suitable. Definitive operation was usually done at the age of 6 to 11 months. The most preferred operation was Duhamel procedure done by 19. Enterocolitis was the most serious complication of HD. Most of patients had normal continence within 6 to 12 months after operation. The follow-up period was less than 6 years in 16 surgeons. The results were presented at the 9th annual meeting of KAPS in June of 1993. This is the first national survey of HD and it can provide guidelines of diagnosis and treatment of Hirschprung's disease even though it is not a detailed study of patient data.

• Journal of Chest Surgery
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• 제41권3호
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• pp.386-389
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• 2008

폐장은 신장세포암의 흔한 전이 장기 중 하나이지만 기관지내 전이는 매우 드물다. 저자들은 신장세포암이 기관지내로 전이한 환자를 수술하였기에 보고한다. 8년전 신장세포암으로 좌측 신장 적출술을 받은 63세 남자가 반복적인 기침을 주소로 내원하였다. 흉부 컴퓨터 단층촬영과 기관지 내시경 검사에서 좌하엽 기관지로부터 이차 기관 분기부까지 자라는 폴립모양의 기관지내 종양이 발견되었고 생검 결과는 만성 염증 소견과 함께 괴사성 조직으로 진단되었다. 수술 중 종괴의 냉동 절편 조직검사에서 전이성 신장세포암으로 확인되었고 상부의 좌하엽 기관지의 점막 침윤이 없어서 좌하엽 절제술과 림프절 청소술을 시행하였다. 치종 병리학적 검사에서도 전이성 신장세포암으로 확진되었고 림프절 전이는 없었다. 환자는 수술 후 10일째 특별한 합병증이 없이 퇴원하였다.

• Advances in pediatric surgery
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• 제1권1호
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• pp.68-72
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• 1995

Segmental dilatation of the colon is a very rare disease entity of unknown etiology and may mimic Hirschsprung's disease. It is characterized by dilatation of a segment of the colon of variable length with obstruction due to lack of peristalsis in a normally innervated intestine. Recently authors experienced a case of segmental dilatation of the sigmoid colon in a 6 month-old male, who presented with severe constipation, abdominal distention, and abdominal mass since 2 months of age. Down's syndrome and congenital nystagmus were associated. Barium enema demonstrated focal dilatation of the sigmoid colon, but the rectum and descending colon proximal t o the affected colon were of normal caliber. Rectal suction biopsy with acetylcholinesterase staining was normal and anorectal manometry showed normal rectosphincteric reflex. At operation, there was a massively dilated and hypertrophied sigmoid colon with increased tortuous serosal vessels, measuring 15 cm in length and 10 cm in width. Teniae coli were identifiable in the affected segment. Frozen section biopsies at the proximal, affected, and distal colon showed ganglion cells. Descending loop colostomy was constructed initially and segmental resection and end to end colocolostomy were carried out 3 months later. Final histologic examination showed 1) normal colonic mucosa with ganglion cells, 2) prominent submucosal fibrosis and marked muscular hypertrophy, 3) unremarkable acetylcholinesterase activity and immunohistochemical findings against S-100 protein. On 8 months follow-up, he has been doing well and moves bowels 1-2 times daily.

• 대한두경부종양학회지
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• 제12권2호
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• pp.177-180
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• 1996

Warthin's tumor is a benign and slow growing tumor found exclusively in the parotid gland or the periparotid lymph nodes. It mostly affects males between the age of forty to seventy years and is closely related with smoking history. Between January 1981 and June 1996, 42 patients underwent surgical excision of Warthin's tumor of the parotid gland; which made up 10.6% of all parotid gland surgeries(398 cases) during the same period. Their ages ranged from 36 to 75 years with a mean age of 56 years. There were 33 male and 9 female patients with a 4.3 : 1 male to female ratio. The majority of the tumors were situated in the parotid tail whereas one was in the deep lobe. Bilateral simultaneous involvements of the parotid gland were found in 4 patients(9.5%) ; therefore total of 46 parotid glands were involved. Four(8.7%) of the 46 parotid glands had multifocal tumors ranginging from two to three lumps. Tumor sizes varied from 1.5 to 6.0cm with mean diameter of 3.lcm. Of the 42 patients, 26(61.9%) were diagnosed preoperatively or peroperatively by means of CT scans, ultrasound, 99m-Tc. scan, fine needle aspiration cytology or intraoperative frozen section biopsy. Of the 46 tumors, 30 underwent a superficial(n=29) or total(n=1) parotidectomy and for 16 cases with tumors suspected preoperatively or peroperatively of being single Warthin's tumor, only enucleation was performed. No cases of recurrence were identified during the follow up period regardless of type of operation performed, however the postoperative complication rate was much higher in the parotidectomy group(33.3%) than in the enucleation only group(12.5%). We feel that an enucleation procedure may be appropriate for the patients with single Warthin's tumor.

• Archives of Plastic Surgery
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• 제36권4호
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• pp.417-421
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• 2009

Purpose: Dermatofibrosarcoma protuberans(DFSP) is a moderate - degree malignant tumor of soft tissue from dermis to fat layer with high recurrences(11% to 73%) due to its local infiltrative characteristic. Many debates and controversies in deciding accurate surgical margin were presented before, but references about depth of invasion and appropriate surgical excision level were not properly made out. Therefore, we tried to identify the degree of tissue invasion of DFSP. Methods: Twenty patients, including 8 patients with recurrent lesions, over last 10 years were reviewed retrospectively. Different surgical margins were applied according to the location and based on histopathologic result, we have defined as a 'deep tissue invasion' if there were infiltration of tumor cell into fascia or underlying muscle layer was present. All invaded tissue including dermis, fat, fascia and muscle were excised until no tumor cell was found during intraoperative frozen section biopsy. And comparative analysis of deep tissue invasion according to age, primary site, duration of disease and recurrence was done. Results: Thirteen patients(65%) showed deep tissue invasion and incidence was found to be increasing with age(over 30 years old). All patients with DFSP on head and neck region revealed deep tissue invasion followed by trunk(54%) and lower extremities(50%). There was no relationship between duration of disease and deep tissue invasion. Conclusions: It is clear that many cases of DFSP had a deep tissue invasion. And high prevalence of deep tissue invasion with age, primary site was intimately associated. So, underlying deep tissue must be completely examined and excised sufficiently throughout the operation for clear resection of DFSP with no recurrences, especially when age is over 30s and on head and neck region.