• 대한두경부종양학회지
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• 제24권1호
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• pp.9-14
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• 2008

The most important concern to do parotidectomy is correct identification of the facial nerve and preservation of the nerve function. Many descriptions for the localization and branching types of the facial nerve trunk have existed. During the parotid surgery, it is necessary to have knowledges about the incidence and prognostic aspect of a invasion of the facial nerve by the parotid tumors. The method of the dissection and the surgical extent of the parotid gland would be decided not only by the anatomic variation of the facial nerve. but also the size and location of the tumor. Invasion of the facial nerve in parotid malignancies is the most significant factors affecting the prognosis, so radical parotidectomy which consists of the total extirpation of the parotid gland in conjunction with resection of the facial nerve is often required for proper management. Radical parotidectomy is advocated for the surgical treatment of high grade malignancies and in selective recurrent benign tumors intimately involving the facial nerve. Unfortunately, the morphologic and functional deficits created by sacrificing the facial nerve can be emotionally and physically traumatizing to the patient. Therefore, when the facial nerve is sacrificed, immediate reconstruction of the facial nerve should be necessary. Immediate nerve repair with direct anastomosis of the resected nerve ends or placement of a cable nerve graft provides the better cosmetic and functional results. Surgical resection remains the mainstay of treatment for cancer of the parotid gland, and there is general agreement that facial nerve should not be sacrificed unless the tumor is adherent to, or surrounds the nerve. The following statement is described general principles of troublesome management of the facial nerve during surgery for parotid tumor.

• Journal of Chest Surgery
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• 제52권1호
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• pp.25-31
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• 2019

Background: The primary goal of this study was to characterize the clinical outcomes of adult patients with hematologic malignancies (HM) who were treated with extracorporeal membrane oxygenation (ECMO) support when conventional treatments failed. Methods: In this retrospective, observational study at a tertiary medical center, we reviewed the clinical course of 23 consecutive patients with HM requiring ECMO who were admitted to the intensive care unit at Asan Medical Center from March 2010 to April 2015. Results: A total of 23 patients (8 female; median age, 44 years; range, 29-51 years) with HM and severe acute circulatory and/or respiratory failure received ECMO therapy during the study period. Fourteen patients received veno-arterial ECMO, while 9 patients received veno-venous ECMO. The median ECMO duration was 104.7 hours (range, 37.1-221 hours). Nine patients were successfully weaned from ECMO. The in-hospital mortality rate was 91.1% (21 of 23). There were complications in 3 patients (cannulation site bleeding, limb ischemia, and gastrointestinal bleeding). Conclusion: ECMO is a useful treatment for patients with circulatory and/or pulmonary failure. However, in patients with HM, the outcomes of ECMO treatment results were very poor, so it is advisable to carefully decide whether to apply ECMO to these patients.

• Applied Microscopy
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• 제51권
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• pp.6.1-6.9
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• 2021

Histopathology is a well-established standard diagnosis employed for the majority of malignancies, including breast cancer. Nevertheless, despite training and standardization, it is considered operator-dependent and errors are still a concern. Fractal dimension analysis is a computational image processing technique that allows assessing the degree of complexity in patterns. We aimed here at providing a robust and easily attainable method for introducing computer-assisted techniques to histopathology laboratories. Slides from two databases were used: A) Breast Cancer Histopathological; and B) Grand Challenge on Breast Cancer Histology. Set A contained 2480 images from 24 patients with benign alterations, and 5429 images from 58 patients with breast cancer. Set B comprised 100 images of each type: normal tissue, benign alterations, in situ carcinoma, and invasive carcinoma. All images were analyzed with the FracLac algorithm in the ImageJ computational environment to yield the box count fractal dimension (Db) results. Images on set A on 40x magnification were statistically different (p = 0.0003), whereas images on 400x did not present differences in their means. On set B, the mean Db values presented promising statistical differences when comparing. Normal and/or benign images to in situ and/or invasive carcinoma (all p < 0.0001). Interestingly, there was no difference when comparing normal tissue to benign alterations. These data corroborate with previous work in which fractal analysis allowed differentiating malignancies. Computer-aided diagnosis algorithms may beneficiate from using Db data; specific Db cut-off values may yield ~ 99% specificity in diagnosing breast cancer. Furthermore, the fact that it allows assessing tissue complexity, this tool may be used to understand the progression of the histological alterations in cancer.

• Annals of Clinical Neurophysiology
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• 제25권2호
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• pp.84-92
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• 2023

Background: Clinical spectrum of immunoglobulin M (IgM) monoclonal gammopathy varies from IgM monoclonal gammopathy of unknown significance (IgM-MGUS) to hematological malignancies. We evaluated the clinical features, electrophysiological characteristics, and prognosis of patients with peripheral neuropathy associated with IgM monoclonal gammopathy (PN-IgM MG). Methods: We retrospectively evaluated 25 patients with PN-IgM MG. Peripheral neuropathy was classified as axonal, demyelinating, or undetermined, based on electrophysiological studies. We classified the enrolled patients into the IgM-MGUS and malignancy groups, and compared the clinical and electrophysiological features between the groups. Results: Fifteen patients had IgM-MGUS and 10 had hematologic malignancies (Waldenström's macroglobulinemia: two and B-cell non-Hodgkin's lymphoma: eight). In the electrophysiological evaluation, the nerve conduction study (NCS) criteria for demyelination were met in 86.7% of the IgM-MGUS group and 10.0% of the malignancy group. In particular, the distal latencies of the motor NCS in the IgM-MGUS group were significantly prolonged compared to those in the malignancy group (median, 9.1 ± 5.1 [IgM-MGUS], 4.2 ± 1.3 [malignancy], p = 0.003; ulnar, 5.4 ± 1.9 [IgM-MGUS], 2.9 ± 0.9 [malignancy], p = 0.001; fibular, 9.3 ± 5.1 [IgM-MGUS], 3.8 ± 0.3 [malignancy], p = 0.01; P-posterior tibial, 8.3 ± 5.4 [IgM-MGUS], 4.4 ± 1.0 [malignancy], p = 0.04). Overall treatment responses were significantly worse in the malignancy group than in the IgM-MGUS group (p = 0.004), and the modified Rankin Scale score at the last visit was higher in the malignancy group than in the IgM-MGUS group (2.0 ± 1.1 [IgM-MGUS], 4.2 ± 1.7 [malignancy], p = 0.001), although there was no significant difference at the initial assessment. Conclusions: The risk of hematological malignancy should be carefully assessed in patients with PN-IgM MG without electrophysiological demyelination features.

• Clinical Endoscopy
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• 제56권6호
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• pp.802-811
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• 2023

Background/Aims: Covered self-expandable metallic stents (cSEMS) have become popular for endoscopic ultrasound-guided hepaticogastrostomy with transmural stenting (EUS-HGS). We compared the time to recurrent biliary obstruction (TRBO), complications, and reintervention rates between EUS-HGS using plastic stent (PS) and cSEMS in patients with unresectable malignancies at multicenter institutions in Japan. Methods: Patients with unresectable malignant biliary obstruction who underwent EUS-HGS between April 2015 and July 2020 at any of the six participating facilities were enrolled. Primary endpoint: TRBO; secondary endpoints: rate of complications other than recurrent biliary obstruction and technical success rate of reintervention were evaluated. Results: PS and cSEMS were used for EUS-HGS in 109 and 43 patients, respectively. The TRBO was significantly longer in the cSEMS group than in the PS group (646 vs. 202 days). Multivariate analysis identified two independent factors associated with a favorable TRBO: combined EUS-guided antegrade stenting with EUS-HGS and the use of cSEMS. No significant difference was observed in the rate of complications other than recurrent biliary obstruction between the two groups. The technical success rate of reintervention was 85.7% for PS and 100% for cSEMS (p=0.309). Conclusions: cSEMS might be a better option for EUS-HGS in patients with unresectable malignancies, given the longer TRBO.

• 한국간담췌외과학회지
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• 제26권4호
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• pp.407-411
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• 2022

Mesenchymal hamartoma of the liver (MHL) is a rare benign tumor that often presents in early childhood, and it rarely occurs in adulthood. Aberrant development of the portal tract is a known cause of MHL. Although limited information is available on the natural course of MHL, malignant transformation has been reported in a few cases. Here, we report a case of a 26-year-old female with intrahepatic cholangiocarcinoma secondary to unresected MHL. The patient underwent resection of the hepatic mass, which was diagnosed as MHL at 2 years of age, due to an increase in mass size and a suspicion of malignant transformation during work-up. Histopathology confirmed intrahepatic adenosquamous carcinoma in the background of MHL, with a T2N0M0 pathological stage (stage II). The surgical margin was free from tumor cells. The patient fully recovered postoperatively and started receiving adjuvant chemotherapy. Previous case reports have only reported about the development of undifferentiated embryonal sarcoma or angiosarcoma as malignant transformation of MHL. Cases of other malignancies have not been published; however, it is difficult to rule out the occurrence of various malignancies related to the portal tract when considering the pathogenesis of the disease. To the best of our knowledge, this is the first case report of adenocarcinoma of bile duct origin secondary to MHL. This case report suggests that aggressive surgical management should be considered after the initial diagnosis of MHL.

• 대한영상의학회지
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• 제85권4호
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• pp.807-812
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• 2024

유방 림프종은 희귀한 유방 악성 종양으로 임상 증상과 경과가 이질적인 패턴을 보인다. 그 중 버킷 림프종은 매우 드물고, 공격적이며 빠르게 성장하는 B세포 비호지킨 림프종이다. 우리는 위에서 시작된 것으로 추정되고, 여러 부위의 전이를 동반한 이차성 유방 버킷 림프종으로 진단받은 27세 여성의 사례를 보고한다. 유방 초음파상에서 후방 음영 증가와 에코성 띠를 포함한 다양한 크기의 비균질한 병변으로 관찰되었다. 이러한 영상 소견은 종종 다른 유방의 악성 종양 소견과 혼동될 수 있다. 그러나 다른 유방 악성 종양과 달리 림프종은 생검을 통해 진단할 수 있으며 외과적 절제가 필요하지 않다. 불필요한 치료를 피하기 위해서 영상의학과 전문의와 임상의는 유방 림프종의 특징적인 영상학적 특징을 알아야 한다.

• Tuberculosis and Respiratory Diseases
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• 제41권3호
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• pp.277-288
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• 1994

연구목적 : "Field Cancerization"의 개념에 따르면, 폐암의 경우에도 여러 기관지들이 발암물질에 동시에 노출되어 다발적 암의 발생이 가능하고, 또한 암발생의 전단계인 precancerous lesion이 발견될 수 있다. 이에 저자들은 폐암의 주요 진단방법인 기관지 내시경 검사를 이용하여 방사선학적으로 나타난 병변뿐 아니라 전체 기관지에 대한 고찰을 하였다. 방법 : 1990년 4월부터 1993년 12월사이에 원자력 병원 내과에서 시행한 총 1855예의 기관지 내시경 검사상 2부위에서 이상소견이 발견되어 각각 조직검사를 시행한 총 21예를 대상으로 대상 환자의 성별, 연령별 분포, 흡연력, 각 병변의 조직학적 소견 및 방사선학적 소견, 병변위치, 치료 및 생존기간 등에 대하여 고찰하였다. 결과 : 총 21예중 14예에서 두 병변 모두 악성으로 나타났으며 이중 서로 조직학적 소견이 다른 경우는 6예, 서로 조직학적 소견이 같은 경우는 8예이었고, 총 21예 중 7예에서 한 병변은 악성, 나머지 병변은 양성으로 나타났다. 전체적으로 11예의 동시성 다발성 원발성 폐암이 있었으며 진단 당시 연령의 중앙치는 63세로 모두 남자였으며, 평균 흡연력은 40PY이었고, 조직학적 조합으로는 편평상피암의 조합이 5예, 소세포암과 편평상피암의 조합이 4예, 선암과 편평상피암의 조합이 1예, 편평상피암과 저분화암의 조합이 1예이었다. 기관지 내시경 검사상 2부위의 기관지 병변을 보인 총 21예중 15예에서 기관지 내시경 술전 방사선학적 검사상 한 병변만 나타났으며, 기관지 내시경 술전 방사선학적 검사상 두 병변 모두 나타난 6예종 5예에서 다발성 원발성 폐암이 나왔다. 결론 : 폐의 기관지 상피는 여러 발암물질에 동시에 노출되어 다발성 암의 발생 및 precancerous lesion이 생길 가능성이 높으므로, 폐암의 진단과정에 있어 방사선학적으로 나타난 병변뿐 아니라 전체 기관지에 대한 면밀한 기관지 내시경 검사 및 조직학적 확인이 필수적이다.

• Journal of Photoscience
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• 제9권2호
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• pp.512-514
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• 2002

S-aminolevulinic acid (ALA) is a new kind drug used in photodynamic therapy. ALA-PDT have successfully used in superficial malignancies and some skin diseases. Here the effects of ALA-PDT were studied on leukemia cells and hepatoma cells to explore the application on different kind cancers. It was found from the fluorescence emission spectra, that after ALA incubation the sensitizer - protoporphyrin IX (PpIX) was endogenously produced in both leukemia and hepatoma cells. The fluorescence images showed that the PpIX distribute in cytoplasm. However the efficiency of ALA photodynamic inactivation to two cell lines was different. The leukemia cells were more sensitive for ALA-PDT than hepatoma cells, revealing that the ALA-PDT effect is cell line dependent. However by using ALA-Hexyl ester (He-ALA) instead of ALA, the cell photo-inactivation was improved. The PDT efficiency of He-ALA was 10 times high than that of ALA, showing He-ALA is a very promising drug in ALA-PDT.

• Journal of Yeungnam Medical Science
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• 제27권2호
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• pp.98-104
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• 2010

원발성 전 종격동 종양은 종격동 종양의 반이상을 차지하고 그 종류도 다양하다. 흉선 상피 종양이 가장 흔하고 악성 흉선종은 드물다. 생식세포종은 두 번째로 흔한 전 종격동 종양으로 보다 어린나이에 발생하며 대부분 양성이다. 임파종은 대부분 전신성 질환의 흉부 침습 형태로 나타나나 원발성 흉부 임파종은 Hodgkin씨 병이 많다. 저자는 대표적인 전종격동 종양의 임상증상과 영상의학적 소견을 소개한다.