폐 편평세포암에서 자발성 아포토시스와 원격전이

오윤경,기근홍,Oh Yoon-Kyeong,Kee Keun-Hong 대한방사선종양학회 1999 Radiation Oncology Journal Vol.17 No.3

목적 : 폐암 환자의 대부분은 진단 당시 수술을 받을 수 없는 병기로 발견되기 때문에 수술 조직이 아닌 기관지내시경 조직에서 자발성 아포토시스 정도를 평가하여 이의 임상적 의의에 대한 기초 자료로 삼고자 본 연구를 시행하였다. 대상 및 방법 : 1990년 9월부터 1994년 9월까지의 4년동안 흉부에 방사선치료를 받은 폐 편평세포암 환자 중 조직표본이 충분히 보관되어 있으며 추적이 가능하였던 19명을 대상으로 하였다. 병기는 II기가 1명, IIIa기 8명, IIIb기 5명, IV기 5명이었다. 면역조직화학적 염색법으로 자발성 아포토시스율(Al)과 p53 단백질 양성률을 관찰하였다. 결과 : 19명 중 16명은 $5\~15$ 개월 후에 사망하였으며 3명은 55, 67, 67 개월간 생존하고 있다. 중앙생존기간은 17개월, 평균 생존기간은 24 개월이었다. AI는 $0\~1\%$의 범위로 중앙값이 $0.4\%$였다. AI가 낮은 군에서 진단 당시 원격전이가 있었던 경우가 $50\%$ (5/10) 였고, 높은 근에서는 원격전이가 전혀 없었다(0/9). 생존기간에 영향을 줄 수 있는 예후인자들의 분석 결과 단변량 분석에서는 M병기가 통계학적으로 유의한 차이를 보였고, 다변량 분석에서는 AI, 화학요법, M병기, T병기, 병기가 의의가 있었다. 자발성 아포토시스와 p53 변이 사이의 관련은 관찰되지 않았다. 결론 : AI는 진단 당시 원격전이와 관련이 있으며, p53 변이와는 관련이 없었다. AI가 낮은 군에서 높은 군보다 생존기간이 짧은 경향을 보였다. Purpose : To evaluate whether spontaneous apoptosis has prognostic value among patients with squamous cell carcinoma of lung. Materials and Methods : Material from 19 patients who received thoracic irradiation between 1990 and 1994 was analyzed. Their stages were II (1), IIIa (8), IIIb (5), and IV (5). Patients were observed from 5 to 67 months (median : 17 months). The spontaneous apoptosis index (AI) and p53 mutation were measured by immunohistochemical stains. Results : AI was found to range from 0 to $1\%$ (median $0.4\%$). Patients with low AI ($AI{\leq}$median) had a much higher distant metastasis rate at diagnosis than patients with high AI. By analysis of prognostic factors for survival, M stage was significant in univariate analysis. AI, chemotherapy, M stage, T stage, and stage were significant in multivariate analysis. The correlation between the AI and p53 mutation was not seen. Conclusion : AI was related with distant metastasis at diagnosis and not with p53 mutation. Also low AI group tended to have shorter survival time than high AI group.

난소 복합기형종의 갑상샘증에서 발생한 유두암

홍란 ( Ran Hong ),임성철 ( Sung Chul Lim ),송창훈 ( Chang Hun Song ),기근홍 ( Keun Hong Kee ),이미자 ( Mi Ja Lee ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.11

Benign or malignant tumors that arise in a benign cystic teratoma are rare. Malignant transformation in mature cystic teratoma of ovary is reported to occur in 1~3%. Several types of malignancy can occur from any of three germ-cell layers, but the most common malignancy is a squamous cell carcinoma derived from ectoderm. We experienced a papillary carcinoma arising in a struma ovarii of the complex teratoma. 74-year-old female presented with an abdominal discomfort. A pelvic ultrasonograph and computed tomography detected a 7×6 cm-sized and well-circumscribed cystic mass at the anterior to the uterus. The inner part of the mass was filled with cystic fluid showing low-density, however, solid portion including fat and soft tissue accompanied by calcification was identified in more than half of the entire tumor volume. The patient underwent a bilateral salpingo-oophorectomy. On histopathologic examination, the lesion was consistent with papillary carcinoma with squamoid features arising in a struma ovarii of the mature cystic teratoma. We herein report a case of the very rare papillary carcinoma arising in a struma ovarii of the complex teratoma and review the available literature.

구개 선양낭포암의 두개내 침습

오윤경(Yoon Kyeong Oh),기근홍(Keun Hong Kee) 대한방사선종양학회 1999 Radiation Oncology Journal Vol.17 No.4

선양낭포암의 두개내 침습은 매우 드물게 보고되어 있고 구개 선양낭포암이 두개내로 침습된 경우는 국내에서 보고된 바 없다. 침습 기전으로는 직접적인 침습, 신경주위 전이, 혈행성 전이등 세 가지 경로가 알려져 있다. 본 증례는 35세 여자환자로 우측 구개 선양낭포암으로 수술과 방사선치료를 받고 3년 10개월 후에 우측 삼차신경의 안신경 가지와 상악신경가지부위에 감각이상을 호소하였으나 CT상 재발소견이 보이지 않았다. 이후 우측 안검하수증과 안구마비 증세가 차례대로 발생되어 2차 수술을 받았으며, 종양이 삼차신경을 따라 두개내 갓세르 반월신경절(Gasserian ganglion)을 거쳐 해면 정맥동과 안와내로 침습됨을 시사했다. 또한 7년 6개월후에 측두골과 접형골 및 접형동을 통해 우측 측두엽으로 직접 침습된 소견이 발견되어 3차 수술을 받았다. 그 후 폐전이가 진단된 상태로서, 일차 수술후 9년 5개월동안 생존하여 있다. Intracranial involvement by adenoid cystic carcinoma (ACC) is very rare and there is no report of intracranial extension from the palate ACC in Korea. Intracranial involvement can occur in one of three ways : direct extension, perineural spread, and hematogenous spread. A case report of a 35-year-old woman with intracranial ACC is presented. Initially she had ACC of the right palate and was treated by surgery and postoperative radiation therapy. Three years and 10 months later, the paresthesia in the distribution of ophthalmic and maxillary branch of right trigeminal nerve developed without evidence of recurrence in CT scan. Ptos and total ophthalmoplegia developed sequentially and the second operation was performed. It was suggested that the tumor was spread perineurally along the trigeminal nerve into the Gasserian ganglion and then cavernous sinus and orbit. Seven years and 6 months after the first operation, direct intracranial extension into the right temporal lobe developed via sphenoid bone, sphenoid sinus and temporal bone and the third operation was done. And then lung metastasis was diagnosed. She is alive for 9 years 5 months after first operation.

갑상선종에서 발생한 다양한 조직학적 양상을 보인 역형성 암종의 세포학적 소견 - 1예 보고 -

이미자,이미숙,정유경,임성철,기근홍,전호종,Lee, Mi-Ja,Lee, Mi-Sook,Jeong, You-Kyung,Lim, Sung-Chul,Kee, Keun-Hong,Jeon, Ho-Jong 대한세포병리학회 1995 대한세포병리학회지 Vol.6 No.2

Anaplastic carcinoma of the thyroid (ACT) is a rare subtype of thyroid neoplasm. This tumor represents approximately 5-10% of all thyroid malignancies and has poor prognosis ACT often arises on a long-standing thyroid nodule and has been documented to be associated with a variety of more well-differentiated thyroid carcinomas. We experienced a case of anaplastic thyroid carcinoma who had had about a year history of thyroid getter. The patient had been injected with sclerosing agents in treatment of preexisting golfer. The ACT in this case had varied cytologic and histologic appearances: pleomorphic, giant cell, spindle and squamoid. Immunohistochemically, strong cytoplasmic positivity for cytokeratin was seen in all kinds of tumor cells. Ultrastructurally, the evidences of epithelial differentiation were seen such as intercellular junctions and tonofibrils.

Ki-1 양성 역형성 대세포 림프종의 체액 세포학적 소견 - 1예 보고 -

이미숙,이미자,정유경,임성철,기근홍,전호종,Lee, Mi-Sook,Lee, Mi-Ja,Jeong, Yu-Kyung,Lim, Sung-Chul,Kee, Keun-Hong,Jeon, Ho-Jong 대한세포병리학회 1995 대한세포병리학회지 Vol.6 No.2

Ki-1 positive anaplastic large cell lymphoma is a newly described high-grade lymphoma and is defined by histopathological and immunologic criteria. We experienced a case of systemically involving Ki-1 positive anaplastic large cell lymphoma in a 44 year-old female which initially manifested as pleural effusion. Abdominopelvic CT scan showed the evidence of marked lymphadenopathy in retroperitoneal and both external and inguinal lymph nodes. On cytologic examination of pleural fluid, tumor cells revealed pleomorphic large isolated cells with prominent nucleoli and abundant cytoplasms. The nuclei were large with irregular profiles including some deep invaginations. Also, occasional multilobed/multinucleated and binucleated nuclei were seen. Immunohistochemical examination was performed to differentiate from the undifferentiated adenocarcinoma, Hodgkin's disease, non-Hodgkin's lymphoma and malignant histiocytosis. The neoplastic cells were positive for leukocyte common antigen, CD3, CD30(Ki-1) but negative for cytokeratin, epithelial membrane antigen, and CD15. A histologic diagnosis of Ki-1 positive anaplastic lymphoma was made by biopsies of the inguinal lymph node, polypoid lesions of the stomach and cecum.

HTLV - I 의 불멸화에 의한 T 세포의 특성 및 한국인 악성 림프종과 Retrovirus 감염과의 관계

전호종(Ho Jong Jeon),서재홍(Chae Hong Suh),기근홍(Keun Hong Kee),김윤신(Yun Sin Kim),이미숙(Mi Sook Lee),정춘해(Choon Hae Chung),정종훈(Jong Hoon Jung),박영진(Young Jin Park),김향우(Hyang Woo Kim),아카키타다쯔(Tadaatsu Akagi) 대한내과학회 1995 대한내과학회지 Vol.49 No.3

N/A Objectives: 1) The relationship between malignant T-cell lymphoma and retroviral infection was examined in sixty-two cases of non Hodgkin's lymphoma arising in nodal and extranodal site to presume the etiologic factors in the pathogenesis of T-cell lymphoma arising in Korean. 2) Human T-cell leukemia/lymphoma virus type I(HTLV-1) is known as an etiologic agent of adult T-cell leukemia/lymphoma(ATL), however, the precise role of the HTLV I on the genesis of ATL is unclear. To elucidate the mechanism of the leukemogenesis on the ATL, establishment of cell line harboring HTLV-I is indispensable. Methods: 1) Sixty- two cases of malignant lymphoma were examined with a battery of monoclonal and polyclonal antibodies directed to T-cell, B-cell and macrophage-lineage to determine the immunophenotypes. Reverse transcriptase activity and the pol gene region in HTLV-I were examined by RNA directed DNA polymerase assay and polymerase chain reaction. 2) Two helper T-cell lines, designated JP(JP-1 and JP-2), were established by co-culturing normal human cord leukocytes with a lethally irradiated HTLV-I-harboring human leukocytes cell line(MT-2). Results: 1) There are no evidence of retroviral infection including HTI.V-I in examined 7 cases of peripheral T-cell lymphama. 2) JP-1(interleukin 2 dependent) had a normal karyotype, and expressed the surface markers CD3+, CD4+, CD8-, CD19-, CD25+ and HLA-DR+. JP-2(IL-2 independent) had tetraploidy on the 22nd passage, and exhibited the surface markers CD3-, CD4+, CD8-, CD19-, CD25+ and HLA-DR+. T-cell receptor(TCR)-β chain gene was detected in these two cell lines by Southern blot hybridization techniques with (32)P-labelled DNA probe Jpconfirming T-cell nature. Jβ2 cells were all immunoreactive with anti-HTLV-1, p 19, p 24, gp46 and pX antibodies. The proviral genome of HTLV-1 was detected in these cell lines by Southern blot hybridization by the (32)P-labelled DNA probe, pHT-1 (M)3.9. Electron microscopy of JP 2 cells revealed a few of type C virus particles. Conelusion: 1) These results suggest that the evidence of retroviral infection as an etiological factors in the pathogenesis of T-cell lymphoma is poor. 2) HTLV-1 was transmitted from the infected human leukocyte cell line to human cord helper T-cells with the development of immortalized HTLV-1 producing T-cell lines, and IL-2 independent cell line(JP-2) lost their CD3 antigen, It is suspicious that there is the second factors to induce malignant transformation in the genesis of adult T-cell leukemia/lymphoma because of absence of the tumorigenecity in the JP cell lines harboring HTLV-1.

Metastatic Cervical Lymphadenopathy from Uterine Leiomyosarcoma with Good Local Response to Radiotherapy and Chemotherapy

오윤경(Yoon Kyeong Oh),박희철(Hee Chul Park),기근홍(Keun Hong Kee),전호종(Ho Jong Jeon),박유환(You Hwan Park),정춘해(Choon Hai Chung) 대한방사선종양학회 2000 Radiation Oncology Journal Vol.18 No.4

자궁 평활근육종의 경부림프절로의 전이는 지금까지 보고되지 않았으며 타 부위로의 전이 시에도 방사선치료는 드물게 이용되어왔다. 저자들은 자궁 평활근육종 환자에서 수술과 골반부 방사선치료를 시행 받고 10개월 후에 경부림프절 전이가 발생하여 인접한 후두주위공간, 척추골, 척추관을 함께 침습하였기에 방사선치료와 화학요법의 경험과 함께 보고하는 바이다. 전이된 종양은 수술이 불가능하여 방사선치료가 의뢰되었으며 총 6,000 cGy의 경부 방사선치료와 taxol과 carboplatin으로 화학요법을 시행하였다. 전이 암은 점차로 크기가 감소하여서 거의 만져지지 않을정도로 되었다. 환자는 경부 방사선치료와 화학요법을 시행 받은 후 8개월간 척수압박증상을 발생하지 않았고, 연하곤란은 회복되어서 좋은 상태를 유지하였다. 광범위한 경부전이 암이 고선량 경부방사선치료와 화학요법에 좋은 국소 반응을 보였기에 수술이 불가능한 전이성 평활근육종 환자에서 이 두 가지 치료법이 고려될 수도 있겠다. The metastasis of uterine leiomyosarcoma to the neck node has not been reported previously and the radiotherapy has been rarely used for the metastatic lesion of the other sites. We report a case of neck metastasis from a uterine leiomyosarcoma, which developed 10 months after surgery and postoperative pelvic radiotherapy. It also involved the parapharyngeal space, adjacent spine, and spinal canal. The metastatic neck mass was inoperable, and was treated by neck radiotherapy (6,000 cGy) and chemotherapy including taxol and carboplatin. The mass has regressed progressively to a nearly impalpable state. She has never developed spinal cord compression syndrome, and has maintained good swallowing for eight months since the neck radiotherapy and chemotherapy. Since the extensive metastatic neck mass showed good local response to high dose radiotherapy and chemotherapy, both treatments may be considered for an unresectable metastatic leiomyosarcoma.

대장 직장암에서 Inducible Nitric Oxide Synthase 및 p53 발현의 임상적 관련성

정성용(Seong Hun Jeong),김정용(Cheong Yong Kim),기근홍(Keun Hong Kee) 대한외과학회 2002 Annals of Surgical Treatment and Research(ASRT) Vol.62 No.1

장중첩증을 유발한 공장의 염증성 섬유양 용종 1예

김정용(Cheong Yong Kim),최종구(Jong Gu Choi),기근홍(Keun Hong Kee) 대한외과학회 1995 Annals of Surgical Treatment and Research Vol.48 No.6

말초혈액 내 림프구의 방사선에 의한 아포프토시스

오윤경(Yoon Kyeong Oh),이태범(Tae Bum Lee),남택근(Taek Keun Nam),기근홍(Keun Hong Kee),최철희(Cheol Hee Choi) 대한방사선종양학회 2003 Radiation Oncology Journal Vol.21 No.1

목 적 : 방사선에 의해 유도되는 림프구의 아포프토시스를 정상 성인의 말초 혈액에서 유세포계측검사로 측정할 때 소량의 혈액으로도 검사가 가능한가를 알아보고 선량 증가와 방사선조사 후 시간 경과에 따른 반응 정도를 알아보고자 본 연구를 시행하였다. 대상 및 방법 : 건강한 성인 남녀 11명을 연구 대상으로 하여 말초혈액 10 mL에서 림프구를 분리하고 이를 각각 15개로 나누어서 실험하였다. 선형가속기를 이용하여 0.5, 1, 2, 5 Gy의 방사선을 조사한 후 24, 48, 72시간 동안 배양하였다. 림프구의 아포프토시스를 정량적으로 측정하기 위해 유세포계측검사를 시행하였으며, 별도로 DNA fragmentation assay와 전자현미경검사를 이용하여 아포프토시스 소견을 추가로 관찰하였다. 결 과 : 방사선을 조사하지 않았을 때의 자발성 아포프토시스율(%)은 배양 후 24, 48, 72시간이 경과함에 따라 증가하는 소견을 보였다(1.761±0.161, 3.563±0.564, 11.098±2.849). 또한 0.5, 1, 2, 5 Gy의 방사선을 조사하여 24, 48, 72시간 동안 배양한 후 측정한 아포프토시스율(%)은 선량 증가와 방사선조사 후 시간 경과에 따라 점차 증가하였다. 방사선조사 후 24시간 후에 0.5~1, 1~2, 2~5 Gy구간의 아포프토시스율의 증가는 비교적 저 선량 영역인 0.5~1, 1~2 Gy에서 2~5 Gy 구간보다 더 큰 기울기를 보였고, 48, 72시간 후에도 0.5~1 Gy구간에서 가장 큰 기울기를 보였다. 결 론 : 유세포계측검사는 10 mL의 혈액으로 15개의 검사 결과를 낼 수 있었으므로 한 검사당 1 mL 미만의 혈액으로도 충분히 검사할 수 있겠으며, 방사선량 증가에 따라 반응의 정도도 증가하였으며, 아포프토시스 관찰 시기는 혈액 채취 후 24시간이나 48시간 후가 적절하다고 사료된다 Purpose : This study quantitatively evaluated the apoptosis in human peripheral blood lymphocytes using flow cytometry, and investigated the possibility of using the method, with a small amount of blood, and the time and dose dependence of radiation-induced apoptosis. Materials and methods : Peripheral blood lymphocytes were isolated from the heparinized venous blood of 11 healthy volunteers, 8 men and 3 women, with each 10 ml blood being divided into 15 samples. The blood lymphocytes were irradiated using a linear accelerator at a dose rate of 2.4 Gy/min, to deliver doses of 0.5, 1, 2 and 5 Gy. The control samples, and irradiated cells, were maintained in culture medium for 24, 48 and 72 hours following the irradiation. The number of apoptotic cells after the in vitro X-irradiation was measured by flow cytometry after incubation periods of 24, 48 and 72 hours. We also observed the apoptotic cells using a DNA fragmentation assay and electron microscopy. Results : The rate of spontaneous apoptosis increased in relation to the time interval following irradiation (1.761±0.161, 3.563±0.564, 11.098±2.849, at 24, 48, and 72 hours). The apoptotic cells also increased in the samples irradiated with 0.5, 1, 2 and 5 Gy, in a radiation dose and time interval after irradiation manner, with the apoptosis being too great at 72 hours after irradiation. The dose-response curves were characterized by an initial steep increase in the number of apoptotic cells for irradiation doses below 2 Gy, with a flattening of the curves as the dose approached towards 5 Gy. Conclusion : The flow cytometric assay technique yielded adequate data, and required less than 1 mL of blood. The time and dose dependence of the radiation-induced apoptosis, was also shown. It is suggested that the adequate time interval required for the evaluation of apoptosis would be 24 to 48 hours after blood sampling.