혈액종양 : 다발성 전이를 동반한 설암 환자의 골격근전이와 β-HCG 상승 1예

함준수 ( Jun Soo Ham ),황금빛 ( Keum Bit Hwang ),황수빈 ( Subin Hwang ),정숙현 ( Suk Hyeon Jeong ),이지윤 ( Ji Yun Lee ),이세훈 ( Se Hoon Lee ),박근칠 ( Keunchil Park ) 대한내과학회 2015 대한내과학회지 Vol.89 No.6

Metastases to skeletal muscle and paraneoplastic syndromes involving β-human chorionic gonadotropin (HCG) production are an extremely rare manifestation of head and neck squamous cell carcinoma. We report a patient with a β-HCG-secreting squamous cell carcinoma of the tongue with diffuse metastases involving skeletal muscle. A 47 year old female, who was being treated heavily with palliative chemotherapy for metastatic tongue cancer, was admitted with a palpable thigh mass and pain. A magnetic resonance image showed an intramuscular metastasis in the thigh. Ultrasound-guided biopsy of the thigh mass confirmed metastatic squamous cell carcinoma. She was scheduled for enrollment into a clinical trial; however, a positive serum β-HCG test was noticed. There was no evidence of pregnancy or a trophoblastic or non-trophoblastic tumor secreting β-HCG. Finally, she was revealed to have a paraneoplastic syndrome with diffuse metastases and was ultimately referred for palliative care. We review the literature of previously reported cases of an increase of β-HCG in patients with head and neck cancer. (Korean J Med 2015;89:719-722)

구연발표 : 간세포암종과 위암환자의 암조직 , 혈청 및 복수에서 핵산분해 효소활성과 뇨중 핵산분해산물의 배설량 변동에 관한 연구

박경남(Kyung Nam Park),한동수(Dong Soo Han),함준수(Jun Soo Ham),이민호(Min Ho Lee),기춘석(Choon Suck Kee),고재경(Jai Kyung Koh) 대한소화기학회 1987 대한소화기학회 추계학술대회 Vol.1987 No.-

간경변증 환자에서의 여성형 유방에 관한 연구

기춘석(Choon Suhk Kee),박동일(Dong Il Park),이오영(Oh Young Lee),한동수(Dong Soo Han),손주현(Joo Hyun Son),윤병철(Byung Chul Yoon),안유헌(Yoo Hern Ahn),함준수(Jun Su Ham),이민호(Min Ho Lee),박경남(Kyung Nam Park) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.5

N/A Gynecomastia occurs in about 30% to 50% of patients with cirrhosis of the liver. Since es- trogens stimulate breast tissue whereas androgens antagonize these effects, gynecomastia has long been considered the result of an imbalance between these hormones. Several mechanisms may operate to produce a relative estrogen excess in hepatic disorders, especially alcoholic cir- rhosis. We have studied the prevalence of gynecomastia and measured the estrogen/testoster- one ratio in cirrhotic subjects and control. Twenty male patients with hepatic cirrhosis were identified from the medical inpatient services of our institution and ten nonobese healthy rnedi- cal students with no history or physical findings of liver disease cornposed the noncirrhotic control group. The mean BMI in the control subjects was 21.3 + 0.8kg/m and that in the group with cirrhosis was 22.1 + l.lkg/m. Therefore, no statistical significance was found. Gy- necomastia was present in 30% of the control subjects and 25% of the cirrhotic subject. No significant correlation existed between breast tissue diameter and the BMI in the subjects with cirrhosis. In the control group, TT concentrations were higher and TE concentrations were lower than the cirrhotic groups, therefore the ratio of TE/TT were more decreased compared with the subjects with cirrhosis. In contrast, the mean total and free serum testosterone con- centrations were considerably lower and the mean total estrogen concentrations were higher in cirrhotic patients with gynecomastia compared with those without gynecomastia as were the ratio of TE/FT, E2/FT, TE/TT and E2/TT. In conclusion, the prevalence of gynecomastia in cirrhotic patients was 25%. Total and free serum testosterone concentrations did not differ statistically significant in the cirrhotic men with and without gynecomastia. Neither the TE FT ratio nor the E2 FT ratio was statistically increased in cirrhotic subjents with gynecomastia compared with those without gynecomastia. These findings imply that factors other than the estrogen testosterone ratio may play a role in the development of gynecomastia in both cirrhotic and control subjects. (Korean J Gastroente- rol 1994; 26: 842 849)

췌장 낭종성 종양으로 오인되었던 부신 기원의 신경절성아세포종

한동수,이민호,김홍주,조윤주,최호순,윤병철,손주현,이오영,전용철,함준수,기춘석,박경남,박석규,임현철 대한소화기학회 2000 대한소화기학회지 Vol.36 No.4

Neuroblastoma, a tumor of the peripheral nervous system, is the most common extracranial solid tumor of childhood. Neurogenic tumor which includes neuroblastoma is classified into neuroblastoma, ganglioneuroblastoma and ganglioneuroma according to cytologic differentiation. Many cases of ganglioneuroblastoma which is the most rare tumor of neurogenic tumors have been reported during past few decades in U. S and European literature. However, in Korea, only 3 cases of ganglioneuroblastoma in adult have been reported. Recently, we experienced a case of ganglioneuroblastoma which was initially misdiagnosed as pancreatic cystic neoplasm by imaging study. A 27-year-old male patient admitted our hospital with chief complaint of left upper quadrant discomfort and intermittent vomiting. Imaging studies, such as abdominal sonogram, abdominal computed tomography, endoscopic retrograde cholangiopan creatography and angiogram revealed a cystic mass in pancreatic tail portion. The patient underwent mass excision, left nephrectomy and adrenalectomy. Diagnosis of ganglioneuroblastoma of adrenal origin was made on the basis of its histopathologic findings.

상행 결장을 침범한 제 1형 신경섬유종증 1예

변태준,이오영,양선영,박성현,현일식,이항락,한동수,전용철,윤병철,최호순,함준수,이흥우,박문향,임현철 한양대학교 의과대학 2002 한양의대 학술지 Vol.22 No.2

Type I neurofibromatosis (NF-1), first clearly described by von Recklinghausen in 1881, is a dominantly inherited neuroectodermal dysplagia occurring in one of 3,000 births. It is fundamentally characterized by the existence of multiple neurofibromas, 'cafe au lait' spots and Lisch nodules (pigmented hamartomas of the iris). NF-1 may affect the gastrointestinal tract in about 25% of cases. Most NF-1 are located in the jejunum or stomach. In up to 40% of patients, there may be acute or recurrent gastrointestinal bleeding. We report the case of a 36-year-old patient diagnosed as having NF-1 in the stool occult blood test accidentally that was located in ascending colon with a review of literature.

전이성 수막암종증을 일으킨 표재확장성 조기위암 1예

박경남,이민호,이동후,기춘석,이종철,홍은경,민경랑,함준수,이성구 대한소화기내시경학회 1986 Clinical Endoscopy Vol.6 No.1

Meningeal carcinomatosis is an important neurological complication of systemic cancer, and is increasingly being recognized as a cause of reurologic disability in life. Also there is evidenee that the incidence of this form of metastasis is increasing. We reported a case of 52-year-old female patient, who was diagnosed as early gastric cancer by biopsy under gastrofiberscopy. Other Lab. findings were all normal range except high alkaline phosphatase level. And then performed Billroth II operation. On 7th post-operative day, she was encountered severe headache and insomnia. Abnormal neurologic signs and subjective symptoms were developed and progressed, Repeated lumbar punture was done and CSF was examed. There findings were abnormal, but no specific finding of certain disease. She died of severe neurologic deficit and sudden respiratory arrest. Autopsy was done, and confirmed leptomeningeal carcinomatosis.

십이지장 제1부에 발생한 원발성 융모성 암종 2예

이재호,박경남,유대현,이민호,최영춘,기춘석,함준수,한동수,고윤석 대한소화기내시경학회 1987 Clinical Endoscopy Vol.7 No.1

Villous tumor of the duodenum are rare, only 89 cases having been reported and reviewed in several recent publication. Malignancy is discovered in approximately 30-45% leading to the recommandation that all such tumors be excised regardless of the endoscopic findings. Two cases of villous tumor of the duodenum were reported and locally excised. The pathologic specimens showed carcinoma in situ, no evidence of hematogenous and lymphatic metastasis.

각종 위장관 악성 종양에 있어서 CA 19-9 의 임상적 의의

박경남,이민호,이성준,이성구,이종철,함준수,한덕호,기춘석,이동후,윤인혁 대한내과학회 1986 대한내과학회지 Vol.30 No.2

We have studied the clinical significance of tumor marker CA 19-9 in various gastrointestinal malignancies compared with normal control, benign diseases, and other malignancies. The results were as followings; 1) There was no age and sex difference in CA 19-9 serum level in control and various gastrointestinal malignancies. 2) There was somewhat increase in CA 19-9 serum level in various gastrointestinal malignancies but not statistically significant. In metastatic cancer, the serum levels of CA 19-9 were increased significantly. 3) The specificity of CA 19-9 in various benign diseases was 86.1% 4) The sensitivity of CA 19-9 in various gastrointestinal malignancies including local and metasis was 42.5%, but in case of metastasis, the sensitivity increased to 78%. 5) When CEA and Calg-9 were checked simu1taneously in diagnosis of metastatic stomach ca., the sensitivity was 88.2%. 6) All cases of pancreatic cancer and cholangiocarcinoma studied, showed marked increase of serum level of CA 19-9.

대장내시경 검사에 관한 임상적 고찰

박경남,이민호,이성준,이동후,기춘석,이종철,홍일,함준수,제정인 대한소화기내시경학회 1986 Clinical Endoscopy Vol.6 No.1

Camparison between American's colonic diseases! are much less prevalence in Korea. But, recent days much increased incidence in these diaases caused by changes of food habtas and development of diagnastic methods. We studied 1456 cases who complained colonic symptoms and colonofiberscopic biopsy was taken from 1981 to 1985 at Han Yang Univ. Hospital:, Age, Sex, clinical symptoms; histopathological findings, location and relation between af barium study were anali2ed for 1002 cases who confirmed by biopsy. The following results were obtained; 1) Age distribution was wide from 1st decade to ii th decade, greatest prevalence was 3 rd decade and male to female ratio was .1:1. 2) The clinical manifestations were abdominal discomfort(64%), diarrhea(31.2%), low back pain(27.6%) and general weakness(22.9%) 3) Histopathological findings were infectious and lion sgecific colitis(44.3%), ulcerative coltis(3.1%), intestinal Tb(!.7%), colon Ca.(9.9i) and colon polyp(5.6%). 4) Location of colon ca. was recturn(42.4%), simaid colon(23.5'0), ascending colon (17.2%), descending calon(14.!%), transverse colonf3.lf ), in order of frequency and adenocarcinoma (95%) was most common. 5) Location of colon polyp was rectum(44.6%), simoid colon(26.8%), deacen ding colon (14.3%), ascending colon(10.7%), transverse colon(3.6%), and histopathalogic clasaifica tion was hyperplastic(46.4,6'), inflam matory(32.20), adenamatous(21.4,%) in order of frequency. 6) Location of divertieulosis was ascending colon(7.7), descending eolon(2.3%). 7) Relation between histapathological and radiolpgical findings, equal was 67.2% and difference was 32. 8%. In different cases, between histopathologicaland radiological findings, colitis was 125cases, colon ca. was 15cases, ulcerative colitis was 13cases, colon polyp was 12 cases.

간경변 환자에서의 대장 점막 변화와 직장정맥류의 관찰

전용철,한동수,이민호,박근태,장세진,최호순,이오영,함준수,기춘석,손주현,박경남,윤병철 대한소화기학회 1998 대한소화기학회지 Vol.31 No.3

Background/Aims: Colonic mucosal lesions akin to mucosal changes in portal hypertensive gastropathy have been observed occasionlly in patients with portal hypertension. However the exact prevalence of these lesions, their relationship to the severity of the liver disease and their associations with gastric mucosal changes is still unclear. The present study assesses the prevalence of rectal varices and colonopathy and factors associated with them in liver cirrhosis. Methods: Thirty one cirrhotic patients and 40 controls underwent endoscopic examinations of upper and lower gastrointestinal tract. Results: Colonic mucosal changes were observed in 16 patients (51.6%) while 0 in control group. They included increased vascularity (12/16, 75.0%), spider like lesion (4/16, 25.0%), nonspecific colitis lesion (1/16, 6.3%). Rectal varices were observed in 2 patients (12.5%) but they were not observed in the controls. Pathologic finding in patients with increased vacularity showed dilatation and increase of vessels (5 of 6 patients), but there was no abnormal finding in patients with spider like lesion (0 of 3 patients). The colonic mucosal changes were not associated with the Child's grade of cirrhosis, the grade of esophageal varices, the presence of gastric varices, the history of bleeding or the patient's experience of ligation therapy. However, cirrhotic patients with portal hypertensive gastropathy had higher prevalence (70.6%) of colonic mucosal change than the patients without it (28.6%, p$lt;0.05). Conclusions: Colonic mucosal changes occur frequently in patients with portal hypertensive gastropathy. However, the prevalence of rectal varices is lower in these patients.