위 상피 이형성의 전향적 연구

이영민(Young Min Lee),오경석(Kyung Seok Oh),조길현(Kil Hyeon Cho),장현정(Hyeon Jung Jang),이상혁(Sang Hyuk Lee),설상영(Sang Yong Seol),정정명(Jung Myung Chung),최하진(Ha Jin Choi),김찬환(Chan Hwan Kim) 대한내과학회 1996 대한내과학회지 Vol.50 No.3

Objectives: Gastric dysplasia is defined as a lesion characterized by cellular atypia, abnormal differentiation and disorganized architecture without showing malignant nature in histology. Even though it was known as a precursor of gastric cancer, there were few studies in clinical and biological aspect in practice. Because the early detection of gastric cancer is very important, we have evaluated the risk of gastric carcinoma following the gastric dysplasia in prevention of gastric cancer. Methods: The authors evaluated the clinical and histological findings of 27 cases of gastric dysplasia for at least 3-12 months among 38 cases of gastric dysplasia and which confirmed from January 1992 to June 1994. Results: The sex distribution of 38 cases with gastric dysplasia was that men were 29 cases and women were 9 cases. The Highest incidence was above 6th decades(30cases) in age. Twenty seven cases of gastric dysplasia could be followed prospectively. Each histologic findings were as follow, mild dysplasia 12 cases, moderate dysplasia 7 cases and severe dysplasia 8 cases respectively. The endoscopic findings showed erosion 6 cases(16%), flat lesion 8 cases(21%), ulcer 10 cases(26%), polypoid lesion 14 cases(37%) respectively, The evolution of dysplasia was regression 4 cases, persistence 4 cases, progression 3 cases, cancer 1 case(9%) in mild dysplasia and regression 2 cases, persistence 2 cases, progression 1 case, cancer 2 cases(29%) in moderate dysplasia. In eight severe dysplasia, 1 case of regression, 3 cases of persistence and 4 cases of cancer(50%) were developed. Polypectomy was performed in 12 cases and 1 case was regressed from severe dysplasia after mucosal resection. In 27 cases of gastric epithelial dysplasia, gastric cancers were developed in 7 cases(26%) and early gastric cancers were 4 cases(57%) among them and the most common lesion was ulcer(5 cases). Conclusion: Gastric dysplasia should be strictly followed up with repeated endoscopic examination as well as treated the adequate endoscopic procedure for the prevention of progression or the risk of developing cancer.

양측성 피질 이형성중의 임상적 고찰

김은영(Eun-Young Kim),김근모(Geun-Mo Kim),우영종(Young-jong Woo) 대한소아신경학회 1998 대한소아신경학회지 Vol.5 No.2

목적 : brain MRI의 도입으로 신경세포 이주 장애(neuronal migration disorder)등 발달 장애아의 원인 진단이 용이하게 되었고, 특히 언어 발달 지연의 원인의 하나로서 congenital bilateral perisylvian syndrome의 진단이 가능하게 되었다. 그러나 피질 이형성증(cortical dysplasia)에 대한 병태 생리, 분류 및 임상적 소견 등에는 아직 명확하지 않은 점이 많다. 이에 저자들은 운동 및 언어 발달의 지연과 경련 등을 주소로 내원, brain MRI/CT를 시행하여 양측성 피질 이형성증(bilateral cortical dysplasias)으로 진단되었던 환아 들의 임상 양상 및 뇌파 소견, MRI/CT소견 등을 분석하여 상호간의 관련성을 알아보고자 하였다. 방법 : 1987년 1월부터 1996년 12월까지 전남대학교병원 소아과에 내원하여 brain CT 및 MRI를 시행하여 양측성 피질 이형성증으로 진단되었던 20례를 대상으로 하였다. 환아들은 MRI 소견에 따라 중심부(centroparietal)에 국한된 군, 미만성(diffuse)이면서 백질부의 병변이 없는 군과 백질부의 병변이 있는 군, 분열뇌증(schizencephaly)등의 4군으로 나누어 각각의 임상 양상 및 뇌파 소견에 관해 조사하였다. 결과 : 1) 내원시 주소(chief complaints)는 언어 발달 지연 (100)%, 운동 발달 지연(95%), 운동 기능 결함(65%), 간질 (40%)순이었다. 2) brain MRI상 양측성 병변은 중심부(centroparietal)에 국한된 6례, 미만성이면서 백질부의 병변이 없는 4례, 미만성이면서 백질부의 병변이 동반된 5례, 분열뇌증이 있으면서 열극 표면의 희피질이 이형성 피질로 되어있는 5례로 구분되었다. 3) 언어 발달 지연이 있는 환아에서 의미있는 단어의 표현이 가능했던 시기는 평균 2년 2개월(1~4년)이었다. 4) 중심부에 국한된 이형성증 1례를 제외한 모든 환아에서 운동 발달 지연을 보였고, 미만성 이형성증에 백질 병변이 동반된 군과 분열뇌증군의 경우 전 례에서 근 긴장 저하나 강직성 마비 등의 운동 장애가 있었다. 5) 간질이 있었던 8례에서 발생 시기는 평균 5년 5개월(2개월~12년)로서 발작의 형태는 다양하였고 대부분에서 항경련제에 의해 조절이 잘 되었다. 6) 동반된 뇌기형은 소두증이 8례, 투명 중격(septum pellucidum)의 소실이 3례, 뇌실 주변의 석회화가 2례이었다. 7) 뇌파 소견은 초점성 이상 5례, 미만성 이상 6례, burst-suppression 1례, 정상 6례등으로 다양하였으나 고진폭의 미만성 속파(high amplitude diffuse fast activity)는 미만성 이형성증에서만 보였다. 결론 : 양측성 피질 이형성증에서 언어 발달 지연이 가장 흔한 증상이었으며 이형성된 피질의 병변이 클수록 발달 장애 등의 임상 양상도 심했으나 간질은 비교적 잘 조절되는 경향을 보였다. 또한 뇌파에서 보이는 고진폭의 미만성 속파는 미만성이형성증을 진단하는데 특이도(specificity)가 높은 것으로 여겨진다. brain MRI는 피질 이형성증을 진단하는데 유용한 검사이며 bilateral centroparietal dysplasia는 발달성 언어 장애의 중요한 원인으로 생각된다. Purpose : Cerebral cortical dysplasias are one of the important causes for epileptic seizures and developmental disabilities in children, particularly in diffuse or bilateral cases. These developmental malformations are generally regarded as a group of neuronal migration disorders, however, the classification system and pathogenetic mechanisms of cortical dysplasias are not yet entirely clear. Even a novel entity, congenital bilateral perisylvian syndrome, characterized by speech delay, pseudobulbar palsy, intractable seizures, and bilateral perisylvian syndrome, characterized by speech delay, pseudobulbar palsy, intractable seizures, and bilateral perisylvian abnormalities on imaging studies, have rather diverse figures on morphology and symptomatology than initially considered. We have studied the clinical features and correlations of clinical outcomes and magnetic resonance imaging(MRI) findings of bilaterally involved cortical dysplasias. Methods : 20 cases of bilateral cortical dyspalsias were grouped into three categories on the basis of MRI findings ; centroparietal dysplasias(6 cases), diffuse dysplasias with (5) or without white matter lesions(4), and schizencephaly(5). EEGs, motor and language development, epilepsy, and outcomes were reviewed in each groups. Results : Language delay(100%), motor developmental delay(94.7%), motor deficit(65%), epilepsy(40%) were the main reasons for their initial hospital visits. A meaningful word expression was possible at the mean age of 2 years and 2 months(1 to 4 years of age). Hypotonia and spastic motor paralysis were evident in all the cases of diffuse dysplasia with white matter lesions and the schizencephaly groups. All but one case of centroparietal dysplasia showed motor developmental delay. Epilepsies were developed in 8 cases at the mean age of 5 years and 5 months(2 months to 12 years of age) and the 8 cases at the mean age of 5 years and 5 months(2months to 12 years of age) and the seizures were relatively well controlled with anticonvulsants. EEG findings were variable; normal, focal of diffuse abnormalities. High amplitude diffuse fast activities were only noted in the diffuse dysplasia group. Conclusion : The severity of neurological deficits and developmental delay had correlated to the size of cortical abnormalities. The epilepsies were relatively well controlled during childhood and the EEG finding of high amplitude diffuse fast activities was specific for the diffuse cortical dysplasias. Bilateral centroparietal dysplasias should be included on consideration of the causes for developmental aphasia.

Clinical and endoscopic characteristics of sessile serrated lesions with dysplasia/carcinoma

Peel Jung,김형욱,Su Bum Park,Dae Hwan Kang,Cheol Woong Choi,Su Jin Kim,Hyeong Seok Nam,Dae Gon Ryu,Dong Hoon Shin,Joo Young Na,Mi Sook Yun 대한내과학회 2023 The Korean Journal of Internal Medicine Vol.38 No.3

Background/Aims: Some sessile serrated lesions (SSLs) progress into dysplasia and colorectal cancer, however, the clinical and endoscopic characteristics of SSLs with dysplasia remain to be determined. In this study, we elucidated these characteristics in SSLs with dysplasia/carcinoma, compared with those of SSLs without dysplasia. Methods: We retrospectively collected the clinical, endoscopic, and pathological data of 254 SSLs from 216 patients endoscopically resected between January 2009 and December 2020. Results: All SSLs included 179 without dysplasia and 75 with dysplasia/carcinoma, including 55 with low-grade dysplasia, 10 with high-grade dysplasia, and 10 with submucosal cancer. In clinical characteristics, SSLs with dysplasia/carcinoma were significantly associated with advanced age, metabolic diseases, and high-risk adenomas. In endoscopic characteristics, SSLs with dysplasia/carcinoma were significantly associated with the distal colon, large size, polypoid morphology, surface-changes, no mucus cap, and narrow-band imaging international colorectal endoscopic classification (NICE) type 2/3. In the multivariate analysis, high-risk adenomas (odds ratio [OR], 2.98; p = 0.01), large size (OR, 1.18; p < 0.01), depression (OR, 11.74; p = 0.03), and NICE type 2/3 (OR, 14.97; p < 0.01) were significantly associated with SSLs with dysplasia/carcinoma. Conclusions: SSLs had a higher risk of dysplasia in the distal colon than in the proximal colon. SSLs with large size, depression, and adenomatous surface-patterns, as well as those in patients with high-risk adenomas, increased the risk of dysplasia/ carcinoma. This suggests that the clinical and endoscopic characteristics can aid in the diagnosis and management of SSLs with dysplasia/carcinoma.

위점막의 이형성의 유형과 조기 위암의 조직학적 유형과의 연관성

장희경,허만하 고신대학교 의학부 1992 高神大學校 醫學部 論文集 Vol.8 No.2

This study was performed to elucidate the relationship of types of dysplasia and histological types of early gastric cancer. And, the correlations between types of gastric dysplasia and sex and age were evaluated. The materials were 141 cases of surgical specimens of early gastric cancer submitted to Department of Pathology following gastrectomy at Kosin Medical Center during 5 years from 1984 to 1989. The results were summarized as follows : 1. The histologic types and incidence of 141 cases of early gastric cancer(EGC) by Lauren system were : diffuse type 59 cases(41.84%) : intermediate type 41 cases(29.08%) ; and intestinal type 41 cases(29.08%). The mean age for the histologic types was 49 years in diffuse type. 51 years in intermediate type, and 54 years in intestinal type. Mean age of EGC overall was 51 years. 2. The types of gastric dysplasia in gastric mucosa adjacent to EGC lesions were classified by the proposed standard of Ghandur-Mnaymneh into metaplastic dysplasia(97 cases : 68.8% ) and nonmetaplastic dysplasia(98cases : 69.50%), Among these. the cases of simultaneous presentation of both dysplasias were 55 cases (39.00%). The severity of the changes was graded by the basis of Ghandur-Mnaymneh in nonmetaplastic dyspiasia and the proposal of WHO expert committee in metaplastic dysplasia. The cases showing severity of more than moderate degree were 82 cases(58. 20%) in metaplastic dysplasia and 86 cases(60.99%) in nonmetaplastic dysplasia. 3. In cases of metaplastic dysplasia, age and frequency and severity showed positive correlation. 4. In relationship of histologic types of EGC and types of gastric dysplasia, the frequency of nonmetaplastic dysplasia in diffuse and intermediate type carcinoma was significantly higher than the corresponding frequency in intestinal type carcinoma, and the frequency of metaplastic dysplasia in intestinal type carcinoma was significantly higher than corresponding frepuency of diffuse and intermediate type carcinoma. 5. The frequency and severity of metaplastic dysplasia of Intermediate type carcinoma was between diffuse type and intestinal type carcinoma, but in frequency and severity, no significant difference in nonmetaplastic dysplasia from diffuse type carcinoma was seen. With the above results, we suggest intermediate type of EGC shows a higher association with diffuse type than intestinal type in histopathogenesis.

위점막의 이형성의 유형과 조기 위암의 조직학적 유형과의 연관성

장희경,허만하 고신대학교(의대) 고신대학교 의과대학 학술지 1992 고신대학교 의과대학 학술지 Vol.8 No.2

-Abstract- This study was performed to elucidate the relationship of types of dysplasia and histological types of early gastric cancer. And, the correlations between types of gastric dysplasia and sex and age were evaluated. The materials were 141 cases of surgical specimens of early gastric cancer submitted to Department of Pathology following gastrectomy at Kosin Medical Center during 5 years from 1984 to 1989. The results were summarized as follows : 1. The histologic types and incidence of 141 cases of early gastric cancer(EGC) by Lauren system were : diffuse type 59 cases(41.84%) ; intermediate type 41 cases(29.08%) ; and intestinal type 41 cases(29.08%). The mean age for the histologic types was 49 years in diffuse type, 51 years intermediate type, and 54 years in intestinal type. Mean age of EGC overall was 51 years. 2. The types of gastric dysplasia in gastric mucosa adjacent to EGC lesions were classified by the proposed standard of Ghandur-Mnaymneh into metaplastic dysplasia(97 cases:68.8%) and nonmetaplastic dysplasia(98 cases: 69.50%). Among these, the cases of simultaneous presentation of both dysplasias were 55 cases (39.00%). The severity of the changes was graded by the basis of Ghandur-Mnaymneh in nonmetaplastic dysplasia and the proposal of WHO expert committee in metaplastic dysplasia. The cases showing severity of more than moderate degree were 82 cases(58.20%) in metaplastic dysplasia and 86 cases(60.99%) in nonmetaplastic dysplasia. 3. In cases of metaplastic dysplasia, age and frequency and severity showed positive correlation. 4. In relationship of histologic types of EGC and types of gastric dysplasia, the frequency of nonmetaplastic dysplasia in diffuse and intermediate type carcinoma was significantly higher than the corresponding frequency in intestinal type carcinoma, and the frequency of metaplastic dysplasia in intestinal type carcinoma was significantly higher than corresponding frequency of diffuse and intermediate type carcinoma. 5. The frequency and severity of metaplastic dysplasia of Intermediate type carcinoma was between diffuse type and intestinal type carcinoma, but in frequency and severity, no significant difference in nonmetaplastic dysplasia from diffuse type carcinoma was seen. With the above results, we suggest intermediate type of EGC shows a higher association with diffuse type than intestinal type in histopathogenesis.

미만형 위암의 전암성 병변으로서의 비화생이형성

장희경,최종순 고신대학교(의대) 고신대학교 의과대학 학술지 2006 고신대학교 의과대학 학술지 Vol.21 No.1

Background : This study was performed to investigate the relationship of types of dysplasia and histologic types in 141 cases of surgical specimens of early gastric cancer. Material and methods : Fromalin-fixed and paraffin-embedded gastric mucosa and cancer tissue from 141 patients with gastric cancer underwent gastrectomy were studided with classification of gasric cancer by Lauren and dysplasia. Results : The histologic types by Lauren 1) were: diffuse type 59 cases (41.84%); intermediate type 41 cases (29乂)8%); and intestinal type 41 cases (29.08%). The types of gastric dysplasia in gastric mucosa adjacent to the tumor were cla然ified into nanmetaplastic dysplasia 98 cases (6致50%) and metaplastic dysplasia 97 cases (68.8%). Simultaneous presentation of both dysplasias was 55 cases (39乂K》%), The frequency of nonmetaplastic dysplasia in diffuse and intermediate type carcinoma was significantly higher than in intestinal type carcinoma (p<0.05),and the frequency of metaplastic dysplasia in intestinal type carcinoma was significantly higher than that of diffuse and intermediate carcinoma (p<0.05〉. In cases of metaplastic dysplasia, age and frequency and severity showed positive correlation (p<0乂)5). Conclusions : These results suggest that types of dysplasias may be related to two different pathways rn human scomach carcinogenesis. And we propose a hypothesis that nonmetaplastic dysplasia and diffuse type adenocarcinoma sequence may be possible in the development of diffuse type of stomach cancer.

Spondylo-epiphyseal dysplasia, Maroteaux type (pseudo-Morquio syndrome type 2), and parastremmatic dysplasia are caused by TRPV4 mutations

Nishimura, Gen,Dai, Jin,Lausch, Ekkehart,Unger, Sheila,Megarbané,, André,Kitoh, Hiroshi,Kim, Ok Hwa,Cho, Tae-Joon,Bedeschi, Francesca,Benedicenti, Francesco,Mendoza-Londono, Roberto,Sileng Wiley Subscription Services, Inc., A Wiley Company 2010 AMERICAN JOURNAL OF MEDICAL GENETICS PART A Vol.a152 No.6

<P>Recent discoveries have established the existence of a family of skeletal dysplasias caused by dominant mutations in TRPV4. This family comprises, in order of increasing severity, dominant brachyolmia, spondylo-metaphyseal dysplasia Kozlowski type, and metatropic dysplasia. We tested the hypothesis that a further condition, Spondylo-epiphyseal dysplasia (SED), Maroteaux type (MIM 184095; also known as pseudo-Morquio syndrome type 2), could be caused by TRPV4 mutations. We analyzed six individuals with Maroteaux type SED, including three who had previously been reported. All six patients were found to have heterozygous TRPV4 mutations; three patients had unreported mutations, while three patients had mutations previously described in association with metatropic dysplasia. In addition, we tested one individual with a distinct rare disorder, parastremmatic dysplasia (MIM 168400). This patient had a common, recurrent mutation seen in several patients with Kozlowski type spondylo-metaphyseal dysplasia. We conclude that SED Maroteaux type and parastremmatic dysplasia are part of the TRPV4 dysplasia family and that TRPV4 mutations show considerable variability in phenotypic expression resulting in distinct clinical-radiographic phenotypes. © 2010 Wiley-Liss, Inc.</P>

미만형 위암의 전암성 병변으로서의 비화생이형성

Chang, HeeKyung,Choi, JongSoon KOSIN UNIVERSITY COLLEGE OF MEDICINE 2006 高神大學校 醫學部 論文集 Vol.21 No.1

배경및 목적 : 장형 위암의 전암성 병변으로는 화생이 형성이 잘 알려져 있고, H.pylori와의 연관성도 설명되고 있으나, 미만형 위암은 전암성 병변이 없는 것으로 알려져 왔다. 본연구는 위암의 전암성 병변으로서 병리학적으로 화생이형성과 비화생이형성을 정의하고 임상적으로 위암의 조직학적 유형과의 관련성을 규명하는 데 있다. 재료 및 방법 : 141예의 포르말린에 고정되고, 파라핀에 포매된 조기위암으로 진단된 환지의 암조직과 인접한 비종양성 위점막 조직을 현미경으로 재 검색하여, 암은 Lauren 분류를 이용하여 분류하였고, 인접 비종양 점막은 화생과 비화생이형성으로 분류하고, 3등급으로 심한 정도를 분류하였다. 결과 : 미만형이 59예(41.84%), 중간형이 41예(29.08%), 장형이 41예(29.08%) 였다. 비화생이형성이 98예(69.50%)이고, 화생이형성이 97(68.8%)였다. 두이형성이 공존하는 예는 55예(39%)였다. 미만형과 중간형에서 비화생이형성의 빈도는 장형보다 높았으며, 장형암에서 장형이형성의 빈도는 다른 두형에서보다 높았다. 장형이형성의 경우 나이와 발현 빈도와 심한 정도는 비례관계를 나타내었다. 결론 : 위암의 발생과정에는 두가지 이형성이 존재하며 비화생이형성은 미만형 위암의 발달에서 전암성 단계의 병변으로 인정된다. Background : This study was performed to investigate the relationship of types of dysplasia and histologic types in 141 cases of surgical specimens of early gastric cancer. Material and methods : Fromalin-fixed and paraffin-embedded gastric mucosa and cancer tissue from 141 patients with gastric cnacer underwent gastrectomy were studided with classification of gasric cancer by Lauren and dysplasia. Results : The histologic types by Lauren1) were: diffuse type 59 cases (41.84%); intermediate type 41 cases (29.08%); and intestinal type 41 cases (29.08%). The types of gastric dysplasia in gastric mucosa adjacent to the tumor were classified into nonmetaplastic dysplasia 98 cases (69.50%) and metaplastic dysplasia 97 cases (68.8%). Simultaneous presentation of both dysplasias was 55 cases (39.00%). The frequency of nonmetaplastic dysplasia in diffuse and intermediate type carcinoma was significantly higher than in intestinal type carcinoma (p<0.05), and the frequency of metaplastic dysplasia in intestinal type carcinoma was significantly higher than that of diffuse and intermediate carcinoma (p<0.05). In cases of metaplastic dysplasia, age and frequency and severity showed positive correlation (p<0.05). Conclusions : These results suggest that types of dysplasias may be related to two different pathways in human stomach carcinogenesis. And we propose a hypothesis that nonmetaplastic dysplasia and diffuse type adenocarcinoma sequence may be possible in the development of diffuse type of stomach cancer.

Absence of dysplasia in the excised cervix by a loop electrosurgical excision procedure in the treatment of cervical intraepithelial neoplasia

류애리,남계현,정수호,김정식,이해혁,고은석,배동한 대한부인종양학회 2010 Journal of Gynecologic Oncology Vol.21 No.2

Objective: Absence of dysplasia in the excised specimen following loop electrosurgical excision procedure (LEEP) for treatment of cervical intraepithelial neoplasia (CIN) 2/3 is an occasional finding of uncertain clinical significance. We evaluated several factors including age, liquid-based Pap (LBP) test, human papillomavirus (HPV) load before treatment, and HPV typing as predictors for absence of dysplasia. Absence of dysplasia in LEEP specimens was analyzed in terms of factors for recurrent disease after LEEP conization. Methods: In total, 192 women (mean age, 39.3±8.4 years; range, 24 to 70 years) with biopsy-proven CIN 2/3 were treated by LEEP conization. Age, LBP test, histological grade, HPV load, and HPV DNA typing were evaluated as possible predictors of the absence of residual dysplasia or recurrent disease. Results: Of the LEEP specimens, 34 (17.7%) showed no dysplasia in preoperative biopsies from patients with proven CIN 2/3. Low HPV load (<100 relative light units [RLU]) was significantly related to the absence of dysplasia in LEEP specimens, using logistic regression. Margin involvement and high HPV load (≥400 RLU) were significant factors for recurrence. Conclusion: Absence of dysplasia in LEEP specimens occurred in 17.7% of our specimens. Prediction of the absence of dysplasia in LEEP specimens was associated with low HPV load. Residual/recurrent disease after LEEP was associated with a positive resection margin and high viral load, and was not associated with absence of dysplasia in LEEP specimens. Even if there is no dysplasia in conization specimens, close follow-up for residual/recurrent disease is needed.

섬유성 이형성증 및 골섬유성 이형성증에서의 c-fos 단백 발현

박혜림,박용구,김덕환,Park, Hye-Rim,Park, Yong-Koo,Kim, Duck-Whan 대한근골격종양학회 1999 대한골관절종양학회지 Vol.5 No.4

The purpose of this study was to evaluate the role of c-fos oncogenes in the development of fibrous dysplasia and osteofibrous dysplasia. The immunohistochemical expression of c-fos protein was evaluated in 15 cases of fibrous dysplasia and 8 cases of osteofibrous dysplasia. Ten cases of fibrous dysplasia were weakly positive with c-fos. Six cases of osteofibrous dysplasia were weakly positive and the remaining two cases were strongly positive. The overall expression of c-fos protein is weaker than high-grade osteosarcoma, thus the implication of c-fos protein is little in the development of these tumors. Fibrous dysplasia and osteofibrous dysplasia share some features of characteristic histology and c-fos expression.