악성중피종의 병리학적 진단

정순희 대한의사협회 2009 대한의사협회지 Vol.52 No.5

Malignant mesothelioma is a primary tumor of the serosal membranes, occurring in the pleura, peritoneum, pericardium, tunica vaginalis, and other related anatomical sites. It is well known that malignant mesothelioma may be a difficult tumor to diagnose pathologically. For the reliable diagnosis of mesothelioma, the adequate representative tissue samples are essential for the routine histology, histochemistry, electron microscopy, and immunohistochemical test. The main differential diagnosis includes metastatic adenocarcinomas or metastatic sarcomas, and even benign mesothelial diseases. As a practical diagnostic method for differential diagnosis of malignant mesothelioma, the immunohistochemistry using a panel of antibodies (positive and negative markers) is considered as the most valuable and useful tool. The use of at least 2 mesothelial markers and 2 or more epithelial markers is recommended, and a diagnostic panel including calretinin, Wilms tumor product 1, cytokeratin 5/6, carcinoembryonic antigen (CEA), and thyroid transcription factor (TTF)-1 could be helpful.

Differential Immunohistochemical Profiles for Distinguishing Prostate Carcinoma and Urothelial Carcinoma

오우진,Arthur Minwoo Chung,김지순,한지헌,홍성후,이지열,최영진 대한병리학회 2016 Journal of Pathology and Translational Medicine Vol.50 No.5

Background: The pathologic distinction between high-grade prostate adenocarcinoma (PAC) involving the urinary bladder and high-grade urothelial carcinoma (UC) infiltrating the prostate can be difficult. However, making this distinction is clinically important because of the different treatment modalities for these two entities. Methods: A total of 249 patient cases (PAC, 111 cases; UC, 138 cases) collected between June 1995 and July 2009 at Seoul St. Mary’s Hospital were studied. An immunohistochemical evaluation of prostatic markers (prostate-specific antigen [PSA], prostate-specific membrane antigen [PSMA], prostate acid phosphatase [PAP], P501s, NKX3.1, and α-methylacyl coenzyme A racemase [AMACR]) and urothelial markers (CK34βE12, p63, thrombomodulin, S100P, and GATA binding protein 3 [GATA3]) was performed using tissue microarrays from each tumor. Results: The sensitivities of prostatic markers in PAC were 100% for PSA, 83.8% for PSMA, 91.9% for PAP, 93.7% for P501s, 88.3% for NKX 3.1, and 66.7% for AMACR. However, the urothelial markers CK34βE12, p63, thrombomodulin, S100P, and GATA3 were also positive in 1.8%, 0%, 0%, 3.6%, and 0% of PAC, respectively. The sensitivities of urothelial markers in UC were 75.4% for CK34βE12, 73.9% for p63, 45.7% for thrombomodulin, 22.5% for S100P, and 84.8% for GATA3. Conversely, the prostatic markers PSA, PSMA, PAP, P501s, NKX3.1, and AMACR were also positive in 9.4%, 0.7%, 18.8%, 0.7%, 0%, and 8.7% of UCs, respectively. Conclusions: Prostatic and urothelial markers, including PSA, NKX3.1, p63, thrombomodulin, and GATA3 are very useful for differentiating PAC from UC. The optimal combination of prostatic and urothelial markers could improve the ability to differentiate PAC from UC pathologically.

피부 악성 흑색종의 임상 및 병리조직학적 소견

박경덕 ( Kyung Duck Park ),이석종 ( Seok Jong Lee ),이원주 ( Weon Ju Lee ),김도원 ( Do Won Kim ),정호윤 ( Ho Yun Chung ),조병채 ( Byung Chae Cho ) 대한피부과학회 2007 대한피부과학회지 Vol.45 No.2

Background: Malignant melanoma is the leading cause of death among skin cancers in western countries. The incidence of melanoma has been steadily increasing over the last 20 years, and age and sex distribution, anatomic location, clinicopathologic subtypes, and prognostic factors of malignant melanoma are also well known. However, various clinicopathologic aspects such as incidence, clinicopathologic subtypes and tumor behaviors are quite different in Asian and black skin. Objective: The purpose of this study was to investigate the clinicopathologic behavior and statistics of malignant melanoma patients of Kyungpook National University Hospital, and to evaluate prognostic predictors. Methods: Of the 97 out of 103 patients diagnosed with malignant melanoma at the Department of Dermatology of Kyungpook National University Hospital over a 14 year period (l992~2006), we analyzed mean age of onset, gender, tumor location, duration, tumor number, color, tumor thickness, Clark`s level, pathologic ulceration, tumor-infiltration lymphocytes, clinicopathologic subtype, and clinical AJCC stage. Univariate analysis and multivariate analyses for survival, according to clinical and histologic tumor settings, were performed by means of the Cox proportional hazard model. Survival curves were plotted by the Kaplan-Meier method. Results: Ninety-seven melanomas were identified and analyzed by both clinical behavior and pathology. Of these, 44 were male and 53 were female patients and the mean age was 59.7 years. Most of the tumors were located on the hands and feet. Thin melanoma was the most common tumor and histologic ulcerations were observed in 37 out of 81 patients who were available for evaluation. For tumor-infiltrating lymphocytes (TIL), 22 out of 76 patients were confirmed with TIL in the pathologic review. Acral lentiginous melanoma was the most common type, followed by nodular melanoma, superficial spreading melanoma, and lentigo maligna melanoma. Univariate analysis for overall survival of melanoma revealed that thickness of tumor, the presence of ulceration, the presence of tumor-infiltrating lymphocytes, clinicopathological subtype, and clinical stage have a tendency for a poorer prognosis. Multivariate analysis demonstrated that advanced stages (III and IV) and tumor thickness were the independent risk factors for poor prognosis. Conclusion: Few similar large studies have been conducted to assess the prognostic factors of melanoma in Korea. Therefore, further prospective studies are needed to assess the biological behavior of malignant melanoma, of which the incidence has been steadily increasing in Korea. (Korean J Dermatol 2007;45(2):149~158)

사행 산업 종사자들에 있어 도박 중독에 대한 인식조사 및병적도박, 알코올, 흡연, 우울증의 유병률

이학승(Hak-Seung Rhee),김진훈(Jin-Hun Kim),윤해주(Hai-Joo Yoon),이태경(Tae-Kyung Lee) 한국중독정신의학회 2006 중독정신의학 Vol.10 No.1

Object:1) The present study examined comprehensive social attitudes about pathologic gambling and 2) the prevalence of pathologic gambling and other health risks (alcohol, smoking, and depression) among gambling industry employees. Methods: A sample of 388 employees was surveyed by questionnaire about 1) social attitudes about behavior problems related to pathologic gambling, 2) pathologic gambling which was assessed with Korean form of Souths Oak Gambling Screen (KSOGS), alcohol-related problems which were assessed with Korean Version of Alcohol Use Disorder Identification Test (AUDITK), smoking, and depression which was assessed with Beck Depression Inventory. Result:This study found that gambling industry employees didn’t have higher prevalence of pathologic gambling, alcohol problem, smoking, and depression than that of the general population. In addition, 54.2% of the employees perceived pathologic gambling problematic and 83.5% of the employees perceived the medical treatment about pathologic gambling necessary. However, the majority (75.4%) of them perceived the reason of pathologic gambling personality problem and only 5.4% of them perceived the reason of pathologic gambling biological factor. Conclusion:Our study suggests that 1) majority of gambling industry employees recognize the pathologic gambling’s severity but they don’t yet have a concept that pathologic gambling is a disease and 2) the individuals exposed to an occupational environment of addictive behavior may show different social pattern of addiction with general population. Therefore, more clinical attention must be needed and gambling industry managers should consider increasing education and systemic information about pathologic gambling and other health risks.

절제 가능한 직장암에서 수술전 방사선 치료의 효과

계철승(Chul Seung Kay),최일봉(Ihl Bong Choi),장지영(Ji Young Jang),김인아(In Ah Kim),신경섭(Kyung Sub Shinn),이종서(Jong Suh Lee),장석균(Suk Kyun Chang),최규용(Kyu Young Choi),김영하(Young Ha Kim),김준기(Jun Gi Kim),전정수(Chung Soo 대한방사선종양학회 1997 Radiation Oncology Journal Vol.15 No.1

목 적 : 절제 가능한 직장암 환자에서 수술전 방사선 치료를 시행한 예들(대상군)과 동일한 임상병기에서 수술만을 시행했던 예들(대조군)사이의 수술후 병리 조직학적 소견들을 비교하여 수술전 방사선 치료의 효과에 대하여 알아 보고자 하였다. 대상 및 방법 : 1995년 7월부터 1996년 4월까지 가톨릭대학교 의과대학 성모병원 방사선종양학과에서 수술전방사선치료를 받았던 19명의 환자중 수술을 시행받은 16명을 대상으로 하였으며, 이를 과거에 수술만을 시행했던 31명과 후향적분석을 통해 비교하였다. 진단 당시 이들의 임상병기 분류는 Thomas Jefferson(TJ) system을 이용하였다. 수술전 방사선 치료는 매일 180-200 cGy로 주 5회, 총 방사선 조사량 4500-5000cGy까지 시행하였으며, 방사선 치료가 끝나고 평균 4주후에 수술을 시행하였다. 수술후 병기 결정은 Modified Astler-Coller(MAC) system을 이용하였다. 방사선 치료후 임상 병기에 따른 수술후 병리학적 병기와 소견을 관찰하고, 이 결과를 수술전 동일한 임상 병기를 지녔던 대조군의 병리학적 소견과 비교하였다. 병리학적 소견으로는 종양 세포의 혈관 침범, 림프관 침범및 신경조직주위 침범여부 등을 관찰하였다. 통계학적 방법으로는 chi-square test를 사용하였다. 결 과 : 대상이 되었던 19명중 16명에서 종양의 위치에 관계없이 방사선 치료후 항문보존적 근치수술을 시행할수 있었으며, 방사선 치료후 1명(6.3%)의 환자가 병리조직학적으로 완전반응을 보였다. 방사선 치료후에 항문보존적 근치수술을 시행했던 대상군과 수술만을 시행했던 대조군사이의 임상적 병기와 수술후 병기를 비교해 보면 TJ stage Ⅱ였던 경우, 9명의 대상군중에서는 완전반응을 보인 1명을 제외하고는, 8명 모두가 MAC stage B로 나타났으며(88.9%), 17명의 대조군에서는 B인 경우가 11명(64.7%), C인 경우가 6명(35.3%)이었으며, TJ stage Ⅲ였던 경우, 7명의 대상군에서는 MAC stage상 B인 경우가 4명(57.1%), C인 경우가 3명 (42.9%)이었고, 14명의 대조군에서는 B인 경우가 4명(28.6%), C인 경우가 10명(71.4%)이었다. 따라서 수술전 방사선 치료를 시행했던 예들에서 병리학적 병기가 낮은 경향을 보였으며, 특히 방사선 치료후 MAC stage C 소견의 급격한 감소가 보였다 (p=0.049). 병리학적인 소견으로 종양세포의 혈관 침범, 림프관 침범과 신경조직 주위 침범등이 대상군에서 대조군에 비하여 모두가 감소하는 것으로 나타났다. 결 론 : 동일한 임상 병기에서 수술전 방사선 치료를 시행한 군과 수술만을 시행한 군 사이의 수술후 병기는 수술전 방사선 치료를 시행한 경우에 비하여 병기가 감소되는 경향을 보였다. 특히 병리학적으로 종양세포의 림프관 침범 소견이 감소된 것은 방사선 치료군에서 수술후 MAC stage C 소견이 감소된 것과 일치되는 소견을 보였다. 이러한 결과를 통해 절제 가능한 직장암 환자에서 수술전 방사선 치료를 하는 것이 효과적일수 있다고 사료된다. 그러나, 좀 더 명확한 결론을 얻기 위해서는 더 많은 수의 환자들을 대상으로 장기적인 추적관찰을 하는 연구가 함께 이루어져야 할 것이라고 생각된다. Purpose: To evaluate the pathologic effects of preoperative radiotherapy on the resectable distal rectal cancer, we analyzed the results of postoperative pathologic findings for the patients with preoperative radiotherapy and surgery. Materials and Methods: From July 1995 to April 1996, we treated sixteen patients of resectable rectal cancer with preoperative radiation therapy and curative surgery. At diagnosis, Thomas Jefferson (TJ) system was used for the clinical stage of the patients. We treated the patients with conventional radiation therapy of 4500∼5000cGy before surgery. The surgery was carried out 4 weeks after completion of radiation therapy. Modified Astler Coller (MAC) system was used for the postoperative pathologic stage. We analyzed the pathologic stages and findings according to preoperative clinical stage and compared with those of the control group in similar clinical stages. Results: All patients were treated with sphincter preservation surgery after preoperative radiation therapy. Pathologic complete response (CR) was shown in 1 case (6.3%). We compared the results between preoperative radiation therapy group (Preop.RT group) and surgery only group (control group). In TJ stage II, among nine patients of Preop.RT group, 8 patients (88.9%) were in MAC stage B except 1 CR patient, but among 17 patients of control group, 11 patients (64.7%) were in MAC stage B and 6 patients (35.3%) in MAC stage C. In TJ stage III, among 7 patients of Preop.RT group, 4 patients (57.1%) were in MAC stage B and 3 patients (42.9%) in MAC stage C. Among 14 patients of control group, 4 patients (28.6%) were in MAC stage B and 10 patients (71.4%) in MAC stage C. Above results showed that postoperative pathologic stage was decreased in Preop.RT group with statistical significance (p=0.049). The postoperative pathologic findings (blood vessel invasion, lymphatic vessel invasion, perineural invasion) were decreased in the Preop.RT group compared with those of control group. But statistical significance was found only in lymphatic vessel invasion (p=0.019). Conclusion: The postoperative pathologic stages and adverse prognostic pathologic findings were decreased in preoperative radiation therapy group. The lymphatic vessel invasion and MAC stage C findings were abruptly decreased in preoperative radiation therapy group. The preoperative radiation therapy was found to be effective in resectable rectal cancer. The patients group in our study was very small and long term follow up was not done. Therefore, further study about this issues is needed .

절제 가능한 직장암에서 수술전 방사선 치료의 효과 -병리 조직학적인 연구를 중심으로-

최일봉,장지영,김인아,신경섭,이종서,장석균,최규용,김영하,김준기,전정수,계철승,Choi, Ihl-Bong,Jang-Ji-Young,Kim, In-Ah,Shinn-Kyung-Sub,Lee, Jong-Suh,Chang-Suk-Kyun,Choi, Kyu-Young,Kim, Young-Ha,Kim, Jun-Gi,Chun-Chung-Soo,Kay-Chul-Seung 대한방사선종양학회 1997 Radiation Oncology Journal Vol.15 No.1

목적 : 절제 가능한 직장암 환자에서 수술전 방사선 치료를 시행한 예들(대상군)과 동일한 임상병기에서 수술만을 시행했던 예들(대조군)사이의 수술후 병리 조직학적 소견들을 비교하여 수술전 방사선 치료의 효과에 대하여 알아보고자 하였다. 대상 및 방법 :1995년 7월부터 1996년 4월까지 가톨릭대학교 의과대학 성모병원 방사선종양 학과에서 수술전방사선치료를 받았던 19명의 환자중 수술을 시행받은 16명을 대상으로 하였으며, 이를 과거에 수술만을 시행했던 31명과 후향적분석을 통해 비교하였다. 진단 당시 이들의 임상병기 분류는 Thomas Jefferson(TJ) system을 이용하였다. 수술전 방사선 치료는 매일 180-200 cGy로 주 5회, 총 방사선 조사량 4500-5000cGy까지 시행하였으며, 방사선 치료가 끝나고 평균 4주후에 수술을 시행하였다. 수술후 병기 결정은 Modified Astler-Coiler(MAC) system을 이용하였다. 방사선 치료후 임상 병기에 따른 수술후 병리학적 병기와 소견을 관찰하고, 이 결과를 수술전 동일한 임상 병기를 지녔던 대조군의 병리학적 소견과 비교하였다 병리학적 소견으로는 종양세포의 혈관 침범, 림프관 침범및 신경조직주위 침범여부 등을 관찰하였다. 통계학적 방법으로는 chi-square test를 사용하였다. 결과 : 대상이 되었던 19명중 16명에서 종양의 위치에 관계없이 방사선 치료후 항문보존적 근치수술을 시행할수 있었으며, 방사선 치료후 1명$(6.3\%)$의 환자가 병리조직학적으로 완전반응을 보였다. 방사선 치료후에 항문보존적 근치수술을 시행했던 대상군과 수술만을 시행했던 대조군사 이의 임상적 병기와 수술후 병기를 비교해 보면 TJ stage III였던 경우, 9명의 대상군중에서는 완전반응을 보인 1명을 제외하고는, 8명 모두가 MAC stage B로 나타났으며$(88.9\%)$, 17명의 대조관에서는 B인 경우가 11명$(64.7\%)$, C인 경우가 6명$(35.3\%)$이었으며, TJ stage III였던 경우, 7명의 대상군에서는 MAC stage상 B인 경우가 4명$(57.1\%)$, C인 경우가 3명 $(42.9\%)$이었고, 14명의 대조관에서는 B인 경우가 4명$(28.6\%)$, C인 경우가 10명$(71.4\%)$이었다. 따라서 수술전 방사선 치료를 시행했던 예들에서 병리학적 병기가 낮은 경향을 보였으며, 특히 방사선 치료후 MAC stage C 소견의 급격한 감소가 보였다(p=0.049). 병리학적인 소견으로 종양세포의 혈관 침범, 림프관 침범과 신경조직 주위 침범등이 대상군에서 대조군에 비하여 모두가 감소하는 것으로 나타났다. 결론 : 동일한 임상 병기에서 수술전 방사선 치료를 시행한 군과 수술만을 시행한 군 사이의 수술후 병기는 수술전 방사선 치료를 시행한 경우에 비하여 병기가 감소되는 경향을 보였다. 특히 병리학적으로 종양세포의 림프관 침범 소견이 감소된 것은 방사선 치료군에서 수술후 MAC Stage C 소견이 감소된 것과 일치되는 소견을 보였다 이러한 결과를 통해 절제 가능한 직장암 환자에서 수술전 방사선 치료를 하는 것이 효과적일수 있다고 사료된다. 그러나, 좀 더 명확한 결론을 얻기 위해서는 더 많은 수의 환자들을 대상으로 장기적인 추적관찰을 하는 연구가 함께 이루어져야 할 것이라고 생각된다. Purpose : To evaluate the pathologic effects of preoperative radiotherapy o the resectable distal rectal cancer, we analyzed the results of postoperative pathologic findings for the patients with preoperative radiotherapy ant surgery Materials and Methods: From July 1995 to April 1996, we treated sixteen patients of resectable rectal cancer with preoperative radiation therapy and curative surgery At diagnosis, Thomas Jefferson (TJ) system was used for the clinical stage of the Patients. We treated the patients with conventional radiation therapy of 4500~5000cGy before surgery. The surgery was carried out 4 weeks after completion of radiation therapy. Modified Astler Coller (MAC) system was used for the postoperative pathologic stage. We analyzed the pathologic stages and findings according to preoperative clinical stage and compared with those of the control group in similar clinical stages. Result : All patients were treated with sphincter preservation surgery after Preoperative radiation therapy. Pathoiogic complete response (CR) was shown in 1 case $(6.3\%)$. We compared the results between preoperative radiation therapy group (Preop.RT group) and surgery only group (control group). In TJ stage II, among nine patients of Preop.RT group, 8 patients $(88.9\%)$ were in MAC stage 8 except 1 CR patient, but among 17 patients of control group. 11 patients$(64.7\%)$ were in MAC stage B and 6 Patients $(35.3\%)$ in MAC stage C. In TJ stage III, among 7 patients of Preop.RT group, 4 patients $(57.1\%)$ were in MAC stage B and 3 patients$(42.9\%)$ in MAC stage C. Among 14 Patients of control group, 4 patients $(28.6\%)$ were in MAC stage B and 10 Patients $(71.4\%)$ in MAC stage C. Above results showed that postoperative Pathologic stage was decreased in Preop.RT group with statistical significance (P=0.049). The postoperative Pathologic findings (blood vessel invasion. Iymphatic vessel invasion, perineural invasion) were decreased in the Preop.RT group compared with those of control group. But statistical significance was found only in Iymphatic vessel invasion (p=0.019). Conclusion : The Postoperative pathologic stages and adverse Prognostic pathologic findings were decreased in preoperative radiation therapy group. The Iymphatic vessel invasion and MAC stage C findings were abruptly decreased in Preoperative radiation therapy group. The preoperative radiation therapy was found to be effective in resectable rectal cancer. The patients group in our study was very small and long term follow up was not done. Therefore, further study about this issues is needed.

내시경점막하박리술 후 병리학적 음성으로 판명된 증례에 대한 고찰

권민정 ( Min Jung Kwon ),박종재 ( Jong Jae Park ),윤재원 ( Jae Won Yun ),노혜진 ( Hye Jin Noh ),윤대웅 ( Dae Woon Yoon ),장원진 ( Won Jin Chang ),오하영 ( Ha Young Oh ),김백희 ( Baek Hui Kim ),이현주 ( Hyun Joo Lee ),주문경 ( Moon 대한소화기학회 2012 대한소화기학회지 Vol.59 No.3

목적: 위선종 혹은 조기위암에 대한 치료로 내시경점막하박리술(ESD)이 널리 시행되고 있다. 그러나 시술 전 조직소견과시술 후 최종 진단의 불일치가 나타나는 경우가 있으며 일부에서는 시술 후 음성소견이 관찰되는 경우도 있다. 이에 이연구는 ESD 시행 후 병리학적 음성으로 판명된 환자를 대상으로 이의 원인에 대해 알아보고자 하였다. 대상 및 방법: 2007년 1월부터 2010년 1월까지 고려대학교 구로병원에서 위선종, 조기위암으로 ESD를 시행받은 환자 중시술 후 조직학적 음성을 보이는 환자를 대상으로 의무기록을 후향적으로 분석하였다. 결과: ESD를 시행받은 환자 792명 중 27명(3.4%)에서 음성 판정을 받았다. 대상환자의 시술 전 진단은 조기위암 11예 (40.8%), 저이형성 선종 13예(48.1%), 고이형성 선종 3예 (11.1%)였다. 병리학적 음성 예의 원인 분류에 따른 빈도는 국소적 병변이 13예(48.2%)로 가장 흔하였고, 병리학적 불일치가 11예(40.7%), 시술자 오류는 3예(11.1%)였다. 원인에 따른 시술 전 병리소견은 병리학적 불일치 11예에서는 모두 저이형성 선종이었고, 국소적 병변에 의한 13예에서는 11예 (84.6%)가 선암으로 통계학적으로 유의하였다. 그리고 시술자 오류에 의한 경우는 주로 전정부 융기성 병변에서 특히 주변에 장상피화생이 동반된 경우였다. 병리학적 불일치가 원인인 11예 중 10예(90.9%)가 타 병원에서 전원된 경우였고, 장상피화생은 시술자 오류가 원인이 된 경우가 100%였다. 결론: ESD 후 병리학적 음성예를 감소시키기 위해서는 특히 저이형성 선종의 경우 시술 전 병리의사와의 긴밀한 협조와 충분한 의사소통이, 장상피화생이 동반된 전정부의 융기성 병변에서는 병변의 정확한 위치를 확인한 후의 신중한 시술이 필요하다. 하지만 보다 흔하게는 병변이 너무 작아 조직검사로 제거되는 경우도 있다는 점을 염두에 두어야한다. Background/Aims: Endoscopic submucosal dissection (ESD) is accepted as a standard treatment of early gastric cancer (EGC) and gastric adenoma, occasionally, tumorous lesion is not found and pathologic discrepancies can occur after ESD. The aim of this study was to analyze the factors affecting the negative pathologic results after ESD. Methods: We retrospectively reviewed the data from all patients with gastric neoplasm (276 EGC and 516 gastric adenomas) who were treated with ESD during past 3 years and enrolled the patients who had negative pathologic results. Results: Out of 792 patients treated with ESD, 27 patients (3.4%) were eligible for inclusion. Among the 27 patients, factors affecting the negative pathologic results were, most commonly, the focal lesion (n=13, 48.2%) which was small enough to be removed completely during pre-ESD biopsy, followed by pathologic discrepancies (n=11, 40.7%) between pathologists and lastly the operator factor (n=3, 11.1%) dissecting incorrect lesions. Of the focal lesions, the initial pathologic diagnoses were adenocarcinoma in 11 cases (84.6%). In cases with pathologic discrepancies, all the pretreatment diagnoses were adenoma with low grade dysplasia. In cases caused by operator factors, intestinal metaplasia was accompanied by elevated adenoma in all cases. Conclusions: To decrease negative pathologic results after ESD, an endoscopist should perform ESD after sufficient communication with pathologists, especially for adenoma with low grade dysplasia, and choose correct lesion, especially located at the antrum and associated with intestinal metaplasia. The possibility of total removal of small lesions even by forcep biopsy should be considered.

Preoperative Concurrent Chemoradiotherapy for Locally Advanced Rectal Cancer: Treatment Outcomes and Analysis of Prognostic Factors

공문규,홍성언,최우석,김시영,최진현 대한암학회 2012 Cancer Research and Treatment Vol.44 No.2

Purpose This study was designed to investigate the long-term oncologic outcomes for locally advanced rectal cancer patients after treatment with preoperative concurrent chemoradiotherapy followed by total mesorectal excision, and to identify prognostic factors that affect survival and pathologic response. Materials and Methods From June 1996 to June 2009, 135 patients with locally advanced rectal cancer were treated with preoperative concurrent chemoradiotherapy followed by total mesorectal excision at Kyung Hee University Hospital. Patient data was retrospectively collected and analyzed in order to determine the treatment outcomes and identify prognostic factors for survival. Results The median follow-up time was 50 months (range, 4.5 to 157.8 months). After preoperative chemoradiotherapy, sphincter preservation surgery was accomplished in 67.4% of whole patients. A complete pathologic response was achieved in 16% of patients. The estimated 5- and 8-year overall survival, loco-regional recurrence-free survival, and distant metastasis-free survival rate for all patients was 82.7% and 75.7%, 76.8% and 71.9%, 67.9% and 63.3%, respectively. The estimated 5- and 8-year overall survival, loco-regional recurrence-free survival, and distant metastasis-free survival rate for pathologic complete responders was 100% and 100%, 100% and 88.9%,95.5% and 95.5%, respectively. In the multivariate analysis, pathologic complete response was significantly associated with overall survival. The predictive factor for pathologic complete response was pretreatment clinical stage. Conclusion Preoperative chemoradiotherapy for locally advanced rectal cancer resulted in a high rate of overall survival, sphincter preservation, down-staging, and pathologic complete response. The patients achieving pathologic complete response had very favorable outcomes. Pathologic complete response was a significant prognostic factor for overall survival and the significant predictive factor for a pathologic complete response was pretreatment clinical stage.

Pathologic and Oncologic Outcomes in Locally Advanced Gastric Cancer with Neoadjuvant Chemotherapy or Chemoradiotherapy

안지영,김형일,정재호,형우진,김충배,노성훈 연세대학교의과대학 2013 Yonsei medical journal Vol.54 No.4

Purpose: Although neoadjuvant therapy has been accepted as a treatment option in locally-advanced gastric cancer, its prognostic value has been difficult to evaluate. Materials and Methods: Seventy-four gastric cancer patients who underwent gastrectomy after neoadjuvant treatment were divided into two groups according to the pathologic response: favorable (ypT0) and others (ypT1-4). The clinicopathologic characteristics, predictive factors for pathologic response, and oncologic outcome were evaluated. Results: Eleven patients (14.8%) demonstrated ypT0 and the remaining 63 patients (85.2%) were ypT1-4. Chemoradiotherapy (CCRTx) rather than chemotherapy (CTx) was the only predictive factor for a favorable pathologic response. Chemotherapeutic factors and tumor marker levels did not predict pathologic response. The 1-, 2-, and 3-year disease-free survivals were 83.4%, 70%, and 52.2%. The 1-, 3-, 5-year overall survivals were 88.5%, 67.5%, and 51.2%, respectively. Although a complete pathologic response (ypT0N0M0) was achieved in 7 patients, 28.6% of them demonstrated recurrence of the tumor within 6 months after curative surgery. Conclusion: CCRTx rather than CTx appears to be more effective for achieving good pathologic response. Although favorable pathologic response has been achieved after neoadjuvant treatment, the survival benefit remains controversial.

병적 근시가 황반 원공 수술 결과에 미치는 영향

김상준,김하경,Sang Joon Kim,MD,Ha Kyoung Kim,MD,PhD 대한안과학회 2013 대한안과학회지 Vol.54 No.6

Purpose: To evaluate if the presence of pathologic myopia could affect the result of macular hole surgery. Methods: This study was a retrospective comparison of the results of macular hole surgery between a pathologic myopia group (11 eyes) and a non-pathologic myopia group (14 eyes). All patients had undergone PPV, ILM peeling and C3F8 (20%) gas temponade. BCVA, IOP and OCT findings were evaluated preoperatively and at 6 months after surgery. Postoperative BCVA, IOP and macular hole closure were compared between each groups. Results: The only statistically significant preoperative parameter between the groups was axial length (p < 0.001). Postoperative BCVA was lower in the pathologic myopia group, but the difference was not statistically significant. The rate of macular hole closure was statistically significant higher in the non-pathologic myopia group (p < 0.001). Conclusions: The presence of pathologic myopia may negatively affect the result of macular hole surgery.