1. KCP 763 (Pleural fliud) 서울대학교병원 전공의 남경한

2.  10 세 남자  재태 연령 37 주 정상 질 분만으로 출생  2010 년 전신 긴장성 발작 (generalized tonic seizure) 발생  뇌 자기공명영상 (MRI) 에서 후두엽의 종괴가 발견되어 수술 시행  수술 후, 두 차례의 간질 발작이 있었으며 약물 복용  2012 년 4 월 왼쪽 고환의 악성종양으로 근치적 절제술 시행  신체 검진상 전신에 검정색의 모반이 관찰됨  흉수 (pleural fluid) 도말 표본

13.  Relatively hypocellular smear  Dispersed and loosely cohesive epithelioid cells  Nuclear pleomorphism and prominent nucleoli  Scant or abundant cytoplasm  Intracytoplasmic pigment, light to heavy brown  Binucleated cells  A few inflammatory cells and mesothelial cells

14.  Diffuse mesothelioma, epithelial type  Adenocarcinoma  Hematological neoplasms  Germ cell tumor such as seminoma  Malignant melanoma

15. Malignant melanoma Embryonal carcinoma Seminoma Pattern Broad range of cytological appearance Pleomorphic single cells or dissociating groups Cohesive clusters of large pleomorphic cells glandular and papillary formation Highly cellular Loosely cohesive clusters or single cells Necrotic cellular debris, Lymphoid cells, histiocytes Cytoplasm Usually pigmented, Amelanotic,vacuolation, Scanty or abunadant Basophilic cytoplasm, ill-defined cell borders Large, uniform in size Nucleus Round to oval, Usually eccentric, Prominent nucleoli, Intranuclear inclusion, Multinucleation Overlapping pleomorphic Large vesicular Prominent nucleoli, Mumerous mitosis Prominent nucleoli Frequent mitosis

16. Pleural fluid, aspiration cytology: Metastatic malignant melanoma

17.  Origin  primary CNS melanoma  cutaneous melanoma  Neurocutaneous melanosis that combines giant melanocytic nevi with leptomeningeal melanosis

18.  Diagnostic criteria were refined in 1991 by Kadonaga and Frieden;  Large (>20 cm in diameter in the adult) CMN or multiple (>3) CMN in association with histologic confirmation of leptomeningeal melanocytosis or CNS melanoma  absence of cutaneous melanoma unless there is no evidence of CNS melanoma  no evidence of meningeal melanoma, unless there is no evidence of cutaneous melanoma

22. 감사합니다