K ore a n Jou rn a l of M e dic in e : V ol. 56, N o. 2, 1999 F ig. 1. P eriphera l blood s m ea r sh ow ing th e increa sed num bers of sm all mature

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1 : C D 5 B 1 * ** * ** *** *** *** : (chronic lym phocytic leuk em ia) (s m all ly m ph ocy te),,,, 30% 1, 2), % 2). 50, 2 : 1. 95% B T. B 95% B CD19, CD20 H LA DR T CD5 1), CD5 B. :, 67, : 6 : : : : 6, (6 17kg ), 20,. :, 90/ 60m m H g, 75 /, 36.5, 20 /.,,. 1cm 2cm 1, 0.5cm 0.5cm 1, 0.5cm 0.5cm 3. 5,. : g / dl, 40.5%, 189,000/ ul, 15,500/ ul( 79%, 17%, 4% ),. 5.4g / dl, 16%, 6,000/ u L, 25,300/ u L ( 91%, 8%, 1% ). s m u dg e cell (F ig. 1)., 7.2 g / dl, 3.6g / dl, Coom b s tes t. X,, 235

K ore a n Jou rn a l of M e dic in e : V ol. 56, N o. 2, 19

CD19, CD20 B CD5. H LA DR sig (T able 1). : 60%, 74.5% s m u dg e cell (F ig. 2). (F ig. 3). : Cy cloph os ph am ide prednis on e 20,000/ ul.. (23.4% ), 1 (49.0%, 3.3% ), Ig M, K appa.

C D n om en c la tu re R es u lts C D 10(CA L LA ) 0.43% CD 19(Leu 12) 89.64% C D 7(L eu 9) 7.51% CD 33(Leu M 9) 1.04% H L A D R 94.98% C D 34(H P C A 1) 0.62% CD 14(Leu M 3) 0% CD 20(Leu 16) 89.

2 K ore a n Jou rn a l of M e dic in e : V ol. 56, N o. 2, 1999 F ig. 1. P eriphera l blood s m ea r sh ow ing th e increa sed num bers of sm all mature lym phocytes and occasiona l ch ara cteris tic s m udg e cells (W rig h t s tein, 400). CD19, CD20 B CD5. H LA DR sig (T able 1). : 60%, 74.5% s m u dg e cell (F ig. 2). (F ig. 3). : Cy cloph os ph am ide prednis on e 20,000/ ul.. (23.4% ), 1 (49.0%, 3.3% ), Ig M, K appa.. : (F A CS A N, Bection Dickin s onr) ly sis 20%, T able 1. Im m un oph eno ty pin g Res ults of the Pe ripheral B loo d in a F lo w c y tom etry F ig. 2. Bone m a rrow a spira tion s m ear s how ing m a rkedly in creas ed ly m phocy tes (W rig h t stein, 200). C D n om en c la tu re R es u lts C D 10(CA L LA ) 0.43% CD 19(Leu 12) 89.64% C D 7(L eu 9) 7.51% CD 33(Leu M 9) 1.04% H L A D R 94.98% C D 34(H P C A 1) 0.62% CD 14(Leu M 3) 0% CD 20(Leu 16) 89.88% C D 5(L eu 1) 8.71% C D 2(L eu 5) CD 13(Leu M 7) CD 56(Leu 19) C D % 5.01% 2.80% 8.72% F ig. 3. Bone m a rrow biops y s how in g hepercellua rity w ith lym ph oid cell infiltra tion in diffus e pattern(h & E s tein, 100). C D 4 C D 8 T d T s Ig 1.46% 4.08% 0.12% 78%,,,, 236

3 Oh K il K im, e t a l : A C a s e of CD5 N eg a t iv e B Ce ll Ch ron ic L y m ph oc y t ic Le u k em ia. 50, 2 : 1., 30% 1, 2), % 2). 95% B 5% T 1, 3, 4). B CD19, CD20 H LA DR 80% B, CD5 8.71% CD5 B.,,,,, 1, 13). 50%,,,,, tris om y 12 14q, 13q, 11q. 1, 59).. 25%,,,,,,,,. 60%,,,,, 10%, 40% 1)., 1). Rai (5,000/ u L ), 30%, B 1, 22). IW CLL(International W orkshop on CLL) 10,000/ u L. IW CLL 10,000/ u L B, 10,000/ u L B 1, 14). NCI sponsored W G(W orking Group on CLL sponsored by the National Cancer Institude) 5,000/ u L 1, 15)., rostte, CD5 2 12, 14). 80% Ig M Ig M Ig D 1, 12, 14, 15). B B 90% B CD19, CD20, CD24 T CD %, CD5 rosette 14% 1, 12). T CD5 67 K D (g ly coprotein ) T, T, CD5 B,,,. CD5 B (B proly m ph ocy tic leu kem ia), (in term ediate ly m ph ocy tic ly m ph om a), B 1013, 16). B B 85 95% CD5, 5 in ternation al w orks h op CD5 B 14), CD5 B CD5 B CD5 12, 14, 16). 10,000/ u L 237

4 : CD5 B CD19 CD20 s Ig H LA DR. (leu k em oid reaction ), (proly m ph ocy tic leu k em ia), (diffus e or follicular ly m ph om a) (leu kem ic ph as e),, W alden s tr m, (h airy cell leu k e m ia), S ezary, (larg e g ran u lar ly m phocy tosis ).,,,,,., s Ig H LA DR B 1, 13). Rai, ( : < 11 g / dl, : < / L) 5, 3 : (stag e 0), (stag e I stag e II), (stag e s tag e ). 30%, 60%, 10% 10, 6, ). Rai 0 B in et A, Rai I II Bin et B,,,,, Rai III IV Bin et C ).,,,. Rai Bin et,, 1921). Rai IV Binet C cyclophosphamide prednisone. 67, CD5 B 1. = A b s t r a c t = A C a s e o f C D 5 N e g a t i v e B C e l l C h ro n i c L y m p h o c y t i c L e u k e m i a O h K il K im, M.D., J in S u k C h e o n M.D. H a g J u n K im, M.D., G u n H o L ee, M.D. Y on g J u n A n, M.D., J oo n H o H a, M.D. K y u n g S e ok O h, M.D., S a n g R y o n g L ee, M.D. H y u n g K im, M.D.*, a n d In S u n J u n, M.D.** D e p artm e nt of I nte rnal M e d icine, D e p artm e nt of Clinical P atholog y *, D e partm e nt of A natom ical P atholog y ** P usan V e te rans H osp ital, K ore a M y e on g Y o u K im, M.D.***J e o n g N y e o L e e, M.D.*** D e p artm e nt of Clinical P atholog y *** P usan P aik hosp ital, Colle g e of M e d icine, I n J e U niv e rsity, P usan, K ore a*** A 67 year old m ale visited Pusan Veterans Hospital due to g eneral w eakness and w eig ht loss for 6 m onths. Physical ex am ination show ed non tender 4 finger breaths sized splenom egaly and both inguinal and cervical lymphadenopathy. T he w hite blood cell count w as 25,300/ ul w ith 91% m orpholog ically mature lym phocytes. Bone m arrow aspirate revealed hypercellularity w ith 74.5% lymphocytes m orpholog ically sim ilar to peripheral lymphocytes. T he im munophenotpying study of lymphocytes displayed the phenotype of CD19(), CD20(), HLA DR(), sig() but CD5( ). W e concluded that this patients's diag nosis is CD 5 negative B cell chronic lym phocytic leukem ia. K ey W o rds : CD5 n eg ativ e, B cell Chronic Ly m phocy tic Leu kem ia 238

5 11 : CD 5 B 1 R E F E R E N C E 1) M ax w ell M. W introb e: C hronic ly m phocy tic le uk e m ia. L e e G R, B ithe ll T C, F oste r J, A the ns J, L uk e ns J. W introbe s clinical he m atolog y. 9th e d. p hilad e lp hia, L e a and F e big e r, , ),, :. 23: , ),,,,,,,, : Ig M, La m bda 1. 50: , ) Y am ada T, N inom iy a H, H oriuch i T, T a kada K, H a to T, Y a m a uchi K, Y a su kaw a M, F ujita S : CD 5 neg ative B cell chronic lym phocytic le u k e m ia(b C L L ) associate d with m assiv e sple nom e g aly and w ithout ly m phad e nop athy. R insho K e ts ue k i 36: , ) Juliu ss on G, Os g ier DG, F itchett M, Ross F M, S tock dill G, M a ckie M J, P arker A C, Cas toldi GL, Cun eo A, K n uutila S, Elon en E, Gah rton G: P rog nostic subg rou ps in B ce ll chronic ly m phocy tic le uk e m ia d e fine d by spe cific chrom osom al abnorm alitie s. N E ng l J M e d 13: , ) Juliu ss on G, Robért K. H., Ö st Å, F riberg K, Bib erfeld P, N ils son B, Zech L, Ga hrton G: P rog nostic inform ation from cy tog e ne tic analy sis in chronic B ly m p hocy tic le u k e m ia and le uk e m ic im m unocy tom a. B lood 65: , ) H a n T, Ozer H, S a dam ori N, Em rich L, Gom ez GA, H enders on ES, Bloom M L, S a ndb erg A A : P rog nostic im p ortance of cy tog e ne tic abnorm alitie s in p atie nts with chronic lym phocy tic le uk e m ia. N E ng l J M e d 2: , ) Bird M L, Y osh im i U, Row ley JD, H aren JM, V a rdim an JW : Chrom osom e abnorm alitie s in B ce ll chronic ly m p hocy tic le uk e m ia and the ir clinical corre lations. L e u k e m ia 3: , ) H a n T, H enders on E S, E m rich LJ, S an dberg A A : P rog nostic sig nificance of k ary oty p ic abnorm alitie s in B ce ll chronic ly m p hocy tic le u k e m ia: A n u pd ate. S e m in H e m atol 24: , ) F ag uet GB, M a rti GE, A g ee JF, Bertin P : CD 5 p ostitiv e and ne g ativ e B CL L. A nn N Y A cad S ci 651: , ) Gadol N, A dult K A : P he noty p ic and fu nctional characte riz ation of hum an L E U 1(CD 5) B ce lls. I m m u nol R e v ie w 93:23 34, ) Bata ta A, S hen B: T he im p ortance of s urface im m unog lobulin, m ouse rose tte s, and CD 5 in the im m unophe noty p ing of chronic ly m p hocy tic le uk e m ia and re activ e ly m p hocy tosis. C ance r 68: , ) Dig hiero G, T ra v ade P, Chev ret S, F en au x P, Cha s ta ng C, Bin et JL, a nd T he F rench Coopera tiv e Group on CLL: B ce ll chronic ly m p hocy tic le uk e m ia: P re se nt status and future d ire ctions. B lood 78: , ) Binet JL, Catov sk y D, Dig hiero G, Gale RP, M onts erra t E, Ra i K R, Rozm a n C, S a w its ky A : C hronic ly m phocy tic le u k e m ia: R e com m e nd ations for d iag nosis, stag ing and re sp onse crite ria. I nte rnational W ork shop on Chronic ly m p hocy tic le uk e m ia. A nn I nte rn M e d 110: , ) Ches on BD, Benn ett JM, Ra i K R, Grev er M R, K a y N E, S chiffer CA, Oken M M, K ea tin g M J, Boldt DH, K em pin S J, F oon K A : G uid e line s for clinical p rotocols for chronic ly m phocy tic le u k e m ia. R e com m endations of the N ational cancer institu te sponsore d work ing g rou ps. A m J H e m atol 29: , ) N a ka m ura N, S uzu ki S, S eg am i H, N ozaw a Y, T om in ag a K, W achi E, H ojo H, A b e M, S a kum a H, W akasa H: Clinicopatholog ical and im m u nop he noty p ic stud ie s on 12 case s with B ce ll chronic ly m phocy tic le uk e m ia. P atholog y I nte rnational 44: , ) Ches on BD; Curre nt ap p roache s to the che m othe rap y of B ce ll chronic ly m phocy tic leu kem ia : A re v ie w. A m J H e m atol 32:72 77, ) O' Brien S, Gig lio A, K eating M : A dv ance s in the biolog y and tre atm e nt of B ce ll chronic ly m phocy tic le uk e m ia. B lood 85: , ) Orfao A, Gon za lez M, S an M ig uel JF, Rios A, Can izo M C, H erna ndez J, M a rica to M L, Borra sca A L: B ce ll ly m p hocy tic le uk ae m ia: P rog nostic v alue of the im m unophe noty p e and the clinicohae m atolog ical fe ature s. A m J H e m atol 31:26 31, ) Zippin C, Cutler S J, Reev es Jr. W J, Lum D : S urv iv al in chronic ly m p hocy tic le uk e m ia. B lood 42: , ) M olica S : P re g re ssion and surv iv al stu d ie s in e arly chronic ly m p hocy tic le u k e m ia. B lood 78: , ) Rai K R: Chronic ly m p hocy tic le uk e m ia In : H offm an R, Benz Jr EJ, S h attil S J, F urie B, Coh en H J: H e m atolog y, basic p rincip le s and p ractice 1st e d. p 990, N e w Y ork, C hurchill L ibing stone I nc

334 退溪學 과 儒敎文化第 55 號角說 에서는 뿔이 난 말과 고양이라는 기형의 동물을 소재로 하여 당대 정치 상 황을 비판하였고, 白黑難 에서는 선과 악을 상징하는 색깔인 白 과 黑 이 서로 벌이 는 문답을 통하여 옳고 그름의 가치관이 전도된 현실세

334 退溪學 과 儒敎文化第 55 號角說 에서는 뿔이 난 말과 고양이라는 기형의 동물을 소재로 하여 당대 정치 상 황을 비판하였고, 白黑難 에서는 선과 악을 상징하는 색깔인 白 과 黑 이 서로 벌이 는 문답을 통하여 옳고 그름의 가치관이 전도된 현실세 南坡洪宇遠 의 논설류 산문 연구 禹芝英 *1) 차 례. 서론. 친근한 소재를 통한 공감의 확대. 문답의 서술방식을 통한 논리성의 강화. 우언의 서술방식을 통한 현실 비판. 결론 국문초록 南坡洪宇遠 은 仁祖 에서 肅宗 연간에 활동한 문인 관료이다. 홍우원의 문집인 南坡集 은 시와 상소문이 대부분의 비중을 차지하고, 記說序 등의 산문