한국인 피부종양에 관한 임상 및 병리조직학적 연구

Abstract

[한글]

피부는 태생학적으로 외배엽성과 중배엽성 성분의 상호작용으로 발생되며, 발생과정에 따라 그 구조가 복잡하며 신체부위에 따라 조직학적으로 서로 다르므로 피부에서 발생하는 종양들은 다른 기관에서 발생하는 종양에 비해 그 종류가 매우 다양하다. 따라서 피부종양을 조직학적으로 정확하게 진단하여 그 조직발생적 근거에 따라 분류하는 것이 용이하지 않은 경우가 많다. 최근 피부종양에 대한 연구가 활발하게 진행되어 괄목할 만한 진전이 있었으나 우리나라에는 피부종양에 대하여 그 임상적 및 병리 조직학적 특이성을 총괄적으로 파악할 수 있는 기초 자료가 부족한 실정이다.

이에 저자는 1971년 1월부터 1980년 12월까지 10년 동안 연세 의료원 병리학 교실에서 확진된 피부종양 1905예를 대상으로 Lever 및 Lever (1975), Andrade등 (1976), Pinkus 및 Mehregan (1981), WHO의 분류법 (Seldam등, 1974)을 기초로 재분류를 시도한 후 육안 및 현미경적 검사에 의하여 조직학적 검색을 하고 임상기록조사가 가능했던 예에서는 환자의 연령, 성별, 발생부위등의 임상소견과 비교하였던 바 그 결과를 요약하면 다음과 같다.

1. 피부종양 총 1905예 중, 피부 유종양이 172예 (9.0%), 양성 종양이 1369예 (71.9%), 전구암이 59예 (3.1%), 악성종양이 305예 (16.0%) 였다.

2. 대체적으로 양성 종양과 유종양은 여자에서, 악성 종양은 남자에 많았으며 전구암의 성멸 발생비율은 비슷했다.

3. 연령 분포상 유종양은 10대와 20대에서, 양성 종양은 20대에서 40대에 걸쳐서, 전구암은 40대에서 60대에 걸쳐서, 그리고 악성 종양은 50대와 60대에서 50%이상 분포했다.

4. 유종양에서는 비후성 반혼과 해족증 (케로이드, keloid)의 빈도가 가장 많았고 섬유 상피종(fibroepithelioma, soft fibroma, cutaneous tag), 지선 모반 (nevus sebaceous)의 순서였으며 양성 종양에서는 표피 낭종이 가장 많았고 모반 (모반 세포 모반, nevocel

lular nevus), 혈관종, 지방종의 순서였고, 전구암에서는 활성각화증 (광 각화증, actinic keratosis), Bowen씨 병, Queyrat씨 홍색비후증의 순서였으며 악성 종양에서는 편평상피세포암, 전이암, 악성 흑색종의 순서였다.

5. 양성 종양은 대다수가 두경부와 체간에, 악성 종양은 하지에 빈발했다.

A Clinical and Histopathological Study of the Skin Tumors among Koreans

Won Hee Choi, M.d.

Department of Medical Science The Graduate School Yonsei University

(Directed by Prof. Yoo Bock Lee, M.D)

The skin is, contrary to the ubiquitous concept, remarkably heterogenous organ.

The tumors (hamartomas, reactive and neoplastic) that occur In the skin are more

numberous than those produced by any other organ. Moreover, being visible,

accessible and commons, cutaneous tumors and tumorous lesions have attracted the

attension of dermatologist and pathologist since early times, and this accounts for

much confusion in terminology and classification. A variety of schemes has been

proposed, but there is no uniformity between different countries, but even within a

single country and between dermatologist, pathologist and surgeon. Recent progress

in this field, brought about by the use of histochemical and electron microscopic

methods, has either confirmed or denied many of the previous concepts about the

origin. Lever and Lever (1975) , Andrade et al(1976), Pinkus and Mehregan (198L),

Ackerman at aL(1981) and WHO (Seldamet al,1974) etc. have made valuable

contribution to the understanding of the skin tumors and tumorous lesions.

However, there is no comprehensive report on tumors and tumorous lesions of the

skin among Koreans based on clinical and histopathological aspects. The present

study is to evaluate types, frequencies, location, age and sex distribution of the

skin tumors and tumorous lesions among Koreans.

The materials used in this study consisted of 1905 cases of skin tumors and

tumorous lesions. The histopathological study was made by microscopic examination

fellowing gross inspection. For all cases of tumors and tumorous lesions of the

skin, whose clinical records were available were analysed. The analysis of 1905

cases of skin tumors and tumorous lesion disclosed following results;

1. Among 1905 cases, 172 cased (9.0%) were tumorous lesions, 1369 cases (71.9%)

benign tumors, 59 cases (3.1%) precancerous lesions, and 305 cases (16.0%)

malignant tumors.

2. The sex distribution of benign tumors and tumorous lesions showed slight

female preponderance (1:1.4 respectively), but that of the malignant tumors was

about 2 times more. common in male than female and that of the precancerous

lesions was about equal (1:1).

3. The peak age for tumorous lesions was distributed from 2nd to 3rd decade, for

benign tumors 3rd to 5th, for precancerous lesions 5th to 7th, and for malignant

tumors 6th and 7th decade.

4. Among the 172 cases of tumorous lesions, hypertrophic scar and keloid were the

most common, followed by soft fibroma (cutaneous tag), nevus sebaceous, and linear

epidermal nervus. Among the 1369 cases of benign tumors, epidermal cyst was the

most common, followed by nevus, hemangioma and lipoma.

Among the 59 cases of precancerous lesions, actinic keratosis was the most

common, fellowed by Bowen's disease, erythroplasia of Queyrat and leukoplakia.

Among the 305 cases of malignant tumors, epidermoid carcinoma was the most

common, followed by metastatic tumors and malignant melanoma.

5. In regard to the location of the lesions, the most predilection site was head

and neck in which 932 cases (48.9%) were observed followed by trunk and

extremities.

The most common tumors and tumorous lesions located on the head and neck, and

trunk was epidermal cyst, on the extremities was hemangioma, and on the external

genitalia was epidermoid carcinoma.

The predilections for the benign tumors were head and neck, and trunks, whil

those of the malignant tumors were lower extremity and trunk. But this specific

predilection sites differed according to the types of the lesion.

[영문]

The skin is, contrary to the ubiquitous concept, remarkably heterogenous organ.

The tumors (hamartomas, reactive and neoplastic) that occur In the skin are more numberous than those produced by any other organ. Moreover, being visible, accessible and commons, cutaneous tumors and tumorous lesions have attracted the attension of dermatologist and pathologist since early times, and this accounts for much confusion in terminology and classification. A variety of schemes has been proposed, but there is no uniformity between different countries, but even within a single country and between dermatologist, pathologist and surgeon. Recent progress

in this field, brought about by the use of histochemical and electron microscopic methods, has either confirmed or denied many of the previous concepts about the origin. Lever and Lever (1975) , Andrade et al(1976), Pinkus and Mehregan (198L), Ackerman at aL(1981) and WHO (Seldamet al,1974) etc. have made valuable

contribution to the understanding of the skin tumors and tumorous lesions.

However, there is no comprehensive report on tumors and tumorous lesions of the skin among Koreans based on clinical and histopathological aspects. The present study is to evaluate types, frequencies, location, age and sex distribution of the

skin tumors and tumorous lesions among Koreans.

The materials used in this study consisted of 1905 cases of skin tumors and tumorous lesions. The histopathological study was made by microscopic examination fellowing gross inspection. For all cases of tumors and tumorous lesions of the skin, whose clinical records were available were analysed. The analysis of 1905 cases of skin tumors and tumorous lesion disclosed following results;

1. Among 1905 cases, 172 cased (9.0%) were tumorous lesions, 1369 cases (71.9%) benign tumors, 59 cases (3.1%) precancerous lesions, and 305 cases (16.0%) malignant tumors.

2. The sex distribution of benign tumors and tumorous lesions showed slight female preponderance (1:1.4 respectively), but that of the malignant tumors was about 2 times more. common in male than female and that of the precancerous lesions was about equal (1:1).

3. The peak age for tumorous lesions was distributed from 2nd to 3rd decade, for benign tumors 3rd to 5th, for precancerous lesions 5th to 7th, and for malignant tumors 6th and 7th decade.

4. Among the 172 cases of tumorous lesions, hypertrophic scar and keloid were the most common, followed by soft fibroma (cutaneous tag), nevus sebaceous, and linear epidermal nervus. Among the 1369 cases of benign tumors, epidermal cyst was the most common, followed by nevus, hemangioma and lipoma.

Among the 59 cases of precancerous lesions, actinic keratosis was the most common, fellowed by Bowen's disease, erythroplasia of Queyrat and leukoplakia.

Among the 305 cases of malignant tumors, epidermoid carcinoma was the most common, followed by metastatic tumors and malignant melanoma.

5. In regard to the location of the lesions, the most predilection site was head and neck in which 932 cases (48.9%) were observed followed by trunk and extremities.

The most common tumors and tumorous lesions located on the head and neck, and trunk was epidermal cyst, on the extremities was hemangioma, and on the external genitalia was epidermoid carcinoma.

The predilections for the benign tumors were head and neck, and trunks, whil those of the malignant tumors were lower extremity and trunk. But this specific predilection sites differed according to the types of the lesion.