연부조직 종양에 관한 임상 및 병리조직학적 고찰

Abstract

[한글]

연부조직은 모두 조직학적으로 간엽성 조직으로 이루어져 있으나 각종 특수조직으로 분화되어 체내에 광범하게 분포되어 있으므로 이들에서 발생하는 종양들은 다양하면서도 성장양상이 유사하고 때로는 형태학적인 특이성이 결여되기도 한다. 따라서 연부조직종양을 조직학적으로 정확하게 진단하여 그 조직발생적 근거에 따라 분류하는 것이 반드시 용이한 일은 아니다. 최근 연부조직종양에 대한 연구가 활발하게 진행되어 괄목할만한 진전이 있었으나 우리나라에는 연부조직 종양에 대하여 그 임상적 및 병리조직학적 특이성을 파악할 수 있는 기초자료가 거의 없는 실정이다.

이에 저자는 1917년 1월부터 1977년 5월까지 만6년 5개월간 연세의료원 병리학교실에서 진단받은 연부조직종양 총502예를 대상으로 Stout와 Lattes(1966), Enzinher (1969), Shuman (1971) Ackerman 과 Rosai (1974)의 분류법을 기초로 재분류를 시도한 후 육안 및 현미경적 검사에 의하여 조직학적 검색을 하고 ,다양성 연부조직육종의 현미경적 감별진단에 도움을 주는 각종특수염색의 특이한 염색반응을 조사하여 그 의의를 검토하였으며, 임상기록 조사가 가능했던 예에서는 환자의 연령, 성별, 발생부위, 주소, 병력기간, 종괴의 크기, 다발성, 치료양식, 재발등의 임상소견을 비교 검토하였던바 그 결과를 요약하면 다음과 같다.

1.연부조직종양 총502예중 양성종양이 431예 (85.9%), 악성 조로 종양이 71예 (14.1%)로서 양성종양의 유병율이 약6배 높았다.

2. 양성종양에서는 지방종의 빈도가 가장 높았고 혈관종, 임파관종의순서였으며 악성종양은 섬유육종이 가장 많았고 다음 횡문근육종과 지방육종의 유병율은 동일했다.

3. 대체적으로 양성종양은 여자에, 악성종양은 남자에 많았다.

4. 양성종양의 연령분포는 전연령층에 걸쳐 비교적 일했으나 악성종양은 성인에 많은 분포를 보였다.

5 .양성종양은 대다수가 두경부와 뭄체에, 악성종양은 하지에 빈발했다.

6. 양성 및 악성종양의 종괴의 크기와 병력기간으로 미루어 악성종영의 진행이 양성에 비해 빠름을 알수 있었다.

7. 양성종양은 대부분 국소절제로 치유되었으나 악성종양은 광범위절제, 방사선 및 화학요법, 혼합요법등을 실시했다.

8.조직학적 진단에 있어서 각종 특수염색이 상당한 진단적 가치가 있었으나 기타 전자현미경,조직배양, 효소측정등의 방법이 요망된다.

[영문]

Soft tissues which are most widespread in body have common mesenchymal derivation and comprise a veriety of more differentiated specific and undifferentiated nonspecific types.

In general the cell types of the tumors of the soft tissue tend to closely resemble to a variable degree their prototype tissues. Howeverm often, because of their pleuripotentiality and common mesenchymal derivation they show wide morphological range and may present similar growth characteristics lacking in morpholigic individuality.

Therefore cpassification of soft tissue tumors on a histogenetic basis is not easily accomplished and controversy concerning the classification has existed for years.

Stout (1966), Enzinger (1969), Shuman (1971), Ackerman (1974) ettal have made valuable contribution to the understanding of many of the soft tissue tumors by a variety of the special diagnostic techniques which brought about great advances in

the classification and more accurate microscopic diagnosis of soft tissue tumors.

However, there is no comprehensive report on soft tissue tumors among Koreans based on clinical and histopathological aspects.

The present study is an attempt to refine classification of the soft tissue tumors, to investigate clinical-histopathological characteristics and diagnostic values of selective special stains which seem to be helpful in differential diagnosis.

Material and Method

The materials used in this study consisted of 502 cases of benign and maligant tumors of soft tissue origen for 6.5years period lasting from 1971 to 1977. The histopathological study was attempt by microscopic examination following gross inspection, and to investigate tinctorial characteristics of selective special stains.

For all cases of soft tissue tumors whose clinical records were available, age, sex, location, chief complaints, duration, size, multiplicity, therapeutic modality, recurrence were investigated.

Results and Summary

Based on clinical and histopathological studies of 502 cases of benign and malignant tumors, which were submitted to the Department of Pathology, Yonsei University, College of Medicine during the period of 6 years and 5 months from Jan., 1971 to May, 1977, following results are obtained.

1. Among 502 cases, 431 cases (85.9%) were benign and 71 cases (14.1%) were malignant, with ratio of approximately 6:1.

2. Lipoma was the most common benign soft tissue tumor, followed by hemangioma, lymphangioma, and neurilemoma. Among the malignant tumors fibrosarcoma was the most common, followed by liposarcoma, and Rhavdomyosarcoma.

3, The sex distirbution of benign tumors showed slight female preponderance (1.2:1), but that of the malignant tumors was about 3 times more common in males than in females.

4. The age of benign tumors was rather evenly distributed from childhood to advanced age, while the majority of malignant tumors developed in adult age group.

5. The predilections for the benign tumors were head, neck and trunk, while those of the malignant tumors were lower extremity and trunk. But the specific predilection sites differed according to the histological types.

6. The clinical course of malignant tumors was rapid compared to benign ones.

7. Most of the benign tumors were fairly well controlled by local excision, but for the malignant tumors therapeutic modalities such as wide excision, chemotherapy and radiotherapy were used.

8. The special stains provied great diagnostic aid, but other specific diagnostic techniques such as electron microscopy, tissue culture and enzyme study were desired to accomplish more accurate microscopic diagnosis.