종격동내 종양 및 유종양의 임상 및 병리조직학적 고찰

Abstract

[한글]

종격동은 외측으로 흉골, 척골, 제1늑골과 횡경막으로 구획되며, 내측으로는 양측 폐장을 제외한 흉막강 사이의 공간으로서 주요 순환기, 신경조직 및 흉선, 임파절 등의 여러 조직을 포함하고 있다. 이곳에는 원발성 혹은 속발성 종양, 낭종 및 염증성 병변이 발생할 수 있는데 조직학적 분류에 따라 일정한 부위에 호발하는 경향을 가지고 있다. 따라서 종격동에 발생한 병변을 진단하는데 있어서 종양의 발생 부위 및 하 자의 임상적인 소견은 매우 중요하다. 이에 저자는 종격동내 병변의 양상과 부위별 호발 종괴의 빈도등을 조사하고 조직학적 분류를 시도하여 외과병리분야에서 중요한 사항을 조사·연구하였다.

1. 종격동내 종양 및 유종양성 병변 95예 중 원발성 종양이 70예(73.6%), 속발성 종양이 13예 (13.6%), 유종양성 병변이 12예 (12.8%)로서 원발성 종양이 가장 많았다.

2. 원발성 종양 70예 중 양성종양이 53예 (75.7%), 악성종양이 14예 (20%)였고 분류할 수 없는 미확인 종양이 3예로 양성종양이 악성이 비해 3.8:1의 높은 빈도를 보였다.

3. 원발성 종양의 조직학적 유형을 보면 총 70예 중 생식세포 종양 27예(28.4%), 신경계종양 22예(23.1%), 흉종 7예(7.3%), 임파종 6예(6.3%), 연부조직 종양 5예(5.3%)로서 생식세포 종양이 가장 많았으며 생식세포종양과 신경계종양이 전체의 50% 이상을 차지하

였다.

4. 성별 분포를 보면 양성종양은 남·여 비율은 4.2:1로 남자에 현저히 많았다.

5. 부위에 따른 종양의 빈도를 살펴보면 전 종격동에는 생식세포종, 흉선종, 임파종의 순서였으며 상 종격동에는 속발성 종양이 가장 많았고 생식세포 종양과 신경계 종양의 분포는 비슷하였으며 연부조직 종양도 2예 발생하였다. 중 종격동에는 증례수는 적었으나 속발성 종양과 발생낭종이 우위를 보였으며 후 종격동에서는 신경계 종양이 현저히 많았다.

6. 양성종양의 크기는 5-10cm인 것이 55.7%로 가장 많았고 2.5-5cm인 것과 10-15cm인 것도 각각 약 20%를 점하였다. 그러나 2.5cm이하의 크기를 가진 것과 15cm이상의 크기를 가진 것은 각각 5% 미만에 불과했다. 그리고 악성종양에서는 81.8%가 10cm이상의 크기를

가지고 있어 양성종양보다 대체적으로 큰 것을 알 수 있었다.

7. 양성종양의 경우 환자들은 증상이 없거나 미약한 흉부 압박감, 호흡곤란, 흉통, 견갑통 및 연하곤란을 호소하였으나 악성종양의 경우에는 상기한 증상 외에 체중감소, 발열, 전신허약감 등의 전신증세를 호소하였다.

Histopathologic Study of the Mediastinal Tumors and Tumor-like Condition

Kyu Rae Kim

Department of Medical Science

The Graduate School, Yonsei University

(Directed by Prof. In Joon Choi)

The mediastinum is bounded by the sternum, vertebra, 1st rib, and diaphragm

externally and by pleural cavity excluding both lungs internally and includes

important structures such as great vessels, nerves, thymus and many lymph nodes.

Primary and metastatic cancers, cysts and inflammatory lesions can be developed in

this region, and the tumor developing in the mediastinum has a tendency to develop

in a specific area of mediastinum depending on the histologic type. Therefore the

developing site of tumor and the clinical findings are very important in diagnosing

the tumor of the mediastinum.

We studied not only the characteristics of mediastinal tumor and tumor-like

conditions but the histologic classification and the frequency of mass to a

specific area and then observed if there is any nformation that could be help in

diagnosis of the lesion of the mediastinum.

Results obtained were as follows:

1. Of the 95 caes of mediastical which excluded inflammatoty. process, there were

70 cases(73.6%), of primary tumors, 13 cases (13.6%) matastatic tumors and 12 cases

(12.8%) of tumor-like conditions.

2. Of the 70 cases of primary tumor, 54 caes(76.8%) were benign, 13 cases(20%)

malignant and 3 cases unclassified or unidentified tumor with the overall 3.8:1

prevalence rate of benign tumor compared to malignancy.

3. Histologic classification of the 70 cases of primary tumor showed 27

cases(28.4%) of germ cell tumor, 22 cases (23.1%) fo neurogenic tumor, 7 cases

(7.3%) of thymoma, 6 cases (6.3%) of lymphoma and 5 cases(5.3%) of soft tissue

tumors with the highestfrequency of germ cell tumor. Germ cell and neurogenic

tumors exceeded 50% of total primary mediastinal tumors.

4. Male to female prevalence rate showed that benign tumor had a high frequency

in female with the ratio of 1:1.4, but malignant tumor showed much higher frequency

in male with the ratio of 4.2:1.

5. Anterior mediastinum had germ cell tumor, thymoma and lymphoma in order of

frequency. Metastatic tumor was the most common insuperior mediastinum. Superior

mediastinum had germ cell tumor and neurogenic tumor with about equal number, and

soft tissue tumor was also developed.

Middle mediastinal tumor was less common compared to other portions of

mediastinum but the majority of tumors developed was developmental cysts and

metastatic tumors. And the majority of neurogenic tumors occured in the posterior

mediastinum.

6. Lesions sized 5-10 cm in diameter were about 55.7% of all benign tumors, 2.5-5

cm and 10-15 cm were about 20% respectively. But the mass sized smaller than 2.5 cm

and larger than 15 cm were about 3% respectively.

And the malignant tumors have more larger size than the benign tumors.

7. Patients with a benign tumor had no symptoms at all or some complaints of

chest tightness, dyspnea, chest pain, shoulder pain and dysphagia. Patients with a

malignant tumor complained of systemic symptoms such as weight loss and fever in

addition to above symptoms.

[영문]

The mediastinum is bounded by the sternum, vertebra, 1st rib, and diaphragm externally and by pleural cavity excluding both lungs internally and includes important structures such as great vessels, nerves, thymus and many lymph nodes. Primary and metastatic cancers, cysts and inflammatory lesions can be developed in this region, and the tumor developing in the mediastinum has a tendency to develop in a specific area of mediastinum depending on the histologic type. Therefore the

developing site of tumor and the clinical findings are very important in diagnosing the tumor of the mediastinum.

We studied not only the characteristics of mediastinal tumor and tumor-like conditions but the histologic classification and the frequency of mass to a specific area and then observed if there is any nformation that could be help in diagnosis of the lesion of the mediastinum.

Results obtained were as follows:

1. Of the 95 caes of mediastical which excluded inflammatoty. process, there were 70 cases(73.6%), of primary tumors, 13 cases (13.6%) matastatic tumors and 12 cases (12.8%) of tumor-like conditions.

2. Of the 70 cases of primary tumor, 54 caes(76.8%) were benign, 13 cases(20%) malignant and 3 cases unclassified or unidentified tumor with the overall 3.8:1 prevalence rate of benign tumor compared to malignancy.

3. Histologic classification of the 70 cases of primary tumor showed 27 cases(28.4%) of germ cell tumor, 22 cases (23.1%) fo neurogenic tumor, 7 cases (7.3%) of thymoma, 6 cases (6.3%) of lymphoma and 5 cases(5.3%) of soft tissue tumors with the highestfrequency of germ cell tumor. Germ cell and neurogenic

tumors exceeded 50% of total primary mediastinal tumors.

4. Male to female prevalence rate showed that benign tumor had a high frequency in female with the ratio of 1:1.4, but malignant tumor showed much higher frequency in male with the ratio of 4.2:1.

5. Anterior mediastinum had germ cell tumor, thymoma and lymphoma in order of frequency. Metastatic tumor was the most common insuperior mediastinum. Superior mediastinum had germ cell tumor and neurogenic tumor with about equal number, and soft tissue tumor was also developed.

Middle mediastinal tumor was less common compared to other portions of mediastinum but the majority of tumors developed was developmental cysts and metastatic tumors. And the majority of neurogenic tumors occured in the posterior mediastinum.

6. Lesions sized 5-10 cm in diameter were about 55.7% of all benign tumors, 2.5-5 cm and 10-15 cm were about 20% respectively. But the mass sized smaller than 2.5 cm and larger than 15 cm were about 3% respectively.

And the malignant tumors have more larger size than the benign tumors.

7. Patients with a benign tumor had no symptoms at all or some complaints of chest tightness, dyspnea, chest pain, shoulder pain and dysphagia. Patients with a malignant tumor complained of systemic symptoms such as weight loss and fever in addition to above symptoms.