후두악성종양의 병리학적 검색
Pathological Study of Malignant Tumors of Larynx
김영민, 함의근,
소속 상세정보
김영민 ( )
서울대학교
함의근 ( )
서울대학교 의과대학 병리학교실
KMID : 0357919860200030313
Abstract
요약 및 결론
1976년 1월부터 1985년 12월까지 만 10년 동안 서울대학교병원에서 생검 또는 절제로 확
진된 후두악성종양 359예 (87예 절제)를 대상으로 병리학적 검색을 시행하고 임상 기록을
검토하여 다음과 같은 결론을 얻었다.
1) 총 359예 중 원발성 악성종양 356예, 전이성 악성 종양 3예였으며, 원발성은 편평상피
세포암종이 348예(97.8%)이고, 우상암종, 악성림프종 및 미분화암종 각 2예, 선상낭성암종
및 육종 각 1예였으며, 전이성은 신세포암종, 악성신경초종, 식도편평상피세포암종 각 1예였
다.
2) 원발성 편평상피세포암종의 남녀비는 7.8 : 1, 발생 평균연령 58.2세(35∼87fl)이었고, 부
위에 따른 발생분포는 성문상부(54.1%)에서 제 일 높았으며, 성문부, 경성문부, 성문하부의
순서였으며, 조직 병리학적으로 고분화도(72.7%)가 대부분이며 중분화도, 저분화도의 순이었
고, 종양등급(Stage)Ⅲ, Ⅳ가 많았고 Ⅰ, Ⅱ가 적었으며, 성문상부 종양이 성문부 종양보다
종양등급이 비교적 높았다.
3) 원발성 편평상피세포암종의 주소(chief complaint)에서 애성(hoarseness)이 종양발생 부
위에 관계없이 가장 많았고, 성문상부 발생 예에서 애성 외에 경부 불쾌감, 경부종괴, 동통,
호홉곤란, 연하곤란, 이물감의 순서로 다양하게 나타났으며, 첫 증상 후 내원 기간은 평균 7
34개월이고 그 중 3개월 이하가 45.5%이었다.
4) 원발성 편평상피세포암종으로 외과적 후두 절제한 87예에서 육안 형태는 궤양돌출형
49.4%, 궤양침습형 47.1%, 편평형 3.5%였으며, 종괴의 크기는 1.5cm이하 30%, 1.6cm이상
70%였고, 침습 정도는 후두점막하까지 침습한 예가 가장 많았고, 후두 연골, 후두골격근, 주
위 연부조직까지 침습의 순서로 많았다. 이 87예 중 림프절 절제를 수반한 65예 에서 25예
(38.5%)가 림프절 전이를 보였고, 종양 발생부위에 따라 전이를 분석하면 성문상부, 경성문
부, 성문하부(50∼60%)가 많았고 성문부는 적었으며, 육안 형태에 따라 보면 궤양침습형
(47.1%)이 가장 많았고 편평형은 없었으며, 종괴의 크기가 클수록 전이도가 높았고 분화도
가 나쁠 수록 전이도가 높음을 보였다.
5) 흡연력이 확인된 140예 중 8예(5.7%)의 비흡연군을 제외한 흡연군의 흡연량 평균이
35.39갑-년였으며,20∼40갑-년이 57.2%를 차지하였다.
6) 후두악성종양에서 원격 전이 한 8예 는 모두 편평 상피 세포암종이었으며 폐, 뇌, 간,
척추의 순이었고 폐와 뇌에 동시에 전이된 3예가 있었다. 후두 편평상피세포암종에서 병발
성 악성종양을 가진 8예가 있었는데, 폐암 5예, 위암 2예, 췌장암 1예 및 갑상선암 1예로, 그
중 1예에서는 후두암, 폐암 및 위암의 삼중 병발도 있었다.
7) 치료 후 6-53개월(평균 25.8개월)경과 추적한 115예에서, 재발이나 전이 없이 살고 있
었던 예가 62예(53.9%)였고, 치료 후 재발은 2∼34개월 (평균 12.0개월)에 나타났으며, 재발
혹은 원격전이가 확인된 다음 추적지 중단되거나 사망이 확인된 예가 46.1%였다.
#초록#
A total of 359 cases of malignant tumors of the larynx(including 87 resected cases)
obtained from the pathology file of the Department of Pathology, College of Medicine,
Seoul National University during a period of 10 years from 1976 to 1985 were studied
by histopathologic and gross investigation with analysis of clinical records, with
following results.
1) Out of 359 cases, 356 cases were primary and 3 cases were metastatic. The
primary malignant tumors consisted of 348 cases (97.8%) of squamous cell carcinoma,
each 2 cases of verrucous carcinoma, malignant lymphoma and undifferentiated
carcinoma, a case of adenoid cystic carcinoma and a case of unclassified sarcoma. The
metastatic malignant tumors were each one case of renal cell carcinoma, malignant
schwanoma and esophageal squamous cell carcinoma.
2) In primary squamous cell carcinoma, the ratio of male to female was 7.8:1 and
mean age was 58.2 years(35-87 years). The location was in order of the supraglottic
(54.1%), the glottic (25.0%),the transglottic (18.0%), and the subglottic (2.9%). The
degree of histologic differentiation was in order of well (72.7%), moderate(23.6%) and
poor(3.7%). The tumor stage was stage I in 7.8% of cases, Stage Ⅱ 19.7%, stage Ⅲ
38.5%, and stage Ⅳ 34.0% , and the supraglottic tumors were relatively higher grade
than the glottic tumors.
3) The chief complaints of the primary squamous cell carcinoma were mostly
hoarseness (70.9% in total case, 49.2% in the supraglottic, 90.9% in the transglottic, and
100% in the glottic and the subglottic), and were variable in the supraglottic cases in
order of sore throat, neck mass, throat pain, dyspnea, swallowing difficulty, and foreign
body sensation. The duration from the time of first symptom to vistiation was average
7.34 months and was less than 3 months in 45.6% of cases, and showed two peaks,
major in 1-2 months and minor in 10-12 months.
4) In the 87 rejected cases of primary squamous cell carcinoma, the gross pattern was
the ulcerofungating type in 49.4% of cases, the ulceroinfiltrative in 47.1% and flat in
3.5%. The size of tumor was up to 1.5 cm in 30% of cases and more than 1.6 cm in
70%. The extent of invasion was to the submucosa in 40.7% of reseated cases, to the
laungeal skeletal muscle(5) 16.3%, to the laryngeal cartilage(s)33.7%, to the perilaryngeal
soft tissue 9.3% .
In the 65 cases of lymph node dissection out of these 87 cases,25 cases (38.5%)
showed metastatic lesion(5). With relation to tumor location, lymph node metastases
were frequent in the supraglottic, the transglottic and the subglottic region (50-60%) and
less common in the glottic region (13.8%). With relation to gross pattern, the metastases
were most frequent in ulceroinfiltrative type and none in flat type. And the metastasis
rate was increased according to the increase of the tumor size and to the decrease of
the tumor differentiation.
5) Smoking history in 140 recorded cases revealed only 8 nonsmokers and average
35.39 pack-years of cigarettes in smoker group with peak in 20-40 pack-years(57.2%).
6) Distant metastases were found in 8 cases. The organs were the lung in 5 cases,
brain 4 cases, liver 1 case (Three cases were positive in two foci, the lung and the
brain). The coexistant primary malignant tumors were found in 8 cases which were 5
bronchogenic squamous cell carcinomas, 2 gastric adenocarcinoma, 1 pancreatic head
adenocarcinoma and 1 thyroid papillary carcinoma (Triple primary cancers in one case,
of the larynx, the lung and the stomach).
7) Follow, up of 6-53 months (mean 25.8 months) in 115 cases resulted in NED in 62
cases (53.9%) and expired or loss of follow, up after recurrence or distant metastasis in
53 cases (46.1%). The recurrence was detected in 2-34 months (average 12.0 months)
after treatment.
키워드
원문 및 링크아웃 정보
등재저널 정보