석회화 활막육종 1예
Calcifying Synovial Sarcoma
소속 상세정보
조남복/Nam Bok Chog
이태진/김미경/송계용/박용욱/Tae Jin Lee/Mi Kyung Kim/Kye Yong Song/Yong Wook Park
KMID : 0357919950290040536
Abstract
활막육종은 젊은 성인의 무릎관절 주변의 연부조직에서 주로 발생하는 비교적 드문 악성종
양으로 비교적 서서히 성장하며 방추헝세포와 선상의 분화가 동시에 또는 한가지만 관찰되
는 이상성(biphasic) 또는 단상성(monophasic)의 형태로 관찰되는 것이 특징이다. 병리조직
학적으로 이상성인 경우에는 진단이 비교적 쉬우나 단상성인 경우는 진단이 섬유육종, 악성
신경초종, 평활근육종 등과 감별해야 하므로 EMA나 cytokeratin 등의 면역조직화학적 방법
과 전자현미경이 도움을 주는 것으로 되어있다. 그러나 EMA와 cytokeratin에 대한 면역조
직화학적반응이 확실하지 않으면 전자현미경소견이 중요한 진단적 기준이 될 수밖에 없다.
본 증례는 심한 석회화를 동반한 단상성의 활막육종 1예를 경험하여 보고하는 바이다.
#초록#
A case of calcifying synovial sarcoma, occuring in the deep muscle fascia of the left
thigh is reported. The presence of extensive calcification in synovial sarcoma is a
favorable sign for prognosis. The patient was a 31-year-old female. The tumor mass
had been present for 3 years, accompanying local tenderness. X-ray revealed a soft
tissue tumor with central calcification, which was located between the adductor magnus
and brevis of the left thigh. The tumor size was 7×5.5 cm. There was no connection
with the flee joint or the femur. Grossly, the tumor was a relatively well circumscribed
hard tumor with massive calcification.
Microscopically, the tumor was composed of predominantly spindle cells with
accompanying hyalinization, numerous spherical concretions and ossification. The
epithelial component was not clearly noted. Mitotic figures were rarely noted in the
densely cellular area. Immunohistochemical staining for EMA, S-100, vimentin, and
carcinoembryonic antigen was negative while vimentin and cytokeratin were weakly and
focally positive. EM study revealed multiple desmosome-like intercellular junctions with
a slit-like lumen and an incomplete basal lamina, which suggest that these cells were
undergoing epithelial differentiation. Above evidence suggest that this tumor is a
synovial sarcoma associated with a large area of calcification, a so called calcifying
synovial sarcoma. No recurrence was noted in one and half years of follow up.
키워드
Synovial sarcoma; Calcification; Calcifying Synovial sarcoma;
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