두개강내 전이를 동반한 Adenoid Cystic Carcinoma의 다발성 전이
Multiple Metastases of the Adenoid Cystic Carcinoma Associated with Intracranial Metastasis
박봉진, 이길호, 김형지, 이길호,
소속 상세정보
박봉진 ( )
단국대학교 의과대학 신경외과학교실
이길호 ( )
단국대학교 의과대학 신경외과학교실
김형지 ( )
단국대학교 의과대학 신경외과학교실
이길호 ( )
단국대학교 의과대학 신경외과학교실
KMID : 0359819990280091348
Abstract
서론
Adenoid cystic carcinoma는 타액선이나 상기도, 누선 및 외이도에 발생되는 악성 종양으
로 발생 빈도는 타액선 종양의 4∼15%, 타액선에 발생되는 악성 종양의 25∼31%, 두경부
종양의 1%를 차지한다. 이 종양의 두개강내 전이는 4∼22%의 발생 빈도를 보이며, 전이 경
로는 직접 침범 (direct extension)과 신경 경로를 따라 전이되는 perineural spread 그리고
혈류를 따라 전이되는 혈행성 전이 등이 있다. 이 종양은 특징적으로 서서히 진행되는 성종
양으로 국소 재발과 혈행성 전이로 인해 5년 생존율과 10년 생존율이 각각 60%와 40%이
다. 최근 본병원에서는 외이도에서 발생한 adenoid cystic carcinoma의 두개강내 전이 및 폐
와 골(bone),그리고 간에까지 다발성으로 전이되었던 환자를 수술 및 방사선 치료와 항암
화학요법으로 치료 경험하였기에 문헌고찰과 함께 보고하고자 한다.
#초록#
Objective : Adenoid cystic carcinoma is a relatively slowly growing malignant tumor.
Probably at 1east 40-50% of patients eventually develop distant metastases. We present
the natural history and treatment modality of this malignancy from our experience and
review of literature.
Methods : We report a case of a 30-year-old man who complained of a headache,
facial pain and hearing disturbance in the right ear. Physical examination revealed soft
protruded mass and narrowed external auditory canal. The cranial MRI showed a well
defined mass in the extradural middle cranial fossa.
Result : The patient underwent subtotal resection of the lesion after tumor
embolization was performed. The pathological diagnosis was adenoid cystic carcinoma.
The patient received postoperative radiation therapy(56Gy) resulting in a complete
neurological recovery. Fifteen months later. the patient was readmitted for severs back
pain. Bone scan disclosed hot uptakes at the upper cervical spine, the 4th lumbar
vertebra, and the pelvic area. These areas were irradiated(40Gy) and the presenting
symptoms were relieved. Twenty months later he complained of respiratory difficulty
and was found to have a multiple nodule(s) in the lung. He was given 10 cycles of
chemotherapy but discharged because of unresponsivencess and development ol new
lesions. Brain MRI and bone scan ware checked 10 months alter his discharge due to
more aggravated lung metastasis although local tumor was controlled. Adjuvant radiation
Therapy(18Gy) was performed and he continued to bs functional independently, although
he was no longer working as a registered nurse. Two months later. dyspnea and
hemoptysis were more improved and chest X-ray showed decreased mass. During the
follow up period, he complained of intercostal pain, chest X-ray showed more
aggregated lung mass. Chest CT scan showed multiple lung metastases and liver
metastasis. In spits of adjuvant radiotherapy, the patient died of multiple systemic
metastases 47 months alter the first operation.
Conclusion : Surgery is essential in the treatment of adenoid cystic carcinoma.
Radiotherapy has gained acceptance as a palliative therapy, as it reduces tumor bulk and
relieves symptoms. The combined treatment do not, however. prevent further recurrence
and distance metastasis.
키워드
Adenoid cystic carcinoma; Perineural spread; Metastasis;
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