운방의 전형적 수질암의 임상
Clinical Analysis of Typical Medullary Carcinoma of the Breast
대한암학회지 1998년 30권 1호 p.113 ~ 118
소속 상세정보
최규환/Kyu Hwan Choir
노우철/백남선/문난모/방호윤/최동욱/이종인/문선미/Woo Chul Nohi/Nam Sun Paiki/Nan Mo Moonr/Ho Yoon Bang/Dong Wook Choi/Jong lnn Lee/Seon Mi Moon
KMID : 0360319980300010113
Abstract
서론
유방의 흔하지 않은 암종인 수질암(medullary carcinoma)의 발생빈도는 전체 유방암의
2.0∼8.0%로 보고되고 있다. 유방의 수질암은 1949년 Moore와 Foote등에 의해 처음 기술된
이후 조직병리학적 정의에 많은 논란이 있어 왔으나 현재는 1977년 Ridolfi등에 의해 전형적
인 수질암은 75% 이상의 합포체형 성장유형(syncytial grow-th pattern), 현미경상 완전히
구분되어지는 경계를 가지는 암종, 중증도 혹은 고도의 단핵구의 기질침윤, 1 혹은 2단계
(grade)의 핵의 분화도를 가지고 유관성분(intraductal component)이나 미세 선형
(microglandular feature)이 없는 암종으로 정의되고 있다. 수질암의 호발 연령은 40∼55세로
보고되고 있으며 같은 기의 다른 유관암보다 비교적 좋은 예후를 갖는 것으로 되어 있으나
정의의 차이에 따라 생존율의 유의한 차이를 보이지 못한 보고도 있다. 저자들은 Ridolfi등
에 의한 정의에 따라 전형적인 수질암으로 진단 받고 치료한 15명의 환자에 대해 발생빈도,
호발연령, 임상적 특성, 호르몬 수용체상태, 림프절 전이 유무, 치료 방법 및 예후에 대한 임
상분석을 후향적으로 시행하여 문헌 고찰과 함께 보고하는 바이다.
Purpose : Medullary carcinoma of the breast is an uncommon subtype of infiltrating
ductal carcinoma and its incidence in different series ranges between 2% and 8% of all
breast cancers. The histopathologic criteria for medullary carcinoma of the breast used
by most pathologists today were delineated by Ridolfi et at. in 1977 The criteria of
typical medullary carcinoma include all of followings: 75% or more of syncytial growth
pattern, microscopically completely circumscribed, no intraductal component, moderate to
marked diffuse mononuclear stromal invasion, nuclear grade 1 or 2. Medullary carcinoma
has a more favorable prognosis than usual invasive breast cancer.
Materials & Methods : To determine clinical characteristics of this tumor, the medical
records of 15 women with typical medullary carcinoma treated at KCCH between 1985
and 1996 were reviewed retrospectively.
Results : The incidence of typical medullary carcinoma in KCCH was 0.51%(15/2946)
of all breast cancers. Age ranged from 27 to 56 years and mean age was 40.1 years.
The peak age group was 4th decade(46.6%), followed by 5 th decade(40%). Most of the
patients were premenopausal status(14/15). The major clinical manifestation of all
patients was a palpable mass. Twelve patients were investigated for ER status, but all
were negative. Preoperative fine needle aspiration cytology was checked in 6 patients, all
cases showed positive findings for malignancy. The mean size of tumor was 3.01 cm in
diameter and the rate of lymph node positivity was 40%(6/15). There was one case of
systemic recurrence at 38 months after operation and the patient expired at 3 months
after detection of recurrence. The others were alive without evidence of disease for
mean follow-up period of 64.7 months.
Conclusions : The mean age of the patients of medullary carcinoma was relatively
younger than that of the patients with other usual invasive breast cancer. The incidence
of medullary carcinoma in this study was slightly lower than western series. Medullary
carcinoma showed good prognosis, even if estrogen receptors were negative, but to
determine clinical characteristics of Korean medullary carcinoma of the breast,
multicenter data should be collected.
키워드
Breast; Typical medullary carcinoma;
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