Extrapleural Pneumonectomy for the Anterior Mediastinal Liposarcoma with Invasion of Pleura and Lung -1 case report -

흉막 및 폐를 침범한 전종격동 지방육종에서의 흉막외 폐전적출술 - 1예 보고 -

  • 박천수 (서울대학교병원 흉부외과, 서울대학교 의과대학 흉부외과학교실, 서울대학교병원 임상의학연구소) ;
  • 김영태 (서울대학교병원 흉부외과, 서울대학교 의과대학 흉부외과학교실, 서울대학교병원 임상의학연구소) ;
  • 성숙환 (서울대학교병원 흉부외과, 서울대학교 의과대학 흉부외과학교실, 서울대학교병원 임상의학연구소) ;
  • 김주현 (서울대학교병원 흉부외과, 서울대학교 의과대학 흉부외과학교실, 서울대학교병원 임상의학연구소)
  • Published : 2004.03.01

Abstract

Mediastinum is a very rare primary site of liposarcoma. In general, wide surgical excision with adequate resection margin is the treatment of choice for lipesarcoma. We experienced a case of liposarcoma in a 24 year-old male who complained of dyspnea and chest discomfort. Symptoms had been developed a month before admission, and the intensity had been gradually increased. He visited another general hospital, and there he received left closed thoracostomy because hemothorax was suspected. Afterwards, he was transferred to our hospital without a specific diagnosis, on review of outside chest computed tomography film, mass shadow was detected in the mediastinum. For the further evaluation, we checked the chest sonography and chest magnetic resonance imaging. MRI showed 10 cm sized mass contacted with pulmonary artery trunk and left main pulmonary artery. The radiologist strongly suggested sarcoma. On the 4th day after admission, we performed emergent exploratory left thoracotomy for hematoma evacuation because mediastinal shifting progressed and heart rate was increased. Biopsy confirmed that the evacuated materials were extraskeletal myxoid chondresarcoma, so we performed extrapleural left pneumonectomy including diaphragm and a part of the pericardium. The final pathologic diagnosis was myxoid/round cell liposarcoma. He was discharged without complication and systemic chemotherapy was scheduled to begin 2 month later. During chemotherapy, local recurrence and peritoneal metastasis developed, and he died 10 month after the surgical excision. We report this case with reviewal of literature.

원발성 지방육종은 종격동에서 매우 드물게 발생하는 악성 종양으로 수술적 절제가 가장 효과적인 치료로 알려져 있다. 24세 남자 환자가 1개월 전부터 시작된 호흡곤란과 흉부 불편감으로 타 병원에서 좌측 혈흉을 의심하여 좌측 흉관삽관술을 시행받았다. 본원 입원 후 흉부 단순촬영에서 종격동 편위소견을 보였고 빈맥이 진행하였으며, 중심정맥압이 상승하는 양상보여 진단 및 혈괴제거를 위해 응급으로 좌측 개흉술을 시행하여 다량의 점액성의 혈성 흉수를 제거하였고, 조직검사 결과 골격계외 점액성 연골육종으로 진단되었다. 2주 후 좌측 개흉술로 횡격막 및 심낭의 일부를 포함하는 흉막외 좌측 전폐적출술과 함께 종격동 종양을 절제하였다. 조직검사에서 점액성/원형세포 지방육종으로 진단되었으며, 입원 54일만에 합병증 없이 퇴원하였다. 술 후 2개월째 1회의 항암화학요법(Ifosfamide+Adriamycin: IA) 후 종격동, 좌측 견갑골 부위 및 종격동 임파선에 재발하여, 약제를 바꾸어 (Etoposide+Ifosfamide+Cisplatin: VIP) 항암화학요법을 시행하였으나 복강전이로 술 후 10개월째 사망하였다. 종격동에 발생하는 원발성 지방육종은 매우 드문 질환으로 수술적 절제 및 항암요법 후 추적관찰한 1예를 문헌고찰과 함께 보고하는 바이다.

Keywords

References

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