Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
권호 표지

Diagnosis and Treatment of Primary Mediastinal Tumors and Cysts - Forty-two years report in a University Hospital -

원발성 종격동 종양 및 낭종의 진단과 치료 -단일 대학병원에서의 42년 보고-

  • Park, Moo Suk (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Chung, Kyung Young (Department of Cardiovascular and Thoracic Surgery, Yonsei University College of Medicine) ;
  • Kim, Kil Dong (Department of Cardiovascular and Thoracic Surgery, Yonsei University College of Medicine) ;
  • Lee, Hong Lyeol (Department of Internal Medicine, Inha University College of Medicine) ;
  • Chung, Jae Ho (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Hahn, Chang Hoon (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Moon, Jin Wook (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Kim, Young Sam (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Shin, Dong Hwan (Department of Pathology, Yonsei University College of Medicine) ;
  • Kim, Se Kyu (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Kim, Hyung Joong (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Chang, Joon (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Ahn, Chul Min (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Kim, Sung Kyu (Department of Internal Medicine, Yonsei University College of Medicine)
  • 박무석 (연세대학교 의과대학 내과학교실) ;
  • 정경영 (연세대학교 의과대학 흉부외과학교실) ;
  • 김길동 (연세대학교 의과대학 흉부외과학교실) ;
  • 이홍렬 (인하대학교 의과대학 내과학교실) ;
  • 정재호 (연세대학교 의과대학 내과학교실) ;
  • 한창훈 (연세대학교 의과대학 내과학교실) ;
  • 문진욱 (연세대학교 의과대학 내과학교실) ;
  • 김영삼 (연세대학교 의과대학 내과학교실) ;
  • 신동환 (연세대학교 의과대학 병리학교실) ;
  • 김세규 (연세대학교 의과대학 내과학교실) ;
  • 김형중 (연세대학교 의과대학 내과학교실) ;
  • 장준 (연세대학교 의과대학 내과학교실) ;
  • 안철민 (연세대학교 의과대학 내과학교실) ;
  • 김성규 (연세대학교 의과대학 내과학교실)
  • Published : 2004.01.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background : The diagnostic and therapeutic approaches to mediastinal tumors and cysts have changed over the past three decades. This report summarizes our forty-two years of experience with these tumors. Methods : This study retrospectively reviewed 479 patients with primary mediastinal tumors and cysts that were diagnosed and managed over the past 17-year period (1985~2002) and compared them to the report of the previous 25-year result (1960~1985) in Yonsei University College of Medicine, Severance Hospital in Seoul, Korea. Results : During the 17 years, there were 479 cases of pathologically proven mediastinal tumors and cysts. Thymoma (38.2%) was the most common mediastinal tumor and has increased noticeably during recent years. The gender ratio showed a male predominance (1.3:1) and the age distributions were even over all the age groups. The most common sites of the tumor and the proportion(28.6%) of malignant tumors were the same as that previously reported. A diagnosis of a tumor in asymptomatic patients was possible in 174 cases (36.3%), which was higher that reported previously. The diagnostic yield of a fine needle aspiration biopsy was 68.6% in the total tumors and 80.9% in the malignant tumors. A surgical resection was the most frequently chosen treatment modality and was performed in 405 cases (84.6%). The complete resection rate was 91.1%, which is higher than the previous result of 78.8%. Conclusion : These results showed that the prevalence of mediastinal tumors and cysts, particularly thymoma, increased. A fine needle aspiration biopsy was a valuable preoperative differential diagnostic method for malignant tumors. The surgical and complete resection rate increased remarkably possibly due to the better applicable chest CT scans, the more frequent health check-up provided by the regular health promotion program for all people as a health insurance policy, and the improved diagnostic techniques in the pathologic, radiological, and clinical fields.

연구 배경 : 종격동 종양과 낭종은 최근 정기적인 건강 검진의 보급 및 진단 수기의 발달로 진단율이 증가하고 있는 추세로 장기간의 경과를 통한 우리나라에서의 특징적인 임상 양상에 대한 연구가 필요하다. 대상 및 방법 : 본 연구는 연세대학교 의과대학 세브란스병원에 입원하여 병리조직학적으로 확진된 환자들을 대상으로 이전 25년 동안의 보고와 1985년 7월부터 2002년 6월까지 최근 17년 동안의 결과를 비교하였다. 결 과 : 전체 종격동 종양 479예 중 흉선종이 183예(382%)로 가장 많았고, 종격동 구획에 따른 분포는 이전 보고와 유사하였다. 흉부 X-선 촬영상 우연히 발견된 경우가 174예(36.3%)로 이전의 보고(10.9%)보다 더 많았다. 악성 종양과의 감별을 위해 시행한 경피세침흡인생검의 전체 진단율은 68.6%이었고 악성 종양에서 80.9%로 진단율이 높았다. 전체 479예 중 수술적 절제를 시행한 환자는 405예(84.6%)이었고, 완전 절제율은 91.1%로 이전의 보고(78.8%)보다 더 높았다. 이전 보고와 본 연구 결과를 종합한 42년 간의 결과는 총 662예 중 흉선종이 205예(31.0%)로 가장 많았다. 결 론 : 종격동 종양과 낭종은 최근 진단율과 완전절제를 통한 적극적인 치료가 급속히 증가하고 있는 추세이며, 특히 흉선종의 비율이 현저히 증가하여 이에대한 관심이 필요하다. 종격동 종양에 대한 경피세침흡인생검(중심침생검 포함)의 전체 진단율이 68.6%이고, 악성 종양에서 80.9%로 높아 수술적절제 전 악성 종양과의 감별을 위한 일차적인 진단법으로 유용하다고 생각된다.

Keywords

References

  1. Wychulis AR, Payne WS, Clagett OT, Woolner LB. Surgical treatment of mediastinal tumors: a 40 year experience. J Thorac Cardiovasc Surg 1971;62:379-92
  2. LeRoux BT. Cysts and tumors of the mediastinum. Surg Gynecol Obstet 1962;115:695-703
  3. Cohen AJ, Thompson L, Edwards FH, Bellamy RF. Primary cysts and tumors of the mdiastinum. Ann Thorac Surg 1991;51:378-86.
  4. Davis RD Jr, Oldham HN Jr, Sabiston DC Jr. Primary cysts and neoplasms of themediastinum: recent changes in clinical presentation, methods of diagnosis, management, and results. Ann Thorac Surg 1987;44:229-37
  5. Park DR, Pierson DJ. Disorders of the mediastinum. Chapter 79. Tumors and cysts of the mediastinum. In: Murray JF, Nadel JA, Mason RJ, Boushey HA Jr, eds. Textbook of respiratory medicine. 3rd ed. Philadelphia: WB Saunders Co.; 2000. p. 2123-37
  6. Silverman NA, Sabiston DC Jr. Mediastinal masses. Surg Clin North Am 1980;60:757-77
  7. 김해균, 이종국, 이두연, 강면식, 조범구, 홍승록, 홍필훈. 종격동 종양의 외과적 적출 ? 183례 보고 -. 대한흉부외과학회지 1985;18:881-5
  8. Rubush JL, Gardner IR, Boyd WC, Ehrenhaft JL. Mediastinal tumors. Review of 186 cases. J Thorac Cardiovasc Surg 1973;65:216-22
  9. Seaton A, Seaton D, Leitch AG. Crofton and Douglas's Respiratory Disease, 4th ed., Oxford: Blackwell Scientific Pub.; 1989. p.1113
  10. Masaoka A, Monden Y, Nakahara K, Tanioka T. Follow-up study of thymomas with special reference to their clinical stages. Cancer 1981;48:2485-92
  11. Rosai J, Sobin LH. Histological typing of tumors of the thymus. International histological classification of tumors, 2nd ed. New York, Berlin: Springer, 1999
  12. 이홍렬, 김세규, 김해균, 정경영, 이두연, 김성은 et al. 원발성 종격동 종양 및 낭종에 대한 임상적 고찰 -344예에 대한 보고-. 결핵 및 호흡기질환 1993;40:575-83
  13. 김성규, 김경희, 강면식, 김기호. 원발성 종격동종양 및 낭종의 임상적 고찰 -한국에서 보고된 증례를 중심으로-. 대한의학협회지 1983;26:851-6
  14. Hoffman OA, Gillespie DJ, Aughenbaugh GL, Brown LR. Primary mediastinal neoplasms (other than thymoma). Mayo Clin Proc 1993;68:880-91
  15. Ahn JM, Lee KS, Goo JM, Song KS, Kim SJ, Im JG. Predicting the histology ofanterior mediastinal masses: comparison of chest radiography and CT. J Thorac Imaging 1996;11:265-71
  16. Wright CD, Mathisen DJ. Mediastinal tumors: diagnosis and treatment. World J Surg 2001;25:204-9
  17. Shabb NS, Fahl M, Shabb B, Haswani P, Zaatari G. Fine-needle aspiration of the mediastinum: a clinical, radiologic, cytologic, and histologic study of 42 cases. Diagn Cytopathol 1998;19:428-36
  18. Greif J, Staroselsky AN, Gernjac M, Schwarz Y, Marmur S, Perlsman M, Yellin A. Percutaneous core needle biopsy in the diagnosis of mediastinal tumors. Lung Cancer 1999;25:169-73
  19. Strollo DC, Rosado-de-Christenson ML, Jett JR. Primary mediastinal tumors. Part I: tumors of the anterior mediastinum. Chest 1997;112:511-22
  20. Strollo DC, Rosado-de-Christenson ML, Jett JR. Primary mediastinal tumors: part II. Tumors of the middle and posterior mediastinum. Chest 1997;112:1344-57
  21. Levitt LJ, Aisenberg AC, Harris NL, Linggood RM, Poppema S. Primary non-Hodgkin's lymphoma of the mediastinum. Cancer 1982;50:2486-92
  22. Bukowski RM, Wolf M, Kulander BG, Montie J, Crawford ED, Blumenstein B.Alternating combination chemotherapy in patients with extragonadal germ cell tumors. A Southwest Oncology Group Study. Cancer 1993;71:2631-8
  23. Chen G, Marx A, Wen-Hu C, Yong J, Puppe B, Stroebel P, Mueller-Hermelink HK. New WHO histologic classification predicts prognosis of thymic epithelial tumors: a clinicopathologic study of 200 thymoma cases from China. Cancer 2002;95:420-9