Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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소아 아급성 괴사성 림프절염의 임상적, 방사선학적, 면역조직화학적 소견

Analysis of disease mechanism of subacute necrotizing lymphadenitis in children

  • 김현정 (경상대학교 의과대학 소아과학교실) ;
  • 염정숙 (경상대학교 의과대학 소아과학교실) ;
  • 박지숙 (경상대학교 의과대학 소아과학교실) ;
  • 박은실 (경상대학교 의과대학 소아과학교실) ;
  • 서지현 (경상대학교 의과대학 소아과학교실) ;
  • 임재영 (경상대학교 의과대학 소아과학교실) ;
  • 박찬후 (경상대학교 의과대학 소아과학교실) ;
  • 우향옥 (경상대학교 의과대학 소아과학교실) ;
  • 조재민 (경상대학교 의과대학 영상의학과교실) ;
  • 이정희 (경상대학교 의과대학 병리학교실) ;
  • 윤희상 (경상대학교 의과대학 소아과학교실)
  • Kim, Hyun Jung (Department of Pediatrics, Gyeongsang National University College of Medicine) ;
  • Yeom, Jung Suk (Department of Pediatrics, Gyeongsang National University College of Medicine) ;
  • Park, Ji Suk (Department of Pediatrics, Gyeongsang National University College of Medicine) ;
  • Park, Eun Sil (Department of Pediatrics, Gyeongsang National University College of Medicine) ;
  • Seo, Ji Hyun (Department of Pediatrics, Gyeongsang National University College of Medicine) ;
  • Lim, Jae Young (Department of Pediatrics, Gyeongsang National University College of Medicine) ;
  • Park, Chan Hoo (Department of Pediatrics, Gyeongsang National University College of Medicine) ;
  • Woo, Hyang Ok (Department of Pediatrics, Gyeongsang National University College of Medicine) ;
  • Cho, Jae Min (Department of Radiology, Gyeongsang National University College of Medicine) ;
  • Lee, Jeong Hee (Departments of Pathology, Gyeongsang National University College of Medicine) ;
  • Youn, Hee Shang (Department of Pediatrics, Gyeongsang National University College of Medicine)
  • 투고 : 2008.03.17
  • 심사 : 2008.08.21
  • 발행 : 2008.11.15
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초록

목 적: 아급성 괴사성 림프절염은 소아에서는 드문 질환으로 병인이 확실히 밝혀져 있지 않다. 본 연구에서는 조직 절제 생검을 시행하여 아급성 괴사성 림프절염으로 진단 받은 소아를 대상으로 임상 양상과 방사선학적 소견, 면역조직화학적 소견을 고찰하여 아급성 괴사성 림프절염의 병인을 이해하는데 도움을 주고자 하였다. 방 법: 1998년 3월부터 2006년 7월까지 경상대학교 병원에서 아급성 괴사성 림프절염으로 진단 받은 17명의 환아를 대상으로 19개의 림프절 조직을 얻어 이에 대해 연구하였다. 의무기록을 기초로 하여 후향적으로 조사하였다. 방사선학적 소견으로는 컴퓨터단층촬영 소견을 분석하였고, 모든 예에서 절제 생검을 시행하여 얻은 조직을 이용하여 면역조직화학 염색을 시행하였다. 결 과: 나이는 5세에서 19세의 범위였다(평균 11.8세). 성별로 보면 남자가 10명, 여자가 7명으로 큰 차이가 없었고 주된 증상으로는 경부 종괴(17/19), 종괴 동통(6/17), 발열(12/19)이였다. 만져지는 림프절은 대부분은 경부 림프절로 방사선학적으로 측정한 최대 직경은 10예 모두 3 cm이하였고 좌측(3/10), 우측(2/10), 양측(5/10)에서 관찰되고 CT 소견상 6명(60%)에서 림프절 주위 침윤과 5명(50%)에서 육안적 괴사부위가 관찰되었다. 병리학적으로 증식형, 괴사형, 황색종형으로 나누었고 괴사형이 가장 많은 비율(58%)을 차지했다. 광학현미경상 Lesion (L), Perilesion (PL), Necrosis (N)으로 새롭게 분류하여 면역조직화학염색을 시행한 결과 모든 부위에서 CD4/CD8 비에서 CD8이 우세를 보였고 CD4는 주로 PL에서 CD8은 주로 L에서 염색 강도가 증가하였다. 결 론: 아급성 괴사성 림프절염에서 방사선학적 소견과 임상 증상, 병리학적 소견을 종합해서 비교함으로써 아급성 괴사성 림프절염의 병인을 이해하는데 도움이 되리라 생각된다.

Purpose : The cause of subacute necrotizing lymphadenitis, a rare disease in children, has not been completely clarified. This study was aimed to investigate the disease mechanism by examining clinical, radiologic, and immunohistochemical findings in children diagnosed with subacute necrotizing lymphadenitis after an excisional biopsy. Methods : We examined 19 lymph node tissue specimens from 17 children diagnosed with subacute necrotizing lymphadenitis at Gyeongsang National University Hospital from March, 1998 to July, 2006. A retrospective survey of the medical records was performed. CT findings were analyzed. Immunohistochemical staining was done on tissues obtained by excisional biopsy from all patients. Results : The patient's age ranged from 5 to 19 years (average age :11.8 years). The main symptoms included a neck mass (17/19), pain in the mass (6/17), and fever (12/19). The palpable lymph nodes were mostly cervical in location; the maximum diameter, which was measured radiologically, was less than 3 cm in all 10 cases. The masses were pathologically divided into proliferative, necrotic, and xanthomatous types. With immunohistochemical staining the masses were divided into lesion (L), perilesion (PL), and necrosis (N). The CD8 staining was stronger than the CD4 staining for all regions in three types. The CD4 staining intensity was mainly increased in the perilesion, and CD8 was mainly increased in the lesion. Conclusion : We compared the radiologic findings, clinical symptoms, and pathology to help understand the cause of disease in patients with subacute necrotizing lymphadenitis.

키워드

참고문헌

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