Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Clinical Features of Thymic Epithelial Tumors

흉선 상피 종양의 임상적 고찰

  • Mok, Jeong Ha (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Seol, Hee Yun (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Kim, Ji Eun (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Kim, Ki Uk (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Park, Hye-Kyung (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Lee, Ho Seok (Department of Thoracic Surgery, Pusan National University School of Medicine) ;
  • Kim, Young Dae (Department of Thoracic Surgery, Pusan National University School of Medicine) ;
  • Kim, Yun Seong (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Lee, Chang Hun (Department of Pathology, Pusan National University School of Medicine) ;
  • Lee, Min Ki (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Park, Soon Kew (Department of Internal Medicine, Pusan National University School of Medicine)
  • 목정하 (부산대학교 의학전문대학원 내과학교실) ;
  • 설희윤 (부산대학교 의학전문대학원 내과학교실) ;
  • 김지은 (부산대학교 의학전문대학원 내과학교실) ;
  • 김기욱 (부산대학교 의학전문대학원 내과학교실) ;
  • 박혜경 (부산대학교 의학전문대학원 내과학교실) ;
  • 이호석 (부산대학교 의학전문대학원 흉부외과학교실) ;
  • 김영대 (부산대학교 의학전문대학원 흉부외과학교실) ;
  • 김윤성 (부산대학교 의학전문대학원 내과학교실) ;
  • 이창훈 (부산대학교 의학전문대학원 병리학교실) ;
  • 이민기 (부산대학교 의학전문대학원 내과학교실) ;
  • 박순규 (부산대학교 의학전문대학원 내과학교실)
  • Received : 2008.06.03
  • Accepted : 2008.06.25
  • Published : 2008.07.30
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Abstract

Background: Thymic epithelial tumors are the most common tumors affecting the anterior mediastinum. The aim of this study is to investigate clinical features of the patients who were diagnosed with thymic epithelial tumors at Pusan National University Hospital. Methods: We retrospectively reviewed the records of thirty-seven patients who were diagnosed with thymic epithelial tumors from Jan. 1997 to Jan. 2007. The pathological classification and clinical stage of the thymic epithelial tumors were based on the WHO classification and Masaoka's staging system. A total 37 patients were enrolled: 23 were males and 14 were females, and their mean age was 51.3 years. Results: Thirty patients presented symptoms at the time of diagnosis and their symptoms were as follows: chest pain (53%), dyspnea (23%), and cough (17%). Myasthenia gravis was diagnosed in five patients. With respect to the tumor staging, three cases (8%) were stage I, 10 cases (28%) were stage II, 12 cases (32%) were stage III, 6 cases (16%) were stage IVA and 6 cases (16%) were stage IVB. Twenty-four cases (67%) displayed stage III or IV disease. The pathological types according to the WHO classification were as follows: B1 (32%), C (23%), B3 (20%), B2 (16%), AB (6%) and A (3%). Twenty-four patients underwent thymothymectomy and four of these patients relapsed. Stage III or type B3 was common in the relapsed patients. Five patientsexpired. Stage IV or type B3 and C were common in the expired patients. Conclusion: In this study, stage III or IV disease and type B3 or C were common at the time of diagnosis and these findings might contribute to postoperative recurrence and a poor outcome.

연구배경: 흉선 상피 종양은 전종격동에 발생하는 가장 흔한 종양으로 비특이적인 증상을 나타내는 경우가 많아 진단 및 치료에 어려움이 있다. 본 연구에서는 부산대학교병원에서 진단된 흉선 상피 종양의 임상적 특징을 알아보고자 하였다. 방 법: 1997년 1월에서 2007년 1월까지 흉선 상피 종양 으로 조직학적 진단을 받은 37명의 환자를 대상으로 임상적, 조직학적 소견을 후향적으로 분석하였다. 조직학적 분류는 WHO 분류법, 임상적 병기는 Masaoka 병기분류법을 기초로 하였다. 대상 환자는 총 37명으로 남자가 23명, 여자가 14명이었고, 평균 연령은 51.3세였다. 결 과: 진단시 무증상인 경우가 7명이었고, 증상이 있는 경우가 30명이었으며, 빈도는 흉통(53%), 호흡곤란(23%), 기침(17%) 순이었다. 5명(17%)에서 중증근무력증이 동반되었다. 진단 당시 병기는 stage I (8%), stage II (28%), stage III (32%), stage IVA (16%), stage IVB (16%)의 순으로, stage III 이상인 경우가 64%를 차지하였다. 조직학적 분류의 빈도는 type B1 (32%), C (23%), B3 (20%), B2 (16%), AB (6%), A (3%) 순이었다. 치료를 받은 31명의 환자 중 24명의 환자가 흉선절제술을 시행받았으며, 5명은 항암화학요법 단독치료, 2명은 항암화학요법과 방사선치료를 병행하였다. 흉선절제술을 시행한 24명의 환자 중 4명에서 흉선 상피 종양이 재발하였으며, stage III 및 type B3인 경우가 많았다. 또한 추적관찰 기간 동안 5명의 환자가 사망하였으며, stage IV 및 type B3, C인 경우가 많았다. 결 론: 흉선 상피 종양은 진단시 stage III 이상 또는 조직학적 분류상 type B, C가 많았고 이러한 경우 재발 및 전이의 위험이 높아 불량한 예후와 연관이 있는 것으로 생각된다.

Keywords

References

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