전신성 홍반성 낭창 환자에서 상악 치은에 발생한 Kaposi's Sarcoma

KAPOSI'S SARCOMA OF MAXILLARAY GINGIVA IN SYSTEMIC LUPUS ERYTHEMATOSUS

  • 김일규 (인하대학교 의과대학 치과학교실 구강악안면외과) ;
  • 조현영 (인하대학교 의과대학 치과학교실 구강악안면외과) ;
  • ;
  • 박승훈 (인하대학교 의과대학 치과학교실 구강악안면외과) ;
  • 박종원 (인하대학교 의과대학 치과학교실 구강악안면외과) ;
  • 사시카라바라라만 (인하대학교 의과대학 치과학교실 구강악안면외과) ;
  • 김준미 (인하대학교 의과대학 치과학교실 병리과)
  • Kim, Il-Kyu (Department of Oral and Maxillofacial Surgery, Department of Dentistry, College of Medicine, In-Ha University) ;
  • Cho, Hyun-Young (Department of Oral and Maxillofacial Surgery, Department of Dentistry, College of Medicine, In-Ha University) ;
  • Chang, Keum-Soo (Department of Oral and Maxillofacial Surgery, Department of Dentistry, College of Medicine, In-Ha University) ;
  • Park, Seung-Hoon (Department of Oral and Maxillofacial Surgery, Department of Dentistry, College of Medicine, In-Ha University) ;
  • Park, Jong-Won (Department of Oral and Maxillofacial Surgery, Department of Dentistry, College of Medicine, In-Ha University) ;
  • Sasikala, Balaraman (Department of Oral and Maxillofacial Surgery, Department of Dentistry, College of Medicine, In-Ha University) ;
  • Kim, Joon-Mee (Department of Oral and Maxillofacial Surgery, Department of Pathology, College of Medicine, In-Ha University)
  • 발행 : 2009.07.31

초록

본 증례는 전신성 홍반성 낭창으로 인해 2000년 4월부터 면역 억제제인 azathioprine 75mg과 prednisolne 35mg을 복용 중인 42세 여성 환자가 2004년 12월 상악 협측 치은의 종창, 증식, 동통 및 출혈을 주소로 내원하여 조직 생검 결과 모세 혈관종으로 진단되었으나, 2005년 1월 치은의 재발 병소의 절제 및 조직 생검으로 카포시 육종으로 진단되었고, 흉부의 피부 병변의 조직 생검과 흉부 전산화 단층 촬영 검사에서도 양측 폐에 다수의 결절을 보이는 카포시 육종으로 진단되었다. 의인성 면역억제제에 의한 카포시 육종으로 최종 진단되어, 면역 억제제와 부신피질호르몬제의 중단과, paclitaxel을 이용한 전신적인 항암화학 요법으로, 2008년11월 현재까지 재발의 징후 없이 구강, 피부, 폐의 병소에 대해 양호한 치료 결과를 얻었으나, 향후 전신성 홍반성 낭창의 악화 또는 카포시 육종의 재발 가능성이 있으므로 지속적인 추적 관찰이 요할 것으로 사료된다.

Kaposi's sarcoma was first descrided by Kaposi in 1872 as an idiopathic multiple hemorrhagic sarcoma. Its clinical features revealed to be erythematous red or purple macule started out, and developing into palpable dome-shaped nodules. Etiology is not defined to detail at present. Kaposi's sarcoma is classified to 4 categories; Classical, African, Epidemic and Immunosuppressive type. Epidemic categories is found approximately 20% of all AIDS patients and has strong predilection for head and neck region. The first case of immunosuppresive type Kaposi's sarcoma in patients with kidney transplants was reported in 1969. Kaposi's sarcoma accounts for 5% of all tumors associated with transplanted patients. The most common site of Kaposi's sarcoma in immunosuppressed patients are extremities, but rare in head and neck area. A 42 years old woman who had systemic lupus erythematosus visited to our clinic because of gingival hyperplasia, and excisional biopsy revealed Kaposi's sarcoma. We experienced a case of favorable results using excision and chemotherapy, so we report with review of literatures.

키워드

참고문헌

  1. Kaposi M : Idiopathisches multiple pigment sarcoma der Haut. Arch Dermatol Syphillis 4 : 265, 1872 https://doi.org/10.1007/BF01830024
  2. Jindal JR, Campbell BH, Ward TO et al : Kaposi`s sarcoma of the oral cavity in a non-AIDS patient; case report and review of the literature. Head & Neck 17 : 64, 1995 https://doi.org/10.1002/hed.2880170114
  3. Goldberg AN: Kaposi's sarcoma of the head and neck in Acquired immunodeficiency syndrome. Am J Otolaryn 14 : 5, 1993 https://doi.org/10.1016/0196-0709(93)90003-P
  4. Singh B, Harel G, Lucente FE : Kaposi's sarcoma of the head and neck in parients with acquired immunodeficiency syndrome. Otolaryngol Head Neck 111 : 618, 1994 https://doi.org/10.1016/S0194-5998(94)70530-5
  5. Markopoulos AK, Papanayotou P, Trigonidis G : Kaposi's sarcoma of the oral cavity; case reports. Quintessence international 25 : 415, 1994
  6. Park DJ, Kim HY, Kim CC et al : Clinical manifestations of systemic lupus erythematosus. The Korean Journal of Medicine 32 : 56, 1987
  7. Jeong JC, Choi SH, Song MS et al : Kaposi's sarcoma of the oral cavity in renal transplanted patient; A case report. J Kor Oral Maxillofac Surg 29 : 186, 2003
  8. Searless GE, Markman S, Yazdi HM : Primary oral Kaposi's sarcoma of the hard palate. J Am Aca Derm 23 : 518, 1990 https://doi.org/10.1016/S0190-9622(08)81111-5
  9. Brooks JJ : Kaposi`s sarcoma : a reversible hyperplasia. Lancet 2 : 1309, 1986 https://doi.org/10.1016/S0140-6736(86)91436-4
  10. Evans SR, Krown E, Tesla MA et al : Phase II evaluation of low-dose oral etoposide for the treatment of related or progressive AIDS-related Kaposi's sarcoma: an AIDS clinical trial group clinical study. J Clin Oncol 20 : 3236, 2002 https://doi.org/10.1200/JCO.2002.12.038
  11. Siegel JH, Janis R, Alper JC et al : Disseminated visceral Kaposi's sarcoma: appearance after human renal homograft operation. JAMA 207 : 1493, 1969 https://doi.org/10.1001/jama.207.8.1493
  12. Harwood AR, Osoba D, Hofstader SL et al : Kaposi's sarcoma in recipients of renal transplants. Am J Med 67 : 759, 1979 https://doi.org/10.1016/0002-9343(79)90731-9
  13. Penn I : Kaposi's sarcoma in organ transplant recipients. Transplantation 27 : 8, 1979 https://doi.org/10.1097/00007890-197901000-00003
  14. Bowie SA, Bach D : Oral Kaposi's sarcoma in a non-AIDS patient. General Dentistry July : 413. 1999
  15. Penn I : Kaposi's sarcoma in immunosuppressed patients. J Clin Lab Immunol 12 : 1, 1983
  16. Rappersberger K, Stingl G, Wolff K : Kaposi's sarcoma. Dermatology in general medicine, 5th ed. New york, McGraw-Hill, 1999, p.1195
  17. Louthrenoo W, Kasitanon N, Mahanuphab P et al : Kaposi's sarcoma in rheumatic diseases. Seminars in Arthritis and Rheumatism 32 : 326, 2003 https://doi.org/10.1053/sarh.2002.59000
  18. Klein MB, Pereira FA, Kantor I : Kaposi sarcoma complicating systemic lupus erythematosus treated with immunosuppression. Arch Dermatol 110 : 602, 1974 https://doi.org/10.1001/archderm.110.4.602
  19. Greenfield D, Trinh P, Fulenwider A et al : Kaposi's sarcoma in a patient with SLE. J Rheumatol 13 : 637, 1986
  20. Maghraoui AE, Sekkach Y, Qacif H et al : Iatrogenic Kaposi's sarcoma following immunosuppressive therpy for systemic lupus erythematosus. Clin Exp Rheumatol 21 : 674, 2003
  21. Chang Y, Cesarman E, Pessin MS et al : Identification of herpesvirus-like DNA sequences in AIDS-associated Kaposi's sarcoma. Science 266 : 1865, 1994 https://doi.org/10.1126/science.7997879
  22. Hudnall SD, Rady PL, Tyring SK et al : Hydrocortisone activation of human herpesvirus 8 viral DNA replication and gene expression in vitro. Transplatation 67 : 648, 1999 https://doi.org/10.1097/00007890-199903150-00002
  23. Trattner A, Hodak E, David M et al : The appearance of Kaposi sarcoma during corticosteroid therapy. Cancer 72 : 1779, 1993 https://doi.org/10.1002/1097-0142(19930901)72:5<1779::AID-CNCR2820720543>3.0.CO;2-M
  24. Rady PR, Hodak E, Yen A et al : Detection of human herpesvirus-8 DNA in Kaposi's sarcomas from iatrogenically immunosuppressed patients. J Am Acad Dermatol 38 : 429, 1998 https://doi.org/10.1016/S0190-9622(98)70501-8
  25. Marsman WA, Gelder TV, Mulder AH et al : Successful treatment of Kaposi's sarcoma in a renal allograft recipients. Nephrol Dial Transplant 10 : 900, 1995