Treatment of Malignant Peripheral Nerve Sheath Tumor Using Surgery and Metronomic Chemotherapy in a Dog

개에서 발생한 악성 말초 신경집 종양의 외과적 절제와 메트로놈 화학요법을 이용한 치료 증례

  • Son, Jin-Na (Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University) ;
  • Park, Seong-Kyu (Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University) ;
  • Choi, Seok-Hwa (Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University) ;
  • Kim, Gon-Hyung (Veterinary Medical Center, College of Veterinary Medicine, Chungbuk National University)
  • 손진나 (충북대학교 수의과대학 동물의료센터) ;
  • 박성규 (충북대학교 수의과대학 동물의료센터) ;
  • 최석화 (충북대학교 수의과대학 동물의료센터) ;
  • 김근형 (충북대학교 수의과대학 동물의료센터)
  • Accepted : 2011.05.30
  • Published : 2011.06.30

Abstract

A 6-year-old female Shih-tzu dog was referred with left elbow joint mass associated with weight bearing lameness. Ultrasonography demonstrated an encapsulated hyperechoic mass at the left elbow joint. Radiography was performed on elbow joint, chest, and abdomen, but there was no evidence of metastasis. Clinicopathologic examination revealed the existence of neoplastic cells with anisocytosis, pleomorphism and increased nuclear-cytoplasmic ratio. The left forelimb was amputated for cure. Histopathological examination diagnosed the mass as a malignant peripheral nerve sheath tumor. During the 4 weeks follow-up, the patient showed full remission and adopted to walk with remaining three legs. Thereafter, the tumor recurred after 5 months of first surgery at the operation site and other two cutaneuos regions. Cytology test revealed the mesenchymal originated tumor cells with malignancy. These tumors were surgically removed and histopathological examination of the resected tissue revealed the recurrence of primary tumor and metastasis. Metronomic therapy with cyclophophamide (10 mg/$m^2$, PO, sid) and piroxicam (0.3 mg/kg, PO, sid) had been adopted for 5 months. At 26 months of follow up after the first surgery, the dog alive with satisfactory quality of life. Aggressive surgical resection with metronomic chemotherapy should be the most effective treatment for malignant peripheral nerve sheath tumor.

6년령 암컷 시츄견이 체중 부하하는 파행을 동반한 좌측 앞다리굽이관절 주위의 종괴를 주증으로 충북대학교 동물의료센터에 내원하였다. 초음파 검사결과 피막에 싸인 고에코성의 종괴가 앞다리굽이관절에서 확인되었으며, 방사선학적 검사 결과 흉부나 복부로의 전이 소견은 관찰되지 않았다. Gun-biopsy 샘플을 이용한 세포학적 검사 결과 세포부동증, 다형성 등 악성의 지표를 보이는 종양세포들이 다수 확인되었으며, 치료를 위하여 좌측 전지의 절단술이 시행되었다. 절제된 조직의 조직병리학적 검사 결과 악성 말초 신경집종으로 진단되었다. 환자는 수술 후 보행이나 전신활력 등이 양호하였으나 술 후 5개월째에 좌측 전지 절단술을 시행했던 부위의 피하 종괴와 다른 두 곳의 피부 종괴가 발생하였다. 종괴는 수술적으로 제거되었으며, 절제된 조직의 세포학적 검사 결과 원발 종양과 유사한 소견으로 종양이 재발되었음이 확인되었다. 술 후 종양의 또 다른 재발을 막고 의심되는 폐 전이의 속도를 늦추기 위한 목적으로 cyclophosphamide와 piroxica을 병용한 화학요법이 시행되었다. 첫 수술로부터 26개월이 경과한 현재 환자는 만족할만한 삶의 질을 유지하며 생존하고 있다. 개의 악성 말초 신경집 종양에서 적극적인 외과적 절제와 metronomic chemotherapy의 병행은 효과적인 치료법이 될 수 있다.

Keywords

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