Waldeyer 편도환 림프종의 임상적 고찰

Abstract

A retrospective review is presented of 24 previously untreated patients with lymphoma of Walde-yer's ring(WR) between January 1972 through December 1984 at the Keimyung University. The incidence of WR involvement of non-Hodgkin's lymphoma was 11.1% and of Hodgkin's disease was 4.7%. The mean age was 48.8 years, with a male to female ratio of 1.7 : 1.0. On admission, neck mass was the most frequent symptom in 14 cases(58.3%) and sore throat, odyno-phagia, dysphagia, hoarseness and nasal stuffiness were commonly presented. The anatomical distribution of the growth within WR was as follow: tonsil, 75.0%; nasopharynx, 25.0%; base of tongue, 4.2%. Histiocytic architecture predominated (83.3%) and local-regional involvement (stage Ⅰand Ⅱ) occurred in 75% with this morphology. Other histologic pattern was 2 cases of diffuse poorly-differentiated lymphocytic, 1 case of nodular poorly-differentiated lymphocytic lymphoma and 1 case of Hodgkin's disease with all in advanced stage (stage Ⅲ and Ⅳ). All ofthe local-regional disease were treated by irradiation and 1 patient were treated in addition with combination chemotherapy. Advanced disease were treated initially by combination chemotherapy. Response rate (complete response plus partial response) of stage Ⅰ and Ⅱ was 60% and stage Ⅲ and Ⅳ was 50%.

저자들은 1972년 1월부터 1984년 12월 사이에 본원에 내원한 치료병력이 없는 Waldeyer 편도환을 침범한 림프종환자 24예를 분석검토하여 다음과 같은 결과를 얻었다. 연령은 14세에서 82세까지로 평균 48.8세였으며 남녀비는 1.7:1로 남자에서 많았다. 초진시의 증상은 경부종양이 14예(58.3%)로 가장 많았으며 인후통 12예(50%) 연하통 6예(25%) 연하곤란 5예(20.8%) 목쉼 및 비폐색이 각기 4예(16.7%)였다. 초진시의 이학적소견은 림프전종대가 19예(79.2%)로 경부 액와부 서혜부 쇄골상와림프길 순으로 빈번하였으며, Waldeyer 편도환의 침범은 비호지킨 림프종의 11.1% 호지킨병의 4.7%에서 동반되었으며 부위별로는 편도가 18예(75%) 비인두가 6예(25%) 설기저부가 1예(4.2%)였다. 조직학적분류를 보면 조직구형이 20예(83.3%)로 대부분을 차지하였으며, diffuse poorly-differentiated lymphocytic형 2예, nodular poorly-differentiated lymphocytic형 1예 그리고 호지킨병이 1예였다. 병기별로는 stageⅠ,Ⅱ가 15예(62.5%)로 모두 조직구형이었으며 stageⅢ,Ⅳ가 9예(37.5%)였고 B형은 4예(16.7%)로 진행된 병기에서 동반율이 높았다. 치료는 stageⅠ,Ⅱ 9예는 방사선요법, stageⅢ,Ⅳ 6예는 다제병합화학요법 그리고 stageⅡ,Ⅲ,Ⅳ 각 1예는 병용치료를 시행하였으며 이 중 stageⅠ,Ⅱ의 6예(60%)외 stageⅢ,Ⅳ의 4예(50%)에서 부분적관해 이상의 반응을 나타내었다.