폐쇄성 폐렴 후 자연 퇴행을 보인 기관지내 육종 1예

Abstract

The spontaneous regression (SR) of cancer is defined as the complete disappearance of a malignant disease without adequate treatment. SR is a very rare biological event, particularly in a pulmonary sarcoma. We report the first documented case of an endobronchial sarcoma that regressed spontaneously in Korea. We encountered a rare case of a 72-year-old woman with an undiagnosed intrapelvic cystic mass, who presented with a smooth surfaced endobronchial tumor obstructing the orifice of the right lower lobe bronchus on a bronchoscopic examination. She had a prior history cervical cancer and adenocarcinoma in the right middle lobe lateral segment of her lung for which she had undergone radiation therapy. The tumor was diagnosed as an endobronchial sarcoma by the histopathology findings and immunohistochemistry. It was unclear if the tumor was a primary sarcoma of the lung or a metastatic lesion of an intrapelvic cystic mass because she refused a diagnostic exploratory laparotomy. Two months later, obstructive pneumonia of the right lower lobe with parapneumonic effusion developed with fever above 38.5℃ for 10 days. After recovering from pneumonia, she was followed up regularly in the outpatient clinic without any specific treatment. One year later after treating the obstructive pneumonia, the follow-up bronchoscopy revealed complete SR of endobronchial sarcoma. It is believed that the obstructive pneumonia accompanied by fever above 38.5℃ for 10 days might have played a role in this SR. (Tuberc Respir Dis 2007; 63: 94-99) Key Words: Spontaneous regression, Endobronchial sarcoma, Pneumonia.

요약 악성 종양의 자연 퇴행은 아주 드물게 보고되고 있 으며 그 중 폐에 발생한 육종의 자연 퇴행의 경우 국 내 보고로 처음이다. 여러 보고들에서 자연 퇴행에 대 한 원인 기전을 밝히려는 많은 노력들이 있었으나 아 직 정확히 규명된 기전은 없으며 최소한 한 가지 이상 의 기전이 관여할 것으로 추정하고 있다. 저자들은 기 관지내 육종을 진단하고 2개월 후 폐쇄성 폐렴과 부 폐렴 흉수로 치료한 것을 제외하고 특별한 치료 없이 지내던 중 폐렴 발생 1년째 기관지경 검사상 기관지 내 육종이 완전히 자연 퇴행되었음을 보여준 1예를 경험하여 이를 보고하는 바이다.