눈물주머니에 발생한 편평상피세포암종의 자연관해 = Spontaneous Regression of Lacrimal Sac Squamous Cell Carcinoma

국문 초록 (Abstract)

목적: 편평상피세포암종의 자연관해는 아주 드문 현상으로 저자들은 눈물주머니에서 발견된 편평상피세포암종이 저절로 호전된 1예를 보고하고자 한다.
증례요약: 69세 여자 환자가 우안의 눈물흘림과 분비물을 주소로 내원하였다. 코눈물관폐쇄 진단하에 코경유 눈물주머니코안연결술을 시행하였다. 수술 후 2년째, 환자는 우안의 눈물흘림과 안통, 안구돌출과 안구내전장애로 내원하였다. 안와컴퓨터단층촬영상 우측 눈물주머니에 종물이 관찰되었고, 절개생검에서 저분화 침습성 편평상피세포암종으로 진단되었다. 추가적 치료를 권유하였으나 환자는 이를 거부하였다. 절개생검 후 6개월째, 안와내벽이 일부 파괴되어 종물이 우측 비강으로 돌출되었고 경부 림프절, 대동맥주위림프절, 용골하 림프절, 식도주위 림프절에 전이가 의심되었다. 하지만 절개생검 후 15개월째, 안와종양은 거의 사라졌고, 체내 모든 부위의 전이병소 또한 감소되었다.
결론: 본 증례는 안와내벽의 파괴, 림프절 전이 등 악성종양의 자연경과를 따르다가 자연관해에 도달하였다. 이처럼 악성종양이 자연관해를 일으키는 원인은 아직 명확히 알려져 있지 않지만 충분한 연구가 이루어진다면 이러한 현상을 이해하는 데 도움이 될 수 있을 것이다.

다국어 초록 (Multilingual Abstract)

Purpose: Spontaneous regression of squamous cell carcinoma is a very rare event. We report a case of primary squamous cell carcinoma in the lacrimal sac which showed spontaneous regression without any treatment.
Case summary: A 69-year-old woman presented with epiphora and ocular discharge from the right eye. Under the diagnosis of nasolacrimal duct obstruction, we performed dacryocystorhinostomy. Two years after the surgery, the patient presented again with severe epiphora and ocular pain accompanied by proptosis and adduction limitation in the right eye. Computed tomography demonstrated a mass occupying the right lacrimal sac and incisional biopsy showed poorly differentiated invasive squamous cell carcinoma. Additional treatment was recommended, but the patient denied any treatments. At 6 months after the biopsy, the medial orbital wall was partially destructed. On positron emission tomography/computed tomography, metastasis was suspected in the cervical, para-aortic, sub-carinal, and peri-esophageal lymph nodes. However, at 15 months after the biopsy, the orbital tumor had almost disappeared. On positron emission tomography/computed tomography, fluorodeoxyglucose uptake was reduced in all areas including the cervical and mediastinal lymph nodes.
Conclusions: This case exhibited a generally natural course of a malignant tumor, including medial orbital wall destruction and lymph node metastasis. However, the course then improved naturally without any treatment. The reason for the spontaneous regression of squamous cell carcinoma is still unclear but might be due to complex effects of one or several factors.

목차 (Table of Contents)

• Abstract
• 증례보고
• 고찰
• REFERENCES
• 국문초록

참고문헌 (Reference)

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