연조직고형종양의 악성과 양성 감별: 임상과 자기공명영상 복합소견

문태용,김정일,신수미,추혜정,최현욱,김수진,Moon, Tae-Yong,Kim, Jung-Il,Shin, Su-Mi,Choo, Hye-Jeung,Choi, Hyun-Wook,Kim, Soo-Jin 대한근골격종양학회 2004 대한골관절종양학회지 Vol.10 No.2

목적: 최근 자기공명영상의 개발로 다양한 연조직종양의 영상의학적 진단이 가능해 졌다. 그러나 연조직종양의 다양한 조직구성이나 시간에 따라 구성분의 변화는 자기공명영상 만으로 악성과 양성 종양조차 감별을 어렵게 한다. 이에 본 저자들은 임상과 자기공명영상의 복합적인 소견으로 악성과 양성 연조직종양을 감별해 보고자 하였다. 대상 및 방법: 병리조직학적으로 확진된 82례(중간성종양을 악성종양으로 포함하여 37례와 염증성 종괴를 양성종양으로 포함하여 45례)를 후향적으로, 임상적 소견으로 연령, 크기, 위치, 그리고 자기공명영상 소견으로 종양경계, T2신호강도양상, 조영제T1신호강도양상, 그리고 조영증강 범위를 연관시켜 분석하였다. 자기공명영상으로 진단이 어렵지 않는 많은 전형적인 지방종과 결절종 그리고 농양같은 낭종은 양성종양 분류에서 제외하였다. 결과: 악성연조직종양은 양성에 비하여 연령으로 21~40세와 61~80세, 크기로 3.0 cm 이상, 발생위치로 몸체-골반-하지, 그리고 자기공명영상에서 불규칙한 경계, 50%이상의 조영증강범위 소견들의 빈도가 높았다. 결론: 발생위치로 몸체-골반-하지 와 상지-어깨-척추 로 나눈 임상소견이 악성과 양성 연조직종양을 감별하는데 통계학적으로 유의성있는 차이를 보였으며 나머지 다른 소견들은 특이적이지는 않았지만 부가적으로 악성과 양성을 감별하는데 도움이 되는 소견이었다. Purpose: The recent development of MR has made to possible radiological diagnosis in various soft tssue tumors. But multifarious components within soft tissue tumors and their periodic change have made to difficult even differentiation of malignant from benign soft tissue tumors solely on the MR. So authors retry to differentiate malignant from benign soft tissue tumors with clinical and MR finding complex. Materials and methods: We were analysed 82 pathologically confirmed soft tissue solid tumors (37 cases as malignancy including intermediate tumors and 45 cases as benign including inflammatory masses) which are correlated with clinical findings such as age, size, and location, MR findings such as tumor border, texture on T2 and contrast-T1 images, and enhancement area retrospectively. Many typical lipoma and cysts including of ganglion and abscess are rejected in the benign soft tissue tumor group because not difficult to diagnose on MR. Results: Malignant soft tissue tumors were more frequent in 21~40 and 61~80 years old of the age, above 3.0 cm of the size, trunk-pelvis-lower extremities of the location, and MR findings with irregular border and above 50% of the enhancement area than those of benign soft tissue tumors. Conclusion: The clinical finding that divided to two locations as trunk-pelvis-lower extremities and upper extremities-shoulder-spine was statistically significant to differentiate malignant from benign soft tissue solid tumors. However, the others would provide some useful informations to differentiate them never specific.

발에서 드문 연부 조직 종양들의 자기공명영상소견: 임상화보

이윤주,천경아,김지영,성미숙,김기태 대한영상의학회 2007 대한영상의학회지 Vol.56 No.6

A large variety of masses occur in the foot. The foot is a comparatively rare site of soft tissue neoplasms. MRI has greatly improved the ability to detect and delineate soft tissue lesions and is now considered the gold-standard imaging technique in their investigation. Recently, we have encountered rare soft tissue tumors of the foot. The presented cases include benign masses such as granuloma annulare, angiomyoma, neural fibrolipoma, and giant cell tumor of tendon sheath, as well as malignant tumors such as melanoma, synovial sarcoma, rhabdomyosarcoma and extraskeletal myxoid chondrosarcoma. We wish to illustrate the MR findings of these uncommon soft tissue tumors to aid in their diagnosis. 다양한 종류의 종괴들이 발에 생긴다. 발은 종양성과 비종양성의 연부 조직 종괴들이 비교적 드물게 생기는 곳이다. 최근 자기공명영상을 통해 연부 조직 병변의 발견과 분석 능력이 크게 향상되었다. 저자들은 발에 생긴 연부조직 종양 중 흔하지 않은 증례들을 경험하였기에 이들의 자기공명영상소견을 보고하고자 한다. 양성 종양으로는 원형 육아종(granuloma annulare), 맥관근종(angiomyoma), 신경성의 섬유지방종(neural fibrolipoma), 힘줄집의 거세포종양(giant cell tumor of tendon sheath)이 있고 악성종양으로는 흑색종(melanoma), 윤활막 육종(synovial sarcoma), 횡문근육종(rhabdomyosarcoma), 골외성 점액양 연골육종(extraskeletal myxoid chondrosarcoma)이 있다.

Soft-tissue Sarcomas in the Asia-Pacific Region: A Systematic Review

Ngan, Roger,Wang, Edward,Porter, David,Desai, Jayesh,Prayogo, Nugroho,Devi, Beena,Quek, Richard Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.11

Background: Soft-tissue sarcomas require tailored and multidisciplinary treatment and management. However, little is known about how sarcomas are treated and managed throughout the Asia-Pacific region. Materials and Methods: MEDLINE was systematically searched using prespecified criteria. Publications (previous 10 years) that reported tumour characteristics, treatment patterns, survival outcomes, and/or safety outcomes of patients with soft-tissue sarcoma were selected. Exclusion criteria were studies of patients <18 years of age; ${\leq}10$ patients; countries other than Australia, Hong Kong, Indonesia, Korea, Malaysia, New Zealand, Philippines, Singapore, Taiwan, or Thailand; >20% benign tumours; sarcomas located in bones or joints; gastrointestinal stromal tumour; Kaposi's sarcoma; or not reporting relevant outcomes. Results: Of the 1,822 publications retrieved, 35 (32 studies) were included. Nearly all patients (98%, 1,992/2,024; 31 studies) were treated with surgery, and more studies used adjuvant radiotherapy than chemotherapy (24 vs 17 studies). Survival outcomes and recurrence rates varied among the studies because of the different histotypes, sites, and disease stages assessed. Only 5 studies reported safety findings. Conclusions: These findings highlight the lack of specific data available about soft-tissue sarcomas in the Asia-Pacific region. Better efforts to understand how the sarcoma is managed and treated will help improve patient outcomes in the region.

골격외 유잉육종의 영상 소견

정경순,허진도,정미희,고지호,이은정,이승룡 대한영상의학회 2005 대한영상의학회지 Vol.53 No.3

Purpose: The purpose of this study is to evaluate the radiologic findings of the extraosseous Ewing's sarcoma. Materials and Methods: Six patients with pathologically confirmed extraosseous Ewing's sarcoma were retrospectively reviewed. Patients included two men and four women with an average age of 21.5 years (age range 9-48 years). Plain radiographs (six patients), magnetic resonance (MR) images (five patients), computed tomographic (CT) scans (three patients) and whole body scintigraphy (two patients) were reviewed and analyzed. Images were evaluated with regard to lesion location, size, margin, muscle or bone involvement and intrinsic imaging characteristics on CT and MRI. Results: The tumors were located in the thigh (three patients), back (two patients) and upper arm (one patient). The tumors ranged in size from 2.3 cm to 7.5 cm (mean, 5.2 cm), were mainly well circumscribed and showed no evidence of calcification prior to treatment. Margins were well defined in four out of the six patients. Four patients had subcutaneous lesions and the other two patients had intramuscular lesions. Muscle (two patients) and bone invasion (one patient) were present. The masses were heterogenous low signal intensity on T1 weighted images and heterogeneous high signal intensity on T2 weighted images compared with muscle. Heterogeneous enhancement within the lesion was observed in all patients on CT and MRI. Whole body scintigraphy using Tc-99 m MIBI showed increased uptake in the masses of two patients. Conclusion: Extraosseous Ewing's sarcomas were frequently seen as a well-circumscribed ovoid mass with nonspecific findings on CT and MRI. Despite being a relative rare tumor, it should be included in the differential diagnosis of a non-calcified soft-tissue mass, especially in subcutaneous tissue. 목적: 골격외 유잉육종의 영상소견을 분석하고 감별진단에 도움이 되는 소견이 있는지 알아보고자 하였다. 대상과 방법: 병리학적으로 확진된 6명을 대상으로 후향적으로 분석하였다. 단순촬영은 모든 환자에서 시행하였으며, MRI가 5예, CT가 3예였으며 전신 섬광조영술(whole body scintigraphy)을 2예에서 시행하였다. CT나 MRI에서 종괴의 위치, 크기, 경계, 주위 조직과의 관계를 분석하였다. MRI 에서는 종괴의 신호강도, CT에서는 종괴의 음영을 관찰하였다. 또한 MRI와 CT에서 종괴의 균질성과 조영증강정도를 살펴보았다. 결과: 종괴의 위치는 대퇴부(thigh)가 3예로 가장 많았고, 배부(back)가 2예, 상지가 1예였다. 종괴의 크기는 장경을 기준으로 평균 5.2 cm이었다. 4예에서 주위 정상 조직과의 경계가 잘 구분되었다. 피부하(subcutaneous)가 4예, 근육내(intramuscular)에 위치하는 경우가 2예였다. 주위 근육을 침범한 예가 2예, 골을 침범한 경우가 1예였다. 전예에서 내부는 불균질성을 보였고 MRI를 시행한 5예 중 4예는 T1강조영상에서 주위 근육과 비교하여 저신호강도를 보였으며 T2강조영상에서는 모두 불균질한 고신호강도를 보였다. 전예에서 불균질한 조영증강을 보였다 Tc-99 m MIBI를 이용한 전신 섬광조영술을 시행한 2예에서 종양부위의 섭취가 증가되었다. 결론: 골격외 유잉육종은 비교적 경계가 분명한 종괴로 MRI나 CT에서 비특이적인 소견을 보이지만 비교적 젊은 연령에서 석회화가 없는 불균질한 연부조직 종양이 피부하에서 발생할 때 비록 드물지만 감별진단에 포함해야 할 것으로 생각한다.

MR Imaging of Soft-Tissue Vascular Lesions: Pathologic Correlation

Lee, Hak-Soo,Joo, Kyung-Bin,Jin, Sung-Chan,Kim, Yong-Soo,Park, Dong-Woo,Park, Choong-Ki,Seo, Heung-Suk,Lee, Won-Mi,Park, Chan-Kem The Korean Radiological Society 2001 대한영상의학회지 Vol.45 No.1

혈관성 병변의 평가시, 자기공명영상은 스핀에코기법의 자기공명영상 신호 특성에 기초하여 저속도성 병변과 고속도성 병변을 구별하는데 이용될 수 있고, 또한 혈관성 병변을 구성하고 있는 섬유지방성분. 혈전. 정맥석 근 위축 등의 정지조직의 영상을 표현하는데 적합하다 본 화보에서는 다양한 혈관성 병변의 자기공명영상 소견을 나열하고, 정지조직을 중심으로 자기공명 영상과 조직학적 소견을 비교하고자 한다. In the evaluation of vascular lesions, MR can be used to distinguish slow- from high (low lesions on the basis of the observed spin-echo MR signal characteristics. MR imaging can also represent features of the static tissues of the vascular lesions that are composed of fibrofatty components, as well as thromboses, phleboliths and muscle atrophy, This paper illustrates the MR findings of various vascular lesions, correlating them with the pathologic specimen and emphasizing on the static tissues.

거대세포종 : 내부에 골화를 동반한 연부조직 재발 -3예보고

전경녀 대한영상의학회 1997 대한영상의학회지 Vol.36 No.5

극소적 절제술 후 거대세포종의 재발은 드물지 않으나 연부조직 재발을 시사하는 변연 골화 소견은 드물지만 중요한 방사선학적 징후가 된다. 저자들이 경험한 3예의 단순촬 영, CT, MRI 소견을 보고한다. We report three cases of recurrence of giant cell tumor characterized by ossification of surrounding soft tissue. On resection, the ossified rim in the soft tissue masses were pathognomonic of recurrence of giant cell tumor. Knowledge of this findings would help for accurate diagnosis and appropriate treatment.

회음부 연부조직에 발생한 염증성 근섬유모세포종:1예보고

권순태,김종철,Gwon, Sun-Tae,Kim, Jong-Cheol 대한영상의학회 2001 대한영상의학회지 Vol.45 No.4

염증성 근섬유모세포종은 원인을 알 수 없는 드문 양성질환으로 간혹 악성종양과 유사한 소견을 보인다.조직학적으로 근섬유모세포와 형질세포,임파구로 구성되어 있고,폐,간,안와,피부,장간막,후복막,그리고 상악동 등에 보고 된 바 있다.저자들은 우측 회음부에서 촉지된 종괴를 주소로 내원한 35세 여자환자에서 피하지방에서 발생한 염증성 근섬유모세포종 1예를 경험하였기에 방사선학적 소견을 중심으로 보고하고자 한다.이 종괴는 초음파 검사에서 우측 회음부에 경계가 좋은 엽상형의 저에코 병변이며 종괴 주변에 일부 고에코의 선상음영들이 관찰 되고,T1 강조 자기공명영상에서 근육과 비슷한 신호강도,T2 강조 자기공명영상에서 불균일 고신호강도로 관찰되며 종괴와 주변 불균일 선상음영의 강한 조영증강을 보였다.환자는 외과적 절제술을 시행하였고 병리조직학적 진단은 염증성 근섬유모세포종이었다. Inflammatory myofibroblastic tumor is a rare benign condition of unknown etiology, and it may simulate malignancy. It is composed of myofibroblast, plasma cells and histiocytes and is found in lung, the liver, orbit, skin, mesentery, retroperitoneum and maxillary sinus. We report a case of inflammatory myofibroblastic tumor of perineal subcutaneous fat in a 35-year-old woman who complained of a palpable mass. Ultrasonography revealed a well-marginated lobulated hypoechoic lesion with peripheral poorly-defined hyperechoic strands in the subcutaneous fat of the right perineum. The lesion demonstrated low signal intensity on T1-weighted images and of heterogenous high signal intensity on T2-weighted images, compared with surrounding muscle. After intravenous injection of gadolinium, it showed clear homogeneous enhancement but poorly-defined adjacent strands. The final histologic diagnosis was inflammatory myofibroblastic tumor.

사지 맥관근종의 자기공명영상 소견 : 2예 보고

최윤선 대한영상의학회 1999 대한영상의학회지 Vol.40 No.2

맥관근종은 혈관의 평활근에서 발생하는 양성 연부조직 종괴로 진피의 심층 또는 피하조직에서 생긴다. 대부분 피막이 형성된 단일 종괴로 크기는 보통 2cm 이하이며 동통을 동반하며 중년 여성에서 하지에 호발한다. 사지 맥관근종의 자기공명영상 소견은 많이 알려져 있지 않으며 저자들은 손과 발에 생긴 맥관근종 2예를 경험하였기에 자기공명영상 소견을 보고하고자 한다. Angiomyoma is a benign soft tissue tumor that arises from the smooth muscle layer of blood vessels in the deeplayers of the dermis, or in subcutaneous tissue. It occurs as a well-encapsulated solitary mass, most of which areless than 2cm in diameter. Some patients complain of pain with or without tenderness. This tumor has apredilection for the lower extremities of middle-aged females. MRI findings of angiomyoma of the extremities haverarely been reported, and we describe these findings in two cases of angiomyoma of the hand and foot.

A Case of Myopericytoma and Review of Korean Literature

박수정,정국진,박재완,홍지연,박귀영,서성준 대한피부과학회 2020 大韓皮膚科學會誌 Vol.58 No.8

Myopericytoma, previously called as hemangiopericytoma, is a rare, soft tissue neoplasm. It usually presents as an asymptomatic solitary lesion, and it most commonly affects the lower extremities. It is characterized by the distinctive perivascular organization of oval-to-spindle-shaped cells in a concentric pattern. Here we report a case of myopericytoma, which was diagnosed in a 60-year-old woman who presented with a one-year history of a deep-seated nodule and reviewed previous cases in the Korean literature and found a predominance of female cases of myopericytoma, contrary to known predilections. Hence, we have reported a typical case and summarized clinical findings in the Korean population.

고분화 뼈대외뼈육종 - 1예 보고 -

고경혁,양정욱,송대현,김동희 대한병리학회 2008 Journal of Pathology and Translational Medicine Vol.42 No.4

A well-differentiated extraskeletal osteosarcoma is very rare, and only seven cases have been reported in the English language clinical literature. We report an additional case of this rare tumor. A 71-year-old man had noticed a mass in the left pubic area for ten years. A CT scan demonstrated the presence of a lobulated calcified mass within the soft tissue. A 5 cm-sized well-circumscribed mass was excised. Histologically the tumor was composed of mature collagenous tissue and bony trabeculae rimmed by osteoblasts. After 43 months, the tumor recurred at the same site and was re-excised. The re-excised tumor contained focal areas of higher cellularity and atypism. We believe that this is the first case of well-differentiated extraskeletal osteosarcoma reported in Korea.