호르몬 치료를 받던 폐경 후 여성에서 발생한 악성 혼합 뮐러종양 1예
One Case of Malignant Mixed Müllerian Tumor Developed in a Postmenopausal Woman under Hormone Therapy
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갱년기 및 폐경기 여성 호르몬 치료는 폐경기 증상의 완화와 골다공증의 예방을 목적으로 광범위하게 사용되고 있다. 호 르몬 요법을 받고 있는 폐경기 여성에서 질 출혈의 가장 흔한 원인은 외인성 호르몬이기는 하지만, 실제 환자 진료 시에는 자궁내막증식증이나 자궁내막암과 같은 자궁내막질환의 가 능성에 대해서도 항상 염두에 두어야 한다. 갱년기 호르몬 치 료에서 나타나는 비정상 자궁 출혈을 평가하기 위해서는 자 세한 병력 청취, 신체 검진 및 골반 검진은 필수사항이며, 이 외 질경유 초음파 검사, 자궁내막 흡인생검, 경관확장 자궁소파 술, 그리고 자궁경 검사 등의 검사법을 통해 도움을 받을 수 있 다. 본 증례는 5년간 지속적 복합호르몬 요법을 받아오던 환자 가 갑작스러운 소량의 파탄성 출혈을 주소로 내원하여, 최적 의 평가 및 검사를 통해 악성혼합 뮐러종양을 진단받은 경우 이다. 저자들은 본 고를 통해 호르몬 치료를 받던 환자에게 비 정상 자궁출혈이 발생하였을 때 고려해야 할 사항들과 그에 따른 적절한 접근 방법 및 단계별 검사의 의미에 대해 고찰함 으로써 일차진료에서의 호르몬 치료에 도움이 되고자 한다.
Abstract
Hormone therapy for peri- and postmenopausal women is widely used for relieving vasomotor symptoms or preventing osteoporosis. Even though exogenous hormone is the most common cause of vaginal bleeding in postmenopausal women under hormone therapy, in clinical practice, physicians must never exclude the possibility of endometrial disorders, such as endometrial hyperplasia or cancer. Taking thorough medical history and performing physical and pelvic examinations are essential for the evaluation of abnormal uterine bleeding in menopausal hormone therapy. Transvaginal ultrasonography, endometrial aspiration biopsy, dilatation and curettage, and hysteroscopy are the options which physicians may use. This case is about a woman with continuous combined hormone therapy for 5 years who had experienced rather sudden onset of vaginal spotting lasting for several months and was fi nally diagnosed as having malignant mixed Müllerian tumor. Our purpose is to inquire into the proper approaching steps for vaginal bleeding in menopausal hormone therapy
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