난소의 미성숙 기형종 3예
Three Cases of Immature Teratoma of the Ovary
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초록
난소의 미성숙 기형종은 배세포 종양 중 3번째의 빈도를 나타내며, 20세 이하의 환자에서 발생하는 난소암 중 10-20%를 차지한다. 임상양상은 보통 복통을 동반한 복부 골반 종괴로 나타나며 대부분 단측성이고 크기가 크며 주로 고형성이면서 일부 낭성조직을 포함하는 형태이다. 세 배엽에서 기원한 성숙 및 미성숙 조직으로 구성되고, 종양의 분화도는 주로 신경외배엽에서 기원한 미성숙 조직의 양에 의해 결정된다. 치료와 예후는 임상적 병기와 조직학적 분화도에 의하여 결정된다. 병소측 난소난관절제술을 시행해야 하며 난소를 벗어난 병소가 있을 경우에는 이를 가능한 많이 제거해야 한다. 보조적 항암화학요법은 stage IA, grade 1 종양의 경우나 성숙 교세포 이식이 있을 때에는 반드시 필요한 것은 아니다. Grade 2 혹은 3인 경우나 미성숙 전이가 있는 경우에는 복합항암화학요법이 추천된다. 항암화학요법이 사용되기 이전에는 미성숙 기형종의 예후는 매우 나쁘다고 알려져 있었으나 복합항암화학요법의 발달로 예전보다 좋은 예후를 보이고 있다. 저자들은 본원 산부인과에서 경험한 난소의 미성숙 기형종 3예를 문헌 고찰과 함께 보고하는 바이다.
Abstract
The immature teratoma is the 3rd most common germ cell tumor and represents 10-20% of all ovarian malignancies occurring in the first two decades of life. The initial clinical manifestation is abdominal/pelvic mass with pain. This tumor is usually unilateral and large, and has a prominent solid component with cystic elements. It is composed of mature and immature tissues derived from the three germ cell layers. Tumor grading is based on the amount of immature tissues which mostly derives from neuroectodermal origin. The prognosis and treatment depend on the clinical stage and histological grade of the tumor. The initial treatment should include unilateral salpingo-oophorectomy and removal of as much extraovarian tumor as possible. Adjuvant chemotherapy is not necessary for the patients with stage IA, grade 1 tumor or those with mature glial implants. Combination chemotherapy is recommended for the patients with grade 2 or 3 tumors or those with immature metastases. Although the immature teratoma was considered aggressive tumor type before the prevalent use of chemotherapy, the advances in combination chemotherapy have leaded to the better prognosis than before. We have experienced three cases of immature teratoma and report them with brief review of literatures.
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