결막에 발생한 결절근막염 1예
Case Report of Nodular Fasciitis in the Conjunctiva
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목적: 국내에는 보고된 바 없는 결막에 발생한 결절근막염 1예를 보고하고자 한다. 증례요약: 18세 여자 환자가 1개월 간 크기가 증가하는 좌안 결막 종괴를 주소로 내원하였다. 종괴는 가로 1 mm, 세로 1.5 mm 정도의 크기의 경계가 뚜렷한 병변이었으며, 좌안 결막 코쪽구석에 위치하였고, 압통이나 발적은 없었다. 외상의 과거력 또한 없었다. 좌안결막 종괴 절제 시행하였으며, 종괴의 공막 침범은 확인되지 않았고, 주변부 결막조직에도 특이 소견은 없었다. 면역조직화학검사상 S-100 음성, smooth muscle actin 양성 확인되었고, HHV8 PCR 검사 상에서는 음성이 확인되었다. 이는 본 증례의 병변이 근섬유모세포 기원임을 보여주는 결과이며, 본 증례의 조직학적, 조직면역학적 특징 및 임상 소견을 종합하여 최종적으로 위와 같은 조직면역학적 특징을 보이는 결절근막염으로 진단할 수 있었으며, 종괴를 제거한 후 4개월 경과 상 재발 소견은 발견되지 않았다. 결론: 악성 종양 및 공막염과 같은 염증성 병변과 결절근막염의 치료 및 예후는 확연한 차이가 있기에 이러한 질환과의 감별은 수술적 절제만으로 예후가 양호한 결절근막염의 진단에 중요하다.
Abstract
Purpose: We report a case of nodular fasciitis of the conjunctiva that has not been previously reported in the Republic of Korea. Case summary: A 18-year-old female patient presented with a left conjunctival mass, which had been enlarging for 1 month. The tumor was located at the corner of the conjunctiva of the left eye. The size of the tumor was 1 mm in width and 1.5 mm in height, and tenderness and redness were not observed. There was no history of trauma, but bilateral upper lid blepharoplasty was performed 2 months prior to her visit. Excision of a conjunctival mass was performed and there was no evidence of involvement of the sclera or peripheral conjunctiva around the mass. We performed immunohistochemistry and PCR for human herpes virus 8 (HHV8). Immunohistochemistry was positive for S-100 and negative for smooth muscle actin and HHV8. The mass was myofibroblastic in nature and the histopathological features and clinical findings of this case were diagnosed as nodular fasciitis with the features as described above. There was no recurrence for 4 months after removal of the mass. Conclusions: Because the treatments and prognoses of malignant tumors or other inflammatory diseases such as nodular scleritis and nodular fasciitis are quite different, differentiation from these diseases is considered an important factor in the diagnosis of nodular fasciitis.
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