본문 바로가기
KERD
논문KCI 등재

원발성 결막 악성림프종 환자의 임상분석

Clinical Analysis of Primary Conjunctival Malignant Lymphoma

윤경철|이제중|양지명
대한안과학회 (The Korean Ophthalmological Society)|2014.09|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제55권 제9호|pp. 1298-1306

2

조회

0

다운로드

3

인용

0

참고문헌

키워드

RadiotherapyRecurrenceDry eye diseaseMalignant lymphomaConjunctival lymphoma
주제분류안과학

초록

목적: 결막에만 발생한 원발성 악성림프종 환자들을 대상으로 임상양상 및 경과, 치료 반응, 재발과 관련된 인자, 치료 후 발생한 합병증에 대하여 알아보고자 하였다. 대상과 방법: 2005년 1월부터 2013년 6월까지 원발성 결막 악성림프종으로 진단받은 39명의 환자들의 의무기록을 후향적으로 분석하였다. 결과: 환자들의 평균 연령은 51.1세였으며, 가장 많이 호소하는 주증상은 결막충혈(33.3%)이었다. 종물의 위치는 결막구석(38.5%)이가장 많았고, 25.6%에서는 종양이 양측성으로 발생하였다. 조직검사상 점막연관 림프조직형 림프종으로 진단된 경우(92.3%)가 가장많았다. 모든 환자에서 수술적 절제술 이후 방사선 치료(92.3%) 또는 화학요법(7.7%)을 시행 받았으며, 치료 후 100% 완전관해를 보였으나, 15.4%에서 평균 8.0 ± 3.3개월 후 재발이 있었으며 추가적인 방사선 및 항암화학요법으로 완전관해를 보였다. Internationalprognostic index (p＜0.01)와 종양의 위치(p=0.02)가 재발과 유의한 관련성을 보였다. 방사선 치료 후 발생한 합병증 중 건성안(44.4%)이 가장 많이 발생하였으며, 총 방사선 조사량(p=0.04) 및 종양의 위치(p=0.04)가 건성안의 발생과 유의한 연관성이 있는인자였다. 결론: 원발성 결막 악성림프종은 악성도가 낮은 점막연관 림프조직형 림프종이 가장 많고, 치료에 대한 반응이 좋지만, 상대적으로재발을 잘하며, 방사선 치료 후 합병증으로 건성안이 잘 발생하기 때문에 이를 예측하고 대비하는 것이 중요하다.

Abstract

Purpose: To investigate clinical outcomes, response to treatment, and the related factors of recurrence and complication, followingtreatment of primary conjunctival malignant lymphoma. Methods: The medical records of 39 patients diagnosed with primary conjunctival malignant lymphoma between January 2005and June 2013 were retrospectively reviewed. Results: The mean age of patients was 51.1 years old. The most common presenting symptom was hyperemia (33.3%). Themost common anatomical location of the mass was the fornix (38.5%) and 25.6% patients had bilateral involvement. Histopathologically, mucosa-associated lymphoid tissue (MALT) lymphoma (92.3%) was the most common subtype. Every patientunderwent radiotherapy (92.3%) or chemotherapy (7.7%) after surgical excision and had 100% complete remission. Localor systemic recurrence was observed in 15.4% of patients after treatment (mean 8.0 ± 3.3 months), but was completely remittedafter additional radiation or chemotherapy. International prognostic index and location of tumor were significantly related factorsfor predicting tumor recurrence (p < 0.01, p = 0.02, respectively). Dry eye disease (DED) was the most common ocular complication(44.4%) after radiotherapy. Total radiation dosage and location of tumor were significantly associated factors for developingDED after radiotherapy (both p = 0.04). Conclusions: Most conjunctival malignant lymphomas were low grade malignant MALT lymphomas that responded well to treatmentbut recurrence of tumor and development of DED after radiotherapy were common, therefore predicting and preparingthese lymphomas is important.

참고문헌 (43)

  1. Freeman C, "Occurrence and prognosis of extranodal lymphomas", Cancer, 29, pp.252~260 (1972)
  2. Knowles DM, "Lymphoid hyperplasia and malignant lymphoma occurring in the ocular adnexa (orbit, conjunctiva, and eyelids): a prospective multiparametric analysis of 108 cases during 1977 to 1987", Hum Pathol, 21, pp.959~973 (1990)
  3. Grossniklaus HE, "Conjunctival lesions in adults. A clinical and histopathologic review", Cornea, 6, pp.78~116 (1987)
  4. Shields CL, "Conjunctival lymphoid tumors: clinical analysis of 117 cases and relationship to systemic lymphoma", Ophthalmology, 108, pp.979~984 (2001)
  5. Tsai PS, "Treatment of conjunctival lymphomas", Semin Ophthalmol, 20, pp.239~246 (2005)
  6. Jenkins C, "Clinical features associated with survival of patients with lymphoma of the ocular adnexa", Eye(Lond), 17, pp.809~820 (2003)
  7. Coupland SE, "Ocular adnexal lymphomas:five case presentations and a review of the literature", Surv Ophthalmol, 47, pp.470~490 (2002)
  8. Matsuo T, "Long-term follow-up results of observation or radiation for conjunctival malignant lymphoma", Ophthalmology, 111, pp.1233~1237 (2004)
  9. Liao SL, "Results of radiotherapy for orbital and adnexal lymphoma", Orbit, 21, pp.117~123 (2002)
  10. Goda JS, "Localized orbital mucosa-associated lymphoma tissue lymphoma managed with primary radiation therapy: efficacy and toxicity", Int J Radiat Oncol Biol Phys, 81, pp.e659~e666 (2011)
  11. 이상준, "안와 및 안부속기 림프종 환자의 임상양상 및 예후인자의 분석", 대한안과학회지, 54(1), pp.12~18 (2013), 대한안과학회
  12. 임대원, "결막에 발생한 림프구증식성 질환의 임상양상 및 치료결과", 대한안과학회지, 45(11), pp.7~7 (2004), 대한안과학회
  13. Swerdlow SH, "WHO classification of tumours of haematopoietic and lymphoid tissues Vol. 2" (2008), IARC Press
  14. Carbone PP, "Report of the Committee on Hodgkin's Disease Staging Classification", Cancer Res, 31, pp.1860~1861 (1971)
  15. "The definition and classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop (2007)", Ocul Surf, 5, pp.75~92 (2007)
  16. White WL, "Ocular adnexal lymphoma. A clinicopathologic study with identification of lymphomas of mucosa-associated lymphoid tissue type", Ophthalmology, 102, pp.1994~2006 (1995)
  17. Johnson TE, "Ocular-adnexal lymphoid tumors: a clinicopathologic and molecular genetic study of 77patients", Ophthal Plast Reconstr Surg, 15, pp.171~179 (1999)
  18. Coupland SE, "Lymphoproliferative lesions of the ocular adnexa. Analysis of 112 cases", Ophthalmology, 105, pp.1430~1441 (1998)
  19. Abd Al-Kader L, "A case of conjunctival follicular lymphoma mimicking mucosa-associated lymphoid tissue lymphoma", J Clin Exp Hematop, 53, pp.49~52 (2013)
  20. Jakobiec FA, "Ocular adnexal lymphoid tumors: progress in need of clarification", Am J Ophthalmol, 145, pp.941~950 (2008)
  21. 지준영, "안와 및 안부속기 악성림프종의 방사선치료", 대한안과학회지, 46(2), pp.3~3 (2005), 대한안과학회
  22. Jung-Min Woo, "The Clinical Characteristics and Treatment Results of Ocular Adnexal Lymphoma", Korean Journal of Ophthalmology, 20(1), pp.7~12 (2006), 대한안과학회
  23. Cho EY, "Clinicopathologic analysis of ocular adnexal lymphomas: extranodal marginal zone b-cell lymphoma constitutes the vast majority of ocular lymphomas among Koreans and affects younger patients", Am J Hematol, 73, pp.87~96 (2003)
  24. Uno T, "Radiotherapy for extranodal, marginal zone, B-cell lymphoma of mucosa-associated lymphoid tissue originating in the ocular adnexa: a multiinstitutional, retrospective review of 50 patients", Cancer, 98, pp.865~871 (2003)
  25. Woolf DK, "Primary lymphoma of the ocular adnexa (orbital lymphoma) and primary intraocular lymphoma", Clin Oncol(R Coll Radiol), 24, pp.339~344 (2012)
  26. 박성진, "안와 부속기 MALT 림프종 환자에서 R-CVP 복합 항암 화학 요법의 치료 효과", 대한안과학회지, 54(8), pp.1157~1164 (2013), 대한안과학회
  27. Nückel H, "Anti-CD20 monoclonal antibody therapy in relapsed MALT lymphoma of the conjunctiva", Eur J Haematol, 73, pp.258~262 (2004)
  28. Zinzani PL, "Rituximab in primary conjunctiva lymphoma", Leuk Res, 29, pp.107~108 (2005)
  29. Kang HJ, "Phase II trial of rituximab plus CVP combination chemotherapy for advanced stage marginal zone lymphoma as a first-line therapy: Consortium for Improving Survival of Lymphoma (CISL) study", Ann Hematol, 91, pp.543~551 (2012)
  30. Jaffe ES, "World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues. A progress report", Am J Clin Pathol, 111, pp.S8~S12 (1999)
  31. 서민희, "결막의 점막연관 림프조직형 림프종(MALToma)의 안구 내 침범 환자 1례 보고", 대한안과학회지, 48(3), pp.460~464 (2007), 대한안과학회
  32. López-Guillermo A, "Applicability of the International Index for aggressive lymphomas to patients with low-grade lymphoma", J Clin Oncol, 12, pp.1343~1348 (1994)
  33. Troch M, "Assessment of the prognostic indices IPI and FLIPI in patients with mucosa-associated lymphoid tissue lymphoma", Anticancer Res, 30, pp.635~639 (2010)
  34. Sjö LD, "Extranodal marginal zone lymphoma in the ocular region: clinical, immunophenotypical, and cytogenetical characteristics", Invest Ophthalmol Vis Sci, 50, pp.516~522 (2009)
  35. Demirci H, "Orbital lymphoproliferative tumors: analysis of clinical features and systemic involvement in 160 cases", Ophthalmology, 115, pp.1626~1631.e1-3 (2008)
  36. Ellis JH, "Lymphoid tumors of the ocular adnexa. Clinical correlation with the working formulation classification and immunoperoxidase staining of paraffin sections", Ophthalmology, 92, pp.1311~1324 (1985)
  37. Avilés A, "Addition of a short course of chemotherapy did not improve outcome in patients with localized marginal B-cell lymphoma of the orbit", Oncology, 70, pp.173~176 (2006)
  38. Bhandare N, "Severe dry eye syndrome after radiotherapy for head-and-neck tumors", Int J Radiat Oncol Biol Phys, 82, pp.1501~1508 (2012)
  39. Bessell EM, "Orbital and conjunctival lymphoma treatment and prognosis", Radiother Oncol, 13, pp.237~244 (1988)
  40. Smitt MC, "Radiotherapy is successful treatment for orbital lymphoma", Int J Radiat Oncol Biol Phys, 26, pp.59~66 (1993)
  41. Letschert JG, "Results of radiotherapy in patients with stage I orbital non-Hodgkin's lymphoma", Radiother Oncol, 22, pp.36~44 (1991)
  42. Erickson BA, "Periocular lymphoproliferative diseases: natural history, prognostic factors, and treatment", Radiology, 185, pp.63~70 (1992)
  43. Claus F, "Short term toxicity profile for 32 sinonasal cancer patients treated with IMRT. Can we avoid dry eye syndrome?", Radiother Oncol, 64, pp.205~208 (2002)

관련 논문AI추천

안와 및 안부속기 림프종 환자의 임상양상 및 예후인자의 분석이상준, 정재호, 최희영대한안과학회 · 대한안과학회지2013 · 제54권 제1호결막의 점막연관 림프조직 림프종에서 냉동요법의 장기 결과김근해, 이시은대한안과학회 · 대한안과학회지2015 · 제56권 제11호안와부속기의 덮개 세포 림프종과 MALT 림프종의 비교김민수, 박근성, 이성복, 이종수, 최희영대한안과학회 · 대한안과학회지2015 · 제56권 제6호The Clinical Characteristics and Treatment Results of Ocular Adnexal Lymphoma권혁찬, 노미숙, 안희배, 이진화, Chien-Kue Tang, Jung-Min Woo대한안과학회 · Korean Journal of Ophthalmology2006 · 제20권 제1호서부 경남지역 안와 및 안부속기 림프종 환자의 역학 및 임상 양상 분석김성재, 서성욱, 정인석대한안과학회 · 대한안과학회지2023 · 제64권 제12호Low-Dose Radiation Therapy for Primary Conjunctival Marginal Zone B-Cell Lymphoma고영혜, 김석진, 김원석, 김윤덕, 안용찬, 오동률, 우경인, 이가인대한암학회 · Cancer Research and Treatment2018 · 제50권 제2호

이 간행물의 다른 논문 (24건)

갑상샘눈병증 환자의 안와감압술에서 2차원 안와 전산화 단층촬영의 4가지 parameter의 유용성이태수, 이종석, 백세현, 이화, 장민욱pp. 1267-1271전산화 단층촬영을 이용한 시신경관의 형태 및 위치측정황진영, 이태수, 장민욱, 이화, 백세현pp. 1272-1276굴절교정레이저각막절제술 후 트라닐라스트의 각막혼탁 억제에 대한 펜타캠을 이용한 분석김성인, 오태훈pp. 1277-1283상피제거회전솔을 이용한 굴절교정레이저각막절제술과 상피통과굴절교정레이저각막절제술의 임상결과 비교김세경, 최태훈, 강현승, 최철명pp. 1284-1290알레르기결막염 환자에서 눈물 호산구양이온단백질 측정정소향, 임병수pp. 1291-1297
원문 보기