수막 혈관주위세포종 환자에서의 수술과 방사선치료 -증례보고- = Meningeal Hemangiopericytoma Treated with Surgery and Radiation Therapy -Case Report-

다국어 초록 (Multilingual Abstract)

Meningeal hemangiopericytoma (HPC) is an uncommon dura-based tumor and can recur not only locally but also distantly in the neural axis or extraneural sites. We report our experience of radiation therapy, one preoperative and one elective postoperative, in two patients with meningeal HPC and reviewed the role of radiation therapy. A 41-year-old man (Case 1) presented with a 3-month history of headache and right hemiparesis. The mass was nearly unresectable at the first and second operation and diagnosed as meningeal HPC. Preoperative radiation therapy was given with a total dose of 55.8 Gy/31 fractions to the large residual mass of left frontoparietal area. Follow-up computerized tomography (CT) showed marked regression of tumor after radiation therapy. The third operation was performed to remove the residual tumor at 6 months after the radiation therapy and a 2×2 cm sized tumor was encountered. The mass was totally removed. The serial follow-up CT showed no evidence of recurrence and he is alive without distant metastasis for 4 years and 10 months after the first operation. A 45-year-old woman (Case 2) presented with suddenly developed headache and visual impairment. Tumor mass occupying right frontal lobe was removed with the preoperative diagnosis of meningioma. It was totally removed with attached sagittal sinus and diagnosed as meningeal HPC. Elective postoperative radiation therapy was performed to reduce local recurrence with a total dose of 54 Gy/30 fractions to the involved area of right frontal lobe. She is alive for 5 years maintaining normal activity without local recurrence and distant metastasis.

국문 초록 (Abstract)

막에 발생하는 혈관주위세포종은 경질막에 기초한 드문 종양으로서 국소재발과 함께 신경축이나 신경외 장소로 원격전이를 일으킬 수도 있다. 저자들은 수막에 발생한 혈관주위세포종 환자 2예에서 수술 전 방사선치료와 수술 후 방사선치료를 각각 경험하였기에 방사선치료의 역할에 관한 문헌고찰과 함께 보고하고자 한다. 첫 번째 증례는 41세 남자로 3개월 동안 두통과 우측 반부전마비가 있었다. 1차 수술과 2차 수술 시 종양은 거의 제거할 수 없었고 수막 혈관주위세포종으로 진단되었다. 수술 전 방사선치료를 좌측 전두두정부의 큰 잔여종양에 일 회에 1.8 Gy씩 31회에 걸쳐 총 55.8 Gy를 조사하였다. 방사선치료 후 CT검사상 종양은 현저하게 크기가 줄었고 방사선치료 후 6개월에 시행한 3차 수술 시 잔여 종양의 크기는 2×2 cm로 완전히 제거되었다. 추적 CT검사상 국소재발의 소견은 없었고, 1차 수술 후 4년 10개월 동안 원격 전이 없이 생존하고 있다. 두 번째 증례는 45세 여자로 갑작스러운 두통과 시력 장애로 수막종이 의심되어 종양제거수술을 받았는데 조직 검사상 우측 전두엽에 발생한 혈관주위세포종으로 진단되었으며 시상동을 침습한 소견을 보였으나 완전히 제거되었다. 국소재발을 줄이기 위해 수술 후 방사선치료가 의뢰되었고 방사선치료는 우측 전두엽 부위에 일 회에 1.8 Gy씩 30회에 걸쳐 총 54 Gy를 조사하였다. 수술 후 5년 동안 국소 재발이나 원격 전이 없이 정상적인 활동을 유지하면서 생존하고 있다.

참고문헌 (Reference)

• 1 "Treatment of intracranial meningioma with linac based radiosurgery" 19 : 81-86, 2001
• 2 "Successful removal after radiotherapy and vascular embolization in a huge tentorial epithelioid hemangioendothelioma" 68 : 177-183, 2004
• 3 "Recurrent intracranial hemangiopericytoma with extracranial and unusual multiple metastases" 90 : 265-268, 2004
• 4 "Recurrence and extraneural metastasis in 31 meningeal hemangiopericytomas" 30 : 349-357, 2001
• 5 "Recent experience in the management of meningeal hemangiopericytomas" 83 : 856-861, 1997
• 6 "Metastasis of intracranial hemangiopericytoma to thoracic spine" 30 : 666-669, 2001
• 7 "Meningeal hemangiopericytomas" 59 : 47-54, 2003
• 8 "Meningeal hemangiopericytomas" 30 (30): 876-882, 2001
• 9 "Meningeal hemangiopericytoma:histopathological features,treatment,and long-term follow-up of 44 cases" 25 : 514-522, 1989
• 10 "Meningeal hemangiopericytoma:defining the role for radiation therapy" 14 : 277-287, 1992
• 11 "Meningeal hemangiopericytoma" 48 : 756-763, 2001
• 12 "Intracranial meningeal hemangiopericytoma" 100 : 1491-1497, 2004
• 13 "Intracranial hemangiopericytoma with extracranial metastasis occurring after 22 years" 42 : 297-300, 2002
• 14 "Intracranial hemangiopericytoma" 143 : 575-586, 2001
• 15 "Imaging intracranial hemangiopericytomas" 46 : 194-197, 2004
• 16 "Hemangiopericytoma:a clinical and radiological comparison with atypical meningiomas" 9 : 127-134, 1995
• 17 "Four cases of meningeal hemangiopericytoma treated with surgery and radiotherapy" 31 : 548-552, 2001
• 18 "Effect of radiation therapy against intracranial hemangiopericytoma" 328-332, 1992
• 19 "Cerebral hemangiopericytoma treated with conservative surgery and radiotherapy" 12 : 124-127, 2000