A Case of Dedifferentiated Chondrosarcoma : It was Changed From a Hamartoma

과오종에서 악성화된 탈분화형 연골육종 1예

Extraosseous pulmonary chondrosarcoma is rare neoplasm, which is characterized into two groups. One is termed a primary chondrosarcoma, and arise de novo (bronchial cartilage), the other is termed a secondary chondrosarcoma, and is superimposed on preexisting benign cartilagenous neoplasms, such as a chondroma or hamartoma. The preferred treatment is surgical resection. We recently experienced a secondary chondrosarcoma changed from a hamartoma. A 54-year-old woman was referred to our hospital because of an abnormal chest X-ray with mild dyspnea. We performed a percutaneous transthoracic needle biopsy and sputum examination. The abnormal mass had been diagnosed as a chondromatous hamartoma with active pulmonary tuberculosis, which had been treated with anti-tuberculosis regimens. Despite her medication, an abnormal mass had grown. Therefore, we undertook a pneumonectomy with chest wall reconstruction. Histopathologically, the mass was a grade II, dedifferenciated chondrosarcoma, with chronic granulomatous inflammation and necrosis. We suggest this case had changed from a chondromatous hamartoma to a dedifferentiated chondrosarcoma, with associated pulmonary tuberculosis. We report this case with a brief literature review.

저자들은 54세 여자 환자에서 좌상엽의 종괴에 대한 경피적 경흉 침생검을 통해 연골성 과오종으로 진단하고 방사선 소견상 폐결핵이 같이 의심되었으나 활동성 여부가 불분명하여 3개월 간격으로 외래 추적관찰 도중, 15개월째 객담 항산균 도말검사상 양성으로 판명되어 항결핵제를 투여하였으나, 21개월째 증상의 호전이 없고 종괴의 크기가 증가되는 소견을 보여 악성변화를 배제할 수 없어 수술을 시행하였으며, 조직검사상 만성 육아종성 병변과 함께 탈분화형 연골육종으로 과오종에서 악성화된 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.