악성흉막삼출액을 동반한 다계열형성이상 급성골수백혈병 1예

A Case of Acute Myeloid Leukemia with Multilineage Dysplasia accompanying Malignant Pleural Effusion

  • 서영익 (순천향대학교 의과대학 임상병리학교실) ;
  • 최태윤 (순천향대학교 의과대학 임상병리학교실) ;
  • 신정원 (순천향대학교 의과대학 임상병리학교실) ;
  • 원종호 (순천향대학교 의과대학 내과학교실) ;
  • 이상철 (순천향대학교 의과대학 내과학교실) ;
  • 박희숙 (순천향대학교 의과대학 내과학교실) ;
  • 이남수 (순천향대학교 의과대학 내과학교실) ;
  • 박노진 (순천향대학교 의과대학 임상병리학교실)
  • Seo, Young Ik (Department of Clinical Pathology, College of Medicine, Soon Chun Hyang University) ;
  • Choi, Tae Youn (Department of Clinical Pathology, College of Medicine, Soon Chun Hyang University) ;
  • Shin, Jeong Won (Department of Clinical Pathology, College of Medicine, Soon Chun Hyang University) ;
  • Won, Jong Ho (Department of Internal Medicine, College of Medicine, Soon Chun Hyang University) ;
  • Lee, Sang-Cheol (Department of Internal Medicine, College of Medicine, Soon Chun Hyang University) ;
  • Park, Hee-Sook (Department of Internal Medicine, College of Medicine, Soon Chun Hyang University) ;
  • Lee, Nam-Soo (Department of Internal Medicine, College of Medicine, Soon Chun Hyang University) ;
  • Park, Rojin (Department of Clinical Pathology, College of Medicine, Soon Chun Hyang University)
  • 투고 : 2008.04.28
  • 심사 : 2008.06.30
  • 발행 : 2008.07.30

초록

저자들은 악성흉막삼출증을 동반한 다계열형성이상 급성골수백혈병 1예를 보고하고자 한다. 73세 남자환자가 열감과 우측흉통을 주소로 내원하여 시행한 흉막천자 흉막액의 세포진 검사에서 2개월 전에 진단받은 다계열형성 이상 급성골수백혈병 진단 당시에 골수에서 보였던 모세포가 다수 관찰되었다. 환자는 고령과 전신쇠약감으로 복합화학요법을 시행하지 않고 hydroxyurea 투여와 함께 보존적 치료만 계속해 왔다. 환자는 다계열형성이상 급성골수백혈병을 진단받은 후 4.5개월 만에 사망하였다. 급성백혈병환자에서 흉막삼출액의 존재는 흉막전이의 가능성을 높여주고 예후에 주는 영향도 완전히 배제할 수 없으므로 흉막삼출액의 악성유무를 가리는 일은 중요하리라고 생각된다.

We report a case of acute myeloid leukemia with multilineage dysplasia accompanying malignant pleural effusion. A 73 year-old male patient was admitted complaining of febrile sensations and right chest pain. The cytology of the pleural fluid revealed malignant pleural effusion showing many blasts, which had previously been identified in his bone marrow when he was diagnosed with acute myeloid leukemia with multilineage dysplasia two months earlier. His age and poor general condition had precluded chemotherapy with the exception of hydroxyurea and conservative treatment. Unfortunately, he succumbed to the disease 4.5 months after diagnosis. This case highlights the importance of determining if the pleural effusion of acute leukemia is malignant or not because it can suggest a pleural metastasis and influence the prognosis.

키워드

참고문헌

  1. Haas AR, Sterman DH, Musani AI. Malignant pleural effusions: management options with onsideration of coding, billing, and a decision approach. Chest 2007; 132:1036-41. https://doi.org/10.1378/chest.06-1757
  2. Fatih T, Selim Y, Mesut A, Demirel YN, Yuksel P. An unusual cause of unilateral pleural effusion in the setting of aortic stenosis: acute myeloid leukemia. Intern Med 2007;46:325-7. https://doi.org/10.2169/internalmedicine.46.6004
  3. Yim JJ, Lee JH, Yoo CG, Chung HS, Han SK, Shim YS, et al. The incidences and characteristics of malignant pleural effusions according to histologic types. Tuberc Respir Dis 1998;45:565-73. https://doi.org/10.4046/trd.1998.45.3.565
  4. Alexandrakis MG, Passam FH, Kyriakou DS, Bouros D. Pleural effusions in hematologic malignancies. Chest 2004;125:1546-55. https://doi.org/10.1378/chest.125.4.1546
  5. Disel U, Yavuz S, Paydas S, Sahin B, Zeren H. Extramedullary relapse in the pleura in acute promyelocytic leukemia. Leuk Lymphoma 2003;44:189-91. https://doi.org/10.1080/1042819031000057270
  6. Dix DB, Anderson RA, McFadden DE, Wadsworth LD. Pleural relapse during hematopoietic remission in childhood acute lymphoblastic leukemia. J Pediatr Hematol Oncol 1997;19:470-2. https://doi.org/10.1097/00043426-199709000-00013
  7. Ruckdeschel JC. Management of malignant pleural effusions. Semin Oncol 1995;22:58-63.
  8. Light RW, Hamm H. Malignant pleural effusion: would the real cause please stand up? Eur Respir J 1997;10:1701-2. https://doi.org/10.1183/09031936.97.10081701