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์™ธ์ด๋„์— ๋ฐœ์ƒํ•œ ์ด๊ตฌ์„  ๋‹คํ˜•์„ ์ข…: 2์ฆ๋ก€๋ณด๊ณ  ๋ฐ ๋ฌธํ—Œ๊ณ ์ฐฐ

Abstract

Ceruminous glands are specialized apocrine glands located in the external auditory canal (EAC). Pleomorphic adenoma (PA) of the EAC is derived from these ceruminous glands. Tumors arising from these ceruminous glands are rare. Furthermore, ceruminous PA of the EAC is extremely rare. About 35 cases have been reported to date in the English literature, and only 4 cases have been reported in Korea. There are several controversial issues about these rare tumors such as nomenclature, histogenesis and classification. We report here on two cases of ceruminous PA and review the cases in the Korean literature.

์„œ ๋ก 

์™ธ์ด๋„์— ๋ฐœ์ƒํ•œ ๋‹คํ˜•์„ ์ข…์€ ํ˜„์žฌ๊นŒ์ง€ ์ „ ์„ธ๊ณ„์ ์œผ๋กœ ์•ฝ 35์˜ˆ๋ฐ–์— ๋ณด๊ณ ๋˜์ง€ ์•Š์€ ๋งค์šฐ ๋“œ๋ฌธ ์งˆํ™˜์ด๋‹ค[1]. ์ฆ๋ก€์˜ ํฌ์†Œ์„ฑ ๋•Œ๋ฌธ์— ๊ทธ๋™์•ˆ ์ข…์–‘์˜ ๊ธฐ์›์— ๋Œ€ํ•œ ๊ฐ€์„ค์ด ํ™•๋ฆฝ๋˜์ง€ ์•Š์•˜๊ณ , ๋˜ํ•œ ์œ ์‚ฌ ์ง„๋‹จ๋ช…์ด ๋‹ค์–‘ํ•˜์—ฌ ํ™˜์ž์˜ ์น˜๋ฃŒ๋ฐฉ์นจ ๋ฐ ์˜ˆํ›„ ์˜ˆ์ธก์— ํ˜ผ๋ž€์ด ์žˆ์—ˆ๋‹ค. ์ด์— ์ €์ž๋“ค์€ ์ง์ ‘ ์น˜ํ—˜ํ•œ 2์˜ˆ์˜ ์™ธ์ด๋„ ๋‹คํ˜•์„ ์ข…๊ณผ ํ•จ๊ป˜ ๊ตญ๋‚ด ๋ฌธํ—Œ์— ๋ณด๊ณ ๋œ 4์˜ˆ์˜ ์™ธ์ด๋„ ๋‹คํ˜•์„ ์ข…์˜ ์ž„์ƒ ์–‘์ƒ์„ ๊ฒ€ํ† ํ•˜๊ณ , ๋”๋ถˆ์–ด ๊ตญ๋‚ด์™ธ ๋ฌธํ—Œ๊ณ ์ฐฐ์„ ํ†ตํ•ด ์™ธ์ด๋„ ๋‹คํ˜•์„ ์ข…์˜ ๊ธฐ์› ๋ฐ ํ†ต์ผ๋œ ์ง„๋‹จ๋ช…์„ ์ œ์‹œํ•˜๊ณ ์ž ํ•œ๋‹ค.

์ฆ ๋ก€

์ฆ ๋ก€ 1

52์„ธ ์—ฌ์ž ํ™˜์ž๊ฐ€ 1๋…„ ์ „ ๋ฐœ์ƒํ•œ ์šฐ์ธก ์™ธ์ด๋„ ์ข…๋ฌผ์„ ์ฃผ์†Œ๋กœ ๋‚ด์›ํ•˜์˜€๋‹ค. ์ด๋ฃจ ๋ฐ ์ฒญ๋ ฅ์ €ํ•˜๋ฅผ ํ˜ธ์†Œํ•˜์˜€๊ณ , ์ด ๋‚ด์‹œ๊ฒฝ์ƒ ์—ฐ๊ณจ๋ถ€ ์™ธ์ด๋„ ํ›„์ƒ๋ฐฉ์— 1 cm ํฌ๊ธฐ์˜ ์œก์•„์กฐ์ง๊ณผ ์œ ์‚ฌํ•œ ์—ฐ๋ถ„ํ™์ƒ‰ ์ข…๊ดด๊ฐ€ ๊ด€์ฐฐ๋˜์—ˆ๋‹ค(Fig. 1A). ๊ณจ๋ถ€ ์™ธ์ด๋„์˜ ํ”ผ๋ถ€์™€ ๊ณ ๋ง‰์€ ์ •์ƒ์ด์—ˆ๊ณ , ์ฒญ๋ ฅ๊ฒ€์‚ฌ ๊ฒฐ๊ณผ๋„ ์ •์ƒ์ด์—ˆ๋‹ค. ์ธก๋‘๊ณจ ์ปดํ“จํ„ฐ๋‹จ์ธต์ดฌ์˜ ๊ฒฐ๊ณผ ์—ฐ๊ณจ๋ถ€ ์™ธ์ด๋„ ํ›„์ƒ๋ฐฉ์—์„œ ๋ฐœ์ƒํ•œ 1 cm ํฌ๊ธฐ์˜ ์ข…๊ดด๊ฐ€ ์™ธ์ด๋„ ์™ธ์ธก 1/2์„ ๊ฑฐ์˜ ํ์‡„์‹œํ‚ค๊ณ  ์žˆ์—ˆ์œผ๋ฉฐ, ๊ฒฝ๊ณ„๊ฐ€ ๋ช…ํ™•ํ•˜๊ณ  ๊ณจ๋ถ€ ์™ธ์ด๋„์˜ ์นจ๋ฒ”์†Œ๊ฒฌ์€ ์—†์—ˆ๋‹ค. ์ค‘์ด๊ฐ• ์นจ๋ฒ”์ด๋‚˜, ์ธก๋‘๊ณจ ํŒŒ๊ดด์†Œ๊ฒฌ์€ ์—†์—ˆ๊ณ , ์œ ์–‘๋™ ํ•จ๊ธฐํ™”๋Š” ์–‘ํ˜ธํ•˜์˜€๋‹ค(Fig. 1B and Fig. C). ๋ถ€๋ถ„ ๋งˆ์ทจํ•˜์— ๊ฒฝ์™ธ์ด๋„ ์ ‘๊ทผ๋ฒ•์œผ๋กœ ์ •์ƒ ์กฐ์ง์˜ ๋ณ€์—ฐ์„ ์•ฝ 2 mm ๋‘๊ณ  ์—ฐ๊ณจ๋ง‰์„ ์ผ๋ถ€ ํฌํ•จํ•˜์—ฌ ์ข…๋ฌผ์„ ์ ์ถœํ•˜์˜€๋‹ค. ์ข…๋ฌผ ์ œ๊ฑฐ ํ›„ ๊ฒฐ์†๋ถ€์œ„๋Š” ํŠน๋ณ„ํžˆ ์žฌ๊ฑด ์—†์ด ์™ธ์ด๋„ ํŒจํ‚น ํ›„ ์ˆ˜์ˆ ์„ ๋งˆ์ณค๋‹ค. ํ˜„๋ฏธ๊ฒฝ ์†Œ๊ฒฌ์ƒ ์ƒํ”ผ์กฐ์ง๊ณผ ๊ฐ„์—ฝ์กฐ์ง์œผ๋กœ ๊ตฌ์„ฑ๋œ ์ข…์–‘์ด ๊ด€์ฐฐ๋˜์—ˆ์œผ๋ฉฐ(Fig. 1D), 2์ธต์œผ๋กœ ์ด๋ฃจ์–ด์ง„ ์„ (gland) ๊ตฌ์กฐ์˜ ๋‚ด์ธก ์„ธํฌ์งˆ์— ํŠน์ง•์ ์ธ ํ™ฉ๊ฐˆ์ƒ‰๊ณผ๋ฆฝ์ด ๊ด€์ฐฐ๋˜์–ด ์ด๊ตฌ์„  ๋‹คํ˜•์„ ์ข…์œผ๋กœ ์ง„๋‹จํ•˜์˜€๋‹ค(Fig. 1E). ์ˆ˜์ˆ  ํ›„ 3๋…„ ๋™์•ˆ ํŠน๋ณ„ํ•œ ํ•ฉ๋ณ‘์ฆ์ด๋‚˜ ์žฌ๋ฐœ ์—†์ด ์–‘ํ˜ธํ•œ ๊ฒฝ๊ณผ๋ฅผ ๋ณด์ด๊ณ  ์žˆ๋‹ค.

์ฆ ๋ก€ 2

73์„ธ ๋‚จ์ž ํ™˜์ž๊ฐ€ 1๋…„ ์ „ ๋ฐœ์ƒํ•œ ์ขŒ์ธก ์ดํ์ƒ‰๊ฐ์„ ์ฃผ์†Œ๋กœ ๋‚ด์›ํ•˜์˜€์œผ๋ฉฐ, 15๋…„ ์ „ ๋งŒ์„ฑ ์ค‘์ด์—ผ์œผ๋กœ ์ขŒ์ธก ๊ท€์ˆ˜์ˆ ์„ ๋ฐ›์€ ๊ณผ๊ฑฐ๋ ฅ์ด ์žˆ์—ˆ๋‹ค. ์ด ๋‚ด์‹œ๊ฒฝ์ƒ ์—ฐ๊ณจ๋ถ€ ์™ธ์ด๋„ ํ›„์ƒ๋ฐฉ์— ์••ํ†ต์ด ์—†๋Š” ๋‹จ๋‹จํ•œ ์ข…๊ดด๊ฐ€ ์™ธ์ด๋„๋ฅผ ๊ฑฐ์˜ ํ์ƒ‰์‹œํ‚ค๊ณ  ์žˆ์—ˆ๊ณ , ํ”ผ๋ถ€๋‚˜ ๊ณจ๋ถ€ ์™ธ์ด๋„๋Š” ์ •์ƒ์ด์—ˆ๋‹ค(Fig. 2A). ๋ถ€๋ถ„ ๋งˆ์ทจํ•˜์— ์ด๋‚ด์ ‘๊ทผ๋ฒ•์„ ํ†ตํ•ด 1 cm ํฌ๊ธฐ์˜ ์—ฐ๋…ธ๋ž€์ƒ‰ ์ข…๊ดด๋ฅผ ๋…ธ์ถœ์‹œ์ผฐ๋‹ค. ์ข…๊ดด๋Š” ์—ฐ๊ณจ๋ถ€ ์™ธ์ด๋„์™€ ๊ณจ๋ถ€ ์™ธ์ด๋„์˜ ์ ‘ํ•ฉ๋ถ€์— ์œ„์น˜ํ•˜์˜€๊ณ , ์—ฐ๊ณจ๋ง‰ ์นจ๋ฒ”์†Œ๊ฒฌ์€ ๊ด€์ฐฐ๋˜์ง€ ์•Š์•˜๋‹ค. ์ •์ƒ ์กฐ์ง์˜ ๋ณ€์—ฐ์„ ๋‘๊ณ  ์—ฐ๊ณจ๋ง‰ ์ผ๋ถ€๋ฅผ ํฌํ•จํ•˜์—ฌ ์ข…๊ดด๋ฅผ ์ œ๊ฑฐํ•˜์˜€๋‹ค. ํ˜„๋ฏธ๊ฒฝ ์†Œ๊ฒฌ์ƒ ์„  ๊ตฌ์กฐ์˜ ์ƒํ”ผ์กฐ์ง๊ณผ ๊ทผ์ƒํ”ผ์กฐ์ง, ๊ทธ๋ฆฌ๊ณ  ํŠน์ง•์ ์ธ ์—ฐ๊ณจ ์ ์•ก์–‘ ๊ธฐ์งˆ(chondromyxoid stroma)์ด ๊ด€์ฐฐ๋˜์–ด ์ด๊ตฌ์„  ๋‹คํ˜•์„ ์ข…์œผ๋กœ ์ง„๋‹จํ•˜์˜€๊ณ (Fig. 2B), ๋ฉด์—ญ์กฐ์งํ™”ํ•™์—ผ์ƒ‰์—์„œ ๋‚ด์ธก ์ƒํ”ผ์„ธํฌ์™€ ์™ธ์ธก ๊ทผ์ƒํ”ผ์„ธํฌ๋Š” ๊ฐ๊ฐ cytokeratin 7(CK7)๊ณผ S-100 protein์— ์–‘์„ฑ์ด์—ˆ๋‹ค(Fig. 2C and D). ์ˆ˜์ˆ  ํ›„ ํŠน๋ณ„ํ•œ ํ•ฉ๋ณ‘์ฆ์ด๋‚˜ ์žฌ๋ฐœ, ์•…์„ฑ ๋ณ€ํ™” ์—†์ด 2๋…„์งธ ์ถ”์ ๊ด€์ฐฐ ์ค‘์ด๋‹ค.

๊ณ  ์ฐฐ

์ด๊ตฌ์„ ์€ ๋ณ€ํ˜•๋œ ์•„ํฌํฌ๋ผ์ธ ํ•œ์„ ์œผ๋กœ ์™ธ์ด๋„์˜ ์—ฐ๊ณจ๋ถ€ ํ”ผ๋ถ€์— ์ฃผ๋กœ ๋ถ„ํฌํ•˜๋ฉฐ, ์ด๊ตฌ(cerumen)๋ฅผ ํ˜•์„ฑํ•œ๋‹ค. ์™ธ์ด๋„์—์„œ ๋ฐœ์ƒํ•œ ๋‹คํ˜•์„ ์ข…์€ ์ด๊ตฌ์„  ์ข…์–‘์˜ ํ•œ ์œ ํ˜•์œผ๋กœ ์•Œ๋ ค์ ธ ์žˆ์œผ๋ฉฐ, ์ด๊ตฌ์„  ์ข…์–‘์€ 1972๋…„ Wetli ๋“ฑ์ด 4๊ทธ๋ฃน์œผ๋กœ ๋ถ„๋ฅ˜ํ•œ ์ดํ›„ 2๊ทธ๋ฃน์ด ์ถ”๊ฐ€๋˜์–ด ํ˜„์žฌ๋Š” 6๊ฐ€์ง€๋กœ ๊ตฌ๋ถ„๋œ๋‹ค[1]. ์–‘์„ฑ ์ข…์–‘์€ 1) ์ด๊ตฌ์„  ์„ ์ข…(ceruminous adenoma), 2) ์ด๊ตฌ์„  ๋‹คํ˜•์„ ์ข…(ceruminous pleomorphic adenoma), 3) ์ด๊ตฌ์„  ์œ ๋‘์ƒ ํ•œ์„ ๋‚ญํฌ์„ ์ข…(ceruminous syringocystadenoma papilliferum)์ด๋ฉฐ, ์•…์„ฑ ์ข…์–‘์€ 4) ์ด๊ตฌ์„ ์•”์ข…(ceruminous adenocarcinoma), 5) ์ด๊ตฌ์„  ์„ ์–‘๋‚ญํฌ์•”์ข…(ceruminous adenoid cystic carcinoma), 6) ์ด๊ตฌ์„  ์ ์•ก์ƒํ”ผ์–‘์•”์ข…(ceruminous mucoepidermoid carcinoma)์ด๋‹ค. ์ด ์ค‘ ์ด๊ตฌ์„  ์„ ์–‘๋‚ญํฌ์•”์ข…์ด ๊ฐ€์žฅ ํ”ํ•˜๋ฉฐ, ์ด๊ตฌ์„  ๋‹คํ˜•์„ ์ข…์ด ๊ฐ€์žฅ ๋“œ๋ฌผ๋‹ค[2]. ์–‘์„ฑ ์ด๊ตฌ์„  ์ข…์–‘์€ ์ฃผ๋ณ€์กฐ์ง๊ณผ์˜ ๊ฒฝ๊ณ„๊ฐ€ ๋น„๊ต์  ๋ช…ํ™•ํ•˜๊ณ , ์„ธํฌ ์ดํ˜•์„ฑ์ด ๊ฑฐ์˜ ์—†์œผ๋ฉฐ, ์œ ์‚ฌ๋ถ„์—ด์ง€์ˆ˜๊ฐ€ ๋งค์šฐ ๋‚ฎ์€ ๋ฐ˜๋ฉด, ์•…์„ฑ ์ด๊ตฌ์„  ์ข…์–‘์€ ์ฃผ๋ณ€์กฐ์ง์œผ๋กœ ์นจ์œคํ•˜์—ฌ ๊ฒฝ๊ณ„๊ฐ€ ๋ถˆ๋ช…ํ™•ํ•˜๊ณ , ์„ธํฌ ์ดํ˜•์„ฑ์ด ์‹ฌํ•˜๋ฉฐ, ์œ ์‚ฌ๋ถ„์—ด์ง€์ˆ˜๊ฐ€ ๋†’๋‹ค[3]. ์ด๋Ÿฌํ•œ ์กฐ์งํ•™์  ํŠน์ง•์œผ๋กœ ์–‘์„ฑ๊ณผ ์•…์„ฑ ์ด๊ตฌ์„  ์ข…์–‘์˜ ๊ฐ๋ณ„์ด ๊ฐ€๋Šฅํ•˜๋ฉฐ, ๊ทธ์ค‘ ์–‘์„ฑ ์ด๊ตฌ์„  ์ข…์–‘ ๊ฐ„์˜ ๊ฐ๋ณ„์ ์„ ์‚ดํŽด๋ณด๋ฉด, ์ด๊ตฌ์„  ์„ ์ข…์€ ์ด๊ตฌ์„  ๋‹คํ˜•์„ ์ข…๊ณผ ์กฐ์งํ•™์ ์œผ๋กœ ์œ ์‚ฌํ•˜๋‚˜, ์ด๊ตฌ์„  ๋‹คํ˜•์„ ์ข…์˜ ํŠน์ง•์ ์ธ ์—ฐ๊ณจ์ ์•ก์–‘ ์ค‘๋ฐฐ์—ฝ์„ฑ ๊ธฐ์งˆ์ด ์ด๊ตฌ์„  ์„ ์ข…์—์„œ๋Š” ๊ด€์ฐฐ๋˜์ง€ ์•Š๋Š”๋‹ค. ๋˜ํ•œ, ์ด๊ตฌ์„  ์œ ๋‘์ƒ ํ•œ์„ ๋‚ญํฌ์„ ์ข…์€ ์œ ๋‘์ƒ ๊ณผ๊ฐํ™”์„ฑ ์ƒํ”ผ๊ฐ€ ์ง„ํ”ผ ๋ฐฉํ–ฅ์œผ๋กœ ํ•จ์ž…๋˜๋Š” ํŠน์ง•์  ์†Œ๊ฒฌ์„ ๋ณด์ด๋Š”๋ฐ, ์ด๋Ÿฌํ•œ ์†Œ๊ฒฌ์€ ์ด๊ตฌ์„  ๋‹คํ˜•์„ ์ข…์—์„œ๋Š” ๊ด€์ฐฐ๋˜์ง€ ์•Š์•„ ๊ฐ๋ณ„์ด ๊ฐ€๋Šฅํ•˜๋‹ค[3].
์™ธ์ด๋„ ๋‹คํ˜•์„ ์ข…์€ Mark์™€ Rothberg [4]๊ฐ€ 1951๋…„์— ์ฒ˜์Œ ๋ณด๊ณ ํ•œ ์ดํ›„, ๋ฌธํ—Œ์ƒ 35์˜ˆ๊ฐ€ ๋ณด๊ณ ๋˜์—ˆ์œผ๋ฉฐ[1], ๊ตญ๋‚ด์—์„œ๋Š” 1989๋…„ Kim ๋“ฑ[5]์˜ ๋ณด๊ณ  ์ด๋ž˜ ํ˜„์žฌ๊นŒ์ง€ 4์˜ˆ๊ฐ€ ๋ณด๊ณ ๋˜์—ˆ๋‹ค[6-8]. ์™ธ์ด๋„ ๋‹คํ˜•์„ ์ข…์€ ๊ทธ ๊ธฐ์›์— ๋Œ€ํ•ด ์—ฌ๋Ÿฌ ์ฃผ์žฅ์ด ์žˆ์—ˆ๋‹ค. ์ฒซ์งธ, ์ด๊ตฌ์„ ์—์„œ ๊ธฐ์›ํ•œ๋‹ค๋Š” ๊ฒƒ๊ณผ ๋‘˜์งธ, ์ด์†Œ์„ฑ ํƒ€์•ก์„  ์กฐ์ง์—์„œ ๊ธฐ์›ํ•œ๋‹ค๋Š” ๊ฒƒ, ๊ทธ๋ฆฌ๊ณ  ์…‹์งธ, ์ดํ•˜์„ ์—์„œ ๋ฐœ์ƒํ•œ ๋‹คํ˜•์„ ์ข…์ด Huschke ๊ณต(foramen) ๋˜๋Š” Santorini ์ ˆํ”(fissure)์„ ํ†ตํ•ด ์™ธ์ด๋„๋กœ ์นจ๋ฒ”๋˜์—ˆ๋‹ค๋Š” ์ฃผ์žฅ ๋“ฑ์ด ๊ทธ๊ฒƒ์ด๋‹ค. ํ˜„์žฌ๋Š” ์ด๊ตฌ์„ ์—์„œ ๊ธฐ์›ํ•œ๋‹ค๋Š” ์ฃผ์žฅ์ด ๊ฐ€์žฅ ํƒ€๋‹นํ•˜๊ฒŒ ๋ฐ›์•„๋“ค์—ฌ์ง€๊ณ  ์žˆ์œผ๋ฉฐ, ๊ทธ ์ด์œ ๋กœ๋Š” ๋ฉด์—ญ์กฐ์งํ™”ํ•™์—ผ์ƒ‰์—์„œ ์™ธ์ด๋„ ๋‹คํ˜•์„ ์ข…๊ณผ ์ด๊ตฌ์„  ์กฐ์ง์ด ์œ ์‚ฌํ•œ ๊ฒฐ๊ณผ๋ฅผ ๋ณด์ด๋ฉฐ, ํ˜„์žฌ๊นŒ์ง€ ์™ธ์ด๋„์—์„œ ์ด์†Œ์„ฑ ํƒ€์•ก์„  ์กฐ์ง์ด ๋ฐœ๊ฒฌ๋œ ์ ์ด ์—†๊ณ , ํƒ€์•ก์„ ์—์„œ ๋ฉ€๋ฆฌ ๋–จ์–ด์ง„ ํ”ผ๋ถ€์—์„œ ๋ฐœ์ƒํ•œ ๋‹คํ˜•์„ ์ข…์€ ํ”ผ๋ถ€ ๋ถ€์†๊ธฐ ํ•œ์„ ์—์„œ ๊ธฐ์›ํ•œ ์ข…์–‘์œผ๋กœ ๋ถ„๋ฅ˜ํ•œ๋‹ค๋Š” ์ ์„ ๋“ค ์ˆ˜ ์žˆ๋‹ค[9]. ์™ธ์ด๋„ ๋‹คํ˜•์„ ์ข…์€ ํ‘œํ”ผ ํ˜ผํ•ฉ์ข…, ์–‘์„ฑ ํ˜ผํ•ฉ์ข…, ์—ฐ๊ณจ์–‘ ํ•œ๊ด€์ข…(chondroid syringoma)์œผ๋กœ๋„ ๋ถˆ๋ฆฌ๋Š”๋ฐ, ๋‘๊ฒฝ๋ถ€์— ๋ฐœ์ƒํ•œ ์—ฐ๊ณจ์–‘ ํ•œ๊ด€์ข…์€ ์˜ˆํ›„๊ฐ€ ๋” ๋ถˆ๋Ÿ‰ํ•˜๋‹ค๊ณ  ์•Œ๋ ค์ ธ ์žˆ๋‹ค[10]. ์ด์™€ ๊ฐ™์ด ๋™์ผํ•œ ๋ณ‘๋ฆฌ์†Œ๊ฒฌ์— ๋Œ€ํ•ด ์—ฌ๋Ÿฌ ์ง„๋‹จ๋ช…์„ ์‚ฌ์šฉํ•  ๊ฒฝ์šฐ, ์˜ˆํ›„ ๋ฐ ์น˜๋ฃŒ์— ํ˜ผ๋ž€์„ ์ค„ ์ˆ˜ ์žˆ์œผ๋ฏ€๋กœ ์™ธ์ด๋„์— ๋ฐœ์ƒํ•œ ๋‹คํ˜•์„ ์ข…์€ ๊ทธ ๊ธฐ์›์„ ๊ณ ๋ คํ•˜์—ฌ โ€˜์ด๊ตฌ์„  ๋‹คํ˜•์„ ์ข…โ€™์ด๋ผ๋Š” ๋™์ผํ•œ ์ง„๋‹จ๋ช…์˜ ์‚ฌ์šฉ์ด ํ•„์š”ํ•˜๋‹ค.
Saito ๋“ฑ[1]์€ 35์˜ˆ์˜ ์™ธ์ด๋„ ๋‹คํ˜•์„ ์ข…์„ ๋ถ„์„ํ•˜์˜€๋Š”๋ฐ, ์ด์— ๋”ฐ๋ฅด๋ฉด ์—ฐ๋ น ๋ถ„ํฌ๋Š” 15~80์„ธ, ํ‰๊ท  ๋‚˜์ด๋Š” 49.7์„ธ์ด๋ฉฐ ์„ฑ๋ณ„ ๋ฐ ์ขŒ์šฐ์ธก ๊ฐ„ ๋ฐœ์ƒ์˜ ์œ ์˜ํ•œ ์ฐจ์ด๋Š” ์—†์—ˆ๋‹ค. ๋ฐœ์ƒ ์œ„์น˜๋Š” ํ›„๋ฒฝ 8์˜ˆ, ํ›„์ƒ๋ฒฝ 7์˜ˆ, ์ „๋ฒฝ 6์˜ˆ, ์ƒ๋ฒฝ 3์˜ˆ, ์ „ํ•˜๋ฒฝ 2์˜ˆ๊ฐ€ ๋ณด๊ณ ๋˜์–ด, ํ›„๋ฒฝ๊ณผ ํ›„์ƒ๋ฒฝ์—์„œ ํ˜ธ๋ฐœํ•˜์˜€๋‹ค. ๋ณธ 2์ฆ๋ก€๋ฅผ ํฌํ•จํ•œ ๊ตญ๋‚ด ๋ณด๊ณ  ์ด 6์˜ˆ์˜ ํ‰๊ท  ๋ฐœ์ƒ ์—ฐ๋ น์€ 57์„ธ์ด๋ฉฐ, ์„ฑ๋ณ„ ๋ฐ ์ขŒ์šฐ์ธก๊ฐ„ ๋ฐœ์ƒ์˜ ์œ ์˜ํ•œ ์ฐจ์ด๋Š” ์—†์—ˆ๊ณ , 6์˜ˆ ์ค‘ 4์˜ˆ๊ฐ€ ํ›„๋ฒฝ๊ณผ ํ›„์ƒ๋ฒฝ์—์„œ ๋ฐœ์ƒํ•˜์—ฌ ๊ธฐ์กด ๋ณด๊ณ ์— ๋ถ€ํ•ฉํ•˜์˜€๋‹ค(Table 1). ๋ฌธํ—Œ์ƒ ์™ธ์ด๋„ ๋‹คํ˜•์„ ์ข…์˜ ํ‰๊ท  ํฌ๊ธฐ๋Š” 1.4 cm์˜€์œผ๋ฉฐ[11], ๊ตญ๋‚ด ๋ณด๊ณ  6์˜ˆ์˜ ํ‰๊ท  ํฌ๊ธฐ๋Š” 1.08 cm์˜€๋‹ค. ํฌ๊ธฐ๊ฐ€ ์ž‘์€ ์ข…์–‘์€ ์ „์Œ์„ฑ ๋‚œ์ฒญ, ์™ธ์ด๋„์—ผ ๋“ฑ์ด ์ฃผ ์ฆ์ƒ์ธ ๋ฐ˜๋ฉด, ํฐ ์ข…์–‘์€ ์ดํ์ƒ‰๊ฐ ๋ฐ ์ดํ†ต ๋“ฑ์ด ์ฃผ ์ฆ์ƒ์ด๋‹ค. ๋˜ํ•œ, ์•…์„ฑ ์ข…์–‘์€ ์–‘์„ฑ ์ข…์–‘์— ๋น„ํ•ด ์ดํ†ต์„ ๋” ํ”ํžˆ ๋™๋ฐ˜ํ•˜๋Š”๋ฐ, ์ด๋Š” ์•…์„ฑ ์ข…์–‘์˜ ์นจ์œค์„ฑ ์„ฑ์žฅ์— ๋”ฐ๋ฅธ ์ฆ์ƒ์ด๋ผ ํŒ๋‹จ๋œ๋‹ค[9]. ์™ธ์ด๋„ ๋‹คํ˜•์„ ์ข…์˜ ๋ฐœ์ƒ ์›์ธ์€ ๋ถ„๋ช…์น˜ ์•Š์œผ๋‚˜, ์žฆ์€ ๋งŒ์„ฑ ์ค‘์ด์—ผ ํ›„ ์ข…์–‘์ด ๋ฐœ์ƒํ•œ ์˜ˆ๊ฐ€ ์‚ฌ๋žŒ๋ฟ ์•„๋‹ˆ๋ผ ๋™๋ฌผ์—์„œ๋„ ๋ณด๊ณ ๋˜์–ด ์ด ๋‘˜์˜ ์—ฐ๊ด€์„ฑ์ด ์ œ๊ธฐ๋˜๊ณ  ์žˆ๋‹ค[3]. ๊ตญ๋‚ด ๋ณด๊ณ  6์˜ˆ ์ค‘ 2์˜ˆ์—์„œ๋„ ๋งŒ์„ฑ ์ค‘์ด์—ผ์˜ ๊ณผ๊ฑฐ๋ ฅ์ด ์žˆ์œผ๋ฉฐ[8], ์ด ๋‘˜์˜ ์—ฐ๊ด€์„ฑ์€ ์•ž์œผ๋กœ ๋” ์—ฐ๊ตฌ๋˜์–ด์•ผ ํ•  ๊ฒƒ์ด๋‹ค.
์˜์ƒํ•™์  ์†Œ๊ฒฌ์œผ๋กœ๋Š” ์ธก๋‘๊ณจ ๋‹จ์ธต์ดฌ์˜์ƒ ๊ฒฝ๊ณ„๊ฐ€ ๋ช…ํ™•ํ•œ ์ข…๊ดด๊ฐ€ ์™ธ์ด๋„๋ฅผ ํ์ƒ‰์‹œํ‚ค๊ณ  ์žˆ๋Š” ๊ฒฝ์šฐ๊ฐ€ ๋งŽ์œผ๋ฉฐ, ์ธก๋‘๊ณจ ํŒŒ๊ดด ๋ฐ ๋‚ด์ด์˜ ์ด์ƒ ์†Œ๊ฒฌ์€ ๊ด€์ฐฐ๋˜์ง€ ์•Š์•˜๊ณ  ์œ ์–‘๋™์˜ ํ•จ๊ธฐํ™”๋Š” ์–‘ํ˜ธํ•˜์˜€๋‹ค. ์ž๊ธฐ๊ณต๋ช…์˜์ƒ๊ฒ€์‚ฌ์—์„œ T1 ๊ฐ•์กฐ์˜์ƒ์—์„œ๋Š” ์ €๊ฐ•๋„, T2 ๊ฐ•์กฐ์˜์ƒ์—์„œ๋Š” ๊ณ ๊ฐ•๋„ ์Œ์˜์„ ๋ณด์ด๋ฉฐ, ์กฐ์˜์ œ ์‚ฌ์šฉ์‹œ ์ฆ๊ฐ•๋˜๋Š” ์†Œ๊ฒฌ์„ ๋ณด์ธ๋‹ค[12]. ์กฐ์งํ•™์ ์œผ๋กœ ์ด๊ตฌ์„  ๋‹คํ˜•์„ ์ข…์€ ๋‘ ์ธต์œผ๋กœ ๊ตฌ์„ฑ๋œ ์„  ๊ตฌ์กฐ๊ฐ€ ์ค‘๋ฐฐ์—ฝ์„ฑ ๊ธฐ์งˆ์„ ๋ฐฐ๊ฒฝ์œผ๋กœ ๋ถ„ํฌํ•˜๊ณ  ์žˆ๋‹ค. ๋‚ด์ธก ์›์ฃผํ˜• ์ƒํ”ผ์„ธํฌ๋Š” ์„ธํฌ์งˆ ๋‚ด ํ™ฉ๊ฐˆ์ƒ‰์˜ ์…€๋กœ์ด๋“œ ์ƒ‰์†Œ(ceroid pigment)๋ฅผ ํ•จ์œ ํ•˜๊ณ  ์žˆ์œผ๋ฉฐ, ๋‚ด๊ฐ• ์ชฝ์˜ ์„ธํฌ์งˆ๋ง‰์€ ๋‹จ๋‘ ๋ถ„๋น„์–‘์ƒ(decapitation secretion)์„ ๋ณด์ธ๋‹ค. ์ด ๋‘ ๊ฐ€์ง€ ์†Œ๊ฒฌ์€ ์™ธ์ด๋„ ์ด์™ธ์—์„œ ๋ฐœ์ƒํ•œ ๋‹คํ˜•์„ ์ข…์—์„œ๋Š” ๊ด€์ฐฐ๋˜์ง€ ์•Š๋Š” ์†Œ๊ฒฌ์œผ๋กœ, ์ด๊ตฌ์„  ๊ธฐ์›์˜ ์ข…์–‘์ž„์„ ์•Œ ์ˆ˜ ์žˆ๋Š” ์ค‘์š”ํ•œ ํ˜„๋ฏธ๊ฒฝ์  ์†Œ๊ฒฌ์ด๋‹ค(Fig. 1E) [3]. ์™ธ์ธก ์ž…๋ฐฉํ˜• ๊ทผ์ƒํ”ผ์„ธํฌ๋Š” ๊ธฐ์ €๋ง‰๊ณผ ์ธ์ ‘ํ•ด ์žˆ์œผ๋ฉฐ, ๊ทผ์ƒํ”ผ์„ธํฌ์—์„œ ๊ธฐ์›ํ•˜๋Š” ๊ฒƒ์œผ๋กœ ์—ฌ๊ฒจ์ง€๋Š” ์ค‘๋ฐฐ์—ฝ์„ฑ ๊ธฐ์งˆ์€ ์ ์•ก์„ฑ, ์—ฐ๊ณจ์„ฑ, ์„ฌ์œ ์„ฑ ๋ฐ ๊ณจ์„ฑ์˜ ๋‹ค์–‘ํ•œ ํ˜•ํƒœ๋ฅผ ๋ณด์ธ๋‹ค. ์ด๋Ÿฌํ•œ ํŠน์ง•์ ์ธ ์—ฐ๊ณจ์ ์•ก์–‘ ๊ธฐ์งˆ์ด ์ ์ ˆํ•˜๊ฒŒ ํก์ธ๋œ๋‹ค๋ฉด ์„ธํฌ ๊ฒ€์‚ฌ๋งŒ์œผ๋กœ๋„ ์ง„๋‹จ์ด ๊ฐ€๋Šฅํ•˜์—ฌ, ์ˆ  ์ „ ์น˜๋ฃŒ ๊ณ„ํš์— ๋„์›€์ด ๋  ์ˆ˜ ์žˆ๋‹ค. ๋‹คํ˜•์„ ์ข…์„ ๊ตฌ์„ฑํ•˜๋Š” ๋‘ ๊ฐ€์ง€ ์„ฑ๋ถ„์ธ ์ƒํ”ผ์„ธํฌ์™€ ๊ธฐ์งˆ์˜ ์–‘๊ณผ ์„ฑ์ƒ์— ๋”ฐ๋ผ ๋ณ‘๋ฆฌ ์กฐ์งํ•™์  ์•„ํ˜•์€ ์„ธ ๊ฐ€์ง€๋กœ ๋‚˜๋‰œ๋‹ค. ์ƒํ”ผ์„ธํฌ ์„ฑ๋ถ„์ด ์ฃผ๋ฅผ ์ด๋ฃจ๋Š” cellular type, ๊ธฐ์งˆ์„ฑ๋ถ„ ์ค‘์—์„œ๋„ ํŠนํžˆ ์—ฐ๊ณจ์ ์•ก์–‘ ๊ธฐ์งˆ์ด ์ฃผ๋ฅผ ์ด๋ฃจ๋Š” myxoid type, ๊ทธ๋ฆฌ๊ณ  ์ƒํ”ผ์„ธํฌ์™€ ๊ธฐ์งˆ์„ฑ๋ถ„์ด ๊ท ํ˜• ์žˆ๊ฒŒ ๋ฐฐ์—ด๋˜์–ด ์žˆ๋Š” classical type์œผ๋กœ ์„ธ๋ถ„ํ•  ์ˆ˜ ์žˆ๋‹ค[13]. ๋ฉด์—ญ์กฐ์งํ™”ํ•™์—ผ์ƒ‰์—์„œ ๋‚ด์ธก ์ƒํ”ผ์„ธํฌ๋Š” CK7, epithelial membrane antigen ๋ฐ gross cystic disease fluid protein-15์— ์–‘์„ฑ์ด๋ฉฐ, ์™ธ์ธก ๊ทผ์ƒํ”ผ์„ธํฌ๋Š” S-100 protein, CK5/6 ๋ฐ p63์— ์–‘์„ฑ์ด๋‹ค(Fig. 2C and D) [11,14]. ์น˜๋ฃŒ๋Š” ์œ„์กฑ(pseudopod)์„ ๋‚ด์–ด ํ˜„๋ฏธ๊ฒฝ์  ์นจ์Šต์„ ํ•˜๋Š” ์ข…์–‘์˜ ํŠน์„ฑ์„ ๊ณ ๋ คํ•˜์—ฌ ์ฃผ์œ„ ํ”ผ๋ถ€๋‚˜ ์—ฐ๊ณจ๋ง‰๊ณผ ๊ฐ™์€ ์ •์ƒ ์กฐ์ง์„ ํฌํ•จํ•˜์—ฌ ์ ˆ์ œํ•˜์—ฌ์•ผ ํ•œ๋‹ค. ์ดํ•˜์„  ๋‹คํ˜•์„ ์ข…์˜ ๊ฒฝ์šฐ ์ตœ์†Œ 4 mm ์ด์ƒ์˜ ๋ณ€์—ฐ์„ ํ™•๋ณดํ•˜์—ฌ ์ ˆ์ œํ•˜์—ฌ์•ผ ํ•œ๋‹ค๋Š” ๋ณด๊ณ ๊ฐ€ ์žˆ์œผ๋‚˜, ์™ธ์ด๋„ ๋‹คํ˜•์„ ์ข…์€ ์ฆ๋ก€ ์ˆ˜๊ฐ€ ์ ์–ด ๊ตฌ์ฒด์ ์ธ ๋ณ€์—ฐ์— ๋Œ€ํ•œ ๋ณด๊ณ ๋Š” ์—†๋‹ค[13]. ๋”ฐ๋ผ์„œ, ์™ธ์ด๋„์˜ ํ•ด๋ถ€ํ•™์  ๊ตฌ์กฐ๋ฅผ ๊ณ ๋ คํ•˜์—ฌ ์ถฉ๋ถ„ํ•œ ์ •์ƒ ์กฐ์ง์˜ ๋ณ€์—ฐ์„ ๋‘๊ณ  ์—ฐ๊ณจ๋ง‰ ์ผ๋ถ€๋ฅผ ํฌํ•จํ•˜์—ฌ ์ ˆ์ œํ•˜์—ฌ์•ผ ์žฌ๋ฐœ๋ฅ ์„ ๋‚ฎ์ถœ ์ˆ˜ ์žˆ๋‹ค. ์ ˆ์ œ์—ฐ์˜ ๊ธธ์ด๊ฐ€ ์งง๊ฑฐ๋‚˜, ๋ถˆ์™„์ „ ํ”ผ๋ง‰, ์œ„์กฑ, ์œ„์„ฑ๊ฒฐ์ ˆ๊ณผ ๊ฐ™์€ ํŠน์ง•๋“ค์— ์˜ํ•œ ์ข…์–‘์˜ ๋ถˆ์™„์ „ ์ ˆ์ œ ์‹œ ์žฌ๋ฐœ์˜ ๊ฐ€๋Šฅ์„ฑ์ด ๋†’๋‹ค[13]. ๋”ฐ๋ผ์„œ ์žฌ๋ฐœ์„ ๋ง‰๊ธฐ ์œ„ํ•ด, ๋‘ ์ฆ๋ก€์—์„œ ๋ชจ๋‘ ์ถฉ๋ถ„ํ•œ ์ •์ƒ ์กฐ์ง์˜ ๋ณ€์—ฐ์„ ๋‘๊ณ  ์—ฐ๊ณจ๋ง‰์„ ์ผ๋ถ€ ํฌํ•จํ•˜์—ฌ ์ข…์–‘์„ ์ ˆ์ œํ•˜์˜€๋‹ค. ์กฐ์งํ•™์  ์•„ํ˜•์— ๋”ฐ๋ผ์„œ๋„ ์žฌ๋ฐœ๋ฅ ์ด ๋‹ฌ๋ผ์งˆ ์ˆ˜ ์žˆ์œผ๋ฉฐ, ์—ฐ๊ณจ์ ์•ก์–‘ ๊ธฐ์งˆ์ด ํ’๋ถ€ํ•œ myxoid type์ด ์„ธํฌ ์„ฑ๋ถ„์ด ๋งŽ์€ cellular type์— ๋น„ํ•ด ์œ ์˜ํ•˜๊ฒŒ ์žฌ๋ฐœ๋นˆ๋„๊ฐ€ ๋†’์•˜๋‹ค[13]. ์ด๋Š” ์žฌ๋ฐœ ์›์ธ์„ ์ œ๊ณตํ•˜๋Š” ์œ„์„ฑ๊ฒฐ์ ˆ ๋ฐ ๋ถˆ์™„์ „ ํ”ผ๋ง‰์„ ๋™๋ฐ˜ํ•˜๋Š” ๋น„์œจ์ด myxoid type์—์„œ cellular type์— ๋น„ํ•ด ์œ ์˜ํ•˜๊ฒŒ ๋†’๋‹ค๋Š” ์ ์— ๊ธฐ์ธํ•œ๋‹ค[13]. ์ด ๋‘˜์˜ ์ค‘๊ฐ„์— ์†ํ•˜๋Š” classical type์€ ์ค‘๋“ฑ๋„์˜ ์žฌ๋ฐœ๋นˆ๋„๋ฅผ ๊ฐ€์ง€๋ฉฐ, ๋ณธ 2์ฆ๋ก€๋Š” ๋ชจ๋‘ classical type์ด์—ˆ๋‹ค. ๊ตญ์™ธ ๋ณด๊ณ  35์˜ˆ ์ค‘ 3์˜ˆ์˜ ์žฌ๋ฐœ์ด ๋ณด๊ณ ๋˜์—ˆ์œผ๋ฉฐ[1], ๊ตญ๋‚ด ๋ณด๊ณ  6์˜ˆ ์ค‘ 1์˜ˆ์—์„œ ์žฌ๋ฐœ์ด ์žˆ์—ˆ๋‹ค[7]. ์ด ์ฆ๋ก€๋Š” 4ํšŒ์˜ ๋ ˆ์ด์ € ์ˆ˜์ˆ  ํ›„์—๋„ ๋ฐ˜๋ณต์ ์œผ๋กœ ์žฌ๋ฐœํ•˜์—ฌ ์—ฐ๊ณจ๋ง‰๊ณผ ํ”ผ๋ถ€๋ฅผ ํฌํ•จํ•œ ๊ด‘๋ฒ”์œ„ํ•œ ์ ˆ์ œ๋ฅผ ์ถ”๊ฐ€๋กœ ์‹œํ–‰ํ•˜์˜€์œผ๋ฉฐ ์ดํ›„ ์žฌ๋ฐœํ•˜์ง€ ์•Š์•˜๋‹ค[7]. ๋”ฐ๋ผ์„œ, ๋‹จ์ˆœํžˆ ์ข…๊ดด๋งŒ์„ ์ ˆ์ œํ•˜๋Š” ๊ฒƒ์€ ๋ฏธ์„ธํ˜„๋ฏธ๊ฒฝ์  ์ž”์—ฌ ์กฐ์ง์„ ๋‚จ๊ธธ ์ˆ˜ ์žˆ๊ณ , ๋ถ€๋ถ„์  ์ ˆ์ œ๊ฐ€ ์ข…์–‘ ํŒŒ์ข…์„ ์ดˆ๋ž˜ํ•  ์ˆ˜ ์žˆ์œผ๋ฉฐ, ์œ ๋ณ‘๊ธฐ๊ฐ„์— ๋”ฐ๋ผ ์•…์„ฑํ™”ํ•  ์ˆ˜ ์žˆ์œผ๋ฏ€๋กœ, ์žฌ๋ฐœ์˜ ๋ฐฉ์ง€๋ฅผ ์œ„ํ•ด์„œ ์ถฉ๋ถ„ํ•œ ์ฃผ์œ„ ์ •์ƒ ์กฐ์ง์„ ํฌํ•จํ•œ ๊ด‘๋ฒ”์œ„ํ•œ ์ ˆ์ œ์™€ ์žฅ๊ธฐ๊ฐ„์˜ ์ถ”์ ๊ด€์ฐฐ์ด ํ•„์š”ํ•  ๊ฒƒ์ด๋‹ค[1]. ์™ธ์ด๋„์— ๋ฐœ์ƒํ•œ ์–‘์„ฑ ์ข…์–‘์˜ ๊ฐ๋ณ„ ์ง„๋‹จ ์‹œ ๋‹คํ˜•์„ ์ข…์˜๊ฐ€๋Šฅ์„ฑ์„ ์—ผ๋‘์— ๋‘๊ณ  ์ˆ  ์ „ ์„ธ์นจํก์ธ๊ฒ€์‚ฌ๋ฅผ ์‹œํ–‰ํ•˜๋Š” ๊ฒƒ์ด ๋„์›€์ด ๋˜๋ฉฐ, ์™ธ์ด๋„ ๋‹คํ˜•์„ ์ข…์€ ๊ทธ ๊ธฐ์›์„ ๊ณ ๋ คํ•˜์—ฌ โ€˜์ด๊ตฌ์„  ๋‹คํ˜•์„ ์ข…โ€™์ด๋ผ๋Š” ์ง„๋‹จ๋ช…์œผ๋กœ ํ†ต์ผํ•˜์—ฌ ์‚ฌ์šฉํ•ด์•ผ ํ•  ๊ฒƒ์ด๋‹ค. ๋˜ํ•œ, ๋‹คํ˜•์„ ์ข…์˜ ์กฐ์งํ•™์  ์•„ํ˜•์— ๋”ฐ๋ผ, myxoid type์ผ ๊ฒฝ์šฐ ์ ˆ์ œ์—ฐ์„ ๋”์šฑ ํ™•๋ณดํ•˜๊ณ  ์žฅ๊ธฐ๊ฐ„์˜ ์ถ”์ ๊ด€์ฐฐ์ด ํ•„์š”ํ•˜๋ฆฌ๋ผ ์ƒ๊ฐ๋œ๋‹ค.

ACKNOWLEDGMENTS

This paper was supported by Wonkwang University in 2016.

REFERENCES

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Fig.ย 1.
Otoscopic examination shows an irregular surfaced mass originating from posteriosuperior wall of the right EAC with small amount of serous discharge (A). Axial (B) and coronal scan (C) of computed tomography of the temporal bone shows a right EAC mass (arrow) with irregular surface. There is no erosion in underlying bone of the EAC (C). Histopathological findings of the tumor show a chondromyxoid stroma admixed with epithelial and myoepithelial components (H&E stain, ร—100) (D). The epithelial cytoplasm contains the gold-to brown-colored ceroid pigment (arrows) and decapitation secretion (arrowheads) (H&E stain, ร—400) (E). EAC: external auditory canal.
kjorl-hns-2016-17314f1.tif
Fig.ย 2.
Otoscopic examination shows a smooth, elevating mass originating from posterosuperior wall of the left EAC (A). Histopathological section reveals a tumor which consists of characteristic chondromyxoidstroma (arrow), myoepithelial elements (arrowhead) and glandular structures (asterisk, H&E stain, ร—100) (B). Immunohistochemical staining shows different expression of inner epithelial cells (C) (CK7, ร—400) and outer myoepithelial cells (D) (S-100 protein, ร—400). CK7: cytokeratin 7, EAC: external auditory canal.
kjorl-hns-2016-17314f2.tif
Tableย 1.
Characteristics of ceruminous pleomorphic adenoma of the external auditory canal in Korea
Authors Sex/age Origin site Size Symptoms Approach Recurrence
Kim, et al. [5] 44/M Rt. Post 15 mm Ear fullness/hearing loss/otorrhea Endaural (-)
Kim, et al. [6] 59/F Rt. Post/Sup 10 mm Ear fullness/hearing loss Endaural (-)
Park, et al. [7] 57/M Rt. Ant/Inf 10 mm Ear fullness/hearing loss Endaural (+)
Choi, et al. [8] 57/F Lt. Ant/Sup 10 mm Ear fullness/COM Transcanal (-)
Case 1 52/F Rt. Post/Sup 10 mm Ear fullness/hearing loss/otorrhea Transcanal (-)
Case 2 73/M Lt. Post/Sup 10 mm Ear fullness/COM Endaural (-)

COM: chronic otitis media, Post: posterior, Sup: superior, Ant: anterior, Inf: inferior

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