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1 DOI: /trd ISSN: (Print)/ (Online) Tuberc Respir Dis 2010;69: CopyrightC2010. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved. 폐의원발성비호지킨림프종의임상상 Original Article 울산대학교의과대학서울아산병원호흡기내과학교실 오동규, 노재형, 송진우, 김동순 Clinical Feature of Primary Pulmonary Non-Hodgkin s Lymphoma Dong Kyu Oh, M.D., Jae Hyung Roh, M.D., Jin Woo Song, M.D., Dong Soon Kim, M.D. Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Background: Primary non-hodgkin s lymphoma of the lung is a rare entity. It is represented commonly as marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) type. Although there have been a few reviews of this lymphoma, clinical features, radiologic findings, management and prognosis have not been well defined. Methods: We reviewed the medical records of 24 patients with primary pulmonary lymphoma between January 1995 and September 2008; all diagnoses had been confirmed based on pathology. Results: The median follow-up time was 42.3 months (range, months). Five (20.8%) patients were asymptomatic, 17 (70.8%) patients had pulmonary symptoms, and the remaining 2 (8.3%) patients presented with constitutional symptoms. There were 16 (66.7%) patients with MALT lymphoma, 4 (16.7%) patients with diffuse large B-cell lymphoma and 4 (16.7%) patients with lymphoma that had not received a WHO classification. Radiologic findings of primary pulmonary lymphoma were diverse and multiple nodule or consolidation was the most common finding regardless of pathologic lymphoma type. PET scan was carried out in 13 (54.2%) patients and all lesions showed notable FDG uptake. MALT lymphoma showed a trend of better prognosis (3-year survival, 78.8% vs. 70.0%; 5-year survival, 78.8% vs. 52.5%; p=0.310) than non-malt lymphoma. Conclusion: Primary non-hodgkin s lymphoma of the lung occurs with nonspecific clinical features and radiologic findings. MALT lymphoma is the most common pathologic type of primary pulmonary lymphoma. This entity of lymphoma appears to have a good prognosis and in this study, there was a trend of better outcome than non-malt lymphoma. Key Words: Lung; Lymphoma; Prognosis; Treatment Outcome 서 폐의원발성림프종은전체악성림프종의 0.4% 를차지하는매우드문질환으로 1 점막연관림프조직 (mucosa-associated lymphoid tissue, MALT) 형의변연부 B세포림프종 (marginal B-cell lymphoma) 이가장흔한것으로알려 Address for correspondence: Dong Soon Kim, M.D. Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap 2-dong, Songpa-gu, Seoul , Korea Phone: , Fax: dskim@amc.seoul.kr Received: Jul. 20, 2010 Accepted: Sep. 27, 2010 론 져있다 1-3. 점막연관림프조직형의변연부 B세포림프종은흡연이나자가면역질환, 감염과같은만성적인자극이기관지의점막연관림프조직에가해질때발생하는것으로알려져있으며 1, 보통천천히진행하여다른장기로전이되기전에비교적오랜기간폐에국한되어있는것으로알려져있다 4,5. 치료는경과관찰, 방사선치료, 수술및복합항암화학요법등이다양하게사용되지만아직확립된치료방식은없다 1,4,6,7. 이에반해폐의원발성고위험군 (aggressive) 비호지킨림프종 (non-hodgkin s lymphoma) 은더욱드물며저위험군 (indolent lymphoma) 에서변형되어발생하거나면역저하환자와같이기저질환을가진환자에서호발하는 354

2 Tuberculosis and Respiratory Diseases Vol. 69. No. 5, Nov 것으로알려져있다 1,6. 이러한환자들은대부분복합항암화학요법과같은공격적인치료가필요하며예후역시 MALT 림프종에비해나쁜것으로보고되고있다 1,6,8. 원발성폐림프종에대한기존의몇몇보고가있었으나 1,9, 그임상양상이나진단방법, 치료, 예후인자등에대해서는아직잘알려져있지않은상황으로저자들은한대학병원에서진단받은원발성폐림프종환자들을대상으로그임상양상과진단방법, 치료, 예후에대해알아보고자하였다. 대상및방법 1995년 1월부터 2008년 9월까지서울아산병원에서진단된원발성폐림프종환자들을대상으로후향적연구를시행하였다. 환자들은모두외과적폐생검이나경피적폐생검, 기관지내시경하점막조직검사등으로림프종을진단받았다. 림프종의진단은 WHO classification 10 에의거하여조직학적소견과면역표현형 (immunophenotype) 을바탕으로이루어졌다. 과거림프종의병력이있거나진단시이학적검사, 복부와골반단층촬영, 양전자방출단층촬영, 양측골수검사에서폐이외의장기침범이있는환자는모두연구에서제외되었으며처음진단후 3개월의추적관찰기간동안폐이외의장기침범이진단된경우도연구에서제외되었다. MALT 림프종의경우위장관등 MALT 림프종이발생할수있는다른장기의침범이없는경우에한해서폐를원발병소로하는 MALT 림프종으로간주하고연구에포함하였다. 위의조건에부합하는환자는총 24명으로상기환자들을대상으로의무기록에의거하여증상, 조직소견, 방사선소견, 양전자방출단층촬영소견및치료방법과예후에대해조사하였다. 통계치는빈도 ( 백분율 ) 나평균 ± 표준편차로나타냈고추적관찰기간및생존기간은중앙값 ( 최소값- 최대값 ) 으로나타냈다. 연속변수는 unpaired t test 혹은 Kruskal-Wallis test를사용하였으며비연속변수는 χ 2 test 혹은 Fisher s exact test를이용하였다. p값이 0.05 이하인것을통계학적으로유의하다고보았고모든데이터는 SPSS version 14.0 (SPSS Inc., Chicago, IL, USA) 을사용하여분석하였다. 결과대상환자는총 24명으로, 이들의관찰기간의중앙값은 42.3개월 ( 개월) 이었고, 13명 (54.2%) 이남자였고평균연령은 58.2±13.2세였다. 11명 (45.8%) 의환자가과거에흡연력이있거나현재흡연중인환자였다. 환자들은진단시에 5명 (20.8%) 이무증상이었고 17명 (70.8%) 이호흡기증상을호소하였으며식욕부진과발열은각각 1명 (4.2%) 에서있었다 (Table 1). 방사선학적소견은다양하였는데, 다발성결절혹은경화가 14명 (58.3%) 으로가장많았고단일결절혹은경화가 4명 (16.7%), 기관지확장증및세기관지염소견이 3명 (12.5%), 미만성간질성폐렴소견이 2명 (8.3%), 정상단순흉부촬영및전산화단층촬영소견이 1명 (4.2%) 에서있었다. 정상흉부전산화단층촬영소견을가지는환자에서는양전자방출단층촬영의이상소견이발견되어조직검사를통해미만성대세포 B형림프종을진단할수있었다 (Table 2). 조직검사는 7명 (29.2%) 에서비디오흉강경을이용하여이루어졌고, 경피적폐생검이 7명 (29.2%), 기관지내병변에대한기관지경하점막조직검사가 6명 (25%), 경기관지폐생검이 4명 (16.7%) 에서시행되었다 (Table 1). 조직소견상 MALT 림프종이 16명 (66.7%) 으로가장많 Table 1. Characteristics of patients with primary pulmonary lymphoma Characteristics No. of patients Total patients 24 Age, yr 58.2±13.2 Male 13 (54.2) Ever-smokers 11 (45.8) Symptoms Cough 10 (41.7) Dyspnea 5 (20.8) Anorexia 1 (4.2) Chest pain 1 (4.2) Blood tinged sputum 1 (4.2) Fever 1 (4.2) Asymptomatic 5 (20.8) Biopsy method VATS 7 (29.2) Percutaneous needle biopsy 7 (29.2) TBLB 4 (16.7) Bronchoscopic mucosal biopsy 6 (25.0) Data are presented as number, mean±standard deviation, or number (%). VATS: video-assisted thoracoscopic surgery; TBLB: transbronchial lung biopsy. 355

3 DK Oh et al: Primary pulmonary lymphoma 았고미만성대세포 B형림프종 (diffuse large B-cell lymphoma) 이 4명 (16.7%), 기타 WHO 분류법으로분류가불가능한림프종이 4명 (16.7%) (B cell lymphoma, large cell type, 1명 ; NK cell lymphoma, 1명 ; B cell lymphoma, 1명, malignant lymphoma, diffuse large cell type, 1명 ) 이었다 (Table 3). 조직소견과폐전산화단층촬영소견과의연관성을비교해보았을때, 모든조직소견에서다발성결절및경화소견이가장많은수를차지하였고, 조직소견에특이적인폐전산화단층촬영소견은없는것으로나타났다 (Table 4). 13명 (54.2%) 의환자가양전자방출단층촬영을시행하였고, 모든환자에서인지가능한병변이발견되었다. MALT 림프종의경우 non-malt 림프종에비해 SUV값이낮은경향을보였으나통계적으로유의한차이는없었다 (p=0.148) (Table 5). 원발성폐림프종의치료는 16명의 MALT 림프종환자중 9명 (56.3%) 의환자에서는항암화학요법이, 4명 (25.0%) 의환자에서는방사선치료가시행되었고, 3명 (18.8%) 의환자에서는항암화학요법이나방사선치료없이경과관찰만시행되었다 (Figure 1). 항암화학요법은 CVP 요법 (cyclophosphamide 750 mg/m 2 i.v. day 1, vincristine 1.4 mg/m 2 i.v. day 1, prednisolone 100 mg p.o. days 1 5, Table 2. Chest CT findings of primary pulmonary lymphoma CT findings No. of patients (%) Multiple nodule or consolidation 14 (58.3) Single nodule or consolidation 4 (16.7) Bronchiectasis and bronchiolitis 3 (12.5) Diffuse interstitial lung disease 2 (8.3) Normal 1 (4.2) 6회를 21일마다반복 ) 이 8명, rituximab (rituximab 375 mg/m 2 i.v. day 1) 과 CVP의병합요법이 1명에서시행되었다. 이들중 4명 (44.4%) 의환자는림프종이진행하여 2차항암화학요법을받았고, 그중 1명은 2차항암화학요법중패혈증으로사망하였으며, 3명은부분관해 (partial response) 되어외래에서경과관찰중이다. 항암화학요법을받은나머지 5명 (55.5%) 의환자들중 1명은치료도중식욕부진으로치료를거부하였고, 3명은부분관해, 1명은완전관해후안정적인상태로외래에서경과관찰중이다. 방사선치료를받은 4명의환자는모두병변의크기가줄어들었고, 이중 2명의환자가완전관해 (complete response) 되었다. 다른치료없이경과관찰만시행하였던 Table 4. Comparison of CT findings according to pathologic diagnosis MALT lymphoma Diffuse large B-cell lymphoma Others* Multiple nodule or 10 (62.5) 1 (25) 3 (75) consolidation Single nodule or 3 (18.8) 0 1 (25) consolidation Bronchiectasis and 2 (12.5) 1 (25) 0 bronchiolitis Diffuse interstitial 1 (6.3) 1 (25) 0 lung disease Normal 0 1 (25) 0 Total 16 (100) 4 (100) 4 (100) Data are presented as number (%). MALT: mucosa-associated lymphoid tissue. *Others include B cell lymphoma with large cell type, NK cell lymphoma, B cell lymphoma and malignant lymphoma with diffuse large cell type. Table 3. Pathologic diagnosis of primary pulmonary lymphoma Pathologic diagnosis No. of patients (%) MALT lymphoma 16 (66.7) Diffuse large B-cell lymphoma 4 (16.7) Others* 4 (16.7) MALT: mucosa-associated lymphoid tissue. *Others include B cell lymphoma with large cell type, NK cell lymphoma, B cell lymphoma and malignant lymphoma with diffuse large cell type. Table 5. Comparison of standard uptake value measured by 18F-FDG PET between MALT and non-malt lymphoma Biopsy finding SUV p-value MALT lymphoma 3.6± Non-MALT lymphoma* 8.5±6.2 Values are presented as mean±standard deviation. MALT: mucosa-associated lymphoid tissue. *Non-MALT lymphoma include diffuse large B cell lymphoma, B cell lymphoma with large cell type, NK cell lymphoma, B cell lymphoma and malignant lymphoma with diffuse large cell type. 356

4 Tuberculosis and Respiratory Diseases Vol. 69. No. 5, Nov Figure 1. Clinical courses and final outcomes of the patients with primary pulmonary lymphoma. MALT: mucosa-associated lymphoid tissue; PD: progressive disease; PR: partial response; SD: stable disease; CR: complete remission; Rec.: recurrence; BMT: bone marrow transplantation; RT: radiotherapy; F/U: follow-up. Figure 2. Comparison of prognosis using Kaplan-Meier survival curves between patients with MALT lymphoma and non-malt lymphoma. MALT: mucosa-associated lymphoid tissue. 3명중 1명은나쁜활동도 (performance status) 로인해항암화학요법을시행하지못한경우로 1개월후림프종의진행에의한호흡부전으로사망하였고, 나머지 2명은치료를받지않았음에도불구하고림프종의악화없이외래에서경과관찰중이다. Non-MALT 림프종의경우총 8명의환자중 7명 (87.5%) 에서 CHOP 요법 (cyclophosphamide 750 mg/m 2 i.v. day 1, doxorubicin 50 mg/m 2 i.v. day 1, vincristine 1.4 mg/ m 2 i.v. day 1, prednisolone 100 mg p.o. days 1 5, 6회를 21일마다반복 ) 이나 R-CHOP 요법 (rituximab 375 mg/ m 2 i.v. day 1, cyclophosphamide 750 mg/m 2 i.v. day 1, doxorubicin 50 mg/m 2 i.v. day 1, vincristine 1.4 mg/m 2 i.v. day 1, prednisolon 100 mg p.o. days 1 5, 6회를 21일마다반복 ) 이시행되었고 (Figure 1), 1명 (12.5%) 은조직검사직후패혈증으로사망하였다. 치료반응은항암화학요법을받은 7명의환자중 5명 (71.4%) 은완전관해, 1명 (14.3%) 은부분관해를보였으나 1명 (14.3%) 은항암화학요법에도불구하고림프종이진행하였다. 완전관해를경험한 5명의환자중 4명은재발하여 2차혹은 3차항암화학요법을시행하였고, 1명은재발없이외래에서안정적으로추적관찰중이다. 재발을경험한 4명의환자중 1명은자의로외래를방문하지않고있고나머지 3명은치료과정중열성호중구감소증이나림프종진행에의한호흡부전으로사망하였다. 부분관해를경험한 1명의환자는잔존림프종에대해방사선치료를시행하였고완전관해되어외래에서추적관찰중이며림프종이진행한 1명의환자는자가말초혈액조혈모세포이식술시행후부분관 357

5 DK Oh et al: Primary pulmonary lymphoma 해되었지만현재자의로치료를중단한상태이다. 원발성폐림프종의예후는전체환자에서 3년생존율이 76.7%, 5년생존율이 70.3% 였다. MALT 림프종의경우 3년생존율과 5년생존율이각각 78.8% 이었고, non- MALT 림프종은 3년생존율이 70.0% 이고 5년생존율이 52.5% 로, MALT 림프종이 non-malt 림프종보다예후가좋은경향을보였지만통계학적유의성은나타나지않았다 (p=0.310) (Figure 2). 고찰폐는악성림프종의전이가 25 40% 정도로흔하게발견되는장기임에도불구하고폐를원발장기로하는비호지킨림프종은매우드물다고알려져있고 1, 원발성폐 MALT 림프종에대한몇몇보고이외에는원발성폐림프종전반에대한보고는드물다 2,11. 가장흔한원발성폐림프종은기관지의점막연관림프조직에서발생하는 MALT 림프종으로 12,13, 폐에서점막연관림프조직의존재가 1973 년처음으로알려진이래 14 대부분의학자들은점막연관림프조직이폐에정상적으로존재하는것이아니고, 위장이나갑상선에서와같이흡연, 자가면역질환, 만성염증등에의한반응으로나타난다고주장하고있다 1,11. 저자들의이번연구에서 MALT 림프종은전체원발성폐림프종중 66.7% 로 Kim 등 15 이보고한 54%, Ferraro 등 1 이보고한 58% 보다는높았으나 Vanden 등 16 이보고한 82% 보다는낮았다. 저자들의연구에서흡연자는 11명 (45.8%) 으로 Ferraro 등 1 이보고한 40%, Kim 등 15 이보고한 41.7%, Vanden 등 16 이보고한 47% 와유사하였으며만성염증성질환이나자가면역질환을앓고있는환자는없었다. MALT 림프종외의원발성폐림프종은드문것으로알려져있는데미만성대세포 B형림프종의경우 Kim 등 17 은 25%, Kim 등 15 은 37.5% 로보고하였으나저자들의연구에서는 16.7% 로더적은경향을보였다. 원발성폐림프종의증상은본연구에서는대부분기침등의호흡기증상으로발현하였고 (70.8%), 무증상환자가 20.8% 였다. 특이한점은 non-malt 림프종환자들은모두증상이나타난것에반해 5명의무증상환자들은모두 MALT 림프종환자였는데이러한소견은 Kim 등 15 의보고에서도확인되었다 (MALT 림프종환자중 61.5% 가무증상 ). 원발성폐림프종의방사선소견은기강경화 (airspace consolidation), 결절 (nodule), 간유리음영 (ground-glass opacity) 등다양한소견으로나타나며대부분이국한된 병변을갖기보다는다발성이고, 양측성분포를한다고알려져있다. Bae 등 18 은 MALT 림프종환자 21명중 9명 (42.9%) 이다발성결절이나경화소견을보인다고보고하였으나본연구에서는 14명 (58.3%) 이다발성결절이나경화로나타나더높은경향을보여주었고이러한소견은모든조직소견에서공통적으로나타나는현상으로조직소견에따른방사선소견의차이는없었다. 현재림프종의진단과병기결정및추적관찰에 18 F- fluorodeoxyglucose (FDG) 를이용한양전자방출단층촬영이널리시행되고있지만원발성폐림프종에서가장흔하게발견되는 MALT 림프종의양전자방출단층촬영소견에대해서는소수의보고가있을뿐이다 MALT 림프종은미만성대세포 B형림프종등빨리진행하는림프종에비해비교적서서히진행하는양상을보이며이러한이유로인해 FDG 의섭취가적어양전자방출단층촬영에서뚜렷한병변을나타내지못한다고알려져왔지만 20,21, 저자들의연구에서는양전자단층촬영을시행한 MALT 림프종환자 8명에서모두평균 SUV 3.6 ( 범위, ) 의인지가능한병변이발견되었다. MALT 림프종에비해빨리진행하여 FDG의섭취가높을것으로생각된 non-malt 림프종과 MALT 림프종의 SUV의비교에서는 non-malt 림프종의 SUV가높은경향을보여주었으나 (3.6 vs. 8.5) 통계적으로는조직형에따른 SUV 차이는없는것으로나타났는데 (p=0.148), 이는대상환자수가적기때문으로생각된다. 또한정상방사선소견을보였던미만성대세포 B형림프종 1예에서도양전자방출단층촬영을통해림프종의진단이가능하였다. 본연구에서 7명 (29.2%) 의환자들이비디오흉강경을이용한수술적폐생검을시행받았고나머지환자들도모두경피적폐생검술이나경기관지폐생검술과같은침습적시술을통해림프종을진단받았다. 림프종의진단에대한몇몇의연구에서기관지폐포세척술로얻어진검체를통한 cell marker study 나 flowcytometry 가진단에도움을줄수있다고보고하였지만 11,22, 무증상의서서히진행하는저위험군림프종환자이외에는거의대부분의환자가비교적심각한부작용을일으킬수있는항암화학요법이나방사선치료를받아야한다는점을고려할때조직학적진단은필수적이며이러한이유로전술한연구에서시행된기관지폐포세척술을이용한검사만으로는부족하다고생각된다. 원발성폐림프종의치료는수술적절제, 방사선치료, 수술후보조항암화학요법, 항암화학요법의단독사용 358

6 Tuberculosis and Respiratory Diseases Vol. 69. No. 5, Nov 등여러가지방법이있음에도불구하고아직까지확립된치료방법은없다 1,4,6,7,11. MALT 림프종과같이서서히진행하는조직형을가진환자에서증상이없는경우특별한치료없이경과관찰하는것도한가지방법일수있는데 6, 이번연구에포함된 24명의환자중나쁜활동도로인해항암화학요법을시행하지못한 1명이외에증상이경하고서서히진행하는 MALT 림프종환자 2명이현재각각 43.8개월, 30.8개월동안치료없이안정적으로추적관찰중이다. MALT 림프종의국소치료로이전의대부분의연구는수술적절제를보고하였으나 1,15,16, 저자들의연구에포함된 16명의 MALT 림프종환자중수술적절제를받은환자는없었고 4명 (25.0%) 의환자에서방사선치료가시행되었다. 방사선치료를받은 4명의환자중 2명이완전관해되었고 2명이부분관해되었다. 부분관해를경험한 2명의환자도림프종의진행없이각각 15.8개월, 22.2개월동안외래에서경과관찰중이다. 본연구에포함된 MALT 림프종환자중 9명 (56.3%) 에서항암화학요법이시행되었고이들중 4명 (44.4%) 의환자가일차항암화학요법에서부분관해이상의치료반응을보였으며일차항암화학요법에반응이없었던 4명 (44.4%) 의환자들중 3명은이차항암화학요법에서부분관해이상의치료반응을나타냈다. MALT 림프종과는달리폐에원발하는 non- MALT 림프종의경우대부분중등도이상의위험도를갖는나쁜예후를가지는것으로알려져있으며 1,8, 대부분의경우방사선치료나수술적절제와같은국소치료와무관하게복합항암화학요법을필요로한다. 이번연구에서도비디오흉강경을이용한폐생검이후패혈증으로사망한 1명의환자이외에 7명의환자에서항암화학요법이시행되었고 5명 (71.4%) 이완전관해, 1명 (14.3%) 이부분관해를경험하였으나완전관해를경험한 5명의환자중 4명의환자가재발하였다. 원발성폐림프종의예후는비교적양호한편이나추적관찰기간동안 MALT 림프종에서 3명, non-malt 림프종에서 3명, 총 6명이사망하였다. 사망한 3명의 MALT 림프종환자중 1명은추적관찰중단으로인해사인을알수없었으나다른 1명은항암화학요법으로인한열성호중구감소증및병발된폐렴으로사망하였고, 또다른 1명은원발성폐림프종의악화로인한호흡부전으로사망하였다. 이에비해사망한 3명의 non-malt 림프종환자들중 1명은조직검사직후패혈증으로사망하였고, 다른 2명은항암화학요법으로인한열성호중구감소증및병발된폐렴으로사망하였다. 폐에원발하는 non-malt 림프종이 대부분 intermediate 나 high grade인사실과이번연구에서나타난것처럼 non-malt 림프종의항암화학요법후높은재발률을고려할때 MALT 림프종의예후가더양호할것으로예상되었으며실제통계적유의성은없었으나 MALT 림프종의예후가더양호한경향 (5년생존율, 78.8% vs. 52.5%) 을나타냈다. 이번연구의가장큰제한점은질환의낮은발병률로인한적은표본수와후향적연구설계에있다고생각된다. 특히생존분석에서 MALT 림프종이 non-malt 림프종에비해좋은예후를가진다고보고한이전연구결과에도불구하고 4,15 이번연구에서통계적유의성을보여주지못한것은이러한제한점을잘나타내준다고하겠다. 요약하면원발성폐림프종은무증상을포함한비특이적인호흡기증상과함께다양한방사선소견을보이는질환으로진단을위해서는다른양성질환과의감별을위해서침습적인조직검사가필수적이며양전자방출단층촬영이진단에도움을줄수있는것으로나타났다. 예후는비교적양호한편이나 non-malt 림프종의경우 MALT 림프종에비해치료후재발률이높고생존율도낮은경향을보였다. 앞으로더많은원발성폐림프종환자를대상으로한전향적연구가필요할것으로생각된다. 참고문헌 1. Ferraro P, Trastek VF, Adlakha H, Deschamps C, Allen MS, Pairolero PC. Primary non-hodgkin's lymphoma of the lung. Ann Thorac Surg 2000;69: Kurtin PJ, Myers JL, Adlakha H, Strickler JG, Lohse C, Pankratz VS, et al. Pathologic and clinical features of primary pulmonary extranodal marginal zone B-cell lymphoma of MALT type. Am J Surg Pathol 2001;25: Ooi GC, Chim CS, Lie AK, Tsang KW. Computed tomography features of primary pulmonary non-hodgkin's lymphoma. Clin Radiol 1999;54: Cordier JF, Chailleux E, Lauque D, Reynaud-Gaubert M, Dietemann-Molard A, Dalphin JC, et al. Primary pulmonary lymphomas: a clinical study of 70 cases in nonimmunocompromised patients. Chest 1993;103: Koss MN, Hochholzer L, Nichols PW, Wehunt WD, Lazarus AA. Primary non-hodgkin's lymphoma and pseudolymphoma of lung: a study of 161 patients. Hum Pathol 1983;14: Cadranel J, Wislez M, Antoine M. Primary pulmonary lymphoma. Eur Respir J 2002;20:

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김범수 Analysis of Outcomes after Resection of Sarcomatous Hepatocellular Carcinoma Purpose: Sarcomatous hepatocellular carcinoma (HCC) is rare. Therefore, the clinicopathologic characteristics and prognosis