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[Biopsy negative Borrmann type IV (1)]

2020-8-10. 8PM. EndoTODAY Live

* Âü°í: In depth analysis º¸¸¸ 4Çü ÁøÇ༺ À§¾Ï À§³»½Ã°æ ¾ÆƲ¶ó½º (PDF) 2024


º¸¸¸ 4Çü ÁøÇ༺ À§¾ÏÀÇ Á¡¸·Ãþ¿¡´Â ¾ÏÀÌ ¾ø°í ±× ¾Æ·¡¿¡¸¸ ¾Ï¼¼Æ÷°¡ À§Ä¡ÇÏ´Â ¿¹°¡ ¸¹¾Æ¼­ forceps biopsy¿¡¼­ ¾ÏÀÌ È®ÀεÇÁö ¾Ê´Â °æ¿ì°¡ ¸¹½À´Ï´Ù.

ÀüÇüÀûÀÎ º¸¸¸ 4Çü ÁøÇ༺ À§¾Ï. ¿©·¯ Á¶Á÷°Ë»ç¿¡¼­ ¾ÏÀÌ ³ª¿ÀÁö ¾Ê¾ÒÀ½.

¼ö¼ú ÈÄ Á¡¸·°ú Á¡¸·ÇÏÃþÀ» »ìÆ캻 ¹Ù Ç¥¸é¿¡´Â ¾Ï¼¼Æ÷°¡ ¾ø°í deep mucosal layer ÀÌÇÏ ÇϹ濡´Â massive desmoplastic reaction°ú poorly cohesive carcinoma ¼¼Æ÷µéÀÌ scattered µÇ¾î ÀÖÀ½.


Á¶Á÷°Ë»ç¿¡¼­ ¾ÏÀÌ ³ª¿ÀÁö ¾Ê´õ¶ó°í Áõ»ó, ³»½Ã°æ À°¾È¼Ò°ß ¹× CT µî¿¡¼­ º¸¸¸ 4Çü ÁøÇ༺À§¾ÏÀÌ °­·ÂÈ÷ ÀǽɵǸé Áï½Ã ȯÀÚ¸¦ ¼ö¼úÀåÀ¸·Î º¸³»¾ß ÇÕ´Ï´Ù. Áï½Ã º¸³»¾ß ÇÕ´Ï´Ù. Áï½Ã.

40´ë ÃÊ¹Ý ¿©¼ºÀ¸·Î mild indigestion ÀÌ¿Ü¿¡ ƯÀ̼ҰßÀÌ ¾ø¾ú½À´Ï´Ù. ³»½Ã°æ¿¡¼­ º¸¸¸ 4Çü ÁøÇ༺À§¾ÏÀÌ ÀǽɵǾî 3¹ø Á¶Á÷°Ë»ç¸¦ ÇÏ¿´À¸³ª ¾ÏÀ¸·Î È®ÀεÇÁö ¾Ê¾Ò½À´Ï´Ù. ±×·¯³ª ³»½Ã°æ ¼Ò°ß°ú CT ¼Ò°ß¿¡¼­ º¸¸¸ 4Çü ÁøÇ༺À§¾ÏÀÌ °­·ÂÈ÷ ÀÇ½ÉµÇ¾î °³º¹ÇÏ¿´À¸³ª peritoneal seedingÀ¸·Î O & C ÇÏ¿´½À´Ï´Ù. ÀÌ·± ȯÀÚ¿¡¼­ Á¶Á÷°Ë»ç¿¡¼­ ¾ÏÀÌ ³ª¿ÀÁö ¾Ê¾Ò´Ù°í ¸î °³¿ù ÈÄ follow-upÀ» ÃßõÇѴٰųª °³º¹¼úÀ» ±ÇÇÏÁö ¾Ê´Â °æ¿ì ³ªÁß¿¡ medicolegal problemÀ¸·Î ¿¬°áµË´Ï´Ù. ÀǽɵǸé Áï½Ã ¼ö¼úÀåÀ¸·Î º¸³»¾ß ÇÕ´Ï´Ù. Áï½Ã.


2016³â Áõ·ÊÀÔ´Ï´Ù.

º¸Åë º¸¸¸ 4Çü ÁøÇ༺ À§¾ÏÀº ¸Å¿ì ¾î·Æ½À´Ï´Ù. ±×·±µ¥ ¾î¶² ȯÀÚ´Â ³Ê¹« ½±½À´Ï´Ù. ³»½Ã°æ°ú CT¿¡¼­ ±×¾ß¸»·Î ¸íÈ®ÇÑ °æ¿ìµµ Àֱ⠶§¹®ÀÔ´Ï´Ù. ¿ÜºÎ Á¶Á÷°Ë»ç¿Í º» º´¿ø Á¶Á÷°Ë»ç¿¡¼­ ¸ðµÎ ¾ÏÀÌ ³ª¿ÀÁö ¾Ê¾ÒÁö¸¸ ³»½Ã°æ À°¾È¼Ò°ßÀÌ ³Ê¹«³ª ¸íÈ®ÇÏ¿© ¹Ù·Î ¼ö¼úÀ» º¸³Â½À´Ï´Ù.

¿Ü·¡ ´çÀÏ ³»½Ã°æ °Ë»ç¸¦ ÇÏ¿´°í, ´ÙÀ½ ³¯ ÀÔ¿øÇÏ¿©, ±× ´ÙÀ½ ³¯ ¿Ü°ú·Î Àü°úÇÏ°í, ±× ´ÙÀ½ ³¯ ¼ö¼úÀ» ÇÏ¿´½À´Ï´Ù. Áö±Ý±îÁö ¼ö¼úÇÑ º¸¸¸ 4Çü ÁøÇ༺ À§¾Ï Áß °¡Àå »¡¶ú´ø °æ¿ì ¾Æ´Ñ°¡ »ý°¢µË´Ï´Ù. Ultra-super-fast high-speed surgical treatment for biopsy-negative Borrmann type IV gastric cancerÀÇ Áõ·Ê¿´½À´Ï´Ù.^^ ´ÙÇེ·´°Ô º¹¸· ÀüÀ̳ª ¸²ÇÁÀý ÀüÀÌ´Â ¾ø¾ú½À´Ï´Ù.


Stomach, total gastrectomy:
Advanced gastric carcinoma
1. Location : [1] middle third, [2] upper third, [3] lower third, [4] duodenum, Center at body and circle
2. Gross type : Borrmann type 4
3. Histologic type : tubular adenocarcinoma, poorly (poorly cohesive) differentiated
4. Histologic type by Lauren : diffuse
5. Size : 18x18 cm
6. Depth of invasion : invades serosa (pT4a)
7. Resection margin: free from carcinoma
8. Lymph node metastasis : no metastasis in 41 regional lymph nodes (pN0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : present
12. Peritoneal cytology : negative
13. AJCC stage by 7th edition: pT4a N0


[2020-5-21. ¾Öµ¶ÀÚ Áú¹®]

±³¼ö´Ô²²¼­´Â EndoTODAY º¸¸¸ 4Çü ÁøÇ༺À§¾Ï¿¡¼­ "ÀÓ»ó»óÀÌ º¸¸¸ 4Çü ÁøÇ༺À§¾Ï¿¡ ÇÕ´çÇÏ¸é ³»½Ã°æ Á¶Á÷°Ë»ç¿¡¼­ ¾ÏÀÌ È®ÀεÇÁö ¾Ê´õ¶óµµ ¼ö¼úÀ» º¸³»°í ÀÖ½À´Ï´Ù"¿Í °°ÀÌ ´äº¯ ÁֽŠ°ÍÀ» º¸¾Ò½À´Ï´Ù.

1) B-IV °¡ ÀǽɵǴ ȯÀÚ¿¡¼­ Á¶Á÷°Ë»ç°¡ negative ·Î ³ª¿ÔÀ» ¶§, ±³¼ö´Ô²²¼­´Â ¾î¶»°Ô f/uÀ» ÇϽôÂÁö¿ä?

2) B-IV°¡ ÀǽɵǴ ȯÀÚ¿¡¼­ multiple site ¿¡¼­ biopsy ¸¦ Çϸé Á¶Á÷°Ë»çÀÇ ¾ç¼º·üÀÌ ¿Ã¶ó°¥Áö ±Ã±ÝÇÕ´Ï´Ù.

[2020-5-21. ÀÌÁØÇà ´äº¯]

¿¹. Áß¿äÇÑ Áú¹®ÀÔ´Ï´Ù. À̹ø ±âȸ¿¡ È®½ÇÈ÷ °³³äÀ» Àâ±â ¹Ù¶ø´Ï´Ù.

1) º¸¸¸ 4Çü ÁøÇ༺À§¾ÏÀÌ ÀǽɵǴ ȯÀÚ¿¡¼­´Â follow-upÀ» ÇÏ¸é ¾È µË´Ï´Ù. ¹Ù·Î °á·ÐÀ» ³»¾ß ÇÕ´Ï´Ù. Áö±Ý ´çÀå. Follow-upÀº º¸Åë '¸î ÁÖ ÈÄ Àç°Ë' ȤÀº '¸î °³¿ù ÈÄ Àç°Ë' ȤÀº 'Åõ¾à ÈÄ Àç°Ë'À» ¸»ÇÏ´Â °ÍÀÔ´Ï´Ù. ÀÌ·± ÀǹÌÀÇ follow-upÀº ¸Å¿ì °ï¶õÇÕ´Ï´Ù. Áö±Ý ´çÀå Àç°ËÇÏ°í CT¸¦ Âï¾î¾ß ÇÕ´Ï´Ù. ¿À´Ã ´çÀå... ¸î °³¿ù ÈÄ Àç°ËÇÏ¿© peritoneal seedingÀÌ ÀÖ´Â »óÅ·Π¹ß°ßµÇ¸é °í¼Ò´çÇϱ⠽±»óÀÔ´Ï´Ù (EndoTODAY Medicolegal risk of biopsy negative Borrmann type IV). Àú´Â º¸¸¸ 4ÇüÀÌ ÀǽɵǾú´Âµ¥ Á¶Á÷°Ë»ç¿¡¼­ ¾ÏÀÌ ³ª¿ÀÁö ¾Ê¾Æ ÀÇ·ÚµÈ È¯ÀÚ¿¡¼­ ¿Ü·¡ ´çÀÏ ³»½Ã°æ °Ë»ç¸¦ ÇÏ°í, ´ÙÀ½ ³¯ ÀÔ¿ø, ±× ´ÙÀ½ ³¯ ¿Ü°ú Àü°ú, ±× ´ÙÀ½ ³¯ ¼ö¼úÇÑ °æ¿ì±îÁö ÀÖ¾ú½À´Ï´Ù. À̸§ÇÏ¿© Ultra-super-fast high-speed surgical treatment for biopsy-negative Borrmann type IV gastric cancerÀÇ Áõ·Ê¿´½À´Ï´Ù.^^


Stomach, total gastrectomy:
Advanced gastric carcinoma
1. Location : [1] middle third, [2] upper third, [3] lower third, [4] duodenum, Center at body and circle
2. Gross type : Borrmann type 4
3. Histologic type : tubular adenocarcinoma, poorly (poorly cohesive) differentiated
4. Histologic type by Lauren : diffuse
5. Size : 18x18 cm
6. Depth of invasion : invades serosa (pT4a)
7. Resection margin: free from carcinoma
8. Lymph node metastasis : no metastasis in 41 regional lymph nodes (pN0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : present
12. Peritoneal cytology : negative
13. AJCC stage by 7th edition: pT4a N0

2) B-IV°¡ ÀǽɵǴ ȯÀÚ¿¡¼­ multiple site¿¡¼­ Á¶Á÷°Ë»ç¸¦ ÇÏ¸é ¾ç¼º·üÀÌ ¿Ã¶ó°¥Áö Áú¹®À» Á̴ּµ¥¿ä... Á¶Á÷°Ë»ç ¸¹ÀÌ ÇÏ´Â °ÍÀº º°·Î Áß¿äÇÏÁö ¾Ê½À´Ï´Ù. »ç½Ç °ÅÀÇ Áß¿äÇÏÁö ¾Ê½À´Ï´Ù. Àß ÇÏ´Â °ÍÀÌ Áß¿äÇÕ´Ï´Ù. Á¶Á÷°Ë»çÀÇ ÁúÀÌ Áß¿äÇÏÁö ¾çÀº Áß¿äÇÏÁö ¾Ê½À´Ï´Ù. Á¶Á÷°Ë»ç ´ëÃæ ÇÏ¿© ¾ÏÀÌ ³ª¿ÀÁö ¾ÊÀ¸¸é false sense of safety¸¸ »ý±é´Ï´Ù. ¾ÆÁÖ ÁÁÁö ¾Ê½À´Ï´Ù. ¾È ÇÏ´À´Ï¸¸ ¸øÇÕ´Ï´Ù. ¸¹ÀÌ ÇÏÁö ¸¶½Ã°í Àß ÇϽʽÿÀ.

»ç½Ç Á¶Á÷°Ë»ç´Â ±×´ÙÁö Áß¿äÇÏÁö ¾Ê½À´Ï´Ù. ³»½Ã°æ À°¾È¼Ò°ßÀÌ ÈξÀ Áß¿äÇÕ´Ï´Ù. ImpressionÀ» Àß Àâ´Â °ÍÀÌ Áß¿äÇÕ´Ï´Ù. º¸¸¸ 4ÇüÀ» ÀǽÉÇÏ´Â °ÍÀÌ 100¹è, 1000¹è Áß¿äÇÕ´Ï´Ù. ÀÏ´Ü º¸¸¸ 4ÇüÀÌ ÀǽɵǸé erosionÀ̳ª ulcer¸¦ ã¾Æ Á¶Á÷°Ë»ç¸¦ ÇϽʽÿÀ. ¿©±â Àú±â ¸· ÇÑ´Ù°í Á¶Á÷ÇÐÀûÀ¸·Î ¾ÏÀÌ È®ÀεǴ °ÍÀº ¾Æ´Õ´Ï´Ù.

¾Æ·¡ ȯÀÚÀÇ Á¶Á÷°Ë»ç¿¡¼­ ¾ÏÀÌ ³ª¿ÀÁö ¾Ê¾Ò½À´Ï´Ù. ¿©·¯ºÐÀº ¾î¶»°Ô ÇϽðڽÀ´Ï±î?

Áï½Ã ¿Ü°ú·Î º¸³Â°í ¾Æ·¡¿Í °°Àº °á°ú¿´½À´Ï´Ù. Âü ´ÙÇེ·¯¿î °æ¿ìÀÔ´Ï´Ù. ¿Ü°ú¿¡¼­´Â ¼ö¼ú Àü ³»½Ã°æ °Ë»ç¸¦ ´Ù½Ã ÀÇ·ÚÇÏ´Â °æ¿ì°¡ ¸¹½À´Ï´Ù. ¿Ü°ú ÀÇ»ç ÀÔÀå¿¡¼­ ¾Æ¹«·¡µµ Á¶Á÷ÇÐÀû È®ÁøÀÌ ÀÖÀ¸¸é ¸¶À½ÀÌ ÆíÇÏ°ÚÁö¿ä. ±×·¯³ª ¿Ü°úÀǻ翡°Ô Á¶Á÷°Ë»ç¿¡¼­ ¾ÏÀÌ ³ª¿ÀÁö ¾Ê´õ¶óµµ ²À, ²À, ²À ¼ö¼úÇØ¾ß ÇÑ´Ù°í °­·ÂÈ÷ ÁÖÀåÇØ¾ß ÇÕ´Ï´Ù. Àý´ë ¹°·¯¼­¸é ¾È µË´Ï´Ù.

Stomach, total gastrectomy: Advanced gastric carcinoma
- Histologic type : tubular adenocarcinoma, poorly differentiated
- Depth of invasion : penetrates subserosal connective tissue (pT3)
- Resection margin: free from carcinoma
- Lymph node metastasis : no metastasis in 36 regional lymph nodes (pN0)
- Lymphatic invasion : not identified
- Venous invasion : not identified
- Perineural invasion : present
- Peritoneal cytology : negative

¹°·Ð ¿Ü·¡ Áø·á ÈÄ¿¡µµ ³õÄ¡´Â °æ¿ì°¡ ÀÖÁö¸¸, screening setting¿¡¼­ º¸¸¸ 4Çü ÁøÇ༺ À§¾ÏÀ» ³õÄ¡´Â °æ¿ì´Â Á¤¸» ¸¹ÀÌ °æÇèÇÏ¿´½À´Ï´Ù. Á¶±Ý¸¸ ¸Ô¾îµµ ºÒÆíÇÏ°í üÁßµµ ºüÁö°í ¹º°¡ À§Àå°ú Áõ¼¼°¡ ÀÖÀ¸¸é Â÷ºÐÈ÷ ¿Ü·¡ ÁøÂûÀ» ¹Þ¾Æ¾ß ÇÕ´Ï´Ù. ±×·¡¼­ ¾ÏÀº ¾Æ´ÑÁö ÀǽÉÇÏ´Â »óÅ¿¡¼­ Á¶½É½º·´°Ô ³»½Ã°æ °Ë»ç¸¦ ¹Þ¾Æ¾ß ÇÕ´Ï´Ù. ±×·± Áß¿äÇÑ °úÁ¤À» »ý·«ÇÏ°í ±×³É °ÇÁøÀ» ¹ÞÀ¸¸é °ÇÁø¿¡¼­´Â ¹«Áõ»óÀ» °¡Á¤Çϱ⠶§¹®¿¡ º¸¸¸ 4Çü ÁøÇ༺ À§¾ÏÀÌ ÀÚ²Ù miss µÇ´Â °Í °°½À´Ï´Ù. ±Ù°Å´Â ¾ø½À´Ï´Ù. ±×³É Á¦ ´À³¦ÀÔ´Ï´Ù. ±×·± °æ¿ì¸¦ ³Ê¹« ¸¹ÀÌ ºÁ¼­ °¡Áö°Ô µÈ ´À³¦ÀÔ´Ï´Ù. À¯Áõ»ó ȯÀÚ¸¦ ¹«Áõ»ó ¼ºÀΰú ¼¯´Â °ÍÀº ¸Å¿ì ³ª»Û ÀÏÀÔ´Ï´Ù. ¸Å¿ì ¸Å¿ì ³ª»Û ÀÏÀÔ´Ï´Ù. ¼±º° Áø·á¼Ò¶óµµ ÇÊ¿äÇÒ °Í °°½À´Ï´Ù. °ÇÁøÇÏ·¯ ¿À¼Ì´Âµ¥ Áõ»óÀÌ ÀÖÀ¸¸é °ÇÁøÀ» ¸ø ¹Þ°Ô ÇÏ°í ÀÏ´Ü ¿Ü·¡ Áø·á ÈÄ Æò°¡¸¦ ¹Þ°í ³­ ´ÙÀ½ ³»½Ã°æ °Ë»ç¸¦ ¹Þµµ·Ï ÇÏ´Â °ÍÀÌ ¿Ã¹Ù¸¥ Á¤Ã¥ ¹æÇâÀÔ´Ï´Ù. Äڷγª ¼±º° Áø·á¼Ò¸¸ ÇÊ¿äÇÑ °Í ¾Æ´Õ´Ï´Ù. À§¾Ï ¼±º° Áø·á¼Òµµ ÇÊ¿äÇÒ °Í °°½À´Ï´Ù.

°Ë»ç ½Ã°£µµ ¹®Á¦ÀÔ´Ï´Ù. À§³»½Ã°æ ÃÖ¼Ò °Ë»ç½Ã°£Àº 5ºÐÀÔ´Ï´Ù. 1-2ºÐ¿¡ ³¡³ª´Â À§³»½Ã°æÀÌ ¾ó¸¶³ª ¸¹ÀºÁö ¾Æ´Â »ç¶÷Àº ´Ù ¾Ð´Ï´Ù. ±× °úÁ¤¿¡¼­ º¸¸¸ 4Çü ´Ù ³õÄ¡´Â °ÍÀÔ´Ï´Ù. 5ºÐ ÀÌ»ó °Ë»çÇսôÙ. (EndoTODAY 2013³â ¾î¶² Áú¹®¿¡ ´äÇÕ´Ï´Ù)

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