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[SMT-like AGC]

2008³â 6¿ù 30ÀÏ EndoTODAY (¾ÏÈ£: smcgi)¸¦ ´Ù½Ã Àо°Ú½À´Ï´Ù.

Áø´Ü ³»½Ã°æ ¿µ¿ª¿¡¼­ decision makingÀÌ °¡Àå ¾î·Á¿î °Í Áß Çϳª°¡ SMTÀÔ´Ï´Ù. Á¶Á÷°Ë»ç·Î °á·ÐÀ» ¾òÀ» ¼ö ¾ø´Â °æ¿ì°¡ ´ëºÎºÐÀÔ´Ï´Ù. EUS, CT µî °Ë»ç¸¦ Ãß°¡ÇÒ ¼ö ÀÖÁö¸¸ decision making¿¡ °áÁ¤ÀûÀÎ µµ¿òÀ» ÁÖ´Â °æ¿ì´Â ¸¹Áö ¾Ê½À´Ï´Ù. Àú´Â EUS´Â ³Ê¹« ÁÖ°üÀûÀÌ°í interobserver variationÀÌ Å©´Ù°í »ý°¢µÇ¾î CT¸¦ Á» ´õ ÀÚÁÖ ½ÃÇàÇÏ´Â ÆíÀÔ´Ï´Ù. ÀÌ ¶ÇÇÑ °áÁ¤ÀûÀÎ Á¤º¸¸¦ Á¦°øÇØ ÁÖ´Â ¿¹°¡ ¸¹Áö ¾ÊÁö¸¸...

ȯÀÚ¸¦ º¸¸é¼­ ´Ã ´À³¢´Â °ÍÀº "¿ª½Ã ³»½Ã°æ À°¾È¼Ò°ßÀÌ °¡Àå Áß¿äÇÏ´Ù"´Â Á¡ÀÔ´Ï´Ù. Á¶Á÷°Ë»ç, EUS, CT¿¡¼­ ¾î¶°ÇÑ °á°ú°¡ ³ª¿À´õ¶óµµ À°¾È¼Ò°ß¿¡¼­ ¾ÏÀÌ ÀÇ½ÉµÇ¸é ¾Ï¿¡ ÁØÇÑ Ä¡·á¸¦ ÇØ¾ß ÇÏ´Â °ÍÀÔ´Ï´Ù. °£È¤ SMT-like cancer¶ó´Â °ÍÀÌ Àֱ⠶§¹®ÀÔ´Ï´Ù.

ÀÌ È¯ÀÚ¿¡¼­ Á¶Á÷°Ë»ç´Â µÎ¹ø ½ÃÇàµÇ¾ú´Âµ¥ ÇѹøÀº ¾ÏÀÌ ³ª¿ÀÁö ¾Ê¾Ò°í ÇѹøÀº ¾ÏÀ¸·Î È®ÀεǾú½À´Ï´Ù. ¼ö¼úÀ» ½ÃÇàÇÏ¿´À¸¸ç "Advanced gastric carcinoma, Borrmann type: unclassifiable, papillary adenocarcinoma (M/D), 4x1.8 cm, extension to proper muscle, no metastasis in 50 regional lymph nodes"ÀÇ °á°ú¸¦ ¾ò¾ú½À´Ï´Ù.

2020-8-17. EoA



Screening endoscopy¿¡¼­ ¹ß°ßµÈ Á¾¾çÀÔ´Ï´Ù. Overlying mucosa°¡ ¿ÏÀü Á¤»óÀ¸·Î º¸¿´´ø SMT-like cancerÀÔ´Ï´Ù.
1. Location: [1] lower third, [2] middle third, center at antrum and lesser curvature
2. Gross type : Borrmann type (unclassifiable)(mimicking submucosal tumor)
3. Histologic type: undifferentiated carcinoma
4. Histologic type by Lauren: indeterminate
5. Size: 5.4x3.5 cm
6. Depth of invasion: invades adjacent structure (pancreas)
7. Resection margin: free from carcinoma. safety margin: proximal 7 cm, distal 4 cm
8. Lymph node metastasis: no metastasis in 50 regional lymph nodes
9. Lymphatic invasion: not identified
10. Venous invasion: not identified
11. Perineural invasion: not identified


1. Location : lower third, center at antrum and anterior wall
2. Gross type : Borrmann type 5 (SMT-like)
3. Histologic type : tubular adenocarcinoma, poorly differentiated
4. Histologic type by Lauren : mixed
5. Size : 3x2.5 cm
6. Depth of invasion : invades serosa
7. Resection margin: free from carcinoma, safety margin: distal 1.5 cm, proximal 7.5 cm
8. Lymph node metastasis : metastasis to 2 out of 43 regional lymph nodes
9. Lymphatic invasion : present

10. Venous invasion : not identified
11. Perineural invasion : not identified
12. Peritoneal cytology : negative


SMT-like AGC¿¡ ´ëÇÑ EndoTODAY°¡ ³ª°£ ÈÄ ÀÛÀº SMT¿¡ ´ëÇÏ¿© Ãß°¡ °Ë»ç°¡ ÇÊ¿äÇÑÁö ¹®ÀÇÇÏ´Â ¸ÞÀÏÀÌ ÀÖ¾ú½À´Ï´Ù.

2010³â ´ëÇѼÒÈ­±âÇÐȸÁö¿¡ ±â°íÇÑ ±ÛÀÇ ÀϺθ¦ ¿Å±é´Ï´Ù. Àü¹®Àº link¸¦ Âü°íÇϽñ⠹ٶø´Ï´Ù.

³»½Ã°æÀÌ ¹ß´ÞÇÏ°í °Ç°­°ËÁøÀÌ º¸ÆíÈ­µÇ¸é¼­ ¹«Áõ»ó ¼ºÀÎÀÇ À§ Á¡¸·ÇÏÁ¾¾çÀÌ ÈçÈ÷ ¹ß°ßµÇ°í ÀÖ´Ù. Áõ»óÀ» ÀÏÀ¸Å² Á¡¸·ÇÏÁ¾¾çÀº ¼ö¼úÀÌ ¿øÄ¢ÀÌ´Ù. ±×·¯³ª °Ç°­°ËÁø¿¡¼­ ¹ß°ßµÈ ÀÛ°í Áõ»óÀÌ ¾ø´Â Á¡¸·ÇÏÁ¾¾çÀ» ¸ðµÎ ¼ö¼úÇÏ´Â °ÍÀº ¾Æ´Ï´Ù. ¹«Áõ»ó ¼ºÀÎÀÇ ÀÛÀº Á¡¸·ÇÏÁ¾¾çÀ» ¾î¶»°Ô °Ë»çÇÏ°í °ü¸®ÇÒ °ÍÀΰ¡¿¡ ´ëÇÑ ÀÇ·á°èÀÇ ÇÕÀÇ°¡ ¾ø´Â »óÅ·Î, ÀûÁö ¾ÊÀº È¥¼±ÀÌ ºú¾îÁö°í ÀÖ´Ù. ¾î¶² À§ Á¡¸·ÇÏÁ¾¾çÀÌ 100% ¾ç¼ºÀÎÁö Á¤È®È÷ ÆÇ´ÜÇϱâ´Â ¾î·Æ´Ù. °æ°ú°üÂû¿¡ µû¸£´Â ¾à°£ÀÇ À§Ç輺À» ¼³¸íÇÏ°í µ¿ÀǸ¦ ¾òÁö ¸øÇϸé ÀÚ²Ù ¹º°¡¸¦ ½ÃÇàÇÏ´Â ¿À·ù, Áï do-somethingism¿¡ ºüÁö±â ½±´Ù. ±×·Î ÀÎÇØ ÀÛÀº º´¼Ò¸¦ °úÀ×Áø´Ü¤ý°úÀ×Ä¡·áÇÔÀ¸·Î½á »îÀÇ ÁúÀÌ ¶³¾îÁú ¼ö ÀÖ´Ù.


[2013-7-20. ¾Öµ¶ÀÚ ÆíÁö] ´õ¿î ³¯¾¾¿¡ Àß Áö³»½ÃÁÒ? Àúµµ gastric SMT·Î fololw-upÇÏ´Ù°¡ Å©±âÀÇ Áõ°¡°¡ ÀÖ¾î (1,7-> 2,0-> 2.8 cm) ¼ö¼ú º¸³½ Áõ·Ê¿¡¼­ SM cancer°¡ Áø´ÜµÈ ÀûÀÌ ÀÖ¾ú½À´Ï´Ù. ¶Ç 2.5 cm ÀÌ»óÀÇ 3rd or 4th layer¿¡ ±â¿øÇÑ SMT¸¦ GIST °¡´É¼ºÀ¸·Î ¼ö¼ú º¸³½ ÈÄ ectopic pancreas·Î Áø´ÜµÈ °æ¿ìµµ ÀÖ½À´Ï´Ù. EUS´Â Á¶Á÷°Ë»ç¸¦ ÇÏÁö ¾ÊÀ¸¸é, Áø´ÜÀÌ ¾Ö¸ÅÇÒ ¶§°¡ ¸¹¾Æ ºñ¿ë ´ëºñ ȯÀÚµéÀÇ ¸¸Á·µµ°¡ ±×´ÙÁö ÁÁÀº °Ë»ç´Â ¾Æ´Ñ °Í °°´Ù´Â »ý°¢ÀÌ µì´Ï´Ù.

ÃÖ±Ù ½Äµµ Á¡¸·ÇÏ Á¾¾çÀ¸·Î ³»¿øÇÑ È¯ÀÚ°¡ ÀÖ¾î ±³¼ö´Ô²² Á¶¾ðÀ» µè°íÀÚ ¸ÞÀÏ º¸³À´Ï´Ù. 60¼¼ ³²È¯ÀÌ 7³â°£ ¸ð º´¿ø¿¡¼­ ½Äµµ ÆòÈ°±ÙÁ¾À¸·Î ÃßÀû°üÂû Áß Å©±â º¯È­°¡ ¾ø¾ú´Ù°í ÇÕ´Ï´Ù. ´ç½Ã ¿ÜºÎ »çÁø¿¡¼­ 15.8 mm x 9.1 mmÀÇ homogenous hypoecholic lesionÀ̾ú½À´Ï´Ù. ÃÖ±Ù "°¡½¿ÀÌ ¾ÆÇÁ´Ù, À½½Ä ¸ÔÀº °ÍÀÌ ³»·Á°¥ ¶§ À§¿¡ °É¸®´Â °Í °°Àº ÅëÁõÀÌ ÀÖ´Ù"´Â Áõ¼¼·Î ÃßÀû EUS¸¦ °Ë»çÇÏ¿´°í, aorta ¿·¿¡ À§Ä¡ÇÑ 20.5 x 7.4 mmÀÇ PM layer¿¡¼­ ±â¿øÇÑ SET°¡ °üÂûµÇ¾ú½À´Ï´Ù. Homogeneous hypoecholic Çϳª, central echogenicity°¡ µ¿¹ÝµÇ¾î ÀÖ½À´Ï´Ù. ȯÀÚ´Â 2008³âµµ »çÁø¿¡ ºñÇØ 5 mm Á¤µµ Ä¿Áø °Í °°´Ù°í ÇÏÀÚ, ¸¹ÀÌ ºÒ¾ÈÇØ ÇÏ°í ¼ö¼úÀû Ä¡·á³ª Á¶Á÷°Ë»ç¸¦ ¿øÇÕ´Ï´Ù. °¡´É¼ºÀº leiomyoma°¡ °¡Àå ÀÖ´Ù°í »ý°¢Çϳª, Ȥ½Ã GIST³ª schwannomaÀÇ °¡´É¼ºµµ ÀÖÀ» °Í °°½À´Ï´Ù. EUS-FNAÀÇ ¼º°ø °¡´É¼º°ú ÃâÇ÷, ½Äµµ õ°ø µîÀÇ ÇÕº´ÁõÀ» ¿ì·ÁÇÏ°í ÀÖ½À´Ï´Ù. ±³¼ö´ÔÀÇ Á¶¾ðÀ» ºÎŹÇÕ´Ï´Ù.


[2013-7-22. ÀÌÁØÇà ´äº¯] ±×·¸½À´Ï´Ù. º¸±â¸¸ÇÏ´Â EUS´Â ºÐ¸í ÇÑ°è°¡ ÀÖ½À´Ï´Ù. EUS-FNAµµ ¸ðµç ¹®Á¦¸¦ ÇØ°áÇØÁÖ´Â °Íµµ ¾Æ´Õ´Ï´Ù. ÀÏ´Ü ½±Áö ¾Ê°í, À§Ç輺ÀÌ ÀÖ°í, ¶Ñ·ÇÇÑ °á·ÐÀ» ÁÖÁö ¸øÇÏ´Â ¿¹°¡ ¸¹½À´Ï´Ù.

¹®ÀÇÇϽŠȯÀÚ¿¡¼­ SET°¡ ÀÖ°í ¼ö³â Àü¿¡ ºñÇÏ¿© 5 mm°¡ Ä¿Áø °ÍÀÌ ºÐ¸íÇÏ´Ù°í ÇÏ´õ¶óµµ (»ç½Ç 5 mm Á¤µµÀÇ Â÷ÀÌ´Â ¿ÀÂ÷¹üÀ§ÀÏ ¼ö ÀÖ½À´Ï´Ù) Áõ»ó°ú´Â ¹«°üÇÑ ÀÏ °°½À´Ï´Ù. 2 cmÀÇ SET°¡, ±×°Íµµ ¼ö³â ÀüºÎÅÍ ÀÖ´ø °ÍÀÌ ÃÖ±Ù ¹ß»ýÇÑ ÈäÅëÀÇ ¿øÀÎÀÏ °¡´É¼ºÀº ³·±â ¶§¹®ÀÔ´Ï´Ù. µû¶ó¼­ ½ÉÀåÁúȯ, ÆóÁúȯ, ½Äµµ¿îµ¿Áúȯ µî ´Ù¸¥ ¿øÀÎÀÌ ¾ø´ÂÁö È®ÀÎÇغ¸´Â °ÍÀÌ ¿ì¼±À̶ó°í »ý°¢ÇÕ´Ï´Ù. EUS-FNA´Â °æÇèÀÌ ¸¹´Ù¸é ½ÃµµÇØ º¼ ¼ö ÀÖ°ÚÁö¸¸, ¾Õ¼­ ¸»¾¸µå¸° ¹Ù¿Í °°ÀÌ ¿À·¡ ÀüºÎÅÍ ÀÖ¾ú°í ÃÖ±Ù ¾ÆÁÖ ¾à°£ Ä¿Áø (?) ½Äµµ SETÀÇ °æ¿ì EUS-FNA°¡ Ä¡·áÀÇ °áÁ¤ÀûÀÎ ´Ü¼­¸¦ Á¦°øÇÒ °Í °°Áö´Â ¾Ê½À´Ï´Ù. ¹«¸®Çؼ­ ½ÃµµÇØ º¼ ÇÊ¿ä´Â ¾øÀ» °Í °°½À´Ï´Ù. Àú °°À¸¸é ¸ÕÀú chest CT¸¦ Âï¾îº¸°Ú½À´Ï´Ù.


Àúµµ ½Äµµ SET¸¦ ¸î ¹ø ¼ö¼úº¸³½ ÀûÀÌ ÀÖ±â´Â ÇÕ´Ï´Ù. ±×·¯³ª ´ëºÎºÐ leiomyoma·Î °á·ÐÁö¾îÁ³½À´Ï´Ù. 2009³â 3¿ù 27ÀÏ EndoTODAY(¾ÏÈ£: smcgi)¸¦ ¾Æ·¡¿¡ ¼Ò°³ÇÕ´Ï´Ù.

40´ë ³²¼ºÀÇ °Ç°­°ËÁø¿¡¼­ ½ÄµµÀÇ SMT°¡ ¹ß°ßµÇ¾î CT¸¦ Âï¾î¼­ supraaortic area¿¡ longest diameter 42 mm Å©±âÀÇ ribbon shapeÀÇ homogeneousÇÑ low-attenuation mass°¡ ¹ß°ßµÇ¾î ÀǷڵǾú½À´Ï´Ù. EUS¿¡¼­µµ ¾Æ¸¶µµ proper muscle layer¿Í ¿¬°áµÇ¾îÀÖ´Â ºñ±³Àû homogeneous low echoic mass·Î °üÂûµÇ¾ú½À´Ï´Ù. Leiomyoma°¡ ÀǽɵǾú½À´Ï´Ù. º°´Ù¸¥ Áõ»óÀº ¾ø¾ú½À´Ï´Ù. ÀÌ·± »óȲ¿¡¼­ ¿©·¯ºÐÀº ¾î¶»°Ô ÃßõÀ» ÇϽðڽÀ´Ï±î?

Àú´Â (1) ´Ù¸¥ ÁúȯÀÌ ¾ø´Â 40´ë ³²¼ºÀ̶ó´Â Á¡, (2) Åë»óÀûÀÎ leiomyomaº¸´Ù´Â Å©´Ù´Â Á¡, (3) ȯÀÚ°¡ ¸Å¿ì ºÒ¾ÈÇØÇÑ´Ù´Â Á¡, (4) VATS¶ó´Â ½Ã¼úÀÌ Àû¿ëµÉ ¼ö ÀÖ´Ù´Â Á¡À» °í·ÁÇÏ¿© ¼ö¼úÀ» ÃßõÇÏ¿´½À´Ï´Ù. ¼ö¼ú(video-assisted thoracotomy's mass enucleation) ÈÄ ÃÖÁ¾°á°úµµ leiomyoma¿´½À´Ï´Ù. ½ÄµµÀÇ ¹«Áõ»ó SMT´Â ´ëºÎºÐ °æ°ú°üÂûÇÏ°í ÀÖ½À´Ï´Ù¸¸ °£È¤ ¼ö¼úÀ» ½ÃÇàÇÏ´Â ¿¹°¡ ÀÖ½À´Ï´Ù. ÀÌ ºÎºÐ¿¡ ´ëÇÑ guidelineÀÌ ÇÊ¿äÇÒ °ÍÀ̶ó »ý°¢µË´Ï´Ù.


½Äµµ schwannomaµµ Çѹø °æÇèÇÑ ¹Ù ÀÖ½À´Ï´Ù. 2008³â 8¿ù 8ÀÏ EndoTODAY(¾ÏÈ£: smcgi)¸¦ ¾Æ·¡¿¡ ¼Ò°³ÇÕ´Ï´Ù.

30´ë ³²ÀÚȯÀÚ·Î 2ÁÖÀüºÎÅÍ ¿¬ÇÏ°ï¶õ, À̹°°¨À¸·Î ³»½Ã°æÀ» ½ÃÇàÇÏ¿© ½Äµµ Á¾±«°¡ ¹ß°ßµÇ¾ú°í chest X-ray¿¡¼­ mediastinal mass·Î °üÂûµÇ¾ú½À´Ï´Ù. VATS·Î mass enucleationÀ» ½ÃÇàÇÏ¿´°í Á¶Á÷°Ë»ç¿¡¼­ Schwannoma, 5 x 3.5 cm, mitosis: up to 2/10 HPF, no necrosisÀÇ ¼Ò°ßÀ̾ú½À´Ï´Ù. Âü°í¹®ÇåÀ» ÀοëÇØ º¸°Ú½À´Ï´Ù.

½ÄµµÀÇ ½Å°æÃÊÁ¾Àº ¹ÌÁֽŰ濡¼­ ¹ß»ýÇÑ °æ¿ì¿Í, ½ÄµµÁ¡¸·ÇÏÀÇ ½Å°æÃÑ¿¡¼­ ¹ß»ýÇÑ °æ¿ì·Î ºÐ·ùµÉ ¼ö ÀÖÀ¸¸ç ÀüÀÚÀÇ °æ¿ì, ¹ÌÁֽŰ濡¼­ ¹ß»ýÇÏ¿© ½Äµµº®À¸·Î È®ÀåµÇ´Â ¾ç»óÀ» º¸À̸ç, ÈÄÀÚÀÇ °æ¿ì´Â ´ë°³ ½ÄµµÁ¡¸·ÇÏÀÇ ½Å°æÃÑ¿¡¼­ À¯·¡ÇÏ¿©, ½Äµµ ±ÙÀ°Ãþ ³»ÀÇ Á¾¾çÀ¸·Î ³ªÅ¸³­´Ù. ½Äµµ¿¡ ¹ß»ýÇÏ´Â ½Å°æÃÊÁ¾Àº ½Äµµ Á¶¿µ¼ú¿¡¼­ ºÎµå·¯¿î Æú¸³°°Àº Ã游 °á¼ÕÀ» º¸ÀÌ¸ç ½Äµµ ³»½Ã°æ¿¡¼­´Â µ¹ÃâÇü Á¡¸·ÇÏ Á¾¾çÀ¸·Î º¸ÀδÙ. ±×·¯³ª ÀÌ°ÍÀº ´Ù¸¥ ½Äµµ Á¡¸·ÇÏ Á¾¾ç°ú ±¸º°À» ÇÒ ¼ö Àִ Ưº°ÇÑ ¼Ò°ßÀÌ ¾Æ´Ï¹Ç·Î¼ö¼ú Àü¿¡´Â ½Äµµ ÆòÈ°±ÙÁ¾À̳ª ³¶Á¾, ¶Ç´Â Áö¹æÁ¾ µîÀ¸·Î Áø´ÜµÇ´Â °æ¿ì°¡ ´ëºÎºÐÀÌ´Ù. Áø´Ü¿¡ À־ Á¾¾çÀÇ ÇüŸ¦ ½±°í Á¤È®ÇÏ°Ô ÃøÁ¤ÇÒ ¼ö ÀÖ´Â ¹æ¹ýÀº ³»½Ã°æ ÃÊÀ½ÆÄÀ̸ç, ÈäºÎ Àü»êÈ­ ´ÜÃþÃÔ¿µÀ» ÇÔ²² ÀÌ¿ëÇÏ¸é ¼ö¼ú¿¡ ´ëÇÑ Á¤º¸¸¦ ´õ ¾òÀ» ¼ö ÀÖ´Ù. ÀϹÝÀûÀ¸·Î ¹æ»ç¼±ÇÐÀû¼Ò°ß¿¡ ÀÇÇØ ³¶Á¾À̳ª Áö¹æÁ¾°úÀÇ ±¸ºÐÀº ½±°Ô ÀÌ·ç¾îÁú¼ö ÀÖ´Ù. ½Å°æÃÊÁ¾Àº ³»½Ã°æÀû ÃÊÀ½ÆÄ»ó °æ°è°¡ ºÐ¸íÇÏ°í Àú¿¡ÄÚ¼Ò°ßÀ» º¸À̸ç, °íÀ¯ ±ÙÀ°Ãþ¿¡¼­ ¹ß»ýÇÏ¿© Á¡¸· ÇÏ¿¡ À§Ä¡ÇÏ°í, ÈäºÎ Àü»êÈ­ ´ÜÃþ ÃÔ¿µ»ó ¿¬ºÎÁ¶Á÷Á¾¾çÀÇ ÇüÅ·Πº¸À̸ç, Á¶¿µÁõ°­ÀÌ ÀßµÇÁö ¾Ê´Â´Ù. [´ëÈä¿ÜÁö 2005;38:589-593]


½Äµµ GISTµµ ¸î Áõ·Ê ¼Ò°³ÇÕ´Ï´Ù.

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