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[Lymphoepithelioma-like carcinoma (1)]

Lymphoepithelioma-like carcinoma (림프양상피종양 암종)은 조직학적으로 비인두암과 유사하고 림프구성 간질을 가진 미분화된 위종양입니다. 조기위암의 경우 일반적인 조기위암과 비슷한 예후를 가지고 있지만 진행성 위암의 경우 일반적인 진행성 위암에 비하여 훨씬 좋은 예후를 가진다고 알려져 있습니다. Lymphoepithelioma-like carcinoma의 원인으로 Epstein-Barr virus가 주목받고 있습니다.


[Cases]


1. Location : upper third, center at cardia (Siewert III)
2. Gross type : Borrmann type 2
3. Histologic type : Medullary carcinoma (lymphoepithelioma-like carcinoma)
4. Histologic type by Lauren : indeterminate
5. Size : 2.2x2.2 cm
6. Depth of invasion : invades muscularis propria
7. Resection margin: free from carcinoma, safety margin: proximal 1.4 cm, distal 2 cm
8. Lymph node metastasis : no metastasis in 52 regional lymph nodes
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
* Result of in-situ hybridization: Epstein-Barr virus: Positive


Stomach, subtotal gastrectomy:
. Early gastric carcinoma
1. Location : middle third, Center at body and posterior wall
2. Gross type : EGC type IIb
3. Histologic type : carcinoma with lymphoid stroma (medullary carcinoma)
4. Histologic type by Lauren : indeterminate
5. Size : 1.8x1 cm
6. Depth of invasion : invades submucosa (sm3) (pT1b)
7. Resection margin: free from carcinoma, safety margin: proximal 1.2 cm, distal 13 cm
8. Lymph node metastasis : no metastasis in 33 regional lymph nodes (pN0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. AJCC stage by 7th edition: pT1b N0

2달 간격으로 3번 내시경 검사를 받으셨고, 마지막 조직검사에서 signet ring cell carcinoma가 나왔습니다. 최종 병리는 carcinoma with lymphoid stroma로 나왔습니다. Lymphoepithelioma-like carcinoma라고 부르는 타입입니다. Lymphoid stroma 사이에 미분화조직형 위암이 박혀있는 형태이므로, 육안적으로는 SMT 비슷하게 보이고, 조직검사의 false negative가 많은 것 같습니다.
Early gastric carcinoma
1. Location : lower third, Center at antrum and greater curvature
2. Gross type : EGC type IIc
3. Histologic type : carcinoma with lymphoid stroma
4. Histologic type by Lauren : mixed
5. Size : 3.8x1.9 cm
6. Depth of invasion : invades mucosa (muscularis mucosae) (pT1a)
7. Resection margin: free from carcinoma
8. Lymph node metastasis : no metastasis in 17 regional lymph nodes (pN0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. AJCC stage by 8th edition: pT1a N0



© 일원내시경교실 바른내시경연구소 이준행. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng.