내시경집담회. EndoTODAY 이준행

[일원내시경교실 목요점심집담회 2015-12-31]

1. EGC

Stomach, subtotal gastrectomy:
.Early gastric carcinoma
1. Location : middle third, Center at low body and anterior wall
2. Gross type : EGC type IIb+IIc
3. Histologic type : signet-ring cell carcinoma
4. Histologic type by Lauren : mixed
5. Size : 3.5x2.9 cm
6. Depth of invasion : invades submucosa (sm3) (pT1b)
7. Resection margin: free from carcinoma, safety margin: proximal 1.9 cm, distal 8.7 cm
8. Lymph node metastasis : no metastasis in 45 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

2. EGC-like AGC

Stomach, subtotal gastrectomy:
Advanced gastric carcinoma
1. Location : middle third, Center at body and lesser curvature
2. Gross type : Borrmann type (unclassifiable) (mimicking EGC type IIc)
3. Histologic type : tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : intestinal
5. Size : 6.6x4.3cm
6. Depth of invasion : invades serosa (pT4a)
7. Resection margin: free from carcinoma, safety margin: proximal 2.5 cm, distal 5.5 cm
8. Lymph node metastasis : no metastasis in 24 regional lymph nodes (pN0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. Peritoneal cytology : negative
13. AJCC stage by 7th edition: T4a N0

3. Mantlc cell lymphoma recurrence at stomach

9년 전 tonsil의 mantle cell lymphoma로 chemotherapy + RT 받은 환자의 위 내시경입니다.

조직검사에서 아래 소견이 나와 stomach RT를 시행하였습니다.

Stomach, fundus, anterior, biopsy: MANTLE CELL LYMPHOMA
. Cyclin D1: Positive in tumor cells
. SOX11 : Positive in tumor cells
. P53 : Focal weak positive in tumor cells
. Ki-67: Positive <5% of tumor cells

* 참고: EndoTODAY Mantle cell lymphoma

4. Burkitt lymphoma of the terminal ileum

우하복부 통증과 체중감소로 내원한 60대 남성입니다.

조직검사 결과는 아래와 같았습니다.

Burkitt lymphoma
. CD10: Positive
. Ki-67: Positive (>99%)
. Bcl-2: Negative
. MUM-1: Negative
. CD20: Positive

* 참고: EndoTODAY Burkitt lymphoma

5. Acute hemorrhagic rectal ulcer syndrome (AHRUS)

우울증으로 정신과 입원하여 약을 먹으면서 변비가 생기고 치질이 생겼다는 환자입니다. Rectal bleeding으로 내원하였습니다.

조직검사 결과는 아래와 같았습니다. Rectal ulcer syndrome으로 판단하였습니다.

Hemorrhagic necrosis without inflammatory background, suggestive of acute hemorrhagic rectal ulcer syndrome (AHRUS). No evidence of malignancy.