내시경집담회. EndoTODAY 이준행

[일원내시경교실 목요점심집담회 2016-1-7]

1. 건진발견 B lymphoblastic lymphoma of the stomach

중년 여성입니다. 건진에서 매우 드문 종류의 림프종이 나왔습니다. 폐와 복부 CT에서 위 이외의 장기에는 침범이 없었습니다. 골수도 정상이었습니다. R-HyperCVAD라는 항암치료를 시작하였습니다.

WJG 2008년 증례에서 설명을 옮깁니다.

- Primary stomach lymphomas are in the minority, most of which are MALToma, DLBCL, extranodal nasal type NK/T cell lymphoma, etc. Primary stomach B-LBL is rare.

- Precursor B lymphoblastic lymphoma (B-LBL)/leukemia (B-ALL) are originated from B cell lineage. ALL and LBL represent different clinical presentations of the same neoplasm and are grouped in the category of precursor B-cell lymphoblastic leukemia/ lymphoma by the revised WHO classification. confined to a mass lesion without any or minimal evidence of blood and marrow involvement : lymphoma extensive marrow and blood are involved : lymphoblastic leukemia

- Frequently involved extranodal sites: skin, bone, soft tissue, and lymph nodes, whereas stomach is uncommon Endoscopy: vary in morphology, for example, ulcerated, polypoid, granulonodular, and infiltrative diffusely thickened gastric wall and large ulcer, multiple flat elevated lesions with irregular mucosa

- Immunophenotypically, the neoplastic cells express TdT and B-cell antigens, such as CD79a, CD10, CD19, and CD22

2. 원인 미상 acute phlegmonous gastritis

80대 고령. 당뇨와 고혈압이 있던 분으로 sudden epigastric pain으로 응급실을 찾으셨습니다.

아래는 표정의 선생님께서 정리한 내용입니다.

3. Gastric mucormycosis

60대 여성입니다. 직장암에 대한 palliative RT와 폐암에 대한 항암치료를 받던 환자의 상부위장관 출혈입니다. 식도 조직검사는 herpetic esophagitis와 mucormycosis가 위는 mucormycosis가 나왔습니다. 치료 후 호전되는 모습입니다.

Initial EGD

3 weeks later

8 weeks later

Mucoraceae are ubiquitous fungi that are commonly found in soil or in decaying matter, but disease is unusual because of the low virulence of the organisms, which mainly affect immunocompromised individuals (eg, poorly controlled diabetes, glucocorticosteroid use, neutropenia in the setting of hematological or solid malignancy, transplantation, and burns). Infection usually follows local exposure, and most common is disease of the facial sinuses. Ingestion of conidia leads to GI disease that most commonly affects the stomach, ileum, and colon. Once spores begin to grow, fungal hyphae invade tissue and blood vessels, producing thrombosis, infarction, and necrosis. Gl mucormycosis range from colonization of peptic ulcers to infiltrative disease. Invasion must be distinguished from colonization. Treatment with iv amphotericin B or oral posaconazole surgical intervention should be considered for uncontrollable gastrointestinal hemorrhage or perforation.

4. 70대 만성 설사. 복부의 lymphoplastmocytic lymphoma였고 대장 조직검사는 전부 amyloidosis로 나옴

아래는 또 다른 환자의 대장 amyloidosis입니다.