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[일원내시경교실 목요점심집담회 2016-1-21]

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1. 식도암 + 폐암

위암 수술 13년만에 위식도 접합부 직상방 식도암 발견. 조직검사는 squamous cell carcinoma. 식도암 workup 중 전이를 동반한 폐암 (samll cell lung cancer) 발견되어 항암치료 시작


2. 식도암 내시경치료

개인의원 내시경에서 식도암이 발견되 의뢰되었고 ESD 후 완전절제로 판정되었음.

Esophagus, endoscopic submucosal dissection:

Squamous cell carcinoma, moderately differentiated
1. Location : 32 cm from incisor
2. Size of carcinoma : (1) longest diameter, 14 mm (2) vertical diameter, 12 mm
3. Depth of invasion : invades mucosa (lamina propria) (pT1a)(M2)
4. Resection margin : free from carcinoma(N), safety margin : distal 5 mm, proximal 8 mm, anterior 8 mm, posterior 10 mm
5. Lymphatic invasion : not identified(N)
6. Venous invasion : not identified(N)
7. Perineural invasion : not identified(N)


3. 조기 식도암 수술

Invasive squamous cell carcinoma, moderately differentiated, esophagus:
1) tumor size: 2.5x2 cm
2) extension to submucosa
3) endolymphatic tumor emboli: not identified
4) perineural invasion: not identified
5) negative resection margins (proximal, 6 cm ; distal, 8 cm)
6) no metastasis in 18 regional lymph nodes


4. 진행성 식도암 수술

Invasive squamous cell carcinoma, poorly differentiated:
1) tumor size: 3x2 cm
2) extension to proper muscle layer
3) endolymphatic tumor emboli: not identified
4) perineural invasion: not identified
5) negative resection margins (proximal, 4.5 cm ; distal, 9 cm)
6) no metastasis in 35 regional lymph nodes


5. 진행성 식도암 수술

Esophagus and upper stomach, Ivor Lewis operation:
Invasive squamous cell carcinoma with focal basaloid differenciation :
1) tumor size: 5.8x2.7cm
2) extension to proper muscle layer
3) endolymphatic tumor emboli: present
4) intramural venous tumor emboli: present
5) intramural (submucosal) metastatic tumor nodules: present (two foci)
6) negative resection margins (proximal, 3.7 cm ; distal, 9 cm)
7) metastasis to 2 out of 22 regional lymph nodes


6. 처음에 위암을 의심하였던 양성 위궤양


[참고자료]

1) EndoTODAY 식도암 내시경 진단

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