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[ÀÏ¿ø³»½Ã°æ±³½Ç ¸ñ¿äÁ¡½ÉÁý´ãȸ 2016-4-14]

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1. ½Äµµ¾Ï

Invasive squamous cell carcinoma, well differentiated:
1) tumor size: about 4.5x4 cm
2) extension to lamina propria (pT1)
3) no involvement of gastroesophageal junction
4) negative resection margins (proximal, 3.5 cm; distal, 7 cm)
5) no metastasis in 43 regional lymph nodes


2. ½Äµµ Èæ»öÁ¾ ¼ö¼ú ÈÄ anastomosis site ±¹¼Ò Àç¹ß

½Äµµ Àç¼ö¼ú¿¡ µû¸¥ À§ÇèÀÌ ³Ê¹« Å©´Ù°í ÆÇ´ÜÇÏ¿© APC ablation Ä¡·á¸¦ ÇÏ¿´´Âµ¥ ÀÌÈÄ Àç¹ß ¾øÀ½.

* Âü°í: EndoTODAY ½Äµµ Èæ»öÁ¾


3. Á¶±âÀ§¾Ï

Stomach, endoscopic submucosal dissection:
Early gastric carcinoma
1. Location : antrum, greater curvature
2. Gross type : EGC type IIc
3. Histologic type : tubular adenocarcinoma, well differentiated
4. Histologic type by Lauren : intestinal
5. Size of carcinoma : (1) longest diameter, 4mm (2) vertical diameter, 2mm
6. Depth of invasion : invades mucosa (lamina propria) (pT1a)
7. Resection margin : free from carcinoma(N)
8. Lymphatic invasion : not identified(N)
9. Venous invasion : not identified(N)
10. Perineural invasion : not identified(N)
11. Microscopic ulcer : absent
12. Histologic heterogeneity: absent


4. Radiation proctitis

Anal cancer·Î ¼ö¼ú ÈÄ ¹æ»ç¼±Ä¡·á¸¦ ¹ÞÀº ȯÀÚÀÇ hematochezia ¿´½À´Ï´Ù. °Ë»ç ÈÄ APC ablation treatment¸¦ ½ÃÇàÇÏ¿´½À´Ï´Ù.

Radiation proctitis´Â ¾Æ·¡ ¹æ½ÄÀ¸·Î ÁßÁõµµ scoringÇÒ ¼ö ÀÖ½À´Ï´Ù.

* Âü°í: EndoTODAY ¹æ»ç¼± À§¿°


5. Appendiceal mucinous neoplasm

¿ì¿¬È÷ ½ÃÇàÇÑ ´ëÀå³»½Ã°æÀÔ´Ï´Ù. Cecum¿¡¼­ SMT-like mass°¡ ¹ß°ßµÇ¾î ¼ö¼ú(laparoscopic appendectomy)À» ÇÏ¿´½À´Ï´Ù.

Appendix, appendectomy:
Low grade appendiceal mucinous neoplasm :
1) size: 6x3.5x3 cm
2) mild dysplasia
3) mucocele formation
4) no mucin is seen outside of the appendix
5) no perforation
6) negative resection margin


6. Gastric syphilis

History: A 25-year-old, apparently healthy man presented with one month history of epigastric tenderness and vomiting. The patient visited a local clinic where he underwent an endoscopic examination and the endoscopic diagnosis was benign gastric ulcer. But gastric ulcer symptom was not improved on ulcer medication. He was transferred to our hospital for further evaluation. His family history and past medical history were negative for any gastrointestinal disease, abdominal surgery or significant medical illness. Physical examinations were normal except minimal epigastric tenderness only. A laboratory evaluation revealed hemoglobin of 16.4 g/dL and hematocrit 47.9%. White blood cell count and differential count were within normal ranges. Total serum protein level was 7.3 g/dL and albumin level 4.3 g/dL.? Serum bilirubin and liver enzymes were within normal ranges. A computed tomographic scan of the abdomen with contrast revealed diffuse layered thickening of the wall of the gastric antrum, pylorus, duodenal bulb, and second portion of duodenal loop without definite perigastric and periduodenal fatty infiltration (Fig. 1). Multiple small and enlarged lymph nodes were identified along both common femoral vessel and inguinal area. Gastric endoscopy showed geographic irregular ulcer and shallow depressed mucosal lesions in almost all aspect of antrum. The ulcer revealed an irregular edge and uneven nodular base (Fig. 2). Endoscope was failed to advance to duodenal bulb due to luminal obstruction. A diagnostic procedure was done.

Biopsy: Chronic gastritis, active, with intestinal metaplasia (incomplete type), large lymphoid follicle and dense lymphoplasma cell infiltration ( Note: Based on histology, syphilitic gastritis could be considered)

Layered wall thickening involving gastric antrum, pylorus, duodenal bulb,and 2nd duodenal loop

Automated Quantitative RPR Test: Reactive(5.00)

Automated Quantitative TPLA Test: Reactive(282.9)

A: foveolar pit ¿¡¼­ H.pylori °¡ °üÂûµÇÁö ¾Ê´Â´Ù. B: ½ÉÇÑ À§¿°¼Ò°ßÀ¸·Î neutrophilic infiltration ÀÌ °üÂûµÈ´Ù. C: lamina propria ¿¡ ½ÉÇÑ lymphoplasma cell infiltration ÀÌ °üÂûµÈ´Ù. D: lagre irregular lymphoid follicular hyperplasia with geographic feature

Large irregular lymphoid follicle : H.pylori °¨¿°°ú´Â ´Þ¸® marginal zone Àº »ó´ëÀûÀ¸·Î À§ÃàµÇ¾î ÀÖÀ¸³ª follicular center °¡ ½ÉÇÏ°Ô ´Ã¾î³ª¸é¼­ Áöµµ¸ð¾ç(geographic feature) À¸·Î Ä¿Á®ÀÖ´Ù.


Çؼ³: ÃÖ±Ù À§¸Åµ¶(gastric syphilis)°¡ Á¶±Ý¾¿ Áõ°¡ÇÏ°í ÀÖ´Â µí ÇÕ´Ï´Ù. ÀüüÀûÀ¸·Î ¸Åµ¶ÀÌ Áõ°¡ÇÏ°í ÀÖÀ¸¹Ç·Î À§¸Åµ¶µµ µû¶ó¼­ Áõ°¡ÇÏ´Â ¸ð¾çÀÔ´Ï´Ù. ¿ì¸®³ª¶ó¿¡¼­ ¸Åµ¶ ȯÀÚ´Â »ý°¢º¸´Ù ¸¹½À´Ï´Ù. 2008³âÀÇ °æ¿ì 1,548¸íÀ̾ú´Ù°í ÇÕ´Ï´Ù (Clin Endosc 2015;48:256). AIDS ¶§¹®¿¡ ´Ù¸¥ ¼ºº´ÀÌ ¹«½ÃµÇ°í Àֱ⠶§¹®ÀÎ °ÍÀ¸·Î ÃßÁ¤ÇÏ°í ÀÖ½À´Ï´Ù.

Gastric syphilisÀÇ Æ¯Â¡À» Á¤¸®ÇÏ¸é ¾Æ·¡¿Í °°½À´Ï´Ù.
1) Secondary and tertiary stage
2) Incidence in syphilis; <1%
3) Endoscopy; erosive gastritis or gastric ulcer with heaped, nodular edges or thickened, edematous rugal folds.
4) Histopathologic findings; suggestive, but not diagnostic

Á¦°¡ Áö±Ý±îÁö ¾Ë°í ÀÖ´Â gastric syphilis 6¿¹ÀÇ »çÁøÀÔ´Ï´Ù. ƯÈ÷ ù¹ø° Áõ·Ê°¡ º¸¸¸ 4Çü ÁøÇ༺ À§¾Ï°ú ºñ½ÁÇß½À´Ï´Ù.


[References]

1) SMC Endoscopy Unit »ï¼º¼­¿ïº´¿ø ³»½Ã°æ½Ç

2) SMC Monday GI conference »ï¼º¼­¿ïº´¿ø ÀÏ¿ø³»½Ã°æ±³½Ç ¿ù¿äÁ¡½É¼ÒÈ­±âÁý´ãȸ

3) SMC Thursday endoscopy conference »ï¼º¼­¿ïº´¿ø ÀÏ¿ø³»½Ã°æ±³½Ç ¸ñ¿äÁ¡½É³»½Ã°æÁý´ãȸ

© EndoTODAY Endoscopy Learninng Center. Jun Haeng Lee.