EndoTODAY | EndoATLAS | Outpatient Clinic

Parasite | Esophagus | Stomach | Cancer | ESD

Home | Guide | Author | Subscription | Links


[Thursday Endoscopy Conference 20170112]

Previous | Next

1. EGC-like AGC


Advanced gastric carcinoma
1. Location : upper third, Center at body and posterior wall
2. Gross type : Borrmann type 3
3. Histologic type : tubular adenocarcinoma, poorly (poorly cohesive) differentiated
4. Histologic type by Lauren : diffuse
5. Size : 3.7x2.8 cm
6. Depth of invasion : penetrates subserosal connective tissue (pT3)
7. Resection margin: free from carcinoma, safety margin: proximal 2.7 cm, distal 11.7 cm
8. Lymph node metastasis : metastasis to 3 out of 38 regional lymph nodes (pN2)
9. Lymphatic invasion : present(+++)
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. Peritoneal cytology : negative
13. AJCC stage by 7th edition: pT3 N2

* Âü°í: EndoTODAY ½É´Þµµ


2. Localized colon amyloidosis

* Âü°í: EndoTODAY ´ëÀå ¾Æ¹Ð·ÎÀ̵åÁõ, EndoTODAY À§ ¾Æ¹Ð·ÎÀ̵åÁõ


3. Gastric metastasis from malignant melanoma

µÎÅëÀ» ÁÖ¼Ò·Î °Ë»çÇÏ¿© lung cancer with brain metastasis·Î ÀÇ·ÚµÈ 70´ë ³²¼ºÀÔ´Ï´Ù. Lung biopsy (gun)Àº "poorly differentiated tumor with dyscohesive anaplastic cells. The possibility of malignant melanoma is suspected."¿´½À´Ï´Ù.

À§³»½Ã°æ Á¶Á÷°Ë»ç´Â ¾Æ·¡¿Í °°¾Ò½À´Ï´Ù.

Malignant melanona.
S-100: diffusely positive in tumor cells
Melanoma Ag (HMB45): diffusely positive in tumor cells
c-kit gene, BRAF gene: no mutation

ÀÌ È¯ÀÚ´Â skin lesionÀº ¾ø¾ú½À´Ï´Ù. µû¶ó¼­ ãÁö ¸øÇÏ´Â skin melanomaÀÇ lung, brain, stomach metastasisÀÏ ¼öµµ ÀÖ°í, primary lung melanomaÀÇ multiple metastasisÀÏ ¼öµµ ÀÖÀ» °Í °°½À´Ï´Ù. Stage°¡ ³Ê¹« ³ô¾Æ Ä¡·á °èȹÀÌ ´Þ¶óÁú °ÍÀº ¾øÁö¸¸... ³»½Ã°æÀÇ»ç·Î¼­ ƯÀÌÇÑ Á¡Àº melanoma stomach metastasisÀÇ »öÁ¶°¡ °ËÁö ¾Ê¾Ò´Ù´Â Á¡ÀÔ´Ï´Ù.


´Ù¾çÇÑ ¾Ç¼ºÁúȯÀÌ À§·Î ÀüÀÌÇÒ ¼ö ÀÖ½À´Ï´Ù. ¼ö³â Àü Elsevier¿¡¼­ ³ª¿À´Â GI & Hepatology News (Korean Edition)¿¡ ±â°íÇÑ ³»¿ëÀÔ´Ï´Ù.

Èæ»öÁ¾ À§ÀüÀÌ¿¡ ´ëÇÏ¿© °ú°Å ¼Ò°³ÇÑ ³»¿ëÀ» ¿Å±é´Ï´Ù. ¿ì¸® ³ª¶ó¿¡¼­´Â ¼­±¸¿¡ ºñÇÏ¿© Èæ»öÁ¾ÀÌ µå¹® ÆíÀÌÁö¸¸, ºñ±³Àû ÁøÇàµÈ »óÅ·Π¹ß°ßµÇ´Â ¿¹°¡ ¸¹¾Æ¼­ ¿¹ÈÄ´Â ºÒ·®ÇÕ´Ï´Ù. Èæ»öÁ¾Àº ¼ÒÈ­°üÀ¸·Î Àß ÀüÀ̵Ǵ ´ëÇ¥ÀûÀÎ ¾Ç¼ºÁúȯÀ¸·Î, Èæ»öÁ¾À¸·Î »ç¸ÁÇÑ È¯ÀÚÀÇ 60%°¡ ºÎ°Ë¿¡¼­ ¼ÒÈ­°ü ÀüÀÌ°¡ ¹ß°ßµË´Ï´Ù. °¡Àå ÀüÀÌ ºóµµ°¡ ³ôÀº °÷Àº ¼ÒÀåÀÌÁö¸¸ ´ëÀå, À§, ½Äµµ µî¿¡µµ ÀüÀÌ°¡ ÈçÇÕ´Ï´Ù. À§·ÎÀÇ ÀüÀÌ´Â ¾à 10-26% Á¤µµÀÌ¸ç ´Ù¹ß¼º Á¡¸·ÇÏ Á¾¾çÀ¸·Î °üÂûµË´Ï´Ù. ƯÈ÷ Á¡¸·ÇÏ Á¾¾ç »ó´ÜÀÇ depression°ú black discolorationÀÌ Æ¯Â¡ÀÔ´Ï´Ù. °£È¤ amelanotic melanomaµµ ÀÖÀ¸¹Ç·Î (ÀÌ °æ¿ì´Â blackÀÌ ¾Æ´Ï´Ù) ÁÖÀÇÇÒ ÇÊ¿ä°¡ ÀÖ½À´Ï´Ù. ±¤¹üÀ§ÇÏ°Ô ÀüÀÌµÈ Èæ»öÁ¾ÀÇ 10% Á¤µµ¿¡¼­´Â ¿ø¹ßºÎÀ§¸¦ ãÀ» ¼ö ¾ø½À´Ï´Ù (´ëÇѼÒÈ­±â³»½Ã°æÇÐȸÁö 2004;28:71-75).

µÎÅë°ú blurred visionÀ¸·Î ³»¿øÇÑ È¯ÀÚÀÔ´Ï´Ù. ³ú MRI¿¡¼­ ¡°Malignant bone mass such as skull base metastasis with hypoglossal canal involvement and denervation injury of tongue, right¡±ÀÇ ¼Ò°ßÀ̾ú°í PET¿¡¼­ multiple metastasis°¡ °üÂûµÇ¾ú½À´Ï´Ù. À§³»½Ã°æ¿¡¼­ À§Ã¼ºÎ¿Í ÀüÁ¤ºÎ¿¡¼­ °ñ°í·ç ¸Å¿ì ¸¹Àº °ËÀº»ö Á¡µéÀÌ °üÂûµÇ¾ú°í Á¶Á÷°Ë»ç¿¡¼­ malignant melanoma, HMB45 (+), S-100 (Focal +), cytokeratin (-)·Î È®ÀεǾú½À´Ï´Ù. µî¿¡¼­ Á¡ÀÌ ¹ß°ßµÇ¾ú°í Á¶Á÷°Ë»ç¿¡¼­ malignant melanoma¿´½À´Ï´Ù. Multiple metastasis°¡ ÀǽɵǾú´ø ȯÀÚ¿¡¼­ À§³»½Ã°æÀ» ÅëÇÏ¿© melanoma°¡ È®ÀÎµÈ ÈÄ Àü½Å¿¡ ´ëÇÑ ÀÚ¼¼ÇÑ ½Åü°ËÁøÀ» ÅëÇÏ¿© ¿ø¹ßº´¼Ò¸¦ ¹ß°ßÇÑ °æ¿ìÀÔ´Ï´Ù. MelanomaÀÇ À§ÀüÀÌ´Â ÁÖ·Î SMT-likeÇÑ elevated lesionÀÌ dark pigmentationµÈ ÇüÅ·Πº¸ÀÔ´Ï´Ù. ¿À´ÃÀÇ Áõ·Ê´Â flat dark spotµé·Î °üÂûµÈ µå¹® ¿¹ÀÔ´Ï´Ù.

¾ó±¼ ÇǺΠÈæ»öÁ¾ À§ÀüÀÌ

Èæ»öÁ¾ ½ÊÀÌÁöÀåÀüÀÌ, ³úÀüÀÌ

Èæ»öÁ¾ À§ÀüÀ̷κÎÅÍÀÇ ÃâÇ÷

* Âü°í: EndoTODAY À§ÀüÀÌ


4. Gastic lymphoma (DLBCL)

¾Æ·¡ ½½¶óÀ̵带 º¸½Ã±â ¹Ù¶ø´Ï´Ù.

PPT PDF 4.6 M

* Âü°í: EndoTODAY À§Àå°ü ¸²ÇÁÁ¾


[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

© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng.