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[Thursday Endoscopy Conference 20170518]

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1. Gallstones in the stomach due to gastrocholecystic fistula

ÀÌ»óÇÏ°Ô »ý±ä À§ À̹°°ú À§ÀüÁ¤ºÎ ±Ë¾çÀ¸·Î ÀǷڵǾú½À´Ï´Ù. ³»½Ã°æ Àç°ËÀ» ÇÏ¿´´Âµ¥ À§¿¡ À̹°ÀÌ Çϳª°¡ ¾Æ´Ï¶ó µÎ°³¿´À¸¸ç, À§ÀüÁ¤ºÎ ±Ë¾çÀÌ ÈξÀ ±í¾îÁö°í ¹«½¼ ±¸¸Û °°Àº °ÍÀÌ º¸¿´½À´Ï´Ù. °ú°Å »çÁø°ú ºñ±³Çغ¸´Ï gastric wall¿¡ ¹ÚÇô ÀÖ´ø µÎ ¹ø° À̹°ÀÌ ºüÁ® ³ª¿Â ÀÚ¸®·Î »ý°¢µÇ¾ú½À´Ï´Ù. CT¸¦ Âï¾ú°í gastro-cholecystic fistula·Î È®ÀεǾú½À´Ï´Ù. ÀÌ fistula¸¦ ÅëÇÏ¿© µÎ °³ÀÇ ´ã¼®ÀÌ À§³»·Î ÀÚ¸®¸¦ ¿Å±ä °ÍÀ̾ú½À´Ï´Ù.

È­»ìÇ¥: gastro-cholecystic fistula

* Âü°í: EndoTODAY À̹°


2. Cardia cancer

Rectal cancer·Î ESD¸¦ ½ÃÇà¹ÞÀº °ú°Å·ÂÀÌ ÀÖ´Â 70´ë ³²¼º.

ESD¸¦ ½ÃÇàÇÏ¿´°í º´¸®ÇÐÀû ¿ÏÀüÀýÁ¦¿´½À´Ï´Ù.

Early gastric carcinoma
1. Location : cardia, greater curvature
2. Gross type : EGC type IIb
3. Histologic type : tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : intestinal
5. Size of carcinoma : (1) longest diameter, 26 mm (2) vertical diameter, 17 mm
6. Depth of invasion : invades mucosa (muscularis mucosa) (pT1a)
7. Resection margin : free from carcinoma(N), safety margin : distal 11 mm, proximal 7 mm, anterior 10 mm, posterior 4 mm
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

[ÀÌÁØÇà comment]

ÀÌ Áõ·Ê¿¡ ´ëÇÏ¿© spontaneous bleedingÀ̶ó°í ¸»¾¸ÇϽŠºÐÀÌ °è¼Ì´Âµ¥, ½ÇÁ¦ ÃâÇ÷ÀÌ ¾ø°í ¹ßÀû Á¤µµ ¾Æ´Ñ°¡¿ä? RBC µÎ °³ ³ª¿Â °Í °°Àºµ¥¿ä... (Àϵ¿ ¿ôÀ½) Àû¾îµµ oozingÀ» º¸ÀÌ´Â °æ¿ì¿¡ sponatneous bleeding ¿ë¾î¸¦ ½á Áֽñ⠹ٶø´Ï´Ù.


3. EGC


Advanced gastric carcinoma
1. Location : middle third, Center at low body and anterior wall
2. Gross type : Borrmann type 3
3. Histologic type : tubular adenocarcinoma, poorly differentiated
4. Histologic type by Lauren : diffuse
5. Size : 2.5x2.3 cm
6. Depth of invasion : invades muscularis propria (pT2)
7. Resection margin: free from carcinoma, safety margin: proximal 2.9 cm, distal 11 cm
8. Lymph node metastasis : no metastasis in 33 regional lymph nodes (pN0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : present
12. AJCC stage by 7th edition: pT2 N0

[ÀÌÁØÇà comment]

1. ¾î¶² ºÐÀº EGC IIa + IIc¶ó°í ÇÏ¼Ì°í ¶Ç ´Ù¸¥ ºÐÀº EGC IIc + IIa¶ó°í ¸»¾¸Çϼ̽À´Ï´Ù. º´¼Ò ÁÖº¯ foldÀÇ ³¡ÀÌ À¶±âµÇ¾î ÀÖ°í ´Ù¸¥ ºÎÀ§µµ edge ÁÖº¯ÀÌ ¾à°£ ¿Ã¶ó¿Í ÀÖÁö¸¸ ("¹ÝÀÀ¼º À¶±â") ÀÌ·± ¼Ò°ßÀ» Áß¿äÇÏ°Ô »ý°¢ÇÏ¿© º´¼ÒÀÇ ÁÖ Æ¯¼ºÀ» elevated lesionÀ¸·Î º¸´Â °ÍÀº À߸øµÈ ÀÏÀÔ´Ï´Ù. ÇÔ¸ôº´¼Ò ÁÖº¯ÀÇ fold´Â Á¶±âÀ§¾Ï ³»½Ã°æ ºÐ·ù¿¡ Æ÷ÇÔ½ÃÅ°Áö ¾Ê½À´Ï´Ù. ÇÔ¸ô º´¼Ò ÁÖº¯ÀÌ ¾à°£ reactiveÇÏ°Ô ¿Ã¶ó¿Í ÀÖ´Â °Íµµ Áß¿äÇÏ°Ô °í·ÁÇÒ Á¡Àº ¾Æ´Ò °Í °°½À´Ï´Ù. ±×³É EGC IIc·Î ÁÖ´Â °ÍÀÌ ÁÁ°Ú°í, IIc°¡ ºÒ¸¸Á·½º·¯¿ì¸é IIc+IIa¶ó°í ÁÖ¼Å°í ¹«³­ÇÕ´Ï´Ù. ±×·¯³ª IIa + IIc·Î ºÐ·ùÇÏ´Â °ÍÀº À߸øµÈ ÀÏÀÔ´Ï´Ù.

¿À´Ã ¼³¸íµå¸° ³»¿ë Áß ¹ÝÀÀ¼º À¶±â¸¦ Àß ÀÌÇØÇÏÁö ¸øÇÑ ºÐµéÀÌ °è½Å °Í °°¾Æ¼­ Ã¥¿¡¼­ ±×¸²À» ¿Å°Üº¾´Ï´Ù. ÇÔ¸ôÇü º´¼Ò ÁÖº¯ÀÇ ¾à°£ À¶±âµÈ ºÎÀ§°¡ ²À ¾ÏÀº ¾Æ´Ï¶ó´Â °ÍÀÔ´Ï´Ù.

ÁÁÀº ³»½Ã°æÃ¥Àº ÀϺ»¿¡¼­ ¸¹ÀÌ ³ª¿É´Ï´Ù. ÀϺ»¸» ¾ÆƲ¶ó½º¸¦ º¸±â À§ÇÏ¿© ±âº» ÇÑÀÚ¸¦ ÀÍÇôµÎ¸é µµ¿òÀÌ µË´Ï´Ù. ÀϺ»¾î¸¦ ¸ô¶óµµ ÇÑÀÚ¸¸ ¾Ë¸é »ó´çÈ÷ ¸¹Àº ³»¿ëÀ» ¾Ë ¼ö Àֱ⠶§¹®ÀÔ´Ï´Ù. "À§¿Í Àå ¾ÆƲ¶ó½º 1 - »óºÎ¼ÒÈ­°ü"À̶ó´Â Ã¥ÀÇ ¸ñÂ÷ÀÔ´Ï´Ù. ÀÌ ¸ñÂ÷¿¡ ³ª¿À´Â ÇÑÀÚ Á¤µµ´Â ÀÍÇôµÎ¸é ÁÁÁö ¾ÊÀ»±î¿ä?

PDF 2.2M

* Âü°íÀÚ·á: À§¾Ï ºÐ·ù¿Í ÀÓ»óÀû Ư¡ (PDF 7.1M, ³»ºÎ¿ë, ¾ÏÈ£ ÀÖÀ½)

2. À°¾È¼Ò°ßÀ¸·Î ÃßÁ¤Çϴ ħÀ± ±íÀÌ(½É´Þµµ)´Â submucosaÀÔ´Ï´Ù. Á¶Á÷°Ë»ç °á°ú°¡ signet ring cell carcinoma°¡ ³ª¿Ô½À´Ï´Ù. Á¶±âÀ§¾Ï ³»½Ã°æ À°¾È¼Ò°ß¿¡ ÀÇ°ÅÇÑ Ä§À± ±íÀÌ(½É´Þµµ) Áø´ÜÀº ÁÖ·Î differentiated type EGC¿¡ Àû¿ëµË´Ï´Ù. Undifferentiated type EGC¿¡¼­´Â Á¾Á¾ ¿¹»óº¸´Ù ħÀ± ±íÀÌ(½É´Þµµ)°¡ ±íÀº °æ¿ì¸¦ ¸¸³³´Ï´Ù. ÀÌ È¯ÀÚµµ PM invasionÀÖ´Â AGC¿´½À´Ï´Ù. EGC-like AGC¶ó°í ºÎ¸¦ ¼ö ÀÖ½À´Ï´Ù.

* Âü°í: EndoTODAY ħÀ± ±íÀÌ (½É´Þµµ)


4. Å©·Ðº´

³»½Ã°æ ÇϽŠÀӻ󰭻粲¼­´Â ¾Æ·¡¿Í °°Àº °á°ú¸¦ ³²°å½À´Ï´Ù.

IC valve¿¡¼­ semicircular ulcer¿Í ÇÔ²² mucosal nodularity°¡ °üÂûµÇ¾úÀ¸³ª (#1x2), terminal ileumÀº »ó´ëÀûÀ¸·Î intact ÇÏ¿´À½. A-colonºÎÅÍ mid S-colon±îÁö ´Ù¹ß¼º ±Ë¾ç º´º¯°ú ÇÔ²² inflammatory polyp µéÀÌ °üÂûµÇ¾úÀ½. ƯÈ÷, HFºÎÅÍ SF±îÁö¿¡¼­´Â linear ulcerµéÀÌ Àü ÀåÀ» ħ¹üÇÏ°í ÀÖ¾úÀ¸¸ç, cobblestone appearance°¡ °üÂûµÇ¾úÀ½. HF ¹× T-colon¿¡¼­ °¢°¢ Á¶Á÷°Ë»ç¸¦ ½ÃÇàÇÏ¿´À½. (#2x2: HF, #3x2: T-colon)
IMPRESSION : Crohn's disease (#1-3)


[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.