내시경집담회. EndoTODAY 이준행

1. Gastric amyloidosis

무증상 성인 건진에서 발견한 isolated gastric amyloidosis

2. Borrmann type IV

사진 한 장으로 맞춰봅시다. 60대 여성.

작은 함몰부가 있지만 주변 위점막이 두꺼워지고 fold가 서로 붙어있는 소견입니다. 전형적인 Borrmann type IV입니다. 조직검사는 signet ring cell carcinoma가 나왔고 CT에서 이미 peritoneal seeding이 확인되어 palliative XELOX 항암치료를 시작하였습니다.

3. EGC IIc

Stomach, subtotal gastrectomy:
Early gastric carcinoma
1. Location : lower third, Center at low body and posterior wall
2. Gross type : EGC type IIc
3. Histologic type : signet-ring cell carcinoma
4. Histologic type by Lauren : diffuse
5. Size : 1.6x1.1 cm
6. Depth of invasion : invades mucosa (lamina propria) (pT1a)
7. Resection margin: free from carcinoma, safety margin: proximal 2.2 cm, distal 9.3 cm
8. Lymph node metastasis : no metastasis in 49 regional lymph nodes (pN0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. AJCC stage by 7th edition: pT1a N0

4. EGC IIb

Stomach, subtotal gastrectomy:
Early gastric carcinoma
1. Location : lower third, Center at low body and anterior wall
2. Gross type : EGC type IIc+IIb
3. Histologic type : signet-ring cell carcinoma
4. Histologic type by Lauren : diffuse
5. Size : 1.8x0.9 cm
6. Depth of invasion : invades mucosa (lamina propria) (pT1a)
7. Resection margin: free from carcinoma, safety margin: proximal 3.4 cm, distal 10 cm
8. Lymph node metastasis : no metastasis in 34 regional lymph nodes (pN0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. AJCC stage by 7th edition: pT1a N0

Signet ring cell carcinoma는 세포가 도장반지처럼 생겼다는 뜻입니다. 영화 벤허를 보면 나옵니다.

5. Lekage after total gastrectomy for AGC B-IV

위전절제술 후 anastomosis site leak가 있어 VAC therapy 후 호전되었음.

Endoscopic vacum therapy는 식도암 수술 후 leak에 가장 효과가 좋지만 위암 수술 후 leak에서도 크게 도움이 되고 있습니다.

Endoscopy 2013

6. EGC (mucosal cancer)

Stomach, radical subtotal gastrectomy:
Early gastric carcinoma
1. Location : lower third, Center at antrum and greater curvature
2. Gross type : EGC type IIa+IIc
3. Histologic type : tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : mixed
5. Size : 5.8x3.2 cm
6. Depth of invasion : invades mucosa (muscularis mucosae)(pT1a)
7. Resection margin: free from carcinoma, safety margin: proximal 3.7 cm, distal 1.5 cm
8. Lymph node metastasis : no metastasis in 31 regional lymph nodes (pN0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. Peritoneal cytology : negative
13. AJCC stage by 7th edition: pT1a N0

7. Duodenal carcinoid

biopsy: well differentiated neuroendocrine tumor

8. Ulcerative colitis

M/72. 반년전부터 시작한 혈변

[References]

1) SMC Endoscopy Unit 삼성서울병원 내시경실

2) SMC Monday GI conference 삼성서울병원 일원내시경교실 월요점심소화기집담회

3) SMC Thursday endoscopy conference 삼성서울병원 일원내시경교실 목요점심내시경집담회