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[Thursday Endoscopy Conference 20180426. ±èÈñÁ¤ ¼±»ý´Ô]

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1. Adenocarcinoma with focal neuroendocrine differentiation

°ËÁø ³»½Ã°æ¿¡¼­ ¹ß°ßµÈ AGCÀÔ´Ï´Ù. MassÀÇ ÀϺΰ¡ ÇÔ¸ôµÇ¾úÁö¸¸ ±×·¡µµ ÀüüÀûÀ¸·Î´Â À¶±âµÈ ¸ð¾çÀ¸·Î AGC Borrmann type IÀ¸·Î Áø´ÜÇÏ¿´½À´Ï´Ù. Á¶Á÷°Ë»ç´Â tubular adenocarcinoma, moderately differentiated with neuroendocrine differentiationÀ¸·Î º¸°íµÇ¾ú½À´Ï´Ù.


Stomach, subtotal gastrectomy: Advanced gastric carcinoma
1. Location : lower third, Center at antrum and lesser curvature
2. Gross type : Borrmann type 2
3. Histologic type : tubular adenocarcinoma, moderately differentiated with focal neuroendocrine differentiation
4. Histologic type by Lauren : intestinal
5. Size : 3.5x4.5 cm
6. Depth of invasion : penetrates subserosal connective tissue (pT3)
7. Resection margin: free from carcinoma, safety margin: proximal 4.5 cm, distal 4 cm
8. Lymph node metastasis : metastasis to 5 out of 52 regional lymph nodes (pN2) (perinodal extension: present) (5/52: "3", 2/17; "4", 1/14; "5", 1/2; "6", 0/4; "7", 0/2; "8a", 0/2; "9", 0/1; "11p", 0/2; "12a", 1/3; "4sb", 0/4; "1", 0/0; "4d", 0/1)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. Associated findings : ulceration
13. Peritoneal cytology : negative
14. AJCC stage by 7th edition: pT3 N2

Áõ·Ê¿Í °ü·ÃÇÏ¿© 3°¡Áö Á¤µµÀÇ »ý°¢ÇØ º¸¾Ò½À´Ï´Ù.

+++ 1 +++

³»½Ã°æ ÀÇ»ç´Â º¸¸¸ 1ÇüÀ¸·Î ÁÖ¾ú´Âµ¥ º´¸®ÀÇ»ç´Â º¸¸¸ 2ÇüÀ¸·Î ÁÖ¾ú½À´Ï´Ù. ÈçÈ÷ ÀÖ´Â ÀÏÀÔ´Ï´Ù. ¾à°£ ±Ë¾çÀÌ ÀÖ´Â °ÍÀº »ç½ÇÀ̴ϱî... º¸Åë ºñ±³Àû µÕ±×·¸°í ±Ë¾çÀÌ ±í°í ±Ë¾ç ÁÖº¯ÀÇ damÀÌ µÎ²®Áö ¾Ê°í ÇöÀúÈ÷ À¶±âµÇ¾î ÀÖÀ¸¸é º¸¸¸ 2ÇüÀ̶ó°í ºÎ¸£°í ÀÖ½À´Ï´Ù. ±×³É µ¢¾î¸®ÀÌ°í Áß¾ÓÀÌ ¾à°£ ÇÔ¸ôµÇ¾î ÀÖÀ¸¸é º¸¸¸ 1ÇüÀ¸·Î ºÎ¸¨´Ï´Ù. ÁÖ°üÀûÀÔ´Ï´Ù.

+++ 2 +++

Forceps biopsy¿Í surgical pathology¿¡¼­ ¸ðµÎ focal neuroendocrine differentiationÀÇ ¾ð±ÞÀÌ ÀÖ½À´Ï´Ù. ÀϹÝÀûÀÎ adenocarcinoma (ÀÌ´Â exocrine tumor¶ó°í ÇÒ ¼ö ÀÖ½À´Ï´Ù. Gastric epithelium¿¡¼­ ¹ß»ýÇÏ´Â tumorÀ̱⠶§¹®ÀÔ´Ï´Ù)¿¡ ¾à°£ÀÇ endocrine component°¡ µ¿¹ÝµÈ °æ¿ì´Â °£È¤ ÀÖ½À´Ï´Ù. Ä¡·á´Â ¶È°°½À´Ï´Ù.

±×·¯³ª exocrine component¿Í endoscrine component°¡ ´ëµîÇϸé amphicrine tumor¶ó°í ÇÕ´Ï´Ù. ±âÁØÀº »ó´çÈ÷ ÀÛÀ§ÀûÀÌÁö¸¸ ´ë°­ 30%·Î Àâ°í ÀÖ½À´Ï´Ù. ÃÖ±Ù¿¡´Â Mixed Adenoneuroendocrine Carcinomas (MANECs)¶ó´Â À̸§À¸·Î ÅëÀϵǰí ÀÖ´Â °Í °°½À´Ï´Ù (Cancers 2012;4:11-30).

Amphicrine tumorÀÇ Æ¯Â¡Àº ¾Æ·¡°ú °°½À´Ï´Ù.

  1. neuroendocrine cells interspersed with carcinomas
  2. carcinoids with interspersed non-endocrine cells
  3. composite glandular-neuroendocrine cell carcinomas containing both areas of carcinoid and conventional carcinoma
  4. collision tumors in which neuroendocrine tumors and conventional carcinomas are closely juxtaposed, but not admixed
  5. amphicrine tumors prodominantly composed of cells exhibiting concurrent neuroendocrine and non-endocrine differentiation
  6. combinations of the previous types

+++ 3 +++

12a ¸²ÇÁÀý ÀüÀÌ°¡ ÀÖ¾ú½À´Ï´Ù. Left hepatoduodenal nodeÀÔ´Ï´Ù. ÀÌ´Â °ú°Å ¹æ½ÄÀ¸·Î´Â group 2 stationÀÔ´Ï´Ù. À§¾ÏÀÌ mid 1/3 ȤÀº distal 1/3¿¡¼­´Â group 2·Î proximal 1/3¿¡¼­´Â group 3·Î ºÒ·¶½À´Ï´Ù.


2. GIST with hepatic metastasis.

FundusÀÇ ºÒ±ÔÄ¢ÇÑ ±Ë¾ç ºÎºÐ(µÎ¹ø°, ¼¼¹ø° »çÁø)¸¸À¸·Î ÆÇ´ÜÇϸé AGC, lymphoma, GIST µîÀ» ¸ðµÎ °í·ÁÇÒ ¼ö ÀÖ°ÚÀ¸³ª, ºÒ±ÔÄ¢ÇÑ ±Ë¾çºÎ ÁÖº¯ÀÇ ³ÐÀº SMT ºÎºÐ(ù¹ø° »çÁø)À» °í·ÁÇϸé AGCÀÇ °¡´É¼ºÀº ¸Å¿ì ¶³¾îÁö´Â °æ¿ìÀÓÀ» ¾Ë ¼ö ÀÖ½À´Ï´Ù. C-kit (CD117) ¾ç¼º GIST¿´½À´Ï´Ù.


3. Antral type Borrmann type IV

º¹ºÎ ºÒÆí°¨°ú üÁß°¨¼Ò·Î ³»¿øÇÑ 20´ë ¿©¼ºÀÇ À§³»½Ã°æ¿¡¼­ ¾Æ·¡¿Í °°Àº ¼Ò°ßÀÌ º¸ÀÌ¸é ¹«½¼ Áúº´À» »ý°¢ÇØ¾ß ÇÒ±î¿ä?

.

.

.

Antral type º¸¸¸ 4Çü ÁøÇ༺ À§¾ÏÀÔ´Ï´Ù. ¹°·Ð duodenal ulcer stricture¿¡¼­µµ gastric outlet obstructionÀÌ °¡´ÉÇÕ´Ï´Ù¸¸, ¿äÁòÀº º¸¸¸ 4Çü À§¾ÏÀ» ´õ ÀÚÁÖ º¸´Â °Í °°½À´Ï´Ù. ¹°·Ð »ó±ÞÁ¾ÇÕº´¿ø¿¡¼­ °¡Áú ¼ö ÀÖ´Â biasÀÏ ¼öµµ ÀÖÁö¸¸...

(2013)

ÀüÁ¤ºÎ º®ÀÌ ÀüüÀûÀ¸·Î µÎ²¨¿öÁ³°í ÆìÁöÁö ¾ÊÀ¸¸é¼­ ½ÊÀÌÁöÀå ÀϺαîÁö ħÀ±µÇ¾î ÀÖ½À´Ï´Ù. ¼Ò¸¸ÂÊÀ» µû¶ó¼­´Â À§Ã¼ÁߺαîÁö ħ¹üµÇ¾î ÀÖ½À´Ï´Ù. ´ë¸¸ Èĺ®ÂÊÀ¸·Î ÀÛÀº ÇÔ¸ôºÎ°¡ ÀÖÁö¸¸, ÀüüÀûÀ¸·Î´Â antral type º¸¸¸ 4Çü ÁøÇ༺ À§¾ÏÀÔ´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

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