위암 1,000. EndoTODAY 이준행

[위암 288]

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작은 암이라고 무시하지 맙시다. Adenosquamous carcinoma는 무섭습니다.

일본 동경암센터의 증례 보고입니다 (Shirahige. WJG 2015). ESD 후 추적관찰 도중 metachronous cancer가 발견되었고 조직검사에서 poorly differentiated adenocarcinoma였습니다. ESD를 하였고 깊은 점막하침윤을 보인 adenosquamous cell carcinoma였습니다. 수 개월 후 간전이가 발견되었다고 합니다.

Initial early gastric cancer lesion in June 2005. A: 0-IIa type well differentiated adenocarcinoma limited to the mucosa, 10 mm in size, without an ulcer scar, on the lesser curvature of the middle gastric body; B: Histopathological findings revealed a well differentiated mucosal adenocarcinoma, 10 mm in size, without lymphovascular involvement or ulcerative finding, as well as tumor-free margins.
Metachronous early gastric cancer lesion in November 2007. A: 0-IIc type metachronous early gastric cancer lesion, 8 mm in size, without an ulcer scar, on the greater curvature of gastric antrum. The estimated tumor depth was up to the mucosa; B: Biopsy revealed well and poorly differentiated adenocarcinoma (hematoxylin-eosin staining).
Histopathological findings of endoscopic submucosal dissection specimens. A: Low magnification view with hematoxylin and eosin staining. Endoscopic submucosal dissection specimen revealed adenosquamous carcinoma invading the deep submucosal layer (1600 μm); B: High magnification view of yellow box in A. The tumor shows a solid growth pattern and prominent keratinization suggesting squamous cell carcinomatous component.
Computerized tomography in January 2008 (two months after the endoscopic submucosal dissection). A and B: Enhanced computerized tomography revealed multiple low density areas suggesting liver metastases (indicated by arrows).

2008년 증례를 왜 2015년에 와서야 발표했는지 알 수 없었습니다 (Shirahige. WJG 2015). 조직검사가 poorly differentiated였는데 ESD를 한 것도 저로서는 못마땅한 일입니다.

[References]

1) 위암 1000. 시즌 1. 증례 82 - 수술로 치료한 adenosquamous cell carcinoma.