조기위암 아틀라스. Early gastric cancer. EGC. EndoTODAY 이준행

[조기위암 아틀라스. Early Gastric Cancer. EGC] - 終

1. Folds of EGC. 조기위암 fold 변화
2. Bleeding is important sign
3. EGC type I
4. EGC type IIa
5. EGC type IIb
6. EGC type IIc
7. EGC type III
8. EGC type IIa+IIc
9. Superficial spreading type EGC
10. AGC-like EGC

1. Folds of EGC. 조기위암 fold 변화

EndoTODAY Folds로 옮겼습니다.

2. Bleeding is important sign

3. EGC type I

4. EGC type IIa

EGC IIa의 ESD를 시행하였습니다. 자세히 관찰한 바 사진만으로 판단한 것에 비하여 넓은 병소였기 때문에 잠시 놀랐지만 시술은 잘 되었습니다.
ESD : Early gastric carcinoma
1. Location : angle, lesser curvature
2. Gross type : EGC type IIa+IIb
3. Histologic type : tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : intestinal
5. Size of carcinoma : (1) longest diameter, 58 mm (2) vertical diameter, 24 mm
6. Depth of invasion : invades mucosa (lamina propria) (pT1a)
7. Resection margin : free from carcinoma(N), safety margin : distal 8 mm, proximal 7 mm, anterior 10 mm, posterior 10 mm, deep 1800 ㎛
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

5. EGC type IIb

6. EGC type IIc

아래와 같은 넓은 EGC는 분류가 쉽지 않습니다. EGC IIc + III라고 할 수는 있겠습니다. 일종의 laterally spreading tumor입니다.

7. EGC type III

전형적인 EGC type III는 많지 않습니다. 뚜렷한 궤양이 있는 환자에서 수술 후 결과가 AGC로 나오는 경우가 많기 때문입니다.

Stomach, radical subtotal gastrectomy: Early gastric carcinoma
1. Location : lower third, Center at body and lesser curvature
2. Gross type : EGC type III
3. Histologic type : tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : intestinal
5. Size : 3.3x1.7 cm
6. Depth of invasion : invades submucosa (sm2) (pT1b)
7. Resection margin: free from carcinoma, safety margin: proximal 2.5 cm, distal 7.3 cm
8. Lymph node metastasis : no metastasis in 32 regional lymph nodes (pN0) (0/32: "1", 0/0; "5", 0/0; "6", 0/0; "7", 0/3; "9", 0/1; "8a", 0/2; "11p", 0/3; "12a", 0/2; "4sb", 0/2; "4", 0/0; 3,5, 0/3; 4,6, 0/4; perigastric LN, 0/12)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. Associated findings : ulceration
13. AJCC stage by 8th edition: pT1b N0

8. EGC type IIa + IIc

9. Superficial spreading EGC

10. AGC-like EGC (= EGC, mimicking AGC)