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[½Äµµ Á¡¸·ÇÏÁ¾¾ç. Esophageal submucosal tumor (SMT)] - ðû

1. Introduction

The majority of small esophageal SMTs are benign. When a small esophageal SMT is found for the first time, 1-2 biopsies are sufficient. When the esophageal SMT is smaller than 5 mm, no biopsy may be OK in some cases. If there is no significant change, you don't need to take biopsy in the follow-up.

The most common esophageal SMT is the leiomyoma of the far distal esophagus. They are benign.

r/o esophageal leiomyoma (histology is unavailable).

Most of the biopsies for esophageal SMTs are reported as normal esophageal mucosa. One rare exception is granular cell tumor.

Esophageal granular cell tumor

5³â µ¿¾È º¯È­°¡ °ÅÀÇ ¾ø´Â ½Äµµ SMT. ÀÌ¿Í °°Àº °æ¿ì Ç¥¸é¿¡¼­ forceps biopsy¸¦ ¹Ýº¹ÇÏ´Â °ÍÀº °ÅÀÇ Àǹ̰¡ ¾ø½À´Ï´Ù.


2. Superficial esophageal neoplasm + SMT

Clinical Endoscopy 2015³â 7¿ùÈ£¿¡ ½Äµµ±ÙÁ¾ À§¿¡ ÀÌÇü¼ºÀÌ ÀÖ¾ú´ø º´¼Ò¸¦ ³»½Ã°æÀ¸·Î Ä¡·áÇÑ Áõ·Ê 3°³°¡ º¸°íµÇ¾ú½À´Ï´Ù (¾Æ»êº´¿ø. Myeongsook Seo. Clin Endosc 2015).


¸î ³â Àü Àúµµ °ÅÀÇ ºñ½ÁÇÑ °æÇèÀ» ÇÏ¿´½À´Ï´Ù. ½Äµµ high grade dysplasia¶ó°í ¿À¼Ì´Âµ¥, SMT À§¿¡ HGD°¡ À§Ä¡ÇÑ ¸ð¾çÀ̾ú½À´Ï´Ù. ³»½Ã°æÀýÁ¦¼úÀ» ÇÏ¿´°í °á°ú´Â ÁÁ¾Ò½À´Ï´Ù. ³»½Ã°æ »çÁø, º´¸® »çÁø, º´¸® °á°úÀÔ´Ï´Ù.

Esophagus, low, endoscopic mucosal resection :
Squamous dysplasia, high grade:
    1) size: longest diameter: 11mm, vertical diameter: 8mm
    2) gross type: flat
    3) negative resection margins
Leiomyoma


3. Neuroendocrine carcinoma of the upper esophagus (2016³â 6¿ù 10ÀÏ SMC Áý´ãȸ Áõ·Ê)

70´ë ¿©ÀÚ°¡ ºñƯÀÌÀû °¡½¿ ºÒÆí°¨À¸·Î ¿ÜºÎ¿¡¼­ ½ÃÇàÇÑ ³»½Ã°æ¿¡¼­ ½Äµµ Á¡¸·ÇÏÁ¾¾çÀÌ ¹ß°ßµÇ¾î ÀǷڵǾú½À´Ï´Ù. ¿ÜºÎ½½¶óÀ̵å ÀçÆǵ¶ °á°ú´Â SCC, M/D with focal neuroendocrine component¿´½À´Ï´Ù. »óºÎ½Äµµ º´¼ÒÀÎ °ü°è·Î ¼ö¼ú¿¡ µû¸¥ À§Ç輺ÀÌ ³ôÀ» °ÍÀ¸·Î ÆǴܵǾî ÈäºÎ¿Ü°ú·ÎºÎÅÍ ³»½Ã°æ Ä¡·á°¡ ÀǷڵǾú½À´Ï´Ù. ESD´Â ¾î·Á¿ò ¾øÀÌ ½ÃÇàµÇ¾ú½À´Ï´Ù.

ESD º´¸®°á°ú°¡ ¾Æ·¡¿Í °°¾Ò½À´Ï´Ù. ¼ö¼úÀ» ÀÇ·ÚÇÏ¿´½À´Ï´Ù.

1. Diagnosis: Large cell neuroendocrine carcinoma
2. WHO classification(2010): Neuroendocrine carcinoma
3. Size: 0.9x0.8 cm
4. Extent: Mucosa and submucosa
5. Grading: Mitotic Count: >20/10 HPF, Ki-67 labeling index: G3>20%
6. Lymphovascular invasion: Present
7. Perineural invasion: Not identified
8. Resection Margins: Involved by tumor with cautery artifacts
Chromogranin: Positive, Synaptophysin: Positive, CD56: Positive, Ki-67: Positive (60%), PHH-3: Positive (198/10 HPFs)

ESD º´¸®. Á¡¸·ÃþÀº ºñ±³Àû intact Çѵ¥ ±× ¾Æ·¡·Î homogenousÇÑ ½Å°æ³»ºÐºñ¼¼Æ÷°¡ ³Ð°Ô º¸ÀÓ

ESD º´¸®. ¶Ñ·ÇÇÑ endolymphatic emboli°¡ °üÂûµÇ¾úÀ½.

¼ö¼ú °á°ú´Â ¾Æ·¡¿Í °°¾Ò½À´Ï´Ù.

Esophagus and upper stomach, Ivor Lewis operation:
Status post endoscopic submucosal dissection (D13-7695)
No residual tumor
1) tumor size: cannot be determined (no residual tumor)
2) depth of invasion: cannot be determined (no residual tumor)
3) endolymphatic tumor emboli: not identified
4) perineural invasion: not identified
5) resection margins: free from carcinoma, safety margin: proximal, 1.5 cm ; distal, 18 cm ;
6) metastasis to 1 out of 25 regional lymph nodes (1/25: "LC omentum", 0/0; "G1", 0/3; "G2", 0/3; "G3", 0/8; "RRLN (right recurrent laryngeal nerve)", 1/2; "LRLN", 0/2; "L9", 0/1; "L10", 0/1; "RD", 0/1; "5", 0/1; "7", 0/2; "8u", 0/1)
7) treatment effect: not applicable

¼ö¼ú º´¸® (¸²ÇÁÀý). ¸²ÇÁÀý¿¡ ½Å°æ³»ºÐºñ¾ÏÀÇ Ä§À±ÀÌ ÀÖ¾úÀ½.


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[2023-5-28] ¸çÄ¥ Àü ÀÖ¾ú´ø KSGE webinar ½Äµµ ¾ç¼ºÁúȯÀ» ¸®ºäÇß½À´Ï´Ù. ½Ç½Ã°£À» µè´Â °Íº¸´Ù ÈξÀ È¿°úÀûÀÔ´Ï´Ù. õõÈ÷ ´Ù½Ãº¸±â Çϸ鼭 °øºÎÇÒ ¼ö ÀÖÀ¸¹Ç·Î

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