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EndoTODAY ³»½Ã°æ ±³½Ç


[EsoTODAY 025 - Esophageal cancer]

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À§¾Ï °ËÁø ³»½Ã°æ¿¡¼­ ¿ì¿¬È÷ ¹ß°ßµÈ ½Äµµ¾ÏÀ¸·Î ÀÇ·ÚµÈ È¯ÀÚÀÔ´Ï´Ù. ³»½Ã°æ ¼Ò°ßÀº ½Äµµ¾ÏÀÌ Æ²¸²¾ø´Âµ¥, ½É´Þµµ Áø´ÜÀÌ ¾î·Æ¿ü°í ºÐ·ù°¡ ¾Ö¸ÅÇß½À´Ï´Ù. SM cancerÀÎ °ÍÀ¸·Î ÃßÁ¤µÇ¾ú±â ¶§¹®¿¡ ³»½Ã°æ °á°úÁö¿¡ 'Ç¥À缺 ½Äµµ¾Ï'À̶ó°í ¾µ ¼ö ÀÖ¾úÁö¸¸, ¾î¶² subtypeÀ» ¼±ÅÃÇØ¾ß ÇÒ °ÍÀÎÁö °í¹ÎÀÔ´Ï´Ù.

Ç¥À缺 ½Äµµ¾ÏÀÇ ³»½Ã°æ ºÐ·ù´Â Á¶±âÀ§¾Ï Æĸ® ºÐ·ù¸¦ µû¸£°í ÀÖ½À´Ï´Ù. À¶±âºÎ¿Í ÇÔ¸ôºÎ°¡ ÀÖ¾úÁö¸¸ ÀüüÀûÀ¸·Î´Â 0-Is Á¤µµ°¡ Àû´çÇÏÁö ¾ÊÀ»±î »ý°¢µÇ¾ú´Âµ¥, ´Ù¸¥ ÀÇ°ßÀ» °¡Áø ºÐµµ ¸¹À» °Í °°½À´Ï´Ù. ³»½Ã°æ ºÐ·ù¿¡ ´ëÇÑ ÀϺ» Ã¥ÀÇ ÇØ´ç ÆäÀÌÁö¸¦ ¼Ò°³ÇÕ´Ï´Ù.

¼ÒÈ­±âÁúȯÀÇ Áø´Ü±âÁØ, º´¸®ºÐ·ù, ÁßÁõµµ (°³Á¤Á¦2ÆÇ) 30ÂÊ

Staging workup¿¡¼­ T1bN0·Î ÆÇ´ÜµÇ¾î ¼ö¼úÀ» ÇÏ¿´½À´Ï´Ù. CT¿Í PET¿¡¼­ ¸²ÇÁÀý ÀÌ»óÀº º¸ÀÌÁö ¾Ê¾Ò½À´Ï´Ù. ±×·±µ¥ º¹ºÎ ¸²ÇÁÀýÀ» Áß½ÉÀ¸·Î ÀüÀÌ°¡ ÀÖ¾ú½À´Ï´Ù.


Invasive squamous cell carcinoma, moderately differentiated, lower thoracic esophagus :
1) tumor size: 3x3cm
2) extension to submucosa
3) endolymphatic tumor emboli: not identified
4) perineural invasion: not identified
5) resection margins: free; safety margin: proximal, 6.2cm ; distal, 2.3cm ; circumferential (adventitial) margin(deep), 0.6cm
6) metastasis to 3 out of 33 regional lymph nodes (pN2) (3/33: "resection margin", 0/0; "G1", 0/0; "G2", 0/1; "G3 (left gastric artery)", 2/18; "G4", 0/2; "RRLN", 0/1; "LRLN", 0/3; "7 (subcarinal)", 1/4; "8d", 0/0; "8m", 0/2; "8u", 0/2)
7) treatment effect: no prior treatment

µû¶ó¼­ stagingÀº T1bN2¿´½À´Ï´Ù.

Adjuvant therapy¸¦ ½ÃÇàÇÑ ÈÄ ÃßÀû°üÂûÀ» ÇÏ¿´½À´Ï´Ù. ¹®ÇպΠÁ÷ÇϺΠ»óºÎ½Äµµ¿¡¼­ µÕ±Ù Á¡¸·º´¼Ò°¡ ¹ß°ßµÇ¾ú½À´Ï´Ù. Dysplastic squamous epitheliumÀÏ ¼öµµ ÀÖ°í, heterotopic gastric mucosaÀÏ ¼öµµ ÀÖ°Ú´Ù ÃßÁ¤ÇÏ¿´´Âµ¥

Á¶Á÷°Ë»ç¿¡¼­´Â gastric mucosa showing chronic gastritis, inactive°¡ ³ª¿Ô½À´Ï´Ù. ¾Æ¸¶µµ ¼ö¼ú Àü¿¡ ¹ß°ßµÇÁö ¸øÇÏ¿´´ø heterotopic gastric mucosaÀÎ ¸ð¾çÀÔ´Ï´Ù.


[References]

1) EsoTODAY - Esophageal diseases

2) SmallTODAY - Small bowel diseases

3) ColonTODAY - Colorectal diseases

4) Dr. Sinn's LiverTODAY - Liver diseases

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