[Description exercise 4 Çؼ³]

[ÀܼҸ® ÇѸ¶µð]

³»½Ã°æ °á°úÁö´Â °ø¹®¼­ÀÔ´Ï´Ù. ÇÑ±Û ¸ÂÃã¹ýµµ ½Å°æ¾²½Ã±â ¹Ù¶ø´Ï´Ù. EndoTODAY ÇÑ±Û ¸ÂÃã¹ýÀ» ÂüÁ¶Çϼ¼¿ä.

¿µ¾îµµ ¹ßÀ½À» Àß ÇØ¾ß ÇÕ´Ï´Ù.^^

°øºÎÇÒ ÀÚ·á°¡ ³ÑÄ¡´Â ½Ã´ëÀÔ´Ï´Ù¸¸...... ³»½Ã°æÇÐȸ¼¼¹Ì³ª °­ÀÇ µ¿¿µ»ó°ú KSGE webinar´Â ¾ÆÁÖ ÁÁ½À´Ï´Ù. °­Ãß.

EndoTODAY Quick Reference¸¦ ¼Ò°³ÇÕ´Ï´Ù. ³»½Ã°æ °Ë»ç µµÁß ¸¸³ª´Â ÈçÇÑ ±Ã±ÝÁõ¿¡ ´ëÇÑ ´äº¯À» ¸ð¾ÆµÐ °ÍÀÔ´Ï´Ù.

2022-2-19. Winter School


Áõ·Ê 22

¼Ò°ß: »óºÎ ½ÄµµºÎÅÍ ÇϺνĵµ±îÁö 1-3 mm Å©±âÀÇ ¸¹Àº white plaqueµéÀÌ scattered µÇ¾î ÀÖÀ½. ÇϺΠ½Äµµ¿¡¼­´Â plaque µéÀÌ ¼­·Î À¶ÇյǴ ¸ð½ÀÀ» º¸ÀÌ°í ÀÖÀ½. Á¡¸·ÀÇ ºÎÁ¾À̳ª ±Ë¾çÀº °üÂûµÇÁö ¾ÊÀ½.

Áø´Ü: Esophageal candidiasis, grade III


[ÀÌÁØÇà comment]

Candidiasisµµ °¡±ÞÀû gradingÀ» ºÙ¿©ÁÝ´Ï´Ù. ÀÌ °æ¿ì´Â ÀϺΠconfluent ÇϹǷΠgrade III°¡ ÁÁ°Ú½À´Ï´Ù. ¿ì¸®ÀÇ ¿øÄ¢Àº ÀÌ°ÍÀÔ´Ï´Ù. ºÐ·ù¹ýÀÌ ÀÖ´Â °ÍÀº ´Ù ºÙ¿©ÁØ´Ù.


[2020-1-16. Çлý Áú¹®] Case 22 °æ¿ì ¾î¶² classification À¸·Î ½á¾ßÇÒÁö ¸ð¸£°Ú½À´Ï´Ù.

[2020-1-17. ÀÌÁØÇà ´äº¯] ºÐ·ù°¡ ´Ù¼Ò ¾Ö¸ÅÇÑ Áõ·ÊÀÔ´Ï´Ù. 2¿Í 3 »çÀ̶ó°í »ý°¢µÇ´Âµ¥... º¸Åë °¡±î¿î ÂÊÀ¸·Î ÁßÁõµµ ºÐ·ù¸¦ Çϴµ¥... »óºÎ ½Äµµ´Â grade 2¿¡ °¡±î°í ÇϺΠ½Äµµ´Â grade 3¿¡ °¡±õ½À´Ï´Ù. À̸¦ Á¾ÇÕÇÏ¿© Àú´Â grade 3À¸·Î ºÙ¿©º¸¾Ò½À´Ï´Ù.

* Âü°í: EndoTODAY ½Äµµ ĵµð´ÙÁõ


Áõ·Ê 23

¼Ò°ß: ÇϺνĵµ¿¡ 5-6 mm Å©±âÀÇ Á¤»óÁ¡¸·À¸·Î µ¤ÀΠȲ»öÀÇ flat elevated ÇüÅÂÀÇ »óÇÇÇÏ Á¾±«°¡ °üÂûµÊ

Áø´Ü: esophageal submucosal tumor (most likely, granular cell tumor)


[ÀÌÁØÇà comment]

Granular cell tumorÀÔ´Ï´Ù. Carcinoidµµ ºñ½ÁÇÏ°Ô º¸ÀÏ ¼ö ÀÖ½À´Ï´Ù. ½Äµµ¿¡¼­´Â carcinoid¿¡ ºñÇÏ¿© granular cell tumor°¡ ÈçÇÏ°í À§³ª ´ëÀå¿¡¼­´Â ´ëºÎºÐ carcinoidÀÔ´Ï´Ù. °£È¤ leimyoma¶ó°í ´äÇÑ ºÐÀÌ °è½Ê´Ï´Ù¸¸... granulcar cell tumor¿Í carcinoid´Â Á¡¸·º´¼ÒÀ̹ǷΠ¾à°£ Åõ¸íÇÏ°Ô ºñÄ¡´Â ¹Ý¸é leiomyoma´Â ´ëºÎºÐ Á¡¸·ÇÏ º´¼ÒÀ̹ǷΠÁ¾¾çÀÌ Åõ¸íÇÏ°Ô ºñÄ¡´Â °æ¿ì´Â °ÅÀÇ ¾ø½À´Ï´Ù.

* Âü°í: EndoTODAY ½Äµµ °ú¸³¼¼Æ÷Á¾


Áõ·Ê 24. Gastric antrum

¼Ò°ß: ÀüÁ¤ºÎ Àü¹Ý¿¡ °ÉÃÄ goose skin appearance (´ß»ì ¸ð¾ç) multiple small nodular lesion µéÀÌ »êÀçµÇ¾î ÀÖÀ½. º´¼ÒµéÀÇ Å©±â¿Í ¸ð¾çÀº 1-2 mm Á¤µµ·Î ºñ±³Àû ÀÏÁ¤ÇÔ.

Áø´Ü: Lymphofollicuar gastritis (= nodular gastritis), small granular type


[ÀÌÁØÇà comment]

¾î¶² Àü°øÀÇ ¼±»ý´ÔÀÇ Áú¹®°ú ÀúÀÇ ´äº¯À» ¼Ò°³ÇÕ´Ï´Ù. ±×·¸½À´Ï´Ù. ÃʽÉÀÚ ÀÔÀå¿¡¼­´Â lymphofollicular gastritis¿Í metaplastic gastritis°¡ ºñ½ÁÇØ º¸ÀÏ ¼ö ÀÖÀ» °Í °°½À´Ï´Ù.

Áø´Ü¸í¿¡ ´ëÇÑ ³í¶õÀÌ ÀÖ½À´Ï´Ù¸¸ Àú´Â nodular gastritis¶ó´Â ÀϺ»½Ä ¿ë¾îº¸´Ù´Â lymphofollicular gastritis¶ó´Â º¸´Ù ÀüÅëÀûÀÎ ¿ë¾î¸¦ ´õ ÁÁ¾ÆÇÕ´Ï´Ù. ¸²Æ÷¿©Æ÷¼º À§¿°Àº ³»½Ã°æ¿¡¼­ ´ß»ì ¸ð¾ç(¿µ¾î·Î´Â goose-skinÀ̶ó°í ºÎ¸¨´Ï´Ù)ÀÇ ÀÛÀº °áÀýµéÀÌ ÀüÁ¤ºÎ¿Í À§Ã¼ÇϺο¡¼­ °üÂûµË´Ï´Ù. Á¶Á÷°Ë»ç¿¡¼­´Â (1) ¸²ÇÁ¿©Æ÷ Çü¼º°ú (2) ¼±¿Í»óÇÇ °úÇü¼º ¼Ò°ßÀÌ °üÂûµË´Ï´Ù.

ÀþÀº ¿©¼º¿¡¼­ ÈçÇϸç Helicobacter pylori °¨¿°¿¡ µû¸¥ ¸é¿ª¹ÝÀÀÀÇ °á°ú·Î ÃßÁ¤µÇ°í ÀÖ½À´Ï´Ù. ³í¶õÀÌ ÀÖÁö¸¸ ¾Ï¹ß»ýÀÇ °íÀ§Çè »óȲÀ¸·Î Çؼ®µÇ´Â °æÇâÀÌ ÀÖ°í, Á¦±ÕÄ¡·á¸¦ ÇÏ´Â °ÍÀÌ ÁÁ°Ú½À´Ï´Ù. ¾Æ·¡´Â À¯»ç Áõ·ÊµéÀÔ´Ï´Ù.

Lymphofollicular gastritis¸¦ small granular type°ú large nodular typeÀ¸·Î ³ª´©±âµµ ÇÕ´Ï´Ù. Àú´Â small granular typeÀ¸·Î Çؼ®Çß½À´Ï´Ù.

ÀϺ»¿¡¼­´Â ÈçÈ÷ °áÀý¼º À§¿°(nodular gastritis)À̶ó°í ºÎ¸£°í ÀÖ°í ¿ì¸®³ª¶ó ³»½Ã°æÃ¥¿¡¼­µµ °áÀý À§¿°À̶ó´Â ¿ë¾î°¡ º¸ÀÔ´Ï´Ù (¾Æ·¡ ±×¸²). Àú´Â lymphofollicular gastritis¶ó°í ¾²´Â ÆíÀÔ´Ï´Ù. ±¹Á¦ÀûÀ¸·Î Á» ´õ Á߸³ÀûÀÎ ¿ë¾î¶ó°í »ý°¢Çϴϱî¿ä. ¿©ÇÏÆ° lymphofollicular gastritis ȤÀº nodular gastritis, ¾î´À ¿ë¾î¸¦ »ç¿ëÇصµ »ó°ü ¾ø½À´Ï´Ù.

Hp °Ë»ç°¡ ÇÊ¿äÇÑÁö ¹®ÀÇÇϽŠ¼±»ý´ÔÀÌ °è¼Ì½À´Ï´Ù. Àú´Â Hp °Ë»ç¸¦ ÇÏ°í ÀÖÀ¸¸ç, È®ÀεǸé Á¦±ÕÄ¡·á¸¦ ÇÕ´Ï´Ù. °ú°Å¿¡´Â »è°¨ ¿ì·Á°¡ ÀÖ¾úÀ¸³ª 2018³â 1¿ù 1ÀϺÎÅÍ´Â ÀÌ·± °æ¿ì 100/100 ºñ±Þ¿©·Î ó¹æÇÒ ¼ö ÀÖ°Ô µÇ¾ú½À´Ï´Ù.

¾Æ·¡ µ¿¿µ»óÀ» º¸½Ã±â ¹Ù¶ø´Ï´Ù.

Helicobacter 2022

* Âü°í 1): EndoTODAY Lymphofollicular gastritis

* Âü°í 2): EndoTODAY Ç︮ÄÚ¹ÚÅÍ À§¿°


Áõ·Ê 25

¼Ò°ß: (1) À§°¢ÀÇ ¼Ò¸¸¿¡, (2) 4x3 cm Å©±âÀÇ, (3) flat elevated lesionÀÌ ÀÖ½À´Ï´Ù. (4) º´º¯ÀÇ °æ°è´Â ºñ±³Àû ¸íÈ®ÇÏ°í, Ç¥¸éÀº ¾à°£ paleÇϸ鼭 nodularÇÕ´Ï´Ù. ÇÔ¹°ºÎ³ª ÁÖ¸§ º¯È­´Â ¾ø½À´Ï´Ù.

Áø´Ü: Gastric adenoma, r/o EGC IIa


[ÀÌÁØÇà comment]

À§¾Ï°ú ¼±Á¾ÀÇ ±¸ºÐÀÌ ¾î·Á¿î Áõ·ÊÀÔ´Ï´Ù. µÎ Áø´Ü Áß ¾î´À °ÍÀÌ ¿ÇÀºÁö ¸íÈ®ÇÏÁö ¾ÊÀ» ¶§ ¾î¶»°Ô Áø´Ü¸íÀ» ºÙ¿©¾ß ÁÁÀ»Áö °í¹ÎÀÔ´Ï´Ù. ¾î´À ÂÊÀÇ °¡´É¼ºÀÌ ´õ ³ôÀºÁö »ý°¢Çغ¸¸é ¾î¶³±î¿ä? ±×·¡¼­ Áø´Ü¸í¿¡ 'µÑ ´Ù °¡´ÉÇѵ¥, ¾î´À ÂÊÀÇ °¡´É¼ºÀÌ ´õ ³ô´Ù'´Â °ÍÀ» ¸íÈ®È÷ Ç¥ÇöÇÏ´Â °ÍÀÌÁö¿ä. ¸¹Àº ÈÆ·ÃÀÌ µÉ °ÍÀÔ´Ï´Ù. ¾î´À Àü°øÀÇ¿¡°Ô ´äÇÑ ³»¿ëÀ» ¼Ò°³ÇÕ´Ï´Ù.

°£È¤ metaplasia¶ó°í ´äÇϽô ºÐÀÌ °è½Ã´Âµ¥ ÀÌ Á¤µµ¸é ºÐ¸íÈ÷ flat elevated neoplastic lesionÀÔ´Ï´Ù.

ESD¸¦ ÇßÀ¸¸ç ÃÖÁ¾ º´¸®°á°ú´Â tubular adenoma, 3 x 3.5 cm, negative resection marginÀ̾ú½À´Ï´Ù.

À§ ¼±Á¾¿¡ ´ëÇÑ ¾Æ·¡ µ¿¿µ»óÀ» ²À º¸½Ã±â ¹Ù¶ø´Ï´Ù.

* Âü°í: EndoTODAY ¼±Á¾/ÀÌÇü¼º


Áõ·Ê 26

¼Ò°ß: À§Ã¼ÇϺΠÀüº®¿¡ ¾à 4cm Å©±âÀÇ °æ°è°¡ ºÒºÐ¸íÇÏ°í Ç¥¸éÀÌ ºÒ±ÔÄ¢ÇÑ ¹ßÀû°ú Åð»öÀÌ È¥ÀçÇÑ ¿µ¿ªÀÌ ÀÖÀ½. ¿©·¯ ¹æÇâ¿¡¼­ Á¡¸·ÁÖ¸§ÀÌ ²ø·Á¿À°í ÀÖÀ¸¸ç º´¼ÒÀÇ °æ°è ºÎ±Ù¿¡¼­ ²÷±è.

Áø´Ü: EGC IIb


[ÀÌÁØÇà comment]

Superfial flat lesionÀÌ°í ºÒ±ÔÄ¢ÇÏ°Ô hyperemicÇÑ Ç¥¸éÀÔ´Ï´Ù. ÁÖ¸§ÀÌ ²ø·Á¿À´Â °ÍÀº ÇÔ¸ôÇü º´¼ÒÀÇ Æ¯Â¡ÀÌÁö¸¸ ÀÌ È¯ÀÚÀÇ °æ¿ì ½ÇÁ¦·Î ÇÔ¸ô·Î º¸ÀÌÁö ¾ÊÀ¸¹Ç·Î EGC IIb¸¦ ÁÖ´Â °ÍÀÌ ¹«³­ÇÏ°Ú½À´Ï´Ù.

ÀÌ È¯ÀÚ´Â ³»½Ã°æ Á¶Á÷°Ë»ç ÈÄ ÃâÇ÷ÀÌ ¹ß»ýÇÏ¿© ³»½Ã°æ Àç°ËÀ» ÇÏ¿´´ø ºÐÀÔ´Ï´Ù. Á¶Á÷°Ë»ç ÈÄ °£È¤ ÃâÇ÷ÀÌ ¹ß»ýÇÒ ¼ö Àִµ¥ À§¾ÏÀÇ °æ¿ìµµ ¿¹¿Ü´Â ¾Æ´Õ´Ï´Ù.

³»½Ã°æ ¹× Á¶Á÷°Ë»ç ÈÄ melena¸¦ º¸¿© ½ÃÇàÇÑ ³»½Ã°æ¿¡¼­ ¶Ñ·ÇÇÑ ±Ë¾çÀÌ °üÂûµÇ¾ú½À´Ï´Ù. Á¶Á÷°Ë»ç·Î ÀÎÇÑ º¯È­ÀÔ´Ï´Ù.

¼ö¼úÀ» ÇÏ¿´°í ÃßÁ¤ÇÏ¿´´ø °Íº¸´Ù Å« °ÍÀ¸·Î ³ª¿Ô½À´Ï´Ù. Signet ring cell carcinoma¿¡¼­ ÈçÈ÷ ÀÖ´Â ÀÏÀÔ´Ï´Ù.

Early gastric carcinoma
1. Location : middle third, center at body and anterior wall
2. Gross type : EGC type IIb
3. Histologic type : signet-ring cell carcinoma
4. Histologic type by Lauren : indeterminate
5. Size : 6.5x3.3 cm
6. Depth of invasion : extension to mucosa (muscularis mucosa) (pT1a)
7. Resection margin: free from carcinoma, safety margin: distal 5.2 cm, proximal 4 cm
8. Lymph node metastasis : no metastasis in 33 regional lymph nodes (pN0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified

ÀÌ·¸°Ô Á¤¸®ÇØ º¾½Ã´Ù. EGC IIb´Â ùÀλ󺸴٠ũ´Ù!!!

EGC ºÐ·ùÀÇ ¸ðÈ£¼º¿¡ ´ëÇؼ­´Â ÀÏÀü¿¡ ¼³¸íµå¸° ¹Ù ÀÖ½À´Ï´Ù. IIb´Â flatÇÑ ÇüÅÂÀε¥, ±×·¸´Ù¸é fold´Â ¾ø¾î¾ß ÇÏ´Â °Í ¾Æ´Õ´Ï±î? ±×·±µ¥ ½ÇÁ¦·Î´Â fold º¯È­°¡ ÀÖ´Â EGC IIbµµ ÀÖ½À´Ï´Ù. ¿©ÇÏÆ° EndoTODAY Á¶±âÀ§¾Ï ³»½Ã°æ ºÐ·ù¸¦ õõÈ÷ Àо½Ã±â ¹Ù¶ø´Ï´Ù.

PPT PDF 0.4 M


Áõ·Ê 27

¼Ò°ß: À§Ã¼ÇϺΠ(À§°¢ Á÷»óºÎ) ¼Ò¸¸-Àüº®¿¡ 3-4cm Å©±âÀÇ À¶±âµÈ º¯¿¬À» °¡Áø ±Ë¾çÀÌ °üÂûµÊ. ±Ë¾çÀÇ edge´Â geographicÇÏ°í spiculationÀ» º¸À̸ç, ±Ë¾çÀÇ ¹Ù´ÚÀº ºñ±³Àû flatÇÏ°í exudate·Î µ¤¿© ÀÖÀ½.

Áø´Ü: EGC IIa+III


[ÀÌÁØÇà comment]

¾ÏÀÎÁö ¾ç¼º ±Ë¾çÀÎÁö ¾Ö¸ÅÇÒ ¶§ °á°ú¸¦ ¾î¶»°Ô ½á¾ß ÇÏ´ÂÁö Áú¹®ÀÌ À־ ¾Æ·¡¿Í °°ÀÌ ´äÇÏ¿´½À´Ï´Ù. »ç½Ç ÀÌ È¯ÀÚ´Â ¾ÏÀÌ È®½ÇÇÑ °æ¿ì¿´Áö¸¸....

DEX workshop °­ÀÇ·Ï Áß¿¡¼­

'Ulcer with marginal edema/thickening'À¸·Î º¼ ¼öµµ ÀÖ°í 'mass with central irregular ulcer'·Î º¸´Â °Íµµ °¡´ÉÇÒ °Í °°½À´Ï´Ù. ¾î´À °ÍÀÌ ´õ Àû´çÇÒÁö °í¹ÎÇØ º¾½Ã´Ù.

À§¾ÏÀÇ ½É´Þµµ Áø´ÜÀº ½±Áö ¾Ê½À´Ï´Ù. 80% ¸ÂÃß¸é ³ª»ÚÁö ¾ÊÀ» Á¤µµÀÔ´Ï´Ù. EndoTODAY À§¾Ï ½É´Þµµ Áø´ÜÀ» ²À Àо½Ã±â ¹Ù¶ø´Ï´Ù.

EGC IIa + III°¡ ´õ ÁÁÀ»Áö IIa + IIc°¡ ´õ ÁÁÀ»Áö Àúµµ Àß ¸ð¸£°Ú½À´Ï´Ù. IIc·Î ºÙÀ̱⿡´Â ±í°í, III·Î ºÙÀ̱⿡´Â ¾èÀº °Í °°°í... »ç½Ç ÀÌ·± Áõ·Ê°¡ ¸Å¿ì ¸¹½À´Ï´Ù. ¼ö¼úÀ» ÇÏ¿´°í »ý°¢º¸´Ù ±íÀº °ÍÀ¸·Î, mass lesionÀ̸鼭 Áß¾Ó¿¡ ±Ë¾çºÎ°¡ µ¿¹ÝµÈ °ÍÀ¸·Î ³ª¿Ô½À´Ï´Ù. º´¸®°á°ú¸¦ º¸°í ÈÄÇâÀûÀ¸·Î »ý°¢Çغ¸¸é º´¼ÒÀÇ ÁÖµÈ Æ¯Â¡ÀÌ ±Ë¾çÀÌ ¾Æ´Ï°í °æ°è°¡ ¸íÈ®ÇÏÁö ¾ÊÀº ³ÐÀº mass·Î º¼ ¼öµµ ÀÖ°Ú´Ù´Â »ý°¢ÀÌ µì´Ï´Ù. ÃßÁ¤Çß´ø °Íº¸´Ù ÈξÀ Å« °ÍÀ¸·Î ³ª¿Ô½À´Ï´Ù.^^

Advanced gastric carcinoma, mimicking EGC type IIb+IIc, low body along the lesser curvature,
Adenocarcinoma, poorly differentiated, diffuse type;
1) tumor size: about 8x4.5 cm
2) extension to the subserosa
3) no endolymphatic tumor emboli
4) negative resection margins (proximal: about 3 cm; distal: about 3 cm)
5) no metastasis in 48 perigastric lymph nodes

* Âü°í: EndoTODAY À§¾Ï ħÀ± ±íÀÌ


Áõ·Ê 28 - ½ÊÀÌÁöÀå

¼Ò°ß: (1) ½ÊÀÌÁöÀå 2ºÎ¿¡, (2) 4-5 cm Å©±âÀÇ (3) ulcerative lesionÀÌ º¸ÀÔ´Ï´Ù. (4) ±Ë¾çÀÇ ¹Ù´ÚÀº necroticÇÏ°í dirty exudate·Î µ¤¿©ÀÖÀ¸¸ç, edge´Â ºñ±³Àû ¸í·áÇÏÁö¸¸ marginÀº heaped up µÇ¾î ÀÖ½À´Ï´Ù.

Áø´Ü: Duodenal cancer


[ÀÌÁØÇà comment]

±Ë¾çÀ¸·Î ´äÇϽŠºÐÀÌ Àý¹Ý Á¤µµ¿´´Âµ¥¿ä... ½ÊÀÌÁöÀåµµ ¾ÏÀÌ ÀÖÀ½À» ÀØÁö ¸¶¼¼¿ä.

¼ö¼ú °á°ú´Â ¾Æ·¡¿Í °°¾Ò½À´Ï´Ù.

PERIAMPULLARY DUODENAL CANCER
1. Type of specimen : Whipple resection
2. Histopathologic Diagnosis : Adenocarcinoma, M / D
(1) Tumor site : duodenal
(2) Tumor size : 6x4 cm
(3) T3 : Tumor invades pancreas and periduodenal adipose tissue
(4) Involvement of pancreas and duodenum : present
(5) N1 : Regional lymph node metastasis (2/5: "LN8", 0/2; "LN12", 0/1; peripancreatic lymph node, 2/2(dNi))
(6) M0 : No distant metastasis
(7) Negative resection margins (R0 : complete resection with grossly and microscopically negative resection margins)
(8) perineural invasion: present
(9) lymphovascular invasion: present
(10) mucin production: irregular
(11) pancreas autolysis, moderate
(12) autolysis: gallbladder

¾Æ·¡ ½ÊÀÌÁöÀå ¾Ï »çÁøµéÀ» Àß ºÁ µÎ¼¼¿ä.

°¡Àå Áß¿äÇÑ Áõ·ÊÀÔ´Ï´Ù!!! ¸î ¹øÀÇ Á¶Á÷°Ë»ç¿¡¼­ ¾ÏÀ¸·Î ³ª¿ÀÁö ¾Ê¾Æ Áø´ÜÀÌ ´Ê¾îÁ³´ø Áõ·ÊÀÔ´Ï´Ù. ÀÌ·± Á¤µµÀÇ ¼Ò°ßÀÌ º¸À̸é Á¶Á÷°Ë»ç¿¡¼­ ¾ÏÀÌ ³ª¿ÀÁö ¾Ê¾Æµµ ¹Ýµå½Ã, ¹Ýµå½Ã ¾ÏÀ» ÀǽÉÇØ¾ß ÇÕ´Ï´Ù.

M/D adenocarcinoma, 3.5 x 3 cm, extension to subserosa, metastasis to 3 out of 10 regional lymph nodes

Obstruction (+), hepatic metastasis (+)

Bowel habit change·Î ´ëÀå³»½Ã°æ¿¡¼­ ¿ìÃø ´ëÀå¾ÏÀÌ ¹ß°ßµÇ¾ú°í ¿ì¿¬È÷ ½ÃÇàÇÑ À§³»½Ã°æ¿¡¼­ duodenal adenocarcinomaµµ ÇÔ²² Áø´ÜµÇ¾úÀ½. Whipple ¼ö¼ú°ú right hemicolectomy¸¦ µ¿½Ã¿¡ ½ÃÇàÇÏ¿´À½.

¿ÜºÎ ³»½Ã°æ¿¡¼­ "duodenal 3rd part ulcer and stricture (biopsy: atypical glands)" ¼Ò°ßÀ¸·Î ÀÇ·ÚµÈ ºÐÀ¸·Î ³»½Ã°æ Àç°Ë¿¡¼­ M/D adenocarcinoma·Î ¼ö¼úÇÑ Áõ·ÊÀÔ´Ï´Ù. ³»½Ã°æ ¼Ò°ß°ú ¼ö¼ú º´¸®¸¦ ¼Ò°³ÇÕ´Ï´Ù.
³»½Ã°æ ¼Ò°ß: Duodenal 2nd to 3rd portionºÎÀ§¿¡ lumenÀ» encirclingÇÏ´Â mass °üÂûµÇ¾úÀ¸¸ç ¼Ò¾Æ¿ë ´ëÀå ³»½Ã°æÀ» ÀÌ¿ëÇÏ¿© ÁøÀÔ ½ÃµµÇÏ¿´À¸³ª massÀÇ À§Ä¡°¡ angulation Á÷ÈÄÀÌ°í lumenÀÌ Á¼¾ÆÁ®ÀÖ¾î scopeÀÌ Åë°úµÇÁö ¸øÇß½À´Ï´Ù. À§³»½Ã°æÀ¸·Î ¹Ù²Ù¾î tryÇßÀ¸³ª ÃÖ´ëÇÑ »ðÀÔÇصµ massÀÇ ÀÔ±¸±îÁö ¹Û¿¡ µµ´ÞÇÏÁö ¸øÇÏ¿©, ´Ù½Ã ¼Ò¾Æ¿ë ´ëÀå³»½Ã°æ¿¡ capÀ» ÀåÂøÈÄ tryÇßÀ¸³ª ¿ª½Ã ÁøÀÔºÒ°¡´ÉÇÏ¿© ÃÖ´ëÇÑ forceps¸¦ ¹Ð¾î³Ö¾î Á¶Á÷°Ë»ç¸¦ ½ÃÇàÇß½À´Ï´Ù.
DUODENAL CANCER
1. Type of specimen : PPPD
2. Histopathologic Diagnosis : Adenocarcinoma, moderately differentiated
(1) Tumor site : duodenal
(2) Tumor size : 4.5x4 cm
(3) T3 : Tumor invades through the muscularis propria into the subserosa
(4) Involvement of pancreas: absent
(5) N1 : Regional lymph node metastasis (2/16: "peri-SMA tissue" for frozen section-1, 0/1; "LN8,12", 0/6; "periCBD&peripancreatic LN", 1/3; periduodenal, 1/2; peripancreatic, 0/4)
(6) M0 : No distant metastasis
(7) Negative (pancreas, common bile duct, retropancreatic) resection margins

EndoTODAY 'À§³»½Ã°æ »ðÀÔ°ú °üÂû' 193ÂÊÀ» Âü°íÇϽʽÿÀ.

* Âü°í: EndoTODAY ½ÊÀÌÁöÀå ¾Ï


[Archives]

2016-11.

2017-8-7. Àü°øÀÇ 3³âÂ÷ ¼±»ý´ÔÀÇ ´äº¯

2018-11-28. ÇÑ ±ºÀÇ°üÀÇ quiz ´ä¾È¿¡ ´äÇÔ

2021-2-22. ÇÑ Àü°øÀÇÀÇ quiz ´ä¾È¿¡ ´äÇÔ



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