[Description exercise 8 ؼ]

[ܼҸ Ѹ]

Ǫ ҽϴ. 50% ߴ Դϴ.

˾ մϴ. ׸ Ʒ Ǹ ñ ٶϴ.

˾ . 2021-9-6

Impression ϳ ϰ մϴ.


Case 50. ϱ, ˾ϱ?


[ ؼ]

˾ Դϴ. ˾ ܹް ġ ŷ ̾ ð Ұ ˾ ⿡ ϴ. Ʒ 3 Դϴ. Ȱҽϴ.


Ƹ ʿ մϴ. ü Ҹ ĺ ˾̾ ︮ڹ ġ PPI 縸 ҽϴ.

Ʒ ˾ ʵԴϴ. κ ǽ Ƿڵ ̾ϴ.

ǽ ̴µ ſ ־ٰ ؼ 7 Ҵµ 100% Ͽ.

Ȥ MALToma ƴѰ Ǵ ʿϴ. ָ ̻Ͽ...

follow up Ͽ ̾ BGU scar. ˾ ġ ٰ Ͻ.

20 ˾ ġ .


׷ ⼭ ϸ Ǵ Ʈ ֽϴ. Ʒ ȯڴ EGC-like AGCϴ. ־ ε...


Advanced gastric carcinoma
1. Location : upper third, Center at body and posterior wall
2. Gross type : Borrmann type 3
3. Histologic type : tubular adenocarcinoma, poorly (poorly cohesive) differentiated
4. Histologic type by Lauren : diffuse
5. Size : 3.7x2.8 cm
6. Depth of invasion : penetrates subserosal connective tissue (pT3)
7. Resection margin: free from carcinoma, safety margin: proximal 2.7 cm, distal 11.7 cm
8. Lymph node metastasis : metastasis to 3 out of 38 regional lymph nodes (pN2)
9. Lymphatic invasion : present(+++)
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. Peritoneal cytology : negative
13. AJCC stage by 7th edition: pT3 N2


Ʒ õϸ鼭 quiz ؼ Ĩϴ. ñ ٶϴ.


Case 51. ϱ, ˾ϱ?


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Դϴ. ܺο atypical gland Դٰ Ƿڵ Դϴ. ܺν̵ ǵ ˻ ˿ ߽ϴ.

ð impression ̴ Ե ϴ. ϴٴ , feeling, ߿մϴ. Edge sharpѵ (overriding), ̰, margin ణ edematous ź ʰ ణ ϰ, ulcer crater ణ exudate ̷̻ ġ ٴ ... ư benign ulcerʹ ٸ Դϴ.

Ұ ϴµ ָ ֽϴ. 亯 Ұմϴ. ƿ﷯ blue book ( ð åԴϴ) Ұմϴ.

ε EGC III ؾ AGC B-II or B-III ؾ ణ ε˴ϴ. ׷ ۰ EGC III ִ . Ȥ AGC ֽ е ôµ... ¥ ϰ ༺ ð 80% ǹǷ ũ ġ ʾƵ ǰڽϴ.

׷... ܺ ð ޸ ð ˾ healing ̾ϴ. PPI ̽ϴ. PPI Ͽ healing Ǿٰ benign ƴմϴ. healing Ǿ ˻簡 ʿ ִ Դϴ.

ũ ߴ ̻̾ϴ. ¾ ֺ ߽ϴ.


Stomach, subtotal gastrectomy:
Early gastric carcinoma
1. Location : lower third, Center at body and lesser curvature
2. Gross type : EGC type IIc and IIa
3. Histologic type : tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : intestinal
5. Size : 3.9x2.5 cm
6. Depth of invasion : invades mucosa (muscularis mucosae) (pT1a)
7. Resection margin: free from carcinoma, safety margin: proximal 3.5 cm, distal 6.3 cm
8. Lymph node metastasis : no metastasis in 65 regional lymph nodes (pN0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. AJCC stage by 7th edition: pT1a N0

* : EndoTODAY ħ


Case 52. ϱ, ˾ϱ?


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˾Դϴ. NSAID-associated ulcerԴϴ. Aspirin, clopidogrel, meloxicam ϰ ִ ȯڰ melena ޽ ã̴ Դϴ. ׷ ˾ ϳ ƴմϴ. ū ˾纸 ణ distal ʿ ˾ ֽϴ. Multiple ulcer NSAIS-associated ulcer ߿ Ư¡ ϳԴϴ.

Fold ʰ ĺʿ Ϳ Ͽ comment ֽ ... fold ֽϴ. ̿ mid-antrum transverse fold pseudo-angle̶ θ Դϴ.

ǥõ ġ ϱ? üϺ Ҹ Ƿڵ ȯڿ, ġ Ҹ transverse fold ٴ ̰, ٴ Ʒ̾ϴ. ȯڿ ġ Ҹ̶ θ Ȯ ǥԴϴ.

2017 ӻ󰭻 Բ ֽ 亯Դϴ. ʹ Ǿ ־ Ұմϴ. ڸ stageԴϴ. H1 ϴ A2 ϴ ָѵ... A2 ϰ ͽϴ. A2 ణ regenerating epithelium ֽϴ.

"Gastric antrum L/C side 2 ulcer . Proximal side ulcer ˾ ο yellowish exudate Ȯ. ο growth Ǹ δ shrinkǾ . ð ˻ÿ Ǵ clip . Distal side ulcer ũⰡ ۰ yellowish exudate .
Impression : BGUs, H1"


Case 53. ϱ, ˾ϱ?


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˾Դϴ. ũٰ ƴմϴ.

ȯڴ ܺ ̴µ, ó ˾ ǽϴ. H. pylori ġḦ ˾ ġḦ ø鼭 Ұ ӵ ȣǾϴ.

ȯڴ 7 ˾ ο ߰ߵǾ ̽ϴ.


Stomach, subtotal gastrectomy:
Early gastric carcinoma
1. Location : middle third, Center at low body and lesser curvature
2. Gross type : EGC type IIc
3. Histologic type : signet-ring cell carcinoma
4. Histologic type by Lauren : diffuse
5. Size : 4x3 cm
6. Depth of invasion : invades submucosa (sm2) (pT1b)
7. Resection margin: free from carcinoma, safety margin: proximal 3 cm, distal 7 cm
8. Lymph node metastasis : no metastasis in 27 regional lymph nodes (pN0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. Peritoneal cytology : negative
13. AJCC stage by 7th edition: T1b N0


Case 54. ϱ, ˾ϱ?


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Դϴ. ˻翡 poorly differentiated tubular adenocarcinoma Ͽ SM1 ħ ̺ȭ ȥ Խϴ.


Stomach, subtotal gastrectomy:
Early gastric carcinoma
1. Location : lower third, Center at antrum and lesser curvature
2. Gross type : EGC type IIc
3. Histologic type : tubular adenocarcinoma, moderately differentiated (60%) >> poorly differentiated (40%)
4. Histologic type by Lauren : intestinal
5. Size : 1.5x1.2 cm
6. Depth of invasion : invades submucosa (sm1) (pT1b)
7. Resection margin: free from carcinoma, safety margin: proximal 10.7 cm, distal 2.4 cm
8. Lymph node metastasis : no metastasis in 20 regional lymph nodes (pN0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. Peritoneal cytology : negative
13. AJCC stage by 7th edition: pT1a N0

 Բ ҿ Ͽ '' ǥ ̽ϴ ("Antrum LC side 2cm . ϸ, ߽ɺο geographic depression ⹰ "). ϸ Ʋ ƴ... ׷ ʸ Ƚϴ.

"̰ ε.... EGC ǽɵǸ 'superficial elevated lesion with central depression ִ' AGC ǽɵǸ 'mass ִ' ֽϴ. impression , '' ǥ ʹ Ƽ 帮 ͽϴ. '۰ ' ϸ ȵǴ ñ ... ׳ ̴ Ͽ ֽñ ٶϴ. ҿ ǥ impression ġŰ Դϴ."


Case 55. ϱ, ˾ϱ?


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Դϴ. tumor island ұ? Ըΰ Ƿ ޲ ִµ ֺ ƴϰ ߾ Դϴ. Բ 'ring ulcer' ǥ ̽ϴ. ϴ. ڸ Ʒ ׸ ϱ...

Subtotal gastrectomy
1. Location : middle third, Center at body and lesser curvature
2. Gross type : EGC type IIc
3. Histologic type : tubular adenocarcinoma, poorly solid(50%) and poorly cohesive(50%)
4. Histologic type by Lauren : mixed
5. Size : 2.3x1.2 cm
6. Depth of invasion : invades mucosa (muscularis mucosae) (pT1a)
7. Resection margin: free from carcinoma, safety margin: proximal 5.4 cm, distal 3.6 cm
8. Lymph node metastasis : no metastasis in 27 regional lymph nodes (pN0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. AJCC stage by 7th edition: pT1a N0


Case 56. ϱ, ˾ϱ?


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˾Դϴ. Edge ణ ұĢϰ overriding ִٰ ƴմϴ. Ʒ 2 Դϴ.

ҽϴ. ̶ ԸλӸ ƴ϶ β ü ̾ ϴµ... Ϳ ϵٴ edema ʽϱ? ׷ϴ. ϴ. ȼҰ߸ 100% ߱ ƽϴ. 츮Դ ˻ follow-up̶ Ⱑ Ȱϸ ϰ ġ ֽϴ.


[Archives]

[2016-11-29. comment]

description ϴ. ׷ "̹ ִ ϴ ̰ ־ϴ.^^" Ϳ comment ֽ е ̽ϴ. մϴ.

ð 2޵ ʾҴµ ߼̽ϴ. Դٰ 100 е ̽ϴ. ϰ մϴ.

׺ Դϴ. ù ϴ.

503/7 (43%)
515/7 (71%)
526/7 (86%)
534/7 (57%)
547/7 (100%)
557/7 (100%)
563/7 (43%)

ڽְ . 'Ulcer lesion ' ٴ 'ulcer ' ϴ. 'Ovoid shape' ٴ 'ovoid' ϴ.

'Lower body lesser curvature side' 'side' ٶϴ. 'üϺ Ҹ' 'üϺ Ҹʿ' Դϴ.

EGC IIc Դϴ. EGC 2c ô. ? ٵ EGC IIc ϱ.

50 - ʽڵ鲲 ϴ. BGU scarε... ̰ ǽϸ ȯڰ ˻縦 ް, ˻縦 ް, ˻縦 ް ˴ϴ.

52 - ٹ߼̶ ġä ʾҽϴ. ū ˾纸 distal ʿ ˾ ̽? NSAIDs-associated ulcers Դϴ.

54 - AGC Ͻ ҽϴ. ׷ EGC ׿. δ , üο fundus ϴ.

55 - EGC з ? Ըΰ ִµ Ը tumor island ִ ? ׷ٸ IIc??? Ե з Դϴ.


2018-11-3.

2024-5-23


ð ⿡ ߿ Դϴ. Ʒ ñ ٶϴ. ð ȣ Բ ۾ Դϴ.

© Ͽð汳 ٸð濬 . EndoTODAY Endoscopy Learning Center. Lee Jun Haeng.