[Description exercise 10 Çؼ³] - ðû

[ÀܼҸ® ÇѸ¶µð]

»ï¼º¼­¿ïº´¿ø ³»½Ã°æ½Ç¿¡¼­ ȯÀÚ¿¡°Ô Á¦°øÇÏ°í ÀÖ´Â '³»½Ã°æ °Ë»ç ÈÄ ÁÖÀÇ»çÇ×'µµ Çѹø Àо½Ã±â ¹Ù¶ø´Ï´Ù.


Case 64.

Áø´Ü: Lymphofollicular gastritis

[ÀÌÁØÇà comment]

³»½Ã°æ ¿ë¾îÀÇ Å©±â ±âÁØ¿¡ ´ëÇÏ¿© Àá½Ã »ý°¢ÇØ º¸¾Ò½À´Ï´Ù.

ÇÑ Àü°øÀÇ ¼±»ý´ÔÀÇ ´äº¯°ú ¶Ç ´Ù¸¥ ±ºÀÇ°ü ¼±»ý´ÔÀÇ ´äº¯¿¡ Á¶±Ý ±æ°Ô comment ÇØ º¸¾Ò½À´Ï´Ù.

ÀϺ»ÀεéÀÌ "°áÀý¼º À§¿° (nodular gastritis)"À̶ó°í À̸§ÁöÀº °ÍÀº ¹«Ã´ ´çȤ½º·¯¿î ÀÏÀÔ´Ï´Ù. ´ëºÎºÐÀÇ °áÀý¼º À§¿°¿¡´Â °áÀýÀº ¾ø±â ¶§¹®ÀÔ´Ï´Ù. °áÀý¼º À§¿°¿¡ °áÀýÀÌ ¾ø´Ù??? ´ëºÎºÐ °ú¸³(granule)ÀÔ´Ï´Ù. 2010³â ¹ß°£µÇ¾î ÇöÀç±îÁö Ç¥ÁØ ³»½Ã°æ ±³°ú¼­·Î »ç¿ëµÇ°í ÀÖ´Â 'Àü°øÀÇ¿Í °³¿øÀǸ¦ À§ÇÑ ¼ÒÈ­±â ³»½Ã°æ ¾ÆƲ¶ó½º' 100ÂÊÀ» º¸¸é, °áÀý¼º À§¿°ÀÇ subtypeÀ» 2-3mm ÀÌ»óÀº nodular pattern, 1-2mm Á¤µµ´Â granular patternÀ¸·Î ºÐ·ùÇÏ°í ÀÖ½À´Ï´Ù. Nodular gastritisÀÇ subtypeÀ» nodular pattern°ú granular patternÀ¸·Î ³ª´« ¼ÀÀÔ´Ï´Ù. Nodular patternÀÇ nodular gastritis´Â µ¿¾î ¹Ýº¹ÀÔ´Ï´Ù. ¿ëÀÇÀÇ Á¤ÀÇ Ãø¸é¿¡¼­µµ Ʋ·È½À´Ï´Ù. NoduleÀº º¸Åë 5mm ÀÌ»óÀÏ ¶§ »ç¿ëÇÏ´Â ¿ë¾îÀ̹ǷΠ2-3mmÀÎ °ÍÀ» nodular patternÀ¸·Î ºÎ¸£´Â °Íµµ ¿ÇÁö ¾Ê½À´Ï´Ù. °Ô´Ù°¡ (non-nodular) granular patternÀÇ nodular gastritis¶ó´Â ¸»Àº ´õ¿í ÀÌ»óÇÕ´Ï´Ù. NoduleÀÌ ¾ø´Â nodular gastritis??? ¿ÂÅë ÀÌ»óÇÕ´Ï´Ù. ±×³É ÀϺ»ÀÇ ÀüÅëÀÏ »ÓÀÔ´Ï´Ù. ±×·¡¼­ Àú´Â lymphofollicular gastritis¶ó´Â ¿ë¾î¸¦ ¼±È£ÇÕ´Ï´Ù. Nodular gastritis¶ó°í ´äÇÏ¿´´Ù°í È¥³»Áö´Â ¾Ê½À´Ï´Ù. "³í¸®ÀûÀ¸·Î ÀÌ»óÇÏ°í èÞßäµµ ÁøÇÑ Ç¥ÇöÀº ÇÇÇÏ´Â °ÍÀÌ ³ªÀ»ÅÙµ¥..."¶ó°í Àú È¥ÀÚ »ý°¢ÇÒ »ÓÀÔ´Ï´Ù. ³»½Ã°æ ¿µ¿ª¿¡¼­ ÀϺ»ÀÇ ¿µÇâ·ÂÀº ³Ê¹« ¸·°­ÇÕ´Ï´Ù. ÀϺ»À» ¿ÏÀüÈ÷ ºÎÁ¤ÇÏ¸é ³»½Ã°æ ÀÚü°¡ ¼º¸³ÇÏÁö ¾Ê½À´Ï´Ù. 'Á¶±â À§¾Ï'À̶ó´Â °³³äÀ» ºÎÁ¤ÇÏ°í ³»½Ã°æÀ» ÇÒ ¼ö ¾ø´Â °Íó·³ ¸»ÀÔ´Ï´Ù. ¿ì¸®µµ ÈûÀ» ¸ð¾Æ ¿ì¸® ÀÚüÀÇ ¿ë¾î¸¦ Á¤¸³ÇÒ ¶§ÀÔ´Ï´Ù. ±×°Ô ÁøÁ¤ÇÑ µ¶¸³ ¾Æ´Ò±î¿ä? ³»½Ã°æ ¼±¹è·Î¼­ ºÎ²ô·¯¿ï µû¸§ÀÔ´Ï´Ù.

ÂüÀ¸·Î ¾Ö¸ÅÇÑ ¹®Á¦ÀÔ´Ï´Ù. Helicobacter °Ë»çÀÇ ÀûÀÀÁõÀÌ ¹ÌÁ¤ÀÔ´Ï´Ù. ÀÏ´Ü Ç︮ÄÚ¹ÚÅÍ°¡ ÀÖÀ» ¶§¿¡ ¾î¶² Á¶°Ç¿¡¼­´Â ²À Ä¡·á¸¦ ÇÏ°í, ¶Ç ´Ù¸¥ Á¶°Ç¿¡¼­´Â ¼±º°±Þ¿©·Î ó¹æÇÒ ¼ö ÀÖ½À´Ï´Ù. ±×·±µ¥ ¾î¶² Á¶°Ç¿¡¼­ Ç︮ÄÚ¹ÚÅ͸¦ °Ë»çÇØ¾ß ÇÏ´ÂÁö°¡ Á¤ÇØÁ® ÀÖÁö ¾Ê½À´Ï´Ù. ÀÌ ºÎºÐ¿¡ ´ëÇؼ­´Â Åä·Ð°ú °¡À̵å¶óÀÎ Á¦Á¤ÀÌ ÇÊ¿äÇÕ´Ï´Ù. ÀÏ´Ü ÀúÀÇ position statement¸¦ º¸½Ã±â ¹Ù¶ø´Ï´Ù. Ä¡·á´Â Àû±ØÀûÀ¸·Î Ç쵂 Áø´ÜÀº ´Ù¼Ò À¯º¸ÀûÀÎ ÀÔÀåÀÔ´Ï´Ù. ´Ù¸¸, lymphofollicular gastritis¿¡¼­´Â ²À °Ë»çÇÏ°í ²À Ä¡·áÇÏ´Â °ÍÀÌ ÁÁ°Ú½À´Ï´Ù. ºñ·Ï ¼±º°±Þ¿©ÀÌ´õ¶óµµ.... lymphofollicular gastritis¸¦ º¸¾Ò´Ù¸é... ȯÀÚ°¡ ¿øÇÏ´ø ¿øÇÏÁö ¾Ê´ø ÀÏ´Ü °Ë»ç¸¦ ÇÏ°í ÀÌÈÄ¿¡ ¿Ü·¡¿¡¼­ Á¦±ÕÄ¡·á¸¦ °­ÇÏ°Ô ±ÇÇϽñ⠹ٶø´Ï´Ù.

* Âü°í: EndoTODAY lymphofollicular gastritis


Case 65

Áø´Ü: Helicobacter gastritis


[ÀÌÁØÇà comment]

Portal hypertensive gastropathy¸¦ »ý°¢ÇϽŠºÐÀÌ °è¼Ì½À´Ï´Ù. ÀÓ»ó»óÀ» ¾Ë¸é ½±°Ô ±¸ºÐÇÒ ¼ö ÀÖ°ÚÁö¸¸ ³»½Ã°æ ¼Ò°ß¸¸À¸·Î´Â ´Ù¼Ò ¾î·Á¿ï ¼ö ÀÖÀ» °Í °°±âµµ ÇÕ´Ï´Ù. ±×·¯³ª H. pylori gastritis¿¡¼­´Â ºÎÁ¾Àº ´úÇÑ ÆíÀÌ°í ºÒ±ÔÄ¢ÇÑ ¹ßÀûÀÌ ÇöÀúÇÑ Á¡À» °í·ÁÇÏ¸é ±¸ºÐÇÒ ¼ö ÀÖÀ» °Í °°½À´Ï´Ù.

ÇÑ ¼±»ý´Ô²²¼­ acute H. pylori-gastritis¶ó´Â Áø´ÜÀ» Áּ̱⿡ H. pylori °¨¿°¿¡¼­ acuteÀÇ Àǹ̿¡ ´ëÇÏ¿© »ý°¢ÇØ º¸¾Ò½À´Ï´Ù.

Hemorrhagic gastritis¶ó°í ´äÀ» ÁֽŠºÐÀÌ °è¼Ì½À´Ï´Ù. °ú°Å¿¡´Â hemorrhagic gastritis¶ó°í ºÎ¸£±âµµ ÇÏ¿´°í, ÀϺ»¿¡¼­´Â ¾ÆÁ÷µµ ±×·¸°Ô ºÎ¸£°í Àֱ⵵ ÇÕ´Ï´Ù. ±×·¯³ª ¿©·¯ ÀÌÀ¯·Î ¿ì¸®³ª¶ó¿¡¼­´Â hemorrhagic gastritis¶ó´Â ¿ë¾î¸¦ ¾²Áö ¸» °ÍÀ» Á¦¾ÈÇÕ´Ï´Ù. ȯÀÚ°¡ ³Ê¹« ³î¶ó°Åµç¿ä. Ç÷¼º ±¸Åä, Ç÷º¯ µîÀÌ ¾ø´ø ȯÀÚ¿¡¼­ hemorrhagic gastritis¶ó´Â ¿ë¾î¸¦ ¾²Áö ¸¿½Ã´Ù.

¾Æ·¡ °­ÀÇ µ¿¿µ»óÀ» ÇÑ ¹ø º¸½Ã±â ¹Ù¶ø´Ï´Ù.

¾Æ·¡ quiz¸¦ Ç®¾îº¸¼¼¿ä.

PDF 1.8M. °Ç±¹´ë À̼±¿µ ±³¼ö´ÔÀÇ À§¿° quiz ¹®Á¦¿Í Çؼ³ (2021-9-13)

* Âü°í: EndoTODAY Ç︮ÄÚ¹ÚÅÍ À§¿°


Case 66. History of liver cancer treatment

Áø´Ü: Radiation gastroduodenitis with bleeding (´õ Á¤È®È÷ ¸»Çϸé gastroduodenopathy°¡ ¸Â½À´Ï´Ù. ¿Ö³ÄÇϸé RT¿¡ ÀÇÇÑ ¼Õ»óÀº ¿°ÁõÀÌ ÇöÀúÇÏÁö ¾ÊÀ¸¹Ç·Î... ±×·¯³ª °ü·Ê»ó ¸ðµÎµé gastroduodenitis¶ó°í ºÎ¸¥´ä´Ï´Ù.)


[ÀÌÁØÇà comment]

Numerous hemorrhagic spotÀ̶ó°í ±â¼úÇϽŠºÐÀÌ °è½Åµ¥¿ä.... numerous petechiae ȤÀº numerous hyperemic spotÀÌ ´õ ÁÁ°Ú½À´Ï´Ù. ¿Ö³ÄÇÏ¸é ½ÇÁ¦·Î numerousÇÑ °÷¿¡¼­ ÇÇ°¡ ³­ °ÍÀº ¾Æ´Ï´Ï±î¿ä.

* Âü°í: EndoTODAY ¹æ»ç¼± °ü·Ã À§Àå°ü ¼Õ»ó


Case 67. History of chronic liver disease and melena

Áø´Ü: Gastric varix with evidence of recent bleeding


[ÀÌÁØÇà comment]

¾Æ·¡ Áõ·Êµµ Âü°íÇϼ¼¿ä.

Gastric varix·Î ÀÎÇÑ ÃâÇ÷À̾ú°í Histoacryl injection À¸·Î ÁöÇ÷µÇ¾úÀ½. Histoacryl¿¡ lipiodolÀ» ¼¯¾î »ç¿ëÇϹǷΠX-ray¿¡¼­ ÁÖ»çºÎÀ§¸¦ ¹ß°ßÇÒ ¼ö ÀÖ½À´Ï´Ù.

* Âü°í: EndoTODAY À§Á¤¸Æ·ù


Case 68. History of hematologic disease

Áø´Ü: CMV gastritis

* Âü°í: EndoTODAY CMV À§¿°


Case 69. Á÷Àå¾Ï¿¡ ´ëÇÑ palliative RT¿Í Æó¾Ï¿¡ ´ëÇÑ Ç×¾ÏÄ¡·á¸¦ ¹Þ´ø ȯÀÚÀÇ »óºÎÀ§Àå°ü ÃâÇ÷

Áø´Ü: Gastric mucormycosis


[ÀÌÁØÇà comment]

°°Àº ȯÀÚÀÇ follow up EGD ¼Ò°ßµµ Âü°íÇϽñ⠹ٶø´Ï´Ù.

3 weeks later

8 weeks later


±×·¸½À´Ï´Ù. ³»½Ã°æ »çÁøÀ» º¸¸é °¡Àå ¸ÕÀú diffuseÇÑÁö focalÇÑÁö ±¸ºÐÇØ º¸½Ê½Ã¿À. °¨º°Áø´ÜÀÌ È® ÁÙ¾îµì´Ï´Ù.

* Âü°í: EndoTODAY Mucormycosis


Case 70. Chronic abdominal pain and weight loss

Áø´Ü: Diffuse large B cell lymphoma


[ÀÌÁØÇà comment]

ÇÑ ¼±»ý´Ô²²¼­ r/o Menetrier's disease¶ó´Â impressionÀ» Áּż­ Á¦°¡ ¾Æ·¡¿Í °°ÀÌ ¾ÆÁÖ °³ÀÎÀûÀÎ ÀÇ°ßÀ» º¸³Â½À´Ï´Ù.

°³ÀÎÀÇ°ßÀÌÁö¸¸... ¿ì¸®³ª¶ó¿¡´Â ¸Þ´ÏÆ®¸®¾îº´Àº Èñ±Íº´ Áß Èñ±Íº´ÀÔ´Ï´Ù. ±¹³»¿¡¼­ ¸î ½Ê Áõ·Ê°¡ º¸°íµÇ¾î Àִµ¥ Á¤¸» ¸Þ´ÏÆ®¸®¾î¶ó´Â º´ÀÌ ¸Â¾Ò´ÂÁö ¾Ë ¼ö ¾ø´Â °æ¿ìµµ ÀÖ½À´Ï´Ù. ¾î¼¸é ±×³É °úÇü¼º À§¿°ÀÎ °æ¿ìµµ ÀÖ¾úÀ» °Í °°½À´Ï´Ù. Àú´Â Menetrier ȯÀÚ¸¦ ÇÑ ¸íµµ Áø·áÇÑ °æÇèÀÌ ¾ø½À´Ï´Ù. ´Ù¸¥ ±³¼ö´Ô ȯÀÚ¸¦ µå¹°°Ô ¸¸³¯ »ÓÀÔ´Ï´Ù.

2013³â, F/49

2023³â, M/60. Á¦°¡ ¿·¿¡¼­ ÁöÄѺ» ȯÀÚ Áß °¡Àå È®½ÇÇÑ Menetrier disease ȯÀÚÀÔ´Ï´Ù.

ÈçÈ÷ º¸¸¸ 4Çü ÁøÇ༺À§¾ÏÀ̳ª ¸²ÇÁÁ¾ÀÇ °¨º°Áø´ÜÀ¸·Î r/o Menetrier's disease¶ó°í ¾²´Â °æÇâÀÌ ÀÖÁö¸¸ ÀÌ´Â À§ÇèÇÑ ÀÏÀÔ´Ï´Ù. ¸ð¾çµµ ´Ù¸£°í ¿¹Èĵµ ´Ù¸£±â ¶§¹®ÀÔ´Ï´Ù. º¸¸¸ 4Çü ÁøÇ༺ À§¾ÏÀ̳ª ¸²ÇÁÁ¾Àº diffuseÇÑ º´º¯ÀÌ°í Menetrier's disease´Â ÀÖ´Ù°í Çصµ ´ú diffuseÇÑ º´ÀÎ °æ¿ì°¡ ¸¹½À´Ï´Ù. ÀÓ»ó¾ç»óµµ ´Ù¸¨´Ï´Ù. ¾Ç¼º ÁúȯÀ» ½Ã»çÇÏ´Â ¼Ò°ß°ú ¸¸¼º protein losing ÁúȯÀÇ Áõ»óÀÌ °°À» ¼ö ¾ø½À´Ï´Ù. ¿©ÇÏ´Â Àú´Â Menetrier º´À̶ó´Â ³»½Ã°æ Áø´ÜÀº °¡±ÞÀû ÇÇÇÏ´Â °ÍÀÌ ÁÁ´Ù°í »ý°¢ÇÕ´Ï´Ù. Impresseion¿¡ Menetrier's disease¸¦ ¾ð±ÞÇÏ´Â ¼ø°£ Áø´ÜÀÌ »êÀ¸·Î °¥ ¼ö Àֱ⠶§¹®ÀÔ´Ï´Ù. º¸¸¸ 4Çü ÁøÇ༺ À§¾ÏÀ̳ª lymphoma¸¦ ÀǽÉÇÏ¿© °Ë»çÇÏ°í Ä¡·áÇÏ´Ù°¡ ¾î¼´Ù °á±¹ Menetrier·Î °á·ÐÀÌ ³ª¸é ¸ð¸¦±î ³»½Ã°æ ÇÑ Àå º¸°í Menetrier's disease¸¦ ÀǽÉÇÏ´Â °ÍÀº ¸Å¿ì À§ÇèÇÕ´Ï´Ù.

ÁÖÀÇÇսôÙ. Menetrier's disease¸¦ ã¾Æ³»´Â °Íº¸´Ù º¸¸¸ 4Çü ÁøÇ༺ À§¾ÏÀ̳ª lymphoma¸¦ ³õÄ¡Áö ¾Ê´Â °ÍÀÌ ÈξÀ Áß¿äÇϴϱî¿ä.

* Âü°í: EndoTODAY Menetrier's disease


À§Àå°ü ¸²ÇÁÁ¾ ³»½Ã°æ Áø´Ü¿¡ ´ëÇÑ ±ØÈ÷ °³ÀÎÀû »ý°¢ÀÔ´Ï´Ù. À§Àå°ü ¸²ÇÁÁ¾Àº ´Ù¾çÇÕ´Ï´Ù. Çѵΰ³ÀÇ °øÅëµÈ Ư¡ÀÌ ¾ø½À´Ï´Ù. ±³°ú¼­¿¡´Â ´ÙÀ½°ú °°ÀÌ ¾º¿© ÀÖ½À´Ï´Ù.

Endoscopic findings described in the textbook (Yamada eds.)
1) Gastric lymphoma can be grossly indistinguishable from adenocarcinoma, but is actually a diffusely infiltrating submucosal lesion.
2) The tumor may present as a polypoid lesion with ulcerations, but like other submucosal lesions, the overlying mucosa may traverse the mass as a characteristic bridging fold.
3) Lymphomas do not have a predilection for any particular region of the stomach, but are more likely than other cancers to present with diffuse infiltration and enlarged rugal folds.

±×·¯³ª ±³°ú¼­ÀÇ ¼³¸í¸¸À¸·Î´Â ÃæºÐÇÏÁö ¾ÊÀº °Í °°½À´Ï´Ù. ±×·¡¼­ °³ÀÎÀûÀÎ ÀÇ°ßÀ» ºÙÀÔ´Ï´Ù.

1) À§Àå°ü ¸²ÇÁÁ¾Àº Á¡¸·ÇϺ´¼Òó·³ º¸ÀÌ´Â °æ¿ìµµ ÀÖÀ¸³ª Á¡¸·º´¼ÒÀÎ °æ¿ì°¡ ´õ ¸¹½À´Ï´Ù.

2) ¾Æ·¡¿Í °°Àº °æ¿ì¿¡´Â ¸²ÇÁÁ¾À» ÀǽÉÇÏ´Â °ÍÀÌ ÁÁ½À´Ï´Ù.

¸²ÇÁÁ¾Àº Á¾·ù°¡ ¸¹¾Æ¼­ ¾î¶»°Ô Á¢±ÙÇÏ´Â °ÍÀÌ ÁÁÀ»Áö ÆÇ´ÜÀÌ ¾î·Æ½À´Ï´Ù. ¾Æ·¡¿Í °°Àº ¼ø¼­¸¦ ±ÇÇÕ´Ï´Ù.

  1. B ¼¼Æ÷ÀÎÁö T ¼¼Æ÷ÀÎÁö ±¸ºÐÇÑ´Ù. --> T ¼¼Æ÷¸é ´ëºÎºÐ Ç×¾ÏÄ¡·á
  2. B ¼¼Æ÷ Áß MALT ¸²ÇÁÁ¾ÀÎÁö ¾Æ´ÑÁö ±¸ºÐÇÏ´Ù. --> MALT ¸²ÇÁÁ¾ÀÌ¸é ´ëºÎºÐ Helicobacter Á¦±ÕÄ¡·á
  3. ´Ù¸¥ °ÍµéÀº °¢ÀÚ °³º° Áø´Ü¿¡ µû¶ó Ä¡·áÇÑ´Ù.

°¢ ¸²ÇÁÁ¾¿¡ µû¸¥ ³»¿ëÀº ¾Æ·¡ ¸µÅ©¸¦ Âü°íÇϽñ⠹ٶø´Ï´Ù.

1) DLBL (diffuse large B cell lymphoma) B¼¼Æ÷ ¸²ÇÁÁ¾
2) MALToma ¸»Æ®¸²ÇÁÁ¾
3) Mantle cell lymphoma
4) Peripheral T cell lymphoma (PTCL)
5) NK T-cell lymphoma
6) Burkitt lymphoma ¹öŶ ¸²ÇÁÁ¾
7) Primary gastric lymphoblastic lymphoma


[Archives]

2023-7-16. º»4 ÇлýÀÇ ´äº¯ Áß

2023-7-16. º»4 ÇлýÀÇ ´äº¯¿¡ Çؼ³À» ºÙ¿© º¸³Â½À´Ï´Ù.


[References]

1) À§¿°ÀÇ ´Ù¾çÇÑ ³»½Ã°æ ¼Ò°ß ¹× ±× ÀÇ¹Ì À̼±¿µ ±³¼ö´Ô. PDF

2) Ç︮ÄÚ¹ÚÅÍ Á¦±ÕÄ¡·á update¿Í °³¿ø°¡¿¡¼­ ¹Ù¶óº» À§¿° - µ¿¿µ»ó

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