[Description exercise 13 - ´ëÀåÁúȯ] - ðû

¸ðó·³ ¸Å¿ì classicÇÑ È¯ÀÚÀÇ·Ú¼­¸¦ ¹Þ¾Ò½À´Ï´Ù. ³»½Ã°æ ¼Ò°ßÀ» ÀÌ Á¤µµ·Î Àß ¾²½Ç ¼ö ÀÖ´Â °Íµµ ¸ÚÁø ÀÏ ¾Æ´Ò±î¿ä? ÀÌÁØÇàÀÇ ÀÇ»ç¸éÇã¹øÈ£´Â 4¸¸¹ø´ëÀÔ´Ï´Ù. ÀÇ·ÚÁֽŠ¼±»ý´ÔÀÇ ÀÇ»ç¸éÇã¹øÈ£´Â 2¸¸¹ø´ë¿´½À´Ï´Ù. ¼±¹è ÀÇ»ç´Ô²² Á¸°æÀÇ ¶æÀ» ÀüÇÕ´Ï´Ù.

¿©·¯ ȸ»ç¿Í ¾ÆƲ¶ó½º¸¦ ¸¸µå´Â »ç¾÷À» ÇÏ°í ÀÖ½À´Ï´Ù. Èï¹Ì·Î¿î Áõ·Ê°¡ ¸¹½À´Ï´Ù. ²À ¹æ¹®ÇÏ¿© Çϳª¾¿ °øºÎÇÏ½Ç °ÍÀ» ±ÇÇÕ´Ï´Ù.

EndoTODAY ¾ÆƲ¶ó½º¿Í ÅäÅ©¼î

13ȸ¿¡ µµÂøÇϽŠ°ÍÀ» ÃàÇÏÇÕ´Ï´Ù.

Fellow »ýÈ°À» ¾ÕµÐ ¾î¶² ±ºÀÇ°üÀÇ ´äº¯¿¡¼­.

³»½Ã°æ½Ç¿¡¼­ °Ë»ç¸¦ Çϸé ó¹æÀ» ³Ö°í °á°ú¸¦ ÀÛ¼ºÇÏ´Â °Íµµ Áß¿äÇÏ´Ù´Â °ÍÀ» ´À³§´Ï´Ù. ó¹æÀ̳ª °á°úÁö´Â °øÀûÀÎ ¾÷¹«À̹ǷΠ½Ç¼öÇÏÁö ¾Êµµ·Ï ÁÖÀÇÇϽñ⠹ٶø´Ï´Ù. ƯÈ÷ midazolamÀ̳ª DemerolÀÇ ¿ë·®Àº Àý´ë·Î Ʋ¸®¸é ¾È µÇ°í °á°ú¿¡¼­´Â Á¶Á÷°Ë»ç °¹¼ö°¡ Á¤È®ÇØ¾ß ÇÕ´Ï´Ù. Àß ºÎŹµå¸³´Ï´Ù.


Case 85. D-colon

Á¤´ä: tubular adenoma


[ÀÌÁØÇà comment]

ÈçÇϵð ÈçÇÑ ¼±Á¾ÀÔ´Ï´Ù. ´ëÀå³»½Ã°æ µµÁß ÀÌ Á¤µµÀÇ º´¼Ò°¡ ¹ß°ßµÇ¸é one stage·Î polypectomy¸¦ ÇÏ´Â °ÍÀÌ standard procedureÀÔ´Ï´Ù. Inject and cut ¹æ¹ý (EMR)À¸·Î polypectomyÇÏ¿´°í ÃÖÁ¾ º´¸®´Â tubular adenoma¿´½À´Ï´Ù.


Case 86. T-colon

Á¤´ä: serrated adenoma


[ÀÌÁØÇà comment]

Focal lesionÀ̹ǷΠneoplastic lesionÀ» °í·ÁÇØ¾ß ÇÕ´Ï´Ù. º¯ÀÌ ¹¯Àº °ÍÀº serrated adenoma¿¡¼­ ÀÚÁÖ º¸ÀÌ´Â Çö»óÀ̶ó°í ÇÕ´Ï´Ù.

Serrated adenoma´Â interval cancerÀÇ Áß¿ä ¿øÀÎ Áß ÇϳªÀÔ´Ï´Ù. ³³ÀÛÇÏ°í ÀÏ°ß hyperplastic polyp°ú ºñ½ÁÇϹǷΠ³õÄ¡±â ½±½À´Ï´Ù.

¾Æ·¡ µ¿¿µ»ó °­ÀǸ¦ ²À º¸½Ã±â ¹Ù¶ø´Ï´Ù.

¹«°æ¼º Åé´Ïº´º¯ÀÇ ³»½Ã°æ Áø´Ü ¼ú±â (±èÇö°Ç ±³¼ö´Ô)

* Âü°í: EndoTODAY serrated adenoma


Case 87

Á¤´ä: ´ëÀå¾Ï


[ÀÌÁØÇà comment]

¹Ù·Î ¼ö¼úÀ» ÇÏ¿´½À´Ï´Ù.

Adenocarcinoma, well differentiated
1. Location: transverse colon
2. Gross type: fungating
3. Size: 1.5x1.5 cm
4. Depth of invasion: invades submucosa (sm2)(pT1)
5. Resection margin: free from carcinoma, safety margin: proximal, 22 cm ; distal, 11 cm ; radial, >10.0 mm
6. Regional lymph node metastasis : no metastasis in all 34 regional lymph nodes(pN0) (0/34: pericolic, 0/30; "right gastroepiploic LN", 0/2; "SMA LN", 0/2)
7. Lymphatic invasion: not identified
8. Venous invasion: not identified
9. Perineural invasion: not identified
10. Tumor budding : negative
11. Pathologic staging: pT1 N0


Case 88

Á¤´ä: Diffuse large B cell lymphoma


[ÀÌÁØÇà comment]

ÀÌ Á¤µµ Å« colon adenocarcinoma´Â ´ëÀåÀÇ ³»°­ÀÌ Á¼¾ÆÁö´Â °æ¿ì°¡ ¸¹´Ù´Â Á¡À» °í·ÁÇÏ°í Ȥ½Ã lymphoma´Â ¾Æ´Ò±î?? Á¤µµ »ý°¢ÇØ º¸¸é ÁÁ½À´Ï´Ù.

* Âü°í: EndoTODAY diffuse Large B-cell Lymphoma


Case 89. Rectum

Á¤´ä: Ulcerative proctitis


[ÀÌÁØÇà comment]

Ulcerative colitis¶ó°í ´äÇÑ ºÐµéÀÌ ¸¹½À´Ï´Ù. ¹üÀ§°¡ ¾îµð±îÁöÀÎÁö »çÁø »ó ¸íÈ®ÇÏÁö ¾Ê½À´Ï´Ù¸¸, ¸¸¾à Á÷Àå¿¡ ±¹ÇѵǾî ÀÖ´Ù¸é ulcerative proctitis·Î ¸í¸íÇÏ´Â °ÍÀÌ ÁÁÀ» °Í °°½À´Ï´Ù.


Case 90. Terminal ileum

Á¤´ä: Behcet's disease


[ÀÌÁØÇà comment]

Ileocecal areaÀÇ ÇϳªÀÇ Å©°í ±íÀº ±Ë¾çÀÎ °æ¿ì°¡ ¸¹½À´Ï´Ù.

2018 GI Winter School

·ù¸¶Æ¼½º °üÀý¿° ȯÀÚÀÇ º£Ã¼ Àå¿°

(2015) M/40, recurrent oral ulcer

2018 GI Winter School

Recurrent oral ulcer (+)


Case 91. Colon and stomach

Colon
Stomach

Á¤´ä: Cowden disease


[ÀÌÁØÇà comment]

FAPÀÇ ÀϹÝÀûÀÎ ¿ëÁ¾°ú ¸ð¾çÀÌ ´Ù¸¨´Ï´Ù. ÀÌ °æ¿ì´Â ¼Õ°¡¶ôó·³ º¸ÀÌÁö ¾Ê½À´Ï±î? FAPÀÇ ÀüÇüÀûÀÎ sessile ȤÀº peduculated adenoma¿Í´Â ´Ù¸¥ ¸ð½ÀÀÔ´Ï´Ù. À§¿¡¼­µµ FAP ȯÀÚÀÇ fundic gland polyposis¿Í ´Ù¸¨´Ï´Ù. Colon polyposis¸¦ °¡Á®¿À´Â ´Ù¸¥ ÁúȯÀ» °í·ÁÇغ¸¸é ÁÁ°Ú½À´Ï´Ù. Á¤´äÀº Cowden disease¿´½À´Ï´Ù. ¾Æ·¡ µ¿¿µ»ó °­ÀǸ¦ ²À º¸½Ã±â ¹Ù¶ø´Ï´Ù.

À§Àå°üÀÇ ´Ù¾çÇÑ hamartomatous polyp¿¡ ´ëÇؼ­´Â Gastric Hamartomatous Polyps - Review and Update (Clin Med Insights Gastroenterol 2016)¸¦ Âü°íÇϽñ⠹ٶø´Ï´Ù. ¹®Çå Áß Cowden syndrome ºÎºÐÀ» ¿Å±é´Ï´Ù.

The incidence of CS (Cowden syndrome) in the general population is 1 in 200,000 and more than 90% patients present in the adult life by the late third decade. Mucocutaneous hamartomas (trichilemmomas, acral keratosis, and papillomatous lesions) are pathognomonic features of CS. Macrocephaly and Lhermitte-Duclos disease or dysplastic cerebellar gangliocytoma are two other features considered specific for CS and are included in the major criteria.

These patients have an increased risk of breast, thyroid, and endometrial carcinoma, which are the other major criteria. Patients with CS also have a predisposition to benign hamartomatous outgrowths such as lipomas, arteriovenous malformations, fibrocystic breast disease, benign thyroid nodules, multiple uterine leiomyomas (fibroids) and/or bicornuate uterus, and gastrointestinal polyps. Diffuse esophageal glycogenic acanthosis is present in more than 80% of CS patients and may be diagnostic for CS in the presence of other benign gastrointestinal polyposis.

Gastrointestinal polyps occur in up to 50% of patients with CS with a wide variety of endoscopic and histologic features, including adenomatous, inflammatory, hyperplastic, lymphoid, ganglioneuromatous, and leiomyomatous polyps. The majority of CS patients (>50%) have two or more different polyp histologies. Though most studies describe polyps in CS being colonic, gastric polyps are present in almost all patients with CS and are usually numerous with a variable appearance. Depending on the major histologic component, they can be smooth contoured or have a hyperplastic/papillary configuration endoscopically. The polyps in the stomach are commonly misdiagnosed as hyperplastic hamartomatous polyps. Though dysplasia has not been reported in gastric polyps in CS, patients with CS and gastric cancer have been reported. The risk of colorectal carcinoma in CS is 7%?15%, and 1 in 100 patients with CS may develop gastric malignancy.

Individuals with multiple gastrointestinal hamartomas or ganglioneuromas should be evaluated for PTEN gene mutation. The recommended gastrointestinal surveillance for patients with PTEN gene mutation is colonoscopy and esophagogastroduodenoscopy examination beginning at the age of 15 years and repeated every two years or two to three years, though different suggestions has been suggested.

¿©·¯ ¿ëÁ¾ÁõÀ» ºñ±³ÇØ º¸½Ã±â ¹Ù¶ø´Ï´Ù.

* Âü°í: EndoTODAY Cowden disease


[Some more ÀܼҸ®]

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