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EndoTODAY ³»½Ã°æ ±³½Ç


[Áö¹æÁ¾°ú Áö¹æÀ°Á¾. lipoma and liposarcoma] - ðû

1. ½Äµµ Áö¹æÁ¾

2. À§ Áö¹æÁ¾

3. ½ÊÀÌÁöÀå Áö¹æÁ¾

4. ¼ÒÀå Áö¹æÁ¾

5. ´ëÀå Áö¹æÁ¾

6. Endoscopic treatment of lipoma

7. Liposarcoma Áö¹æÀ°Á¾

8. References


1. Esophageal lipoma

°í·É ¿©¼ºÀ¸·Î »óºÎ ½Äµµ IT 20cmÀÇ Á¡¸·ÇÏ Á¾¾çÀ¸·Î ³»¿øÇÏ¿© ½ÃÇàÇÑ EUS¿¡¼­ Á¡¸·ÇÏÃþ¿¡¼­ ±â¿øÇÏ´Â °í¿¡ÄÚ¼º º´º¯ÀÌ °üÂûµÇ¾ú½À´Ï´Ù. »ïÅ´ °ï¶õ Áõ»óÀÌ ÀÖ¾ú½À´Ï´Ù. Á¡¸·ÇÏ ¿ë¾× ÁÖÀÔ ÈÄ needle knife·Î ¾î·ÆÁö ¾Ê°Ô ¹ØµÕÀ» dissection ÇÏ¿´Áö¸¸ ±æÀÌ¿Í ±½±â°¡ »ó´çÇÏ¿© snare, net µîÀ» ÀÌ¿ëÇÏ¿© ȸ¼öÇÏ·Á ÇÏ¿´Áö¸¸ ÀÚ²Ù ¹Ì²ô·¯Á³´Âµ¥ snare °¡ ´ÙÇàÀÌ Áß°£ºÎºÐÀ» Àß Àâ°Ô µÇ¾ú°í UES¸¦ Åë°úÇÏ°Ô µÇ¾î Á¦°ÅÇÒ ¼ö ÀÖ¾ú½À´Ï´Ù. Áö¹æÁ¾Àº º¸Åë À§³ª ´ëÀå¿¡ ´õ ¸¹ÀÌ »ý±âÁö¸¸ ½Äµµ¿¡¼­µµ ¹ß»ýÇÒ ¼ö ÀÖ°í ¿¬µ¿¿îµ¿ÀÇ ÈûÀÌ Å« UES ±Ùó¿¡ À§Ä¡ÇÏ°í ÀÖ¾î pseudopolypÀÇ ÇüÅ·Πũ±â°¡ ¸Å¿ì Ä¿Áø °Í °°½À´Ï´Ù. (ÀÚ·á Á¦°ø: »ï¼º¼­¿ïº´¿ø ±èÅÂÁØ)


2. Gastric lipoma

SMT lipomaÀÇ ÀüÇüÀû ¼Ò°ßÀÔ´Ï´Ù. Cushiong sign°ú tenting sign ¼Ò°ßÀÌ ¶Ñ·ÇÇÏ¿´½À´Ï´Ù.

°Ç°­°ËÁø ³»½Ã°æÀ» ½ÃÇàÇÑ ÈÄ Àü¿øµÈ 56¼¼ ¿©ÀÚÀÔ´Ï´Ù. ¿©·¯ºÐÀº ÀÌ·± ȯÀÚ¸¦ ¸¸³­´Ù¸é ¾î¶»°Ô ÇϽðڽÀ´Ï±î. Àú´Â 1-2³â ÈÄ follow up ³»½Ã°æ¸¸À» ±ÇÇÏ¿´½À´Ï´Ù. CT ¼Ò°ß¸¸À¸·Îµµ lipoma¶ó°í °ÅÀÇ È®½ÅÀ» °¡Áú ¼ö Àֱ⠶§¹®ÀÔ´Ï´Ù. EUS¸¦ Çؼ­ hyperechoicÇÑ º´¼Ò·Î ³ª¿Â´Ù¸é Á¶±Ý ´õ È®½ÅÀ» °¡Áú ¼ö ÀÖÀ» °ÍÀÔ´Ï´Ù. ±×·¯³ª ÀÌ °æ¿ì¿¡ º¸Çèµµ ¾È µÇ´Â °í°¡ÀÇ °Ë»ç¸¦ ÅëÇÏ¿© ¾òÀ» ¼ö ÀÖ´Â Ãß°¡ÀûÀÎ informationÀº ±ØÈ÷ Á¦ÇÑÀûÀÏ °ÍÀ¸·Î ÆÇ´ÜÇÏ¿´½À´Ï´Ù. ÀÌ·± ºñ½ÁÇÑ °æ¿ì¿¡ EUS¸¦ À§ÇÏ¿© ÀǷڵǴ ȯÀںеéÀÌ ¸¹Àºµ¥ Àú´Â ³»½Ã°æ°ú CT¸é ´õ ÀÌ»óÀÇ °Ë»ç´Â ÇÊ¿äÇÏÁö ¾ÊÀ» °Í °°´Ù°í ´äº¯À» µå¸®°ï ÇÕ´Ï´Ù.

Gastric lipoma·Î °æ°ú Áß ½ÊÀÌÁöÀå herniation µÇ¸é¼­ SMTÀÇ Ç¥¸é¿¡ ±Ë¾çÀÌ ¹ß»ýÇÏ¿´À½.

CT¿¡¼­´Â ¶Ñ·ÇÇѵ¥ ³»½Ã°æ¿¡¼­´Â ¸íÈ®ÇÏÁö ¾Ê¾Ò´ø Áö¹æÁ¾. ¾Æ¸¶µµ pyloric ring¿¡ °¡±î¿î distal antrum lesser curvature ÂÊÀÌ ¾Æ´Ñ°¡ ÃßÁ¤µÇÁö¸¸ ¸íÈ®ÇÏÁö ¾Ê½À´Ï´Ù. ÀÓ»óÀû ÀÇÀÇ´Â ¾ø½À´Ï´Ù.

15³â »çÀÌ¿¡ Á¶±Ý¾¿ Å©±â Áõ°¡¸¦ º¸¿´´ø Áö¹æÁ¾


[2017-4-18. ³»½Ã°æÇÐȸ Áý´ãȸ °æÈñ´ë Áõ·Ê]

Melena¸¦ ÁÖ¼Ò·Î ³»¿øÇÏ¿´°í ³»½Ã°æ¿¡¼­ ÀüÁ¤ºÎÀÇ Å« SMT with central ulceration ¼Ò°ßÀ̾ú½À´Ï´Ù. EUS¿¡¼­ hyperechoic mass°¡ 3rd layer¿¡¼­ ±âÀÎÇÏ°í ÀÖ¾ú°í Áß¾Ó¿¡ ¾à°£ hypoechoicÇÑ ºÎÀ§°¡ ÀÖ¾úÀ½. LipomaÀÇ °¡´É¼ºÀÌ ³ô°í liposarcoma¸¦ ¹èÁ¦ÇÒ ¼ö ¾ø¾î ¼ö¼úÀ» ±ÇÀ¯ÇÏ¿´À¸³ª °ÅºÎÇÏ¿© °æ°ú°üÂû ÇÏ´ø Áß Å©±â°¡ Áõ°¡ÇÏ¿© ESD¸¦ ½ÃÇàÇÏ¿´À½. Resected specimenÀÌ ³Ê¹« Ä¿¼­ ÀϺθ¸ ¼ö°ÅÇÏ¿´°í lipoma¿´À½.

Á¶ÁÖ¿µ ±³¼ö´Ô comment: unroofing¸¸ Çصµ ÁÁÁö ¾Ê¾ÒÀ»±î?

ÀåÀ翵 ±³¼ö´Ô ´äº¯: hardÇÑ °æ¿ì´Â unroofing¸¸À¸·Î ÃæºÐÈ÷ Á¦°ÅµÇÁö ¾Ê´Â °æ¿ìµµ ÀÖ½À´Ï´Ù. ESD´Â 40ºÐ¿¡ ½ÃÇàÇÒ ¼ö ÀÖ¾ú´Âµ¥ ¼ö°ÅÇϴµ¥ ¾î·Á¿òÀÌ ÀÖ¾ú½À´Ï´Ù. Liposarcoma´Â ¾Æ´ÑÁö °ÆÁ¤µÇ¾ú±â ¶§¹®¿¡ ¾î¶»°Ôµç ÀýÁ¦ÇÏ°í ¼ö°ÅÇÏ°íÀÚ ³ë·ÂÇß´ø Áõ·ÊÀÔ´Ï´Ù.

ÀüÈÆÀç ±³¼ö´Ô comment: Endoscopy hood protector¸¦ »ç¿ëÇϸé Å« °Ëüµµ Á¦°ÅÇÒ ¼ö ÀÖ¾úÀ» °ÍÀÔ´Ï´Ù.


3. Duodenal lipoma


[Duodenal lipoma with bleeding]

Áö¹æÁ¾ÀÌ ÃâÇ÷À» ÀÏÀ¸Å³ ¼ö ÀÖ½À´Ï´Ù.


4. Small bowel lipoma

60´ë ¿©¼ºÀ̸ç screening ¸ñÀûÀ¸·Î ´ëÀå³»½Ã°æÀ» ½ÃÇàÇÏ¿´°í ³»½Ã°æ °á°ú¿¡´Â ¡°The CF 240I was inserted up to the terminal ileum¡±¿´½À´Ï´Ù. ƯÀ̼ҰßÀº ¾ø¾ú´ø °ÍÀÌÁö¿ä. ±×·±µ¥ ´ëÀå³»½Ã°æ °Ë»ç 1ÁÖÀÏ ÈÄ °©Àڱ⠽ÉÇÑ ¿ìÇϺ¹ºÎ ÅëÁõÀ¸·Î ³»¿øÇϼ̽À´Ï´Ù.

CT¿¡¼­ Áö¹æÁ¾(³ë¶õ È­»ìÇ¥)¿¡ ÀÇÇÑ ÀåÁßøÁõÀ¸·Î Áø´ÜµÇ¾ú½À´Ï´Ù. Ileocecectomy¸¦ ½ÃÇàÇÏ¿´À¸¸ç ileum¿¡ À§Ä¡ÇÑ 4.5 cmÅ©±âÀÇ Á¡¸·ÇÏ Áö¹æÁ¾À¸·Î È®ÀεǾú½À´Ï´Ù. ¼ºÀÎ ÀåÁßøÁõÀÇ ÈçÇÑ ¿øÀÎ Áß Çϳª°¡ Áö¹æÁ¾°ú °°Àº Á¡¸·ÇÏ Á¾¾çÀÔ´Ï´Ù.

¾ï¼¼°Ô Àç¼ö ¾ø´Â °æ¿ìÀϱî¿ä, ¾ï¼¼°Ô Àç¼ö ÁÁÀº °æ¿ìÀϱî¿ä. ¿©ÇÏÆ° ȯÀÚºÐÀº ÁÁ¾ÆÁ®¼­ Åð¿øÇϼ̽À´Ï´Ù.


[more cases]

º¹ÅëÀ¸·Î ½ÃÇàÇÑ °Ë»çÀÔ´Ï´Ù. Terminal ileumÀÇ IC valve 10cm »ó¹æ¿¡ Å©±â 2.5 cmÀÇ stalk¸¦ °¡Áø Á¾±«°¡ °üÂûµÇ¾ú½À´Ï´Ù. Ç¥¸éÀÌ °æÇÑ lobulation, hyperemia°¡ ÀÖ¾ú°í °âÀÚ·Î ´­·¶À» ¶§ ´Ù¼Ò ´Ü´ÜÇß½À´Ï´Ù. Cushion signÀº ¾ø¾ú½À´Ï´Ù. Á¶Á÷°Ë»ç¸¦ ÇÏ¿´°í "No significant pathological alteration"À¸·Î º¸°íµÇ¾ú½À´Ï´Ù. CT¿¡¼­´Â ÀúÀ½¿µ º´¼Ò¿´½À´Ï´Ù. ³»½Ã°æÀýÁ¦¼úÀ» ½ÃÇàÇÏ¿´½À´Ï´Ù. º´¸®°á°ú´Â ¾Æ·¡¿Í °°¾Ò½À´Ï´Ù.
Terminal ileum, endoscopic mass excision: Lipoma:
1) size: 2.7x2.6 cm
2) negative resection margins


5. Colon lipoma

´ëÀå³»½Ã°æ µµÁß ÀüÇüÀûÀÎ ´ëÀå Áö¹æÁ¾ÀÌ ¹ß°ßµÇ¾î inject and cut·Î ÀýÁ¦¼úÀ» ÇÏ¿´½À´Ï´Ù.

´ëÀå Áö¹æÁ¾µµ ´Ù¾çÇÑ ÀÓ»ó ¾ç»óÀ» º¸ÀÏ ¼ö ÀÖ½À´Ï´Ù.

´ëÀå SMT·Î lipoma°¡ ÀǽɵǾú´Âµ¥ Á¶Á÷°Ë»ç¸¦ ÇÏ¿´´õ´Ï Ç¥¸é ¾Æ·¡¿¡¼­ ³ë¶õ»öÀÇ Áö¹æ µ¢¾î¸®°¡ ¹ß°ßµÇ¾î ¹Ù·Î È®ÁøÀÌ µÇ¾ú½À´Ï´Ù.

´ëÀå SMTÀε¥ À°¾È¼Ò°ßµµ lipomaÀÌÁö¸¸ Á¶Á÷°Ë»ç¿¡¼­ lipoma°¡ È®ÀεǾú½À´Ï´Ù. °£È¤ Á¶Á÷°Ë»ç·Î È®ÀεǴ lipoma°¡ ÀÖ½À´Ï´Ù.

CT·Î È®ÀεǾú´ø colon lipoma

º¹ÅëÀ¸·Î ½ÃÇàÇÑ ´ëÀå³»½Ã°æ¿¡¼­ Ç¥¸éÀÌ ¿ïÅüºÒÅüÇÑ mass°¡ ¹ß°ßµÇ¾ú°í, CT µîÀ» ÂüÁ¶ÇÏ¿© ÀåÁßøÁõÀ¸·Î Áø´ÜÇÏ°í ¼ö¼úÇÏ¿´½À´Ï´Ù. CT¿¡¼­ fatty mass·Î º¸¿´±â ¶§¹®¿¡ Áö¹æÁ¾ÀÎ °ÍÀº ¹Ì¸® ¾Ë¾Ò½À´Ï´Ù. º´¸®»çÁø¿¡¼­ ¾Ë ¼ö ÀÖµíÀÌ Áö¹æÁ¾Àο¡ Ç¥¸éÀÌ ºÒ±ÔÄ¢ÇÏ¿´´ø ƯÀÌÇÑ °æ¿ìÀÔ´Ï´Ù.


6. Endoscopic treatment of lipoma

ÀÛÀº Áö¹æÁ¾Àº Ä¡·áÇÒ ÇÊ¿ä°¡ ¾ø½À´Ï´Ù. Å©°Å³ª Áõ»óÀ» µ¿¹ÝÇϸé Áö¹æÁ¾ÀÌ¶óµµ Ä¡·áÇÏ´Â °æ¿ì°¡ ÀÖ½À´Ï´Ù. Unlooping ¹æ¹ýÀÌ À¯¿ëÇÕ´Ï´Ù. ¶Ñ²±À» ¾ø¾Ö¸é ³»¿ë¹°ÀÌ ºüÁ®³ª°¡´Â ¿ø¸®ÀÔ´Ï´Ù.

³»½Ã°æ ÀýÁ¦¼úÀ» Çϱ⵵ Çϴµ¥ Áö¹æÁ¾ÀÌ Å©¸é ±â¼úÀûÀ¸·Î ¾î·Á¿î °æ¿ìµµ ÀÖ½À´Ï´Ù.

Detachable snare¸¦ ÀÌ¿ëÇÑ ¹æ¹ý (Dig Liver Dis. 2008)


7. Liposarcoma. Áö¹æÀ°Á¾

Liposarcoma is the most common soft tissue sarcoma and accounts for 15-20% of all mesenchymal malignancy. The tumor occurs most frequently in the limbs, retroperitoneum and rarely has a visceral location.

Liposarcoma of the stomach is extremely rare (37 case reported worldwide up to 2018). The origin of gastric liposarcomas is likely the proliferation of undifferentiated mesenchymal cells within the submucosa and the tunica muscularis layer of the stomach. Gastric liposarcomas are characterized by an exophytic growth that adheres to the gastric wall, and the typical location of gastric liposarcomas is the antrum (38.8%, Kang 2018).

Of the 37 cases described six patients died of the disease. Mortality is usually in cases of dedifferentiated, myxoid, pleomorphic and mixed type liposarcoma.

Pathology (pathologyoutlines.com)


[References]

1) EndoTODAY Áö¹æÁ¾

2) Áö¹æÁ¾ ³»½Ã°æÄ¡·á (ºÎ»ê´ë) Gastrointest Endosc 2014

3) Liposarcoma

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