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[Endoscopic findings of gastric MALToma] - ðû
À»Áö´ëÇб³ ¼º°á - MALToma symposium (2022)
2. Multifocal atrophy pattern MALTomas
5. Polypoid/mass/SMT-like MALToma
7. Others
8. FAQs
9. References
ÀüÅëÀûÀ¸·Î À§ MALT ¸²ÇÁÁ¾ÀÇ ³»½Ã°æÀû Ư¡Àº ¡®Æ¯Â¡ÀÌ ¾ø´Â °Í¡¯À̶ó°í °¡¸£Ä¡°í ¹è¿ö¿Ô½À´Ï´Ù. ±×¸¸Å ´Ù¾çÇÑ ¸ð¾çÀ» °¡Áú ¼ö ÀÖ´Ù´Â ÀǹÌÀÏ °ÍÀÔ´Ï´Ù.
ƯÈ÷ ¡®°íµµ ¿ä¼Ò¸¦ °¡Áø MALT ¸²ÇÁÁ¾¡¯À» À§ MALT ¸²ÇÁÁ¾¿¡ Æ÷ÇÔ½ÃÅ°´ø ½ÃÀý¿¡´Â ÁøÇà À§¾Ï°ú ºñ½ÁÇÑ ÇüŸ¦ º¸ÀÎ °æ¿ìµµ ÀÖ¾ú½À´Ï´Ù. ±×·¯³ª ¡®°íµµ ¿ä¼Ò¸¦ °¡Áø MALT ¸²ÇÁÁ¾¡¯À» MALT ¸²ÇÁÁ¾¿¡ Æ÷ÇÔ½ÃÅ°Áö ¾Ê°Ô µÇ¸é¼ À§ MALT ¸²ÇÁÁ¾Àº ´ëºÎºÐ À§¿°À̳ª Á¶±âÀ§¾Ï°ú ºñ½ÁÇÑ ¸ð¾çÀ» º¸ÀÌ°Ô µÇ¾ú½À´Ï´Ù.
³»½Ã°æÀû Ư¡¿¡ µû¸¥ ºÐ·ù¹ýÀº ¸¹Àº ÀúÀÚµéÀÌ Á¦½ÃÇÏ°í ÀÖÀ¸³ª ÇÊÀÚ´Â ´ÙÀ½°ú °°ÀÌ ³ª´©°í ÀÖ½À´Ï´Ù. (1) gastritis-like MALTomas, (2) multifocal atrophy pattern MALTomas, (3) multinodular MALToma, (4) ulcerative MALTomas, (5) polypoid /mass/SMT-like MALToma, (6) EGC-like MALTomas. ½ÇÁ¦·Î´Â ¾à°£ ÁöÀúºÐÇÏ¸é¼ ½ÉÇÏ°í ºÒ±ÔÄ¢ÇÏ°Ô ºÐÆ÷ÇÏ´Â ¹Ì¶õ¼º À§¿°°ú ºñ½ÁÇÑ ÇüŸ¦ º¸ÀÌ´Â °æ¿ì°¡ °¡Àå ¸¹½À´Ï´Ù.
ù Á¦±ÕÄ¡·á ÈÄ Àç°ËÇÏ¿´´Âµ¥ ±Õµµ ¾ø¾îÁöÁö ¾Ê°í MALTomaµµ °è¼Ó ³ª¿ÔÀ½ (´ÙÀ½ ÀÛÀº »çÁø).
À§Ã༺ À§¿° °°Àºµ¥ Á¶±Ý ºÒ±ÔÄ¢ÇÑ ºÎÀ§°¡ ÀÖ¾î¼ Á¶Á÷°Ë»çÇÏ¿´°í ÀÇ¿Ü·Î MALToma°¡ ³ª¿Í ÀÇ·ÚµÊ.
ÀÏ°ß Á¶±Ý ³Ð°Ô ºÐÆ÷µÈ lymphofollicular gastritis Á¤µµ·Î »ý°¢µÇ¾ú´Âµ¥ Á¶Á÷°Ë»ç¿¡´Â ÀÇ¿Ü·Î MALT ¸²ÇÁÁ¾À¸·Î º¸°íµÇ¾ú½À´Ï´Ù.
88¼¼ ¿©¼ºÀÇ °ËÁø ³»½Ã°æ¿¡¼ ¹ß°ßµÈ Hp (-) MALToma. ¿Ö °ËÁøÀ» ¹ÞÀ¸¼ÌÀ»±î? (Âü°í: EndoTODAY °ÇÁø À§³»½Ã°æÀ» ¸î ¼¼¿¡ Áß´ÜÇÒ °ÍÀΰ¡?)
55¼¼ ¿©¼º. °ËÁø ³»½Ã°æ¿¡¼ ¹ß°ßµÈ MALToma. Á¦±ÕÄ¡·á¸¦ ÇÏ¿´°í ¼ö °³¿ù ÈÄ Àç°ËÇÏ¿´À¸³ª À°¾È¼Ò°ßÀÌ ¾ÇȵǾúÀ½ (´ÙÀ½ ÀÛÀº »çÁø)
2. Multifocal atrophy pattern MALTomas
[ù ³»½Ã°æ¿¡¼ À§±Ë¾çÀ¸·Î Æò°¡µÇ¾úÀ¸³ª ÃßÀû³»½Ã°æ¿¡¼ MALT ¸²ÇÁÁ¾À¸·Î Áø´ÜµÈ Áõ·Ê]
50´ë ÃÊ¹Ý ³²¼ºÀÔ´Ï´Ù. °ÇÁø ³»½Ã°æ¿¡¼ ÀÛÀº ±Ë¾çÀÌ ¹ß°ßµÇ¾ú°í Á¶Á÷°Ë»ç¿¡¼ ¾Ï ¼Ò°ßÀÌ ¾ø¾î¼ ¾ç¼ºÀ§±Ë¾çÀ¸·Î ÆÇ´ÜÇÏ¿© 1ÁÖ°£ÀÇ Ç︮ÄÚ¹ÚÅÍ Á¦±ÕÄ¡·á + 3ÁÖ°£ÀÇ PPI Åõ¾à ÈÄ ÃßÀû³»½Ã°æ °Ë»ç¸¦ ½ÃÇàÇÏ¿´½À´Ï´Ù. ´Ù¼Ò ÀÌ»óÇÑ ¸ð¾çÀÇ ±Ë¾ç ¹ÝÈçÀ̾ú´Âµ¥ Á¶Á÷°Ë»ç¿¡¼ MALToma°¡ ³ª¿Ô½À´Ï´Ù.
MALT ¸²ÇÁÁ¾Àε¥ ù Áø´Ü¿¡¼ underestimation µÈ °æ¿ì·Î ÆǴܵ˴ϴÙ. ù ³»½Ã°æ »çÁøÀ» º¸¸é ÀÛ°í ¾èÀº ±Ë¾çÀº ÀÖÁö¸¸ fold´Â ±Ë¾ç °æ°è¿Í ¾à°£ ¶³¾îÁø °÷¿¡¼ ¸ØÃß°í ÀÖ½À´Ï´Ù. ±Ë¾ç°ú fold ³¡ »çÀÌ¿¡µµ Á¡¸·º´¼Ò°¡ ÀÖ´Ù´Â ÀǹÌÀÌ°í, ½ÇÁ¦·Î ¾à°£ÀÇ ¹ßÀû°ú Ç¥¸é º¯È°¡ ÀÖ½À´Ï´Ù. ÈÄÇâÀûÀ¸·Î ÆÇ´ÜÇÏ¸é ¾ç¼º À§±Ë¾çÀº ¾Æ´Ï¾ú½À´Ï´Ù. º´¸® ½½¶óÀ̵带 ¸®ºäÇϸé ÁÁ°Ú½À´Ï´Ù. º´¸® ¼±»ý´Ô²²¼ Ưº°È÷ chronic gastritis, active, with lymphoid follicles¶ó°í ¾ð±ÞÇÑ °Íµµ ¹º°¡ Àǹ̰¡ ÀÖ¾úÀ» °Í °°½À´Ï´Ù.
ÃßÀû³»½Ã°æ »çÁøµµ ¿¹»Ú°Ô ¾Æ¹® ±Ë¾ç ¹ÝÈçÀÌ ¾Æ´Ï°í, MALT ¸²ÇÁÁ¾ Ä¡·á ÈÄ °üÂûµÇ´Â white atrophic scar¿¡ ÇÕ´çÇÑ ¸ð¾çÀÔ´Ï´Ù. ±×·¯´Ï±î óÀ½ºÎÅÍ MALT ¸²ÇÁÁ¾À̾ú´ø °ÍÀ¸·Î º¸¸é ¹«³ÇÕ´Ï´Ù.
ÀÏ´Ü Á¦±ÕÄ¡·á´Â ÇÏ¿´°í À°¾ÈÀûÀ¸·Î È£ÀüµÇ¾ú´Âµ¥, ´ÜÁö Á¶Á÷°Ë»ç¿¡¼ MALT ¸²ÇÁÁ¾ÀÌ ³ª¿À°í ÀÖÀ¸¹Ç·Î Áö±ÝÀº ±â´Ù¸®¸é µË´Ï´Ù. (¾î¿ ¼ö ¾ø´Â »ç¿¬À¸·Î ¾à°£ ´Ê¾úÁö¸¸) Stomach CT Á¤µµ Âï¾î¼ ÁÖº¯ ¸²ÇÁÀý¿¡´Â ¹®Á¦°¡ ¾ø´ÂÁö È®ÀÎÇØ µÎ´Â Á¤µµ°¡ ÀüºÎÀÏ °Í °°½À´Ï´Ù. 3-6°³¿ù °£°ÝÀ¸·Î ³»½Ã°æ ¹× Á¶Á÷°Ë»ç¸¦ ÇÏ¿© ¿ÏÀü °üÇØ°¡ ¿À´ÂÁö È®ÀÎÇÏ¸é µÇ°Ú°í 1³âÀ̳ª 1³â ¹Ý ÈıîÁö ¿ÏÀü °üÇØ°¡ ¿ÀÁö ¾ÊÀ¸¸é ¹æ»ç¼± Ä¡·á¸¦ °í·ÁÇϸé ÁÁ°Ú½À´Ï´Ù.
2012³â Áõ·Ê. 40´ë ¿©¼º. ¸ñÀÌ ½ÉÇÏ°Ô µû²û°Å¸®´Â Áõ¼¼·Î º´¿øÀ» ¹æ¹®ÇÏ¿© ³»½Ã°æ¿¡¼ À§ MALT ¸²ÇÁÁ¾À¸·Î Áø´ÜµÇ¾úÀ¸³ª CT¿Í PET¿¡¼ ¿©·¯ ºÎÀ§ÀÇ multiple lymph node enlargment ¼Ò°ßÀÌ ÀÖ¾î H. pylori Á¦±ÕÄ¡·á ÈÄ ÀǷڵǾú½À´Ï´Ù. ¿ø¹ß¼º À§ MALT ¸²ÇÁÁ¾ÀÇ Àü½Å ¸²ÇÁÀý ħ¹üÀÎÁö ¾Æ´Ï¸é neck nodal lymphomaÀÇ À§ ħ¹üÀÎÁö ±¸ºÐÀÌ ¾î·Æ½À´Ï´Ù. Á¦±ÕÄ¡·á¸¸À¸·Î´Â ºÎÁ·ÇÏ´Ù°í ÆǴܵǾî Ç×¾ÏÄ¡·á¸¦ ±ÇÇß½À´Ï´Ù.
±è±¤ÇÏ ±³¼ö´ÔÀÇ ¸®ºä¿¡ MALT ¸²ÇÁÁ¾°ú EGC IIbÀÇ ±¸ºÐ¿¡ ´ëÇÑ Ç¥°¡ ÀÖ¾î ¼Ò°³ÇÕ´Ï´Ù. (Korean J Gastroenterol 2011)
6. Polypoid/mass/SMT-like MALToma
Á¦±ÕÄ¡·á¸¦ ÇÏ¿´À¸³ª È£ÀüÀÌ ¾ø¾î polypectomy¸¦ ÇÏ¿´°í ÀÌÈÄ Àç¹ßÀÌ ¾ø¾ú½À´Ï´Ù. (Clin Endosc 2013)
½ÊÀÌÁöÀå ±Ë¾ç ¹ÝÈç ȯÀÚ¿¡¼ Hp¸¦ º¸±â À§ÇÑ Á¶Á÷°Ë»ç¿¡¼ ¿ì¿¬È÷ MALToma°¡ ³ª¿ÔÀ¸¹Ç·Î À§³»½Ã°æ ¼Ò°ßÀº Ưº°ÇÑ °ÍÀÌ ¾ø¾ú½À´Ï´Ù.
¼±Á¾ ÀǽÉÇÏ°í EMR Çߴµ¥ MALToma°¡ ³ª¿Ô´Ù°í ÀÇ·ÚµÈ È¯ÀÚÀÔ´Ï´Ù.
FundusÀÇ SMT ¾ç»óÀ¸·Î ÀǷڵǾú´ø ºÐÀ¸·Î ÃÖÁ¾ÀûÀ¸·Î MALToma·Î È®ÀεǾî RT ½ÃÇà (2015)
Multifocal MALToma ȯÀÚÀÇ Helicobacter Á¶Á÷°Ë»ç(Á¶Á÷°Ë»ç site »çÁøÀº ¾øÀ½)¿¡¼ consistent with MALToma°¡ ³ª¿Â °æ¿ìÀÔ´Ï´Ù. ºñ±³Àû Á¤»óÀ¸·Î º¸ÀÌ´Â °÷¿¡¼ Á¶Á÷°Ë»ç¸¦ ÇßÀ» °ÍÀε¥ MALToma¿¡ ÇÕ´çÇÏ°Ô ³ª¿ÔÁö¸¸ ±×¸® ³î¶ö ÀÏÀº ¾Æ´Õ´Ï´Ù. MALToma¶ó´Â °ÍÀÌ ¿ø·¡ diffuse multifocalÇÑ Æ¯Â¡À» °¡Áö°í Àֱ⠶§¹®ÀÔ´Ï´Ù. ´ÜÁö ¾Æ¹«¸® ±ÞÇß´õ¶óµµ ÀüÁ¤ºÎ¿Í üºÎÀÇ Á¶Á÷À» ÇÑ Åë¿¡ ´ã±Å º´¸®°á°ú¸¦ º¸³½ °ÍÀº ³Ê¹«ÇÑ °Í °°½À´Ï´Ù. ¼·Î ´Ù¸¥ °÷ÀÇ °Ëü´Â ¼·Î ´Ù¸¥ Åë¿¡ ´ãµµ·Ï ÇսôÙ.
[Multifocal patch distribution]
Gastric MALToma´Â multifocal patch distributionÀÌ Æ¯Â¡ÀÔ´Ï´Ù. Áø´Ü½Ã º´¼Ò°¡ 1-2°³¿¡ ºÒ°úÇÏ¿´´Âµ¥ Á¦±ÕÄ¡·á ÈÄ ÃßÀû³»½Ã°æ¿¡¼ À̺¸´Ù ÈξÀ ¸¹Àº white atrophic scarµéÀÌ °üÂûµÇ´Â °æ¿ì°¡ ÀÖ½À´Ï´Ù. óÀ½ºÎÅÍ ¸Å¿ì ¸¹Àº ¼öÀÇ MALToma focus°¡ patch distribution ÇØ ÀÖ¾ú´ø °ÍÀÏ »ÓÀÔ´Ï´Ù. ¹ãÇÏ´ÃÀÇ º°Ã³·³ º¸ÀÔ´Ï´Ù. ³î¶ó¿î ÀÏÀº ¾Æ´Ï°í »ç½Ç Á¦¹ý ÈçÇÑ Çö»óÀÔ´Ï´Ù.
Á¦±ÕÄ¡·á ÈÄ index º´¼Ò´Â CR (complete remission)ÀÌ µÇ¾ú½À´Ï´Ù. ±×·±µ¥ À§ fundus¿Í body¿¡ ¸Å¿ì ¸¹Àº white atrophic scarµéÀÌ °üÂûµÇ¾ú½À´Ï´Ù. ¹ãÇÏ´ÃÀÇ º°Ã³·³ º¸ÀÔ´Ï´Ù.
[2015-1-3. Ãß°¡] Gastric mapping for gastric MALToma
2014³â 12¿ù Best Pract Res Clin GastroenterolÀÇ Á¾¼³¿¡ MALToma Áø´Ü °úÁ¤ÀÇ gastric mapping¿¡ ´ëÇÑ ¼Ò°³°¡ ÀÖ¾ú½À´Ï´Ù (Fischbach, 2014). Á¶Á÷°Ë»ç·Î È®ÀÎµÈ MALToma ȯÀÚ¿¡¼ ´Ù½Ã ³»½Ã°æ °Ë»ç¸¦ ÇÏ¿© 20°³ Á¤µµÀÇ Á¶Á÷°Ë»ç¸¦ Ãß°¡·Î ÇÏ´Â °ÍÀÌ gastric mappingÀÔ´Ï´Ù. À¯·´¿¡¼´Â ÃßõµÇÁö¸¸, ¿ì¸®³ª¶ó³ª ÀϺ»¿¡¼´Â ¾Æ¹«µµ ¾È ÇÏ°í ÀÖ´Â ¹æ¹ýÀÔ´Ï´Ù. »ç½Ç À¯·´ ÀÇ»çµéÀÌ ´Ù ÀÌ·¸°Ô ÇÏ°í ÀÖ´ÂÁöµµ ¹ÌÁö¼öÀÔ´Ï´Ù. ³»½Ã°æ À°¾È¼Ò°ßº¸´Ù º´¸® °á°ú¿¡ ÀÇÁ¸ÇÏ¿© ȯÀÚ¸¦ Áø´ÜÇÏ´Â À¯·´ ÀÇ»çµéÀÇ ³ª»Û ½À°üÀ̶ó°í »ý°¢ÇÕ´Ï´Ù. ÀÌ·± °ÍÀº Àý´ë µû¶óÇÏÁö ¸¿½Ã´Ù.
In view of the nonspecific appearance of gastric MALT lymphoma [8] and the need for an exact diagnosis and typing of the lymphoma, a sufficient number of biopsies from both macroscopic lesions and normal appearing mucosa is necessary. This procedure named gastric mapping is recommended by the German S3 guideline (grade C, evidence lever 5; 19) as well as in the European EGILs Consensus Report of 2011. The minimal number of biopsy samples that should be taken from visible lesions is ten. The number of biopsies to be taken from macroscopically normal mucosa is not specified. However, four biopsies from the antrum and body, respectively, and two additional biopsies from the fundus seem reasonable. In general, such a biotic protocol is not performed during a routine diagnostic endoscopy. Therefore, a diagnostic algorithm as outlined in Fig. 2 seems appropriate.
© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng