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[One point lesson 3 - ½Äµµ¾Ï]

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EndoTODAY ½Äµµ¾ÏÀÇ Áø´Ü°ú Ä¡·á¸¦ Âü°íÇϽñ⠹ٶø´Ï´Ù.


½Äµµ¾ÏÀº À§¾Ï¸¸Å­ ³»½Ã°æ ºÐ·ù°¡ À¯¿ëÇÏÁö ¾Ê½À´Ï´Ù. ³»½Ã°æ °á°úÁö¿¡´Â superficial esophageal cancer ȤÀº advanced esophageal cancer¶ó°í °£´ÜÈ÷ ¾²´Â °æ¿ì°¡ ¸¹½À´Ï´Ù. ±×·¯³ª ½Äµµ¾Ï¿¡¼­µµ À§¾Ïó·³ ³»½Ã°æ ºÐ·ù¸¦ Àû¿ëÇÏ¸é ¿©·¯ Ãø¸é¿¡¼­ À¯¿ëÇÒ °Í °°½À´Ï´Ù. 2009³â ¹ßÇ¥µÈ Japanese classification of esophageal cancer (10th ed)¿¡¼­ Á¦½ÃµÈ ¹æ¹ýÀ» µû¸¨½Ã´Ù (Esophagus 2009:6:1-25). À§¾ÏÀÇ ºÐ·ù¿Í ¸Å¿ì À¯»çÇϱ⠶§¹®¿¡ ¿Ü¿ì±â´Â ½±½À´Ï´Ù.


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[ÁøÇ༺ ½Äµµ¾Ï]

³»½Ã°æ Áø´ÜÀº Advanced esophageal cancer, 4 cm, type 2·Î ¾²½Ç °ÍÀ» ±ÇÇÕ´Ï´Ù. Type 3 °°´Ù±¸¿ä? »ó°ü¾ø½À´Ï´Ù.
Invasive squamous cell carcinoma, moderately differentiated, esophagus:
1) tumor size: 4x2 cm
2) extension to perimuscular adventitia
3) endolymphatic tumor emboli: not identified
4) perineural invasion: present
5) involvement of radial margin
6) negative resection margins (proximal, 3 cm ; distal, 10 cm)
7) metastasis to 3 out of 62 regional lymph nodes

³»½Ã°æ Áø´ÜÀº Advanced esophageal cancer, 3 cm, type 3·Î ¾²½Ç °ÍÀ» ±ÇÇÕ´Ï´Ù. Type 2 °°´Ù±¸¿ä? »ó°ü¾ø½À´Ï´Ù.
Esophagus and upper stomach, Ivor Lewis operation:
Invasive squamous cell carcinoma, moderately differentiated;
1) tumor size: 3.5x1.8cm
2) extension to perimuscular adventitia
3) endolymphatic tumor emboli: absent
4) perineural invasion: absent
5) negative resection margins (proximal, 5.8cm ; distal, 8.2cm)
6) no metastasis in 59 regional lymph nodes

³»½Ã°æ Áø´Ü: Advanced esophageal cancer, 3 cm, type 3
Esophagus and upper stomach, Ivor Lewis operation : Invasive squamous cell carcinoma, moderately differentiated, middle thoracic esophagus :
1) invasive carcinoma size: 3.5x2.5 cm
2) extension to periesophageal soft tissue (adventitia)
3) endolymphatic tumor emboli: present
4) perineural invasion: not identified
5) resection margins: free from carcinoma, but very close to circumferential resection margin. safety margin: proximal, 4.5 cm ; distal, 8.5 cm ; circumferential (adventitial) margin(deep), 50 §­
6) metastasis to 1 out of 29 regional lymph nodes without extracapsular extension, (size of the largest metastasis: 0.4 cm) (1/29 : "7(Subcarinal)", 1/10; "Gastric lymph node 1", 0/2; "Gastric lymph node 3", 0/10; "Gastric lymph node 4", 0; "Lt Recurrent Laryngeal Nerve lymph node", 0/4; "Rt Recurrent Laryngeal Nerve lymph node", 0/3)
7) treatment effect: no prior treatment


[½Äµµ melanoma]

ÀÏ°ß advanced esophageal cancer, 9cm, type 3·Î ¾²±â ½¬¿ï °Í °°½À´Ï´Ù. ±×·¯³ª °ËÀº »ö plaque¿Í mass »çÀÌ»çÀÌÀÇ °ËÀº »ö¿¡ ÁÖÀÇÇØÁֽñ⠹ٶø´Ï´Ù.

Esophagus and upper stomach, Ivor Lewis operation:
Malignant melanoma:
1) tumor size: 9x9 cm
2) extension to proper muscle layer
3) depth of invasion: 1.5 cm
4) endolymphatic tumor emboli: present
5) necrosis: about 10 %
6) growing with pushing border
7) mitosis: 9/10 HPFs
8) negative mucosal resection margins, but lymphatic emboli present in "proximal resection margin"
9) metastasis to 9 out of 25 regional lymph nodes

* Âü°í: EndoTODAY ½Äµµ Èæ»öÁ¾

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