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[Serrated lesions of the colorectum. Åé´Ï»ó º´º¯] - ðû

1. Definition of serrated polyps and lesions - 2019³â WHO Á¤ÀÇ¿Í ºÐ·ù

2. Serrated polyposis

3. µÎ Á¾·ùÀÇ serrated pathway

4. Cases

5. FAQs - Sessile serrated lesionÀÇ ÄÚµå

6. References

2022-8-24 Sessile serrated lesions ¹«°æ¼º Åé´Ïº´º¯ÀÇ ³»½Ã°æ Áø´Ü ¼ú±â (±èÇö°Ç ±³¼ö´Ô)

2018-4-30 ±èÅÂÁØ ±³¼ö´Ô °­ÀÇ (PDF)

Sessile serrated adenoma


1. Definition of serrated polyps and lesions

2013³â 6¿ù 23ÀÏ »ï¼º¼­¿ïº´¿ø Á¦ 13ȸ ¼ÒÈ­±âº´ ½ÉÆ÷Áö¾ö°ú 2016³â 1¿ù 30ÀÏ »ï¼º¼­¿ïº´¿ø Winter School¿¡¼­ À嵿°æ ±³¼ö´Ô²²¼­ °­ÀÇÇϽŠ³»¿ëÀÇ ÀϺθ¦ ³ª¸§ Á¤¸®Çؼ­ ¿Å±é´Ï´Ù.

Serrated polyp (°ÅÄ¡»ó Æú¸³)À̶õ cryptÀÇ ÇüÅ°¡ Å鳯¸ð¾çÀ» ´à¾Ò´Ù´Â Á¡¿¡¼­ À¯·¡ÇÑ À̸§ÀÔ´Ï´Ù (serrated = saw-tooth appearance). Crypt epithelial cellÀÇ apoptosis°¡ ÀϾÁö ¾Ê¾Æ¼­ ³ëÈ­µÈ ¼¼Æ÷°¡ ÃàÀûµÊ¿¡ µû¶ó Á¼Àº °ø°£¿¡ ¼¼Æ÷°¡ ½×À̸鼭 cryptÀÇ ±¸Á¶°¡ Åé´Ïó·³ µé¾¦³¯¾¦ÇÑ ÇüÅ·Πº¯ÇÑ °ÍÀÔ´Ï´Ù. ºÐ·ù´Â °è¼Ó º¯ÇÏ°í ÀÖÁö¸¸ 2010³â WHO ºÐ·ù´Â ¾Æ·¡ Ç¥¿Í °°½À´Ï´Ù. ¾ÆÁ÷±îÁö´Â ¹«Ã´ ºÒ¿ÏÀüÇÑ ºÐ·ù¹ýÀ̶ó´Â »ý°¢ÀÌ µì´Ï´Ù.

Non-dysplasticDysplastic
Hyperplastic polyps
- Goblet cell-rich
- Microvesicular
- Mucin-poor
Sessile serrated adenoma/polyp with dysplasia
Sessile serrated adenoma/polyp (without dysplasia)Traditional serrated adenoma (TSA)

°úÇü¼ºÆú¸³Àº Á¶Á÷ÇÐÀûÀ¸·Î °ÅÄ¡»ó º¯È­°¡ ¼±¿ÍÀÇ »óºÎ¿¡ ±¹Çѵ˴ϴÙ. Microvesicular typeÀÌ °¡Àå ÈçÇÑ ÇüÅÂÀÔ´Ï´Ù. µå¹°°Ô sessile serrated adenoma/polypÀ¸·Î ÁøÇàÇÒ ¼ö ÀÖ´Ù°í ÇÕ´Ï´Ù. Goblet cell-rich typeÀº µå¹°°í traditional serrated adenoma·Î ÁøÇàÇÏ´Â °Í °°½À´Ï´Ù. Mucin-poor typeÀº ¸Å¿ì µå¹® ÇüÅÂÀÔ´Ï´Ù.

Sessile serrated adenoma/polyp (SSA/P)Àº ¹«Ã´ ÀÌ»óÇÑ °³³äÀÔ´Ï´Ù. Àüü Æú¸³ÀÇ 5% Á¤µµÀ̸ç, ÇüÅ´ ¹«°æ¼ºÀÌ°í, ºñ¸¸°îºÎ »ó¹æ¿¡¼­ ÁÖ·Î ¹ß°ßµË´Ï´Ù. °æ°è´Â ºÒºÐ¸íÇÏ°í ¹ÝÅõ¸íÇϸç Á¡¸ÆÀÌ ¹¯¾îÀÖ´Â °æ¿ìµµ ÀÖ½À´Ï´Ù. °ÅÄ¡»ó º¯È­°¡ ¼±¿ÍÀÇ ÇϺαîÁö ¹ß»ýÇϸç, ÇϺΠ¼±¿Í°¡ È®ÀåµÇ¾î ÀåÈ­°°Àº ¸ð¾çÀ» º¸ÀÔ´Ï´Ù(boot-shaped ȤÀº inverted T-shaped). ƯÀÌÇÑ Á¡Àº dysplasia°¡ ¾ø¾îµµ malignant potentialÀÌ ÀÖ´Ù´Â °ÍÀÔ´Ï´Ù. ±×·¡¼­ dysplasia°¡ ¾ø¾îµµ adenoma¶ó°í ºÒ¸³´Ï´Ù. (ÀÌ»óÇÑ ÀÏÀÌÁö¿ä?) ºñ·Ï celluar atypia´Â ¾øÁö¸¸ structural atypia°¡ Àֱ⠶§¹®¿¡ malignant potentialÀÌ ÀÖ´Â °ÍÀ¸·Î Àú´Â ÀÌÇØÇÏ°í ÀÖ½À´Ï´Ù.

Gut Liver 2021

ÀÓ»óÀû ÀÇÀÇ¿¡ ´ëÇÏ¿© À嵿°æ ±³¼ö´ÔÀÇ ¿ä¾àÀ» ±×´ë·Î ¿Å±é´Ï´Ù. "Sessile serrated polypÀº ³³ÀÛÇÏ°í °æ°è°¡ ¸íÈ®ÇÏÁö ¾Ê¾Æ barium enema³ª CT colonography·Î´Â ¹ß°ßÀÌ °ÅÀÇ ºÒ°¡´ÉÇÏ°í, ´ëÀå³»½Ã°æÀ¸·Îµµ ³õÄ¡±â ½±´Ù. ÃâÇ÷ÇÏ´Â °æ¿ìµµ ¸Å¿ì µå¹°¾î¼­ fecal occult blood test·Î ¹ß°ßÇϱ⵵ ¾î·Æ´Ù. ¾ÏÀ¸·Î ÀÌÇàÇÏ´Â ¼Óµµ°¡ ºü¸£°Ç ´À¸®°Ç °£¿¡ ÀÌ·¯ÇÑ ¹ß°ß»óÀÇ ¾Ö·ÎÁ¡ÀÌ interval cancer·Î ±Í°áµÇ´Â °ÍÀ̶ó´Â ÃßÁ¤µµ ÀÖ´Ù. ±×·¯¹Ç·Î ¿ìÃø ´ëÀåÀÇ ³»½Ã°æ °Ë»ç½Ã¿¡´Â sessile serrated polypÀÇ Á¸À縦 ¿°µÎ¿¡ µÎ°í Á» ´õ ¼¼½ÉÇÏ°Ô °üÂûÇÒ ÇÊ¿ä°¡ ÀÖ´Ù."

Proposed new surveillance guideline for serrated polyps (Terdiman et al. Gastroenterology 2010;139:1444-1447)

Lesion foundSurveillance interval (years)
Serrated polyposis
1
Serrated polyp with any cytological dysplasia
3
Serrated polyp proximal to the splenic flexure
3
Serrated polyp >= 10 mm
3
Serrated polyps < 10 mm and distal to the splenic flexure
10


[2019³â »õ·Î¿î ºÐ·ù]

Serrated º´¼Ò¿¡ ´ëÇÑ 2019³â WHOÀÇ ºÐ·ùÀÔ´Ï´Ù. Ư±âÇÒ Á¡Àº sessile serrated adenoma/polyp (SSA/P)¶ó´Â °ú°Å¿¡ »ç¿ëÇÏ´ø ¹¦ÇÑ À̸§ÀÌ ¾ø¾îÁ³´Ù´Â °ÍÀÔ´Ï´Ù. ¹°·Ð SSA/PÀ» ´ëüÇÏ´Â SSL ¶Ç´Â SSLDµµ ¹¦ÇÑ À̸§ÀÎ °ÍÀº ¸¶Âù°¡Áö¸¸ SSA/Pº¸´Ù´Â ³ªÀº °Í °°½À´Ï´Ù.

Summary of changes:

ÀÚ·áÁ¦°ø: ±èÀº¶õ ±³¼ö´Ô

Histological criteria for sessile lesions and polyps:

M/65 (2023)

À§ ȯÀÚÀÇ EMR º´¸®. Sessile serrated lesion

Serrated polyposisÀÇ Á¤Àǵµ º¹ÀâÇØÁ³½À´Ï´Ù.

2019³â WHO ºÐ·ù


2. Serrated polyposis

2019³â serrated lesion¿¡ ´ëÇÑ Á¤ÀÇ°¡ ¹Ù²î¸é¼­ serrated polyposisÀÇ Á¤Àǵµ º¹ÀâÇØÁ³½À´Ï´Ù.

2019³â WHO ºÐ·ù

¿©·¯ºÐÀÇ °­ÀÇ¿¡¼­ Á¶±Ý¾¿ °¡Á®¿Ô½À´Ï´Ù.

À嵿°æ. 2016 Winter School

2022-4-16 SIDDS ÀÌÁØ ±³¼ö´Ô (Á¶¼±´ë) °­ÀÇ


3. µÎ Á¾·ùÀÇ serrated pathway (sessile serrated pathway¿Í traditional serrated pathway)

[2015-10-30. ¾Öµ¶ÀÚ Áú¹®]

´ëÀå¾Ï °¡Á··ÂÀÌ ÀÖ´Â ºÐÀ¸·Î ¸î ´Þ ÀüºÎÅÍ °¡²û Ç÷º¯ÀÌ ÀÖ´Ù°í ¹æ¹®ÇÑ 50¼¼ ³²¼ºÀÔ´Ï´Ù. Mid ascending colon ºÎÀ§¿¡ 2 cm Isp ¿ëÁ¾ÀÌ ¹ß°ßµÇ¾ú½À´Ï´Ù. ¸ð¾çÀÌ ÁÁÁö ¾Ê¾Æ º¸¿´°í °¡Á··Âµµ ÀÖ¾î cancer °¡´É¼ºµµ ÀÖ°Ú´Ù ½Í¾ú½À´Ï´Ù. Injection ÈÄ¿¡ lifting ¿©ºÎ¿¡ µû¶ó EMRÀ» ÇÒÁö ±×³É Á¶Á÷°Ë»ç¸¸ ÇÒÁö °áÁ¤Çϱâ·Î ÇÏ¿´°í ´ÙÇàÈ÷ liftingÀÌ Àß µÇ¾î EMRÀ» ½ÃÇàÇÏ¿´½À´Ï´Ù.

º´¸® °á°ú traditional serrated adenoma with clear resection margin À¸·Î ³ª¿Ô½À´Ï´Ù. Serrated adenoma ´Â ÀÚ¼¼È÷ º¸Áö ¾ÊÀ¸¸é ³õÄ¡±â ½¬¿î flatÇϰųª sessileÇÑ Å¸ÀÔÀÎ ÁÙ ¾Ë¾Ò´Âµ¥ ³í¹®À» °Ë»öÇغ¸´Ï sessile or pedunculated shapeÀ¸·Î ´ëºÎºÐ distal colon¿¡ À§Ä¡Çϸç malignant potentialÀÌ ÀÖ´Ù°í ¼³¸íµÇ¾î ÀÖ½À´Ï´Ù. Pedunculated polypÀÇ ¸ð¾çÀ̸鼭 proximal colon ºÎÀ§¿¡ ÀÖ´Â traditional serrated adenoma¸¦ óÀ½ °æÇèÇؼ­ Áõ·Ê·Î º¸³»µå¸³´Ï´Ù.


[2015-11-1. °¡Å縯´ëÇб³ ³»°ú À̺¸ÀÎ ±³¼ö´Ô ´äº¯]

Serrated pathway´Â Å©°Ô sessile serrated pathway¿Í traditional serrated pathway·Î ³ª´©¾îÁý´Ï´Ù.

Gut Liver 2021

Sessile serrated pathway´Â BRAF mutation, CIMP µîÀÇ °æ·Î¸¦ ¹â¾Æ sessile serrated adenoma (SSA)·Î ¹ßÀüÇϸç MLH-1 promoter hypermethylation µîÀÇ °æ·Î¸¦ ¹â¾Æ SSA with dysplasia, MSI cancer·Î ÁøÇàÇÕ´Ï´Ù.

Traditional serrated pathway´Â K-ras mutation µîÀÇ °æ·Î¸¦ ¹â¾Æ traditional serrated adenoma (TSA), MGMT promoter hypermethylation µîÀÇ °æ·Î¸¦ °ÅÃÄ TSA with HGD, MSS Ca·Î ¹ßÀüÇÕ´Ï´Ù.

¿ì¸®°¡ interval cancerÀÇ ÁÖ¹üÀ¸·Î ¾Ë°í ÀÖ´Â serrated adenoma´Â ÁÖ·Î SSA (sessile serrated adenoma)¸¦ ¸»ÇÏ´Â °ÍÀÔ´Ï´Ù. ÀÌ´Â ÁÖ·Î ¿ìÃø´ëÀå¿¡ ¹ß»ýÇϸç ÀϹÝÀûÀÎ hyperplastic polypº¸´Ù Å« °æÇâÀ» º¸ÀÔ´Ï´Ù. ÁÖº¯Á¡¸·¿¡ ºñÇØ À¶±â°¡ ¹Ì¹ÌÇϸç ÆòźÇÏ°í ¹ÝÅõ¸íÇϰųª paleÇÑ Á¡¸·À» ¶ç°í °æ°èµµ ºÒºÐ¸íÇÏ¿©¼­ ÁÖÀÇÇÏÁö ¾ÊÀ¸¸é ¹ß°ßÀÚü°¡ ¾î·Æ½À´Ï´Ù. À°¾ÈÀû Áø´ÜÀÇ clue´Â Á¡¾×À» ¸¹ÀÌ ºÐºñÇؼ­ Ç¥¸é¿¡ Àß ¾Ä±âÁö ¾Ê´Â mucous capÀ» °®°í ÀÖ´Ù´Â °ÍÀε¥ À̵µ 2/3¸¸ ÀÖ´Ù°í ÇÕ´Ï´Ù. È®´ë³»½Ã°æÀ» Çصµ ÁÖ·Î Kudo pit pattern type II¸¦ º¸¿©¼­ hyperplastic polyp°ú ±¸ºÐµµ ½±Áö ¾Ê½À´Ï´Ù. type II pitÀÌ mucous material·Î È®ÀåµÈ type II-O patternÀÌ ¹ß°ßµÇ´Âµ¥ ±¹¼ÒÀûÀ¸·Î¸¸ ³ªÅ¸³ª¸ç ¹Î°¨µµ°¡ ³·½À´Ï´Ù. NBI¿¡¼­µµ subepithelial capillary networkÀÌ ¾ÆÁÖ µå¹® NICE I pattern (Sano I, Showa - faint)À» º¸À̹ǷΠÀ°¾ÈÀû °¨º°ÀÌ ½±Áö ¾Ê½À´Ï´Ù. ÀÌ·Î ÀÎÇؼ­ Western¿¡¼­ ÁÖÀåÇÏ´ø resect and discard strategyÀÇ ¼öÁ¤ÀÌ Á¦¾ÈµÉ Á¤µµÀÔ´Ï´Ù. SSA¸¦ Àß ¸ð¸£´Â community pathologistµµ ¸¹±â ¶§¹®¿¡ ¿ìÃø´ëÀå¿¡ ¹ß°ßµÈ ³ÐÀº º´º¯Àº ÀýÁ¦Á¶Á÷¼Ò°ßÀÌ hyperplastic polypÀ¸·Î ³ª¿Íµµ SSA¿¡ ÁØÇØ FUÇÏÀÚ´Â ÁÖÀåµµ ÀÖ½À´Ï´Ù.

TSA (traditional serrated adenoma)´Â ÁÖ·Î distal colorectum¿¡ À§Ä¡Çϸç SSAº¸´Ù µå¹°°Ô ¹ß°ßµË´Ï´Ù. Serrated polyp (hyperplastic polyp±îÁö Æ÷ÇÔ)ÀÇ 1% Á¤µµ¸¦ Â÷ÁöÇÕ´Ï´Ù. flatÇÑ Çüź¸´Ù protruded (sessile or pedunculated) ÇüŸ¦ °¡Áö¸ç Ç¥¸éµµ villous stricture¸¦ °¡Áö°í ¹ßÀûÀÌ ÀÖ´Â °æ¿ìµµ ¸¹¾Æ ¹ß°ßÀÌ ¾î·ÆÁö´Â ¾Ê½À´Ï´Ù. ¾ÏÈ­°¡´É¼ºµµ »ó´ëÀûÀ¸·Î ³ô¾Æ ÀϹÝÀûÀ¸·Î advanced adenoma¿¡ ÁØÇØ ÃßÀûÇÕ´Ï´Ù.

µ¶ÀÚºÐÀÌ º¸³»ÁֽŠTSA´Â º´¸®ÇÐÀû Áø´ÜÀÌ ¸Â´Â´Ù¸é Ç¥¸éÀÌ ºñ±³Àû smoothÇÏ°í ¿ìÃø¿¡¼­ ¹ß°ßµÈ Á¡(¹°·Ð ¿ìÃø ´ëÀå¿¡ ÀÖÀ» ¼öµµ ÀÖ½À´Ï´Ù¸¸)µîÀÌ Á» ƯÀÌÇÏ´Ù°í ÇÒ ¼ö ÀÖÀ¸³ª °£È¤ º¸´Â ÇüŶó°í ÇÒ ¼ö ÀÖÀ» µí ÇÕ´Ï´Ù.


[Cases]

°¡Àå ÀüÇüÀûÀÎ ÇüÅÂÀÇ A colon serrated adenoma

A colonÀÇ LSTÀÔ´Ï´Ù. Á¶Á÷°Ë»ç°¡ hyperplastic polypÀ¸·Î ³ª¿ÔÀ¸³ª EMRÀ» ÇÏ¿´°í ÃÖÁ¾ °á°ú´Â serrated adenoma·Î ³ª¿Ô½À´Ï´Ù.

Rectum, 3cm from anal verge, biopsy:
Serrated adenoma with low grade dysplasia :
1) size: 1.6x0.8 cm
2) gross type: elevated
3) negative resection margins

Mucocele ÀǽÉÇÏ¿´À¸³ª Á¶Á÷°Ë»ç¿¡¼­ Villotubular adenoma°¡ ³ª¿Í ¼ö¼úÀ» ÇÏ¿´°í ÀÇ¿ÜÀÇ °á°ú¿´½À´Ï´Ù.
Cecum and ileum, ileocecectomy :
Serrated adenocarcinoma, well differentiated
1. Location: cecum
2. Gross type: superficial
3. Size: 5.5x3.8 cm
4. Depth of invasion: invades pericolic adipose tissue(pT3)
5. Resection margin: free from carcinoma, safety margin: proximal, 6 cm ; distal, 6.5 cm
6. Regional lymph node metastasis : no metastasis in all 10 regional lymph nodes(pN0)
7. Lymphatic invasion: not identified
8. Venous invasion: not identified
9. Perineural invasion: not identified
10. Tumor budding: negative

Á¶Á÷°Ë»ç: Traditional serrated adenoma.
ÁÖÄ¡ÀÇ ÆÇ´Ü: Huge rectal mass. Á¶Á÷ °Ë»ç¿¡¼­ serrated adenoma¿´°í ƯÀÌ °ú°Å·Â ¾øÀ¸³ª ÁÖº¯¿¡ postinflmmatory change º¸ÀÓ. Å©±â°¡ Å©°í ¾Ç¼º ¹èÁ¦µÇÁö ¾Ê¾Æ ¼ö¼úÀû Ä¡·á°¡ ÇÊ¿äÇÒ °ÍÀ¸·Î »ç·áµË´Ï´Ù.
¼ö¼ú (Low anterior resection) º´¸®
Serrated adenoma, high grade:
1) size: 3.5x2.5 cm
2) type: fungating
3) no metastasis in 18 regional lymph nodes
4) negative resection margins


[FAQs]

[2013-9-26. ¾Öµ¶ÀÚ Áú¹®]

1 cm flat elevated lesion in the sigmoid colon (hyperplatic polyp or serrated adenoma)

±³¼ö´Ô ¾È³çÇϽʴϱî. ±³¼ö´Ô²²¼­ ¸ÞÀÏ·Î º¸³»Áֽô EndoTODAY´Â Ç×»ó °¨¸í±í°Ô Àо°í ÀÖ´Â ÁßÀÔ´Ï´Ù. ´ëÇк´¿ø¿¡¼­ Æӷοì 2³âÀ» ¸¶Ä¡°í °­È£·Î ³ª¿Â ÀÌÈÄ ±×µ¿¾È ³»°¡ ¸ô¶ú°Å³ª ¾Ë¾Ò¾îµµ º°·Î °ü½ÉÀ» °¡ÁöÁö ¾Ê¾Ò´ø »çÇ×ÀÌ Âü ¸¹¾ÆÁø °Í °°½À´Ï´Ù.

¿À´ÃÀº Distal sigmoid colonÀÇ Àå°æ 1cm, flat (°ÅÀÇ LST-like) hyperplastic polypÀÇ management¿¡ ´ëÇØ ¹®Àǵ帳´Ï´Ù. »ç½Ç º´¿øÀ̾ú´Ù¸é ´ç¿¬È÷ EMR·Î Á¦°ÅÇÏ¿´°ÚÁö¸¸, Á¦°¡ ±Ù¹«ÇÏ´Â °ËÁø ±â°üÀÇ Æ¯¼º»ó Ȥ½Ã³ª ÀÖÀ»Áö ¸ð¸£´Â ÇÕº´ÁõÀ» °í·ÁÇÏ¿© Àα٠º´¿øÀ¸·Î ´çÀÏ ¿ëÁ¾ÀýÁ¦¸¦ referÇÕ´Ï´Ù.

Á¦ ¹®ÀÇ »çÇ×Àº Á¶Á÷°Ë»ç¿¡¼­ Á¤¸»·Î hyperplastic polyp(Á¶Á÷°Ë»ç´Â ³ª¿ÀÁö ¾Ê¾ÒÁö¸¸ °ÅÀÇ ±×·² °ÍÀ̶ó°í »ý°¢ÇÕ´Ï´Ù)À¸·Î ³ª¿Â´Ù¸é, ÀÌ°ÍÀ» °ú¿¬ Á¦°ÅÇØ¾ß Çϴ°¡ÀÔ´Ï´Ù. Proximal colon¿¡¼­ °üÂûµÇ¾ú´Ù¸é ÃßÈĸ¦ °í·ÁÇÏ¿© EMRÀ» À§ÇØ Å¸º´¿øÀ¸·Î referÇßÀ» °ÍÀε¥, À̹ø °æ¿ì´Â distal sigmoid colon(AV 15cm Á¤µµ)¿¡¼­ °üÂûµÇ¾î °æ°ú°üÂûÀ» ÇÒ Áö ¾Æ´Ï¸é EMRÀ» ÇÒ Áö °í¹ÎÀÔ´Ï´Ù. Âü°í·Î distal sigmoid colon ¹× rectum¿¡´Â ´Ù¼öÀÇ ÀÛÀº hyperplastic polypµéÀÌ °üÂûµÇ¾î °æ°ú°üÂûÇϱâ·Î Çß½À´Ï´Ù.


[°­µ¿°æÈñ´ëº´¿ø Â÷Àç¸í ±³¼ö´Ô ´äº¯]

°ú°Å hyperplastic polyp°ú adenoma·Î ¾çºÐµÇ´ø ´ëÀå Æú¸³ÀÌ serrated polyp °³³äÀÇ µîÀåÀ¸·Î ¸¹ÀÌ Çê°¥¸®°Ô µÇ¾ú½À´Ï´Ù. º¸¿©ÁֽŠ»çÁøÀÇ º´º¯Àº hyperplastic polypÀ¸·Î »ý°¢µÇÁö¸¸ sessile serrated adenoma (SSA)ÀÇ °¡´É¼ºÀ» ¹èÁ¦ÇÒ ¼ö ¾ø´Ù°í »ý°¢µË´Ï´Ù. °ú°Å ¾Ë°í ÀÖ´ø Á÷Àå°ú ±¸ºÒ°áÀåÀÇ ÀüÇüÀûÀÎ 5mm Å©±âÀÇ ´Ù¼öÀÇ hyperplastic polypÀÌ ¾Æ´Ï¶ó¸é ³»½Ã°æ ¿ÏÀü ÀýÁ¦¸¦ ±ÇÇÕ´Ï´Ù. ¼³»ç Á¶Á÷°Ë»ç¿¡¼­ hyperplastic polypÀ¸·Î ÆÇÁ¤µÇ¾ú´Ù°í ÇÏ´õ¶óµµ ¸¶Âù°¡Áö ÀÔ´Ï´Ù.

1) Serrated lesion¿¡ ´ëÇÑ ÃÖ±Ù Àü¹®°¡ ÇÕÀÇ¿¡ µû¶ó Á÷Àå/±¸ºÒ°áÀåÀÇ 5mmÀÌÇÏ ´Ù¼ö Æú¸³ÀÇ ÇüÅ°¡ ¾Æ´Ï¶ó¸é ³»½Ã°æ ¿ÏÀüÀýÁ¦¸¦ ±ÇÇÕ´Ï´Ù. Àú´Â EMR·Î Á¦°ÅÇÕ´Ï´Ù¸¸ ½Ã¼úÀÚ¸¶´Ù Á¦°Å ¹æ¹ýÀº Á¶±Ý¾¿ ´Ù¸¥ °Í °°½À´Ï´Ù.

"We recommend complete removal of all serrated lesions, except for diminutive sigmoid or rectal lesions. Multiple diminutive (= 5 mm) serrated-appearing lesions in the rectum and/or sigmoid should be randomly sampled for histology, but complete resection of all diminutive rectosigmoid serrated lesions is unnecessary. Almost all serrated lesions can be excised endoscopically, and the principles of resection are similar to those governing removal of adenomas." Rex DK, et al. Am J Gastroenterol 201;107(9):1315-1330.

2) ÀÌ º´º¯Àº À°¾ÈÀûÀ¸·Î hyperplastic polyp°ú sessile serrated adenoma¸¦ ¿ÏÀüÈ÷ ±¸ºÐÇϱ⠾î·Æ½À´Ï´Ù. SSAÀÇ °æ¿ì º´º¯ÀÇ 1/3ÀÌÇÏ ºÎºÐ¿¡ Ư¡ÀûÀÎ ¼Ò°ßÀÌ ºÐÆ÷Çϱ⠶§¹®¿¡ Á¶Á÷°Ë»ç¿¡¼­ hyperplastic polyp·Î ¿ÀÀεǴ °æ¿ì°¡ ¸¹½À´Ï´Ù. ½ÉÁö¾î Á¶Á÷ °Ë»ç¿¡¼­ hyperplastic polypÀ¸·Î ÆǸíµÇ¾ú´õ¶óµµ ÀÌ º´º¯ÀÌ ¿ÏÀüÈ÷ SSA°¡ ¾Æ´Ï¶ó°í ÇÒ ¼ö ¾ø½À´Ï´Ù.

¿ìÃø ´ëÀå¿¡ ÀÌ·± º´º¯ÀÌ ºÐÆ÷ÇÏ¸é ´ç¿¬È÷ SSAÀÇ °¡´É¼ºÀ» °í·ÁÇÏ¿© ÀýÁ¦¸¦ ÇÏ°Ú°í, ±¸ºÒ°áÀåÀ̶ó°í ÇÏ´õ¶óµµ SSAÀÇ °¡´É¼ºÀ» ¹èÁ¦Çϱâ À§ÇÑ Áø´Ü °â Ä¡·á ¸ñÀûÀ¸·Î ¿ÏÀü ÀýÁ¦¸¦ ÇÒ °Í °°½À´Ï´Ù. ½ÉÁö¾î Æú¸³ÀýÁ¦¼ú·Î Á¦°ÅµÈ º´º¯µµ °æÇèÀÖ´Â GI º´¸® Àǻ簡 º¸¸é SSA·Î Áø´ÜÀÌ ¹Ù²î´Â °æ¿ìµµ ÀÖ½À´Ï´Ù. ÀúÈñ º´¿ø¿¡¼­ ¸î ³â Àü °ú°Å EMRÈÄ Á¦°ÅÇÑ hyperplastic polyp Áø´ÜÀ» ¸ðµÎ °ËÅäÇÏ¿´´õ´Ï ±× Áß ¾à 18%°¡ Áø´ÜÀÌ SSA(sessile serrated adenoma)·Î ¹Ù²î±âµµ ÇÏ¿´½À´Ï´Ù (Kim SW, Gut Liver 2010). °ü½ÉÀÖ´Â º´¸® Àǻ簡 ¾Æ´Ï¸é Á¶Á÷°Ë»ç ¶Ç´Â Æú¸³ÀýÁ¦¼úÈÄ¿¡µµ sessile serrated adenoma¸¦ hyperplastic polypÀ¸·Î ¿ÀÁøµÉ ¼ö ÀÖ´Ù´Â ¾ê±âÀÔ´Ï´Ù.

PDF, 0.5 M

ÀÌ¿Í °°Àº ±Ù°Å·Î Àú´Â EMRÀ» ±ÇÇÏ°í ½Í½À´Ï´Ù. °¨»çÇÕ´Ï´Ù.


[2013-6-27. ¾Öµ¶ÀÚ Áú¹®]

±³¼ö´Ô ¾È³çÇϼ¼¿ä? º¸³»ÁֽŠ¼ÒÁßÇÑ ³»¿ëÀº ¿­½ÉÈ÷ °øºÎÇÏ°í ÀÖ½À´Ï´Ù. 6¿ù 24ÀÏ º¸³»ÁֽŠserrated adenoma ³»¿ë Áß ±Ã±ÝÇÑ °ÍÀÌ ÀÖ¾î ¸ÞÀÏ µå¸³´Ï´Ù. New surveillance guideline for serrated polyps Áß¿¡¼­ serrated polyposis¿Í serrated polypÀÇ surveillance intervalÀÌ ¼­·Î ´Þ¶ú½À´Ï´Ù. Polyposis¶ó ÇÔÀº FAP µî°ú °°Àº polyposis·Î ÀÌÇØÇØ¾ß ÇÏ´ÂÁö¿ä? ±×¸®°í serrated¶ó ÇÔÀº Á¶Á÷°Ë»ç·Î È®ÀεǴ °ÍÀε¥ serrated polyposis¶ó°í Á¤Àdz»¸®´Â ±âÁØÀÌ ¹«¾ùÀÎÁö¿ä? ÷ºÎµÈ ³í¹®À» ã¾Æº¸´Ï ¾Æ·¡ table°ú °°¾Ò½À´Ï´Ù. Hyperplastic polyposis¸¦ serrated polyposis ¶ó°í ´Ù½Ã ¸í¸íÇÒ ¼öµµ ÀÖ´Â °ÇÁöµµ Á¶±Ý ÀǾÆÇÕ´Ï´Ù.^^

The criteria for the diagnosis of hyperplastic polyposis, recently renamed serrated polyposis, published by WHO and NCCN
(1) At least 5 histologically diagnosed HPs proximal to the sigmoid colon, of which 2 are larger than 10 mm in diameter, or
(2) Any number of HPs occurring proximal to the sigmoid colon in an individual who has a first-degree relative with hyperplastic/serrated polyposis (HPSP), or
(3) More than 20 HPs of any size but distributed throughout the colon.


[2013-6-27. ´ëÀå Àü¹® H ±³¼ö´Ô²² ¹®ÀÇÇÏ¿© ¹ÞÀº ´äº¯]

Á¦°¡ »ý°¢ÇÏ´Â ´äº¯Àº ´ÙÀ½°ú °°½À´Ï´Ù. (¾à°£ÀÇ ÁÖ°üÀÌ °³ÀԵǾî ÀÖ½À´Ï´Ù )

1. Serrated polyposis¿Í serrated polyp´Â surveillance °£°ÝÀÌ ´Ù¸¥ °ÍÀº ¾î¶»°Ô ÀÌÇØÇÏ¿©¾ß Çմϱî?

Familiar adenomatous polyposis (FAP)¿Í tubular adenomaÀÇ surveillance interval ÀÌ ´Ù¸¥ °Íó·³ »ý°¢ÇϽøé ÁÁ°Ú½À´Ï´Ù.

2. Polyposis¶ó ÇÔÀº FAP µî°ú °°Àº polyposis·Î ÀÌÇØÇØ¾ß ÇÏ´ÂÁö¿ä?

→ ³×, ÀϹÝÀûÀ¸·Î polyposis¶ó°í Çϸé ÀüÅëÀûÀ¸·Î 100°³ ÀÌ»óÀ» À̾߱âÇÏÁö¸¸, ½Ã°£ÀÌ Áö³ª¸é¼­ attenuated FAP ȤÀº MYH polyposisµî°ú °°ÀÌ 30 (Àû°Ô´Â 10 or 20) ~ 100 »çÀÌÀÇ polypÀÌ Á¸ÀçÇÏ´Â °æ¿ìµµ polyposis¶ó°í ÇÕ´Ï´Ù. Hyperplastic/serrated polyposis (HPSP)µµ 20°³ ÀÌ»óÀÇ SP(HP)°¡ ÀÖÀ¸¸é Áø´ÜµÇ¹Ç·Î ±×·¸°Ô ÀÌÇØÇϼŵµ ¹®Á¦´Â ¾ø½À´Ï´Ù.

3. Serrated polypÀº Á¶Á÷°Ë»ç·Î È®ÀεǴ °ÍÀε¥ serrated polyposis¶ó°í Á¤ÀÇÇÏ´Â ±âÁØÀº ¹«¾ùÀÎÁö¿ä?

→ ¾Õ¼­ ¾ð±ÞÇØ µå¸° multiple HP¿Ü¿¡µµ 2°³ ÀÌ»óÀÇ 1cm ÀÌ»óÀÇ large SP¸¦ Æ÷ÇÔÇÏ´Â 5°³ ÀÌ»óÀÇ proximal SP/HP°¡ Á¸ÀçÇÏ´Â °Í°ú serrated polyposis(SPS)ÀÇ 1Â÷ °¡Á··ÂÀÌ ÀÖÀ¸¸é¼­ HP/SP°¡ Á¸ÀçÇÏ´Â °æ¿ì¸¦ Æ÷ÇÔÇÏ¿© SPS¶ó°í ÇÕ´Ï´Ù. ´Ù¸¥ polypsis¿Í ´Þ¸® serrated polyposis(SPS)´Â heterogenousÇϸ鼭 uniqueÇÑ genetic mutationÀÌ ¾ø½À´Ï´Ù. Serrated polyposisµµ Æò»ý ´©Àû ´ëÀå¾Ï ¹ß»ý·üÀÌ 25-70%·Î ³ô±â ¶§¹®¿¡ ÀϹÝÀûÀÎ SP/HP¿Í ´Þ¸® intensive surveillance°¡ ÇÊ¿äÇÕ´Ï´Ù.

4. Hyperplastic polyposis¿Í serrated polyposis´Â °á±¹ °°Àº °ÍÀԴϱî?

→ µ¿ÀÏÇÏ´Ù°í »ý°¢Çصµ µÇ°í ½ÇÁ¦ ÀÓ»ó ¹× ½ÇÇè research paper·Î º¸¼Åµµ µ¿ÀÏÇÏ°Ô »ç¿ëµÇ°í ÀÖ½À´Ï´Ù. ½ÇÁ¦ serrated (hyperplastic) polyposisÀÇ ÇÙ½ÉÀº SSA/P¿¡ ÀÖ½À´Ï´Ù. °ú°Å sessile serrated adenoma/polypÀÌ hyperplastic polypÀ¸·Î ºÐ·ùµÇ¾ú´ø ½Ã±â¿¡´Â hyperplastic polyposis·Î ĪÇÏ´ø Áúº´ÀÌ ÃÖ±Ù SSA/P°¡ ºñ±³Àû ¸íÈ®È÷ ±¸ºÐµÇ¸é¼­ serrated polypsis·Î ¹Ù²ã ºÎ¸£°Ô µÈ °ÍÀÔ´Ï´Ù.


[2021-4-30. ¾Öµ¶ÀÚ Áú¹®]

2³âÀü ³»½Ã°æ ÃʽÉÀÚ ¶§ ¿©·¯ Áú¹®À» µå¸° ÈÄ ±³¼ö´ÔÀÇ Ä£ÀýÇÑ ´äº¯À» ¹Þ¾Ò´ø ¶§°¡ »ý°¢³ª³×¿ä. ¾ù±×Á¦ °°Àºµ¥ ¹ú½á 2³âÀÇ ½Ã°£ÀÌ Èê·¶½À´Ï´Ù.

Àú´Â ÃÖ±Ù À§³»½Ã°æ ÃßÀû°Ë»ç¸¦ ÇÏ¸ç ´ë´Ù¼ö ¼ºÀÎ ³²¼ºÀÇ À§¿° »óÅ°¡ È£ÀüµÈ °ÍÀ» °æÇèÇÏ°í ÀÖ½À´Ï´Ù. ±×·±ºÐµéÀº Çϳª°°ÀÌ Äڷγª·Î »çÀû ¸ðÀÓÀÌ Á¦ÇѵǸ鼭 ȸ½Ä ÀÚ¸®°¡ ÁÙ¾î µé¾ú´Ù°í ÇÕ´Ï´Ù. Äڷγª°¡ ¿ì¸® ÀÏ»óÀ» µÚ¹Ù²Ù¾î ³õ¾Ò°í ±¹¹Îµé°ú ÀÇ·áÁøµéÀÌ ¾î·Á¿ò °¡¿îµ¥ ÀÖÁö¸¸ À¯µ¶ 'À§' ¸¸Å­Àº µµ¸®¾î ¼ú·ÎºÎÅÍ º¸È£¹Þ°í ÀÖ´Ù´Â »ý°¢ÀÌ µì´Ï´Ù. ¾ÆÀÌ·¯´Ï Çϳ׿ä.

´Ù¸§ÀÌ ¾Æ´Ï¿À¶ó ´ëÀå ¿ëÁ¾ Á¶Á÷°Ë»ç¸¦ º¸´Ùº¸´Ï SSL(sessile serrated lesion)À̶ó´Â ¿ë¾î¸¦ »ç¿ëÇϽô º´¸® ¼±»ý´ÔµéÀÌ °è½Ã´õ¶ó±¸¿ä. ±×·¡¼­ ÀڷḦ ã¾Æº¸´Ï The 5th edition of the WHO Classification of Tumours of the Digestive System (2019) ¿¡¼­ SSA/P ´ë½Å SSL À̶ó´Â ¿ë¾î·Î ´ëüµÇ¾úÀ½À» È®ÀÎÇß½À´Ï´Ù. (https://www.researchgate.net/publication/335314153_The_2019_WHO_classification_of_tumours_of_the_digestive_system)

1) ±³¼ö´ÔÀº SSL À̶ó´Â ¿ë¾î·Î ¹Ù²Ù¾î »ç¿ëÇϽôÂÁö¿ä? ¾Æ´Ï¸é WHO ÀÌ¿Ü ´Ù¸¥ classification ¿¡ ÇØ´çÇÏ´Â ¿ë¾î¸¦ »ç¿ëÇϽôÂÁö¿ä?

2) SSL ·Î º´¸®°Ë»ç °á°ú°¡ ÁÖ¾îÁ³À» °æ¿ì Áúº´ºÐ·ù ÄÚµå´Â ¹«¾ùÀ¸·Î ÁֽôÂÁö¿ä? (Àú´Â D126A À» »ç¿ëÇϴµ¥ SSL À̶ó´Â ¿ë¾î¾È¿¡ adenoma ¶ó´Â ´Ü¾î°¡ ¾ø¾î ¸Á¼³¿©Áö³×¿ä)

¹Ù»Ú½ÅÁÙ ¾ËÁö¸¸ ¿°Ä¡ ºÒ±¸ÇÏ°í ¹®Àǵ帳´Ï´Ù. °í°ßÀ» ±â´Ù¸®°í ÀÖ°Ú½À´Ï´Ù. ´Ã °Ç°­ÇϽʽÿÀ.

* Âü°í: 2019³â WHO ºÐ·ù (PDF)

[2021-5-1. »ï¼º¼­¿ïº´¿ø ±èÅÂÁØ ±³¼ö´Ô ´äº¯]

Q1. ±³¼ö´ÔÀº SSL À̶ó´Â ¿ë¾î·Î ¹Ù²Ù¾î »ç¿ëÇϽôÂÁö¿ä? ¾Æ´Ï¸é WHO ÀÌ¿Ü ´Ù¸¥ classification ¿¡ ÇØ´çÇÏ´Â ¿ë¾î¸¦ »ç¿ëÇϽôÂÁö¿ä?

A1. ´ëÀå¿ëÁ¾ º´¸® °á°ú´Â º´¸®°ú Àǻ翡 ÀÇÇÏ¿© Æǵ¶µÇ°í ¸®Æ÷Æ® µÇ°í Àִµ¥ ÀúÈñ º´¿ø¿¡¼­µµ ¾ÆÁ÷Àº sessile serrated lesion, sessile serrated adenoma ¸ðµÎ »ç¿ëÇÏ°í ÀÖ½À´Ï´Ù. Serrated lesion Àº º´¸®ÀûÀ¸·Î cytologic dysplasia ¸¦ ÀǹÌÇÏ´Â °ÍÀÌ ¾Æ´Ï¶ó architectural dystorsion À» ÀǹÌÇϱ⠶§¹®¿¡ adenoma¿Í dysplasia¸¦ °ÅÀÇ °°Àº ¶æÀ¸·Î ¿©±â´Â »óȲ¿¡¼­´Â SSAº¸´Ù´Â SSLÀÌ Á» ´õ Á¤È®ÇÑ Ç¥ÇöÀ̶ó »ý°¢ÇÕ´Ï´Ù.

Q2. SSL ·Î º´¸®°Ë»ç °á°ú°¡ ÁÖ¾îÁ³À» °æ¿ì Áúº´ºÐ·ù ÄÚµå´Â ¹«¾ùÀ¸·Î ÁֽôÂÁö¿ä? (Àú´Â D126A À» »ç¿ëÇϴµ¥ SSL À̶ó´Â ¿ë¾î¾È¿¡ adenoma ¶ó´Â ´Ü¾î°¡ ¾ø¾î ¸Á¼³¿©Áö³×¿ä)

A2. Serrated lesionÀÇ »ó´ç¼ö´Â ´ëÀå¾ÏÀÇ precursor lesionÀÌ¶ó ¿©°ÜÁö°í ÀÖ°í Ưº°È÷ sigmoid proximal part¿¡ ¹ß»ýÇÏ´Â serrated lesion¿¡ ´ëÇؼ­´Â tubular adenoma¿Í °°ÀÌ complete resectionÀ» ¸ñÇ¥·Î Á¦°ÅÇϱ⠶§¹®¿¡ Àú´Â ±×µ¿¾È °³ÀÎÀûÀ¸·Î tubular adenoma¿Í °°ÀÌ D12.6 Äڵ带 »ç¿ëÇÏ°í ÀÖ½À´Ï´Ù. ¹°·Ð rectum, rectosigmoidÀÇ 5mmÀÌÇÏ ´Ù¼ö ¿ëÁ¾µéÀº ¿©±â¿¡ ÇØ´çµÇÁö ¾Ê½À´Ï´Ù.

[2021-5-2. ÀÌÁØÇà ´äº¯]

Äڷγª °ü·ÃÇÏ¿© ¿ì¸®³ª¶ó ³²¼ºµéÀÇ À§¿°ÀÌ ÁÁ¾ÆÁö°í ÀÖ´Ù´Â °ÍÀº Èï¹Ì·Î¿î ´º½ºÀÔ´Ï´Ù. »ç½Ç Àúµµ ¼úÀ» ¸¹ÀÌ ÁÙ¿´½À´Ï´Ù.

WHO´Â °¢ ³ª¶ó¿¡ ¹ÌÄ¡´Â ¿µÇâÀ» °í·ÁÇÏÁö ¾Ê°í ÀÚ±âµé ¸¶À½´ë·Î ³Ê¹« ÀÚÁÖ Á¤Àdzª ºÐ·ù¸¦ ¹Ù²Ù°í ÀÖ¾î ¸¶À½¿¡ µéÁö ¾Ê½À´Ï´Ù. Çй®Àº private ¿µ¿ªÀε¥ public ¿µ¿ª¿¡¼­ Áö³ªÄ£ ±ÇÀ§¸¦ °¡Áö°í °£¼·ÇÏ´Â ¼ÀÀÔ´Ï´Ù. À̹ø Äڷγª pandemic¿¡¼­ º¸¿©ÁÖ´Â ¹Ù¿Í °°ÀÌ ÀÌÁ¦´Â WHO°¡ °¡Áö´Â ±àÁ¤Àû Ãø¸éº¸´Ù´Â ºÎÁ¤Àû Ãø¸éÀÌ ´õ Ä¿Á³½À´Ï´Ù. WHO°¡ Á¶±Ý °â¼ÕÇØÁ³À¸¸é ÇÕ´Ï´Ù.

¿ë¾î¿¡ ´ëÇÑ ¼¼ºÎ Á¤ÀÇ°¡ ÀÖÁö¸¸ Àú´Â ±×³É serrated polypÀ̶ó°í ºÎ¸£°í ÀÖ½À´Ï´Ù. ³Ê¹« ÀÚÁÖ, ³Ê¹« º¹ÀâÇÏ°Ô º¯ÇÏ´Â ¼¼ºÎ »çÇ×À» µû¶ó°¡±â ¾î·Æ±â ¶§¹®¿¡ Å« Ʋ¿¡¼­ Àû´çÇÑ À̸§À» ºÙÀÎ´Ù¸é ¿ì¸®³ª¶ó ȯÀÚ¸¦ Áø·áÇϴµ¥´Â º° ¹®Á¦°¡ ¾øÀ» °Í °°½À´Ï´Ù. ³»½Ã°æÀ¸·Î Àß º¸°í ÇÊ¿äÇϸé Á¦°ÅÇÏ°í ÀûÀýÇÏ°Ô follow-up Çϴµ¥´Â WHO¿¡¼­ ÀÚ±âµé ¸¾´ë·Î º¯°æÇÑ ¼¼ºÎ »çÇ×ÀÌ Å©°Ô µµ¿òµÇÁö ¾Ê½À´Ï´Ù.

ÄÚµå´Â ´Ù¼Ò °æÁ÷µÈ ±¸Á¶ÀÔ´Ï´Ù (EndoTODAY ÄÚµå). Public ¿µ¿ªÀÇ ÇàÁ¤ÀÔ´Ï´Ù. Private ¿µ¿ªÀÇ Çй®À» µû¶ó°¥ ¼ö ¾ø½À´Ï´Ù. ±×·¡¼­ Äڵ忡 ´ëÇÑ Á¤´äÀº ¾ø½À´Ï´Ù. °¡Àå °¡±î¿î °ÍÀ» ºÙÀÌ¸é ±×¸¸ÀÔ´Ï´Ù. À̸¦ ±ÔÁ¤À¸·Î Á¦¾îÇÏ°í º¸ÇèÀ¸·Î Á¦¾îÇÏ·Á´Â ¸ðµç ³ë·ÂÀº ȯÀÚ¿¡°Ô µµ¿òµÇÁö ¾Ê½À´Ï´Ù. Áú¹®ÇϽŠ¹Ù¿¡ ´ëÇؼ­´Â ¸¶Ä§ "Sessile serrated lesion (SSL) is the new term for lesions formerly designated as sessile serrated adenoma (SSA)."¶ó´Â Ç¥ÇöµÇ°í ÀÖ½À´Ï´Ù. ±×³É D12.6 ÁÖ½Ã¸é µÉ °Í °°½À´Ï´Ù.

°¨»çÇÕ´Ï´Ù.


[2021-7-27. ¾Öµ¶ÀÚ Áú¹®] Sessile serrated lesionÀÇ malignant potential

±³¼ö´Ô ¾È³çÇϽʴϱî? ?³»°ú°³¿øÀÇÀÔ´Ï´Ù. ´ëÀåÀÇ sessile serrated lesion ÀÇ malignant potential Àº low grade tubular adenoma, high grade tubular adenoma ¿Í ºñ±³ÇÏ¸é ¾î´À Á¤µµÀÎÁö ¹®Àǵ帳´Ï´Ù. ?Malignant potential ÀÌ low grade tubular adenoma ¿Í ºñ½ÁÇÑÁö¿ä? ?

Sessile serrated lesion Àº complete resection ÇÏ¿©¾ß ÇÏÁö¸¸, ¸¸¾à¿¡ °¡ÀåÀÚ¸®¿¡ Á¶±Ý ³²¾Æ¼­ incomplete ÇÑ°Í°°Àº ´À³¦ÀÌ µé °æ¿ì¿¡´Â ¾î¶»°Ô Á¶Ä¡ÇÏ¸é µÇ´ÂÁö¿ä?

[2022-7-14. À̺¸ÀÎ ±³¼ö´Ô ´äº¯]

1) SSLÀÇ malignant potential

°ú°Å¿¡´Â SSLÀ̶ó°í ÇÏ¸é ¸ðµÎ advanced neoplasmÀ¸·Î Ãë±ÞÇÏ´ø ½ÃÀýÀÌ ÀÖ¾úÀ¸³ª ÇöÀç´Â ¿©·¯ ¿¬±¸¸¦ ÅëÇØ ÀϹÝÀûÀÎ conventional adenoma°ú ¾ÏÈ­ À§Çèµµ°¡ ºñ½ÁÇÏ´Ù°í »ý°¢ÇÏ°í ÀÖ½À´Ï´Ù. ´Ù¸¸ ÀÌ´Â SSL (without dysplasia) º´º¯¿¡ ±¹ÇÑµÇ¾î ¸»ÇÏ´Â °ÍÀ̸ç SSL with dysplasia º´º¯ÀÇ °æ¿ì¿¡Àº ÀϹÝÀûÀÎ adenomaº¸´Ù ºü¸£°Ô cancer changeÇÏ´Â °ÍÀ¸·Î ¾Ë·ÁÁ® ÀÖ½À´Ï´Ù.

SSL (without dysplasia)Àº cytologic dysplasia ¾øÀÌ glandÀÇ distortionÀ» º¸ÀÌ´Â º´º¯À» ÀǹÌÇϸç ÀÌ·¯ÇÑ º´º¯¿¡¼­ ¿À·£ ½Ã°£¿¡ °ÉÃÄ ¼¼Æ÷ÀÇ elongation, pseudo stratification, hyperchrommatic neuclei, basophilic cytoplasm (ÀüÇüÀû dysplasia)°¡ ¹ß»ýÇϰųª cuboidal cell, eosinophilic cytoplasm, mitosis Áõ°¡(serrated dysplasia) µî ¼¼Æ÷ ÀÚüÀÇ dysplasia°¡ ¹ß»ýÇϸé SSL with dysplasia¶ó°í ÇÕ´Ï´Ù.

¿ªÇÐ ¿¬±¸¸¦ ÅëÇØ SSLÀÌ SSL with dysplasia·Î ¹ßÀüÇϴµ¥´Â ¾à 17³â Á¤µµÀÇ ½Ã°£ÀÌ ¼Ò¿äµÈ´Ù°í ¾Ë·ÁÁ® ÀÖÀ¸¸ç (Bettington M et al. Gut 2017) ÀÌ´Â µ¿¹°½ÇÇè µîÀ» ÅëÇؼ­ ¾Ë°ÔµÈ "DNA methylationÀÌ ÃàÀûµÈ °í·ÉÀÚ¿¡¼­ BRAF mutationÀÌ Á¾¾çÈ­ À§ÇèÀ» ´õ ³ôÀδÙ"´Â »ç½Ç·Î ¼³¸íÀÌ °¡´ÉÇÒ µí ÇÕ´Ï´Ù(Fennell L et al. Gut 2022).

Á¤¸®Çؼ­ ¸»¾¸µå¸®¸é SSL without dysplasia´Â ÀÏ¹Ý ¼±Á¾°ú ºñ½ÁÇÏ°Ô Å©±â¿¡ µû¶ó ÃßÀû ´ëÀå³»½Ã°æ ½ºÄÉÁÙÀ» ÀâÀ¸½Ã¸é µÉ µíÇϸç SSL with dysplasia´Â advanced neoplasm¿¡ ÁØÇØ ÃßÀû ´ëÀå³»½Ã°æÀÌ ÇÊ¿äÇÏ´Ù°í »ý°¢ÇÕ´Ï´Ù.

2) SSLÀÇ ºÒ¿ÏÀü ÀýÁ¦ ¹®Á¦

Àß ¾Æ½Ã´Ù½ÃÇÇ SSLÀº Å©±â°¡ Å« °æ¿ì°¡ ¸¹°í °æ°è°¡ ºÒºÐ¸íÇϸç flatÇÑ ÇüÅ°¡ ´ëºÎºÐÀ̶ó ºÒ¿ÏÀü ÀýÁ¦µÇ±â ½¬¿ì¸ç ÀÌ·Î ÀÎÇØ post colonoscopy colorectal cancerÀÇ Áß¿äÇÑ ¿øÀÎ Áß Çϳª·Î Áö¸ñµÇ°í ÀÖ½À´Ï´Ù. µû¶ó¼­ ù snaring Àü¿¡ º´º¯ÀÇ °æ°è¸¦ ¸íÈ®È÷ ±¸ºÐÇÏ¸ç °¡±ÞÀû ÀÏ°ý Æ÷ȹÇÏ·Á´Â ³ë·ÂÀÌ ÇÊ¿äÇÕ´Ï´Ù. dysplasia°¡ ¾ø´Â SSLÀ» ESDÇÏ´Â °ÍÀº °³ÀÎÀûÀ¸·Î´Â Âù¼ºÇϱ⠾î·Á¿ì¸ç º´º¯ÀÇ Å©±â°¡ Å©´Ù¸é Â÷¶ó¸® anchoring EMR°ú °°Àº modified EMR techniqueÀ» ±ÇÀåÇÏ°í ½Í½À´Ï´Ù(Oh CK et al. Endoscopy 2022).

ÀýÁ¦ ÈÄ¿¡´Â ÀýÁ¦¸éÀ» ¿öÅÍÁ¬ µîÀ¸·Î Àß ¼¼Ã´ÇÏ°í near-focus ±â´É°ú NBI¸¦ ÇÔ²² »ç¿ëÇϸé ÀÜÁ¸ º´º¯ÀÇ ±¸ºÐÀÌ ¿ëÀÌÇÕ´Ï´Ù. ºÒ¿ÏÀü ÀýÁ¦°¡ È®ÀÎµÇ¸é °¡±ÞÀû ±×ÀÚ¸®¿¡¼­ Ãß°¡ÀýÁ¦¸¦ ½ÃµµÇÕ´Ï´Ù. SSLÀº º´º¯ÀÌ ¾ã°í Á¡¸·ÇÏÃþ Á¶Á÷µµ looseÇϱ⠶§¹®¿¡ dedicated cold snare µîÀ» »ç¿ëÇÏ¸é ºñ±³Àû ¿ëÀÌÇÏ°Ô Ãß°¡ Æ÷ȹÀÌ °¡´ÉÇÕ´Ï´Ù.


[2022-7-14. ¾Öµ¶ÀÚ Áú¹®] Sessile serrated lesionÀÇ ÄÚµå

±³¼ö´Ô ¾È³çÇϽʴϱî? ·ÎÄ®¿¡¼­ ³»½Ã°æÇÏ´Â ÀÇ»çÀÔ´Ï´Ù.

´ëÀå³»½Ã°æ ¿ëÁ¾À» ÀýÁ¦ÇßÀ»¶§, Á¶Á÷º´¸®°á°ú°¡, Sessile serrated lesion(Sessile serrated adenoma) without dysplasia À¸·Î ³ª¿ÔÀ»¶§, º¸Çèȸ»ç Á¦Ãâ¿ë Áø´Ü¼­¿¡´Â ¼±Á¾À̶ó°í ±âÀçÇÏ°í, ÄÚµå´Â d122,d123 À¸·Î ±âÀçÇÏ¸é µÇ´ÂÁö ¹®Àǵ帳´Ï´Ù. Sessile serrated lesion À» Áø´Ü¼­¿¡ ±âÀçÇÒ¶§´Â Çѱ۷Π¼±Á¾À̶ó°í ÀûÀ¸½Ã´ÂÁö ¹®Àǵ帳´Ï´Ù.

º¸Åë Áø´Ü¼­¿¡´Â ¿ëÁ¾ÀýÁ¦¼ú ÈÄ Á¶Á÷°Ë»ç»ó, oooÀ¸·Î ÆǸíµÊ. À̶ó°í Àú´Â Àû°íÀִµ¥¿ä. Sessile serrated lesion Àº "¼±Á¾"À̶ó°í ÀûÀ¸½Ã´ÂÁö, ´Ù¸¥ ÇÑ±Û º´¸íÀ¸·Î ¹ø¿ªÇÏ¿© ÀûÀ¸½Ã´ÂÁö ¹®Àǵ帳´Ï´Ù.

°ü·Ã Á¤º¸¸¦ ¾Ë ¼ö ¾ø¾î¼­ ¹Ù»Ú½Å ±³¼ö´Ô²² ¹®Àǵ帮°Ô µÇ¾ú½À´Ï´Ù. Æò¼Ò ¿£µµÅõµ¥ÀÌ·Î ¸¹Àº °¡¸£Ä§À» Áּż­ ¹è¿ï¼ö ÀÖ´Â ±âȸ¸¦ Áּż­ Ç×»ó °¨»çµå¸³´Ï´Ù.

[2022-7-14. À̺¸ÀÎ ±³¼ö´Ô ´äº¯]

ÀÌÁØÇà ±³¼ö´Ô. ¸Å¿ì ¾î·Á¿î ¹®Á¦ÀÔ´Ï´Ù.

1. ¾Ö¼®ÇÏ°Ôµµ ¾ÆÁ÷±îÁö KCD¿¡ SSL¿¡ ÇØ´çÇÏ´Â ÄÚµå´Â ¾ø½À´Ï´Ù.

2. ¡°K63.5 ´ëÀå¿ëÁ¾" ÄÚµå´Â ³»°­ ³»·Î µ¹ÃâµÈ »óÇǼº º´º¯À» ÀǹÌÇÏ´Â À°¾ÈÀû ¼Ò°ß Áø´ÜÀ̹ǷΠSSL¿¡ K63.5 Äڵ带 ºÎ¿©ÇÏ´Â °ÍÀº Å« ¹«¸®°¡ ¾øÀ» µí ÇÕ´Ï´Ù.

3. SSL¿¡ ¼±Á¾À» ÀǹÌÇÏ´Â D12.X Äڵ带 ºÎ¿©Çصµ µÇ´Â°¡?

SSLÀº SSL (without dysplasia)¿Í SSL with dysplasia·Î ±¸ºÐÇÒ ¼ö ÀÖ½À´Ï´Ù. Àß ¾Æ½Ã´Ù½ÃÇÇ SSL (without dysplasia)Àº cytologic dysplasia ¾øÀÌ glandÀÇ distortionÀ» º¸ÀÌ´Â º´º¯À» ÀǹÌÇϸç ÀÌ·¯ÇÑ º´º¯¿¡¼­ ¿À·£ ½Ã°£¿¡ °ÉÃÄ ¼¼Æ÷ÀÇ elongation, pseudo stratification, hyperchrommatic neuclei, basophilic cytoplasm (ÀüÇüÀû dysplasia)°¡ ¹ß»ýÇϰųª cuboidal cell, eosinophilic cytoplasm, mitosis Áõ°¡(serrated dysplasia) µî ¼¼Æ÷ ÀÚüÀÇ dysplasia°¡ ¹ß»ýÇϸé SSL with dysplasia¶ó°í ÇÕ´Ï´Ù.

¼¼Æ÷ÀÚüÀÇ dysplasia¸¦ °¡Áø SSL with dysplasiaÀÇ °æ¿ì¿¡´Â D12.X ÄÚµå ºÎ¿©¿¡ Å« ¹®Á¦°¡ ¾ø¾îº¸ÀÔ´Ï´Ù. Àý´ë´Ù¼öÀÎ SSL (without dysplasia)ÀÇ °æ¿ì ¼¼Æ÷ ÀÚüÀÇ dysplasia´Â ¾øÀ¸³ª Àå±â°£¿¡ °ÉÃÄ ¾ÏÈ­°úÁ¤À» ¹âÀ» °¡´É¼ºÀÌ ÀÖ´Ù´Â Á¡À» °í·ÁÇϸé D12XÄÚµå ºÎ¿©°¡ °¡´ÉÇغ¸ÀÌÁö¸¸ ¶Ç ÇÑÆíÀ¸·Î´Â ¼¼Æ÷ ÀÚü¿¡ ¾ÆÁ÷ dysplasia°¡ ¾ø´Ù´Â ¸é¿¡¼± Á» ¸ÂÁö ¾Ê¾Æº¸ÀÔ´Ï´Ù.

°á·ÐÀûÀ¸·Î´Â ´ë´Ù¼öÀÇ È¯ÀÚ°¡ ¿ä±¸ÇÏ´Â º¸Çè±Ý ¼ö·ÉÀ» À§ÇÑ Áø´Ü¼­ÀÇ °æ¿ì ´ëÀå¿ëÁ¾ÀÌ³Ä ´ëÀå¼±Á¾À̳ÄÀÇ Á¶Á÷ÇÐÀû Áø´Üº¸´Ù ¿ëÁ¾ÀýÁ¦¼úÀ» Çß´À³Ä´Â »ç½ÇÀ» ´õ Áß¿ä½Ã ¿©±â¹Ç·Î Áø´Ü¸í¿¡ ´ëÇؼ­´Â ³Ê¹« °í¹ÎÇÏÁö ¾ÊÀ¸¼Åµµ µÉ µíÇϸç ÇâÈÄ ICD, KCD µîÀÌ SSL¿¡ ´ëÇÑ Áø´Ü¸íÀ» ºÎ¿©ÇÒ ³¯ÀÌ ¿Ã °ÍÀ¸·Î ¿¹»óÇÕ´Ï´Ù.


°ü·Ã Áú¹®Àº °è¼Ó µé¾î¿À°í ÀÖ½À´Ï´Ù.

[2022-12-22. ¾Öµ¶ÀÚ Áú¹®]

¾È³çÇϼ¼¿ä ±³¼ö´Ô. Áö¹æ¿¡¼­ °³¿øÇÑ ¼ÒÈ­±âÀü°ø ÀÇ»çÀÔ´Ï´Ù.

¿ëÁ¾ÀýÁ¦¼úÈÄ SSL·Î È®ÀÎµÈ °æ¿ì Áö±Ý±îÁö Áø´Ü¼­ adenoma·Î DÄÚµå·Î ±âÀçÇØ¿Ô¾ú´Âµ¥¿ä, XX»ý¸í¿¡¼­ SSLÀε¥ DÄÚµå ±âÀç¸Â´ÂÁö º¸ÇèÁö±Þ ¾ÈµÈ´Ù°í ȯÀںР³»¿øÇÏ¿´½À´Ï´Ù. º´¸®°ú ¼±»ý´Ô²² ¿©Â庸´Ï WHO¿¡¼­ SSL without dysplasiaÀÎ °æ¿ì DÄÚµå ¾ÈÇÑ´Ù°í ´äº¯ÀÌ ¿Ô½À´Ï´Ù. Áö±Ý±îÁö DÄÚµå Á൵ ´Ù¸¥ º¸Çè»ç¿¡¼± ¾Æ¹« ¹®Á¦ ¾ø¾ú´Âµ¥ ÀÌ·±°æ¿ì°¡ ¹ß»ýÇÏ¿© ¾î¶»°Ô ÇØ¾ß ÇÏ´ÂÁö ¹®Àǵ帳´Ï´Ù.

Àϸé½Äµµ ¾ø´Âµ¥ °©ÀÛ½º·´°Ô ¸ÞÀÏ·Î ¹®Àǵå·Á¼­ ¿¹ÀÇ°¡ ¾Æ´ÑÁö ¾ËÁö¸¸ ¿°Ä¡ºÒ±¸ÇÏ°í ¿¬¶ôµå·È½À´Ï´Ù.

[2022-12-22. ÀÌÁØÇà ´äº¯]

¾È³çÇϼ¼¿ä.

ÀÌ À̽´´Â ´äÀÌ ¾ø½À´Ï´Ù. °ø½ÄÀûÀÎ ÀÔÀåÀ» ³½ °÷ÀÌ ¾îµð¿¡µµ ¾øÀ¸¹Ç·Î Á¤´ä ȤÀº Ç¥ÁØ ÀÇ°ßÀÌ ¾ø½À´Ï´Ù. °¢ÀÚ ¸¾´ë·Î ÇÏ°í ÀÖ°í ȸ»ç¿¡¼­µµ ¸¾´ë·Î ÇÏ°í ÀÖ´Â »óȲÀÔ´Ï´Ù. º¸Åë dysplasia°¡ ¾øÀ¸¸é K code¸¦ ¾²´Â °Í °°½À´Ï´Ù.

°ü·Ã ÇÐȸ¿¡¼­ ÀÇ°ßÀ» ³» ´Þ¶ó°í ¼öÂ÷·Ê ¿ä±¸ÇÏ¿´Áö¸¸ ´äÀÌ ¾ø½À´Ï´Ù. »ç½Ç »çº¸Çè¿¡¼­ ¸¶À½´ë·Î Á¤ÇÑ °ÍÀ̹ǷΠ°øÀûÀÎ ±â°ü¿¡¼­ ²À ÀÇ°ßÀ» ³»¾ßÇÒ ÀÌÀ¯´Â ¾ø´Ù´Â °Í¿¡ ¼ö±àÇÏÁö ¾Ê´Â °ÍÀº ¾Æ´ÏÁö¸¸, ±×·¡µµ ±¹¹ÎµéÀÌ °Þ´Â È¥¼±À» »ý°¢ÇÏ¸é °ü·ÃÇÐȸ¿¡¼­ ÀÇ°ßÀ» ³»Áö ¾Ê°í ÀÖ´Â Çö½ÇÀÌ ´ä´äÇϱ⠱×Áö ¾ø½À´Ï´Ù.

ÀÏÀü¿¡ ÇÑ Àü¹®°¡¿¡°Ô ¹®ÀÇÇÏ¿© ¹ÞÀº ´äº¯À¸·Î ´ë½ÅÇÏ°Ú½À´Ï´Ù.


[Reference]

1) Serrated adenoma and serrated adenocarcinoma of the stomach

2) 2019³â WHO ºÐ·ù (PDF)

3) 2021-9-4. Àü³²´ë ¸í´ë¼º ±³¼ö´Ô °­ÀÇ. IEE and SSL

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