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[Signet ring cell carcinoma (SRC). ¹ÝÁö¼¼Æ÷¾Ï. ÀÎȯ¼¼Æ÷¾Ï] - ðû

1. Definition of signet ring cell carcinoma

2. ESD for undifferentiated type EGC at Yonsei University

3. Growth pattern of signet ring cell carcinoma

4. SRC È®´ë³»½Ã°æ ¼Ò°ß - stretch sign

5. Cases

6. FAQs - 2014³â ´ëÅä·Ð, signet ring cell change¿Í Á¶Á÷°Ë»ç false positive

7. References

¹ÝÁö¼¼Æ÷¾ÏÀº ¾Ï µ¢¾î¸®°¡ ¹ÝÁöó·³ »ý±ä °ÍÀÌ ¾Æ´Ï¶ó ¾Ï ¼¼Æ÷°¡ ¹ÝÁö ¸ð¾çÀ̶ó´Â ¶æÀÔ´Ï´Ù.

´ÙÀ̾Ƹóµå ¹ÝÁö°¡ ¾Æ´Ï¶ó sign ¹ÝÁöÀÔ´Ï´Ù. ¿µÈ­ º¥Çã¿¡ ³ª¿É´Ï´Ù. Signet ring

ESD for EGC (signet ring cell carcinoma)


1. Definition of SRC (signet ring cell carcinoma)

Signet-ring cell carcinoma (SRC) is defined as a tumor that predominantly consists of isolated or small groups of tumor cells containing intracytoplasmic mucin.

³ÐÀº ÀǹÌÀÇ poorly cohesive carcinoma´Â 4°³ÀÇ cell typeÀÌ ÀÖ½À´Ï´Ù. À̸¦ WHO 2010¿¡¼­´Â µÑ·Î ³ª´©°í ÀÖ½À´Ï´Ù.

4 cell types of poorly cohesive carcinomaWHO 2010
1. Nuclei push against cell membranes by intracytoplasmic mucin (typical SRC)Poorly cohesive carcinoma, SRC phenotype
2. Central nuclei with intracytoplasmic mucinPoorly cohesive carcinoma, other cell types
(ÀϺ»ÀÇ Por2 (non-solid type)¿¡ ÇØ´ç)
3. Eosinophlic cytoplasmic mucin
4. Cells without mucin

ÀϺ»¿¡¼­´Â poorly cohesive carcinoma Áß SRC typeÀ» SRC·Î ºÎ¸¨´Ï´Ù. ³ª¸ÓÁö cell typeÀº Por2 (non-solid type)¶ó°í ºÎ¸¨´Ï´Ù. ÀüÅëÀûÀÎ ÀǹÌÀÇ poorly differentiated tubular adenocarcinoma´Â WHO 2010¿¡¼­´Â Poorly differentiated tubular (solid) carcinoma¶ó°í ºÎ¸¨´Ï´Ù.

Poorly¶ó°í ½ÃÀÛÇÏ´Â Á¾·ù´Â ¾Æ·¡ Ç¥¿Í °°ÀÌ ¼¼ °³ÀÔ´Ï´Ù. ¼ÂÀ» µÑ·Î ³ª´©´Â ¹æ¹ýÀÌ »ó´çÈ÷ Çò°¥¸³´Ï´Ù. WHO 2010¿¡¼­´Â poorly cohesive carcinoma¶ó´Â À̸§À¸·Î µÎ group(³ë¶õ»ö)À» ¹­¾ú°í, ÀϺ»¿¡¼­´Â Por¶ó´Â À̸§À¸·Î µÎ group(¿¬µÎ»ö)À» ¹­¾ú½À´Ï´Ù. Áï ÀϺ»¿¡¼­´Â SRCÀ» º°°³ÀÇ ÁúȯÀ¸·Î ÇÏ°í Por1°ú Por2¸¦ ºñ½ÁÇÏ´Ù°í º» °Í °°½À´Ï´Ù.

WHO 2010Japanese 2017ÀÌÁØÇàÀÇ Çؼ®
Poorly differentiated (solid) carcinomaPor1 (solid type)ÀüÅëÀûÀÎ P/D¹Ì¸¸Çüº¸´Ù ÀåÇü¿¡ °¡±õ´Ù.
Poorly cohesive carcinoma, SRC phenotypeSignet ring cell carcinomaPoorly cohesive ñé cell type 1
Poorly cohesive carcinoma, other cell typesPor2 (non-solid type)Poorly cohesive ñé cell type 2, 3, 4¹Ì¸¸Çü

* Âü°í: Á¦57ȸ ³»½Ã°æ ¼¼¹Ì³ª ÁÖ¹Ì ±³¼ö´Ô °­ÀÇ

* Âü°í: Consensus on the pathological definition and classification of poorly cohesive gastric carcinoma Gastric Cancer 2019

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A consensus was reached on the need to classify gastric carcinoma according to the most recent edition of the WHOclassification which is currently WHO 2010. Moreover, to standardize the definition of SRC carcinomas, the proposal that only WHO PC carcinomas with more than 90% poorly cohesive cells having signet ring cell morphology have to be classified as SRC carcinomas was made. All other PC non-SRC types have to be further subdivided into PC carcinomas with SRC component (<90% but >10% SRCs) and PC carcinomas not otherwise specified (<10% SRCs).

Áï ´ÙÀ½°ú °°ÀÌ ³ª´©¾ú´Ù´Â ÀǹÌÀÔ´Ï´Ù.


[Advances in surgical pathology. Gastric cancer (2011)]

Signet ring cell and other poorly cohesive carcinomas (60ÂÊ)

SRCCs are tumors composed solely of signet ring cells. However, many tumors are composed of a mixture of poorly cohesive non-signet ring cells as well as signet ring cells. In many cases, signet ring cells are restriced to the upper half of the a mucosal component of the tumors in combination with poorly cohesive cells withing deeper levels of the gastric wall. Poorly cohesive non-signet ring cells include those that resemble plasma cells, histiocytes, or lymphocytes. The tumor cells of poorly cohesive carcinomas can be arranged in lace-like gland or delicate microtrabecular patterns. Usually, they are accompanied by marked desmoplasia in the gastric wall.


2. ESD for undifferentiated type EGC at Yonsei University

Gut and Liver 2015³â 11¿ùÈ£¿¡ ½Ç¸° ¿¬¼¼´ëÇб³ ±èÁöÇö ±³¼ö´Ô µîÀÇ Growth patterns of SRC for endoscopic resection (Kim H. Gut Liver 2015) ³í¹®À» Èï¹Ì·Ó°Ô º¸¾Ò½À´Ï´Ù.

¿¬¼¼´ëÇб³¿¡¼­´Â ¿À·¡ ÀüºÎÅÍ undifferentiated type EGCÀÇ ³»½Ã°æÄ¡·á ¼ºÀûÀ» ²ÙÁØÈ÷ ¹ßÇ¥ÇÏ¿´½À´Ï´Ù. ù Áß¿ä ¼º°ú´Â 2009³â GIE¿¡ ¹ßÇ¥ÇÑ ¾Æ·¡ ÀÚ·á¿´½À´Ï´Ù (Kim JH. GIE 2009). Poorly differentiated adenocarcinoma¿¡¼­´Â vertical margin ¾ç¼ºÀÌ ¸¹°í, signet ring cell carcinoma (SRC)¿¡¼­´Â lateral margin ¾ç¼ºÀÌ ¸¹¾Ò½À´Ï´Ù.

2014³â ¿¬¼¼´ëÇб³ °­³²º´¿ø¿¡¼­´Â undifferentiated type EGC ³»½Ã°æÄ¡·á Àå±â¼ºÀûÀ» ¹ßÇ¥ÇÏ¿´½À´Ï´Ù (Kim JH. GIE 2014).

2014³â ¿¬¼¼´ëÇб³ ½ÅÃ̺´¿ø¿¡¼­´Â SRC¿¡ ´ëÇÑ ³»½Ã°æÄ¡·á¸¦ µû·Î ºÐ¼®ÇÏ¿© ¹ßÇ¥ÇÏ¿´½À´Ï´Ù (Kim MN. DLD 2014). ¿¹»óµÇ¾ú´ø ¹Ù¿Í °°ÀÌ Size underestimationµÈ °æ¿ì(=ÀÛ´Ù°í »ý°¢ÇÏ¿© ESD ÇÏ¿´´Âµ¥ ½ÇÁ¦·Î´Â ÀÛÁö ¾ÊÀº ¿¹)¿¡¼­ incomplete resectionÀÌ ¸¹¾Ò½À´Ï´Ù.


3. Growth pattern of signet ring cell carcinoma

SRC´Â ³»½Ã°æÀ¸·Î Å©±â ¹× °æ°è ÆÇÁ¤ÀÌ ¾î·Æ°í, °á±¹ ESD¿¡¼­ lateral margin ¾ç¼ºÀ¸·Î ³ªÅ¸³­´Ù°í Çؼ®µË´Ï´Ù. À̹ø¿¡ ±èÁöÇö ±³¼öÆÀÀº SRC¸¦ º´¸®ÇÐÀû growth patternÀ» ¹ÙÅÁÀ¸·Î expanding type°ú infiltrative typeÀ¸·Î ³ª´©¾î ºÐ¼®ÇÏ¿´½À´Ï´Ù (Kim H. Gut Liver 2015).

The expanding type was defined as a tumor that had a margin that was clearly lined from the non-neoplastic mucosa, that is, epithelial spreading pattern.

The infiltrative type was defined as a tumor that showed diffuse spreading tumor cells, that is, supepitheial spreading pattern.

Signet ring cell carcinoma intramucosal spreading types. Expansive type. (A) Tumor cells (circle) were exposed at a superficial part of the mucosa. A tumor with a margin was distinct from the nonneoplastic mucosa (H&E stain, ¡¿40). (B) Tumor cells (circles) were located in the intermediate or deeper parts of the nonneoplastic mucosa. Diffuse-spreading tumor cells were evident (H&E stain, ¡¿40).

´ë·« expanding type°ú infiltrative typeÀÌ ¹Ý¹ÝÀ̾ú´Âµ¥, infiltrative typeÀÇ ÁÖº¯ Á¡¸·¿¡ atrophy¿Í intestinal metaplasia°¡ ¸¹¾Ò½À´Ï´Ù. ÀúÀÚ´Â surrounding mucosa°¡ SRCÀÇ tumor cell spreadÀÇ mechanical barrierÀÏ ¼ö ÀÖ´Ù°í Çؼ®ÇÏ¿´½À´Ï´Ù. ¹«Ã´ Èï¹Ì·Ó½À´Ï´Ù.

This indicates that the surrounding mucosa may be important as a mechanical barrier to tumor cell spread in SRC. If mechanical barrier represented by the surrounding mucosa is weak, such as due to atrophy/IM or no neutrophil infiltration, tumor cells tend to spread spontaneously or diffusely into the deeper part of the mucosa.

ÀúÀÚ´Â SRCÀÇ ³»½Ã°æ °æ°èÆÇÁ¤ÀÌ ¾î·Á¿î ÀÌÀ¯·Î SRCÀÇ ±â¿øÀÌ ¿©´À À§¼±¾Ï°ú ´Ù¸£´Ù´Â Á¡À» ÁöÀûÇϸ鼭 tubule neck dysplasia (TND)°¡ SRCÀÇ precursor¶ó´Â º´¸® ³í¹®(Kumarasinghe MP. Pathology 2006)À» ÀοëÇÏ¿´½À´Ï´Ù (¾Æ½±°Ôµµ ³í¹® PDF¸¦ ±¸ÇÒ ¼ö ¾ø¾ú½À´Ï´Ù).

Tubule neck dysplasia can spread upwards towards the foveolar surface and possibly downwards to the gastric glands. The gastric mucosa of SRC may show a largely intact surface epithelium, despite the presence of cancer in the lamina propria.


±èÁöÇö ±³¼ö´Ô ³í¹®¿¡ ´ëÇÏ¿© ºÎ»ê´ëÇб³ ±è±¤ÇÏ ±³¼ö´Ô²²¼­ ³íÆòÀ» ºÙÀ̼̽À´Ï´Ù (Kim GH. Gut Liver 2015). »ö¼Ò³»½Ã°æÀ̳ª È®´ë³»½Ã°æÀÌ undifferentiated type À§¾ÏÀÇ °æ°èÆÇÁ¤¿¡ µµ¿òÀ» ÁÖÁö ¸øÇÏ´Â Çö½Ç(Lee BE. BMC Gastroenterology 2010)¿¡¼­ ±èÁöÇö ±³¼ö´ÔÀÇ ÀÇ°ßÀÌ Áß¿äÇÏ´Ù°í ÁöÀûÇϼ̽À´Ï´Ù.

Several studies have shown the efficacy of acetic acid-indigo carmine chromoendoscopy and magnifying endoscopy with narrow-band imaging to identify the horizontal margins of differentiated-type carcinoma.However, these techniques do not give additional information to delineate the horizontal margins of undifferentiated-type carcinoma, especially SRC, because of the subepithelial spreading tendency of SRC.

¾Æ·¡´Â ±è±¤ÇÏ ±³¼ö´ÔÀÇ 2010³â ³í¹®(Lee BE. BMC Gastroenterology 2010)¿¡ ³ª¿Â »çÁøÀÔ´Ï´Ù. Undifferentiated type¿¡¼­´Â »ö¼Ò³»½Ã°æµµ º° º¼ÀÏÀÌ ¾ø´Ù´Â °á·ÐÀ̾ú½À´Ï´Ù.

Chromoendoscopy of an undifferentiated adenocarcinoma. (A) A flat discolored lesion with an unclear border at the lower body of the stomach is shown. (B) Endoscopic view after acetic acid was sprinkled. (C) Endoscopic view after indigo carmine was additionally sprinkled. (D) Endoscopic view after the lesion was washed with clean water. After chromoendoscopy with indigo carmine dye added to acetic acid, the lesion's border was still indistinct and the image was mottled. The lesion was resected by laparoscopic gastrectomy and was shown to be an undifferentiated adenocarcinoma.


Á¶±âÀ§¾Ï ³»½Ã°æÄ¡·á¸¦ Àü¹®ÇÏ´Â ÀÇ»çÀÇ ÀÔÀå¿¡¼­ ±èÁöÇö ±³¼ö´Ô ³í¹®¿¡ Á¦½ÃµÈ ¾Æ·¡ »çÁøÀÌ ¹«Ã´ ±³ÈÆÀûÀ¸·Î ´Ù°¡¿Ô½À´Ï´Ù. ÀÛÀº SRC·Î »ý°¢ÇÏ¿© ESD ÇÏ¿´À¸³ª ¿©·¯ ¹æÇâÀÇ multiple lateral margin ¾ç¼ºÀÌ ³ª¿Â °æ¿ì¿´½À´Ï´Ù. ÀÛÀº SRC·Î ÃßÁ¤µÇ´õ¶óµµ ÁÖº¯ Á¡¸·ÀÌ atrophicÇϸé infiltrative type growth (= subepithelial spreading pattern)ÀÇ °¡´É¼ºÀ» °í·ÁÇÏ¿© ´õ¿í ÁÖÀÇÇØ¾ß ÇÒ ¸ð¾çÀÔ´Ï´Ù.

Clinical case of the infiltrative intramucosal-spreading type of signet ring cell carcinoma (SRC). (A) Endoscopic image of early gastric cancer showing a flat lesion located in the lesser curvature of the lower body (circle). Endoscopically, the surrounding mucosa was combined with atrophic gastritis. (B) After endoscopic resection, three lateral margins were positive (circles). (C) Pathological findings after endoscopic resection (H&E stain, ¡¿40). SRC cells exhibited subepithelial spread, indicating that the lesion was of the infiltrative type (circle).

»ç½Ç Àú´Â undifferentiated type Á¶±âÀ§¾ÏÀÇ ³»½Ã°æ Ä¡·á´Â ±ØÈ÷ µå¹°°Ô ½ÃÇàÇÏ°í ÀÖÀ» »ÓÀÔ´Ï´Ù. ³í¹®À» ³½ ÀûÀÌ ÀÖÁö¸¸ ¸î ¿¹ µÇÁö ¾Ê¾Ò½À´Ï´Ù (Dig Dis Sci 2014). ÇâÈÄ Á» ½ÃÇàÇÒ±î ½Í¾î¼­ ±âÃÊ ÀڷḦ ºÐ¼®ÇÏ¿© 2015³â ¼ÒÈ­±âÇÐȸ¿¡¼­ ¹ßÇ¥ÇÏ¿´½À´Ï´Ù (2015³â 11¿ù 27ÀÏ 15½Ã 50ºÐ. Á¦3ȸÀÇÀå. ¹ßÇ¥ÀÚ °ûµ¿½Å).


[2015-11-11. ±èÁöÇö ±³¼ö´Ô ÆíÁö]

Á¦ °³ÀÎÀûÀÎ °æÇèÀ¸·Î´Â (ÃßÈÄ ´õ Á¶»çÇÒ »ý°¢ÀÌÁö¸¸) ºÐÈ­Çü¿¡¼­ cancer dedifferentiation¿¡ ÀÇÇØ ¹ÌºÐÈ­Çü¾ÏÀÌ »ý±ä °æ¿ì¿¡¼­´Â ¾î´À Á¤µµ ¼ú Àü¿¡ proximal margin clip½Ã¿¡ µµ¿òÀÌ µÇ¾ú´ø °°½À´Ï´Ù. ´Ù½Ã ÇÑ ¹ø Á¦ ¿¬±¸ Àο뿡 °¨»çµå¸®¸ç, Áñ°Ì°í ÇູÇÑ ÇÏ·ç º¸³»½Ê½Ã¿ä.


4. SRC È®´ë³»½Ã°æ ¼Ò°ß - stretch sign

Showa ´ëÇÐ ÆÀ¿¡¼­ signet ring cell carcinomaÀÇ NBI È®´ë³»½Ã°æ¿¡ ´ëÇÑ ÂªÀº ³í¹®À» ¹ßÇ¥ÇÏ¿´½À´Ï´Ù (Phalanusitthepha C. WJGE 2015). ȯÀÚ ¼ö´Â 12¸í¹Û¿¡ µÇÁö ¾Ê¾Ò½À´Ï´Ù.

RESULTS: Twelve patients with early signet ring cell gastric carcinoma were identified; 75% were male, and average age was 61 years. Most of the lesions were stage T1a (83%), while the remainder were T1b (17%). The mean lesion size was 1.4 cm(2). On standard endoscopy, all 12 patients had a pale, flat lesion without any evidence of mucosal abnormality such as ulceration, elevation, or depression. On magnification endoscopy with NBI, all of the patients had irregularities in the glands and microvasculature consistent with early gastric cancer. In addition, all 12 patients exhibited the "stretch sign", an elongation or expansion of the architectural structure. Histologic examination of the resected specimens demonstrated an expanded and edematous mucosal layer infiltrated with tumor cells.

Gastric gland°¡ stretched µÇ¾î º¸Àδٴ ¶æÀä.... ±× ±âÀüÀ» ¾Æ·¡¿Í °°ÀÌ ¼³¸íÇÏ°í À־ Èï¹Ì·Î¿ü½À´Ï´Ù.


[Cases]

[Case 1 (À§¾Ï 614)]

Á¶±âÀ§¾Ï expanded indication¿¡ ´ëÇÑ ³íÀÇ°¡ È°¹ßÇÕ´Ï´Ù. Àú´Â ºÐÈ­Çü Á¡¸·¾ÏÀÇ °æ¿ì size ±âÁØÀ» flexible ÇÏ°Ô Àû¿ëÇÏ°í ÀÖ½À´Ï´Ù¸¸, ¹ÌºÐÈ­ Á¶Á÷Çü¾Ï¿¡ ´ëÇؼ­´Â ¸Å¿ì º¸¼öÀûÀÎ ÀÔÀåÀ» °¡Áö°í ÀÖ½À´Ï´Ù. 1cm ÀÌÇÏ flatÇÑ signet ring cell carcinoma Á¤µµ°¡ ÇöÀçÀÇ ÀûÀÀÁõÀÔ´Ï´Ù. ±×¿¡ ÇØ´çÇϴ ȯÀÚ¿¡ ´ëÇÏ¿© Á¶½É½º·´°Ô ½Ã¼úÇÏ°í ÀÖ½À´Ï´Ù. ¾ÆÁ÷±îÁö ÀÌ ±âÁØ¿¡ ÇØ´çÇÏ´Â ºÐ Áß¿¡´Â Àç¹ß¿¹´Â ¾ø¾ú½À´Ï´Ù.

Àα٠º´¿ø¿¡¼­ ÀÇ·ÚµÈ 2016³â ȯÀÚÀÔ´Ï´Ù. Signet ring cell carcinoma¶ó´Â Á¶Á÷Áø´ÜÀ̾ú½À´Ï´Ù. ȯÀÚ¿Í Àß »óÀÇ ÈÄ ESD¸¦ ÁøÇàÇÏ¿´½À´Ï´Ù.

À§¾Ï ³»½Ã°æÄ¡·áÀÇ Àý´ëÀûÀÀÁõÀº Á¡¸·¿¡ ±¹ÇÑµÈ ±Ë¾çÀÌ ¾ø´Â 2cm ÀÌÇÏÀÇ ºÐÈ­Çü Á¶±âÀ§¾ÏÀÔ´Ï´Ù (2012³â 4¿ù 1ÀÏ ½ÉÆò¿ø). ÀÌ·¯ÇÑ ±âÁØÀ» ¹þ¾î³­ Á¶±âÀ§¾Ï¿¡ ´ëÇؼ± º¸Åë ¼ö¼úÀ» ±ÇÇÕ´Ï´Ù. ±×·¯³ª ±âÁØÀ» ¾à°£ ¹þ¾î³­ º´¼Ò¿¡ ´ëÇؼ­´Â ³»½Ã°æÄ¡·á¸¦ ½ÃµµÇØ º¸±âµµ ÇÕ´Ï´Ù. À̸¦ È®´ëÀûÀÀÁõÀ̶ó°í ÇÕ´Ï´Ù.

°ú°Å¿¡´Â Àý´ëÀûÀÀÁõÀ» È®½ÇÇÏ°Ô ÁöÄ×½À´Ï´Ù. Á¶±ÝÀÌ¶óµµ ±âÁØÀ» ¹þ¾î³ª¸é ¹Ýµå½Ã Å« ¼ö¼úÀ» ¹Þµµ·Ï ±ÇÇÏ´Â ¹æ½ÄÀ̾ú½À´Ï´Ù. ´Ù¸¸ °í·ÉÀ̰ųª ½ÉÇÑ ´Ù¸¥ Àå±â ÁúȯÀÌ À־ ¼ö¼úÀÌ ¾î·Á¿î ȯÀÚ¿¡¼­¸¸ È®´ëÀûÀÀÁõ¿¡ ´ëÇÑ ³»½Ã°æ Ä¡·á¸¦ Çß½À´Ï´Ù. ±× °á°ú ÀÛÀº À§¾Ï¿¡ ´ëÇؼ­µµ Å« Ä¡·á¸¦ ÇÏ´Â ¼ÀÀÌ µÇ¾ú°í, ºñ·Ï ¾Ï Àç¹ß·üÀº ³·¾ÒÁö¸¸ ¼ö¼ú¿¡ µû¸¥ ÇÕº´Áõ°ú »îÀÇ Áú ÀúÇÏ°¡ Å« ¹®Á¦°¡ µÇ¾ú½À´Ï´Ù.

ÃÖ±Ù¿¡´Â Àý´ëÀûÀÀÁõÀ» ¹þ¾î³­ À§¾ÏÀÌ¶óµµ ¼¼Æ÷ÇüÀÌ ¹ÝÁö¼¼Æ÷¾Ï (signet ring cell carcinoma, ÀÎȯ¼¼Æ÷¾Ï)ÀÌ°í Å©±â°¡ ÀÛÀº °æ¿ì, Áï È®´ëÀûÀÀÁõ Áß ±×·¡µµ ³»½Ã°æ Ä¡·á¸¦ ÇÒ ¼ö ÀÖ´Ù°í »ý°¢µÇ´Â ÀϺο¡ ´ëÇؼ­´Â ¾ÆÁ÷ Á¤ºÎ(½ÉÆò¿ø)¿¡¼­ º¸Çè ±Þ¿©·Î ÀÎÁ¤ÇÏ°í ÀÖ´Â ºÎºÐÀº ¾Æ´Õ´Ï´Ù¸¸ ¼ö¼úÀ» ÇÇÇÏ°í ³»½Ã°æ Ä¡·á¸¦ ¼±ÅÃÇϱ⵵ ÇÕ´Ï´Ù. ÀϹÝÀûÀ¸·Î Àý´ëÀûÀÀÁõ ³»½Ã°æ Ä¡·á ÈÄ ¼ö¼úÀÌ ÇÊ¿äÇÏ´Ù´Â º´¸®°á°ú°¡ ³ª¿À´Â °æ¿ì´Â 15%, Àå±âÀûÀÎ Àç¹ß·üÀº 5% ¼öÁØÀÔ´Ï´Ù. È®´ëÀûÀÀÁõÀº À̺¸´Ù Á¶±Ý »óȸÇÏ´Â ¼öÁØÀÏ °ÍÀ¸·Î »ý°¢ÇÏ½Ã¸é µÇ°Ú½À´Ï´Ù. ´ë½Å ¼ö¼ú¿¡ µû¸¥ ÇÕº´Áõ°ú »îÀÇ Áú ÀúÇÏ°¡ ¾ø´Ù´Â Å« ÀåÁ¡ÀÌ ÀÖ½À´Ï´Ù.

½Ã¼úÀº ¹«³­ÇÏ°Ô ÁøÇàµÇ¾ú°í °á°úµµ Àß ³ª¿Ô½À´Ï´Ù.

(2016)
Posterior wall of proximal antrum, ESD : Early gastric carcinoma
1. Location : antrum, posterior wall
2. Gross type : EGC type IIc
3. Histologic type : signet ring cell carcinoma
4. Histologic type by Lauren : diffuse
5. Size of carcinoma : (1) longest diameter, 10 mm (2) vertical diameter, 6 mm
6. Depth of invasion : invades mucosa (lamina propria) (pT1a)
7. Resection margin : free from carcinoma(N), safety margin : distal 10 mm, proximal 16 mm, anterior 12 mm, posterior 8 mm, deep 1700 §­
8. Lymphatic invasion : not identified(N)
9. Venous invasion : not identified(N)
10. Perineural invasion : not identified(N)
11. Microscopic ulcer : absent
12. Histologic heterogeneity: absent

½Ã¼ú °ü·ÃÇÏ¿© µÎ °¡Áö À̽´°¡ ÀÖ½À´Ï´Ù.

(1) º´¼ÒÀÇ °æ°è ÆÇÁ¤ÀÔ´Ï´Ù. ¹ÌºÐÈ­ Á¶Á÷Çü À§¾ÏÀÇ °æ¿ì º´¼ÒÀÇ °æ°è°¡ ¸ðÈ£Çϱ⠶§¹®ÀÔ´Ï´Ù. ½Ã¼ú Àü Æò°¡ÇÏ¿´´ø °Íº¸´Ù Å©°Ô ³ª¿À´Â °æ¿ìµµ ¸¹½À´Ï´Ù. ÀÌ È¯ÀÚµµ 5mm Á¤µµ·Î »ý°¢Çߴµ¥ ½ÇÁ¦·Î´Â 10mm·Î ³ª¿Ô½À´Ï´Ù. µû¶ó¼­ ¹ÌºÐÈ­ Á¶Á÷Çü À§¾ÏÀÇ ³»½Ã°æ Ä¡·á Àü 4 quadrant biopsy¸¦ ÅëÇÏ¿© negative resection marginÀ» È®º¸ÇÏ·Á´Â ³ë·ÂÀ» Çϱ⵵ ÇÕ´Ï´Ù. ±×·±µ¥ ÀÌ·¯ÇÑ ³ë·ÂÀº ¹«Ã´ ¹ø°Å·Ó±âµµ ÇÏ°í ¾ÆÁ÷ ±× È¿°ú°¡ 100% ÀÔÁõµÈ °Íµµ ¾Æ´Ï¹Ç·Î, ½Ã¼úÀÚ¿¡ µû¸¥ ¼±È£µµ Â÷ÀÌ°¡ Å©°í, º´¼Ò¿¡ µû¶ó¼­ ºÒÇÊ¿äÇÑ °æ¿ì(¿¹¸¦ µé¾î À°¾È ¼Ò°ßÀ¸·Î °æ°è°¡ ºñ±³Àû ¸íÈ®ÇØ º¸ÀÓ µî)µµ ÀÖ½À´Ï´Ù. Àú´Â °ÅÀÇ ½ÃÇàÇÏÁö ¾Ê°í ÀÖ½À´Ï´Ù.

(2) Á¡¸·¾ÏÀÇ ³»½Ã°æ Ä¡·á¶ó°í ÇÏ´õ¶óµµ °¡´ÉÇϸé vertical marginÀ» ÃæºÐÈ÷ È®º¸Çϱâ À§ÇÏ¿© deep SM layer¸¦ dissection ÇÏ°í ÀÖ½À´Ï´Ù. ¹ÌºÐÈ­ Á¶Á÷Çü ¾Ï¿¡¼­´Â ´õ¿í ±íÀº ÀýÁ¦¸¦ Çϱâ À§ÇÏ¿© ³ë·ÂÀ» ÇÕ´Ï´Ù. ÀÌ È¯ÀÚ¿¡¼­´Â vertical resection margin (SM layer)°¡ 1,700um·Î ºñ±³Àû ³Ë³ËÇÏ°Ô ³ª¿Ô½À´Ï´Ù. ½Ã¼úÀڷμ­´Â ¾ÆÁÖ ÈíÁ·ÇÑ °á°úÀÔ´Ï´Ù.


[Case 2]

2019³â signet ring cell carcinoma·Î ÀÇ·ÚµÈ 40´ë ¿©¼ºÀÔ´Ï´Ù.

(2019)

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³»½Ã°æ ½Ã¼ú ÈÄ ÃÖÁ¾ º´¸®°á°ú´Â 1ÁÖÀÏ ÈÄ ¿Ü·¡¿¡¼­ º¸½Ç ¼ö ÀÖ½À´Ï´Ù. ºÐÈ­Á¶Á÷Çü À§¾Ï¿¡¼­´Â 7¸í Áß 1¸í, Áï 15% Á¤µµ´Â º´¸®°á°ú¿¡¼­ ¼¼Æ÷Çü, ±íÀÌ, ¹üÀ§, ¸²ÇÁ°ü ħÀ± µî¿¡ ¹®Á¦°¡ ÀÖ¾î ¼ö¼úÀÌ ÇÊ¿äÇÏ´Ù°í ³ª¿À°í 7¸í Áß 6¸í, Áï 85% Á¤µµ´Â Ãß°¡ Ä¡·á°¡ ÇÊ¿ä¾ø´Â °ÍÀ¸·Î ³ª¿É´Ï´Ù. ¹ÌºÐÈ­Á¶Á÷Çü À§¾Ï¿¡¼­´Â ¹ÝÁö¼¼Æ÷¾Ï(signet ring cell carcinoma)ÀÇ °æ¿ì´Â 20% Á¤µµ, Àúµî±Þ ºÐÈ­Çü À§¾Ï (poorly differentiated adenocarcinoma)¿¡¼­´Â 30% Á¤µµ ¼ö¼úÀÌ ÇÊ¿äÇÏ´Ù°í ³ª¿É´Ï´Ù. Àç¹ß À§ÇèÀÌ ³ô¾Æ¼­ ¼ö¼ú(À§ÀýÁ¦¼ú)ÀÌ ÇÊ¿äÇÏ´Ù°í ³ª¿À¸é ¿Ü°ú·Î ÀÔ¿øÇÏ¿© ¼ö¼úÀ» ¹Þ°Ô µË´Ï´Ù. °£È¤ ¾ÏÀ̶ó´Â Áø´ÜÀ¸·Î ³»½Ã°æÄ¡·á¸¦ ÇÏ¿´À¸³ª ´Ü¼ø ¿°ÁõÀ¸·Î¸¸ ³ª¿À´Â ºÐµµ ÀÖÀ¸³ª ±× ºóµµ´Â 3%ÀÔ´Ï´Ù.
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Áú¹®: Å©±â´Â ¾î¶°Çմϱî?
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°èȹ 1: ±âº» °Ë»ç
°èȹ 2: Àǹ«±â·Ï º¹»ç
°èȹ 3: 1ÁÖÀÏ ÈÄ ¿Ü·¡
°èȹ 4: ³»½Ã°æÀýÁ¦¼ú(ESD) ¿¹¾à"

1ÁÖÀÏ ÈÄ ¿Ü·¡¿¡¼­ °Ë»ç °á°ú¸¦ È®ÀÎÇÏ¿´°í ÀüÀÌ ¼Ò°ßÀº ¾ø¾ú½À´Ï´Ù. ȯÀÚ´Â °¡Á·µé°ú ÃæºÐÈ÷ »óÀÇÇß´Ù°í ¸»ÇÏ¿´°í ESD¸¦ ¿øÇÏ¿´½À´Ï´Ù. ÀÔ¿ø ÈÄ ½Ã¼úÇÏ¿´½À´Ï´Ù.

Åð¿ø ÈÄ ´ÙÀ½ ÁÖ ¿Ü·¡¿¡¼­ °á°ú¸¦ È®ÀÎÇß½À´Ï´Ù.

º´¸® ¼¼¹Ì³ª¿¡¼­ Á¦ ´«À¸·Î º´¼Ò¸¦ È®ÀÎÇß½À´Ï´Ù. Lamina propria¿¡ ±¹ÇÑµÈ ÀüÇüÀûÀÎ signet ring cell carcinoma¿´½À´Ï´Ù. Á¡¸·Ãþ ÇÏ´Ü¿¡´Â lymphocyte/plasma cell infiltrationÀÌ ÇöÀúÇÏ°í lymphoid follicleÀÌ denseÇÏ°Ô °üÂûµÇ°í ÀÖ¾ú½À´Ï´Ù. ¿ª½Ã Helicobacter°¡ ¹üÀÎ °°½À´Ï´Ù. ³ª»Û ³à¼® °°À¸´Ï¶ó°í.... º´¸® °á°ú¸¦ º¸°í ¾È½ÉÇÏ¿´Áö¸¸ Á÷Á¢ ´«À¸·Î º¸ÀÌ ´õ¿í È®½ÅÀÌ µé¾ú½À´Ï´Ù.

Signet ring cell carcinoma ȯÀÚ ÇÑ ¸íÀ» Ä¡·áÇϱâ À§Çؼ­´Â Á¤¸» ¸¹Àº Á¤½Å·Â°ú ³ëµ¿ÀÌ ÇÊ¿äÇÕ´Ï´Ù. Èûµç ÀÏÀÔ´Ï´Ù.


[Case 3]

SRC·Î ESD ÈÄ Á¡¸·¾Ï º´¸®ÇÐÀû ¿ÏÀüÀýÁ¦¿´Áö¸¸ 1.7cmÀÌ°í ¶Ñ·ÇÇÑ ÇÔ¸ôÇüÀ̹ǷΠ¼ö¼úÀû Ä¡·á¸¦ ±ÇÀ¯¹Þ°í ÀÌÂ÷ ÀÇ°ß À§ÇÏ¿© ÀǷڵǾú½À´Ï´Ù. Àúµµ ¼ö¼úÀ» ±ÇÇÏ¿´½À´Ï´Ù. ½Ã¼úÀÚ°¡ ¼ö¼úÀ» ±ÇÇϴµ¥ ´Ù¸¥ Àǻ簡 °æ°ú°üÂûÀ» ±ÇÇϱâ´Â °ÅÀÇ ºÒ°¡´ÉÇÑ »óȲÀÔ´Ï´Ù.

(2018)


[Case 4]

Signet ring cell carcinomaÀÔ´Ï´Ù. »ý°¢º¸´Ù ¹üÀ§°¡ ³ÐÀ» ¼ö ÀÖ´Ù´Â Á¡¿¡ ÁÖÀÇÇϽñ⠹ٶø´Ï´Ù. ÁÖº¯ÀÇ Åð»öºÎ±îÁö ÀüºÎ ¾ÏÀÔ´Ï´Ù (³ë¶õ»ö È­»ìÇ¥).

Àç°Ë ÈÄ fold º¯È­°¡ ÇöÀúÇÑ Á¡ÀÌ Æ¯Â¡À̾ú½À´Ï´Ù. Á¶Á÷°Ë»ç ÈÄ fold ¸ð¾çÀÌ ¹Ù²ð ¼ö ÀÖ½À´Ï´Ù. ¾ø´ø °ÍÀÌ »ý±æ ¼öµµ ÀÖ½À´Ï´Ù.

ÃÖÁ¾ °á°ú´Â ¾Æ·¡¿Í °°¾Ò½À´Ï´Ù.

Stomach, radical subtotal gastrectomy: Early gastric carcinoma
1. Location : middle third, Center at proximal antrum and greater curvature
2. Gross type : EGC type IIc
3. Histologic type : signet-ring cell carcinoma
4. Histologic type by Lauren : diffuse
5. Size : 4.0x2.5 cm
6. Depth of invasion : invades submucosa (sm1) (pT1b)
7. Resection margin: free from carcinoma, safety margin: proximal 5.0 cm, distal 5.3 cm
8. Lymph node metastasis : no metastasis in 58 regional lymph nodes (pN0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. AJCC stage by 8th edition: pT1b N0


[FAQ]

[2014³â ´ëÅä·Ð]

[2014-9-30. ¾Öµ¶ÀÚ Áú¹®]

ÃÖ±Ù ÀúÈñ º´¿ø º´¸® ¼±»ý´ÔµéÀº signet ring cell cancer¸¦ poorly cohesive cancer¶ó°í È¥¿ëÇؼ­ ÁÖ´Â °æÇâÀÌ ÀÖ½À´Ï´Ù. ±×·¡¼­ ¹°¾îºÃ´õ´Ï ÀÌ µÎ°¡Áö °³³äÀÌ ¿ÏÀüÈ÷ ÀÏÄ¡ÇÏÁö´Â ¾Ê´Â´Ù°í ÇÏ´õ±º¿ä. ±×³É Áö±ÝÀº È¥¿ëÇؼ­ ¾µ¼ö ¹Û¿¡ ¾ø´Ù°í Çϴµ¥ ¼±»ý´Ô »ý°¢Àº ¾î¶°½ÅÁö¿ä?

[2014-9-30. ÀÌÁØÇà ´äº¯]

¸Â½À´Ï´Ù. ¹«Ã´ Çò°¥¸®´Â ÀÏÀÔ´Ï´Ù. À§¾Ï ºÐÈ­µµ¿¡´Â Çò°¥¸®´Â À̽´°¡ ¹«Ã´ ¸¹½À´Ï´Ù. ÀÏÀü¿¡ Á¤¸®ÇÑ ³»¿ëÀº ¾Æ·¡¿Í °°½À´Ï´Ù. Signet ringÀÌ ¶Ñ·ÇÇÏ°Ô º¸À̸é SRCÀÌ°í ±×·¸Áö ¾ÊÀ¸¸é SRC¸¦ Æ÷ÇÔÇÏ´Â º¸´Ù ³ÐÀº °³³äÀÎ poorly cohesive¶ó°í Áشٴ Á¤µµ·Î ¾Ë°í Àִµ¥¿ä..... Á¦°¡ ¸î ºÐ º´¸®¼±»ý´Ô²² ¹®ÀÇÇÏ¿© ¾òÀº ´äº¯À» ¼Ò°³ÇÕ´Ï´Ù.

À§¾Ïº´¸®Æǵ¶ÀÇ ±âÁØÀ¸·Î °£ÁֵǴ 2005³â ´ëÇѺ´¸®ÇÐȸ ¼ÒÈ­±âº´¸®Çבּ¸È¸ÀÇ À§¾Ï º´¸®º¸°í¼­ ±âÀç»çÇ× Ç¥ÁØÈ­ (PDF 0.3M)¿¡´Â (1) À§¾ÏÀÇ histologic typeÀº 2000³â WHO ºÐ·ù¸¦ µû¸§, (2) µÎ °¡Áö ÀÌ»óÀÇ ºÐÈ­µµ°¡ ¼¯¿© ³ª¿Ã ¶§´Â °£ÁúÀ» Á¦¿ÜÇÑ ¾Ï¼¼Æ÷ÀÇ ¸éÀûÀÌ °¡Àå ¸¹Àº À¯ÇüÀ¸·Î ºÐ·ùÇÔ, (3) ¼±±¸Á¶³ª ÆíÆò»óÇÇ ºÐÈ­°¡ ¾ø´Â °æ¿ì¿¡´Â undifferentiated carcinoma·Î ºÐ·ùÇÔÀ» ¸íÈ®È÷ ¹àÈ÷°í ÀÖ½À´Ï´Ù.

À§¿¡¼­ ¾ð±ÞÇÑ 2005³â º´¸® Ç¥Áؾȿ¡¼­´Â 2000³â WHO ºÐ·ù¸¦ µû¸¥´Ù°í µÇ¾î ÀÖ½À´Ï´Ù. ±×·±µ¥ 2010³â WHO 4ÆÇ ºÐ·ù°¡ ³ª¿Ô°í, À§¾ÏÀÇ Á¶Á÷ÇüÀº ´ÙÀ½°ú °°ÀÌ ¹Ù²î¾ú½À´Ï´Ù. ±×·¯´Ï±î 2014³â ÇöÀçÀÇ ±¹Á¦ Ç¥ÁØÀÔ´Ï´Ù. °¡Àå Å« Â÷ÀÌ´Â poorly cohesive carcinoma°¡ Ãß°¡µÈ °ÍÀÌ°í ±× Àǹ̴ ¾Æ·¡ screenshot°ú °°½À´Ï´Ù.

8140/3 Adenocarcinoma, NOS
  - 8260/3 Papillary adenocarcinoma, NOS
  - 8211/3 Tubular adenocarcinoma
  - 8480/3 Mucinous adenocarcinoma
  - 8490/3 Poorly cohesive carcinoma, including signet ring cell carcinoma and other variants
  - 8255/3 Adenocarcinoma with mixed subtypes
8560/3 Adenosquamous carcinoma
8512/3 Medullary carcinoma with lymphoid stroma
8576/3 Hepatoid carcinoma
8070/3 Squamous cell carcinoma, NOS
8020/3 Undifferentiated carcinoma

[2014-9-30. º´¸® ±³¼ö´Ô 1 ´äº¯]

WHO ºÐ·ù 4ÆÇ¿¡ ¼Ò°³µÈ Poorly cohesive carcinoma´Â signet ring cell carcinoma¸¦ Æ÷ÇÔÇÏ´Â °³³äÀÔ´Ï´Ù. ¾ÏÁ¾¼¼Æ÷´Â ´Ù¸¥ ¼¼Æ÷¿¡ ºñÇÏ¿© ¼¼Æ÷°£ÀÇ ÀÀÁý·ÂÀÌ ³ô±â ¶§¹®¿¡ ¼­·Î ¹¶Ãļ­ ƯÁ¤ ±¸Á¶¸¦ ¸¸µå´Â °ÍÀÌ ÀϹÝÀûÀΠƯ¡ÀÔ´Ï´Ù. ±×·¯³ª ÀúºÐÈ­ ¾ÏÁ¾ (poorly differentiated carcinoma) Áß¿¡´Â ¾ÏÁ¾¼¼Æ÷ °£¿¡ ÀÀÁý·ÂÀÌ ¶³¾îÁ®¼­ ¼­·Î ¹¶Ä¡Áö ¾Ê´Â ÇüŸ¦ º¸ÀÌ´Â °æ¿ì°¡ Àִµ¥, À̸¦ ÅëĪÇÏ¿© poorly cohesive carcinoma¶ó°í ÇÕ´Ï´Ù. À̸¦ ±¸¼ºÇÏ´Â °¢°¢ÀÇ ¾ÏÁ¾¼¼Æ÷¸¦ ÇüÅÂÇÐÀûÀ¸·Î »ìÆ캸¸é, ¹ÝÁö¸ð¾ç ¼¼Æ÷ (signet ring cell)ÀÎ °æ¿ì°¡ °¡Àå ÈçÇÏÁö¸¸, ±× ¿Ü¿¡µµ Á¶Á÷±¸ (histiocyte)³ª ¸²ÇÁ±¸ (lymphocyte)¸¦ ´àÀº °æ¿ìµµ ÀÖ½À´Ï´Ù. µû¶ó¼­ Á¶Á÷ÇÐÀûÀ¸·Î ÀÀÁý·ÂÀÌ ¶³¾îÁö´Â ÀúºÐÈ­ ¾ÏÁ¾ÀÌ °üÂûµÉ ¶§, ±× ±¸¼º¼¼Æ÷ÀÇ 50%ÀÌ»óÀÌ ¹ÝÁö¸ð¾çÀ» ÃëÇÏ´Â °æ¿ì¿¡´Â Signet ring cell carcinoma·Î, ´Ù¸¥ ÇüÅ°¡ ´õ ¿ì¼¼ÇÑ °æ¿ì¿¡´Â poorly cohesive carcinoma·Î Áø´ÜÇÏ°Ô µË´Ï´Ù.

[2014-9-30. ÀÌÁØÇàÀÇ Ãß°¡ Áú¹®°ú º´¸®°ú ±³¼ö´Ô 1ÀÇ ´äº¯]

1) ÀÌÁØÇà Áú¹®: WHO 4ÆÇÀ» ÅëÇÏ¿© poorly cohesive carcinoma¶ó´Â ºÐ·ù°¡ µµÀԵDZâ ÀÌÀü¿¡ "Á¶Á÷ÇÐÀûÀ¸·Î ÀÀÁý·ÂÀÌ ¶³¾îÁö´Â ÀúºÐÈ­ ¾ÏÁ¾¿¡¼­ ±¸¼º¼¼Æ÷ÀÇ 50%ÀÌ»óÀÌ ¹ÝÁö¸ð¾çÀ» ÃëÇÏ´Â °æ¿ì(Signet ring cell carcinoma)°¡ ¾Æ´Ñ Áõ·Ê", ´Ù½Ã ¸»Çϸé 50% ÀÌÇÏÀÇ signet ring cell carcinoma°¡ ÀÖ´Â ÀÀÁý·ÂÀÌ ¶³¾îÁö´Â ÀúºÐÈ­¾ÏÁ¾Àº ¾î¶»°Ô ºÒ¸®¾ú´ÂÁö ±Ã±ÝÇÕ´Ï´Ù.

º´¸®°ú ±³¼ö´Ô ´äº¯: ÀÌ ´äº¯Àº ¹®Çå¿¡ ±Ù°ÅÇϱ⠺¸´Ù´Â Á¦ °æÇè°ú ÃßÃø¿¡ ÀÇÇÑ °ÍÀ̶ó´Â ÀüÁ¦¸¦ µå¸³´Ï´Ù. ¼±»ý´Ô²²¼­ ¸»¾¸ÇϽô "50% ÀÌÇÏÀÇ signet ring cell carcinoma°¡ ÀÖ´Â ÀÀÁý·ÂÀÌ ¶³¾îÁö´Â ÀúºÐÈ­¾ÏÁ¾"ÀÇ °æ¿ìÀÇ ´ëºÎºÐÀº signet ring cell carcinoma·Î Áø´ÜµÇ¾úÀ» °¡´É¼ºÀÌ °¡Àå ³ô½À´Ï´Ù. ¿Ö³ÄÇϸé 2000³â WHOÀÇ signet ring cell carcinomaÀÇ ÇüÅÂÇÐÀû ±â¼úÀ» Àо¸é Áö±ÝÀÇ poorly cohesive carcinoma¿Í ±×¸® ´Ù¸£Áö ¾Ê±â ¶§¹®ÀÔ´Ï´Ù (2010³â¿¡´Â ¼¼Æ÷ÇüÅÂÇÐÀûÀ¸·Î signet ring cell morphology°¡ ¾Æ´Ñ °ÍµéÀ» Æ÷ÇÔÇÒ ¼ö ÀÖ´Â "poorly cohesive carcinoma"¶ó´Â ¿ë¾î¸¦ Çϳª ¸¸µç °Í °°½À´Ï´Ù). ±×·¯³ª ÀϺδ poorly differentiated adenocarcinoma·Î Áø´ÜµÇ¾úÀ» °¡´É¼ºµµ ÀÖ½À´Ï´Ù. ¿Ö³ÄÇϸé ÀÀÁý·ÂÀº ¶³¾îÁöÁö¸¸ Á¾¾ç¼¼Æ÷°¡ »ª»ªÇÏ°Ô µé¾î Â÷ ÀÖ´Â °æ¿ì´Â poorly differentiated adenocarcinoma, solid type°ú ±¸ºÐÀÌ ¾î·Æ±â ¶§¹®ÀÔ´Ï´Ù. ¶ÇÇÑ signet ring cell carcinoma³ª poorly differentiated adenocarcinoma°¡ ¸ðµÎ diffuse type (undifferentiated type)¿¡ ¼ÓÇϱ⠶§¹®¿¡ ¹Ýµå½Ã ±¸ºÐÇÒ Çʿ伺ÀÌ ¾ø´Ù°í »ý°¢ÇÑ ¸éµµ ¾øÁö ¾Ê½À´Ï´Ù.

2) ÀÌÁØÇà Áú¹®: WHO 4ÆÇÀ» ÅëÇÏ¿© poorly cohesive carcinoma¶ó´Â ºÐ·ù°¡ µµÀԵDZâ ÀÌÀü¿¡ poorly differentiated adenocarcinoma¶ó°í ºÐ·ùµÇ´Â °Í Áß ¾î´À Á¤µµ´Â ¾ÆÁ÷µµ poorly differentiated adenocarcinoma·Î ºÒ¸®°í ¾î´À Á¤µµ´Â poorly cohesive carcinoma¶ó°í ºÒ¸®°í ÀÖ´ÂÁö¿ä?

º´¸®°ú ±³¼ö´Ô ´äº¯: ¾î´À Á¤µµ¶ó°í´Â ´ÜÁ¤ÁöÀ» ¼ö´Â ¾øÀ¸³ª µÎ°¡Áö Áø´ÜÀÌ ´Ù ¾²ÀÏ °ÍÀ¸·Î »ý°¢µË´Ï´Ù. À­ Áú¹®¿¡ ´ä°ú ¾î´À Á¤µµ °ãÄ¡´Â °Í °°½À´Ï´Ù.

3) ÀÌÁØÇà Áú¹®: ¾ð¶æ »ý°¢Çϱâ°Ô mucinious adenocarcinomaµµ poorly cohesiveÇÑ ¼º°ÝÀ» °¡Áø °ÍµéÀÌ Á¾Á¾ ÀÖÀ» °Í °°½À´Ï´Ù. ¾î¶»°Ô ÀÌÇØÇÏ¿©¾ß ÇÏ¿ÃÁö ±Ã±ÝÇÕ´Ï´Ù.

º´¸®°ú ±³¼ö´Ô ´äº¯: Mucinous adenocarcinoma¸¦ ´Ù½Ã low grade (differentiated type)°ú high grade(undifferentiated type)À¸·Î ³ª´­ ¼ö ÀÖ½À´Ï´Ù. Extracellular mucinÀ» Á¦¿ÜÇÑ Á¾¾ç¼¼Æ÷ÀÇ ÇüÅ°¡ ¸»¾¸ÇϽŠ°Íó·³ poorly cohesive, signet ring cellÀÇ ÇüŸ¦ ¶ç´Â °æ¿ì´Â high grade (undifferentiated type)À¸·Î ºÐ·ùµË´Ï´Ù.

[2014-10-1. º´¸® ±³¼ö´Ô 2 ´äº¯]

´äº¯: Poorly cohesive carcinoma´Â 2010³â¿¡ °³Á¤µÈ WHO classification of digestive system¿¡ »õ·ÎÀÌ µîÀåÇÑ ¿ë¾îÀÔ´Ï´Ù.Çö¹Ì°æ ¼Ò°ß»ó adenocarcinomaÀÌÁö¸¸ Á¾¾ç¼¼Æ÷µéÀÌ gland¸¦ ¸¸µé±â º¸´Ù´Â ³¹°³ ¶Ç´Â ÀÛÀº ±ºÁýÀ» Çü¼ºÇÏ´Â °æ¿ì¸¦ ÅëĪÇÏ´Â ºÐ·ùÀÔ´Ï´Ù. ÀÌ Áß Á¾¾ç¼¼Æ÷ ¸ð¾çÀÌ ¹ÝÁö ¸ð¾çÀÎ °æ¿ì°¡ signet rign cell carcinomaÀÌ°í °¡Àå ´ëÇ¥ÀûÀÌÁö¸¸, ÀÌ¿Ü¿¡µµ Á¾¾ç¼¼Æ÷ ¸ð¾çÀÌ histiocyte³ª lymphocyteó·³ »ý±ä °æ¿ìµµ ÀÖ°í, ¾ÆÁÖ bizarre/pleomorphic cell·Î ±¸¼ºµÈ ¿¹µµ ÀÌ¿¡ Æ÷ÇԵDZ⠶§¹®¿¡ µ¿ÀϾî´Â ¾Æ´Ï°í Æ÷°ýÀûÀÎ ¿ë¾î¶ó°í »ý°¢ÇØ¾ß ÇÒ °Í °°³×¿ä. WHO blue book¿¡´Â adenocarcinomaÀÇ Á¶Á÷ÇÐÀû ¾ÆÇüÁß Çϳª·Î poorly cohesive carcinoma, including signet ring cell carcinoma and other variant·Î ³ª¿Í ÀÖ½À´Ï´Ù.

[2014-10-1. º´¸® ±³¼ö´Ô 3 ´äº¯]

signet ring cell carcinoma´Â poorly cohesive carcinomaÀÇ ÇÑ À¯ÇüÀÔ´Ï´Ù. º´¸®ÇÐȸ Áöħ¼­¿¡´Â WHO classificationÀ» µû¸£µµ·Ï ±ÇÀ¯ÇÏ°í ÀÖ±¸¿ä, Àú´Â 2010³â WHO classification¿¡ µû¶ó Áø´Ü ¿ë¾î¸¦ ¾²°í ÀÖ½À´Ï´Ù.

[2014-10-1. º´¸® ±³¼ö´Ô 4 ´äº¯]

¾Æ½Ã´Ù½ÃÇÇ 2010³â WHO blue book (Á¦°¡ "½ÅÁÖ´ÜÁö" ·Î Ç¥ÇöÇÏ°í ¼±»ý´Ô²²¼­ È­´äÇØ Á̴ּø Ã¥ÀÔ´Ï´Ù^^) ÀÌ °³Á¤µÇ¾ú½À´Ï´Ù. Adenocarcinoma ºÐ·ù°¡ ´Þ¶óÁø Á¡Àº ¾Æ·¡¿Í °°½À´Ï´Ù.

2010 ÀÌÀüÆÇ Adenocarcinoma
- Papillary
- Tubular
- Mucinous
- Signet ring cell

2010 ÆÇ Adenocarcinoma
- Papillary
- Tubular
- Mucinous
- Poorly cohesive (including signet ring cell carcinoma and other variants)

Áï ¾óÇͺ¸¸é signet ring cell ´ë½Å poorly cohesive°¡ µé¾î°¡¼­ µÑÀÌ °°Àº °ÍÀΰ¡ ½ÍÁö¸¸ °ýÈ£¾ÈÀ» º¸¸é poorly cohesive¿¡ signet ring ¹× ¶Ç ´Ù¸¥ °ÍÀÌ Æ÷ÇÔµÈ °ÍÀÓÀ» ¾Ë ¼ö ÀÖ°í ¿ÏÀü µ¿ÀǾ ¾Æ´ÔÀ» ¾Ë ¼ö ÀÖ½À´Ï´Ù. Poorly cohesive carcinoma¿¡ Æ÷ÇԵǴ ´Ù¸¥ ÇüÅ·δ histiocyte ³ª lymphocyte ¸¦ ´àÀº cancer (hematopoietic ¼¼Æ÷´Â cohesiveness °¡ ¾ø½À´Ï´Ù) deeply eosinophilic cytoplasmaÀ» º¸À̰ųª irregular bizarre nuclei¸¦ º¸À̸鼭 cohesiveÇÏÁö ¾ÊÀº, ±×·¸Áö¸¸ signet ring cell ¸ð¾çÀ» ³ªÅ¸³»Áö ¾Ê´Â cancer°¡ Æ÷ÇԵ˴ϴÙ. ÇÏÁö¸¸ ¿ö³« signet ring cell carcinoma°¡ ¶Ñ·ÇÇÏ°Ô °¢ÀÎµÈ typeÀÌ´Ùº¸´Ï signet ring cell carcinoma·Î ¾²±âµµ ÇÏ°í poorly cohesive carcinoma·Î ¾²±âµµ ÇÏ´Â °Í °°½À´Ï´Ù.

ÀúÀÇ °æ¿ì´Â signet ring cell carcinoma´Â ±×³É signet ring cell carcinoma·Î ¾²°í signet ring ¿¡ ¶Ç ´Ù¸¥ poorly cohesive carcinoma°¡ ¸¹ÀÌ ¼¯À̰ųª signet ring ÀÌ ¾Æ´Ñ ´Ù¸¥ poorly cohesive carcinomaÀ϶§´Â poorly cohesive·Î ¾²°í ÀÖ½À´Ï´Ù. ±×·±µ¥ ¾î¶² ¼±»ý´ÔÀº signet ring cell carcinoma¸¦ ¾Æ¿¹ poorly cohesive carcinoma ·Î Áø´ÜÇϽñ⵵ ÇÏ´õ¶ó°í¿ä.

WHO ¿¡¼­ º¯È­°¡ ÀÖÀ¸´Ï ±×¿¡ µû¶ó¾ß°ÚÁö¸¸ Á¦ »ý°¢¿¡µµ Á» ´õ Ä£ÀýÇÏ°Ô ºÐ·ù¸¦ ÇØÁÖ¸é ÁÁ°Ú´Ù ½Í½À´Ï´Ù. ¾î¼¸é ´ÙÀ½ÆÇ¿¡´Â poorly cohesive carcinoma, signet rin cell type °ú poorly cohesive carcinoma, NOS typeÀ¸·Î ºÐ·ù°¡ µÉÁöµµ ¸ð¸£°Ú½À´Ï´Ù. Á¦Å¿Àº ¾Æ´ÏÁö¸¸ Á˼ÛÇÕ´Ï´Ù.¤Ð¤Ð ÁÁÀº ÇÏ·ç µÇ¼¼¿ä^^

[2014-10-1. º´¸® ±³¼ö´Ô 5 ´äº¯]

Poorly cohesive carcinoma´Â signet ring cell carcinoma¸¦ Æ÷ÇÔÇÏ´Â °³³äÀ¸·Î »õ·Î ¹Ù²ï WHO classification 2010¿¡ »õ·Ó°Ô µîÀåÇÑ ¿ë¾îÀÔ´Ï´Ù. ´ëºÎºÐÀÇ carcinoma´Â ¼¼Æ÷³¢¸® ¼­·Î ºÙ¾îÀÖ´Â °ÍÀÌ Æ¯Â¡Àε¥, signet ring cell carcinoma¸¦ Æ÷ÇÔ ÀϺο¡¼­´Â ÀÌ·± Ư¡À» ÀÒ¾î ¹ö¸®°í ÀϺΠe-cadherinÀÇ ¹ßÇöÀÌ ¾ø¾îÁö°Ô µË´Ï´Ù.

Signet ring cell carcinoma ¿Ü¿¡µµ lymphocyte ȤÀº histiocyte¸¦ ´àÀº Á¾¾ç¼¼Æ÷³ª eosinophilic cytoplasmÀ» °¡Áø ¼¼Æ÷µé, ȤÀº irregular, bizzare nuclei¸¦ °¡Áø ¼¼Æ÷µéÀÌ pooly cohesiveÇÏ°Ô ºÐÆ÷ÇÒ ¶§¸¦ ¾ð±ÞÇÏ´Â ¸»ÀÔ´Ï´Ù. ÀÌ ¿ë¾î´Â ¾ÆÁ÷ ¸¹Àº º´¸®Àǻ翡°Ô »ý¼ÒÇÏ¸ç ¸¹Àº º´¸®ÀÇ»çÀÇ ÁöÁö¸¦ ¹Þ´Â´Ù°í´Â ÇÒ ¼ö ¾øÀ» µí ÇÕ´Ï´Ù. ´Ü, Áö±Ý WHO ºÐ·ùü°è¿¡¼­ signet ring cell carcinoma°¡ ¿©±â¿¡ Æ÷ÇԵǹǷΠºÒ°¡ÇÇÇÏ°Ô ¿ë¾î¸¦ »ç¿ëÇÏ°í °è½Å´Ù°í »ý°¢µË´Ï´Ù.

[2014-10-1. Åä·ÐÀ» ÁöÄѺ» ³»°ú ±³¼ö´Ô comment]

Á¦°¡ º´¸® Àü¹®°¡°¡ ¾Æ´Ñ ÀÔÀå¿¡¼­ ¹¹¶ó Å並 ´Þ±â°¡ ¾î·Æ½À´Ï´Ù. ´Ù¸¸, ³»½Ã°æ ÀÇ»çµéÀÌ º´¸® ÀÇ»çµéÀÇ Áø´Ü±âÁØÀ» Á¶±Ý ´õ Á¸ÁßÇßÀ¸¸é ÇÏ´Â ¹Ù·¥ÀÔ´Ï´Ù. º´¸®°ú¿¡¼­ poorly-cohesive·Î ÅëÀÏÇßÀ½¿¡µµ ºÒ±¸ÇÏ°í, signet ring cell carcinoma (SRCC)·Î ¸¶À½´ë·Î ¹Ù²ã¼­ ¹ßÇ¥ÇÏ´Â ¼ÒÈ­±â³»°ú ÀÇ»çµéÀÌ ¾ø¾úÀ¸¸é ÁÁ°Ú½À´Ï´Ù.

[2014-10. 2014³â ´ëÅä·Ð¿¡ ´ëÇÑ ÀÌÁØÇà ÃÑÆò]

Àú´Â ´Ã °í¹ÎÇÕ´Ï´Ù. "¿ì¸® ±âÁØÀÌ ÀÖ°í WHO ±âÁØÀÌ ÀÖÀ» ¶§ ¾î´À °ÍÀ» µû¸¦ °ÍÀΰ¡?" ¿ì¸® ±âÁØ°ú WHO ±âÁØÀÌ µ¿½Ã¿¡ ¹Ù²î´Â ¹ýÀº ¾ø½À´Ï´Ù. º¸Åë WHO ±âÁØÀÌ ¸ÕÀú ¹Ù²î°í ³ªÁß¿¡ ¿ì¸® Çö½ÇÀ» ¹Ý¿µÇÑ »õ·Î¿î ¿ì¸® ±âÁØÀÌ ³ª¿É´Ï´Ù. ±× »çÀÌ°¡ ¹®Á¦ÀÔ´Ï´Ù. WHO¿¡¼­´Â ¿ë¾î¸¦ ¹Ù²å´Âµ¥ ¿ì¸®´Â ¾ÆÁ÷ ¾È ¹Ù²Û »óȲ¿¡¼­ WHO ¿ë¾î¸¦ ½á¾ß ÇÒ±î¿ä, (´Ù¼Ò ³°¾ÒÁö¸¸ ±×·¡µµ) ¿ì¸® ¿ë¾î¸¦ ½á¾ß ÇÒ±î¿ä? WHO ±âÁØÀÌ ¹Ù²î¸é Áï½Ã »ç¿ëÇÏ´Â ¼±»ý´ÔÀÌ °è½Å°¡ ÇÏ¸é ¿ì¸® ±âÁØÀÌ ¹Ù²î±â Àü±îÁö´Â ¿ø·¡ ¿ë¾î ±×´ë·Î »ç¿ëÇÏ´Â ºÐµµ °è½Ê´Ï´Ù. ¿©·¯ºÐÀº ¾î¶² »ý°¢À̽ʴϱî?

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ÀÌ·± ¹®Á¦ÀǽÄÀÌ ¾ø´Â »óÅ¿¡¼­ ÀÏ´Ü ¿ì¸®´Â ¿ì¸®ÀÇ ±âÁØÀ» ¸¸µé¾ú½À´Ï´Ù. ±×¸®°í WHO¸¦ ¾µ °ÍÀÎÁö ¿ì¸® °ÍÀ» ¾µ °ÍÀÎÁö ¸íÈ®È÷ Á¤ÇÏÁö ¾ÊÀº »óÅ¿¡¼­ ¿À·£ ½Ã°£ÀÌ Áö³ª°¬½À´Ï´Ù. »ç½Ç º° ¹®Á¦°¡ ¾ø¾ú½À´Ï´Ù. ÀüÆÇ WHO ±âÁØ°ú ¿ì¸® ±âÁØÀÌ °°¾Ò±â ¶§¹®ÀÔ´Ï´Ù. ¸¹Àº ºÐµéÀÌ Àß ¸ô¶ú½À´Ï´Ù. ¿ì¸® ±âÁØÀ» ¾²°í ÀÖ´ø °ÍÀÎÁö WHO ±âÁØÀ» ¾²°í ÀÖ´ø °ÍÀÎÁö º»ÀÎ ½º½º·Î ¸íÈ®ÇÏÁö ¾Ê¾Ò½À´Ï´Ù. ³í¸®ÀûÀ¸·Î´Â ¿ì¸® ±âÁØÀ» ¾²°í ÀÖ´ø °ÍÀε¥ - ¿ì¸® ±âÁØÀ» ¸¸µç °Í ÀÚü°¡ ¿ì¸® ±âÁØÀ» ¾²°Ú´Ù´Â ÀǹÌÀÔ´Ï´Ù - ¸¹Àº »ç¶÷µéÀº WHO ±âÁØÀ» ¾²°í ÀÖ´Ù°í Âø°¢Çß´ø °ÍÀÔ´Ï´Ù. ±×·±µ¥ °©ÀÚ±â WHO ±âÁØÀÌ º¯°æµÇ¾ú½À´Ï´Ù. È¥¶õÀÌ ¿Ã ¼ö ¹Û¿¡ ¾ø½À´Ï´Ù. ¿ì¸® ±âÁØÀ» ¾²°í ÀÖ´Ù°í »ý°¢ÇÏ´ø »ç¶÷Àº ½ÅÆÇ WHO ±âÁØ ¿ë¾î¸¦ ¹Þ¾ÆµéÀÌÁö ¾Ê¾Ò°í, WHO ±âÁØÀ» ¾²°í ÀÖ´Ù°í »ý°¢ÇÏ´ø »ç¶÷Àº À绡¸® ½ÅÆÇ ¿ë¾î·Î º¯°æÇÏ¿´½À´Ï´Ù. ´ëÈ¥¶õÀÌ ¹ú¾îÁ³½À´Ï´Ù.

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WHO ±âÁصµ ÁÁ°í ¿ì¸® ±âÁصµ ÁÁ½À´Ï´Ù. ¿ì¸® ȯÀÚ¿¡°Ô µµ¿òµÇ¸é ±×¸¸ÀÌ°í, ȯÀÚ¸¦ Ä¡·áÇÏ´Â ÀÇ»çµéÀÌ Çò°¥¸®Áö ¾ÊÀ¸¸é ±×¸¸ÀÔ´Ï´Ù. ºÎµð ½±°í Æí¸®ÇÑ ¹æÇâÀ¸·Î Á¤¸®µÇ±â¸¦ ¹Ù¶ö »ÓÀÔ´Ï´Ù. Á¦°¡ ÆľÇÇϱâ·Î´Â 2010³â WHO ºÐ·ù°¡ 2014³â ÇöÀç ´ëÇѹα¹ º´¸® ¿ë¾îÀÇ Ç¥ÁØÀÎ °Í °°½À´Ï´Ù. ¸ðµç º´¸®°ú ÀÇ»çµéÀÌ ÀÌ ¿ë¾î·Î ÅëÀÏµÈ º¸°í¼­¸¦ ³» ÁÙ °ÍÀ» ¹Ù¶ö »ÓÀÔ´Ï´Ù. ±×¸®°í ÇÑ ³»°ú ¼±»ý´Ô²²¼­ ÁöÀûÇÑ ¹Ù¿Í °°ÀÌ º´¸®°ú ¼±»ý´ÔÀÇ Áø´Ü¸íÀ» ³»°úÀǻ簡 ÀÚÀÇÀûÀ¸·Î º¯°æÇÏ¿© »ç¿ëÇÏÁö ¸»¾ÒÀ¸¸é ÇÕ´Ï´Ù.

Á¤¸®ÇÕ´Ï´Ù. º´¸® ÀÇ»ç´Â Ç¥ÁؾÈÀ» Çϳª Á¤ÇÏ¿© ¸ðµÎ µû¶óÁÖ¸é ÁÁ°Ú°í, ³»°ú ÀÇ»ç´Â º´¸® ÀÇ»çÀÇ ¿ë¾î¸¦ Á¸ÁßÇϸé ÁÁ°Ú½À´Ï´Ù.


[2021-4-30. ¾Öµ¶ÀÚ Áú¹®]

±³¼ö´Ô ¾È³çÇϽʴϱî. EndoTODAY ȨÆäÀÌÁö Àß º¸°í ÀÖ½À´Ï´Ù. ÀÛ¼ºÇØÁֽŠ±Ûµé »Ó ¾Æ´Ï¶ó ¾Öµ¶ÀÚ Áú¹®µµ °øÀ¯ÇØÁֽŠ´öºÐ¿¡ ÁøÇàµÇ¾ú´ø ÅäÀǵé, ´Ù¸¥ ºÐµéÀÇ ÀÇ°ßµéÀ» º¸¸é¼­ ¹è¿ï ¼ö ÀÖ´Â Á¡ °¨»çÇÕ´Ï´Ù. ´Ù¸§ÀÌ ¾Æ´Ï¶ó ´ÙÀ½ ±Ûµé º¸°í Áú¹®ÀÌ »ý°Ü¼­ ¸ÞÀÏ µå·Áº¾´Ï´Ù. http://endotoday.com/endotoday/src.html#2014

Signet ring cell carcinoma Æǵ¶ ¼Ò°ßÀÌ ³ª¿À¸é ÀûÀÀÁõ ¿©ºÎ¿¡ µû¶ó ³»½Ã°æ Ä¡·á³ª ¿Ü°ú ¿Ü·¡·Î ÀÇ·ÚÇÕ´Ï´Ù.

1. ÃÖ±Ù ³í¹®µéÀ» º¸¸é ³»½Ã°æ Ä¡·á ÈÄ Á¶Á÷°Ë»ç °á°ú°¡ non-neoplasticÀÎ °æ¿ì°¡ ÀÖ½À´Ï´Ù. http://endotoday.com/endotoday/esd_nonneoplastic.html¿¡¼­µµ ¼Ò°³ÇØ Áּ̽À´Ï´Ù.

(1) Predictive Model of Nonneoplastic Pathology after Endoscopic Resection of Gastric Epithelial Neoplasia: The rate of nonneoplastic pathology (NNP) after endoscopic resection (ER) of gastric epithelial neoplasia (GEN) has been reported to be 3%?7%.

(2) Non-neoplastic pathology results after endoscopic submucosal dissection for gastric epithelial dysplasia or early gastric cancer: The ESD specimens included 52 (4.4 %) that were confirmed as negative or indefinite for neoplasia.

(3) Clinical outcomes of no residual disease in the specimen after endoscopic resection for gastric neoplasms : NRD was detected in 143 (3.2%) of 4401 cases of gastric neoplasms treated with ER.

2. signet ring cell cancer pathology °ü·ÃÇÏ¿© Á» ´õ ã´Ùº¸´Ï signet ring cell change°¡ signet ring cell carcinoma ¼Ò°ßÀ» mimicking ÇÏ´Â °æ¿ì°¡ ÀÖ´Ù°í º¸°íÇÑ ÄÉÀ̽ºµéÀÌ ÀÖ¾ú½À´Ï´Ù (Mimickers in GI pathology - PDF).

(1) Nonneoplastic signet-ring cell change in gastrointestinal and biliary tracts: a pitfall for overdiagnosis : Nonneoplastic signet-ring cell change (SRCC) is a rare but known phenomenon in gastrointestinal and biliary tracts and is always associated with underlying mucosal ulceration/erosion secondary to infection, ischemia, or other etiology. Because nonneoplastic SRCC closely mimics signet-ring cell adenocarcinoma (SRCA), differentiation of these 2 entities is critical because misdiagnosis of nonneoplastic SRCC as SRCA can lead to intense therapeutic interventions such as surgery and/or chemoradiation therapy. In this review, a brief overview on nonneoplastic SRCC in gastrointestinal and biliary tracts, including the spectrum of clinical presentation, important histologic features, and immunohistochemical markers that are useful in differentiating nonneoplastic SRCC from SRCA, is provided. The pathogenesis of nonneoplastic SRCC in gastrointestinal and biliary tracts is discussed.

(2) Reticulin staining clarifies florid benign signet ring cell change with mitotic activity in a penetrating gastric ulcer : Signet ring cell change is a benign process that can be mistaken for signet ring cell adenocarcinoma. Signet ring cell change remains confined within the basement membrane and lacks an infiltrative growth pattern. It typically lacks cellular atypia, nuclear hyperchromasia, prominent nucleoli, or mitotic activity. This study illustrates a case of signet ring cell change with mitotic activity in a background of Helicobacter pylori gastritis with a penetrating ulcer.

(3) Signet-ring cell change versus signet-ring cell carcinoma: a comparative analysis : Signet-ring cell change (SCC) is a nonneoplastic condition that morphologically simulates signet-ring cell carcinoma (SRCA). The few case reports on SCC have focused on morphologic characteristics in distinguishing benign from malignant. In biopsy specimens, however, SCC can be easily confused with SRCA, which often demonstrates innocuous cytologic features. Cells in SCC were strongly positive for E-cadherin and negative for p53 and Ki-67. In contrast, cells in SRCA were strongly positive for p53, exhibited high proliferation, and demonstrated absent or weak positivity for E-cadherin.

3. ³»½Ã°æ Ä¡·á ÈÄ Á¶Á÷°Ë»ç °á°ú°¡ non-neoplasticÀÎ °æ¿ì°¡ º¸°íµÇ°í ÀÖ°í, ¸é¿ªÁ¶Á÷È­Çа˻ç (Reticulin, p53, Ki-67, and E-cadherin)¸¦ ó¹æÇÏ´Â °æ¿ì°¡ µå¹® Çö½Ç¿¡¼­ Á¶±â À§¾Ï biopsy (signet ring cell carcinoma) Æǵ¶ ¼Ò°ß È®ÀÎÇϽŠÈÄ (º´¸®°ú ¼±»ý´Ô²²¼­ ±ÇÀ¯ÇϽô °æ¿ìµµ µå¹® µí ÇÕ´Ï´Ù.) Ãß°¡ ó¹æÀ¸·Î À§¾ç¼º(misdiagnosis or over-diagnosis)ÀÌ ¾Æ´ÔÀ» È®ÀÎÇØ º¸½Ã´Â °æ¿ìµµ ÀÖÀ¸½ÅÁö °í°ßÀÌ ±Ã±ÝÇÕ´Ï´Ù. Çö½ÇÀûÀ¸·Î ±Ù°Å´Â ºÎÁ·ÇÏÁö¸¸ »óȲ¿¡ µû¶ó ȯÀÚ µ¿ÀÇ ÀÖ´Â °æ¿ì ½ÃµµÇØ º¼ ÇÊ¿äµµ ÀÖÀ»±î ÇÏ¿© ¹®Àǵ帳´Ï´Ù.

¹Ù»Ú½Å Áß¿¡ ±ä ±Û ÀоîÁּż­ °¨»çÇÕ´Ï´Ù. °Ç°­ÇÏ°í Áñ°Å¿î º½³¯ º¸³»½Ã±æ ¹Ù¶ø´Ï´Ù.

[2021-5-2. ÀÌÁØÇà ´äº¯]

Signet ring cell carcinoma¿Í ºñ½ÁÇÒ ¼ö ÀÖ´Â signet ring cell change¸¦ ¾ÏÁø·á ÇöÀå¿¡¼­´Â ¾î¶»°Ô ÇÏ°í ÀÖ´ÂÁö ¹®ÀÇÇÏ¿© Áּż­ °¨»çÇÕ´Ï´Ù.

³»½Ã°æ Á¶Á÷°Ë»çÀÇ sensitivity°¡ 100%°¡ ¾Æ´Ï¶ó´Â °ÍÀº ´©±¸³ª ¾Ë°í ÀÖ½À´Ï´Ù. ¾ÏÀÌ ÀǽɵǴµ¥ Á¶Á÷°Ë»ç¿¡¼­ ¾ÏÀÌ ³ª¿ÀÁö ¾ÊÀ¸¸é Áï½Ã ȤÀº short-term follow-up biopsy¸¦ ÇÕ´Ï´Ù. ³»½Ã°æ Á¶Á÷°Ë»çÀÇ specificityµµ 100%°¡ ¾Æ´Õ´Ï´Ù. ¾ÏÀ̶ó°í ³ª¿Ô¾îµµ ¾ÏÀÌ ¾Æ´Ñ °æ¿ì°¡ ÀÖ½À´Ï´Ù. ÀÌ´Â ºñ´Ü signet ring cell carcinoma¿¡¸¸ ÇØ´çÇÏ´Â °ÍÀº ¾Æ´Ï°í ´Ù¸¥ ¸ðµç ¾Ïµµ ¸¶Âù°¡ÁöÀÔ´Ï´Ù.

Á¶Á÷°Ë»ç¿¡¼­ ¾ÏÀÌ ³ª¿Ô´õ¶óµµ ³»½Ã°æ ¼Ò°ßÀÌ ¾Ï °°Áö ¾ÊÀ¸¸é ÇÕ¸®ÀûÀÎ ÀǽÉÀ» ÇØ¾ß ÇÕ´Ï´Ù. ÀÌ ¶§ Å©°Ô °í·ÁÇÏ´Â °ÍÀÌ Ä¡·á¹æ¹ýÀÔ´Ï´Ù. Subtotal gastrectomyó·³ Å©°í ºñ°¡¿ªÀûÀÎ Ä¡·á¸¦ ÇØ¾ß ÇÏ´Â »óȲ¿¡¼­´Â Áø´ÜÀÇ Á¤È®¼ºÀÌ 100%¿¡ ±ÙÁ¢ÇØ¾ß ÇÕ´Ï´Ù. ±×·¯³ª ESD³ª H. pylori Á¦±ÕÄ¡·áó·³ Ȥ½Ã ¾à°£ÀÇ °úÀ×Ä¡·á°¡ µÇ¾ú´õ¶óµµ ȯÀÚ¿¡°Ô ³²´Â À§ÇØ°¡ Å©Áö ¾Ê´Â °æ¿ì´Â Áø´ÜÀÇ Á¤È®µµ°¡ ´Ù¼Ò ³·´õ¶óµµ Ä¡·á¸¦ ½ÃÀÛÇÒ ¼ö ÀÖ½À´Ï´Ù.

1. Á¶Á÷°Ë»ç¿¡¼­ ¾ÏÀ¸·Î ÀÇ·ÚµÈ È¯ÀÚ¿¡¼­ ¼ö¼úÀÌ ÇÊ¿äÇÑ °æ¿ì¿¡´Â ³»½Ã°æ Á¶Á÷°Ë»ç¸¦ Àç°ËÇÏ¿© ´Ù½Ã ÇÑ ¹ø Á¶Á÷ÇÐÀû ¾ÏÁø´ÜÀ» È®ÀÎÇÑ ÈÄ ¼ö¼úÀ» ÇÏ°í ÀÖ½À´Ï´Ù.

2. Á¶Á÷°Ë»ç¿¡¼­ ¾ÏÀ¸·Î ÀÇ·ÚµÈ È¯ÀÚ¿¡¼­ ESD°¡ ÇÊ¿äÇÑ °æ¿ì¿¡´Â ³»½Ã°æ Á¶Á÷°Ë»ç Àç°ËÀ» ÇÏÁö ¾Ê°í ¿ÜºÎ ½½¶óÀ̵å ÀçÆǵ¶ ÈÄ ESD¸¦ ÇÏ°í ÀÖ½À´Ï´Ù.

3. °£È¤ ¿ÜºÎ Á¶Á÷°Ë»ç¿¡¼­ ¾ÏÀ¸·Î ³ª¿ÔÀ¸³ª ÀÇ·Ú ÈÄ Àç°Ë¿¡¼­ ¾ÏÀ¸·Î ³ª¿ÀÁö ¾Ê´Â °æ¿ì´Â ´Ù½Ã Çѹø ³»½Ã°æ Á¶Á÷°Ë»ç¸¦ ÇÏ°í ÀÖ½À´Ï´Ù. ÀÌ À̽´¿¡ ´ëÇؼ­´Â °³ÀÎÀûÀ¸·Î °ü½ÉÀÌ À־ 2016³â Negative biopsy after referral for biopsy-proven gastric cancer¶ó´Â Á¦¸ñÀ¸·Î ¹ßÇ¥ÇÑ ¹Ù ÀÖ½À´Ï´Ù. ¾ÆÁÖ ¿©·¯¹ø ÃßÀû°Ë»ç¸¦ Çصµ ¾ÏÀ¸·Î ³ª¿ÀÁö ¾Ê´Â ºÐÀÌ ºÐ¸í °è½Ê´Ï´Ù. ±× ÀÌÀ¯ Áß Çϳª°¡ biopsy false positiveÀÏ °ÍÀ̸ç signet ring cell changeµµ ±× ¿øÀÎ Áß ÇϳªÀÏ ¼ö ÀÖ´Ù°í »ý°¢ÇÕ´Ï´Ù.

°á±¹ ³»½Ã°æ ¼Ò°ßÀÌ Á¶Á÷°Ë»ç °á°ú¿Í ¾î¿ï¸®´ÂÁö Á¶½É½º·´°Ô »ìÇÇ´Â ¼ö ¹Û¿¡ ´Ù¸¥ µµ¸®°¡ ¾ø½À´Ï´Ù. ÀÌ·± °üÁ¡¿¡¼­ ³»½Ã°æÀ» ¹è¿ìÁö ¸øÇÑ Àǻ簡 (°ÇÁø °°Àº °÷¿¡¼­) Á¶Á÷°Ë»ç °á°ú¸¦ ÆÇÁ¤ÇÏ´Â Çö½ÇÀÌ ¸Å¿ì °ÆÁ¤½º·´½À´Ï´Ù. ³»½Ã°æ Á¶Á÷°Ë»ç °á°ú ÆÇÁ¤Àº ³»½Ã°æ specialistÀÇ ¿ªÇÒÀÔ´Ï´Ù.

Signet ring cell carcinoma°¡ ÀǽɵÇÁö¸¸ È®½ÇÇÏÁö ¾Ê´Ù°í ÀÇ·ÚµÈ È¯ÀÚ·Î Á¦±ÕÄ¡·á¸¦ ÇÏ¿´°í ÀÌÈÄ ¼öÂ÷·Ê Á¶Á÷°Ë»ç¿¡¼­µµ ¾ÏÀÌ ³ª¿ÀÁö ¾Ê¾ÒÀ½

[2022-1-16. ÀÌÁØÇà Ãß°¡] 2000ÆÇ WHO tumours of the digestive system 44ÂÊ¿¡¼­ ÀÌ·± ¾ð±ÞÀ» º¸¾Ò½À´Ï´Ù. "Several conditions mimic signet-ring cell carcinoma including signet-ring lymphoma, lamina propria muciphages, xanthomas and detached or dying cells associated with gastritis."


[References]

1) EndoTODAY À§Àå°ü º´¸®

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