Gastric cancer. EndoTODAY

[Gastric cancer 795. Timing of follow-up EGD for suspected cancer lesion with negative biopsy]

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Four months after initial screening endoscopy (biopsy result is not available, but no cancer), AGC was detected at the lesser curvature of the antrum. After referral, surgery was done

Stomach, subtotal gastrectomy: Advanced gastric carcinoma
1. Location : lower third, Center at antrum and lesser curvature
2. Gross type : Borrmann type 3
3. Histologic type : tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : intestinal
5. Size : 3.1x1.9 cm
6. Depth of invasion : invades muscularis propria (pT2)
7. Resection margin: free from carcinoma, safety margin: proximal 3.7 cm, distal 4.2 cm
8. Lymph node metastasis : no metastasis in 22 regional lymph nodes (pN0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : present
12. Peritoneal cytology : negative
13. AJCC stage by 8th edition: pT2 N0

[ ǽɺ ҿ ˻ ]

1. ð ܿ ˻ ŷڼ ? ð ȼҰ ߿ ϴ

ð Ȯ 100% ƴϴ . ð ˻ ŷ . ˻ ϰ ̴ . ð ȼҰ߿ ǽɵǾ ˻縦 ȯ ˷ ʴ . 쿬 ˻翡 Ȯ ε . Ȳ ǿ ũ ޶ ۿ ̴ . Ƿ ȭ . ڽ ִ м Ͽ ȯ ڿ Ǵ ӻ Ǵ ۿ .

80-90% ù ˻翡 ܵǴ . ̴ 10-20% ù ˻翡 ʰ , ˾ Ȥ ܵ ǹ Ѵ . ϾϿ Ͽ ˻ Ȯ ټ ( ̳ 찡 ). ˻翡 ȯ Ϻδ 1 Ȥ 2 ڴʰ ܵǱ⵵ Ѵ . ù ˻翡 Ȯ εǾ ˿ ʴ 찡 ִ ( ). ̷ 츦  ǻ 'invisible gastric cancer' ҷ . 츮 δ ǥ .

༺ ù ˻翡 ܵǴ ξ . ׷ ǰ ʿ ϴ . ˾缺 ˻翡 ϼ ʰ θ Ǵ 찡 ִ . Ȯ ̱ Ͽ ˾ , ˾ ٴ ο ˻縦 ϴ . 4 ༺ ˻翡 ϴ 찡 . ̶ ã Ƽ ˻縦 ؾ Ѵ . ĵ ָ ܺ ָ ָ Ը ˻簡 ٴ ǰߵ ڰ ٿ ū ̰ ( ̹ ǥ ڷ ). ˻ ˿ Ȯ ε ʴ ð ȼҰ߰ CT 4 ༺ ǽɵǸ ü ϱ ٶ .

2. ˻縦 ʴ ʴ´

ð ˻簡 ϻ ȭ Ǿ Ϻ Ƿ ˻縦 Ȧ ϴ ̴ . ˻縦 ʴ پ ϴ . (1) ð ˻翡 ߰ߵǴ ̻ Ұ߿ Ͽ ˻縦 ϴ ü ŷο ̴ . (2) ˻ Ŀ ٷ ̴ 쵵 ִ .3 (3) Ƿ ˸ ʰ ƽ Ǹ ϴ ȯ ڰ . (4) ˻ ϰ Ÿ Ƿ ȯ ڶ ˻簡 ʿ ٰ ϴ Ƿ ִ . ׷ ̷ ˻縦 Ȧ Ѵٴ ſ ƴ . 츮 󿡼 ð ̻ Ұ߿ ˻ 뼺 ſ ũ .

ƽ Ǹ ̳ Ÿ ϰ ִ ȯ ڿ ˻ ߻ ִ . ׷ ʴ ȯ ڿ Ͼ . ̵ ʰ ˻縦 ϶ ̴ . ˻ 輺 ߴ 輺 Ÿ ǰ . ٽ ˻ ϶ ǻ ϰ ʴ ȯ ڵ . ˻簡 ʿ ϸ ( ƽ Ǹ ԰ ִ ) ˻縦 ϴ Ǵ .

3. ǽɵ ϴ°

ź ǽɵǸ 6 ˻縦 ϴ ʿ ( ︮ ڹ ʷθ Graham ڻ ϴ ). ð ߵ â ⿡ ð ̿ ̼ Ȯ targetting ٴ , ߴٴ , ϴ ܵǸ ٷ Ͽ ٴ ϸ ͵ Ÿ 缺 ־ . ׷ ׿ ʴ EMR/ESD ô밡 Ǹ鼭䰡 ʿ ϰ Ǿ .

켱 ȯ ڿ ó ˻簡 ʿ ƴϴ . ǻ ڼ ɽ м , ȿ ˻縦 Ͽ Ȯ ִ . ̼ ù ˻翡 Ȯ ε ɼ ̾ ˻翡 Ȯ . , ˻ ̡ ༺ Ͽ ܿ ʴ .

˻ ȭ Ų . ༺ Ͽ ˻翡 ȭ ġ ħ ʴ´ . ׷ Ҽ ˻縸 ġ ħ ȥ ִ . 1 cm Ұ ˻ ˾ ҷ Ǿ ð ġ Ḧ 赵 ( ſ ַ Ͽ ֱٿ ๰ ð ġ Ḧ ȣ Ѵ ).

̳ 6 ˻縦 ϸ Ұ ŵǴ ϵ ִ . ˻縸 ġ ȴٸ , ִ . Ƿ ̳ ܹް Ÿ Ƿڵ ȯ ð ˿ Ұ ߰ߵ Ͽ ġ ħ ߻ ִ .1

˻ ð ġ Ḧ ư ִ . ˻ ̶ ̳ ˾ ȭ ų ֱ ̴ . Ϻ 忡 ̳ ǽɵǴ Ҹ ˻ ʰ ð ġ ϱ⵵ Ѵ ( ̸ 츮 ٷ ϱ ƴ ). Ͽ Ÿ Ȯ ʰ ٷ EMR/ESD ʴ´ . ټ ˻ EMR/ESD ǽɵǴ ʰ . ֱ PACS ð ġ Ḧ Ͽ Ƿڵ ȯ ڰ Ǹ ð . ð ˻縦 ݺ ϱ⺸ ٴ ܺ ð ġ ϴ ͵ ̴ . ڰ ̸ Ͽ ܺ ̵ ϴ ϴ . EMR/ESD ô뿡 ° Ͽ ð ˻ ؾ Ѵ .

4. ˻ ؼ

ٸ ˻ ԰ų , ǹ̰ Ҹ Ȯ ó ʿ ϴ . Ͽ Ȯ ϰ ̴ . Ȥ (atypical gland) ִ ȯ ˿ ܵ 󸶵 . ǽɵǾ ˻簡 Ư Ұ 쿡 ʿ ϴ . ð ˻翡 ϼ ߰ߵ ʾҴ ȼҰ ϰ û ϸ Ƿ ִ (Ư 4 ༺ ǽɵ ).

ϼ ̴ . ׷ Ȯ ܱ , 簣 ǰ Ŀ ġ ħ ӵǰ ִ . ǿ ð ȯ ü ˻ Ͽ , 1.0% ü ٲ 31.8% ٲ . ó ־ ˻ Ұ߸ ߴ ̴ .

5. ù ܰ ˻ ˻縦 Ѵ

ð ū ̴ . ð ˻ Ϻ ̴ . ʿ ؾ Ѵ . ' ˾ ð ' ̶ ʴ´ . 缺 ˾翡 ˻縦 Ͽ ؾ Ѵ . 缺 ˾ ϰ 2-3 ð Ͽ ġ Ǿ 쵵 ٽ ѹ ϴ ϴ . Ǽ ˾絵缺 ˾ Ȱ 縦 , ġ Ḧ ϸ Ǽ ˾絵 Ͻ ġ Ǿ ̱ ̴ .

6. ˻ ġ Ȯ д

ο ǰ ð , ̼ ν ð ⱸ ߴ޿ Ͽ ߰ߵǰ ִ . ׷ ġ Ȯ ʾ ġ ῡ ޴ 찡 ϴ . ù ˻翡 ġ Ȯ Ͽ ð ǻ ڽ Ӹ ƴ϶ , Ƿڹ޴ ǻ絵 ֵ ϴ ߿ ϴ .

ġ, , ũ ⸦ ϴ Ϲ ڼ ۼ ̴ . ׸ ̿ Ͽ ġ ǥ ϴ ͵ . ˻縦 Ͽ ȣ ٿ ǥ ־ ϴ . Կ ʼ . Ͽ Ư¡ ݿ ǵ . ġ Ȯ ǥ ϴ δ ȭ 鿡 ȭ ǥ ߰ ϴ , ڳ ð (scale) ̿ Ͽ ϴ , ణ Կ ϴ ִ . Ҹ ϴ ͵ . Ǵ Ҵ indigocarmine ε , ̴ ʰ ö ϴ (contrast dye) ̴ ( ֱ indigocarmine Ҿ ϴ . 2010 ⿡ Ѷ ߴܵǱ⵵ Ͽ . Indigocarmine ٺ ȭ ʿ ϴ ).

[Cases]

ù ˻翡 ʾ Ƿڵ Ͽ signet ring cell carcinoma Ȯ .