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EndoTODAY ³»½Ã°æ ±³½Ç


[Gastric cancer 888. Interobserver variation and coding. Xanthoma]

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Prepyloric antrum anterior wallÀÇ xanthoma º´¼ÒÀÇ Á¶Á÷°Ë»ç¿¡¼­ ¾ÏÀÌ ³ª¿Í ÀÇ·ÚµÈ È¯ÀÚÀÔ´Ï´Ù.

ESD¸¦ ½ÃÇàÇÏ¿´½À´Ï´Ù. Pyloric ring¿¡ ´êÀº º´¼ÒÀ̹ǷΠdistal resection marginÀ» ÃæºÐÈ÷ È®º¸Çϱ⠾î·Á¿üÀ¸¹Ç·Î ÀýÁ¦¼ú ÈÄ distal ºÎÀ§´Â APC ablationÀ» Ãß°¡ÇÏ¿´½À´Ï´Ù (¿ìÃø ¾Æ·¡ »çÁø). Pyloric ring stricture ¹ß»ý À§ÇèÀÌ ³ô´Ù°í ÆÇ´ÜµÇ¾î ´ÙÀ½°ú °°Àº °æ±¸ ½ºÅ×·ÎÀÌµå º¹¿ëÀ» ÃßõÇÕ´Ï´Ù. ½Ã¼ú 2ÀÏ ÈÄ prednisolone Åõ¾àÀ» ½ÃÀÛÇØ Áֽʽÿä. ù 1ÁÖ: ¸ÅÀÏ Pd 30mg (5mg 6¾Ë) → ´ÙÀ½ ÁÖ: ¸ÅÀÏ Pd 20mg (5mg 4¾Ë) → ´ÙÀ½ ÁÖ: ¸ÅÀÏ Pd 10mg (5mg 2¾Ë) → ´ÙÀ½ ÁÖ: ¸ÅÀÏ Pd 5mg (5mg 1¾Ë) → Áß´Ü. Áï ½Ã¼ú ´ÙÀ½´ÙÀ½ ³¯ ½ÃÀÛÇÏ¿© 1ÁÖ °£°ÝÀ¸·Î ¿ë·®À» ÁÙ¿©³ª°¡´Â ½ºÄÉÁìÀÔ´Ï´Ù (¸ÅÁÖ ¾àÀ» ÁÙ¿©°¡¸ç ÃÑ 4ÁÖ º¹¿ë ÈÄ Áß´Ü).

ÃÖÁ¾ º´¸®°á°ú´Â ¾ÏÀ¸·Î ³ª¿ÀÁö ¾Ê°í ´ÙÀ½°ú °°Àº °á°ú¿´½À´Ï´Ù. ¿©·¯ºÐÀº ¾î¶»°Ô ÇϽðڽÀ´Ï±î? ¾Ï Äڵ带 À¯ÁöÇÒ °ÍÀÎÁö, D code·Î º¯°æÇØ ÁÙ °ÍÀÎÁö °í¹ÎÀÌ ¾Æ´Ò ¼ö ¾ø½À´Ï´Ù.

Stomach, #1x1 : Anterior wall of prepyloric antrum, biopsy(ESD) : Atypical glands with high grade dysplasia
1. Location : antrum, anterior wall
2. Gross type : elevated
3. Size of adenoma : (1) longest diameter, 3 mm (2) vertical diameter, 2 mm
4. Resection margin : negative resection margins(N)
5. Associated finding: xanthoma

Àú´Â C-code¸¦ À¯ÁöÇÏ°í ¾Æ·¡¿Í °°ÀÌ ¼³¸íÇÏ¿´½À´Ï´Ù.


ÃÖÁ¾º´¸®°á°ú´Â Atypical glands with high grade dysplasia (°íµµÀÌÇü¼ºÀε¥ ¼¼Æ÷°¡ ºñÀüÇüÀûÀÌ´Ù) À¸·Î ³ª¿Ô½À´Ï´Ù. ¾Ï Á÷Àü ´Ü°è´Â Ʋ¸²¾ø´Âµ¥ ¾ÏÀ̶ó´Â È®ÁøÀº ¾Æ´Ñ °ÍÀ¸·Î Çؼ®µË´Ï´Ù. ±×·¡¼­ ´Ù¼Ò ¾Ö¸ÅÇÕ´Ï´Ù. ¿ÜºÎ º´¸® ¼±»ý´ÔÀº ¾ÏÀ̶ó°í Çߴµ¥ ÃÖÁ¾ º´¸®°á°ú°¡ ¾ÏÁ÷Àü´Ü°è·Î ³ª¿À¸é ¾ÏÀ̶ó°í ºÎ¸¦Áö Àü¾Ï¼º º´¼Ò·Î ºÎ¸¦Áö Àǻ簣 °ßÇØ°¡ ÅëÀϵǾî ÀÖÁö ¾Ê½À´Ï´Ù. ¾ÏÀ̶ó¸é Àç¹ß·üÀÌ 5% Á¤µµÀÏ °ÍÀÌ°í ¾Ï Á÷Àü´Ü°è¶ó¸é Àç¹ß·üÀº À̺¸´Ù ³·À» °ÍÀÔ´Ï´Ù.
ÀÌ·± °æ¿ì Àú´Â º¸Åë ¿ÜºÎ Æǵ¶ °á°ú ÀÇ°Å ¾ÏÀ̶ó´Â Áø´ÜÀº À¯ÁöÇÏ°í ÀÖ½À´Ï´Ù. C ÄÚµå¶ó°í ÇÕ´Ï´Ù. ±×·¯³ª ´Ù¸¥ ÀÇ»çµéÀ̳ª º¸Çè ȸ»ç³ª Á¤ºÎ¿¡¼­´Â ´Ù¸¥ ÆÇ´ÜÀ» ÇÒ ¼öµµ ÀÖÀ» °Í °°½À´Ï´Ù. µû¶ó¼­ ½É»ç °á°ú ÀÇ°Å ÇâÈÄ Äڵ尡 º¯°æµÉ ¼ö ÀÖ´Ù´Â Á¡À» ¸»¾¸µå¸³´Ï´Ù. ÃâÇ÷°ú °°Àº Ưº°ÇÑ ¹®Á¦°¡ ¾øÀ¸¸é 2-3°³¿ù ÈÄ ³»½Ã°æ °Ë»ç¸¦ ÇÏ°í ÀÖ½À´Ï´Ù. »óó´Â ´Ù ¾Æ¹°¾ú´ÂÁö ÀÜ·ùº´¼Ò´Â ¾ø´ÂÁö ´Ù½Ã Çѹø È®ÀÎÇÏ´Â °úÁ¤ÀÔ´Ï´Ù. ¿¹¾àµÇ¾î ÀÖÀ» °ÍÀÔ´Ï´Ù. ¸î ÁÖ Á¤µµ ¾àÀÌ ÇÊ¿äÇѵ¥ ³²Àº ¾àÀº ÃæºÐÇϽʴϱî?

±¹¹Î°Ç°­º¸Ç踸 ½Å°æ¾´´Ù¸é ´ç¿¬È÷ C code¸¦ À¯ÁöÇÏ°í Ãß°¡ ¼³¸íÀÌ ÇÊ¿äÇÏÁö ¾Ê½À´Ï´Ù. ±×·¯³ª »çº¸ÇèÀÌ ¸¹Àº ¿ì¸®³ª¶ó ÀÇ·áȯ°æ¿¡¼­ ¾Ö¸ÅÇÑ »óȲÀÌ ³ª¿À¸é º¹ÀâÇÏ°Ô ¼³¸íÇÏÁö ¾ÊÀ» µµ¸®°¡ ¾ø½À´Ï´Ù. Àú´Â ´Ü¼øÇÑ °ÍÀ» ÁÁ¾ÆÇÏ´Â ÆíÀε¥ ¼¼»óÀº Á¡Á¡ Á¦°¡ ÀÏÇϱ⠾î·Á¿î ¹æÇâÀ¸·Î ¹Ù²î°í ÀÖ½À´Ï´Ù.

© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng. (2021-3-2)