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[StomachTODAY 056. Oxyntic gland adenoma (OGA)]
Oxyntic gland adenoma Áõ·Ê¸¦ ¼Ò°³ÇÕ´Ï´Ù. ESD·Î Ä¡·áÇÏ¿´½À´Ï´Ù.
¿ÜºÎ Á¶Á÷°Ë»ç´Â a few typical oxyntic glands, suspicious for oxyntic gland adenoma¿´½À´Ï´Ù. ÀÌÁ¦´Â ¿ì¸®³ª¶ó º´¸®ÀÇ»çµéµµ oxyntic gland adenoma¿¡ °ü½ÉÀ» ±â¿ïÀ̱⠽ÃÀÛÇÑ °Í °°½À´Ï´Ù. ¹Ý°©½À´Ï´Ù. ÀçÆÇµ¶Àº fundic gland dysplasia¿´½À´Ï´Ù.
¾Æ·¡´Â ESD º´¸®ÀÔ´Ï´Ù. ¿¹»óÇÏ¿´´ø ¹Ù¿Í °°ÀÌ oxyntic gland adenomaÀÇ complete resectionÀ¸·Î ³ª¿Ô½À´Ï´Ù.
Oxyntic gland adenoma (OGA)ÀÇ Æ¯Â¡ÀÔ´Ï´Ù. Ç︮ÄÚ¹ÚÅÍ °¨¿°ÀÌ ¾ø´Â 60´ëÀÇ À§Ã¼ºÎ¿¡¼ flat pale elevated lesionÀÌ ÀÖÀ» ¶§ ÀǽÉÇÒ ¼ö ÀÖ½À´Ï´Ù. Á¾±Ù´ç À§Áúȯ ¾ÆÆ²¶ó½º¿¡ Áõ·Ê¸¦ ¼Ò°³ÇÏ¿´½À´Ï´Ù.
À§¿ëÁ¾Àº Å©°Ô Ç¥¸é»óÇÇ¿¡¼ ½ÃÀÛµÈ Á¾·ù¿Í À§¼±(gastric gland)¿¡¼ ±â¿øÇÏ´Â Á¾·ù·Î ³ª´¶´Ù (±×¸² 6). Ç¥¸é»óÇÇ¿¡¼ ±â¿øÇÑ °Í, Áï foevolar epithelium ±â¿ø ¿ëÁ¾¿¡´Â °úÇü¼º ¿ëÁ¾, °ü»ó ¼±Á¾, ¿¬¼Ò¼º ¿ëÁ¾Áõ(juvenile polyposis), Peutz-Jeghers ÁõÈıº µîÀÌ ÀÖÀ¸¸ç, À§¼±¿¡¼ ±â¿øÇÑ °ÍÀº À§Àú¼± ¿ëÁ¾(fundic gland polyp), »êºÐºñ¼± ¼±Á¾(oxyntic gland adenoma, OGA), À¯¹®¼± ¼±Á¾ (pyloric gland adenoma, PGA), °¡Á·¼º À¯Àü¼º ¿ëÁ¾Áõ°ú ¿¬°üµÈ À§Àú¼± ¿ëÁ¾Áõ µîÀÌ ÀÖ´Ù.
°ú°Å OGA´Â ÁÖ¼¼Æ÷ ¿ì¼¼Çü À§Àú¼±Çü À§¾Ï(gastric adenocarcinoma of fundic gland type with chief cell differentiation)·Î ºÎ¸£´ø Á¾·ù¿´´Ù. 2012³â ¿¬±¸(Singhi, et al. Am J Surg Pathol 2012;36:1030)¿¡¼ ºÐ¹®ºÎ¿Í À§ÀúºÎÀÇ »êºÐºñÁ¡¸·(oxyntic mucosa)¿¡¼ ±â¿øÇϸç, ¸²ÇÁÇ÷°ü ħ¹ü, ÀüÀ̳ª Àç¹ßÀÌ ¸Å¿ì µå¹°±â ¶§¹®¿¡ ¾ÏÀ̶ó±âº¸´Ù´Â ¼±Á¾À¸·Î ¸í¸íÇÏ´Â °ÍÀÌ Å¸´çÇϰڴٴ Àǰ߿¡ µû¶ó OGA·Î ¸íĪÀÌ º¯°æµÇ¾ú´Ù.
OGA ȯÀÚÀÇ Æò±Õ ¿¬·ÉÀº 66¼¼ÀÌ¸ç ³²³àºñ´Â 3:1ÀÌ´Ù. OGA¸¦ ³»½Ã°æ ¼Ò°ßÀ¸·Î Áø´ÜÇϱâ´Â ¾î·Æ´Ù. ÁÖ·Î À§Ã¼ºÎ³ª À§ÀúºÎÀÇ Á¡¸·ÀÇ ÀÛ°í ¾à°£ À¶±âµÇ°Å³ª ÆòźÇÑ º´º¯À¸·Î °üÂûµÇÁö¸¸ µå¹°°Ô ÇÔ¸ôÇüÀÎ °æ¿ìµµ ÀÖ´Ù. Å©±â´Â ´Ù¾çÇѵ¥ 3mmºÎÅÍ 40 mm±îÁö º¸°íµÇ°í ÀÖ´Ù. »óÇÇÇϺ´º¯°ú À¯»çÇÏ°Ô °üÂûµÇ´Â °æ¿ìµµ Àִµ¥ ÀÌ´Â Á¤»ó foveolar epithelium (¼Ò¿Í »óÇÇ) ¾Æ·¡ÀÇ À§¼±¿¡¼ ¹ß»ýÇϱ⠶§¹®À¸·Î ÃßÁ¤µÈ´Ù.
Á¶Á÷ÇÐÀû ¼Ò°ßÀº Å©±â¿Í ¸ð¾çÀÌ ´Ù¾çÇÑ ºñÁ¤ÇüÀûÀÎ ¼±±¸Á¶°¡ Á¤»óÀûÀÎ Á¡¸· »çÀÌ¿¡ °üÂûµÇ´Â °ÍÀÌ´Ù (tightly packed tubules and trabeculae). ±¸Á¶ÀûÀÎ ÀÌÇü¼º¿¡ ºñÇÏ¿© ¼¼Æ÷ÇÙÀÇ ÀÌÇü¼ºÀº °¡º¿î ÆíÀε¥, µÕ±Û°í ÀÛÀº ÇÙÀ» °¡Áö¸é¼ °í¹èÀ²¿¡¼ Á¤»ó À§Àú¼± ¼¼Æ÷º¸´Ù´Â ÇÙÀÌ ´Ù¼Ò Å©°í ÀÛ°í ¸íÈ®ÇÑ ÇÙ¼Òü¸¦ °¡Áö°í ÀÖ´Ù. À¯»çºÐ¿Àº °ÅÀÇ ¹ß°ßµÇÁö ¾Ê´Â´Ù. ¼¼Æ÷ÇüÀº ÁÖ¼¼Æ÷ À§ÁÖÀÎ °æ¿ì (chief cell-predominant pattern)°¡ °¡Àå ÈçÇϰí ÁÖ¼¼Æ÷¿Í º®¼¼Æ÷°¡ ¼¯ÀÎ ÇüŰ¡ ÀÖ´Ù. ¸ñÁ¡¾×¼¼Æ÷ (mucous neck cell)À̳ª ¼Ò¿Í º¯Çü(foveolar differentiation)À» º¸ÀÌ´Â Á¾·ù´Â ¿¹Èİ¡ ³ª»Ü ¼ö ÀÖ´Ù. ½Å°æ³»ºÐºñÁ¾¾ç°úÀÇ °¨º°ÀÌ ¾î·Á¿î °æ¿ì¿¡´Â chromogranin A³ª synaptophysin ¿°»öÀ» ÀÌ¿ëÇÑ´Ù. ¹Â½Å¿°»ö¿¡¼´Â MUC5AC À½¼º, MUC 6 ¾ç¼ºÀ» º¸ÀδÙ. °íµµ OGA¿¡¼´Â ¼±±¸Á¶°¡ º¸´Ù º¹ÀâÇØÁö°í ¼¼Æ÷ÇÙÀÇ ÀÌÇü¼ºÀÌ ½ÉÇØÁú ¼ö ÀÖ´Ù (complex anastomosing glands and more pronounced cytonuclear atypia). Wnt/b-catenin ½ÅÈ£Àü´Þü°è¿Í °ü·ÃµÈ À¯ÀüÀÚµé(CTNNB1, AXINs, APC, GNAS)ÀÇ º¯À̰¡ º¸°íµÈ ¹Ù ÀÖ´Ù.
[2025-5-30. ¾Öµ¶ÀÚ Áú¹®]
Oxyntic gland neoplasm¿¡ ´ëÇÑ Áú¹®ÀÔ´Ï´Ù. ±Ã±ÝÇÑ °ÍÀº °øºÎÁß¿¡ fundic gland polypÀÌ °á±¹ oxyntic mucosa¿¡¼ ¹ß»ýÇÏ´Â °ÍÀε¥ fundic gland dysplasiaµµ oxyntic gland neoplasmÀ¸·Î º¼ ¼ö´Â ¾ø´Â °ÍÀÎÁö ÀÌÇØ°¡ Àß °¡Áö°¡ ¾Ê½À´Ï´Ù. Oxyntic gland neoplasmÀ̶ó Çϸé Oxyntic gland adenoma ¿Í ADC of fundic gland type¸¸ ³íÇϰí fundic gland dysplasia °°Àº °æ¿ì ã¾Æº¸¸é FAP ȯÀÚ¿¡¼ ÁÖÀÇÇØ¾ßÇÒ »çÇ×À̶ó°í¸¸ ³íÇϰí ÀÖ¾î¼ °³³ä ÀÚü°¡ Çò°¥¸³´Ï´Ù. ¿£µµÅõµ¥ÀÌ¿Í À§Áúȯ ³»½Ã°æ ¾ÆÆ²¶ó½º¿¡¼µµ Oxyntic gland adenoma »ç·Ê·Î fundic gland dysplasia¸¦ ¼Ò°³ÇØÁ̴ּµ¥, Ȥ½Ã FAP ȯÀÚ°¡ ¾Æ´Ñ °æ¿ì fundic gland dysplasia¶ó°í º´¸® ÆÇµ¶ÀÌ ³ª¿Â´Ù¸é oxyntic gland neoplasmÀ¸·Î º¼ ¼ö ÀÖ´Â °ÍÀϱî¿ä? ±âÃÊÀûÀÎ Áú¹® Á˼ÛÇÕ´Ï´Ù.
[2025-5-30. ÀÌÁØÇà ´äº¯]
ÁÁÀº Áú¹® °¨»çÇÕ´Ï´Ù. Àúµµ ¾ÆÁ÷ Á¤È®È÷ °³³ä°ú ¿ë¾î¸¦ Á¤¸®ÇÏÁö ¸øÇß½À´Ï´Ù. ÀÏ´Ü ¸®ºäÀÇ ±×¸²°ú WHO blue book (5ÆÇ)ÀÇ tumors of the stomachÀÇ ¸ñÂ÷¸¦ Àß º¸½Ã±â ¹Ù¶ø´Ï´Ù.
Gastric gland´Â pyloric gland¿Í fundic gland (= oxyntic gland)·Î ³ª´©¾îÁý´Ï´Ù. ÀÌ µÎ Á¾·ù gland ¸ðµÎ pit (= foveola)¿Í proper gland·Î ±¸¼ºµË´Ï´Ù. NeoplasmÀº pit (= foveolar epithelium)¿Í proper gland ¸ðµÎ¿¡¼ ¹ß»ýÇÒ ¼ö ÀÖ½À´Ï´Ù. Àú´Â ¾Æ·¡¿Í °°Àº °³³äÀ» °¡Áö°í ÀÖ½À´Ï´Ù.
Pit Proper gland À§Ä¡ Antrum Body/Fundus Antrum Body/Fundus Non-dysplastic polyp Hyperplastic polyp ? Fundic gland polyp Dysplasia Intestinal type adenoma (=tubular adenoma) and foveolar type adenoma Pyloric gland adenoma Oxyntic gland adenoma Cancer Gastric adenocarcinoma Gastric type adenocarcinoma Adenocarcinoma of fundic gland type Pit (= foveolar epithelium)¿¡¼ ¹ß»ýÇÏ´Â °ÍµéÀº antrumÀ̳ª body/fundusÀÇ Â÷À̰¡ ¾øÀ¸¹Ç·Î ½±½À´Ï´Ù. WHO blue book 5ÆÇ 92ÂÊ gastric adenocarcinoma of fundic gland type ¼³¸íÀ» º¸¸é "This type is assumed to develop from oxyntic gland adenoma."¶ó°í ºÐ¸íÈ÷ ¾º¿© ÀÖ½À´Ï´Ù. Á¦°¡ º¸±â¿¡´Â oxyntic gland¿Í fundic gland°¡ °ÅÀÇ °°Àº ÀǹÌÀÌ¸ç ´Ü¼øÈ÷ óÀ½ À̸§ÁöÀº °ü·Ê¿¡ µû¶ó (1) non-dysplastic º´¼Ò´Â fundic gland polypÀ¸·Î, (2) non-cancer dysplasia º´¼Ò´Â oxyntic gland adenoma·Î, (3) cancer´Â gastric adenocarcinoma of fundic gland type·Î ºÎ¸£°í ÀÖÀ» »ÓÀÎ °Í °°½À´Ï´Ù. µû¶ó¼ Á¦ ¸Ú´ë·Î »õ·Î À̸§À» Áþ´Â´Ù¸é fundic gland proper¿¡¼ ¹ß»ýÇÏ´Â ¿©·¯ ÁúȯÀ» (1) fundic gland polyp = oxyntic gland polyp, (2) fundic gland adenoma = oxyntic gland adenoma, (3) adenocarcinoma of fundic gland type = fundic gland adenocarcinoma = oxyntic gland adenocarcinoma·Î ¸í¸íÇÏ°í ½Í½À´Ï´Ù. ºñ½ÁÇÑ ¹æ½ÄÀ¸·Î pyloric gland proper¿¡¼ ¹ß»ýÇÏ´Â °ÍÀº (1) pyloric gland adenoma = gastric gland adenoma, (2) gastric type adenocarcinoma = pyloric adenocarcinoma·Î ¸í¸íÇÏ°í ½Í½À´Ï´Ù.
¾Æ·¡´Â ÀúÀÇ ÁÖÀåÀÔ´Ï´Ù. ÀÌ·¸°Ô °£´ÜÈ÷ Á¤¸®ÇÏ¸é ¾ó¸¶³ª ÁÁÀ»±î¿ä?
Proper gland¿¡¼ ¹ß»ýÇÏ´Â º´¼Ò¿¡ ´ëÇÑ ¸í¸í¹ý ÅëÀÏ¾È (ÀÌÁØÇà Á¦¾È. 2025-5-30) À§Ä¡ Antrum Body/Fundus Non-dysplastic polyp ? Fundic gland polyp Dysplasia Pyloric gland adenoma Fundic gland adenoma Cancer Pyloric gland adenocarcinoma Fundic gland adenocarcinoma ¾ÆÁ÷ fundic gland polyp¿¡ ´ëÀÀÇÏ¿© antrumÀÇ pyloric gland proper¿¡¼ ¹ß»ýÇÏ´Â polyp¿¡ ´ëÇÑ Æ¯º°ÇÑ À̸§Àº ¾ø´Â °Í °°½À´Ï´Ù. ±×·¡¼ ?Ç¥ ÀÔ´Ï´Ù.
Dysplasia¿Í adenoma¿¡ ´ëÇÑ °³³äÀº ¶Ç ´Ù¸¥ ¹®Á¦Àε¥, Àú´Â °£´ÜÈ÷ dysplasia°¡ ÀÖÀ¸¸é adenoma·Î ºÎ¸¥´Ù°í »ý°¢ÇÕ´Ï´Ù. ÀÌ¿¡ ´ëÇØ¼´Â EndoTODAY À§¼±Á¾¿¡¼ ÀÚ¼¼È÷ ±â¼úÇØ µÎ¾ú½À´Ï´Ù.
º¯¸í ÇÑ ¸¶µð µ¡ºÙÀÔ´Ï´Ù. Àúµµ ¾ÆÁ÷ Á¤È®È÷ °³³ä°ú ¿ë¾î¸¦ Á¤¸®ÇÏÁö ¸øÇÑ ÀÌÀ¯´Â °á±¹ º´¸®ÇÐÀÚµéÀÌ °¢ÀÚ Àû´çÇÏ´Ù°í »ý°¢Çϴ¿ë¾î¸¦ ¸¸µé¾î »ç¿ëÇÏ¿´´Âµ¥ À̸¦ ¸ð¾Æ Á¤¸®ÇÏ´Â ÀÛ¾÷À» ÇÏÁö ¸øÇÑ Å¿ÀÌ Å« °Í °°½À´Ï´Ù. ƯÈ÷ stomach ºÎºÐÀº ÀϺ» º´¸®ÀÇ»ç¿Í ¼¾ç º´¸®ÀÇ»çµéÀÌ ¿µ ÀǰßÀ» ¸ÂÃßÁö ¸øÇϰí ÀÖ¾î¼ ´õ¿í Çò°¥¸³´Ï´Ù. ±×·¯³ª ÃÖ±Ù WHO blue bookÀ» º¸¸é °ú°Åº¸´Ù´Â ¸¹ÀÌ Á¤¸®°¡ µÇ¾î ÀÖ½À´Ï´Ù. ¾ðÁ¨°¡´Â ÅëÀϾÈÀÌ ³ª¿À°ÚÁö¿ä. ±â´ëÇØ º¾´Ï´Ù.
1) EsoTODAY - ½ÊÀÌÁöÀåÁúȯ Áõ·ÊÅäÀÇ
2) SmallTODAY - ¼ÒÀåÁúȯ Áõ·ÊÅäÀÇ
3) ColonTODAY - ´ëÀåÁúȯ Áõ·ÊÅäÀÇ
4) Dr. Sinn's LiverTODAY - °£Áúȯ Áõ·ÊÅäÀÇ
- Usually arising within the lower zone of oxyntic mucosa
- Clusters of irregular glands typically separated by radiating wisps of smooth muscle
- Dilated, branched, fused and anastomosed glands can be seen
- Composed predominantly of columnar epithelial cells with chief cell differentiation characterized by basophilic cytoplasm and relatively uniform round nuclei
- Can have minor components of parietal cells and mucus cells
- No more than mild nuclear atypia
- No mitosis, necrosis, desmoplasia or lymphovascular invasion
- Mucosal surface may be spared and covered by gastric foveola and nonneoplastic oxyntic glands
- If submucosal invasion is present, should be classified as gastric adenocarcinoma of fundic gland type
© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng (2023-11-5)