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[À§¾ÏÀÇ ±íÀÌ. Depth of invasion of gastric cancer (ħÀ± ±íÀÌ. ½É´Þµµ)] - ðû
½É´Þµµ(ä¢Ó¹Óø)´Â ÀϺ»½Ä Ç¥ÇöÀ̹ǷΠ°¡±ÞÀû 'ħÀ± ±íÀÌ'¶ó´Â Ç¥ÇöÀ» »ç¿ëÇϽñ⠹ٶø´Ï´Ù.
1. Á¶±âÀ§¾Ï°ú ÁøÇ༺À§¾ÏÀÇ ±¸ºÐ - º´¸®ÇÐÀû ±âÁØ
2. Á¶±âÀ§¾Ï Áß Á¡¸·¾Ï°ú Á¡¸·ÇϾÏÀÇ ±¸ºÐ
3. Á¡¸·¾Ï°ú Á¡¸·ÇÏ¾Ï ±¸ºÐÀ» À§ÇÑ tip
4. EGC IIa+IIc´Â »ý°¢º¸´Ù ±í½À´Ï´Ù.
6. º¸¸¸ 1Çü ÁøÇ༺ À§¾Ï°ú EGC type IÀÇ ±¸ºÐ
7. Cases
8. FAQs
9. References
1. Á¶±âÀ§¾Ï°ú ÁøÇ༺À§¾ÏÀÇ ±¸ºÐ
À§¾ÏÀÇ ±íÀÌ¿¡ ´ëÇÑ ³»½Ã°æ Æò°¡ÀÇ Á¤È®¼º¿¡ ´ëÇÑ ³í¹®Àº °´°üÀûÀÌ±â ¾î·Æ½À´Ï´Ù. °üÂûÀÚ°£ Â÷À̰¡ Å©±â ¶§¹®ÀÔ´Ï´Ù. ÀϺ»°ú ¿ì¸®³ª¶óÀÇ °á°úµµ Á¦¹ý ´Ù¸¨´Ï´Ù. ¿ì¸®´Â ¿ì¸® ½ÇÁ¤¿¡ ¸Â´Â µ¥ÀÌŸ¸¦ Âü°íÇÏ¿© ȯÀÚÁø·á¿¡ ÀÀ¿ëÇÏ´Â °ÍÀÌ ÁÁÀ» °ÍÀÔ´Ï´Ù. 2011³â ¼¿ï´ëÇб³º´¿ø¿¡¼ À§¾Ï ±íÀÌ Æò°¡ÀÇ Á¤È®¼º¿¡ ´ëÇÑ ³í¹®À» ³½ ¹Ù Àִµ¥ ¿ì¸® Çö½ÇÀ» Àß º¸¿©ÁÖ´Â ÁÁÀº Âü°íÀÚ·á¶ó°í »ý°¢ÇÕ´Ï´Ù (ÃÖÁ¤¹Î. GIE 2011).
Á¶±âÀ§¾Ï¿¡¼ ÁøÇ༺À§¾ÏÀ¸·Î º¯ÇÏ´Â ±â°£Àº ¿¬±¸ÇÏ±â ¾î·Æ½À´Ï´Ù. ÀϺ»ÀÇ ÇÑ ¿¬±¸¿¡¼´Â 44°³¿ùÀ» Á¦½ÃÇÑ ¹Ù ÀÖ½À´Ï´Ù (Tsukuma H. Stomach Intestine 2008:43:1777-83). °°Àº ¿¬±¸¿¡¼ 5³â ÈÄ 64.7%, 10³â ÈÄ 95% ÀÌ»óÀÌ ÁøÇ༺À§¾ÏÀ¸·Î ¹ßÀüÇÑ´Ù°í ÇÕ´Ï´Ù.
2010³â »ï¼º¼¿ïº´¿ø ¿Ü°úÀÇ ºÐ¼®(Shin SH. J Surg Oncol 2010)¿¡ µû¸£¸é, ³»½Ã°æ¿¡¼ Á¶±âÀ§¾ÏÀ¸·Î ÃßÁ¤ÇÏ¿´´ø 1,611¸í Áß 120¸í(7.4%)ÀÌ ÁøÇ༺À§¾ÏÀ̾ú½À´Ï´Ù. ³»½Ã°æÄ¡·á¸¦ ÇÏ¿´´ø Á¶±âÀ§¾ÏÀÌ Æ÷ÇԵǾú´õ¶ó¸é ¾à°£ ´õ ÁÁ¾ÒÀ» °ÍÀÔ´Ï´Ù. ³»½Ã°æ¿¡¼ ÁøÇ༺ À§¾ÏÀ¸·Î ÃßÁ¤ÇÏ¿´´ø 1,299¸í Áß 132¸í(10.2%)Àº Á¶±âÀ§¾ÏÀ̾ú½À´Ï´Ù. ÀϹÝÀûÀ¸·Î ³»½Ã°æ¿¡¼ Á¶±âÀ§¾ÏÀ¸·Î »ý°¢ÇÑ À§¾ÏÀÇ 5%´Â ÁøÇ༺ À§¾Ï, ³»½Ã°æ¿¡¼ ÁøÇ༺À§¾ÏÀ¸·Î »ý°¢ÇÑ À§¾ÏÀÇ 10%´Â Á¶±âÀ§¾ÏÀ¸·Î »ý°¢Çϱ⠹ٶø´Ï´Ù.
2011³â ¼¿ï´ëº´¿ø ³í¹® (ÃÖÁ¤¹Î. GIE)¿¡¼ ³»½Ã°æÀ¸·Î Á¶±âÀ§¾ÏÀ¸·Î ÃßÁ¤µÈ 2,105¸í Áß 2.9%ÀÎ 60¸íÀº ½ÇÁ¦·Î´Â ÁøÇ༺À§¾ÏÀ̾ú½À´Ï´Ù. ÀÌ Á¤µµÀÇ Á¤È®µµ´Â ¸Å¿ì ¿ì¼öÇÑ °ÍÀÔ´Ï´Ù.
2013³â °Ç±¹´ë ³í¹® (Clin Endosc)¿¡¼ Á¶±âÀ§¾ÏÀ¸·Î ÃßÁ¤µÈ 207¸í Áß 6.8%ÀÎ 14¸íÀº ½ÇÁ¦·Î´Â ÁøÇ༺ À§¾ÏÀ̾ú½À´Ï´Ù. Proximal part¿¡ EGC-like AGC°¡ ¸¹¾Ò½À´Ï´Ù.
AGC-like EGCs predominate in the distal part of the stomach, while EGC-like AGCs predominate in the proximal part. When evaluating the depth of a gastric cancer, care should be taken not to underestimate measurements in proximal gastric cancers since they tend to be poorly-differentiated adenocarcinomas, in Lauren¡¯s diffuse type, and invade deeper than their endoscopic appearance might suggest.
2015³â ÇѾç´ëº´¿ø ³í¹®¿¡¼ ³»½Ã°æ¿¡¼ Á¶±âÀ§¾ÏÀ¸·Î ÆÇ´ÜÇÏ¿´´ø 367¸í Áß 40¸í(11 %)ÀÌ ÁøÇ༺À§¾ÏÀ̾ú½À´Ï´Ù (Lee JH. Surg Endosc 2015 - Epub).
PM cancer´Â Á¶±âÀ§¾Ï°ú ÁøÇ༺ À§¾ÏÀÇ Áß°£Àû ¼º°ÝÀ» °¡Áö°í ÀÖ½À´Ï´Ù. Á¦°¡ Àü°øÀÇ ½ÃÀý¿¡ ºÐ¼®ÇÑ ÀڷḦ ±º´ë ±â°£µ¿¾È ÃâÆÇÇÑ ³í¹®ÀÌ PM cancer¿¡ ´ëÇÑ °ÍÀ̾ú½À´Ï´Ù.
[Á¶±â À§¾Ï°ú ÁøÇ༺ À§¾ÏÀÇ ±¸ºÐÀÇ º´¸®ÇÐÀû ±âÁØ]
¾Ï¼¼Æ÷°¡ ¸í¹éÇÏ°Ô proper muscle layerÀÇ muscle »çÀÌ¿¡ ħÀ±ÇÏ¸é ´ç¿¬È÷ PM cancerÀÔ´Ï´Ù. ±×·¯³ª ¾Ï¼¼Æ÷°¡ ¸í¹éÈ÷ muscle Á¶Á÷À» ħÀ±ÇÏÁö ¾Ê¾ÒÁö¸¸ ¶Ñ·ÇÇÏ°Ô PM layer¸¦ ´©¸£°í ÀÖÀ¸¸é (= PM »ó´ÜÀ» ¿¬°áÇÑ °¡»óÀÇ ¼± ¾Æ·¡±îÁö ħÀ±µÈ °æ¿ì) º´¸®ÇÐÀûÀ¸·Î´Â PM cancer·Î ºÐ·ùµË´Ï´Ù. Áï, ÁøÇ༺ À§¾ÏÀÔ´Ï´Ù. ±×·±µ¥ ÀϺ»ÀÇ ÀϺΠº´¸®ÇÐÀÚµéÀº À̸¦ SM massive¶ó°í ºÎ¸¥´Ù°í ÇÕ´Ï´Ù. Áï, Á¶±âÀ§¾ÏÀ¸·Î ºÐ·ùÇÑ´Ù´Â °ÍÀÔ´Ï´Ù. Èï¹Ì·Î¿î ±¹°¡°£ Â÷ÀÌÀä, ¿©ÇÏÆ° ¿ì¸®³ª¶ó¿¡¼´Â ¿ì¸®³ª¶óÀÇ ±âÁØÀ» µû¶ó¾ß ÇϰÚÁö¿ä.
À°¾È¼Ò°ßÀ¸·Î deep SM cancer¸¦ ÀǽÉÇÏ¿´´Âµ¥ ÁøÇ༺ À§¾ÏÀ¸·Î º¸°íµÇ¾ú½À´Ï´Ù.
PM Ãþ »ó´ÜÀ» ¿¬°áÇÏ´Â °¡»óÀÇ ¼± ¾Æ·¡±îÁö ¾Ï ħÀ±ÀÌ ÀÖ¾î¼ T2ÀÔ´Ï´Ù.
¸ðó·³ º´¸® °¡À̵å¶óÀÎÀÌ update µÇ¾î 2023³â ´ëÇÑÀ§¾ÏÇÐȸÁö(JGC)¿Í ´ëÇѺ´¸®ÇÐȸÁö(JPTM)¿¡ µ¿½Ã ÃâÆÇµÇ¾ú½À´Ï´Ù. ÇØ´ç º´¸® °¡À̵å¶óÀÎ Áß À§¾Ï ħÀ± ±íÀÌ ÆÇÁ¤¿¡ ´ëÇÑ ³»¿ëÀ» ¼Ò°³ÇÕ´Ï´Ù. Depth of invasion ÆÇ´Ü°ú T staging °áÁ¤Àº »ý°¢¸¸Å °£´ÜÇÏÁö ¾Ê½À´Ï´Ù. Lymphatic vessel ³»¿¡ ÀÖ´Â °ÍÀº T staging¿¡ ¹Ý¿µÇÏÁö ¾Ê´Â´Ù´Â ºÎºÐµµ À¯ÀÇÇϽñ⠹ٶø´Ï´Ù.
A standardized pathology report for gastric cancer: 2nd edition (Journal of Pathology and Translational Medicine 2023;57:1-27)
The depth of the tumor invasion follows the AJCC 8th edition and Japanese guidelines. Notably, the Japanese guideline does not accept carcinoma in situ (pTis). In the AJCC 8th edition, pTis is defined as an intraepithelial tumor without invasion of the lamina propria, which is equivalent to high-grade dysplasia. pT1b is subdivided into sm1, sm2, and sm3. If cancer cells are present below an imaginary line dividing the submucosa and proper muscle, the case is considered pT2 even if the cancer cells are not actually within the muscle fibers. If there is no proper muscle layer due to ulceration, and the cancer cells are below the imaginary line drawn at the lower border of the proper muscle, the case is considered pT3. Invasion of the omentum and perigastric fat is considered pT3. Ink should be applied at the serosal surface nearest the tumor during gross examination to properly evaluate serosal (visceral peritoneum) invasion. The case is considered pT4a if the cancer cells are adherent to or exposed beyond mesothelial cells. Because the mesocolon and gastric serosa (including the greater and lesser omentum) have different embryological origins, invasion of the mesocolon should be classified as pT4b. However, some areas are tightly fused, such as the posterior wall of the antrum, the gastric serosa, and the anterior side of the transverse mesocolon. Therefore, the Japanese guideline indicates that invasion of the transverse mesocolon is not pT4b unless it extends to the colic vessels or penetrates the posterior surface of the mesocolon. Some cases can be either pT4a or pT4b, depending on the site of the tumor. Invasion of the pancreas capsule is considered pT4b. Direct duodenal or esophageal invasion is not considered pT4b. Any involvement of other organs, such as the liver, pancreas, colon, spleen, diaphragm, or kidney, should be recorded. Cancer cells within lymphatic or vascular spaces are not considered in the determination of invasion depth. The presence of lymphatic or vascular invasion should be recorded separately in parentheses (e.g., tumor invades proper muscle [involvement of subserosa by lymphatic emboli]).
2. Á¶±âÀ§¾Ï Áß Á¡¸·¾Ï°ú Á¡¸·ÇϾÏÀÇ ±¸ºÐ
Á¶±âÀ§¾Ï ±íÀÌ(depth of invasion) Æò°¡ÀÇ Áß¿äÇÑ ¿ä¼Ò Áß Çϳª´Â fold º¯ÈÀÔ´Ï´Ù. Fold´Â À§³»¿¡ °ø±â¸¦ ¾î´À Á¤µµ »°À» ¶§ Àß °üÂûµË´Ï´Ù. °ø±â¸¦ ¾à°£¾¿ ³Ö°í »©¸é¼ º´¼Ò ÁÖº¯ Á¡¸·ÀÇ º¯È¸¦ Á¶½É½º·´°Ô °üÂûÇÏ´Â °ÍÀÌ ÁÁ½À´Ï´Ù.
Á¶±âÀ§¾Ï fold¿¡ ´ëÇÑ (°£´ÜÇÏÁö¸¸ ±×¸® Á¤È®ÇÏÁö ¾ÊÀº) ´ë¿øÄ¢Àº ´ÙÀ½°ú °°½À´Ï´Ù. Á¡¸·¾Ï¿¡¼´Â abrupt cutting, rapid tapering (= rat-tailing, Áã ²¿¸®Ã³·³ »ý°å´Ù´Â ÀǹÌ), Á¡¸·ÇϾϿ¡¼´Â fusion, clubbingÀÌ, °íÀ¯±Ù¾Ï(PM cancer)¿¡¼´Â dam-formationÀÌ °üÂûµË´Ï´Ù. Fold º¯È´Â À§¾Ï ±íÀÌ ¿¹ÃøÀÇ Áß½ÉÀÌÁö¸¸ fold¿¡ µû¸¥ ±íÀÌ Áø´ÜÀÌ ²À ¿ÇÀº °ÍÀº ¾Æ´Õ´Ï´Ù. ±íÀÌ ¿¹ÃøÀº ¿¹¼úÀÔ´Ï´Ù. EGC·Î ÃßÁ¤Çߴµ¥ AGC·Î ³ª¿À´Â °æ¿ì´Â ¾à 5-10%ÀÔ´Ï´Ù. AGC·Î ÃßÁ¤Çߴµ¥ EGC·Î ³ª¿À´Â °æ¿ìµµ ¾à 5-10%ÀÔ´Ï´Ù. (´ëÇѼÒȱ⳻½Ã°æÇÐȸÁö 2007;35:297-303)
À̹ø Áõ·Ê´Â (1) ÇÔ¸ôºÎ°¡ ºñ±³Àû ±í°í, (2) fold fusion ¼Ò°ßÀÌ ¿©·µ °üÂûµÇ°í, (3) Á¶Á÷ÇüÀÌ signet ring cell carcinomaÀ̾úÀ¸¹Ç·Î ´«À¸·Î º¸±âº¸´Ù ´Ù¼Ò ±íÀ» ¼ö ÀÖÀ» ¿©Áö°¡ ¸¹¾Ò´ø °æ¿ìÀÔ´Ï´Ù. ºñ·Ï ³»½Ã°æ¿¡¼ EGC III (r/o submucosal cancer)¶ó´Â impressionÀ» ºÙÀÏ ¼ö ¹Û¿¡ ¾øÁö¸¸... ¾à°£ ±í´Ù°í ³ª¿ÔÁö¸¸ ³î¶ö ÇÊ¿ä´Â ¾øÀ» °Í °°½À´Ï´Ù.
¼¿ï´ë ³í¹® (ÃÖÁ¤¹Î. GIE)¿¡¼ Á¡¸·¾ÏÀ¸·Î ÃßÁ¤µÈ 1,276¸í Áß 1,026¸í(82.0%)´Â Á¡¸·¾ÏÀ̾ú°í, Á¡¸·ÇϾÏÀ¸·Î ÃßÁ¤µÈ 829¸í Áß 596¸í (71.9%)´Â Á¡¸·ÇϾÏÀ̾ú½À´Ï´Ù.
¼¿ï´ë ³í¹®¿¡¼´Â Á¶±âÀ§¾Ï ħÀ±±íÀÌ ¿¹ÃøÀÇ ±âÁØÀÌ µÇ´Â ¿©·¯ ¼Ò°ßÀÇ Àǹ̰¡ ºÐ¼®µÇ¾î ÀÖ½À´Ï´Ù. ³Ê¹« º¹ÀâÇÏ¿© ±× Àǹ̸¦ Á¤È®±â ¾Ë±â´Â ¾î·Æ½À´Ï´Ù. ±×·¯³ª °£´ÜÈ÷ »ý°¢Çϸé À̰ÍÀÔ´Ï´Ù. "¾î´À ÇÑ ¼Ò°ßÀ¸·Î Á¡¸·¾Ï°ú Á¡¸·ÇϾÏÀ» ±¸ºÐÇÒ ¼ö ¾ø´Ù."
¼¿ï´ë ³í¹®¿¡¼ Á¦°¡ Èï¹Ì·Ó°Ô º» °ÍÀº ´Üº¯·® ºÐ¼®°ú ´Ùº¯·® ºÐ¼®ÀÇ Â÷ÀÌÀÔ´Ï´Ù. ¾Æ·¡ Ç¥¿¡¼ ÁÂÃøÀÌ ´Üº¯·® ºÐ¼®ÀÌ°í ¿ìÃøÀÌ ´Ùº¯·® ºÐ¼®ÀÔ´Ï´Ù. ´Üº¯·® ºÐ¼®¿¡¼ undifferentiate-type histology´Â differentiated-type histology¿¡ ºñÇÏ¿© ħÀ±±íÀÌ ¿¹Ãø Á¤È®µµ°¡ ¶³¾îÁý´Ï´Ù (OR=0.804, p=0.046). ´Ùº¯·® ºÐ¼®¿¡¼´Â p °ª 0.889 (OR=0983)·Î Â÷À̰¡ ¾ø¾ú½À´Ï´Ù. ¹«¾ù¶§¹®¿¡ ´Üº¯·®¿¡¼ÀÇ Àǹ̰¡ ´Ùº¯·®¿¡¼´Â »ç¶óÁ³´ÂÁö Àú·Î¼´Â ¾Ë µµ¸®°¡ ¾ø½À´Ï´Ù.
2023³â Surgical EndoscopyÁö¿¡ Á¶±âÀ§¾Ï ½É´Þµµ Æò°¡¸¦ À§ÇÑ conventional endoscopy¿Í EUSÀÇ Á¤È®µµ¿¡ ´ëÇÑ ÀϺ»ÀÇ ´Ù±â°ü ÀüÇâÀû ¿¬±¸ °á°ú°¡ ¹ßÇ¥µÇ¾ú½À´Ï´Ù (Surg Endosc 2023). SM2 ÀÌ»óÀÇ Á¡¸·ÇÏ¾Ï (massive submucosal invasionÀ̶ó°í ĪÇϱ⵵ ÇÕ´Ï´Ù)À» ½Ã»çÇÏ´Â ¼Ò°ßÀ¸·Î ¾Æ·¡ »çÁøÀÌ Á¦½ÃµÇ¾ú½À´Ï´Ù.
3. Á¡¸·¾Ï°ú Á¡¸·ÇÏ¾Ï ±¸ºÐÀ» À§ÇÑ tip
Clin Endosc 2015³â 6¿ùÈ£¿¡ ½Ç¸° Ãæ³²´ë ¹®Èñ¼® ±³¼öÀÇ Á¾¼³(Improving the Endoscopic Detection Rate...)¿¡¼ Èï¹Ì·Î¿î »çÁøÀ» ¿Å±é´Ï´Ù (À§¾Ï 294).
¹®±³¼ö´ÔÀº ÀÌ·¸°Ô ¾²¼Ì½À´Ï´Ù. "Remarkable elevation of the tumor is seen with a converging fold. This findings fulfill the criteria for massive submucosal invasion by tumor." ÀÏÀü¿¡ differentiated-type EGCÀÇ depth-predicting score¸¦ ¼Ò°³ÇÑ ¹Ù ÀÖ½À´Ï´Ù (Abe. Gastric Cancer 2011). ÀÌ ³í¹®ÀÇ °á·ÐÀº ¾Æ·¡¿Í °°¾Ò½À´Ï´Ù.
On logistic regression analysis, tumor size more than 30 mm, remarkable redness, uneven surface, and margin elevation were significantly associated with deeper submucosal cancers. A depth-predicting score was created by assigning 2 points for margin elevation and tumor size more than 30 mm, and 1 point for each of the other endoscopic features. When validation lesions of 3 points or more were diagnosed as deeper submucosal cancers, the sensitivity, specificity, and accuracy as evaluated by three endoscopists were 29.7-45.9, 93.1-93.7, and 82.5-84.8%, respectively.
ÀϺ» ÀúÀÚ°¡ ¸»ÇÑ margin elevation°ú ¹®Èñ¼® ±³¼ö´ÔÀÇ ¸»¾¸Àº ¾à°£ ´Ù¸£±â´Â ÇÕ´Ï´Ù. ¿©ÇÏÆ° ÇÔ¸ôÇü º´¼Ò¿¡¼ °ø±â¸¦ ¾à°£ »©°í °üÂûÇÏ¿´À» ¶§ ÀüüÀûÀ¸·Î À¶±âµÈ º´¼Ò´Â massive submucosal invasionÀ» ½Ã»çÇÏ´Â ¼Ò°ßÀÔ´Ï´Ù. ´ëÀå¾Ï¿¡¼´Â ÀÌ·¯ÇÑ Æ¯Â¡ÀÌ º¸´Ù ÇöÀúÈ÷ °üÂûµË´Ï´Ù.
Á¡¸·ÇϾÏÀ¸·Î ÃßÁ¤Çߴµ¥ ÀǿܷΠÁ¡¸·¾ÏÀÌ ³ª¿Ô½À´Ï´Ù. ½É´Þµµ´Â ¾î·Æ½À´Ï´Ù.
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Stomach, Subtotal gastrectomy: Early gastric carcinoma
1. Location : middle third, Center at mid body and posterior wall
2. Gross type : EGC type IIc
3. Histologic type : tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : mixed
5. Size : 3.8x2.4 cm
6. Depth of invasion : invades mucosa (lamina propria) (pT1a)
7. Resection margin: free from carcinoma, safety margin: proximal 1.5 cm, distal 11.7 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 : not identified
12. AJCC stage by 8th edition: pT1a N0
Á¶Á÷°Ë»ç¿¡¼ poorly differentiated·Î ³ª¿À´Â °æ¿ì´Â À°¾È¼Ò°ßº¸´Ù ´Ù¼Ò ±íÀº °æ¿ì°¡ ¸¹½À´Ï´Ù. ¿ì¸®°¡ ħÀ± ±íÀ̸¦ ³íÇÏ´Â °ÍÀº ºÐÈ Á¶Á÷Çü À§¾Ï¿¡ ÇØ´çÇÑ´Ù°í ÀÌÇØÇÏ´Â °ÍÀÌ ÁÁ°Ú½À´Ï´Ù.
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Stomach, radical subtotal gastrectomy: Advanced gastric carcinoma
1. Location : middle third, Center at body and anterior wall
2. Gross type : Borrmann type 2
3. Histologic type : tubular adenocarcinoma, poorly (solid) differentiated
4. Histologic type by Lauren : diffuse
5. Size : 2.5x2.2 cm
6. Depth of invasion : invades muscularis propria (pT2)
7. Resection margin: free from carcinoma, safety margin: proximal 3.4 cm, distal 7.0 cm
8. Lymph node metastasis : no metastasis in 32 regional lymph nodes (pN0) (0/32: "1", 0/1; "3", 0/11; "4", 0/4; "5", 0/0; "6", 0/5; "7", 0/5; "9", 0/0; "8a", 0/1; "11p", 0/3; "12a", 0/2; "4sb", 0/0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. AJCC stage by 8th edition: pT2 N0
ñÉ: EGC-like AGC·Î ºÎ¸£´Â °ÍÀÌ Å¸´çÇÑ Áõ·ÊÀÔ´Ï´Ù.
ÀÌ °æ¿ì´Â Á¶Á÷°Ë»ç¿¡¼ moderatele differentiated·Î ³ª¿Ô´Âµ¥ º´¼ÒÀÇ °æ°è°¡ ¸Å¿ì ¸ðÈ£ÇÏ¿´Áö¸¸ ¿©ÇÏÆ° »ó´çÈ÷ ³ÐÀº °ÍÀ¸·Î ÃßÁ¤ÇÏ¿´½À´Ï´Ù. ¼ö¼ú ÈÄ º´¸®°ú¿¡¼µµ Å©±â¸¦ ´Ù¼Ò ¾Ö¸ÅÇÏ°Ô ½á Áּ̽À´Ï´Ù.^^ ½É´Þµµ´Â SM3¿´°í ¸²ÇÁÀý ÀüÀÌ´Â ¾ø¾ú½À´Ï´Ù.
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Stomach, radical subtotal gastrectomy: Early gastric carcinoma
1. Location : lower third, Center at antrum and circle
2. Gross type : EGC type IIc
3. Histologic type : tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : intestinal
5. Size : encircling x 6.0 cm
6. Depth of invasion : invades submucosa (sm3) (pT1b)
7. Resection margin: free from carcinoma, safety margin: proximal 5.0 cm, distal 1.0 cm
8. Lymph node metastasis : no metastasis in 29 regional lymph nodes (pN0) (0/29 : "3,5", 0/9; "4,6", 0/8; "1", 0/1; "5", 0/1; "6", 0/4; "7", 0/2; "9", 0/1; "8a", 0/0; "11p", 0/2; "12a", 0/1; "4sb", 0/0)
9. Lymphatic invasion : present
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. Peritoneal cytology : negative
13. AJCC stage by 8th edition: pT1b N0
ñÉ: ù ³»½Ã°æ °Ë»ç´Â ±¸Çü Pentax ³»½Ã°æÀ̾ú°í ÀÇ·Ú ÈÄ Àç°ËÀº Olympus 260H ¿´½À´Ï´Ù. Àΰ£ À§ÀÇ Á¤»ó »ö±òÀº ¹«¾ùÀϱî¿ä? ù ³»½Ã°æÀÇ »öÁ¶¿Í µÎ¹øÂ° ³»½Ã°æÀÇ »öÁ¶ Áß°£ ¾îµð°¡ °¡Àå ÀÚ¿¬½º·¯¿î ³»½Ã°æ »çÁø ¾Æ´Ò±î »ý°¢µÇ¾ú½À´Ï´Ù. Pentax´Â toneÀÌ ³·Àº °æÇâÀÌ ÀÖ¾î °Ë»ç°¡ Â÷ºÐÇÏ°Ô ÁøÇàµÇÁö¸¸ ¼±¸íÇÏÁö ¾Ê´Ù°í ÀÌ´À³¢½Ã´Â ºÐµéÀÌ ¸¹½À´Ï´Ù. Olympus´Â toneÀÌ ³ô¾Æ °Ë»çÀÚ¸¦ ÈïºÐ½ÃŰÁö¸¸ ¼±¸íÇÏ°Ô º¸ÀÎ´Ù°í ´À³¢½Ã´Â ºÐµéÀÌ ¸¹½À´Ï´Ù. »ç½Ç »öÁ¶´Â ¼±¸íµµ¿Í´Â ¾Æ¹« »ó°üÀÌ ¾øÁö¸¸ ´À³¦ÀÌ ±×·¸´Ù´Â °ÍÀÔ´Ï´Ù. °°Àº ¸ðµ¨ÀÌ¶óµµ »öÁ¶°¡ Á¶±Ý¾¿ ´Ù¸£°í, ¿À·¡ »ç¿ëÇÏ¸é »öÁ¶°¡ ´Ù¼Ò ³·¾ÆÁöÁö¸¸... ÀüüÀûÀÎ Áø´ÜÀ²¿¡´Â º°´Ù´Â ¿µÇâÀ» ÁÖÁö ¾Ê´Â °Í °°½À´Ï´Ù. ÃëÇâ°ú ½À°ü Á¤µµÀÏ °Í °°½À´Ï´Ù.
4. EGC IIa+IIc´Â »ý°¢º¸´Ù ±í½À´Ï´Ù.
IIa+IIc Çü Á¶±âÀ§¾ÏÀº ±íÀ̰¡ Á¡¸·ÇÏÃþÀÎ °æ¿ì°¡ ¸¹½À´Ï´Ù. ±×·¯³ª ¸ðµÎ ´Ù ±×·± °Íµµ ¾Æ´Ï±â ¶§¹®¿¡ óÀ½ºÎÅÍ ¼ö¼úÀ» ±ÇÇϱ⵵ ¾î·Æ½À´Ï´Ù. EUS¸¦ ÇØµµ º° µµ¿òÀÌ ¾È µÇ°í......
ESD ÈÄ ¼ö¼ú
Early gastric carcinoma
1. Location : proximal antrum, postero-greater curvature
2. Gross type : EGC type IIc
3. Histologic type : tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : intestinal
5. Size of carcinoma : (1) longest diameter, 16 mm (2) vertical diameter, 14 mm
6. Depth of invasion : invades submucosa, (depth of sm invasion : 650 §) (pT1b)
7. Resection margin : free from carcinoma(N), safety margin : distal 11 mm, proximal 12 mm, anterior 10 mm, posterior 12 mm, deep 200§ (sm only)
8. Lymphatic invasion : present (++)
9. Venous invasion : not identified(N)
10. Perineural invasion : not identified(N)
11. Microscopic ulcer : absent
12. Histologic heterogeneity: absent
ESD ÈÄ ¼ö¼ú
Stomach, endoscopic submucosal dissection:
Early gastric carcinoma
1. Location : angle, lesser curvature
2. Gross type : EGC type IIa+IIc
3. Histologic type : tubular adenocarcinoma, well differentiated
4. Histologic type by Lauren : intestinal
5. Size of carcinoma : (1) longest diameter, 16 mm (2) vertical diameter, 10 mm
6. Depth of invasion : invades submucosa, (depth of sm invasion : 1700 §) (pT1b)
7. Resection margin : involved deep resection margin by carcinoma, safety margin : distal 13 mm, proximal 13 mm, anterior 8 mm, posterior 18 mm, deep 0 mm (sm only)
8. Lymphatic invasion : present (++)
9. Venous invasion : not identified(N)
10. Perineural invasion : not identified(N)
11. Microscopic ulcer : absent
12. Histologic heterogeneity: absent
óÀ½ºÎÅÍ ¼ö¼ú
Stomach, radical subtotal gastrectomy: Early gastric carcinoma
1. Location : middle third, Center at body and lesser curvature
2. Gross type : EGC type IIc
3. Histologic type : tubular adenocarcinoma, poorly (solid) differentiated
4. Histologic type by Lauren : diffuse
5. Size : 1.5x1.3 cm
6. Depth of invasion : invades submucosa (sm3) (pT1b)
7. Resection margin: free from carcinoma, safety margin: proximal 2.8 cm, distal 8.3 cm
8. Lymph node metastasis : no metastasis in 20 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
ÀüÁ¤ºÎ ¼Ò¸¸ mid-antrum transverse fold¿¡ À§¾ÏÀÌ ³õ¿©ÀÖÀ¸¸é ½É´Þµµ ¿¹ÃøÀÌ Á¦¹ý ¾î·Æ½À´Ï´Ù. IIc¶ó°í ÇØ¾ß ÇÒÁö IIa+IIc¶ó°í ºÒ·¯¾ß ÇÒÁöµµ ¾Ö¸ÅÇÕ´Ï´Ù. Àú´Â ÁÖº¯ À¶±âºÎ°¡ Á¶±Ý ÇöÀúÇÏ´Ù°í º¸°í IIa+IIc¿¡ ÁØÇÏ¿© ÆÇ´ÜÇÏ¿´½À´Ï´Ù. º´¸®°ú¿¡¼´Â IIc·Î º¸¾Ò½À´Ï´Ù. ³»½Ã°æ Ä¡·á Çϱâ´Â ½¬¿î À§Ä¡À̹ǷΠÁ¶±Ý Àû±ØÀûÀ¸·Î ½ÃµµÇØ º¸±âµµ Çϴµ¥, ÀÌ È¯ÀÚ¿¡¼´Â ÇÔ¸ôºÎÀ§°¡ ¶Ñ·ÇÇϰí tumor island±îÁö ÀÖ´Â °ÍÀÌ ¿µ ¸¶À½¿¡ °É·Á ¹Ù·Î ¼ö¼úÀ» º¸³Â½À´Ï´Ù. SM3·Î ³ª¿Ô½À´Ï´Ù. ÈÞ~~~
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À§Ã¼»óºÎ Èĺ®ÀÇ ÀÛÀº depressed lesionÀÌ ¹ß°ßµÇ¾ú°í ³»½Ã°æÀÇ´Â ´ç¿¬È÷ EGC·Î »ý°¢ÇÏ¿´Áö¸¸ º´¸®°á°ú°¡ ÀǿܷΠ¾Æ·¡¿Í °°ÀÌ ³ª¿Ô½À´Ï´Ù.Advanced gastric carcinoma
- Gross type : Borrmann type (unclassifiable) (mimicking EGC type IIc)
- Histologic type : tubular adenocarcinoma, poorly differentiated
- Size : 3.2x2.1x0.2 cm
- Depth of invasion : extension to proper muscle (pT2a)´Ù½Ã ºÁµµ ¿ª½Ã EGC¶ó°í ºÎ¸¦ ¼ö ¹Û¿¡ ¾ø´Â º´¼Ò¿´½À´Ï´Ù. ¾Æ¹«¸® ÁÖÀÇÇØµµ EGC¿Í AGC¸¦ ³ª´©´Â Á¤È®µµ´Â 80-90%ÀüÈÄÀÔ´Ï´Ù. ¹°·Ð ¾ÆÁÖ definiteÇÑ EGC°¡ ÀÖ°í ¹Ý¹ÚÇÒ ¼ö ¾ø´Â AGCµµ ÀÖ½À´Ï´Ù. ±×·¯³ª ¸¹Àº °æ¿ì ¿ì¸®ÀÇ ¿¹»óÀÌ Æ²¸³´Ï´Ù. ±×´ÙÁö ³î¶ö ÀÏÀº ¾Æ´Õ´Ï´Ù.
ÀÌ È¯ÀÚ¿¡¼ Èï¹Ì·Î¿î °ÍÀº º´¸®°ú¿¡¼ Barrett esophagus°¡ ÀÖ´Ù°í ¿¬¶ôÀ» ÇØ ÁØ Á¡ÀÔ´Ï´Ù. »çÁøÀ» reviewÇØº¸´Ï ultrashort segment Barrett esophagus°¡ ÀÖ´Ù°í ¸»ÇÒ ¼ö ÀÖ´Â ±×·± ¸ð¾çÀ̾ú½À´Ï´Ù. ±×·±µ¥ °õ°õÈ÷ »ý°¢Çغ¾½Ã´Ù. ÀÌ Á¤µµÀÇ ¹Ì¼¼ÇÑ º¯È´Â ³Ê¹«³ª ¸¹Áö ¾Ê½À´Ï±î? ¿À´Ã ³»½Ã°æÇÑ È¯ÀÚ Áß¿¡µµ ÀÌ·± ºñ½ÁÇÑ ¸ð¾çÀ» º¸ÀÎ »ç¶÷ÀÌ ¿©·¯ºÐ ÀÖ¾ú´ø °Í °°Áö ¾Ê½À´Ï±î? ÀÌ È¯ÀÚÀÇ °æ¿ì¿¡´Â À§¾ÏÀ¸·Î ÀÎÇÏ¿© ¼ö¼úÀ» ÇÏ¿´±â ¶§¹®¿¡ ÇϺνĵµÀÇ Á¶Á÷ÀÇ ¾çÀÌ ¸¹¾Æ¼ BarrettÀ̶ó°í º´¸®ÇÐÀû Áø´ÜÀ» ÇÒ ¼ö ÀÖ¾ú´ø ¿¹ÀÔ´Ï´Ù. ±×·¯³ª forcep biopsy·Î´Â ¾î¸² ¾øÁö¿ä. ´ëºÎºÐ Áø´ÜµÇÁö ¾Ê½À´Ï´Ù. Ȥ½Ã ÀÌ·± ªÀº ¹Ù·¿½Äµµ(Àú´Â ultra ultra ultra-short Barrett esophagus¶ó°í ºÎ¸¨´Ï´Ù)°¡ ÀÖ´Â °æ¿ì ÀÓ»óÀû ÀÇÀÇ´Â ¾ó¸¶³ª µÉ±î¿ä? ¿ª½Ã 1 cmÀÌÇÏÀÇ ¸Å¿ì ªÀº ESEM (endoscopically suspected esophageal metaplasia)´Â ¿ì¼± ¹«½ÃÇÏ´Â °ÍÀÌ Çö½ÇÀûÀÏ °Í °°½À´Ï´Ù. 1 cmÀÌÇÏÀÇ ESEM¿¡ °ü½ÉÀ» °¡Áö´À´Ï Â÷¶ó¸® Á¶±âÀ§¾ÏÀ» ã±â À§ÇÏ¿© À§¸¦ Á» ´õ ¸é¹ÐÈ÷ °üÂûÇÒ °ÍÀ» ±ÇÇÏ°í ½Í½À´Ï´Ù.
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Stomach, subtotal gastrectomy:
Advanced gastric carcinoma
1. Location : lower third, Center at body and greater curvature
2. Gross type : Borrmann type 3
3. Histologic type : tubular adenocarcinoma, poorly (poorly cohesive) differentiated
4. Histologic type by Lauren : diffuse
5. Size : 3.7x1.4 cm
6. Depth of invasion : invades muscularis propria (pT2)
7. Resection margin: free from carcinoma, safety margin: proximal 2.3 cm, distal 9.4 cm
8. Lymph node metastasis : metastasis to 1 out of 37 regional lymph nodes (pN1), (perinodal extension: present) (1/37: "3", 1/11; "4", 0/11; "5", 0/0; "6", 0/0; "7", 0/4; "9", 0/0; "8a", 0/3; "11p", 0/2; "12a", 0/5; "4sb", 0/0; "1", 0/1)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : present
12. AJCC stage by 7th edition: pT2 N1À̹ø Áõ·Ê´Â (1) ÇÔ¸ôºÎ°¡ ºñ±³Àû ±í°í, (2) fold fusion ¼Ò°ßÀÌ ¿©·µ °üÂûµÇ°í, (3) Á¶Á÷ÇüÀÌ signet ring cell carcinomaÀ̾úÀ¸¹Ç·Î ´«À¸·Î º¸±âº¸´Ù ´Ù¼Ò ±íÀ» ¼ö ÀÖÀ» ¿©Áö°¡ ¸¹¾Ò´ø °æ¿ìÀÔ´Ï´Ù. ºñ·Ï ³»½Ã°æ¿¡¼ EGC III (r/o submucosal cancer)¶ó´Â impressionÀ» ºÙÀÏ ¼ö ¹Û¿¡ ¾øÁö¸¸... ¾à°£ ±í´Ù°í ³ª¿ÔÁö¸¸ ³î¶ö ÇÊ¿ä´Â ¾øÀ» °Í °°½À´Ï´Ù.
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Stomach, subtotal gastrectomy:
Advanced gastric carcinoma
1. Location : middle third, Center at body and greater curvature
2. Gross type : Borrmann type 3
3. Histologic type : tubular adenocarcinoma, poorly (poorly cohesive) differentiated
4. Histologic type by Lauren : diffuse
5. Size : 2.5x2.5 cm
6. Depth of invasion : penetrates subserosal connective tissue (pT3)
7. Resection margin: free from carcinoma, safety margin: proximal 3 cm, distal 11 cm
8. Lymph node metastasis : no metastasis in 70 regional lymph nodes (pN0), (0/70 : "3", 0/31; "4", 0/17; "5", 0/3; "6", 0/5; "7", 0/3; "9", 0/5; "8a", 0/4; "11p", 0/2; "12a", 0/0; "4sb", 0/0; "1", 0/0)
9. Lymphatic invasion : present (+++)
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. Peritoneal cytology : negative
13. AJCC stage by 7th edition: pT3 N0
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Stomach, subtotal gastrectomy:
Advanced gastric carcinoma
1. Location : middle third, Center at body and greater curvature
2. Gross type : Borrmann type 2
3. Histologic type : tubular adenocarcinoma, poorly (poorly cohesive) differentiated
4. Histologic type by Lauren : diffuse
5. Size : 2.6x2.2 cm
6. Depth of invasion : invades muscularis propria (pT2)
7. Resection margin: free from carcinoma, safety margin: proximal 3.8 cm, distal 13.5 cm
8. Lymph node metastasis : no metastasis in 47 regional lymph nodes (pN0) (0/47: "3", 0/14; "4", 0/6; "5", 0/1; "6", 0/9; "7", 0/2; "9", 0/0; "8a", 0/2; "11p", 0/1; "12a", 0/2; "4sb", 0/10; "1", 0/0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : present
12. Peritoneal cytology : negative
13. AJCC stage by 7th edition: pT2 N0
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1. Location : middle third, center at body and posterior wall
2. Gross type : mimicking EGC type IIc
3. Histologic type : tubular adenocarcinoma, poorly differentiated
4. Histologic type by Lauren : diffuse
5. Size : 5x4x0.5 cm
6. Depth of invasion : extension to subserosa
7. Resection margin: free from carcinoma: safety margin
8. Lymph node metastasis : metastasis to 2 out of 35 regional lymph nodes (pN1)
9. Lymphatic invasion : present
10. Venous invasion : not identified
11. Perineural invasion : not identified
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1. Location : middle third, center at body and lesser curvature
2. Gross type : Borrmann type (mimicking EGC type IIc+III)
3. Histologic type : signet-ring cell carcinoma
4. Histologic type by Lauren : diffuse
5. Size : 9.5x5.3x0.4 cm
6. Depth of invasion : extension to proper muscle (pT2a)
7. Resection margin: free from carcinoma: safety margin
8. Lymph node metastasis : metastasis to 9 out of 62 regional lymph nodes
9. Lymphatic invasion : present
10.Venous invasion : not identified
11.Perineural invasion : not identified
12.Associated findings : ulceration(ul IV)
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Advanced gastric carcinoma
1. Location : lower third, Center at angle and lesser curvature
2. Gross type : Borrmann type 3
3. Histologic type : tubular adenocarcinoma, poorly (poorly cohesive) differentiated
4. Histologic type by Lauren : diffuse
5. Size : 2.4x2.2 cm
6. Depth of invasion : penetrates subserosal connective tissue (pT3)
7. Resection margin: free from carcinoma
8. Lymph node metastasis : no metastasis in 31 regional lymph nodes (pN0)
9. Lymphatic invasion : present
10. Venous invasion : not identified
11. Perineural invasion : not identified
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Stomach, subtotal gastrectomy: Advanced gastric carcinoma
1. Location : middle third, Center at body and greater curvature
2. Gross type : Borrmann type 2
3. Histologic type : signet-ring cell carcinoma
4. Histologic type by Lauren : diffuse
5. Size : 3.6x2.7 cm
6. Depth of invasion : invades muscularis propria (pT2)
7. Resection margin: free from carcinoma
8. Lymph node metastasis : no metastasis in 44 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 7th edition: pT2 N0
EGC ¾Æ´Ñ°¡ »ý°¢Çߴµ¥ AGC¿´°í multiple lymph node ÀüÀÌ¿Í bilateral ovary metastasis±îÁö ÀÖ¾ú½À´Ï´Ù.
(2012³â, 50¼¼ ¿©¼º)
Stomach, radical subtotal gastrectomy: Advanced gastric carcinoma
1. Location : middle third, Center at angle and posterior wall
2. Gross type : Borrmann type 3
3. Histologic type : tubular adenocarcinoma, poorly (solid) differentiated >> mucinous adenocarcinoma (mucinous carcinoma portion: 20%)
4. Histologic type by Lauren : mixed
5. Size : 3.3x3.0 cm
6. Depth of invasion : penetrates subserosal connective tissue (pT3)
7. Resection margin: free from carcinoma, safety margin: proximal 3.3 cm, distal 3.8 cm
8. Lymph node metastasis : metastasis to 6 out of 32 regional lymph nodes (pN2) (perinodal extension: present) (6/32: "1", 0/2; "3", 2/2; "4", 2/9; "5", 0/0; "6", 2/5; "7", 0/4; "9", 0/6; "8a", 0/3; "11p", 0/1; "12a", 0/0; "4sb", 0/0)
9. Lymphatic invasion : present
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. AJCC stage by 8th edition: pT3 N2Ovary and salpinx, bilateral salpingo-oophorectomy : METASTATIC CARCINOMA, clinically from stomach
Location: Bilateral ovaries
Greatest dimension: 5.5 cm (left)
Lymphovascular invasion: PRESENT (focal)
Salpingeal extension: Absent (lymphovascular invasion only; left salpinx)
Á¶Á÷°Ë»ç M/D. ESD ¾ÆÁÖ Àá±ñ °í·ÁÇÏ¿´´Ù°¡ 2cm°¡ ³Ñ°í °æ°è°¡ ºÒºÐ¸íÇÏ¿© ¼ö¼úÀ» º¸³Â´Âµ¥...
Stomach, radical total gastrectomy: Advanced gastric carcinoma
1. Location : upper third, Center at high body and lesser curvature
2. Gross type : Borrmann type unclassifiable (mimicking EGC type IIc)
3. Histologic type : tubular adenocarcinoma, poorly (poorly cohesive) differentiated
4. Histologic type by Lauren : diffuse
5. Size : 5.1x3.1 cm
6. Depth of invasion : invades serosa (pT4a)
7. Resection margin: free from carcinoma, safety margin: proximal 0.3 cm, distal 16.2 cm
8. Lymph node metastasis : no metastasis in 42 regional lymph nodes (pN0) (0/42: "1", 0/2; "2", 0/3; "5", 0/0; "6", 0/3; "7", 0/5; "9", 0/2; "8a", 0/2; "11p", 0/1; "12a", 0/1; "4sb", 0/0; "8p", 0/1; "lymph node", 0/1; 3,5, 0/9; 4,6, 0/12)
9. Lymphatic invasion : present
10. Venous invasion : not identified
11. Perineural invasion : present
12. AJCC stage by 8th edition: pT4a N0
W/D³ª M/D¿Í °°Àº ºÐÈÁ¶Á÷Çü À§¾Ï¿¡¼´Â ³»½Ã°æ À°¾È¼Ò°ß°ú depth of invasionÀÇ correlationÀÌ ºñ±³Àû ÁÁ½À´Ï´Ù. ±×·¯³ª, P/D³ª SRC°ú °°Àº ¹ÌºÐÈÁ¶Á÷Çü À§¾Ï¿¡¼´Â º¸±âº¸´Ù ±íÀº °æ¿ì°¡ ¸¹½À´Ï´Ù.
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Stomach, radical total gastrectomy: Advanced gastric carcinoma
1. Location : upper third, Center at body and posterior wall
2. Gross type : Borrmann type 3
3. Histologic type : tubular adenocarcinoma, poorly (poorly cohesive) differentiated
4. Histologic type by Lauren : diffuse
5. Size : 3.7x2.8 cm
6. Depth of invasion : penetrates subserosal connective tissue (pT3)
7. Resection margin: free from carcinoma, safety margin: p 2.7 cm, d 11.7 cm
8. Lymph node metastasis : metastasis to 3 out of 38 regional lymph nodes (pN2) (perinodal extension: present) (3/38: "2", 0/0; "3", 3/10; "4", 0/9; "5", 0/0; "6", 0/4; "7", 0/2; "9", 0/2; "8a", 0/5; "11p", 0/0; "12a", 0/2; "4sb", 0/0; "1", 0/4)
9. Lymphatic invasion : present(+++)
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. Peritoneal cytology : negative
13. AJCC stage by 7th edition: pT3 N2
[µ¿¿µ»ó] Depth of invasion of a small depressed lesion with focal wall thickening. Á¶±âÀ§¾ÏÀΰ¡ ÁøÇ༺ À§¾ÏÀΰ¡?
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2025-1-15. ECR
More cases
6. º¸¸¸ 1Çü ÁøÇ༺ À§¾Ï°ú EGC type IÀÇ ±¸ºÐ
º¸¸¸ 1Çü ÁøÇ༺ À§¾Ï°ú EGC type IÀÇ ±¸ºÐÀº ½±Áö ¾Ê½À´Ï´Ù. °¡Å縯ÀÇ´ë ±èÅÂÈ£ ¼±»ý´ÔÀÇ ³»½Ã°æÇÐȸ ±³À°ÀÚ·á¿¡¼´Â ¾Æ·¡¿Í °°Àº ¾ð±ÞÀÌ ÀÖ½À´Ï´Ù.
Borrmann type I ÇüÀÇ ÁøÇ༺À§¾Ï°ú EGCa I ÇüÀÇ Á¶±âÀ§¾ÏÀ» ³»½Ã°æ ¼Ò°ß¸¸À¸·Î ¸íÈ®È÷ °¨º°ÇÒ ¼ö´Â ¾øÀ¸³ª, µÐ´öÀ̳ª bridging fold ¿Í °°ÀÌ ÁÖº¯ Á¡¸·ÀÇ º¯È, °âÀÚ·Î ¾Ð¹ÚÇßÀ» ¶§ ¹Ð¸®Áö ¾Ê´Â ¼Ò°ßÀº Á¡¸·ÇÏÃþ ÀÌ»óÀÇ Ä§À±ÀÌ ÀÖÀ½À» ½Ã»çÇÏ´Â ¼Ò°ßÀÌ´Ù.
º¸¸¸ 1Çü ÁøÇ༺À§¾ÏÀÌ Ä¿Áö¸é¼ Áß¾Ó¿¡ ÇÔ¸ôºÎ°¡ ¹ß»ýÇÏ¿© º¸¸¸ 2ÇüÀÌ µÇ´Â °æ¿ìµµ ÀÖÀ» °ÍÀÔ´Ï´Ù. °æ¿ì¿¡ µû¶ó¼´Â ³»½Ã°æÀÇ»ç´Â º¸¸¸ 1ÇüÀ¸·Î, º´¸®ÀÇ»ç´Â º¸¸¸ 2ÇüÀ¸·Î ¼·Î ´Ù¸£°Ô ºÐ·ùÇϱ⵵ ÇÕ´Ï´Ù.
Áõ·Ê »çÁø(EndoTODAY À§¾Ï 481)À» º¸¸é ¾Æ½Ã°ÚÁö¸¸.... ¾ö¹ÐÇÑ ÀǹÌÀÇ º¸¸¸ 1Çü ÁøÇ༺ À§¾ÏÀº ÈçÇÏÁö ¾Ê½À´Ï´Ù. ³»½Ã°æ¿¡¼ º¸¸¸ 1Çü ÁøÇ༺ À§¾ÏÀ¸·Î ÃßÁ¤ÇÏ¿´¾îµµ ¸·»ó SM cancer·Î ³ª¿À´Â °æ¿ìµµ ÀûÁö ¾Ê¾Ò½À´Ï´Ù. ±×·¯¸é... 'ȯÀÚ¿¡°Ô´Â ´ÙÇེ·¯¿î ÀÏÀ̱º' Á¤µµ »ý°¢ÇÏ°í ³Ñ¾î°¥ ¼ö ¹Û¿¡ ¾øÀ» °Í °°½À´Ï´Ù. ¿äÄÁµ¥ ´©±¸³ª Ʋ¸± ¼ö ¹Û¿¡ ¾øÀ» °Í °°À¸´Ï ³Ê¹« ½Å°æ¾²Áö ¾ÊÀ¸¼Åµµ ÁÁÀ» °Í °°½À´Ï´Ù.
F/55. ´Ù¹ß¼º À§¾Ï. À§Ã¼ÇϺΠÈĺ®¿¡ ÇÔ¸ôÇü º´¼Ò°¡ ÀÖ°í ±ÙÀ§ÀüÁ¤ºÎ Èĺ®¿¡ À¶±âÇü º´¼Ò°¡ ÀÖ´Ù.
¼ö¼úÀ» ÇÏ¿´À¸¸ç ÇÔ¸ôÇü º´¼Ò´Â ÁøÇ༺ À§¾ÏÀ¸·Î, À¶±âÇü º´¼Ò´Â ¿ëÁ¾Çü Á¶±âÀ§¾Ï (Á¡¸·¾Ï)À̾ú´Ù.
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STG: Early gastric carcinoma
1. Location : lower third, Center at antrum and lesser curvature
2. Gross type : EGC type IIa+IIc
3. Histologic type : tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : intestinal
5. Size : 2.8x1.5 cm
6. Depth of invasion : invades mucosa (muscularis mucosae) (pT1a)
7. Resection margin: free from carcinoma. safety margin: proximal 12 cm, distal 1.7 cm
8. Lymph node metastasis : no metastasis in 16 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: pT1a N0
FundusÀÇ ¾ÏÀº »ý°¢º¸´Ù ħÀ±ÀÌ ±íÀ» ¼ö ÀÖ½À´Ï´Ù. ÀÌ Áõ·ÊÀÇ depth of invasionÀ» ¾î¶»°Ô ÃßÃøÇϽʴϱî?
¾Æ·¡´Â ¼ö¼ú °á°úÀÔ´Ï´Ù. ±í¾ú°í ¸²ÇÁÀý ÀüÀ̵µ ½ÉÇß½À´Ï´Ù.
[2015-1-29. ¾Öµ¶ÀÚ Áú¹®]
¾È³çÇϼ¼¿ä, ±³¼ö´Ô. ÃÖ±Ù À§¾Ï Áõ·Ê¿¡¼ EGC-mimicking AGC, AGC-mimicking EGC µî¿¡ ´ëÇÑ endotoday¸¦ ¹Þ¾Æº¸¸é¼ ÃÖ±Ù ³»½Ã°æÀû EGC/AGC ±¸ºÐÇÏ´Â ¹æ¹ýÀÌ ¹»±î ¶ÇÇÑ, Àß ±¸ºÐÇÏ·Á¸é ¾î¶»°Ô ÇØ¾ß Çϳª »ý°¢ÀÌ µé¾ú½À´Ï´Ù. ¿Ü·¡¿¡¼ ¿ÜºÎ º´¿ø ³»½Ã°æ »çÁøÀ» º¸°í AGC·Î ¼³¸íÇߴµ¥, º»¿ø¿¡¼ ´Ù½Ã ³»½Ã°æÀ» Çß´õ´Ï ´©°¡ ºÁµµ EGC ¿´´ø case¸¦ °æÇèÇÏ¿´½À´Ï´Ù.
¼Òȱ⳻½Ã°æ¾ÆÆ²¶ó½º¿¡ ÀûÇô ÀÖ´Â 2910¸íÀÇ ºÐ¼®°ú 91.3%ÀÇ ±¸ºÐ¿¡ ´ëÇØ¼ ³í¹®À» ã¾Æº¸´Ï ¹Ý°©°Ôµµ »ï¼ºº´¿ø¿Ü°ú¿¡¼ ½èÁö¸¸, ¼±»ý´Ô²²¼ ÇÔ²² Âü¿©Çß´ø ³í¹®ÀÌ ÀÖ¾ú½À´Ï´Ù. (J Sur Onc, 2010;101:384-388) 2001~2003³â±îÁöÀÇ 2910¸íÀÇ ´ë±Ô¸ð ºÐ¼®À¸·Î ÁÁÀº ±âÁØ(À§Ä¡, Å©±â, ºÐȵµ, Lauren's type, ly+, v+, perineural invasion)À» ¾Ë·ÁÁÖ¼ÌÁö¸¸ ÀÚ¼¼È÷ Àо´Ï, method¿¡¼ EGC Áø´Ü°ú AGC Áø´Ü¿¡ Â÷À̸¦ µÎ¾ú½À´Ï´Ù.
EGC : ¹Ù·ý ¶Ç´Â ³»½Ã°æ»ó EGC
AGC : ¹Ù·ý°ú ³»½Ã°æ¿¡¼ ¸ðµÎ AGCÀÌ·¸°Ô Â÷À̸¦ µÖ¼, ½ÇÀº ³»½Ã°æ Àü¹®ÀǸ¦ ÁöÇâÇÏ´Â ÀÔÀå¿¡¼ barium studyÀÇ ¿µÇâ·ÂÀ» ±¸ºÐÇÏ°í ½Í¾îÁ³½À´Ï´Ù. ÇÏÁö¸¸ ³í¹®»ó¿¡ ³»½Ã°æ¸¸À¸·Î ±¸ºÐÇÏ´Â ÀÔÀåÀ» º¸ÀÌ´Â ¿¬±¸´Â °ÅÀÇ ¾ø°í, ¿äÁòÀº NBI, EUS µîÀÇ Ãֽбâ¹ý¿¡ ´ëÇÑ ³í¹®¸¸ °Ë»öµÇ¾ú½À´Ï´Ù. ´Ù½Ã µ¹ÀÌÄѼ, Ȥ½Ã 2910¸í Áß, ³»½Ã°æ¸¸ ½ÃÇàÇÑ group¿¡¼ÀÇ Â÷ÀÌ´Â ¾î¶»°Ô ³ª¿Ô´ÂÁö ±Ã±ÝÇØ¼ ±³¼ö´Ô²² ÀÌ·¸°Ô ¸ÞÀÏÀ» º¸³À´Ï´Ù. ¾Æ´Ï¸é ÀÌ·± °ü·ÃµÈ ³í¹®À» ¼ÒÀåÇÏ½Ã°í °è½Å´Ù¸é ¾Ë·ÁÁÖ½Ã¸é °¨»çÇϰڽÀ´Ï´Ù.
1) Á¶±â À§¾Ï¿¡¼ ÁøÇ༺ À§¾ÏÀ¸·ÎÀÇ ÀÌÇ༺ º´º¯À¸·Î¼ÀÇ °íÀ¯±ÙÃþ À§¾Ï ±èÀç±Ô, ÀÌÁØÇà µî. ´ëÇѼÒȱâÇÐȸÁö 1999 (PDF)
2) [2013-4-17 ´ëÇѼÒȱ⳻½Ã°æÇÐȸ ±³À°ÀÚ·á] À§¾ÏÀÇ ³»½Ã°æ Áø´Ü ºÐ·ù ü°è
3) Survey on endoscopic classification of EGC (EndoTODAY 2013-5-23)
4) À§¾Ïº´¸® °¡À̵å¶óÀÎ (2023) - ¿ì¸®¸» version
5) AJCC 8th ÇØ¼³ (±è¼ºÀº)
6) AJCC 8th PPT ÀÎÅÍ³Ý ÀÚ·á
© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng.