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EndoTODAY ³»½Ã°æ ±³½Ç


[½ÊÀÌÁöÀå Á¡¸·ÇÏÁ¾¾ç. Duodenal submucosal tumor (SMT)]

- ÁغñÁß -


2. Duodenal GIST


Duodenum, common bile duct, gallbladder and head of pancreas, pylorus preserving pancreatoduodectomy: Gastrointestinal stromal tumor of high risk of aggresive behavior, duodenum:
1) tumor size : 6.5x5 cm
2) mitosis: 18 / 50HPF
3) histologic type : mixed
4) necrosis : present
5) cellularity : high
6) invasion into mucosa : absent
7) resection margin involvement : absent

Melena·Î ½ÃÇàÇÑ »óºÎ³»½Ã°æ¿¡¼­ ¹ß°ßµÈ duodenal GIST
Gastrointestinal stromal tumor of low risk of malignant potential by proposed modification for adjuvant therapy (2008) (see note);
1) tumor size: 4.5x3x3 cm
2) mitosis: 1/50 HPF (high powered fields)
3) histological type: spindle
4) necrosis: present
5) cellularity: intermediate
6) cellular atypia: mild
7) invasion into mucosa: absent
8) resection margin involvement: absent
9) no metastasis in 1 regional lymph nodes (0/1: "LN16", 0/1)

Gastrointestinal stromal tumor of low risk of malignant potential, duodenum;
1) tumor size: 2.7x2.3 cm
2) mitosis: 1/50 HPF (high powered fields)
3) histological type: spindle
4) necrosis: absent
5) cellularity: intermediate
6) cellular atypia: mild
7) invasion into mucosa: absent
8) resection margin involvement: absent

¸íÄ¡ºÎ ºÒÆí°¨À¸·Î ½ÃÇàÇÑ CT¿¡¼­ ¿ì¿¬È÷ ¹ß°ßµÇ duodenal 3rd portion hypervascular mass¿´À¸¸ç ¼Ò¾Æ ´ëÀå°æÀ» ÀÌ¿ëÇÑ push enteroscopy ÈÄ ¼ö¼ú ½ÃÇà
Duodenal wedge resection: Gastrointestinal stromal tumor of very low risk of malignant potential by proposed modification for adjuvant therapy (2008);
1) tumor size: 1.8x1.8 cm
2) mitosis: 0/50 HPF (high powered fields)
3) histological type: spindle
4) necrosis: absent
5) cellularity: intermediate
6) cellular atypia: moderate
7) invasion into mucosa: absent
8) resection margin involvement: absent
Note: Very low risk by NIH (2002) and none risk (0%) of progressive disease by Miettinen (2006).
. Ki-67 : Positive in up to about 2% of tumor cells
. C-KIT (CD 117) : Positive in tumor cells
. DOG-1 : Positive in tumor cells


3. Pancreatic heterotopia

biopsy: pancreatic adenomyoma


[FAQ]

[2015-5-22. ¾Öµ¶ÀÚ Áú¹®]

70´ë ¿©ÀÚ ¼ö°ËÀÚÀÇ ½ÊÀÌÁöÀå Á¦ 2ºÎ¿¡ ±×¸²°ú °°Àº À¶±â º´º¯ÀÌ ÀÖ¾ú½À´Ï´Ù.

Ampulla of Vater ÀÌÀü¿¡ ÀÖ¾î prominant minor papillaÀÎÁö SMTÀÎÁö ±¸ºÐÀÌ ¾È°¡¸ç Á¶Á÷°Ë»ç Çʿ伺¿¡ ´ëÇؼ­µµ ¹®Àǵ帳´Ï´Ù.
1. ±³¼ö´Ô²² ÀÌ·± ¼Ò°ßÀ» ¾î¶»°Ô »ý°¢ÇÏ½Ã¸ç ¾î¶² °Ë»ç´Â ÇؾßÇÏ´ÂÁö ¹®Àǵ帳´Ï´Ù.
2. ´õºÒ¾î ½Äµµ³ª ½ÊÀÌÁöÀå¿¡ SMT¶ó°í »ý°¢µÇ´Â º´º¯Àº 1cmÀÌÇÏ¶óµµ EUS¸¦ ÇÏ´Â °ÍÀÌ ÁÁÀ»±î¿ä? °¡À̵å¶óÀο¡´Â À§ SMT´Â 1cm ÀÌ»óÀÇ º´º¯¿¡ ´ëÇØ EUSÇ϶ó°í Çϴµ¥, ½ÊÀÌÁöÀå°ú ½Äµµµµ °°ÀÌ Àû¿ëµÇ´Â °ÍÀÎÁö¿ä?

[2015-5-24. ERCP Àü¹®°¡¿¡°Ô ¹®ÀÇÇÏ¿© ¹ÞÀº ´äº¯]

Áú¹® 1¿¡ ´ëÇÑ ´äº¯: 2nd portionÀÇ À¶±âµÈ º´º¯Àº Á÷½Ã°æÀ¸·Î ´ëºÎºÐ ±¸ÃøÀ¶±â¸¸ °üÂûµÇ¾î ±¸ºÐÇÏ´Â °ÍÀº ½±Áö ¾ÊÀº ¹Ý¸é¿¡ Ãø½Ã°æÀ¸·Î °üÂûÇÏ¸é º´º¯À» ±¸ºÐÇÏ´Â °ÍÀÌ ¿ëÀÌÇÕ´Ï´Ù. ½ÊÀÌÁöÀå 2nd portionÀÇ À¶±âµÈ º´º¯¿¡¼­ normal papilla°ú ´Ù¸¥ ½ÊÀÌÁöÀå º´º¯°ú ±¸ºÐÇÏ´Â °ÍÀº ½±Áö ¾Ê½À´Ï´Ù. ´ë°³ prominant minor papilla¸¦ AOV·Î ¿ÀÀÎÇÏ´Â °æ¿ìµµ ¸¹½À´Ï´Ù.

ÀϹÝÀûÀ¸·Î Ãø½Ã°æÀ» ±âÁØÀ¸·Î ºÎÀ¯µÎ´Â ´ë°³ ½ÊÀÌÁöÀå ÁÖÀ¯µÎ·ÎºÎÅÍ ±ÙÀ§ºÎÂÊÀ¸·Î 2~3cm À§Ä¡Çϸç ÁÖÀ¯µÎÀÇ ¿ì»ó¹æ¿¡ À§Ä¡ÇÕ´Ï´Ù. ¶§·Î´Â ÁÖÀ¯µÎ·ÎºÎÅÍ 1cm Á¤µµ¸¸ ¶³¾îÁ® ÁÖÀ¯µÎÀÇ Á¾ÁÖÇÏ´Â Á¡¸·ÁÖ¸§ÀÇ ±¸°­ Ãø °¡ÀåÀÚ¸®¿¡ À§Ä¡ÇÏ´Â °æ¿ìµµ ÀÖ½À´Ï´Ù. ¸ð¾çÀÌ ´Ù¾çÇÏ¿© Å©±â°¡ À۾Ƽ­ ÆíÆòÇÏ¿© ±¸ºÐÀÌ µÇÁö ¾Ê°Å³ª ½ÊÀÌÁöÀå ÁÖ¸§»çÀÌ¿¡ ¿¶Àº ºÐÈ«»ö À¯µÎ Çü´ë·Î °üÂûµÇ±â°í ÇÕ´Ï´Ù. µ¹ÃâµÈ ÁÖÀ¯µÎ´Â °¡²û ÁÖÀ¯µÎ·Î ¿ÀÀ뵃 ¼ö Àִµ¥ ºÎÀ¯µÎ´Â ÁÖÀ¯µÎ¿Í °°ÀÌ Á¾ÁÖÇÏ´Â ¸íÈ®ÇÑ Á¡¸·ÁÖ¸§À» °¡ÁöÁö ¾Ê´Â °ÍÀÌ Æ¯Â¡ÀÔ´Ï´Ù.

½ºÆ¿À̹ÌÁö¸¸ À־ ÆÇ´ÜÇϱ⠽±Áö ¾ÊÁö¸¸ 4¹ø° »çÁø¿¡¼­ Á¾ÁÖÁÖ¸§ÀÌ °üÂûµÇ¾î ÁÖÀ¯µÎ ÁÖº¯À¸·Î »ý°¢µÇ°í 1,2,3¹ø¿¡¼­ °üÂûµÇ´Â º´º¯Àº À§Ä¡»ó ºÎÀ¯µÎ °¡´É¼ºµµ ÀÖ¾î º¸ÀÔ´Ï´Ù. SMT ±¸ºÐÀ» À§Çؼ­´Â ÇöÀç ³»½Ã°æ »çÁø¸¸À¸·Î ÆÇ´ÜÇϱâ Èûµé °Í °°½À´Ï´Ù. Rolling signÀ» È®ÀÎÇϰųª cap Àû¿ëÇÏ¿© ±¸ÃøÀ¶±â ÇϹæÀ» °üÂûÇÏ¸é °¨º°¿¡ µµ¿òÀÌ µÉ °Í °°½À´Ï´Ù. ÇÏÁö¸¸ Å»ýÀû ÇÑ°è·Î Á÷½Ã°æ¸¸À¸·Î À¯ºÎµÎ °üÂûÀº Á¦ÇÑÀûÀÏ ¼ö ÀÖ½À´Ï´Ù. ±¸ºÐÀÌ ¸ðÈ£Çϰųª °üÂûÀÌ ¿ëÀÇÇÏÁö ¾Ê´Ù¸é Ãø½Ã°æÀ¸·Î Ãß°¡ °üÂûÇÏ´Â °ÍÀÌ °¡Àå È¿À²ÀûÀÎ ¹æ¹ýÀ¸·Î »ý°¢µË´Ï´Ù.

Áú¹® 2¿¡ ´ëÇÑ ´äº¯: ½ÊÀÌÁöÀå SMT°¡ Ưº°È÷ risk factor´Â ¾Æ´Ï¶ó°í »ý°¢ÇÕ´Ï´Ù. µû¶ó¼­ 1cm ÀÌÇÏÀÇ º´º¯À» Ãß°¡°Ë»çÇÏ´Â °ÍÀº ºÒÇÊ¿äÇÏ´Ù°í »ý°¢ÇÕ´Ï´Ù.

[2015-5-25. ÀÌÁØÇà ´äº¯]

¹«Áõ»ó 70´ë¿¡¼­ ÀÌ·¯ÇÑ ¼Ò°ßÀº ÇÑ ¸¶µð·Î Å« Àǹ̰¡ ¾ø´Ù°í »ý°¢ÇÕ´Ï´Ù. ºÎÀ¯µÎÀÎÁö ¿©ºÎ´Â Ãø½Ã°æÀ» Çغ¸¸é µµ¿òÀÌ µÇ°ÚÁö¸¸, »ç½Ç ºÎÀ¯µÎ¿©µµ ÁÁ°í ¾Æ´Ï¾îµµ º° »ó°üÀÌ ¾øÀ» °Í °°½À´Ï´Ù. ÀÌ Á¤µµÀÇ ½ÊÀÌÁöÀå SMT´Â ±×³É 1³â ÈÄ ³»½Ã°æ Á¤µµ¸é ¾î¶³±î¿ä? »ç½Ç 70´ë ¿©¼ºÀ̹ǷΠÃßÀû ³»½Ã°æÀ» ±ÇÇÏ´Â °Í ÀÚü°¡ °úÀ×ÀÌ ¾Æ´ÑÁö Á¶±Ý ¿ì·Á½º·´±â´Â ÇÕ´Ï´Ù.

»óºÎÀ§Àå°ü ³»½Ã°æ¿¡¼­ 1cm ÀÌ»óÀÏ ¶§ EUS¸¦ Ç϶ó´Â °ÍÀº °¡À̵å¶óÀÎÀÌ ¾Æ´Õ´Ï´Ù. ¸î¸î editorialÀ̳ª review¿¡ ³ª¿Â ³»¿ëÀÔ´Ï´Ù. ½ÇÁ¦ 1 cm À̻󿡼­ EUS¸¦ ÇÏ´Â °ÍÀÌ µµ¿òÀÌ µÈ´Ù´Â ½Å·ÚÇÒ¸¸ÇÑ ¿¬±¸°á°ú´Â ÀüÇô ¾ø´Â ½ÇÁ¤ÀÔ´Ï´Ù. ÀÓ»ó¿¡¼­´Â EUS¿¡ ÀÇÇÑ °úÀ×Áø´ÜÀÌ ¹®Á¦°¡ µÇ°í ÀÖÀ¸¸ç, ƯÈ÷ ¿ì¸®³ª¶ó¿¡¼­´Â EUS°¡ ÀÎÁ¤ ºñ±Þ¿©¶ó´Â ÀÌÀ¯·Î ³²¿ëµÇ´Â Ãø¸éÀÌ ÀÖ½À´Ï´Ù. EUS´Â Á¶Á÷À» ¾ò´Â´Ù°Å³ª intervention ¸ñÀûÀ¸·Î´Â ¸Å¿ì ÁÁÀº ¹æ¹ý·ÐÀÌÁö¸¸, ÀÛÀº »óºÎÀ§Àå°ü SMT¿¡ ´ëÇÑ Áø´ÜÀû °Ë»ç·Î¼­ÀÇ °¡Ä¡´Â ¸Å¿ì ³·´Ù°í »ý°¢ÇÕ´Ï´Ù. Àú´Â °ÅÀÇ ½ÃÇàÇÏÁö ¾Ê°í ÀÖ½À´Ï´Ù.


[±×¸²] 1 cm À̻󿡼­ EUS¸¦ ±ÇÇÏ°í ÀÖ´Â ¿¹. °¡À̵å¶óÀÎÀÌ ¾Æ´Ï¶ó ÇÑ »ç¶÷ÀÇ ÀÇ°ßÀÏ »ÓÀÔ´Ï´Ù. µû¶ó¾ß ÇÒ ¸íÈ®ÇÑ ÀÌÀ¯°¡ ¾ø½À´Ï´Ù. ºñÆÇÀûÀ¸·Î Á¢±ÙÇϱ⸦ ±ÇÇÕ´Ï´Ù.


[References]

1) ±è±¤ÇÏ. ½ÊÀÌÁöÀå ±âŸÁúȯ ´ëÇÑÀÓ»ó¼ÒÈ­±â³»°ú 2016 (PDF, 5.5M)

2) ±è¼ºÈÆ. ½ÊÀÌÁöÀå ¾ç¼ºÁúȯ ´ëÇÑÀÓ»ó¼ÒÈ­±â³»°ú 2016 (PDF, 2.2M)

3) ¼ºÀç±Ô. ½ÊÀÌÁöÀå Á¦48ȸ ³»½Ã°æÇÐȸ ¼¼¹Ì³ª (PDF, 0.7M)

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