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[Á¶±âÀ§¾Ï ¾ÆƲ¶ó½º. Early Gastric Cancer. EGC] - ðû

1. Folds of EGC

2. Bleeding is important sign

3. EGC type I

4. EGC type IIa

5. EGC type IIb

6. EGC type IIc

7. EGC type III

8. EGC type IIa+IIc

9. Superficial spreading type EGC

10. AGC-like EGC


1. Folds of EGC

Fold´Â Á¤¸» ¾î·Æ½À´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.

Fold°¡ ÀÖ´ÂÁö ¾ø´ÂÁö ¾Ö¸ÅÇÑ °æ¿ì¸¦ ¾î¶»°Ô ÇÏ´Â °ÍÀÌ ÁÁÀ»Áö Áú¹®À» ¹Þ´Â °æ¿ì°¡ ¸¹½À´Ï´Ù. Á¦ »ý°¢Àº ÀÌ·¸½À´Ï´Ù. ¸Ç´«À¸·Îµµ Àß º¸ÀÌ´Â fold¿¡¸¸ Àǹ̸¦ ºÎ¿©ÇÏ´Â °ÍÀÌ ÁÁ°Ú½À´Ï´Ù. Indigo carmine°ú °°Àº »ö¼Ò¸¦ »Ñ¸° ÈÄ Èñ¹ÌÇÏ°Ô °üÂûµÇ´Â °ÍµéÀº ¹«½ÃÇÏ´Â °ÍÀÌ ¾î¶»°Ú½À´Ï±î? ³»½Ã°æ Áø´Ü¿¡ ´ëÇÑ ¸ðµç ¿øÄ¢ÀÌ »ö¼Ò³ª È®´ë¾øÀÌ °üÂûµÇ´Â fold¸¦ ±âÁØÀ¸·Î ¸¸µé¾îÁ® Àֱ⠶§¹®¿¡ »ö¼Ò³ª È®´ë¾øÀÌ °üÂûµÇ´Â fold¸¸ °í·ÁÇÏ¿© Á¶±âÀ§¾ÏÀÇ Áø´Ü, Á¶±âÀ§¾ÏÀÇ ºÐ·ù, ³»½Ã°æÄ¡·á ÀûÀÀÁõ ¿©ºÎ ÆÇ´Ü µîÀ» ÇÏ´Â °ÍÀÌ ¹Ù¶÷Á÷ÇÕ´Ï´Ù.

Àú´Â °ú°Å fold´Â (Á¡¸·ÇÏÃþ±îÁö ħ¹üÇÑ) ±Ë¾çÀÌ ¾Æ¹°¸é¼­ ¸¸µé¾îÁø´Ù°í ¹è¿ü½À´Ï´Ù. ±×·¯³ª À§¾Ï¿¡¼­´Â Á¡¸·º´¼Ò¶ó ÇÏ´õ¶óµµ desmoplastic reaction¿¡ ÀÇÇÏ¿© fold¸¦ ¸¸µé ¼ö ÀÖ½À´Ï´Ù´Ù. Á¶±âÀ§¾Ï fold¿¡ ´ëÇÑ ´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 ħÀ± ±íÀÌ (½É´Þµµ) ¿¹ÃøÀÇ Áß½ÉÀÌÁö¸¸ fold¿¡ µû¸¥ ħÀ± ±íÀÌ (½É´Þµµ) Áø´ÜÀÌ ²À ¿ÇÀº °ÍÀº ¾Æ´Ï¶ó°í »ý°¢ÇÕ´Ï´Ù. ħÀ± ±íÀÌ (½É´Þµµ) ¿¹ÃøÀº ¿¹¼úÀ̱⠶§¹®ÀÔ´Ï´Ù.

¾Æ·¡ Áõ·ÊµéÀ» Âü°íÇϽʽÿÀ.


2. Bleeding is important sign


3. EGC type I


4. EGC type IIa

EGC IIaÀÇ ESD¸¦ ½ÃÇàÇÏ¿´½À´Ï´Ù. ÀÚ¼¼È÷ °üÂûÇÑ ¹Ù »çÁø¸¸À¸·Î ÆÇ´ÜÇÑ °Í¿¡ ºñÇÏ¿© ³ÐÀº º´¼Ò¿´±â ¶§¹®¿¡ Àá½Ã ³î¶úÁö¸¸ ½Ã¼úÀº Àß µÇ¾ú½À´Ï´Ù.
ESD : Early gastric carcinoma
1. Location : angle, lesser curvature
2. Gross type : EGC type IIa+IIb
3. Histologic type : tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : intestinal
5. Size of carcinoma : (1) longest diameter, 58 mm (2) vertical diameter, 24 mm
6. Depth of invasion : invades mucosa (lamina propria) (pT1a)
7. Resection margin : free from carcinoma(N), safety margin : distal 8 mm, proximal 7 mm, anterior 10 mm, posterior 10 mm, deep 1800 §­
8. Lymphatic invasion : not identified(N)
9. Venous invasion : not identified(N)
10. Perineural invasion : not identified(N)
11. Microscopic ulcer : absent
12. Histologic heterogeneity: absent



5. EGC type IIb




6. EGC type IIc



¾Æ·¡¿Í °°Àº ³ÐÀº EGC´Â ºÐ·ù°¡ ½±Áö ¾Ê½À´Ï´Ù. EGC IIc + III¶ó°í ÇÒ ¼ö´Â ÀÖ°Ú½À´Ï´Ù. ÀÏÁ¾ÀÇ laterally spreading tumorÀÔ´Ï´Ù.


7. EGC type III

ÀüÇüÀûÀÎ EGC type III´Â ¸¹Áö ¾Ê½À´Ï´Ù. ¶Ñ·ÇÇÑ ±Ë¾çÀÌ Àִ ȯÀÚ¿¡¼­ ¼ö¼ú ÈÄ °á°ú°¡ AGC·Î ³ª¿À´Â °æ¿ì°¡ ¸¹±â ¶§¹®ÀÔ´Ï´Ù.

Stomach, radical subtotal gastrectomy: Early gastric carcinoma
1. Location : lower third, Center at body and lesser curvature
2. Gross type : EGC type III
3. Histologic type : tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : intestinal
5. Size : 3.3x1.7 cm
6. Depth of invasion : invades submucosa (sm2) (pT1b)
7. Resection margin: free from carcinoma, safety margin: proximal 2.5 cm, distal 7.3 cm
8. Lymph node metastasis : no metastasis in 32 regional lymph nodes (pN0) (0/32: "1", 0/0; "5", 0/0; "6", 0/0; "7", 0/3; "9", 0/1; "8a", 0/2; "11p", 0/3; "12a", 0/2; "4sb", 0/2; "4", 0/0; 3,5, 0/3; 4,6, 0/4; perigastric LN, 0/12)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. Associated findings : ulceration
13. AJCC stage by 8th edition: pT1b N0


8. EGC type IIa + IIc


9. Superficial spreading EGC


10. AGC-like EGC (= EGC, mimicking AGC)

© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng. (since 1999-8-23)