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[Undifferentiated type ¹ÌºÐÈ­ Á¶Á÷ÇüÀ̶ó´Â ¿ë¾î¿¡ ´ëÇÏ¿©] - ðû

1. 2023³â º´¸® °¡À̵å¶óÀÎ - differentiated type/undifferentiated typeÀ¸·Î ³ª´©´Â Nakamura ºÐ·ù´Â Æ÷ÇÔÇÏÁö ¾ÊÀ½

2. ¿ë¾î È¥¶õÀÇ ¹è°æ

3. ÀÏ»ê ¹éº´¿ø ÁÖ¹Ì ±³¼ö´Ô ÀÇ°ß (2014)

4. ÀÌÁØÇàÀÇ ÀÇ°ß (2014³â)

5. FAQs

6. Cases

7. References


1. 2023³â º´¸® °¡À̵å¶óÀÎ

2023³â º´¸® °¡À̵å¶óÀο¡´Â differentiated type/undifferentiated typeÀ¸·Î ³ª´©´Â Nakamura ºÐ·ù´Â ±âÀçÇÏÁö ¾Ê´Â´Ù°í ¸í½ÃµÇ¾î ÀÖ½À´Ï´Ù.

"To determine the feasibility of an endoscopic resection of tumors, most clinical guidelines and studies apply the differentiatedpapillary adenocarcinoma, tubular adenocarcinoma WD and MD/undifferentiatedtubular adenocarcinoma PD and poorly cohesive carcinoma, including SRC carcinoma criteria of the Japanese guideline. In these criteria, PD adenocarcinoma is classified as the undifferentiated type. To prevent confusion with undifferentiated carcinoma, we do not recommend using the 'differentiated type/undifferentiated type' criteria in pathology reports. Instead, using the histologic classificaion and/or Lauren classification can provide sufficient information to clinicians and researchers."

¿ì¸®³ª¶ó º´¸®°ú ¼±»ý´ÔµéÀÇ ÀÇ°ß°ú °°ÀÌ ¿ì¸® ³»½Ã°æÀǻ絵 °¡±ÞÀû ºÐÈ­Á¶Á÷Çü, ¹ÌºÐÈ­Á¶Á÷ÇüÀ̶ó´Â ¿ë¾î¸¦ ¾²Áö ¾Ê´Â °ÍÀÌ ÁÁ°Ú½À´Ï´Ù.


2. ¿ë¾î È¥¶õÀÇ ¹è°æ

¿ì¸®³ª¶óÀÇ Á¶±âÀ§¾Ï ³»½Ã°æÄ¡·á ³í¹®¿¡ undifferentiated type EGC³ª undifferentiated histology µî Àǹ̰¡ ºÒ¸íÈ®ÇÑ ¿ë¾î°¡ ³Î¸® »ç¿ëµÇ°í ÀÖ½À´Ï´Ù. ±×·¯³ª ÀÌ·± Ç¥ÇöÀ¸·Î ÀÎÇÏ¿© ÀûÁö ¾ÊÀº È¥¶õÀÌ ¹ß»ýÇÏ°í ÀÖ½À´Ï´Ù. ±¹³»¿Ü¿¡¼­ À̸¦ ÁöÀûÇÏ´Â ¸ñ¼Ò¸®µµ ÀûÁö ¾Ê½À´Ï´Ù. ÀÌÀ¯´Â µÎ °¡ÁöÀÔ´Ï´Ù. (1) WHO¿¡¼­ Á¤ÀÇÇÑ À§¾Ï Á¶Á÷ÇÐÀû ºÐ·ù¿¡ undifferentiated carcinoma(Àüü À§¾ÏÀÇ 1% ¹Ì¸¸¿¡ ÇØ´çÇÏ´Â µå¹® ÇüÅÂ)¶ó´Â °ÍÀÌ ÀÖ½À´Ï´Ù. ÀÌ°Í°ú ±¸ºÐÀÌ ¾î·Æ±â ¶§¹®ÀÔ´Ï´Ù. ¼­·Î ¿ÏÀüÈ÷ ´Ù¸¥ °³³äÀÓ¿¡µµ ºÒ±¸ÇÏ°í undifferentiated¶ó´Â °°Àº ´Ü¾î°¡ ¾²ÀÌ°í ÀÖÀ¸¹Ç·Î È¥¶õÀº ºÒ°¡ÇÇÇÕ´Ï´Ù. (2) ¼­±¸¿Í ´Þ¸® ÀϺ» º´¸®ÀÇ»çµéÀº °ú°ÅºÎÅÍ À§¾ÏÀÇ Á¶Á÷ÇÐÀû ºÐ·ù¿¡¼­ differentiated vs undifferentiated¶ó´Â ¿ë¾î¸¦ ½á ¿Ô½À´Ï´Ù. ÀÌ´Â ¿ì¸®³ª¶ó ³í¹®¿¡ »ç¿ëµÇ´Â undifferentiated type, undifferentiated histology µî°ú ¹Ì¹¦ÇÑ Â÷ÀÌ°¡ ÀÖ½À´Ï´Ù.

2018³â ¹ßÇ¥µÈ ÀϺ»À§¾Ï°¡À̵å¶óÀÎ 5ÆÇ(Gastric Cancer 2021)¿¡¼­ ¾Æ·¡¿Í °°Àº ¹æ½ÄÀ¸·Î »ç¿ëµÇ°í ÀÖ½À´Ï´Ù.

WHO classification (4th, 2010)¿¡¼­ Lauwers µîÀÌ ¾´ À§¾Ï ÆÄÆ®¿¡´Â undifferentiated¿¡ ´ëÇÏ¿© °ÅÀÇ ¼³¸íµÇ¾î ÀÖÁö ¾Ê½À´Ï´Ù. ´Ù¸¸ rare histological variantsÀÇ Çϳª·Î ¾ð±ÞµÇ¾î ÀÖÀ» »ÓÀÔ´Ï´Ù. Èï¹Ì·Î¿î Á¡Àº other classification scheme¿¡ Lauren, Ming, Nakamura, Mulligan, Goseki, Carneiro µîÀÇ ¹æ½ÄÀÌ ¼Ò°³µÇ¾î ÀÖ´Ù´Â Á¡ÀÔ´Ï´Ù. ÀÌ Áß Nakamura ¹æ½ÄÀº ¾Æ·¡¿Í °°Àº ´Ü ÇÑ ¹®ÀåÀ¸·Î ¼³¸íµÇ¾î ÀÖ½À´Ï´Ù. ¼­¾ç ÀÇ»çµéµµ Nakamura ¹æ½ÄÀ» ¾Ë°í ÀÖ´Ù´Â À̾߱âÀÔ´Ï´Ù. ´ÜÁö »ç¿ëÇÏÁö ¾ÊÀ» »ÓÀÔ´Ï´Ù.

"Nakamura categorizes all tumours as either differentiated or undifferentiated."

ÀϺ»Àº º´¿ø¿¡ µû¶ó º´¸® º¸°í¼­¿¡ ¿ø·¡ºÎÅÍ differentiated vs undifferentiated¶ó´Â ¿ë¾î°¡ ¾²ÀÌ´Â ¸ð¾çÀÔ´Ï´Ù. Nakamura ºÐ·ùÀÔ´Ï´Ù. ±×·¸´Ù¸é À̸¦ ±×´ë·Î ³í¹®¿¡ »ç¿ëÇصµ º° ¹®Á¦°¡ ¾ø½À´Ï´Ù. ±¹Á¦ Ç¥ÁØÀÎ WHO ºÐ·ù°¡ ¾Æ´Ï¶ó´Â Á¡¿¡¼­ º°·Î ÁÁÁö´Â ¾ÊÁö¸¸, ±×³É ÀϺ» °íÀ¯ÀÇ Çö»óÀ¸·Î ¹Þ¾ÆµéÀÌ¸é ±×»ÓÀÎ °ÍÀÔ´Ï´Ù. Âü ƯÀÌÇÑ ÀÏÀ̱º.... ¹¹ ÀÌ·¸°Ô »ý°¢ÇÏ¸é ±×¸¸ÀÔ´Ï´Ù.

¿ì¸®³ª¶ó º´¸® ¼±»ý´ÔµéÀº ¿¹³ª Áö±ÝÀ̳ª WHO ±âÁØ¿¡ µû¶ó ºÐ·ùÇÏ¿© Áø´ÜÇÏ°í ÀÖ½À´Ï´Ù. ´ÜÁö ¼ÒÈ­±â³»°ú³ª ¿Ü°ú ÀÇ»çµéÀÌ poorly differentiated adenocarcinoma¿Í signet ring cell carcinoma·Î º¸°íµÈ °ÍÀ» undifferentiated type, undifferentiated histology µîÀÇ ¿ë¾î·Î ¹­¾î¼­ »ý°¢ÇÏ°í ½À°üÀÌ ÀÖÀ» »ÓÀÔ´Ï´Ù. ¿ì¸®³ª¶óÀÇ 2023³â º´¸® °¡À̵å¶óÀο¡¼­´Â differentiated type/undifferentiated typeÀ̶ó´Â °³³äÀº º¸°í¼­¿¡ ±âÀçÇÏÁö ¾Ê´Â´Ù°í È®½ÇÈ÷ ¹àÈ÷°í ÀÖ½À´Ï´Ù.

Æí¸®ÇÑ Ãø¸éÀÌ ÀÖ´Ù´Â °ÍÀº ÀÎÁ¤ÇÏÁö¸¸, ¿ì¸®´Â differentiated type/undifferentiated typeÀ̶ó´Â ¿ë¾î¸¦ °¡±ÞÀû ¾²Áö ¾Ê´Â °ÍÀÌ ÁÁÀ» °Í °°½À´Ï´Ù.

[Âü°í 1] ¿ì¸®³ª¶ó ESD °ü·Ã ³í¹®¿¡¼­´Â ¾î¶»°Ô »ç¿ëµÇ°í Àִ°¡? - Undifferentiated type, undifferentiated histology, ¶Ç´Â undifferentiated carcinoma¶ó´Â ¿ë¾î°¡ È¥¿ëµÇ°í ÀÖ´Ù.

2007³â ±¹³» ÃÖÃÊÀÇ Á¶±âÀ§¾Ï ³»½Ã°æÄ¡·á ´Ù±â°ü¿¬±¸(Gastrointest Endosc 2007)¿¡¼­´Â undifferentiated¿¡ ´ëÇÑ ¾ð±ÞÀÌ ¾Æ·¡¿Í °°ÀÌ µÎ ¹ø ³ª¿É´Ï´Ù. Undifferentiated histology°¡ ¹«¾ùÀÎÁö Á¤È®È÷ Á¤ÀÇÇÏÁö ¾ÊÀº »óÅ¿¡¼­ poorly differentiated adenocarcinoma¿Í signet ring cell carcinoma¸¦ undifferentiated typeÀ¸·Î °£ÁÖÇÑ °Í °°½À´Ï´Ù. ÀÌ ¿¬±¸ÀÇ ÀÚ·á¼öÁý¿¡ Àúµµ ÁÖµµÀûÀ¸·Î Âü¿©ÇÏ¿´´Âµ¥, ´ç½Ã ÀÌ·¯ÇÑ ¹®Á¦Á¡À» ±íÀÌ ÀÎÁöÇÏÁö ¸øÇß½À´Ï´Ù.

  • The resection was regarded as incomplete if histopathologic examination revealed a positive resection margin or submucosal invasion or positive lymphovascular invasion or undifferentiated histologic diagnosis.
  • Twenty-seven tumors (5.3%) were classified into undifferentiated type (18 poorly differentiated adenocaracinomas and 9 signet ring cell carcinomas).

Á¦°¡ 2ÀúÀÚ·Î Âü¿©ÇÏ¿´´ø ³í¹®(Digest Liver Dis 2009)¿¡¼­µµ undifferentiated histology¶ó´Â ¿ë¾î¸¦ »ç¿ëÇÑ ÀûÀÌ ÀÖ½À´Ï´Ù. ¾Æ·¡ table¿¡¼­ ÀúÈñ´Â "Undifferentiated histology included the cases with poorly differentiated or signet ring cell carcinoma"¶ó´Â ¼³¸íÀ» ºÙ¿´½À´Ï´Ù.

ÀúÈñ º´¿øÀÇ ¶Ç ´Ù¸¥ ³í¹®(Surg Endosc 2011)ÀÇ discussion¿¡ "Undifferentiated cancers were excluded from the comparison because, even when small, they have a high risk of lymph node metastasis and are not usually treated endoscopically"¶ó´Â Ç¥ÇöÀ» »ç¿ëÇÑ ÀûÀÌ ÀÖ½À´Ï´Ù.

[Âü°í 2] ÀϺ»¿¡¼­´Â ¾î¶² Àǹ̷Π»ç¿ëµÇ°í Àִ°¡?

Àú´Â ÀϺ»¿¡¼­ undifferentiated adenocarcinoma°¡ ¾î¶² Àǹ̷Π»ç¿ëµÇ°í ÀÖ´ÂÁö Á¤È®È÷ ¾ËÁö ¸øÇÕ´Ï´Ù. ÃÖ±Ù °¡Å縯´ëÇб³¿¡¼­ ³ª¿Â ³í¹®(World J Surg Oncol 2012)¿¡ ¾Æ·¡¿Í °°Àº ¾ð±ÞÀÌ Àִµ¥, ÀϺ» »çÁ¤À» Á¤È®È÷ ¹Ý¿µÇÏ°í ÀÖ´ÂÁö Àú·Î¼­´Â È®ÀÎÇÒ µµ¸®°¡ ¾ø½À´Ï´Ù.

The Japanese classification system categorizes gastric adenocarcinomas into two groups: differentiated and undifferentiated. The differentiated group consists of well-differentiated, moderately-differentiated and papillary adenocarcinoma. The undifferentiated group consists of poorly differentiated adenocarcinoma (PDAC) and SRC. Interestingly, mucinous adenocarcinoma can be regarded as either a differentiated or undifferentiated type depending on the predominant components. In the same context, Nakamura categorized all gastric cancer as either differentiated or undifferentiated.

¾ÆÁÖ ¿À·¡ Àü¿¡ ÀϺ»¿¡¼­ À§¾ÏÀ» differentiated¿Í undifferentiated·Î ³ª´©´Â °ü·Ê°¡ »ý±ä °Í °°½À´Ï´Ù. 1970³â´ë ȤÀº 1980³â´ë ³í¹®¿¡¼­´Â ÀÚÁÖ ¾ºÀÌ°í ÀÖ½À´Ï´Ù. ¿äÁòÀº Á»Ã³·³ ³í¹®¿¡¼­ ã¾Æº¸±â´Â ¾î·Æ½À´Ï´Ù. ´ÜÁö ÀÓ»óÀÇ º´¸®º¸°í¼­¿¡¼­ ¾ÆÁ÷ ¾ºÀÌ°í ÀÖ´Â ¸ð¾çÀÔ´Ï´Ù.

¿À·¡µÈ ÀϺ» ³í¹® ÃÊ·ÏÀ» ¿Å±é´Ï´Ù. 1982³âÀÔ´Ï´Ù. ÇöÀç °³³äÀ¸·Î º¸¸é ¾à°£ ÀÌ»óÇÑ À̾߱⵵ ¸¹ÀÌ ¾º¿© ÀÖ½À´Ï´Ù. ¿¾³¯ À̾߱âÀÎ °ÍÀÌÁö¿ä.

Historical review of the pathological investigation on stomach cancer in Japan shows that the central problem had been whether or not gastric cancer developed from chronic peptic ulcer. This theory of ulcer cancer sequence was developed from chronic peptic ulcer. This theory of ulcer cancer sequence was supported by many researchers after the war in the period of 1946-64. Subsequently, systematic studies made at the Cancer Institute revealed that carcinoma arises from the gastric mucosa independently of chronic ulcer. The pathological interest then shifted toward investigation of the histogenesis and biological characteristics of gastric carcinoma. It is concluded that gastric carcinoma can be classified into two types; undifferentiated carcinoma (UCA or gastric type) and differentiated one (DCA or intestinal type). The former arises from the ordinary mucosa and cancer phenotype of this carcinoma resembles to that of the ordinary mucosa, and the latter arises from the metaplastic epithelium of intestinal type showing a cancer phenotype resembling to that of the intestinal metaplastic epithelium. These two carcinomas are also different in biological behaviors, such as growth pattern, invasiveness, metastasis, and prognosis. The frequency of UCA is almost the same in both sexes. DCA, however, occurs more often in male than in female. The time trend data indicates that in both sexes the number of DCA decreased, but that of UCA is steady, so that the ratio of DCA to UCA decreased since 1965. These results combined with the concept of the basic and variable cancer leads to a conclusion that UCA is a basic cancer and DCA is a variable cancer of the stomach.

Japanese Red Cross Kyoto Daiichi Hospital ³í¹®(Digestion 2012)¿¡´Â "who had a final pathological diagnosis of undifferentiated adenocarcinoma (por, sig, or por+sig) were enrolled this study"¶ó´Â ºÎºÐÀÌ ³ª¿É´Ï´Ù. Áï ÀϺ»¿¡¼­µµ º´¿ø¿¡ µû¶ó¼­´Â poorly differentiated adenocarcinoma¿Í signet ring cell carcinoma¸¦ undifferentiated adenocarcinoma·Î ¾ð±ÞÇÏ´Â °æ¿ì°¡ ÀÖ´Â °ÍÀÔ´Ï´Ù. ÀÌ º´¿ø º´¸®°ú ½ºÅ¸ÀÏÀº ¿ì¸®³ª¶ó¿Í ºñ½ÁÇÏ°Ô WHO ºÐ·ù¹ýÀ» ÀÌ¿ëÇÏ´Â ¸ð¾çÀÔ´Ï´Ù. À̸¦ ÀÓ»óÀÇ°¡ ºÎÀûÀýÇÏ°Ô differentiated vs undifferentiatedÀÇ Æ²·Î ¹­¾î¼­ ³í¹®À» ³½ °Í °°½À´Ï´Ù.

[Âü°í 3] ÀϺ»À§¾ÏºÐ·ù (1998)¿¡ ¾ð±ÞµÈ ³»¿ë

1998³â ¹ßÇ¥µÈ ÀϺ»À§¾ÏºÐ·ù(Japanese Classification of Gastric Carcinoma - 2nd English Edition -)¿¡ µû¸£¸é ÀϺ»¿¡¼­ ¿Ü°úÀÇ»çµéÀÌ ÀÌÇØÇÏ°í ÀÖ´Â À§¾ÏÀÇ Á¶Á÷ÇÐÀû ºÐ·ù´Â ¾Æ·¡¿Í °°½À´Ï´Ù (Reference). ´ç½Ã ºÐ·ù¹ý¿¡¼­´Â differentiated¿Í undifferentiatedÀÇ ±¸ºÐÀº ¾ø½À´Ï´Ù. ´ÜÁö ´ÙÀ½°ú °°Àº note°¡ Çϳª ÀÖÀ» »ÓÀÔ´Ï´Ù. "Note 1: Undifferentiated carcinoma combined with a small adenocarcinoma component should be classified as poorly differentiated adenocarcinoma."

1. Common types
Papillary adenocarcinoma (pap)
Tubular adenocarcinoma
Well-differentiated type (tub 1)
Moderately differentiated type (tub 2)
Poorly differentiated adenocarcinoma
- Solid type (por 1)
- Non-solid type (por 2)
Signet-ring cell carcinoma (sig)
Mucinous adenocarcinoma (muc)

2. Special types
Adenosquamous carcinoma
Squamous cell carcinoma
Carcinoid tumor
Other tumors

¸ðµç ºÐ·ù°¡ ±×·¸Áö¸¸ ½ÇÁ¦·Î ÀϺ»ÀÇ ¸ðµç º´¸®°ú ÀÇ»çµéÀÌ ÀϺ»À§¾ÏºÐ·ù¸¦ µû¸£°í ÀÖ´Â °ÍÀº ¾Æ´Ñ °Í °°½À´Ï´Ù. ÀϺ»À§¾ÏºÐ·ù¿¡ ¾ø´Â differentiated vs undifferentiated¶ó´Â °³³äÀÌ ½ÇÁ¦ º¸°í¼­¿¡ ¸¹ÀÌ ÀÌ¿ëµÇ°í ÀÖ´Â °Í ¾Æ´Ò±î¿ä? º¸´Ù »ó¼¼ÇÑ ÀϺ» Çö½ÇÀ» ¾Ë±â´Â ¾î·ÆÁö¸¸...

[Âü°í 4] Practical ÀϺ»½Ä »ç°í¹æ½ÄÀÌ ¿ë¾î Á¤ÀÇÀÇ ¸ðÈ£¼º¿¡ ¹ÌÄ¡´Â ¿µÇâ

À¯¸íÇÑ ¿À·¡µÈ ³í¹®À» ¼Ò°³ÇÕ´Ï´Ù. ÀÌ ³í¹®¿¡¼­´Â differentiated vs undifferentiatedÀÇ Æ²ÀÌ »ç¿ëµÇ°í ÀÖ½À´Ï´Ù. Áï WHOÀÇ À§¾Ï ºÐ·ù°¡ º°·Î ¹Ý¿µµÇÁö ¾Ê¾Ò½À´Ï´Ù.

±×·¯³ª °°Àº ÀúÀÚÀÇ ±Ù°£ ¸®ºä¿¡¼­´Â well differentiated, moderately differentiated µî WHO ºÐ·ù¹ýÀÌ ¾ð±ÞµÇ°í ÀÖ½À´Ï´Ù. °£È¤ undifferentiated adenocarcinoma¶ó´Â ¾Ö¸ÅÇÑ ¿ë¾î°¡ ¾ÆÁ÷ ¾ºÀÌ°í ÀÖ´Ù´Â °ÍÀ» ¾Ë ¼ö ÀÖÁö¸¸... »ç½ÇÀº Ʋ¸° ¿ë¾îÀÔ´Ï´Ù. Adenocarcinoma´Â gland ºÐÈ­¸¦ º¸ÀÎ °ÍÀ̹ǷΠundifferentiatedÀÏ ¼ö ¾ø½À´Ï´Ù. ¾Æ·¡¿¡ ³ª¿À´Â º´¸®°ú ¼±»ý´ÔÀº ÀÌ·¯ÇÑ À߸øÀ» 'Çü¿ë¸ð¼ø(oxymoron)'À̶ó°í ¼³¸íÇÏ°í ÀÖ½À´Ï´Ù.

ÀϺ» ÀÇ»çµéÀº ¿ë¾î¸¦ Á¤È®È÷ Á¤ÀÇÇÏÁö ¾Ê°í ´ëÃæ »ç¿ëÇÏ´Â °ÍÀ¸·Î À¯¸íÇÕ´Ï´Ù. Differentiated/undifferentiated À̽´¿¡ ´ëÇؼ­µµ Àû¿ëµË´Ï´Ù. Áï ÀϺ» ÀÇ»çµéµµ ¸íÈ®È÷ Á¤ÀÇÇÏÁö ¾Ê°í »ç¿ëÇÏ´Â °ÍÀ» ¿ì¸®³ª¶ó ÀÇ»çµéÀÌ µû¶óÇÏ°í ÀÖ´Â ¼ÀÀÌ´Ï º»ÁúÀûÀ¸·Î È¥¶õÀÌ °¡ÁßµÉ ¼ö ¹Û¿¡ ¾ø½À´Ï´Ù. È¥¶õÀ» ÇÇÇϱâ À§Çؼ­´Â ¿ì¸® ½º½º·Î ÀϺ»À» Èä³»³»´ø ±¸Å¿¡¼­ ¹þ¾î³ª´Â ¼ö ¹Û¿¡ ¾ø½À´Ï´Ù.

ÀϺΠÀϺ» ÀÇ»çµéÀÌ differentiated vs undifferentiated¶ó´Â ºÐ·ùÀÇ Æ²ÀÌ ±¹Á¦ÀûÀÎ °ßÁö¿¡¼­´Â ÀûÀýÇÏÁö ¾Ê´Ù´Â °ÍÀ» ÀÎÁöÇϱ⠽ÃÀÛÇÏ´Â °Í °°½À´Ï´Ù. ±×·¯³ª ´ë´Ù¼öÀÇ ÀϺ» ÀÇ»çµéÀº ÀڽŵéÀÇ °íÀ¯ÇÑ ¹æ½ÄÀ» »ç¿ëÇÏ°í ÀÖ½À´Ï´Ù. ¿¹¸¦ µé¾î 2010³â ÀϺ» À§¾Ï Ä¡·á °¡À̵å¶óÀο¡¼­´Â ¾ÆÁ÷µµ ¿ë¾îÀÇ »ç¿ëÀÌ ÀÌ»óÇÕ´Ï´Ù. Differentiated¶ó°í ¾ºÀÎ °÷µµ ÀÖ°í differentiated typeÀ̶ó°í ¾ºÀÎ °÷µµ ÀÖ½À´Ï´Ù.

ÀϺ» ÀÇ»çµéÀº ¿ë¾î¸¦ Á¤È®È÷ Á¤ÀÇÇÏÁö ¾Ê°í ´ëÃæ »ç¿ëÇÏ´Â °ÍÀ¸·Î À¯¸íÇÕ´Ï´Ù. À¯±³ ¹®È­°¡ °­ÇÑ ¿ì¸®³ª¶ó¿Í´Â ´Þ¸® »ç¹«¶óÀ̵éÀÌ Áö¹èÇÏ´ø ÀϺ»Àº ¿ì¸®º¸´Ù ÈξÀ practicalÇÕ´Ï´Ù. ¸íºÐ¿¡ ´ëÇÑ ÁýÂøÀÌ ¾àÇÕ´Ï´Ù. ±×·¯ÇÑ ¹®È­°¡ ÀÇÇп¡¼­´Â ¿ë¾îÀÇ Á¤ÀÇ¿¡ ÁýÂøÇϱ⺸´Ù´Â ½Ç¿ëÀûÀÎ ÇØ°áÃ¥À» Á¦½ÃÇÏ´Â ÀϺ» ƯÀ¯ÀÇ ¹æ½ÄÀ¸·Î ³ªÅ¸³ª´Â °ÍÀÔ´Ï´Ù. Differentiated/undifferentiated À̽´¿¡¼­µµ ÀϺ»ÀÇ Æ¯»öÀÌ Àß ³ªÅ¸³³´Ï´Ù. µµ¹«Áö Á¤ÀÇ°¡ ¸íÈ®ÇÏÁö ¾Ê½À´Ï´Ù. ±×·¯³ª ´ëºÎºÐÀÇ ÀϺ»ÀεéÀº ¹¬½ÃÀûÀ¸·Î ±× Àǹ̸¦ Àß ÀÌÇØÇÏ°í ÀÖ½À´Ï´Ù. Á¶±âÀ§¾Ï ³»½Ã°æ ºÐ·ù¸¦ »ý°¢Çغ¸¸é Àß ÀÌÇØÇÒ ¼ö ÀÖÀ» °ÍÀÔ´Ï´Ù.

¿äÄÁµ¥ ÀϺ» ÀÇ»çµéÁ¶Â÷µµ ¸íÈ®È÷ Á¤ÀÇÇÏÁö ¾Ê°í »ç¿ëÇÏ´Â ¿ë¾î¸¦ ¿ì¸®³ª¶ó ÀÇ»çµéÀÌ µû¶óÇÏ°í ÀÖ´Â ¼ÀÀÔ´Ï´Ù. È¥¶õÀº ´ç¿¬ÇÕ´Ï´Ù. ¿ì¸® ½º½º·Î ÀϺ»À» Èä³»³»´ø ±¸Å¿¡¼­ ¹þ¾î³ª´Â ¼ö ¹Û¿¡ ¾ø½À´Ï´Ù.


3. 2014³â ÀÏ»ê ¹éº´¿ø ÁÖ¹Ì ±³¼ö´Ô ÀÇ°ß (´ëÇÑ»óºÎÀ§Àå°üÇ︮ÄÚ¹ÚÅÍÇÐȸ Ãá°è¿öÅ©¼¥)

´ëÇѺ´¸®ÇÐȸ ¼ÒÈ­±âº´¸®Çבּ¸È¸¿¡¼­ ¹ßÇ¥ÇÑ À§¾Ï º´¸®º¸°í¼­ ±âÀç»çÇ× Ç¥ÁØÈ­ (2005)¿Í ´ëÇÑÀÇÇÐȸ¿¡¼­ ¹ß°£ÇÑ À§¾ÏÇ¥ÁØÁø·á±Ç°í¾È (2012) [ÀÌÁØÇà ñÉ: ºÐ·®À» ¾à°£ ÁÙ¿©¼­ ±Ù°Å±â¹Ý À§¾ÏÁø·á ±Ç°í¾È(´ëÇѼÒÈ­±âÇÐȸÁö 2014)À¸·Î ´Ù½Ã ¹ßÇ¥µÊ]¿¡ ÀÇÇϸé, À§¾ÏÀÇ º´¸® Áø´Ü º¸°í¼­¿¡ À§¾ÏÀÇ Á¶Á÷Çü(histological type)¿¡ ´ëÇÑ ±âÀç´Â ±âº»ÀûÀ¸·Î WHO ºÐ·ù(Ç¥ 1)¸¦ µû¸£¸ç Lauren ºÐ·ù¸¦ Ãß°¡ÇÒ ¼ö ÀÖ´Ù. ½ÇÁ¦·Î ´ëºÎºÐÀÇ º´¸®ÀÇ»çµéÀº ±ÇÀå»çÇ׿¡ µû¶ó ³»½Ã°æ »ý°ËÀÇ °æ¿ì¿¡´Â WHO ºÐ·ù¸¸, ÀýÁ¦ À§¾ÏÀÇ °æ¿ì¿¡´Â WHO ºÐ·ù¿Í Lauren ºÐ·ù¸¦ µ¿½Ã¿¡ ±âÀçÇÏ°í ÀÖ´Ù. À§¾Ï WHO ºÐ·ùÀÇ º´¸®ÇÐÀû Áø´Ü ±âÁØÀº ºñ±³Àû Àß Á¤¸³µÇ¾î ÀÖ°í º¸°í¼­ ÀÛ¼ºÀÇ Ç¥ÁØÈ­µµ »ó´çºÎºÐ ÀÌ·ç¾îÁ® À־ À§¾ÏÀÇ Á¶Á÷ÇÐÀû ºÐ·ù ÀÚüÀÇ Å« ¹®Á¦Á¡Àº ¾ø´Ù.

ÇÑÆí ÀϺ» À§¾Ï ºÐ·ù(Japanese classification of gastric carcinoma - 2nd English edition)¿¡´Â À§¾ÏÀÇ 95%¸¦ Â÷ÁöÇÏ´Â ¼±¾ÏÁ¾(adenocarcinoma)ÀÇ Á¶Á÷ÇÐÀû ¾ÆÇüµé(Ç¥ 2)À» ºÐÈ­Çü(differentiated type)°ú ¹ÌºÐÈ­Çü(undifferentiated type)À¸·Î ³ª´©´Â Á¶Á÷ÇÐÀû ºÐ·ù°¡ ±â¼úµÇ¾î ÀÖ´Ù[ÀÌÁØÇà ñÉ: 2010³â ÀϺ» À§¾Ï Ä¡·á °¡À̵å¶óÀÎ]. ÀÌ ºÐ·ù´Â ¼ÒÈ­±â³»°ú¹× ¿Ü°ú ÀÇ»çµé¿¡°Ô ³Î¸® »ç¿ëµÇ¸ç ƯÈ÷ À§¾ÏÀÇ ³»½Ã°æÄ¡·áÀÇ ÀûÀÀÁõÀÇ ±âÁØÀ¸·Î½á ±× Á߿伺ÀÌ ³ô´Ù. ±×·¯³ª, ¡°¼±¾ÏÁ¾ÀÇ Á¶Á÷ÇÐÀû ºÐ·ù¿¡ µû¸¥ ¹ÌºÐÈ­Çü¡±À̶ó´Â Àǹ̷Π»ç¿ëµÇ´Â ¿ë¾î°¡ ´ÜÀÏÈ­µÇ¾î ÀÖÁö ¾Ê°í ¸Å¿ì ´Ù¾çÇϸç, À§¾Ï WHO ºÐ·ù»ó ¼±¾ÏÁ¾°ú´Â º°°³·Î Á¤ÀÇµÈ ¡°¹ÌºÐÈ­¾ÏÁ¾(undifferentiated carcinoma, ICD-O code: 8020/3)¡±À̶ó´Â ¿ë¾î¿Í È¥µ¿µÉ °¡´É¼ºÀÌ ÀÖ´Ù. ¶ÇÇÑ ÀÌ ºÐ·ù´Â º´¸®º¸°í¼­¿¡´Â ´ëºÎºÐ ±âÀçµÇÁö ¾Ê±â ¶§¹®¿¡, ¼ÒÈ­±â³»°ú ¹× ¿Ü°ú ÀÇ»çµé ³ª¸§ÀÇ ±âÁØÀ» °¡Áö°í ºÐ·ùÇÏ°Ô µÈ´Ù. µû¶ó¼­ ¿©±â¿¡¼­ ¹ß»ýÇÒ ¼ö ÀÖ´Â ¸î °¡Áö ¹®Á¦Á¡¿¡ ´ëÇÑ °íÂûÀÌ ÇÊ¿äÇÏ´Ù°í »ý°¢ÇÑ´Ù.


[3-1. ¡°Undifferentiated¡±¶ó´Â ¿ë¾î¿¡ °üÇÑ °íÂû]

¡°Undifferentiated¡±¶ó´Â ¿ë¾î´Â ÀÇÇÐÀûÀ¸·Îµµ ¾²ÀÓÀÌ ¸¹´Ù. ¿ì¸®¸»·Î´Â ¡°¹ÌºÐÈ­¡±À̸ç, ÀÌ´Â ÀüÇô ºÐÈ­°¡ µÇÁö ¾ÊÀ½À» ÀǹÌÇÑ´Ù. Áï ¿ø½ÃÀûÀÎ ¹Ì¼º¼÷ »óÅ¿¡ ¸Ó¹°¸ç ¾î¶² ÂÊÀ¸·Îµµ ºÐÈ­°¡ µÇÁö ¾ÊÀ½À» ¶æÇÑ´Ù. º´¸® Áø´Ü¿¡¼­µµ undifferentiated tumor¿Í °°Àº ¿ë¾î°¡ »ç¿ëµÇ´Âµ¥, Á¾¾ç¼¼Æ÷°¡ ¸Å¿ì ¹Ì¼º¼÷ÇÏ¿© Á¶Á÷ÇÐÀûÀ¸·Î ¾î¶°ÇÑ ºÐÈ­ÀÇ ±â¹Ìµµ ã¾Æ º¼ ¼ö ¾ø´Â Á¾¾çÀ» ÀÏÄ´´Ù. µû¶ó¼­ Á¾¾çÀÇ Áø´Ü¿¡¼­ ¡°undifferentiated¡±¶ó´Â ¿ë¾î´Â ƯÁ¤ ºÐÈ­ÀÇ Àǹ̸¦ ³»Æ÷ÇÏÁö ¾ÊÀº ¿ë¾îÀÎ tumor, neoplasm, carcinoma, sarcoma µî°ú °°ÀÌ ¾²ÀδÙ. Áï ¡°undifferentiated¡±¶ó´Â ¿ë¾î´Â ƯÁ¤ ºÐÈ­ÀÇ Àǹ̸¦ ³»Æ÷ÇÏ´Â ¿ë¾îÀÎ ¼±¾ÏÁ¾(adenocarcinoma), ÆíÆò¼¼Æ÷¾ÏÁ¾(squamous cell carcinoma), °£¼¼Æ÷¾ÏÁ¾(hepatocellular carcinoma)µî°ú´Â °°ÀÌ ¾µ ¼ö ¾ø´Ù. µû¶ó¼­ À§¾ÏÀÇ Á¶Á÷ÇÐÀû ºÐ·ù»ó¿¡¼­ Á¾Á¾ »ç¿ëµÇ´Â ¡°undifferentiated adenocarcinoma¡±À̶ó´Â ¿ë¾î´Â ÀÏÁ¾ÀÇ Çü¿ë¸ð¼ø(oxymoron)ÀÎ ¼ÀÀÌ´Ù.

ÇÑÆí À§¾Ï WHO ºÐ·ù¿¡ ¸í½ÃµÈ ¹ÌºÐÈ­¾ÏÁ¾(Undifferentiated carcinoma)Àº ¸Å¿ì ¹Ì¼º¼÷ÇÑ Á¾¾ç¼¼Æ÷·Î ±¸¼ºµÇ¾î »óÇǼ¼Æ÷ ±â¿øÀ̶ó´Â ±Ù°Å ÀÌ¿Ü¿¡´Â ¾î¶² ºÐÈ­µµ º¸ÀÌÁö ¾Ê´Â Á¾¾çÀ¸·Î½á Àüü À§¾ÏÀÇ 1% ¹Ì¸¸À¸·Î ¸Å¿ì µå¹°¸ç, ¹ÌºÐÈ­(Á¶Á÷)Çü ¼±¾ÏÁ¾(undifferentiated type adenocarcinoma)°ú´Â ¿ÏÀüÈ÷ ´Ù¸¥ °ÍÀÌ´Ù.


[3-2. ¹ÌºÐÈ­(Á¶Á÷)Çü ¼±¾ÏÁ¾ÀÇ Ç¥±â¹ý¿¡ ´ëÇÑ °íÂû]

ÀϺ» À§¾Ï ºÐ·ù¿¡ ±â¼úµÈ À§¾ÏÀÇ Á¶Á÷ÇÐÀû ºÐ·ù»óÀÇ ¹ÌºÐÈ­(Á¶Á÷)Çü ¼±¾ÏÁ¾À» ´ë»óÀ¸·Î ¿¬±¸ÇÑ ³í¹®µé¿¡¼­ À̸¦ ÁöĪÇÏ´Â µ¥´Â ¸Å¿ì ´Ù¾çÇÑ Ç¥Çö¹æ½ÄÀÌ »ç¿ëµÇ°í ÀÖ´Ù. ¾Æ·¡ÀÇ ¿ë¾îµéÀº ½ÇÁ¦·Î ³í¹®¿¡ »ç¿ëµÈ °ÍµéÀÌ´Ù.

Undifferentiated-type adenocarcinoma or carcinoma or cancer
Undifferentiated type adenocarcinoma or carcinoma or cancer
Undifferentiated adenocarcinoma (or carcinoma)
Adenocarcinoma (or carcinoma) with undifferentiated histology
Adenocarcinoma (or carcinoma) with undifferentiated type histology

»ó±â ¿ë¾îµéÀ» »ìÆ캸¸é, ¹ÌºÐÈ­(Á¶Á÷)Çü¿¡ ´ëÇÑ Ç¥Çö ¹æ½ÄÀÌ ¡°undifferentiated-type¡±, ¡°undifferentiated type¡±, ¡°undifferentiated histology¡±, ¡°undifferentiated type histology¡± ¶Ç´Â ´Üµ¶À¸·Î ¡°undifferentiated¡±¸¸ ¾²ÀÎ °æ¿ì±îÁö ¸Å¿ì ´Ù¾çÇÏ´Ù. °Ô´Ù°¡ carcinoma, adenocarcinoma, cancer±îÁöµµ È¥¿ëÇÔÀ¸·Î½á ¿ë¾îÀÇ È¥¶õÀ» °¡Áß½ÃÅ°°í ÀÖ´Ù. ƯÈ÷ ¡°undifferentiated carcinoma¡±¶ó´Â ¿ë¾î´Â ¾Õ¼­ ¾ð±ÞµÈ ¹Ù¿Í °°ÀÌ WHO À§¾Ï ºÐ·ù ICD-O code 8020/3·Î ºÐ·ùµÇ´Â ¹ÌºÐÈ­¾ÏÁ¾(undifferentiated carcinoma)°ú ¿ë¾î»óÀ¸·Î´Â ÀüÇô ±¸ºÐµÇÁö ¾Ê´Â´Ù. µû¶ó¼­ ¼±¾ÏÁ¾ÀÇ ¹ÌºÐÈ­Á¶Á÷ÇüÀ» ³ªÅ¸³»°íÀÚ ÇÒ ¶§´Â ¡°type¡± ¶Ç´Â ¡°histology¡± µîÀÇ ¿ë¾î¸¦ ÇÔ²² »ç¿ëÇÏ¿© ±¸º°µÇµµ·ÏÇÏ´Â °ÍÀÌ ¹Ù¶÷Á÷ÇÏ´Ù.

¶ÇÇÑ ÀϺ» À§¾Ï ºÐ·ù¿¡ ±â¼úµÈ ºÐÈ­Çü°ú ¹ÌºÐÈ­ÇüÀ¸·ÎÀÇ ±¸ºÐÀº ¾ÏÁ¾(carcinoma) Àüü¸¦ ´ë»óÀ¸·Î ÇÑ °ÍÀÌ ¾Æ´Ï¶ó ¼±¾ÏÁ¾(adenocarcinoma)¸¸À» ´ë»óÀ¸·Î ÇÑ °ÍÀ̹ǷΠadenocarcinoma·Î Á¤È®È÷ »ç¿ëÇÏ´Â °ÍÀÌ ¹Ù¶÷Á÷ÇÏ´Ù. µû¶ó¼­ °³ÀÎÀûÀ¸·Î´Â ¹ÌºÐÈ­Çü ¼±¾ÏÁ¾(undifferentiated type adenocarcinoma) ¶Ç´Â ¹ÌºÐÈ­ Á¶Á÷Çü ¼±¾ÏÁ¾(adenocarcinoma with undifferentiated type histology)ÀÌ °¡Àå ÀûÀýÇÑ Ç¥Çö¹æ½ÄÀ̶ó°í »ý°¢ÇÑ´Ù. ±×·¯³ª ÀÌ¿¡ ´ëÇÑ Á» ´õ ¸¹Àº ÀÇ°ß ¼ö·ÅÀÌ ÇÊ¿äÇÒ °ÍÀ¸·Î »ý°¢µÈ´Ù.


[3-3. ¹ÌºÐÈ­(Á¶Á÷)Çü ¼±¾ÏÁ¾À¸·Î ±¸ºÐµÇ´Â ¼±¾ÏÁ¾ÀÇ ¾ÆÇüµé¿¡ °üÇÑ °íÂû]

ÀϺ» À§¾Ï ºÐ·ù (1998)¿¡ ¾ð±ÞµÈ ºÐÈ­Çü, ¹ÌºÐÈ­ÇüÀ¸·ÎÀÇ Á¶Á÷ÇÐÀû ±¸ºÐ¿¡ ´ëÇÑ ±â¼úÀº ¾Æ·¡¿Í °°ÀÌ ¸Å¿ì °£´ÜÇÏ´Ù.

¡®In clinicopathological or epidemiological studies, papillary or tubular adenocarcinoma can be interpreted as differentiated or intestinal type whereas "por" and "sig" can be regarded as the undifferentiated or diffuse type. Mucinous carcinoma can be interpreted as either intestinal or diffuse, depending upon the other predominant elements (pap, tub, por or sig)¡¯.

ÀϺ»ÀÇ ¼±¾ÏÁ¾ ºÐ·ù¹ýÀº WHO ºÐ·ù¿Í Å« Â÷À̸¦ º¸ÀÌÁö´Â ¾ÊÁö¸¸ ¸î °¡Áö ¼­·Î ´Ù¸¥ ¿ë¾î¸¦ »ç¿ëÇÏ°í ÀÖ´Ù. WHO ºÐ·ù¿¡¼­´Â tubular adenocarcinoma¸¦ well, moderately, poorly differentiated·Î ³ª´©´Â ¹Ý¸é, ÀϺ» ºÐ·ù¹ý¿¡¼­´Â well, moderately differentiatedÀÎ °æ¿ì¸¸ tubular adenocarcinoma·Î ºÎ¸£°í poorly differentiatedÀÎ °æ¿ì´Â poorly differentiated adenocarcinoma, solid type(por 1)À¸·Î ºÎ¸¥´Ù. WHO ºÐ·ù»ó poorly cohesive carcinoma´Â ÀϺ» ºÐ·ù»óÀ¸·Î´Â poorly differentiated adenocarcinoma, non-solid type(por 2)¿¡ ÇØ´çµÈ´Ù. µû¶ó¼­ ÀϺ» ºÐ·ù»ó tubular adenocarcinoma´Â ¸ðµÎ ºÐÈ­Çü(differentiated type)¿¡ ÇØ´çµÇÁö¸¸, WHO ºÐ·ù»ó¿¡¼­´Â tubular adenocarcinoma¶óµµ poorly differentiatedÀÎ °æ¿ì´Â ¹ÌºÐÈ­Çü, ³ª¸ÓÁö´Â ºÐÈ­Çü¿¡ ÇØ´çµÈ´Ù.

ÇÑÆí Á¡¾×¼º¼±¾ÏÁ¾(mucinous adenocarcinoma)ÀÇ °æ¿ì´Â ºÐÈ­Çü ¶Ç´Â ¹ÌºÐÈ­ÇüÀ¸·Î ³ª´µ¾î ºÐ·ùµÉ ¼ö ÀÖ´Ù´Â Ãß°¡ÀûÀÎ ±â¼ú¿¡ ÁÖ¸ñÇÒ ÇÊ¿ä°¡ ÀÖ´Ù. Á¡¾×¼º¼±¾ÏÁ¾Àº Á¶Á÷ÇÐÀûÀ¸·Î ¼¼Æ÷¿ÜÁ¡¾×(extracellular mucin) ³»¿¡ Á¾¾ç¼¼Æ÷°¡ ¶°ÀÖ´Â ÇüŸ¦ ÃëÇϴµ¥, À̶§ Á¾¾ç¼¼Æ÷°¡ ¼±±¸Á¶¸¦ Àß Çü¼ºÇÏ´Â °æ¿ì¿Í ¼±±¸Á¶¸¦ Çü¼ºÇÏÁö ¾Ê°í ÀÎȯ¼¼Æ÷(signet ring cell)¸¦ ÈçÈ÷ Æ÷ÇÔÇÏ´Â °æ¿ì·Î ³ª´©¾îÁö±âµµ ÇÑ´Ù. Áï ¼¼Æ÷¿ÜÁ¡¾×À» Á¦¿ÜÇÏ°í Á¾¾ç¼¼Æ÷ÀÇ ÇüŸ¸ °í·ÁÇÏ¿© ºÐÈ­ÇüÀÎÁö ºñºÐÈ­ÇüÀÎÁö¸¦ ³ª´©´Â ¹æ½ÄÀε¥, ÀÌ °æ¿ì ¹ÌºÐÈ­Çü Á¡¾×¼º¼±¾ÏÁ¾ÀÌ ºÐÈ­Çü Á¡¾×¼º¼±¾ÏÁ¾¿¡ ºñÇÏ¿© ¿¹ÈÄ°¡ ³ª»Ú´Ù´Â º¸°í°¡ ÀÖ´Ù. µû¶ó¼­ »ó±â ±â¼úÀº Á¡¾×¼º¼±¾ÏÁ¾À» ºÐÈ­Çü°ú ¹ÌºÐÈ­ÇüÀ» ÀçºÐ·ù ÈÄ °¢°¢ ºÐÈ­Çü, ¹ÌºÐÈ­ÇüÀ¸·Î ºÐ·ùÇ϶ó´Â Àǹ̷ΠÇؼ®ÇÒ ¼ö ÀÖ´Ù. ±×·¯³ª ÀÌ ºÎºÐ ¿ª½Ã Ãß°¡ÀûÀÎ ³íÀÇ°¡ ÇÊ¿äÇÒ °ÍÀ¸·Î »ý°¢µÈ´Ù.

¹ÌºÐÈ­Çü ¼±¾ÏÁ¾(undifferentiated type adenocarcinoma)À̶ó´Â ¿ë¾î´Â Çü¿ë¸ð¼ø¾îÀÌ°í ¹ÌºÐÈ­¾ÏÁ¾(undifferentiated carcinoma)¿Í È¥µ¿ µÉ ¼ö ÀÖ´Ù´Â Á¡¿¡¼­´Â »ç¿ëÀ» Áö¾çÇØ¾ß ÇÒ °ÍÀ¸·Î »ý°¢µÈ´Ù. ±×·¯³ª ÀÌ ¿ë¾î°¡ ¼ÒÈ­±â³»°ú ¹× ¿Ü°ú ÀÇ»çµé¿¡°Ô ³Î¸® ¾Ë·ÁÁ® ÀÖ°í Áß¿äµµ°¡ ³ô´Ù´Â Á¡¿¡¼­ ÀÌ¿¡ ´ëÇÑ Çʿ伺Àº ¾ÕÀ¸·Îµµ °è¼ÓµÉ °¡´É¼ºÀÌ ³ô´Ù. µû¶ó¼­ ¿ë¾î·Î ÀÎÇÑ È¥¶õ°ú ¿ÀÇظ¦ ÃÖ¼ÒÇÑÀ¸·Î ÁÙÀ̱â À§ÇÑ °í¹Î°ú ÀûÀýÇÑ ¹æ¾ÈÀÌ ÇÊ¿äÇÏ´Ù°í »ý°¢ÇÑ´Ù.


4. ÀÌÁØÇàÀÇ ÀÇ°ß (2014³â)

1) WHO¿¡¼­ ¾ð±ÞÇÑ undifferentiated carcinoma´Â ±×´ë·Î ÀÎÁ¤ÇØ¾ß ÇÕ´Ï´Ù. ¿ì¸®¸»·Î´Â ¹ÌºÐÈ­¾ÏÀÔ´Ï´Ù.

2) "Undifferentiated histology´Â differentiated type histology ¿¡ »ó¹ÝµÇ´Â °³³äÀ¸·Î poorly differentiatd adenocarcinoma or signet ring cell carcinoma¸¦ ÀǹÌÇϴ ǥÇö"À̶ó´Â º´¸®°ú ¼±»ý´ÔÀÇ ÀÇ°ß¿¡ µ¿ÀÇÇÕ´Ï´Ù. Undifferentiated type histologyÀº ¿ì¸®¸»·Î '¹ÌºÐÈ­Á¶Á÷Çü'ÀÔ´Ï´Ù. À̸¦ '¹ÌºÐÈ­¾Ï'À¸·Î ºÎ¸£¸é ¾È µË´Ï´Ù.

3) Signet ring cell carcinoma°¡ carcinomaÀÎ °ÍÀº ¸Â½À´Ï´Ù. ±×·¯³ª tubular adenocarcinoma´Â ¾Æ´Õ´Ï´Ù. µû¶ó¼­ P/D¿Í signet ring cell carcinoma¸¦ Æ÷ÇÔÇÑ °³³äÀ» undifferentiated adenocarcinoma¶ó°í ºÎ¸£´Â °ÍÀº ºÎÀûÀýÇÕ´Ï´Ù.

4) µû¶ó¼­ ¾Æ·¡¿Í °°ÀÌ ¿ä¾àÇÒ ¼ö ÀÖ½À´Ï´Ù.

Gastric carcinomas with differentiated type histologyW/D & M/D adenocarcinoma.
Gastric carcinomas with undifferentiated type histologyP/D adenocarcinoma & signet ring cell carcinoma1. ¹«Ã´ Çò°¥¸®´Â ¸»À̹ǷΠ°¡±ÞÀû ¾²Áö ¾Ê´Â °ÍÀÌ ÁÁ°Ú½À´Ï´Ù.
2. WHOÀÇ undifferentiated carcinoma(¹ÌºÐÈ­¾Ï)¿Í ºÐ¸íÈ÷ ´Ù¸¥ °³³äÀÔ´Ï´Ù.

5) ¿©±â±îÁö Á¤¸®ÇØ º¸¾ÒÀ¸³ª ¿©ÀüÈ÷ ¹®Á¦´Â ³²½À´Ï´Ù. 'ÀÖ´Ù'´Â 'ÀÖ´Ù'°í '¾ø´Ù'´Â '¾ø´Ù'ÀÔ´Ï´Ù. 'Á¶±Ý ÀÖ´Ù'´Â 'ÀÖ´Ù'ÀÔ´Ï´Ù. Poorly differentiated, Áï ÀúºÐÈ­´Â ¾à°£¸¸ ºÐÈ­µÇ¾ú´Ù´Â ¶æÀÔ´Ï´Ù. ºÐÈ­³Ä ¾Æ´Ï³Ä¸¦ µûÁöÀÚ¸é 'ºÐÈ­' ÂÊÀÔ´Ï´Ù. Poorly differentiated´Â differentiatedÀÎ °ÍÀÔ´Ï´Ù. À̸¦ ¹«¸®Çؼ­ undifferentiated·Î ºÎ¸£´Ï ÀÌ»óÇÑ °ÍÀÔ´Ï´Ù. Áï '(Á¶±Ý) ÀÖ´Ù'¸¦ '¾ø´Ù'·Î ºÎ¸£´Â ¼ÀÀÌ´Ï ÀÌ»óÇÑ °ÍÀÔ´Ï´Ù. ÀϺ»½Ä differentiated/undifferentiated ºÐ·ùÀÇ ¸ð¼øÀÔ´Ï´Ù. ¼­¾ç»ç¶÷µéÀº Àý´ë·Î ÀÌÇØÇÒ ¼ö ¾ø½À´Ï´Ù. °á±¹ ¿øÁ¡À¸·Î µ¹¾Æ°¡´Â À̾߱âÀÔ´Ï´Ù¸¸, ¿ì¸®´Â ÀϺ»½Ä ºÐ·ù¸¦ ¾²Áö ¸»°í WHO ºÐ·ù¸¸ ¾²´Â °ÍÀÌ ÁÁ°Ú´Ù´Â »ý°¢ÀÔ´Ï´Ù.

ÀϺ» º´¸®ÀÇ»çµéÀº ³ª¸§´ë·ÎÀÇ °íÁýÀÌ ÀÖ½À´Ï´Ù. ÀÌ´Â À߸øµÈ °ÍÀÌ ¾Æ´Õ´Ï´Ù. ´Ù¸¸ ¿ì¸®¿Í ´Ù¸¦ »ÓÀÔ´Ï´Ù. ¿ì¸®³ª¶ó º´¸®ÀÇ»çµéµµ ³ª¸§´ë·ÎÀÇ °íÁýÀÌ ÀÖ½À´Ï´Ù. ÀÌ ¶ÇÇÑ À߸øµÈ °ÍÀÌ ¾Æ´Õ´Ï´Ù. ´Ù¸¸ ÀϺ» º´¸®ÀÇ»çµéº¸´Ù ¿ì¸®³ª¶ó º´¸®ÀÇ»çµéÀÌ WHO ºÐ·ù¿¡ ´õ °¡±î¿ï »ÓÀÔ´Ï´Ù.

ÀϺ» ³»½Ã°æÀÇ»çµéÀº ÀϺ» º´¸®ÀÇ»çµé°ú ÇÔ²² ÀÏÇÕ´Ï´Ù. ÆÄÆ®³ÊÀÎ ÀϺ» º´¸®ÀÇ»çÀÇ °ßÇØ¿Í ¿ë¾î°¡ ÀϺ» ³»½Ã°æÀÇ»çÀÇ Çൿ°ú ±Û¾²±â¿¡ ³ì¾Æµé¾î °¥ ¼ö ¹Û¿¡ ¾ø½À´Ï´Ù. ¿ì¸® ³»½Ã°æÀÇ»ç´Â ¿ì¸® º´¸®ÀÇ»ç¿Í ÇÔ²² ÀÏÇØ¾ß ÇÕ´Ï´Ù. ¿ì¸® º´¸®ÀÇ»çÀÇ °ßÇØ¿Í ¿ë¾î¸¦ Á¸ÁßÇÏ°í ÇÔ²² ¹ßÀüÇØ¾ß ÇÕ´Ï´Ù.

¹®Á¦ÀÇ ½ÃÀÛÀº ¿ì¸® ³»½Ã°æÀǻ簡 ¿ì¸® º´¸®ÀÇ»çÀÇ °ßÇØ¿Í ¿ë¾îº¸´Ù ÀϺ» ³»½Ã°æÀÇ»çÀÇ °ßÇØ¿Í ¿ë¾î¿¡ ´õ Àͼ÷ÇÏ´Ù´Â °ÍÀÔ´Ï´Ù. »ç½Ç Àúµµ ¿ì¸® º´¸®Àǻ簡 ¾´ ³í¹®º¸´Ù ÀϺ» ³»½Ã°æÀǻ簡 ¾´ ³í¹®À» ´õ ¸¹ÀÌ º¸°í ÀÖ½À´Ï´Ù.

¿ª»çÀûÀ¸·Î ÀϺ»ÀÌ À§³»½Ã°æºÐ¾ß¸¦ ¼±µµÇß½À´Ï´Ù. ±×·¡¼­ ÀϺ»À» Âü°íÇÏÁö ¾ÊÀ» ¼ö ¾ø½À´Ï´Ù. ¿¹Àü¸¸Àº ¸øÇÏÁö¸¸ ¾ÆÁ÷µµ »ó´çÇÑ ¿µÇâ·ÂÀÌ ³²¾ÆÀֱ⠶§¹®¿¡ ¾î¿ ¼ö ¾ø´Â Ãø¸éµµ ÀÖ½À´Ï´Ù. ±×·¯³ª ÀÌÁ¦ºÎÅÍ´Â ¿ì¸® ½º½º·Î Á» ´õ Á¶½É½º·´°í ÁøÁöÇØÁú ÇÊ¿ä°¡ ÀÖ´Ù°í »ý°¢ÇÕ´Ï´Ù. ÀϺ»°ú ¿ì¸®ÀÇ Â÷À̸¦ Á¤È®È÷ ÀνÄÇÑ »óÅ¿¡¼­ ³ÃöÇÑ Åµµ·Î ºñÆÇÀû ±ÛÀб⸦ ½ÃÀÛÇսôÙ. ÀÏ»ó Áø·á¿¡¼­ ±×¸®°í ³í¹® ¾²±â¿¡¼­ ¿ë¾î¸¦ Á» ´õ ÁÖÀÇÇÏ¿© »ç¿ëÇսôÙ. ¿ì¸® º´¸®ÀÇ»ç¿Í Á» ´õ ¼ÒÅëÇÏ¿© ¿ì¸®ÀÇ ¹æ½ÄÀ» ¿ì¸® ½º½º·Î ¸¸µé¾î ³ª°©½Ã´Ù.


[FAQs]

[2014-3-29. ¾Öµ¶ÀÚ 1]

ÀϺ» º´¸®ÀÇ»ç ±³À°°úÁ¤¿¡´Â differentiated vs. undifferentiated ¾ÏÀ» ±¸ºÐÇÏ´Â ¾È¸ñÀ» Å°¿ì±â À§ÇÑ ±ä °úÁ¤ÀÌ ÀÖ´Ù°í ÇÕ´Ï´Ù.

ºñ±³Àû ºÐ·ù°¡ ½¬¿î °©»ó¼±¾ÏºÎÅÍ ½ÃÀÛÇؼ­ ºñ´¢±â°è, »êºÎÀΰú°è ¾Ï µî...±×¸®°í °¡Àå ¸¶Áö¸·¿¡ È¥µ·ÀÌ ¸¹°í ¾î·Á¿î À§Àå°ü¾ÏÀÇ differentiated vs. undifferentiated¾ÏÀ» Áø´Ü³»¸®´Â ÈƷðúÁ¤À» °ÅÄ£´Ù°í µé¾ú½À´Ï´Ù. WHO ºÐ·ù¸¦ µû¸£¶ó´Â ¼­¾çÀÇ ¾Ð¹Ú¿¡µµ ºÒ±¸ÇÏ°í ÀÌ °úÁ¤À» °íÁýÇÏ´Â ÀÌÀ¯´Â Ä¡·á¹æħ °áÁ¤°ú ¿¹ÈÄ ÆÇ´Ü¿¡ ´õ Àß µé¾î¸Â±â ¶§¹®À̶ó°í ÇÕ´Ï´Ù. ¿¹¸¦ µé¸é, °©»ó¼±¾ÏÀÇ °æ¿ì, ¹ÌºÐÈ­Çü¾Ï¸¸ ¼ö¼úÀû ÀýÁ¦¸¦ ¿äÇÏ´Â °æ¿ì°¡ ¸¹Àºµ¥, WHO ±âÁØÀ» µû¸£´Ùº¸¸é °ÅÀÇ ¸ðµç °¨»ó¼±¾ÏÀ» ¼ö¼úÇÏ°Ô µÇ±â¿¡, À̸¦ ¸·±â À§Çؼ­¶óµµ ÀϺ» º´¸® ºÐ·ù¸¦ °íÁýÇÒ ¼ö ¹Û¿¡ ¾ø´Ù´Â ¼³¸íÀÔ´Ï´Ù.

À§¾Ï¿¡¼­ÀÇ ºÐÈ­Çü/¹ÌºÐÈ­Çü ¿ë¾î »ç¿ë ÀÚÁ¦ ÀÌÈÄ¿¡ "¸»µµ ¾È µÈ´Ù. PD + signet ring cell ca = ¹ÌºÐÈ­¾ÏÀ̶ó´Â °É °ÅºÎÇϸé, Áö±ÝÀÇ Çѱ¹°ú ÀϺ»ÀÇ ºÐÈ­Çü : ¹ÌºÐÈ­Çü ¾ÏÀÇ ºñÀ²Àº ¾î¶»°Ô ¼³¸íÇÒ °ÍÀ̳Ä, ±×·¯¸é ¿Ö ÀϺ»¿¡¼­ ºÐÈ­Çü ¾ÏÀÌ ±×·¸°Ô ¸¹³Ä"°í ¹Ý¹ßÇϽô ±³¼ö´ÔµéÀÌ °è¼Ì´Âµ¥, ÀÌ´Â ´ÙÀ½°ú °°ÀÌ º¸Á¶ ¼³¸íÀ» ÇÏ½Ã¸é µÉ °Í °°½À´Ï´Ù.

±¹Á¦ ¾Ï ¿¬±¸¼Ò¿¡ µî·ÏµÈ ÀϺ» À§¾Ï Áß ¾à 1/3Àº Á¡¸·³»¾ÏÀ̰ųª WHO ±âÁØ»ó ÀÌÇü¼ºÁõÀ» Áö´Ñ ¼±Á¾¿¡ ÇØ´çÇÏ´Â Á¾¾çµéÀÔ´Ï´Ù. À̵éÀÌ ÀϺ» ³í¹®¿¡¼­´Â ¸ðµÎ ºÐÈ­Çü ¾ÏÀ¸·Î º¸°íµÇ±â¿¡, ¿ì¸®³ª¶ó ¼±»ý´ÔµéÀÌ »ý°¢ÇϽô ºÐÈ­Çü ¾Ï(MD 90% + signet ring cell 10%)ÀÌ ÀϺ»¿¡¼­´Â ¹ÌºÐÈ­ÇüÀ¸·Î ºÐ·ùµÇ´õ¶óµµ, ÀϺ»¿¡¼­´Â ¿©ÀüÈ÷ ºÐÈ­Çü ¾ÏÀÌ ¸¹À» ¼ö ¹Û¿¡ ¾ø´Â °ÍÀÔ´Ï´Ù. ÀϺ» À§¾Ï Áöħ¼­¿¡´Â "°íµµÀÇ ÀÌÇü¼ºÁõÀ» Áö´Ñ ¼±Á¾"À̶õ ¿ë¾î ÀÚü°¡ ¾ø½À´Ï´Ù.

[2014-5-16. ´ëÀü KINGCA À§¾ÏÇÐȸ ¿¬¼¼´ë ±¸¿¬]

¿¬¼¼´ëÇб³¿¡¼­ 'Is new criteria for mixed histology is necessary for endoscopic resection in EGC?'¶ó´Â Á¦¸ñÀÇ ¹ßÇ¥¸¦ ÇÏ¿´½À´Ï´Ù. Á¦°¡ Èï¹Ì·Ó°Ô º» °ÍÀº Japanese classificationÀÔ´Ï´Ù. ¿ì¸®´Â ÈçÈ÷ ÀϺ»¿¡¼­ ¸»ÇÏ´Â differentiated cancer´Â WHO ºÐ·ù·Î well-differentiated¿Í moderately-differentiated adenocarcinoma¸¦ ÇÕÇÑ °Í°ú ºñ½ÁÇÏ´Ù°í »ý°¢ÇÕ´Ï´Ù. ±×·±µ¥ À̹ø ¹ßÇ¥¸¦ º¸´Ï ÀϺ» ºÐ·ù¿¡¼­ differentiated°¡ 49.7%ÀÎ ¹Ý¸é well-differentiated¿Í moderately-differentiated adenocarcinomaÀÇ ÇÕÀº 48%¿´½À´Ï´Ù. Áï 2% Â÷ÀÌ°¡ ÀÖ½À´Ï´Ù. ÀÌ È¯ÀÚµéÀº ¾î¶² Á¶Á÷ÇÐÀû Ư¡ÀÎ ÀÖ´ÂÁö ±Ã±ÝÇÒ »ÓÀÔ´Ï´Ù. ÀϺ» ºÐ·ù¸¦ WHO ºÐ·ù¿Í mappingÇÏ´Â ÀÏÀº ¹«Ã´ ¾î·Á¿î ÀÏÀÔ´Ï´Ù. 2% ºÎÁ·ÇÕ´Ï´Ù.


[2016-11-26/27] ÀϺ»°ú ¿ì¸®³ª¶óÀÇ undifferentiated typeÀÌ Â÷ÀÌ¿¡ ´ëÇÑ ¾Öµ¶ÀÚ ÆíÁö

¿À´Ã ¿¬¶ôÀ» µå¸®´Â ÀÌÀ¯´Â 'ºÐÈ­Çü À§¾Ï¡¯°ú '¹ÌºÐÈ­Çü À§¾Ï'¿¡ ´ëÇÑ ºÐ·ù°¡ Çмú´ëȸ ¿¬ÀÚÀÇ °­ÀÇ·Ï¿¡¼­Á¶Â÷ Âü°í¹®Çå ¾øÀÌ À߸ø ±â¼úµÇ¾î ÀÖ°í, ´ëºÎºÐÀÇ Ã»ÁßÀº ¹«¾ùÀÌ ¿Ö Ʋ¸°Áö Á¶Â÷ ¸ð¸£°í ÀÖ´Ù´Â °É ´À²¼±â ¶§¹®ÀÔ´Ï´Ù. EndoTODAY¿¡¼­µµ ¿©·¯ Â÷·Ê ´Ù·ç¾îÁּ̱⿡ Áö±ÝÂëÀº ¡°¿Ö Çѱ¹º´¸®Àǻ簡 Æǵ¶ÇÑ WD, MD, PD, Sig, Muc À§¾ÏÀ» ÀϺ»º´¸®Àǻ簡 Æǵ¶ÇÑ ºÐÈ­Çü/¹ÌºÐÈ­ÇüÀ¸·Î ¸¶À½´ë·Î ºÐ·ùÇÏ¸é ¾È µÇ´ÂÁö¡±¸¦ ´ëºÎºÐ ¾Ë°í °è½Ç °Å¶ó »ý°¢ÇÏ°í ÀÖ´ø ÅͶó ¸Å¿ì Ãæ°ÝÀûÀ̾ú½À´Ï´Ù.

¿äÁ¡ºÎÅÍ ¸»¾¸µå¸®ÀÚ¸é 'WD + MD = ºÐÈ­Çü', 'PD + Sig + Muc = ¹ÌºÐÈ­Çü'ÀÌ ¾Æ´Õ´Ï´Ù. ¾ÏÀÇ ºÐÈ­µµ¿Í Á¶Á÷°è´Â ¾ö¿¬È÷ ´Ù¸£±â¿¡ muc À§¾ÏÀÇ ÀϺδ ºÐÈ­Çü¿¡ ÇØ´çÇÕ´Ï´Ù. ¶ÇÇÑ, ÀϺΠMD´Â PD³ª sig¿Í È¥ÀçµÇ¾î ÀÖ¾î ¹ÌºÐÈ­Çü À§¾Ï¿¡ ÇØ´çµÇ¹Ç·Î, WHOºÐ·ùÀÇ MD À§¾ÏÀÌ ÀϺ»º´¸®±âÁØ»ó ºÐÈ­Çü À§¾ÏÀϰŶó°í ´ÜÁ¤Áþ´Â °ÍÀº ¸Å¿ì À§ÇèÇÕ´Ï´Ù.

½ÇÁ¦·Î À߸øµÈ ÀÌÁߺзù¹ýÀ¸·Î ÀÎÇØ ÀÇ·á¼Ò¼Û±îÁö °£ »ç·ÊµéÀÌ À־ ÀϺθ¦ Á¤¸®Çؼ­ º¸³»µå¸³´Ï´Ù. https://avance-media.com/iryou/36281177/

º¯È£»çÀÇ ¼³¸íÀ» ¿ä¾àÇÏ¸é ´ÙÀ½°ú °°½À´Ï´Ù.

ÀÌ¿Ü¿¡ À¯»ç ÀÇ·á¼Ò¼ÛÁõ·ÊµéÀ» ´Ù·é º¯È£»çµéÀÌ Á¤¸®ÇØ µÐ ÁÖÀÇ»çÇ×µéÀº ´ÙÀ½°ú °°½À´Ï´Ù.

°á·ÐÀûÀ¸·Î, ºÐÈ­Çü/¹ÌºÐÈ­ÇüÀ§¾ÏÀº º´¸®Àǻ簡 ÀϺη¯ ½Ã°£À» ³»¼­ ÀϺ»ÀÌÁߺзù¹ý¿¡ ±âÁØÇÏ¿© Æǵ¶Çؼ­ Ãß°¡·Î ±âÀÔÇÏÁö ¾Ê´Â ÇÑ ÆÇ´ÜÇÒ ¼ö ¾øÀ¸¸ç, WHO ±âÁØÀ¸·Î º´¸®Àǻ簡 Æǵ¶ÇÑ WD, MD, PD, Sig, Muc À§¾ÏÀ» ÀÓ»óÀǻ簡 ¸¶À½´ë·Î ºÐÈ­Çü/¹ÌºÐÈ­ÇüÀ¸·Î ºÐ·ùÇÏ´Â °ÍÀº Ʋ¸° Áö½ÄÀ̶ó°í ¸»¾¸µå¸®°í ½Í½À´Ï´Ù.

Ãß½Å: °ø½ÄÆǵ¶±âÁØÀڷḦ ÆÄÀϷΠ÷ºÎÇÕ´Ï´Ù (PDF file, ÀϺ»¾îÀÔ´Ï´Ù).

´ÙÀ½Àº ÷ºÎÈ­ÀÏÀÇ 4ÂÊ¿¡ Àִ ǥ·Î¼­ MucÀº PD, Sig¿Í °¢°¢ ´Ù¸¥ ÄÚµå·Î ºÐ·ùÇÏ°í ÀÖÀ¸¸ç, ºÐÈ­Çü/¹ÌºÐÈ­ÇüÀº ÀÌ¿Í º°µµ·Î º´¸®Àǻ簡 µû·Î ±âÀçÇϵµ·Ï µÇ¾î ÀÖ½À´Ï´Ù.

àÍäß, NOSAdenocarcinoma, NOS8140/3
êáÔéàÍäßPapillary adenocarcinoma (pap)8260/3
ηßÒàÍäß
- ÍÔÝÂûùúþ
- ñéÝÂûùúþ
Tubular adenocarcinoma (tub)
- well differentiated type (tub1)
- moderately differentiated type (tub2)
8211/3
- 8211/31
- 8211/32
î¸ÝÂûùàÍäß
- õöãùúþ
- Þªõöãùúþ
Poorly differentiated adenocarcinoma (por)
- solid type (por1)
- non-solid type (por2)
8140/33
- 8140/33
- 8140/33
ìÔü»á¬øàäßSignet-ring cell carcinoma (sig)8490/3
ïÄäûäßMucinous adenocarcinoma (muc)8480/3
àÍø·øÁß¾ù«äßAdenosquamous carcinoma8560/3
ø·øÁß¾ù«äßSquamous cell carcinoma8070/3


[°°Àº ¼±»ý´Ô²²¼­ ´ÙÀ½ ³¯ Ãß°¡·Î º¸³»ÁֽŠÆíÁö]

¾îÁ¦ º¸³»µå¸° ÷ºÎÈ­ÀÏ (êÖ stomach)Àº ¾Æ·¡ ¸ñÂ÷ Áß¿¡¼­ À§¾Ï¿¡ ÇØ´çµÇ´Â ºÎºÐÀ¸·Î¼­, º´¸®°á°úÁö Çü½ÄÀº 1ÀåÀÎ Ãѷп¡ ÀÖÀ¸¸ç, ¿äûÇϽŠ´äº¯Àº ÷ºÎÈ­ÀÏ (ICD-O-3 ÀÌ¿ëÀÇ ½ÇÁ¦)¿¡ ÀÖ½À´Ï´Ù.

÷ºÎÈ­ÀÏ (ICD-O-3 ÀÌ¿ëÀÇ ½ÇÁ¦) Áß "ºÐÈ­Çü/¹ÌºÐÈ­ÇüÀº ÀÌ¿Í º°µµ·Î º´¸®Àǻ簡 µû·Î ±âÀçÇϵµ·Ï ÇÑ´Ù"´Â ÇØ´ç ºÎºÐ¸¸ ¿À·Á¼­ Ãß°¡¼³¸íÀ» µå¸®ÀÚ¸é, º´¸®°á°úÁö ±âÀçÇü½ÄÀº ´ÙÀ½°ú °°½À´Ï´Ù.

À§¾Ï¿¡¼­ÀÇ ¿¹¸¦ Ãѷп¡¼­ ¼Ò°³ÇÑ °ÍÀε¥, ¼¼Æ÷ ÇüŸ¦ ¸ÕÀú ¾Õ¿¡ Àû°í ±× µÚ¿¡ ºÐÈ­µµ¸¦ º°µµ·Î µû·Î Àûµµ·Ï µÇ¾î ÀÖ½À´Ï´Ù. ÀÌ ¿øÄ¢¿¡ ÁØÇÏ¿© ¾îÁ¦ º¸³»µå¸° ÷ºÎÈ­ÀÏ (êÖ stomach) 7ÂÊ Ç¥6ÀÇ table footnote ù ÁÙ¿¡ ´ÙÀ½°ú °°ÀÌ ÀûÇô ÀÖ½À´Ï´Ù. "ºÐÈ­µµ¸¸ ±âÀçÇÒ °æ¿ì, 8140/3(¼±¾Ï)À» ä¿ëÇÑ´Ù. ¿¹: ÁߺÐÈ­¾Ï 8140/32" Áï, º´¸®Á¶Á÷¸í°ú ºÐÈ­µµ¸¦ °¢°¢ ±âÀçÇÏ´Â °ÍÀÌ ¿øÄ¢Àε¥, ¼¼Æ÷ÇüÀ» ÀûÁö ¾Ê°í ºÎµæÀÌÇÏ°Ô ºÐÈ­µµ¸¸ ±âÀçÇÏ´Â °æ¿ì¿¡´Â Á¶Á÷¸íÀ» 8140/3À¸·Î °£ÁÖÇÏ°Ú´Ù´Â ºÎ¿¬¼³¸íÀÔ´Ï´Ù.

ÇöÀç ÀϺ»º´¸®ÀÇ»çµéÀº °³Á¤µÈ À§ ±âÁØ¿¡ ¸ÂÃç¼­ ¼¼Æ÷Çü°ú ºÐÈ­µµ¸¦ °¢°¢ ±âÀçÇϴµ¥, 'differentiated-type = ¿ì¸®³ª¶ó º´¸®Àǻ簡 Æǵ¶ÇÑ Lauren¡¯s intestinal-type'¿¡ °¡±õ°í, 'undifferentiated-type = Lauren¡¯s diffuse-type'¿¡ °¡±õÁö 'PD + Sig + Muc'Àº ¾Æ´Ï¶ó°í ÇÕ´Ï´Ù.

µû¶ó¼­ ¿ì¸®³ª¶ó À§¾Ï ³í¹®¿¡´Â ºÐÈ­Çü/¹ÌºÐÈ­Çü ´ë½Å¿¡ intestinal/diffuseÀ̶ó´Â º´¸®Æǵ¶ÀÌ ±âÀçµÇ¾î¾ß ÇÕ´Ï´Ù. ºñ·Ï mixed-type ¶§¹®¿¡ °í¹ÎµÇ´õ¶óµµ ±×°ÍÀÌ Áø½ÇÀ̱⠶§¹®ÀÔ´Ï´Ù. À̸¦ ÁöÅ°Áö ¾Ê¾ÒÀ» ¶§, ¹ß»ýÇÒ ¼ö ÀÖ´Â ±¸Ã¼ÀûÀÎ ¿ì¸®³ª¶ó ¿¹¸¦ ÇÑ°¡Áö¸¸ µé¾îº¸°Ú½À´Ï´Ù.

ÇöÀç ¿ì¸®³ª¶ó¿¡¼­´Â '¹ÌºÐÈ­¾Ï'À̶ó°í ºÐ·ùµÇ°í ÀÖÁö¸¸, ÀÌ Áõ·Ê´Â ¾ö¿¬È÷ Lauren¡¯s intestinal-typeÀ¸·Î¼­ ÀϺ»¿¡¼­´Â 'ºÐÈ­¾Ï'À̶ó°í ºÐ·ùµË´Ï´Ù. Áï, À§¿Í °°Àº Áõ·Ê´Â ¾ç±¹ º´¸®ÀÇ»çµéÀÌ ¸ðµÎ 'ºÐÈ­µµ°¡ ÁÁÀº ¾Ï'À̶ó°í ºÐ·ùÇϴµ¥, ¿ì¸®³ª¶ó ÀÓ»óÀÇ»çµé¸¸ À̸¦ '¹ÌºÐÈ­¾Ï'À̶ó°í ¸¶À½´ë·Î À߸ø ºÐ·ùÇÏ´Â ¿À·ù°¡ ÇàÇØÁö°í ÀÖ¾î ´ä´äÇؼ­ ¾îÁ¦ ¸ÞÀÏÀ» µå·È¾ú½À´Ï´Ù. ¾ðÁ¨°¡ EndoTODAY¸¦ ÅëÇØ Áø½ÇÀ» ¾Ë·ÁÁֽñ⠹ٶø´Ï´Ù.


[2017-1-24. ÀÌÁØÇà ÀÇ°ß]

´Ê¾ú½À´Ï´Ù¸¸, ÁÁÀº ÀÇ°ß °¨»çÇÕ´Ï´Ù. ºÐÈ­Çü/¹ÌºÐÈ­Çü ºÐ·ùÀÇ Á߿伺°ú È¥¼±À» Àß ÁöÀûÇØ Áּż­ °¨»çÇÕ´Ï´Ù. ƯÈ÷ ÇÑÀÏ ¾ç±¹ÀÇ Â÷ÀÌÁ¡¿¡ ´ëÇÑ Á¤º¸´Â ¸Å¿ì À¯¿ëÇß½À´Ï´Ù.

¿ì¸®°¡ ÈçÈ÷ WHO ºÐ·ù¿¡ µû¸¥ W/D¿Í M/D´Â ºÐÈ­ÇüÀ¸·Î, P/D¿Í SRC´Â ¹ÌºÐÈ­ÇüÀ¸·Î °£ÁÖÇÏ°í ÀÖÁö¸¸, ÀϺ»¿¡¼­´Â ¿ì¸®¿Í ´Ù¸£°Ô ºÐ·ùÇÏ°í ÀÖ´Ù´Â Á¡ÀÌ ÁöÀûµÇ¾ú´Ù°í »ý°¢ÇÕ´Ï´Ù. Ÿ´çÇÑ ÁöÀûÀÔ´Ï´Ù. ±×·¯³ª ¸î °¡Áö Àǹ®Á¡ÀÌ ³²¾Æ ÀÖ½À´Ï´Ù.

ÀÏÀü¿¡ ¼±»ý´Ô²²¼­ Á¦¾ÈÇϽŠ¹Ù¿Í °°ÀÌ º´¸®°ú Àǻ簡 º´¸® º¸°í¼­¿¡ ºÐÈ­ÇüÀÎÁö ¹ÌºÐÈ­ÇüÀÎÁö ¸íÈ®ÇÏ°Ô ½á ÁÖ°í, ³»°ú ÀÇ»ç´Â º´¸®°ú ÀÇ»çÀÇ ¸»À» ±×´ë·Î °¡Á®´Ù ¾²´Â °ÍÀÌ ÃÖ¼±ÀÔ´Ï´Ù. º´¸®°ú ÀÇ»çÀÇ º¸°í¼­ ³»¿ëÀ» ±âÃÊ·Î ³»°ú Àǻ簡 Àû´çÈ÷ ´Ù¸¥ ¸»·Î ¹Ù²Ù¾î »ç¿ëÇϰųª regrouping ÇÏ´Â °ÍÀº ÁÁÀº ¹æ¹ýÀÌ ¾Æ´Õ´Ï´Ù.

ÀϺ» µ¥ÀÌŸ¸¦ ¹Ù¶óº¼ ¶§¿¡´Â ¿ì¸®ÀÇ ¿ë¾î¿Í ÀϺ»ÀÇ ¿ë¾î°¡ Ç¥ÇöÀº °°¾Æµµ ³»¿ëÀÌ ´Ù¸£´Ù´Â Á¡À» °í·ÁÇØ¾ß ÇÒ °Í °°½À´Ï´Ù. ºñ´Ü ÀÇÇлӸ¸ ¾Æ´Ï¶ó ¸¹Àº ºÐ¾ß¿¡¼­ Àü¹®¿ë¾îÀÇ »ç¿ë¹ýÀÌ ¾ç±¹°£¿¡ Å« Â÷ÀÌ°¡ ÀÖ½À´Ï´Ù.

ÇâÈÄ ¿ì¸®³ª¶ó¿¡¼­ 'ºÐÈ­Çü/¹ÌºÐÈ­Çü' ¿ë¾î¸¦ ¾î¶»°Ô »ç¿ëÇÒ °ÍÀΰ¡¿¡ ´ëÇÑ Åä·ÐÀÌ ÀÖ¾î¾ß ÇÒ °ÍÀÔ´Ï´Ù. ÇöÀçó·³ ±×³É ´ëÃæ »ç¿ëÇÏ´Â °ÍÀº ¿ÇÁö ¾Ê´Ù´Â Á¡¿¡ µ¿ÀÇÇÕ´Ï´Ù. °¨»çÇÕ´Ï´Ù.


[2017-1-25. ¾Öµ¶ÀÚ ´äº¯]

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¿¹¸¦ µé¸é, ³»½Ã°æ Á¶Á÷°Ë»ç»ó¿¡¼­ À§¾ÏÀÌ Áø´ÜµÇ¾îµµ º´¸®Æǵ¶Áö¿¡ Lauren's classificationÀÌ ¾øÀ¸¹Ç·Î, °á±¹ ³»½Ã°æÀû ÀýÁ¦¼úÀ» ÇÒÁö °áÁ¤Çϱâ À§Çؼ­ ½º½º·Î "WHOºÐ·ù»óÀÇ WD+MD À§¾ÏÀº ÀϺ»ºÐ·ù»óÀÇ ºÐÈ­Çü¾Ï", "³ª¸ÓÁö Á¶Á÷ÇüÀº ¹ÌºÐÈ­¾Ï"À̶ó°í °£ÁÖÇÑ µÚ, ³»½Ã°æ ÀýÁ¦¼úÀÇ Àý´ëÀûÀÀÁõÀÎÁö È®´ëÀûÀÀÁõÀÎÁö ÆÇ´ÜÇÏ°í ÀÖ´Â ¼ÀÀÔ´Ï´Ù. ¿Ü°úÀÇ»çµéµµ ºñ½ÁÇÑ ½ÉÁ¤ÀϰŶó »ý°¢Çϴµ¥, ¼ö¼ú ÈÄ º´¸®Æǵ¶Áö¿¡ Lauren's classificationÀÌ mixed typeÀ̶ó´Â µµ¿ò ¾ÈµÇ´Â Æǵ¶À» º¼ ¶§¸¶´Ù Çö½Ç°úÀÇ ±«¸®°¡ ½ÉÇØÁ®¼­, ³»°úÀÇ»çµé°ú ¸¶Âù°¡Áö ÀÔÀåÀÌ µÇ´Â °ÍÀ̶ó »ý°¢ÇÕ´Ï´Ù.

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Lauren¿¡¼­´Â poorly differentiated adenocarcinoma´Â °í·ÁµÇÁö ¾Ê¾Ò½À´Ï´Ù. (didn't consider ¶Ç´Â intermediate)

Japanese ¹æ½Ä¿¡¼­´Â WHO ¹æ½ÄÀÇ (1) poorly differentiated tubular adenocarcinoma¿Í (2) poorly cohesive carcinoma Áß signet ring cell carcinoma°¡ ¾Æ´Ñ °ÍÀ» °¢°¢ Por1 (solid type)°ú Por2 (non-solid type)À¸·Î Ç¥ÇöÇÕ´Ï´Ù.

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[Cases]

2015³â. °í·É ȯÀÚ¿¡¼­´Â À§¾Ï°ú ÇÔ²² ´Ù¸¥ ÁúȯÀÌ ¹ß°ßµÇ±âµµ ÇÕ´Ï´Ù. ÀÌ °æ¿ì´Â multiple myeloma¿´½À´Ï´Ù. À§¾ÏÀÇ Á¶Á÷°Ë»ç´Â poorly differentiated carcinoma¿´°í, CT¿¡¼­ regional node µé°ú ÇÔ²² º¹¸·ÀüÀÌ°¡ ÀǽɵǾú½À´Ï´Ù. O & C°¡ µÉ È®·üÀÌ ³ô¾Æ¼­ »çÀü¿¡ ¿­½ÉÈ÷ ¼³¸íÇÏ¿´½À´Ï´Ù. ¾Æ½±°Ôµµ ¼ö¼úÀå¿¡¼­ º¹¸· ÀüÀÌ°¡ È®ÀεǾú½À´Ï´Ù.

¾Æ¹«¸® poorly cohesive¶óÁö¸¸ ÀþÀº Á¶±âÀ§¾Ï ȯÀÚ¿¡°Ô ¸Íµ¶¼ºÀ̶ó´Â Ç¥ÇöÀº Áö³ªÄ¡±º¿ä.


[References]

1) EndoTODAY À§¾Ï Á¶Á÷Çü°ú ºÐÈ­µµ

2) EndoTODAY Undifferentiated type ¹ÌºÐÈ­Á¶Á÷ÇüÀ̶ó´Â ¿ë¾î¿¡ ´ëÇÏ¿©

3) EndoTODAY Expanded indication/criteria

4) Á¶±âÀ§¾Ï ³»½Ã°æ Ä¡·á ÈÄ º´¸®ÇÐÀû Æò°¡ (2017. ÀÎÁ¦ÀÇ´ë º´¸®°ú ÁÖ¹Ì) °­ÀÇ µ¿¿µ»ó

°­ÀÇ µ¿¿µ»ó

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