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부울경소화기내시경학회 6월집담회 고신대학교복음병원소화기내과전임의서광일

F/63 CASE C.C) epigastric pain for 2 wks P. I) 2014.04.16 EGD at LMC adm via OPD for further evaluation.

P. Hx) CASE HTN/DM/Hepatitis/Tbc (+/+/-/-) S. Hx) N-S

ROS) CASE general weakness/weight loss (-/-) fever/chilling/myalgia/headache (-/-/-/-) Anorexia/nausea/vomiting (-/-/-) dyspepsia/dysphagia (+/-) postprandial epigastric soreness (+)

P. Ex) General appearance CASE alert mentality/not illing being appearance HEENT : N-S Chest : N-S Abdomen : N-S Extremity : N-S

Laboratory CBC 12.9 g/dl 9600 /ul - 240K /ul S-GOT/S-GPT 29 / 39 IU/L Total bilirubin/direct bilirubin 0.5 / 0.2 mg/dl Protein /Albumin 7.8 / 4.9 g/dl BUN/ Cr 20.5 / 0.83 mg/dl Na/ K 147 / 4.1 meq/l PT (INR) / PTT 12.3 (0.91) / 35.0 sec LDH 391 IU/L HS-CRP 0.06 mg/dl Total cholesterol 191 mg/dl CEA 0.96 ng/ml CA 19-9 3.90 U/ml

Image

LMC (04.16)

본원 (04.28)

본원 (05.02)

본원 Pathology (04.28)

본원 Pathology (04.28 05.09) p53

본원 Pathology (04.28 05.09) Ki67

본원 Pathology (05.02)

본원 OP (05.22)

Diagnosis Stomach, total gastrectomy: - Early gastric carcinoma, (pt1an0) 1. Location: upper third, center at upper body, posterior wall 2. Gross type: EGC type llc 3. Histologic type: tubular adenocarcinoma, well-differentiated 4. Histologic type by Lauren: intestinal 5. Size: 1.5x0.4x0.1cm 6. Depth of invasion: invades mucosa(lamina propria) (pt1b) 7. Resection margin: free from the carcinoma (safety margin: distal 16.5cm, proximal 2cm) 8. Lymph node metastasis: no metastasis in 33 regional lymph nodes --- 1(0/10), 2(0/0), 3(0/5), 4(0/2), 4D(0/0), 4S(0/0), 5(0/2), 6(0/4), 7(0/2), 8(0/2), 9(0/1), 11(0/1), 14(0/4) 9. Lymphatic invasion: not identified 10. Venous invasion: not identified 11. Perineural invasion: not identified

P. Hx) S. Hx) N-S CASE HTN/DM/Hepatitis/Tbc (+/+/-/-) EGD (`2011) : r/o EGC at LMC Gastritis on repeated Bx. at KUGH

LMC (`10.12.21)

본원 (`11.01.11)

본원 Pathology (`11.01.11)

본원 (`11.01.17)

본원 Pathology (`11.01.17)

본원 (`11.03.18)

본원 Pathology (`11.03.18)

본원 (`11.06.28)

본원 Pathology (`11.06.28)

본원 (`11.11.01)

본원 Pathology (`11.11.01)

2010.12.21 r/o adenocarcinoma 2011.01.11 Indefinite focal dysplasia 2011.03.18 Focal metaplasia 2011.06.28 Active gastritis 2011.11.01 Active gastritis 2014.04.28 Adenocarcinoma Time

Korean J Gastroenterol 2012;60:224-228

2001 년 1 월 ~ 2010 년 12 월 고신대학교복음병원 조직학적위암진단 (9,990 명 ) 수술, 내시경치료 (7,460 명 ) 항암약물치료 (2,112 명 ) 전원, 추적불가 (391 명 ) 치료거부 (27 명 ) 내시경추적관찰 (12 명 ) Korean J Gastroenterol 2012;60:224-228

12 명, 평균 39.8 개월 (4-121 개월 ) 추적관찰, 3 명 (25%) 진행위암 평균발육진전기간 : 9.6 개월 (5~12 개월 ) Korean J Gastroenterol 2012;60:224-228

생존중앙값 : 40 개월 5 년생존율 : 45% Korean J Gastroenterol 2012;60:224-228

Osaka cancer registery file (~ 1988.10) 1. Endoscopic Dx. 2. Biopsy confirm 3. No resection at least 6 mons 10 yrs f/u (1988~1998) Natural course of EGC (56 cases) 20 case remained in EGC 36 case progressed to AGC Gut 2000;47:618 621

Mean duration of Remained in EGC 44 mons 5 yrs risk for progressing To the advanced stage 63% Hazard rate ratio for stomach ca. 0.51 Gut 2000;47:618 621

initial 12 m 25 m 74 m 68 m 30 m Gastrointestinal Endoscopy 60(3):476-80

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