내시경 점막하 박리술로 진단된 상피하종양으로 발현한 위 신경내분비암 1예
A Case of Neuroendocrine Carcinoma Presenting as a Subepithelial Tumor Diagnosed by ESD
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초록
위에서 발생하는 신경 내분비 암은 매우 드물며 진단하기 쉽지가 않다. 상대적으로 맥관의 침윤도가 높고 조기 전이 소견을 보여 예후도 좋지 않다. 특히 소화불량이나 오심 등의 비특이적 증상뿐 아니라 내시경 검사 소견에서도 선암과의 구별이 쉽지 않다. 국내에서 보고된 증례들의 경우, 대부분 선암으로 진단된 뒤 수술후 생검된 조직검사 및 면역화학 염색 검사 결과를 통해 진단되었다. 저자는 55세의 남자가 건강검진에서 우연히 상피하종양이 발견되어 내시경 점막하 박리술을 권유 받은 후 추적 소실되었고 4년 후 상부위장관 내시경 검사에서 종양의 크기 증가로 인하여 내시경 점막하 박리술을 받고 고분화 신경내분비암으로 진단된 증례를 경험하여 고찰과 함께 보고한다.
Abstract
A gastric neuroendocrine carcinoma is very rare, and the histological diagnosis is very difficult. These carcinomas result in a poor prognosis because they are preceded by severe lymphovascular invasion and early metastasis. In particular, it is difficult to distinguish between adenocarcinoma and neuroendocrine carcinoma by endoscopy when no specific symptoms are present (e.g., dyspepsia, nausea). According to published articles in Korea, most cases were diagnosed as adenocarcinoma initially; however, they were confirmed postoperatively as neuroendocrine carcinoma based on a histological examination using immunohistochemical staining. A case of a 55-year-old man, who had an incidental finding of a subepithelial tumor during his health check-up, was recommended for an endoscopic submucosal dissection (ESD). But the patient was lost to follow-up for 4 years. When he was examined again, the size of the tumor had increased from the previous exam. He underwent ESD and was diagnosed with a well-differentiated neuroendocrine carcinoma.
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