44개월간의 경과관찰 중에 악성으로 변화한 위 간질종양 1예
Malignant Transformation of Gastric Gastrointestinal Stromal Tumor in 44 Months Observational Period: A Case Report
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초록
위장관 간질종양은 간엽조직 기원의 종양 중 가장 흔한 종양이다. 위장관 간질 종양은 3 cm 이하의 크기인 경우 환자의 나이, 순응도, 건강상태, 검사자의 악성 의심 정도에 따라 추적검사를 해야 한다고 알려져 있고, 약 2년마다 내시경초음파 추적 검사를 하여, 2번의 내시경초음파에서 크기의 변화가 없다면, 추적검사기간을 늘릴 수 있다고 하였다. 하지만 저자들은 양성의 내시경초음파 소견 및 3 cm 이하의 위장관 간질종양으로 내원한 45세 여자에서 약 44개월간 3번의 추적 내시경 검사에서 크기 변화가 없다가, 마지막 추적 내시경 검사 6개월 후 복부 불편감으로 내원하여 시행한 내시경초음파 검사에서 크기의 변화는 없으나, 표면에 궤양 형성을 보이고, 내부의 비 균질 에코를 보여 시행한 쐐기 절제술에서 악성 위장관 간질종양으로 확진한 증례를 경험하여 고찰과 함께 보고한다.
Abstract
Gastrointestinal stromal tumor is a common type of gastrointestinal mesenchymal tumor. Depending on the patient’s age, compliance and health status, and the level of suspicion of malignancy, tumors ≤3 cm in size are typically monitored annually by endoscopic ultrasonography. The examination interval can be extended if no size change is noted on consecutive examinations. We report here on a 44-year-old female who presented with abdominal discomfort and displayed no size change of her gastrointestinal stromal tumor on three consecutive endoscopies over a 44- month interval. The patient was diagnosed with malignant gastrointestinal stromal tumor on the basis of the evident ulceration seen on esophagogastroduodenoscopy and the inhomogenous echo noted on the endoscopic ultrasonography and the pathologic findings by gastric wedge resection.
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