조기위암과 동반된 사르코이드증 1예
Systemic Sarcoidosis Associated with Early Gastric Cancer
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초록
악성종양을 가진 환자에서 림프절 비대가 관찰될 때 악성 종양의 림프절 전이와 사르코이드증 혹은 사르코이드 반응과 같은 양성질환을 감별해야 한다. 사르코이드증에서 악성 종양의 발생에 대한 보고는 최근까지 많이 이루어 졌으나 위암과 동반하여 발생한 사르코이드증의 국내 보고는 없었다. 건강검진 내시경에서 조기위암으로 진단 받은 환자가 내원하여 시행한 흉부 X선 촬영에서 양측 폐문 림프절 비대가 관찰되어 흉부 전산화 단층 촬영, 조직 검사 등을 시행하여 사르코이드증으로 진단하였고 조기위암에 대해서는 내시경 점막하 박리술을 시행한 후 추적관찰 중인 환자를 경험하였기에 보고한다.
Abstract
For a potentially malignant lymphadenopathy, it is clinically important to distinguish between metastasis of a primary tumor and a benign lesion such as systemic sarcoidosis or sarcoid reaction. We describe here a case of systemic sarcoidosis that was associated with early gastric cancer. A patient was found to have early gastric cancer (EGC) during routine clinical examination. The chest radiography demonstrated bilateral hilar lymphadenopathy and further examination showed that he had multiple lymphadenopathies. We diagnosed systemic sarcoidosis with EGC because of the elevated serum ACE-I, the chest CT findings and the pathological analysis. We performed endoscopic submucosal dissection (ESD) for EGC, and there was no local recurrence and distant metastasis for eighteen months. These findings suggest that the possibility of systemic sarcoidosis should be considered in cases with established malignancy and multiple lymphadenopathies.
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