점막하 종양의 형태를 보인 진행성 위암 2예
Two Cases of Advanced Gastric Carcinomas Showing Features of Submucosal Tumors
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점막하 종양과 유사한 형태의 위암의 빈도는 절제된 위암의 0.2∼0.62% 정도로 매우 드물다. 최근 저자 등은 내시경 소견에서 위의 점막하 종양과 구분하기 어려웠던 위암 2예를 경험하였는데, 1예는 흑색변을 주소로 내원한 58세 남자 환자에서 중앙의 궤양성 병변을 동반한 3 cm의 점막하종양의 형태를 보인 종괴가 전정부 후벽에 관찰되어 수술적 절제를 실시하여 회복하였다. 수술 후 조직 검사에서 위 림프상피종양 암종(lymphoepitheloma-like carcinoma)으로 진단하였다. 다른 1예는 소화 불량을 주소로 내원한 64세 남자 환자에서 체상부 대만에 궤양을 동반하면서 주변은 정상 점막으로 덮여 있는 4 cm의 종괴가 보였고, 면역조직화학염색에서 vimentin에 대해 양성인 횡문양 암(rhabdoid tumor)의 특징을 동반한 분화도가 나쁜 선암이었다. 수술적 치료를 실시하였으나 환자는 2개월 후에 다발성 간 전이로 사망하였다. 서로 다른 임상 경과를 보였던 점막하 종양과 유사한 진행성 위암 2예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.
Abstract
Gastric carcinoma showing the features of a submucosal tumor (SMT) is extremely rare. The incidence of this type of tumor has been reported to be 0.1∼0.63%. We report two cases of advanced gastric carcinomas showing the features of SMT. A 58-year-old man visited our hospital with a melena. An endoscopic examination revealed a 3.0 cm sized protruding lesion on the posterior wall of the gastric antrum. Most of the tumor surface was covered with normal mucosa and ulceration was observed in the center. Although the histological diagnosis could not be obtained prior to surgery, a gastrectomy was performed due to the high risk of malignancy. The tumor was diagnosed histologically as a lymphoepithelioma-like carcinoma. The other patient was a 64-year-old man with the chief complaint of epigastric discomfort. An endoscopic examination revealed a SMT like lesion with a central ulceration and hard coated exudate in the high body of the stomach. The microscopic examination revealed a poorly differentiated vimentin-positive adenocarcinoma. Unfortunately, he died from the disease two months later. (Korean J Gastrointest Endosc 2007;35:175-180)
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