내시경 점막절제술로 진단된 점막하종양과 유사한 형태를 보인 조기 위선암 1예
A Case of Submucosal Tumor-like Early Gastric Adenocarcinoma Diagnosed by Endoscopic Mucosal Resection
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초록
내시경 육안소견에서 점막하종양의 특징을 보이는 조기 위암의 예는 드물다. 종양의 표면이 정상 점막으로 덮혀 있기 때문에 반복적인 조직생검으로 정확한 조직학 진단을 얻는 것은 어렵다. 악성 점막하 종양을 시사하는 소견으로는 3～5 cm 이상의 크기, 빠른 성장, 내시경 초음파 검사에서 비균질 에코, 불규칙한 변연 등이 제시된 바 있으며 진단율 향상을 위해 올가미를 이용한 내시경 부분 절제나, 초음파 유도하 세침 흡인검사 등이 권장되기도 한다. 저자들은 육안적으로 점막하 종양의 특징을 보이나 내시경 점막 절제술을 통한 조직학 검사에서 조기위암으로 진단된 1예를 경험하였기에 문헌고찰과 함께 보고한다.
Abstract
In rare cases, early gastric cancer resembles the endoscopic features of a submucosal tumor (SMT). A correct histological diagnosis is difficult with repeated biopsy specimens because they are covered with normal mucosa. Some features known to suggest malignant SMT include a size greater than 3 to 5 cm, a rapid growth rate, echoheterogeneity and irregular margins on endoscopic ultrasonography (EUS). Various techniques including US- guided biopsy, partial removal by an endoscopic snare excision, as well as EUS with a fine needle aspiration were used to enhance the diagnostic accuracy. We recently experienced a case of early gastric cancer, presenting as a submucosal tumor-like lesion, which was confirmed by endoscopic mucosal resection. We report this case with a review of the relevant literature.
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