단분절 바렛식도에서 발생한 식도선암 2예
Two Cases of Adenocarcinoma Arising from Short Segment Barrett's Esophagus
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초록
바렛식도는 하부식도가 특수화된 원주상피로 변형된 것으로 식도선암의 중요한 발생인자로 알려져 있다. 위내시경 검사에서 위식도접합부 상방으로 편평원주상피접합부가 상승되어 있으면서 조직검사에서 배상세포(goblet cell)가 관찰되는 불완전 장상피화생이 보일 경우 진단이 가능하며, 편평원주상피접합부가 위식도접합부 상방으로 3 cm 이상 상승된 장분절 바렛식도와 3 cm 미만으로 상승된 단분절 바렛식도로 분류된다. 이 중 장분절 바렛식도는 내시경 소견으로 쉽게 진단이 가능하지만 단분절 바렛식도의 경우는 진단에 어려움이 있다. 최근 cytokeratin (CK) 면역염색법에서 특징적인 바렛 CK 7/20 양상은 바렛식도의 진단뿐만 아니라 위장의 장상피화생과의 감별진단에도 유용하다는 보고가 있다. 저자들은 위식도 역류 질환이 있고, 위내시경검사에서 편평원주상피접합부의 고분화 선암이 발견되어 위식도 역류에 의한 단분절 바렛식도에 합병된 식도선암 의심하에 내시경적 점막절제술 시행 후, 절제조직의 H&E 염색, alcian blue 염색, CK 면역염색법에서 단분절 바렛식도에 합병된 조기 식도선암으로 생각되는 2예를 경험하였기에 이를 보고한다.
Abstract
Barrett's esophagus is considered as a premalignant condition in which columnar epithelium replaces the normal esophageal squamous epithelium. The diagnosis of Barrett's esophagus is based on the endoscopic finding of columnar epithelium lining the distal esophagus and histologic confirmation of the presence of specialized intestinal metaplasia. According to the extent of the metaplastic lining from the esophagogastric junction, Barrett's esophagus has been divided into long-segment (≥3 cm in length) and short-segment (＜3 cm in length). Long- segment Barrett's esophagus can be easily identified at endoscopy, but it is difficult to separate short-segment Barrett's esophagus from intestinal metaplasia of cardia. It has been reported that Barrett's CK 7/20 pattern is an objective marker of Barrett's mucosa, and can differentiate Barrett's mucosa from gastric intestinal metaplasia. We report here two cases of adenocarcinoma of esophagus arising from short-segment Barrett's esophagus, diagnosed by endoscopic and histologic findngs, and treated by endoscopic mucosal resection.
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