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직장 신경내분비종양의 진단과 치료

Diagnosis and Treatment of Rectal Neuroendocrine Tumor

신현덕
대한내과학회 (The Korean Association Of Internal Medicine)|2014.10|대한내과학회지 (The Korean Journal of Medicine)|제87권 제4호|pp. 415-423|DOI http://dx.doi.org/10.3904/kjm.2014.87.4.415

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참고문헌

키워드

PrognosisEndoscopic treatment직장Rectum예후Neuroendocrine tumor신경내분비종양내시경 치료
주제분류내과학

초록

Rectal neuroendocrine tumors (NETs) are not uncommon. Recently, the incidence of rectal NETs has increased markedly due tothe widespread use of screening colonoscopy. Most rectal NETs detected incidentally are asymptomatic and at an early stage atdiagnosis. Typical NETs < 10 mm in size and confined to the submucosal layer can be resected completely using various endoscopictreatments. These NETs have a good prognosis. However, not all NETs necessarily have good prognoses; those > 10 mm insize, with ulceration or depression, muscularis invasion seen on endoscopic ultrasonography (EUS), lymphovascular invasion, or ahigh mitotic index histologically are associated with metastasis. Generally, NETs < 10 mm can be treated endoscopically, whilethose > 20 mm should be resected surgically. The treatment of NETs between 10 and 20 mm is controversial. For these, it is necessaryto choose an effective, safe primary resection method to ensure complete resection and to perform a careful histological examinationof the resected tissue.

Abstract

Rectal neuroendocrine tumors (NETs) are not uncommon. Recently, the incidence of rectal NETs has increased markedly due tothe widespread use of screening colonoscopy. Most rectal NETs detected incidentally are asymptomatic and at an early stage atdiagnosis. Typical NETs < 10 mm in size and confined to the submucosal layer can be resected completely using various endoscopictreatments. These NETs have a good prognosis. However, not all NETs necessarily have good prognoses; those > 10 mm insize, with ulceration or depression, muscularis invasion seen on endoscopic ultrasonography (EUS), lymphovascular invasion, or ahigh mitotic index histologically are associated with metastasis. Generally, NETs < 10 mm can be treated endoscopically, whilethose > 20 mm should be resected surgically. The treatment of NETs between 10 and 20 mm is controversial. For these, it is necessaryto choose an effective, safe primary resection method to ensure complete resection and to perform a careful histological examinationof the resected tissue.

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