department of internal medicine samsung medical center · 2017. 7. 8. · department of internal...

Superficial Esophageal Cancer

R4. Heejung Kim Department of Internal medicine

Samsung Medical Center

ESD indication

Superficial esophageal cancer

Superficial esophageal cancer

Japanese Classification of esophageal cancer, 11th edition : Part II and III, Japan esophageal society

Superficial esophageal cancer

Superficial esophageal cancer

Superficial esophageal cancer

Superficial esophageal cancer

Superficial esophageal cancer의 내시경적 소견

• Faint hyperemia

• Change of microvasculature

• Eroded/ulcerated

• Mucosal thickening

• Coarsening of the mucosa

• Multiple white mucosal plaques

• NBI magnifying endoscopy (NBI-ME)

• Lugol’s solution apply : Lugol-voiding lesion

Biopsy

• Is, III >> IIc > IIa > IIb

• 종양의 표면에 과립상이 불규칙하게 있는 경우

• 종양의 주변부 융기가 동반된 경우

• 종양의 크기가 큰 경우

• 식도 굴곡이 많아 정확한 관찰 어려움

• 미소침윤이 있는 경우 실제보다 심달도 얕게 판단됨

Submucosa >> Mucosa Esophageal cancer

Mucosal cancer

-

Squamous cell carcinoma in-situ, 1.2x0.4cm Basement membrane in ESD

Superficial esophageal cancer

Squamous cell carcinoma in-situ, 3x1.5cm confined to mucosa, LN(-), Op

Superficial esophageal cancer

Squamous cell carcinoma MD, 0.7x0.6cm Lamina propria, LN(-), ESD

Superficial esophageal cancer

STG 이후에 EJ junction 에 발생

Squamous cell carcinoma MD, 1.8x0.6cm Lamina propria, LN(-), Op

Superficial esophageal cancer

Squamous cell carcinoma MD, 0.4x0.4cm Lamina propria, LN(-), ESD+Ablation

Superficial esophageal cancer

Squamous cell carcinoma MD, 3x2.5cm Lamina propria, LN(-), Op

Superficial esophageal cancer

Squamous cell carcinoma MD, 1x0.6cm Muscularis mucosa, LN(-), Op

Superficial esophageal cancer

Squamous cell carcinoma MD, 1.6x0.5cm Muscularis mucosa, LN(-), ESD

Superficial esophageal cancer

SQUAMOUS CELL CARCINOMA (MD)

Initially referred for ESD

R/O T1aN1

Lesion : superficial flat mucosa >> submucosa

Lt.lower paratracheal LN >1cm, LN meta

Enlarged LN was found in staging w/u

Rare case of lymph node metastasis in M2 esophageal cancer

Squamous cell carcinoma (MD);

1) tumor size: 1.3x0.3 cm (lower esophagus)

2) extension to mucosa (lamina propria)

3) multifocal mucosal high grade dysplasia

4) endolymphatic tumor emboli: not identified

5) perineural invasion: not identified

6) negative resection margins

(proximal, 6.5 cm ; distal, 13 cm)

7) metastasis to 1 out of 41 regional LN

Submucosal cancer

Squamous cell carcinoma MD, 2.5x2cm Submucosa, LN(-), Op

Superficial esophageal cancer

Squamous cell carcinoma MD, 1.5x1.5cm Submucosa, LN(-), Op

Superficial esophageal cancer

Squamous cell carcinoma, 2x1cm Submucosa, LN(-), Op

Superficial esophageal cancer

Squamous cell carcinoma MD, 2.7x2cm Submucosa, LN(-), Op

Superficial esophageal cancer

Squamous cell carcinoma MD, 3x2.5cm Submucosa, LN(-), Op

Superficial esophageal cancer

Squamous cell carcinoma WD, 2.5x2cm Submucosa(SM3),

endolymphatic tumor emboli, LN(-), Op

Superficial esophageal cancer

Squamous cell carcinoma MD, 2.5x1.5cm Submucosa, LN(+)1/22, Op

Superficial esophageal cancer

Squamous cell carcinoma, 1.3x0.8cm Submucosa, LN(+) 2/40, Op

Superficial esophageal cancer

Squamous cell carcinoma MD, 2.9x1.2cm Submucosa, LN(+) 1/42, Op

Superficial esophageal cancer

Conclusion

환자의

전처지

고해상도

내시경 장비

식도 자세히 관찰

마음가짐

내시경

의사 경험

감사합니다