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