Department of Internal medicine Samsung Medical Center · 2017. 7. 8. · Department of Internal...
Transcript of Department of Internal medicine Samsung Medical Center · 2017. 7. 8. · Department of Internal...
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Superficial Esophageal Cancer
R4. Heejung Kim Department of Internal medicine
Samsung Medical Center
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ESD indication
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Superficial esophageal cancer
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Superficial esophageal cancer
Japanese Classification of esophageal cancer, 11th edition : Part II and III, Japan esophageal society
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Superficial esophageal cancer
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Superficial esophageal cancer
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Superficial esophageal cancer
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Superficial esophageal cancer
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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
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• 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
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Mucosal cancer
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Squamous cell carcinoma in-situ, 1.2x0.4cm Basement membrane in ESD
Superficial esophageal cancer
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Squamous cell carcinoma in-situ, 3x1.5cm confined to mucosa, LN(-), Op
Superficial esophageal cancer
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Squamous cell carcinoma MD, 0.7x0.6cm Lamina propria, LN(-), ESD
Superficial esophageal cancer
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STG 이후에 EJ junction 에 발생
Squamous cell carcinoma MD, 1.8x0.6cm Lamina propria, LN(-), Op
Superficial esophageal cancer
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Squamous cell carcinoma MD, 0.4x0.4cm Lamina propria, LN(-), ESD+Ablation
Superficial esophageal cancer
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Squamous cell carcinoma MD, 3x2.5cm Lamina propria, LN(-), Op
Superficial esophageal cancer
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Squamous cell carcinoma MD, 1x0.6cm Muscularis mucosa, LN(-), Op
Superficial esophageal cancer
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Squamous cell carcinoma MD, 1.6x0.5cm Muscularis mucosa, LN(-), ESD
Superficial esophageal cancer
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SQUAMOUS CELL CARCINOMA (MD)
Initially referred for ESD
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R/O T1aN1
Lesion : superficial flat mucosa >> submucosa
Lt.lower paratracheal LN >1cm, LN meta
Enlarged LN was found in staging w/u
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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
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Submucosal cancer
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Squamous cell carcinoma MD, 2.5x2cm Submucosa, LN(-), Op
Superficial esophageal cancer
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Squamous cell carcinoma MD, 1.5x1.5cm Submucosa, LN(-), Op
Superficial esophageal cancer
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Squamous cell carcinoma, 2x1cm Submucosa, LN(-), Op
Superficial esophageal cancer
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Squamous cell carcinoma MD, 2.7x2cm Submucosa, LN(-), Op
Superficial esophageal cancer
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Squamous cell carcinoma MD, 3x2.5cm Submucosa, LN(-), Op
Superficial esophageal cancer
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Squamous cell carcinoma WD, 2.5x2cm Submucosa(SM3),
endolymphatic tumor emboli, LN(-), Op
Superficial esophageal cancer
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Squamous cell carcinoma MD, 2.5x1.5cm Submucosa, LN(+)1/22, Op
Superficial esophageal cancer
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Squamous cell carcinoma, 1.3x0.8cm Submucosa, LN(+) 2/40, Op
Superficial esophageal cancer
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Squamous cell carcinoma MD, 2.9x1.2cm Submucosa, LN(+) 1/42, Op
Superficial esophageal cancer
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Conclusion
환자의
전처지
고해상도
내시경 장비
식도 자세히 관찰
마음가짐
내시경
의사 경험
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감사합니다