2018년 4월 19일 목요일

Refractory ulcer로 의뢰되신 lymphoepithelioma-like carcinoma (adenocarcinoma with lymphoid stroma)

2달 간격으로 3번 내시경 검사를 받으셨고, 마지막 조직검사에서 signet ring cell carcinoma가 나왔습니다. 최종 병리는 carcinoma with lymphoid stroma로 나왔습니다. Lymphoepithelioma-like carcinoma라고 부르는 타입입니다. Lymphoid stroma 사이에 미분화조직형 위암이 박혀있는 형태이므로, 육안적으로는 SMT 비슷하게 보이고, 조직검사의 false negative가 많은 것 같습니다.

 
Early gastric carcinoma 
1. Location : lower third, Center at antrum and greater curvature 
2. Gross type : EGC type IIc 
3. Histologic type : carcinoma with lymphoid stroma 
4. Histologic type by Lauren : mixed 
5. Size : 3.8x1.9 cm 
6. Depth of invasion : invades mucosa (muscularis mucosae) (pT1a) 
7. Resection margin: free from carcinoma 
8. Lymph node metastasis : no metastasis in 17 regional lymph nodes (pN0) 
9. Lymphatic invasion : not identified 
10. Venous invasion : not identified 
11. Perineural invasion : not identified 
12. AJCC stage by 8th edition: pT1a N0


+++++

Lymphoepithelioma-like carcinoma(LELC)는 비인두암과 조직학적으로 유사하고, 림프구성 간질을 가진 미분화된 위종양입니다. Epstein-Barr 바이러스와의 연관성도 언급되고 있습니다. LELC은 식도, 위, 담관, 타액 선, 폐, 자궁, 피부 등에서 발생합니다. 위 LELC는 전체 위암의 l-4%를 차지하는데 조기위암의 경우 IIa + IIc형이 많으며 진행성 위암의 경우 Borrmann type IV 형이 많다고 합니다. 조기위암의 형태로 나타날 경우는 일반적인 조기위암과 예후가 비슷하나 진행성 위암의 형태를 취할 경우 일반적인 진행성 위암에 비하여 예후가 훨씬 좋은 것으로 알려져 있습니다. 드물게 점막하 종양의 형태로 나타나는 경우도 있어 주의가 필요합니다. (참고: 대한소화기내시경학회지 2004;28:123-126)

관련 저널 하나 소개합니다. Wang HH, Wu MS, Shun CT, Wang HP, Lin CC, Lin JT. Lymphoepithelioma-like carcinoma of the stomach: a subset of gastric carcinoma with distinct clinicopathological features and high prevalence of Epstein-Barr virus infection. Hepatogastroenterology. 1999;46(26):1214-9.

METHODOLOGY: Of 379 patients with gastric adenocarcinoma, from 1993 to 1996, 6 of them with lymphoepithelioma-like carcinoma of stomach were retrospectively studied.

RESULTS: Five patients were females and one patient was male. Their age ranged from 51-75 years with a mean age of 61.5 years. Endoscopically, 2 patients were initially diagnosed as early gastric cancer and the other 4 were diagnosed as advanced gastric cancer. Three patients had tumors located in the lower third of the stomach, while the other three tumors were located in the middle and upper third. Two tumors invaded into the serosal layer and the other four lesions were confined at submucosal and muscular layers. Using the in situ hybridization method, all 6 patients (100%) had positive nuclear Epstein-Barr virus-encoded small RNA signals in the tumor cells but not in the surrounding lymphoid stroma and non-neoplastic gastric mucosa. Helicobacter pylori was found in 4 (66.7%) of the cases. The mean follow-up period of the 6 patients was 27 months. Five patients were free of the disease. Lymph node involvement and mesenteric implantation was noted in one patient in which cancer recurred 1 year after gastrectomy.

CONCLUSIONS: Lymphoepithelioma-like carcinoma of stomach in this study revealed a female predominance, preferential localization in the proximal part of the stomach, better prognosis, and a high association with Epstein-Barr virus infection



댓글 없음:

댓글 쓰기