The rate of pathological non-curative resection of EGC by ESD is about 10-20%. In additional surgery for non-curative resection cases, local residual tumor is found in 5-10%, and lymph node metastasis is also found in 5-10%. In this case of histological heterogeneity, lateral margin was involved. Surgery was done and 1.2cm x 0.3cm sized residual tumor in lamina propria was found.
ESD: Early gastric carcinoma
1. Location : angle, anterior wall
2. Gross type : EGC type IIa+IIc
3. Histologic type : tubular adenocarcinoma, well differentiated (WHYX type) >> tubular adenocarcinoma, poorly differentiated (10%) > signet ring cell carcinoma (10%)
4. Histologic type by Lauren : mixed
5. Size of carcinoma : (1) longest diameter, 28 mm (2) vertical diameter, 26 mm
6. Depth of invasion : invades mucosa (lamina propria) (pT1a)
7. Resection margin : involvement of proximal margin by carcinoma (poorly differentiated) safety margin : distal 6 mm, proximal 0 mm, anterior 8 mm, posterior 6 mm, deep 1000 ㎛
8. Lymphatic invasion : not identified(N)
9. Venous invasion : not identified(N)
10. Perineural invasion : not identified(N)
11. Microscopic ulcer : absent
12. Histologic heterogeneity: present
Resectio margin positive에서 ESD나 ablation을 추가하기도 하고 수술을 권할 수도 있습니다. 경계가 불분명한 부위였고, resection margin 부위가 poorly differentiated component였으므로 수술을 권했습니다. 1.2cm의 residual tumor가 있었습니다. 수술하기를 잘했다고 생각하였습니다.