2018년 8월 12일 일요일

조직검사 음성 보만 4형 진행성 위암으로 의뢰된 환자

Histologic examination of poorly differentiated carcinoma may be tricky. A patient was referred for biopsy for suspected Borrmann type 4 AGC. Endoscopy with biopsy was done and the pathology was poorly differentiated carcinoma ans surgery was done. To my surprise, outside pathology reading was also poorly differentiated carcinoma.

 The first two biopsies were negative for malignancy. The third biopsy showed P/D adenocarcinoma. 
Stomach, subtotal gastrectomy: Advanced gastric carcinoma 
1. Location : [1] middle third, [2] lower third Center at body and lesser curvature 
2. Gross type : Borrmann type 4 
3. Histologic type : tubular adenocarcinoma, poorly (poorly cohesive) differentiated 
4. Histologic type by Lauren : diffuse 
5. Size : 6x5 cm 
6. Depth of invasion : invades serosa (pT4a) 
7. Resection margin: free from carcinoma, safety margin: proximal 5 cm, distal 2.7 cm 
8. Lymph node metastasis : metastasis to 1 out of 48 regional lymph nodes (pN1) (perinodal extension: absent) (1/48: "3", 0/12; "4", 0/2; "5", 0/1; "6", 0/3; "7", 0/10; "9", 0/2; "8a", 0/8; "11p", 0/0; "12a", 0/0; "4sb", 0/0; "1", 0/3; "2", 0/1; "mesentery LN", 0/2; perigastric, 1/4) 
9. Lymphatic invasion : present 
10. Venous invasion : present(extramural) 
11. Perineural invasion : present (+++) 
12. Peritoneal cytology : negative 
13. AJCC stage by 8th edition: pT4a N1

내시경 소견이 틀림없이 암인데 조직 병리에서 암이 나오지 않으면 재검에 앞서 병리과 의사에게 슬라이드를 다시 한번 봐 달라고 요청할 일입니다. 


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