위에 발생한 신경내분비 암종 -18예의 위신경내분비 암종의 임상병리학적 고찰-

Neuroendocrine Carcinoma of the Stomach -A Clinicopathologic Study of 18 Cases-

  • 김병식 (울산대학교 의과대학 서울아산병원 외과학교실) ;
  • 신동규 (울산대학교 의과대학 서울아산병원 외과학교실) ;
  • 장세진 (울산대학교 의과대학 서울아산병원 병리학교실) ;
  • 최원용 (울산대학교 의과대학 서울아산병원 외과학교실) ;
  • 김용진 (울산대학교 의과대학 서울아산병원 외과학교실) ;
  • 육정환 (울산대학교 의과대학 서울아산병원 외과학교실) ;
  • 오성태 (울산대학교 의과대학 서울아산병원 외과학교실)
  • Kim Byung Sik (Department of Surgery Gastrointestinal Division University of Ulsan College of Medicine and Asan Medical Center) ;
  • Shin Dong Gyeu (Department of Surgery Gastrointestinal Division University of Ulsan College of Medicine and Asan Medical Center) ;
  • Jang Se Jin (Department of Pathology, University of Ulsan College of Medicine and Asan Medical Center) ;
  • Choi Won Yong (Department of Surgery Gastrointestinal Division University of Ulsan College of Medicine and Asan Medical Center) ;
  • Kim Yong Jin (Department of Surgery Gastrointestinal Division University of Ulsan College of Medicine and Asan Medical Center) ;
  • Yook Jung Hwan (Department of Surgery Gastrointestinal Division University of Ulsan College of Medicine and Asan Medical Center) ;
  • Oh Sung Tae (Department of Surgery Gastrointestinal Division University of Ulsan College of Medicine and Asan Medical Center)
  • 발행 : 2003.12.01

초록

Purpose: Neuroendocrine carcinomas of the stomach account for only about $0.3\%$ of all gastric tumors. The prognosis of this disease is very poor compared with the common type of gastric adenocarcinoma. The purpose of this retrospective study was to review the clinicopathologic features of 18 cases of this unusual gastric tumor and to establish a treatment strategy for this tumor. Materials and Methods: Excluding 2 cases of non-curative resection and 1 case of operative mortality, 18 cases of typical neuroendocrine carcinoma who had curative resection from January 1991 to December 2000 at Asan Medical Center were analyzed; 6841 gastric cancer patient were treated surgically during the same period. Results: The mean age at the time of diagnosis was 58.6 years (range: $35\∼75$ yr). Sixteen patients were male, and two were female. Eleven tumors ($61.1\%$) developed in the lower part of the stomach, three ($16.7\%$) in the middle part, and three ($16.7\%$) in the upper part. One tumor involved the entire stomach. Eight cases ($44.4\%$) were Borrmann type 2, and six case ($33.3\%$) were Borrmann type 3. The mean tumor size was 6.94 cm (range: $0.6\∼15$ cm). Nine cases ($50\%$) showed recurrence of the disease, and eight of them died within 20 months. Of the nine recurred cases, 7 cases ($77.8\%$) showed liver metastasis. The mean disease-free interval was 6.8 months (range: $2.5\∼11$ months) after surgical resection, and the mean survival was 17.9 months (range: $8\∼40$ months) for recurrence cases. One patient with liver metastasis was treated with a liver-wedge resection just after diagnosis and was still alive for 37.5 months postoperatively. There were 9 deaths after the median follow- up period of 40 months (range: $8\∼72$ months). Conclusion: Gastric neuroendocrine carcinomas frequently recur at the liver, even in early stage cancer, and have a poor prognosis. We experienced a case of successful control of hepatic metastasis by surgical resection and a case of a small cell carcinoma which was successfully controlled with systemic chemotherapy.

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