Clinical Endoscopy

  • 제42권2호
  • /
  • Pages.98-104
  • /
  • 2011
  • /
  • 2234-2400(pISSN)
  • /
  • 2234-2443(eISSN)
대한소화기내시경학회 (The Korean Society of Gastrointestinal Endoscopy)
권호 표지

내시경적 절제술로 치료된 위장의 고위험성 위장관 기질 종양 3예

Endoscopic Treatment of 3 Cases of GIST with High Aggressive Behavior

  • 조영주 (아주대학교 의과대학 소화기내과학교실) ;
  • 이기명 (아주대학교 의과대학 소화기내과학교실) ;
  • 정기명 (아주대학교 의과대학 소화기내과학교실) ;
  • 임선교 (아주대학교 의과대학 소화기내과학교실) ;
  • 김진홍 (아주대학교 의과대학 소화기내과학교실) ;
  • 신성재 (아주대학교 의과대학 소화기내과학교실) ;
  • 황재철 (아주대학교 의과대학 소화기내과학교실) ;
  • 김영배 (아주대학교 의과대학 병리학교실)
  • Cho, Young-Ju (Department of Gastroenterology, Ajou University School of Medicine) ;
  • Lee, Kee-Myung (Department of Gastroenterology, Ajou University School of Medicine) ;
  • Jung, Kee-Myoung (Department of Gastroenterology, Ajou University School of Medicine) ;
  • Lim, Sun-Gyo (Department of Gastroenterology, Ajou University School of Medicine) ;
  • Kim, Jin-Hong (Department of Gastroenterology, Ajou University School of Medicine) ;
  • Shin, Sung-Jae (Department of Gastroenterology, Ajou University School of Medicine) ;
  • Hwang, Jae-Chul (Department of Gastroenterology, Ajou University School of Medicine) ;
  • Kim, Young-Bae (Department of Pathology, Ajou University School of Medicine)
  • 발행 : 2011.02.27
⟨ 이전 논문 다음 논문 ⟩

초록

GIST는 위장관의 간엽 조직에서 발생하고, 상피하병변에서 가장 흔한 종양성 병변 중 하나이다. GIST는 양성과 악성의 경계가 불분명하여 종양의 크기, 유사분열 수, 위치, 기원한 층, 합병증의 유무 등을 종합적으로 고려하여 치료 전략을 결정하지만 현재까지는 주기적인 경과 관찰, 개복 혹은 복강경을 통한 절제수술 등이 치료의 주류를 이루어 왔다. GIST 중 크기가 큰 경우는 악성화 위험도가 높아서 수술적 절제가 표준치료이고, 직경 3 cm 미만의 종양의 경우는 대개 양성의 임상경과를 보여 수술을 할지 혹은 경과 관찰할 지에 대한 정립된 치료방침이 없으나 최근 내시경 기구의 발달로 위장관 상피하종양을 내시경적 방법으로 절제하는 시도가 늘고 있다. 저자들은 위장에서 발생한 GIST를 내시경적 방법으로 절제하였고 조직 검사상 고위험군에 해당되었던 3예를 경험하였기에 이를 보고한다.

Gastrointestinal stromal tumors (GISTs) are the most common subepithelial tumor of the gastrointestinal tract. They originate from mesenchymal tissue. Because of difficulties in discriminating between benign and malignant GISTs, the treatment modality is selected on the base of tumor size, mitosis count, location, originating layer, and the presence of complications. Regular follow-up, open resection, or laparoscopic operation were considered main treatments for GISTs. Surgical resection is standard treatment for a huge GIST. However, the treatment method is not determined for GISTs of less than 3 cm that show a benign clinical course. Recently, endoscopic treatment was attempted because of recent endoscope developments and associated devices. We report three cases of gastric GISTs with a high risk of aggressive behavior that were successfully treated by endoscopic resection.

키워드

참고문헌

  1. Fletcher CD, Berman JJ, Corless C, et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol 2002;33:459-465. https://doi.org/10.1053/hupa.2002.123545
  2. Kim KM, Kang DW, Moon WS, et al; Gastrointestinal Stromal Tumor Committee; The Korean Gastrointestinal Pathology Study Group. Gastrointestinal stromal tumors in Koreans: It's incidence and the clinical, pathologic and immunohistochemical findings. J Korean Med Sci 2005;20:977-984. https://doi.org/10.3346/jkms.2005.20.6.977
  3. Sircar K, Hewlett BR, Huizinga JD, Chorneyko K, Berezin I, Riddell RH. Intestinal cells of Cajal as precursors of gastrointestinal stromal tumors. Am J Surg Pathol 1999;23:377-389. https://doi.org/10.1097/00000478-199904000-00002
  4. Kindblom LG, Remotti HE, Aldenborg F, Meis-Kindblom JM. Gastrointestinal pacemaker cell tumors (GIPACT): gastrointestinal stromal tumors show phenotypic characteristics of the interstitial cells of Cajal. Am J Pathol 1998;152:1259-1269.
  5. Seidal T, Edvardsson H. Expression of c-kit (CD117) and Ki67 provides information about the possible cell of origin and clinical course of gastrointestinal stromal tumours. Histopathology 1999;34:416-424. https://doi.org/10.1046/j.1365-2559.1999.00643.x
  6. Kim MK, Lee JK, Park ET, et al. Gastrointestinal stromal tumors: clinical, pathologic features and effectiveness of new diagnostic criteria. Korean J Gastroenterol 2004;43:341-348.
  7. Amin MB, Ma CK, Linden MD, Kubus JJ, Zarbo RJ. Prognostic value of proliferating cell nuclear antigen index in gastric stromal tumors. Correlation with mitotic count and clinical outcome. Am J Clin Pathol 1993;100:428-432. https://doi.org/10.1093/ajcp/100.4.428
  8. Palazzo L, Landi B, Cellier C, Cuillerier E, Roseau G, Barbier JP. Endosonographic features predictive of benign and malignant gastrointestinal stromal cell tumors. Gut 2000;46:88-92. https://doi.org/10.1136/gut.46.1.88
  9. Grant CS, Kim CH, Farrugia G, Zinsmeister A, Goellner JR. Gastric leiomyosarcoma. Prognostic factors and surgical management. Arch Surg 1991;126:985-989. https://doi.org/10.1001/archsurg.1991.01410320071009
  10. Park YS, Park SW, Kim TI, et al. Endoscopic enucleation of upper-GI submucosal tumors by using an insulated-tip electrosurgical knife. Gastrointest Endosc 2004;59:409-415. https://doi.org/10.1016/S0016-5107(03)02717-2
  11. Rosch T, Sarbia M, Schumacher B, et al. Attempted endoscopic en bloc resection of mucosal and submucosal tumors using insulated-tip knives: a pilot series. Endoscopy 2004;36:788-801. https://doi.org/10.1055/s-2004-825838
  12. Piccinni G, Marzullo A, Angrisano A, Iacobone D, Nacchiero M. Endoscopic resection of benign very low-risk gastric gastrointestinal stromal tumors. Is it enough? Eur J Gastroenterol Hepatol 2007;19:177-179. https://doi.org/10.1097/01.meg.0000252632.80796.24
  13. Saftoiu A, Ciurea T, Georgescu CV, Comanescu V, Popescu C. Curative endoscopic ultrasound-assisted submucosal resection of a gastric stromal tumor. Rom J Gastroenterol 2005;14:177-182.
  14. Schnadig ID, Blanke CD. Gastrointestinal stromal tumors: imatinib and beyond. Curr Treat Options Oncol 2006;7:427-437. https://doi.org/10.1007/s11864-006-0018-5