• 보험의학회지
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• 제27권2호
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• pp.68-74
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• 2008

Medical verification of cancer diagnosis in insurance claims is a very important procedure in insurance administrations. Claims staffs are in need of medical experts' opinions about claim administration. This procedure is called medical claim review (MCR) and is composed of verification and advice. MCR verification evaluates the insured’s physical condition by medical records and compares it with product coverage. It is divided into assessment of living assurance benefit, verification of cancer, and assessment of the cause of death. Actually cancer verification of MCR is applicable to coding because the risk ratio in product development is usually coded data. There are some confusing neoplastic diseases in assessing the verification of cancer. This article reviews gastrointestinal stromal tumors (GIST) and mucosa-associated lymphoid tissue tumors (MALToma) of the stomach. The second most common group of stromal or mesenchymal neoplasms affecting the gastrointestinal tract is GIST. Nowadays there are many articles about the pathophysiology of GIST. However there are few confirmative theories except molecular cell biology of KIT mutation and some tyrosine kinase. Therefore, coding the GIST, which has previously been classified as an intermediate risk group according to NIH2001 criteria, for cancer verification of MCR is suitable for D37.1; neoplasm of uncertain or unknown behavior of digestive organs and the stomach. The gastrointestinal tract is the predominant site of extranodal non-Hodgkin's lymphomas. B-cell lymphomas of the MALT type, now called extranodal marginal zone B-cell lymphoma of MALT type in the REAL/WHO classification, are the most common primary gastric lymphomas worldwide. Its characteristics are as follows. First, it is different from traditional stomach cancers such as gastric adenocarcinoma. Second, the primary therapy of MALToma is the eradication of H. pylori by antibiotics and the remission rate is over 80%. Third, it has a different clinical course compared to traditional malignant lymphoma. Someone insisted that cancer verification is not possible for the above reasons. However, there have been findings on pathologic mechanism, and according to WHO classification, MALToma is classified into malignant B-cell lymphoma and it must be verified as malignancy in MCR.

• Journal of Gastric Cancer
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• 제18권1호
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• pp.99-107
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• 2018

Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated fibro-inflammatory disorder characterized by specific pathological findings and elevated serum IgG4 level. IgG4-RD in the stomach is rare, and occasionally diagnosed as gastric subepithelial tumor (SET) by endoscopy or computed tomography scan. Two female patients in the age group of 40-50 years were diagnosed with 4 cm sized gastric SET. One underwent laparoscopic gastric wedge resection. Another one had a history of subtotal gastrectomy for early gastric cancer and idiopathic thrombocytopenic purpura with oral steroids administration. She underwent a completion total gastrectomy with splenectomy for the gastric SET and ITP. The pathology showed storiform fibrosis, and IgG4 was positive in immunohistochemistry (IHC) stain. IgG4-RD is known as a medical disease that could be treated with oral steroids. The difficulty in preoperative diagnosis of the disease occasionally causes unnecessary gastric resection. Thus, preoperative diagnostic methods for IgG4-RD such as deep biopsy with IHC stain or magnetic resonance imaging are needed.

• Journal of Gastric Cancer
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• 제11권1호
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• pp.55-58
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• 2011

The simultaneous occurrence of a gastrointestinal stromal tumor (GIST) and a gastric adenocarcinoma is uncommon, and has rarely been reported in the literature. The present report describes the case of a 74-year-old male patient who initially presented with an adenocarcinoma that had invaded the antral mucosa. Computed tomography then revealed the presence of a suspected GIST, in the form of a $2{\times}2$ cm mass at the hilum of the spleen. In view of the advanced age of the patient, a surgical approach that would minimize risk and maximize quality of life was preferred. The patient therefore underwent simultaneous laparoscopy-assisted distal gastrectomy for the adenocarcinoma and wedge resection for the GIST. This approach was only chosen after confirming that it would be possible to preserve three or more of the short gastric arteries that supply the area below the wedge resection site. This may be considered a feasible apapproach to the management of the simultaneous occurrence of a mid-to-low gastric body adenocarcinoma and a high gastric body GIST.

• Asian Pacific Journal of Cancer Prevention
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• 제16권12호
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• pp.5111-5113
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• 2015

Background: To investigate the diagnostic and treatment methods for Chinese patients with gastrointestinal stromal tumor (GIST). Materials and Methods: From January 2004 to June 2014, patients diagnosed with primary GIST and treated by a single medical team in the Department of Digestive Disease of XuYi Hospital of Traditional Chinese Medicine were retrospectively recruited. Re-examination and follow-up was conducted regularly and abdominal enhanced CT, blood biochemistry and responses to surgery or imatinib were recorded. Results: A total of 15 patients were enrolled, including 9 male and 6 female patients, with an average age of 54 years (ranging from 32-81 years). The primary symptoms were abdominal uncomfortable in 5 patients, abdominal pain in 6 patients as well as nausea and vomiting in 4 patients. One patient was diagnosed with bowl obstruction at the first visit. All patients were treated with surgery, and tumor site was confirmed 1 esophagus, 6 stomach, 4 small bowel, and 4 colorectal and all patients were pathologically diagnosed with GIST. Immunochemical test positive for CD 117 was found 12 patients, and positive for CD 34 in7 patients. The median follow-up time was 24 months (range of 3-63). Three metastasis were confirmed 1.5, 2 and 2.6 years postoperatively. Three patients were treatment by imatinib postoperatively. Conclusions: Surgery remains the main treatment method for Chinese patients with GIST and imatinib could be feasible and safe for treating Chinese patients with GIST.

• Journal of Gastric Cancer
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• 제12권3호
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• pp.201-204
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• 2012

Gastroduodenal intussusception is an infrequent cause of gastrointestinal obstructive disease. Benign neoplasms, gastrointestinal stromal tumors and pedunculated adenocarcinomas of less than 5 cm have been reported to cause gastroduodenal intussusception. We report a case of 76-year-old woman who was presented with a 3-day history of nausea and vomiting due to upper gastrointestinal obstruction. Computed tomography revealed gastroduodenal intussusception with the transpyloric herniation of alarge gastric hyperplastic polyp. The patient underwent laparoscopic wedge resection with the eversion method.

• Tuberculosis and Respiratory Diseases
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• 제59권4호
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• pp.423-426
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• 2005

Imatinib-mesylate는 만성 골수성 백혈병과 소화기 위장관 기질암의 효과적인 치료제로 인정되면서 사용량이 급격하게 증가하고 있다. Imatinib-mesylate로 치료 중 발생하는 기침이나 호흡곤란은 대부분 폐부종이나 흉수, 간질성 폐질환에 의하여 발생하며, 간질성 폐질환의 경우 조직학적으로는 비특이적 간질성 폐렴, 과민성 폐렴, 호산구 침착 등의 형태로 발생한다. 그러나 imatinib-mesylate에 의하여 간질성 폐질환이 발생하는 기전은 아직 알려져 있지 않다. 치료는 대부분 imatinib-mesylate를 중단하거나 부신피질호르몬제를 사용한 후 호전된다. Imatinib-mesylate를 사용하는 경우 호흡기계에 발생하는 부작용에 대한 관찰이 필요할 것이다. 저자들은 위장관 기질암으로 imatinib-mesylate를 복용하던 중 발생한 과민성 폐렴을 경험하여 보고하는 바이다.

• Journal of Gastric Cancer
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• 제11권4호
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• pp.225-229
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• 2011

Purpose: Laparoscopic wedge resection of gastric submucosal tumor may be difficult in case of the endophytic mass or the mass located unreachable area such as cardia, and intragastric approach can be useful. We would present the experiences of the intragastric wedge resection. Materials and Methods: There were 7 patients diagnosed as gastric submucosal tumor and underwent the intragastric wedge resection at Surgery, Chungnam National University Hospital. We reviewed medical record. Results: There were 3 male and 4 female. Mean age was 65 years-old (57~73). Mean body mass index was 26.28 kg/$m^2$ (21.28~35.30). Location of lesions was 4 cardia, 2 fundus and 1 midbody, respectively. Mean operation time was 83.6 minutes (70~105). All patients were healed without any complication. Mean postoperative hospital stay was 5.4 days (4~6). Mean size was 2.7 cm (2.3~3.8). Pathologic finding was 5 gastrointestinal stromal tumor and 2 leiomyoma. Conclusions: The single incision intragastric wedge resection of gastric submucosal tumor is feasible and acceptable, especially in mass of gastric upper part.

• Asian Pacific Journal of Cancer Prevention
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• 제17권6호
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• pp.2795-2799
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• 2016

Purpose: To study histomorphological and immunohistochemical patterns of gastro-intestinal stromal tumours (GISTs) in Malaysia. Materials and Methods: A total of 29 GIST cases from Hospital Tuanku Ja'afar, Seremban, were studied retrospectively over a period of 10 years from January 2002 to December 2011. Patient demographic data like age, sex and etnicity were collected. Tumour characteristics like site, maximum dimension and specimen type were analysed. Evaluation was according to established criteria into very low, low, intermediate and high-risk categories. Immunohistochemical characteristics were also analysed. Results: The mean age of patients was 59.7 years. Males (59%) were found to be more commonly affected than females (41%). The Chinese (45%) were commonly affected than Malays (41%), and Indians (10%). The most common symptom was pain in the abdomen (13.8%). More than half of the cases were seen in stomach (53%). The tumour size ranged from 1.5 cm to 17 cm with a mean of 6.94cm. Microscopic findings revealed that the spindle cell type was the most common (76%). It was observed that the majority of the cases (48%) were categorised in the intermediate risk group. Immunohistochemical staining showed positivity for CD117 (78.6%), CD34 (71.4%), vimentin (86.2%), S-100 (27.6%), SMA (35.7%), PKC THETA (46.4%) and PDGRFA (67.9%).

• 보험의학회지
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• 제24권
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• pp.27-42
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• 2005

Among medical claims review, decision of malignancy is very important. According to the pathologic report may be ordinary pathway. Some tumors are not completely studied especially malignancy. Wheather malignancy or benign is the important thing in medical claims review. We here disscuss on the debatable tumors such as carcinoid tumor, gastrointestinal stromal tumor (GIST), desmoid tumor, MALToma, and pseudomyxoma peritonei. Another controversial subject in the medical claims review is selection of pathologic report. If the result of the pathologic report is not same in one patient, We prefer the selsection of the report from more professional hospital. We have called this professional hospital l as "third hospital" or 'refferal hospital".

• Journal of Gastric Cancer
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• 제5권2호
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• pp.120-126
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• 2005

목적: 내시경 초음파 검사는 종양의 입체상을 파악하기가 용이하므로 위에 발생하는 점막 하 종양의 진단에 효과적으로 이용된다. 저자들은 위의 위장관 간질성 종양에 대한 내시경 초음파 소견을 분석하여 악성과 양성 종양을 감별할 수 있는 지표를 규명하고자 하였다. 대상 및 방법: 위에 발생한 위장관 간질성 종양으로 수술하고 절제 표본의 조직 진단으로 확진한 30예(양성 종양 23예, 악성 종양 7예)를 대상으로 하였다. 수술 전의 내시경 초음파 검사 소견을 조사하고 양성과 악성 종양으로 구분하여 비교하였다. 내시경 초음파 소견상 감별 지표로는 병변의 크기, 병변의 위치, 종양 내부의 낭성 병변, 종양 내의 에코성 초점, 종양 외벽 변연의 규칙성, 병변 내부의 불균질성, 종양 표면의 궤양 형성 등을 조사하였다. 결과: 병변의 크기는 악성 종양의 $85.7\%$, 양성 종양의 $8.7\%$에서 40 mm 이상이었다(P=0.000). 병변의 위치 분포는 악성과 양성 종양에 차이가 없었다(P=0.437). 병변 내부의 낭성 병변이 악성 종양의 $71.4\%$, 양성 종양의 $8.7\%$에서 관찰되었다(P=0.003). 종양 내 에코성 초점의 존재는 악성 종양 $42.9\%$, 양성 종양 $8.7\%$로 차이가 없었다(P=0.068). 병변 외벽 변연의 규칙성은 악성 종양의 $71.4\%$, 양성 종양의 $17.4\%$가 불규칙한 변연 소견을 보였다(P=0.014).악성 종양의 $85.7\%$, 양성 종양의 $13.0\%$에서 병변 내부의 불균질성을 보였다(P=0.001). 종양 표면의 궤양 형성은 악성 종양의 $28.6\%$, 양성 종양의 $8.7\%$에 발견되어 차이가 없었다(P=0.225). 결론: 종양의 크기가 4 cm 이상, 종양 내 낭성 병변의 존재, 불규칙한 종양의 외측 변연, 종양 내부 에코의 불균질성 등이 악성 종양의 가능성을 시사하는 소견으로 조사되었다. 위의 위장관 간질성 종양의 치료 방침을 결정하는데 이러한 지표들을 임상적으로 유용하게 적용할 수 있을 것이다.