• Journal of Yeungnam Medical Science
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• 제28권2호
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• pp.165-172
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• 2011

Gastric glomus tumor is a rare mesenchymal tumor that originates from modified smooth muscle cells of the glomus body. Glomus tumors are commonly observed in peripheral soft tissue, such as dennis or subungal region, but rarely in the gastrointestinal tract. A 39-year-old woman was admitted due to epigastric soreness. Upper gastrointestinal endoscopy revealed a subepithelial mass measuring 3.5 cm with central ulceration at the lesser curvature-posterior wall of the antrum. Characteristically, contrast enhanced abdominal computed tomography scan demonstrated high enhancement of the submucosal mass up to the same level of the abdominal aorta in the arterial phase; this enhancement persisted to delayed phase. Due to the risk of bleeding and malignancy, wedge resection of the submucosal tumor was performed. Histologic findings were compatible with a glomus tumor.

• Journal of Gastric Cancer
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• 제10권4호
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• pp.188-195
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• 2010

Purpose: This study was done to evaluate the usefulness of preoperative computed tomography (CT) and intraoperative laparoscopic ultrasound to facilitate treatment of gastric submucosal tumors. Materials and Methods: The feasibility of laparoscopic wedge resection as determined by CT findings of tumor size, location, and growth pattern was correlated with surgical findings in 89 consecutive operations. The role of laparoscopic ultrasound for tumor localization was analyzed. Results: Twenty-three patients were considered unsuitable for laparoscopic wedge resection because of large tumor size (N=13) or involvement of the gastroesophageal junction (N=9) or pyloric channel (N=1). Laparoscopic wedge resection was not attempted in 11 of these patients because of large tumor size. Laparoscopic wedge resection was successfully performed in 65 of 66 (98.5%) patients considered suitable for this procedure. Incorrect interpretation of preoperative CT resulted in a change of surgery type in seven patients (7.9%): incorrect CT diagnosis on gastroesophageal junction involvement (N=6) and on growth pattern (N=1). In 18 patients without an exophytic growth pattern, laparoscopic ultrasound was necessary and successfully localized all lesions. Conclusions: Preoperative CT and laparoscopic ultrasound are useful for surgical planning and tumor localization in laparoscopic wedge resection.

• Journal of Gastric Cancer
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• 제14권2호
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• pp.138-141
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• 2014

Gastric metastasis from ovarian cancer is rarely reported worldwide. In Korea, only 2 such cases have been reported. Here we report a case of a 58-year-old woman with metastatic gastric cancer from an ovarian adenocarcinoma. Endoscopic examination showed that the cancer presented as a submucosal tumor without ulceration. A subsequent gastrectomy confirmed the diagnosis of metastatic ovarian serous adenocarcinoma.

• Clinical Endoscopy
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• 제55권4호
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• pp.496-506
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• 2022

Recently, research on rectal neuroendocrine tumors (NETs) has increased during the last few decades. Rectal NETs measuring <10 mm without atypical features and confined to the submucosal layer have only 1% risk of metastasis, and the long-term survival probability of patients without metastasis at the time of diagnosis is approximately 100%. Therefore, the current guidelines suggest endoscopic resection of rectal NETs of <10 mm is regarded as a safe therapeutic option. However, there are currently no clear recommendations for technique selection for endoscopic resection. The choice of treatment modality for rectal NETs should be based on the lesion size, endoscopic characteristics, grade of differentiation, depth of vertical involvement, lymphovascular invasion, and risk of metastasis. Moreover, the complete resection rate, complications, and experience at the center should be considered. Modified endoscopic mucosal resection is the most suitable resection method for rectal NETs of <10 mm, because it is an effective and safe technique that is relatively simple and less time-consuming compared with endoscopic submucosal dissection. Endoscopic submucosal dissection should be considered when the tumor size is >10 mm, suctioning is not possible due to fibrosis in the lesion, or when the snaring for modified endoscopic mucosal resection does not work well.

• Journal of Yeungnam Medical Science
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• 제33권1호
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• pp.37-39
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• 2016

Schwannomas are uncommon neoplasms arising from Schwann cells of the neural sheath. Gastrointestinal schwannomas are rare, accounting for 1% of all malignant gastrointestinal tumors. Colonoscopic biopsy with immunohistochemical (IHC) staining is useful for confirming this tumor. We report on a patient with schwannoma arising from the ascending colon, which was detected by colonoscopy and endoscopic submucosal dissection was attempted. A 41-year-old man presented with abdominal discomfort. The patient was diagnosed with a subepithelial tumor on colonoscopy. He underwent endoscopic submucosal dissection. Histopathology and IHC staining confirmed that the colonic lesion was a benign schwannoma. However, the resection margin was positive. Therefore, laparoscopic ileocolectomy was performed.

• Clinical Endoscopy
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• 제55권1호
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• pp.136-140
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• 2022

Eradication of Helicobacter pylori is the first-line treatment for gastric mucosa-associated lymphoid tissue (MALT) lymphomas; however, lesions may persist in 20% of patients after initial treatment, thereby necessitating the use of an additional therapeutic approach. Other treatment options include radiation therapy, chemotherapy, endoscopic resection, rituximab therapy, or watchful waiting. We present a case of localized gastric MALT lymphoma that did not respond to H. pylori eradication therapy. The patient waited for 12 months but the tumor showed no signs of regression endoscopically. Histologic examination revealed residual MALT lymphoma. The tumor was then successfully treated using endoscopic submucosal dissection and the patient remained disease-free for 4 years. To our knowledge, this is the first case in which a gastric MALT lymphoma was treated with endoscopic submucosal dissection. In conclusion, endoscopic resection may be recommended as second-line therapy for properly selected patients with gastric MALT lymphoma as it is effective and minimally invasive.

• Journal of Gastric Cancer
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• 제8권4호
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• pp.225-231
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• 2008

목적: 위 점막하 종양(gastric submucosal tumor, gastric SMT)은 최근 건강검진의 보편화로 증가하는 추세에 있다. 이에 반해 악성도에 따라 예후가 달라지고, 방사선 검사나 내시경 조직검사로 다른 종양과의 감별이 어려워 아직도 치료 방침을 결정하는데 어려움이 있다. 이에 저자들은 위 점막하 종양 환자에서 임상병리학적 특성을 분석하고, 이에 따른 복강경 수술과 개복술의 결과를 각각 비교 분석하였다. 위 점막하종양의 복강경 절제술의 학습곡선 의미를 도출하여, 위 점막하종양의 적절한 치료방법을 제시하고자 한다. 대상 및 방법: 2003년 4월부터 2008년 8월까지 본원에서 위점막하종양으로 개복 위절제술을 받은 25명과 복강경 위절제술을 시행 받은 78명의 환자들을 대상으로 하였으며, 수술 후 임상경과 및 병리학적 특징에 대하여 전향적인 자료 수집 후 후향적으로 결과를 비교 분석하였다. 결과: 환자의 평균 연령은 53.7세(22~80세)였으며 남녀비는 각각 44명, 59명으로 1 : 1.34였다. 대부분 무증상으로 내원하였으며, 주로 쐐기형 위절제술을 시행 받았다. 종양의 평균 장경은 4.33 cm (1.2~17.0 cm)였고, 주로 위상부에 위치하였으며, 평균 수술 시간은 117.3분(35~255분)이었다. 평균 출혈량은 113.9 ml (0~1,000 ml), 평균 수술 후 재원기간은 8.0일(1~69일)이었다. 술 전 내시경적 절제술이 실패하여 수술이 의뢰된 환자가 5명 있었다. 수술 후 합병증은 13명(12.6%)에서 발생하였고, 수술과 관련된 사망은 없었다. 위 점막하종양의 대부분은 간질유래성증양으로 58명(56.3%)이며, 이중 현재까지 크기가 5 cm 이상이고 복강경 위절제술을 시행한 2명이 재발되었다. 복강경 수술 군과 개복 수술 군에 따라 수술 시간 및 출혈량, 합병증에는 차이가 없었지만, 두 군 간에 환자의 증상(P<0.001), 종양의 크기 (P<0.001), 수술방법 중 쐐기형 절제술 시행(P=0.037), 술 후 연식섭취 시간(P<0.001), 술 후 퇴원 일(P=0.002)에는 차이가 있었다. 위 점막하종양의 복강경 위절제술은 26예 이상의 수술 경험이 필요하고, 이러한 학습 곡선을 극복함으로써 수술 시간, 출혈량을 줄일 수 있다. 결론: 5 cm 미만의 위 점막하종양에서는 복강경적 치료방법이 개복술보다 안전하고, 효과적인 치료방법으로 생각되며, 다양한 형태의 위 점막하종양을 복강경적 절제술로 시행 할 경우에는 학습 곡선을 먼저 극복하기 위해 노력하는 것이 권장된다.

• Journal of Gastric Cancer
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• 제8권2호
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• pp.104-109
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• 2008

목적: 국내 위 점막하 종양의 임상병리학적 양상과 치료방법에 대해 파악하고자 전국조사를 실시하였다. 대상 및 방법: 국내 47개 병원에서 2005년부터 2006년까지 위 점막하 종양으로 수술 받은 환자 878명의 자료를 수집하여, 진단명, 증상, 위치, 수술법, 사망률, 종양의 크기, 악성도 등을 조사하였다. 결과: 위 점막하 종양의 수술 후 진단으로는 위장관 간질 종양(Gastrointestinal stromal tumor, GIST)이 586명(66.8%)으로 가장 많았고, 평활근종(Leiomyoma) 97명(11.1%), 신경초종(schwannoma) 70명(8.0%), 이소성 췌장(Ectopic pancreas) 68명(7.8%), 유암종(carcinoid) 16명(1.8%) 순이었다. 환자의 평균 나이는 56.0세, 남녀 비는 1:1.18이었으며, 50.9%의 환자가 증상 없이 발견되었다. 위 상부 1/3에 위치한 위 점막하 종양이 가장 흔했으며(n=449, 52.0%), GIST의 55.4% (n=319), 평활근종의 84.5% (n=82)가 위 상부 1/3에 위치하였다. 복강경적 접근이 전체 환자의 44.2% (n=388)에서 시행되었으며, 수술방법으로는 쐐기 절제술(n=726, 82.8%)이 가장 빈번히 시행되었다. 전체 환자 중 1명(0.1%)만이 수술 후 30일 이내에 사망하였다. GIST 환자 중 115명(21.1%, 115/544)이 고위험도의 악성도를 가졌고, 41명(8.3%, 45/495)에서 수술 후 imatinib mesylate 항암 치료를 하였다. 결론: 조사된 국내 점막하 종양의 약 2/3가 GIST였으며, 약 1/2에서 복강경하 절제술이 이루어졌다. 향후 이 보고가 위점막하 종양의 진료 및 연구의 참고자료로 활용되기를 기대한다.

• Journal of Gastric Cancer
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• 제13권2호
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• pp.93-97
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• 2013

Purpose: Endoscopic submucosal dissection has recently been practiced on a differentiated type of early gastric cancer. However, there is no clear evidence for endoscopic treatments of signet ring cell carcinoma. The aim of this study is to identify the predictive clinicopathological factors for lymph node metastasis in signet ring cell carcinoma for assisting endoscopic submucosal dissection trials. Materials and Methods: A total of 186 patients with early signet ring cell carcinoma who underwent radical curative gastrectomy between January 2001 and September 2009 were enrolled in this study. Retrospective reviews of their medical records are being conducted. Several clinicopathologic factors were being investigated in order to identify predictive factors for lymph nodes metastasis: age, gender, tumor size, type of operation, tumor location, gross type, ulceration, Lauren's classification, depth of invasion, and lymphatic invasion. Results: The lymph node metastasis rate for signet ring cell carcinoma was 4.3% (n=8). Of the 186 lesions with early signet ring cell carcinoma, 91 (48.9%) tumors were larger than 15 mm in size and 40 (21.5%) showed submucosal invasions in the resection specimens. In multivariate analysis, only the lymphatic invasion (P<0.0001) showed an association with lymph node metastasis. To evaluate cutoff values for tumor sizes in the presence of lymph node metastasis, early signet ring cell carcinomas with lymphatic invasions were excluded. In the absence of lymphatic invasion, mucosal cancer with tumor sizes <15 mm had no lymph node metastasis. Conclusions: Endoscopic submucosal dissection can be performed on patients with early signet ring cell carcinoma limited to the mucosa and less than 15 mm.

• Journal of Medicine and Life Science
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• 제16권1호
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• pp.27-30
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• 2019

We describe a case of a 48-year-old Korean woman who had a subepithelial mass incidentally discovered by endoscopic examination. Endoscopic mucosal resection revealed a well-circumscribed whitish solid mass within the submucosal space. Microscopically, the tumor was comprised of sparse spindle cells in the dense collagenous stroma with several calcifications and lymphoid aggregates. Immunohistochemical analysis showed that the tumor cells are negative for c-kit, smooth muscle actin, desmin, S-100 and CD34. Based on these findings, the tumor was diagnosed with calcifying fibrous tumor.