조기위암 내시경 절제, 그 후 소화기내과 R1 박민아 /prof. 장재영

주소 뒤무직 onset : 3 개월 전 현병력 3 개월 전부터 뒤무직, 소화불량 있어 1 개월 전에 본원에서 상부위장관내 시경을 시행받았음. 조기위암 의심되어 진단 및 치료 위해 입원함. 증례 1. 정 O 기 M/

과거력 DM/HTN/TB/ hepatitis (-/-/-/-) Op Hx (+) : cataract op, both 5 년 전 개인력 Alcohol (-) : 10 년 전 금주 Smoking(-) : 2 년 전 금연 가족력 특이사항 없음 증례 1 (M/69)

Review of systems 증례 1 (M/69) General fever(-) chills(-) weight loss(+) :-5kg/2 months Respiratory cough(-)sputum(-) dyspnea(-) GI A/N/V/D/C(-/-/-/-/-) abd discomfort(+) hematochezia(-) melena(-) hematemesis(-) GU flank pain(-) hematuria(-)dysuria(-) Physical examination Vital sign 110/60mmHg - 60/min - 20/min ℃ - 98% General Alert mentality Not so ill looking appearance Chest Clear breathing sound s rale Regular heart beat s murmur Abdomen Soft & flat abdomen, no palpable mass Normoactive bowel sound

CBC/DC 4,060/mm² g/dl – 30.9% - 286K (Seg. 53.8%) Chemistry Prot/Alb6.0/3.6 g/dLBUN/Cr14/0.7 mg/dL TB/DB0.64/0.20 mg/dLNa/K/Cl140/3.7/104mEq/L AST/ALT19/15 IU/LCa/P/Mg8.2/2.9/2.3 Glucose79 mg/dL Iron 36 ug/dL TIBC 356 ug/dL, U/A RBC 0-1/HFP WBC 0-1/HPF Tumor marker Total/Free PSA <0.5/0.11 ng/mL CA U/mL 증례 1 (M/69)

EGD, Bx : Atypical cell, suspected adenocarcinoma

Problem list #1. Suspected early gastric cancer #2. Tenesmus #3. Iron deficiency anemia #4. Weight loss Assessment & Plan #1. Suspected early gastric cancer → EGD or ESD, Abd CT #2. R/O hidden malignancy (colorectal) R/O IBS → colonoscopy 증례 1 (M/69)

Abdomen CT

ESD

Colonoscopy, Bx : adenocarcinoma

Chest CT

PET-CT NO DISTANT METASTASIS !

ㄱ Pre-op stage : T1N0M0 LAR d/t rectal cancer

EGC Pathologic Report

Rectal cancer Pathologic Report

Final Diagnosis Double primary synchronous cancer I.EGC, ESD, Complete resection (stage Ⅰ A, T1aN0M0) II.Advanced rectal cancer, LAR (stage IIA, T3N0M0) 증례 1 (M/69)

증례 2. 박 O 희 F/ 주소 복부 불편감 onset : 2 개월 전 현병력 두달 전부터 복부 불편감있어 개인의원 방문하였으나 증상호 전 없어 본원에서 내시경을 시행함. 조기위암 진단받고 치료 위해 입원함.

증례 2 (F/78) 과거력 DM/HTN/TB/ hepatitis (-/+/-/-) : po med Antihypertensive drug: Amlodipine 5 mg, 10 년 전 Op Hx (-) 개인력 Alcohol (-) Smoking(-) 가족력 특이사항 없음

Review of systems 증례 2 (F/78) General fever(-) chill(-) Wt loss(-) GI A/N/V/D/C(-/-/-/-/-)abd discomfort(+) hematochezia(-) melena(-)hematemesis(-) GU flank pain(-) hematuria(-)dysuria(-) Physical examination Vital sign 120/70mmHg - 68/min - 20/min ℃ - 99% General Alert mentality Not so ill-looking appearance Chest Clear breathing sound s rale Regular heart beat s murmur Abdomen Soft & flat abdomen Normoactive bowel sound

증례 2 (F/78) CBC/DC 5,040/mm² g/dl – 33.3% - 189K (Seg. 46.8%) Chemistry Prot/Alb7.2/3.9 g/dLBUN/Cr18/0.7 mg/dL TB/DB0.34/0.11 mg/dLNa/K/Cl144/4.5/106mEq/L AST/ALT18/9 IU/LCa/P/Mg9.2/3.6/2.2 ALP/γGT96/15 IU/LCRP<0.3 mg/dL Tumor marker CA U/mL CA U/mL

증례 2 (F/78)

EGD High grade dysplasia Adenocarcinoma

Problem list #1. Early gastric cancer #2. Gastric high grade dysplasia #3. Pneumonia suspected, asymptomatic #4. HTN Assessment & Plan #1. #2. EGC, Gastric adenoma → ESD, EUS, Abd CT #3. Pneumonia → Chest CT #4. HTN → 혈압 안정적이므로 복용하던 medication 유지 증례 2 (F/78)

Chest CT

Abdomen CT

ESD, EGC (Gastric adenocarcinoma)

ESD, High grade dysplasia

EGC Pathologic Report

High grade dysplasia Pathologic Report

Clinical course ESD, CR Lung cancer ? IG 입원 IG 재입원 f/u EGD f/u EGD f/u EGD Abd CT Chest CT f/u EGD Abd CT Chest CT

Follow-up EGD

Chest CT

Chest CT 비교

PET-CT NO DISTANT METASTASIS !

ㄱ Pre-op stage : T2N0M0 RLL lobectomy c MLD via VATS, Rt

Lung cancer Pathologic Report

Final Diagnosis Double primary metachronous cancer I.EGC, ESD, Complete resection (stage Ⅰ A, T1aN0M0) II.Lung cancer, RLL lobectomy (stage IB, T2aN0M0) 증례 2 (F/78)