외부 검진에서 우연히 발견된 stomach lesion 으로 내원한 70 세 여자환자. 순천향 대학교 부천 병원 소화기 내과

환자 증례  한 OO, F/70  검진위해 외부 병원에서 우연히 시행한 gastroscopy 에서 발 견된 stomach Ca. 평가위해 내원함.  P/Hx.) hypertension 1 년전 진단, medication 중임.

Laboratory test  CBC /  CEA 2.62 ng/ml (0.21~5.40)  LDH 328 IU/L (219~480)  freeT ng/dl (0.8~2.0)  TSH uIU/ml (0.390~5.440)

가계도 Pt Pancreatic Ca Breast Ca, F/30

Gastroscopy & EUS Antrum, GC IIa + IIc, suggestive pm invastion

Colonosopy large Isp type polypoid lesion with normal mucosa on proxiaml AC

Colonosopy large Isp type polypoid lesion with normal mucosa on proxiaml AC -> snare 를 이용하여 EMR 시행함.

Thyroid USG & FNA -Round hypoechoic solid nodule with inner calcification and extracapsular extension. 0.7x0.8x0.8cm(0.28cm3) -> suspicious malignancy. -dense calcification on Upper pole

Pathology-Stomach gross

Pathology-Stomach Depth of invasion: invades submucosa (sm3) (pT1b) Lymph node metastasis: no metastasis in 19 regional lymph nodes (pN0) Histologic type: tubular adenocarcinoma, poorly differentiated

Pathology-Colon Mature B- cell lymphoma, consistent with follicular lymphoma, grade 1-2 (low grade)

Pathology-Colon  The result of immunohistochemical stains; CD3: Negative. CD20: Positive CD5: Non-specific. CD10: Positive. bcl-2: Positive. Cyclin D1: Negative.

Pathology-Thyroid Papillary microcarcinoma, multiple (* size: 0.8x0.7 cm and 5x0.3 cm), intrathyroidal.

 Thyroid gland, both, thyroidectomy; Right: 1. Papillary microcarcinoma, multiple (* size: 0.8x0.7 cm and 5x0.3 cm), intrathyroidal. 2. Nodular hyperplasia. Left: Nodular hyperplasia. Pathology-Thyroid

GI Lymphoma  The GI tract is the most common site of primary extranodal non-Hodgkin’s lymphomas (NHLs) with diffuse large B-cell lymphoma (DLBCL) 4~18% of all NHL in Western countries up to 25% of cases in the Middle East  Sometimes, DLBLC or/with Burkitt lymphomas and peripheral T cell lymphoma => High grade lymphoma requiring aggressive therapy

Primary GI follicular lymphoma  Rare(1%~3.6%)  Most commonly occurs in the elderly women with indolent clinical course  Mainly duodenum(particullary arund ampulla of Vater) & terminal ileum but colorectum can be possible.  Currently, the optimal management of non-Hodgkin’s lymphomas of the GI tract has not been determined by prospective randomized clinical trials.  There are no standard guidelines for the use of various treatment regimens. (surgery +/- chemotherapy, radiotherapy, EMR on single lesion) J Clin Gastroenterol 2008;42:997–1002 Am J Surg Pathol 26(2): 216–224, 2002 Inter Med 47: , 2008