1. Hallym University Sacred Heart Hospital 한림대학교 성심병원 소화기내과 김 유 진 위암 치료를 위해 내원한 60 세 남자 제 83 회 내시경 집담회

2. Hallym University Sacred Heart Hospital Chief complaint 위암 치료를 위하여 Present illness 평소 건강하게 지내던 60 세 남자로, 4 일 전 건강 검진 상부 위장관 내시경 에서 위암 진단받고 내원 Past medical History : Not specific Family history N/S : Not specific Social history N/S : Not specific

3. Hallym University Sacred Heart Hospital Physical examination Mental status : Alert Vital sign 120/70 mmHg – 62 회 / 분 – 18 회 / 분 – 36.2 ℃ HEENT : Anicteric sclera, not anemic conjunctiva Palpable Rt. supraclavicular LN Chest : CBS without crackle or wheezing Regular heart rhythm without murmur Abdomen : Soft and flat No tenderness / rebound tenderness Normoactive bowel sound No organomegaly Back and extremity : No pitting edema No CVATd

4. Hallym University Sacred Heart Hospital Review of system General weakness / fatigue / poor oral intake (-/-/-) Fever/chill (-/-) Weight loss / gain (-/-) A/N/V/D/C (-/-/-/-/-) Melena / Hematochezia / Hematemesis (-/-/-) Cough /Sputum / Rhinorrhea (-/-/-) Dysuria / Frequency (-/-)

5. Hallym University Sacred Heart Hospital LAB WBC 5,100 x 10 3 /uLHBsAg(-) anti-HBs(+) Hb 16.3 g/dLAnti-HCV (-) Platelet 284 x 10 3 /uLBilirubin T/D 0.8/0.2 mg/dL BUN/Cr 20/1.2 mg/dLAST/ALT 17/13 IU/L Na/K 143/5.4 mEq/LGGT 62 IU/L Ca/P 9.1/3.1 mg/dLALP 189 IU/L

6. Hallym University Sacred Heart Hospital EGD Biopsy : Adenocarcinoma, well differentiated

7. Hallym University Sacred Heart Hospital Chest X-ray

8. Hallym University Sacred Heart Hospital Problem List #1. Adenocarcinoma, stomach #2. Multiple lymphadenopathy Impression #1. Stomach cancer with multiple metastasis #2. R/O Lymphoma #3. R/O Sarcoiosis Plan #1. Chest CT #2. Abdomen CT #3. PET CT #4. Rt. supraclavicular LN biopsy

9. Hallym University Sacred Heart Hospital Chest CT

10. Hallym University Sacred Heart Hospital Abdomen CT

11. Hallym University Sacred Heart Hospital PET CT

12. Hallym University Sacred Heart Hospital Rt. Supraclavicular LN biopsy Chronic noncaseating small granulomatous inflammation, suggestive of Sarcoidisis X 40, H&E X 200, H&EX 200, CD3

13. Hallym University Sacred Heart Hospital ACE (angiotensin converting enzyme) 58.1 IU/L (N:18-55) Tuberculosis work-up –AFB stain : negative –AFB culture : negative –TB PCR : negative

14. Hallym University Sacred Heart Hospital ESD

15. Hallym University Sacred Heart Hospital Biopsy Stomach, antrum Adenocarcinoma, well differentiated EGC type I+IIb with 1. confinement within mucosa 2. no lymphatic/vascular tumor emboli 3. clear resection margins X 40, H&E X 100, H&E

16. Hallym University Sacred Heart Hospital Final diagnosis Systemic sarcoidosis with Early gastric cancer DDx. EGC with sarcoid reaction

17. Hallym University Sacred Heart Hospital F/U EGD (2 months after ESD)

18. Hallym University Sacred Heart Hospital F/U PET CT (6 months later)