1. 건강검진을 위해 내원한 74 세 여자 환자 연세대학교 원주의과대학 원주기독병원 소화기내과, 1 병리과 석기태, 조미연 1, 김현수

2. Present Illness & Past History 74 세 여자 건강검진을 위하여 본원 검진센터로 내원 no known Hx of DM, Hepatitis, Pul Tbc HTN – po medication.

3. ROS and P/Ex 체중감소 (-) 피로감 (-) 혈변 (-) 복통 (-) 식욕부진 / 오심 / 구토 (-/-/-) 활력 징후 130/90 mmHg – 62/min 18/min – 36.6ºC 복부 압통 / 반발통 (-/-) 복부 팽만 (-)

4. Laboratory Finding 백혈구 4,900/mm 3 ( 중성구 : 70.8%), 혈색소 14.3 g/dL, 헤마토크리트 41.6%, 혈소판 266,000/mm 3 AST 18 IU/L, ALT 20 IU/L, 총빌리루빈 1.2 mg/dL 혈청 총 단백 7.1 g/dL, 알부민 4.0 g/dL, 아밀라아제 40 U/L Tumor marker: all negative BUN 10 mg/dL, 크레아티닌 1.01 mg/dL HBsAg 음성, anti-HBs 음성, anti-HCV 음성

5. EGD

6. Pathology S08-17734 AW of angle

7. EUS

8. S08-17734 AW of angle CT

9. PET-CT

10. ESD

11. Pathology S09-1878 ESD Lesser curvature Greater curvature Proximal Distal 1-1 1-2 1-3 2-1 2-2 2-3 3-1 3-2 3-3 4-1 4-2 4-3 5-1 5-2 5-3 6-1 6-2 6-3 7-1 7-2 Mucosa 2 mm Stomach, ESD and mapping ; Early gastric carcinoma. 1. Location ; Anterior wall of antrum. 2. Gross type ; EGC type IIc + IIb. 3. Histologic type ; Signet ring cell carcinoma. 4. Histologic type by Lauren ; Diffuse. 5. Size ; 1.4 x 1 x 0.1 cm, 1.5 x 0.6 x 0.1 cm, 0.2 x 0.2 x 0.1 cm. See note. 6. Depth of invasion ; Confined to the lamina propria of the mucosa (pT1a).

12. 1-1 1-2 2-1 2-2 3-1 3-2 Mucosa

13. Final diagnosis Stomach, subtotal gastrectomy ; S/P ESD with very focal residual signet ring cell carcinoma. 1. Location ; L/C of L/B. 2. Histologic type ; Signet ring cell carcinoma. 3. Histologic type by Lauren ; Intestinal. 4. Size ; 0.2 x 0.2 x 0.1 cm. 5. Depth of invasion ; Confined to the lamina propria of the mucosa (pT1a). 6. Resection marginal proximal and distal ; Free from tumor. 7. Lymph node metastasis ; (0/10) Free from tumor 8. Lymphatic, Venous, and Perineural invasion ; Not identified. 9. Multifocal chronic gastritis with IM both in the body and the antrum.

14. Expanded indications of ESD Histology Mucosal cancerSM cancer UL(-)UL(+)SM1SM2 ≤20mm20mm<≤30mm30mm<≤30mmAny size 분화 ABBDBD 미분화 CDDDDD A:Definite indication, B: expanded indication, C: surgery, or D: surgery consider A: definite indication B: Expanded indication C: Surgery – but need for more consideration D: Surgery A:Definite indication, B: expanded indication, C: surgery, or D: surgery consider