위점막하종양 gist - wijeommaghajong-yang gist

위점막하종양 gist - wijeommaghajong-yang gist
[GIST (gastrointestinal stromal tumor). �������������. �������������]

위점막하종양 gist - wijeommaghajong-yang gist
1. SMT�� GIST - ������ ���� ������ �ٸ���?

GIST�� �ϳ��� ���ܸ��Դϴ�. GIST�� heterogeneous�Ͽ� Kit (+) GIST, Kit (-) GIST�� ���� ������ �پ��� ������ �����з��� �����մϴ�. �׷��� GIST�� GIST�Դϴ�. �ϳ��� �������� ���ܸ��Դϴ�.

SMT�� ���� ������ ���� ���� ��� finding�Դϴ�. GIST�� ���� ������ �ƴ� ���� �ֽ��ϴ�. SMT�� �������� ���ܸ��� �ƴմϴ�. SMT�� ���� ������ ã�Ƴ����� �Ϻΰ� GIST������, Ư�� �������� GIST�� SMT�� GIST�� �ƴ� SMT�� ��Ȯ�� ������ �� �����ϴ�. 2016�� Gastric Cancer�� 1��ȣ�� �׸��� �̷� ��Ȳ�� �� �����ݴϴ�. �� ������ ���Դϴ�.

���⼭ ù ������ �߿��մϴ�. Undiagnosed SET(SMT)�� histological GIST��� �� ���� �� ������ ������ �����ؾ� �մϴ�. ������ ������ ���� ���ð濡�� ������ ��κ��� SMT�� undiagnosed SMT�� ��, histological GIST�� �ƴմϴ�. ������ ������ 2 cm �̸� undiagnossed SMT�� ���� ǥ�� ���ٹ��� high risk features (ulceration, irregular border, increase in size)�� ���� �� CT, EUS, EUS-FNA�� �ϴ� ���� �ƴϰ� ���ð� ���������Դϴ�. 1-2 cm �̸��� SMT�� ���Ͽ� ��� EUS�� ���ϴ� ������ ������ ������ Ʋ���� ������ ����� ���Դϴ�.

위점막하종양 gist - wijeommaghajong-yang gist
2. GIST ��������

(1) Spindle: Bland spindle cells with faintly eosinophilic cytoplasm in a syncytial pattern; elongated nuclei with inconspicuous nucleoli; artifactual paranuclear vacuoles common in stomach GIST.
- Subtypes: sclerosing, palisaded, vacuolated, diffuse hypercellular, sarcomatoid features with significant nuclear atypia and mitotic activity

(2) Epithelioid: Round cells with clear to eosinophilic cytoplasm in sheets or nests; increased tendency for pleomorphism versus spindle type
- Subtypes: sclerosing, discohesive, hypercellular, sarcomatous with significant atypia and mitotic activity

(4) SDH deficient: epithelioid or mixed epithelioid / spindle cell morphology, multinodular pattern, minimal nuclear pleomorphism, occasional atypical mitoses

(5) Dedifferentiated: anaplastic appearance with an unusual phenotype (may lose expression of KIT or may aberrantly express other markers such as cytokeratin)

위점막하종양 gist - wijeommaghajong-yang gist

위점막하종양 gist - wijeommaghajong-yang gist

Histologic features and patterns of gastrointestinal stromal tumor (GIST). (Arch Pathol Lab Med 2011)
A, Spindle cell GIST composed of fascicles of uniform, bland cells with pale, eosinophilic cytoplasm.
B, Spindle cell GIST with myxoid change.
C, Another GIST with foci of osseous metaplasia.
D, Spindle cell GIST with prominent paranuclear vacuoles.
E, Spindle cell GIST with nuclear palisading that is reminiscent of Antoni A areas encountered in a schwannoma.
F, Spindle cell GIST arising in the small bowel, displaying numerous bundles of deeply eosinophilic ����skeinoid fibers.����
G, Epithelioid GIST arising in the stomach, composed of cells with abundant, eosinophilic cytoplasm and distinct cell borders.
H, Dedifferentiated GIST composed of atypical epithelioid and spindle cells

위점막하종양 gist - wijeommaghajong-yang gist
Korean J Pathol 2012

�� ������������ ���ð� �����˻翡�� GIST�� Ȯ�ε� ���� ���� �ʽ��ϴ�. �幰�� �ѷ��� �Ը��ΰ� �ִ� ���� ���ð� �����˻�� Ȯ�εDZ⵵ �մϴ�.

GIST�� malignant risk�� ���� �з����� ���Ƽ� �� ȯ�ڰ� ���� �ٸ� risk�� �з��DZ⵵ �մϴ�. �򰥸��� ���� �����ϴ�. �Դٰ� ��� �ٲ�ϴ�.

위점막하종양 gist - wijeommaghajong-yang gist

Stomach, body, wedge resection: Gastrointestinal stromal tumor of intermediate risk of malignant potential by proposed modification for adjuvant therapy (2008) (see note);
1) tumor size: 2.8x2.5 cm
2) mitosis: 7/50 HPF (high powered fields)
3) histological type: spindle
4) necrosis: absent
5) cellularity: intermediate
6) cellular atypia: moderate
7) invasion into mucosa: absent
8) resection margin involvement: absent
Note: Intermediate risk by NIH (2002) and moderate risk (16%) of progressive disease by Miettinen (2006).

위점막하종양 gist - wijeommaghajong-yang gist

Risk Stratification of Primary Gastrointestinal Stromal Tumors (GISTs) under the National Institutes of Health (NIH) Criteria and Modified NIH Criteria

위점막하종양 gist - wijeommaghajong-yang gist

Risk stratification according to the National Institutes of Health (NIH) and modified NIH criteria. Twenty-two patients with intermediate risk under the original NIH criteria were reclassified into the high-risk category by the modified NIH criteria. Among the 22 reclassified patients, 6 patients experienced tumor recurrence. GISTs, gastrointestinal stromal tumors.

�� ������ ���� �Z���ﺴ�� �嵿�� �������� editorial�� ���ҽ��ϴ�. Modified NIH criteria�� ���� high risk�� �з��� ȯ�ڿ��� adjuvant imatinib�� �ʿ��ϴ��� �����̾����ϴ�. ���� ���ؿ� ���� intermediate risk�� �з��Ǿ����� �ű��ؿ� ���� high risk�� �ٲ� ȯ�ڿ��� ������ �� �� �����ϴ�.

위점막하종양 gist - wijeommaghajong-yang gist
3. Mini-GIST Ȥ�� mini-SMT

���� undiagnosed SMT �� ���� ���� ������ mini-GIST�� ���Դϴ�. �׷��� mini-GIST ���� �ſ� ���ϰ� ��κ� indolent�ϰ� �� ġ���ؾ� �ϴ��� ��Ȯ���� �ʽ��ϴ�.

�ٸ� ���� ���ڵ��� mini-SMT Ȥ�� mini-GIST�� ���ϸ鼭 high-risk features�� irregular border�� ulceration�� �Բ� EUS�� �ؾ߸� �� �� �ִ� internal heterogeneity�� ����ϰ� �ֱ� ������ EUS�� ���� ó��ǰ� ���� ���Դϴ�. EUS���� �����Ǵ� internal heterogeneity�� ū GIST������ ���� �ǹ̰� ������, mini-GIST Ȥ�� mini-SMT���� �����Ǵ� internal heterogeneity�� �ӻ��� ���Ǵ� ��Ȯ���� �ʴٰ� ���� ���� �½��ϴ�.

Undiagnosed SMT�� ���� ������ ���̵������ �����ϴ�. GIST ���̵������ �Ϻημ� ��޵ǰ� ���� ���Դϴ�. ���ð� �������� ������ ������ ���·� �������ٴ� �����Դϴ�. EGD�� EUS�� ȥ���ϰų� ��Ȯ�� �������� �ʰ� ������ ���̵������ ���� ���� �� �����Դϴ�. ���ǰ� �ʿ��մϴ�. ���� ���, 2016�� Gastric Cancer ������ �Ǹ� ���� ������ Table�� ����� ��ġ���� �ʽ��ϴ�. Misleading�� ���ɼ��� ���� Ʋ�� �����Դϴ�. "The standard diagnosis, treatment, and follow-up of GIST When small esophageal or gastric nodules (SMTs smaller than 2 cm) having no high-risk features are detected, they can usually be followed by periodic endoscopic ultrasonography (EUS) until the tumors increase in size or become symptomatic." ��ġ 5 mm SMT�� ���ؼ��� EUS�� �ؾ� �ϴ� ��ó�� ������ �ʽ��ϱ�? EGD�� EUS�� �������� �ʾҴٴ� ���� Ȳ���� ���Դϴ�. 2 cm �̸��̰� ������ ���ڰ� ���� �ĵ�/�� SMT�� (EUS�� �ƴ϶�) EGD�� �������� �� �� �ֽ��ϴ�. EUS�� �ʼ��� �ƴ϶� �����Դϴ�. ���� GIST ���̵���� �۾����� ���ð� �������� �����ؾ� �մϴ�.

������� �� �ѷ��� ��� ��ȭ�� ���� ������ ������ ���ϴ� ���� �����ϴ�.

위점막하종양 gist - wijeommaghajong-yang gist
4. GIST ġ��

2 cm �̻��� GIST�� ǥ�� ġ��� ������ �����Դϴ�. ���ð� �������� �Ϻ� �õ��ǰ� ������ �ܰ��ǻ���� ���� positive margins�̳� tumor spillage�� �����ϰ� �ֽ��ϴ�. ���� ���� 3-4 cm ������ ���� GIST�� ���ɽ����� ���ð�ġ�Ḧ �� �� �� �ְڴٰ� �����մϴ�.

2 cm �̸��� GIST�� ������ Ȥ�� ��������� ������ �� �ֽ��ϴ�. ��� 2 cm �̸��� undiagnosed SMT������ �������� ������ �� �ʿ��� ���� �ƴմϴ�. 2 cm �̸����� ���������� ���� �ʴ� ö���� ���� �ǻ�� 2 cm �̸� GIST�� ���� ������ �����ϴ�.

�Ʒ��� unresectable, metastatic Ȥ�� recurrent GIST�� ���� ġ�� algorithm�Դϴ�.

�ʹ� Ŀ�� Gleevec ���� �����ϴ� ȯ���� �ܷ� ����Դϴ�.

위점막하종양 gist - wijeommaghajong-yang gist
5. �������� ������ ������ GIST

위점막하종양 gist - wijeommaghajong-yang gist
Melena
Stomach, subtotal gastrectomy:
Gastrointestinal stromal tumor of high risk of malignant potential by NIH criteria:
1) tumor size: 6.5x6.0 cm
2) mitosis: 6 /50 HPF (high powered fields)
3) histological type: spindle
4) necrosis: absent
5) cellularity: intermediate
6) cellular atypia: mild
7) invasion into mucosa: present
8) myxoid change: present
9) resection margin involvement: absent
10) no metastasis in 4 regional lymph nodes

위점막하종양 gist - wijeommaghajong-yang gist
Melena
Stomach, cardia, wedge resection:
Gastrointestinal stromal tumor of high risk of malignant potential by NIH (2002) and moderate risk(16 %) of progressive disease by Miettinen(2006) ;
1) tumor size: 3.5x2.5x2.4 cm
2) mitosis: 88/50 HPF (high powered fields)
3) histological type: mixed spindle and epithelioid
4) necrosis: present
5) cellularity: high
6) cellular atypia: moderate
7) invasion into mucosa: present
8) resection margin involvement: absent

위점막하종양 gist - wijeommaghajong-yang gist
Melena�� ���̴µ� SMT ������ ���� ������ ���ٰ� �ǷڵǾ���. �ڼ��� ���� �˾��� �־���.
Stomach, body, wedge resection:
Gastrointestinal stromal tumor of high risk of malignant potential by proposed modification for adjuvant therapy (2008) (see note);
1) tumor size: 5.5x3.5 cm
2) mitosis: 40/50 HPF (high powered fields)
3) histological type: spindle
4) necrosis: absent
5) cellularity: high
6) cellular atypia: moderate
7) invasion into mucosa: absent
8) resection margin involvement: absent
Note: high risk by NIH (2002) and high risk (55%) of progressive disease by Miettinen (2006).
[Addendum]
Ki-67 : Positive in 10% of tumor cells
DOG-1 : Positive in tumor cells
C-KIT (CD 117) : Positive in tumor cells

위점막하종양 gist - wijeommaghajong-yang gist
6. ù ���ܽ� ���̰� �־��� GIST

위점막하종양 gist - wijeommaghajong-yang gist
GIST with hepatic metastasis. Fundus�� �ұ�Ģ�� �˾� �κ�(�ι�°, ����° ����)������ �Ǵ��ϸ� AGC, lymphoma, GIST ���� ��� ������ �� �ְ�����, �ұ�Ģ�� �˾�� �ֺ��� ���� SMT �κ�(ù��° ����)�� �����ϸ� AGC�� ���ɼ��� �ſ� �������� ������� �� �� �ֽ��ϴ�. C-kit (CD117) �缺 GIST�����ϴ�.

위점막하종양 gist - wijeommaghajong-yang gist
Hepatic metastasis

위점막하종양 gist - wijeommaghajong-yang gist
Hepatic metastasis

위점막하종양 gist - wijeommaghajong-yang gist
���ð濡�� ���� SMT�� �ִ� ��ó�� �������� CT������ proximal stomach ���� ��ü�� ���δ� GIST ������, MRI������ �� ���� metastastasis�� �־����ϴ�.

위점막하종양 gist - wijeommaghajong-yang gist

�����˻�: Gastrointestinal stromal tumor, high risk of malignant behavior;
1) mitosis: 11/16 HPF
2) histological type: mixed
3) necrosis: absent
4) cellularity: high
5) myxoid change: present
ó������ �� ���̰� �־ imatinib�� �����Ͽ����ϴ�.

위점막하종양 gist - wijeommaghajong-yang gist

Liver biopsy: Gastrointestinal stromal tumor
C-KIT (CD 117) : Diffusely positive in tumor cells
Ki-67 : Positive in up to 8% of tumor cells
DOG-1 : Focally positive in tumor cells
Gleevec ���� �� ȣ����� �߻�. CT���� drug-induced BOOP �Ұ����� �ϴ� Gleevec �ߴ��Ͽ����ϴ�. Gleevec�� �幮 �պ����̶�� �մϴ�.

위점막하종양 gist - wijeommaghajong-yang gist
(2017, 49�� ����) �쿬�� �����Ŀ��� �������� �߰ߵǾ����ϴ�. ���ð濡���� Ư�̼Ұ��� �������ϴ�. CT���� �̹� ������ ���� metastatic nodule ���� �����Ǿ����ϴ�. EUS-guided biopsy�� �Ͽ��� GIST�� Ȯ�εǾ����ϴ�. Gleevec ġ�Ḧ �Ͽ����ϴ�. Exophytic growth�� ���� gastric GIST�� ù ���ܽ� �� ħ���� ���� ���̰� �־��� ���ʷ� ����������ϴ�.

위점막하종양 gist - wijeommaghajong-yang gist
���ð� ���� �ǻ簡 ���� clot���� �ִµ� �����˻縦 �ص� ������ realtime���� ���ǰ� �ͼ� �����˻縦 �ϵ��� ���Ͽ��� c-kit positive GIST�� Ȯ�εǾ���.

위점막하종양 gist - wijeommaghajong-yang gist
7. ������� �� �˾��� �߻��Ͽ� ������ ����

위점막하종양 gist - wijeommaghajong-yang gist
3�� ������� �� ũ�Ⱑ �����Ͽ��� �۰� ���� �˾��� �߻��Ͽ� ����
Stomach, fundus, wedge resection: Gastrointestinal stromal tumor of intermediate risk of malignant potential by proposed modification for adjuvant therapy (2008) (see note);
1) tumor size: 3.8x3.0 cm
2) mitosis: 9/50 HPF (high powered fields)
3) histological type: spindle
4) necrosis: absent
5) cellularity: intermediate
6) cellular atypia: moderate
7) invasion into mucosa: absent
8) resection margin involvement: absent
Note: intermediate risk by NIH (2002) and moderate risk (16%) of progressive disease by Miettinen (2006).

위점막하종양 gist - wijeommaghajong-yang gist
������� �� �˾�
Gastrointestinal tumor of high risk of aggresive behavior:
1) tumor size : 2.7x2x1.5 cm
2) mitosis: 26/50 HPF
3) histologic type : spindle
4) necrosis : present
5) cellularity : high
6) invasion into mucosa : present
7) resection margin involvement : absent
8) histologic subtype: cellular spindle cell type

위점막하종양 gist - wijeommaghajong-yang gist
������� �� �˾�
Stomach, mid body, posterior, wedge resection:
Gastrointestinal stromal tumor of low risk of malignant potential by NIH (2002) and very low risk (1.9 %) of progressive disease by Miettinen (2006):
1) tumor size: 3.5x3x2 cm
2) mitosis: 2/50 HPF (high powered fields)
3) histological type: spindle
4) necrosis: absent
5) cellularity: high
6) cellular atypia: mild
7) invasion into mucosa: absent
8) resection margin involvement: absent

위점막하종양 gist - wijeommaghajong-yang gist
ó�� ���ð� ��ÿ��� ������ �����µ� ���� ��ٸ��� ��ĥ ���̿� melena�� ���� ���ѷ� ������
Stomach, body, posterior wall, wedge resection:
Gastrointestinal stromal tumor of high risk of malignant potential:
1) tumor size: 4.2x3.8x3.3 cm
2) mitosis: 10/50 HPF (high powered fields)
3) histological type: spindle
4) necrosis: absent
5) cellularity: intermediate
6) cellular atypia: mild
7) invasion into mucosa: absent
8) resection margin involvement: absent

위점막하종양 gist - wijeommaghajong-yang gist
8. ������� �� ������ ������ GIST

위점막하종양 gist - wijeommaghajong-yang gist
�������� �� melena
Stomach, high body, wedge resection:
Gastrointestinal stromal tumor of low risk of malignant potential by proposed modification for adjuvant therapy (2008), low by NIH and very low risk (1.9 %) of progressive disease by Miettinen (2006) :
1) tumor size: 2.2x2 cm
2) mitosis: 4 /50 HPF (high powered fields)
3) histological type: spindle
4) necrosis: absent
5) cellularity: intermediate
6) cellular atypia: moderate
7) invasion into mucosa: present
8) resection margin involvement: absent

위점막하종양 gist - wijeommaghajong-yang gist
�������� �� melena
Stomach, fundus, wedge resection:
Gastrointestinal stromal tumor of low risk of malignant potential by NIH (2002) and very low risk (1.9 %) of progressive disease by Miettinen (2006):
1) tumor size: 2.1x1.9x1.7 cm
2) mitosis: 1/50 HPF (high powered fields)
3) histological type: spindle
4) necrosis: absent
5) cellularity: low
6) cellular atypia: mild
7) invasion into mucosa: absent
8) resection margin involvement: absent

위점막하종양 gist - wijeommaghajong-yang gist
9. ���ڰ� ������ ���� ū GIST

2�� ������ ���۵� ���� �ظ����� �����Ͽ����ϴ�. ���� CT������ 30x24cm�� �����Ǿ����� ��� �� Ŀ�������ϴ�.

��Ȯ�� ������ ���Ͽ� sono-guided biopsy�� �Ͽ����ϴ�. GIST (high risk of malignant potential)�� ���԰� ��� mitosis�� 4/17 HPFs, �������� mixed spindle and epitheloid�����ϴ�.

Gleevec���� 16���� ġ���Ͽ��� ���Ұ� ������ �۾������ϴ�.

Surgical wedge resection�� �Ͽ����ϴ�. ������ ũ��� 15x9x9cm����, neat total necrosis�� ���Ͽ� mitosis�� ������ �� �������ϴ�.

�� 1�� �� �������ð濡�� ���� 1��, ���� 1���� �߰ߵǾ� ESD�� �Ͽ����ϴ�.

Surgical wedge resection �� 5�Ⱓ adjuvant imatinib ����Ͽ����ϴ�. ���� ������� �� �ᱹ ����ϼ̽��ϴ�.

�� ȯ�� ������ ũ�� �ʾƵ� locally advanced disease�� �ٷ� surgical resection�� ��Ʊ� ������ �ϴ� Gleevec ġ����� �����մϴ�. ������ ������ ������ �ϱ⵵ �մϴ�.

위점막하종양 gist - wijeommaghajong-yang gist
10. ������ �����޾����� �ź��ϰ� �����ٰ� ������ ���·� �Ƿڵ� ȯ��

���� �������� ������ �����ް� �� ���� �ܰ��� ã�Ҵٰ�, ȯ�ڰ� �������� �ʴ� ������ ������ �ٲپ� ��ȭ�⳻���� ã�� ���Դϴ�. �翬�� ������ �������� ���� follow-up loss �Ǿ����ϴ�.

3�� �� ���̵� ���·� �ٽ� �����ϼ̽��ϴ�. ��Ÿ��� ���Դϴ�.

EUS guided biopsy�� c-kit positive malignant GIST�� �����Ͽ����ϴ�.


위점막하종양 gist - wijeommaghajong-yang gist
11. More cases of gastric GIST

�쿬�� �߰ߵ� ���� gastric SMT�� ��κ��� Ŀ���� ������ ����� �ݹ��Դϴ�. �и� Ŀ���� ��쵵 �ֱ� �����Դϴ�. �Ʒ� ���ʴ� ����� ȯ�ڿ��� �쿬�� �߰ߵ� �� SMT�����ϴ�. ���������� ���Ͽ����� follow up loss �Ǿ����ϴ�. 6�⸸�� ���̴µ� ���� Ŀ�� ���¿����ϴ�. CT �˻� �� ������ �Ͽ����ϴ�.

위점막하종양 gist - wijeommaghajong-yang gist
(2012. F/61)
Stomach, wedge resection: Gastrointestinal stromal tumor of high risk of malignant potential by proposed modification for adjuvant therapy (2008) (see note);
1) tumor size: 6.5x4 cm
2) mitosis: 6/50 HPF (high powered fields)
3) histological type: mixed spindle and epithelioid
4) necrosis: absent
5) cellularity: intermediate
6) cellular atypia: moderate
7) invasion into mucosa: absent
8) resection margin involvement: absent
Note: High risk by NIH (2002) and High risk (55%) of progressive disease by Miettinen (2006).
. DOG-1 : Positive in tumor cells
. Ki-67 : Positive in about 10% of tumor cells
. C-KIT (CD 117) : Positive in tumor cells

������ 10�� ���̿� ũ�� ������ �־� �����Ͽ��� ȯ���Դϴ�. �Ƿ� �� Ư���� ������ ������ �־����ϴ�. ���ð� �����˻� �� ������ ��Ʋ ���� ���� ���� �־��µ� ȯ�ڲ����� ������ �� �𸣰� �������ٴ� ������ �α� ���к��� �Ű���� �湮�Ͽ� �Ӹ� MRI�� ��� �̻��� ���ٴ� �̾߱⸦ ����ٰ� �մϴ�. 119�� �� �� �Ƿ����µ� �ƹ��� ���ð� �˻� �ߴ���, ������ �������� ����� �ʾҴٰ� �մϴ�. �Ű�� �����Ե鲲 ��Ź�մϴ�. ���� û�븦 �� ���ֽñ� �ٶ��ϴ�.

위점막하종양 gist - wijeommaghajong-yang gist

Stomach, wedge resection: Gastrointestinal stromal tumor of intermediate risk of malignant potential by proposed modification for adjuvant therapy (2008) (see note);
1) tumor size: 2.5x1.5 cm
2) mitosis: 7/50 HPF (high powered fields)
3) histological type: spindle
4) necrosis: absent
5) cellularity: high
6) cellular atypia: moderate
7) invasion into mucosa: absent
8) resection margin involvement: absent
Ki-67 : Positive in up to about 3% of tumor cells
C-KIT (CD 117) : Positive in tumor cells
DOG-1 : Positive in tumor cells
* Note: Intermediate risk by NIH (2002) and moderate risk (16%) of progressive disease by Miettinen (2006).


�پ��� �����Դϴ�.

위점막하종양 gist - wijeommaghajong-yang gist

Stomach, wedge resection: Gastrointestinal stromal tumor of low risk of malignant potential by NIH (2002) and very low risk (1.9 %) of progressive disease by Miettinen (2006):
1) tumor size: 3.5x2.5x2 cm
2) mitosis: 5/50 HPF (high powered fields)
3) histological type: spindle
4) necrosis: absent
5) cellularity: high
6) cellular atypia: mild
7) invasion into mucosa: absent
8) resection margin involvement: absent


위점막하종양 gist - wijeommaghajong-yang gist
�ѷ��� bridging fold�� ���� �˾��� ������ GIST
Gastrointestinal stromal tumor of intermediate risk of malignant potential;
1) tumor size: 3.5x3.5x2 cm
2) mitosis: 10 / 50 HPF (high powered fields)
3) histological type: spindle (hypercellular spindle type)
4) necrosis: absent
5) cellularity: high
6) cellular atypia: mild
7) invasion into mucosa: absent
8) resection margin involvement: absent
C-kit: Positive, DOG-1: Positive, CD34 : Positive, PDGFRA: Positive, Ki-67: Positive in 11% of tumor cells


위점막하종양 gist - wijeommaghajong-yang gist
Forceps biopsy�� ���ܵǾ��� GIST
Gastrointestinal stromal tumor of low risk of aggressive behavior, stomach:
1) tumor size: 6.5x6 cm
2) mitosis: 3/50 HPF
3) histological type: mixed spindle and epithelioid
4) necrosis: absent
5) cellularity: high
6) invasion into mucosa: present
7) resection margin involvement: absent
C-kit: Positive, PKC-��: Strong positive, CD34: Strong positive, PDGFRA: Positive with dot-like accentuation, Ki-67: Positive (3%)


위점막하종양 gist - wijeommaghajong-yang gist
�쿬�� ������ ���������Ŀ��� �߰��� GIST. ���ÿ� ������ ���ð濡���� SMT�� �ǽɵ��� �ʾҴٰ� �մϴ�.
Gastrointestinal stromal tumor of moderate risk of malignant potential:
1) size: 11x9x8 cm
2) mitosis : 2/50 HPFs
3) histologic type: epithelioid
4) necrosis: present
5) cellularity: high
6) cellular atypia: moderate
7) invasion to mucosa: absent
8) resection margin involvement: absent
DOG-1 : Positive, C-kit : Negative, PKC-Q : Weak positive, CD34 : Focal positive, PDGFRA: Positive (dot-like), Ki-67 : Positive in 20% of tumor cells


위점막하종양 gist - wijeommaghajong-yang gist
22G Precore ����Ͽ� EUS-guided FNAB ������. GIST�� ���� ������ �����Ͽ����ϴ�.
Stomach, mid body, wedge resection:
Gastrointestinal stromal tumor of very low by NIH and none risk (0%) of progressive disease by Miettinen (2006) :
1) tumor size: 1.9x1.8x1 cm
2) mitosis: 1/50 HPF (high powered fields)
3) histological type: spindle
4) necrosis: absent
5) cellularity: intermediate
6) cellular atypia: mild
7) invasion into mucosa: absent
8) resection margin involvement: absent


위점막하종양 gist - wijeommaghajong-yang gist
�鹮�� GIST
Stomach, esophagogastric junction, mass excision:
Gastrointestinal stromal tumor of high risk of malignant potential:
1) tumor size: 5.1x3.5 cm
2) mitosis: 38/50 HPF (high powered fields)
3) histological type: spindle (palisading-vacuolated)
4) necrosis: absent
5) cellularity: high
6) cellular atypia: moderate
7) invasion into mucosa: absent
8) resection margin involvement: absent


위점막하종양 gist - wijeommaghajong-yang gist
�鹮�� ���ϰ� ������ ������� GIST
Stomach and esophagus, proximal subtotal gastrectomy :
Gastrointestinal stromal tumor of high risk of malignant potential :
1) tumor size: 5.5x3.5 cm
2) mitosis: 61/50 HPF (high powered fields)
3) histological type: mixed spindle and epithelioid
4) necrosis: present
5) cellularity: high
6) cellular atypia: marked
7) invasion into mucosa: present
8) resection margin involvement: absent
9) no metastasis in 2 perigastric lymph node (0/2: perigastric LN, 0/2)


위점막하종양 gist - wijeommaghajong-yang gist
Non-healing ulcer�� �ǷڵǾ��� ū GIST�Դϴ�.
Stomach, subtotal gastrectomy:
Gastrointestinal stromal tumor of high risk of malignant potential by NIH consensus guideline:
1) tumor size: 12x11 cm
2) mitosis: 1/50 HPF (high powered fields)
3) histological type: spindle
4) necrosis: present
5) cellularity: intermediate
6) cellular atypia: moderate
7) invasion into mucosa: absent
8) resection margin involvement: absent
9) No metastasis in 42 regional lymph nodes


위점막하종양 gist - wijeommaghajong-yang gist
ũ�Ⱑ �����ϴ� �������������� �Ƿڵ�. CT���� �� ��������, ���� ��������, lesser omentum�� �������� �ָ��Ͽ���. EUS-guided biopsy�� ���� ������ ���Ͽ� �����ϰ� ȯ�ڿ� �����Ͽ� �ᱹ �ٷ� laparoscopic wedge resection�� �Ͽ��� GIST�� Ȯ�ε�.


위점막하종양 gist - wijeommaghajong-yang gist
Gastrointestinal stromal tumor
High risk of malignant potential by NIH (2002) and moderate risk (16 %) of progressive disease by Miettinen (2006) :
1) tumor size: 3.5x2.7 cm
2) mitosis: 14/50 HPF (high powered fields)
3) histological type: spindle
4) necrosis: absent
5) cellularity: intermediate
6) cellular atypia: mild
7) invasion into mucosa: absent
8) resection margin involvement: absent


위점막하종양 gist - wijeommaghajong-yang gist
������ �ϰ� ����� SMT --> fundus, wedge resection
Gastrointestinal stromal tumor of low risk of malignant potential by proposed modification for adjuvant therapy (2008) and very low risk (1.9 %) of progressive disease by Miettinen (2006):
1) tumor size: 4x3x3 cm
2) mitosis: 3/50 HPF (high powered fields)
3) histological type: spindle
4) necrosis: absent
5) cellularity: intermediate
6) cellular atypia: mild
7) invasion into mucosa: absent
8) resection margin involvement: absent


위점막하종양 gist - wijeommaghajong-yang gist
Stomach, fundus, wedge resection:
Gastrointestinal stromal tumor of low by NIH and very low risk (1.9%) of progressive disease by Miettinen (2006) :
1) tumor size: 3.3x2.5 cm
2) mitosis: 2/50 HPF (high powered fields)
3) histological type: spindle
4) necrosis: absent
5) cellularity: intermediate
6) cellular atypia: mild
7) invasion into mucosa: absent
8) resection margin involvement: absent


위점막하종양 gist - wijeommaghajong-yang gist
Stomach, lesser curvature of lower body, wedge resection:
Gastrointestinal stromal tumor of low by NIH and very low risk (1.9 %) of progressive disease by Miettinen (2006) :
1) tumor size: 2.6x2.3 cm
2) mitosis: 1/50 HPF (high powered fields)
3) histological type: spindle
4) necrosis: absent
5) cellularity: intermediate
6) cellular atypia: mild
7) invasion into mucosa: absent
8) resection margin involvement: absent


위점막하종양 gist - wijeommaghajong-yang gist
Gastrointestinal stromal tumor of high risk by NIH and high risk (55 %) of progressive disease by Miettinen (2006) :
1) tumor size: 6.8x6.6x6.2 cm
2) location: high body, posterior wall of stomach
3) mitosis: 11/50 HPF (high powered fields)
4) histological type: spindle
5) necrosis: present
6) cellularity: high
7) cellular atypia: moderate
8) invasion into mucosa: absent
9) resection margin involvement: absent
10) tumor adhesion but no invasion into pancreas
11) 7 reactive lymph nodes


위점막하종양 gist - wijeommaghajong-yang gist

Stomach, low body, wedge resection:
Gastrointestinal stromal tumor of low risk of malignant potential by proposed modification for adjuvant therapy (2008), low by NIH and very low risk (1.9 %) of progressive disease by Miettinen (2006) :
1) tumor size: 2.2x1.6x1.4 cm
2) mitosis: up to 1/50 HPF (high powered fields)
3) histological type: epithelioid
4) necrosis: absent
5) cellularity: intermediate
6) cellular atypia: moderate
7) invasion into mucosa: absent
8) resection margin involvement: absent


위점막하종양 gist - wijeommaghajong-yang gist
Exophytic growth�� ���� GIST�� ���ð� ������ ��ƽ��ϴ�.
Stomach, lower body, wedge resection:
Gastrointestinal stromal tumor of low risk of malignant potential by proposed modification for adjuvant therapy (2008) (see note);
1) tumor size: 3.5x3 cm
2) mitosis: up to 2/50 HPF (high powered fields)
3) histological type: epithelioid
4) necrosis: absent
5) cellularity: intermediate
6) cellular atypia: moderate
7) invasion into mucosa: absent
8) resection margin involvement: present
Note: Low risk by NIH (2002) and very low risk (1.9 %) of progressive disease by Miettinen (2006).


위점막하종양 gist - wijeommaghajong-yang gist
Exophytic growth�� ���� GIST�� ���ð� ������ ��ƽ��ϴ�.
Stomach, wedge resection: Gastrointestinal stromal tumor of low risk of malignant potential by proposed modification for adjuvant therapy (2008) (see note);
1) tumor size: 2.6x2 cm
2) mitosis: 1/50 HPF (high powered fields)
3) histological type: spindle
4) necrosis: absent
5) cellularity: intermediate
6) cellular atypia: mild
7) invasion into mucosa: absent
8) resection margin involvement: absent
Note: Low risk by NIH (2002) and very low risk (1.9 %) of progressive disease by Miettinen (2006).


위점막하종양 gist - wijeommaghajong-yang gist
Exophytic growth�� ���� GIST�� ���ð� ������ ��ƽ��ϴ�.
Stomach, lower antrum, wedge resection:
. Gastrointestinal stromal tumor of low risk of malignant potential by proposed modification for adjuvant therapy (2008) (see note);
1) tumor size: 2.8x1.9 cm
2) mitosis: 1/50 HPF (high powered fields)
3) histological type: epithelioid
4) necrosis: absent
5) cellularity: intermediate
6) cellular atypia: mild
7) invasion into mucosa: cannot be evaluated
8) resection margin involvement: absent
Note: Low risk by NIH (2002) and very low risk (1.9%) of progressive disease by Miettinen (2006).


위점막하종양 gist - wijeommaghajong-yang gist
������ ���� �����Ŀ��� �� ���� mass�� �߰ߵǾ����ϴ�. ���ð�� CT �� ������ ����Ǿ��� GIST�� ���Խ��ϴ�. ���� �����ķ� ���� ������ ���� ���� �ƴմϴ�. �̰� ���� �� ���� �����ϴ�.
Stomach, GIST, wedge resection: Gastrointestinal stromal tumor of low risk of malignant potential by proposed modification for adjuvant therapy (2008) (see note);
1) tumor size: 2.5x2 cm
2) mitosis: 3/50 HPF (high powered fields)
3) histological type: mixed spindle and epithelioid
4) necrosis: absent
5) cellularity: intermediate
6) cellular atypia: mild
7) invasion into mucosa: absent
8) resection margin involvement: absent


위점막하종양 gist - wijeommaghajong-yang gist
�� SMT�ε� CT���� hypervascular ����̾��� ������ GIST�� �ƴ� ���� �ְڴٰ� �����Ǿ����ϴ�. CT �ǵ��� ������ ���ҽ��ϴ�. Very hypervascular mass abutting stomach. DDx. Gastric subepithelial tumor such as GIST, glomus tumor vs. primary mesenteric origin tumor such as Castleman's disease. �׷��� ���� ����� ���� GIST�� ���Խ��ϴ�. GIST�� ������ �پ��� ����� ���� �� �ֽ��ϴ�.
Stomach, posterior wall of low body, wedge resection: Gastrointestinal stromal tumor of low risk of malignant potential
1) tumor size: 2.7x2.4 cm
2) mitosis: 3/50 HPF (high powered fields)
3) histological type: epithelioid
4) necrosis: absent
5) cellularity: intermediate
6) cellular atypia: moderate
7) invasion into mucosa: absent
8) resection margin involvement: absent
Ki-67: positive in 3% of tumor cells
DOG-1: positive in tumor cells
C-kit (CD 117): positive in tumor cells


위점막하종양 gist - wijeommaghajong-yang gist

Surgery was recommended for a large gastric SMT 9 years ago, but the patient refused it. Nine years later, the patient visited my clinic again for the surgical treatment. In CT images, the diameter was 4.8cm in 9 years ago, and 5.1cm in recent images. Surgery was done.
9�� �� ������ ���ߴµ� ȯ�ڲ��� ������ ���� �ʰ� �����ôٰ� 9�� ���� �ܺ� �������� ���ð� �˻縦 ���� �� ���ڱ� ������ �ްڴٰ� ã�ƿ��̽��ϴ�.
CT�� �ٽ� ����µ� ���ེ���� ���� ���� �ڶ� ������ ���Խ��ϴ�. " Gastric fundus�� �ºپ� �ִ� submucosal tumor�� �ǴܵǴ� ������ 2011�� ���������� 4.8 cm���� �����ǰ� ����� 5.1 cm���� �ణ ũ�� ������. �������� ����� ū ��ȭ ������ ascites�� peritoneal nodule ������ ����." ������ �Ͽ����ϴ�.
Stomach, laparoscopic wedge resection: Gastrointestinal stromal tumor of intermediate risk of malignant potential by proposed modification for adjuvant therapy (2008) (see note);
1) tumor size: 5.5x4.0 cm
2) mitosis: 3/50 HPF (high powered fields)
3) histological type: spindle
4) necrosis: absent
5) cellularity: intermediate
6) cellular atypia: mild
7) invasion into mucosa: absent
8) resection margin involvement: absent
Note: intermediate risk by NIH (2002) and low risk (3.6 %) of progressive disease by Miettinen (2006).
���� �ڶ�� GIST�� �ְ� õõ�� �ڶ�� GIST�� �ֽ��ϴ�. ���� ��Ȯ�� ������ �Ұ����� �����Դϴ�. ����̶���ۿ� �� �� �����ϴ�.


위점막하종양 gist - wijeommaghajong-yang gist
M/50 (2017)


위점막하종양 gist - wijeommaghajong-yang gist
12. ���� GIST

위점막하종양 gist - wijeommaghajong-yang gist
Duodenal GIST. 3.2x1.8cm

위점막하종양 gist - wijeommaghajong-yang gist
�������� GIST�� necrosis�� ���ϸ� �����˻翡�� ������ ���� �� �ֽ��ϴ�. Melena�� �����Ͻ� ������ �� ���� EGD �����˻翡�� �������� Ȯ���� ���� �ʾ� ������ EUS-guided biopsy�� �������� Ȯ���� ���� �� �־��� duodenal GIST with hepatic metastais �����Դϴ�. (F/60, 2018)

위점막하종양 gist - wijeommaghajong-yang gist

Duodenum, common bile duct and pancreas, PPPD: Gastrointestinal stromal tumor of low risk of malignant potential, duodenum;
1) tumor size: 2.7x2.3 cm
2) mitosis: 1/50 HPF (high powered fields)
3) histological type: spindle
4) necrosis: absent
5) cellularity: intermediate
6) cellular atypia: mild
7) invasion into mucosa: absent
8) resection margin involvement: absent
. Chronic cholecystitis with cholelithiasis and cholesterol polyps, gallbladder

위점막하종양 gist - wijeommaghajong-yang gist
������ ������ 30�� ������ �������忡�� SMT�� �߰ߵǾ��� �� �Ϻΰ� �Ը��Ǿ� �־����� ������ �������� �ǴܵǾ��� ������ ������ (2017)
Duodenum, 2nd portion, wedge resection: Gastrointestinal stromal tumor of low risk of malignant potential by proposed modification for adjuvant therapy (2008)
1) tumor size: 4.2x4x2.5 cm
2) mitosis: 3/50 HPF (high powered fields)
3) histological type: spindle
4) necrosis: absent
5) cellularity: intermediate
6) cellular atypia: mild
7) invasion into mucosa: present
8) resection margin involvement: absent
9) no metastasis in 2 lymph nodes


위점막하종양 gist - wijeommaghajong-yang gist
Pancreas uncinate process�� duodenum ������ enhancing mass�� 9�� ���̿� ���ݾ� Ŀ���� ���� �� duodenal GIST�� Ȯ�� (2018, F/62)

위점막하종양 gist - wijeommaghajong-yang gist

Excision: Gastrointestinal stromal tumor of low risk of malignant potential by proposed modification for adjuvant therapy (2008) (see note);
1) tumor size: 3x2 cm
2) mitosis: 2/50 HPF (high powered fields)
3) histological type: spindle
4) necrosis: absent
5) cellularity: intermediate
6) cellular atypia: moderate
7) invasion into mucosa: absent
8) resection margin involvement: absent


위점막하종양 gist - wijeommaghajong-yang gist
���� �����Ŀ��� ���� Ȥ�� ���� ������ �߰ߵǾ����ϴ� ("R/O Low echoic mass lesion or collapsed bowel, inferior aspect of pancreatic tail"). CT �� jejunum GIST�� �ǴܵǾ� ������ �����̽��ϴ�. (2015)
Small intestine, wedge resection: Gastrointestinal stromal tumor of low risk of malignant potential:
1) tumor size: 4.5x3 cm
2) mitosis: 0/50 HPF (high powered fields)
3) histological type: spindle
4) necrosis: absent
5) cellularity: intermediate
6) cellular atypia: mild
7) invasion into mucosa: absent
8) resection margin involvement: absent
C-kit, PKC-e, DOG-1, CD34: all positive
Ki-67: positive in less than 2% of tumor

7�� �� ���� �������� �˻縦 �޾� �� �������� �ǷڵǾ����ϴ�. �� �����˻縦 �Ͽ����ϴ�.
Liver, S8/7, biopsy : Gastrointestinal stromal tumor
C-KIT (CD 117) : Diffusely positive in tumor cells
DOG-1 : Diffusely positive in tumor cells
Cytokeratin (AE1/AE3) : Negative in tumor cells
Ki-67 : Positive in about 3% of tumor cells
Actin (Smooth muscle) : Focally positive in tumor cells

�ٸ� ���� ���Ұ� �������Ƿ� ���� jejunal GIST�� �����̷� �Ǵ��Ͽ����ϴ�. �۸��� ġ�Ḧ ���Ͽ� ���系���� �ǷڵǾ����ϴ�. ���� GIST�� �������ϴ�. "Low risk of malignant potential"�� ���Դ� ȯ�ڿ����� �����̸� ���̴� ��찡 �����ϱ��. Low�� No�� �ƴմϴ�.


[More cases]

위점막하종양 gist - wijeommaghajong-yang gist
Gastrointestinal stromal tumor of intermediate risk of malignant potential by NIH (2002) and moderate risk (24 %) of progressive disease by Miettinen (2006) :
1) tumor size: 5.5x5.5x5 cm
2) mitosis: 0/50 HPF (high powered fields)
3) histological type: spindle
4) necrosis: absent
5) cellularity: intermediate
6) cellular atypia: mild
7) invasion into mucosa: present
8) resection margin involvement: absent
9) no metastasis in 3 regional lymph node (0/3 : "mesenteric LN", 0/3)

위점막하종양 gist - wijeommaghajong-yang gist
Jejunal GIST
Gastrointestinal stromal tumor of high risk of malignant potential by NIH (2002) and high risk (85%) of progressive disease by Miettinen (2006) :
1) tumor size: 7.8x7x5 cm
2) mitosis: 22/50 HPF (high powered fields)
3) histological type: spindle
4) necrosis: present
5) cellularity: intermediate
6) cellular atypia: mild
7) invasion into mucosa: present
8) myxoid change: present
9) resection margin involvement: absent

위점막하종양 gist - wijeommaghajong-yang gist
Jejunal GIST

위점막하종양 gist - wijeommaghajong-yang gist
small bowel malignant GIST with peritoneal seeding (exon 11 mutation +)

위점막하종양 gist - wijeommaghajong-yang gist
Ileal GIST with liver metastasis

위점막하종양 gist - wijeommaghajong-yang gist
�ٹ߼� �����̸� ������ GIST�����ϴ�. EGD���� ���� ���������� mucosal lesion�� �������� CT �Ұ��� �ٰŷ� gastric GIST with liver metastasis�� ���� �����ϰ� imatinib�� ����Ͽ����ϴ�. �� ���Ҵ� �� �������� ���ߺ��Ҹ� ���Ƽ� ������ �Ͽ��µ� ������ ��ġ�� ���� �ƴ϶� ���������̾����ϴ�. ó������ duodenal GIST with liver metastasis���� ������ �Ǵ��Ͽ����ϴ�.

위점막하종양 gist - wijeommaghajong-yang gist
���Ҿ� �ǽ��Ͽ� ������ �����Ͽ����� ���� GIST�� ���Խ��ϴ�.

위점막하종양 gist - wijeommaghajong-yang gist
��ġ�� ���������� ������ CT���� �쿬�� �߰ߵ� duodenal 3rd portion hypervascular mass������ �Ҿ� ������� �̿��� push enteroscopy �� ���� ����
Duodenal wedge resection: Gastrointestinal stromal tumor of very low risk of malignant potential by proposed modification for adjuvant therapy (2008);
1) tumor size: 1.8x1.8 cm
2) mitosis: 0/50 HPF (high powered fields)
3) histological type: spindle
4) necrosis: absent
5) cellularity: intermediate
6) cellular atypia: moderate
7) invasion into mucosa: absent
8) resection margin involvement: absent
Note: Very low risk by NIH (2002) and none risk (0%) of progressive disease by Miettinen (2006).
. Ki-67 : Positive in up to about 2% of tumor cells
. C-KIT (CD 117) : Positive in tumor cells
. DOG-1 : Positive in tumor cells


위점막하종양 gist - wijeommaghajong-yang gist
13. ���� GIST ����

위점막하종양 gist - wijeommaghajong-yang gist

Rectum, trans-anal endoscopic microsurgery:
. Gastrointestinal stromal tumor of very low risk of malignant potential by proposed modification for adjuvant therapy (2008), none risk (0 %) of progressive disease by Miettinen (2006) :
1) tumor size: 1.4x1.2x0.4 cm
2) mitosis: 3/50 HPF (high powered fields)
3) histological type: spindle
4) necrosis: absent
5) cellularity: intermediate
6) cellular atypia: mild
7) invasion into mucosa: absent
8) resection margin involvement: absent
. Pho-H-H3: Positive in less than 5% of tumor cells
. C-kit : Positive
. DOG1 : Positive
. Ki-67: Negative
. PKC-��: Weakly positive

�� ������ �ƴ�����... �̷��� ���� GIST�� follow up �ϸ� ��� ������ ���ҽ��ϴ�.


위점막하종양 gist - wijeommaghajong-yang gist
14. ��Ÿ ��� GIST

위점막하종양 gist - wijeommaghajong-yang gist
�ĵ� GIST. ��� ������ ������ �� �ĵ� GIST�� ���� �����Դϴ�. �ĵ� GIST�� leiomyoma���� �ſ� rare�մϴ�. �Ϻνĵ��� ��ġ�ϰ� lobulated �Ǵ� ������ �ְ� leiomyoma���� soft �մϴ�. Leiomyoma�� ���� �ſ� �ܴ��մϴ�.

위점막하종양 gist - wijeommaghajong-yang gist
���� GIST
Small intestine, pancreas, CBD and gallbladder, PPPD : Gastrointestinal stromal tumor of low risk of malignant potential by proposed modification for adjuvant therapy (2008), low risk (8.3%) of progressive disease by Miettinen (2006)
1) tumor size: 2.3x2x1.8cm
2) mitosis: up to 1/50HPF (high powered fields)
3) histological type: epithelioid
4) necrosis: absent
5) cellularity: low
6) cellular atypia: mild
7) invasion into mucosa: absent
8) resection margin involvement: absent
. 20 reactive lymph nodes


위점막하종양 gist - wijeommaghajong-yang gist
15. Code

������ �� GIST�� �ڵ忡 ���� ������ �־� �������� �����Ͽ����ϴ�. (2017/3)

위점막하종양 gist - wijeommaghajong-yang gist

���ڷ� �� Į�ڷ縦 ������ �ִ� ���ο����� ���غ��� �����ϰ� ������ �� ���Դϴ�. ȯ���� ������ ���Ͽ� ������ �ð��� �����ѵ� �ڵ� ������ �ڲ� �ð��� �����ϴٴ� ��Ÿ�����ϴ�. �����ϴ� �ٿ� ���� '�ϵ�Ϻ���'�� ������ �ƴմϴ�. �ƹ��� ������ �� �˷��ִ� ���� ���� �񷯺� ���Դϴ�. '�ϵ�Ϻ���'�� �� �� �ϳ��Դϴ�.


위점막하종양 gist - wijeommaghajong-yang gist
[FAQ]

[2016-11-14. 2016�� ��ǥ�� GIST management ������ ���� ���� ������ ����]

1) 2-5 cm GIST �� ���� malignant risk�� very low risk���� intermediate���� �پ��մϴ�. Very low rsk�� �ش��ϴ� ��찡 ���� ��Ȳ���� ��� ȯ�ڿ��� ������ �����ϴ� ���� ����ġ�ᰡ �� �� �ֽ��ϴ�. High risk feature�� ���� ȯ�ڿ� ���� ġ�ᰡ �̷������ ���� �ٶ����� ������ ���̳�, �������� ���� � ���� �׷� ��������� �̸� Ȯ���ϴ� ���� ���������� ��ƴٴ� �Ѱ谡 �ֽ��ϴٸ� (ũ��, �˾��� ����, ���� necrosis ���� ���� ������ ū ���谡 ���� ��찡 �����ϴ�).

2) 2 cm �̸��� GIST�� mitotic index�� ���þ��� ��� very low risk�� �ش��մϴ� (Hornick JL. Hum Pathol 2007�� ������ ������ �ƴ����� �� GIST�� ��� ũ�Ⱑ 2 cm �����̸� mitotic index�� 5/50 HPF ���Ͽ� �̻� ��� very low risk�� �ش��մϴ�). �� ���� ������ �ʿ���ٰ� �����մϴ�. ��, very low risk�� ���� ����� �������� �ݿ��ϴ� ���̹Ƿ� �ð� ����� ���� ��ȭ ���δ� �� Ȯ���ؾ� �մϴ� (ũ�� ��ȭ�� ��ü�� 5% �̸�).

위점막하종양 gist - wijeommaghajong-yang gist

[2016-11-20. ������ �亯]

���� �ǰ� �����մϴ�.

�� GIST�� 2cm ���ϸ� ���� ũ���� �����̳� ���� GIST���� ���輺�� ���մϴ�. 2 cm ������ �� SMT�� ��� ������������ GIST�� Ȯ�εǴ��� ������ ������ ������ �ʽ��ϴ�. 2016�� ��ǥ�� GIST management ������ algorithm���� �� �� �ֵ��� ��� ������������ GIST��� Ȯ�εǴ��� high risk feature�� ������ ��������� �����մϴ�.

2 cm ������ �� SMT Ȥ�� �� GIST�� ���� ���� �˻�� ���� ġ���� ���ɼ��� ������ �ּż� �����մϴ�.


[2017-2-15. �ֵ��� ����]

�����Բ��� �����ֽ� ���� �߿� �Ʒ� ���ʰ��� ��� (1-3 cm ������ ���) ���� �������� ��� �������� �׻� �����Դϴ�. FNAB�� incision�� �ؼ� �����˻��ϴ� ���� ���������� �ǰ��Ͻô�����?

위점막하종양 gist - wijeommaghajong-yang gist
22G Precore ����Ͽ� EUS-guided FNAB ������. GIST�� ���� ������ �����Ͽ����ϴ�.

[2017-2-15. ������ �亯]

�߿��� �����̶�� �����մϴ�. ���� �츮���󿡼� ������ '������ ������ �� SMT�� ���� ���̵����'�� ���� ������, �Ʒ��� ���� �Ϻ� ���̵������ ������ ��찡 �����ϴ�. ���� ���ε� ������ �ƴմϴ�.

위점막하종양 gist - wijeommaghajong-yang gist

�Ϻ��� �ǰ߿� ������ 2cm�� ���� �ʴ� SMT���� Ư���� ���� �Ұ��� ������ ������ ���� ���� ��������� �ϸ� �˴ϴ�. �̷��� ���ϴ� ���� �� �ϳ��� ������ �� GIST�� ������ ������ �� �� �ۿ� ���� �����Դϴ�. ������ �𸣴� ���¿����� ���ɽ����� ��������� �� �� ������, �ϴ� GIST�� ���� �˸� ������ ���� ���� �� �����ϴ�. ������ ������ �ֱ� �����Դϴ�. '�𸣴� �� ���̴�'��� ���� �ִµ� �� ���⿡ �ش��մϴ�.

���ϵ� ���� ���̵������ ���� ������, ������ ������ �ǰ����� �߻��մϴ�. ���� ������ ���̰� Ů�ϴ�. �� ���� �������� �ǰ��� ���ϵǾ� ���� ���մϴ�. �����Ͻ� ���ʴ� �� ȯ�ڴ� �ƴϾ����ϴ�. EUS���� ��� 18.9mm�� �����Ǿ���, EUS-guided�� ������ �������, GIST�� ���԰�, ������ ����Ǿ����ϴ�. Ÿ���� �˻�� Ÿ���� �����̾����ϴ�. �ٸ� ��� �ǻ簡 �� �׷��� �ؾ߸� �ϴ� ��Ȳ�� �ƴϾ����ϴ�.

�켱 CT�� ��� 2cm �̸����� ������ ���ð� ���� ������ ������ option�̾����ϴ�. �� Ŀ���ų� ������ ���� ���� �������ڴ� �����Դϴ�. ���� �׷��� ���� �� �����ϴ�.

�ᱹ ���� �������� ���ص� �����ϰ� �ټ� �������� ���ص� ������ ȯ�ڿ����ϴ�. ���� ���ϵ� ���� ���̵������ �ʿ��մϴ�. �׷��� �ſ� �ſ� �ſ� �ſ� ����� ���� ���Դϴ�. ������ �ƽð����� ..... (�۷δ� �� �� �����ϴ�. �� ������ �˰� �����ø� ��ȸ�� ����ȸ�� ���������� ������ ���ô�. �� ���� �� �޶�� ã�ƿ��ŵ� �����ϴ�.)


위점막하종양 gist - wijeommaghajong-yang gist
[References]

1) EndoTODAY ���������� submucosal tumor

2) The standard diagnosis, treatment, and follow-up of GIST - 2016�� Gastric Cancer�� 1��ȣ ����

© �Ͽ����ð汳�� �ٸ����ð濬���� ������. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng