위의 원발성 악성 림프종의 임상적 특성 : MALT림프종을 포함하여

이병석,이엄석,김선문,양현웅,서승원,정현용 충남대학교 의과대학 의학연구소 2002 충남의대잡지 Vol.29 No.1

Primary gastric lymphoma is the most common in extralymphoid and gastrointestinal lymphoma and clinical feature is variable. We reprted clinical feature of primary gastric lymphoma. Seventeen cases of primary gastric lymphoma were analyzed retrospectively from March, 1996 to December, 2000. Clinical feature and endoscopic finding with pathologic finding were analyzed. Mean age of patients was 57.6 years and M/F ratio was 1.12 to 1. The most frequent initial symptoms were epigastric discomfort and weight loss (each 47.1%). Endoscopic findings were ulcerofungating and ulceroinfiltrative lesion(each 29.4%), followed by infiltrative lesion (23.4%). Primary gastric lymphoma was suggested in 7 cases, advanced gastric cancer in 5 cases and eary gastric cancer in 2 cases. According to histologic finding, MALToma was 6 cases. One case of MALToma has done Helicobacter pylori eradication therapy. The overall 2 year and 3year survival rate were 63.3% and 50.0%. Differential diagnosis of primary gastric lymphoma and gastric adenocarcinoma was difficult in endoscopic finding. But early and precise diagnosis may been important because that prognosis of primary gastric lymphoma was superior to gastric adenocarcinoma.

원발성 위림프종에서 외과적 치료의 역할

류창학(Chang Hak Yoo),노성훈(Sung Hun Noh),김용일(Yong Il Kim),서진학(Jin Hak Suh),민진식(Jin Sik Min),이경식(Kyong Sik Lee) 대한소화기학회 1998 대한소화기학회지 Vol.30 No.1

N/A Background/Aims: Prirnary gastric lymphoma is an uncommom tumor, constituting less than 5% of gastric malignancies. Optimal treatment of early-stage gastric lymphoma has been a matter of debate for several years. Our purpose in this study is to evaluate the exact role of surgery in the treatment of gastric lymphoma. Methods: Retrospective study of 63 patients, treated at the Dept. of Surgery, Yonsei Univ., College of Medicine from 1980 to 1994 was performed. Survival and multivariate analyses were done using the Kaplan-Meier method and Coxs proportional hazard model. Results: The mean age was 49.4 years, the ale to female ratio was 1.5:1 and the mean tumor size was 5.lcm in maximal diameter. The distribution of histologic grade according to the Working formulation was low-grade(n=24), intermediate-grade(n=32), high-grade(n=7) and high with low-grade(n=l). The distribution of stage according to the criteria of Musshoff was I(n=35), II-1(n=l 1), II-2(n=14), IV(n=3). Fifty two patients underwent gastric resection: subtotal(n=29), total (n=23) and the remaining 11 patients were diagnosed by laparotomy biopsy(n=4) and endoscopic biopsy(n=7) without gastric resection. Treatment modalities included surgery(S), chemotherapy (CT), and radiotherapy(RT) in the following proportions: only S(n=l9), S+CT(n=17), S+RT(n=4), S+CT+RT(n=12) and CT+RT(n=l 1). The overall 5-year survival rate was 72.5%. The 5-year survival rates according to stage were 87.3% in stage I, 76.2% in II-1, and 45.7% in II-2. No difference in survival rate was found according to treatrnent modality. Significant prognostic factors by univariate analysis were histologic grade, multifocality, lymph node metastasis, gastric resection and stage. Among them, independent prognostic factor by multivariate analysis was stage (p=0.0011). Conclusions: We suggested that surgical role in the treatment of early gastric lymphoma(stage I, II) may still be primary therapeutic procedure and the extent of sugical resection should be a standard radical gastrectomy with D2 or D2+a lymph node dissection. But in the intermediate or high grade tumor, multifocal lesions, LN metastasis and advanced stage, chemotherapy or radiotherapy should be considered as adjuvant therapy. (Korean J Gastroenterol 1997; 30:39 - 47)

위-위 장중첩증을 유발한 원발 위 림프종 1예

조형호 ( Hyeong Ho Jo ),강선미 ( Sun Mi Kang ),김시혜 ( Si Hye Kim ),라모니 ( Moni Ra ),박병규 ( Byeong Kyu Park ),권중구 ( Joong Goo Kwon ),김은영 ( Eun Young Kim ),정진태 ( Jin Tae Jung ),김호각 ( Ho Gak Kim ),류헌모 ( Hun Mo Ry 대한소화기학회 2016 대한소화기학회지 Vol.68 No.1

In adults, most intussusceptions develop from a lesion, usually a benign or malignant neoplasm, and can occur at any site in the gastrointestinal tract. Intussusception in the proximal gastrointestinal tract is uncommon, and gastro-gastric intussusception is extremely rare. We present a case of gastro-gastric intussusception secondary to a primary gastric lymphoma. An 82-year-old female patient presented with acute onset chest pain and vomiting. Abdominal CT revealed a gastro-gastric intussusception. We performed upper gastrointestinal endoscopy, revealing a large gastric mass invaginated into the gastric lumen and distorting the distal stomach. Uncomplicated gastric reposition was achieved with endoscopy of the distal stomach. Histological evaluation of the gastric mass revealed a diffuse large B cell lymphoma that was treated with chemotherapy. (Korean J Gastroenterol 2016;68:40-44)

원발성 위림프종에서 외과적 치료의 역할

류창학,노성훈,김용일,서진학,민진식,이경식 大韓消化器病學會 1997 大韓消化器病學會誌 Vol.30 No.1

원발성 위 림프종의 임상연구

황일란(Il Ran Hwang),김정원(Jung Won Kim),박선미(Sun Mi Park),김해련(Hae Ryun Kim),민영일(Young Il Min) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.1

N/A Background/Aims: Primary gastric non-Hodgkins lymphoma is rare and represents a minority of 1-7% of all gastric malignancy. Prognosis and early diagnosis remains important. Methods: We analysed clinical and endoscopic findings in 27 patients with primary gastric non-Hodgkins lymphoma between June 1989 and July 1994 at the Asan Medical Center. Results: The prevalence of primary gastric lymphoma occupied 1.2% of all gastric cancers. The most frequent chief complaint was epigastric pain(74%), followed by postprandia] epigastric discomfort (19%), abdominal mass(15%) and gastrointestinal bleeding(11%). Initial endoscopic findings suggested gastric lyrnphoma in 6 cases(22%), advanced gastric cancer in 14 cases(52%) and benign gastric ulcer in 2 cases(7%). The macroscopic type of 15 cases(56%) was ulcerative, while 5(19%) were superficial, 5(19%) giant mucosal fold, and 2(6%) polypoid. Pathologic findings of initial endoscopic biopsy specimens in 18 operated cases were gastric lymphoma in 7 cases, atypical lymphocyte infiltration in 3 cases, adenocarcinoma in 4 cases and ulcer or erosion in 3 cases. Conclusions: A definite diagnosis of primary gastric non-Hodgkins lymphoma was difficu]t to be confirmed by endoscopic examination and biopsy. Recognition of specific endoscopic findings with a high index of suspicions is essential for early diagnosis, and multiple biopsies with/without submucosa are required. (Korean J Gastroenterol 1996;28: 11 - 18)

Management of Suspicious Mucosa-Associated Lymphoid Tissue Lymphoma in Gastric Biopsy Specimens Obtained during Screening Endoscopy

양효준,임선희,이창현,최지민,양종인,정수진,최승호,임종필,김상균,김주성 대한의학회 2016 Journal of Korean medical science Vol.31 No.7

It is often difficult to differentiate gastric mucosa-associated lymphoid tissue (MALT) lymphoma from Helicobacter pylori-associated follicular gastritis, and thus, it becomes unclear how to manage these diseases. This study aimed to explore the management strategy for and the long-term outcomes of suspicious gastric MALT lymphoma detected by forceps biopsy during screening upper endoscopy. Between October 2003 and May 2013, consecutive subjects who were diagnosed with suspicious gastric MALT lymphomas by screening endoscopy in a health checkup program in Korea were retrospectively enrolled. Suspicious MALT lymphoma was defined as a Wotherspoon score of 3 or 4 upon pathological evaluation of the biopsy specimen. Of 105,164 subjects who underwent screening endoscopies, 49 patients with suspicious MALT lymphomas who underwent subsequent endoscopy were enrolled. Eight patients received a subsequent endoscopy without H. pylori eradication (subsequent endoscopy only group), and 41 patients received H. pylori eradication first followed by endoscopy (eradication first group). MALT lymphoma development was significantly lower in the eradication first group (2/41, 4.9%) than in the subsequent endoscopy only group (3/8, 37.5%, P = 0.026). Notably, among 35 patients with successful H. pylori eradication, there was only one MALT lymphoma patient (2.9%) in whom complete remission was achieved, and there was no recurrence during a median 45 months of endoscopic follow-up. H. pylori eradication with subsequent endoscopy would be a practical management option for suspicious MALT lymphoma detected in a forceps biopsy specimen obtained during screening upper endoscopy.

조기위암 치료 후 발생한 속발성 외투막세포백혈병의 증례보고

어완규,안규정,이우인,임성직,정종수 대한혈액학회 2008 Blood Research Vol.43 No.4

We report here on a case of metachronous second primary non-Hodgkin’s lymphoma (NHL) that was diagnosed 6 years after performing subtotal gastrectomy for treating early gastric cancer (EGC). The subtype analysis revealed mantle cell lymphoma (MCL) of the blastic variant with a leukemic presentation, which was composed of mixed small and medium-sized cells. The immunohistochemical staining for cyclin-D1 was positive. The cytogenetic study revealed t(4;6). In Korea, the risk of developing a second primary cancer following gastric cancer was reported to be less than 3.4%, and NHL comprised less than 6.3% of this second primary cancer. Furthermore, MCL represents about 2% of all lymphomas in Korea. To the best of our knowledge, this is the first report of metachronous primary MCL with a leukemic presentation following curative resection of EGC. (Korean J Hematol 2008;43:247-252.)

Correlation of Endoscopic Findings of Gastric Mucosa-Associated Lymphoid Tissue Lymphoma with Recurrence after Complete Remission

이창민,이동호,안병규,황재진,윤혁,박영수,신철민,김나영 대한소화기내시경학회 2017 Clinical Endoscopy Vol.50 No.1

Background/Aims: In gastric mucosa-associated lymphoid tissue (MALT) lymphoma, the clinical significance of various endoscopic findings has not yet been determined. This study aimed to compare the time to complete remission (CR) and relapse-free survival (RFS) in gastric MALT lymphoma based on endoscopic findings. Methods: In this single-center retrospective cohort study, the medical records of 122 consecutive adult patients with gastric MALT lymphoma were collected over a period of 12 years. CR was defined by the absence of macroscopic or microscopic features of lymphoma on two subsequent follow-ups. Relapse was clinically defined by a positive endoscopic biopsy after CR. Results: The median time to CR did not differ significantly between treatment methods. However, it was significantly longer in the group with polypoid endoscopic appearance than in the groups with diffuse infiltration or ulceration (7.83, 3.43, and 3.10 months, respectively; p=0.003). Six patients relapsed after CR. Kaplan-Meier analysis showed that RFS differed significantly between groups based on Ann Arbor staging, treatment methods, and initial endoscopic findings. Conclusions: In gastric MALT lymphoma, the endoscopically defined polypoid type was characterized by a longer duration to CR, with a higher likelihood of recurrence, compared to the endoscopically defined diffuse infiltration or ulceration types.

원발성 점막연관 림프조직형 위 림프종의 임상 및 병리학적 분석 - 저위도 점막연관 림프조직 림프종을 중심으로 -

진영주,장동경,이경미,정운태,정현채,송인성,최규완,김정룡,김철우 大韓消化器病學會 1998 大韓消化器病學會誌 Vol.31 No.4

조기 위암과 동반된 비장 변연부 림프종 1예

박효준,김경미,최민규,노재형,손태성,배재문,김성 대한위암학회 2009 Journal of gastric cancer Vol.9 No.2

비장 변연부 림프종(Splenic marginal zone lymphoma)은 드문 종양이며, 주로 노년층에서 발견되며, 절반 이상이 10년 이상 생존할 만큼 양호한 경과를 보인다. 본원에서는 이전에 보고된 바가 없는 비장 변연부 림프종과 조기위암이 동시에 발견된 환자의 수술적 치료를 경험하였기에 보고하는 바이다. 74세 남자환자로 5년 전 알코올성 간경화를 진단받은 이후 추적관찰 중 시행한 위내시경 검사에서 유문부에 조기위암이 발견되었다. 복부 전산화 단층 촬영 결과, 경미한 간경화와 비장비대, 복강 내 림프절병증이 관찰되었고, 근치적 절제를 위해 위 아전절제술을 시행하였다. 수술 당시 경미한 간경화와 비장이 매우 커져 있는 것과 더불어 다수의 복부 림프절비대가 관찰되었다. 이후 조직검사 결과에서 조기위암과 림프절에서 비장 변연부 B 세포 림프종으로 진단되었다. 환자는 회복 후 골수검사와 PET검사 등을 시행하였으며, 조직검사와 같은 결과를 얻었다. 이후 환자는 항암치료 계획 중이다. 비장 변연부 림프종은 Schmid 등에 의해 처음 명명되었으며, 비호치킨성 림프종의 1∼2%를 차지한다. 이는 진단 당시 평균 나이가 65세이고, 드문 질환이지만 완만한 경과로 긴 생존 기간을 가지므로 추가로 악성종양이 발생될 수 있다. 대부분 진단 당시 무증상이며, 심각한 혈구 감소증이 없거나, 중등도의 비장비대를 동반한 무증상의 환자는 경과를 관찰하는 것이 타당하다. 본 환자는, 조기 위암 수술 중 발견되어 비장 변연부 림프종으로 진단된 경우로, 동시에 발견된 경우는 보고된 바가 없다. 드물기는 하지만, 비장 변연부 림프종을 가진 환자의 주의 깊은 추적 관찰로 이차로 발생되는 악성 종양을 조기에 발견하는 것이 중요하다.