完全に管理人独断の読影ですので何かご意見等ありましたらコメントくださいね❗️
Today, I would like to show you an example of a reading of a case that I recently presented in an installment.
The reading is completely at the discretion of the manager, so if you have any comments or suggestions, please feel free to comment.
症例は10年以上前にピロリ除菌成功が確認された胃角部大彎後壁寄りに認める7mm程度の発赤調陥凹性病変です。
The case is a 7mm erythematous depressed lesion located near the posterior wall of the greater fold of the gastric horn, which was confirmed to have been successfully sterilized of H. pylori more than 10 years ago.
まず、白色光にて発赤・陥凹が視認できますが何より少し出血していることに目を引きます。
こちらは内視鏡の接触はない状態ですので自然出血を認めていることになり、陥凹部の輪郭に一致して血液が付着している様に見えます。そのためなんとなく陥凹がある様に思われますが境界としては不明瞭と考えます。
First of all, the redness and depression are visible in white light, but what is most striking is that there is a little bleeding.
Since there is no endoscopic contact here, spontaneous bleeding is observed, and the blood appears to be adherent to the contour of the depression. Therefore, it seems that there is a depression, but the boundary of the depression is unclear.
続いてインジゴカルミン散布による色素内視鏡像です。色素を散布すると先程の陥凹と思われていた箇所がより際立って明らかな陥凹所見として確認できます。陥凹部は不整形かつ境界が明瞭となり、その一周外側には隆起が見られます。
Next is a dye endoscopic image with indigocarmine sprayed. The area that was thought to be a depression is more prominent and clearly visible when the dye is sprayed. The depression is irregularly shaped with a well-defined border and an elevation can be seen on its outer circumference.
NBI観察では陥凹部に一致してdemarcation line(;DL)を認め、一部白色不透明物質(white opaque substance;WOS)の沈着を認めます。腺管構造はabsent、血管構造はirregularであり癌と診断します。分化型腺癌を疑い、また粘膜下腫瘍(SMT)様の隆起や台状挙上などの粘膜下層(SM)浸潤を示唆する所見はもちろんありませんのでESDを施行しております。
結果は同様にぶ分化型腺癌(tub1>2)で進達度はMでした。
NBI observation reveals a demarcation line (;DL) in line with the depressed area and some deposition of white opaque substance (WOS). The glandular duct structure is absent and the vascular structure is irregular. Since there is no submucosal tumor (SMT)-like elevation or elevation of the peduncle that would suggest submucosal (SM) invasion, ESD is performed.
The result was a similarly poorly differentiated adenocarcinoma (tub1>2) with an M degree of progression.
この様に内視鏡挿入時の自然出血が早期癌発見の一助になることがあります。
腫瘍性病変を疑う所見の1つとして是非注意してみてください👀
Spontaneous bleeding during endoscopic insertion may help in the early detection of cancer.
Please pay attention to it as one of the findings to suspect neoplastic lesions!
